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Fezzi S, Del Sole PA, Pighi M, Flaim M, Mammone C, Rizzetto F, Tavella D, Mcinerney A, Pesarini G, Benfari G, Scarsini R, Mylotte D, Ribichini FL. Right Ventricle Pulmonary Artery Coupling and Renal Function in Patients With Severe Aortic Stenosis Undergoing TAVR. JACC Cardiovasc Imaging 2024; 17:451-453. [PMID: 37999658 DOI: 10.1016/j.jcmg.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023]
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Pighi M, Tomai F, Fezzi S, Pesarini G, Petrolini A, Spedicato L, Tarantini G, Ferlini M, Calabrò P, Loi B, Ferrero V, Forero MNT, Daemen J, Ribichini F. Safety and efficacy of everolimus-eluting bioresorbable vascular scaffold for cardiac allograft vasculopathy (CART). Clin Res Cardiol 2024:10.1007/s00392-023-02351-9. [PMID: 38170246 DOI: 10.1007/s00392-023-02351-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is still the main drawback of heart transplantation (HTx) and percutaneous coronary intervention (PCI) is a palliative measure because of the high incidence of failure. OBJECTIVE This study aimed to investigate the safety and efficacy of bioresorbable scaffolds (BRSs) as potential novel therapeutic tool for the treatment of coronary stenoses in CAV. METHODS This is a multicenter, single-arm, prospective, open-label study (CART, NCT02377648), that included patients affected by advanced CAV treated with PCI and second-generation ABSORB BRS (Abbott Vascular). The primary endpoint was the incidence of 12-month angiographic in-segment scaffold restenosis (ISSR). Secondary endpoints were the incidence of major adverse cardiac events (MACEs) at 12- and 36-month follow-up and the incidence of ISSR at 36 months. A paired intracoronary imaging analysis at baseline and follow-up was also performed. RESULTS Between 2015 and 2017 35 HTx patients were enrolled and treated for 44 coronary lesions with 51 BRSs. The primary endpoint occurred in 13.5% of the lesions (5/37), with a cumulative ISSR rate up to 3 years of 16.2% (6/37). Angiographic lumen loss was 0.40 ± 0.62 mm at 12 months and 0.53 ± 0.57 mm at 36 months. Overall survival rate was 91.4% and 74.3%, and MACEs incidence 14.2% and 31.4% at 12 and 36 months, respectively. At the paired intracoronary imaging analysis, a significant increase of the vessel external elastic membrane area in the treated segment and some progression of CAV proximally to the BRS were detected. CONCLUSIONS BRS-based PCI for the treatment of CAV is feasible and safe, with an ISSR incidence similar to what reported in retrospective studies with drug-eluting stents.
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Affiliation(s)
- Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Simone Fezzi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
| | | | - Leonardo Spedicato
- Department of Cardiovascular Sciences, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Division of Clinical Cardiology, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - Bruno Loi
- Division of Cardiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | | | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy
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Fezzi S, Pighi M, Del Sole PA, Scarsini R, Mammone C, Zanforlin R, Ferrero V, Lunardi M, Tavella D, Pesarini G, Ribichini FL. Long-term intracoronary imaging and physiological measurements of bioresorbable scaffolds and untreated atherosclerotic plaques. Int J Cardiol 2024; 394:131341. [PMID: 37678431 DOI: 10.1016/j.ijcard.2023.131341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Bioresorbable scaffolds (BRS) provide the prospect of restoring the anatomic and physiologic characteristics of the vascular wall. OBJECTIVE This study sought to examine the long-term outcomes of BRS-based coronary intervention in a young population with diffuse and severe coronary atherosclerotic disease (CAD) and to compare the long-term evolution of treated segments versus the natural progression of untreated non-flow limiting stenoses. METHODS Observational, single-center cohort study that prospectively included patients that underwent percutaneous coronary intervention with implantation of ABSORB BRS (Abbott Vascular). The clinical endpoint was the incidence of device-oriented composite endpoint (DoCE) up to 5 years follow-up. A subgroup of patients with baseline intracoronary imaging assessment of long lesions and/or multivessel disease underwent elective angiographic (70 patients, 129 lesions) and intracoronary imaging (55 patients, 102 lesions) follow-up. Paired intravascular ultrasound (IVUS) and quantitative flow reserve (QFR) were analyzed. RESULTS Between 2012 and 2017, 159 patients (mean age 54.0 ± 11.1) with native CAD were treated with BRS on 247 lesions. Patients were mainly at their first cardiac event, mostly acute coronary syndromes (86.5%). At the median follow-up time of 56 months [41-65], DoCE occurred in 15/159 (9.4%) patients, while non-target vessel-oriented composite endpoint occurred in 16 patients (10.4%). A significant atherosclerotic progression was detected on residual non-flow limiting plaques as per IVUS and QFR assessment, while no significant change was detected in the treated segment. CONCLUSIONS Mild-to-moderate asymptomatic CAD progressed significantly at 5-year despite OMT. BRS-treated segments had a less aggressive progression at 5-year despite more severe and symptomatic CAD at baseline.
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Affiliation(s)
- Simone Fezzi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy; The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Paolo Alberto Del Sole
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Concetta Mammone
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Roberto Zanforlin
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
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Rheude T, Costa G, Ribichini FL, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Ribeiro HB, Saia F, Bunc M, Tchétché D, Garot P, Mylotte D, Burzotta F, Watanabe Y, Bedogni F, Tesorio T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Xhepa E, Kargoli F, Tamburino C, Joner M, Barbanti M. Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2023; 19:589-599. [PMID: 37436190 PMCID: PMC10495747 DOI: 10.4244/eij-d-23-00186] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 03/06/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown. AIMS We sought to compare different PCI timing strategies in TAVI patients. METHODS The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method. RESULTS A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days. CONCLUSIONS In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.
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Affiliation(s)
- Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ignacio J Amat Santos
- CIBERCV, Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Matjaz Bunc
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Philippe Garot
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | | | - Francesco Burzotta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Tullio Tesorio
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | | | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Italo Porto
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Caterina Gandolfo
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda ospedaliera-universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Alessandro S Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | - Luigi Biasco
- Azienda Sanitaria Locale di Ciriè, Chivasso e Ivrea, ASL TO4, Ivrea, Italy
| | | | - Marco Zimarino
- Department of Cardiology, SS. Annunziata Hospital Chieti, ASL 2 Abruzzo, Chieti, Italy and Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | | | | | - Alexandre Gautier
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Galway University Hospital, Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Vincenzo De Marzo
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Elisa Piredda
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Stefano Cannata
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | | | | | | | | | | | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Erion Xhepa
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Michael Joner
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
- Università degli Studi di Enna "Kore", Enna, Italy
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Abdelshafy M, Serruys PW, Tsai TY, Revaiah PC, Garg S, Aben JP, Schultz CJ, Abdelghani M, Tonino PAL, Miyazaki Y, Rutten MCM, Cox M, Sahyoun C, Teng J, Tateishi H, Abdel-Wahab M, Piazza N, Pighi M, Modolo R, van Mourik M, Wykrzykowska J, de Winter RJ, Lemos PA, de Brito FS, Kawashima H, Søndergaard L, Rosseel L, Wang R, Gao C, Tao L, Rück A, Kim WK, van Royen N, Terkelsen CJ, Nissen H, Adam M, Rudolph TK, Wienemann H, Torii R, Josef Neuman F, Schoechlin S, Chen M, Elkoumy A, Elzomor H, Amat-Santos IJ, Mylotte D, Soliman O, Onuma Y. Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement. Front Cardiovasc Med 2023; 10:1161779. [PMID: 37529710 PMCID: PMC10389707 DOI: 10.3389/fcvm.2023.1161779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/24/2023] [Indexed: 08/03/2023] Open
Abstract
Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries.
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Affiliation(s)
- Mahmoud Abdelshafy
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
| | - Patrick W. Serruys
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
- NHLI, Imperial College London, London, United Kingdom
| | - Tsung-Ying Tsai
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Pruthvi Chenniganahosahalli Revaiah
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | | | - Carl J. Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Mohammad Abdelghani
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Pim A. L. Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Marcel C. M. Rutten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | | | | | - Justin Teng
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Hiroki Tateishi
- Department of Cardiology, Shibata Hospital, Yamaguchi, Japan
- Division of Cardiology, Department of Clinical Science and Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University, Montreal, QC, Canada
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Martijn van Mourik
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | | | - Robbert J. de Winter
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Pedro A. Lemos
- Heart Institute (InCor), University of São Paulo Medical School (USP), São Paulo, Brazil
| | - Fábio S. de Brito
- Heart Institute (InCor), University of São Paulo Medical School (USP), São Paulo, Brazil
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Liesbeth Rosseel
- Department of Cardiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Andreas Rück
- Department of Cardiology, Karolinska Institute, Stockholm, Sweden
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Centre, Bad Nauheim, Germany
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Matti Adam
- Department of Cardiology, Faculty of Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Tanja K. Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Hendrik Wienemann
- Department of Cardiology, Faculty of Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Franz Josef Neuman
- Division of Cardiology and Angiology II, University Heart Centre Freiburg—Bad Krozingen, Bad Krozingen, Germany
| | - Simon Schoechlin
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ahmed Elkoumy
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | - Hesham Elzomor
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | | | - Darren Mylotte
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Osama Soliman
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Yoshinobu Onuma
- Department of Cardiology, CORRIB Research Centre for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG), Galway, Ireland
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6
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Adamo M, Rubbio AP, Zaccone G, Pighi M, Massussi M, Tomasoni D, Pancaldi E, Testa L, Tusa MB, De Marco F, Giannini C, Grasso C, De Felice F, Denti P, Godino C, Mongiardo A, Crimi G, Villa E, Monteforte I, Citro R, Giordano A, Bartorelli AL, Petronio AS, Chizzola G, Tarantini G, Tamburino C, Bedogni F, Metra M. Prediction of mortality and heart failure hospitalisations in patients undergoing M-TEER: external validation of the COAPT risk score. EUROINTERVENTION 2023; 18:1408-1417. [PMID: 36809256 PMCID: PMC10111134 DOI: 10.4244/eij-d-22-00992] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/09/2022] [Accepted: 01/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND A risk score was recently derived from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) Trial. However, external validation of this score is still lacking. AIMS We aimed to validate the COAPT risk score in a large multicentre population undergoing mitral transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR). METHODS The Italian Society of Interventional Cardiology (GIse) Registry of Transcatheter Treatment of Mitral Valve RegurgitaTiOn (GIOTTO) population was stratified according to COAPT score quartiles. The performance of the COAPT score for 2-year all-cause death or heart failure (HF) hospitalisation was evaluated in the overall population and in patients with or without a COAPT-like profile. RESULTS Among the 1,659 patients included in the GIOTTO registry, 934 had SMR and complete data for a COAPT risk score calculation. The incidence of 2-year all-cause death or HF hospitalisation progressively increased through the COAPT score quartiles in the overall population (26.4% vs 44.5% vs 49.4% vs 59.7%; log-rank p<0.001) and COAPT-like patients (24.7% vs 32.4% vs 52.3% vs. 53.4%; log-rank p=0.004), but not in those with a non-COAPT-like profile. The COAPT risk score had poor discrimination and good calibration in the overall population, moderate discrimination and good calibration in COAPT-like patients and very poor discrimination and poor calibration in non-COAPT-like patients. CONCLUSIONS The COAPT risk score has a poor performance in the prognostic stratification of real-world patients undergoing M-TEER. However, after application to patients with a COAPT-like profile, moderate discrimination and good calibration were observed.
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Affiliation(s)
- Marianna Adamo
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gregorio Zaccone
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Massussi
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Pancaldi
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maurizio B Tusa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | | | - Gabriele Crimi
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa, Genova, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit and Transcatheter Valve Therapy Group, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Ida Monteforte
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Rodolfo Citro
- University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | | | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuliano Chizzola
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Metra
- Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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7
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Leone PP, Regazzoli D, Pagnesi M, Cannata F, Mangieri A, Hokken TW, Costa G, Barbanti M, Teles RC, Adamo M, Taramasso M, Reifart J, De Marco F, Giannini F, Kargoli F, Ohno Y, Saia F, Buono A, Ielasi A, Pighi M, Chiarito M, Bongiovanni D, Cozzi O, Stefanini G, Ribichini FL, Maffeo D, Chizzola G, Bedogni F, Kim WK, Maisano F, Tamburino C, Van Mieghem NM, Colombo A, Reimers B, Latib A. Implantation of contemporary transcatheter aortic valves in small aortic annuli: the international multicentre TAVI-SMALL 2 registry. EUROINTERVENTION 2023:EIJ-D-22-00843. [PMID: 36950893 DOI: 10.4244/eij-d-22-00843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Treatment of aortic stenosis in patients with small annuli is challenging and can result in prosthesis-patient mismatch (PPM). AIMS We aimed to compare the forward flow haemodynamics and clinical outcomes of contemporary transcatheter valves in patients with small annuli. METHODS The TAVI-SMALL 2 international retrospective registry included 1,378 patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm2) treated with transfemoral self-expanding (SEV; n=1,092) and balloon-expandable valves (BEV; n=286) in 16 high-volume centres between 2011 and 2020. Analyses comparing SEV versus BEV and supra-annular (SAV; n=920) versus intra-annular valves (IAV; n=458) included inverse probability of treatment weighting (IPTW). The primary endpoints were the predischarge mean aortic gradient and incidence of severe PPM. The secondary endpoint was the incidence of more than mild paravalvular leak (PVL). RESULTS The predischarge mean aortic gradient was lower after SAV versus IAV (7.8±3.9 vs 12.0±5.1; p<0.001) and SEV versus BEV implantation (8.0±4.1 vs 13.6±4.7; p<0.001). Severe PPM was more common with IAV and BEV when compared to SAV and SEV implantation, respectively, (8.8% vs 3.6%; p=0.007 and 8.7% vs 4.6%; p=0.041). At multivariable logistic regression weighted by IPTW, SAV protected from severe PPM regardless of its definition. More than mild PVL occurred more often with SEV versus BEV (11.6% vs 2.6%; p<0.001). CONCLUSIONS In small aortic annuli, implantation of SAV and SEV was associated with a more favourable forward haemodynamic profile than after IAV and BEV implantation, respectively. More than mild PVL was more common after SEV than BEV implantation.
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Affiliation(s)
- Pier Pasquale Leone
- Montefiore Medical Center, New York, NY, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Thijmen W Hokken
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Giuliano Costa
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Marco Barbanti
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich, Zurich, Switzerland and University of Zurich, Zurich, Switzerland
| | - Jorg Reifart
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | - Yohei Ohno
- Department of Cardiology, Tokai University Hospital, Kanagawa, Japan
| | - Francesco Saia
- Cardiology Unit, Sant'Orsola Polyclinic, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Dario Bongiovanni
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Ottavia Cozzi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giuliano Chizzola
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy.Misc
| | - Corrado Tamburino
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
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8
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Leone PP, Gohar A, Pagnesi M, Mangieri A, Stefanini G, Cacia M, Cozzi O, Barbanti M, Teles R, Adamo M, Taramasso M, De Marco F, Giannini F, Ohno Y, Saia F, Buono A, Ielasi A, Pighi M, Ribichini F, Maffeo D, Bedogni F, Kim WK, Maisano F, Tamburino C, Van Mieghem NM, Colombo A, Reimers B, Latib A, Regazzoli D. Clinical outcomes in women and men with small aortic annuli undergoing transcatheter aortic valve implantation: A multicenter, retrospective, propensity score-matched comparison. Int J Cardiol 2023; 379:16-23. [PMID: 36863420 DOI: 10.1016/j.ijcard.2023.02.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/17/2022] [Revised: 02/05/2023] [Accepted: 02/26/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Sex-specific characteristics in patients with aortic stenosis and small annuli undergoing transcatheter aortic valve implantation (TAVI) might affect clinical outcomes and hemodynamics. METHODS TAVI-SMALL 2 international retrospective registry included 1378 patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area < 400 mm2) treated with transfemoral TAVI at 16 high-volume centers between 2011 and 2020. Women (n = 1233) were compared with men (n = 145). One-to-one propensity score (PS) matching resulted in 99 pairs. Primary endpoint was incidence of all-cause mortality. Incidence of pre-discharge severe prosthesis-patient mismatch (PPM) and its association with all-cause mortality were investigated. Binary logistic and Cox regression were performed to adjust the treatment effect for PS quintiles. RESULTS Incidence of all-cause mortality at a median follow-up of 377 days did not differ between sex in the overall (10.3 vs. 9.8%, p = 0.842) and PS-matched (8.5 vs. 10.9%, p = 0.586) populations. After PS matching, pre-discharge severe PPM was numerically higher in women vs. men (10.2 vs. 4.3%), even though no evidence of a difference was found (p = 0.275). Within the overall population, women with severe PPM suffered a higher incidence of all-cause mortality when compared to those with less than moderate PPM (log-rank p = 0.024) and less than severe PPM (p = 0.027). CONCLUSIONS No difference in all-cause mortality at medium-term follow-up was observed between women and men with aortic stenosis and small annuli undergoing TAVI. Incidence of pre-discharge severe PPM was numerically higher in women than men, and it was associated with increased all-cause mortality in women.
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Affiliation(s)
- Pier Pasquale Leone
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Aisha Gohar
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Michele Cacia
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ottavia Cozzi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Barbanti
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Rui Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich, Switzerland and University of Zurich, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Yohei Ohno
- Department of Cardiology, Tokai University Hospital, Kanagawa, Japan
| | - Francesco Saia
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Corrado Tamburino
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA.
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
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9
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Fezzi S, Rubino F, Del Sole PA, Pesarini G, Mammone C, Scarsini R, Lunardi M, Pighi M, Tavella D, Ribichini FL. 405 A NATURAL HISTORY OF VERY LONG-TERM BIORESORBABLE ATHEROSCLEROTIC RESTORATION THERAPY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.366] [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: 12/23/2022]
Abstract
Abstract
A 49-year-old man was referred to our cath-lab in 2015 after the detection of inducible ischaemia in the infero-lateral wall on single-photon emission CT performed due to a worsening stable angina. His cardiovascular risk factors accounted for family history of ischemic disease, high blood pressure and dyslipidaemia. The echocardiography highlighted a mildly reduced left ventricular function with infero-lateral wall hypokinesia. Coronary angiography revealed a chronic total occlusion (CTO) of the left circumflex artery (LCX) and a long diffuse severe disease of the right coronary artery (RCA). The left anterior descending artery (LAD) showed a diffuse atherosclerotic involvement without critical stenoses.
Percutaneous coronary intervention (PCI) was performed after Heart Team discussion with implantation of two 3.5×28mm and 3.5×23mm Absorb bioresorbable vascular scaffold (BVS) on the RCA. Moreover, the LCX CTO was successfully treated by anterograde approach with implantation of a 3.0×28 mm Absorb BVS. Intravascular ultrasound confirmed the optimal result of both the interventions, while confirmed the long diffuse calcific involvement of the LAD with a thick cap calcific fibroatheroma at the virtual histology. The patient was discharged on dual antiplatelet therapy for twelve months.
After five uneventful years, he was readmitted to our department for recurrence of worsening stable angina. At the coronary angiography a significant progression of the proximal LAD disease was noted. The lesion was judged hemodynamic relevant with pressure derived indices (instantaneous wave-free ratio 0.86; fractional flow reserve 0.70). The IVUS and optical coherence tomography (OCT) analysis confirmed the significant progression of the disease with a long, diffuse, sub-occlusive thick cap fibroatheroma stenosis (minimal lumen area 1.9 mm2; plaque burden 91%). The OCT analysis showed the complete resorption of the devices previously implanted to the RCA and the LCX, with optimal long-term results and positive remodelling in the LCX. Therefore, an OCT-guided PCI with marker-to-marker implantation of two 3.5×25 and 3×20 mm magnesium-based Magmaris BVS was performed.
In 2022, the patient underwent an elective coronary angiography that demonstrated a complete resorption of both the Magmaris with an optimal OCT result. Conversely, the positive remodelled segment resulting from complete resorption of the poly-L-lactic-based BVS in the mid-LCX was shown to be progressed to a critical sub-occlusive fibroatheroma. A further OCT-guided PCI with deployment one 3.5×20mm Magmaris BVS was performed.
Six months later, patient was asymptomatic with a good performance status.
To the best of our knowledge, the present is the first case of multivessel repetitive imaging-based percutaneous revascularizations with the use of two different BVS technologies and a total of six devices implanted, with very long-term intracoronary imaging result. Through the paired intravascular imaging analysis, this case sought to provide insightful findings on vulnerable plaque atherosclerotic progression and on BVS biologic restoration therapy, a process that appears particularly appealing in young patients with advanced CAD, namely multivessel involvement and diffuse disease that still poses limitations to PCI.
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Affiliation(s)
- Simone Fezzi
- University Of Verona
- University Of Galway , Irland
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10
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Facci G, Alberti G, Dotto A, Briani F, Benfari G, Pighi M, Ribichini F. 1130 ZEBRA HOOFBEATS: A RARE CASE OF STEMI IN GRANULOMATOUS NECROTIZING AORTITIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.758] [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: 12/23/2022]
Abstract
Abstract
We present the unusual case of an AMI STEMI, complicated by ventricular fibrillation, in a 26 years old caucasic male patient, affected by necrotizing and granulomatous aortitis, in the context of a primary immunodeficiency.
Initially the patient was referred to the Cardiology Unit for worsening dyspnea and fatigue. In his medical history he has primary immunodeficiency complicated by multiple opportunistic infections.
We performed an echocardiography that revealed an aneurismatic ascending aorta (58 mm) with associated significant aortic valvular regurgitation. He was later referred to heart surgery OR where Bentall-De Bono operation was performed. Two years later he developed a lateral STEMI, complicated by ventricular fibrillation. The coronary angiography, performed in foreign country, showed total occlusion of the circumflex coronary artery with diffuse aneurismatic coronary disease, granulomatosis and ulcerative lesions. A percutaneous revascularization approach was tried, but ineffective.
Actually the patient, during follow up, presents dilatative post-ischemic cardiopathy with moderate ejection fraction reduction, initial aortic bioprosthesis failure. We noted at follow up echocardiograms early dilatation of the native aortic arch (35 mm), suggesting a progressive disease.
In conclusion, AMI's etiology includes many non atherosclerotic mechanisms that should be considered alongside common causes.
This case shows a rare cause of STEMI in a very young male patient, and teaches us that aortitis is a progressive and complex pathology, often involving multiple arteriosus districts, that needs close follow-up and integrated management.
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Affiliation(s)
- Gabriele Facci
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
| | - Giorgia Alberti
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
| | - Alberto Dotto
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
| | - Francesco Briani
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
| | - Giovanni Benfari
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
| | - Michele Pighi
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
| | - Flavio Ribichini
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
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11
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Del Sole PA, Fezzi S, Mammone C, Flaim M, Lunadi M, Scarsini R, Tavella D, Pesarini G, Pighi M, Ribichini FL. 961 RIGHT VENTRICLE-PULMONARY ARTERY COUPLING RATIO AS PROGNOSTIC FACTOR FOR PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TAVI. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.732] [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: 12/23/2022]
Abstract
Abstract
Background
Right Ventricle/Pulmonary Artery (RV/PA) coupling has recently emerged as a relevant prognostic factor in patients undergoing transcatheter valvular interventions. The aim of this study is to assess the interaction between RV/PA coupling ratio and the incidence of Acute Kidney Injury (AKI) following TAVI in patients with severe aortic stenosis. Furthermore we investigated the interaction between this novel ratio and adverse events at 24 months follow-up.
Methods
A population of 283 patients was selected from the Verona Valvular Registry (CESC n =1918). RV/PA coupling was estimated as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PAPs) obtained through transthoracic echocardiograms. AKI was defined as an increase in serum creatinine (sCr) of at least 0.3 mg/dL up to 48 hours following TAVI. Major adverse cardiovascular events (MACEs) were defined as the composite occurrence of cardiac death, re-hospitalization for congestive heart failure and stroke.
Results
Mean age was 83.4 ± 5.36 years and 41.3% of patients were female. The median value of TAPSE/PAPs ratio was 0.5667 mm/mmHg and was used as a cut-off. A TAPSE/PASP ratio <0.5667 was found to be associated with a higher incidence of MACE at Kaplan Meyer analysis at 24 months (10.4% vs 3.5%, log p = 0.004) and higher occurrence of AKI (17.0% vs. 7.7%; p=0.027). Notably TAPSE/PAPs interquartile comparison showed higher incidence for AKI in patients in the lowest quartile compared to higher ones (24.2% vs. 8.5%; p = 0.001). Following Cox multivariate analysis, TAPSE/PAPs ratio and diabetes mellitus were found to be independent predictors of AKI.
Furthermore, risk for 24 months MACEs was higher in the population with lower TAPSE/PAPs ratio (HR 2.672; CI 95% [1.195–5.974]; p = 0.017).
Conclusion
RV/PA coupling, as characterized by TAPSE/PAPs ratio, is a promising independent predictor of AKI, also associated with higher risk of major adverse cardiac events at follow-up in subjects undergoing TAVI. These data suggest a possible role for this novel index in risk stratification, assessment of the prognosis, and decision-making in these patients.
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Affiliation(s)
| | - Simone Fezzi
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Concetta Mammone
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Massimo Flaim
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Mattia Lunadi
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Roberto Scarsini
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Domenico Tavella
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Gabriele Pesarini
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
| | - Michele Pighi
- Division Of Cardiology Medicine Department Of Medicine University Of Verona
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12
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Rubino F, Fezzi S, Maisenti S, Facci G, Pesarini G, Mammone C, Lunardi M, Scarsini R, Ferrero V, Pighi M, Tavella D, Ribichini FL. 837 COMPLETE MAGNESIUM BIORESORBABLE SCAFFOLD ABSORPTION AT 1-YEAR OF INTRACORONARY IMAGING FOLLOW UP. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.367] [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: 12/23/2022]
Abstract
Abstract
Background
the development of bioresorbable scaffolds (BRSs) has been conceived as revolution in interventional cardiology for the prospective improvements in the treatment of coronary artery disease. However, metallic drug eluting stent (DES) demonstrated greater safety and efficacy than bioresorbable vascular scaffold (BVS) Absorb in dedicated trials culminating in the commercial withdrawal of Absorb device in 2017. Nevertheless, the progressive absorption of the scaffold and the restoration of physiological coronary artery characteristics attracted attention, so currently research on BRSs is in progress.
Case presentation
a 58-year-old woman was admitted in our department after an episode of typical angina at rest without significant troponin elevation. The electrocardiogram showed T wave inversion in lateral leads. Hypokinesia of distal septum and anterior wall and mildly reduced left ventricular ejection fraction (LVEF 50%) were observed on echocardiography. Her cardiovascular risk factors included obesity, arterial hypertension, dyslipidaemia, family history of ischemic heart disease and former smoking. Her past medical history was remarkable for chronic kidney disease (CKD EPI eGFR 50 ml/min) and previous connective tissue disease.
Coronary angiography highlighted a critical stenosis in the middle segment of left anterior descending artery (LAD). Optical coherence tomography (OCT) imaging showed recanalized and organized throumbus and calcific plaques. After adequate predilatation and stent sizing by OCT, a 3×25 mm Magnesium-based BVS (Magmaris, Biotronik AG, Buelach, Switzerland) was implanted. OCT confirmed good expansion and apposition of the stent after postdilatation. Patient was discharged on dual antiplatelet therapy (DAPT) for 12 months, anti-remodeling cardiac and lipid-lowering therapy. One year later, the patient underwent and elective coronary angiography and OCT control showing a complete reabsorption of the Magmaris BVS with positive remodelling and luminal enlargement of the vessel. The patient was asymptomatic throughout the year with a good performance status.
Conclusion
The present case illustrates an example of imaging-based revascularization with BVS Magmaris and optimal intracoronary imaging result at 1 year follow up in agreement with the last available evidence. The last European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines on myocardial revascularization recommends the use of BVS only in the context of clinical controlled studies. However, encouraging results obtained and what expected from the current studies with Magmaris scaffolds, might change indications considering the potential benefit about the restoration of natural vasomotion, the reduced risk of neoatherosclerosis and the positive vascular remodelling following the scaffold absorption.
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13
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Galli V, Trento L, Galuppi E, Casal M, Cecchin E, Fezzi S, Castaldi G, Widmann M, Ruzzarin A, Marin F, Gambaro A, Pesarini G, Pighi M, Scarsini R, Ferrero V, Tavella D, Luciano Ribichini F. 745 INTERDISCIPLINARY EVALUATION IN RESISTANT ARTERIAL HYPERTENSION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.101] [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: 12/23/2022]
Abstract
Abstract
Background
Arterial hypertension is a complex and in most cases multifactorial pathology. Despite the numerous pharmacological treatments available, it is estimated that in Europe only 25%-39% of hypertensive patients achieve adequate blood pressure (BP) control. Renal arteries denervation (RDN) is an additional therapeutic weapon, complementary to Optimal Medical Therapy (OMT) in patients with resistant or refractory primary (or essential) arterial hypertension. In order to improve patients management and select those who are eligible for renal denervation, our Center has established the Interdisciplinary Group for the Treatment of Resistant Arterial Hypertension (G.I.T.I.A.R.), including Cardiologists, Nephrologists, Internists and Geriatricians.
Methods
From January 2018 to July 2022 the G.I.T.I.A.R. held twelve meetings evaluating 62 patients with resistant or refractory forms of arterial hypertension, contraindications or intolerance to antihypertensive drugs, suspected secondary or pseudoresistant forms (i.e. linked to poor patient compliance, drugs and/or inadequate dosages, concomitant intake of substances with hypertensive effect, incorrect measurements). For each of them, medical therapy was optimized and the need for second level diagnostic tests, multi-specialist follow-up and RDN candidacy were assessed. After three, six, twelve months and then annually following RDN, the patients underwent clinical and multi-specialist evaluation (where deemed appropriate), blood tests monitoring and 24-hour ambulatory blood pressure monitoring (ABPM).
Results
Of the 62 patients evaluated by the G.I.T.I.A.R., 64.5% (n=40) were male. The mean age at the time of evaluation was 64 years (range 18-87). After the first collegial discussion, 46.8% (n=29) have been declared eligible for RDN, while 53.2% (n=33) of the patients was initially rejected: 39.4% of these (n=13) for suspected or ascertained secondary hypertension, 12.1% (n=4) for the possibility of further optimization of medical therapy, 48.5% (n=16) for the presence of inclusion or exclusion criteria of ongoing studies design. Among the excluded patients, six presented moderate renal artery stenosis on non-invasive imaging: in two patients (33.3%) the stenosis turned out to be hemodynamically significant on angiographic and functional evaluation (Pd/Pa measurement), so renal angioplasty was performed; RDN was performed in the remaining 66.7% (n=4), in which a hemodynamic significance of the stenosis was excluded. Of the subgroup who had optimized medical therapy, one patient (25%) was subsequently referred to RDN for failure of all pharmacological strategies, while 3 of 4 (75%) achieved adequate BP control.
Conclusions
Resistant arterial hypertension is associated with an increased risk of development and progression of cardiovascular and renal diseases, with a significant impact on mortality and morbidity. Renal denervation has proved to be an effective and safe therapeutic strategy, complementary to OMT, whose selection of the ideal patient actually represents one of the greatest challenges. The integrated multidisciplinary approach improves the management of the hypertensive patient, the individualization of therapy and allows the identification of subjects who may benefit from RDN.
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Affiliation(s)
| | - Laura Trento
- Azienda Ospedaliera Universitaria Integrata Verona
| | | | - Matteo Casal
- Azienda Ospedaliera Universitaria Integrata Verona
| | | | - Simone Fezzi
- Azienda Ospedaliera Universitaria Integrata Verona
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14
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Ruzzarin A, Pighi M, Marin F, Zucchelli F, Portolan L, Mainardi A, Mora FD, Luciano Ribichini F. 386 IMPACT OF REVASCULARIZATION COMPLETENESS ON ONE-YEAR OUTCOMES OF IMPELLA-SUPPORTED PCI IN ACUTE CORONARY SYNDROME: A SINGLE-CENTER EXPERIENCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
The use of mechanical circulatory support in high-risk percutaneous coronary intervention (HRPCI) has grown over the past decade. We aimed to evaluate the impact of coronary revascularization extent on one-year outcomes of Impella-supported HRPCI in the setting of acute coronary syndrome (ACS).
Methods
We performed a single-center retrospective study including all patients who underwent coronary angiography supported by Impella at our institution. Patients undergoing HRPCI in the setting of ACS with Impella-assistance were identified for the analysis. Revascularization extent was assessed using the British Cardiovascular Intervention Society (BCIS) jeopardy score revascularization index (RI). Patients were classified into two groups according to the completeness of revascularization in high RI (RI>0.75) and low RI (RI<0.75).
The primary study endpoint was survival free from major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke, heart failure hospitalization) at one-year follow-up.
Results
Among fifty patients enrolled in the study, forty ACS patients (mean age 69.2±9 years) were identified for the analysis.
At coronary angiography, 76.3% had multivessel disease, and the mean BCIS-JSPRE-PCI score was 10.2±2.1. After Impella-supported PCI, BCIS-JSPOST-PCI score was 2.1±2.0 (p<0.01) and RI>0.75 was reached in 89.2% of cases (mean RI 0.8±0.2).
In-hospital mortality was 20.5% without a statistical difference between high and low RI (p=0.1).
Within 12 months, time-to-MACCE was statistically higher in patients with high RI as compared to low RI (288.2 vs. 189.8 days, p<0.05) (Figure).
Conclusions
Our single-center experience suggests a more extensive revascularization, aiming for a positive impact on outcomes, when a Impella-protected strategy is performed in the setting of acute coronary syndromes.
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Affiliation(s)
- Alessandro Ruzzarin
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Michele Pighi
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Federico Marin
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Federico Zucchelli
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Leonardo Portolan
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Andrea Mainardi
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
| | - Francesco Della Mora
- Division Of Cardiology, Department Of Medicine, University Of Verona , Verona , Italy
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15
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Mainardi A, Nicolini E, Andreaggi S, Fabroni M, Maolo A, Mariottini M, Pesarini G, Scarsini R, Mammone C, Ribichini F, Piva T, Pighi M. 735 CLINICAL EFFICACY OF CEREBRAL EMBOLIC PROTECTION IN TRANSFEMORAL TAVI PROCEDURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.327] [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: 12/23/2022]
Abstract
Abstract
Background
Although in the context of Transcatheter Aortic Valve Implantation (TAVI) technological improvements, refinements in technique and increased operator experience have led to progressive reduction in most complications, periprocedural neurological ischemic event (stroke and TIA) continues to occur in up to 2% of patients undergoing TAVI. Many of these are attributed to embolic events during the procedure and can lead to potentially devastating consequences. Cerebral Embolic Protection (CEP) devices have been developed to mitigate this risk. Data regarding the clinical efficacy of these devices in preventing neurological events in TAVI are conflicting. The aim of the present study is to investigate the impact of CEP on clinical neurological events in TAVI.
Methods
We performed a multicentric retrospective observational case-control study to evaluate the rate of periprocedural clinical neurological ischemic event in patients undergoing transfemoral TAVI with or without using CEP (Sentinel, Boston Scientific) during the procedure. Patients were consecutively enrolled between January 2018 and December 2021 by two tertiary centers (Verona and Ancona). A total population of 1042 patients were enrolled. The primary endpoint was the rate of a periprocedural clinical neurological ischemic event. The secondary was a composite endpoint: in-hospital death, periprocedural major vascular complication and periprocedural major bleeding. Clinical events at 30-day follow-up were evaluated (death, clinical neurological ischemic event, vascular complications, major bleeding). In consideration of the retrospective study design, we performed a propensity match analysis to account for differences in the baseline characteristics of patients in the two enrolling centers.
Results
The overall population comprised patients who underwent TAVI without using CEP (No-CEP group, n=581) and with CEP (CEP group, n=461). The propensity match analysis yielded a final population of 922 patients: 461 patients in the No-CEP group and 461 patients in the CEP group. There were no differences in baseline characteristics between the groups. Primary endpoint occurred in 8 (0,9%) patients overall, 3 (0,7%) patients in the No-CEP group and in 5 (1,1%) patients in CEP group (p=0,725). There were no differences in secondary endpoint: 25 (5,4) patients in No-CEP group and 20 (4,3%) in CEP group (p=0,541). In particular: in-hospital death (0,7% vs 1,3%, p=0,506), periprocedural major vascular complications (2,0% vs 0,7%, p=0,143), periprocedural major bleeding (5,0% vs 3,0%, p=0,179). No differences were observed in 30-days outcomes: death (0,0% vs 0,9%, p=0,131), clinical neurological ischemic events (0,8% vs 0,7%, p=1), vascular complications (0,3% vs 0,0%, p=0,450), major bleeding (0,8% vs 0,7%, p=1). The multiple logistic regression performed to estimate the effect of CEP on the primary endpoint showed Euroscore II (OR, 1.10; 95% CI, 1.00–1.19; P=0.028) and predilatation (OR, 4.84; 95% CI, 1.21–21.64; P=0.028) was associated with an increase in primary endpoint after TAVI, while CEP and valve type did not contribute significantly.
Conclusions
This study suggests that using CEP devices during transfemoral TAVI is safe and does not increase vascular complications, although it does not impact the rate of periprocedural clinical neurological ischemic events.
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Affiliation(s)
- Andrea Mainardi
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Elisa Nicolini
- Division Of Cardiology , Azienda Ospedaliero Universitaria Delle Marche
| | - Stefano Andreaggi
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | | | - Alessandro Maolo
- Division Of Cardiology , Azienda Ospedaliero Universitaria Delle Marche
| | | | - Gabriele Pesarini
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Roberto Scarsini
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Concetta Mammone
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Flavio Ribichini
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Tommaso Piva
- Division Of Cardiology , Azienda Ospedaliero Universitaria Delle Marche
| | - Michele Pighi
- Division Of Cardiology, Department Of Medicine, University Of Verona
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16
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Scarsini R, Pighi M, Mainardi A, Portolan L, Springhetti P, Mammone C, Della Mora F, Fanti D, Tavella D, Gottin L, Bergamini C, Benfari G, Pesarini G, Ribichini FL. Proof of concept study on coronary microvascular function in low flow low gradient aortic stenosis. Heart 2022; 109:785-793. [PMID: 36598066 DOI: 10.1136/heartjnl-2022-321907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We hypothesised that low flow low gradient aortic stenosis (LFLGAS) is associated with more severe coronary microvascular dysfunction (CMD) compared with normal-flow high-gradient aortic stenosis (NFHGAS) and that CMD is related to reduced cardiac performance. METHODS Invasive CMD assessment was performed in 41 consecutive patients with isolated severe aortic stenosis with unobstructed coronary arteries undergoing transcatheter aortic valve implantation (TAVI). The index of microcirculatory resistance (IMR), resistive reserve ratio (RRR) and coronary flow reserve (CFR) were measured in the left anterior descending artery before and after TAVI. Speckle tracking echocardiography was performed to assess cardiac function at baseline and repeated at 6 months. RESULTS IMR was significantly higher in patients with LFLGAS compared with patients with NFHGAS (24.1 (14.6 to 39.1) vs 12.8 (8.6 to 19.2), p=0.002), while RRR was significantly lower (1.4 (1.1 to 2.1) vs 2.6 (1.5 to 3.3), p=0.020). No significant differences were observed in CFR between the two groups. High IMR was associated with low stroke volume index, low cardiac output and reduced peak atrial longitudinal strain (PALS). TAVI determined no significant variation in microvascular function (IMR: 16.0 (10.4 to 26.1) vs 16.6 (10.2 to 25.6), p=0.403) and in PALS (15.9 (9.9 to 26.5) vs 20.1 (12.3 to 26.7), p=0.222). Conversely, left ventricular (LV) global longitudinal strain increased after TAVI (-13.2 (8.4 to 16.6) vs -15.1 (9.4 to 17.8), p=0.047). In LFLGAS, LV systolic function recovered after TAVI in patients with preserved microvascular function but not in patients with CMD. CONCLUSIONS CMD is more severe in patients with LFLGAS compared with NFHGAS and is associated with low-flow state, left atrial dysfunction and reduced cardiac performance.
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Affiliation(s)
- Roberto Scarsini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy .,Department of Medicine, Division of Cardiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
| | - Michele Pighi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Andrea Mainardi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Leonardo Portolan
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Paolo Springhetti
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Concetta Mammone
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Francesco Della Mora
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Diego Fanti
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Domenico Tavella
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Leonardo Gottin
- Department of Intensive Care and Anesthesiology, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
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17
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Costa G, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Barbosa Ribeiro H, Saia F, Bunc M, Tchetche D, Garot P, Ribichini FL, Mylotte D, Burzotta F, Watanabe Y, De Marco F, Tesorio T, Rheude T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Joner M, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Kargoli F, Tamburino C, Barbanti M. Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2022; 15:e012417. [PMID: 36538579 DOI: 10.1161/circinterventions.122.012417] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. METHODS The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. RESULTS Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio' 0.88 [95% CI, 0.66-1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio' 0.97 [95% CI, 0.76-1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). CONCLUSIONS The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Ignacio J Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.C.)
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Won-Keun Kim
- Kerckhoff Heart Center, Bad Nauheim, Germany (W.-K.K.)
| | | | - Francesco Saia
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Matjaz Bunc
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Philippe Garot
- Institute cardiovasculaire Paris Sud, Massy, France (P.G., A.G.)
| | - Flavio Luciano Ribichini
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | | | - Francesco Burzotta
- IRCSS Policlinico Universitario "Agostino Gemelli," Università Cattolica del Sacro Cuore, Roma, Italy (F.B.)
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Federico De Marco
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Tullio Tesorio
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy (M.T.)
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Roberto Valvo
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Italo Porto
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, UOSA Cardiologia Interventistica, Policlinico Le Scotte, Siena, Italy (A.I.)
| | - Alessandro Santo Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | - Markus Mach
- Wien University Hospital, Austria (M.M., M.A.)
| | - Azeem Latib
- Montefiore Medical Center, New York (A.L., F.K.)
| | - Luigi Biasco
- Azienda sanitaria locale di Ciriè, Chivasso e Ivrea, ASLTO4, Italy (L.B.)
| | - Maurizio Taramasso
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Switzerland (M.T.)
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Brazil (H.B.R., S.F.C.)
| | - Tullio Palmerini
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Mateusz Orzalkiewicz
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | | | | | | | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.).,Galway University Hospital, Ireland (D.M., M.L.)
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Vincenzo Cesario
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Vincenzo De Marzo
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Elisa Piredda
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | | | | | - Elena Dipietro
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | | | - Silvia Motta
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Marco Barbanti
- University Medical Centre Ljubljana, Slovenia (M.B., K.S.)
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18
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Angelini F, Pidello S, Frea S, Bocchino P, Boretto P, Gravinese C, Mandurino Mirizzi A, Masiero G, Montonati C, Biasco L, Pighi M, Giannini F, Montefusco A, Tarantini G, De Ferrari GM. Determinants and prognostic impact of afterload mismatch after MitraClip implantation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Mitral transcatheter edge-to-edge repair (TEER) is a widespread option to treat mitral regurgitation in high-risk patients. The sudden reduction of mitral regurgitation (MR) following TEER abruptly eliminates the low-impedance regurgitant flow into the left atrium, leading to an increase in left ventricle (LV) afterload with possible impairment of LV systolic function, defined afterload mismatch (AM).
Purpose
To explore a new definition of AM and to analyze the determinants and prognostic role of AM in patients with functional MR (FMR) undergoing TEER.
Methods
This was an international multicenter case-control study including adult patients with severe FMR and LVEF ≤35% undergoing TEER between 2012 and 2020. AM was defined as the acute need to initiate or increase inotropic support by a vasoactive inotropic score ≥3 or the need for a mechanical circulatory support following TEER.
Results
80 patients with AM were compared to 80 consecutive patients undergoing TEER not meeting the criteria for AM. Median age was 67 years, 79% of patients were male, had a median LVEDV of 240 ml with severely reduced LVEF (median 26%) and pulmonary hypertension (median 48 mmHg). Median EROA/LVEDV ratio was 0.17 (IQR 0.12–0.24) based on which 37% of the total population presented with proportionate MR. Levosimendan was administered before TEER in 42% of patients while intravenous vasodilators in 43%. In most patients more than 1 clip were needed (2 clips in 88 patients, 3 clips in 11). Patients presenting AM more commonly had a lower EROA/LVEDV ratio (0.14 vs. 0.18, p<0.001) leading to a higher percentage of patients with proportionate MR (55% vs. 22%, p<0.001; Figure 1) and had more clips implanted (p=0.008). AM was graded as mild in 74% of patients, moderate in 15% and severe in 11%. At multivariate analysis, patients with proportionate MR were more likely to develop AM after TEER (OR 2.95, 95% CI: 1.32–6.60, p=0.008), while those treated with levosimendan (OR 0.32, 95% CI: 0.15–0.71, p=0.005) and/or IV vasodilators (OR 0.44, 95% CI: 0.21–0.96, p=0.040) before TEER were less likely to suffer from AM. In-hospital death occurred in 7 cases, all being part of AM group. Patients were more likely to die in-hospital if AM was more severe (OR 2.56, 95% CI: 1.19–5.54, p=0.017), and for higher grades of residual MR (OR 3.35, 95% CI: 1.27–8.79, p=0.014). The 2-year survival rate did not differ significantly between groups (66% vs 75%, HR 1.51, 95% CI: 0.73–3.12, p=0.270; Figure 2). At 2 years 51 patients (32%) were re-hospitalized for HF, independently from post-procedural AM (HR 1.36, 95% CI: 0.70–2.67, p=0.363).
Conclusions
In patients with LVEF ≤35% and severe FMR undergoing TEER, the development of AM predicted in-hospital mortality, while long-term outcomes were not affected by acute AM. The use of levosimendan or intravenous vasodilators during the pre-procedural phase reduced the risk of acute AM.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Angelini
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology , Turin , Italy
| | - S Pidello
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology , Turin , Italy
| | - S Frea
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology , Turin , Italy
| | - P Bocchino
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology , Turin , Italy
| | - P Boretto
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology , Turin , Italy
| | - C Gravinese
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology , Turin , Italy
| | - A Mandurino Mirizzi
- Policlinic Foundation San Matteo IRCCS, Division of Cardiology , Pavia , Italy
| | - G Masiero
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences , Padua , Italy
| | - C Montonati
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences , Padua , Italy
| | - L Biasco
- Civic Hospital of Cirie, Division of Cardiology , Cirie , Italy
| | - M Pighi
- University of Verona, Department of Medicine, Division of Cardiology , Verona , Italy
| | - F Giannini
- Maria Cecilia Hospital, Interventional Cardiology Unit , Cotignola , Italy
| | - A Montefusco
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology , Turin , Italy
| | - G Tarantini
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences , Padua , Italy
| | - G M De Ferrari
- A.O.U. Citta della Salute e della Scienza di Torino, Division of Cardiology , Turin , Italy
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19
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Rubino F, Scarsini R, Piccoli A, San Biagio L, Tropea I, Pighi M, Prati D, Tavella D, Onorati F, Faggian G, Ribichini F. Comparative prognostic value of parameters of right ventricular pulsatile afterload in patients with advanced heart failure awaiting heart transplantation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) function demonstrated a strong impact on survival of patients with advanced heart failure with reduced ejection fraction (HFrEF). In particular, increased RV pulsatile afterload (RVPA) was associated with poor prognosis. Several right heart catheterization-derived parameters have been proposed to characterize RVPA, including pulmonary artery compliance (PAC), elastance (PAE) and pulsatile index (PAPi). However, among these indices, the best prognostic indicator is undetermined.
Purpose
To assess the prognostic relevance of RVPA parameters in patients with advanced HFrEF evaluated for heart transplantation.
Methods
149 patients with end-stage HFrEF underwent right heart catheterization during the evaluation for heart transplantation. All patients were clinically followed up until death or any censoring events including heart transplantation, left ventricular assist device (LVAD) and hospitalization for acute heart failure. Cox regression and ROC-curve analysis were used to test the prognostic value of RVPA determinants. Multivariate regression models with C-statistics were used to test the independent predictive value of RVPA indices.
Results
The mean age of the study population was 56.6±10.1 years and 85.2% were male. The most frequent aetiology of HFrEF was ischemic cardiomyopathy (52.3%). Mean LV ejection fraction was 25.7±10.2%.
During a mean follow up time of 17±15 months, 29 (19.5%) patients met the primary endpoint: 9 (6%) patients died, 4 (2.68%) patients underwent an urgent heart transplantation, 11 (7.3%) patients underwent urgent LVAD implantation (as bridge to transplantation therapy) and 5 (3.3%) were hospitalized for HF.
Patients who met the primary endpoint were significantly older patients (61.2±7.8 vs 55.4±10.2, p=0.006) and with worse hemodynamic profile than event-free survivors (PAC [1.8±0.8 vs. 2.7±2.0, p=0.01], mPAP [33.5±11.3 vs. 29.3±11.0, p=0.05], PVR [3.0±1.6 vs. 2.6±2.0, p=0.09] and PAE [1.12±0.5 vs. 0.98±0.6, p=0.04]).
Among the RVPA parameters PAC<1.9 mL/mmHg (HR 4.0, CI 1.3–6.0, p=0.007) and PAE>0.9 mmHg/mL (HR 2.5, 95% CI 1.1–5.2, p=0.02) were associated with the primary endpoint. On the contrary, PAPi was not significantly associated with the outcome.
PAC demonstrated a superior predictive value for the composite adverse outcome compared with pulmonary vascular resistances (PVR) (AUC comparison p=0.019) and PAPi (p=0.03) but similar compared with PAE (p=0.19) and mPAP (p=0.51). In multivariable regression models, PAC, but not PAE showed incremental prognostic value compared with cardiac index (p=0.02).
Conclusions
Hemodynamic indices of RVPA are associated with worse survival in patients with end-stage heart failure. In particular, PAC and PAE demonstrated superior prognostic value compared with PAPi and steady-state PVR. Moreover, PAC showed incremental prognostic value compared with cardiac index in patients awaiting heart transplantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Rubino
- University of Verona , Verona , Italy
| | | | - A Piccoli
- University of Verona , Verona , Italy
| | | | - I Tropea
- University of Verona , Verona , Italy
| | - M Pighi
- University of Verona , Verona , Italy
| | - D Prati
- University of Verona , Verona , Italy
| | - D Tavella
- University of Verona , Verona , Italy
| | - F Onorati
- University of Verona , Verona , Italy
| | - G Faggian
- University of Verona , Verona , Italy
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20
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Pighi M, Tomai F, Fezzi S, Pesarini G, Petrolini A, Spedicato L, Tarantini G, Ferlini M, Calabro P, Loi B, Tovar Forero N, Daemen J, Ribichini FT. Everolimus-eluting bioresorabable scaffold system in the treatment of cardiac allograft vasculopathy: the cardiac allograft reparative therapy (CART) prospective multicentre pilot study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac allograft vasculopathy (CAV) is still the main drawback of heart transplantation (HTx) and percutaneous coronary intervention (PCI) is a palliative measure because of the high incidence of PCI failure. The bioresorbable scaffolds (BRS) could represent a potential novel therapeutic tool for the treatment of coronary obstructions in CAV.
Purpose
To investigates the effects of BRS implantation in CAV patients in a Nationwide prospective study.
Methods
Multicentre, single-arm, prospective, open-label study that included patients affected by advanced CAV treated with PCI and second-generation ABSORB BRS. The primary endpoint was the incidence of 12-month angiographic in-segment scaffold restenosis (ISSR). Secondary endpoints were the composite of cardiac death, myocardial infarction, and target lesion revascularisation at 12-and 36-month follow-up and the incidence of ISSR at 36 months. A paired analysis of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) at baseline and follow-up was also performed.
Results
Between 2015–2017 35 HTx patients were enrolled and treated on 44 coronary lesions with 51 BRS. The primary endpoint occurred in 13.5% of the lesions (5/37), with a cumulative ISSR rate up to 3 years of 16.2% (6/37).Angiographic lumen loss was 0.40±0.62mm at 12 months and 0.53±0.57mm at 36 months. Overall survival was 91.4% and 74.3%, and MACEs 14.2% and 31.4% at 12 and 36 months, respectively. At the paired intracoronary imaging analysis a significant increase of the vessel external elastic membrane area in the treated segment of the BRS was described at the OCT, while some progression of CAV was detected proximally at the IVUS assessment.
Conclusions
BRS in CAV was feasible and safe, with an ISSR incidence similar to drug-eluting stents. For the first time, a positive remodeling was observed in HTx patients after PCI. Vessel enlargement and the lack of metallic stents may allow repeated PCI avoiding the vessel shrinkage caused by the addition of multiple metal layers, being CAV a complex clinical scenario with a high incidence of MACEs, mainly driven by PCI failure.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Partial funding by Abbott Vascular Italy
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Affiliation(s)
- M Pighi
- University of Verona, Department of Biomedical and Surgical Sciences, Section of Cardiology , Verona , Italy
| | - F Tomai
- European Hospital , Rome , Italy
| | - S Fezzi
- University of Verona, Department of Biomedical and Surgical Sciences, Section of Cardiology , Verona , Italy
| | - G Pesarini
- University of Verona, Department of Biomedical and Surgical Sciences, Section of Cardiology , Verona , Italy
| | | | - L Spedicato
- Citta di Udine C.D.C Health Centre , Udine , Italy
| | | | - M Ferlini
- I.R.C.C.S. San Matteo Polyclinic , Pavia , Italy
| | - P Calabro
- Luigi Vanvitelli University Hospital , Naples , Italy
| | - B Loi
- AO Brotzu Hospital , Cagliari , Italy
| | - N Tovar Forero
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - J Daemen
- Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - F T Ribichini
- University of Verona, Department of Biomedical and Surgical Sciences, Section of Cardiology , Verona , Italy
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21
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Scarsini R, Pighi M, Mainardi A, Portolan L, Mammone C, Benfari G, Springhetti P, Fanti D, Bergamini C, Tavella D, Pesarini G, Ribichini FL. Coronary microvascular dysfunction is associated with reduced cardiac performance in low flow low gradient aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Little is known about coronary microvascular function of patients with low-flow low-gradient aortic stenosis (LFLGAS). We hypothesized that LFLGAS is associated with more severe coronary microvascular dysfunction (CMD) compared with normal-flow high-gradient aortic stenosis (NFHGAS) and that CMD is related to reduced cardiac efficiency.
Purpose
To perform a prospective invasive assessment of CMD in patients with LFLGAS undergoing TAVI and to compare it with patients with NFHGAS. Moreover, we aimed to assess the possible acute impact of TAVI on coronary microvascular function and the interactions between CMD and of cardiac performance at speckle tracking echocardiography (STE).
Methods
Invasive thermodilution-based assessment was systematically performed in 41 consecutive patients with isolated severe AS with angiographic unobstructed coronary arteries undergoing TAVI. The index of microcirculatory resistance (IMR), resistive reserve ratio (RRR) and coronary flow reserve (CFR) were derived to assess coronary microcirculatory function before and after TAVI. Advanced echocardiographic imaging, including STE, was performed to assess cardiac function.
Results
IMR was significantly higher in patients with LFLGAS compared with patients with NFHGAS (24.1 [14.6–39.1] vs 12.8 [8.6–19.2] p=0.002). Similarly, RRR was significantly lower in LFLGAS compared with NFHGAS (1.4 [1.1–2.1] vs 2.6 [1.5–3.3] p=0.020). No significant differences were observed in CFR between the two groups.
High IMR was associated with low stroke volume index (rho=−0.427, p=0.005), low cardiac output (rho=−0.517, p=0.001), reduced peak atrial longitudinal strain (PALS) (rho=−0.610, p≤0.001) and presence of atrial fibrillation (54.6% vs 21.1%, p=0.036). Conversely, IMR was only modestly associated with the mean pressure aortic valve gradient (rho=−0.304, p=0.054). Notably, the mean gradient was significantly associated with IMR in the NFHGAS group (rho=0.632, p=0.003) but not in the LFLGAS (rho=−0.222, p=0.333). Similarly, high IMR was associated with the AVA in the NFHGAS group (rho=−0.50, p=0.025) but not in patients with LFLGAS (rho=0.157, p=0.497).
Paradoxical LFLGAS emerged as a phenotype associated with CMD, poor left ventricular longitudinal systolic function and left atrial dysfunction. TAVI determined no significant variation in microvascular function (IMR: 16.0 [10.4–26.1] vs 16.6 [10.2–25.6], p=0.403) and in PALS (15.9 [9.9–26.5] vs 20.1 [12.3–26.7], p=0.222). Conversely, left ventricular global longitudinal strain increased overall after TAVI (−13.2 [8.4–16.6] vs −15.1 [9.4–17.8], p=0.047).
Conclusions
LFLGAS is associated with impaired coronary microvascular function compared with NFHGAS. Combined invasive assessment of microvascular function and advanced non-invasive imaging contributed to define different AS phenotypes. CMD was associated with low-flow state, left atrial dysfunction and reduced cardiac efficiency in patients with AS.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Vascular
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Affiliation(s)
- R Scarsini
- Integrated University Hospital of Verona , Verona , Italy
| | - M Pighi
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - A Mainardi
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - L Portolan
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - C Mammone
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - G Benfari
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - P Springhetti
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - D Fanti
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - C Bergamini
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - D Tavella
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - G Pesarini
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - F L Ribichini
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
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22
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Castaldi G, Fezzi S, Widmann M, Lia M, Rizzetto F, Mammone C, Galli V, Piccolo S, Pazzi S, Pighi M, Pesarini G, Prati D, Scarsini R, Tavella D, Ribichini FL. Angiography derived index of microvascular resistance (IMR) in Takotsubo syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify CMD in patients with TTS through angiography-derived index of microcirculation (IMR) and evaluate its correlation with clinical presentation.
Methods
Coronary angiograms of 41 consecutive TTS patients were retrospectively offline analyzed to derive angiography-based indices of CMD. Three recently developed indices (NH-IMRangio, AngioIMR and A-IMR) were calculated and compared based on Quantitative Flow Reserve (QFR) analysis. CMD was defined as an IMRangio ≥25 units. The correlation between CMD and clinical presentation and outcomes was then assessed.
Results
Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. Angiography-derived IMR was higher in Left Anterior Descending artery (LAD) than Circumflex artery (LCX) and Right Coronary artery (RCA) with either NH-IMRangio (52.7 vs 35.3 vs 41.4), AngioIMR (47.2 vs 31.8 vs 37.3) or A-IMR (52.7 vs 36.1 vs 41.8). All patients presented CMD with angiography-derived IMR ≥25 in at least one territory with each formula. Angiography-derived IMR in LAD territory was significantly higher in patients presenting with LVEF impairment (≤40%) than in those with preserved ventricular global function (NH-IMRangio: 59.3 vs 46.3, p. value=0.030; AngioIMR: 52.9 vs 41.4, p-value=0.037; A-IMR: 59.2 vs 46.3, p-value=0.035).
Conclusion
CMD, assessed with angiography-derived IMR, is a common finding in TTS and it is inversely correlated with LV function. The available formulas have a substantial superimposable diagnostic performance in assessing coronary microvascular function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Fezzi
- University of Verona , Verona , Italy
| | - M Widmann
- University of Verona , Verona , Italy
| | - M Lia
- University of Verona , Verona , Italy
| | | | - C Mammone
- University of Verona , Verona , Italy
| | - V Galli
- University of Verona , Verona , Italy
| | - S Piccolo
- University of Verona , Verona , Italy
| | - S Pazzi
- University of Verona , Verona , Italy
| | - M Pighi
- University of Verona , Verona , Italy
| | | | - D Prati
- University of Verona , Verona , Italy
| | | | - D Tavella
- University of Verona , Verona , Italy
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23
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Fezzi S, Castaldi G, Widmann M, Marin F, Galli V, Ruzzarin A, Pesarini G, Scarsini R, Pighi M, Tavella D, Ribichini F. Spontaneous, independent, single-center renal denervation registry of a resistant hypertension multidisciplinary team. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Uncontrolled resistant hypertension (URH) is defined as PAS ≥140mmHg despite the adherence to at least 3 maximally tolerated doses of antihypertensive medications. In the adult population URH is a common condition with a prevalence that ranges between 10–15% and is related with poor prognosis and higher risk of major adverse cardiovascular events.
Renal sympathetic denervation (RDN) has recently proved efficacy in different hypertensive subsets of patients. However, patients with chronic kidney disease (CKD) IIIB-V stages (i.e. glomerular filtrate rate <45 ml/min) have been systematically excluded from randomized clinical trials (RCT).
Purpose
To evaluate the safety and the efficacy of RDN in a daily practice population of patients with URH on top of medical therapy, including patients with renal function impairment (GFR<45ml/min).
Methods
Consecutive unselected patients with URH undergoing RDN were enrolled. Indication of RDN was assessed in a multidisciplinary team involving cardiologist, nephrologist and hypertension specialists, after secondary forms of hypertension had been excluded. Efficacy was defined as the inter-individual change of office (OBP) and ambulatory blood pressure monitoring (ABPM) at 3, 6 and 12 months after RDN. Safety as the absence of any device-related major complication (BARC classification), end-stage renal disease, stroke, acute myocardial infarction and any cause of death within 1 month of the procedure. Safety and efficacy profile was assessed in patients with an estimated GFR below 45 ml/min/1.73 m2.
Results
Seventy-two patients underwent RDN for URH from 2012 to 2022. The population presented with multiple comorbidities and target organ damage: almost 50% were smoker, 43% diabetic, 33% PAD, 25% CAD and 60% CKD. Isolated systolic hypertension prevalence was 53%. The average number of antihypertensive medications at baseline was 5.3±1.1. Baseline OBP and ABPM were 158.8/86.6±23.4/15.3 mmHg and 151.4/87.6±18.8/14.2 mmHg, respectively. The vast majority of the procedures were performed with tetrapolar radio-frequency catheter (91.7%), with 37.3±14.3 number of ablations per procedure. The average amount of contrast medium was 72.1±38.1 ml. At 12-month follow-up a significant reduction of office and ambulatory systolic BP, respectively by −15.66±29.73 mmHg (P<0.01) and by −11.3±23.1mmHg (P<0.05), was noticed. BP reduction at 12-month follow-up among patients with eGFR <45 ml/min was similar to that obtained in patients with higher eGFR. No major complications were observed and renal function was stable up to 12 months, even in patients with lowest eGFR at baseline.
Conclusion(s)
RDN is safe and feasible in patients with URH on top of medical therapy, even in a high-risk CKD population with multiple comorbidities. Our experience underlines the central role of multidisciplinary team evaluation for the targeted management of uncontrolled resistant hypertension.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Fezzi
- Integrated University Hospital of Verona , Verona , Italy
| | - G Castaldi
- Integrated University Hospital of Verona , Verona , Italy
| | - M Widmann
- Integrated University Hospital of Verona , Verona , Italy
| | - F Marin
- Integrated University Hospital of Verona , Verona , Italy
| | - V Galli
- Integrated University Hospital of Verona , Verona , Italy
| | - A Ruzzarin
- Integrated University Hospital of Verona , Verona , Italy
| | - G Pesarini
- Integrated University Hospital of Verona , Verona , Italy
| | - R Scarsini
- Integrated University Hospital of Verona , Verona , Italy
| | - M Pighi
- Integrated University Hospital of Verona , Verona , Italy
| | - D Tavella
- Integrated University Hospital of Verona , Verona , Italy
| | - F Ribichini
- Integrated University Hospital of Verona , Verona , Italy
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24
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Picard F, Pighi M, Marquis-Gravel G, Labinaz M, Cohen EA, Tanguay JF. The Ongoing Saga of the Evolution of Percutaneous Coronary Intervention: From Balloon Angioplasty to Recent Innovations to Future Prospects. Can J Cardiol 2022; 38:S30-S41. [PMID: 35777682 DOI: 10.1016/j.cjca.2022.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/30/2022] Open
Abstract
The advances in percutaneous coronary intervention (PCI) have been, above all, dependent on the work of pioneers in surgery, radiology, and interventional cardiology. From Grüntzig's first balloon angioplasty, PCI has expanded through technology development, improved protocols, and dissemination of best-practice techniques. We can nowadays treat more complex lesions in higher-risk patients with favourable results. Guide wires, balloon types and profiles, debulking techniques such as atherectomy or lithotripsy, stents, and scaffolds all represent evolutions that have allowed us to tackle complex lesions such as an unprotected left main coronary artery, complex bifurcations, or chronic total occlusions. Best-practice PCI, including physiology assessment, imaging, and optimal lesion preparation are now the gold standard when performing PCI for sound indications, and new technologies such as intravascular lithotripsy for lesion preparation, or artificial intelligence, are innovations in the steps of 4 decades of pioneers to improve patient care in interventional cardiology. In the present review, major innovations in PCI since the first balloon angioplasty and also uncertainties and obstacles inherent to such medical advances are described.
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Affiliation(s)
- Fabien Picard
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France.
| | - Michele Pighi
- Department of Medicine, University of Verona, Verona, Italy
| | - Guillaume Marquis-Gravel
- Interventional Cardiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Marino Labinaz
- Ottawa University Heart Institute, Ottawa, Ontario, Canada
| | - Eric A Cohen
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jean-François Tanguay
- Interventional Cardiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
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25
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Marin F, Pighi M, Zucchelli F, Ruzzarin A, Russo G, Aurigemma C, Romagnoli E, Ferrero V, Piccoli A, Scarsini R, Pesarini G, Trani C, Burzotta F, Ribichini FL. Predictors and Prognostic Impact of Left Ventricular Ejection Fraction Recovery after Impella-Supported Percutaneous Coronary Interventions in Acute Myocardial Infarction. J Pers Med 2022; 12:jpm12101576. [PMID: 36294715 PMCID: PMC9604820 DOI: 10.3390/jpm12101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Aim: The aim of our study is to assess the predictors and the prognostic role of left ventricle ejection fraction (LVEF) recovery after Impella-supported percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction (AMI). Methods: This retrospective, observational study included patients admitted for AMI who underwent Impella-supported PCI in two Italian high-volume cardiac catheterization laboratories. Only patients who underwent an echocardiographic assessment of left ventricle ejection fraction (LVEF) before the procedure (acute LVEF) and during follow-up (follow-up LVEF) were included in the present analysis. Patients with a baseline LVEF ≥40% were excluded from the present analysis. LVEF recovery was calculated as the difference between follow-up LVEF and acute LVEF. A delta ≥5% was considered significant and was used to define the responder group. Results: From April 2007 to December 2020, 64 consecutive patients were included in our study. A total of 55 patients (86%) received hemodynamic support with Impella 2.5, and 9 patients (14%) with Impella CP. Median LVEF at follow-up was significantly higher compared to baseline (36% (30−42) vs. 30% (24−33), p < 0.001). Based on LVEF recovery, 37 patients (57.8%) were deemed responders. According to multivariate analysis, complete functional revascularization was an independent predictor of a significant EF recovery (OR: 0.159; 95% CI: 0.038−0.668; p = 0.012). At three-year follow-up, lack of LVEF recovery was the only predictor of mortality (HR: 5.315; 95% CI: 1.100−25.676; p = 0.038). Conclusions: Functional complete revascularization is an independent predictor of the recovery of LVEF in patients presenting with AMI who underwent Impella-supported PCI. The recovery of LV function is associated with improved prognosis and could be used to stratify the risk of future events at long-term follow-up.
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Affiliation(s)
- Federico Marin
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
- Correspondence:
| | - Federico Zucchelli
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Alessandro Ruzzarin
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Giulio Russo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Anna Piccoli
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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26
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Rubino F, Scarsini R, Piccoli A, San Biagio L, Tropea I, Pighi M, Prati D, Tavella D, Pesarini G, Benfari G, Onorati F, Gottin L, Faggian G, Ribichini FL. Comparative Prognostic Value of Parameters of Pulsatile Right Ventricular Afterload in Patients With Advanced Heart Failure Awaiting Heart Transplantation. Am J Cardiol 2022; 183:55-61. [PMID: 36109208 DOI: 10.1016/j.amjcard.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/18/2022] [Accepted: 08/06/2022] [Indexed: 11/01/2022]
Abstract
Right ventricular pulsatile afterload (RVPA) demonstrated a strong impact on survival of patients with advanced heart failure (HF) with reduced ejection fraction. The best prognostic parameter of RVPA is unknown. The aim of this work was to examine the prognostic relevance of pulmonary artery compliance (PAC), pulmonary artery elastance (PAE), and pulmonary artery pulsatile index (PAPi) in a consecutive cohort of patients with advanced HF evaluated for heart transplantation (HT). A total of 149 patients with end-stage HF underwent right-sided cardiac catheterization and were clinically followed up until death or any censoring events, including HT, left ventricular assist device, and hospitalization for acute HF. The primary endpoint occurred in 29 patients (19.5%) during a median follow-up time of 12 (interquartile range 3 to 34) months. This cohort presented a worse hemodynamic profile than event-free survivors. PAC <1.9 mL/mm Hg (hazard ratio 3, 95% confidence interval 1.3 to 6.0, p= 0.007) and PAE >0.9 mmHg/mL (hazard ratio 2.5, 95% confidence interval 1.1 to 5.2, p= 0.02) were associated with the adverse outcome. On the contrary, PAPi was not associated with the outcome. PAC demonstrated a superior predictive value for the composite adverse outcome compared with pulmonary vascular resistance (area under the curve comparison p= 0.019) and PAPi (p= 0.03) but similar compared with PAE (p= 0.19) and mean pulmonary arterial pressure (p= 0.51). PAC, but not PAE, showed incremental prognostic value compared with cardiac index (p= 0.02). In conclusion, hemodynamic indexes of RVPA are associated with worse survival in patients with end-stage HF. PAC and PAE demonstrated superior prognostic value compared with PAPi and pulmonary vascular resistance. Moreover, PAC showed incremental prognostic value compared with cardiac index in patients awaiting HT.
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Affiliation(s)
- Francesca Rubino
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
| | - Anna Piccoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Livio San Biagio
- Division of Cardiac Surgery, Department of Cardio-Thoracic Surgery, University of Verona, Verona, Italy
| | - Ilaria Tropea
- Division of Cardiac Surgery, Department of Cardio-Thoracic Surgery, University of Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Daniele Prati
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Department of Cardio-Thoracic Surgery, University of Verona, Verona, Italy
| | - Leonardo Gottin
- Department of Anesthesiology and Intensive care, University of Verona, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Cardio-Thoracic Surgery, University of Verona, Verona, Italy
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Leone PP, Regazzoli D, Mangieri A, Pagnesi M, Barbanti M, de Cruz H, Adamo M, Taramasso M, De Marco F, Giannini F, Ohno Y, Saia F, Ielasi A, Pighi M, Ribichini F, Maffeo D, Bedogni F, Kim WK, Maisano F, Tamburino C, Van Mieghem N, Colombo A, Reimers B, Latib A. TCT-323 Measured vs Predicted Effective Orifice Area-derived Prosthesis-Patient Mismatch and Clinical Outcomes in Small Aortic Annuli. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.378] [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: 11/28/2022]
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28
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Leone PP, Regazzoli D, Cannata F, Pagnesi M, Barbanti M, de Cruz H, Adamo M, Taramasso M, De Marco F, Mangieri A, Giannini F, Ohno Y, Saia F, Ielasi A, Pighi M, Ribichini F, Maffeo D, Stefanini G, Bedogni F, Kim WK, Maisano F, Tamburino C, Van Mieghem N, Colombo A, Reimers B, Latib A. TCT-500 Prosthesis–Patient Mismatch After Transcatheter Implantation of Contemporary Balloon-Expandable and Self-Expandable Valves in Small Aortic Annuli. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.590] [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: 10/14/2022]
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29
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Fezzi S, Pighi M, Alberto del Sole P, Mammone C, Scarsini R, Tavella D, Pesarini G, Ribichini F. TCT-57 Everolimus-Eluting Bioresorbable Vascular Scaffolds for Coronary Atherosclerosis Restoration Therapy: Insights on Long-Term Intracoronary Imaging and Physiologic Results of Bioresorption. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.069] [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: 11/25/2022]
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30
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Lunardi M, Venturi G, Del Sole PA, Ruzzarin A, Mainardi A, Pighi M, Pesarini G, Scarsini R, Tavella D, Gottin L, Ribichini FL. Optimal timing for percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation. Int J Cardiol 2022; 365:114-122. [PMID: 35870638 DOI: 10.1016/j.ijcard.2022.07.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 05/24/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The best timing to perform percutaneous coronary interventions (PCI) in patients undergoing TAVI is unknown. Most PCI are performed before TAVI, because of concerns about potential ischemic complications during valve implantation. In this study we aimed to compare short-and long-term outcomes of patients undergoing PCI before or after TAVI. METHODS Patients undergoing TAVI and PCI from 2010 to 2021 were analyzed. PCI was defined as high-risk when involving unprotected left main, proximal left anterior descending, proximal dominant right coronary artery or 3-vessel disease. The primary endpoint was the cumulative incidence of any TAVI procedural complication and in-hospital adverse events (VARC-3 criteria). RESULTS Out of 1162 patients, 144 underwent PCI, 68% after TAVI, 78.4% of which were at high-risk. The primary endpoint occurred in 28.4% of patients in PCI pre-TAVI group vs 21.4% in PCI post-TAVI group (p = 0.403) and in 34.4% vs 17.3% of patients respectively among high-risk patients (p = 0.075). A higher rate of stroke was observed in the PCI pre-TAVI group regardless of the PCI complexity (6.5% vs 0.0%, p = 0.031; 9.3% vs 0.0% p = 0.025 in the high-risk group). At 24 months, MACCE-free survival was lower in patients who underwent PCI before TAVI (84.4% vs 97.9%, adjusted HR 10.16, 95% CI 1.19-86.57, p = 0.019; and 84.4% vs 97.3%, adjusted HR 7.34 95% CI 0.78-62.28 p = 0.082 in the high-risk group). CONCLUSIONS PCI performed after TAVI does not expose patients to higher risks of peri-procedural hazards and provides a trend towards favourable clinical outcome at mid-to-long term.
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Affiliation(s)
- Mattia Lunardi
- Cardiology Division, Department of Medicine, University of Verona, Italy
| | - Gabriele Venturi
- Cardiology Division, Department of Medicine, University of Verona, Italy
| | | | | | - Andrea Mainardi
- Cardiology Division, Department of Medicine, University of Verona, Italy
| | - Michele Pighi
- Cardiology Division, Department of Medicine, University of Verona, Italy
| | - Gabriele Pesarini
- Cardiology Division, Department of Medicine, University of Verona, Italy
| | - Roberto Scarsini
- Cardiology Division, Department of Medicine, University of Verona, Italy
| | - Domenico Tavella
- Cardiology Division, Department of Medicine, University of Verona, Italy
| | - Leonardo Gottin
- Division of Cardio-Thoracic Anesthesiology and Intensive Care, Department of Surgery, University of Verona, Verona, Italy
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31
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Leone PP, Regazzoli D, Cannata F, Pagnesi M, Barbanti M, Teles R, Taramasso M, Mangieri A, Ohno Y, Saia F, Buono A, Ielasi A, Pighi M, Stefanini G, Ribichini F, Maffeo D, Bedogni F, Kim WK, Maisano F, Curello S, Tamburino C, Van Mieghem N, Colombo A, Reimers B, Latib A. Implantation of Contemporary Transcatheter Aortic Valves in Small Aortic Annuli: The International Multicenter TAVI-SMALL 2 Registry. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.226] [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: 11/16/2022]
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32
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Chiarito M, Sanz-Sanchez J, Pighi M, Cannata F, Rubbio AP, Munafò A, Cao D, Roccasalva F, Pini D, Pagnotta PA, Ettori F, Petronio AS, Tamburino C, Reimers B, Colombo A, Di Mario C, Grasso C, Mehran R, Godino C, Stefanini GG. Edge-to-edge percutaneous mitral repair for functional ischaemic and non-ischaemic mitral regurgitation: a systematic review and meta-analysis. ESC Heart Fail 2022; 9:3177-3187. [PMID: 35770326 DOI: 10.1002/ehf2.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 11/08/2022] Open
Abstract
AIM Randomized controlled trials comparing the use of the MitraClip device in addition to guideline directed medical therapy (GDMT) to GDMT alone in patients with secondary mitral regurgitation (MR) have shown conflicting results. However, if these differences could be due to the underlying MR aetiology is still unknown. Therefore, we aimed to evaluate if the effects of percutaneous edge-to-edge repair with MitraClip implantation could differ in patients with ischaemic (I-MR) and non-ischaemic mitral regurgitation (NI-MR). METHODS AND RESULTS PubMed, Embase, BioMed Central, and the Cochrane Central Register of Controlled Trials were searched for all studies including patients with secondary MR treated with the MitraClip device. Data were pooled using a random-effects model. Primary endpoint was the composite of all-cause death and heart failure-related hospitalization. Secondary endpoints were the single components of the primary endpoint, New York Heart Association functional Classes III and IV, and mitral valve re-intervention. Seven studies enrolling 2501 patients were included. Patients with I-MR compared with patients with NI-MR had a similar risk of the primary endpoint (odds ratio: 1.17; 95% confidence interval: 0.93 to 1.46; I2 : 0%). The risk of all-cause death was increased in patients with I-MR (odds ratio: 1.31; 95% confidence interval: 1.07 to 1.62; I2 : 0%), while no differences were observed between the two groups in terms of the other secondary endpoints. CONCLUSIONS The risk of mortality after MitraClip implantation is lower in patients with NI-MR than in those with I-MR. No absolute differences in the risk of heart failure related hospitalization were observed between groups.
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Affiliation(s)
- Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Jorge Sanz-Sanchez
- Hospital Universitari i Politecnic La Fe, Valencia, Spain.,Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Antonio Popolo Rubbio
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | - Andrea Munafò
- Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Fausto Roccasalva
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Daniela Pini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paolo A Pagnotta
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy.,Centro Cuore Columbus, GVM care and research, Milan, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Carmelo Grasso
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Cosmo Godino
- Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
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Castaldi G, Fezzi S, Widmann M, Mammone C, Rizzetto F, Lia M, Prati D, Pighi M, Pesarini G, Tavella D, Scarsini R, Ribichini F. P73 ANGIOGRAPHY–DERIVED INDEX OF MICROVASCULAR RESISTANCE (IMR–ANGIO) IN TAKOTSUBO SYNDROME. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify CMD in patients with TTS through non–invasive angio–derived index of microcirculation (IMRangio) and evaluate its correlation with clinical and instrumental presentation.
Methods
41 consecutive TTS patients were retrospectively analyzed. Three different formulas for compute Non–Hyperemic IMRangio (NH–IMRangio) derived by 3D–Quantitative Coronary Angiography (3D–QCA) and Quantitative Flow Reserve (QFR) analysis were used according to each fluidodynamic mathematical expression as reported by respective authors. CMD was defined as an IMRangio ≥ 25. The correlation between NH–IMRangio and clinical presentation and the comparation between the three formulas were provided.
Results
Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. NH–IMRangio was higher in Left Anterior Descending artery (LAD) than Circumflex artery (CX) and Right Coronary artery (RCA) with either NH–IMRangio 1 (52.7 vs 35.3 vs 41.4), NH–IMRangio 2 (47.2 vs 31.8 vs 37.3) or NH–IMRangio 3 (52.7 vs 36.1 vs 41.8). All patients presented CMD with NH–IMR angio ≥ 25 in at least one territory with each formula. NH–IMRangio in LAD territory was significantly higher in patients presenting with LVEF impairment (≤40%) than in those with preserved ventricular global function (NH–IMRangio LAD 1: 59.3 vs 46.3, p. value=0.030; NH–IMRangio LAD 2: 52.9 vs 41.4, p–value=0.037; NH–IMRangio LAD 3: 59.2 vs 46.3, p–value=0–035). Association between NH–IMRangio computed in LAD and LVEF showed a moderate correlation (NH–IMRangio 1: r = –0,3485, Rho = 0,1214, p = 0,0256; NH–IMRangio 2: r = –0,3513; Rho = 0,1234, p = 0,0256; NH–IMRangio 3: r = –0,3326, Rho = 0,1106, p = 0,0336). Finally, Bland–Altman plot analysis showed good agreement between NH–IMRangio 1 and 3, while NH–IMRangio 2 showed a consistent bias of –5 units against both NH–IMRangio 1 and NH–IMRangio 2 with increasing difference at higher absolute values.
Conclusion
CMD, assessed with NH–IMRangio, is a common finding in TTS and it is inversely correlate with LVEF dysfunction. The available formulas for NH–IMRangio computation have a substantial superimposable diagnostic performance in assessing CMD.
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34
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Mattesini A, Demola P, Parikh SA, Secco GG, Pighi M, Di Mario C. Material Selection. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch5] [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: 11/08/2022] Open
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Lunardi M, Pighi M, Banning A, Reimers B, Castriota F, Tomai F, Venturi G, Pesarini G, Scarsini R, Kotronias R, Regazzoli D, Maurina M, Nerla R, De Persio G, Ribichini FL. Vascular complications after transcatheter aortic valve implantation: treatment modalities and long-term clinical impact. Eur J Cardiothorac Surg 2022; 61:934-941. [DOI: 10.1093/ejcts/ezab499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/30/2021] [Accepted: 10/03/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Vascular complications (VC) are the most frequent drawback of transcatheter aortic valve implantation (TAVI), affecting up to 20% of overall procedures. Data on the treatment and their long-term impact are scarce. The goal of this study was to report on the incidence, management and impact on the long-term outcomes of VC following TAVI.
METHODS
This was a multicentric retrospective analysis of consecutive patients undergoing TAVI. The primary endpoint was freedom from major adverse cardiac and cerebrovascular events at long-term follow-up. Adverse events were evaluated according to Valve Academic Research Consortium-2 criteria.
RESULTS
A total of 2145 patients were included: VC occurred in 188 (8.8%); of which 180 were limited to the access site. Two-thirds of the VC were minor; 8% required surgical treatment; the remaining were repaired percutaneously. The major adverse cardiac and cerebrovascular events-free survival at 2 years was 83.0% for patients with VC and 86.7% for those without (P = 0.143), but 71.9% for patients with major compared to 89.0% in those with minor VC (P = 0.022). Major VC and diabetes mellitus independently predicted worse outcomes at 2 years. The major adverse cardiac and cerebrovascular events-free survival rate and the occurrence of vascular adverse events in the long term among patients with VC at the access site treated by endovascular techniques (covered stent implantation or angioplasty) were similar to those without VC (84.2% vs 86.7%; P = 0.635).
CONCLUSIONS
Major but not minor VC impact long-term survival after TAVI. Covered stents implanted to manage VC at the access site have no impact on the long-term clinical outcome of TAVI.
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Affiliation(s)
- Mattia Lunardi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Adrian Banning
- Cardiology Department, John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Bernhard Reimers
- Cardiovascular Department, Humanitas Clinical and Research Center, Rozzano-Milan, Italy
| | | | - Fabrizio Tomai
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
| | - Gabriele Venturi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
- Cardiology Department, John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Rafail Kotronias
- Cardiology Department, John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Damiano Regazzoli
- Cardiovascular Department, Humanitas Clinical and Research Center, Rozzano-Milan, Italy
| | - Matteo Maurina
- Cardiovascular Department, Humanitas Clinical and Research Center, Rozzano-Milan, Italy
| | - Roberto Nerla
- Cardiovascular Department, Humanitas-Gavazzeni, Bergamo, Italy
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Venturi G, Scarsini R, Pighi M, Kotronias RA, Piccoli A, Lunardi M, Del Sole P, Mainardi A, Gambaro A, Tavella D, De Maria GL, Kharbanda R, Pesarini G, Banning A, Ribichini F. Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI. Catheter Cardiovasc Interv 2022; 99:1925-1934. [PMID: 35312158 PMCID: PMC9546166 DOI: 10.1002/ccd.30156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/05/2022] [Indexed: 11/27/2022]
Abstract
The volume of contrast to creatinine clearance ratio (CV/CrCl) is a useful indicator of the risk of acute kidney injury (AKI) in patients undergoing percutaneous interventional procedures. Association between CV/CrCl and adverse outcome after transcatheter aortic valve implantation (TAVI) was suggested but it is not well established. A large retrospective multicenter cohort of 1381 patients treated with TAVI was analyzed to assess the association between CV/CrCl and the risk of AKI and mortality at 90 days and 1 year after TAVI. Patients receiving renal replacement therapy at the time of TAVI were excluded. CV/CrCl ≥ 2.2 was associated with the risk of AKI and 90 days mortality after TAVI after adjustment for age, sex, diabetes, baseline left ventricular function, baseline chronic kidney disease (CKD), previous myocardial infarction and peripheral vascular disease (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.09–1.22, p < 0.0001). Importantly, CV/CrCl was associated with the adverse outcome independently from the presence of baseline CKD (p for interaction = 0.22). CV/CrCl was independently associated with the individual components of the composite primary outcome including AKI (odds ratio: 1.18, 95% CI: 1.08–1.28, p < 0.0001) and 90 days mortality (HR: 1.90, 95% CI: 1.01–3.60, p = 0.047) after TAVI. AKI (HR: 1.94, 95% CI: 1.21–3.11, p = 0.006) but not CV/CrCl was associated with the risk of 1‐year mortality after TAVI. CV/CrCl is associated with excess renal damage and early mortality after TAVI. Procedural strategies to minimize the CV/CrCl during TAVI may improve early clinical outcomes in patients undergoing TAVI.
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Affiliation(s)
- Gabriele Venturi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | | | - Anna Piccoli
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Mattia Lunardi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Del Sole
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Mainardi
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Alessia Gambaro
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico Tavella
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | | | - Rajesh Kharbanda
- John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Gabriele Pesarini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
| | - Adrian Banning
- John Radcliffe Oxford University Hospital, NHS Trust, Oxford, UK
| | - Flavio Ribichini
- Cardiology Division, Department of Medicine, University of Verona, Verona, Italy
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Biscaglia S, Erriquez A, Serenelli M, D'Ascenzo F, De Ferrari G, Ariza Sole A, Sanchis J, Giannini F, Gallo F, Scala A, Menozzi A, Pighi M, Moreno R, Iannopollo G, Menozzi M, Guiducci V, Tebaldi M, Campo G. Complete versus culprit-only strategy in older MI patients with multivessel disease. Catheter Cardiovasc Interv 2022; 99:970-978. [PMID: 35170844 DOI: 10.1002/ccd.30075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 11/20/2021] [Accepted: 12/26/2021] [Indexed: 11/08/2022]
Abstract
AIMS The revascularization strategy to pursue in older myocardial infarction (MI) patients with multivessel disease (MVD) is currently unknown. For this reason, while waiting for the results of dedicated trials, we sought to compare a complete versus a culprit-only strategy in older MI patients by merging data from four registries. METHODS AND RESULTS The inclusion criteria for the target population of the present study were (i) age ≥ 75 years; (ii) MI (STE or NSTE); (iii) MVD; (iv) successful treatment of culprit lesion. Propensity scores (PS) were derived using logistic regression (backward stepwise selection, p < 0.2). The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular (CV) death, MI, and major bleeding. Multivariable adjustment included the PS and inverse probability of treatment weighting (IPTW). The Kaplan-Meier plots were weighted for IPT. Among 2087 patients included, 1362 (65%) received culprit-only treatment whereas 725 (35%) complete revascularization. The mean age was 81.5 years, while the mean follow-up was 419 ± 284 days. Seventy-four patients (10%) died in the complete group and 223 in the culprit-only one (16%). The adjusted cumulative 1-year mortality was 9.7% in the complete and 12.9% in the culprit-only group (adjusted HR: 0.67, 95% CI: 0.50-0.89). Complete revascularization was associated with lower incidence of CV death (adjusted HR: 0.68, 95% CI: 0.48-0.95) and MI (adjusted HR 0.67, 95% CI: 0.48-0.95). CONCLUSIONS Culprit-only is the default strategy in older MI patients with MVD. In our analysis, complete revascularization was associated with lower all-cause and CV mortality and with a lower MI rate.
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Affiliation(s)
- Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Ferrara, Italy
| | - Andrea Erriquez
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Ferrara, Italy
| | - Matteo Serenelli
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Ferrara, Italy
| | - Fabrizio D'Ascenzo
- Cardiology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gaetano De Ferrari
- Cardiology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Albert Ariza Sole
- Cardiology Department, Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Sanchis
- Cardiology Department, University Clinic Hospital of Valencia, INCLIVA, University of Valencia, CIBERCV, Valencia, Spain
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Francesco Gallo
- Interventional Cardiology, Ospedale dell'Angelo, Venezia, Venice, Italy
| | - Antonella Scala
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Ferrara, Italy
| | - Alberto Menozzi
- S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia, Liguria, Italy
| | - Michele Pighi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Raul Moreno
- Interventional Cardiology, University Hospital La Paz, Madrid, Spain
| | | | - Mila Menozzi
- Cardiovascular Department, Infermi Hospital, Rimini, Italy
| | - Vincenzo Guiducci
- Cardiology Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Ferrara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Ferrara, Italy
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Leone PP, Regazzoli D, Cannata F, Pagnesi M, Barbanti M, Teles R, Taramasso M, Mangieri A, Ohno Y, Saia F, Buono A, Ielasi A, Pighi M, Stefanini G, Ribichini F, Maffeo D, Bedogni F, Kim WK, Maisano F, Curello S, Tamburino C, Van Mieghem N, Colombo A, Reimers B, Latib A. CRT-700.31 Implantation of Contemporary Transcatheter Aortic Valves in Small Aortic Annuli: The International Multicenter TAVI-SMALL 2 Registry. JACC Cardiovasc Interv 2022. [DOI: 10.1016/j.jcin.2022.01.239] [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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39
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Scarsini R, Venturi G, Pighi M, Lunardi M, Kotronias R, Del Sole PA, Rubino F, Tavella D, Pesarini G, Banning A, Ribichini F. Incomplete functional revascularization is associated with adverse clinical outcomes after transcatheter aortic valve implantation. Cardiovascular Revascularization Medicine 2022; 42:47-52. [DOI: 10.1016/j.carrev.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 01/09/2023]
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40
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Fezzi S, Pesarini G, Mammone C, Flaim M, Castaldi G, Tavella D, Scarsini R, Ribichini F, Pighi M. 111 Extravalvular cardiac damage and renal function following TAVI for severe aortic stenosis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Acute kidney injury (AKI) represents a common complication following TAVI, that correlates strictly with in-hospital, short, and long-term mortality. Extra-valvular cardiac damage (EVCD) showed to affect long-term outcomes in patients with severe aortic stenosis (AS). We sought to determine the differences in the incidence of AKI and acute kidney recovery (AKR) among patients undergoing TAVI and their impact on clinical outcomes according to EVCD.
Methods and results
706 symptomatic severe AS patients were selected and retrospectively analysed. Based on echocardiography findings, patients were classified based on the degree of EVCD. AKI was defined as a relative increase at 24–72H in sCr concentration of at least 0.3 mg/dl, and was classified according to AKIN stages. AKR was defined either as an increase of GFR of 25% or a decrease in sCr of at least 0.3 mg/dl, both measured at 24–72H after the procedure. After dichotomized analysis, patients in EVCD stage 3–4 reported a significantly higher rate of AKI (27.4% vs. 11.3%; P < 0.001), significant AKI (5.3% vs. 1.5%; P < 0.010) and the need for continuous renal replacement therapy (CRRT) after TAVI (2.7% vs. 0.7%; P = 0.052), whereas a lower incidence of AKR was reported (11.6% vs. 6.2%; P = 0.087). At the multivariate model higher EVCD stage, lower GFR and the amount of contrast used were found to be independent predictors of AKI, while early stages of cardiac damage (HR: 0.420; 95% CI: 0.224–0.785; P = 0.007) and lower GFR were found to be independent predictors of AKR. In the overall population, at a median 24-months follow-up, after multivariate analysis AKI was associated with a higher incidence of all-cause mortality [HR: 2.636; 95% CI: (1.360–5.108); P = 0.004] and MACEs [HR: 2.122; 95% CI: (1.170–3.849); P = 0.013]. Notably, at the multivariate analysis, AKI significantly impacted on survival in patients in stages 3–4 [HR: 2.461; 95% CI: (1.017–6.067); P = 0.046], but not in patients in stages 0–2 [HR: 1.301; 95% CI: (0.380–4.457); P = 0.675], with an interaction that achieved statistical significance (p for interaction 0.006). AKR did not reduce adverse clinical outcomes [HR: 0.742; 95% CI: (0.339–1.623); P = 0.455 for all-cause mortality; HR: 0.701; 95% CI: (0.351–1.397); P = 0.312 for MACEs] but was associated with an improvement of renal function at 12 months.
Conclusions
AKI demonstrated to negatively impact on 24-month all-cause mortality only when occurring in advanced stages of EVCD, but not in early stages. Conversely, early EVCD was associated with a higher incidence of AKR, which not significantly improved clinical outcomes but was associated with an improvement of renal function at 12-months. The application of this staging system may provide an additional tool for the decision-making process in patients with severe AS. 111 Figure
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Venturi G, Scarsini R, Pighi M, Sole PAD, Mainardi A, Ribichini F. 374 Volume of contrast to creatinine clearance ratio predicts early mortality and AKI after TAVI. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
The volume of contrast to creatinine clearance ratio (CV/CrCl) is a useful indicator of the risk of acute kidney injury (AKI) in patients undergoing percutaneous interventional procedures. Association between CV/CrCl and adverse outcome after transcatheter aortic valve implantation (TAVI) was suggested but it is not well established.
Methods and results
A large retrospective multicentre cohort of 1381 patients treated with TAVI was analysed to assess the association between CV/CrCl and the risk of AKI and mortality at 90 days and one year after TAVI. Patients receiving renal replacement therapy at the time of TAVI were excluded. CV/CrCl was associated with the risk of AKI and 90 days mortality after TAVI after adjustment for age, sex, diabetes, baseline left ventricular function, baseline chronic kidney disease (CKD), previous myocardial infarction and peripheral vascular disease (HR: 1.16, 95% CI: 1.09–1.22, P < 0.0001). Importantly, CV/CrCl was associated with the adverse outcome independently from the presence of baseline CKD (p for interaction = 0.22). CV/CrCl was independently associated with the individual components of the composite primary outcome including AKI (OR: 1.18, 95% CI: 1.08–1.28, P < 0.0001) and 90 days mortality (HR: 1.90, 95% CI: 1.01–3.60, P = 0.047) after TAVI. AKI (HR: 1.94, 95% CI: 1.21–3.11, P = 0.006) but not CV/CrCl was associated with the risk of 1-year mortality after TAVI.
Conclusions
CV/CrCl is associated with excess renal damage and early mortality after TAVI. Procedural strategies to minimize the CV/CrCl during TAVI may improve early clinical outcomes in patients undergoing TAVI.
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Affiliation(s)
- Gabriele Venturi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Roberto Scarsini
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Michele Pighi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Paolo Alberto Del Sole
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Andrea Mainardi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Flavio Ribichini
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
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Rubino F, Capocci S, Portolan L, Gambaro A, Pighi M, Ribichini FL. 436 A peri-myocarditis unmasks an underlying hypertrophic cardiomyopathy. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.047] [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: 11/15/2022]
Abstract
Abstract
Methods and results
A 41-year-old black man complaining of severe oppressive chest pain radiated to the back presented to our accident & emergency department (A&E). His symptoms started few days before his hospital admission. Past medical history was remarkable for arterial hypertension in medical therapy and microdrepanocytosis. In A&E, the patient’s physical examination and vital signs were normal, he was normotensive, apyretic with normal oxygen saturation. The ECG showed ST elevation in anterior and lateral leads. Because of his history of arterial hypertension, and the severe chest pain irradiated to the back, an angio-CT was indicated at first. The CT ruled out acute aortic disease. Excluded the acute aortic disease, the patient underwent an urgent coronary angiography. No coronary stenosis was found. Therefore, the patient was admitted in cardiac intensive care unit. The blood test showed an elevation of high sensitive cardiac troponin T (cTnT peak 3093 ng/L) and inflammatory index (leukocytosis 13.65 109/l and protein C reactive peak 347 mg/L). An in-depth anamnestic collection revealed fever with respiratory symptoms about 2 weeks before. The echocardiography demonstrated left ventricular (LV) dysfunction with increased ventricular wall thickness and mild pericardial effusion. No LV outflow tract obstruction was found. A provisional diagnosis of peri-myocarditis was made. During hospitalization, anti-remodelling cardiac therapy was introduced and up titrated. To confirm the provisional diagnosis, a Gadolinium cardiac Magnetic Resonance (CMR) was performed, and it revealed myocardial oedema on basal anterior interventricular septum and multiple areas of late gadolinium enhancement with subepicardial pattern. Moreover, severe LV hypertrophy was confirmed (interventricular septum 19 mm, inferior wall 17 mm). This pattern was consistent to the diagnosis of peri-myocarditis on a hypertrophic cardiomyopathy (HCM). Main infectious causes of peri-myocarditis were investigated, but the results were inconclusive. Unfortunately, genetic test results are still not available. Patient was discharged with recovered LV systolic function and free of symptoms on optimal medical therapy; no ventricular arrhythmias was detected during hospitalization. HCM risk sudden cardiac death (SCD) was lower than 4%.
Conclusions
Peri-myocarditis can mimic symptoms of an acute coronary syndrome. Furthermore, the inflammation of cardiac muscle and the subsequent interstitial oedema may cause an increase in LV wall thickness. In this setting, the diagnosis of an underlying cardiomyopathy is challenging. This interesting and unusual case highlights the relevance of an accurate diagnostic work up to deliver good clinical practice. In particular, Gadolinium CMR is of paramount importance in this setting.
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Mora FD, Fezzi S, Porto MD, Pighi M, Ribichini F. 472 Coronary disease in ADPKD patient: a giant coronary aneurysm. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.021] [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
Autosomal dominant polycystic kidney disease (ADPKD) is a monogenic disorder driven by mutation of one of two genes: PKD1, which codifies polycystin-1, and PKD2, which codifies polycystin-2. The mutated proteins determine the formation of multiple renal cysts with a consequent decline in kidney function eventually leading to end-stage renal disease (ESRD). In the last decades the cardiovascular complications of ADPKD are emerging as the leading cause of death, but coronary artery disease (CAD) remains to be an uncommon complication.
Methods and results
A 60-year-old male patient affected by ADPKD, in dialysis treatment for ESRD, was admitted in 2020 to our hospital for invasive coronary angiography (ICA), checking eligibility for kidney transplantation. He had a previous history of hypertension and chronic ischaemic cardiomyopathy. ICA performed in 2017 for unstable angina assessed ectasiant coronary arteries with diffuse atherosclerotic disease (Figure 1), determining significant stenosis of the proximal left anterior descending artery and proximal circumflex artery, treated with percutaneous coronary intervention (PCI). In 2020 was so repeated ICA, that evidenced a good result of the previous PCI, but pointed out a severe progression of ectasiant disease, which led to formation of giant aneurysm of the proximal tract of the right coronary artery, assessed at 3.8 cm × 2.5 cm (Figure 2), fistulizing to the right atrium and determining significant flow limitation in the following part of the right coronary artery. The absence of any symptoms and the lack of evidence of ongoing heart dysfunction, led our team to indicate conservative management and angiography follow-up.
Conclusions
Cardiovascular disease is a major cause of morbidity and death in ADPKD, underlying a tendency towards accelerated atherosclerosis, but wide data about coronary involvement are still lacking. ADPKD patients seem to have an increased risk of developing coronary aneurisms, but either due to the expression of mutated proteins in arterial smooth cells, to the accelerated atherosclerotic disease or to the combination of both, is still controversial. Consequently, it is difficult to differentiate the underlying pathophysiology of aneurysm formation in an individual patient and to speculate whether ADPKD patients have an increased risk of developing coronary aneurysms independent of their accelerated atherosclerotic process.
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Affiliation(s)
| | - Simone Fezzi
- Azienda Ospedaliera Universitaria Integrata—Verona, Italy
| | | | - Michele Pighi
- Azienda Ospedaliera Universitaria Integrata—Verona, Italy
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Rubino F, Scarsini R, Piccoli A, Biagio LS, Tropea I, Onorati F, Faggian G, Pighi M, Tavella D, Mammone C, Ribichini F. 393 Long-term prognostic value of haemodynamic determinants of right ventricular pulsatile afterload in patients with advanced heart failure. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Right ventricular (RV) dysfunction demonstrated a strong impact on survival of patients with advanced heart failure with reduced ejection fraction (HFrEF). Increased RV afterload is associated with poor prognosis in patients with HF. To examine the prognostic relevance of RV pulsatile afterload parameters, in particular pulmonary artery compliance (PAC), elastance (PAE), and pulsatile index (PAPi) in a large cohort of patients with advanced HFrEF evaluated for heart transplantation (HT).
Methods and results
149 patients with HFrEF enlisted for HT were evaluated with right heart catheterization (RHT) and echocardiography and were followed until death or any censoring events including HT, left ventricular assist device (LVAD), and hospitalization for acute heart failure (HHF). Cox regression and ROC-curve analysis were used to test the prognostic value of RV pulsatile afterload determinants. During a mean observation time of 500 ± 424 days, the primary endpoint occurred in 29 (19.5%) patients. The mean age was 56.6 ± 10.1 years and 85.2% were male. The most frequent etiology of HF was ischaemic cardiomyopathy (52.3%). Mean LV ejection fraction was 25.7 ± 10.2%. Patients who met the primary endpoint were significantly older and with worse haemodynamic profile than event-free survivors. In particular, the primary endpoint occurred in patients with lower PAC (1.8 ± 0.8 vs. 2.7 ± 2.0, P = 0.01), higher mean pulmonary arterial pressure (mPAP) (33.5 ± 11.3 vs. 29.3 ± 11.0, P = 0.05), PVR (3.0 ± 1.6 vs. 2.6 ± 2.0, P = 0.09), and PEA (1.12 ± 0.5 vs. 0.98 ± 0.6, P = 0.04). A significant increased risk of adverse outcome was observed in patients with PAC <1.9 ml/mmHg (HR: 3, 95% CI: 1.3–6, P = 0.007), PEA > 0.9 mmHg/ml (HR: 2.5, 95% CI: 1.1–5.2, P = 0.02) and mPAP ≥25 mmHg (HR: 3.0, 95% CI: 1.0–7.5, P = 0.03). The predictive value of PAC was superior compared with PVR (AUC comparison, P = 0.019) and PAPi (P = 0.03). Conversely, PAC presented similar prognostic accuracy compared with mPAP (P = 0.51) and PEA (P = 0.19). Moreover, PAC demonstrated incremental prognostic value compared with the cardiac index (P = 0.02), whereas mPAP and PAE did not.
Conclusions
Impaired haemodynamic RV parameters are associated with worse survival in patients with advanced HFrEF. Pulsatile RV afterload indices should be considered in the evaluation of patients enlisted for HT. PAC demonstrated an independent prognostic value in this highly selected cohort of patients awaiting HT.
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Affiliation(s)
- Francesca Rubino
- Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - Anna Piccoli
- Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - Livio San Biagio
- Division of Cardiac Surgery, Department of Cardio-Thoracic Surgery, University of Verona, Italy
| | - Ilaria Tropea
- Division of Cardiac Surgery, Department of Cardio-Thoracic Surgery, University of Verona, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Department of Cardio-Thoracic Surgery, University of Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Cardio-Thoracic Surgery, University of Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - Concetta Mammone
- Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Italy
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Venturi G, Scarsini R, Pighi M, Ribichini F. 376 Incomplete functional revascularization is associated with adverse clinical outcomes after TAVI. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Whether incomplete functional revascularization has an impact on the clinical outcome of patients treated with transcatheter aortic valve implantation (TAVI) is still unknown. We aim to assess the prognostic value of residual functional Syntax score (rFSS) in a cohort of patients undergoing TAVI.
Methods and results
One-hundred-twenty-four patients (229 lesions) with severe aortic stenosis and coronary artery disease (CAD) underwent fractional flow reserve (FFR)-guided revascularization. The primary endpoint of the study was the composite of cardiac death, myocardial infarction and revascularization at last available follow-up after TAVI. Median Syntax score (SS) and Functional Syntax score (FSS) at baseline were 7 (range 5–12) and 0 (range 0–7) respectively. After revascularization or deferral according to FFR, residual SS (rSS) and rFSS were 5 (range 0–8) and 0 (range 0–0), respectively. At COX regression analysis, angiographic incomplete revascularization (rSS = 0) was not associated with the primary endpoint (HR: 1.26; 95% CI: 0.40; 3.95; P-value 0.698), whereas functional incomplete revascularization was associated with worse event-free survival at Follow-up after adjusting for clinical confounders (HR: 3.74, 95% CI: 1.02–13.75, P = 0.047).
Conclusions
Incomplete functional revascularization is associated with adverse clinical outcome after TAVI. rFSS may be regarded as a treatment goal for patients with CAD undergoing TAVI. Further studies are warranted to confirm our hypothesis. 376 Central FigureMACEs free survival analysis of patients stratified according to complete revascularization vs. incomplete revascularization assessed according to anatomy (residual SYNTAX score) (A) or physiology (residual functional SYNTAX score) (B).
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Affiliation(s)
- Gabriele Venturi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Roberto Scarsini
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Michele Pighi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Flavio Ribichini
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
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Portolan L, Minnucci I, Piccolo S, Pighi M, Ribichini F. 495 New-onset left ventricular dysfunction and critical coronary artery disease: an MRI can help—a clinical case. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Understanding the aetiology of heart failure is crucial for treatment. Gadolinium cardiac magnetic resonance (CMR) is a powerful technique to distinguish dilated cardiomyopathy (DCM) from left ventricular (LV) dysfunction related to coronary artery disease (CAD).
Methods and results
Clinical case: a 61 years old Caucasian woman with a history of hypertension and dyslipidaemia presented to the emergency department of our hospital with pulmonary oedema and hypertensive crisis, requiring non-invasive ventilatory support. She complained about shortness of breath and exertional angina for almost one year. On admission, the echocardiography showed severe LV systolic dysfunction and severe functional mitral regurgitation (FMR). Troponin levels were slightly increased, and NT-proBNP was 2809 pg/ml. Once obtained clinical stability, anti-remodelling cardiac therapy was introduced and up titrated. Due to the history of angina and the new-onset severe LV systolic dysfunction, coronary angiography was performed, showing critical stenosis of the left main (LM) and of the proximal tract of the left anterior descending artery (LAD). In deciding the best treatment pathway for the patient evaluate myocardial viability and characterize myocardial tissue was of paramount importance. Subsequently, a CMR confirmed severe LV systolic dysfunction and severe functional mitral regurgitation but demonstrated myocardial viability, with no late gadolinium enhancement.
Therefore the patient underwent surgical myocardial revascularization with triple coronary artery bypass grafts (left internal mammary artery-LAD, saphenous vein graft-obtuse marginal artery, saphenous vein graft-diagonal branch of LAD) and mitral valve repair (annuloplasty). The patient underwent a period of cardiac rehabilitation asymptomatic and in good clinical status. Three months later, echocardiography demonstrated an initial recovery of LV systolic dysfunction with signs of reverse cardiac remodelling and a good result of mitral valve repair. The patient is now on optimal medical therapy, free of symptoms and in good clinical and functional condition.
Conclusions
Cardiovascular magnetic resonance (CMR) is an excellent diagnostic tool in heart failure. This clinical case can be formative, confirming once again the importance of an accurate and complete diagnostic workup and a subsequent therapy of aetiology in heart failure.
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Affiliation(s)
| | - Ilaria Minnucci
- Azienda Ospedaliera, Universitaria Integrata di Verona, Italy
| | - Solange Piccolo
- Azienda Ospedaliera, Universitaria Integrata di Verona, Italy
| | - Michele Pighi
- Azienda Ospedaliera, Universitaria Integrata di Verona, Italy
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Castaldi G, Fezzi S, Widmann M, Mammone C, Rizzetto F, Lia M, Prati D, Pighi M, Pesarini G, Tavella D, Scarsini R, Ribichini F. 720 Angiography-derived index of microvascular resistance (IMR-angio) in Takotsubo syndrome. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an ‘adrenergic storm’ upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify coronary microvascular disfunction in patients with TTS using the recently developed angiography-derived index of microcirculation (IMRangio) and evaluate its correlation with clinical and instrumental presentation.
Methods and results
41 consecutive TTS patients were retrospectively analysed. Three different formulas for compute non-hyperemic IMRangio (NH-IMRangio) derived by 3D-Quantitative Coronary Angiography (3D-QCA) and Quantitative Flow Reserve (QFR) analysis were used according to each fluidodynamic mathematical expression as reported by respective authors. CMD was defined as an IMRangio ≥25. Moreover, correlation between NH-IMRangio and clinical presentation and a comparation between the three formulas were provided. Median age was 76 years, 85.7% were women and mean LVEF at first echocardiogram was 41.2%. All patients presented CMD with NH-IMRangio ≥25 in at least one territory. Mean NH-IMRangio was higher in Left Anterior Descending artery (LAD) than Circumflex artery (CX) and Right Coronary artery (RCA) with either Oxford-NH-IMRangio (52.7 ± 18.6 vs. 35.3 ± 13.6 vs. 41.4 ± 15.1, P-value < 0.001), Madrid-NH-IMRangio (47.2 ± 17.3 vs. 31.8 ± 12.2 vs. 37.3 ± 13.7, P-value <0.001) or Ferrara-NH-IMRangio (52.7 ± 19 vs. 36.1 ± 14.1 vs. 41.8 ± 16.1, P-value < 0.001). Furthermore, the mean values of NH-IMRangio were not significantly different using the different equations (OXFvsMAD P-value = 0.1930; OXFvsFER P-value = 0.9609; MADvsFER P-value = 0.2144). NH-IMRangio in LAD territory was significantly higher in pts presenting with LVEF impairment (≤40%) than pts with preserved ventricular global function (mean NH-IMRangio LAD 59.3 ± 18.1 vs. 46.3 ± 16, P-value = 0.030). NH-IMRangio assessed in LAD territory showed a trend towards linear association with LVEF (Figure 1). 720 Figure
Conclusions
CMD, assessed with NH-IMRangio, is a common finding in TTS and it is associated with LVEF dysfunction and LVEF recovery. The validated formulas for NH-IMRangio computation have a superimposable diagnostic performance and accuracy.
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Affiliation(s)
| | - Simone Fezzi
- Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | | | | | | | - Micaela Lia
- Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Daniele Prati
- Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Michele Pighi
- Azienda Ospedaliera Universitaria Integrata di Verona, Italy
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Scarsini R, Fezzi S, Pesarini G, Sole PAD, Mammone C, Marcoli M, Venturi G, Tavella D, Pighi M, Ribichini F. 256 Impact of physiologically diffuse vs. focal pattern of coronary disease on quantitative flow reserve diagnostic accuracy. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.017] [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
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) disagree in ∼20% of intermediate coronary lesions. The physiological pattern of disease has a significant influence on FFR-iFR discordance. However, if the pattern of disease (diffuse vs. focal) impacts on QFR accuracy and on its agreement with FFR and iFR remains unknown.
Methods and results
194 unselected patients with 224 intermediate coronary lesions were investigated with iFR, FFR and QFR. The physiological pattern of disease was independently assessed with iFR Scout pullback in all the cases by two expert interventional cardiologists who were blinded to the clinical presentation, patient characteristics, coronary angiography and QFR results. A predominantly physiologically focal pattern was observed in 81 (36.2%) lesions, whereas a predominantly physiologically diffuse was observed in 143 (63.8%) cases. QFR demonstrated a significant correlation (r = 0.581, P < 0.001) and a substantial agreement with iFR, both in diffuse (AUC = 0.798) and in focal (AUC = 0.812) pattern of disease. Disagreement between QFR and iFR was observed in 51 (22.8%) lesions, consisting of iFR+/QFR − (64.7%) and iFR−/QFR + (35.3%). Notably, the physiological pattern of disease was the only variable significantly associated with iFR/QFR disagreement. In particular, coronary lesions with iFR+/QFR− demonstrated a significantly higher prevalence of predominantly physiologically diffuse pattern of disease compared with the subgroup with iFR−/QFR + [81.3% (26 of 32) vs. 55.6% (10 of 18); P = 0.012]. QFR virtual pullback demonstrated an excellent agreement (83.9%) with iFR Scout pullback in classifying the physiological pattern of disease.
Conclusions
QFR has a good diagnostic accuracy in assessing myocardial ischemia independently of the pattern of coronary disease. However, the physiological pattern of disease has an influence on the QFR/IFR disagreement, which occurs in ∼20% of the cases. The QFR virtual pullback correctly defined the physiological pattern of disease in the majority of the cases using the iFR pullback as reference.
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Venturi G, Scarsini R, Pesarini G, Pighi M, Ribichini F. 363 Old but fashioned: IVUS and chromaflo guidance for definition of thrombosis mechanism. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.047] [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
Plaque rupture and plaque erosion are the main causes of coronary thrombosis. While the first one involves fibrous cap disruption, the second one is caused by loss of endothelial continuity. In selected cases with evidence of plaque erosion, antithrombotic therapy without stenting has been suggested as a possible option. OCT is considered the gold standard for definition of thrombosis mechanism and has recently been included in algorithms for evaluation and management of patients with ACS. Also, high definition IVUS was compared with OCT in defining plaque erosion showing promising results. However, the cost and the large amount of contrast medium needed for OCT performance make these diagnostic tools of scarce applicability in daily practice.
Methods and results
We herein describe the case of a young man acceding to the Cath Lab with the diagnosis of NSTEMI. After baseline angiography and IVUS confirmed presence of Thrombus (Figure 1A and B), thromboaspiration was successfully performed (Figure 1D). The definition of thrombosis mechanism, revealing plaque rupture, was then performed with IVUS and ChromaFlo devices (Figure 1C and E). Also, IVUS was used to optimize stent implantation.
Conclusions
Although requiring further confirmations, we believe that in selected cases IVUS and ChromaFlo could provide a more applicable first-line diagnostic tool to define thrombosis mechanism. 363 Figure 1Baseline angiographic and IVUS evaluation confirming presence of coronary thrombus (A, B). After successful performance of thromboaspiration (D), plaque rupture was revealed by IVUS and ChromaFlo (C).
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Affiliation(s)
- Gabriele Venturi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi Verona, Italy
| | - Roberto Scarsini
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi Verona, Italy
| | - Gabriele Pesarini
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi Verona, Italy
| | - Michele Pighi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi Verona, Italy
| | - Flavio Ribichini
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi Verona, Italy
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Venturi G, Lunardi M, Sole PAD, Pighi M, Scarsini R, Ribichini F. 377 Optimal timing for percutaneous coronary interventions in patients undergoing TAVI. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
PCI timing in patients undergoing TAVI is still controversial, with most cases treated before TAVI, because of concerns about potential ischaemic complications during valve replacement. This study aims to compare procedural and in-hospital outcomes in patients undergoing PCI before or after TAVI.
Methods and results
Patients undergoing TAVI and PCI from 2010 to 2021 at Verona University Hospital were included. High-risk PCI were defined when performed in unprotected left main, proximal left anterior descending, proximal dominant right coronary artery or in 3-vessel disease. The primary endpoint was the cumulative incidence of any TAVI procedural complication and in-hospital adverse events (VARC-3 criteria). 129/940 TAVI patients underwent PCI was performed before TAVI in 33.4% of cases. Most patients (76.4%) were at high-risk. The primary endpoint occurred in 30.2% PCI pre-TAVI vs. 23.3% post-TAVI (HR: 0.72; 95% CI: 0.26–2.86; P = 0.671); and in 37.9% vs. 18.5% respectively, among high-risk PCI (HR: 1.62; 95% CI: 0.86–3.76; P = 0.102). At 24 months, MACCE-free survival was comparable (PCI pre-TAVI 91.7% vs. post-TAVI 97.5%, HR: 0.88, 95% CI: 0.13–4.77, P = 0.765).
Conclusions
PCI performed after TAVI does not expose patients to higher risks of peri-procedural or long-term complications when compared with pre-TAVI procedures, even in presence of high-risk lesions. 377 FigureAn example of post-TAVI high risk PCI. Pre-TAVI coronary angiography showed ostial left main critical lesion (A). After Symetis Aortic valve deployment, balloon angioplasty and stent implantation were performed (B and C) with good final angiographic result (D).
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Affiliation(s)
- Gabriele Venturi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Mattia Lunardi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Paolo Alberto Del Sole
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Michele Pighi
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Roberto Scarsini
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
| | - Flavio Ribichini
- Dipartimento di Medicina, Reparto di Cardiologia, Università degli Studi di Verona, Italy
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