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Pignata S, Califano D, Lorusso D, Arenare L, Bartoletti M, De Giorgi U, Andreetta C, Pisano C, Scambia G, Lombardi D, Farolfi A, Cinieri S, Passarelli A, Salutari V, De Angelis C, Mignogna C, Priolo D, Capoluongo ED, Tamberi S, Scaglione GL, Arcangeli V, De Cecio R, Scognamiglio G, Greco F, Spina A, Turinetto M, Russo D, Carbone V, Casartelli C, Schettino C, Perrone F. MITO END-3: Efficacy of Avelumab immunotherapy according to molecular profiling in first-line endometrial cancer therapy. Ann Oncol 2024:S0923-7534(24)00128-5. [PMID: 38704093 DOI: 10.1016/j.annonc.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/28/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Immunotherapy combined with chemotherapy significantly improves progression-free survival compared to first-line chemotherapy alone in advanced endometrial cancer, with a much larger effect size in microsatellite-instability high (MSI-H) cases. New biomarkers might help to select patients that may have benefit among those with a microsatellite-stable (MSS) tumor. METHODS In a pre-planned translational analysis of the MITO END-3 trial, we assessed the significance of genomic abnormalities in patients randomized to standard carboplatin/paclitaxel without or with avelumab. RESULTS Out of 125 randomized patients, 109 had samples eligible for next-generation sequencing (NGS) analysis, and 102 had MSI tested. According to The Cancer Genome Atlas (TCGA), there were 29 cases MSI-H, 26 MSS TP53 wild-type (wt), 47 MSS TP53 mutated (mut), and one case with POLE mutation. Four mutated genes were present in more than 30% of cases: TP53, PIK3CA, ARID1A, and PTEN. Eleven patients (10%) had a BRCA1/2 mutation (five in MSI-H and six in MSS). High TMB (≥10 Muts/Mb) was observed in all MSI-H patients, in four out of 47 MSS/TP53 mut, and no case in the MSS/TP53 wt category. The effect of avelumab on progression-free survival significantly varied according to TCGA categories, being favorable in MSI-H and worst in MSS/TP53 mut (P interaction=0.003); a similar non-significant trend was seen in survival analysis. ARID1A and PTEN also showed a statistically significant interaction with treatment effect, which was better in the presence of the mutation (ARID1A P interaction=0.01; PTEN P interaction=0.002). CONCLUSION The MITO END-3 trial results suggest that TP53 mutation is associated with a poor effect of avelumab, while mutations of PTEN and ARID1A are related to a positive effect of the drug in patients with advanced endometrial cancer.
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Affiliation(s)
- S Pignata
- Uro-Gynecological Medical Oncology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy.
| | - D Califano
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - D Lorusso
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - L Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - M Bartoletti
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano 33081 (PN), Italy
| | - U De Giorgi
- Dipartimento Oncologico, IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST Dino Amadori, Meldola (FC)
| | - C Andreetta
- Dipartimento di Oncologia - ASU FC S. Maria della Misericordia -Udine
| | - C Pisano
- Uro-Gynecological Medical Oncology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - D Lombardi
- Unit of Medical Oncology and Cancer Prevention, Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano 33081 (PN), Italy
| | - A Farolfi
- Clinical and Experimental Oncology Unit, Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, IRCCS, Meldola, Italy
| | - S Cinieri
- U.O.C. Oncologia Medica - Ospedale Senatore Antonio Perrino, Brindisi, Italy
| | - A Passarelli
- Uro-Gynecological Medical Oncology, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - V Salutari
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - C De Angelis
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - C Mignogna
- Division of Anatomic Pathology and Cytopathology. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - D Priolo
- Oncology Unit, S Vincenzo Hospital, Taormina, Italy
| | - E D Capoluongo
- Department of Molecular Medicine and Medical Biotechnology, Università degli Studi di Napoli Federico II, Naples, Italy; Azienda Ospedaliera per L'Emergenza, Cannizzaro, Catania, Italy
| | - S Tamberi
- Oncology Unit, Santa Maria hospital, Ravenna AUSL Romagna, Italy
| | - G L Scaglione
- Istituto Dermopatico Dell'Immacolata IDI-IRCSS, Rome, Italy
| | - V Arcangeli
- UO Oncologia - Ospedale degli Infermi Rimini (RN), Italy
| | - R De Cecio
- Division of Anatomic Pathology and Cytopathology. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - G Scognamiglio
- Division of Anatomic Pathology and Cytopathology. Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy
| | - F Greco
- Medical Oncology Unit, AULSS 9 Regione Veneto, Scaligera - Ospedale Generale Mater Salutis, Legnago, Italy
| | - A Spina
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - M Turinetto
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, 10128 Turin, Italy
| | - D Russo
- Microenvironment Molecular Targets Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - V Carbone
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - C Casartelli
- Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy
| | - C Schettino
- Clinical Trial Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
| | - F Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G Pascale, Naples, Italy
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Giordano M, Gaio G, Marzullo R, Scognamiglio G, Altobelli I, Russo MG, Sarubbi B. Patent foramen ovale closure with NobleStitch EL system in a case of Ebstein's anomaly after a failed device closure attempt. J Cardiovasc Med (Hagerstown) 2024:01244665-990000000-00205. [PMID: 38625819 DOI: 10.2459/jcm.0000000000001615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
In the setting of an Ebstein's anomaly, a right-to-left shunt via a patent foramen ovale (PFO) may be the cause of a significant cyanosis. In these patients, the PFO closure is able to improve the arterial saturation. Furthermore, a partial closure is often recommended to obtain a reduction in the PFO right-left shunt without a significant impact on the right chamber hemodynamics. However, in some cases, a complex PFO anatomy may prevent an effective device closure. We describe the case of a patient with Ebstein's anomaly and a significant cyanosis due to a right-to-left shunt via the PFO wherein an effective partial PFO closure with a suture-mediated NobleStitch EL system was achieved in a setting of a complex PFO anatomy (large aneurismatic septum, long stiff tunnel, and hypertrophic septum secundum) after a failed device-closure attempt.
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Affiliation(s)
- Mario Giordano
- Pediatric Cardiology Unit, University of Campania 'Luigi Vanvitelli'
| | - Gianpiero Gaio
- Pediatric Cardiology Unit, University of Campania 'Luigi Vanvitelli'
| | | | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, AORN 'Ospedali dei Colli', Monaldi Hospital, Naples, Italy
| | - Ippolita Altobelli
- Adult Congenital Heart Disease Unit, AORN 'Ospedali dei Colli', Monaldi Hospital, Naples, Italy
| | | | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AORN 'Ospedali dei Colli', Monaldi Hospital, Naples, Italy
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Fusco F, Scognamiglio G, Sorice D, Abbate M, Altobelli I, Sarubbi B. Biventricular performance in adults with a systemic right ventricle: new insights from myocardial work analysis. Int J Cardiovasc Imaging 2024:10.1007/s10554-024-03076-0. [PMID: 38578362 DOI: 10.1007/s10554-024-03076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/27/2024] [Indexed: 04/06/2024]
Abstract
To evaluate biventricular mechanics by means of echo-derived myocardial work (MW) analysis in patients with a systemic right ventricle (sRV). Comprehensive echo data were collected in all patients with a sRV who underwent transthoracic echocardiography at our tertiary centre between 2020 and 2021 including sRV function indices, global longitudinal strain (GLS) of right and left ventricle (RV/LV), biventricular MW, and atrial strain in those with congenitally corrected transposition of the great arteries (ccTGA). Fifty-six patients (37 [30.97-45.87]years, 59% male) and 49 healthy individuals matched per age and sex were included for comparison. Global work index (GWI:1106 [869.80-1293.10] Vs 314.2 [281.5-358.2]mmHg%, p < 0.0001) and global constructive work(GCW: 1542.50 [1338.9-1718.50] Vs 416.4 [365.70-464]mmHg%, p < 0.0001) were both increased for sRV compared to normal RV, reflecting exposition to a systemic afterload, with a contemporary raise in wasted work (GWW:197 [138.50-322.20] Vs 26.09 [17.80-43.48]mmHg%, p < 0.0001) and impaired efficiency (GWE:89 [83-93.54] Vs 93.67 [91.67-96] %, p < 0.0001). Conversely, sRV showed reduced MW indices in comparison to normal LV(p < 0.0001 for all). Non-systemic LV demonstrated normal GLS values (19.51 ± 3.9%), but reduced GWI (479 [368-665] Vs 2172 [1978-2386]mmHg%, p < 0.0001) and GCW (708 [490-815]mmHg% Vs 86.5 [59.25-118], p < 0.0001). Nevertherless, non-systemic LV showed also impaired efficiency (91 [88-94] Vs 95 [94-97]%, p < 0.0001). LVGLS values were related to RVGLS (R = 0.5, p = 0.00019), suggesting a consistent interventricular dependency. Atrial strain could be assessed in 16 out of 20 (80%) patients with ccTGA: both atria had reduced strain values compared to their normal counterparts. Moreover, pulmonary atrial strain during the reservoir phase was related to LVGWE (R = 0.58, p = 0.047) and inversely related to LVGLS (R = - 0.71, p = 0.0043). MW analysis is feasible in sRV and may provide additional clinical data. In our cohort MW revealed biventricular impairment, in particular for non-systemic LV, in spite of normal GLS values.
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Affiliation(s)
- Flavia Fusco
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Davide Sorice
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Massimiliana Abbate
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Ippolita Altobelli
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
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Fusco F, Scognamiglio G, Abbate M, Merola A, Grimaldi N, Ciriello GD, Sarubbi B. Dapagliflozin in Patients With a Failing Systemic Right Ventricle: Results From the DAPA-SERVE Trial. JACC Heart Fail 2024; 12:789-791. [PMID: 38430085 DOI: 10.1016/j.jchf.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 03/03/2024]
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Fusco F, Scognamiglio G, Roma AS, Abbate M, Papaccioli G, Merola A, Palma M, Borrelli N, Barracano R, Correra A, Grimaldi N, Ciriello GD, D'Abbraccio M, Scavone C, Capuano A, Sarubbi B. Mid-term follow-up after COVID-19 vaccination in adults with CHD: a prospective study. Cardiol Young 2023; 33:2574-2580. [PMID: 37038838 DOI: 10.1017/s1047951123000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Long-term data on COVID-19 vaccine safety, immunogenicity, and acceptance in adults with CHD are lacking. METHODS This is a prospective study including adults with CHD patients undergoing COVID-19 vaccination from January 2021 to June 2022. Data on adverse events, antispike IgG titre, previous or subsequent COVID-19 infection, booster doses, and patients' attitude towards vaccination were collected. RESULTS Four hundred and ninety CHD patients (36 ± 13 years, 53% male, 94% with moderate/complex defects) were prospectively included: 433 (88%) received a Pfizer-BioNTech mRNA vaccine, 31 (6%) Moderna mRNA vaccine, 23 (5%) AstraZeneca-Oxford ChAdOx1 nCov-19 vaccine, and 3 (0.6%) Janssen Vaccine; 310 (63%) received a booster dose. Median follow-up after vaccination was 1.53 [1.41-1.58] years. No major adverse event was reported. Eighty-two fully vaccinated patients contracted COVID-19 during follow-up after a median of 5.4 [4.3-6.5] months from the last dose. One patient with Ebstein's disease died from severe COVID-19. Symptoms' duration in patients who tested positive after vaccination was significantly shorter than in the group tested positive before vaccination (5.5 [3-8] versus 9 [2.2-15] days, p = 0.04). Median antispike IgG titre measured in 280 individuals (57%) at a median of 1.4 [0.7-3.3] months from the last dose was 2381 [901-8307] BAU/ml. Sixty patients (12%) also showed positive antinucleocapsid antibodies, demonstrating previous SARS-COV2 exposure. Twenty-nine percent appeared to have concerns regarding vaccine safety and 42% reported fearing potential effects of the vaccine on their cardiac disease before discussing with their CHD cardiologist. CONCLUSION COVID-19 vaccines appear safe in the mid-term follow-up in adults with CHD with satisfactory immunogenicity and reduction of symptoms' duration in case of infection.
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Affiliation(s)
- Flavia Fusco
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - Anna Selvaggia Roma
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Massimiliana Abbate
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Giovanni Papaccioli
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Nicola Grimaldi
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - Maurizio D'Abbraccio
- Vaccination Unit for Vulnerable Patients, AO dei Colli - Cotugno Hospital, Naples, Italy
| | - Cristina Scavone
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "LuigiVanvitelli", Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "LuigiVanvitelli", Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
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Brida M, De Rosa S, Legendre A, Ladouceur M, Dos Subira L, Scognamiglio G, Di Mario C, Roos-Hesselink J, Goossens E, Diller G, Gatzoulis MA. Acquired cardiovascular disease in adults with congenital heart disease. Eur Heart J 2023; 44:4533-4548. [PMID: 37758198 DOI: 10.1093/eurheartj/ehad570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Rates of successful surgical repair and life expectancy for patients with congenital heart disease have increased dramatically in recent decades. Thanks to advances in diagnosis, treatment, and follow-up care, an ever-increasing number of individuals with congenital heart disease are reaching advanced age. The exposure to cardiovascular risk factors during their lifetime is modifying the outlook and late clinical trajectory of adult congenital heart disease (ACHD). Their disease burden is shifting from congenital to acquired, primarily atherosclerotic cardiovascular disease (ASCVD) with worrisome consequences. In addition, the complex background of ACHD often curbs appropriate preventive strategies by general practitioners or adult cardiologists. Comprehensive guidance for the prevention and management of acquired heart disease in ACHD patients is currently not available, as this topic has not been covered by the European Society of Cardiology (ESC) guidelines on cardiovascular disease prevention or the ESC guidelines for the management of ACHD. In this document, a state-of-the-art overview of acquired heart disease in ACHD patients and guidance on ASCVD prevention for both ACHD specialists and non-ACHD cardiologists are provided. The aim is to provide a clinical consensus statement to foster the development of a sustainable strategy for the prevention of ASCVD in a practical and simple-to-follow way in this ever-growing cardiovascular cohort, thus reducing their cardiovascular burden.
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Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
- Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Croatia
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - Antoine Legendre
- Congenital and Pediatric Cardiology, Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, Paris, France
- Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Laura Dos Subira
- Unitat de Cardiopaties Congènites de l'Adolescent i de l'Adult (UCCAA); CIBERCV, European Reference Network for rare, low-prevalence, or complex diseases of the heart (ERN GUARD-Heart), Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | | | - Eva Goossens
- Centre for Research and Innovation in Care, Faculty of Nursing, University of Antwerp, Antwerp, Belgium
| | - Gerhard Diller
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust and National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
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Fusco F, Scognamiglio G. Heart failure management in adults with congenital heart disease: are we on the 'right path'? Heart 2023; 109:1502-1503. [PMID: 37290902 DOI: 10.1136/heartjnl-2023-322807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- Flavia Fusco
- Adult Congenital Heart Disease Centre, Monaldi Hospital, Napoli, Italy
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Borrelli N, Di Salvo G, Ciriello GD, Sabatino J, Avesani M, Leo I, Barracano R, Scognamiglio G, Russo MG, Sarubbi B. Myocardial work in children with Wolff-Parkinson-White syndrome. Int J Cardiovasc Imaging 2023; 39:1697-1705. [PMID: 37244886 DOI: 10.1007/s10554-023-02883-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
Wolff-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardial deformation, and when left ventricular dysfunction is present, catheter ablation of the accessory pathway may be required, even in asymptomatic patients. We aimed to evaluate the diagnostic value of non-invasive myocardial work in predicting subtle abnormalities in myocardial performance in children with WPW.Seventy-five paediatric patients (age 8.7 ± 3.5 years) were retrospectively recruited for the study: 25 cases with manifest WPW and 50 age- and sex- matched controls (CTR). Global myocardial work index (MWI) was measured as the area of the left ventricle (LV) pressure-strain loops. From MWI, global Myocardial Constructive Work (MCW), Wasted Work (MWW), and Work Efficiency (MWE) were estimated. In addition, standard echocardiographic parameters of LV function were evaluated. Despite normal LV ejection fraction (EF) and global longitudinal strain (GLS), children with WPW had worse MWI, MCW, MWW, and MWE. At multivariate analysis, MWI and MCW were associated with GLS and systolic blood pressure, and QRS was the best independent predictor of low MWE and MWW. In particular, a QRS > 110 ms showed good sensitivity and specificity for worse MWE and MWW values. In children with WPW, myocardial work indices were found significantly reduced, even in the presence of normal LV EF and GLS. This study supports the systematic use of myocardial work during the follow-up of paediatric patients with WPW. Myocardial work analysis may represent a sensitive measure of LV performance and aid in decision-making.
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Affiliation(s)
- Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy.
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Giovanni Domenico Ciriello
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Jolanda Sabatino
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Martina Avesani
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Isabella Leo
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Maria Giovanna Russo
- Division of Paediatric Cardiology, University of Campania 'Luigi Vanvitelli', AO Dei Colli, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AO Dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
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Trevisan B, Pepe FF, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V, Cazzaniga ME. Final results of the real-life observational VICTOR-6 study on metronomic chemotherapy in elderly metastatic breast cancer (MBC) patients. Sci Rep 2023; 13:12255. [PMID: 37507480 PMCID: PMC10382472 DOI: 10.1038/s41598-023-39386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
Nowadays, treatment of metastatic breast cancer (MBC) has been enriched with novel therapeutical strategies. Metronomic chemotherapy (mCHT) is a continuous and frequent administration of chemotherapy at a lower dose and so whit less toxicity. Thus, this strategy could be attractive for elderly MBC patients. Aim of this analysis is to provide insights into mCHT's activity in a real-life setting of elderly MBC patients. Data of patients ≥ 75 years old included in VICTOR-6 study were analyzed. VICTOR-6 is a multicentre, Italian, retrospective study, which collected data on mCHT in MBC patients treated between 2011 and 2016. A total of 112 patients were included. At the beginning of mCHT, median age was 81 years (75-98) and in 33% of the patients mCHT was the first line choice. Overall Response Rate (ORR) and Disease Control Rate (DCR) were 27.9% and 79.3%, respectively. Median PFS ranged between 7.6 and 9.1 months, OS between 14.1 and 18.5 months. The most relevant toxicity was the hematological one (24.1%); severe toxicity (grade 3-4) ranged from 0.9% for skin toxicity up to 8% for hematologic one. This is a large study about mCHT in elderly MBC patients, providing insights to be further investigated in this subgroup of frail patients.
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Affiliation(s)
- B Trevisan
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - F F Pepe
- Azienda Ospedaliera San Gerardo, Monza, Italy
| | - I Vallini
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Montagna
- European Institute of Oncology, Milan, Italy
| | | | - R Berardi
- Azienda Ospedaliera Universitaria Ospedali Riuniti, Torrette, Italy
| | - A Butera
- Nuovo Ospedale San Giovanni Di Dio, Florence, Italy
| | | | - L Cavanna
- Azienda Ospedaliera Piacenza, Piacenza, Italy
| | | | - S Cinieri
- Ospedale A. Perrino, Brindisi, Italy
| | | | | | - A Febbraro
- Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Ospedale San Vincenzo, Taormina, Italy
| | - A Ferzi
- Azienda Ospedaliera Ospedale Civile Di Legnano, Magenta, Italy
| | | | - A Fontana
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - O Garrone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Gebbia
- Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Istituti Ospitalieri Cremona, Cremona, Italy
| | | | | | | | | | - S Sarti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - C Putzu
- Azienda Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Ospedale Antonio Cardarelli, Naples, Italy
| | - D Santini
- Università Campus Bio-Medico, RomE, Italy
| | | | | | | | - P Spadaro
- Casa di Cura Villa Salus-Messina, Messina, Italy
| | | | | | | | | | | | - M R Valerio
- A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- INT Regina Elena, Rome, Italy
| | - L Clivio
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
| | - V Torri
- IRCCS Mario Negri Institute of Pharmacological Research, Milan, Italy
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Abbate M, Fusco F, Columbano L, Sarubbi B, Scognamiglio G. Fulminant biventricular multivalvular infective endocarditis in complex congenital heart disease: a case report. Eur Heart J Case Rep 2023; 7:ytad236. [PMID: 37252200 PMCID: PMC10212534 DOI: 10.1093/ehjcr/ytad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/23/2022] [Accepted: 05/04/2023] [Indexed: 05/31/2023]
Abstract
Background Infective endocarditis (IE) is a major issue during follow-up of adults with congenital heart disease (ACHD), leading to significant mortality. Case summary A 37-year-old woman with transposition of great arteries and previous Mustard operation developed a drug-resistant pneumonia shortly after a pacemaker implant procedure performed at a local hospital. After referral to the ACHD centre, the patient was diagnosed with multivalvular IE with biventricular involvement by methicillin-resistant Staphylococcus aureus. On admission, the patient was already in acute respiratory distress and presented both systemic and pulmonary embolization. Despite adequate treatment was promptly started, the patient developed multiorgan failure. Discussion This case depicts a particularly aggressive of infective endocarditis forms caused with biventricular involvement and multiple embolization. Patients with congenital heart disease are at high risk of IE with adverse impact on the prognosis. Early recognition and treatment are the keys to improve prognosis. Therefore, suspicion should be high, especially following invasive procedure, which should be preferably performed at ACHD specialized centres.
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Affiliation(s)
- Massimiliana Abbate
- Adult Congenital Heart Disease Unit, AO dei Colli, Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
| | - Flavia Fusco
- Corresponding author. Tel: +390817064206, Fax: +390817062501,
| | - Laura Columbano
- Neurosurgery Department, AO dei Colli, CTO Hospital, Viale Colli Aminei 21, 80131 Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, AO dei Colli, Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
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Roma AS, Fusco F, D’Arienzo D, De Rimini ML, Scognamiglio G, Sarubbi B. Infective Endocarditis in Adults With Congenital Heart Disease. JACC: Case Reports 2023; 11:101798. [PMID: 37077441 PMCID: PMC10107041 DOI: 10.1016/j.jaccas.2023.101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/09/2023] [Indexed: 03/06/2023]
Abstract
A challenging case of infective endocarditis in a young woman with repaired tetralogy of Fallot and a diagnosis of ankylosing spondylitis is described. Despite the presence of multiple confounding factors, a multidisciplinary approach with the use of multimodality cardiac imaging allowed a correct diagnosis and effective medical treatment. (Level of Difficulty: Intermediate.).
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12
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Fusco F, Scognamiglio G, Merola A, Iannuzzi A, Palma M, Grimaldi N, Sarubbi B. Safety and Efficacy of Sacubitril/Valsartan in Patients With a Failing Systemic Right Ventricle: A Prospective Single-Center Study. Circ Heart Fail 2023; 16:e009848. [PMID: 36458541 DOI: 10.1161/circheartfailure.122.009848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Sacubitril/valsartan was demonstrated to reduce hospitalization rate and mortality in patients with heart failure with reduced ejection fraction. Data on the effects of sacubitril/valsartan in patients with a systemic right ventricle are still lacking. METHODS Patients with transposition of the great arteries following Senning/Mustard procedure or congenitally corrected transposition of the great arteries with impaired systemic right ventricle systolic function were prospectively included. Primary end points included sacubitril/valsartan safety and efficacy. Primary efficacy end points were NT-proBNP (N-terminal pro-B-type natriuretic peptide) and systolic function improvement. Secondary end points included New York Heart Association class, 6-minute walking distance, and quality of life change. RESULTS Fifty patients (38±12 years, 60% male, 35% congenitally corrected transposition of the great arteries) were included and followed for 1 year. No major adverse events occurred. Two (4%) patients ceased treatment due to hypotension and 1 (2%) developed a nephrotic syndrome. The target dose was reached in 20 (42%) patients. NT-proBNP values decreased significantly immediately after treatment initiation, while returned to baseline at 1 year. Echocardiography showed progressive fractional area change increase (29.2±5.8 versus 34.9±5.1%; P<0.001), and right ventricle global longitudinal strain (-13.9 [-15.1, -11.8] versus -15.3 [-17.2, -13.4]%; P<0.001) and free-wall global longitudinal strain (-14.3 [-17.3, -12.3] versus -17.2 [-19.3, -15.8]%; P<0.001) raise, whereas tricuspid regurgitation severity improved only in transposition of the great arteries patients (P=0.006). Moreover, 3-dimensional echocardiography demonstrated right ventricle volumes reduction (end-diastolic volume: 181±63 versus 156±50 mL; P=0.002; end-systolic volume: 117±48 versus 89±33 mL; P<0.001), and significantly increased systemic right ventricle ejection fraction (35.6±8.1 versus 41.5±7.5%; P<0.001). Clinical improvement was suggested by New York Heart Association class change (P<0.001), increased 6-minute walking distance (425 [333, 480] versus 500 [443, 560] m; P<0.001) as well as improved quality of life at 1-year follow-up. Beneficial effects were observed irrespective of the underlying anatomy and were more pronounced in those on target dose. CONCLUSIONS Our data showed that sacubitril/valsartan is well tolerated and is associated with systemic right ventricle remodeling and improved systolic function as well as improved clinical status, supporting its use in this complex population.
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Affiliation(s)
- Flavia Fusco
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | - Assunta Merola
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Angela Iannuzzi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Nicola Grimaldi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
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Borrelli N, Di Salvo G, Ciriello GD, Sabatino J, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Romeo E, Colonna D, Palma M, Scognamiglio G, Russo MG, Sarubbi B. Myocardial work impairment in children with Wolff-Parkinson-White syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Wolf-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardium deformation during systole. According to guidelines, when the left ventricle (LV) dysfunction is present catheter ablation of the accessory pathway may be required, even in asymptomatic patients.
Purpose
The study aimed to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in children with WPW.
Methods
Eighty pediatric patients (age 7.91±3.2 years) were included in the study: 20 cases with manifest WPW and 60 age- and sex-matched controls (CTR). Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. In addition, standard echocardiographic parameters of LV function were evaluated.
Results
Patients characteristics are summarized in the table. Despite normal LV EF and GLS, children with WPW had worse MWI (WPW 1292.90±307.67 mmHg% vs CTR 1658.73±241.74 mmHg%, p=0.0000005), MCW (WPW 1844.15±267.96 mmHg% vs CTR 2104.90±237.85 mmHg%, p=0.00009), MWW (WPW 101.5 [85–148.25] mmHg% vs CTR 72 [54.75–109.25] mmHg%, p=0.004) and GWE (WPW 94 [91.75–95] mmHg% vs 96 [95–97] mmHg%, p=0.00012) (table). In the WPW group, MWE (r=−0.6, p=0.009) and MWW (r=0.6, p=0.01) was found to correlate with a prolonged QRS (figure).
A multiple regression model was generated to identify the relation between abnormal myocardial work indices (worst interquartile range as dependent variable) and several independent variables. QRS was the best independent predictor of impaired myocardial work. In particular, a QRS>110 msec showed an 86% sensibility and 85% specificity for abnormal MWE (AUC of 0.85), and a 75% sensibility and 83% specificity for abnormal MWW (AUC of 0.83) (figure).
Conclusion
In children with WPW, myocardial work indices were found significantly reduced, even in presence of normal LV EF and GLS. Prolonged QRS independently predicted myocardial impairment. In pediatric patients with WPW, myocardial work may represent a sensitive measure of LV dysfunction and help in the decision-making.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Borrelli
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - G Di Salvo
- University Hospital of Padova , Padua , Italy
| | - G D Ciriello
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - J Sabatino
- University Hospital of Padova , Padua , Italy
| | - N Grimaldi
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - R Barracano
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - F Fusco
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - A Merola
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - A Correra
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - E Romeo
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - D Colonna
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - M Palma
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | | | - M G Russo
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - B Sarubbi
- AO dei Colli - Monaldi Hospital , Naples , Italy
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14
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Roma AS, Fusco F, Papaccioli G, Abbate M, Scognamiglio G, Merola A, Palma M, Correra A, Borrelli N, Barracano R, Grimaldi N, Colonna D, Romeo E, Sarubbi B. COVID-19 vaccination in adults with congenital heart disease: results of 1-year prospective study. Eur Heart J 2022. [PMCID: PMC9619553 DOI: 10.1093/eurheartj/ehac544.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Adults with congenital heart disease (ACHD) are a vulnerable population. Routine vaccination is the only strategy to prevent a life-threatening infection. However, concerns on the cardiac safety and efficacy of COVID-19 vaccines have been raised. Aim To assess safety and efficacy of available COVID-19 vaccines in ACHD patients. Methods Data on COVID-19 infection and vaccines including booster doses and any suspected or confirmed adverse events were prospectively collected for all ACHD patients attending our tertiary centre from the beginning of the vaccination campaign (March 2021). A group of 75 healthy volunteers, matched per age and sex, was included for comparison. Antispike IgG titre was routinely obtained at the ACHD clinic. Patients' attitude towards COVID-19 was explored with a questionnaire. Results As of February 2022, 498 ACHD patients (36.7±16 years, 54% male,69% with moderate-complex defects, 48% with advanced physiological stage) were enrolled. Four hundred and sixty-one (92%) were fully vaccinated: the type of vaccine was Pfizer-BioNTech for 399 (86%) patients, Moderna for 20 (4%) and AstraZeneca for 26 (6%), 9 received a mixed vaccine regimen (2%). Forty-two (9%) had a history of previous COVID-19 infection and therefore received only one dose. Two-hundred and sixty-nine (58%) patients received a booster dose. Adverse events were mainly mild and transient. One patient complaining of chest pain following administration of mRNA-based vaccination was diagnosed with acute pericarditis, which made full remission after appropriate therapy. Two patients reported a non-specific increment of inflammatory markers. No other severe adverse events were reported. Thirty-seven (7%) refused COVID-19 vaccination being scared of potential cardiac/extra-cardiac adverse events. Among those not-vaccinated, 9 (24%) had a history of previous mild COVID-19 infection. IgG titre was measured in 243 patients at 1915 [835–5934] BAU/ml, which was significantly higher compared to controls (1196 [827–2048] BAU/ml, p=0.002). Three ACHD patients contracted COVID-19 infection after the first dose, while 65 (14%) fully vaccinated patients tested positive for COVID-19, all with mild to moderate symptoms. COVID-19 symptoms duration was significantly longer in case of infection before vaccination (10 [2.7–15] vs 3 [1.2–7], p=0.03). One Fontan patient was tested positive for COVID-19 twice, before and after COVID-19 vaccination, requiring hospitalization in both cases. Four hundred and seven patients completed the questionnaire: 128 (31%) declared to be scared of potential cardiac effects of the vaccine and that the discussion with the ACHD cardiologist was crucial to decide to undergo COVID-19 vaccination. Conclusions Our data provide real-world evidence on COVID-19 vaccines safety and efficacy in ACHD patients. Patients' education from the ACHD team may play a key role in vaccine acceptance in this vulnerable population. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- A S Roma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - G Papaccioli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - M Abbate
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
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15
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Fusco F, Scognamiglio G, Merola A, Iannuzzi A, Palma M, Borrelli N, Barracano R, Correra A, Ciriello GD, Grimaldi N, Colonna D, Romeo E, Sarubbi B. Effects of sacubitril/valsartan in patients with a systemic right ventricle. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sacubitril/valsartan has been proved to reduce mortality in heart failure and reduced ejection fraction (EF) and is currently recommended as first-line therapy. However, effects in patients with a systemic right ventricle (sRV) have not been systematically investigated yet.
Purpose
We aimed to assess safety and efficacy of sacubitril/valsartan in patients with a sRV
Methods
From September 2020 to April 2021, all patients with congenitally corrected transposition of the great arteries (TGA) or TGA after Senning/Mustard repair attending our tertiary centre were prospectively enrolled. Inclusion criteria were: age ≥18 years, 3-months of optimal medical therapy including ACEi/ARB and sRV EF≤40%. Patients with univentricular physiology, systolic blood pressure (SBP) <90 mmHg, glomerular filtration rate (GFR) <30 ml/min or K >5.5 mEq/L were excluded. SBP and blood samples were obtained at 1-month of treatment. Other clinical and echocardiographic variables were reassessed at 6 and 12-month follow-up and the medication was progressively up-titrated to the highest tolerated dose.
Results
Fifty-one patients (38±11 years, 60% male, 34% ccTGA) were included. Up to March 2022, 48 (92%) patients were reviewed after 6 months of therapy and 35 (68%) completed the first year of follow-up. Baseline patients' characteristics are summarized in Table 1. At 1 month, treatment did not impact on the serum potassium values (4.5±0.3 vs 4.4±0.3 mEq/L, p=0.9) and GFR (112±33 vs 112±31 ml/min, p=0.3), while SBP dropped significantly (119±13 vs 108±18 mmHg, p=0.003). Two patients ceased the treatment due to symptomatic hypotension during the first month. One patient developed a nephrotic syndrome at 4 months of follow-up, which was likely unrelated to the treatment. No other major adverse events were reported. One patient was lost to follow-up after 3 months. Despite no significant change in the NYHA class (p=0.9), the 6-minute walking distance increased significantly at 6-month (Table 2). Nt pro BNP values were significantly decreased at 6-month, and returned to baseline at 12-month. Improved sRV systolic function was demonstrated at 6 and 12-month by significant increase in fractional area change, RV global longitudinal strain and sRV EF measured with 3D echocardiography.
Conclusions
Our mid-term results showed that sacubitril/valsartan is well tolerated in patients with a sRV and leads to signficant improvement of sRV systolic function, supporting its use in this complex population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Iannuzzi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - G D Ciriello
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit , Naples , Italy
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Sarubbi B, Palma M, Merola A, Fusco F, Correra A, Colonna D, Romeo E, Grimaldi N, Ciriello GD, Scognamiglio G, Russo MG. Wearable cardioverter-defibrillator (life-vest): A feasible bridging treatment in adult congenital heart disease. Indian Pacing Electrophysiol J 2022; 22:217-222. [PMID: 35777690 PMCID: PMC9463467 DOI: 10.1016/j.ipej.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/25/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Wearable cardioverter-defibrillators (WCDs) are currently used in patients at temporarily heightened risk for sudden cardiac death (SCD) who are temporarily unable to receive an implantable cardioverter-defibrillator (ICD). WCD can safely record and terminate life-threatening arrhythmias through a non-invasive electrode-based system. The current clinical indications for WCD use are varied and keep evolving as experience with this technology increases. Methods We reviewed and explored the data behind indications for WCD use and discuss its usefulness in congenital heart disease (CHD) patients. Results We considered 8 consecutive patients (mean age 35.25 years, range 18–51 years, average duration of WCD use 4 months, range 3–6 months) with complex CHD, in which a WCD was used between June 2018 and January 2022. No sustained ventricular arrhythmias requiring shocks were recorded in the observation period. No inappropriate shocks were recorded. All the patients showed a good compliance and a very high mean wear time per day (21.2 ± 1 h a day). Four patients implanted a permanent device (3 CRT-D, 1 ICD), three underwent cardiac surgery at the end of the WCD period and one is still on the waiting list for the operation. Conclusions Larger trial could confirm the possible conceivable benefit from an extended use of the WCD in certain populations with complex CHD as in our case series, especially in patients with life-treating ventricular arrhythmias waiting for surgery for residual cardiac defects or in the early phases following the surgical/hemodynamic interventions, patients with tachycardiomyopathy expected to improve after the arrhythmias are removed and patients awaiting implantation of an ICD at high risk due to active infection.
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Affiliation(s)
- Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy.
| | - Michela Palma
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Nicola Grimaldi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | | | - Maria Giovanna Russo
- Paediatric Cardiology Unit, "L.Vanvitelli" University - Monaldi Hospital, Naples, Italy
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Marzullo R, Gaio G, Giordano M, Palladino M, Ancona R, Scognamiglio G, D‘Alto M, Russo M, Sarubbi B. P156 TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT IN OVER 60 YEARS OLD PATIENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Ostium secundum ASD (ASDII) is the most common type of congenital heart disease in adults. Percutaneous closure has emerged as the first–line treatment for the majority of ASDII. However, the occurrence of Pulmonary Hypertension (PH) with combined pre– and post–capillary component may render ASD management challenging in elderly patients.
Methods
We report the hemodynamic data and clinical findings of elderly patients (> 60 years old) undergoing transcatheter closure of an ASDII at our department.
Results
From 2000 to 2021, 82 elderly patients were scheduled (mean age 65,4+ 4,4) of which 60 (73%) were female. Systemic arterial hypertension and supraventricular arrhythmias were the most common comorbidities accounting respectively 51% and 38% of cases. The right ventricular overload supported the ASD closure in 76 cases (93%) and paradoxical embolism in the remaining 6 (7%). 17 patients (21%) were in NYHA class III– IV. At right heart catheterization, 33 patients had normal pulmonary arterial pressure and 49 patients showed a mean pulmonary artery pressure > 20 mmhg. In the latter cohort, 33 showed a pulmonary artery wedge pressure (PAWP) < 15 mmHg (Group I) and 16 > 15 mmHg (Group II). The device implantation was completed in all patients except one with elevated pulmonary vascular resistance (PVR) of the Group I. For 14 patients of Group II, balloon occlusion test was required during the catheterization. ASD closure was achieved promptly in 10 patients. However, to reduce the risk of acute pulmonary oedema, in one case we created a small fenestration in the occluder device and in other case we retained the patency of additional defect (both patients exhibiting slightly PAWP increase during balloon occlusion test). In one patient showing significantly PAWP increase during balloon test, delayed ASD closure was performed ensuring the improvement of hemodynamic parameters at 3 months initiation of medical therapy with angiotensin–converting enzyme inhibitor and loop diuretic diuretics. For the remaining 4 patients, the percutaneous closure was not been done because of prohibitive hemodynamic parameters. Overall, ASD closure was performed successfully in 94% of cases.
Conclusions
Age and comorbidities are not absolute contraindications to ASDII percutaneous closure. In the complex cases, both medical therapies and balloon occlusion test may be use to support the decision–making process.
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Affiliation(s)
- R Marzullo
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - G Gaio
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - M Giordano
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - M Palladino
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - R Ancona
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - G Scognamiglio
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - M D‘Alto
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - M Russo
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
| | - B Sarubbi
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”, OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOC CARDIOLOGIA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI”, OSPEDALE. MONALDI– AORN OSPEDALI DEI COLLI, NAPOLI
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Ancona R, Gaio G, Giordano M, Marzullo R, Cappelli Bigazzi M, Palladino M, Scognamiglio G, Sarubbi B, Russo M. C84 PERCUTANEOUS TREATMENT OF INTERATRIAL MULTIFENESTRATE ANEURYSM IN PAEDIATRIC POPULATION: INFLUENCE OF THE LAYOUT DURING MID–TERM AND LONG–TERM FOLLOW–UP. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Multifenestrate aneurysms of interatrial septum (ISA) are a challenge in paediatric age, not only for the complex anathomy, but also for small body surface and small dimensions of cardiac chambers of the patients, that may limit the use of large and multiple devices. Aim of the study: to evaluate the efficacy of percutaneous closure of multifenestrate aneurysms during mid–term and long–term follow–up; to evaluate if the morphological characteristics of interatrial septum may influence the success of the procedure.
Materials and Methods
We retrospectively analyzed 63 patients (mean–age 9,12±3,12 years) undergone to cardiac catheterism from 2000 to 2021, for percutaneous closure of interatrial aneurysm in our division of Cardiology, subdivided into 3 groups on the basis of side and morphological characteristics of the interatrial aneurysm: Group I (2 o more defects DIA>5 mm); Group II (one defect >5 mm and more than one further fenestrations); Group III (multiple fenestrations).
Results
Percutaneous closure was efficacy in 60 patients (95%), while in 3 patients (5%) surgery closure was necessary. In half of the treated patients (30) we used 2 devices. Complications occurred in 4 patients (6%). Only in 2 patients occurred major complications (Atrio–Ventricular Block that needed PMK implantation and partial displacement of device, treated by removal and percutaneous replanting). Residual shunts, not emodynamically significant appear in the immediate post–operative period in 26% and during the follow–up in 18%. The group I was associated with greater risk of failure of the procedure (P < 0.01) and need of implantations of more than one devices (P < 0.01).
Conclusions
Percutaneous closure of multifenestrate aneurysm of interatrial septum in paediatric age are effective and shows low incidence of failure and complications. If is present residual shunt is not significant. The anathomy of interatrial septum influences procedural outcome.
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Affiliation(s)
- R Ancona
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - G Gaio
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - M Giordano
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - R Marzullo
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - M Cappelli Bigazzi
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - M Palladino
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - G Scognamiglio
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - B Sarubbi
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
| | - M Russo
- UOC CARDIOLOGIA E UTIC PEDIATRICA, UNIVERSITÀ DELLA CAMPANIA “L.VANVITELLI “OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI; UOSD CARDIOPATIE CONGENITE DELL’ADULTO, UNIVERSITÀ DELLA CAMPANIA “L. VANVITELLI”,OSPEDALE MONALDI – AORN DEI COLLI, NAPOLI
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19
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Fusco F, Borrelli N, Palma M, Sarubbi B, Scognamiglio G. Imaging of ventricular septal defect: Native and post-repair. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Sperlongano S, Renon F, Del Giudice C, Iannuzzi A, Bocchetti M, Liccardo B, Malvezzi Caracciolo D"aquino M, Scognamiglio G, Salerno G, Ciccarelli G, Bianchi R, Tartaglione D, Cappelli Bigazzi M, D"andrea A, Golino P. Myocardial work evaluation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
myocardial work (MW) is a novel echocardiographic technique which assesses left ventricular (LV) performance through LV pressure-strain loops. MW corrects speckle tracking echocardiography (STE)-derived parameters for afterload using non-invasive systolic blood pressure (SBP) as a surrogate for LV systolic pressure. In patients with severe aortic stenosis (AS), the corrected MW (cMW) has been proposed, consisting in adding the mean aortic gradient in SBP. This method revealed to be feasible and reliable, demonstrating good correlation with invasively measured LV systolic pressure.
Purpose
to evaluate myocardial performance of patients with severe AS, before and after transcatheter aortic valve implantation (TAVI), by MW indices.
Methods
patients with severe AS undergoing TAVI were included. Transthoracic, standard echocardiography and STE were performed the day before the procedure and within 2 days after. MW was calculated by combining STE-derived indices with non-invasively estimated LV systolic pressure.
Results
30 patients (79 ± 5 years old, 56% females) with severe AS (mean gradient 47 ± 14 mmHg, aortic valve area 0.6 ± 0.1 cm2), and eligible for TAVI were enrolled. Baseline global longitudinal strain was impaired (GLS -15 ± 4%), in presence of normal LV ejection fraction (LVEF 57 ± 10%). Corrected global work index and global constructive work were preserved at baseline and markedly decreased after TAVI (cGWI 2322 ± 791 vs 1710 ± 505 mmHg%, p = 0.001; cGCW 2774 ± 803 vs 2083 ± 536 mmHg%, p = 0.0007). Corrected global wasted work and global work efficiency were higher than reference values existing in literature, and no significant changes were observed after TAVI (cGWW 276 ± 174 vs 277 ± 165 mmHg%, p = 0.974; cGWE 89 ± 5 vs 87 ± 5%, p = 0.177). A significant inverse correlation was found between baseline cGWI and left atrial volume index (r=-0.5, p = 0.03).
Conclusions
patients with severe aortic stenosis and preserved LVEF show a good LV performance before and after TAVI, with a significant decrease in MW indices after TAVI, because of the reduced afterload due to AS treatment. The negative correlation between left atrial volume and cGWI may reflect the extent of myocardial damage in AS. However, further studies with larger sample size and appropriate follow-up are needed to evaluate the role of MW in prognosis and risk stratification of this subset of patients.
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Affiliation(s)
- S Sperlongano
- University of Campania Luigi Vanvitell, Naples, Italy
| | - F Renon
- University of Campania Luigi Vanvitell, Naples, Italy
| | - C Del Giudice
- University of Campania Luigi Vanvitell, Naples, Italy
| | - A Iannuzzi
- University of Campania Luigi Vanvitell, Naples, Italy
| | - M Bocchetti
- University of Campania Luigi Vanvitell, Naples, Italy
| | - B Liccardo
- University of Campania Luigi Vanvitell, Naples, Italy
| | | | | | - G Salerno
- University of Campania Luigi Vanvitell, Naples, Italy
| | - G Ciccarelli
- University of Campania Luigi Vanvitell, Naples, Italy
| | - R Bianchi
- University of Campania Luigi Vanvitell, Naples, Italy
| | - D Tartaglione
- University of Campania Luigi Vanvitell, Naples, Italy
| | | | - A D"andrea
- University of Campania Luigi Vanvitell, Naples, Italy
| | - P Golino
- University of Campania Luigi Vanvitell, Naples, Italy
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21
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Borrelli N, Di Salvo G, Ciriello GD, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Colonna D, Palma M, Scognamiglio G, Russo MG, Sarubbi B. Blood flow vortices adapt their behaviour to the presence of kent accessory pathway. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Blood speckle imaging (BSI) is a new speckle-tracking-based technique for the evaluation of blood flow. Ventricular flow vortices have been studied in sinus rhythm in normal and dysfunctional hearts, however, data are lacking in patients with Kent accessory pathway (KAP) and short atrio-ventricular (AV) conduction.
Purpose
We aimed to evaluate the characteristics of left ventricle blood vortices in children with KAP.
Methods
Nineteen paediatric patients (age 7 ± 2.9 years) were included in the study: 13 patients with manifest KAP (KAP group) and 6 age and sex -matched controls with normal AV conduction (CTR group). A thorough echocardiographic evaluation with 2D, color doppler and BSI was performed in all the included patients. BSI was recorded in apical 3-chamber view with a 6S-D probe. Vortices characteristic were analysed during filling phase of the left ventricle. We focused on the anterior vortex generated by mitral valve, which persisted longer during the cardiac cycle and is assumed to contribute to optimizing cardiac function. A standard 12-lead ECG was also recorded for each child in KAP group to esteem KAP localization.
Results
According to Arruda criteria for KAP localization, all patients in KAP group manifested the accessory pathway in the septal region. All patients in CTR group presented one major anterior vortex during filling phase, while in KAP group 10 patients out of 13 (p= 0.009) lacked of this main anterior vortex, showing instead fragmented different vortices. There were no differences in term of left ventricle function (KAPg 59.8 ± 4.02% vs CTRg 59.0 ± 2.5%, p= 0.6) and global longitudinal strain (KAPg -18.6 ± 1.0% vs CTRg -19.6 ± 3.1%, p= 0.5) between the two groups.
Conclusion
In our preliminary analysis, in patients with septal KAP, blood vortices adapted their diastolic traces to the septal dyssynchrony showing a fragmented pattern. We speculate this fragmentation may contribute to impair the performance of the left ventricle. Abstract Figure. BSI in control vs patient with WPW
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Affiliation(s)
- N Borrelli
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - G Di Salvo
- University Hospital of Padova, Padua, Italy
| | - GD Ciriello
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - N Grimaldi
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - R Barracano
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - F Fusco
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - A Merola
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - A Correra
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - D Colonna
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - M Palma
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - MG Russo
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - B Sarubbi
- AO dei Colli - Monaldi Hospital, Naples, Italy
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22
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Fusco F, Scognamiglio G, Merola A, Roma AS, Del Giudice C, Abbate M, Palma M, Correra A, Borrelli N, Barracano R, Grimaldi N, Colonna D, Romeo E, Sarubbi B. Myocardial work indices and ventricular dyssynchrony in adults with aortic coarctation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Adults with coarctation of the aorta (CoA) may present residual aortic obstruction and develop arterial vasculopathy and subclinical left ventricular (LV) dysfunction. Myocardial work (MW) is a novel non-invasive index of myocardial efficiency calculated from echocardiographic LV pressure-strain loops, which yields incremental information over ejection fraction and global longitudinal strain. (GLS)
Purpose
Aim of the present study is to analyze LVMW in a cohort of adult patients with operated aortic CoA
Methods
CoA patients aged > 18 years who underwent transthoracic echocardiography between September 2020 and July 2021 at our tertiary centre were included. Exclusion criteria were significant recoarctation, impaired LVEF, significant valvular disease and suboptimal image quality. A group of healthy individuals with no cardiac abnormalities. GLS and peak strain dispersion(PSD) were measured. MW indices were calculated using the blood pressure measured in the right arm at the time of the exam.
Results
Sixty patients (26[22-33]years, 66%male) were included. Data on previous medical history, clinical status at last assessment and Coa-related echocardiographic findings are showed in table 1. No significant differences in traditional parameters of LV systolic and diastolic function were found between groups (EF 60[57-64] vs 57[53-61],p = 0.6), however Coa patients had higher LVmass (84[75-97] vs 68[56-75]g). GLS and MW indices in the study population and in the control group are reported in table 2. Coa group showed lower GLS values and higher PSD (p < 0.0001 for both). Global work index(GWI) and global constructive work(GCW) values were not significantly different between groups, whereas CoA group showed significant increase of global wasted work(GWW) and impaired global work efficiency(GWE,p = 0.003 and 0.0005 respectively). Spearman’s linear method illustrated that both GCW and GWI had a moderate positive relation with mean gradient across the descending aorta at continuous wave Doppler. PSD was positively related to GWW and inversely related to GWE(Figure 1). Using linear regression model with the log of GWE values as dependent variable,PSD,age(β:-0.002,p = 0.03) and LVmass(β:-0.06,p = 0.004)were related to GWE. However, only PSD retained a significant relation on multivariable analysis(β:-0.002,p > 0.0001).
Conclusion
MW indices assessment is feasible in Coa patients may provide a more comprehensive understanding of the overall myocardial mechanics and performance. In particular, MW demonstrated impaired LV efficiency, which was strongly related to increased mechanical dispersion in Coa patients. Abstract Figure. Abstract Figure.
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - AS Roma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - C Del Giudice
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - M Abbate
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
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23
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Borrelli N, Di Salvo G, Ciriello GD, Sabatino J, Bucciarelli V, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Romeo E, Palma M, Scognamiglio G, Russo MG, Sarubbi B. Impaired myocardial work in paediatric patients with wolff-parkinson-white syndrome. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Wolff-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardium deformation during systole. Left ventricle (LV) dysfunction due to electrical dyssynchrony may require catheter ablation of the accessory pathway, even in asymptomatic patients.
Purpose
The study aimed to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in patients with WPW.
Methods
Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in the study: 12 cases with manifest WPW and 32 age-, sex- and arterial pressure- matched controls (CTR). LV ejection fraction (EF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated.
Results
Despite normal LV systolic function by standard echocardiographic parameters, patients with WPW had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs 1624.0 ± 305.8 mmHg% in CTR, p = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs 2069.0 ± 319.9 mmHg% in CTR, p= 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs 90.9 ± 58.9 mmHg% in CTR, p= 0.0008) and GWE (90.5 ± 4.8% in WPW vs 95.2 ± 2.2% in CTR, p= 0.00006). There were no significant differences in GLS and EF between patients with WPW and controls.
Conclusion
Myocardial work indices were found significantly reduced in patients with WPW, even in presence of normal LV EF and GLS. In patients with WPW, MWI may represent a sensitive measure of myocardial dysfunction and help in the decision-making for catheter ablation. Abstract Figure. Myocardial work in WPW Abstract Figure. Myocardial work in control patient
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Affiliation(s)
- N Borrelli
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - G Di Salvo
- University Hospital of Padova, Padua, Italy
| | - GD Ciriello
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - J Sabatino
- University Hospital of Padova, Padua, Italy
| | | | - N Grimaldi
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - R Barracano
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - F Fusco
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - A Merola
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - A Correra
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - E Romeo
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - M Palma
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - MG Russo
- AO dei Colli - Monaldi Hospital, Naples, Italy
| | - B Sarubbi
- AO dei Colli - Monaldi Hospital, Naples, Italy
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Borrelli N, Di Salvo G, Ciriello GD, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Colonna D, Romeo E, Palma M, Scognamiglio G, Russo MG, Sarubbi B. 136 Blood vortices analysis in children with Wolff–Parkinson–White syndrome. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Wolff–Parkinson–White syndrome (WPW) is a clinical condition characterized by pre-excitation on electrocardiogram (ECG) and symptoms of arrhythmias. It has been described that premature ventricular activation induces septal wall motion abnormalities and ventricular dyssynchrony, causing detrimental effects on cardiac performance. The new speckle-tracking-based technique, blood speckle imaging (BSI), has been previously used to evaluate blood flow characteristics in normal and dysfunctional hearts in patients with normal atrio-ventricular (AV) conduction. We aimed to study the features of left ventricle blood vortices in patients with WPW and short AV conduction by using BSI.
Methods and results
Nineteen paediatric patients (age 7 ± 2.9 years) were included in the study: 13 patients with manifest WPW (WPW group) and 6 age and sex -matched controls with normal AV conduction (CTR group). A complete echocardiographic evaluation with 2D, color Doppler, and BSI was performed in all the included patients. BSI was recorded in apical 3-chamber view with a 6S-D probe. Vortices characteristics were analysed during the filling phase of the left ventricle. We focused on the anterior vortex generated by the mitral valve, which persisted longer during the cardiac cycle and is assumed to contribute to optimizing cardiac function. For each child in the WPW group, Arruda criteria were used to esteem accessory pathway localization from a 12-lead surface ECG. All patients in the WPW group manifested the accessory pathway in the septal region. All patients in the CTR group presented one major anterior vortex along the septal wall during the filling phase (Figure A), while in the WPW group, 10 patients out of 13 (P = 0.009) lacked this main anterior vortex, showing instead fragmented vortices (Figure B). Interestingly, the main differences in blood vortices pattern were showed in the last part of filling phase, when blood flow could be affected by premature activation of the septal wall. There were no differences in terms of left ventricle function (WPWg 59.8 ± 4.02% vs. CTRg 59.0 ± 2.5%, P = 0.6) and global longitudinal strain (WPWg −18.6 ± 1.0% vs. CTRg −19.6 ± 3.1%, P = 0.5) between the two groups. 136 Figure A and B
Conclusions
In our preliminary study, patients with WPW showed a fragmented pattern of diastolic blood vortices that adapted to septal dyssynchrony. We speculate this fragmentation may contribute to impair the performance of the left ventricle.
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Ciriello GD, Borrelli N, Di Salvo G, Sabatino J, Bucciarelli V, Avesani M, Grimaldi N, Barracano R, Fusco F, Merola A, Correra A, Romeo E, Colonna D, Palma M, Scognamiglio G, Russo MG, Sarubbi B. 276 Wolff–Parkinson–White syndrome was associated with reduced myocardial work. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Paediatric patients with a diagnosis of Wolff–Parkinson–White (WPW) Syndrome may develop a reduction of local myocardial deformation because of accessory pathway-related electrical dyssynchrony, which may lead to an impairment of left ventricular systolic function. The presence of ventricular dysfunction may be an indication for these patients to undergo radiofrequency catheter ablation (RFCA), even if asymptomatic. However, myocardial abnormalities are sometimes subtle and cannot be detected by standard echocardiographic evaluation. The purpose of this study was to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in paediatric patients with WPW Syndrome.
Methods and results
Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in this study: 12 cases with manifest WPW Syndrome and 32 age-, sex-, and arterial pressure-matched controls (CTR). Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global constructive work (MCW), wasted work (MWW), and work efficiency (MWE) were estimated. Despite normal LV systolic function by standard echocardiographic parameters, paediatric patients with WPW Syndrome had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs. 1624.0 ± 305.8 mmHg% in CTR, P = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs. 2069.0 ± 319.9 mmHg% in CTR, P = 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs. 90.9 ± 58.9 mmHg% in CTR, P = 0.0008), and GWE (90.5 ± 4.8% in WPW vs. 95.2 ± 2.2% in CTR, P = 0.00006). There were no significant differences in GLS and LVEF between patients with WPW Syndrome and controls.
Conclusions
WPW Syndrome was found to be associated with a significant reduction of myocardial work indices in the paediatric population. The assessment of MWI may represent a sensitive measure to identify a subtle myocardial dysfunction in an early stage, even when LVEF and GLS are normal. It might be considered a further diagnostic parameter for referring little patients to RFCA.
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Affiliation(s)
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | | | | | | | - Nicola Grimaldi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
| | | | - Maria Giovanna Russo
- University of Campania Luigi Vanvitelli, Naples, Italy
- Paediatric Cardiology Unit, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy
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Fusco F, Scognamiglio G, Merola A, Roma AS, Nicastro C, Spatarella M, D'Abbraccio M, Di Mauro G, Atripaldi U, Atripaldi L, Correra A, Palma M, Barracano R, Borrelli N, Capuano A, Sarubbi B. COVID-19 vaccination in adults with congenital heart disease: Real-world data from an Italian tertiary centre. Int J Cardiol Congenit Heart Dis 2021; 6:100266. [PMID: 35360668 PMCID: PMC8552781 DOI: 10.1016/j.ijcchd.2021.100266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 11/01/2022] Open
Abstract
Background real-world data on COVID-19 vaccine safety, immunogenicity and acceptance in adults with congenital heart disease (ACHD) are lacking. Methods ACHD patients who were offered COVID-19 vaccination from January to June 2021 were included. Data on adverse events, on patients' attitude towards vaccination and antispike IgG titre were retrospectively collected. A group of healthy individuals with similar age and sex undergoing vaccination was included for comparison. Results 208 patients followed in a single ACHD tertiary centre (33.3 [26-45] years, 54% male) received COVID-19 vaccine, 65% vaccinated at our institution: 199 (96%) received Pfizer-BioNTech BNT162b2 vaccine, 4 (2%) Moderna-1273 and 5 (2%) AstraZeneca-ChAdOx1. Median follow-up after vaccination was 79 [57-96] days. No major adverse event was reported and the incidence of minor events was not different between ACHD patients and the control group. One patient was diagnosed with acute pericarditis. There were two deaths unrelated to the vaccine during follow-up. Three (1.5%) vaccinated patients tested positive for COVID-19. Antispike IgG titre, available in 159 (76%) patients, was 1334 [600-3401] BAU/ml, not significantly different from the control group (p=0.2). One patient with Fontan failure was seronegative. Advanced physiological stage was associated with lower antibody response, independently from previous viral exposure (p<0.0001). Fourteen percent refused COVID-19 vaccination at our institution. However, 50% of vaccinated patients declared to have been influenced by the discussion with the ACHD cardiologist and 66% of those vaccinated in situ reported that undergoing COVID-19 vaccination at the ACHD centre made them feel safer. Conclusion COVID-19 vaccines appear safe in ACHD with satisfactory immunogenicity. However, the most vulnerable patients showed lower antibody response. ACHD team may play a key role in vaccine acceptance.
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Affiliation(s)
- Flavia Fusco
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - Assunta Merola
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Anna Selvaggia Roma
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Carmine Nicastro
- Department for Laboratory Medicine, AO dei Colli - Monaldi Hospital, Naples, Italy
| | | | - Maurizio D'Abbraccio
- Vaccination Unit for Vulnerable Patients, AORN dei Colli - Cotugno Hospital, Naples, Italy
| | - Gabriella Di Mauro
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Umberto Atripaldi
- Department for Laboratory Medicine, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Lidia Atripaldi
- Department for Laboratory Medicine, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Rosaria Barracano
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, AO dei Colli - Monaldi Hospital, Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Berardo Sarubbi
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Fusco F, Merola A, Scognamiglio G, Palma M, Correra A, Barracano R, Borrelli N, Grimaldi N, Spinelli Barrile C, Puzone N, Ciriello GD, Colonna D, Romeo E, Sarubbi B. Effects of sacubitril/valsartan in patients with a systemic right ventricle: early evidence of exercise tolerance and systolic function improvement. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sacubitril/valsartan has been shown to reduce mortality and morbidity inpatients with heart failure and reduced systolic function. However, the effects of this novel association in patients with congenital heart disease and a systemic right ventricle (sRV) have not been investigated yet.
Purpose
We aimed to assess tolerability and efficacy of sacubitril/valsartan in patients with a sRV
Methods
From September 2020 to March 2021, 38 patients with congenitally corrected transposition of the great arteries or transposition of the great arteries after Senning or Mustard repair were prospectively enrolled. Inclusion criteria were: age ≥18 years, optimal medical therapy including ACEi/ARB for at least 6 months and EF of the sRV ≤40%. Patients with univentricular physiology, systolic blood pressure (SBP) <90mmHg, glomerular filtration rate (GFR) <30ml/min or K >5.5mEq/L were excluded. RV systolic function was assessed on echocardiography using a multiparametric evaluation. The study protocol contemplates serial assessments at 1, 3, 6 and 12 months after treatment initiation.
Results
Up to March 31th, 23 patients completed 1-month and 15 completed 3-month assessment after treatment initiation. Baseline patients' characteristics are summarized in table 1. The medication dose was up-titrated to the highest tolerated dose during follow-up. During early follow-up, no major adverse events were reported. Treatment did not impact significantly on the values of serum potassium (basal K+ 4.4 [4.2–4.6] mEq/L, K+ at 3 months 4.4 [4.3–4.6] mEq/L, p=0.7) and GFR (basal GFR 113.9±35ml/min, GFR at 3 months 107.8±21 ml/min, p=0.7). Although SBP did not change significantly (114±12 vs 113.9±19 mmHg at 1-month and 117.3±12 mmHg at 3 months; p=0.9 for both), 2 (5%) patients ceased the treatment due to symptomatic hypotension during the first month of treatment. There was no significant change in the NYHA class. However, the 6-minute walking distance increased significantly after 3 months (365±120 vs 498.3±71 min; p=0.01). Furthermore, while traditional echocardiographic parameters of RV systolic function (TAPSE, s wave and FAC) did not change significantly, RV global longitudinal strain (GLS) and RV free wall GLS demonstrated subclinical improvement in right ventricular systolic function (table 2).
Conclusions
Our short-term results from an ongoing prospective study showed that sacubitril/valsartan is well tolerated in patients with a sRV with early evidence of improvement in exercise tolerance and sRV systolic function. Longer follow-up is warranted to confirm these data.
Funding Acknowledgement
Type of funding sources: None. Table 1Table 2
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - C Spinelli Barrile
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Puzone
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G D Ciriello
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
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28
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Fusco F, Scognamiglio G, Guarguagli S, Merola A, Palma M, Borrelli N, Barracano R, Grimaldi N, Correra A, Piccolo G, La Rocca F, Del Giudice C, Colonna D, Romeo E, Sarubbi B. Prognostic relevance of thyroid disease in adults with congenital heart disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adults with congenital heart disease (ACHD) are frequently affected by thyroid diseases (TD). However, the clinical relevance of TD in ACHD remains unknown.
Purpose
We aimed to describe the prevalence of TD in the ACHD population and to ascertain whether TD are associated with worse outcome.
Methods
Clinical data on all consecutive patients aged >18 years attending our ACHD unit for a day-case between 2014 and 2019 were retrospectively collected. For statistical analysis, a composite endpoint was created combining the following events at follow-up: hospitalization for heart failure, new-onset tachyarrhythmic or bradyarrhythmic events and death.
Results
Four hundred ninety-five ACHD patients with a median age of 32.2 [24.5–45.6] years (46% male) were included. There was an overall prevalence of patients with moderate or complex lesions (414=84%). Compared to the group with no history of TD, patients in the TD were older, (41.9 [29.7–53.5] vs 30.2 [24.3–39] years; p<0.0001) and mainly female (77% vs 46%; p<0.0001) and more likely to have undergone at least two cardiac catheterization procedures (29 vs 13%; p<0.0001). Genetic disorders including Down syndrome were more prevalent in the group with TD (p<0.0001). Moreover, at last follow-up, those with TD had higher pro-BNP-nt values (243.5 [96.5–523] pg/ml Vs 94 [45–207] pg/ml; p<0.0001) and were in a more advanced NYHA class (27% vs 13% in class III-IV; p=0.0002). Echocardiography showed lower EF in the TD group (55 [55–60]% vs 60 [55–65]%; p=0.0002).
Median follow-up was 9.4 [4.5–13.1] years. Patients with TD had a higher unadjusted mortality rate, with a trend towards statistical significance (p=0.07). Sixty-four (42%) patients in the TD group and 43 (12.5%) met our composite endpoint, leading to a 10-year survival free from events of 53.7% Vs 86.5%, respectively (p<0.0001, Figure1). Multivariate analysis showed that age, ejection fraction, previous surgical palliation, advanced physiological stage and TD were independent predictors of our composite endpoint, even after stratification for genetic disorders as reported in table1. After adjustment for baseline differences between groups with propensity matching score using age, sex, disease complexity, physiological stage, previous palliative or reparative surgery, normal or reduced systemic ventricle ejection fraction, pulmonary arterial hypertension, cyanosis and presence of systemic right ventricle as independent variables, TD remained a strong predictor of cardiac events at follow-up with an hazard ratio of 4.47 (95% CI 2.42–8.28; p<0.0001).
Conclusion
TD is a strong predictor of adverse outcome in the ACHD population after exclusion of potential confounding factors, being related to a fourfold increased risk of events at follow-up.
Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G Scognamiglio
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - S Guarguagli
- Ospedale SS Giovanni e Paolo AULSS3 Serenissima Venezia, Venice, Italy
| | - A Merola
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Borrelli
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - R Barracano
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - N Grimaldi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - A Correra
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - G Piccolo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - F La Rocca
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - C Del Giudice
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - D Colonna
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - E Romeo
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
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29
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Cazzaniga ME, Vallini I, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Baldelli A, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Sarti S, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Di Mauro P, Cogliati V, Capici S, Clivio L, Torri V. Metronomic chemotherapy (mCHT) in metastatic triple-negative breast cancer (TNBC) patients: results of the VICTOR-6 study. Breast Cancer Res Treat 2021; 190:415-424. [PMID: 34546500 PMCID: PMC8558172 DOI: 10.1007/s10549-021-06375-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Triple-negative breast cancer (TNBC) represents a subtype of breast cancer which lacks the expression of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2): TNBC accounts for approximately 20% of newly diagnosed breast cancers and is associated with younger age at diagnosis, greater recurrence risk and shorter survival time. Therapeutic options are very scarce. Aim of the present analysis is to provide further insights into the clinical activity of metronomic chemotherapy (mCHT), in a real-life setting. Methods We used data included in the VICTOR-6 study for the present analysis. VICTOR-6 is an Italian multicentre retrospective cohort study, which collected data of metastatic breast cancer (MBC) patients who have received mCHT between 2011 and 2016. Amongst the 584 patients included in the study, 97 were triple negative. In 40.2% of the TNBC patients, mCHT was the first chemotherapy treatment, whereas 32.9% had received 2 or more lines of treatment for the metastatic disease. 45.4% out of 97 TNBC patients received a vinorelbine (VRL)-based regimen, which resulted in the most used type of mCHT, followed by cyclophosphamide (CTX)-based regimens (30.9%) and capecitabine (CAPE)-based combinations (22.7%). Results Overall response rate (ORR) and disease control rate (DCR) were 17.5% and 64.9%, respectively. Median progression free survival (PFS) and overall survival (OS) were 6.0 months (95% CI: 4.9–7.2) and 12.1 months (95% CI: 9.6–16.7). Median PFS was 6.9 months for CAPE-based regimens (95% CI: 5.0–18.4), 6.1 months (95% CI: 4.0–8.9) for CTX-based and 5.3 months (95% CI: 4.1–9.5) for VRL-based ones. Median OS was 18.2 months (95% CI: 9.1-NE) for CAPE-based regimens and 11.8 months for VRL- (95% CI: 9.3–16.7 and CTX-based ones (95%CI: 8.7–52.8). Tumour response, PFS and OS decreased proportionally in later lines. Conclusion This analysis represents the largest series of TNBC patients treated with mCHT in a real-life setting and provides further insights into the advantages of using this strategy even in this poor prognosis subpopulation.
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Affiliation(s)
- M E Cazzaniga
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- Oncology Unit, ASST Monza, Monza, MB, Italy.
| | - I Vallini
- Medical Oncology, ASST Sette Laghi Ospedale Di Circolo E Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Versilia, ATNO, Lido Di Camaiore, LU, Italy
| | - R Berardi
- Medical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti, Ancona, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni Di Dio, Agrigento, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, Bolzano, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese Legnano, Legnano, Italy
| | - A Baldelli
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology 2, Az. Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli Sacco, Milano, Italy
| | - O Garrone
- Breast Unit Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - F Giovanardi
- AUSL IRCCS Reggio Emilia Provincial Oncology Unit, Reggio Emilia, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, Italy
| | - S Sarti
- IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - A Musolino
- Department of Medicine and Surgery, Medical Oncology and Breast Unit, University of Parma and University Hospital of Parma, Parma, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, Italy
| | - D Santini
- Medical Oncology, Università Campus Bio-Medico, Roma, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria degli Angeli, Pordenone, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus-Messina, Messina, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città della Salute e della Scienza, Osp. Molinette, Torino, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense, Ospedale di Circolo Rho, Rho, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, Italy
| | - M R Valerio
- Department of Discipline Chirurgiche, Oncologiche e Stomatologiche (DICHIRONS), Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, Italy
| | - P Vici
- Phase IV trials, IRCCS, INT Regina Elena, Rome, Italy
| | - P Di Mauro
- Oncology Unit, ASST Monza, Monza, MB, Italy
| | - V Cogliati
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - S Capici
- Phase 1 Research Centre and Oncology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - L Clivio
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
| | - V Torri
- Oncology Department, IRCCS Mario Negri Institute, Milan, Italy
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Barracano R, Scognamiglio G, Palma M, Sica G, Merola A, Borrelli N, Fusco F, Correra A, Ciriello GD, Sarubbi B. Chylothorax Due to Superior Vena Cava Obstruction in a Patient With Complex Congenital Heart Disease. JACC Case Rep 2021; 3:736-739. [PMID: 34317616 PMCID: PMC8311179 DOI: 10.1016/j.jaccas.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/11/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Obstruction of the superior vena cava represents an under-recognized cause of chylothorax in the adult population. Our case report describes the successful conservative management of chylothorax due to bilateral superior vena cava obstruction in an adult patient with complex congenital heart disease. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Rosaria Barracano
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Giacomo Sica
- Division of Radiology, Monaldi Hospital, Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
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Sarubbi B, Correra A, Colonna D, Romeo E, Palma M, Merola A, D'Alto M, Scognamiglio G, Fusco F, Barracano R, Borrelli N, Grimaldi N, D'Onofrio A, Russo MG. Subcutaneous implantable cardioverter defibrillator in complex adult congenital heart disease. Results from the S-ICD “Monaldi Care” registry. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Spiniello G, Scognamiglio G, Merola A, Palma M, Fusco F, Sarubbi B. Ischemic dilated cardiomyopathy complicating Tetralogy of Fallot. J Cardiovasc Med (Hagerstown) 2021; 22:143-145. [PMID: 32740416 DOI: 10.2459/jcm.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giorgio Spiniello
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
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Fusco F, Uebing A, Scognamiglio G, Guarguagli S, Kempny A, Diller G, Gatzoulis M, Babu-Narayan S, Li W. Long-term follow-up after percutaneous pulmonary valve implantation: sustained clinical benefit with evidence of persistent biventricular reverse remodeling and improved global performance. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with native or post-surgical right ventricular outflow tract (RVOT) dysfunction often require several re-interventions. Percutaneous pulmonary valve implantation (PPVI) has recently been proposed as an attractive alternative to surgery, but there is still lack of data on long-term results.
Aim
To determine the long-term outcome after PPVI and to investigate whether clinical benefit and cardiac performance improvement is achieved after the procedure.
Methods and results
Seventy-eight patients (mean age 31.75±11.7) undergoing PPVI between April 2007 and July 2017 at Royal Brompton Hospital were retrospectively included in the study. The median follow-up was 6.1 years (2.1–11.2). Overall survival was 90.8%±4.1 at 6 years and 85%±5.9 at 11 years with freedom from valve failure (defined as either severe stenosis or regurgitation) of 87.6%±5 at 6 years of follow-up. Annual reintervention rate was 3.2% (95% CI 1.6–5.5). Infective endocarditis was a major concern with annual incidence rate of 1.6% (95% CI 0.5–3.4) and 50% of adverse outcome. Male sex (HR 3.2, 95% CI 1.3–7.9, p=0.013), age at procedure>50 years (HR 4.7, 95% CI 1.5–15.1, p=0.01) and residual mean gradient>25 mmHg at immediate postprocedural echo (HR 4.6, 95% CI 1.6–13.5%, p=0.006) were independently associated to the composite endpoint (including death, re-intervention, valve failure and arrhythmia). At latest follow-up, significant NYHA class (Pre Vs 6.1yrs Post p<0.0001) and cardiopulmonary test results improvement (peakVO2 p=0.01) and arrhythmic burden reduction (p=0.002) were found. Both cardiovascular magnetic resonance (CMR) and serial echocardiograms showed biventricular reverse remodeling (Pre Vs 1.3yrs Post CMR: RVEDVi p=0.0002, RVESVi p=0.0012, LVEDVi p=0.028). Furthermore, speckle tracking assessments demonstrated significant improvement of RV free wall GLS (Pre Vs 6.4yrs Post p=0.03) and LV GLS (p=0.01) at long-term. Moreover, concomitant improvement of RV relaxation properties was suggested by echo evidence of right atrial (RA) reverse remodeling (Pre Vs 6.4yrs Post RA area p=0.0001), increased RA strain (p=0.0005) and reduction of the patients with restrictive RV physiology (p<0.0001).
Conclusion
PPVI is a reliable alternative to surgery with long-lasting favourable clinical effects associated with significant and persistent structural biventricular reverse remodeling and global systolic and diastolic functional improvement. Valve failure and infective endocarditis remain major complications during follow-up. Older and male patients and those with residual transvalvular gradients immediately post procedure are at higher risk of adverse clinical events, thus suggesting that re-intervention should be anticipated and that complete relief of RVOT obstruction should be pursued.
Kaplan-Meier curves for survival free from VF
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - A Uebing
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | | | - S Guarguagli
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - A Kempny
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - G.P Diller
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - M.A Gatzoulis
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | | | - W Li
- Royal Brompton and Harefield Hospital, London, United Kingdom
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Fusco F, Scognamiglio G, Correra A, Merola A, Colonna D, Palma M, Romeo E, Sarubbi B. Pulmonary valve endocarditis in adults with congenital heart disease: the role of echocardiography in a case series. Eur Heart J Case Rep 2020; 4:1-7. [PMID: 33204982 PMCID: PMC7649497 DOI: 10.1093/ehjcr/ytaa195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/02/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022]
Abstract
Background Pulmonary valve (PV) endocarditis is a frequent complication during follow-up in patients with repaired right ventricular outflow tract (RVOT) obstruction and poses relevant diagnostic and treatment challenges. We aimed to describe in details the possible different clinical presentations of this rare condition and to highlight the role of both transthoracic and transoesophageal echocardiography which, in experienced hands, may provide comprehensive useful information for the clinicians. Case summary We below describe the clinical presentation and the echo findings of three cases of pulmonary valve endocarditis complicating disease course after different repair modalities of congenital right ventricular outflow tract obstruction. Discussion The present case series outlines the diagnostic challenges of this increasingly frequent complication during follow-up of patients with congenital RVOT dysfunction after both surgical and percutaneous repair. Despite the diffusion of multimodality imaging, echocardiography with PV-dedicated views play a pivotal role in diagnosing such condition and guiding clinical management. Furthermore, this case series highlight that the suspicion of infective endocarditis should be raised whenever a sudden increase in transvalvular gradient is found during follow-up.
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Affiliation(s)
- Flavia Fusco
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Leonardo Bianchi Street 1, 80131 Naples, Italy
| | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Leonardo Bianchi Street 1, 80131 Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Leonardo Bianchi Street 1, 80131 Naples, Italy
| | - Assunta Merola
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Leonardo Bianchi Street 1, 80131 Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Leonardo Bianchi Street 1, 80131 Naples, Italy
| | - Michela Palma
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Leonardo Bianchi Street 1, 80131 Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Leonardo Bianchi Street 1, 80131 Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Leonardo Bianchi Street 1, 80131 Naples, Italy
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Scognamiglio G, Fusco F, Hankel TC, Bouma BJ, Greutmann M, Khairy P, Ladouceur M, Dimopoulos K, Niwa K, Broberg CS, Miranda B, Budts W, Bouchardy J, Schwerzmann M, Lipczyńska M, Tobler D, Tsai SF, Egbe AC, Aboulhosn J, Fernandes SM, Garr B, Rutz T, Mizuno A, Proietti A, Alonso-Gonzalez R, Mulder BJM, Sarubbi B. Safety and efficacy of non-vitamin K antagonist oral anticoagulants for prevention of thromboembolism in adults with systemic right ventricle: Results from the NOTE international registry. Int J Cardiol 2020; 322:129-134. [PMID: 32805330 DOI: 10.1016/j.ijcard.2020.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/07/2020] [Accepted: 08/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with systemic right ventricle (sRV), including transposition of great arteries (TGA) after atrial switch procedure and congenitally corrected transposition of great arteries (ccTGA), may require anticoagulation for thromboembolism (TE) prevention. In the absence of data on non-vitamin K antagonist oral anticoagulants (NOACs), vitamin K antagonists (VKAs) remain the agent of choice. We investigated the safety, efficacy and feasibility of NOACs treatment in adults with sRV in a worldwide study. METHODS This is an international multicentre prospective study, using data from the NOTE registry on adults with sRV taking NOACs between 2014 and 2019. The primary endpoints were TE and major bleeding (MB). The secondary endpoint was minor bleeding. RESULTS A total of 76 patients (42.5 ± 10.0 years, 76% male) with sRV (74% TGA, 26% ccTGA) on NOACs were included in the study. During a median follow-up of 2.5 years (IQR1.5-3.9), TE events occurred in 3 patients (4%), while no MB episodes were reported. Minor bleeding occurred in 9 patients (12%). NOAC treatment cessation rate was 1.4% (95%CI:0.3-4%) during the first year of follow-up. All the patients with TE events had a CHA2DS2-VASc score ≥ 2 and impaired sRV systolic function at baseline. The total incidence of major events during follow-up was significantly lower compared to historical use of VKAs or aspirin before study inclusion (1.4% (95%CI:0.29-4%) vs 6,9% (95%CI:2.5-15.2%); p = .01). CONCLUSIONS In this prospective study, NOACs appear to be well-tolerated, with excellent efficacy and safety at mid-term in patients with sRV.
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Affiliation(s)
- Giancarlo Scognamiglio
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy.
| | - Flavia Fusco
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Tara C Hankel
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Matthias Greutmann
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Disease Centre, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Centre de Référence M3C, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Disease Centre, Royal Brompton Hospital and Imperial College of London, London, United Kingdom
| | - Koichiro Niwa
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Craig S Broberg
- Department of Cardiology, Oregon Health & Science University Hospital, Portland, United States of America
| | - Berta Miranda
- Integrated Adult Congenital Heart Disease Unit of Vall d' Hebron-Sant Pau University Hospitals, Division of Cardiology, Vall d'Hebron Hospital, Barcelona, Spain
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Judith Bouchardy
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland; Department of Cardiology, University Hospital Geneva, Genève, Switzerland
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Magdalena Lipczyńska
- Adult Congenital Heart Center, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Shane F Tsai
- Department of Cardiology, University of Nebraska Medical Centre, NE, United States of America
| | - Alexander C Egbe
- Department of Cardiology, Mayo Clinic, Rochester, United States of America
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, LosAngeles, United States of America
| | - Susan M Fernandes
- Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children's Hospital, Stanford Health Care, Stanford School of Medicine, Palo Alto, CA, United States of America
| | - BreAnn Garr
- Department of Cardiology, Cincinnati Children's Hospital Medical Centre, Cincinnati, United States of America
| | - Tobias Rutz
- Service of Cardiology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Anna Proietti
- Electrophysiology Service and Adult Congenital Heart Disease Centre, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Rafael Alonso-Gonzalez
- Adult Congenital Heart Disease Centre, Royal Brompton Hospital and Imperial College of London, London, United Kingdom
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Netherlands Heart Institute, Utrecht, the Netherlands
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy
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Giordano M, Gaio G, D'Alto M, Santoro G, Scognamiglio G, Cappelli Bigazzi M, Palladino MT, Sarubbi B, Golino P, Russo MG. Transcatheter closure of atrial septal defect in the elderly: Early outcomes and mid-term follow-up. International Journal of Cardiology Congenital Heart Disease 2020. [DOI: 10.1016/j.ijcchd.2020.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Sperlongano S, Scognamiglio G, D'Andrea A, Golino P. A Systolic Murmur Late after Infective Endocarditis: Looking for the Guilty. J Cardiovasc Echogr 2020; 29:183-184. [PMID: 32090002 PMCID: PMC7011495 DOI: 10.4103/jcecho.jcecho_59_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aortic location of infective endocarditis is a risk factor for perivalvular extension of infection, even when a native valve is involved. We report the case of a 50-year-old man with a systolic murmur and a history of previous aortic valve infective endocarditis requiring cardiac surgery. A thorough echocardiographic assessment, including three-dimensional transesophageal echocardiography, clearly demonstrated the presence of two distinct postinfective complications, i.e., a fistula of the mitral-aortic intervalvular curtain communicating in systole with the left atrium and an acquired Gerbode-type ventricular septal defect. Our case highlights the pivotal role of echocardiography for a correct and comprehensive diagnostic assessment in the complex scenarios frequently encountered after infective endocarditis.
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Affiliation(s)
- Simona Sperlongano
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Giancarlo Scognamiglio
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy.,Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore, Salerno, Italy
| | - Paolo Golino
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
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Palma M, Scognamiglio G, Fusco F, Merola A, Correra A, Colonna D, Romeo E, Sarubbi B. Challenges and Growth as a Mental Health Professional from Volunteering Experiences in the Community Gambling Awareness Campaign. CONGENIT HEART DIS 2020. [DOI: 10.32604/chd.2020.011523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yang H, Bouma B, Dimopoulos K, Khairy P, Ladouceur M, Niwa K, Greutmann M, Schwerzmann M, Egbe A, Scognamiglio G, Budts W, Veldtman G, Opotowsky A, Broberg C, Gumbiene L, Meijboom F, Rutz T, Post M, Moe T, Lipczyńska M, Tsai S, Chakrabarti S, Tobler D, Davidson W, Morissens M, van Dijk A, Buber J, Bouchardy J, Skoglund K, Christersson C, Kronvall T, Konings T, Alonso-Gonzalez R, Mizuno A, Webb G, Laukyte M, Sieswerda G, Shafer K, Aboulhosn J, Mulder B. Non-vitamin K antagonist oral anticoagulants (NOACs) for thromboembolic prevention, are they safe in congenital heart disease? Results of a worldwide study. Int J Cardiol 2020; 299:123-130. [DOI: 10.1016/j.ijcard.2019.06.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/21/2019] [Accepted: 06/09/2019] [Indexed: 12/17/2022]
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Fusco F, Castro M, Rigby M, Shore D, Scognamiglio G, Gatzoulis M, Li W. P1598 Ruptured Sinus of Valsalva: clinical and echocardiographic features at presentation and long-term results after surgical and percutaneous repair. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Rupture of Sinus of Valsalva (rSOV) is a rare and potentially life-threatening condition often misdiagnosed. Percutaneous device closure has been replacing surgical repair as a treatment of choice. However, long-term outcome is poorly documented.
Methods
Echo database (2001-2019) was searched for patients >16y with rSOV. Clinical data were collected from ACHD database. Marfan Syndrome patients were excluded.
Results
Fifteen patients (42.2y, 10M) were diagnosed with rSOVbetween 1979 and 2019. HF symptoms at initial presentation were reported in 50%. All cases were diagnosed by TTE with finding of high velocity continuous flow from SOV to right heart. Two were initially misdiagnosed as VSD. Digital imaging recordings of 10/15 were available. The aortic root was dilated in 8/10. Four had asymmetrical SOV dilatation. LV and LA were dilated in 7/10 and 9/10. Significant aortic regurgitation was in 4. Two had RVOTO. RVSP was always raised. Echo findings are summarised in the Table.
Mean FU after repair was 10,7y (0,9-39). Ten patients had surgical repair and 5 device closure. Seven had repair of concomitant lesions (4 VSD closure and 3 AVR) at the time of the procedure. One redo device closure was performed. During FU 1 died from Cardiomyopathy. At the latest FU significant improvement in functional class, LV and LA size and RVSP was found.
Conclusion
Patients with rSOV may present with acute HF. High velocity continuous flow from SOV to right heart on TTE is characteristic feature for diagnosis. Percutaneous closure is an attractive alternative to surgery in patients with isolated lesion. Significant haemodynamic improvement can be achieved with good long-term haemodynamic results
Tot = 15 Initial findings Latest FU NYHA class 4 class I 2 class II 2 class III 4 class IV 3 unknown 11 class I 2 class II 1 class III 0 class IV* SOV (mm) 38.2 (33-44) STJ (mm) 36.2 (26-42 Asc Ao (mm) 30.3 (25-34) rupture site 8 RC sinus, 2 NC sinus Shunt to 8 RVOT, 1 RA, 1 RVOT + RA LVEDV (ml) 169.7 (114-330) 120 (67-230)* LVESV (ml) 66(42-130) 46 (28-80)* LAVi (ml/m2) 53.1 (30-129) 35 (24-53)* LV EF% 61.2 (57-65) 60.4 (50-70) RVSP (mmHg) 53.2 (37-130) 24.06 (15-32)** Pre VS post procedure p-value: * P < 0,05 **P < 0,01
Abstract P1598 Figure. PLAX in patient with ruptured RC sinus
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Affiliation(s)
- F Fusco
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Castro
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - M Rigby
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - D Shore
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | | | - M Gatzoulis
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - W Li
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Fusco F, Scognamiglio G, Colonna D, Palma M, Granata G, Russo MG, Sarubbi B. 1107 An unusual vegetation on a prosthetic pulmonary valve. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Patient presentation
During a routine check up, a 47yo man with Tetralogy of Fallot and congenital absence of left pulmonary branch was found to have a vegetation on his prosthetic pulmonary valve. His surgical history included TOF repair with left pulmonary branch bypass aged 4 years and a redo surgery for pulmonary valve replacement 3 years earlier. Before last surgery, CMR showed severe pulmonary regurgitation, dilated RV with mildly impaired systolic function (EF 40%) and absent flow in left pulmonary branch due to bypass occlusion.
Diagnostic work-up
The patient reported increasing shortness of breath (NYHA class III) over the last months. He reported one single fever peak two months before.He was on Apixaban and Amiodarone for previous history of AF. He was afebrile and an ejective systolic 4/6 murmur was heard. He was in sinus rhythm at 70 bpm. The TTE showed dilated RV with severely reduced systolic function (FAC 12%), severe pulmonary stenosis (peak gradient of 70 mmHg) with mild regurgitation, and a mobile and echogenic vegetation of 10 X 9 mm was seen on the prosthetic pulmonary valve. His blood tests at the admission demostrated raised WBC (9.460/uL) and PCR 11.7 mg/dl (n.v. < 3.0). The PCR remained stable during the following days. Serial blood samples for cultures were obtained, but all resulted negative. Uncommom causes of negative blood culteres infective endocarditis were investigated with specific serological tests for research of fastious agents, but all resulted negative. Antinuclear and antiphospholipid antibodies were also tested. A total-body CT was performed and it showed several liver formations. A FDG PET-CT was requested and it demostrated active marked glucose uptake by a mediastinic node, as well as by liver, brain and prosthetic pulmonary valve.
Diagnosis and outcome
After a careful review of all the clinical and imaging data, our opinion was that the most probable diagnosis was non infective thrombotic endocarditis in patient with metastatic cancer. In this situation, the valvular glucose uptake was likely due active thrombus formation rathen then being a sign of inflammatory response. Unfortunately, the patient died suddenly two weeks after the PET-CT and it was impossible to confirm the diagnosis with biopsy.
Conclusion
Differential diagnosis of cardiac vegetations is a challenging process including microbological tests, multi modality imaging and clinical reasoning. It is always necessary to consider alternative diagnosis, even when traditional imaging tests seem to suggest infective endocarditis.
Non infective thrombotic endocarditis are a rare form of negative blood culteres endocarditis related to systemic hypercoagulable state (i.e. antiphospholipid syndrome, systemic lupus, behcet syndrome, cancer). Malignancies can be considered an unusual cause of cardiac vegetation and they must be taken into account on differential diagnosis.
Abstract 1107 Figure. FDG uptake in pulmonary position
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - D Colonna
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - G Granata
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M G Russo
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Naples, Italy
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Fusco F, Scognamiglio G, Vitiello F, Gilli M, Piantedosi F, Colonna D, Palma M, Granata G, Sarubbi B. P781 Role of serum biomarkers combined with two-dimensional speckle tracking echocardiography for screening of immunotherapy-induced cardiotoxicity. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Immune checkpoint inhibitors (ICIs) are a novel class of antineoplastic drugs which have dramatically changed the management of non-small cell lung cancer. ICI-associated cardiotoxicity is rare, but potentially fatal, presenting in most of cases as autoimmune acute myocarditis during the first phase of treatment. However, since an extensive cardiac monitoring is not routinely performed in most immunotherapy trials, the true incidence of ICIs related cardiac effects is largely unknown.
Aim
Aim of our study is to ascertain a possible subclinical cardiac involvement in patients with non-small cell lung cancer treated with ICIs.
Methods
We prospectively recruited 40 patients (13 males; mean age 64.3 ± 8.3 years) starting immunotherapy with PD-1/PDL-1 inhibitors for non-small lung cancer between January and August 2018. Demographic and clinical data were recorded and all patients underwent a standard 12-lead ECG and a transthoracic echocardiogram with assessment of left ventricular global longitudinal strain (LV GLS). Furthermore, blood samples for pro BNP-nt and high sensitivity Troponin T (hsTnT) measurements were collected. Serial assessments were performed before and 1 and 3 months after initiation of immunotherapy.
Results
A history of previous coronary artery disease was documented in eight cases (20%). At follow-up no cardiovascular events were recorded. Compared with baseline, echocardiographic parameters of ventricular function did not significantly changed at 1 and 3 months (LVEF 61 ± 6% at baseline, 61 ± 5% at 1 month, 60,2 ± 5% at 3 months, p =0.1; E/E’at baseline 9.2 ± 3, 9.2 ± 2.8 at 1 month, 9.1 ±3,5 at 3 months, p = 0.2;TAPSE 20 ± 3.4 mm at baseline, 21.3 ± 2.8 mm at 1 month, 20 ± 3.8 mm at 3 months, p =0.1; LV GLS -20.3 ± 3.6% at baseline, -20.8 ± 2.3% at 1 month, -20.6 ± 3% at 3 months; p = 0.4). Analogously, no significant increase in circulating levels of cardiac biomarkers was found with hsTnT <0.015 ng/ml in all patients at baseline, 1 month and 3 months and median proBNP-nt 118 pg/ml (IQR 47-200) at baseline, 171 pg/ml (IQR 91-520) at 1 month, and 182 pg/ml (IQR 78-470) at 3 months, p = 0.9.
Conclusions
In our study no significant clinical or subclinical evidence of myocardial involvement was detected during treatment with ICIs in patients with non-small cell lung cancer, thus suggesting the potential cardiovascular safety of this promising class of antineoplastic drugs.
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Affiliation(s)
- F Fusco
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - F Vitiello
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M Gilli
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - D Colonna
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M Palma
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - G Granata
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - B Sarubbi
- AO dei Colli-Monaldi Hospital, Naples, Italy
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Fusco F, Shimada E, Scognamiglio G, Senior R, Gatzoulis MA, Babu-Narayan S, Li W. Restrictive ventricular septal defect resulting in systemic outflow obstruction in adults with Fontan circulation: challenging diagnosis of a serious and potentially fatal complication. J Cardiovasc Med (Hagerstown) 2019; 21:276-279. [PMID: 31789717 DOI: 10.2459/jcm.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Flavia Fusco
- Royal Brompton Hospital and Harefield NHS Foundation Trust.,AORN Monaldi Hospital, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Eriko Shimada
- Royal Brompton Hospital and Harefield NHS Foundation Trust
| | | | - Roxy Senior
- Royal Brompton Hospital and Harefield NHS Foundation Trust.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Michael A Gatzoulis
- Royal Brompton Hospital and Harefield NHS Foundation Trust.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sonya Babu-Narayan
- Royal Brompton Hospital and Harefield NHS Foundation Trust.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Wei Li
- Royal Brompton Hospital and Harefield NHS Foundation Trust.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
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44
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Fenizia F, Esposito Abate R, Pasquale R, Roma C, Lambiase M, Chicchinelli N, Graziano P, Botti G, Tatangelo F, Scognamiglio G, Pietrantonio F, Normanno N. Tumour mutation burden and microsatellite instability in colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cazzaniga ME, Pinotti G, Montagna E, Amoroso D, Berardi R, Butera A, Cagossi K, Cavanna L, Ciccarese M, Cinieri S, Cretella E, De Conciliis E, Febbraro A, Ferraù F, Ferzi A, Fiorentini G, Fontana A, Gambaro AR, Garrone O, Gebbia V, Generali D, Gianni L, Giovanardi F, Grassadonia A, Leonardi V, Marchetti P, Melegari E, Musolino A, Nicolini M, Putzu C, Riccardi F, Santini D, Saracchini S, Sarobba MG, Schintu MG, Scognamiglio G, Spadaro P, Taverniti C, Toniolo D, Tralongo P, Turletti A, Valenza R, Valerio MR, Vici P, Clivio L, Torri V. Metronomic chemotherapy for advanced breast cancer patients in the real world practice: Final results of the VICTOR-6 study. Breast 2019; 48:7-16. [PMID: 31470257 DOI: 10.1016/j.breast.2019.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 12/21/2022] Open
Abstract
Metronomic chemotherapy (mCHT) refers to the minimum biologically effective dose of a chemotherapy agent given as a continuous dosing regimen, with no prolonged drug-free breaks, that leads to antitumor activity. Aim of the present study is to describe the use of mCHT in a retrospective cohort of metastatic breast cancer (MBC) patients in order to collect data regarding the different types and regimens of drugs employed, their efficacy and safety. Between January 2011 and December 2016, data of 584 metastatic breast cancer patients treated with mCHT were collected. The use of VRL-based regimens increased during the time of observation (2011: 16.8% - 2016: 29.8%), as well as CTX-based ones (2011: 17.1% - 2016: 25.6%), whereas CAPE-based and MTX-based regimens remained stable. In the 1st-line setting, the highest ORR and DCR were observed for VRL-based regimens (single agent: 44% and 88%; combination: 36.7% and 82.4%, respectively). Assuming VRL-single agent as the referee treatment (median PFS: 7.2 months, 95% CI: 5.3-10.3), the longest median PFS were observed in VRL-combination regimens (9.5, 95%CI 88.8-11.3, HR = 0.72) and in CAPE-single agent (10.7, 95%CI 8.3-15.8, HR = 0.70). The VICTOR-6 study provides new data coming from the real-life setting, by adding new information regarding the use of mCHT as an option of treatment for MBC patients.
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Affiliation(s)
- M E Cazzaniga
- Research Unit Phase I Trials, ASST Monza, Monza, Italy; Oncology Unit, ASST Monza, Italy.
| | - G Pinotti
- Medical Oncology, ASST Sette Laghi "Ospedale di Circolo e Fondazione Macchi, Varese, VA, Italy
| | - E Montagna
- Medical Senology Division, IEO, Milan, Italy
| | - D Amoroso
- Medical Oncology, Ospedale Della Versilia, Lido di Camaiore, IT, Italy
| | - R Berardi
- Medical Oncology, A. Ospedaliero-universitaria Ospedali Riuniti, Ancona, IT, Italy
| | - A Butera
- Medical Oncology, Ospedale San Giovanni di Dio, Agrigento, IT, Italy
| | - K Cagossi
- Medical Oncology, Ospedale Ramazzini, Carpi, IT, Italy
| | - L Cavanna
- Medical Oncology, Azienda Ospedaliera Piacenza, Piacenza, IT, Italy
| | - M Ciccarese
- Medical Oncology, Ospedale Vito Fazzi, Lecce, IT, Italy
| | - S Cinieri
- Medical Oncology, ASL Brindisi, Brindisi, Italy
| | - E Cretella
- Medical Oncology, Ospedale Bolzano, IT, Italy
| | | | - A Febbraro
- Medical Oncology, Ospedale S. Cuore di Gesù Fatebenefratelli, Benevento, Italy
| | - F Ferraù
- Medical Oncology, Osp Taormina, Taormina, IT, Italy
| | - A Ferzi
- Medical Oncology, A.S.S.T. Ovest Milanese, Legnano, IT, Italy
| | - G Fiorentini
- Medical Oncology, Ospedale San Salvatore, Pesaro, Italy
| | - A Fontana
- Medical Oncology, Az. Ospedaliero-Universitaria, Pisana, IT, Italy
| | - A R Gambaro
- Medical Oncology, ASST Fatebenefratelli, Sacco, IT, Italy
| | - O Garrone
- Medical Oncology, A.O. S. Croce e Carle, Cuneo, Italy
| | - V Gebbia
- Medical Oncology, Ospedale La Maddalena, Palermo, IT, Italy
| | - D Generali
- Medical Oncology, Istituti Ospitalieri Cremona, Cremona, IT, Italy
| | - L Gianni
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - F Giovanardi
- Medical Oncology, Ospedale Civile, Guastalla, IT, Italy
| | - A Grassadonia
- Medical Oncology, P.O. SS Annunziata -ASL2 Lanciano-Vasto, Chieti, IT, Italy
| | - V Leonardi
- Medical Oncology, Ospedale Civico, Palermo, IT, Italy
| | - P Marchetti
- Medical Oncology, A.O. Sant'Andrea, Roma, IT, Italy
| | - E Melegari
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - A Musolino
- Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, IT, Italy
| | - M Nicolini
- Medical Oncology, Azienda USL Romagna, U.O. di Oncologia Rimini, Cattolica, IT, Italy
| | - C Putzu
- Medical Oncology, A. Ospedaliera-Universitaria, Sassari, IT, Italy
| | - F Riccardi
- Medical Oncology, A. Ospedaliera Antonio Cardarelli, Napoli, IT, Italy
| | - D Santini
- Medical Oncology Università Campus Bio-Medico, Roma, IT, Italy
| | - S Saracchini
- Medical Oncology, Az. Osp. Santa Maria Degli Angeli, Pordenone, IT, Italy
| | - M G Sarobba
- Medical Oncology, Ospedale San Francesco, Nuoro, IT, Italy
| | - M G Schintu
- Medical Oncology, Osp Giovanni Paolo II, Olbia, IT, Italy
| | | | - P Spadaro
- Medical Oncology, Casa di Cura Villa Salus, Messina, IT, Italy
| | - C Taverniti
- Medical Oncology, A.O.U. Città Della Salute e Della Scienza, Osp. Molinette, Torino, IT, Italy
| | - D Toniolo
- Medical Oncology, ASST Rhodense 3 Ospedale di Circolo Rho, IT, Italy
| | - P Tralongo
- Medical Oncology, Osp. Umberto I, Siracusa, IT, Italy
| | - A Turletti
- Medical Oncology, P.O. Martini, Torino, IT, Italy
| | - R Valenza
- Medical Oncology, P.O. Vittorio Emanuele, Gela, IT, Italy
| | - M R Valerio
- Medical Oncology, A.O.U. Policlinico Paolo Giaccone, Palermo, IT, Italy
| | - P Vici
- Medical Oncology, B, INT Regina Elena, Roma, IT, Italy
| | - L Clivio
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
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Yang H, Veldtman GR, Bouma BJ, Budts W, Niwa K, Meijboom F, Scognamiglio G, Egbe AC, Schwerzmann M, Broberg C, Morissens M, Buber J, Tsai S, Polyzois I, Post MC, Greutmann M, Van Dijk A, Mulder BJ, Aboulhosn J. Non-vitamin K antagonist oral anticoagulants in adults with a Fontan circulation: are they safe. Open Heart 2019; 6:e000985. [PMID: 31245011 PMCID: PMC6560660 DOI: 10.1136/openhrt-2018-000985] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 12/30/2022] Open
Abstract
Background In Fontan patients with atrial arrhythmias (AA), non-vitamin K antagonist oral anticoagulants(NOACs) have a class III recommendation according to the Pediatric & Congenital Electrophysiology Society (PACES)/Heart Rhythm Society (HRS) guideline in 2014, due to lack of data on outcomes as opposed to evidence of harm. To address this gap in data, we investigated the safety and efficacy of NOACs in adults with a Fontan circulation in a worldwide study. Methods This is an international multicentre prospective cohort study, using data from the NOTE (non-vitamin K antagonist oral anticoagulants for thromboembolic prevention in patients with congenital heart disease) registry. The study population comprised consecutive adults with a Fontan circulation using NOACs. Follow-up took place at 6 months and yearly thereafter. The primary endpoints were thromboembolism and major bleeding. Secondary endpoint was minor bleeding. Results From April 2014 onward, 74 patients (mean age 32±10 years (range 18–68), 54% male) with a Fontan circulation using NOACs were included. During a median follow-up of 1.2 (IQR 0.8–2.0) years, three thromboembolic events (2.9 per 100 patient-years (95% CI 0.7 to 7.6)) and three major bleedings (2.9 per 100 patient-years (95% CI 0.7 to 7.6)) occurred in five atriopulmonary Fontan and one total cavopulmonary connection Fontan patients with AA. Fifteen patients experienced minor bleeding episodes (15.8 per 100 patient-years (95% CI 9.1 to 25.2)). In patients (n=37) using vitamin K antagonists (VKAs) prior to the initiation of NOAC, annual incidence of historical thromboembolic events and major bleeding were 2.4% (95% CI 0.4% to 7.4%) (n = 2) and 1.2% (95% CI 0.7% to 5.1%) (n = 1), respectively. Conclusions In this review of the largest Fontan cohort using NOACs with prospective follow-up, NOACs appear to be well tolerated and their efficacy and safety during short-term follow-up seem comparable to VKAs. Longer term data are required to confirm these promising short-term results.
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Affiliation(s)
- Hayang Yang
- Deparment of Cardiology, AMC, Amsterdam, The Netherlands
| | - Gruschen R Veldtman
- Adolescent and Adult Congenital Heart Disease Program, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Berto J Bouma
- Cardiology, Academical Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Werner Budts
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Koichiro Niwa
- Deparment of Cardiology, St Luke's International Hospital, Tokyo, Japan
| | - Folkert Meijboom
- Cardiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Alexander Chima Egbe
- Deparment of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, New York, USA
| | - Markus Schwerzmann
- Adult Congenital Heart Diseae Program, University Hospital Inselspital, Bern, Switzerland
| | - Craig Broberg
- Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland, Oregon, USA
| | | | | | - Shane Tsai
- Department of Cardiology, University of Nebraska Medical Centre, Omaha, Nebraska, USA
| | - Ioannis Polyzois
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Martijn C Post
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Arie Van Dijk
- Cardiology, Nijmegen University Medical Center, Nijmegen, The Netherlands
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Abstract
The right ventricle plays a major role in congenital heart disease. This article describes the right ventricular mechanics in some selected congenital heart diseases affecting the right ventricle in different ways: tetralogy of Fallot, Ebstein anomaly, and the systemic right ventricle.
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Affiliation(s)
- Inga Voges
- Royal Brompton and Harefield Trust, London, UK
| | - Mouaz H Al-Mallah
- National Guard Health Affairs, Riyadh King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia
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Sarubbi B, Scognamiglio G, Fusco F, Melillo E, D'Alto M, Russo MG. A "long-standing" malpositioned pacing lead. Long-term follow-up after extraction. Monaldi Arch Chest Dis 2018; 88:927. [PMID: 30183161 DOI: 10.4081/monaldi.2018.927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/12/2018] [Accepted: 07/11/2018] [Indexed: 11/22/2022] Open
Abstract
Transvenous pacemaker (PM) catheters can be unintentionally placed in the left ventricle (LV) during the implantation procedure. An 8-year-old girl was discovered with a malpositioned pm wire, seven years after the implant. Trans-thoracic echocardiogram revealed the lead traversing the inter-atrial septum, crossing the mitral valve and embedded in the basal lateral wall of the LV. This is a report of a 14-year long follow-up after the surgical extraction of the malpositioned PM lead.
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Fossati R, Alexanian A, Liberati A, Marsoni S, Monferroni N, Nicolucci A, Parazzini F, Giganti M, Piffanelli A, Ghezzi P, Magnanini S, Rinaldini M, Berardi F, Di Biagio G, Testore F, Tavoni N, Palmieri D, Schittulli F, Pedicini T, Fumagalli M, Gritti G, Braga M, Marini G, Zamboni A, Cosentino D, Epifani C, Scognamiglio G, Perroni D, Peradotto F, Saba V, Indelli M, Santini A, Isa L, Scapaticci R, Aitini E, Gavazzini G, Smerieri F, Lomonaco I, Nascimben O, Locatelli E, Monti M, Ghislandi E, Gottardi O, Majno M, Poma C, Pluchinotta A, Armaroli L, Confalonieri C, Viola P, Sisto R, Buda F, Plaino R, Galletto L, Trolli B, Biasio M, Rolfo A, Vaudano G, Giolito M, Scoletta G, Ambrosini G, Busana L, Molteni M, Richetti A. Breast Cancer Estrogen and Progesterone Receptors: Associations with Patients' Clinical and Epidemiologic Characteristics. Tumori 2018; 77:472-8. [DOI: 10.1177/030089169107700605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A total of 1095 patients with operable breast cancer and en-rolled in a randomized clinical trial were analysed for estrogen (ER) and progesterone (PgR) receptor content of their primary tumor, and the relationships between steroid receptor status and several epidemiologic characteristics were studied. The proportion of ER+ and median ER levels increased with age: compared to women younger than 40, those aged 66 or more were approximately three times more likely to have an ER+ tumor (OR = 3.0, 95% C.I. = 1.6–5.7). This difference tended to be more marked after comparison between patients with ER > 100 fmol/mg protein and ER- within the same age groups: OR = 7.04, 95 % C.I. = 2.89–17.12. No association emerged between age and PgR. ER status and concentrations were independent of menopausal status after adjustment for age, whereas the proportion of PgR+ and PgR levels were significantly lower in postmenopausal patients of the same age. The distribution of ER and PgR profiles was similar in relation to family history of breast cancer, reproductive events and other selected epidemiologic characteristics of the patients.
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Affiliation(s)
| | - R. Fossati
- G.I.V.I.O. Coordinating Center, Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - A.A. Alexanian
- G.I.V.I.O. Coordinating Center, Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - A. Liberati
- G.I.V.I.O. Coordinating Center, Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - S. Marsoni
- G.I.V.I.O. Coordinating Center, Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - N. Monferroni
- G.I.V.I.O. Coordinating Center, Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - A. Nicolucci
- G.I.V.I.O. Coordinating Center, Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - F. Parazzini
- G.I.V.I.O. Coordinating Center, Istituto di Ricerche Farmacologiche Mario Negri, Milano
| | - M. Giganti
- Cattedra Medicina Nucleare, Istituto Radiologia, Università degli Studi di Ferrara
| | - A. Piffanelli
- Cattedra Medicina Nucleare, Istituto Radiologia, Università degli Studi di Ferrara
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Sarubbi B, Rea G, Santoro G, Melillo E, Scognamiglio G, Russo MG. Pulmonary veins stenosis relief after an inappropriate radiofrequency catheter ablation of atrial fibrillation in a young non-competitive athlete. Monaldi Arch Chest Dis 2018; 88:895. [PMID: 29557576 DOI: 10.4081/monaldi.2018.895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 11/23/2022] Open
Abstract
One of the major complications of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is pulmonary vein stenosis (PVS). The natural history of PVS, especially when it involves more than one vein, leads to severe and irreversible pulmonary hypertension with end-stage right heart failure that can require, in extreme cases, even heart-lung transplantation. We report the case of a young patient who underwent RFCA for a single lasting episode of AF and developed PVS years later. He was treated with ballon venoplasty followed by stent implantation in left pulmonary vein because of PVS relief. This reported case emphasizes the need of an adequate indication for RFCA for AF, considering the benefit-risk ratio especially in young patients with normal cardiac function.
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Affiliation(s)
- Berardo Sarubbi
- Monaldi Hospital Naples, Adult Congenital Heart Disease Unit.
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