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Paglianiti DA, Busco M, Bettari L, Bellamoli M, Campopiano E, Basile M, Maffeo D, Buono A. Coronary obstruction during TAVI procedure: When calcification distribution matters. Cardiovasc Revasc Med 2024:S1553-8389(24)00116-7. [PMID: 38575448 DOI: 10.1016/j.carrev.2024.03.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Donato Antonio Paglianiti
- Valve Center, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Busco
- Valve Center, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Bettari
- Valve Center, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Michele Bellamoli
- Valve Center, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | - Mattia Basile
- Valve Center, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Diego Maffeo
- Valve Center, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Andrea Buono
- Valve Center, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
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Busco M, Paglianiti DA, Bellamoli M, Bettari L, De Rosa ML, Messina A, Villa E, Maffeo D, Buono A. Contrast-zero TAVI with new-generation EVOLUT FX platform. Cardiovasc Revasc Med 2024:S1553-8389(24)00066-6. [PMID: 38402111 DOI: 10.1016/j.carrev.2024.02.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Marco Busco
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Donato Antonio Paglianiti
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Luca Bettari
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Maria Luisa De Rosa
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy; Department of Cardiovascular Sciences, Federico II Hospital, Naples, Italy
| | - Antonio Messina
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Emmanuel Villa
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Diego Maffeo
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Andrea Buono
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy.
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Bianchini E, Morello A, Bellamoli M, Romagnoli E, Aurigemma C, Tagliaferri M, Montonati C, Dumonteil N, Cimmino M, Villa E, Corcione N, Bettari L, Messina A, Stanzione A, Troise G, Mor D, Maggi A, Bellosta R, Pegorer MA, Zoccai GB, Ielasi A, Burzotta F, Trani C, Maffeo D, Tchétché D, Buono A, Giordano A. Comparison of ultrasound- versus fluoroscopy-guidEd femorAl access In tranS-catheter aortic valve replacement In the Era of contempoRary devices: The EASIER registry. Cardiovasc Revasc Med 2023:S1553-8389(23)00938-7. [PMID: 38135568 DOI: 10.1016/j.carrev.2023.12.007] [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: 11/15/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Vascular complications (VCs) still represent one of the principal concerns of trans-femoral trans-catheter aortic valve replacement (TF-TAVR). New-generation devices can minimize such complications but the arterial access management is left to the operator's choice. This study aims to describe the rate of VCs in a contemporary cohort of patients undergoing TAVR with new-generation devices and to determine whether an ultrasound-guided (USG) vs. a fluoroscopy-guided (FG) femoral access management has an impact on their prevention. METHODS This is a prospective, observational, multicenter study. Consecutive patients undergoing TAVR with new-generation devices were analyzed from January 2022 to October 2022 in five tertiary care centers. Femoral accesses were managed according to the operator's preferences. All the patients underwent a pre-discharge peripheral ultrasound control. VCs and bleedings were the main endpoints of interest. RESULTS A total of 458 consecutive patients were enrolled (274 in the USG group and 184 in the FG group). VCs occurred in 6.5 % of the patients (5.2 % minor and 1.3 % major). There was no difference between the USG and the FG groups in terms of any VCs (7.3 % vs. 5.4 %; p = 0.4), or any VARC-3 bleedings (6.9 % vs 6 %, p = 0.9). At logistic regression analysis, the two guidance strategies did not result as predictors of VCs (odds Ratio 0.8, 95 % Confidence Interval 0.46-1.4; P = 0.4). CONCLUSIONS In a contemporary cohort of patients undergoing TAVR with new-generation devices, the occurrence of VCs is low and mostly represented by minor VCs. USG and FG modalities did not affect the rate of VCs.
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Affiliation(s)
- Emiliano Bianchini
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy; Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Morello
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Bellamoli
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy; Clinique Pasteur, Toulouse, France
| | - Enrico Romagnoli
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Carolina Montonati
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
| | | | - Michele Cimmino
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Emmanuel Villa
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Nicola Corcione
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Luca Bettari
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Antonio Messina
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | | | - Giovanni Troise
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Donata Mor
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Antonio Maggi
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Department Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Matteo Alberto Pegorer
- Vascular Surgery, Department Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Alfonso Ielasi
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Diego Maffeo
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | | | - Andrea Buono
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy.
| | - Arturo Giordano
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
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Restivo A, Bianchini E, Bellamoli M, Buono A, Bettari L, Stanzione A, De Ornelas B, Maffeo D. Intravascular ultrasound-guided 'OrbiTripsy' for a severely calcified neo-atherosclerotic coronary in-stent restenosis. J Cardiovasc Med (Hagerstown) 2023; 24:931-932. [PMID: 37851371 DOI: 10.2459/jcm.0000000000001572] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Attilio Restivo
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome
| | - Emiliano Bianchini
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome
| | - Michele Bellamoli
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
| | - Luca Bettari
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
| | - Alessio Stanzione
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
| | - Benjamin De Ornelas
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
- Division of Cardiology, University Hospital 'P. Giaccone', University of Palermo, Palermo, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
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Munafò AR, Scotti A, Estévez-Loureiro R, Adamo M, Hernàndez AP, Peregrina EF, Gutierrez L, Taramasso M, Fam NP, Ho EC, Asgar A, Vitrella G, Raineri C, Chizzola G, Pezzola E, Le Ruz R, Montalto C, Oreglia JA, Fraccaro C, Giannini C, Fiorelli F, Rubbio AP, Ooms JF, Compagnone M, Marcelli C, Maffeo D, Bettari L, Fürholz M, Arzamendi D, Guerin P, Tamburino C, Petronio AS, Grasso C, Agricola E, Van Mieghem NM, Tarantini G, Praz F, Pascual I, Potena L, Colombo A, Maisano F, Metra M, Margonato A, Crimi G, Saia F, Godino C. 2-year outcomes of MitraClip as a bridge to heart transplantation: The international MitraBridge registry. Int J Cardiol 2023; 390:131139. [PMID: 37355239 DOI: 10.1016/j.ijcard.2023.131139] [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] [Received: 05/08/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND In the first report from the MitraBridge registry, MitraClip as a bridge to heart transplantation (HTx) proved to be at 1-year an effective treatment strategy for 119 patients with advanced heart failure (HF) who were potential candidates for HTx. We aimed to determine if benefits of MitraClip procedure as a bridge-to-transplant persist up to 2-years. METHODS By the end of the enrollment period, a total of 153 advanced HF patients (median age 59 years, left ventricular ejection fraction 26.9 ± 7.7%) with significant secondary mitral regurgitation, who were potential candidates for HTx and were treated with MitraClip as a bridge-to-transplant strategy, were included in the MitraBridge registry. The primary endpoint was the 2-year composite adverse events rate of all-cause death, first hospitalization for HF, urgent HTx or LVAD implantation. RESULTS Procedural success was achieved in 89.5% of cases. Thirty-day mortality was 0%. At 2-year, Kaplan-Meier estimates of freedom from primary endpoint was 47%. Through 24 months, the annualized rate of HF rehospitalization per patient-year was 44%. After an overall median follow-up time of 26 (9-52) months, elective HTx was successfully performed in 30 cases (21%), 19 patients (13.5%) maintained or obtained the eligibility for transplant, and 32 patients (22.5%) no longer had an indication for HTx because of significant clinical improvement. CONCLUSIONS After 2-years of follow-up, the use of MitraClip as a bridge-to-transplant was confirmed as an effective strategy, allowing elective HTx or eligibility for transplant in one third of patients, and no more need for transplantation in 22.5% of cases.
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Affiliation(s)
- Andrea Raffaele Munafò
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, NY, New York, USA
| | | | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | | | - Estefanìa Fernàndez Peregrina
- Interventional Cardiology Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lola Gutierrez
- Interventional Cardiology Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Neil P Fam
- Division of Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Edwin C Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anita Asgar
- Interventional Cardiology Unit, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada
| | | | - Claudia Raineri
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuliano Chizzola
- Cardiac Catheterization Laboratory and Cardiology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Elisa Pezzola
- Cardiac Catheterization Laboratory and Cardiology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Robin Le Ruz
- Interventional Cardiology Unit, Inserm UMR 1229, L'Institut du Thorax, University Hospital of Nantes, Nantes, France
| | - Claudio Montalto
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy
| | - Jacopo A Oreglia
- De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Cristina Giannini
- Cardiac Thoracic and Vascular Department, Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Francesca Fiorelli
- Cardiac Thoracic and Vascular Department, Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Antonio Popolo Rubbio
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy
| | - J F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Miriam Compagnone
- Cardiology Unit, Cardio-Thoraco-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Chiara Marcelli
- Cardiology Unit, Cardio-Thoraco-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Diego Maffeo
- Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Bettari
- Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Monika Fürholz
- Department of Cardiology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Dabit Arzamendi
- Interventional Cardiology Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patrice Guerin
- Interventional Cardiology Unit, Inserm UMR 1229, L'Institut du Thorax, University Hospital of Nantes, Nantes, France
| | - Corrado Tamburino
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy
| | - A Sonia Petronio
- Cardiac Thoracic and Vascular Department, Department of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | - Carmelo Grasso
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Eustachio Agricola
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Isaac Pascual
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Luciano Potena
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano-, Milan, Italy
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology Unit, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Margonato
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Crimi
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Interventional Cardiology Unit, Cardio Thoraco Vascular Department (DICATOV). IRCCS, AOU San Martino IST, University of Genoa, Genova, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Cosmo Godino
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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6
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Barki M, Ielasi A, Buono A, Maffeo D, Montonati C, Pellegrini D, Pellicano M, Gorla R, Costa G, Cozzi O, Ancona M, Soriano F, De Carlo M, Ferrara E, Giannini F, Massussi M, Fovino LN, Messina A, Sgroi C, Gallo F, Nerla R, Saccocci M, D'Ascenzo F, Conrotto F, Bettari L, Fiorina C, Castriota F, Poli A, Petronio AS, Oreglia J, Montorfano M, Regazzoli D, Reimers B, Barbanti M, Tamburino C, Bedogni F, Tarantini G, Tespili M. Transcatheter aortic valve replacement with the self-expanding ACURATE Neo2 in patients with horizontal aorta: Insights from the ITAL-neo registry. Int J Cardiol 2023; 389:131236. [PMID: 37532153 DOI: 10.1016/j.ijcard.2023.131236] [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] [Received: 05/15/2023] [Revised: 07/12/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Horizontal aorta (HA), defined by an aortic angulation (AA) ≥48°, is associated with worse outcomes particularly after self-expanding (SE) trans-catheter heart valve (THV) implantation. Although the SE ACURATE Neo THV demonstrated favorable procedural success rates in patients with HA, it remains associated with a non-negligible rate of moderate or greater paravalvular leak (PVL). OBJECTIVES Aim of the study was to assess the performance of ACURATE Neo2 in the setting of HA. METHODS We performed a multicenter cohort analysis on patients with severe aortic valve stenosis and HA undergoing transcatheter aortic valve replacement (TAVR) with the Neo or Neo2 THV enrolled in the ITAL-neo registry. The primary endpoint was a composite of early safety and clinical efficacy at 30 days according to the Valve Academic Research Consortium-3 (VARC-3). Secondary endpoints included the occurrence of moderate or severe PVL and 90-day clinical outcomes. RESULTS Among 900 patients included in the ITAL-neo registry, 407 exhibited HA; of these, 300 received a Neo THV and 107 a Neo2 THV. HA, irrespective of the THV implanted, emerged as an independent risk factor for developing ≥ moderate PVL. Technical and device success at 30-day follow-up was comparable between groups. However, Neo2 was associated with a significantly lower rate of ≥moderate PVL vs. Neo: (5% vs. 15%; p < 0.001), which was confirmed also at 90-day follow-up. Additionally, no correlation was found between ≥moderate PVL and AA in the Neo2 group, while PVL degree increased proportionally to the AA in the Neo cohort. CONCLUSION In patients with HA, the new generation Acurate Neo2 THV was associated with a comparable device success rate and a significantly lower rate of ≥moderate PVL, when compared with its predecessor.
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Affiliation(s)
- Monica Barki
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Università Vita Salute San Raffaele, Milano, Italy
| | - Alfonso Ielasi
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy.
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Carolina Montonati
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Dario Pellegrini
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Mariano Pellicano
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Riccardo Gorla
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuliano Costa
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Ottavia Cozzi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Marco Ancona
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Marco De Carlo
- Cardiac Catheterization Laboratory, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Erica Ferrara
- Interventional Cardiology Unit, Legnano Civil Hospital, Legnano, Italy
| | - Francesco Giannini
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Mauro Massussi
- Cardiothoracic Department, Spedali Civili Brescia, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Antonio Messina
- Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Carmelo Sgroi
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Francesco Gallo
- Cardiology Department, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre, Venice, Italy
| | - Roberto Nerla
- GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Matteo Saccocci
- Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Luca Bettari
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | | | - Arnaldo Poli
- Interventional Cardiology Unit, Legnano Civil Hospital, Legnano, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Jacopo Oreglia
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | | | - Corrado Tamburino
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Maurizio Tespili
- Cardiology Division, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
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Buono A, Bettari L, Pero G, Stanzione A, Troise G, Cuccia C, Luzzani L, Maffeo D. Fully Percutaneous Retrieval of Delivery System After Balloon Rupture During Trans-Catheter Aortic Valve-in-Valve Implantation. Cardiovasc Revasc Med 2023; 48:43-44. [PMID: 35786537 DOI: 10.1016/j.carrev.2022.06.253] [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] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
| | - Luca Bettari
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Gaetano Pero
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Alessio Stanzione
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giovanni Troise
- Division of Cardiac Surgery, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Claudio Cuccia
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Luzzani
- Vascular and Endovascular Surgery Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
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Buono A, Messina A, Bettari L, Pero G, Cuccia C, Ielasi A, Bieliauskas G, Maffeo D. Commissural alignment with the novel Hydra transcatheter heart valve during aortic valve replacement. EUROINTERVENTION 2022; 18:822-823. [PMID: 35514218 PMCID: PMC9724965 DOI: 10.4244/eij-d-22-00173] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Antonio Messina
- Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Bettari
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Gaetano Pero
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Claudio Cuccia
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Clinical Institute, Milan, Italy
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
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9
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Buono A, Gorla R, Ielasi A, Costa G, Cozzi O, Ancona M, Soriano F, De Carlo M, Ferrara E, Giannini F, Massussi M, Fovino LN, Pero G, Bettari L, Acerbi E, Messina A, Sgroi C, Pellicano M, Sun J, Gallo F, Franchina AG, Bruno F, Nerla R, Saccocci M, Villa E, D'Ascenzo F, Conrotto F, Cuccia C, Tarantini G, Fiorina C, Castriota F, Poli A, Petronio AS, Oreglia J, Montorfano M, Regazzoli D, Reimers B, Tamburino C, Tespili M, Bedogni F, Barbanti M, Maffeo D. Transcatheter Aortic Valve Replacement With Self-Expanding ACURATE neo2: Postprocedural Hemodynamic and Short-Term Clinical Outcomes. JACC Cardiovasc Interv 2022; 15:1101-1110. [PMID: 35595675 DOI: 10.1016/j.jcin.2022.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 12/01/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The first-generation ACURATE neo transcatheter heart valve (THV) (Boston Scientific) was associated with a non-negligible occurrence of moderate or greater paravalvular aortic regurgitation (AR) following transcatheter aortic valve replacement. To overcome this issue, the ACURATE neo2 iteration, which incorporates a taller outer skirt aimed at reducing the occurrence of paravalvular AR, has recently been developed. OBJECTIVES The aim of this study was to assess the efficacy and safety of the ACURATE neo2 (Boston Scientific) THV in patients with severe aortic valve stenosis. METHODS ITAL-neo was an observational, retrospective, multicenter registry enrolling consecutive patients with severe aortic valve stenosis, treated with first- and second-generation ACURATE neo THVs, via transfemoral and trans-subclavian access, in 13 Italian centers. One-to-one propensity score matching was applied to account for baseline characteristics unbalance. The primary endpoint was the occurrence of moderate or greater paravalvular AR on predischarge echocardiographic assessment. Secondary endpoints included postprocedural technical success and 90-day device success and safety. RESULTS Among 900 patients included in the registry, 220 received the ACURATE neo2 THV, whereas 680 were treated with the first-generation device. A total of 410 patients were compared after 1:1 propensity score matching. The ACURATE neo2 THV was associated with a 3-fold lower frequency of postprocedural moderate or greater paravalvular AR (11.2% vs 3.5%; P < 0.001). No other hemodynamic differences were observed. Postprocedural technical success was similar between the 2 cohorts. Fewer adverse events were observed in patients treated with the ACURATE neo2 at 90 days. CONCLUSIONS Transfemoral transcatheter aortic valve replacement using the ACURATE neo2 was associated with a significant lower frequency of moderate or greater paravalvular AR compared with the earlier generation ACURATE neo device, with encouraging short-term safety and efficacy.
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Affiliation(s)
- Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
| | - Riccardo Gorla
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giuliano Costa
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Ottavia Cozzi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Marco Ancona
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Marco De Carlo
- Cardiac Catheterization Laboratory, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Erica Ferrara
- Interventional Cardiology Unit, Legnano Civil Hospital, Legnano, Italy
| | | | - Mauro Massussi
- Civil Hospital and University of Brescia, Brescia, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Gaetano Pero
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Bettari
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Elena Acerbi
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Messina
- Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Carmelo Sgroi
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Mariano Pellicano
- Clinical and Interventional Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Jinwei Sun
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Francesco Gallo
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | | | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Roberto Nerla
- GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Matteo Saccocci
- Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Emmanuel Villa
- Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Claudio Cuccia
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | | | | | - Arnaldo Poli
- Interventional Cardiology Unit, Legnano Civil Hospital, Legnano, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, University of Pisa and Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Jacopo Oreglia
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Corrado Tamburino
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Maurizio Tespili
- Clinical and Interventional Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Barbanti
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
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Cerrato E, Giacobbe F, Quadri G, Macaya F, Bianco M, Mori R, Biolè CA, Boi A, Bettari L, Rolfo C, Ferrari F, Annibali G, Scappaticci M, Pavani M, Barbero U, Buccheri D, Cavallino C, Lombardi P, Bernelli C, D'Ascenzo F, Infantino V, Gambino A, Cinconze S, Rognoni A, Montagna L, Porto I, Musumeci G, Escaned J, Varbella F. Corrigendum to: Antiplatelet therapy in patients with conservatively managed spontaneous coronary artery dissection from the multicentre DISCO registry. Eur Heart J 2021; 43:87. [PMID: 34654925 DOI: 10.1093/eurheartj/ehab720] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Benenati S, Giacobbe F, Zingarelli A, Alessandra TG, Lombardi P, Musumeci G, Cinconze S, Barbero U, Iannaccone M, Patti G, Rognoni A, Menunni M, Di Leo A, Infantino V, Gambino A, D’Ascenzo F, Bruno F, Pavani M, Gagnor A, Ugo F, Cavallino C, Campo GC, Bettari L, Cassano F, Perfetti M, Scappaticci M, Buccheri D, Bordoni E, Bernelli C, Boi A, Mori R, Macaya F, Escaned J, Cerrato E, Porto I. 580 Percutaneous coronary intervention or medical therapy as initial management strategy of patients with spontaneous coronary artery dissections: insight from the multicentre, international dissezioni spontanee coronariche (disco) registry. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Whether patients with spontaneous coronary artery dissection (SCAD) should undergo an initial conservative management or immediate revascularization through percutaneous coronary intervention (PCI) remains debated. To investigate the frequency and predictors of choosing a strategy of immediate PCI for SCAD, and to compare the clinical outcomes of immediate PCI patients with those undergoing an initial strategy of medical management.
Methods and results
369 patients enrolled in the multicentre international DIssezioni Spontanee COronariche (DISCO) registry between January 2009 and December 2020 were included. The primary endpoint was major adverse cardiovascular events (MACE), a composite of cardiac death, non-fatal myocardial infarction (MI) and any PCI. 240 (65%) patients underwent initial medical management, whereas 129 (35%) had immediate PCI. PCI patients presented more frequently with ST segment-elevation myocardial infarction (STEMI) (68.2% vs. 35%, P < 0.001) and had higher frequency of proximal coronary segment SCAD (31.8% vs. 6.7%, P < 0.001), Thrombolysis in Myocardial infarction (TIMI) flow grade 0–1 (54.3% vs. 20.4%, P < 0.001) and multivessel SCAD (18.6% vs. 9.2%, P = 0.015), as well as a more severe diameter stenosis [99% (100–90) vs. 90% (99–75), P < 0.001]. At multivariate logistic regression, STEMI at presentation (vs. NSTE-ACS, OR: 3.30 95% CI: 1.56–7.12, P = 0.002), proximal coronary segment involvement (OR: 5.43, 95% CI: 1.98–16.45, P = 0.002), TIMI flow grade 0–1 and 2 (respectively, vs. grade 3: OR: 3.22 95% CI: 1.08–9.96, P = 0.038; and OR: 3.98; 95% CI: 1.38–11.80, P = 0.009) and diameter stenosis (per 5% increase, OR: 1.13; 95% CI: 1.01–1.28, P = 0.037) were predictors of immediate PCI, whereas the angiographic subtype 2B predicted a conservative approach (OR: 0.25; 95% CI: 0.07–0.83, P = 0.026). The frequency of in-hospital major adverse cardiac events did not differ between medically and PCI-treated patients. At 2-year follow-up, there were no differences with respect to the composite of MACE (11.7% vs. 13.9%, P = 0.47) and the individual components of cardiovascular death (0.4% vs. 0.7%, P = 0.65), non-fatal MI (8.3% vs. 9.3%, P = 0.92), and any PCI (8.7% vs. 12.4%, P = 0.23).
Conclusions
The choice between an immediate medical or PCI management of SCAD is mostly driven by clinical presentation and procedural aspects. In the DISCO cohort, the primary treatment approach was not associated with the risk of short-to-midterm adverse events.
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Affiliation(s)
- Stefano Benenati
- Dipartimento di Medicina Interna (DIMI), University of Genoa, Genoa, Italy
| | - Federico Giacobbe
- Cardiology Department, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Zingarelli
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino—IRCCS Italian Cardiovascular Network, Italy
| | | | - Primiano Lombardi
- Interventional Cardiology Unit, Cardinal Massaia Civil Hospital, Asti, Italy
| | | | | | - Umberto Barbero
- Interventional Cardiology Unit, Ospedale Maggiore SS. Annunziata, Savigliano, Cuneo, Italy
| | - Mario Iannaccone
- Interventional Cardiology Unit, Ospedale Maggiore SS. Annunziata, Savigliano, Cuneo, Italy
| | - Giuseppe Patti
- Cardiology Department, Ospedale Maggiore Della Carità, Novara, Italy
| | - Antonio Rognoni
- Cardiology Department, Ospedale Maggiore Della Carità, Novara, Italy
| | - Marco Menunni
- Cardiology Department, Ospedale Maggiore Della Carità, Novara, Italy
| | - Angelo Di Leo
- Division of Cardiology, Ospedale Civile di Ciriè, Turin, Italy
| | | | - Alfonso Gambino
- Interventional Cardiology Unit, Santa Croce Hospital, Moncalieri, Turin, Italy
| | - Fabrizio D’Ascenzo
- Cardiology Department, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Bruno
- Interventional Cardiology Unit, Santa Croce Hospital, Moncalieri, Turin, Italy
| | - Marco Pavani
- Cardiology Department, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | | | | | | | | | - Luca Bettari
- Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Francesco Cassano
- SS. Annunziata Hospital, Taranto, Italy
- Ospedale di Venere, Bari, Italy
| | | | | | - Dario Buccheri
- Interventional Cardiology Unit, S. Antonio Abate Hospital, Trapani, Italy
| | | | - Chiara Bernelli
- Interventional Cardiology Unit, Santa Corona Hospital, Pietra Ligure, Savona, Italy
| | | | - Ricardo Mori
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Fernando Macaya
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Javier Escaned
- Hospital Clinico San Carlos IdISSC, Complutense University of Madrid, Madrid, Spain
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
- Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Italo Porto
- Dipartimento di Medicina Interna (DIMI), University of Genoa, Genoa, Italy
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino—IRCCS Italian Cardiovascular Network, Italy
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Buono A, Pero G, Bettari L, Pezzotti E, Cortinovis S, Gentili L, Mor D, Cuccia C, Maffeo D. Recurrent idiopathic carotid and coronary artery vasospasm treated by stent implantations. J Cardiovasc Med (Hagerstown) 2021; 22:e37-e40. [PMID: 34482326 DOI: 10.2459/jcm.0000000000001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Arterial vasospasm is a well known cause of ischemia and, if prolonged, of parenchymal infarction. The clinical presentation varies according to the involved arterial district. We describe a rare case, which occurred in a young lady, of recurrent and multisystem vasospasm, resulting in multiple cerebral and myocardial infarctions. Our patient was resistant to medical therapy, requiring stent implantation of the involved vessels.
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Affiliation(s)
| | | | | | - Elena Pezzotti
- Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Sarah Cortinovis
- Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Luisa Gentili
- Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Donata Mor
- Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Claudio Cuccia
- Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
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13
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Zanchi S, La Greca C, Forgione C, Bettari L, Cortinovis S, Pero G, Pecora D, Botti P, Bnà C, Cuccia C. [Pulmonary embolism and SARS-CoV-2: analysis of patients hospitalized for pulmonary embolism and COVID-19 in a Northern Italian center]. G Ital Cardiol (Rome) 2021; 22:704-711. [PMID: 34463678 DOI: 10.1714/3660.36446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has shown high morbidity and mortality and the relationship between pulmonary embolism (PE) and COVID-19 is well established in the literature. METHODS We describe the characteristics of a cohort of COVID-19 patients (EP-COV) hospitalized at our Centre with PE, investigating how COVID-19 may have influenced their outcomes, as compared to patients without COVID-19 hospitalized for PE in the same months of 2020 (EP-2020) and 2019 (EP-2019). RESULTS EP-COV patients (n=25) were younger (60.5 ± 8.5 vs 71.4 ± 14.5 vs 70.9 ± 11.8 years, p=0.003), more frequently male (76% vs 48% vs 35%, p=0.016), with a lower history of neoplasia (12% vs 47% vs 40%, p=0.028) and more clinically severe (SOFA score 3.4 ± 1.4 vs 2.2 ± 1.4 vs 1 ± 1.1, p<0.001 and PaO2/FiO2 ratio 223.8 ± 75.5 vs 306.5 ± 49.3 vs 311.8 ± 107.5) than EP-2020 (n=17) and EP-2019 patients (n=20). D-dimer and C-reactive protein were higher in EP-COV (p=0.038 e p<0.001, respectively). The rate of concomitant deep vein thrombosis associated with PE did not differ significantly between the three groups. EP-COV patients developed PE more frequently during in-hospital stay than non-COVID-19 patients (p = 0.016). The mortality rate was higher in EP-COV than in EP-2020 and EP-2019 patients (36% vs 0% vs 5%, p=0.019). CONCLUSIONS In our study, the risk factors for PE in COVID-19 patients seem to differ from the traditional risk factors for venous thromboembolism; EP-COV patients are clinically more severe and display a higher mortality rate than EP-2020 and EP-2019 patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Paolo Botti
- Dipartimento di Radiologia, Fondazione Poliambulanza, Brescia
| | - Claudio Bnà
- Dipartimento di Radiologia, Fondazione Poliambulanza, Brescia
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Mori R, Macaya F, Giacobbe F, Salinas P, Pavani M, Boi A, Bettari L, Rolfo C, Porto I, Gonzalo N, Varbella F, Cerrato E, Escaned J. Clinical outcomes by angiographic type of spontaneous coronary artery dissection. EUROINTERVENTION 2021; 17:516-524. [PMID: 33650491 PMCID: PMC9724881 DOI: 10.4244/eij-d-20-01275] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 11/23/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an increasingly diagnosed cause of myocardial infarction. Although different SCAD angiographic classifications exist, their clinical impact remains unknown. AIMS The aim of this study was to evaluate the relationship between an angiographic classification and the development of adverse clinical events during the follow-up of a large, unselected cohort of patients with SCAD. METHODS We conducted an observational study of consecutive SCAD patients from 26 centres across Italy and Spain. Cases were classified into five different angiotypes according to the latest classification endorsed by the European Society of Cardiology. The main composite endpoint included all-cause death, non-fatal myocardial infarction (MI), and any unplanned revascularisation. RESULTS In total, 302 SCAD patients (mean age 51.8±19 years) were followed up for a median of 22 months (IQR 12-48). At 28 days, the composite outcome was higher for the angiotypes with a circumscribed contained intramural haematoma (2A and 3): 20.0% vs 5.4%, p<0.001 (non-fatal MI: 11.0% vs 3.5%, p=0.009; unplanned revascularisation: 11.0% vs 2.5%, p<0.001). This was sustained during follow-up (24.5% vs 9.9%, p=0.001). There were no differences in mortality (0.3% overall). The presence of an angiotype 2A or 3 was an independent predictor of a higher incidence of the composite outcome (adjusted HR 2.44, CI: 1.24-4.80, p=0.010). CONCLUSIONS The SCAD angiographic classification correlates with outcome. Those presenting with an angiographically circumscribed contained intramural haematoma (angiotypes 2A and 3) showed an increased risk of short-term adverse clinical events that was maintained during follow-up.
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Affiliation(s)
- Ricardo Mori
- Hospital Clínico San Carlos, IdiSSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Macaya
- Hospital Clínico San Carlos, Calle del Prof Martín Lagos s/n, 28040 Madrid, Spain
| | | | - Pablo Salinas
- Hospital Clínico San Carlos, IdiSSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Marco Pavani
- Ospedale Maggiore SS. Annunziata, Savigliano, Italy
| | | | - Luca Bettari
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | - Italo Porto
- Ospedale Policlinico San Martino, Genoa, Italy
| | - Nieves Gonzalo
- Hospital Clínico San Carlos, IdiSSC, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Javier Escaned
- Hospital Clínico San Carlos, IdiSSC, Universidad Complutense de Madrid, Madrid, Spain
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Cerrato E, Giacobbe F, Quadri G, Macaya F, Bianco M, Mori R, Biolè CA, Boi A, Bettari L, Rolfo C, Ferrari F, Annibali G, Scappaticci M, Pavani M, Barbero U, Buccheri D, Cavallino C, Lombardi P, Bernelli C, D'Ascenzo F, Infantino V, Gambino A, Cinconze S, Rognoni A, Montagna L, Porto I, Musumeci G, Escaned J, Varbella F. Antiplatelet therapy in patients with conservatively managed spontaneous coronary artery dissection from the multicentre DISCO registry. Eur Heart J 2021; 42:3161-3171. [PMID: 34338759 DOI: 10.1093/eurheartj/ehab372] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [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: 10/29/2020] [Revised: 02/23/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS The role of antiplatelet therapy in patients with spontaneous coronary artery dissection (SCAD) undergoing initial conservative management is still a matter of debate, with theoretical arguments in favour and against its use. The aims of this article are to assess the use of antiplatelet drugs in medically treated SCAD patients and to investigate the relationship between single (SAPT) and dual (DAPT) antiplatelet regimens and 1-year patient outcomes. METHODS AND RESULTS We investigated the 1-year outcome of patients with SCAD managed with initial conservative treatment included in the DIssezioni Spontanee COronariche (DISCO) multicentre international registry. Patients were divided into two groups according to SAPT or DAPT prescription. Primary endpoint was 12-month incidence of major adverse cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction (MI), and any unplanned percutaneous coronary intervention (PCI). Out of 314 patients included in the DISCO registry, we investigated 199 patients in whom SCAD was managed conservatively. Most patients were female (89%), presented with acute coronary syndrome (92%) and mean age was 52.3 ± 9.3 years. Sixty-seven (33.7%) were given SAPT whereas 132 (66.3%) with DAPT. Aspirin plus either clopidogrel or ticagrelor were prescribed in 62.9% and 36.4% of DAPT patients, respectively. Overall, a 14.6% MACE rate was observed at 12 months of follow-up. Patients treated with DAPT had a significantly higher MACE rate than those with SAPT [18.9% vs. 6.0% hazard ratios (HR) 2.62; 95% confidence intervals (CI) 1.22-5.61; P = 0.013], driven by an early excess of non-fatal MI or unplanned PCI. At multiple regression analysis, type 2a SCAD (OR: 3.69; 95% CI 1.41-9.61; P = 0.007) and DAPT regimen (OR: 4.54; 95% CI 1.31-14.28; P = 0.016) resulted independently associated with a higher risk of 12-month MACE. CONCLUSIONS In this European registry, most patients with SCAD undergoing initial conservative management received DAPT. Yet, at 1-year follow-up, DAPT, as compared with SAPT, was independently associated with a higher rate of adverse cardiovascular events (ClinicalTrial.gov id: NCT04415762).
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Federico Giacobbe
- Cardiology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giorgio Quadri
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Fernando Macaya
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Ricardo Mori
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Carlo Alberto Biolè
- Interventional cardiology unit, Cardinal Massaia Civil Hospital, Asti, Italy
| | | | - Luca Bettari
- Interventional cardiology unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Cristina Rolfo
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Fabio Ferrari
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Gianmarco Annibali
- Cardiology Department, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | | | - Marco Pavani
- Interventional cardiology unit, Ospedale Maggiore Ss. Annunziata, Savigliano, CN, Italy
| | - Umberto Barbero
- Interventional cardiology unit, Ospedale Maggiore Ss. Annunziata, Savigliano, CN, Italy
| | - Dario Buccheri
- Interventional Cardiology Unit, S. Antonio Abate Hospital, Trapani, Italy
| | | | - Primiano Lombardi
- Interventional cardiology unit, Cardinal Massaia Civil Hospital, Asti, Italy
| | - Chiara Bernelli
- Interventional cardiology unit, Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - Fabrizio D'Ascenzo
- Cardiology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Alfonso Gambino
- Interventional cardiology unit, Santa Croce Hospital, Moncalieri, TO, Italy
| | - Sebastian Cinconze
- Cardiology Department, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Andrea Rognoni
- Cardiology Department, Ospedale Maggiore della Carità, Novara, Italy
| | - Laura Montagna
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
| | - Giuseppe Musumeci
- Cardiology Department, A.O. Ordine Mauriziano, Ospedale Umberto I, Turin, Italy
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.,Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
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16
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Buono A, Morello A, Pero G, Corcione N, Bettari L, Saccocci M, Villa E, Biondi-Zoccai G, Giordano A, Maffeo D. Commissural alignment with new-generation self-expanding transcatheter heart valves during aortic replacement. Cardiovasc Revasc Med 2021; 40S:139-143. [PMID: 34362686 DOI: 10.1016/j.carrev.2021.07.027] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023]
Abstract
Preserving coronary artery access is a crucial goal during transcatheter aortic valve replacement (TAVR) procedures, especially in case of self-expandable transcatheter heart valve (SE-THV) implantation. In this light, a proper commissural alignment is needed to avoid the risk of coronary obstruction and to permit easy vessels re-cannulation for diagnostic and interventional purposes. New-generation SE-THVs have been furnished of different markers, able to guide operators to perform a correct commissural alignment. In this case series, we describe key procedural aspects of commissural alignment for the different available SE-THVs, providing a step-by-step tutorial for each device. Lastly, we illustrate a commissural alignment in a contrast-zero TAVR.
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Affiliation(s)
- Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
| | - Alberto Morello
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Via Domitiana km 30.00, 81030 Castel Volturno, Italy
| | - Gaetano Pero
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Via Domitiana km 30.00, 81030 Castel Volturno, Italy
| | - Luca Bettari
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Matteo Saccocci
- Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Emmanuel Villa
- Department of Cardiothoracic Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Via Domitiana km 30.00, 81030 Castel Volturno, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
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17
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Godino C, Munafò A, Scotti A, Estévez-Loureiro R, Portolés Hernández A, Arzamendi D, Fernández Peregrina E, Taramasso M, Fam NP, Ho EC, Asgar A, Vitrella G, Raineri C, Adamo M, Fiorina C, Montalto C, Fraccaro C, Giannini C, Fiorelli F, Popolo Rubbio A, Ooms J, Compagnone M, Maffeo D, Bettari L, Fürholz M, Tamburino C, Petronio AS, Grasso C, Agricola E, Van Mieghem NM, Tarantini G, Curello S, Praz F, Pascual I, Potena L, Colombo A, Maisano F, Metra M, Margonato A, Crimi G, Saia F. MitraClip in secondary mitral regurgitation as a bridge to heart transplantation: 1-year outcomes from the International MitraBridge Registry. J Heart Lung Transplant 2020; 39:1353-1362. [DOI: 10.1016/j.healun.2020.09.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/13/2020] [Accepted: 09/13/2020] [Indexed: 01/08/2023] Open
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18
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Bellosta R, Pegorer MA, Bettari L, Luzzani L, Attisani L, Fossati A, Consoli L, Maffeo D, Cuccia C, Terragnoli P, Bush RL, Piffaretti G. Major cardiovascular events in patients with Coronavirus Disease 2019: Experience of a cardiovascular department of Northern Italy. Thromb Res 2020; 197:202-204. [PMID: 33260043 PMCID: PMC7647441 DOI: 10.1016/j.thromres.2020.10.038] [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: 06/12/2020] [Revised: 09/21/2020] [Accepted: 10/31/2020] [Indexed: 01/19/2023]
Abstract
We report a translational experience of a cardiovascular department facing MACE in COVID-19 patients. Acute arterial events are the real emergency into this COVID-19 pandemic. COVID-19 infection may trigger a hypercoagulable status leading to MACE and high mortality rate. In this COVID-19 outbreak, the adjunct of heparin provides better survival chance independently of the infection-related drug treatment.
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Affiliation(s)
- Raffaello Bellosta
- Vascular Surgery, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
| | - Matteo Alberto Pegorer
- Vascular Surgery, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Bettari
- Vascular Surgery, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Luzzani
- Vascular Surgery, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Attisani
- Vascular Surgery, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Alessandro Fossati
- Vascular Surgery, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Letizia Consoli
- Emergency Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Diego Maffeo
- Vascular Surgery, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Claudio Cuccia
- Vascular Surgery, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Paolo Terragnoli
- Emergency Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Ruth L Bush
- University of Houston College of Medicine, Houston, TX, USA
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine and ASST Settelaghi University Teaching Hospital, Varese, Italy
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19
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Monfardini L, Morassi M, Botti P, Stellini R, Bettari L, Pezzotti S, Alì M, Monaco CG, Magni V, Cozzi A, Schiaffino S, Bnà C. Pulmonary thromboembolism in hospitalised COVID-19 patients at moderate to high risk by Wells score: a report from Lombardy, Italy. Br J Radiol 2020; 93:20200407. [PMID: 32735448 PMCID: PMC7465860 DOI: 10.1259/bjr.20200407] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Indexed: 12/23/2022] Open
Abstract
Objectives: To present a single-centre experience on CT pulmonary angiography (CTPA) for the assessment of hospitalised COVID-19 patients with moderate-to-high risk of pulmonary thromboembolism (PTE). Methods: We analysed consecutive COVID-19 patients (RT-PCR confirmed) undergoing CTPA in March 2020 for PTE clinical suspicion. Clinical data were retrieved. Two experienced radiologists reviewed CTPAs to assess pulmonary parenchyma and vascular findings. Results: Among 34 patients who underwent CTPA, 26 had PTE (76%, 20 males, median age 61 years, interquartile range 54–70), 20/26 (77%) with comorbidities (mainly hypertension, 44%), and 8 (31%) subsequently dying. Eight PTE patients were under thromboprophylaxis with low-molecular-weight heparin, four PTE patients had lower-limbs deep vein thrombosis at ultrasound examination (performed in 33/34 patients). Bilateral PTE characterised 19/26 cases, with main branches involved in 10/26 cases. Twelve patients had a parenchymal involvement >75%, the predominant pneumonia pattern being consolidation in 10/26 patients, ground glass opacities in 9/26, crazy paving in 5/26, and both ground glass opacities and consolidation in 2/26. Conclusion: COVID-19 patients are prone to PTE. Advances in knowledge: PTE, potentially attributable to an underlying thrombophilic status, may be more frequent than expected in COVID-19 patients. Extension of prophylaxis and adaptation of diagnostic criteria should be considered.
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Affiliation(s)
- Lorenzo Monfardini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy
| | - Mauro Morassi
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy
| | - Paolo Botti
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy
| | - Roberto Stellini
- Infectious Diseases Service, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy
| | - Luca Bettari
- Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy
| | - Stefania Pezzotti
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy
| | - Marco Alì
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, San Donato Milanese, Italy.,Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano S.p.A., Via Simone Saint Bon 20, Milano, Italy
| | - Cristian Giuseppe Monaco
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, San Donato Milanese, Italy
| | - Veronica Magni
- Medical School, Università degli Studi di Milano, Via Festa del Perdono 7, Milano, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, San Donato Milanese, Italy
| | - Claudio Bnà
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy
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20
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Bettari L, Pero G, Maiandi C, Messina A, Saccocci M, Cirillo M, Troise G, Conti E, Cuccia C, Maffeo D. Exploring Personal Protection During High-Risk PCI in a COVID-19 Patient: Impella CP Mechanical Support During ULMCA Bifurcation Stenting. JACC Case Rep 2020; 2:1279-1283. [PMID: 32292917 PMCID: PMC7151247 DOI: 10.1016/j.jaccas.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/11/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/28/2022]
Abstract
The correct management of patients with coronavirus disease-2019 (COVID-19) and acute coronary syndrome is still uncertain. We describe the percutaneous treatment of an unprotected left main coronary artery in a patient who is positive for COVID-19 with unstable angina, dyspnea and fever. Particular attention will be dedicated to the measures adopted in the catheterization laboratory to protect the staff and to avoid further spread of the infection. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Luca Bettari
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Gaetano Pero
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Cristian Maiandi
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Antonio Messina
- Cardiac Surgery Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Matteo Saccocci
- Cardiac Surgery Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Marco Cirillo
- Cardiac Surgery Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.,Heart Failure Surgery Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Elena Conti
- Cardiovascular Intensive Care Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Claudio Cuccia
- Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
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21
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Maffeo D, Bettari L, Latib A, Maiandi C, Villa E, Messina A, Saccocci M, Arneri A, Cuccia C, Troise G. Transfemoral transcatheter aortic valve replacement without contrast medium using the Medtronic CoreValve system: a single center experience. J Cardiovasc Surg 2020; 61:489-495. [DOI: 10.23736/s0021-9509.20.11083-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Cerrato E, Quadri G, Cavallino C, Porto I, Bettari L, Franzè A, Lo Savio L, Demarchi A, Rametta F, Barbero U, Rolfo C, Pavani M, Ferrari F, Giachet AT, Campo G, Bordoni E, Di Leo A, Beqaraj F, Greco Lucchina GP, Cassano F, Tomassini F, Varbella F. TCT-469 Percutaneous Coronary Intervention Performance in Spontaneous Coronary Artery Dissection: Insight From an Italian Multicenter Registry. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.561] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Quadri G, Cerrato E, Porto I, Cavallino C, Bettari L, Tomassini F, Franzè A, Ferrari F, Iannaccone M, Pavani M, Rametta F, Giachet AT, Lo Savio L, Campo G, Demarchi A, Rolfo C, Bordoni E, Infantino V, Bernelli C, Gambino A, Cassano F, Varbella F. TCT-470 Acute Management of Patients With Spontaneous Coronary Artery Dissection: The DISCO (DIssezioni Spontanee COronariche) Italian Registry. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.562] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Nodari S, Rocca P, Saporetti A, Bettari L, Foresti AL, Tanghetti E, Metra M, Dei Cas L. The Combination of Ezetimibe and Statin: A New Treatment for Hypercholesterolemia. Heart Int 2018. [DOI: 10.1177/1826186807003001-202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Savina Nodari
- Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia - Italy
| | - Patrizia Rocca
- Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia - Italy
| | - Alberto Saporetti
- Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia - Italy
| | - Luca Bettari
- Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia - Italy
| | - Anna Lucia Foresti
- Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia - Italy
| | - Elena Tanghetti
- Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia - Italy
| | - Marco Metra
- Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia - Italy
| | - Livio Dei Cas
- Section on Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia - Italy
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25
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Di Tano G, Caretta G, De Maria R, Bettari L, Parolini M, Testa S, Pirelli S. Galectin-3 and outcomes after anterior-wall myocardial infarction treated by primary percutaneous coronary intervention. Biomark Med 2017; 12:21-26. [PMID: 29243525 DOI: 10.2217/bmm-2017-0178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Galectin-3 (Gal-3), a biomarker of inflammation, tissue repair and fibrogenesis, is associated to left ventricular remodeling after ST-elevated myocardial infarction (STEMI), but its relation with long-term outcomes is unclear. METHODS In 103 consecutive patients with a first anterior STEMI treated by primary angioplasty, we assayed Gal-3 and NT-proBNP. RESULTS Age was 65 (56-76) years, 28% were women. During 18 ± 13 months, 20 patients (19.4%) died or were admitted for heart failure. After adjustment for age, gender, renal and ventricular function, troponin, NT-proBNP and Gal-3 independently predicted the combined end point (hazard ratio: 1.11; 95% CI: 1.05-1.17; per 1 ng/ml increase). Event-free survival was 42.3 versus 93.5% for Gal-3≥ versus <16.8 ng/ml (p < 0.001). CONCLUSION Among anterior STEMI patients, early postangioplasty Gal-3 levels may be useful for risk stratification.
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Affiliation(s)
- Giuseppe Di Tano
- Division of Cardiology, ASST - Hospital of Cremona, Cremona, Italy
| | - Giorgio Caretta
- Division of Cardiology, Sant'Andrea Hospital, ASL 5 Liguria - La Spezia, Italy
| | - Renata De Maria
- CNR Clinical Physiology Institute Cardiothoracic & Vascular Department ASST-Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Luca Bettari
- Division of Cardiology, ASST - Hospital of Cremona, Cremona, Italy
| | - Marina Parolini
- CNR Clinical Physiology Institute Cardiothoracic & Vascular Department ASST-Great Metropolitan Hospital Niguarda, Milan, Italy
| | - Sophie Testa
- Division of Laboratory Medicine, ASST - Hospital of Cremona, Cremona, Italy
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26
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Leonardi S, Marino M, Crimi G, Maiorana F, Rizzotti D, Lettieri C, Bettari L, Zuccari M, Sganzerla P, Tresoldi S, Adamo M, Ghiringhelli S, Sponzilli C, Pasquetto G, Pavei A, Pedon L, Bassan L, Bollati M, Camisasca P, Trabattoni D, Brancati M, Poli A, Panciroli C, Lettino M, Tarelli G, Tarantini G, De Luca L, Varbella F, Musumeci G, De Servi S. APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study. BMJ Open 2017; 7:e016909. [PMID: 28877948 PMCID: PMC5588962 DOI: 10.1136/bmjopen-2017-016909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To first explore in Italy appropriateness of indication, adherence to guideline recommendations and mode of selection for coronary revascularisation. DESIGN Retrospective, pilot study. SETTING 22 percutaneous coronary intervention (PCI)-performing hospitals (20 patients per site), 13 (59%) with on-site cardiac surgery. PARTICIPANTS 440 patients who received PCI for stable coronary artery disease (CAD) or non-ST elevation acute coronary syndrome were independently selected in a 4:1 ratio with half diabetics. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of patients who received appropriate PCI using validated appropriate use scores (ie, AUS≥7). Also, in patients with stable CAD, we examined adherence to the following European Society of Cardiology recommendations: (A) per cent of patients with complex coronary anatomy treated after heart team discussion; (B) per cent of fractional flow reserve-guided PCI for borderline stenoses in patients without documented ischaemia; (C) per cent of patients receiving guideline-directed medical therapy at the time of PCI as well as use of provocative test of ischaemia according to pretest probability (PTP) of CAD. RESULTS Of the 401 mappable PCIs (91%), 38.7% (95% CI 33.9 to 43.6) were classified as appropriate, 47.6% (95% CI 42.7 to 52.6) as uncertain and 13.7% (95% CI 10.5% to 17.5%) as inappropriate. Median PTP in patients with stable CAD without known coronary anatomy was 69% (78% intermediate PTP, 22% high PTP). Ischaemia testing use was similar (p=0.71) in patients with intermediate (n=140, 63%) and with high PTP (n=40, 66%). In patients with stable CAD (n=352) guideline adherence to the three recommendations explored was: (A) 11%; (B) 25%; (C) 23%. AUS was higher in patients evaluated by the heart team as compared with patients who were not (7 (6.8) vs 5 (4.7); p=0.001). CONCLUSIONS Use of heart team approaches and adherence to guideline recommendations on coronary revascularisation in a real-world setting is limited. This pilot study documents the feasibility of measuring appropriateness and guideline adherence in clinical practice and identifies substantial opportunities for quality improvement. TRIAL REGISTRATION NUMBER NCT02748603.
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Affiliation(s)
- Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Gabriele Crimi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Florinda Maiorana
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Diego Rizzotti
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Luca Bettari
- Cardiology, ASST Cremona–Ospedale di Cremona, Cremona, Italy
| | - Marco Zuccari
- Cardiology, Ospedale Fornaroli di Magenta, Magenta, Italy
| | - Paolo Sganzerla
- Cardiology, ASST Bergamo Ovest–Ospedale di Treviglio, Treviglio, Italy
| | - Simone Tresoldi
- Cardiology, Azienda Ospedaliera di Desio e Vimercate, Vimercate, Italy
| | | | | | | | - Giampaolo Pasquetto
- Cardiology, Ospedali Riuniti Padova Sud Madre Teresa di Calcutta, Monselice, Italy
| | - Andrea Pavei
- Cardiology, Presidio Ospedaliero di Conegliano, Conegliano, Italy
| | - Luigi Pedon
- Cardiology, Presidio Ospedaliero di Cittadella, Cittadella, Italy
| | | | - Mario Bollati
- Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Di Tano G, Bettari L. Adoption of Sacubitril/Valsartan Must Take Into Account Different Heart Failure Patient Types. JACC Heart Fail 2017; 5:688-689. [PMID: 28859758 DOI: 10.1016/j.jchf.2017.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 01/14/2023]
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Stienen S, Salah K, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Tijssen JP, Pinto YM, Kok WE. Targeting N-Terminal Pro-Brain Natriuretic Peptide in Older Versus Younger Acute Decompensated Heart Failure Patients. JACC Heart Fail 2016; 4:736-45. [PMID: 27395353 DOI: 10.1016/j.jchf.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the prognostic value and attainability of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in young and elderly acute decompensated heart failure (ADHF) patients. BACKGROUND Less-effective NT-proBNP-guided therapy in chronic heart failure (HF) has been reported in elderly patients. Whether this can be attributed to differences in prognostic value of NT-proBNP or to differences in attaining a prognostic value is unclear. The authors studied this question in ADHF patients. METHODS Our study population comprised 7 ADHF cohorts. We defined absolute (<1,500 ng/l, <3,000 ng/l, <5,000 ng/l, and <15,000 ng/l) and relative NT-proBNP discharge cut-off levels (>30%, >50%, and >70%). Six-month all-cause mortality after discharge was studied for each level in Cox regression analyses, and compared between elderly (age >75 years) and young patients (age ≤75 years). Thereafter, we compared percentages of elderly and young patients attaining NT-proBNP levels (= attainability). RESULTS A total of 1,235 patients (59% male, 45% >75 years of age) was studied. Admission levels of NT-proBNP were significantly higher in elderly versus younger patients. The prognostic value of absolute and relative NT-proBNP levels was similar in elderly and young patients. Attainability was significantly lower in elderly patients for all absolute levels and a >50% relative reduction, but not for >30% and >70%. For absolute levels, attainability differences between age groups were decreased to a large extent after correction for admission NT-proBNP and anemia at discharge. For relative levels, attainability differences disappeared after correction for HF etiology and anemia at discharge. CONCLUSIONS In young and elderly ADHF patients, it is not the prognostic value of absolute and relative NT-proBNP levels that is different, but the attainability of these levels that is lower in the elderly. This can largely be attributed to factors other than age.
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Affiliation(s)
- Susan Stienen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Khibar Salah
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Luc W Eurlings
- Department of Cardiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Paulo Bettencourt
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Joana M Pimenta
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Valerio Verdiani
- Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy
| | - Luca Bettari
- Department of Cardiology, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Valentina Lazzarini
- Department of Cardiology, Ospedale San Pellegrino, Castiglione delle Stiviere, MN, Italy
| | - Jan P Tijssen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Yigal M Pinto
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Wouter E Kok
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
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Mann DL, Lee RJ, Coats AJ, Neagoe G, Dragomir D, Pusineri E, Piredda M, Bettari L, Kirwan BA, Dowling R, Volterrani M, Solomon SD, Sabbah HN, Hinson A, Anker SD. One-year follow-up results from AUGMENT-HF: a multicentre randomized controlled clinical trial of the efficacy of left ventricular augmentation with Algisyl in the treatment of heart failure. Eur J Heart Fail 2015; 18:314-25. [PMID: 26555602 DOI: 10.1002/ejhf.449] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 10/29/2015] [Accepted: 11/01/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Douglas L. Mann
- Washington University School of Medicine; Barnes-Jewish Hospital; St. Louis MO USA
| | - Randall J. Lee
- Department of Medicine; University of California-San Francisco; San Francisco CA USA
| | - Andrew J.S. Coats
- Monash University, Melbourne; Australia and University of Warwick; Warwick UK
| | | | | | - Enrico Pusineri
- Cardio-thoracic Center; Istituto Clinico Sant'Ambrogio; Milan Italy
| | - Massimo Piredda
- Cardio-thoracic Center; Istituto Clinico Sant'Ambrogio; Milan Italy
| | | | | | | | | | - Scott D. Solomon
- Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
| | | | | | - Stefan D. Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumonology; University Medical Centre Göttingen (UMG); Göttingen Germany
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Stienen S, Salah K, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Tijssen JP, Pinto YM, Kok WE. Challenging the two concepts in determining the appropriate pre-discharge N-terminal pro-brain natriuretic peptide treatment target in acute decompensated heart failure patients: absolute or relative discharge levels? Eur J Heart Fail 2015. [DOI: 10.1002/ejhf.320] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Susan Stienen
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Khibar Salah
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Luc W.M. Eurlings
- Department of Cardiology; Maastricht University Medical Center; The Netherlands
| | - Paulo Bettencourt
- Department of Internal Medicine, Centro Hospitalar de S. João; University of Porto Medical School; Porto Portugal
| | - Joana M. Pimenta
- Department of Internal Medicine, Centro Hospitalar de S. João; University of Porto Medical School; Porto Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialties; Radiological Sciences and Public Health; University of Brescia Italy
| | - Antoni Bayes-Genis
- Department of Cardiology; Hospital Universitari Germans Trias i Pujol; Barcelona Spain
| | - Valerio Verdiani
- Department of Internal Medicine and Emergency; Careggi University Hospital; Florence Italy
| | - Luca Bettari
- Department of Cardiology; Azienda Istituti Ospitalieri di Cremona; Cremona Italy
| | - Valentina Lazzarini
- Department of Medical and Surgical Specialties; Radiological Sciences and Public Health; University of Brescia Italy
| | - Jan P. Tijssen
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Yigal M. Pinto
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Wouter E.M. Kok
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
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Anker SD, Coats AJS, Cristian G, Dragomir D, Pusineri E, Piredda M, Bettari L, Dowling R, Volterrani M, Kirwan BA, Filippatos G, Mas JL, Danchin N, Solomon SD, Lee RJ, Ahmann F, Hinson A, Sabbah HN, Mann DL. A prospective comparison of alginate-hydrogel with standard medical therapy to determine impact on functional capacity and clinical outcomes in patients with advanced heart failure (AUGMENT-HF trial). Eur Heart J 2015; 36:2297-309. [PMID: 26082085 PMCID: PMC4561351 DOI: 10.1093/eurheartj/ehv259] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [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: 04/30/2015] [Accepted: 05/21/2015] [Indexed: 01/19/2023] Open
Abstract
Aims AUGMENT-HF was an international, multi-centre, prospective, randomized, controlled trial to evaluate the benefits and safety of a novel method of left ventricular (LV) modification with alginate-hydrogel. Methods Alginate-hydrogel is an inert permanent implant that is directly injected into LV heart muscle and serves as a prosthetic scaffold to modify the shape and size of the dilated LV. Patients with advanced chronic heart failure (HF) were randomized (1 : 1) to alginate-hydrogel (n = 40) in combination with standard medical therapy or standard medical therapy alone (Control, n = 38). The primary endpoint of AUGMENT-HF was the change in peak VO2 from baseline to 6 months. Secondary endpoints included changes in 6-min walk test (6MWT) distance and New York Heart Association (NYHA) functional class, as well as assessments of procedural safety. Results Enrolled patients were 63 ± 10 years old, 74% in NYHA functional class III, had a LV ejection fraction of 26 ± 5% and a mean peak VO2 of 12.2 ± 1.8 mL/kg/min. Thirty-five patients were successfully treated with alginate-hydrogel injections through a limited left thoracotomy approach without device-related complications; the 30-day surgical mortality was 8.6% (3 deaths). Alginate-hydrogel treatment was associated with improved peak VO2 at 6 months—treatment effect vs. Control: +1.24 mL/kg/min (95% confidence interval 0.26–2.23, P = 0.014). Also 6MWT distance and NYHA functional class improved in alginate-hydrogel-treated patients vs. Control (both P < 0.001). Conclusion Alginate-hydrogel in addition to standard medical therapy for patients with advanced chronic HF was more effective than standard medical therapy alone for improving exercise capacity and symptoms. The results of AUGMENT-HF provide proof of concept for a pivotal trial. Trial Registration Number NCT01311791.
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Affiliation(s)
- Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumonology, University Medical Centre Göttingen (UMG), Robert-Koch-Str. 40, Göttingen D-37075, Germany
| | - Andrew J S Coats
- Monash University, Melbourne, Australia University of Warwick, Warwick, UK
| | | | | | | | | | | | | | | | | | | | - Jean-Louis Mas
- Paris Descartes University, Saint-Anne Hospital, Paris, France
| | | | - Scott D Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Randall J Lee
- Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | | | | | | | - Douglas L Mann
- Washington University School of Medicine, Barnes Jewish Hospital, St. Louis, MO, USA
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Stienen S, Salah K, Eurlings L, Bettencourt P, Metra M, Bayes-Genis A, Bettari L, Tijssen J, Pinto Y, Kok W. ABSOLUTE DISCHARGE LEVEL OR RELATIVE REDUCTION IN NT-PROBNP DURING HOSPITALISATION FOR ACUTE DECOMPENSATED HEART FAILURE AS A TARGET TO REDUCE 6-MONTH MORTALITY? J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61029-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Damman P, Tijssen JG, Pinto YM. A novel discharge risk model for patients hospitalised for acute decompensated heart failure incorporating N-terminal pro-B-type natriuretic peptide levels: a European coLlaboration on Acute decompeNsated Heart Failure: ELAN-HF Score. Heart 2013; 100:115-25. [PMID: 24179162 DOI: 10.1136/heartjnl-2013-303632] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [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: 12/23/2022] Open
Abstract
BACKGROUND Models to stratify risk for patients hospitalised for acute decompensated heart failure (ADHF) do not include the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels during hospitalisation. OBJECTIVE The aim of our study was to develop a simple yet robust discharge prognostication score including NT-proBNP for this notorious high-risk population. DESIGN Individual patient data meta-analyses of prospective cohort studies. SETTING Seven prospective cohorts with in total 1301 patients. PATIENTS Our study population was assembled from the seven studies by selecting those patients admitted because of clinically validated ADHF, discharged alive, and NT-proBNP measurements available at admission and at discharge. MAIN OUTCOME MEASURES The endpoints studied were all-cause mortality and a composite of all-cause mortality and/or first readmission for cardiovascular reason within 180 days after discharge. RESULTS The model that incorporated NT-proBNP levels at discharge as well as the changes in NT-proBNP during hospitalisation in addition to age ≥75 years, peripheral oedema, systolic blood pressure ≤115 mm Hg, hyponatremia at admission, serum urea of ≥15 mmol/L and New York Heart Association (NYHA) class at discharge, yielded the best C-statistic (area under the curve, 0.78, 95% CI 0.74 to 0.82). The addition of NT-proBNP to a reference model significantly improved prediction of mortality as shown by the net reclassification improvement (62%, p<0.001). A simplified model was obtained from the final Cox regression model by assigning weights to individual risk markers proportional to their relative risks. The risk score we designed identified four clinically significant subgroups. The pattern of increasing event rates with increasing score was confirmed in the validation group (BOT-AcuteHF, n=325, p<0.001). CONCLUSIONS In patients hospitalised for ADHF, the addition of the discharge NT-proBNP values as well as the change in NT-proBNP to known risk markers, generates a relatively simple yet robust discharge risk score that importantly improves the prediction of adverse events.
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Affiliation(s)
- Khibar Salah
- Heart failure Research Center & Department of Cardiology, Academic Medical Center, University of Amsterdam, , Amsterdam, The Netherlands
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Agostoni P, Corrà U, Cattadori G, Veglia F, La Gioia R, Scardovi AB, Emdin M, Metra M, Sinagra G, Limongelli G, Raimondo R, Re F, Guazzi M, Belardinelli R, Parati G, Magrì D, Fiorentini C, Mezzani A, Salvioni E, Scrutinio D, Ricci R, Bettari L, Di Lenarda A, Pastormerlo LE, Pacileo G, Vaninetti R, Apostolo A, Iorio A, Paolillo S, Palermo P, Contini M, Confalonieri M, Giannuzzi P, Passantino A, Cas LD, Piepoli MF, Passino C. Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: A multiparametric approach to heart failure prognosis. Int J Cardiol 2013; 167:2710-8. [DOI: 10.1016/j.ijcard.2012.06.113] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 05/30/2012] [Accepted: 06/24/2012] [Indexed: 10/28/2022]
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Abstract
Renal dysfunction is often present and/or worsens in patients with heart failure and this is associated with increased costs of care, complications and mortality. The cardiorenal syndrome can be defined as the presence or development of renal dysfunction in patients with heart failure. Its mechanisms are likely related to low cardiac output, increased venous congestion and renal venous pressure, neurohormonal and inflammatory activation and local changes, such as adenosine release. Many drugs, including loop diuretics, may contribute to worsening renal function through the activation of some of these mechanisms. Renal damage is conventionally defined by the increase in creatinine and blood urea nitrogen blood levels. However, these changes may be not related with renal injury or prognosis. New biomarkers of renal injury seem promising but still need to be validated. Thus, despite the epidemiological evidence, we are still lacking of satisfactory tools to assess renal injury and function and its prognostic significance.
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Affiliation(s)
- Valentina Carubelli
- Cardiology, c/o Spedali Civili di Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
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Metra M, Bettari L, Lazzarini V, Piovanelli B, Carubelli V, Bugatti S, Lombardi C, Cas LD, Davison B, Sun H, Edwards C, Cotter G. Response to Letter Regarding Article, “Is Worsening Renal Function an Ominous Prognostic Sign in Patients With Acute Heart Failure? The Role of Congestion and Its Interaction With Renal Function”. Circ Heart Fail 2012. [DOI: 10.1161/circheartfailure.112.969014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Metra
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia
| | - Luca Bettari
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia
| | - Valentina Lazzarini
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia
| | - Barbara Piovanelli
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia
| | - Valentina Carubelli
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia
| | - Silvia Bugatti
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia
| | - Carlo Lombardi
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia
| | - Livio Dei Cas
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia
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Abstract
Heart failure is one of the most common, costly, disabling and growing diseases (McMurray and Pfeffer in Lancet 365(9474):1877-1889, 2005). Hyponatremia, conventionally defined as a serum-sodium concentration equal or less than 135 mmol/l (American Heart Association in Heart disease and stroke statistics--2007 update. American Heart Association, Dallas, 2007; Stewart et al. in Eur J Heart Fail 4:361-371, 2002), is a common phenomenon in patients with heart failure, with an incidence of 20-25% (Krumholz et al. in Arch Intern Med 157:e99-e104, 1997; Rosamond et al. in Circulation 117(4):e25-e146, 2008; Adrogue and Madias in N Engl J Med 342:1581-1589, 2000) and seems to be of prognostic importance in patients with heart failure (Luca et al. in Am J Cardiol 96:19L-23L, 2005; Gheorghiade et al. in Eur Heart J 28:980-988, 2007; Gheorghiade et al. in Arch Intern Med 167:1998-2005, 2007). So far treatment strategies have been limited and burdened by side effects. The development of hyponatremia in the setting of heart failure is related to the arginine vasopressin (AVP) dysregulation. Thus, AVP receptor antagonists are a promising approach to treatment. However, several questions remain: whether there is a cause-and-effect mechanism, if the correction of hyponatremia improves outcomes, and defining the specific cut-off level of serum-sodium that should be used to define hyponatremia. In this review, we aim to summarize the literature on hyponatremia in patients with heart failure within several aspects: incidence in clinical trials and registries, prognostic value, underlying mechanisms, therapeutic options, and possible future perspectives.
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Affiliation(s)
- Luca Bettari
- University of the Studies of Brescia, Piazzale Spedali Civili 1, Brescia, Italy.
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Abstract
Despite the epidemiologic importance, large investments, and careful design, recent results of heart failure (HF) trials have been unable to demonstrate significant treatment improvements. This shortcoming has led to a reassessment of research methodology, particularly related to sample size and costs, for which end-point selection is a main issue. In comparing interventions in clinical trials, surrogate end points may be used to reduce the costs. To this end, ongoing research into the roles of imaging biomarkers as reliable surrogate end points may lead to better clinical trial design and more efficient development of new therapies for HF.
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Affiliation(s)
- Luca Bettari
- Division of Cardiology, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA.
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Metra M, Davison B, Bettari L, Sun H, Edwards C, Lazzarini V, Piovanelli B, Carubelli V, Bugatti S, Lombardi C, Cotter G, Dei Cas L. Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function. Circ Heart Fail 2011; 5:54-62. [PMID: 22167320 DOI: 10.1161/circheartfailure.111.963413] [Citation(s) in RCA: 358] [Impact Index Per Article: 27.5] [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: 12/30/2022]
Abstract
BACKGROUND Worsening renal function (WRF), traditionally defined as an increase in serum creatinine levels ≥0.3 mg/dL, is a frequent finding in patients with acute heart failure (AHF) and has been associated with poorer outcomes in some but not all studies. We hypothesized that these discrepancies may be caused by the interaction between WRF and congestion in AHF patients. METHODS AND RESULTS We measured serum creatinine levels on a daily basis during the hospitalization and assessed the persistence of signs of congestion at discharge in 599 consecutive patients admitted at our institute for AHF. They had a postdischarge mortality and mortality or AHF readmission rates of 13% and 43%, respectively, after 1 year. Patients were subdivided into 4 groups according to the development or not of WRF and the persistence of ≥1 sign of congestion at discharge. Patients with WRF and no congestion had similar outcomes compared with those with no WRF and no congestion, whereas the risk of death or of death or AHF readmission was increased in the patients with persistent congestion alone and in those with both WRF and congestion (hazard ratio, 5.35; 95% confidence interval, 3.0-9.55 at univariable analysis; hazard ratio, 2.44; 95% confidence interval, 1.24-4.18 at multivariable analysis for mortality; hazard ratio, 2.14; 95% confidence interval, 1.39-3.3 at univariable analysis; and hazard ratio, 1.39; 95% confidence interval, 0.88-2.2 at multivariable analysis for mortality and rehospitalizations). CONCLUSIONS WRF alone, when detected using serial serum creatinine measurements, is not an independent determinant of outcomes in patients with AHF. It has an additive prognostic value when it occurs in patients with persistent signs of congestion.
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Affiliation(s)
- Marco Metra
- Institute of Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy.
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Abstract
Inotropic agents are administered to improve cardiac output and peripheral perfusion in patients with systolic dysfunction and low cardiac output. However, there is evidence of increased mortality and adverse effects associated with current inotropic agents. These adverse outcomes may be ascribed to patient selection, increased myocardial energy expenditure and oxygen consumption, or to specific mechanisms of action. Both sympathomimetic amines and type III phosphodiesterase inhibitors act through an increase in intracellular cyclic adenosine monophoshate and free calcium concentrations, mechanisms that increase oxygen consumption and favor arrhythmias. Concomitant peripheral vasodilation with some agents (phosphodiesterase inhibitors and levosimendan) may also lower coronary perfusion pressure and favor myocardial damage. New agents with different mechanisms of action might have a better benefit to risk ratio and allow an improvement in tissue and end-organ perfusion with less untoward effects. We have summarized the characteristics of the main inotropic agents for heart failure treatment, the data from randomized controlled trials, and future perspectives for this class of drugs.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Civil Hospital of Brescia, Italy.
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Felker GM, Fiuzat M, Shaw LK, Clare R, Whellan DJ, Bettari L, Shirolkar SC, Donahue M, Kitzman DW, Zannad F, Piña IL, O'Connor CM. Galectin-3 in ambulatory patients with heart failure: results from the HF-ACTION study. Circ Heart Fail 2011; 5:72-8. [PMID: 22016505 DOI: 10.1161/circheartfailure.111.963637] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [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: 11/16/2022]
Abstract
BACKGROUND Galectin-3 is a soluble ß-galactoside-binding lectin released by activated cardiac macrophages. Elevated levels of galectin-3 have been found to be associated with adverse outcomes in patients with heart failure. We evaluated the association between galectin-3 and long-term clinical outcomes in ambulatory heart failure patients enrolled in the HF-ACTION study. METHODS AND RESULTS HF-ACTION was a randomized, controlled trial of exercise training in patients with chronic heart failure caused by left ventricular systolic dysfunction. Galectin-3 was assessed at baseline in a cohort of 895 HF-ACTION subjects with stored plasma samples available. The association between galectin-3 and clinical outcomes was assessed using a series of Cox proportional hazards models. Higher galectin-3 levels were associated with other measures of heart failure severity, including higher New York Heart Association class, lower systolic blood pressure, higher creatinine, higher amino-terminal proB-type natriuretic peptide (NTproBNP), and lower maximal oxygen consumption. In unadjusted analysis, there was a significant association between elevated galectin-3 levels and hospitalization-free survival (unadjusted hazard ratio, 1.14 per 3-ng/mL increase in galectin-3; P<0.0001). In multivariable modeling, the prognostic impact of galectin-3 was significantly attenuated by the inclusion of other known predictors, and galectin-3 was no longer a significant predictor after the inclusion of NTproBNP. CONCLUSIONS Galectin-3 is elevated in ambulatory heart failure patients and is associated with poor functional capacity and other known measures of heart failure severity. In univariate analysis, galectin-3 was significantly predictive of long-term outcomes, but this association did not persist after adjustment for other predictors, especially NTproBNP. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047437.
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Metra M, Bettari L, Carubelli V, Bugatti S, Dei Cas A, Del Magro F, Lazzarini V, Lombardi C, Dei Cas L. Use of inotropic agents in patients with advanced heart failure: lessons from recent trials and hopes for new agents. Drugs 2011; 71:515-25. [PMID: 21443277 DOI: 10.2165/11585480-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abnormalities of cardiac function, with high intraventricular filling pressure and low cardiac output, play a central role in patients with heart failure. Agents with inotropic properties are potentially useful to correct these abnormalities. However, with the exception of digoxin, no inotropic agent has been associated with favourable effects on outcomes. This is likely related to the mechanism of action of current agents, which is based on an increase in intracellular cyclic adenosine monophosphate and calcium concentrations. Novel agents acting through different mechanisms, such as sarcoplasmic reticulum calcium uptake, cardiac myosin and myocardial metabolism, have the potential to improve myocardial efficiency and lower myocardial oxygen consumption. These characteristics might allow a haemodynamic improvement in the absence of untoward effects on the clinical course and prognosis of the patients.
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Affiliation(s)
- Marco Metra
- Institute of Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy.
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Fiuzat M, Bettari L, Shaw LK, Shailesh S, Felker MG, O'Connor CM. HYPONATREMIA AND LONG-TERM OUTCOMES IN HEART FAILURE. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61268-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Metra M, Bugatti S, Bettari L, Carubelli V, Danesi R, Lazzarini V, Lombardi C, Cas LD. Can we improve the treatment of congestion in heart failure? Expert Opin Pharmacother 2011; 12:1369-79. [PMID: 21342081 DOI: 10.1517/14656566.2011.557069] [Citation(s) in RCA: 13] [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: 01/08/2023]
Abstract
INTRODUCTION Dyspnoea and peripheral oedema, caused by fluid redistribution to the lungs and/or by fluid overload, are the main causes of hospitalization in patients with heart failure and are associated with poor outcomes. Treatment of fluid overload should relieve symptoms and have a neutral or favorable effect on outcomes. AREAS COVERED We first consider the results obtained with furosemide administration, which is still the mainstay of treatment of congestion in patients with heart failure. We then discuss important shortcomings of furosemide treatment, including the development of resistance and side effects (electrolyte abnormalities, neurohormonal activation, worsening renal function), as well as the relationship of furosemide - and its doses - with patient prognosis. Finally, the results obtained with potential alternatives to furosemide treatment, including different modalities of loop diuretic administration, combined diuretic therapy, dopamine, inotropic agents, ultrafiltration, natriuretic peptides, vasopressin and adenosine antagonists, are discussed. EXPERT OPINION Relief of congestion is a major objective of heart failure treatment but therapy remains based on the administration of furosemide, an agent that is often not effective and is associated with poor outcomes. The results of the few controlled studies aimed at the assessment of new treatments to overcome resistance to furosemide and/or to protect the kidney from its untoward effects have been mostly neutral. Better treatment of congestion in heart failure remains a major unmet need.
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Affiliation(s)
- Marco Metra
- University of Brescia, Cardiology, Department of Experimental and Applied Medicine Spedali Civili , Piazzale Spedali Civili, Italy.
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Milo-Cotter O, Cotter-Davison B, Lombardi C, Sun H, Bettari L, Bugatti S, Rund M, Metra M, Kaluski E, Kobrin I, Frey A, Rainisio M, McMurray JJ, Teerlink JR, Cotter-Davison G. Neurohormonal Activation in Acute Heart Failure: Results from VERITAS. Cardiology 2011; 119:96-105. [DOI: 10.1159/000330409] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 06/21/2011] [Indexed: 01/08/2023]
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Metra M, Lombardi C, Carubelli V, Bettari L, Bugatti S, Danesi R, Lazzarini V, Monti A, Villa C, Dei Cas L. [Treatment of heart failure patients with inotropic drugs: beyond traditional agents]. G Ital Cardiol (Rome) 2010; 11:143S-148S. [PMID: 21416846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hospitalizations for acute heart failure are associated with high mortality and readmission rates. Ten to 20% of the patients have signs of low cardiac output and fluid overload. The administration of inotropic agents to correct these hemodynamic abnormalities may be indicated in these patients. However, the risk to benefit ratio of inotropic agents is high and an increase of untoward effects and mortality has been suggested by many retrospective analyses and meta-analyses. Limitations of inotropic therapy seem mainly related to their mechanisms of action based, in the case of the traditional agents, on an increase in intracellular cyclic AMP and calcium concentrations. Concomitant peripheral vasodilation, such as in the case of the novel agent levosimendan is another important limitation, above when patients are hypotensive and/or treated with vasodilators and high doses of diuretics. Myosin activators, histaroxime, sarcoplasmic reticulum ATPase activators and metabolic agents seem promising as active through different mechanisms than traditional agents and, in many cases, not associated with tachycardia or hypotension. Further studies are, however, needed.
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Affiliation(s)
- Marco Metra
- Cardiologia, Dipartimento di Medicina Sperimentale ed Applicata, Università degli Studi, Spedali Civili, Brescia.
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Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Bettari L, Bayes-Genis A, Verdiani V, Tijssen JG. Prognostic Value of Discharge Levels of N-Terminal Pro-Brain Natriuretic Peptide in 1301 Patients: A European Collaborative Study. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.227] [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: 11/26/2022]
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Lombardi C, Metra M, Manerba A, Bettari L, Bugatti S, Vizzardi E, Cuminetti G, Pezzotti E, Adamo M, Cas LD. Prognostic Value of Blood Urea Nitrogen and Its Variations in Patients With Chronic Heart Failure. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.307] [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: 10/19/2022]
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Metra M, Felker GM, Zacà V, Bugatti S, Lombardi C, Bettari L, Voors AA, Gheorghiade M, Dei Cas L. Acute heart failure: multiple clinical profiles and mechanisms require tailored therapy. Int J Cardiol 2010; 144:175-9. [PMID: 20537739 DOI: 10.1016/j.ijcard.2010.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 04/02/2010] [Indexed: 11/16/2022]
Abstract
Acute heart failure (HF) is the most common diagnosis at discharge in patients aged >65years. It carries a dismal prognosis with a high in-hospital mortality and very high post-discharge mortality and re-hospitalization rates. It is a complex clinical syndrome that cannot be described as a single entity as it varies widely with respect to underlying pathophysiologic mechanisms, clinical presentations and, likely, treatments. It is the aim of this paper to describe some of the main clinical presentations of acute HF. Amongst them, we will consider de novo HF versus acutely decompensated chronic HF, HF caused, and/or worsened, by myocardial ischemia, acute HF with low, normal, or high systolic blood pressure, acute HF caused by lung congestion or fluid retention or fluid redistribution to the lungs, and acute HF with comorbidities (diabetes, anemia, renal insufficiency, etc.). Different pathophysiologic mechanisms and clinical presentations may coexist in the same patient. Identification and, whenever possible, treatment of underlying pathophysiologic mechanisms may become important for acute HF management.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Italy.
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Milo-Cotter O, Bettari L, Kleijn L, Bugatti S, Lombardi C, Rund M, Metra M, Voors AA, Cotter G, Kaluski E, Weatherley BD. The management of acute heart failure. Panminerva Med 2010; 52:53-66. [PMID: 20228726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hospitalization for acute heart failure (AHF) is one of the burdensome aspects of 21st century medicine, leading to significant debilitating symptoms, high morbidity and mortality and consuming significant portion of the health care budget. Management of AHF is thought-provoking given the heterogeneity of the patient population, absence of a universally accepted definition, incomplete understanding of the pathophysiology and the beneficial and adverse effects of currently used therapies and lack of robust evidence-based guidelines. The article will discuss the clinical approach to the patients admitted with AHF, reviewing types of intervention (both approved and investigational) and will delineate their role and timing in specific AHF presentations. One of the challenges of AHF management is to effectively treat the subsets of patients with slow improvement or those with refractory AHF or early recurrence (worsening HF) during their initial admission. Unfortunately, the majority of these patients are at increased risk for subsequent complications and adverse outcomes. Therefore, considerable efforts in AHF management should be directed towards this population. Regretfully, to date no specific targeted therapy was proven beneficial for these patients, being one of the leading reasons for the lack of improvement in AHF outcomes over the last 30 years.
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Affiliation(s)
- O Milo-Cotter
- Momentum Research Inc., 3100 Tower Boulevard, Durham, NC 27707, USA.
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