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Guo M, Diaz-Canestro C, Pugliese NR, Paneni F, Montero D. Lean body mass and the cardiorespiratory phenotype: An ethnic-specific relationship in Hans Chinese women and men. J Cachexia Sarcopenia Muscle 2024. [PMID: 38632694 DOI: 10.1002/jcsm.13464] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/27/2023] [Accepted: 01/14/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Lean body mass (LBM) and the functional capacity of cardiovascular (CV) and respiratory systems constitute a female-specific relationship in European-American individuals. Whether this recent finding be extrapolated to the world's largest ethnic group, that is, Hans Chinese (HC, a population characterized by low LBM), is unknown. METHODS Healthy HC adults (n = 144, 50% ♀) closely matched by sex, age and physical activity were included. Total and regional (leg, arm and trunk) LBM and body composition were measured via dual-energy X-ray absorptiometry. Cardiac structure, stiffness, central/peripheral haemodynamics and peak O2 consumption (VO2peak) were assessed via transthoracic echocardiography and pulmonary gas analyses at rest and during exercise up to peak effort. Regression analyses determined the sex-specific relationship of LBM with cardiac and aerobic phenotypes. RESULTS Total and regional LBM were lower and body fat percentage higher in women compared with men (P < 0.001). In both sexes, total LBM positively associated with left ventricular (LV) mass and peak volumes (r ≥ 0.33, P ≤ 0.005) and negatively with LV end-systolic and central arterial stiffness (r ≥ -0.34, P ≤ 0.004). Total LBM strongly associated with VO2peak (r ≥ 0.60, P < 0.001) and peak cardiac output (r ≥ 0.40, P < 0.001) in women and men. Among regional LBM, leg LBM prominently associated with the arterio-venous O2 difference at peak exercise in both sexes (r ≥ 0.43, P < 0.001). Adjustment by adiposity or CV risk factors did not modify the results. CONCLUSIONS LBM independently determines internal cardiac dimensions, ventricular mass, distensibility and the capacity to deliver and consume O2 in HC adults irrespective of sex.
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Affiliation(s)
- Meihan Guo
- Faculty of Medicine, Hong Kong University, Hong Kong
| | - Candela Diaz-Canestro
- Faculty of Medicine, Hong Kong University, Hong Kong
- Department of Medicine, School of Clinical Medicine, Hong Kong University, Hong Kong
| | | | - Francesco Paneni
- Center for Translational and Experimental Cardiology (CTEC), Zurich University Hospital, University of Zurich, Zurich, Switzerland
- University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Montero
- Faculty of Medicine, Hong Kong University, Hong Kong
- Department of Medicine, School of Clinical Medicine, Hong Kong University, Hong Kong
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Rastogi T, Gargani L, Pellicori P, Lamiral Z, Ambrosio G, Bayés-Genis A, Domingo M, Lupon J, Simonovic D, Pugliese NR, Ruocco G, Duarte K, Coiro S, Palazzuoli A, Girerd N. Prognostic implication of lung ultrasound in heart failure: pooled analysis of international cohorts. Eur Heart J Cardiovasc Imaging 2024:jeae099. [PMID: 38606932 DOI: 10.1093/ehjci/jeae099] [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: 02/09/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is often used to assess congestion in heart failure (HF). In this study, we assessed the prognostic role of LUS in HF patients at admission and hospital discharge, and in an out-patient setting and explored whether clinical factors (age, sex, left ventricular ejection fraction (LVEF) and atrial fibrillation) impact the prognostic value of LUS findings. Further, we assessed the incremental prognostic value of LUS on top of AHEAD and MAGGIC clinical risk scores. METHODS AND RESULTS We pooled data of patients hospitalized for HF or followed-up in out-patient clinics from international cohorts. We enrolled 1,947 patients, at admission (n=578), discharge (n=389) and in out-patient clinic (n=980). Total LUS B-line count was calculated for the 8-zone scanning protocol. The primary outcome was a composite of re-hospitalization for HF and all-cause death. Compared to those in the lower tertiles of B-lines, patients in the highest tertile were older, more likely to have signs of HF and higher NT-proBNP levels. A higher number of B-lines was associated with increased risk of primary outcome at discharge (Tertile3 vs Tertile1: adjustedHR= 5.74 (3.26- 10.12), p<0.0001) and in out-patients (Tertile3 vs Tertile1: adjustedHR= 2.66 (1.08- 6.54), p=0.033). Age and LVEF did not influence the prognostic capacity of LUS in different clinical settings. Adding B-line count to MAGGIC and AHEAD scores improved net reclassification significantly in all three clinical settings. CONCLUSION A higher number of B-lines in patients with HF was associated with increased risk of morbidity and mortality, regardless of the clinical setting.
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Affiliation(s)
- Tripti Rastogi
- Centre d'Investigation Clinique Pierre Drouin -INSERM- Unité mixte de recherche U1116 DCAC - CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, Nancy, France
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow
| | - Zohra Lamiral
- Centre d'Investigation Clinique Pierre Drouin -INSERM- Unité mixte de recherche U1116 DCAC - CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, Nancy, France
| | - Giuseppe Ambrosio
- Cardiology Department, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Antoni Bayés-Genis
- Heart Failure Clinic, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Autonomous University of Barcelona, Barcelona, CIBERCV, Spain
| | - Mar Domingo
- Heart Failure Clinic, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Autonomous University of Barcelona, Barcelona, CIBERCV, Spain
| | - Josep Lupon
- Heart Failure Clinic, Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Autonomous University of Barcelona, Barcelona, CIBERCV, Spain
| | - Dejan Simonovic
- Institute for Treatment and Rehabilitation 'Niška Banja', Clinic of Cardiology, University of Niš School of Medicine, Niš, Serbia
| | | | - Gaetano Ruocco
- Cardiology Division, Regina Montis Regalis Hospital, ASL CN-1, Mondovì, Cuneo, Italy
| | - Kevin Duarte
- Centre d'Investigation Clinique Pierre Drouin -INSERM- Unité mixte de recherche U1116 DCAC - CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, Nancy, France
| | - Stefano Coiro
- Cardiology Department, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department Le Scotte Hospital University of Siena, Siena, Italy
| | - Nicolas Girerd
- Centre d'Investigation Clinique Pierre Drouin -INSERM- Unité mixte de recherche U1116 DCAC - CHRU de Nancy, Institut lorrain du cœur et des vaisseaux Louis Mathieu, Nancy, France
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Gargani L, Pugliese NR, Mazzola M, Naeije R, Bossone E. Reply: Echocardiographic mPAP/CO Slope: Limitations and Strengths of a Noninvasive Tool for Assessing Exercise Pulmonary Hemodynamics. J Am Coll Cardiol 2024; 83:e143-e144. [PMID: 38569770 DOI: 10.1016/j.jacc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 04/05/2024]
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Hoedemakers S, Pugliese NR, Stassen J, Vanoppen A, Claessens J, Gojevic T, Bekhuis Y, Falter M, Moura Ferreira S, Dhont S, De Biase N, Del Punta L, Di Fiore V, De Carlo M, Giannini C, Colli A, Dulgheru RE, Geers J, Yilmaz A, Claessen G, Bertrand P, Droogmans S, Lancellotti P, Cosyns B, Verbrugge FH, Herbots L, Masi S, Verwerft J. mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis. Circulation 2024; 149:1172-1182. [PMID: 38410954 DOI: 10.1161/circulationaha.123.067130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L-1·min-1. A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown. METHODS In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm2 underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141). RESULTS One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48; P=0.036), indexed left atrial volume (OR per SD, 2.15; P=0.001), E/e' at rest (OR per SD, 1.61; P=0.012), mPAP/CO slope (OR per SD, 2.01; P=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; P=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; P=0.219). Peak Vo2 (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (P<0.001). These results were confirmed in the validation cohort. CONCLUSIONS In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo2 were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak Vo2 and mPAP/CO slope cumulatively improved risk stratification.
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Affiliation(s)
- Sarah Hoedemakers
- Departments of Cardiology (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.), Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.H., J.G., S.D., B.C., F.H.V.)
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.)
| | - Jan Stassen
- Departments of Cardiology (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.), Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
| | | | - Jade Claessens
- Department of Cardiothoracic Surgery (J.C., A.Y.), Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
| | - Tin Gojevic
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
| | - Youri Bekhuis
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Faculty of Medicine, KU Leuven, Belgium (A.V., Y.B., M.F.)
| | - Maarten Falter
- Departments of Cardiology (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.), Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Faculty of Medicine, KU Leuven, Belgium (A.V., Y.B., M.F.)
| | - Sara Moura Ferreira
- Departments of Cardiology (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.), Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
| | - Sebastiaan Dhont
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.H., J.G., S.D., B.C., F.H.V.)
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (S.D., P.B.)
- Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Jette, Belgium (S.D., B.C., F.H.V.)
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.)
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.)
| | - Valerio Di Fiore
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.)
| | - Marco De Carlo
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., C.G., A.C.)
| | - Cristina Giannini
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., C.G., A.C.)
| | - Andrea Colli
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., C.G., A.C.)
| | - Raluca Elena Dulgheru
- Department of Cardiology, University Hospital of Liège, GIGA Cardiovascular Sciences, Liège, Belgium (R.E.D., P.L.)
| | - Jolien Geers
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.H., J.G., S.D., B.C., F.H.V.)
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery (J.C., A.Y.), Jessa Hospital, Hasselt, Belgium
| | - Guido Claessen
- Departments of Cardiology (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.), Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
| | - Philippe Bertrand
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (S.D., P.B.)
| | - Steven Droogmans
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
| | - Patrizio Lancellotti
- Department of Cardiology, University Hospital of Liège, GIGA Cardiovascular Sciences, Liège, Belgium (R.E.D., P.L.)
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy (P.L.)
| | - Bernard Cosyns
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.H., J.G., S.D., B.C., F.H.V.)
- Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Jette, Belgium (S.D., B.C., F.H.V.)
| | - Frederik H Verbrugge
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.H., J.G., S.D., B.C., F.H.V.)
- Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Jette, Belgium (S.D., B.C., F.H.V.)
| | - Lieven Herbots
- Departments of Cardiology (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.), Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.)
| | - Jan Verwerft
- Departments of Cardiology (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.), Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
- Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.)
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Dini FL, Carluccio E, Ghio S, Pugliese NR, Galeotti G, Correale M, Beltrami M, Tocchetti CG, Mercurio V, Paolillo S, Palazzuoli A. Patient phenotype profiling using echocardiography and natriuretic peptides to personalise heart failure therapy. Heart Fail Rev 2024; 29:367-378. [PMID: 37728750 DOI: 10.1007/s10741-023-10340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
Heart failure (HF) is a progressive condition with a clinical picture resulting from reduced cardiac output (CO) and/or elevated left ventricular (LV) filling pressures (LVFP). The original Diamond-Forrester classification, based on haemodynamic data reflecting CO and pulmonary congestion, was introduced to grade severity, manage, and risk stratify advanced HF patients, providing evidence that survival progressively worsened for those classified as warm/dry, cold/dry, warm/wet, and cold/wet. Invasive haemodynamic evaluation in critically ill patients has been replaced by non-invasive haemodynamic phenotype profiling using echocardiography. Decreased CO is not infrequent among ambulatory HF patients with reduced ejection fraction, ranging from 23 to 45%. The Diamond-Forrester classification may be used in combination with the evaluation of natriuretic peptides (NPs) in ambulatory HF patients to pursue the goal of early identification of those at high risk of adverse events and personalise therapy to antagonise neurohormonal systems, reduce congestion, and preserve tissue/renal perfusion. The most benefit of the Guideline-directed medical treatment is to be expected in stable patients with the warm/dry profile, who more often respond with LV reverse remodelling, while more selective individualised treatments guided by echocardiography and NPs are necessary for patients with persisting congestion and/or tissue/renal hypoperfusion (cold/dry, warm/wet, and cold/wet phenotypes) to achieve stabilization and to avoid further neurohormonal activation, as a result of inappropriate use of vasodilating or negative chronotropic drugs, thus pursuing the therapeutic objectives. Therefore, tracking the haemodynamic status over time by clinical, imaging, and laboratory indicators helps implement therapy by individualising drug regimens and interventions according to patients' phenotypes even in an ambulatory setting.
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Affiliation(s)
- Frank L Dini
- Istituto Auxologico IRCCS, Centro Medico Sant'Agostino, Via Temperanza, 6, 20127, Milan, Italy.
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Stefano Ghio
- Cardiology Division, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | | | | | - Michele Correale
- Department of Cardiology, University Hospital Policlinico, Riuniti, Foggia, Italy
| | - Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Azienda USL Toscana Centro, Florence, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences (DISMET), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-thoracic and vascular Department, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy
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Nesti L, Pugliese NR, Santoni L, Armenia S, Chiriacò M, Sacchetta L, De Biase N, Del Punta L, Masi S, Tricò D, Natali A. Distinct effects of type 2 diabetes and obesity on cardiopulmonary performance. Diabetes Obes Metab 2024; 26:351-361. [PMID: 37828824 DOI: 10.1111/dom.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
AIM Effort intolerance is frequent in patients with overweight/obesity and/or type 2 diabetes (T2D) free from cardiac and respiratory disease. We sought to quantify the independent effects of T2D and body mass index (BMI) on cardiopulmonary capacity and gain insights on the possible pathophysiology by case-control and regression analyses. METHODS Patients at high/moderate cardiovascular risk, with or without T2D, underwent spirometry and combined echocardiography-cardiopulmonary exercise test as part of their clinical workup. Subjects with evidence of cardiopulmonary disease were excluded. The effects of T2D and obesity were estimated by multivariable models accounting for known/potential confounders and the major pathophysiological determinants of oxygen uptake at peak exercise (VO2peak ) normalized for fat-free mass (FFM). RESULTS In total, 109 patients with T2D and 97 controls were included in the analysis. The two groups had similar demographic and anthropometric characteristics except for higher BMI in T2D (28.6 ± 4.6 vs. 26.3 ± 4.4 kg/m2 , p = .0003) but comparable FFM. Patients with T2D achieved lower VO2peak than controls (18.5 ± 4.4 vs. 21.7 ± 8.3 ml/min/kg, p = .0006). Subclinical cardiovascular dysfunctions were observed in T2D: concentric left ventricular remodelling, autonomic dysfunction, systolic dysfunction and reduced systolic reserve. After accounting for confounders and major determinants of VO2peakFFM , T2D still displayed reduced VO2peak by 1.0 (-1.7/-0.3) ml/min/kgFFM , p = .0089, while the effect of BMI [-0.2 (-0.3/0.1) ml/min/kgFFM , p = .06 per unit increase], was largely explained by a combination of chronotropic incompetence, reduced peripheral oxygen extraction, impaired systolic reserve and ventilatory (in)efficiency. CONCLUSIONS T2D is an independent negative determinant of VO2peak whose effect is additive to other pathophysiological determinants of oxygen uptake, including BMI.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenza Santoni
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Armenia
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Chiriacò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Sacchetta
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicolò De Biase
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Masi
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Tricò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Heart Failure Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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7
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Gargani L, Bruni C, Todiere G, Pugliese NR, Bandini G, Bellando-Randone S, Guiducci S, D’Angelo G, Campochiaro C, De Luca G, Stagnaro C, Lombardi M, Dagna L, Pepe A, Allanore Y, Moggi-Pignone A, Matucci-Cerinic M. Digital Ulcers and Ventricular Arrhythmias as Red Flags to Predict Replacement Myocardial Fibrosis in Systemic Sclerosis. J Clin Med 2023; 13:89. [PMID: 38202095 PMCID: PMC10779804 DOI: 10.3390/jcm13010089] [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: 10/27/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Cardiac involvement in systemic sclerosis (SSc) affects the prognosis of the disease. Echocardiography is the first line imaging tool to detect cardiac involvement, but it is not able to routinely detect myocardial fibrosis. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is the gold standard for replacement myocardial fibrosis assessment, but its availability is currently limited. AIM We aimed to assess the clinical and instrumental parameters that would be useful for predicting the presence of LGE-CMR, to achieve a better selection of patients with SSc that could benefit from third-level CMR imaging. METHODS 344 SSc patients underwent a comprehensive echocardiogram and LGE-CMR on the same day; for 189 patients, a 24 h ECG Holter monitoring was available. RESULTS CMR showed non-junctional replacement myocardial fibrosis via LGE in 25.1% patients. A history of digital ulcers (OR 2.188; 95% C.I. 1.069-4.481) and ventricular arrhythmias at ECG Holter monitoring (OR 3.086; 95% C.I. 1.191-7.998) were independent predictors of replacement myocardial fibrosis. CONCLUSIONS CMR can detect patterns of clinical and subclinical cardiac involvement, which are frequent in SSc. A history of digital ulcers and evidence of ventricular arrhythmias at ECG Holter monitoring are red flags for the presence of replacement myocardial fibrosis in CMR. The association between digital ulcers and myocardial fibrosis suggests that a similar pathological substrate of abnormal vascular function may underlie peripheral vascular and cardiac complications.
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Affiliation(s)
- Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, 50121 Florence, Italy
| | - Giancarlo Todiere
- U.O.C. Risonanza Magnetica Specialistica, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy
| | | | - Giulia Bandini
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Florence, 50121 Florence, Italy
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, 50121 Florence, Italy
| | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, 50121 Florence, Italy
| | - Gennaro D’Angelo
- U.O.C. Risonanza Magnetica Specialistica, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Chiara Stagnaro
- Department of Rheumatology, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, Policlinico San Donato, 20097 Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, 35122 Padua, Italy
| | - Yannick Allanore
- French National Institute of Health and Medical Research (INSERM) U1016, Université de Paris, Hôpital Cochin, 75014 Paris, France
| | - Alberto Moggi-Pignone
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Florence, 50121 Florence, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
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8
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Gargani L, Pugliese NR, De Biase N, Mazzola M, Agoston G, Arcopinto M, Argiento P, Armstrong WF, Bandera F, Cademartiri F, Carbone A, Castaldo R, Citro R, Cocchia R, Codullo V, D'Alto M, D'Andrea A, Douschan P, Fabiani I, Ferrara F, Franzese M, Frumento P, Ghio S, Grünig E, Guazzi M, Kasprzak JD, Kolias T, Kovacs G, La Gerche A, Limogelli G, Marra AM, Matucci-Cerinic M, Mauro C, Moreo A, Pratali L, Ranieri B, Rega S, Rudski L, Saggar R, Salzano A, Serra W, Stanziola AA, Vannan MA, Voilliot D, Vriz O, Wierzbowska-Drabik K, Cittadini A, Naeije R, Bossone E. Exercise Stress Echocardiography of the Right Ventricle and Pulmonary Circulation. J Am Coll Cardiol 2023; 82:1973-1985. [PMID: 37968015 DOI: 10.1016/j.jacc.2023.09.807] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Exercise echocardiography is used for assessment of pulmonary circulation and right ventricular function, but limits of normal and disease-specific changes remain insufficiently established. OBJECTIVES The objective of this study was to explore the physiological vs pathologic response of the right ventricle and pulmonary circulation to exercise. METHODS A total of 2,228 subjects were enrolled: 375 healthy controls, 40 athletes, 516 patients with cardiovascular risk factors, 17 with pulmonary arterial hypertension, 872 with connective tissue diseases without overt pulmonary hypertension, 113 with left-sided heart disease, 30 with lung disease, and 265 with chronic exposure to high altitude. All subjects underwent resting and exercise echocardiography on a semirecumbent cycle ergometer. All-cause mortality was recorded at follow-up. RESULTS The 5th and 95th percentile of the mean pulmonary artery pressure-cardiac output relationships were 0.2 to 3.5 mm Hg.min/L in healthy subjects without cardiovascular risk factors, and were increased in all patient categories and in high altitude residents. The 5th and 95th percentile of the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio at rest were 0.7 to 2.0 mm/mm Hg at rest and 0.5 to 1.5 mm/mm Hg at peak exercise, and were decreased at rest and exercise in all disease categories and in high-altitude residents. An increased all-cause mortality was predicted by a resting tricuspid annular plane systolic excursion to systolic pulmonary artery pressure <0.7 mm/mm Hg and mean pulmonary artery pressure-cardiac output >5 mm Hg.min/L. CONCLUSIONS Exercise echocardiography of the pulmonary circulation and the right ventricle discloses prognostically relevant differences between healthy subjects, athletes, high-altitude residents, and patients with various cardio-respiratory conditions. (Right Heart International NETwork During Exercise in Different Clinical Conditions; NCT03041337).
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Affiliation(s)
- Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Mazzola
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Michele Arcopinto
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Paola Argiento
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli," Naples, Italy
| | - William F Armstrong
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Francesco Bandera
- Heart Failure and Rehabilitation Cardiology Unit, IRCCS MultiMedica, Sesto San Giovanni, Milano, Italy; Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | | | - Andreina Carbone
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli," Naples, Italy
| | | | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona," Salerno, Italy; Department of Vascular Pathophysiology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | - Veronica Codullo
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli," Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital Nocera Inferiore, Nocera Inferiore, Italy
| | | | - Iacopo Fabiani
- Department of Imaging, Fondazione Monasterio/CNR, Pisa, Italy
| | - Francesco Ferrara
- Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona," Salerno, Italy
| | | | - Paolo Frumento
- Department of Political Sciences, University of Pisa, Pisa, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ekkehard Grünig
- Center of Pulmonary Hypertension, Thoraxklinik Heidelberg at Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Guazzi
- University of Milano School of Medicine, Department of Biological Sciences, Milano, Italy; San Paolo Hospital, Cardiology Division, Milano, Italy
| | - Jaroslaw D Kasprzak
- Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Theodore Kolias
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Gabor Kovacs
- Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - André La Gerche
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Fitzroy, Vicotria, Australia
| | - Giuseppe Limogelli
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli," Naples, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Ciro Mauro
- Cardiology Division, "A. Cardarelli" Hospital, Naples, Italy
| | - Antonella Moreo
- A. De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenza Pratali
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Salvatore Rega
- Department of Public Health, University of Naples "Federico II," Naples, Italy
| | - Lawrence Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rajan Saggar
- Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | - Anna A Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II," Naples, Italy
| | - Mani A Vannan
- Piedmont Heart Institute, Marcus Heart Valve Center, Atlanta, Georgia, USA
| | - Damien Voilliot
- Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Karina Wierzbowska-Drabik
- Department of Internal Diseases and Clinical Pharmacology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University of Naples "Federico II," Naples, Italy
| | | | - Eduardo Bossone
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
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9
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Costantino S, Mengozzi A, Velagapudi S, Mohammed SA, Gorica E, Akhmedov A, Mongelli A, Pugliese NR, Masi S, Virdis A, Hülsmeier A, Matter CM, Hornemann T, Melina G, Ruschitzka F, Luscher TF, Paneni F. Treatment with recombinant Sirt1 rewires the cardiac lipidome and rescues diabetes-related metabolic cardiomyopathy. Cardiovasc Diabetol 2023; 22:312. [PMID: 37957697 PMCID: PMC10644415 DOI: 10.1186/s12933-023-02057-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Metabolic cardiomyopathy (MCM), characterized by intramyocardial lipid accumulation, drives the progression to heart failure with preserved ejection fraction (HFpEF). Although evidence suggests that the mammalian silent information regulator 1 (Sirt1) orchestrates myocardial lipid metabolism, it is unknown whether its exogenous administration could avoid MCM onset. We investigated whether chronic treatment with recombinant Sirt1 (rSirt1) could halt MCM progression. METHODS db/db mice, an established model of MCM, were supplemented with intraperitoneal rSirt1 or vehicle for 4 weeks and compared with their db/ + heterozygous littermates. At the end of treatment, cardiac function was assessed by cardiac ultrasound and left ventricular samples were collected and processed for molecular analysis. Transcriptional changes were evaluated using a custom PCR array. Lipidomic analysis was performed by mass spectrometry. H9c2 cardiomyocytes exposed to hyperglycaemia and treated with rSirt1 were used as in vitro model of MCM to investigate the ability of rSirt1 to directly target cardiomyocytes and modulate malondialdehyde levels and caspase 3 activity. Myocardial samples from diabetic and nondiabetic patients were analysed to explore Sirt1 expression levels and signaling pathways. RESULTS rSirt1 treatment restored cardiac Sirt1 levels and preserved cardiac performance by improving left ventricular ejection fraction, fractional shortening and diastolic function (E/A ratio). In left ventricular samples from rSirt1-treated db/db mice, rSirt1 modulated the cardiac lipidome: medium and long-chain triacylglycerols, long-chain triacylglycerols, and triacylglycerols containing only saturated fatty acids were reduced, while those containing docosahexaenoic acid were increased. Mechanistically, several genes involved in lipid trafficking, metabolism and inflammation, such as Cd36, Acox3, Pparg, Ncoa3, and Ppara were downregulated by rSirt1 both in vitro and in vivo. In humans, reduced cardiac expression levels of Sirt1 were associated with higher intramyocardial triacylglycerols and PPARG-related genes. CONCLUSIONS In the db/db mouse model of MCM, chronic exogenous rSirt1 supplementation rescued cardiac function. This was associated with a modulation of the myocardial lipidome and a downregulation of genes involved in lipid metabolism, trafficking, inflammation, and PPARG signaling. These findings were confirmed in the human diabetic myocardium. Treatments that increase Sirt1 levels may represent a promising strategy to prevent myocardial lipid abnormalities and MCM development.
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Affiliation(s)
- Sarah Costantino
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital and University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
- Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
| | - Alessandro Mengozzi
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital and University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Health Science Interdisciplinary Center, Sant'Anna School of Advanced Studies, Pisa, Italy
| | | | - Shafeeq Ahmed Mohammed
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital and University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Era Gorica
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital and University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Alexander Akhmedov
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Alessia Mongelli
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital and University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | | | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andreas Hülsmeier
- Institute for Clinical Chemistry, University Hospital and University of Zürich, Zurich, Switzerland
| | - Christian Matthias Matter
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital and University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
- Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
| | - Thorsten Hornemann
- Institute for Clinical Chemistry, University Hospital and University of Zürich, Zurich, Switzerland
| | - Giovanni Melina
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Frank Ruschitzka
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital and University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
- Department of Cardiology, Zurich University Hospital, Zurich, Switzerland
| | - Thomas Felix Luscher
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Royal Brompton and Harefield Hospitals and Imperial College, London, UK
| | - Francesco Paneni
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital and University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland.
- Department of Cardiology, Zurich University Hospital, Zurich, Switzerland.
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10
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De Biase N, Mazzola M, Del Punta L, Di Fiore V, De Carlo M, Giannini C, Costa G, Paneni F, Mengozzi A, Nesti L, Gargani L, Masi S, Pugliese NR. Haemodynamic and metabolic phenotyping of patients with aortic stenosis and preserved ejection fraction: A specific phenotype of heart failure with preserved ejection fraction? Eur J Heart Fail 2023; 25:1947-1958. [PMID: 37655676 DOI: 10.1002/ejhf.3018] [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: 06/10/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023] Open
Abstract
AIMS Degenerative aortic valve stenosis with preserved ejection fraction (ASpEF) and heart failure with preserved ejection fraction (HFpEF) display intriguing similarities. This study aimed to provide a non-invasive, comparative analysis of ASpEF versus HFpEF at rest and during exercise. METHODS AND RESULTS We prospectively enrolled 148 patients with HFpEF and 150 patients with degenerative moderate-to-severe ASpEF, together with 66 age- and sex-matched healthy controls. All subjects received a comprehensive evaluation at rest and 351/364 (96%) performed a combined cardiopulmonary exercise stress echocardiography test. Patients with ASpEF eligible for transcatheter aortic valve replacement (n = 125) also performed cardiac computed tomography (CT). HFpEF and ASpEF patients showed similar demographic distribution and biohumoral profiles. Most patients with ASpEF (134/150, 89%) had severe high-gradient aortic stenosis; 6/150 (4%) had normal-flow, low-gradient ASpEF, while 10/150 (7%) had low-flow, low-gradient ASpEF. Both patient groups displayed significantly lower peak oxygen consumption (VO2 ), peak cardiac output, and peak arteriovenous oxygen difference compared to controls (all p < 0.01). ASpEF patients showed several extravalvular abnormalities at rest and during exercise, similar to HFpEF (all p < 0.01 vs. controls). Epicardial adipose tissue (EAT) thickness was significantly greater in ASpEF than HFpEF and was inversely correlated with peak VO2 in all groups. In ASpEF, EAT was directly related to echocardiography-derived disease severity and CT-derived aortic valve calcium burden. CONCLUSION Functional capacity is similarly impaired in ASpEF and HFpEF due to both peripheral and central components. Further investigation is warranted to determine whether extravalvular alterations may affect disease progression and prognosis in ASpEF even after valve intervention, which could support the concept of ASpEF as a specific sub-phenotype of HFpEF.
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Affiliation(s)
- Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Matteo Mazzola
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Di Fiore
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco De Carlo
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Giannini
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giulia Costa
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesco Paneni
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lorenzo Nesti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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11
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Fabiani I, Pugliese NR, Pedrizzetti G, Tonti G, Castiglione V, Chubuchny V, Taddei C, Gimelli A, Del Punta L, Balletti A, Del Franco A, Masi S, Lombardi CM, Cameli M, Emdin M, Giannoni A. Haemodynamic forces predicting remodelling and outcome in patients with heart failure treated with sacubitril/valsartan. ESC Heart Fail 2023; 10:2927-2938. [PMID: 37461184 PMCID: PMC10567631 DOI: 10.1002/ehf2.14346] [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: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 10/13/2023] Open
Abstract
AIMS A novel tool for the evaluation of left ventricular (LV) systo-diastolic function through echo-derived haemodynamic forces (HDFs) has been recently proposed. The present study aimed to assess the predictive value of HDFs on (i) 6 month treatment response to sacubitril/valsartan in heart failure with reduced ejection fraction (HFrEF) patients and (ii) cardiovascular events. METHODS AND RESULTS Eighty-nine consecutive HFrEF patients [70% males, 65 ± 9 years, LV ejection fraction (LVEF) 27 ± 7%] initiating sacubitril/valsartan underwent clinical, laboratory, ultrasound and cardiopulmonary exercise testing evaluations. Patients experiencing no adverse events and showing ≥50% reduction in plasma N-terminal pro-B-type natriuretic peptide and/or ≥10% LVEF increase over 6 months were considered responders. Patients were followed up for the composite endpoint of HF-related hospitalisation, atrial fibrillation and cardiovascular death. Forty-five (51%) patients were responders. Among baseline variables, only HDF-derived whole cardiac cycle LV strength (wLVS) was higher in responders (4.4 ± 1.3 vs. 3.6 ± 1.2; p = 0.01). wLVS was also the only independent predictor of sacubitril/valsartan response at multivariable logistic regression analysis [odds ratio 1.36; 95% confidence interval (CI) 1.10-1.67], with good accuracy at receiver operating characteristic (ROC) analysis [optimal cutpoint: ≥3.7%; area under the curve (AUC) = 0.736]. During a 33 month (23-41) median follow-up, a wLVS increase after 6 months (ΔwLVS) showed a high discrimination ability at time-dependent ROC analysis (optimal cut-off: ≥0.5%; AUC = 0.811), stratified prognosis (log-rank p < 0.0001) and remained an independent predictor for the composite endpoint (hazard ratio 0.76; 95% CI 0.61-0.95; p < 0.01), after adjusting for clinical and instrumental variables. CONCLUSIONS HDF analysis predicts sacubitril/valsartan response and might optimise decision-making in HFrEF patients.
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Affiliation(s)
| | | | - Gianni Pedrizzetti
- Department of Engineering and ArchitectureUniversity of TriesteTriesteItaly
- Department of Biomedical EngineeringUniversity of CaliforniaIrvineCaliforniaUSA
| | - Giovanni Tonti
- Division of Cardiology‘G. D'Annunzio’ UniversityChietiItaly
| | - Vincenzo Castiglione
- Fondazione Toscana Gabriele MonasterioPisaItaly
- ‘Health Science’ Interdisciplinary Research CenterScuola Superiore Sant'AnnaPisaItaly
| | | | | | | | - Lavinia Del Punta
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Alessio Balletti
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | | | - Stefano Masi
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Carlo Mario Lombardi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Civil HospitalBresciaItaly
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Michele Emdin
- Fondazione Toscana Gabriele MonasterioPisaItaly
- ‘Health Science’ Interdisciplinary Research CenterScuola Superiore Sant'AnnaPisaItaly
| | - Alberto Giannoni
- Fondazione Toscana Gabriele MonasterioPisaItaly
- ‘Health Science’ Interdisciplinary Research CenterScuola Superiore Sant'AnnaPisaItaly
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12
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Del Punta L, De Biase N, Mazzola M, Filidei F, Balletti A, Armenia S, Di Fiore V, Buralli S, Galeotti GG, De Carlo M, Giannini C, Masi S, Pugliese NR. Bio-Humoral and Non-Invasive Haemodynamic Correlates of Renal Venous Flow Patterns across the Heart Failure Spectrum. Medicina (Kaunas) 2023; 59:1704. [PMID: 37893422 PMCID: PMC10608031 DOI: 10.3390/medicina59101704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
Background: We evaluated the bio-humoral and non-invasive haemodynamic correlates of renal congestion evaluated by Doppler renal venous flow (RVF) across the heart failure (HF) spectrum, from asymptomatic subjects with cardiovascular risk factors (Stage A) and structural heart disease (Stage B) to patients with clinically overt HF (Stage C). Methods: Ultrasound evaluation, including echocardiography, lung ultrasound and RVF, along with blood and urine sampling, was performed in 304 patients. Results: Continuous RVF was observed in 230 patients (76%), while discontinuous RVF (dRVF) was observed in 74 (24%): 39 patients had pulsatile RVF, 18 had biphasic RVF and 17 had monophasic RVF. Stage C HF was significantly more common among patients with dRVF. Monophasic RVF was associated with worse renal function and a higher urinary albumin-to-creatinine ratio (uACR). After adjusting for hypertension, diabetes mellitus, the presence of Stage C HF and serum creatinine levels, worsening RVF patterns were associated with higher NT-proBNP levels, worse right ventricular-arterial coupling, larger inferior vena cava and higher echo-derived pulmonary artery wedge pressure. This trend was confirmed when only patients with HF Stage C were analysed after adjusting for the left ventricle ejection fraction (LVEF). Conclusion: Abnormal RVF is common across the HF spectrum. Worsening RVF patterns are independently associated with increased congestion, worse non-invasive haemodynamics and impaired RV-arterial coupling. RVF evaluation could refine prognostic stratification across the HF spectrum, irrespective of LVEF.
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Affiliation(s)
- Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
| | - Matteo Mazzola
- Department of Pathology, Cardiology Division, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Francesco Filidei
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
| | - Alessio Balletti
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
| | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
| | - Valerio Di Fiore
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
| | - Simona Buralli
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
| | - Gian Giacomo Galeotti
- Department of Pathology, Cardiology Division, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Marco De Carlo
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (M.D.C.)
| | - Cristina Giannini
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy; (M.D.C.)
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy
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13
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Pugliese NR, Taddei S. Low-dose aspirin therapy for primary prevention of cardiovascular disease: where are we at? Eur J Prev Cardiol 2023; 30:1170-1171. [PMID: 37070422 DOI: 10.1093/eurjpc/zwad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
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14
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Maloberti A, Mengozzi A, Russo E, Cicero AFG, Angeli F, Agabiti Rosei E, Barbagallo CM, Bernardino B, Bombelli M, Cappelli F, Casiglia E, Cianci R, Ciccarelli M, Cirillo M, Cirillo P, Desideri G, D'Elia L, Dell'Oro R, Facchetti R, Ferri C, Galletti F, Giannattasio C, Gesualdo L, Iaccarino G, Lippa L, Mallamaci F, Masi S, Masulli M, Mazza A, Muiesan ML, Nazzaro P, Parati G, Palatini P, Pauletto P, Pontremoli R, Pugliese NR, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Virdis A, Grassi G, Borghi C. The Results of the URRAH (Uric Acid Right for Heart Health) Project: A Focus on Hyperuricemia in Relation to Cardiovascular and Kidney Disease and its Role in Metabolic Dysregulation. High Blood Press Cardiovasc Prev 2023; 30:411-425. [PMID: 37792253 PMCID: PMC10600296 DOI: 10.1007/s40292-023-00602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
The relationship between Serum Uric Acid (UA) and Cardiovascular (CV) diseases has already been extensively evaluated, and it was found to be an independent predictor of all-cause and cardiovascular mortality but also acute coronary syndrome, stroke and heart failure. Similarly, also many papers have been published on the association between UA and kidney function, while less is known on the role of UA in metabolic derangement and, particularly, in metabolic syndrome. Despite the substantial number of publications on the topic, there are still some elements of doubt: (1) the better cut-off to be used to refine CV risk (also called CV cut-off); (2) the needing for a correction of UA values for kidney function; and (3) the better definition of its role in metabolic syndrome: is UA simply a marker, a bystander or a key pathological element of metabolic dysregulation?. The Uric acid Right for heArt Health (URRAH) project was designed by the Working Group on uric acid and CV risk of the Italian Society of Hypertension to answer the first question. After the first papers that individuates specific cut-off for different CV disease, subsequent articles have been published responding to the other relevant questions. This review will summarise most of the results obtained so far from the URRAH research project.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich, University of Zurich, Schlieren, Switzerland
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Bruno Bernardino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Bombelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Internal Medicine, Pio XI Hospital of Desio, ASST Brianza, Desio, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Rosario Cianci
- Department of Translational and Precision Medicine, University of Rome La Sapienza, Rome, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Massimo Cirillo
- Department of Public Health, ''Federico II'' University of Naples, Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Raffaella Dell'Oro
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Rita Facchetti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, ''Federico II'' University of Naples, Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - Francesca Mallamaci
- Reggio Cal Unit, Clinical Epidemiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Masulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Gianfranco Parati
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Palatini
- Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Pauletto
- Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | | | - Fosca Quarti-Trevano
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | | | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, 06100, Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- IRCCS San Raffaele, Rome, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy
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15
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Del Punta L, De Biase N, Pugliese NR. Replay to 'Combined extracardiac ultrasound in heart failure: a step forward in congestion assessment' Letter regarding the article 'The incremental value of multi-organ assessment of congestion using ultrasound in outpatients with heart failure'. Eur Heart J Cardiovasc Imaging 2023; 24:e279-e280. [PMID: 37392476 DOI: 10.1093/ehjci/jead152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023] Open
Affiliation(s)
- Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy
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16
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Pugliese NR, Pellicori P, Filidei F, Del Punta L, De Biase N, Balletti A, Di Fiore V, Mengozzi A, Taddei S, Gargani L, Mullens W, Cleland JGF, Masi S. The incremental value of multi-organ assessment of congestion using ultrasound in outpatients with heart failure. Eur Heart J Cardiovasc Imaging 2023; 24:961-971. [PMID: 36595324 DOI: 10.1093/ehjci/jeac254] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 10/14/2022] [Accepted: 11/25/2022] [Indexed: 01/04/2023] Open
Abstract
AIMS We investigated the prevalence and clinical value of assessing multi-organ congestion by ultrasound in heart failure (HF) outpatients. METHODS AND RESULTS Ultrasound congestion was defined as inferior vena cava of ≥21 mm, highest tertile of lung B-lines, or discontinuous renal venous flow. Associations with clinical characteristics and prognosis were explored. We enrolled 310 HF patients [median age: 77 years, median NT-proBNP: 1037 ng/L, 51% with a left ventricular ejection fraction (LVEF) <50%], and 101 patients without HF. There were no clinical signs of congestion in 224 (72%) patients with HF, of whom 95 (42%) had at least one sign of congestion by ultrasound (P < 0.0001). HF patients with ≥2 ultrasound signs were older, and had greater neurohormonal activation, lower urinary sodium concentration, and larger left atria despite similar LVEF. During a median follow-up of 13 (interquartile range: 6-15) months, 77 patients (19%) died or were hospitalized for HF. HF patients without ultrasound evidence of congestion had a similar outcome to patients without HF [reference; hazard ratio (HR) 1.02, 95% confidence interval (CI) 0.86-1.35], while those with ≥2 ultrasound signs had the worst outcome (HR 26.7, 95% CI 12.4-63.6), even after adjusting for multiple clinical variables and NT-proBNP. Adding multi-organ assessment of congestion by ultrasound to a clinical model, including NT-proBNP, provided a net reclassification improvement of 28% (P = 0.03). CONCLUSION Simultaneous assessment of pulmonary, venous, and kidney congestion by ultrasound is feasible, fast, and identifies a high prevalence of sub-clinical congestion associated with poor outcomes.
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Affiliation(s)
- Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8QQ, UK
| | - Francesco Filidei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Alessio Balletti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Valerio Di Fiore
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
| | - Luna Gargani
- Department of Pathology, Cardiology Division, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8QQ, UK
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124, Pisa, Italy
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Holm H, Magnusson M, Jujić A, Pugliese NR, Bozec E, Lamiral Z, Huttin O, Zannad F, Rossignol P, Girerd N. Ventricular-arterial coupling (VAC) in a population-based cohort of middle-aged individuals: The STANISLAS cohort. Atherosclerosis 2023; 374:11-20. [PMID: 37159989 DOI: 10.1016/j.atherosclerosis.2023.04.010] [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: 01/17/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND AIMS Data exploring normal values of different ventricular-arterial coupling (VAC) parameters and their association with anthropometric and cardiovascular (CV) factors are scarce. We aim to report values of two different methods of VAC assessment according to age and sex and explore their association with CV factors within a large population-based cohort of middle-aged individuals. METHODS For 1333 (mean age 48 ± 14) individuals participating in the 4th visit of the STANISLAS cohort, VAC was assessed by two methods [1]: arterial elastance (Ea)/end-systolic elastance (Ees) and [2] Pulse wave velocity (PWV)/Global longitudinal strain (GLS). RESULTS The mean values of Ea/Ees and PWV/GLS were 1.06 ± 0.20 and 0.42 ± 0.12, respectively. The two methods of VAC assessment were poorly correlated (Pearson's correlation coefficient r = 0.14 (0.08; 0.19)). Increased PWV/GLS was associated with older age and a higher degree of cardiovascular risk factors (i.e., BMI, blood pressure, LDL, diabetes, hypertension) in the whole population as well as in the parent generation. In contrast, higher Ea/Ees were associated with decreasing age, and lower prevalence of risk factors in the whole cohort but neutrally associated with risk factors in the parent generation. CONCLUSIONS Higher PWV/GLS is significantly associated with CV factors regardless of age. In contrast, worse Ea/Ees is associated with a better CV risk profile when considering individuals aged 30 to 70 but neutrally associated with CV factors when considering only older patients. These results may suggest that PWV/GLS should preferably be used to explore VAC. In addition, age-individualized threshold of Ea/Ees should be used.
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Affiliation(s)
- H Holm
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
| | - M Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - A Jujić
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | | | - E Bozec
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Z Lamiral
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - O Huttin
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - F Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - P Rossignol
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - N Girerd
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques-1433, and Inserm, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
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18
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Wenzl FA, Mengozzi A, Mohammed SA, Pugliese NR, Mongelli A, Gorica E, Ambrosini S, Riederer P, Fischer P, Hinterberger M, Puspitasari Y, Lüscher TF, Camici GG, Matter CM, Fadini GP, Virdis A, Masi S, Ruschitzka F, Grünblatt E, Paneni F, Costantino S. Circulating Long Noncoding RNA Signatures Associate With Incident Diabetes in Older Adults: a Prospective Analysis From the VITA Cohort Study. Diabetes Care 2023; 46:1239-1244. [PMID: 37040472 DOI: 10.2337/dc23-0012] [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: 01/03/2023] [Accepted: 03/19/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE Long noncoding RNAs (lncRNAs) are involved in diabetogenesis in experimental models, yet their role in humans is unclear. We investigated whether circulating lncRNAs associate with incident type 2 diabetes in older adults. RESEARCH DESIGN AND METHODS A preselected panel of lncRNAs was measured in serum of individuals without diabetes (n = 296) from the Vienna Transdanube Aging study, a prospective community-based cohort study. Participants were followed up over 7.5 years. A second cohort of individuals with and without type 2 diabetes (n = 90) was used to validate our findings. RESULTS Four lncRNAs (ANRIL, MIAT, RNCR3, and PLUTO) were associated with incident type 2 diabetes and linked to hemoglobin A1c trajectories throughout the 7.5-year follow-up. Similar results (for MIAT and PLUTO also in combined analysis) were obtained in the validation cohort. CONCLUSIONS We found a set of circulating lncRNAs that independently portends incident type 2 diabetes in older adults years before disease onset.
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Affiliation(s)
- Florian A Wenzl
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Alessandro Mengozzi
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Scuola Superiore Sant'Anna, Pisa, Italy
| | - Shafeeq A Mohammed
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Alessia Mongelli
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Era Gorica
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Samuele Ambrosini
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Riederer
- Center of Mental Health, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Peter Fischer
- Department of Psychiatry, Medical Research Society Vienna D.C., Danube Hospital Vienna, Vienna, Austria
| | - Margareta Hinterberger
- Department of Psychiatry, Medical Research Society Vienna D.C., Danube Hospital Vienna, Vienna, Austria
| | | | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Royal Brompton and Harefield Hospitals and Imperial College, London, U.K
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Christian M Matter
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, London, U.K
| | - Frank Ruschitzka
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH, Zurich, Switzerland
| | - Francesco Paneni
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
- University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Sarah Costantino
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
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19
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Mandoli GE, Pastore MC, Giannoni A, Benfari G, Dini FL, Rosa G, Pugliese NR, Taddei C, Correale M, Brunetti ND, Mazzeo P, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, De Carli G, Degiovanni A, Patti G, Santoro C, Moderato L, Cicoira M, Canepa M, Malagoli A, Emdin M, Cameli M. Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry. ESC Heart Fail 2023; 10:846-857. [PMID: 36448244 PMCID: PMC10053272 DOI: 10.1002/ehf2.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS Sacubitril/valsartan has changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects on morbidity and mortality, partly mediated by left ventricular (LV) reverse remodelling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration. METHODS AND RESULTS Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included. Echocardiographic parameters including LV global longitudinal strain (GLS) and global peak atrial longitudinal strain by speckle tracking echocardiography were measured to find the predictors of LVRR [= LV end-systolic volume reduction ≥10% and ejection fraction (LVEF) improvement ≥10% at follow-up] at 6 month follow-up as the primary endpoint. Changes in symptoms [New York Heart Association (NYHA) class] and neurohormonal activations [N-terminal pro-brain natriuretic peptide (NT-proBNP)] were also evaluated as secondary endpoints; 341 patients (excluding patients with poor acoustic windows and missing data) were analysed (mean age: 65 ± 10 years; 18% female, median LVEF 30% [inter-quartile range: 25-34]). At 6 month follow-up, 82 (24%) patients showed early complete response (LVRR and LVEF ≥ 35%), 55 (16%) early incomplete response (LVRR and LVEF < 35%), and 204 (60%) no response (no LVRR and LVEF < 35%). Non-ischaemic aetiology, a lower left atrial volume index, and a higher GLS were all independent predictors of LVRR at multivariable logistic analysis (all P < 0.01). A baseline GLS < -9.3% was significantly associated with early response (area under the curve 0.75, P < 0.0001). Left atrial strain was the best predictor of positive changes in NYHA class and NT-proBNP (all P < 0.05). CONCLUSIONS Speckle tracking echocardiography parameters at baseline could be useful to predict LVRR and clinical response to sacubitril-valsartan and could be used as a guide for treatment in patients with HFrEF.
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Affiliation(s)
- Giulia Elena Mandoli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine DepartmentFondazione Toscana G. MonasterioPisaItaly
- Institute of Life SciencesScuola Superiore Sant'AnnaPisaItaly
| | - Giovanni Benfari
- Section of Cardiology, Department of MedicineUniversity of VeronaVeronaItaly
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical SpecialitiesUniversity of GenoaGenoaItaly
| | | | - Claudia Taddei
- Cardiology and Cardiovascular Medicine DepartmentFondazione Toscana G. MonasterioPisaItaly
| | - Michele Correale
- Cardiology DepartmentPoliclinico Riuniti University HospitalFoggiaItaly
| | | | - Pietro Mazzeo
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ HospitalUniversity of PerugiaPerugiaItaly
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ HospitalUniversity of PerugiaPerugiaItaly
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic DepartmentPolyclinic University HospitalBariItaly
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic DepartmentPolyclinic University HospitalBariItaly
| | - Rodolfo Citro
- Cardio‐Thoracic‐Vascular DepartmentUniversity Hospital San Giovanni di Dio e Ruggi d'AragonaSalernoItaly
| | - Michele Ciccarelli
- Department of Medicine, Surgery and DentistryUniversity of SalernoBaronissiItaly
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic SciencesFondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro CuoreRomeItaly
| | - Valentina Loria
- Department of Cardiovascular and Thoracic SciencesFondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro CuoreRomeItaly
| | - Giuseppe De Carli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular DiseasesMaggiore della Carità HospitalNovaraItaly
| | - Giuseppe Patti
- Department of Thoracic, Heart and Vascular DiseasesMaggiore della Carità HospitalNovaraItaly
- Department of Translational MedicineUniversity of Piemonte OrientaleNovaraItaly
| | - Ciro Santoro
- Department of Advanced Biomedical ScienceFederico II University HospitalNaplesItaly
| | - Luca Moderato
- Cardiology DepartmentOspedale Guglielmo da SalicetoPiacenzaItaly
| | | | - Marco Canepa
- Cardiovascular Disease UnitIRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular NetworkGenoaItaly
- Department of Internal MedicineUniversity of GenoaGenoaItaly
| | - Alessandro Malagoli
- Division of Cardiology, Nephro‐Cardiovascular Department, Baggiovara HospitalUniversity of Modena and Reggio EmiliaModenaItaly
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine DepartmentFondazione Toscana G. MonasterioPisaItaly
- Institute of Life SciencesScuola Superiore Sant'AnnaPisaItaly
| | - Matteo Cameli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
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20
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Pugliese NR, De Biase N, Del Punta L, Balletti A, Armenia S, Buralli S, Mengozzi A, Taddei S, Metra M, Pagnesi M, Borlaug BA, Williams B, Masi S. Deep phenotype characterization of hypertensive response to exercise: implications on functional capacity and prognosis across the heart failure spectrum. Eur J Heart Fail 2023; 25:497-509. [PMID: 36992634 DOI: 10.1002/ejhf.2827] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/31/2023] Open
Abstract
AIMS Limited evidence is available regarding the role of hypertensive response to exercise (HRE) in heart failure (HF). We evaluated the systolic blood pressure (SBP) to workload slope during exercise across the HF spectrum, investigating haemodynamic and prognostic correlates of HRE. METHODS AND RESULTS We prospectively enrolled 369 patients with HF Stage C (143 had preserved [HFpEF], and 226 reduced [HFrEF] ejection fraction), 201 subjects at risk of developing HF (HF Stages A-B), and 58 healthy controls. We performed a combined cardiopulmonary exercise stress echocardiography testing. We defined HRE as the highest sex-specific SBP/workload slope tertile in each HF stage. Median SBP/workload slope was 0.53 mmHg/W (interquartile range 0.36-0.72); the slope was 39% steeper in women than men (p < 0.0001). After adjusting for age and sex, SBP/workload slope in HFrEF (0.47, 0.30-0.63) was similar to controls (0.43, 0.35-0.57) but significantly lower than Stages A-B (0.61, 0.47-0.75) and HFpEF (0.63, 0.42-0.86). Patients with HRE showed significantly lower peak oxygen consumption and peripheral oxygen extraction. After a median follow-up of 16 months, HRE was independently associated with adverse outcomes (all-cause mortality and hospitalization for cardiovascular reasons: hazard ratio 2.05, 95% confidence interval 1.81-5.18), while rest and peak SBP were not. Kaplan-Meier analysis confirmed a worse survival probability in Stages A-B (p = 0.005) and HFpEF (p < 0.001), but not HFrEF. CONCLUSION A steeper SBP/workload slope is associated with impaired functional capacity across the HF spectrum and could be a more sensitive predictor of adverse events than absolute SBP values, mainly in patients in Stages A-B and HFpEF.
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Affiliation(s)
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessio Balletti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Buralli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, 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
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, and National Institute for Health Research University College London Biomedical Research Centre, London, UK
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, and National Institute for Health Research University College London Biomedical Research Centre, London, UK
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21
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Dini FL, Pestelli G, Pugliese NR, D'Agostino A, Pedrinelli R, Mele D. Combining echo-derived haemodynamic phenotypes and myocardial strain for risk stratification of chronic heart failure with reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2023; 24:483-491. [PMID: 35788645 DOI: 10.1093/ehjci/jeac127] [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: 10/25/2021] [Revised: 06/04/2022] [Accepted: 06/17/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Echocardiography has shown to categorize heart failure (HF) patients according to haemodynamic profiles. Whether left ventricular (LV) global longitudinal strain (LV-GLS) could integrate echo-derived haemodynamic profiles to risk stratify chronic HF patients is still unknown. METHODS AND RESULTS Chronic HF outpatients with LV ejection fraction (LV-EF) <50% (n = 351) and LV-GLS assessment were evaluated and divided according to four haemodynamic phenotypes based on LV stroke volume index (SVI), LV filling pressure (LVFP), and right ventricular (RV) function: normal output-normal LVFP (NO-NP), normal output-high LVFP (NO-HP), low output-no RV dysfunction (LO-NRVD), and low output-RV dysfunction (LO-RVD). RV function was defined using the tricuspid annular plane systolic excursion and RV free-wall longitudinal strain. The median follow-up duration was 3.3 years. The combination of all-cause mortality and HF hospitalization was the primary endpoint. Secondary endpoints were all-cause mortality and cardiovascular mortality. The prevalence of NO-NP, NO-HP, LO-NRVD, and LO-RVD were 38%, 22%, 30%, and 10%, respectively. The haemodynamic model independently predicted primary and secondary outcomes, with incremental prognostic information over LV-EF (all P-values <0.001 for C-statistics). When univariate Cox regression analysis was performed to assess the prognostic stratification capability of LV-GLS in different haemodynamic subgroups, we observed a reduction in LV-GLS hazard ratios from the NO-NP to the LO-RVD for every endpoint. CONCLUSION There was a continuum in LV-GLS impairment across the spectrum of haemodynamic phenotypes and its prognostic value resulted variable depending on the types of chronic HF patients. The highest prognostic information added by LV-GLS was in patients with normal SVI.
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Affiliation(s)
- Frank Lloyd Dini
- Cardiovascular Unit 1, Cardiac, Thoracic and Vascular Department, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Gabriele Pestelli
- Cardiology Unit, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy
- Cardiovascular Research Unit, Fondazione Sacco, 47121 Forlì, Italy
| | | | - Andreina D'Agostino
- Cardiovascular Unit 1, Cardiac, Thoracic and Vascular Department, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Roberto Pedrinelli
- Cardiovascular Unit 1, Cardiac, Thoracic and Vascular Department, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Donato Mele
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
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22
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Dini FL, Baldini U, Bytyçi I, Pugliese NR, Bajraktari G, Henein MY. Acute pericarditis as a major clinical manifestation of long COVID-19 syndrome. Int J Cardiol 2023; 374:129-134. [PMID: 36513284 PMCID: PMC9734068 DOI: 10.1016/j.ijcard.2022.12.019] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The long COVID-19 syndrome has been recently described and some reports have suggested that acute pericarditis represents important manifestation of long COVID-19 syndrome. The aim of this study was to identify the prevalence and clinical characteristics of patients with long COVID-19, presenting with acute pericarditis. METHODS We retrospectively included 180 patients (median age 47 years, 62% female) previously diagnosed with COVID-19, exhibiting persistence or new-onset symptoms ≥12 weeks from a negative naso-pharyngeal SARS CoV2 swamp test. The original diagnosis of COVID-19 infection was determined by a positive swab. All patients had undergone a thorough physical examination. Patients with suspected heart involvement were referred to a complete cardiovascular evaluation. Echocardiography was performed based on clinical need and diagnosis of acute pericarditis was achieved according to current guidelines. RESULTS Among the study population, shortness of breath/fatigue was reported in 52%, chest pain/discomfort in 34% and heart palpitations/arrhythmias in 37%. Diagnosis of acute pericarditis was made in 39 patients (22%). Mild-to-moderate pericardial effusion was reported in 12, while thickened and bright pericardial layers with small effusions (< 5 mm) with or without comet tails arising from the pericardium (pericardial B-lines) in 27. Heart palpitations/arrhythmias (OR:3.748, p = 0.0030), and autoimmune disease and allergic disorders (OR:4.147, p = 0.0073) were independently related to the diagnosis of acute pericarditis, with a borderline contribution of less likelihood of hospitalization during COVID-19 (OR: 0.100, p = 0.0512). CONCLUSION Our findings suggest a high prevalence of acute pericarditis in patients with long COVID-19 syndrome. Autoimmune and allergic disorders, and palpitations/arrhythmias were frequently associated with pericardial disease.
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Affiliation(s)
- Frank Lloyd Dini
- Centro Medico Sant'Agostino, Milano, Italy; University Clinical Centre of Kosova, Prishtina, Kosovo.
| | | | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; University Clinical Centre of Kosova, Prishtina, Kosovo
| | | | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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23
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Balletti A, De Biase N, Del Punta L, Filidei F, Armenia S, Masi F, Di Fiore V, Mazzola M, Bacca A, Dini FL, Taddei S, Masi S, Pugliese NR. Cardiometabolic Phenotyping in Heart Failure: Differences between Patients with Reduced vs. Preserved Ejection Fraction. Diagnostics (Basel) 2023; 13:diagnostics13040790. [PMID: 36832278 PMCID: PMC9955832 DOI: 10.3390/diagnostics13040790] [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: 01/16/2023] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
AIMS We explored multiple cardiometabolic patterns, including inflammatory and congestive pathways, in patients with heart failure (HF). METHODS AND RESULTS We enrolled 270 HF patients with reduced (<50%, HFrEF; n = 96) and preserved (≥50%, HFpEF; n = 174) ejection fraction. In HFpEF, glycated hemoglobin (Hb1Ac) seemed to be relevant in its relationship with inflammation as Hb1Ac positively correlated with high-sensitivity C-reactive protein (hs-CRP; Spearman's rank correlation coefficient ρ = 0.180, p < 0.05). In HFrEF, we found a correlation between Hb1Ac and norepinephrine (ρ = 0.207, p < 0.05). In HFpEF, we found a positive correlation between Hb1Ac and congestion expressed as pulmonary B lines (ρ = 0.187, p < 0.05); the inverse correlation, although not significant, was found in HFrEF between Hb1Ac and N-terminal pro-B-type natriuretic peptide (ρ = 0.079) and between Hb1Ac and B lines (ρ = -0.051). In HFrEF, we found a positive correlation between E/e' ratio and Hb1Ac (ρ = 0.203, p < 0.05) and a negative correlation between tricuspid annular systolic excursion (TAPSE)/echocardiographically measured systolic pulmonary artery pressure (sPAP) (TAPSE/sPAP ratio) (ρ = -0.205, p < 0.05) and Hb1Ac. In HFpEF, we found a negative correlation between TAPSE/sPAP ratio and uric acid (ρ = -0.216, p < 0.05). CONCLUSION In HF patients, HFpEF and HFrEF phenotypes are characterized by different cardiometabolic indices related to distinct inflammatory and congestive pathways. Patients with HFpEF showed an important relationship between inflammatory and cardiometabolic parameters. Conversely, in HFrEF, there is a significant relationship between congestion and inflammation, while cardiometabolism appears not to influence inflammation, instead affecting sympathetic hyperactivation.
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Affiliation(s)
- Alessio Balletti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francesco Filidei
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Filippo Masi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Valerio Di Fiore
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Matteo Mazzola
- Department of Pathology, Cardiology Division, University of Pisa, 56124 Pisa, Italy
| | - Alessandra Bacca
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | | | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Correspondence: ; Tel.: +39-050-992-409
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24
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Mengozzi A, Pugliese NR, Desideri G, Masi S, Angeli F, Barbagallo CM, Bombelli M, Cappelli F, Casiglia E, Cianci R, Ciccarelli M, Cicero AFG, Cirillo M, Cirillo P, Dell’Oro R, D’Elia L, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Grassi G, Iaccarino G, Lippa L, Mallamaci F, Maloberti A, Masulli M, Mazza A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Russo E, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C, Virdis A. Serum Uric Acid Predicts All-Cause and Cardiovascular Mortality Independently of Hypertriglyceridemia in Cardiometabolic Patients without Established CV Disease: A Sub-Analysis of the URic acid Right for heArt Health (URRAH) Study. Metabolites 2023; 13:metabo13020244. [PMID: 36837863 PMCID: PMC9959524 DOI: 10.3390/metabo13020244] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
High serum uric acid (SUA) and triglyceride (TG) levels might promote high-cardiovascular risk phenotypes across the cardiometabolic spectrum. However, SUA predictive power in the presence of normal and high TG levels has never been investigated. We included 8124 patients from the URic acid Right for heArt Health (URRAH) study cohort who were followed for over 20 years and had no established cardiovascular disease or uncontrolled metabolic disease. All-cause mortality (ACM) and cardiovascular mortality (CVM) were explored by the Kaplan-Meier estimator and Cox multivariable regression, adopting recently defined SUA cut-offs for ACM (≥4.7 mg/dL) and CVM (≥5.6 mg/dL). Exploratory analysis across cardiometabolic subgroups and a sensitivity analysis using SUA/serum creatinine were performed as validation. SUA predicted ACM (HR 1.25 [1.12-1.40], p < 0.001) and CVM (1.31 [1.11-1.74], p < 0.001) in the whole study population, and according to TG strata: ACM in normotriglyceridemia (HR 1.26 [1.12-1.43], p < 0.001) and hypertriglyceridemia (1.31 [1.02-1.68], p = 0.033), and CVM in normotriglyceridemia (HR 1.46 [1.23-1.73], p < 0.001) and hypertriglyceridemia (HR 1.31 [0.99-1.64], p = 0.060). Exploratory and sensitivity analyses confirmed our findings, suggesting a substantial role of SUA in normotriglyceridemia and hypertriglyceridemia. In conclusion, we report that SUA can predict ACM and CVM in cardiometabolic patients without established cardiovascular disease, independent of TG levels.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, 8952 Schlieren, Switzerland
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Correspondence: or or ; Tel.:+39-05-099-2558
| | | | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, 21100 Varese, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, 90100 Palermo, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Michele Ciccarelli
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80133 Naples, Italy
| | - Arrigo F. G. Cicero
- Department Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Heart-Chest-Vascular Department, IRCCS AOU of Bologna, 40126 Bologna, Italy
| | - Massimo Cirillo
- Department of Public Health, “Federico II” University of Naples, 80133 Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
| | - Raffaella Dell’Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Lanfranco D’Elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80133 Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), 67051 Avezzano, Italy
| | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, 89124 Reggio Calabria, Italy
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80133 Naples, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria Della Misericordia General Hospital, AULSS 5 Polesana, 45100 Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | - Pietro Nazzaro
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Neurosciences and Sense Organs, University of Bari Medical School, 70122 Bari, Italy
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
| | - Gianfranco Parati
- S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, 20126 Milan, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padova, Medicina Interna 1°, Ca’ Foncello University Hospital, 31100 Treviso, Italy
| | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, 06100 Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
| | | | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00185 Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa; IRCSS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00185 Rome, Italy
| | - Claudio Borghi
- Department Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Heart-Chest-Vascular Department, IRCCS AOU of Bologna, 40126 Bologna, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Pugliese NR, Pellicori P, Filidei F, De Biase N, Maffia P, Guzik TJ, Masi S, Taddei S, Cleland JGF. Inflammatory pathways in heart failure with preserved left ventricular ejection fraction: implications for future interventions. Cardiovasc Res 2023; 118:3536-3555. [PMID: 36004819 PMCID: PMC9897694 DOI: 10.1093/cvr/cvac133] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 02/07/2023] Open
Abstract
Many patients with symptoms and signs of heart failure have a left ventricular ejection fraction ≥50%, termed heart failure with preserved ejection fraction (HFpEF). HFpEF is a heterogeneous syndrome mainly affecting older people who have many other cardiac and non-cardiac conditions that often cast doubt on the origin of symptoms, such as breathlessness, or signs, such as peripheral oedema, rendering them neither sensitive nor specific to the diagnosis of HFpEF. Currently, management of HFpEF is mainly directed at controlling symptoms and treating comorbid conditions such as hypertension, atrial fibrillation, anaemia, and coronary artery disease. HFpEF is also characterized by a persistent increase in inflammatory biomarkers. Inflammation may be a key driver of the development and progression of HFpEF and many of its associated comorbidities. Detailed characterization of specific inflammatory pathways may provide insights into the pathophysiology of HFpEF and guide its future management. There is growing interest in novel therapies specifically designed to target deregulated inflammation in many therapeutic areas, including cardiovascular disease. However, large-scale clinical trials investigating the effectiveness of anti-inflammatory treatments in HFpEF are still lacking. In this manuscript, we review the role of inflammation in HFpEF and the possible implications for future trials.
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Affiliation(s)
| | - Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow G12 8QQ, UK
| | - Francesco Filidei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples 80138, Italy
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
- Department of Internal and Agricultural Medicine, Jagiellonian University, Collegium Medicum, Krakow 31-008, Poland
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56126, Italy
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow G12 8QQ, UK
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Pugliese NR, Masi S, Taddei S. Rethinking albuminuria as a marker to drive treatment in congestive heart failure. Eur Heart J 2023; 44:381-382. [PMID: 36369982 DOI: 10.1093/eurheartj/ehac612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126 Pisa, Italy
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27
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Nesti L, Pugliese NR, Chiriacò M, Trico D, Baldi S, Natali A. Epicardial adipose tissue thickness is associated with reduced peak oxygen consumption and systolic reserve in patients with type 2 diabetes and normal heart function. Diabetes Obes Metab 2023; 25:177-188. [PMID: 36066008 PMCID: PMC10087544 DOI: 10.1111/dom.14861] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 07/14/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
AIM To investigate the impact of epicardial adipose tissue (EAT) thickness on cardiopulmonary performance in patients with type 2 diabetes (T2D) and normal heart function. MATERIALS AND METHODS We analysed EAT thickness in subjects with T2D and normal biventricular systo-diastolic functions undergoing a maximal cardiopulmonary exercise test combined with stress echocardiography, speckle tracking and pulmonary function assessment, as well as serum N-terminal pro B-type natriuretic peptide (NT-proBNP). RESULTS In the 72 subjects enrolled, those with EAT thickness above the median (> 5 mm) showed higher body fat mass, smaller indexed left ventricular dimensions and marginally reduced diastolic function variables at rest. Higher EAT thickness was associated with lower peak oxygen uptake (VO2peak 17.1 ± 3.6 vs. 21.0 ± 5.7 ml/min/kg, P = .001), reduced systolic reserve (ΔS' 4.6 ± 1.6 vs. 5.8 ± 2.5 m/s, P = .02) and higher natriuretic peptides (NT-proBNP 64 [29-165] vs. 31 [26-139] pg/ml, P = .04), as well as chronotropic insufficiency and impaired heart rate recovery. Ventilatory variables and peripheral oxygen extraction were not different between groups. EAT was independently associated with VO2peak and linearly and negatively correlated with peak heart rate, heart rate recovery, workload, VO2 at the anaerobic threshold and at peak, and cardiac power output, and was directly correlated with natriuretic peptides. CONCLUSION Higher EAT thickness in T2D is associated with worse cardiopulmonary performance and multiple traits of subclinical cardiac systolic dysfunction.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Chiriacò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Trico
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Baldi
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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28
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Pugliese NR, Colli A, Falcetta G, Del Punta L, Puccinelli C, Fiocco A, Petronio AS, Taddei S, Masi S, Besola L. Flow dynamic assessment of native mitral valve, mitral valve repair and mitral valve replacement using vector flow mapping intracardiac flow dynamic in mitral valve regurgitation. Front Cardiovasc Med 2023; 10:1047244. [PMID: 37034321 PMCID: PMC10080047 DOI: 10.3389/fcvm.2023.1047244] [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: 09/17/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives The present study aims to assess and describe the intracardiac blood flow dynamic in patients with mitral regurgitation (MR), repaired mitral valves (MV) and mitral valve prostheses using vector flow mapping (VFM). Methods Patients with different MV pathologies and MV disease treatments were analysed. All patients underwent 2D transthoracic echocardiography, and images for flow visualization were acquired in VFM mode in an apical three-chamber view and four-chamber view. Vectors and vortices were qualitatively analyzed. Results thirty-two (32) patients underwent 2D transthoracic echocardiography (TTE) with VFM analysis. We evaluated intracardiac flow dynamics in 3 healthy subjects, 10 patients with MR (5 degenerative, 5 functional), 4 patients who underwent MV repair, 5 who underwent MV replacement (3 biological, 2 mechanical), 2 surgically implanted transcatheter heart valve (THV), 2 transcatheter edge-to-edge MV repair with MitraClip (TEER), 3 transcatheter MV replacement (TMVR) and 3 transapical off-pump MV repair with NeoChord implantation. Blood flow patterns are significantly altered in patients with MV disease and MV repair compared to control patients. MV repair is superior to replacement in restoring more physiologicalpatterns, while TMVR reproducesan intraventricular flowcloser to normal than surgical MVR and TEER. Conclusions Intracardiac flow patterns can be clearly defined using VFM. Restoration of a physiological blood flow pattern inside the LV directly depends on the procedure used to address MV disease.
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Affiliation(s)
| | - Andrea Colli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Correspondence: Andrea Colli
| | - Giosuè Falcetta
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlo Puccinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Fiocco
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Anna Sonia Petronio
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Besola
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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29
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Castiglione V, Fabiani I, Pugliese NR, Pedrizzetti G, Tonti G, Chubuchny V, Taddei C, Gimelli A, Del Punta L, Balletti A, Masi S, Cameli M, Emdin M, Giannoni A. 500 HEMODYNAMIC FORCES AS PREDICTORS OF CARDIAC REMODELING AND OUTCOME IN PATIENTS WTH HEART FAILURE WITH REDUCED EJECTION FRACTION TREATED WITH SACUBITRIL/VALSARTAN. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.439] [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
Aims
To evaluate the predictive value of echo-derived hemodynamic forces (HDF) compared to other echocardiographic, biohumoral and cardiopulmonary parameters on: a) angiotensin receptor-neprilysin inhibition (ARNI) response to 6-months treatment; b) cardiovascular events at follow-up.
Methods
Eighty-nine consecutive patients with heart failure with reduced ejection fraction (HFrEF) performed clinical, laboratory, ultrasound, and cardiopulmonary exercise testing. Patients experiencing no adverse events and showing ≥50% reduction in plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and/or ≥10% increase in left ventricle ejection fraction over 6 months were considered responders to ARNI. We conducted a clinical follow-up for the composite endpoint of HF-related hospitalization, new-onset atrial fibrillation and cardiovascular death.
Results
Out of 89 patients, 45 (51%) were ARNI-responders. Among several variables evaluated at baseline, only the whole cardiac cycle left ventricle strength (wLVS) calculated from HDF was found to be higher in responders (4.4±1.3 vs 3.6±1.2; p=0.01) and the only independent predictor of ARNI-response at multivariate logistic regression analysis (odds ratio 1.36; 95% confidence interval 1.10–1.67; p=0.004), with good accuracy at receiver operating characteristic (ROC) analysis (optimal cut-off ≥3.7%; area under the curve [AUC]=0.736, 0.607–0.840; p<0.0001). During a median follow-up of 33 months (interquartile range 23-41), 6-month wLVS increase (ΔwLVS) showed a high discrimination ability at time-dependent ROC analysis (optimal cut-off ≥0.5%; AUC=0.811, 0.69–0.90; p<0.0001), stratified prognosis (log-rank p<0.0001) and remained an independent prognostic predictor for the composite endpoint (hazard ratio 0.76, 0.61–0.95; p<0.01), after adjusting for all clinical, functional and conventional echocardiographic parameters (Figure).
Conclusions
HDF analysis helps in predicting ARNI-response and optimizing follow-up and medical/device decision-making in patients with HFrEF.
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Affiliation(s)
- Vincenzo Castiglione
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
| | | | | | - Gianni Pedrizzetti
- Department Of Engineering And Architecture, University Of Trieste - Trieste - Italy
- Department Of Biomedical Engineering, University Of California - Irvine - United States Of America
| | - Giovanni Tonti
- Cardiology Division, D’annunzio University - Chieti - Italy
| | | | | | | | - Lavinia Del Punta
- Department Of Clinical And Experimental Medicine, University Of Pisa - Pisa - Italy
| | - Alessio Balletti
- Department Of Clinical And Experimental Medicine, University Of Pisa - Pisa - Italy
| | - Stefano Masi
- Department Of Clinical And Experimental Medicine, University Of Pisa - Pisa - Italy
| | - Matteo Cameli
- Department Of Cardiovascular Diseases, University Of Siena - Siena - Italy
| | - Michele Emdin
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
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30
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De Biase N, Del Punta L, Pugliese NR. The dangerous liaison between epicardial adipose tissue and heart failure with preserved ejection fraction. Eur J Heart Fail 2022; 24:2261-2263. [PMID: 36377107 DOI: 10.1002/ejhf.2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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31
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Giannini C, Mazzola M, Pugliese NR, Petronio AS. Mitral valve stenosis in the current era: a changing landscape. J Cardiovasc Med (Hagerstown) 2022; 23:701-709. [PMID: 36219149 DOI: 10.2459/jcm.0000000000001384] [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: 11/05/2022]
Abstract
Mitral stenosis results from haemodynamic obstruction at the mitral valve level because of structural abnormalities of the valve apparatus, leading to increased resistance to the transmitral flow. Although rheumatic fever remains the predominant cause of mitral stenosis worldwide, other causes are increasingly relevant in the developed countries with degenerative mitral stenosis (DMS) because of mitral annulus calcification (MAC) becoming growingly prevalent in industrialized countries with higher life expectancy. Rheumatic mitral stenosis (RMS) and DMS display dramatic differences in pathophysiology, prognosis, and disease progression. Furthermore, to date, robust evidence regarding the management of DMS because of MAC is lacking. Nevertheless, new diagnostic techniques and catheter-based interventions are changing this landscape and paving the way to a significant reduction in DMS-related morbidity and mortality. Here we briefly review the current knowledge on the pathophysiology, diagnosis and treatment of DMS and RMS, underscoring the current diagnostic and therapeutic pathways, as well as persisting uncertainties and perspectives.
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Affiliation(s)
- Cristina Giannini
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana
| | - Matteo Mazzola
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana
| | | | - Anna Sonia Petronio
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana
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32
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Fabiani I, Pugliese NR, Castiglione V, Pedrizzetti G, Tonti G, Chubuchny V, Becherini F, Taddei C, Gimelli A, Del Punta L, Balletti A, Masi S, Cameli M, Emdin M, Giannoni A. Haemodynamic forces as predictors of cardiac remodelling and outcome in heart failure with reduced ejection fraction treated with sacubitril/valsartan. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Angiotensin receptor-neprilysin inhibitor (ARNI) is a cornerstone of treatment in heart failure (HF) with reduced ejection fraction (HFrEF), but its effectiveness shows interindividual differences.
Objectives
To evaluate the predictive value of echo-derived hemodynamic forces (HDF), together with other echocardiographic, biohumoral and cardiopulmonary parameters on a) response to ARNI after 6 months; b) adverse cardiovascular events at follow-up.
Methods
Eighty-nine consecutive HFrEF patients from two HF centers performed clinical evaluation, laboratory analyses, rest echocardiography and cardiopulmonary exercise testing. Response to ARNI at 6 months was considered in patients without HF admissions, death, or urgent heart transplant and with a ≥50% reduction in NT-proBNP levels and/or ≥10% increase in left ventricle ejection fraction. After 6 months, patients were followed up for a composite endpoint of cardiovascular death, HF-related hospitalization and new-onset atrial fibrillation.
Results
Response to ARNI was documented in 45/89 (51%) of patients. At baseline, responders and non-responders were paired in clinical assessment, conventional echocardiography, functional status and therapy. At multivariate logistic regression analysis, HDF-derived whole cardiac cycle left ventricle strength (wLVS) was the only independent predictor of ARNI response at 6 months (odds ratio 1.36, 95% confidence interval 1.10–1.67; p=0.004). A wLVS ≥3.7% showed a good accuracy in predicting ARNI response (AUC = 0.736, 0.607–0.840; p<0.0001). During a median of 33 (IQR 23–41) months, wLVS increase from baseline to 6-month (ΔwLVS) showed a high discrimination ability at time-dependent ROC analysis (optimal cut-off: ≤0.5%; AUC=0.811, 0.69–0.90; p<0.0001), stratified prognosis at Kaplan-Meier analysis (log-rank p<0.0001), and remained an independent prognostic predictor of the composite endpoint (hazard ratio 0.76, 0.61–0.95; p<0.01) even after adjusting for clinical, functional and conventional echocardiographic parameters.
Conclusions
HDF analysis may help predict ARNI response and optimize follow-up and medical/device strategies in patients with HfrEF.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Affiliation(s)
- I Fabiani
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - N R Pugliese
- University of Pisa, Department of Clinical and Experimental Medicine , Pisa , Italy
| | | | - G Pedrizzetti
- University of Trieste, Dipartimento di Ingegneria e Architettura , Trieste , Italy
| | - G Tonti
- G. d Annunzio University , Chieti , Italy
| | - V Chubuchny
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - F Becherini
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Taddei
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - A Gimelli
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - L Del Punta
- University of Pisa, Department of Clinical and Experimental Medicine , Pisa , Italy
| | - A Balletti
- University of Pisa, Department of Clinical and Experimental Medicine , Pisa , Italy
| | - S Masi
- University of Pisa, Department of Clinical and Experimental Medicine , Pisa , Italy
| | - M Cameli
- University of Siena, Department of Cardiovascular Diseases , Siena , Italy
| | - M Emdin
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - A Giannoni
- Sant'Anna School of Advanced Studies , Pisa , Italy
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Pugliese NR, Balletti A, Armenia S, De Biase N, Faita F, Mengozzi A, Paneni F, Ruschitzka F, Virdis A, Ghiadoni L, Taddei S, Williams B, Antonini-Canterin F, Masi S. The impact of ventricular-arterial coupling on aerobic capacity across the heart failure spectrum. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.750] [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
Ventricular-arterial coupling (VAC) can be evaluated as the ratio between arterial stiffness (pulse wave velocity, PWV) and myocardial deformation (global longitudinal strain, GLS).
Objectives
To evaluate VAC across the spectrum of heart failure (HF).
Methods
We introduced a Doppler-derived, single-beat technique to estimate aortic arch PWV (aa-PWV) in addition to tonometry-derived carotid-femoral PWV (cf-PWV). We measured PWVs and 3D-GLS in 155 healthy controls, 75 subjects at risk of developing HF (American College of Cardiology/American Heart Association Stage A-B) and 236 patients in HF Stage C with preserved (HFpEF, n=104) or reduced ejection fraction (HFrEF, n=132). We evaluated peak oxygen consumption (VO2) and peripheral extraction (AVO2diff) using combined cardiopulmonary-echocardiography exercise stress.
Results
aa-PWV was obtainable in all subjects and significantly lower than cf-PWV in all subgroups (p<0.01). PWVs were directly related and increased with age (all p<0.0001). cf-PWV/3D-GLS was similarly compromised in HFrEF (1.08±0.36) and HFpEF (1.05±0.22), while aa-PWV/3D-GLS was more impaired in HFpEF (0.69±0.11) than HFrEF (0.60±0.15; p<0.01). Stage A-B had values of cf-PWV/3D-GLS and aa-PWV/3D-GLS (0.66±0.25 and 0.47±0.12) higher than controls (0.47±0.10 and 0.40±0.10) but lower than Stage C (all p<0.01). Peak AVO2diff was inversely related with cf-PWV/3D-GLS and aa-PWV/3D-GLS (all p<0.01). cf-PWV/3D-GLS and aa-PWV/3D-GLS independently predicted peak VO2 in the overall population (adjusted R2=0.32 and 0.35; all p<0.0001) but only aa-PWV/3D-GLS was independently associated with flow reserve during exercise (R2=0.51; p<0.0001).
Conclusion
Abnormal VAC is directly correlated with greater severity of HF and worse functional capacity. HFpEF shows a worse VAC than HFrEF when expressed by aa-PWV/3D-GLS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N R Pugliese
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - A Balletti
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - S Armenia
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - F Faita
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - A Mengozzi
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - F Paneni
- University Heart Center , Zurich , Switzerland
| | | | - A Virdis
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - L Ghiadoni
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
| | - B Williams
- University College London , London , United Kingdom
| | | | - S Masi
- Azienda Ospedaliero Universitaria Pisana , Pisa , Italy
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Nesti L, Pugliese NR, Sciuto P, Trico D, Dardano A, Baldi S, Pinnola S, Fabiani I, Di Bello V, Natali A. Effect of empagliflozin on left ventricular contractility and peak oxygen uptake in subjects with type 2 diabetes without heart disease: results of the EMPA-HEART trial. Cardiovasc Diabetol 2022; 21:181. [PMID: 36096863 PMCID: PMC9467417 DOI: 10.1186/s12933-022-01618-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 06/06/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background The mechanism through which sodium-glucose cotransporter 2 inhibitors (SGLT2i) prevent the incidence of heart failure and/or affect cardiac structure and function remains unclear. Methods The EMPA-HEART trial is aimed at verifying whether empagliflozin improves myocardial contractility (left ventricle global longitudinal strain, LV-GLS) and/or cardiopulmonary fitness (peak oxygen uptake, VO2peak) in subjects with type 2 diabetes (T2D) without heart disease. Patients with T2D, normal LV systolic function (2D-Echo EF > 50%), and no heart disease were randomized to either empagliflozin 10 mg or sitagliptin 100 mg for 6 months and underwent repeated cardiopulmonary exercise tests with echocardiography and determination of plasma biomarkers. Results Forty-four patients completed the study, 22 per arm. Despite comparable glycaemic control, modest reductions in body weight (− 1.6; [− 2.7/− 0.5] kg, p = 0.03) and plasma uric acid (− 1.5; [− 2.3/− 0.6], p = 0.002), as well as an increase in haemoglobin (+ 0.7; [+ 0.2/+ 1.1] g/dL, p = 0.0003) were evident with empagliflozin. No difference was detectable in either LV-GLS at 1 month (empagliflozin vs sitagliptin: + 0.44; [− 0.10/+ 0.98]%, p = 0.11) and 6 months of therapy (+ 0.53; [− 0.56/+ 1.62]%), or in VO2peak (+ 0.43; [− 1.4/+ 2.3] mL/min/kg, p = 0.65). With empagliflozin, the subgroup with baseline LV-GLS below the median experienced a greater increase (time*drug p < 0.05) in LV-GLS at 1 month (+ 1.22; [+ 0.31/+ 2.13]%) and 6 months (+ 2.05; [+ 1.14/+ 2.96]%), while sitagliptin induced a modest improvement in LV-GLS only at 6 months (+ 0.92; [+ 0.21/+ 0.62]%). Conclusions Empagliflozin has neutral impact on both LV-GLS and exercise tolerance in subjects with T2D and normal left ventricular function. However, in patients with subclinical dysfunction (LV-GLS < 16.5%) it produces a rapid and sustained amelioration of LV contractility. Trial registration EUDRACT Code 2016-002225-10 Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01618-1.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. .,Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Sciuto
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Trico
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi 27, 56100, Pisa, Italy
| | - Angela Dardano
- Diabetology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Baldi
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Pinnola
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Cardiopulmonary Laboratory, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Mengozzi A, Costantino S, Paneni F, Duranti E, Nannipieri M, Mancini R, Lai M, La Rocca V, Puxeddu I, Antonioli L, Fornai M, Ghionzoli M, Georgiopoulos G, Ippolito C, Bernardini N, Ruschitzka F, Pugliese NR, Taddei S, Virdis* A, Masi S. Targeting SIRT1 Rescues Age- and Obesity-Induced Microvascular Dysfunction in Ex Vivo Human Vessels. Circ Res 2022; 131:476-491. [PMID: 35968712 PMCID: PMC9426744 DOI: 10.1161/circresaha.122.320888] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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] [Indexed: 01/26/2023]
Abstract
BACKGROUND Experimental evidence suggests a key role of SIRT1 (silent information regulator 1) in age- and metabolic-related vascular dysfunction. Whether these effects hold true in the human microvasculature is unknown. We aimed to investigate the SIRT1 role in very early stages of age- and obesity-related microvascular dysfunction in humans. METHODS Ninety-five subjects undergoing elective laparoscopic surgery were recruited and stratified based on their body mass index status (above or below 30 kg/m2) and age (above or below 40 years) in 4 groups: Young Nonobese, Young Obese, Old Nonobese, and Old Obese. We measured small resistance arteries' endothelial function by pressurized micromyography before and after incubation with a SIRT1 agonist (SRT1720) and a mitochondria reactive oxygen species (mtROS) scavenger (MitoTEMPO). We assessed vascular levels of mtROS and nitric oxide availability by confocal microscopy and vascular gene expression of SIRT1 and mitochondrial proteins by qPCR. Chromatin immunoprecipitation assay was employed to investigate SIRT1-dependent epigenetic regulation of mitochondrial proteins. RESULTS Compared with Young Nonobese, obese and older patients showed lower vascular expression of SIRT1 and antioxidant proteins (FOXO3 [forkhead box protein O3] and SOD2) and higher expression of pro-oxidant and aging mitochondria proteins p66Shc and Arginase II. Old Obese, Young Obese and Old Nonobese groups endothelial dysfunction was rescued by SRT1720. The restoration was comparable to the one obtained with mitoTEMPO. These effects were explained by SIRT1-dependent chromatin changes leading to reduced p66Shc expression and upregulation of proteins involved in mitochondria respiratory chain. CONCLUSIONS SIRT1 is a novel central modulator of the earliest microvascular damage induced by age and obesity. Through a complex epigenetic control mainly involving p66Shc and Arginase II, it influences mtROS levels, NO availability, and the expression of proteins of the mitochondria respiratory chain. Therapeutic modulation of SIRT1 restores obesity- and age-related endothelial dysfunction. Early targeting of SIRT1 might represent a crucial strategy to prevent age- and obesity-related microvascular dysfunction.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Sarah Costantino
- Center for Molecular Cardiology, University of Zürich, Switzerland (S.C., F.P.)
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Switzerland (S.C., F.P.).,Department of Cardiology, University Heart Center (F.P., F.R.), University Hospital Zurich, Switzerland.,Department of Research and Education (F.P.), University Hospital Zurich, Switzerland
| | - Emiliano Duranti
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Rudj Mancini
- Unit of Bariatric Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (R.M.)
| | - Michele Lai
- Retrovirus Center and Virology Section, Department of Translational Research and New Technologies in Medicine and Surgery (M.L., V.L.R.), University of Pisa, Italy
| | - Veronica La Rocca
- Retrovirus Center and Virology Section, Department of Translational Research and New Technologies in Medicine and Surgery (M.L., V.L.R.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Ilaria Puxeddu
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Luca Antonioli
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Matteo Fornai
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Marco Ghionzoli
- Paediatric Surgery Unit, Meyer Children’s Hospital, Florence, Italy (M.G.)
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (G.G.).,Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Greece (G.G.)
| | - Chiara Ippolito
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Nunzia Bernardini
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center (F.P., F.R.), University Hospital Zurich, Switzerland
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Agostino Virdis*
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Institute of Cardiovascular Science, University College London, United Kingdom (S.M.)
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Dini FL, Franzoni F, Scarfò G, Pugliese NR, Imazio M. Acute pericarditis in patients receiving coronavirus disease 2019 vaccines: a case series from the community. J Cardiovasc Med (Hagerstown) 2022; 23:551-558. [PMID: 35904995 DOI: 10.2459/jcm.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND International agencies reported that cases of pericarditis occur very rarely following the administration of coronavirus disease 2019 (COVID-19) vaccines. Herewith, we described a series of patients from the community diagnosed with acute pericarditis after vaccination. METHODS We retrospectively included 28 patients (median age 51 years, 79% female) with or without a positive history of acute respiratory syndrome coronavirus 2 recovered infection who were diagnosed with acute pericarditis following the administration of COVID-19 vaccine. We excluded specific identifiable causes of pericarditis, including infectious, autoimmune, neoplastic and metabolic disease. Patients were referred for a complete cardiovascular evaluation. Transthoracic echocardiography (TTE) was performed and diagnosis of acute pericarditis was achieved according to current guidelines. RESULTS There were 16 patients administered with Pfizer-BioNTech/Comirnaty vaccine, 8 with Moderna/Spikevax vaccine and 4 with Astra Zeneca/Vaxzevria vaccine. Nine patients had been previously diagnosed with COVID-19, while the others had no prior history of COVID-19. Eleven patients had no comorbidity while the others had between one and four comorbidities. Ten patients had a history of rheumatic or autoimmune diseases. Chest pain was present in 24 patients. Minor ECG abnormalities were detected in 10 patients, T-wave inversion in 6, and 7 patients had concave ST elevation. The majority of patients showed mild pericardial effusions at TTE. Only two patients exhibited large pericardial effusions. CONCLUSION This case series shows a higher incidence of acute pericarditis in patients administered with COVID-19 vaccines than previously estimated, probably because of a more comprehensive assessment of clinical as well as echocardiographic parameters.
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Affiliation(s)
- Frank L Dini
- Centro Medico Sant'Agostino, Milano, Italy
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Giorgia Scarfò
- Department of Clinical and Experimental Medicine, University of Pisa
| | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy
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Pugliese NR, Balletti A, Armenia S, De Biase N, Faita F, Mengozzi A, Paneni F, Ruschitzka F, Virdis A, Ghiadoni L, Taddei S, Williams B, Antonini-Canterin F, Masi S. Ventricular-arterial coupling derived from proximal aortic stiffness: impact on aerobic capacity across the heart failure spectrum. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.010] [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] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Ventricular-arterial coupling (VAC) can be evaluated as the ratio between arterial stiffness (pulse wave velocity, PWV) and myocardial deformation (global longitudinal strain, GLS).
Objectives
To evaluate VAC across the spectrum of heart failure (HF).
Methods
We introduced a Doppler-derived, single-beat technique to estimate aortic arch PWV (aa-PWV) in addition to tonometry-derived carotid-femoral PWV (cf-PWV). We measured PWVs and GLS in 155 healthy controls, 75 subjects at risk of developing HF (American College of Cardiology/American Heart Association Stage A-B) and 236 patients in HF Stage C with preserved (HFpEF, n=104) or reduced ejection fraction (HFrEF, n=132). We evaluated peak oxygen consumption (VO2) and peripheral extraction (AVO2diff) using combined cardiopulmonary-echocardiography exercise stress.
Results
aa-PWV was obtainable in all subjects and significantly lower than cf-PWV in all subgroups (p<0.01). PWVs were directly related and increased with age (all p<0.0001). cf-PWV/GLS was similarly compromised in HFrEF (1.08±0.36) and HFpEF (1.05±0.22), while aa-PWV/GLS was more impaired in HFpEF (0.69±0.11) than HFrEF (0.60±0.15; p<0.01). Stage A-B had values of cf-PWV/GLS and aa-PWV/GLS (0.66±0.25 and 0.47±0.12) higher than controls (0.47±0.10 and 0.40±0.10) but lower than Stage C (all p<0.01). Peak AVO2diff was inversely related with cf-PWV/GLS and aa-PWV/GLS (all p<0.01). cf-PWV/GLS and aa-PWV/GLS independently predicted peak VO2 in the overall population (adjusted R2=0.32 and 0.35; all p<0.0001) but only aa-PWV/GLS was independently associated with flow reserve during exercise (R2=0.51; p<0.0001).
Conclusion
Abnormal VAC is directly correlated with greater severity of HF and worse functional capacity. HFpEF shows a worse VAC than HFrEF when expressed by aa-PWV/GLS.
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Affiliation(s)
- NR Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Balletti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Armenia
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Faita
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Mengozzi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Paneni
- University Heart Center, Zurich, Switzerland
| | | | - A Virdis
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Ghiadoni
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - B Williams
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | | | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Pugliese NR, Balletti A, Armenia S, De Biase N, Faita F, Mengozzi A, Paneni F, Ruschitzka F, Virdis A, Ghiadoni L, Taddei S, Williams B, Antonini-Canterin F, Masi S. Ventricular-Arterial Coupling Derived From Proximal Aortic Stiffness and Aerobic Capacity Across the Heart Failure Spectrum. JACC Cardiovasc Imaging 2022; 15:1545-1559. [DOI: 10.1016/j.jcmg.2022.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/28/2022] [Accepted: 03/25/2022] [Indexed: 12/27/2022]
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Dini FL, Carluccio E, Bitto R, Ciccarelli M, Correale M, D'Agostino A, Dattilo G, Ferretti M, Grelli A, Guida S, Jacoangeli F, Lupi L, Luschi L, Masarone D, Mercurio V, Pacileo G, Pugliese NR, Rispoli A, Scelsi L, Tocchetti CG, Brunetti ND, Palazzuoli A, Piepoli M, Nodari S, Ambrosio G. Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan. ESC Heart Fail 2022; 9:1107-1117. [PMID: 35122477 PMCID: PMC8934975 DOI: 10.1002/ehf2.13779] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/06/2021] [Accepted: 12/05/2021] [Indexed: 12/11/2022] Open
Abstract
AIM Echo-derived haemodynamic classification, based on forward-flow and left ventricular (LV) filling pressure (LVFP) correlates, has been proposed to phenotype patients with heart failure and reduced ejection fraction (HFrEF). To assess the prognostic relevance of baseline echocardiographically defined haemodynamic profile in ambulatory HFrEF patients before starting sacubitril/valsartan. METHODS AND RESULTS In our multicentre, open-label study, HFrEF outpatients were classified into 4 groups according to the combination of forward flow (cardiac index; CI:< or ≥2.0 L/min/m2 ) and early transmitral Doppler velocity/early diastolic annular velocity ratio (E/e': ≥ or <15): Profile-A: normal-flow, normal-pressure; Profile-B: low-flow, normal-pressure; Profile-C: normal-flow, high-pressure; Profile-D: low-flow, high-pressure. Patients were started on sacubitril/valsartan and followed-up for 12.3 months (median). Rates of the composite of death/HF-hospitalization were assessed by multivariable Cox proportional-hazards models. Twelve sites enrolled 727 patients (64 ± 12 year old; LVEF: 29.8 ± 6.2%). Profile-D had more comorbidities and worse renal and LV function. Target dose of sacubitril/valsartan (97/103 mg BID) was more likely reached in Profile-A (34%) than other profiles (B: 32%, C: 24%, D: 28%, P < 0.001). Event-rate (per 100 patients per year) progressively increased from Profile-A to Profile-D (12.0%, 16.4%, 22.9%, and 35.2%, respectively, P < 0.0001). By covariate-adjusted Cox model, profiles with low forward-flow (B and D) remained associated with poor outcome (P < 0.01). Adding this categorization to MAGGIC-score and natriuretic peptides, provided significant continuous net reclassification improvement (0.329; P < 0.001). Intermediate and high-dose sacubitril/valsartan reduced the event's risk independently of haemodynamic profile. CONCLUSIONS Echocardiographically-derived haemodynamic classification identifies ambulatory HFrEF patients with different risk profiles. In real-world HFrEF outpatients, sacubitril/valsartan is effective in improving outcome across different haemodynamic profiles.
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Affiliation(s)
- Frank L. Dini
- Cardiac, Thoracic and Vascular DepartmentUniversity of PisaPisaItaly
| | - Erberto Carluccio
- Cardiology and Cardiovascular PathophysiologyUniversity of PerugiaPerugiaItaly
| | - Roberto Bitto
- Department of Clinical and Experimental Medicine Section of CardiologyUniversity of MessinaMessinaItaly
| | - Michele Ciccarelli
- Chair of Cardiology, Department of Medicine, Surgery and DentistryUniversity of SalernoSalernoItaly
| | | | | | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine Section of CardiologyUniversity of MessinaMessinaItaly
| | - Marco Ferretti
- Department of CardiologyUniversity Hospital of ParmaParmaItaly
| | - Arianna Grelli
- Division of CardiologyFondazione I.R.C.C.S. Policlinico San MatteoPaviaItaly
| | - Stefania Guida
- Division of CardiologyFondazione I.R.C.C.S. Policlinico San MatteoPaviaItaly
| | | | - Laura Lupi
- Department of CardiologyUniversity of Brescia and ASST Spedali Civili di BresciaBresciaItaly
| | - Lorenzo Luschi
- Cardiovascular Diseases Unit, Department of Internal MedicineUniversity of SienaSienaItaly
| | | | - Valentina Mercurio
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | | | | | - Antonella Rispoli
- Chair of Cardiology, Department of Medicine, Surgery and DentistryUniversity of SalernoSalernoItaly
| | - Laura Scelsi
- Division of CardiologyFondazione I.R.C.C.S. Policlinico San MatteoPaviaItaly
| | | | | | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal MedicineUniversity of SienaSienaItaly
| | - Massimo Piepoli
- Heart Failure Unit, Cardiology DepartmentGuglielmo da Saliceto Hospital, AUSLPiacenzaItaly
| | - Savina Nodari
- Department of CardiologyUniversity of Brescia and ASST Spedali Civili di BresciaBresciaItaly
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular PathophysiologyUniversity of PerugiaPerugiaItaly
- CERICLET‐Centro Ricerca Clinica e TraslazionaleUniversity of PerugiaPerugiaItaly
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Pugliese NR, Mazzola M, Madonna R, Gargani L, De Biase N, Dini FL, Taddei S, De Caterina R, Masi S. Exercise-induced pulmonary hypertension in HFpEF and HFrEF: Different pathophysiologic mechanism behind similar functional impairment. Vascul Pharmacol 2022; 144:106978. [PMID: 35301117 DOI: 10.1016/j.vph.2022.106978] [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] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/01/2022] [Accepted: 03/07/2022] [Indexed: 12/27/2022]
Abstract
AIMS Pathophysiological mechanisms behind cardio-pulmonary impairment in heart failure (HF) with reduced (HFrEF) and preserved (HFpEF) ejection fraction are likely different. We analysed them using combined cardiopulmonary-exercise stress echocardiography (CPET-ESE). METHODS We matched 1:1 subjects with HFrEF (n = 90) and HFpEF (n = 90) for age, sex, body mass index (BMI), peak oxygen consumption, and minute ventilation/carbon dioxide production slope. All patients underwent a symptom-limited graded ramp bicycle CPET-ESE compared with 40 age-, sex- and BMI-matched healthy controls. RESULTS During a median follow-up of 25 months, we observed 22 deaths and 80 HF hospitalisations, with similar distribution between HFpEF and HFrEF. Compared with HFrEF, HFpEF had a higher prevalence of metabolic syndrome (p = 0.02) with higher levels of high-sensitivity C-reactive protein and uric acid (p < 0.01). The multipoint mean pulmonary artery pressure/cardiac output (mPAP/CO) slope showed equally increased values in HFrEF and HFpEF (3.5 ± 1.8 and 3.7 ± 1.5 mmHg/L/min) compared with controls (1.8 ± 1.1 mmHg/L/min; p < 0.0001). During exercise, HFpEF displayed more adverse interaction of right ventricle-pulmonary artery (RV-PA; tricuspid annular plane systolic excursion/systolic pulmonary artery pressure: 0.40 ± 0.2 vs 0.47 ± 0.2 mm/mmHg in HFrEF; p < 0.01) and left atrium-left ventricle (LA-LV; LA reservoir strain/LV global longitudinal strain: 1.5 ± 0.8 vs 2.2 ± 1.1 in HFrEF; p < 0.01). The latter were independent predictors of mPAP/CO slope, along with hs-CRP (adjusted R2: 0.21; p < 0.0001). CONCLUSION Despite similar disease severity, HFpEF and HFrEF show different pathophysiological mechanisms. HFpEF is characterised by a worse LA-LV and RV-PA interaction than HFrEF, with more prevalent low-grade systemic inflammation. In HFpEF, these features may have a role in exercise-induced pulmonary hypertension.
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Affiliation(s)
| | - Matteo Mazzola
- Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Rosalinda Madonna
- Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology - C.N.R., Pisa, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffale De Caterina
- Department of Pathology, Cardiology Division, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Albani S, Mesin L, Roatta S, De Luca A, Giannoni A, Stolfo D, Biava L, Bonino C, Contu L, Pelloni E, Attena E, Russo V, Antonini-Canterin F, Pugliese NR, Gallone G, De Ferrari GM, Sinagra G, Scacciatella P. Inferior Vena Cava Edge Tracking Echocardiography: A Promising Tool with Applications in Multiple Clinical Settings. Diagnostics (Basel) 2022; 12:diagnostics12020427. [PMID: 35204518 PMCID: PMC8871248 DOI: 10.3390/diagnostics12020427] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/29/2022] [Indexed: 01/25/2023] Open
Abstract
Ultrasound (US)-based measurements of the inferior vena cava (IVC) diameter are widely used to estimate right atrial pressure (RAP) in a variety of clinical settings. However, the correlation with invasively measured RAP along with the reproducibility of US-based IVC measurements is modest at best. In the present manuscript, we discuss the limitations of the current technique to estimate RAP through IVC US assessment and present a new promising tool developed by our research group, the automated IVC edge-to-edge tracking system, which has the potential to improve RAP assessment by transforming the current categorical classification (low, normal, high RAP) in a continuous and precise RAP estimation technique. Finally, we critically evaluate all the clinical settings in which this new tool could improve current practice.
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Affiliation(s)
- Stefano Albani
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
- Correspondence: ; Tel.: +39-3285999910
| | - Luca Mesin
- Mathematical Biology & Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy;
| | - Silvestro Roatta
- Integrative Physiology Lab, Department of Neuroscience, University of Turin, 10125 Turin, Italy;
| | - Antonio De Luca
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Alberto Giannoni
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy;
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy
| | - Davide Stolfo
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Lorenza Biava
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Caterina Bonino
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Laura Contu
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Elisa Pelloni
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Emilio Attena
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli-Monaldi Hospital—A.O.R.N. Dei Colli, 80131 Naples, Italy; (E.A.); (V.R.)
| | - Vincenzo Russo
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli-Monaldi Hospital—A.O.R.N. Dei Colli, 80131 Naples, Italy; (E.A.); (V.R.)
| | | | | | - Guglielmo Gallone
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy; (G.G.); (G.M.D.F.)
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy; (G.G.); (G.M.D.F.)
| | - Gianfranco Sinagra
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Paolo Scacciatella
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
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Pugliese NR, De Biase N, Mazzola M, Paneni F, Del Punta L, Gargani L, Mengozzi A, Virdis A, Nesti L, Taddei S, Flammer A, Borlaug BA, Ruschitzka F, Masi S. The relationship of epicardial adipose tissue with hemodynamics and cardiopulmonary fitness in heart failure with preserved and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Recent evidence shows epicardial adipose tissue (EAT) acts as a paracrine organ and may directly alter myocardial function by exerting mechanical compression.
Purpose. We evaluated EAT thickness through transthoracic echocardiography and investigated its relationship with cardiopulmonary fitness and cardiovascular haemodynamics at rest and during exercise in a population of heart failure (HF) patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction.
Methods. We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) who had been referred to our hospital due to dyspnoea and/or effort intolerance, together with 44 healthy controls. We performed a resting state-of-the-art echocardiographic evaluation, followed by combined cardiopulmonary-echocardiography exercise stress.
Results. EAT thickness was higher in HFpEF (median 8 mm, interquartile range [IQR] 4–12 mm) and progressively reduced in controls (median 5 mm, IQR 3–7 mm; p < 0.0001) and HFrEF (median 3 mm, IQR 2–6 mm). In HFpEF, EAT thickness was inversely correlated with peak oxygen consumption (VO2) and peripheral oxygen extraction (AVO2diff), while a direct association was observed for the same parameters in HFrEF (Figure 1). Furthermore, EAT independently predicted peak VO2 and AVO2diff in HFrEF and HFpEF regardless of body mass index and waist circumference. These relationships were direct in HFrEF (standard regression coefficient [SRC] for peak VO2: 0.18, p = 0.02; SRC for peak AVO2diff: 0.17, p = 0.03) and indirect in HFpEF (SRC for peak VO2: -0.33, p < 0.0001; SRC for peak AVO2diff: -0.25, p < 0.0001).
As there are no definite cut-off values to define increased EAT, patients were divided based on the median EAT value (5 mm) of the overall population. Thinner EAT (≤5 mm) was associated with worse LV systolic dysfunction (peak average S’) and remodeling (3D LV mass index) in HFrEF. In HFpEF, on the other hand, increased EAT (>5 mm) was related to worse right ventricular systolic dysfunction (3D right ventricular ejection fraction) and more severe left atrio-ventricular (left atrium reservoir strain/left ventricle global longitudinal strain) and right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) coupling (Figure 2).
Conclusion. In HFpEF, increased EAT thickness is associated with a worse hemodynamic profile and functional capacity. Conversely, in HFrEF, EAT thinning portends more advanced LV dysfunction and impaired cardiopulmonary fitness. Abstract Figure 1 Abstract Figure 2
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Affiliation(s)
- NR Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Paneni
- University Heart Center, Zurich, Switzerland
| | - L Del Punta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Gargani
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Mengozzi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Virdis
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Nesti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Flammer
- University Heart Center, Zurich, Switzerland
| | - BA Borlaug
- Mayo Clinic, Rochester, United States of America
| | | | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Pugliese NR, De Biase N, Mazzola M, Paneni F, Del Punta L, Gargani L, Mengozzi A, Virdis A, Nesti L, Taddei S, Flammer A, Borlaug BA, Ruschitzka F, Masi S. The association between epicardial adipose tissue and prognosis in heart failure with preserved and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.381] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Recent evidence shows that increased epicardial adipose tissue (EAT) thickness is associated with metabolic syndrome, microvascular dysfunction and enhanced pericardial restraint.
Purpose. We measured echocardiography-derived EAT thickness in a population of heart failure (HF) patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction to examine the relationship between EAT and prognosis at clinical follow-up.
Methods. We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) who had been referred to our hospital due to dyspnoea and/or effort intolerance. We performed a resting clinical and biohumoral evaluation, followed by combined cardiopulmonary-echocardiography exercise stress. We considered a composite endpoint of cardiovascular death and HF-related hospitalization during follow-up.
Results. Patients with HFpEF displayed greater EAT thickness (median 8 mm, interquartile range [IQR] 4–12 mm) than HFrEF (median 3 mm, IQR 2–6 mm; p < 0.0001). During a median follow-up of 20.9 months (IQR 15-25 months), 34 cardiovascular deaths and 146 HF hospitalizations were reported, with no significant differences between the two HF phenotypes. EAT was shown to predict adverse events independently from body mass index, waist circumference and other well-established prognostic markers in HF (such as NT-proBNP and peak oxygen consumption). The risk of adverse events increased with increasing EAT thickness in HFpEF and with EAT thinning in HFrEF. Kaplan-Meier analyses for the composite endpoint showed that in HFpEF, the survival probability was significantly lower in patients with thicker EAT than those with thinner EAT. In HFrEF, conversely, patients with increased EAT thickness had a higher survival probability than those with reduced EAT thickness (Figure 1).
Conclusion. EAT accumulation is increased in HFpEF compared to HFrEF and carries different prognostic meanings in the two subsets. In HFpEF, EAT thickening portends adverse outcomes, which may be due to the secretion of pro-inflammatory and pro-atherogenic adipokines and increased mechanical restraint. In HFrEF, EAT thinning is associated with a worse prognosis, probably reflecting a more advanced catabolic state (e.g., cardiac cachexia). Larger studies are needed to determine whether or not EAT has a causal role in influencing progression and survival in the different HF phenotypes. Abstract Figure 1
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Affiliation(s)
- NR Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Paneni
- University Heart Center, Zurich, Switzerland
| | - L Del Punta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Gargani
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Mengozzi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Virdis
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Nesti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Flammer
- University Heart Center, Zurich, Switzerland
| | - BA Borlaug
- Mayo Clinic, Rochester, United States of America
| | | | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Pugliese NR, Del Punta L, Falcetta G, Besola L, De Biase N, Mazzola M, Giannini C, Petronio AS, Taddei S, Masi S, Colli A. Evaluation of energy loss in patients with severe primary valvular heart disease before cardiac valve intervention. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Valvular heart disease (VHD) determines non-physiological, inefficient blood flow within the left ventricle, resulting in abnormal vortex formation and energy loss (EL). EL evaluation could provide valuable insights in addition to more common parameters of left ventricle systolic and diastolic dysfunction. Vector flow mapping (VFM) is a novel, non-invasive echocardiographic technique that measures EL through the study of intraventricular flow.
Purpose. To assess EL throughout the whole cardiac cycle in patients with severe primary left-sided VHD before cardiac valve intervention.
Methods. VFM is based on the continuity equation applied to colour Doppler and speckle tracking echocardiography, acquired from the apical long-axis view. VFM estimates blood flow velocity and vortex characteristics to quantify energy dissipation (i.e., EL) due to blood viscosity in a turbulent flow. EL was calculated frame by frame and averaged over three beats.
Results. We enrolled 20 healthy controls (55 ± 19 years old, 65% male) and 73 patients (70 ± 17 years old, 59% male) with severe VHD before cardiac surgery: 30 with primary mitral regurgitation (MR), 8 with mitral stenosis (MS), 15 with aortic regurgitation (AR), 20 with aortic stenosis (AS). All patients had a left ventricle (LV) ejection fraction ≥50% and no wall motion abnormalities. We observed an increased number of vortexes in patients with VHD when compared to controls, especially in mid-diastole (p = 0.003). This is reflected in a significantly higher EL during the whole cardiac cycle in VHD patients than controls (p < 0.0001), with the highest values observed in MS and AR (post-hoc test: all p < 0.0.1; Figure 1 and Figure 2). The differences were driven by the diastolic EL (p < 0.0001), while the systolic EL values were similar between patients with VHD and controls (p = ns).
Conclusions. In addition to standard baseline echocardiography, VFM can quantitatively evaluate the energy dissipation in different subsets of VHD. EL is not uniform during the cardiac cycle, as diastole seems significantly more affected than systole. The assessment of EL after valve intervention is ongoing. VFM could provide further insights into the pathophysiology of heart valve disease and help to evaluate the efficacy of the procedure (repair/replacement) performed. Abstract Figure 1 Abstract Figure 2
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Affiliation(s)
- NR Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Del Punta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Falcetta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Besola
- St Paul"s Hospital, Division of Cardiac Surgery, Vancouver, Canada
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - C Giannini
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - AS Petronio
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Colli
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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De Biase N, Del Punta L, Pugliese NR. Reply to 'Epicardial adipose tissue: does it mediate the cardio-protective effects of sodium-glucose co-transporter 2 inhibitors in subjects with heart failure?' Letter regarding the article 'Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure'. Eur J Heart Fail 2022; 24:401. [PMID: 34985799 DOI: 10.1002/ejhf.2423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Carluccio E, Dini FL, Bitto R, Ciccarelli M, Correale M, D'Agostino A, Dattilo G, Ferretti M, Grelli A, Guida S, Jacoangeli F, Lupi L, Luschi L, Masarone D, Mercurio V, Pacileo G, Pugliese NR, Rispoli A, Scelsi L, Tocchetti CG, Brunetti ND, Palazzuoli A, Piepoli M, Nodari S, Ambrosio G. Benefit from sacubitril/valsartan is associated with hemodynamic improvement in heart failure with reduced ejection fraction: An echocardiographic study. Int J Cardiol 2022; 350:62-68. [PMID: 34998946 DOI: 10.1016/j.ijcard.2022.01.004] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/15/2021] [Accepted: 01/02/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sacubitril/valsartan improves outcome in patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (EF, HFrEF). However, little is known about possible mechanisms underlying this favourable effect. PURPOSE To assess changes in echocardiographically-derived hemodynamic profiles induced by sacubitril/valsartan and their impact on outcome. METHODS In this multicenter, open-label study, 727 HFrEF outpatients underwent comprehensive echocardiography at baseline (before starting sacubitril/valsartan) and after 12 months. Estimated LV filling pressure (E/e') and cardiac index (CI, l/min/m2) were combined to determine 4 hemodynamic profiles: profile-A (normal-flow/normal-pressure); profile-B (low-flow/normal-pressure); profile-C: (normal-flow/high-pressure); profile-D: (low-flow/high-pressure). Changes among categories were recorded, and their associations with rates of the composite of death/HF-hospitalization were assessed by multivariable Cox analysis. RESULTS At baseline, 29% had profile-A, 15% had profile-B, 32% profile-C, and 24% profile-D. After 12 months, the hemodynamic profile improved in 53% of patients (all profile-A achievers, or profile-D patients achieving either C or B profile), while it remained unchanged in 39% patients and worsened in 9%. Prevalence of improved profile progressively increased with increasing dose of sacubitril/valsartan (P < 0.0001). After the second echocardiography, patients were followed up 12.6 ± 7.6 months: event-rate was lower in patients with improved profile (12.3%, 95%CI: 9.4-16.1) compared to patients in whom hemodynamic profile remained unchanged (29.9%, 24.0-37.3) or worsened (31.2%, 20.7-46.9, P < 0.0001). Improved hemodynamic profile was associated with favourable outcome independent of LVEF and other covariates (HR 0.65, 95%CI: 0.45-0.95, P < 0.05). CONCLUSION In HFrEF patients, the beneficial prognostic effects of sacubitril/valsartan are associated with improvement in hemodynamic conditions.
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Affiliation(s)
- Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, University of Perugia, Italy.
| | - Frank L Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Italy
| | - Roberto Bitto
- Dpt. of Clinical and Experimental Medicine Section of Cardiology, University of Messina, Italy
| | - Michele Ciccarelli
- Chair of Cardiology, Dept. of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | | | | | - Giuseppe Dattilo
- Dpt. of Clinical and Experimental Medicine Section of Cardiology, University of Messina, Italy
| | - Marco Ferretti
- Department of Cardiology, University Hospital of Parma, Parma, Italy
| | - Arianna Grelli
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Stefania Guida
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | - Laura Lupi
- Department of Cardiology, University of Brescia and ASST Spedali Civili di Brescia, Italy
| | - Lorenzo Luschi
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Siena, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | | | - Antonella Rispoli
- Chair of Cardiology, Dept. of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | | | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Siena, Italy
| | - Massimo Piepoli
- Heart Failure Unit, Cardiology Department, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Savina Nodari
- Department of Cardiology, University of Brescia and ASST Spedali Civili di Brescia, Italy
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, University of Perugia, Italy; CERICLET-Centro Ricerca Clinica e Traslazionale, University of Perugia, Italy
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Pastore MC, Mandoli GE, Giannoni A, Benfari G, Dini FL, Pugliese NR, Taddei C, Correale M, Brunetti ND, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, Degiovanni A, Patti G, Santoro C, Moderato L, Malagoli A, Emdin M, Cameli M, Rosa G, Magnesa M, Mazzeo P, De Carli G, Bellino M, Iuliano G, Casciano O, Binno S, Canepa M, Tondi S, Cicoira M, Mega S. Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register. Eur Heart J Open 2022; 2:oeab046. [PMID: 35919657 PMCID: PMC9242049 DOI: 10.1093/ehjopen/oeab046] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/03/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Abstract
Aims This sub-study deriving from a multicentre Italian register [Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry (DISCOVER)-ARNI] investigated whether sacubitril/valsartan in addition to optimal medical therapy (OMT) could reduce the rate of implantable cardioverter-defibrillator (ICD) indications for primary prevention in heart failure with reduced ejection fraction (HFrEF) according to European guidelines indications, and its potential predictors. Methods and results In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centres were included. Lack of follow-up or speckle tracking data represented exclusion criteria. Demographic, clinical, biochemical, and echocardiographic data were collected at baseline and after 6 months from sacubitril/valsartan initiation. Of 351 patients, 225 (64%) were ICD carriers and 126 (36%) were not ICD carriers (of whom 13 had no indication) at baseline. After 6 months of sacubitril/valsartan, among 113 non-ICD carriers despite having baseline left ventricular (LV) ejection fraction (EF) ≤ 35% and New York Heart Association (NYHA) class = II-III, 69 (60%) did not show ICD indications; 44 (40%) still fulfilled ICD criteria. Age, atrial fibrillation, mitral regurgitation > moderate, left atrial volume index (LAVi), and LV global longitudinal strain (GLS) significantly varied between the groups. With receiver operating characteristic curves, age ≥ 75 years, LAVi ≥ 42 mL/m2 and LV GLS ≥-8.3% were associated with ICD indications persistence (area under the curve = 0.65, 0.68, 0.68, respectively). With univariate and multivariate analysis, only LV GLS emerged as significant predictor of ICD indications at follow-up in different predictive models. Conclusions Sacubitril/valsartan may provide early improvement of NYHA class and LVEF, reducing the possible number of implanted ICD for primary prevention in HFrEF. Baseline reduced LV GLS was a strong marker of ICD indication despite OMT. Early therapy with sacubitril/valsartan may save infective/haemorrhagic risks and unnecessary costs deriving from ICDs.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Frank Lloyd Dini
- Centro Medico Sant’Agostino, via Temperanza 6, 20127 Milano, Italy
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy
| | - Claudia Taddei
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Michele Correale
- Cardiology Department, Policlinico Riuniti University Hospital Foggia, Viale Pinto, 1 71100 Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Via Antonio Gramsci, 89, 71122 Foggia, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Policlinico Bari, piazza Giulio Cesare n.11, 70120 Bari, Italy
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Policlinico Bari, piazza Giulio Cesare n.11, 70120 Bari, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84125 Salerno, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Salerno, Italy
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo Giaccone, University of Palermo, Via del Vespro, 129 , 90127 Palermo, Italy
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo Giaccone, University of Palermo, Via del Vespro, 129 , 90127 Palermo, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Valentina Loria
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular Diseases, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100 Novara, Italy
| | - Giuseppe Patti
- Department of Thoracic, Heart and Vascular Diseases, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Via Paolo Solaroli, 17, 28100 Novara, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131 Napoli, Italy
| | - Luca Moderato
- Cardiology Department, Ospedale Guglielmo da Saliceto—Piacenza, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio-Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Modena, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa, Via Balbi 5, 16126 Genova, Italy
| | - Michele Magnesa
- Cardiology Department, Policlinico Riuniti University Hospital Foggia, Viale Pinto, 1 71100 Foggia, Italy
| | - Pietro Mazzeo
- Department of Medical and Surgical Sciences, University of Foggia, Via Antonio Gramsci, 89, 71122 Foggia, Italy
| | - Giuseppe De Carli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | - Michele Bellino
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84125 Salerno, Italy
| | - Giuseppe Iuliano
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84125 Salerno, Italy
| | - Ofelia Casciano
- Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131 Napoli, Italy
| | - Simone Binno
- Cardiology Department, Ospedale Guglielmo da Saliceto—Piacenza, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Largo Rosanna Benzi, 10, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, Via Balbi 5, 16126 Genova, Italy
| | - Stefano Tondi
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio-Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Modena, Italy
| | - Mariantonietta Cicoira
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Simona Mega
- Cardiocenter and Unit of Cardiology, University Campus Bio-Medico of Rome, Via Álvaro del Portillo, 21, 00128 Roma, Italy
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Mandoli GE, Pastore MC, Giannoni A, Benfari G, Dini FL, Rosa G, Pugliese NR, Taddei C, Correale M, Brunetti ND, Mazzeo P, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, Carli GD, Degiovanni A, Patti G, Santoro C, Moderato L, Cicoira M, Canepa M, Malagoli A, Emdin M, Cameli M. 266 Deformation imaging by strain in chronic heart failure over sacubitril–valsartan: a multicentre echocardiographic registry (discover)—ARNI. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.037] [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
Sacubitril/valsartan have changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects morbidity and mortality partly mediated by left ventricular reverse remodelling (LVRR). The aim of this multicentre study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration.
Methods and results
Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included. Echocardiographic indexes including speckle tracking echocardiography (STE) indexes were used to predict LVRR [defined as LV end-systolic volume reduction and ejection fraction (LVEF) improvement > 10% at follow-up] at 6 months follow-up as the primary endpoint. Changes in symptoms (NYHA class) and neurohormonal activations [N-terminal-pro-brain natriuretic peptide (NTproBNP)] were also evaluated as secondary endpoints. The final population (excluding patients with poor acoustic windows and missing data) consists of 341 patients [mean age: 65 ± 10 years; 18% female, median LVEF 30% (interquartile range: 25–34)]. At 6 months follow-up, 82 (24%) patients showed early complete response (LVRR and LVEF ≥35%), 55 (16%) early incomplete response (LVRR and LVEF <35%), 204 (60%) no response (no LVRR and LVEF <35%). Non-ischaemic etiology, a lower left atrial volume index and a higher global longitudinal strain were all independent predictors of LVRR at multivariable logistic analysis (all P < 0.01). LA strain was the best predictor of positive changes in NYHA class and NT-proBNP (all P < 0.05) (Figure 1).
Conclusions
STE parameters at baseline could be useful to predict LVRR and clinical response to sacubitril-valsartan, and thus could be used as a guide for treatment in patients with HFrEF.
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Affiliation(s)
- Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa, Genoa, Italy
| | | | - Claudia Taddei
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Michele Correale
- Cardiology Department, Policlinico Riuniti University Hospital Foggia, Italy
| | | | - Pietro Mazzeo
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Italy
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University Hospital Paolo Giaccone, University of Palermo, Italy
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University Hospital Paolo Giaccone, University of Palermo, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinical Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Loria
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinical Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe De Carli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Luca Moderato
- Cardiology Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | | | - Marco Canepa
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Emdin
- Scuola Superiore Sant’Anna, Institute of Life Sciences, Pisa, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Pastore MC, Mandoli GE, Giannoni A, Benfari G, Dini FL, Rosa G, Pugliese NR, Taddei C, Correale M, Brunetti ND, Magnesa M, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, Carli GD, Degiovanni A, Patti G, Santoro C, Moderato L, Cicoira M, Canepa M, Malagoli A, Emdin M, Cameli M. 279 Medical treatment with ARNI may reduce indications for primary prevention of sudden cardiac death in heart failure with reduced ejection fraction: insights from discover-ARNI, a multicentre Italian register. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.039] [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
This sub-study deriving from a multicentre Italian register (DISCOVER-ARNI) investigated whether sacubitril/valsartan in adjunction of optimal medical therapy (OMT) could reduce the rate of implantable cardioverter-defibrillator(ICD) indications for primary prevention in heart failure with reduced ejection fraction (HFrEF) according to European guidelines indications, and its potential predictors.
Methods and results
In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centres were included. Lack of follow-up or speckle tracking data represented exclusion criteria. Demographic, clinical, biochemical and echocardiographic data were collected at baseline and after 6 months of therapy. Of 351 patients, 225 (64%) were ICD carriers and 126 (36%) were not ICD carriers (of whom 13 had not indication) at baseline. After 6 months of sacubitril/valsartan, among 113 non-ICD carriers despite having baseline left ventricular (LV)EF ≤ 35% and New York Heart Association (NYHA) class = II–III, 69(60%) did not show ICD indications; 44(40%) still fulfilled ICD criteria (Figure 1). Age, atrial fibrillation, mitral regurgitation>moderate, left atrial volume index (LAVi), and LV global longitudinal strain (GLS) significantly varied between the groups. With ROC curves, age ≥ 75 years, LAVi ≥ 42 ml/m2 and LV GLS ≥ −8.3% were associated with ICD indications persistence (AUC = 0.65, 0.68, and 0.68, respectively). With univariate and multivariate analysis, age and LV GLS emerged as the only significant predictors of ICD indications at follow-up.
Conclusions
Sacubitril/valsartan provided early improvement of NYHA class and LVEF, reducing the possible number of implanted ICD for primary prevention in HFrEF. Baseline advanced age and reduced LV GLS were markers of ICD indication despite OMT. Early therapy with sacubitril/valsartan may save infective/haemorrhagic risks and unnecessary costs deriving from ICDs.
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Affiliation(s)
- Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa, Genoa, Italy
| | | | - Claudia Taddei
- Scuola Superiore Sant’Anna, Institute of Life Sciences, Pisa, Italy
| | - Michele Correale
- Cardiology Department, Policlinico Riuniti University Hospital, Foggia, Italy
| | | | - Michele Magnesa
- Cardiology Department, Policlinico Riuniti University Hospital, Foggia, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, Heart Failure Unit, ‘Santa Maria Della Misericordia’ Hospital, University of Perugia, Italy
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology, Heart Failure Unit, ‘Santa Maria Della Misericordia’ Hospital, University of Perugia, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University Hospital Paolo Giaccone, University of Palermo, Italy
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University Hospital Paolo Giaccone, University of Palermo, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Loria
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe De Carli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Luca Moderato
- Cardiology Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | | | - Marco Canepa
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio-Emilia, Modena, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Pugliese NR, Balletti A, Armenia S, Biase ND, Faita F, Ruschitzka F, Ghiadoni L, Taddei S, Williams B, Antonini-canterin F, Masi S. 581 Ventricular–arterial coupling derived from proximal aortic stiffness and aerobic capacity across the heart failure spectrum. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.045] [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
Ventricular–arterial coupling (VAC) can be evaluated as the ratio between arterial stiffness (pulse wave velocity, PWV) and myocardial deformation (global longitudinal strain, GLS). To evaluate VAC across the spectrum of heart failure (HF).
Methods and results
We introduced a Doppler-derived, single-beat technique to estimate aortic arch PWV (aa-PWV) in addition to tonometry-derived carotid-femoral PWV (cf-PWV). We measured PWVs and GLS in 155 healthy controls, 75 subjects at risk of developing HF (American College of Cardiology/American Heart Association Stage A-B) and 236 patients in HF Stage C with preserved (HFpEF, n = 104) or reduced ejection fraction (HFrEF, n = 132). We evaluated peak oxygen consumption (VO2) and peripheral extraction (AVO2diff) using combined cardiopulmonary-echocardiography exercise stress. aa-PWV was obtainable in all subjects and significantly lower than cf-PWV in all subgroups (P < 0.01). PWVs were directly related and increased with age (all P < 0.0001). cf-PWV/GLS was similarly compromised in HFrEF (1.08 ± 0.36) and HFpEF (1.05 ± 0.22), while aa-PWV/GLS was more impaired in HFpEF (0.69 ± 0.11) than HFrEF (0.60 ± 0.15; P < 0.01). Stages A and B had values of cf-PWV/GLS and aa-PWV/GLS (0.66 ± 0.25 and 0.47 ± 0.12) higher than controls (0.47 ± 0.10 and 0.40 ± 0.10) but lower than Stage C (all P < 0.01). Peak AVO2diff was inversely related with cf-PWV/GLS and aa-PWV/GLS (all P < 0.01). cf-PWV/GLS and aa-PWV/GLS independently predicted peak VO2 in the overall population (adjusted R2 = 0.32 and 0.35; all P < 0.0001) but only aa-PWV/GLS was independently associated with flow reserve during exercise (R2 = 0.51; P < 0.0001).
Conclusions
Abnormal VAC is directly correlated with greater severity of HF and worse functional capacity. HFpEF shows a worse VAC than HFrEF when expressed by aa-PWV/GLS.
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