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Attanasio A, Tondi L, Castelvecchio S, Pazzanese V, Palmisano A, Esposito A, Ameri P, Canale C, Cappelletti A, Alberti LP, Tavano D, Camporotondo R, Costantino I, Campodonico J, Pontone G, Villani A, Gallone GP, Montone RA, Niccoli G, Gargiulo P, Punzo B, Vicenzi M, Carugo S, Disabato G, Guida G, Camporeale A, Carrafiello G, Spagnolo P, Menicanti L, Ambrosio G, Piepoli M, Lombardi M, Camici PG. Left atrial dysfunction predicts left ventricular remodeling in patients with preserved ejection fraction after acute ST-elevation myocardial infarction. Eur J Prev Cardiol 2024:zwae072. [PMID: 38381565 DOI: 10.1093/eurjpc/zwae072] [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: 01/09/2024] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Andrea Attanasio
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, 20122 Milan, Italy
| | | | | | - Anna Palmisano
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy
| | - Pietro Ameri
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudia Canale
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | | | - Rita Camporotondo
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Costantino
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jenness Campodonico
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | | | - Marco Vicenzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giandomenico Disabato
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianluigi Guida
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Pietro Spagnolo
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
- Department of Preventive Cardiology, Wroclaw Medical University, Wroclaw, Poland
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo G Camici
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy
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Pica S, Crimi G, Castelvecchio S, Pazzanese V, Palmisano A, Lombardi M, Tondi L, Esposito A, Ameri P, Canale C, Cappelletti A, Alberti LP, Tavano D, Camporotondo R, Costantino I, Campodonico J, Pontone G, Villani A, Gallone GP, Montone RA, Niccoli G, Gargiulo P, Punzo B, Vicenzi M, Carugo S, Menicanti L, Ambrosio G, Camici PG. Corrigendum to "Cardiac magnetic resonance predictors of left ventricular remodelling following acute ST elevation myocardial infarction: The VavirimS study, Pica, Silvia et al." [International Journal of Cardiology, Volume 370, 8-17]. Int J Cardiol 2024:131824. [PMID: 38311510 DOI: 10.1016/j.ijcard.2024.131824] [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: 02/06/2024]
Affiliation(s)
- Silvia Pica
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Anna Palmisano
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Lara Tondi
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Esposito
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Ameri
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudia Canale
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | | | - Rita Camporotondo
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Costantino
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jenness Campodonico
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Medicine, University of Parma, Parma, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | | | - Marco Vicenzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Paolo G Camici
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy.
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Ammirati E, Marchetti D, Colombo G, Pellicori P, Gentile P, D'Angelo L, Masciocco G, Verde A, Macera F, Brunelli D, Occhi L, Musca F, Perna E, Bernasconi DP, Moreo A, Camici PG, Metra M, Oliva F, Garascia A. Estimation of Right Atrial Pressure by Ultrasound-Assessed Jugular Vein Distensibility in Patients With Heart Failure. Circ Heart Fail 2024; 17:e010973. [PMID: 38299348 DOI: 10.1161/circheartfailure.123.010973] [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: 06/20/2023] [Accepted: 12/19/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Clinical evaluation of central venous pressure is difficult, depends on experience, and is often inaccurate in patients with chronic advanced heart failure. We assessed the ultrasound-assessed internal jugular vein (JV) distensibility by ultrasound as a noninvasive tool to identify patients with normal right atrial pressure (RAP ≤7 mm Hg) in this population. METHODS We measured JV distensibility as the Valsalva-to-rest ratio of the vein diameter in a calibration cohort (N=100) and a validation cohort (N=101) of consecutive patients with chronic heart failure with reduced ejection fraction who underwent pulmonary artery catheterization for advanced heart failure therapies workup. RESULTS A JV distensibility threshold of 1.6 was identified as the most accurate to discriminate between patients with RAP ≤7 versus >7 mm Hg (area under the receiver operating characteristic curve, 0.74 [95% CI, 0.64-0.84]) and confirmed in the validation cohort (receiver operating characteristic, 0.82 [95% CI, 0.73-0.92]). A JV distensibility ratio >1.6 had predictive positive values of 0.86 and 0.94, respectively, to identify patients with RAP ≤7 mm Hg in the calibration and validation cohorts. Compared with patients from the calibration cohort with a high JV distensibility ratio (>1.6; n=42; median RAP, 4 mm Hg; pulmonary capillary wedge pressure, 11 mm Hg), those with a low JV distensibility ratio (≤1.6; n=58; median RAP, 8 mm Hg; pulmonary capillary wedge pressure, 22 mm Hg; P<0.0001 for both) were more likely to die or undergo a left ventricular assist device implant or heart transplantation (event rate at 2 years: 42.7% versus 18.2%; log-rank P=0.034). CONCLUSIONS Ultrasound-assessed JV distensibility identifies patients with chronic advanced heart failure with normal RAP and better outcomes. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03874312.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Davide Marchetti
- Cardiology Department, Galeazzi-Sant'Ambrogio Hospital, Milan, Italy (D.M.)
| | - Giada Colombo
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, Italy (G.C., M.M.)
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (P.P.)
| | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Luciana D'Angelo
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Gabriella Masciocco
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Alessandro Verde
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Francesca Macera
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Dario Brunelli
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Lucia Occhi
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Francesco Musca
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Enrico Perna
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Davide P Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Center, School of Medicine and Surgery, University of Milano-Bicocca, Italy (D.P.B.)
| | - Antonella Moreo
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Paolo G Camici
- Cardiovascular Research Center, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy (P.G.C.)
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, Italy (G.C., M.M.)
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
| | - Andrea Garascia
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., P.G., L.D., G.M., A.V., F. Macera, D.B., L.O., F. Musca, E.P., A.M., F.O., A.G.)
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Pelliccia F, Hänsel M, Wegener S, Camici PG. Concomitant Takotsubo Syndrome and stroke: Two separate disorders or do they share a common etiology? Eur J Prev Cardiol 2023:zwad323. [PMID: 37811669 DOI: 10.1093/eurjpc/zwad323] [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: 09/21/2023] [Revised: 09/21/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Affiliation(s)
| | - Martin Hänsel
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Paolo G Camici
- Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy
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Ranasinghe S, Merz CNB, Khan N, Wei J, George M, Berry C, Chieffo A, Camici PG, Crea F, Kaski JC, Marzilli M, Gulati M. Sex Differences in Quality of Life in Patients with Ischemia with No Obstructive Coronary Artery Disease (INOCA): A Patient Self-Report Retrospective Survey from INOCA International. J Clin Med 2023; 12:5646. [PMID: 37685713 PMCID: PMC10488627 DOI: 10.3390/jcm12175646] [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: 07/03/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Women with obstructive coronary artery disease (CAD) have a relatively lower quality of life (QoL) compared to men, but our understanding of sex differences in QoL in ischemia with no obstructive coronary artery disease (INOCA) is limited. We conducted a survey of patient members of INOCA International with an assessment of self-reported health measures. Functional capacity was retrospectively estimated using the Duke Activity Status Index (DASI), assessing levels of activities performed before and after INOCA symptom onset. Of the 1579 patient members, the overall survey completion rate was 21%. Women represented 91% of the respondents. Estimated functional capacity, expressed as metabolic equivalents (METs), was higher before compared to after INOCA diagnosis comparably for both women and men. For every one MET decline in functional capacity, there was a significantly greater decline in QoL for men compared with women in physical health (4.0 ± 1.1 vs. 2.9 ± 0.3 days/month, p < 0.001), mental health (2.4 ± 1.2 vs. 1.8 ± 0.3 days/month, p = 0.001), and social health/recreational activities (4.1 ± 1.0 vs. 2.9 ± 0.3 days/month, p = 0.0001), respectively. In an international survey of patients living with INOCA, despite similar diagnoses, clinical comorbidities, and symptoms, INOCA-related functional capacity declines are associated with a greater adverse impact on QoL in men compared to women.
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Affiliation(s)
- Sachini Ranasinghe
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Najah Khan
- Houston Methodist Hospital, Houston, TX 77030, USA
| | - Janet Wei
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8QQ, UK
| | - Alaide Chieffo
- IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Medicine, Vita Salute San Raffaele University, 20132 Milan, Italy
| | | | - Filippo Crea
- Department of Cardiology, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s University of London, London SW17 0RE, UK
| | - Mario Marzilli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University of Pisa, 56126 Pisa, Italy
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Ammirati E, Lupi L, Palazzini M, Ciabatti M, Rossi VA, Gentile P, Uribarri A, Vecchio CR, Nassiacos D, Cereda A, Conca C, Tumminello G, Piriou N, Lelarge C, Pedrotti P, Stucchi M, Peretto G, Galasso M, Huang F, Ianni U, Procopio A, Saponara G, Cimaglia P, Tomasoni D, Moroni F, Turco A, Sala S, Di Tano G, Bollano E, Moro C, Abbate A, Della Bona R, Porto I, Carugo S, Campodonico J, Pontone G, Grosu A, Bolognese L, Salamanca J, Diez-Villanueva P, Ozieranski K, Tyminska A, Sardo Infirri L, Bromage D, Cannatà A, Hong KN, Adamo M, Quattrocchi G, Foà A, Potena L, Garascia A, Giannattasio C, Adler ED, Sinagra G, Ruschitzka F, Camici PG, Metra M, Pieroni M. Outcome and Morphofunctional Changes on Cardiac Magnetic Resonance in Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination. Circ Heart Fail 2023; 16:e010315. [PMID: 37183708 DOI: 10.1161/circheartfailure.122.010315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Enrico Ammirati
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Laura Lupi
- Institute of Cardiology, Azienda Socio-Sanitaria Territoriale Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., D.T., M.A., M.M.)
| | - Matteo Palazzini
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
- Department of Medicine and Surgery, Bicocca University, Milano, Italy (M. Palazzini, M.G., C.G.)
| | - Michele Ciabatti
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy (M.C., L.B., M. Pieroni)
| | - Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Switzerland (V.A.R., F.R.)
| | - Piero Gentile
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Aitor Uribarri
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (A.U.)
- Vall d'Hebron Institute de Recerca, Barcelona, Spain (A.U.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (A.U.)
| | - Chiara R Vecchio
- Department of Cardiology, Presidio Ospedaliero di Saronno, Azienda Socio-Sanitaria Territoriale Valle Olona, Saronno, Varese, Italy (C.R.V., D.N.)
| | - Daniele Nassiacos
- Department of Cardiology, Presidio Ospedaliero di Saronno, Azienda Socio-Sanitaria Territoriale Valle Olona, Saronno, Varese, Italy (C.R.V., D.N.)
| | - Alberto Cereda
- Cardiovascular Department, Association Socio Sanitary Territorial Santi Paolo e Carlo, Milano, Italy (A. Cereda, C.C.)
| | - Cristina Conca
- Cardiovascular Department, Association Socio Sanitary Territorial Santi Paolo e Carlo, Milano, Italy (A. Cereda, C.C.)
| | - Gabriele Tumminello
- Division of Cardiology, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy (G.T., S.C.)
| | - Nicolas Piriou
- Nantes Université, CHU Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, l'Institut du Thorax, France (N.P., C.L.)
| | - Coline Lelarge
- Nantes Université, CHU Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, l'Institut du Thorax, France (N.P., C.L.)
| | - Patrizia Pedrotti
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Miriam Stucchi
- Cardiology Unit, Azienda Socio-Sanitaria Territoriale della Brianza (MB), Vimercate Hospital, Italy (M.S.)
| | - Giovanni Peretto
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G. Peretto, S.S., P.G.C.)
| | - Michele Galasso
- Department of Medicine and Surgery, Bicocca University, Milano, Italy (M. Palazzini, M.G., C.G.)
| | - Florent Huang
- Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H.)
| | - Umberto Ianni
- Cardiology Unit, Madonna del Soccorso Hospital, Azienda Sanitaria Unica Regionale Marche 5, San Benedetto del Tronto, Italy (U.I.)
| | - Antonio Procopio
- Intensive Cardiac Care Unit, "F. Renzetti" Hospital, Lanciano, Chieti, Italy (A.P.)
| | - Gianluigi Saponara
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy (G.S.)
| | - Paolo Cimaglia
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy (P.C)
| | - Daniela Tomasoni
- Institute of Cardiology, Azienda Socio-Sanitaria Territoriale Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., D.T., M.A., M.M.)
| | - Francesco Moroni
- Pauley Heart Center, Virginia Commonwealth University, Richmond (F.M., A.A.)
| | - Annalisa Turco
- Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (A. Turco)
| | - Simone Sala
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G. Peretto, S.S., P.G.C.)
| | - Giuseppe Di Tano
- Unità Operativa Cardiologia, Azienda Socio-Sanitaria Territoriale di Cremona, Ospedale OglioPo, Casalmaggiore, Cremona, Italy (G.D.T.)
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.B.)
| | - Claudio Moro
- Department of Cardiology, Azienda Socio-Sanitaria Territoriale Monza, Desio, Italy (C.M.)
| | - Antonio Abbate
- Pauley Heart Center, Virginia Commonwealth University, Richmond (F.M., A.A.)
| | - Roberta Della Bona
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy (R.D.B., I.P.)
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy (R.D.B., I.P.)
- Department of Internal Medicine and Medical Specialties, University of Genoa, Italy (I.P.)
| | - Stefano Carugo
- Division of Cardiology, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda Ospedale Maggiore Policlinico, University of Milan, Italy (G.T., S.C.)
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Italy (S.C., J.C.)
| | - Jeness Campodonico
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Italy (S.C., J.C.)
- Centro Cardiologico Monzino IRCCS, University of Milan, Italy (J.C., G. Pontone)
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, University of Milan, Italy (J.C., G. Pontone)
| | - Aurelia Grosu
- Cardiovascular Department, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy (A. Grosu)
| | - Leonardo Bolognese
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy (M.C., L.B., M. Pieroni)
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Pablo Diez-Villanueva
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Krzysztof Ozieranski
- First Department of Cardiology, Medical University of Warsaw, Poland (K.O., A. Tyminska)
| | - Agata Tyminska
- First Department of Cardiology, Medical University of Warsaw, Poland (K.O., A. Tyminska)
| | - Loren Sardo Infirri
- Ospedale di Circolo e fondazione Macchi, Azienda Socio-Sanitaria Territoriale Sette Laghi, Varese, Italy (L.S.I.)
| | - Daniel Bromage
- School of Cardiovascular Medicine and Metabolic Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, King's College London, United Kingdom (D.B., A. Cannatà)
- Department of Cardiology, King's College Hospital London, United Kingdom (D.B., A. Cannatà)
| | - Antonio Cannatà
- School of Cardiovascular Medicine and Metabolic Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, King's College London, United Kingdom (D.B., A. Cannatà)
- Department of Cardiology, King's College Hospital London, United Kingdom (D.B., A. Cannatà)
| | - Kimberly N Hong
- Division of Cardiology, Department of Medicine, University of California San Diego (K.N.H., E.D.A.)
| | - Marianna Adamo
- Institute of Cardiology, Azienda Socio-Sanitaria Territoriale Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., D.T., M.A., M.M.)
| | - Giuseppina Quattrocchi
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Alberto Foà
- Academic Hospital S. Orsola-Malpighi, Bologna, Italy (A.F., L.P.)
| | - Luciano Potena
- Academic Hospital S. Orsola-Malpighi, Bologna, Italy (A.F., L.P.)
| | - Andrea Garascia
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
| | - Cristina Giannattasio
- Department of De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy (E.A., M. Palazzini, P.G., P.P., G.Q., A. Garascia, C.G.)
- Department of Medicine and Surgery, Bicocca University, Milano, Italy (M. Palazzini, M.G., C.G.)
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California San Diego (K.N.H., E.D.A.)
| | - Gianfranco Sinagra
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Italy (G.S.)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Switzerland (V.A.R., F.R.)
- Center for Translational and Experimental Cardiology, Department of Cardiology, University Hospital Zurich, University of Zurich, Schlieren, Switzerland (F.R.)
| | - Paolo G Camici
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G. Peretto, S.S., P.G.C.)
| | - Marco Metra
- Institute of Cardiology, Azienda Socio-Sanitaria Territoriale Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., D.T., M.A., M.M.)
| | - Maurizio Pieroni
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy (M.C., L.B., M. Pieroni)
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Pelliccia F, Camici PG. Updates on MINOCA and INOCA through the 2022 publications in the International Journal of Cardiology. Int J Cardiol 2023; 374:8-11. [PMID: 36649889 DOI: 10.1016/j.ijcard.2023.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Affiliation(s)
| | - Paolo G Camici
- Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy
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8
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Gulati M, Khan N, George M, Berry C, Chieffo A, Camici PG, Crea F, Kaski JC, Marzilli M, Merz CNB. Ischemia with no obstructive coronary artery disease (INOCA): A patient self-report quality of life survey from INOCA international. Int J Cardiol 2023; 371:28-39. [PMID: 36162521 DOI: 10.1016/j.ijcard.2022.09.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 06/02/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is limited information available regarding evidence of ischemia with no obstructive coronary arteries (INOCA) and quality of life. PURPOSE To determine associations between INOCA and self-reported physical, social, and mental health. METHODS We conducted a survey of all members (n = 1579) of the INOCA International patient support group. Current self-reported diagnosis and health measures were collected. Functional capacity was retrospectively estimated using the Duke Activity Status Index (DASI), assessing levels of activities performed prior and after symptom onset. RESULTS A total of 297 (20.8% response rate, 91% women) reported symptoms of chest pain, pressure, or discomfort in 92.9%. Overall, 34.4% were living with symptoms for ≥3 years before an INOCA diagnosis, and 77.8% were told their symptoms were not cardiac. Estimated functional capacity was higher prior to compared to after symptom onset (8.6 ± 1.8 METs vs 5.6 ± 1.8 METs; P < 0.0001). Most respondents reported an adverse impact of symptoms on their home life (80.5%), social life (80.1%), mental health (70.4%), outlook on life (69.7%), sex life (55.9%), and their partner/spouse relationship (53.9%), while approximately three-quarters reduced their work hours or stopped work completely, 47.5% retired early, and 38.4% applied for disability. CONCLUSIONS INOCA symptoms are associated with adverse physical, mental and social health quality of life. Increased patient awareness, physician recognition and diagnosis, and clinical trials are needed to develop evidence-based guidelines for this increasingly recognized cardiovascular disorder.
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Affiliation(s)
- Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA.
| | - Najah Khan
- Houston Methodist Hospital, Houston, TX, USA
| | | | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - Paolo G Camici
- San Raffaele Hospital and Vita-Salute University, Milan, Italy
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | - Juan-Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | | | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
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9
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Schindler TH, Fearon WF, Pelletier-Galarneau M, Ambrosio G, Sechtem U, Ruddy TD, Patel KK, Bhatt DL, Bateman TM, Gewirtz H, Shirani J, Knuuti J, Gropler RJ, Chareonthaitawee P, Slart RHJA, Windecker S, Kaufmann PA, Abraham MR, Taqueti VR, Ford TJ, Camici PG, Schelbert HR, Dilsizian V. PET for Detection and Reporting Coronary Microvascular Dysfunction: A JACC: Cardiovascular Imaging Expert Panel Statement. JACC Cardiovasc Imaging 2023; 16:536-548. [PMID: 36881418 DOI: 10.1016/j.jcmg.2022.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [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: 08/29/2022] [Revised: 11/14/2022] [Accepted: 12/02/2022] [Indexed: 02/11/2023]
Abstract
Angina pectoris and dyspnea in patients with normal or nonobstructive coronary vessels remains a diagnostic challenge. Invasive coronary angiography may identify up to 60% of patients with nonobstructive coronary artery disease (CAD), of whom nearly two-thirds may, in fact, have coronary microvascular dysfunction (CMD) that may account for their symptoms. Positron emission tomography (PET) determined absolute quantitative myocardial blood flow (MBF) at rest and during hyperemic vasodilation with subsequent derivation of myocardial flow reserve (MFR) affords the noninvasive detection and delineation of CMD. Individualized or intensified medical therapies with nitrates, calcium-channel blockers, statins, angiotensin-converting enzyme inhibitors, angiotensin II type 1-receptor blockers, beta-blockers, ivabradine, or ranolazine may improve symptoms, quality of life, and outcome in these patients. Standardized diagnosis and reporting criteria for ischemic symptoms caused by CMD are critical for optimized and individualized treatment decisions in such patients. In this respect, it was proposed by the cardiovascular council leadership of the Society of Nuclear Medicine and Molecular Imaging to convene thoughtful leaders from around the world to serve as an independent expert panel to develop standardized diagnosis, nomenclature and nosology, and cardiac PET reporting criteria for CMD. This consensus document aims to provide an overview of the pathophysiology and clinical evidence of CMD, its invasive and noninvasive assessment, standardization of PET-determined MBFs and MFR into "classical" (predominantly related to hyperemic MBFs) and "endogen" (predominantly related to resting MBF) normal coronary microvascular function or CMD that may be critical for diagnosis of microvascular angina, subsequent patient care, and outcome of clinical CMD trials.
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Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
| | - William F Fearon
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Giuseppe Ambrosio
- University of Perugia School of Medicine Ospedale S. Maria della Misericordia Perugia, Italy
| | - Udo Sechtem
- Cardiologicum Stuttgart, Stuttgart, Baden-Wuerttemberg, Germany
| | | | - Krishna K Patel
- Icahn School of Medicine at Mount Sinai, Zena, New York, New York, USA; Michael A. Wiener Cardiovascular Institute, New York, New York, USA
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Timothy M Bateman
- Saint-Lukes Health System and the Mid-America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Henry Gewirtz
- Cardiac Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jamshid Shirani
- Cardiology, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Juhani Knuuti
- Heart Center, Turku University Hospital, Turku, Finland
| | - Robert J Gropler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine-Cardiovascular, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | | | - Riemer H J A Slart
- Medical Imaging Center, Departments of Radiology and Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Maria R Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, University of California, San Francisco, California, USA
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thomas J Ford
- The University of Newcastle, Faculty of Medicine, Newcastle, Australia
| | - Paolo G Camici
- San Raffaele Hospital, Milan Italy; Vita Salute University, Milan, Italy
| | - Heinrich R Schelbert
- Department of Molecular Imaging and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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10
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Pica S, Crimi G, Castelvecchio S, Pazzanese V, Palmisano A, Lombardi M, Tondi L, Esposito A, Ameri P, Canale C, Cappelletti A, Alberti LP, Tavano D, Camporotondo R, Costantino I, Campodonico J, Pontone G, Villani A, Gallone GP, Montone RA, Niccoli G, Gargiulo P, Punzo B, Vicenzi M, Carugo S, Menicanti L, Ambrosio G, Camici PG. Cardiac magnetic resonance predictors of left ventricular remodelling following acute ST elevation myocardial infarction: The VavirimS study. Int J Cardiol 2023; 370:8-17. [PMID: 36351542 DOI: 10.1016/j.ijcard.2022.11.006] [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: 10/19/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Left ventricular (LV) remodelling (REM) ensuing after ST-elevation myocardial infarction (STEMI), has typically been studied by echocardiography, which has limitations, or cardiac magnetic resonance (CMR) in early phase that may overestimate infarct size (IS) due to tissue edema and stunning. This prospective, multicenter study investigated LV-REM performing CMR in the subacute phase, and 6 months after STEMI. METHODS AND RESULTS patients with first STEMI undergoing successful primary angioplasty were consecutively enrolled. CMR was done at 30-days and 6-months. Primary endpoint was prevalence at 6 months of LV-REM [≥12% increase in LV end-diastolic volume index (LV-REMEDV)]; LV-REM by end-systolic volume index increase ≥12% (LV-REMESV) was also calculated. Of 325 patients enrolled, 193 with a full set of research-quality CMR images were analyzed. LV-REMEDV and LV-REMESV were present in 36/193 (19%) and 34/193 (18%) patients, respectively. At follow up, LV ejection fraction (EF) improved in patients with or without LV-REMEDV, whilst it decreased in those with LV-REMESV (p < 0.001 for interaction). Considering predictors of LV-REM, IS in the highest tertile was clearly separated from the two lower tertiles. In LV-REMEDV, the highest tertile was associated with significantly higher LV-EDV, LV-ESV, and lower EF. CONCLUSIONS In a contemporary cohort of STEMI patients studied by CMR, prevalence of LV-REMEDV was lower than previously reported. Importantly, our data indicate that LV-REMEDV might not be "adverse" per se, but rather "compensatory", being associated with LV-EF improvement at follow-up. Conversely, LV-REMESV might be an "adverse" phenomenon associated with decreased LV-EF, driven by IS.
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Affiliation(s)
- Silvia Pica
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Anna Palmisano
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Lara Tondi
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Esposito
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Ameri
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudia Canale
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | | | - Rita Camporotondo
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Costantino
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jenness Campodonico
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Medicine, University of Parma, Parma, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | | | - Marco Vicenzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Paolo G Camici
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy.
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Palazzini M, Lupi L, Ammirati E, Giannattasio C, Soriano F, Pedrotti P, Briguglia D, Mapelli M, Campodonico J, Agostoni P, Leonardi S, Turco A, Guida S, Peretto G, Sala S, Camici PG, Marzo F, Grosu A, Senni M, Turrini F, Bramerio M, Marini M, Matassini MV, Rizzo S, Basso C, De Gaspari M, Hendren NS, Schmidt M, Bochaton T, Piriou N, Ubarri A, Van De Heyning C, Sole AA, Cannatà A, Salamanca J, Lehtonen J, Huang F, Adler ED, Metra M. 132 PREVALENCE CHARACTERISTICS AND OUTCOMES OF COVID 19 ASSOCIATED ACUTE MYOCARDITIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19–associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe.
Methods
A total of 112 patients with suspected AM from 56963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19–associated AM.
Results
AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19–associated pneumonia. Twenty- one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%).
Conclusions
AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
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Affiliation(s)
- Matteo Palazzini
- De Gasperis Cardio Center And Transplant Center , Niguarda, Milano
| | - Laura Lupi
- Institute Of Cardiology, Department Of Medical And Surgical Specialties, Radiological Science And Public Healt, University Of Brescia
| | - Enrico Ammirati
- De Gasperis Cardio Center And Transplant Center , Niguarda, Milano
| | | | | | | | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS Milano Italy, Department Of Clinical Sciences And Community Healt Cardiovascular Section, University Of Milano , Milano
| | - Jeness Campodonico
- Centro Cardiologico Monzino, IRCCS Milano Italy, Department Of Clinical Sciences And Community Healt Cardiovascular Section, University Of Milano , Milano
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS Milano Italy, Department Of Clinical Sciences And Community Healt Cardiovascular Section, University Of Milano , Milano
| | - Sergio Leonardi
- Coronary Care Unit And Laboratory Of Clinical And Experimental Cardiology Fondazione Irccs Policlinico S Matteo
| | - Annalisa Turco
- Coronary Care Unit And Laboratory Of Clinical And Experimental Cardiology Fondazione Irccs Policlinico S Matteo
| | - Stefania Guida
- Coronary Care Unit And Laboratory Of Clinical And Experimental Cardiology Fondazione Irccs Policlinico S Matteo
| | - Giovanni Peretto
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | - Simone Sala
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | - Paolo G Camici
- San Raffaele Hospital And Vita Salute University , Milano , Italy
| | | | - Aurelia Grosu
- Cardiovascular Department , Asst Papa Giovanni Xxiii, Bergamo , Italy
| | - Michele Senni
- Cardiovascular Department , Asst Papa Giovanni Xxiii, Bergamo , Italy
| | | | - Manuela Bramerio
- Department Of Histopathology, Niguarda Hospital , Milano , Italy
| | - Marco Marini
- Cardiology Division, Cardiovascular Department , Azienda Ospedaliero Universitaria Ospedali Riuniti Di Ancona, Umberto I, Gm Lancisi, G Salesi, Ancona , Italy
| | - Maria Vittoria Matassini
- Cardiology Division, Cardiovascular Department , Azienda Ospedaliero Universitaria Ospedali Riuniti Di Ancona, Umberto I, Gm Lancisi, G Salesi, Ancona , Italy
| | - Stefania Rizzo
- Cardiovascular Patology Unit, Azienda Ospedaliera, Department Of Cardiac, Thoracic, Vascular Science And Public Healt, University Of Padua , Italy
| | - Cristina Basso
- Cardiovascular Patology Unit, Azienda Ospedaliera, Department Of Cardiac, Thoracic, Vascular Science And Public Healt, University Of Padua , Italy
| | - Monica De Gaspari
- Cardiovascular Patology Unit, Azienda Ospedaliera, Department Of Cardiac, Thoracic, Vascular Science And Public Healt, University Of Padua , Italy
| | - Nicholas S Hendren
- Division Of Cardiology, Department Of Internal Medicine, University Of Texas Southwestern Medical Center , Dallas
| | - Matthieu Schmidt
- Sorbonne Universitè, Umrs 1166, Institute Of Cardiometabolism And Nutrition, Service De Medecine Intensive-Reanimation, Institute De Cardiologie Assistant Publique-Hopitaux De Paris Hopital Pitie-Salpetriere , France
| | - Thomas Bochaton
- Urgences Et Soins Critiques Cardiologiques , Hopital Cardiologique, Hospices Civils De Lyon, Bron , France
| | - Nicolas Piriou
- Universite Nantes, Chu Nantes, Centre National De La Recherche Scientifique, Institute National De La Santè Et De La Recherche Medicale , France
| | - Aitor Ubarri
- Departamento De Cardiologia, Hospital Clinico Universitario , Valladolid , Spain
| | - Caroline Van De Heyning
- Department Of Cardiology, Antwerp University Hospital, Genetics, Pharmacology And Physiopathology Of Heart, Blood And Vessels And Skeleton Research Group, Antwerp University , Belgium
| | - Albert Ariza Sole
- Cardiology Department, Bellvitge University Hospital , Bioheart, Grup De Malalties Cardiovasculars, Institut De Investigacio Biomedica De Bellvitge, L’hospotalet Del Llobregat, Barcelona , Spain
| | - Antonio Cannatà
- School Of Cardiovascular Medicine And Science, King’s College, London, British Heart Foundation, Centre Of Excellence, James Black Centre , United Kingdom
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario De La Princesa , Madrid , Spain
| | - Jukka Lehtonen
- Heart And Lung Center, Department Of Cardiology, Helsinki University Hospital,Finland
| | - Florent Huang
- Service De Cardiologie , Hopital Foch, Suresnes , France
| | - Eric D Adler
- Division Of Cardiology, Department Of Medicine, University Of California San Diego
| | - Marco Metra
- Institute Of Cardiology, Department Of Medical And Surgical Specialties, Radiological Science And Public Healt, University Of Brescia
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Varrenti M, Ammirati E, Sormani P, Moro C, D´elia S, Bernasconi P, Raineri C, Quattrocchi G, Milazzo A, Maestroni A, Valsecchi MG, Garascia A, Oliva F, Giannattasio C, Camici PG, Pedrotti P. 1070 PROGNOSTIC PERFORMANCE OF CARDIAC MAGNETIC RESONANCE IMAGING MARKERS VERSUS COMPLICATED CLINICAL PRESENTATION AFTER AN ACUTE MYOCARDITIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Identifying markers associated with adverse events after acute myocarditis (AM) is clinically relevant to plan follow-up. We aimed to compare the prognostic performance of previously described cardiac magnetic resonance imaging (CMRI) markers: septal late gadolinium enhancement (LGE) localization and left ventricular ejection fraction (LVEF)<50% on baseline CMRI, versus complicated clinical presentation (CCP) of AM (defined as the presence of sustained ventricular arrhythmias or LVEF <50% on the first echocardiogram or fulminant presentation).
Methods
We retrospectively assessed 248 AM patients from 6 hospitals with onset of cardiac symptoms <30 days, increased troponin, and CMRI consistent with myocarditis.
Results
Patients had a median age of 34 years (male prevalence of 87.1%) and a median LVEF of 61% on baseline CMRI. Thirteen patients (5.2%) experienced at least one major cardiac event after a median follow-up of 1708 days. Among these 13 patients, 10 (76.9%) had septal LGE, 8 (61.5%) had LVEF<50%, and 12 (92.3%) had a CCP. The best performance was observed for CCP in terms of sensitivity (0.99), and for LVEF<50% in terms of specificity (0.90). The negative predictive value was at least 0.98 for all markers.
Conclusions
Major cardiac events after an AM are relatively low, and septal LGE, LVEF<50% on CMRI, and CCP are significantly associated with events. The most relevant finding is the high NPV of these markers to identify patients without events after an AM. This observation can help clinicians to monitor the patients after an AM, in fact, patients without these markers had an uneventful follow-up.
Figure
A] Acute Myocarditis with complicated clinical presentation (CCP AM) vs non-complicated clinical presentation (NO CCP AM);
B] FE > 50% vs FE < 50% at basal cardiac MRI;
C] Presence of septal late gadolinium enhancemnet (LGE) vs no septal LGE on basal cardiac MRI.
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Affiliation(s)
| | | | - Paola Sormani
- De Gasperis Cardio Center, Niguarda Hospital , Milan
| | | | | | | | | | | | | | | | | | | | | | | | - Paolo G Camici
- Vita Salute University And San Raffaele Hospital , Milan
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13
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Suda A, Takahashi J, Schwidder M, Ong P, Ang D, Berry C, Camici PG, Crea F, Carlos Kaski J, Pepine C, Rimoldi O, Sechtem U, Yasuda S, Beltrame JF, Noel Bairey Merz C, Shimokawa H. Prognostic association of plasma NT-proBNP levels in patients with microvascular angina -A report from the international cohort study by COVADIS. Int J Cardiol Heart Vasc 2022; 43:101139. [PMID: 36338319 PMCID: PMC9626381 DOI: 10.1016/j.ijcha.2022.101139] [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] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
BackgroudThe aim of this study was to assess the prognostic association of plasma levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) with clinical outcomes of patients with microvascular angina (MVA). Methods In this international prospective cohort study of MVA by the Coronary Vasomotor Disorders International Study (COVADIS) group, we examined the association between plasma NT-proBNP levels and the incidence of major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization due to heart failure or unstable angina. Results We examined a total of 226 MVA patients (M/F 66/160, 61.9 ± 10.2 [SD] yrs.) with both plasma NT-proBNP levels and echocardiography data available at the time of enrolment. The median level of NT-proBNP level was 94 pg/ml, while mean left ventricular ejection fraction was 69.2 ± 10.9 % and E/e' 10.7 ± 5.2. During follow-up period of a median of 365 days (IQR 365-482), 29 MACEs occurred. Receiver-operating characteristics curve analysis identified plasma NT-proBNP level of 78 pg/ml as the optimal cut-off value. Multivariable logistic regression analysis revealed that plasma NT-proBNP level ≥ 78 pg/ml significantly correlated with the incidence of MACE (odds ratio (OR) [95 % confidence interval (CI)] 3.11[1.14-8.49], P = 0.001). Accordingly, Kaplan-Meier survival analysis showed a significantly worse prognosis in the group with NT-proBNP ≥ 78 (log-rank test, P < 0.03). Finally, a significant positive correlation was observed between plasma NT-proBNP levels and E/e' (R = 0.445, P < 0.0001). Conclusions These results indicate that plasma NT-proBNP levels may represent a novel prognostic biomarker for MVA patients.
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Affiliation(s)
- Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Maike Schwidder
- Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Peter Ong
- Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Daniel Ang
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Paolo G. Camici
- Vita Salute University and San Raffaele Hospital, Milan, Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Juan Carlos Kaski
- Cardiovascular and Cell Sciences Res Institute, St George’s, University of London, UK
| | - Carl Pepine
- Division of Cardiovascular Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Ornella Rimoldi
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy
| | - Udo Sechtem
- Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - John F. Beltrame
- The Discipline of Medicine, University of Adelaide, Basil Hetzel Institute, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- International University of Health and Welfare, Narita, Japan
| | - on behalf of the Coronary Vasomotor Disorders International Study COVADIS Group
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
- Vita Salute University and San Raffaele Hospital, Milan, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Cardiovascular and Cell Sciences Res Institute, St George’s, University of London, UK
- Division of Cardiovascular Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy
- The Discipline of Medicine, University of Adelaide, Basil Hetzel Institute, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- International University of Health and Welfare, Narita, Japan
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14
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Pelliccia F, Cecchi F, Olivotto I, Camici PG. Microvascular Dysfunction in Hypertrophic Cardiomyopathy. J Clin Med 2022; 11:jcm11216560. [PMID: 36362787 PMCID: PMC9658510 DOI: 10.3390/jcm11216560] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
Myocardial ischemia is an established pathophysiological feature of hypertrophic cardiomyopathy (HCM) that impacts various clinical features, including heart failure (HF) and sudden cardiac death (SCD). The major determinant of myocardial ischemia in HCM is coronary microvascular dysfunction (CMD) in the absence of epicardial coronary artery abnormalities. Despite the impossibility to directly visualize microcirculation in vivo, a multimodality approach can allow a detailed assessment of microvascular dysfunction and ischemia. Accordingly, the non-invasive assessment of CMD using transthoracic Doppler echocardiography, positron emission tomography, and cardiac magnetic resonance should now be considered mandatory in any HCM patient. Noteworthy, a complete diagnostic work-up for myocardial ischemia plays a major role in the approach of the patients with HCM and their risk stratification. Chronic and recurrent episodes of ischemia can contribute to fibrosis, culminating in LV remodeling and HF. Ischemia can potentially constitute an arrhythmic substrate and might prove to have an added value in risk stratification for SCD. Accordingly, strategies for the early diagnosis of CMD should now be considered an important challenge for the scientific community.
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Affiliation(s)
- Francesco Pelliccia
- Department of Cardiovascular Sciences, Sapienza University, 00166 Rome, Italy
- Correspondence:
| | - Franco Cecchi
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20100 Milan, Italy
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children Hospital and Careggi University Hospital, 50123 Florence, Italy
| | - Paolo G. Camici
- San Raffaele Hospital, Vita-Salute University, 20121 Milan, Italy
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15
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Pisano A, Pera LL, Carletti R, Cerbelli B, Pignataro MG, Pernazza A, Ferre F, Lombardi M, Lazzeroni D, Olivotto I, Rimoldi OE, Foglieni C, Camici PG, d'Amati G. RNA-seq profiling reveals different pathways between remodeled vessels and myocardium in hypertrophic cardiomyopathy. Microcirculation 2022; 29:e12790. [PMID: 36198058 PMCID: PMC9787970 DOI: 10.1111/micc.12790] [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: 04/05/2022] [Revised: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Coronary microvascular dysfunction (CMD) is a key pathophysiological feature of hypertrophic cardiomyopathy (HCM), contributing to myocardial ischemia and representing a critical determinant of patients' adverse outcome. The molecular mechanisms underlying the morphological and functional changes of CMD are still unknown. Aim of this study was to obtain insights on the molecular pathways associated with microvessel remodeling in HCM. METHODS Interventricular septum myectomies from patients with obstructive HCM (n = 20) and donors' hearts (CTRL, discarded for technical reasons, n = 7) were collected. Remodeled intramyocardial arterioles and cardiomyocytes were microdissected by laser capture and next-generation sequencing was used to delineate the transcriptome profile. RESULTS We identified 720 exclusive differentially expressed genes (DEGs) in cardiomyocytes and 1315 exclusive DEGs in remodeled arterioles of HCM. Performing gene ontology and pathway enrichment analyses, we identified selectively altered pathways between remodeled arterioles and cardiomyocytes in HCM patients and controls. CONCLUSIONS We demonstrate the existence of distinctive pathways between remodeled arterioles and cardiomyocytes in HCM patients and controls at the transcriptome level.
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Affiliation(s)
- Annalinda Pisano
- Department of Radiological, Oncological and Pathological SciencesSapienza University of RomeRomeItaly
| | - Loredana Le Pera
- Italian National Institute of Health (ISS), Core FacilitiesRomeItaly,National Research Council (IBIOM‐CNR)Institute of Biomembranes, Bioenergetics and Molecular BiotechnologiesBariItaly
| | - Raffaella Carletti
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Bruna Cerbelli
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Maria G. Pignataro
- Department of Chemistry and Drug TechnologiesSapienza University of RomeRomeItaly
| | - Angelina Pernazza
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Fabrizio Ferre
- Department of Pharmacy and Biotechnology (FABIT)University of BolognaBolognaItaly
| | - Maria Lombardi
- Cardiovascular Research CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Davide Lazzeroni
- Cardiovascular Research CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | | | - Ornella E. Rimoldi
- National Research Council (IBFM‐CNR)Institute of Molecular Bioimaging and PhysiologyMilanItaly
| | - Chiara Foglieni
- Cardiovascular Research CenterIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Paolo G. Camici
- Cardiovascular Research CenterIRCCS San Raffaele Scientific InstituteMilanItaly,Faculty of Medicine and SurgeryVita‐Salute UniversityMilanItaly
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological SciencesSapienza University of RomeRomeItaly
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16
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Gulati M, Khan N, George M, Berry C, Chieffo A, Camici PG, Crea F, Kaski JC, Marzilli M, Merz CNB. The Impact of Living with INOCA. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1116] [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
There is limited literature available on the impact of myocardial ischemia but no obstructive coronary arteries (INOCA) on patients' lives.
Purpose
We sought to determine how INOCA impacts the physical, social, and mental health of persons with this diagnosis.
Methods
A survey was made available to all members of the patient support group from INOCA International over a 3-month time period. Fitness was estimated using the Duke Activity Status Index (DASI), assessing levels of activities performed prior to the onset of INOCA symptoms, and after the diagnosis of INOCA. The formula to estimate fitness in metabolic equivalents (METs) = 0.43 × DASI + 9.6 / 3.5
Results
A total of 297 patients with INOCA responded to the survey; 91.2% were women. The most common diagnosis was coronary microvascular dysfunction (64.3%) and coronary artery spasm (50.5%) (Table 1). 34.4% reported living with symptoms for ≥3 years before their diagnosis of INOCA was made. 77.8% who had been told their symptoms were not cardiac. The symptoms the respondents experienced were numerous, but 92.9% reported symptoms of chest pain, pressure, or discomfort. Fitness levels prior to the onset of INOCA symptoms were significantly higher compared to after diagnosed with INOCA (8.6±1.8 METs vs 5.6±1.8 METs; P<0.0001). Most respondents reported an adverse impact on their home life (80.5%), social life (80.1%), mental health (70.4%), outlook on life (69.7%), sex life (55.9%), and their partner/spouse relationship (53.9%). Work life was also affected once living with INOCA: approximately three-quarters had reduced their work hours or stopping work completely, 47.5% retired early, and 38.4% applied for disability. While living with INOCA, for each 1-MET decrease in fitness, there was a loss of 3.0±0.6 days/months of physical health, 1.8±0.6 days/month of mental health, and 2.9±0.7 days/months of inability to perform recreational activities (p<0.0001) (Figure 1).
Conclusions
Living with INOCA has significant impact on physical, mental and social health. Significant physical fitness declines are seen in those living with INOCA and are lower in those experiencing any adverse impact of living with INOCA. Additionally, the impact of INOCA on the ability to work has important economic consequences to both the patient and society. Increased recognition of the impact of INOCA on these aspects of health need to be recognized and further work is needed to better diagnosis and treat the symptoms of INOCA to improve the quality of life, cardiovascular outcomes, and overall health of this frequently encountered cardiovascular disorder.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Gulati
- Cedars-Sinai Smidt Heart Institute , Los Angeles , United States of America
| | - N Khan
- The Methodist Hospital, Cardiology , Houston , United States of America
| | - M George
- INOCA International , Glasgow , United Kingdom
| | - C Berry
- University of Glasgow, Cardiovascular Research Centre , Glasgow , United Kingdom
| | - A Chieffo
- San Raffaele Hospital , Milan , Italy
| | | | - F Crea
- Catholic University of the Sacred Heart , Rome , Italy
| | - J C Kaski
- St George's University of London , London , United Kingdom
| | | | - C N B Merz
- Cedars-Sinai Smidt Heart Institute , Los Angeles , United States of America
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17
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Ammirati E, Raimondi F, Piriou N, Sardo Infirri L, Mohiddin SA, Mazzanti A, Shenoy C, Cavallari UA, Imazio M, Aquaro GD, Olivotto I, Pedrotti P, Sekhri N, Van de Heyning CM, Broeckx G, Peretto G, Guttmann O, Dellegrottaglie S, Scatteia A, Gentile P, Merlo M, Goldberg RI, Reyentovich A, Sciamanna C, Klaassen S, Poller W, Trankle CR, Abbate A, Keren A, Horowitz-Cederboim S, Cadrin-Tourigny J, Tadros R, Annoni GA, Bonoldi E, Toquet C, Marteau L, Probst V, Trochu JN, Kissopoulou A, Grosu A, Kukavica D, Trancuccio A, Gil C, Tini G, Pedrazzini M, Torchio M, Sinagra G, Gimeno JR, Bernasconi D, Valsecchi MG, Klingel K, Adler ED, Camici PG, Cooper LT. Acute Myocarditis Associated With Desmosomal Gene Variants. JACC Heart Fail 2022; 10:714-727. [PMID: 36175056 DOI: 10.1016/j.jchf.2022.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 04/29/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The risk of adverse cardiovascular events in patients with acute myocarditis (AM) and desmosomal gene variants (DGV) remains unknown. OBJECTIVES The purpose of this study was to ascertain the risk of death, ventricular arrhythmias, recurrent myocarditis, and heart failure (main endpoint) in patients with AM and pathogenic or likely pathogenetic DGV. METHODS In a retrospective international study from 23 hospitals, 97 patients were included: 36 with AM and DGV (DGV[+]), 25 with AM and negative gene testing (DGV[-]), and 36 with AM without genetics testing. All patients had troponin elevation plus findings consistent with AM on histology or at cardiac magnetic resonance (CMR). In 86 patients, CMR changes in function and structure were re-assessed at follow-up. RESULTS In the DGV(+) AM group (88.9% DSP variants), median age was 24 years, 91.7% presented with chest pain, and median left ventricular ejection fraction (LVEF) was 56% on CMR (P = NS vs the other 2 groups). Kaplan-Meier curves demonstrated a higher risk of the main endpoint in DGV(+) AM compared with DGV(-) and without genetics testing patients (62.3% vs 17.5% vs 5.3% at 5 years, respectively; P < 0.0001), driven by myocarditis recurrence and ventricular arrhythmias. At follow-up CMR, a higher number of late gadolinium enhanced segments was found in DGV(+) AM. CONCLUSIONS Patients with AM and evidence of DGV have a higher incidence of adverse cardiovascular events compared with patients with AM without DGV. Further prospective studies are needed to ascertain if genetic testing might improve risk stratification of patients with AM who are considered at low risk.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.
| | - Francesca Raimondi
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C Hôpital Necker Enfants Malades, APHP Paris Cité, Paris, France
| | - Nicolas Piriou
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | | | - Saidi A Mohiddin
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Andrea Mazzanti
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ugo A Cavallari
- Medical Genetics Unit, Department of Laboratory Medicine, Niguarda Hospital, Milano, Italy
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, "Santa Maria della Misericordia," Udine, Italy
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Firenze, Italy
| | | | - Neha Sekhri
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Giovanni Peretto
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Oliver Guttmann
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Randal I Goldberg
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Alex Reyentovich
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Christopher Sciamanna
- University of Illinois at Chicago, Advocate Christ Medical Center Cardiothoracic and Vascular Surgical Associates, Oak Lawn, Illinois, USA
| | - Sabine Klaassen
- Department of Paediatric Cardiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Poller
- Department of Paediatric Cardiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Berlin, Germany; Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany
| | - Cory R Trankle
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Antonio Abbate
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andre Keren
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Julia Cadrin-Tourigny
- Division of Electrophysiology and Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Rafik Tadros
- Division of Electrophysiology and Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | | | - Claire Toquet
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Pathology Department, CHU Nantes, Nantes University, Nantes, France
| | - Lara Marteau
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Vincent Probst
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Jean Noël Trochu
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Antheia Kissopoulou
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Aurelia Grosu
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Deni Kukavica
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Alessandro Trancuccio
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Cristina Gil
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia, Spain
| | - Giacomo Tini
- Clinic of Cardiovascular Disease, Ospedale Policlinico San Martino, Università di Genova, Genova, Italy
| | - Matteo Pedrazzini
- Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Margherita Torchio
- Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Juan Ramón Gimeno
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia, Spain
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging (B4) Center, School of Medicine and Surgery, University of Milano-Bicocca, Bicocca, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging (B4) Center, School of Medicine and Surgery, University of Milano-Bicocca, Bicocca, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Eric D Adler
- Department of Cardiology, University of California-San Diego, San Diego, California, USA
| | - Paolo G Camici
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.
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18
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Calabretta R, Kokomani A, Fumagalli C, Olivotto I, Camici PG, Hacker M, Sciagrà R. Evaluation of stress myocardial blood flow patterns in patients with apical hypertrophic cardiomyopathy. J Nucl Cardiol 2022; 29:1946-1951. [PMID: 35112308 DOI: 10.1007/s12350-022-02911-y] [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: 07/25/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Among the other variants, the apical pattern of hypertrophic cardiomyopathy (AHCM) is probably the most important, with possible aneurysmatic evolution. METHODS AND RESULTS We analyzed 12 patients with AHCM who underwent [13N]NH3-PET/CT. Regional perfusion, stress global myocardial blood flow (MBF), and transmural perfusion patterns were assessed. To evaluate the LV-MBF distribution, we compared the apex with septum and infero-lateral wall. Furthermore, global stress MBF distribution in AHCM patients was compared with a reference septal HCM cohort. Visual regional perfusion analysis demonstrated an apical hypoperfusion in 10 of 12 patients, without correlation with the stress MBF of the whole LV. Significant differences among stress MBF in apical, in septal, and in the infero-lateral walls were recorded (P < .02). The transmural analysis showed a significant difference among the three segment groups for epicardial (P < .003) as well for endocardial MBF (P < .005). In the post hoc analysis, the apical MBF was significantly lower than in septal and infero-lateral walls in epicardium (P < .005) and significantly lower than the infero-lateral MBF in endocardium (P < .001). CONCLUSION In patients with AHCM, more severe apical microvascular impairment was found as compared to patients with classical septal HCM, supporting the suspicion that ischemia could play a role in the future aneurysmatic evolution of AHCM.
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Affiliation(s)
- Raffaella Calabretta
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
| | - Aurora Kokomani
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Paolo G Camici
- Vita Salute University and Scientific Institute San Raffaele, Milan, Italy
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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19
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Morrone D, Gentile F, Aimo A, Cameli M, Barison A, Picoi ME, Guglielmo M, Villano A, DeVita A, Mandoli GE, Pastore MC, Barillà F, Mancone M, Pedrinelli R, Indolfi C, Filardi PP, Muscoli S, Tritto I, Pizzi C, Camici PG, Marzilli M, Crea F, Caterina RD, Pontone G, Neglia D, Lanza G. Perspectives in noninvasive imaging for chronic coronary syndromes. Int J Cardiol 2022; 365:19-29. [PMID: 35901907 DOI: 10.1016/j.ijcard.2022.07.038] [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: 05/10/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022]
Abstract
Both the latest European guidelines on chronic coronary syndromes and the American guidelines on chest pain have underlined the importance of noninvasive imaging to select patients to be referred to invasive angiography. Nevertheless, although coronary stenosis has long been considered the main determinant of inducible ischemia and symptoms, growing evidence has demonstrated the importance of other underlying mechanisms (e.g., vasospasm, microvascular disease, energetic inefficiency). The search for a pathophysiology-driven treatment of these patients has therefore emerged as an important objective of multimodality imaging, integrating "anatomical" and "functional" information. We here provide an up-to-date guide for the choice and the interpretation of the currently available noninvasive anatomical and/or functional tests, focusing on emerging techniques (e.g., coronary flow velocity reserve, stress-cardiac magnetic resonance, hybrid imaging, functional-coronary computed tomography angiography, etc.), which could provide deeper pathophysiological insights to refine diagnostic and therapeutic pathways in the next future.
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Affiliation(s)
- Doralisa Morrone
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy.
| | - Francesco Gentile
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Alberto Aimo
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Maria Elena Picoi
- Azienda Tutela Salute Sardegna, Ospedale Giovanni Paolo II, Unità di terapia intensiva Cardiologica, Olbia, Sardegna, Italy
| | - Marco Guglielmo
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | - Angelo Villano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio DeVita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesco Barillà
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Policlinico Umberto I, Roma, Italy
| | - Massimo Mancone
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Policlinico Umberto I, Roma, Italy
| | - Roberto Pedrinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro - Mediterranea Cardiocentro, Napoli, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy, Mediterranea Cardiocentro, Naples, Italy
| | - Saverio Muscoli
- U.O.C. Cardiologia, Fondazione Policlinico "Tor Vergata", Roma, Italy
| | - Isabella Tritto
- Università di Perugia, Dipartimento di Medicina, Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Perugia, Italy
| | - Carmine Pizzi
- Università di Bologna, Alma Mater Studiorum, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Bologna, Italy
| | - Paolo G Camici
- Vita-Salute University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Mario Marzilli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Filippo Crea
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | - Raffaele De Caterina
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-Cardiology Division, University Hospital of Pisa, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan 20138, Italy
| | | | - Gaetano Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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20
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Ammirati E, Lupi L, Palazzini M, Hendren NS, Grodin JL, Cannistraci CV, Schmidt M, Hekimian G, Peretto G, Bochaton T, Hayek A, Piriou N, Leonardi S, Guida S, Turco A, Sala S, Uribarri A, Van de Heyning CM, Mapelli M, Campodonico J, Pedrotti P, Barrionuevo Sánchez MI, Ariza Sole A, Marini M, Matassini MV, Vourc'h M, Cannatà A, Bromage DI, Briguglia D, Salamanca J, Diez-Villanueva P, Lehtonen J, Huang F, Russel S, Soriano F, Turrini F, Cipriani M, Bramerio M, Di Pasquale M, Grosu A, Senni M, Farina D, Agostoni P, Rizzo S, De Gaspari M, Marzo F, Duran JM, Adler ED, Giannattasio C, Basso C, McDonagh T, Kerneis M, Combes A, Camici PG, de Lemos JA, Metra M. Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis. Circulation 2022; 145:1123-1139. [PMID: 35404682 PMCID: PMC8989611 DOI: 10.1161/circulationaha.121.056817] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19–associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe. Methods: A total of 112 patients with suspected AM from 56 963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19–associated AM. Results: AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19–associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47; P<0.0001) similarly in patients with or without pneumonia. Corticosteroids were frequently administered (55.5%). Conclusions: AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Laura Lupi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra)
| | - Matteo Palazzini
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Nicholas S Hendren
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.)
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.)
| | - Carlo V Cannistraci
- Center for Complex Network Intelligence, Tsinghua Laboratory of Brain and Intelligence, Department of Computer Science, Department of Biomedical Engineering, Tsinghua University, Beijing, China (C.V.C.).,Center for Systems Biology Dresden, Germany (C.V.C.)
| | - Matthieu Schmidt
- Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, France (M. Schmidt, G.H., A. Combes)
| | - Guillaume Hekimian
- Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, France (M. Schmidt, G.H., A. Combes)
| | - Giovanni Peretto
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.)
| | - Thomas Bochaton
- Urgences et Soins Critiques Cardiologiques, Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France (T.B., A.H.)
| | - Ahmad Hayek
- Urgences et Soins Critiques Cardiologiques, Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France (T.B., A.H.)
| | - Nicolas Piriou
- Université Nantes, CHU Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, l'Institut du Thorax, France (N.P.)
| | - Sergio Leonardi
- University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.)
| | - Stefania Guida
- University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.)
| | - Annalisa Turco
- University of Pavia and Fondazione Istituto di Ricovero e Cura a Carattere Scientificio Policlinico S. Matteo, Italy (S.L., S.G., A.T.)
| | - Simone Sala
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.)
| | - Aitor Uribarri
- Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain (A.U.).,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain (A.U.)
| | - Caroline M Van de Heyning
- Department of Cardiology, Antwerp University Hospital, and Genetics, Pharmacology and Physiopathology of Heart, Blood Vessels and Skeleton Research Group, Antwerp University, Belgium (C.M.V.d.H.)
| | - Massimo Mapelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.)
| | - Patrizia Pedrotti
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Maria Isabel Barrionuevo Sánchez
- Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, L'Hospotalet del Llobregat, Barcelona, Spain (M.I.B.S., A.A.S.)
| | - Albert Ariza Sole
- Cardiology Department, Bellvitge University Hospital, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge, L'Hospotalet del Llobregat, Barcelona, Spain (M.I.B.S., A.A.S.)
| | - Marco Marini
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I-GM Lancisi-G Salesi, Ancona, Italy (M. Marini, M.V.M.)
| | - Maria Vittoria Matassini
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I-GM Lancisi-G Salesi, Ancona, Italy (M. Marini, M.V.M.)
| | - Mickael Vourc'h
- Department of Anesthesiology and Surgical Intensive Care, Hôpital Laennec, University Hospital of Nantes, France (M.V.).,School of Medicine, UPRES EA 3826, Thérapeutiques Cliniques et Expérimentales des Infections, IRS2 Nantes Biotech, France (M.V.)
| | - Antonio Cannatà
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).,Department of Cardiology, King's College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.)
| | - Daniel I Bromage
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).,Department of Cardiology, King's College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.)
| | | | - Jorge Salamanca
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Pablo Diez-Villanueva
- Cardiology Department, Hospital Universitario De La Princesa, Madrid, Spain (J.S., P.D.-V.)
| | - Jukka Lehtonen
- Heart and Lung Center, Department of Cardiology, Helsinki University Hospital, Finland (J.L.)
| | - Florent Huang
- Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H., S. Russel)
| | - Stéphanie Russel
- Service de Cardiologie, Hôpital Foch, Suresnes, France (F.H., S. Russel)
| | - Francesco Soriano
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | | | - Manlio Cipriani
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.)
| | - Manuela Bramerio
- Department of Histopathology, Niguarda Hospital, Milano, Italy (M.B.)
| | - Mattia Di Pasquale
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra)
| | - Aurelia Grosu
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A.G., M. Senni)
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy (A.G., M. Senni)
| | - Davide Farina
- Institute of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (D.F.)
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientificio, Milano, Italy (M. Mapelli, J.C., P.A.).,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Italy (M. Mapelli, J.C., P.A.)
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.)
| | - Monica De Gaspari
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.)
| | - Francesca Marzo
- Department of Cardiology, Infermi Hospital, Rimini, Italy (F.M.)
| | - Jason M Duran
- Division of Cardiology, Department of Medicine, University of California San Diego (J.M.D., E.D.A.)
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, University of California San Diego (J.M.D., E.D.A.)
| | - Cristina Giannattasio
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.P., P.P. F.S., M.C., C.G.).,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy (C.G.)
| | - Cristina Basso
- Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy (S. Rizzo, M.D.G., C.B.)
| | - Theresa McDonagh
- School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, James Black Centre, United Kingdom (A. Cannatà, D.I.B., T.M.).,Department of Cardiology, King's College Hospital London, United Kingdom (A. Cannatà, D.I.B., T.M.)
| | - Mathieu Kerneis
- Sorbonne Université, ACTION Study Group, Institut National de la Santé et de la Recherche Médicale UMRS1166, Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France (M.K.)
| | - Alain Combes
- Sorbonne Université, UMRS 1166, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, France (M. Schmidt, G.H., A. Combes)
| | - Paolo G Camici
- San Raffaele Hospital and Vita Salute University, Milano, Italy (G.P., S.S., P.G.C.)
| | - James A de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (N.S.H., J.L.G., J.A.d.L.)
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (L.L., M.D.P., M. Metra)
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21
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Calabretta R, Kokomani A, Fumagalli C, Olivotto I, Camici PG, Hacker M, Sciagrà R. Correction to: Evaluation of stress myocardial blood flow patterns in patients with apical hypertrophic cardiomyopathy. J Nucl Cardiol 2022; 29:893. [PMID: 35194754 DOI: 10.1007/s12350-022-02926-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Raffaella Calabretta
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
| | - Aurora Kokomani
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Paolo G Camici
- Vita Salute University and Scientific Institute San Raffaele, Milan, Italy
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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22
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Pelliccia F, Camici PG. Acute neurological dysfunction: The missing link in the pathophysiology of takotsubo syndrome. Int J Cardiol 2021; 345:26-28. [PMID: 34728261 DOI: 10.1016/j.ijcard.2021.10.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/28/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022]
Affiliation(s)
| | - Paolo G Camici
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
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23
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Shimokawa H, Suda A, Takahashi J, Berry C, Camici PG, Crea F, Escaned J, Ford T, Yii E, Kaski JC, Kiyooka T, Mehta PK, Ong P, Ozaki Y, Pepine C, Rimoldi O, Safdar B, Sechtem U, Tsujita K, Yasuda S, Beltrame JF, Merz CNB. Clinical characteristics and prognosis of patients with microvascular angina: an international and prospective cohort study by the Coronary Vasomotor Disorders International Study (COVADIS) Group. Eur Heart J 2021; 42:4592-4600. [PMID: 34038937 PMCID: PMC8633728 DOI: 10.1093/eurheartj/ehab282] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/01/2021] [Accepted: 04/23/2021] [Indexed: 12/30/2022] Open
Abstract
AIMS To provide multi-national, multi-ethnic data on the clinical characteristics and prognosis of patients with microvascular angina (MVA). METHODS AND RESULTS The Coronary Vasomotor Disorders International Study Group proposed the diagnostic criteria for MVA. We prospectively evaluated the clinical characteristics of patients according to these criteria and their prognosis. The primary endpoint was the composite of major cardiovascular events (MACE), verified by institutional investigators, which included cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization due to heart failure or unstable angina. During the period from 1 July 2015 to 31 December 2018, 686 patients with MVA were registered from 14 institutes in 7 countries from 4 continents. Among them, 64% were female and the main ethnic groups were Caucasians (61%) and Asians (29%). During follow-up of a median of 398 days (IQR 365-744), 78 MACE occurred (6.4% in men vs. 8.6% in women, P = 0.19). Multivariable Cox proportional hazard analysis disclosed that hypertension and previous history of coronary artery disease (CAD), including acute coronary syndrome and stable angina pectoris, were independent predictors of MACE. There was no sex or ethnic difference in prognosis, although women had lower Seattle Angina Questionnaire scores than men (P < 0.05). CONCLUSIONS This first international study provides novel evidence that MVA is an important health problem regardless of sex or ethnicity that a diagnosis of MVA portends a substantial risk for MACE associated with hypertension and previous history of CAD, and that women have a lower quality of life than men despite the comparable prognosis.
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Affiliation(s)
- Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Sendai, Japan
- International University of Health and Welfare, Narita, Japan
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Sendai, Japan
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Paolo G Camici
- Vita Salute University and San Raffaele Hospital, Milan, Italy
| | - Filippo Crea
- Department of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Tom Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Juan Carlos Kaski
- Department of Cardiovascular Science, Cardiovascular and Cell Sciences Res Institute, St George’s, University of London, UK
| | - Takahiko Kiyooka
- Department of Cardiology, Tokai University Oiso Hospital, Oiso, Japan
| | - Puja K Mehta
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyonaka, Aichi, Japan
| | - Carl Pepine
- Division of Cardiovascular Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Ornella Rimoldi
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Sendai, Japan
| | - John F Beltrame
- The Discipline of Medicine, University of Adelaide, Basil Hetzel Institute, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - C Noel Bairey Merz
- Department of Cardiology, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Smidt Heart Institute, Los Angeles, CA, USA
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24
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Merz CNB, Beltrame JF, Berry C, Boden WE, Camici PG, Crea F, Hochman JS, Kaski JC, O'Gara PT, Ong P, Pepine CJ, Shimokawa H, Sechtem U, Stone GW. Insights to advance our management of myocardial ischemia: From obstructive epicardial disease to functional coronary alterations. Am Heart J Plus 2021; 11:100060. [PMID: 38559316 PMCID: PMC10978135 DOI: 10.1016/j.ahjo.2021.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/09/2021] [Indexed: 04/04/2024]
Abstract
Study objective The Coronary Vasomotor Disorders International Study Group (COVADIS) invited leading experts to address strategies to enhance our clinical understanding of INOCA with an emphasis on the management of coronary vasomotor disorders. Design Under-recognition of coronary vasomotor disorders, distinguishing different presentations of angina due to vasospasm and/or abnormal microvascular vasodilatation, developing invasive/non-invasive testing and treatment protocols, integrating diagnostic protocols into cardiologists' workflow and trials to inform guideline development were identified as key knowledge gaps and will be briefly addressed in this Viewpoint article. Setting Virtual international meeting. Participants Leading international experts in ischemic heart disease with no obstructive coronary artery disease. Interventions None. Main outcome measures None. Results Topics discussed include: 1. Obstructive epicardial disease, functional vasospasm and microvascular disorders; 2. Under-recognition of coronary vasomotor disorders in clinical practice; 3. Complexity of coronary vasomotor disorders; 4. Understanding different presentations - vasospastic disease and microvascular angina; 5. Invasive/noninvasive testing and treatment protocols for vasospasm and microvascular angina assessment; 6. Treatment challenges; 7. Integrating diagnostic protocols into cardiologists' workflow; 8. The path forward to advance our approach to managing myocardial ischemia. Conclusions Obstructive epicardial disease, functional vasospasm and microvascular disorders often co-exist and contribute to myocardial ischemia. Under-recognition, the complexity of coronary vasomotor disorders, understanding different presentations, testing and treatment protocols, treatment challenges, and integrating diagnostic protocols into cardiologists' workflow all contribute to the path forward to advance our management of myocardial ischemia for improved patient outcomes.
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Affiliation(s)
- C. Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John F. Beltrame
- The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Colin Berry
- West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - William E. Boden
- VA New England Health Care System, Massachusetts Veterans Epidemiology, Research, and Informatics Center, Boston University School of Medicine, Boston, MA, USA
| | | | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Juan Carlos Kaski
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, UK
| | - Patrick T. O'Gara
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Gregg W. Stone
- Division of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
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25
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Pelliccia F, Marzilli M, Boden WE, Camici PG. Why the Term MINOCA Does Not Provide Conceptual Clarity for Actionable Decision-Making in Patients with Myocardial Infarction with No Obstructive Coronary Artery Disease. J Clin Med 2021; 10:4630. [PMID: 34682754 PMCID: PMC8538927 DOI: 10.3390/jcm10204630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 01/18/2023] Open
Abstract
When acute myocardial injury is found in a clinical setting suggestive of myocardial ischemia, the event is labeled as acute myocardial infarction (MI), and the absence of ≥50% coronary stenosis at angiography or greater leads to the working diagnosis of myocardial infarction with non-obstructed coronary arteries (MINOCA). Determining the mechanism of MINOCA and excluding other possible causes for cardiac troponin elevation has notable implications for tailoring secondary prevention measures aimed at improving the overall prognosis of acute MI. The aim of this review is to increase the awareness that establishing the underlying cause of a MINOCA is possible in the vast majority of cases, and that the proper classification of any MI should be pursued. The initial diagnosis of MINOCA can be confirmed or ruled out based on the results of subsequent investigations. Indeed, a comprehensive clinical evaluation at the time of presentation, followed by a dedicated diagnostic work-up, might lead to the identification of the pathophysiologic abnormality leading to MI in almost all cases initially labeled as MINOCA. When a specific cause of acute MI is identified, cardiologists are urged to transition from the "all-inclusive" term "MINOCA" to the proper classification of any MI, as evidence now exists that MINOCA does not provide conceptual clarity for actionable decision-making in MI with angiographically normal coronary arteries.
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Affiliation(s)
- Francesco Pelliccia
- Department of Cardiovascular Sciences, Sapienza University, 00166 Rome, Italy
| | - Mario Marzilli
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, 56121 Pisa, Italy;
| | - William E. Boden
- Department of Cardiology, VA New England Health Care System, Boston, MA 02101, USA;
| | - Paolo G. Camici
- Department of Cardiology, San Raffaele Hospital and Vita e Salute University, 20100 Milan, Italy;
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26
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Camici PG, Cianflone D. Professor Attilio Maseri died on 3 September 2021 in his native town of Udine, in the north east of Italy, where he was born 85 years ago. Int J Cardiol 2021; 343:S0167-5273(21)01333-4. [PMID: 34563402 DOI: 10.1016/j.ijcard.2021.09.010] [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: 11/20/2022]
Affiliation(s)
- Paolo G Camici
- San Raffaele Hospital, Via Olgettina 58, 20132 Milan, Italy.
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27
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Masci PG, Pavon AG, Pontone G, Symons R, Lorenzoni V, Francone M, Zalewski J, Barison A, Guglielmo M, Aquaro GD, Galea N, Muscogiuri G, Muller O, Carbone I, Baggiano A, Iglesias JF, Nessler J, Andreini D, Camici PG, Claus P, de Luca L, Agati L, Janssens S, Schwitter J, Bogaert J. Early or deferred cardiovascular magnetic resonance after ST-segment-elevation myocardial infarction for effective risk stratification. Eur Heart J Cardiovasc Imaging 2021; 21:632-639. [PMID: 31326993 DOI: 10.1093/ehjci/jez179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 02/05/2019] [Revised: 04/04/2019] [Accepted: 06/20/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS In ST-segment-elevation myocardial infarction (STEMI), cardiovascular magnetic resonance (CMR) holds the potentiality to improve risk stratification in addition to Thrombolysis in Myocardial Infarction (TIMI) risk score. Nevertheless, the optimal timing for CMR after STEMI remains poorly defined. We aim at comparing the prognostic performance of three stratification strategies according to the timing of CMR after STEMI. METHODS AND RESULTS The population of this prospective registry-based study included 492 reperfused STEMI patients. All patients underwent post-reperfusion (median: 4 days post-STEMI) and follow-up (median: 4.8 months post-STEMI) CMR. Left ventricular (LV) volumes, function, infarct size, and microvascular obstruction extent were quantified. Primary endpoint was a composite of all-death and heart failure (HF) hospitalization. Baseline-to-follow-up percentage increase of LV end-diastolic (EDV; ΔLV-EDV) ≥20% or end-systolic volumes (ESV; ΔLV-ESV) ≥15% were tested against outcome. Three multivariate models were developed including TIMI risk score plus early post-STEMI (early-CMR) or follow-up CMR (deferred-CMR) or both CMRs parameters along with adverse LV remodelling (paired-CMRs). During a median follow-up of 8.3 years, the primary endpoint occurred in 84 patients (47 deaths; 37 HF hospitalizations). Early-CMR, deferred-CMR, and paired-CMR demonstrated similar predictive value for the primary endpoint (C-statistic: 0.726, 0.728, and 0.738, respectively; P = 0.663). ΔLV-EDV ≥20% or ΔLV-ESV ≥15% were unadjusted outcome predictors (hazard ratio: 2.020 and 2.032, respectively; P = 0.002 for both) but lost their predictive value when corrected for other covariates in paired-CMR model. CONCLUSION In STEMI patients, early-, deferred-, or paired-CMR were equivalent stratification strategies for outcome prediction. Adverse LV remodelling parameters were not independent prognosticators.
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Affiliation(s)
- Pier Giorgio Masci
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital Campus, Westminster Bridge Road, London SE1 7EH, UK
| | - Anna Giulia Pavon
- Cardiology Division, Heart & Vessels Department, Center of Cardiac Magnetic Resonance, Rue du Bugnon 46, 1005 Lausanne, University Hospital, Lausanne, Switzerland
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS Via Carlo Parea, 4, 20138 Milan, Italy
| | - Rolf Symons
- Radiology Department, Gasthuisberg University Hospitals, Herestraat 49, 3000 Leuven, Belgium
| | - Valentina Lorenzoni
- Institute of Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 24, 56127 Pisa, Italy
| | - Marco Francone
- Department of Radiological, Oncological, and Pathological Sciences, La Sapienza University, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - Jaroslaw Zalewski
- Department of Coronary Disease, Jagiellonian University Medical College, Gołębia 24, 31-007 Kraków, Poland.,Department of Interventional Cardiology, John Paul II Hospital, Prądnicka 80, 31-202 Kraköw, Poland
| | - Andrea Barison
- Fondazione CNR-Regione Toscana 'G.Monasterio', Via Moruzzi 1, 56100 Pisa, Italy
| | - Marco Guglielmo
- Centro Cardiologico Monzino, IRCCS Via Carlo Parea, 4, 20138 Milan, Italy
| | | | - Nicola Galea
- Department of Radiological, Oncological, and Pathological Sciences, La Sapienza University, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | | | - Olivier Muller
- Cardiology Division, Heart & Vessels Department, Center of Cardiac Magnetic Resonance, Rue du Bugnon 46, 1005 Lausanne, University Hospital, Lausanne, Switzerland
| | - Iacopo Carbone
- Department of Radiological, Oncological, and Pathological Sciences, La Sapienza University, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - Andrea Baggiano
- Radiology Department, Gasthuisberg University Hospitals, Herestraat 49, 3000 Leuven, Belgium
| | - Juan F Iglesias
- Cardiology Division, University Hospitals Geneve, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| | - Jadwiga Nessler
- Department of Coronary Disease, Jagiellonian University Medical College, Gołębia 24, 31-007 Kraków, Poland
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS Via Carlo Parea, 4, 20138 Milan, Italy
| | - Paolo G Camici
- Cardiology Division, Heart & Vessels Department, Center of Cardiac Magnetic Resonance, Rue du Bugnon 46, 1005 Lausanne, University Hospital, Lausanne, Switzerland
| | - Piet Claus
- Cardiology Department, Gasthuisberg University Hospitals, Herestraat 49, 3000 Leuven, Belgium
| | - Laura de Luca
- Cardiology Department, La Sapienza University, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - Luciano Agati
- Cardiology Department, La Sapienza University, Piazzale Aldo Moro, 5, 00185 Rome, Italy
| | - Stefan Janssens
- Cardiology Department, Gasthuisberg University Hospitals, Herestraat 49, 3000 Leuven, Belgium
| | - Jurg Schwitter
- Cardiology Division, Heart & Vessels Department, Center of Cardiac Magnetic Resonance, Rue du Bugnon 46, 1005 Lausanne, University Hospital, Lausanne, Switzerland
| | - Jan Bogaert
- Radiology Department, Gasthuisberg University Hospitals, Herestraat 49, 3000 Leuven, Belgium
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Ammirati E, Varrenti M, Veronese G, Fanti D, Nava A, Cipriani M, Pedrotti P, Garascia A, Bottiroli M, Oliva F, Bramerio M, Veronese S, Giannattasio C, Bonoldi E, Perno CF, Camici PG, Frigerio M. Prevalence and outcome of patients with acute myocarditis and positive viral search on nasopharyngeal swab. Eur J Heart Fail 2021; 23:1242-1245. [PMID: 34036693 DOI: 10.1002/ejhf.2247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/28/2020] [Revised: 04/06/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Marisa Varrenti
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Giacomo Veronese
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Diana Fanti
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alice Nava
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | | | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy
| | | | | | - Cristina Giannattasio
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | | | - Carlo F Perno
- Chemical-Clinical and Microbiological Analyses, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo G Camici
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Maria Frigerio
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy
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29
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Ammirati E, Camici PG, Lehtonen J. Overcoming the low yield of histology for the diagnosis of cardiac sarcoidosis. Int J Cardiol 2021; 337:86-87. [PMID: 34102244 DOI: 10.1016/j.ijcard.2021.06.004] [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: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Enrico Ammirati
- Transplant Center and "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
| | - Paolo G Camici
- San Raffaele Hospital and Vita Salute University, Milan, Italy
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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30
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Pelliccia F, Pepine CJ, Berry C, Camici PG. The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review. Int J Cardiol 2021; 336:1-7. [PMID: 34087335 DOI: 10.1016/j.ijcard.2021.05.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
The role of cardiac magnetic resonance (CMR) in identifying mechanisms for myocardial infarction with non-obstructed coronary arteries (MINOCA) is well established. Recent reports have highlighted the potentially key role of invasive management in this diagnostic process. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) allow precise evaluation of coronary anatomy, and assessment of coronary physiology in the catheter laboratory provides information on the hemodynamic significance of sub-critical atherosclerosis and on coronary microvascular dysfunction (CMD). We reviewed the evidence for the contribution of invasive diagnostic techniques in identifying provisional causes for MINOCA. Overall, among 82 studies including 8457 patients were selected. In the acute phase, 16 studies with IVUS or OCT (1207 patients) disclosed that plaque disruption and spontaneous coronary artery dissection had a pooled prevalence of 38% (95% confidence intervals (CI): 29% to 51%) and 16% (95% CI: 9% to 27%), respectively. In 18 studies, coronary function testing (1449 patients) showed a pooled prevalence of spontaneous and/or provoked epicardial coronary spasm of ~28% (95% CI:17% to 41%). In 3 studies (456 patients), the pooled prevalence of CMD was ~32% (95% CI: 20% to 49%). In the subacute phase, 42 CMR studies (5821 patients) showed that a pooled prevalence of myocarditis, takotsubo syndrome and cardiomyopathy of 26% (95% CI: 12% to 40%), 11% (95% CI: 5% to 25%), and 7% (95% CI: 1% to 19%), respectively. In 12 studies on thrombophilia screening (n = 834), the pooled prevalence of thrombotic disorder was ~11% (95% CI: 7%% to 25%). In conclusion, the pathophysiology of MINOCA can be established in the majority of cases using both invasive and non-invasive tools to provide direction for appropriate management.
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Affiliation(s)
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of FL, Gainesville, FL, USA
| | - Colin Berry
- British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Paolo G Camici
- San Raffaele Hospital and Vita e Salute University, Milan, Italy
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31
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De Gregorio MG, Fumagalli C, Tomberli A, Baldini K, Puccini G, d'Amati G, Foglieni C, Camici PG, Sciagrà R, Olivotto I. Myocardial blood flow in patients with hypertrophic cardiomyopathy receiving perindopril (CARAPaCE): a pilot study. J Cardiovasc Med (Hagerstown) 2021; 22:511-513. [PMID: 33186235 DOI: 10.2459/jcm.0000000000001144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Coronary microvascular dysfunction (CMD) represents a powerful independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM). No treatment for CMD exists. The angiotensin-converting enzyme (ACE)-inhibitor perindopril improves myocardial blood flow (MBF) in animal models of cardiac hypertrophy and in hypertensive patients. Whether HCM patients with CMD may benefit is unknown. METHODS Fourteen HCM patients aged 18-60 years with CMD [MBF post 0.56 mg/kg dipyridamole (Dip) infusion <2.1 ml/min∗g] were included. Presence of left ventricular outflow obstruction, hypertension and coronary artery disease were exclusion criteria. Perindopril was administered after the initial Dip 13N-NH3 PET study at 10 mg for 6 months. After wash-out, a second PET was performed. MBF before and after treatment was compared. RESULTS No relevant associations were found between baseline MBF values and sex, genetics, history of angina, type of HCM (apical/classic), maximum left ventricular thickness and left ventricular mass. No significant improvement in Dip-MBF was observed with treatment (1.79 ± 0.30 vs.1.76 ± 0.26 ml/min∗g at baseline; P = 0.59). A limited but significant improvement in Dip-MBF was seen only in the subset without evidence of fibrosis at cardiac MRI (n = 4; 28%; 2.03 ± 0.13 vs.1.77 ± 0.26 ml/min∗g at baseline; P = 0.014). The drug was generally well tolerated: only one patient temporarily stopped the drug, because of cough. CONCLUSION A 6-month perindopril treatment course in HCM patients with CMD was not associated with significant improvement in Dip-MBF. A limited but significant improvement was observed only in the subset of patients without myocardial fibrosis, suggesting potential utility in early disease stages.
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Affiliation(s)
- Maria Grazia De Gregorio
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Alessia Tomberli
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Katia Baldini
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Giulia Puccini
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome
| | - Chiara Foglieni
- Vita Salute University and San Raffaele Hospital, Milan, Italy
| | - Paolo G Camici
- Vita Salute University and San Raffaele Hospital, Milan, Italy
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
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32
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Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AHEM, Prescott E, Karam N, Appelman Y, Fraccaro C, Louise Buchanan G, Manzo-Silberman S, Al-Lamee R, Regar E, Lansky A, Abbott JD, Badimon L, Duncker DJ, Mehran R, Capodanno D, Baumbach A. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J 2021; 41:3504-3520. [PMID: 32626906 DOI: 10.1093/eurheartj/ehaa503] [Citation(s) in RCA: 332] [Impact Index Per Article: 110.7] [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: 02/03/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022] Open
Abstract
This consensus document, a summary of the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), appraises the importance of ischaemia with non-obstructive coronary arteries (INOCA). Angina pectoris affects approximately 112 million people globally. Up to 70% of patients undergoing invasive angiography do not have obstructive coronary artery disease, more common in women than in men, and a large proportion have INOCA as a cause of their symptoms. INOCA patients present with a wide spectrum of symptoms and signs that are often misdiagnosed as non-cardiac leading to under-diagnosis/investigation and under-treatment. INOCA can result from heterogeneous mechanism including coronary vasospasm and microvascular dysfunction and is not a benign condition. Compared to asymptomatic individuals, INOCA is associated with increased incidence of cardiovascular events, repeated hospital admissions, as well as impaired quality of life and associated increased health care costs. This consensus document provides a definition of INOCA and guidance to the community on the diagnostic approach and management of INOCA based on existing evidence from research and best available clinical practice; noting gaps in knowledge and potential areas for further investigation.
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Affiliation(s)
- Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University and Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, M4:146 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
| | | | - Paolo G Camici
- Vita Salute University and San Raffaele Hospital, Milan, Italy
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University, Madrid, Spain
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Nicole Karam
- European Hospital Georges Pompidou (Cardiology Department), Paris University and Paris Cardiovascular Research Center (INSERMU970), Paris, France
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, the Netherlands
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Science and Public Health, Padova, Italy
| | | | | | - Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.,Bart's Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - J Dawn Abbott
- Lifespan Cardiovascular Institute and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lina Badimon
- Cardiovascular Program-ICCC, IR-Hospital de la Santa Creu i Sant Pau, CiberCV, Barcelona, Spain
| | - Dirk J Duncker
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
| | - Davide Capodanno
- CardioThoracic-Vascular and Transplant Department, A.O.U. 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK.,Yale University School of Medicine, New Haven, CT, USA
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Ammirati E, Cavalotti C, Milazzo A, Pedrotti P, Soriano F, Schroeder JW, Morici N, Giannattasio C, Frigerio M, Metra M, Camici PG, Oliva F. Temporal Relation Between Second Dose BNT162b2 mRNA Covid-19 Vaccine and Cardiac involvement in a Patient with Previous SARS-COV-2 Infection. Int J Cardiol Heart Vasc 2021:100778. [PMID: 33842684 PMCID: PMC8020086 DOI: 10.1016/j.ijcha.2021.100778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ijcha.2021.100774 . The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Enrico Ammirati
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Angela Milazzo
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | | | | | - Jan W Schroeder
- Unit of Allergology and Immunology, Niguarda Hospital, Milan, Italy
| | - Nuccia Morici
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Cristina Giannattasio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Maria Frigerio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paolo G Camici
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Fabrizio Oliva
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
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34
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Ammirati E, Cavalotti C, Milazzo A, Pedrotti P, Soriano F, Schroeder JW, Morici N, Giannattasio C, Frigerio M, Metra M, Camici PG, Oliva F. Temporal relation between second dose BNT162b2 mRNA Covid-19 vaccine and cardiac involvement in a patient with previous SARS-COV-2 infection. Int J Cardiol Heart Vasc 2021; 34:100774. [PMID: 33821210 PMCID: PMC8011690 DOI: 10.1016/j.ijcha.2021.100774] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Enrico Ammirati
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Angela Milazzo
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | | | | | - Jan W Schroeder
- Unit of Allergology and Immunology, Niguarda Hospital, Milan, Italy
| | - Nuccia Morici
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Cristina Giannattasio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.,Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Maria Frigerio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, c/o Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy
| | - Paolo G Camici
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Fabrizio Oliva
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
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35
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Aimo A, Pelliccia F, Panichella G, Vergaro G, Barison A, Passino C, Emdin M, Camici PG. Indications of beta-adrenoceptor blockers in Takotsubo syndrome and theoretical reasons to prefer agents with vasodilating activity. Int J Cardiol 2021; 333:45-50. [PMID: 33667578 DOI: 10.1016/j.ijcard.2021.02.074] [Citation(s) in RCA: 9] [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: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/26/2022]
Abstract
Takotsubo syndrome (TTS) is estimated to account for 1-3% of all patients presenting with suspected ST-segment elevation myocardial infarction. A sudden surge in sympathetic nervous system is considered the cause of TTS. Nonetheless, no specific recommendations have been provided regarding β-blocking therapy. Apart from specific contra-indications (severe LV dysfunction, hypotension, bradycardia and corrected QT interval >500 ms), treatment with a β-blocker seems reasonable until full recovery of LV ejection fraction, though evidence is limited to a few animal studies, case reports or observational studies. In this review, we will reappraise the rationale for β-blocker therapy in TTS and speculate on the pathophysiologic basis for preferring non-selective agents with vasodilating activity over β1-selective drugs.
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Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | | | | | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Andrea Barison
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Paolo G Camici
- San Raffaele Hospital and Vita Salute University, Milan, Italy
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36
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Camporeale A, Moroni F, Lazzeroni D, Garibaldi S, Pieroni M, Pieruzzi F, Lusardi P, Spada M, Mignani R, Burlina A, Carubbi F, Econimo L, Battaglia Y, Graziani F, Pica S, Chow K, Camici PG, Lombardi M. Trabecular complexity as an early marker of cardiac involvement in Fabry disease. Eur Heart J Cardiovasc Imaging 2021; 23:200-208. [PMID: 33486507 DOI: 10.1093/ehjci/jeaa354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 12/15/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Fabry cardiomyopathy is characterized by glycosphingolipid storage and increased myocardial trabeculation has also been demonstrated. This study aimed to explore by cardiac magnetic resonance whether myocardial trabecular complexity, quantified by endocardial border fractal analysis, tracks phenotype evolution in Fabry cardiomyopathy. METHODS AND RESULTS Study population included 20 healthy controls (12 males, age 32±9) and 45 Fabry patients divided into three groups: 15 left ventricular hypertrophy (LVH)-negative patients with normal T1 (5 males, age 28±13; Group 1); 15 LVH-negative patients with low T1 (9 males, age 33±9.6; Group 2); 15 LVH-positive patients (11 males, age 53.5±9.6; Group 3). Trabecular fractal dimensions (Dfs) (total, basal, mid-ventricular, and apical) were evaluated on cine images. Total Df was higher in all Fabry groups compared to controls, gradually increasing from controls to Group 3 (1.27±0.02 controls vs. 1.29±0.02 Group 1 vs. 1.30±0.02 Group 2 vs. 1.34±0.02 Group 3; P<0.001). Group 3 showed significantly higher values of all Dfs compared to the other Groups. Both basal and total Dfs were significantly higher in Group 1 compared with controls (basal: 1.30±0.03 vs. 1.26±0.04, P =0.010; total: 1.29±0.02 vs. 1.27±0.02, P=0.044). Total Df showed significant correlations with: (i) T1 value (r=-0.569; P<0.001); (ii) LV mass (r=0.664, P<0.001); (iii) trabecular mass (r=0.676; P <0.001); (iv) Mainz Severity Score Index (r=0.638; P<0.001). CONCLUSION Fabry cardiomyopathy is characterized by a progressive increase in Df of endocardial trabeculae together with shortening of T1 values. Myocardial trabeculation is increased before the presence of detectable sphingolipid storage, thus representing an early sign of cardiac involvement.
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Affiliation(s)
- Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Via Morandi 30, Milan 20097, Italy
| | - Francesco Moroni
- Cardiothoracic and Vascular Department, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Lazzeroni
- Department of Cardiology, IRCCS Don Carlo Gnocchi Foundation, Via Olgettina 60, 20132 Milan, Italy
| | - Silvia Garibaldi
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Federico Pieruzzi
- Nephrology and Dialysis Unit, Department of Medicine and Surgery, University of Milano Bicocca, ASST-Monza San Gerardo Hospital, Monza, Italy
| | - Paola Lusardi
- Department of Cardiology, Humanitas Hospital, Torino, Italy
| | - Marco Spada
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Renzo Mignani
- Nephrology and Dialysis Department, Infermi Hospital, Rimini, Italy
| | | | - Francesca Carubbi
- Metabolic Medicine Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Econimo
- Nephrology and Dialysis Unit, Hospital of Montichiari, Spedali Civili Brescia, Italy
| | - Yuri Battaglia
- Nephrology and Dialysis Unit, University-Hospital St. Anna, Ferrara, Italy
| | - Francesca Graziani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Via Morandi 30, Milan 20097, Italy
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | - Paolo G Camici
- Cardiothoracic and Vascular Department, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Via Morandi 30, Milan 20097, Italy
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Affiliation(s)
- Francesco Pelliccia
- Department of Cardiovascular Sciences, Sapienza University, Rome, Italy (F.P.)
| | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN (B.J.G.)
| | - Paolo G Camici
- Vita-Salute University and San Raffaele Hospital, Milan, Italy (P.G.C.)
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38
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Pavasini R, Camici PG, Crea F, Danchin N, Fox K, Manolis AJ, Marzilli M, Rosano GMC, Lopez-Sendon JL, Pinto F, Balla C, Ferrari R. Corrigendum to "Anti-anginal drugs: Systematic review and clinical implications" [Int. J. Cardiol. 283 (2019) 55-63]. Int J Cardiol 2020; 321:23. [PMID: 32653211 DOI: 10.1016/j.ijcard.2020.06.028] [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: 10/23/2022]
Affiliation(s)
- Rita Pavasini
- Centro Cardiologico Universitario, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.
| | - Paolo G Camici
- Vita Salute University and San Raffaele Hospital, Via Olgettina Milano, 58-60, 20132 Milan, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Catholic University, Largo Francesco Vito, 1, 00168 Rome, Italy
| | - Nicolas Danchin
- Cardiology, European Hospital Georges-Pompidiou, 20 Rue Leblanc, 75015 Paris, France
| | - Kim Fox
- National Heart and Lung Institute, Imperial College and Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Sydney Street, London SW36NP, UK
| | - Athanasios J Manolis
- Department of Cardiology, Asklepeion General Hospital, 1, Vas. Pavlou Street, 16673 Voula, Athens, Greece
| | - Mario Marzilli
- Cardiothoracic Department, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy; Nottola Cardiology Division, Località Nottola, 53045, Ospedali Riuniti Valdichiana Sudest, Siena, Italy
| | - Giuseppe M C Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - José L Lopez-Sendon
- Cardiology Department, Hospital Universitario La Paz, IdiPaz, Paseo de la Castellana 261, Madrid 28036, Spain
| | - Fausto Pinto
- Hospital Universitário de Santa Maria/Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Cristina Balla
- Centro Cardiologico Universitario, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Roberto Ferrari
- Centro Cardiologico Universitario, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, RA, Italy
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Aimo A, Di Paolo M, Castiglione V, Modena M, Barison A, Benvenuti M, Bugelli V, Campobasso CP, Guidi B, Camici PG, Emdin M. Scared to Death. JACC Case Rep 2020; 2:2400-2403. [PMID: 34317180 PMCID: PMC8304531 DOI: 10.1016/j.jaccas.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/07/2020] [Accepted: 08/14/2020] [Indexed: 12/04/2022]
Abstract
Myocardial infarction with nonobstructed coronary arteries (MINOCA) can be triggered by intense emotions. We report 5 cases of emotional stress–related death where forensic examination attributed myocardial infarction to a coronary spasm, with the ultimate cause of death being arrhythmias in 4 cases and cardiac rupture in the fifth. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Cardiology Division, University Hospital of Pisa, Pisa, Italy
| | - Marco Di Paolo
- Department of Forensic Medicine, University of Pisa, Pisa, Italy
| | - Vincenzo Castiglione
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Cardiology Division, University Hospital of Pisa, Pisa, Italy
| | - Martina Modena
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Andrea Barison
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Matteo Benvenuti
- Department of Forensic Medicine, University of Pisa, Pisa, Italy
| | | | | | - Benedetta Guidi
- Department of Forensic Medicine, University of Pisa, Pisa, Italy
| | - Paolo G. Camici
- Cardiology Division, Vita Salute University and San Raffaele Hospital, Milan, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
- Cardiology Division, Vita Salute University and San Raffaele Hospital, Milan, Italy
- Address for correspondence: Dr. Michele Emdin, Scuola Superiore Sant’Anna and Fondazione Toscana Gabriele Monasterio, Via G. Moruzzi 1, 56124 Pisa, Italy.
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Suda A, Takahashi J, Beltrame JF, Berry C, Camici PG, Crea F, Escaned J, Ford T, Carlos Kaski J, Kiyooka T, Metha PK, Ong P, Ozaki Y, Pepine C, Rimoldi O, Safdar B, Sechtem U, Tsujita K, Yii E, Noel Bairey Merz C, Shimokawa H. International prospective cohort study of microvascular angina - Rationale and design. Int J Cardiol Heart Vasc 2020; 31:100630. [PMID: 32984497 PMCID: PMC7494778 DOI: 10.1016/j.ijcha.2020.100630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with signs and symptoms of myocardial ischemia and non-obstructive coronary artery disease (CAD) frequently have coronary functional abnormalities, including coronary microvascular dysfunction. Those with the latter are grouped under the term "microvascular angina" (MVA). Although diagnostic criteria exist for MVA, as recently proposed by our COVADIS (COronary VAsomotor Disorders International Study) group and the condition has been increasingly recognized in clinical practice, the clinical characteristics and long-term prognosis of MVA patients in the current era remain to be fully elucidated. AIMS In the present study, we aimed to prospectively assess the clinical characteristics and long-term prognosis of MVA subjects in the current era in an international, multicenter, observational, and prospective registry study. METHODS A total of 15 medical centers across 7 countries (USA, UK, Germany, Spain, Italy, Australia, and Japan) enrolled subjects fulfilling the COVADIS diagnostic criteria for MVA as follows; (1) signs and/or symptoms of myocardial ischemia, (2) absence of obstructive CAD, and (3) objective evidence of myocardial ischemia and/or coronary microvascular dysfunction. The primary endpoint was the composite of major cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, hospitalization due to heart failure or unstable angina. Between July 2015 and December 2018, a total of 706 subjects with MVA (M/F 256/450, 61.1 ± 11.8 [SD] yrs.) were registered. Subjects will be followed for at least 1 year. SUMMARY The present study will provide important information regarding the clinical characteristics, management, and long-term prognosis of MVA patients in the current era.
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Affiliation(s)
- Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - John F Beltrame
- The Discipline of Medicine, University of Adelaide, Basil Hetzel Institute, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Paolo G Camici
- Vita Salute University and San Raffaele Hospital, Milan, Italy
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Tom Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Juan Carlos Kaski
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, UK
| | - Takahiko Kiyooka
- Department of Cardiology, Tokai University Oiso Hospital, Oiso, Japan
| | - Puja K Metha
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University, Toyonaka, Aichi, Japan
| | - Carl Pepine
- Division of Cardiovascular Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Ornella Rimoldi
- Institute of Molecular Bioimaging and Physiology, Consiglio Nazionale delle Ricerche, Segrate, Italy
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eric Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- International University of Health and Welfare, Narita, Japan
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Pelliccia F, Pasceri V, Tanzilli G, Speciale G, Camici PG, Gaudio C. Malignancy in patients with myocardial infarction and non-obstructive coronary arteries: A systematic review and meta-regression. Eur J Intern Med 2020; 81:38-43. [PMID: 32593577 DOI: 10.1016/j.ejim.2020.06.018] [Citation(s) in RCA: 4] [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: 05/01/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND The significance of malignancy in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) is poorly defined. This study aimed at determining the prevalence of malignancy and its association with long-term outcome in MINOCA. METHODS We searched the MEDLINE, EMBASE, and CENTRAL databases up to March 31, 2020 to identify studies reporting data on malignancy in full. We performed a random effects meta-analysis of proportions and assessed statistical heterogeneity using the I2 statistic and meta-regression analysis. RESULTS A total of 9 studies including 26,636 patients (11,910 men and 14,726 women) were selected for the meta-analysis. Of them, 655 patients (2.5%) had a diagnosis of malignancy at presentation. Comparison of presenting features and outcome between patients with MINOCA and patients with myocardial infarction and coronary artery disease (MI-CAD) showed that malignancy was significantly more common in the former as compared with the latter (p = 0.019). During a median follow-up of 39 months, 2,081 patients with MINOCA died (7.8%). Meta-regression analysis demonstrated that long-term mortality was associated with left ventricular ejection fraction (p = 0.0001; coefficient: -0.001; 95% CI: from -0.002 to 0.002), malignancy at presentation (p = 0.01; coefficient: 0.001; 95% CI: from -0.001 to 0.001), and use of beta-blockers during follow-up (p = 0.03; coefficient: 0.001; 95% CI: from -0.000 to 0.001). CONCLUSION This study shows that the prevalence of malignancy in patients with MINOCA is not trivial and is significantly greater than in patients with MI-CAD. Malignancy is significantly associated with an unfavorable long-term prognosis in MINOCA.
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Affiliation(s)
| | - Vincenzo Pasceri
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Gaetano Tanzilli
- Department of Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Giulio Speciale
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Paolo G Camici
- San Raffaele Hospital and Vita e Salute University, Milan, Italy
| | - Carlo Gaudio
- Department of Cardiovascular Sciences, Sapienza University, Rome, Italy
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Ammirati E, Frigerio M, Adler ED, Basso C, Birnie DH, Brambatti M, Friedrich MG, Klingel K, Lehtonen J, Moslehi JJ, Pedrotti P, Rimoldi OE, Schultheiss HP, Tschöpe C, Cooper LT, Camici PG. Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circ Heart Fail 2020; 13:e007405. [PMID: 33176455 PMCID: PMC7673642 DOI: 10.1161/circheartfailure.120.007405] [Citation(s) in RCA: 305] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Myocarditis is an inflammatory disease of the heart that may occur because of infections, immune system activation, or exposure to drugs. The diagnosis of myocarditis has changed due to the introduction of cardiac magnetic resonance imaging. We present an expert consensus document aimed to summarize the common terminology related to myocarditis meanwhile highlighting some areas of controversies and uncertainties and the unmet clinical needs. In fact, controversies persist regarding mechanisms that determine the transition from the initial trigger to myocardial inflammation and from acute myocardial damage to chronic ventricular dysfunction. It is still uncertain which viruses (besides enteroviruses) cause direct tissue damage, act as triggers for immune-mediated damage, or both. Regarding terminology, myocarditis can be characterized according to etiology, phase, and severity of the disease, predominant symptoms, and pathological findings. Clinically, acute myocarditis (AM) implies a short time elapsed from the onset of symptoms and diagnosis (generally <1 month). In contrast, chronic inflammatory cardiomyopathy indicates myocardial inflammation with established dilated cardiomyopathy or hypokinetic nondilated phenotype, which in the advanced stages evolves into fibrosis without detectable inflammation. Suggested diagnostic and treatment recommendations for AM and chronic inflammatory cardiomyopathy are mainly based on expert opinion given the lack of well-designed contemporary clinical studies in the field. We will provide a shared and practical approach to patient diagnosis and management, underlying differences between the European and US scientific statements on this topic. We explain the role of histology that defines subtypes of myocarditis and its prognostic and therapeutic implications.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.F., P.P.)
| | - Maria Frigerio
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.F., P.P.)
| | - Eric D. Adler
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla (E.D.A., M.B.)
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy (C.B.)
| | - David H. Birnie
- University of Ottawa Heart Institute, Ontario, Canada (D.H.B.)
| | - Michela Brambatti
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla (E.D.A., M.B.)
- IONIS Pharmaceuticals, Carlsbad, CA (M.B.)
| | - Matthias G. Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada (M.G.F.)
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Germany (K.K.)
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University Hospital, Finland (J.L.)
| | - Javid J. Moslehi
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (J.J.M.)
| | - Patrizia Pedrotti
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milano, Italy (E.A., M.F., P.P.)
| | | | | | - Carsten Tschöpe
- Institute of Health Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany (C.T.)
- Department of Cardiology, Charité–University Medicine Berlin, Campus Virchow Klinikum, Germany (C.T.)
| | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (L.T.C.)
| | - Paolo G. Camici
- Vita Salute University and San Raffaele Hospital, Milano, Italy (P.G.C.)
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43
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Camici PG, Tschöpe C, Di Carli MF, Rimoldi O, Van Linthout S. Coronary microvascular dysfunction in hypertrophy and heart failure. Cardiovasc Res 2020; 116:806-816. [PMID: 31999329 DOI: 10.1093/cvr/cvaa023] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [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: 08/29/2019] [Revised: 12/05/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
Left ventricular (LV) hypertrophy (LVH) is a growth in left myocardial mass mainly caused by increased cardiomyocyte size. LVH can be a physiological adaptation to physical exercise or a pathological condition either primary, i.e. genetic, or secondary to LV overload. Patients with both primary and secondary LVH have evidence of coronary microvascular dysfunction (CMD). The latter is mainly due to capillary rarefaction and adverse remodelling of intramural coronary arterioles due to medial wall thickening with an increased wall/lumen ratio. An important feature of this phenomenon is the diffuse nature of this remodelling, which generally affects the coronary microvessels in the whole of the left ventricle. Patients with LVH secondary to arterial hypertension can develop both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). These patients can develop HFrEF via a 'direct pathway' with an interval myocardial infarction and also in its absence. On the other hand, patients can develop HFpEF that can then progress to HFrEF with or without interval myocardial infarction. A similar evolution towards LV dysfunction and both HFpEF and HFrEF can occur in patients with hypertrophic cardiomyopathy, the most common genetic cardiomyopathy with a phenotype characterized by massive LVH. In this review article, we will discuss both the experimental and clinical studies explaining the mechanisms responsible for CMD in LVH as well as the evidence linking CMD with HFpEF and HFrEF.
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Affiliation(s)
- Paolo G Camici
- Vita Salute University and San Raffaele Hospital, Milano, Italy
| | - Carsten Tschöpe
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ornella Rimoldi
- Vita Salute University and San Raffaele Hospital, Milano, Italy.,CNR IBFM, Segrate, Italy
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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44
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Ammirati E, Moroni F, Magnoni M, Rocca MA, Messina R, Anzalone N, De Filippis C, Scotti I, Besana F, Spagnolo P, Rimoldi OE, Chiesa R, Falini A, Filippi M, Camici PG. Extent and characteristics of carotid plaques and brain parenchymal loss in asymptomatic patients with no indication for revascularization. Int J Cardiol Heart Vasc 2020; 30:100619. [PMID: 32904369 PMCID: PMC7452655 DOI: 10.1016/j.ijcha.2020.100619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/01/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Extent of subclinical atherosclerosis has been associated with brain parenchymal loss in community-dwelling aged subjects. Identification of patient-related and plaque-related markers could identify subjects at higher risk of brain atrophy, independent of cerebrovascular accidents. Aim of the study was to investigate the relation between extent and characteristics of carotid plaques and brain atrophy in asymptomatic patients with no indication for revascularization. METHODS AND RESULTS Sixty-four patients (aged 69 ± 8 years, 45% females) with carotid stenosis <70% based on Doppler flow velocity were enrolled in the study. Potential causes of cerebral damage other than atherosclerosis, including history of atrial fibrillation, heart failure, previous cardiac or neurosurgery and neurological disorders were excluded. All subjects underwent carotid computed tomography angiography, contrast enhanced ultrasound for assessment of plaque neovascularization and brain magnetic resonance imaging for measuring brain volumes. On multivariate regression analysis, age and fibrocalcific plaques were independently associated with lower total brain volumes (β = -3.13 and β = -30.7, both p < 0.05). Fibrocalcific plaques were also independently associated with lower gray matter (GM) volumes (β = -28.6, p = 0.003). On the other hand, age and extent of carotid atherosclerosis were independent predictors of lower white matter (WM) volumes. CONCLUSIONS WM and GM have different susceptibility to processes involved in parenchymal loss. Contrary to common belief, our results show that presence of fibrocalcific plaques is associated with brain atrophy.
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Affiliation(s)
- Enrico Ammirati
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
- De Gasperis Cardio Center, Niguarda Ca’ Granda Hospital, Milan, Italy
| | | | - Marco Magnoni
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Maria A Rocca
- Vita-Salute University and Neuroimaging Research Unit, Institute of Experimental Neurology, and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Messina
- Vita-Salute University and Neuroimaging Research Unit, Institute of Experimental Neurology, and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Nicoletta Anzalone
- Vita-Salute University and Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Costantino De Filippis
- Vita-Salute University and Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Isabella Scotti
- Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - Francesca Besana
- Cardiovascular Prevention Center, San Raffaele Institute, Milan, Italy
| | - Pietro Spagnolo
- Cardiovascular Prevention Center, San Raffaele Institute, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Roberto Chiesa
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Andrea Falini
- Vita-Salute University and Department of Neuroradiology, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Vita-Salute University and Neuroimaging Research Unit, Institute of Experimental Neurology, and Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo G Camici
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
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45
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Crea F, Bairey Merz CN, Beltrame JF, Berry C, Camici PG, Kaski JC, Ong P, Pepine CJ, Sechtem U, Shimokawa H. Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization. Eur Heart J 2020; 40:2455-2462. [PMID: 30608528 DOI: 10.1093/eurheartj/ehy857] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/09/2018] [Accepted: 11/28/2018] [Indexed: 01/09/2023] Open
Abstract
Persistence or recurrence of angina after a percutaneous coronary intervention (PCI) may affect about 20-40% of patients during short-medium-term follow-up. This appears to be true even when PCI is 'optimized' using physiology-guided approaches and drug-eluting stents. Importantly, persistent or recurrent angina post-PCI is associated with a significant economic burden. Healthcare costs may be almost two-fold higher among patients with persistent or recurrent angina post-PCI vs. those who become symptom-free. However, practice guideline recommendations regarding the management of patients with angina post-PCI are unclear. Gaps in evidence into the mechanisms of post-PCI angina are relevant, and more research seems warranted. The purpose of this document is to review potential mechanisms for the persistence or recurrence of angina post-PCI, propose a practical diagnostic algorithm, and summarize current knowledge gaps.
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Affiliation(s)
- Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Roma, Italy
| | - Cathleen Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 San Vicente Blvd, Los Angeles, CA, USA
| | - John F Beltrame
- Discipline of Medicine, Ward 5B, The Queen Elizabeth Hospital, 28 Woodville Rd, Woodville South, Adelaide, South Australia, Australia
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, University Place, Glasgow, UK
| | - Paolo G Camici
- Department of Cardiology, Vita Salute University and San Raffaele Hospital, Via Olgettina 60, Milano, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London, UK
| | - Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, Stuttgart, Germany
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Departmant of Medicine, College of Medicine, University of Florida, 1600 SW Archer Rd, Box 100288, Gainesville, FL, USA
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, Stuttgart, Germany
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Seiryo-machi, Aoba-ku, Sendai, Japan
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46
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Gramegna M, Baldetti L, Beneduce A, Pannone L, Falasconi G, Calvo F, Pazzanese V, Sacchi S, Pagnesi M, Moroni F, Ajello S, Melisurgo G, Agricola E, Camici PG, Scandroglio AM, Landoni G, Ciceri F, Zangrillo A, Cappelletti AM. ST-Segment–Elevation Myocardial Infarction During COVID-19 Pandemic. Circ Cardiovasc Interv 2020; 13:e009413. [DOI: 10.1161/circinterventions.120.009413] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 01/09/2023]
Abstract
Background:
Coronavirus disease 2019 (COVID-19) pandemic has led to a fast and radical transformation in social, economic, and healthcare networks. COVID-19 outbreak may thus have profound indirect consequences on clinical presentation and management of patients with ST-segment–elevation myocardial infarction (STEMI). Aim of this study was to assess clinical features of patients with STEMI during COVID-19 pandemic.
Methods:
This single-center, prospective study from a regional public service healthcare hub in Milan included all consecutive patients with STEMI admitted to our institute from February 21 to April 1, 2020 (during COVID-19 pandemic). These patients were compared with a historical cohort of patients admitted for STEMI during the analogous time period (February 21 to April 1) in 2018 and 2019, in terms of time from symptoms onset to hospital admission, clinical characteristics, and in-hospital outcomes.
Results:
A total of 26 patients were admitted for STEMI during the study period, and 7 (26.9%) of these patients tested positive for severe acute respiratory syndrome coronavirus 2. On admission, medical therapy, including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers use, was similar between cohorts. Median (interquartile range) time from symptoms onset to hospital admission was significantly longer in 2020 as compared to the historical cohort (15.0 [2.0–48.0] versus 2.0 [1.0–3.0] hours;
P
<0.01). A higher proportion of patients presenting with late presentation STEMI was observed in 2020 compared with the historical cohort (50.0% versus 4.8%;
P
<0.01). Primary percutaneous coronary intervention resulted indicated in 80.8% of patients in 2020 compared with 100% in the historical cohort (
P
=0.06). In-hospital death, thromboembolism, mechanical ventilation, or hemodynamic decompensation needing inotropic or mechanical support were similar between years.
Conclusions:
These preliminary results from a cardiovascular regional public service healthcare hub demonstrate a significantly longer time from symptoms onset to hospital admission among patients with STEMI during COVID-19 pandemic compared with the same time period in the previous 2 years.
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Affiliation(s)
- Mario Gramegna
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Baldetti
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Interventional Cardiology Unit (A.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Pannone
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Falasconi
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Calvo
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Pazzanese
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Sacchi
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Pagnesi
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Moroni
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Ajello
- Cardiac Surgery Intensive Care Unit (S.A., G.M., A.M.S.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Melisurgo
- Cardiac Surgery Intensive Care Unit (S.A., G.M., A.M.S.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiac Imaging Unit (E.A.), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy (E.A., P.G.C., G.L., F. Ciceri, A.Z.)
| | - Paolo G. Camici
- Vita-Salute San Raffaele University, Milan, Italy (E.A., P.G.C., G.L., F. Ciceri, A.Z.)
| | - Anna Mara Scandroglio
- Cardiac Surgery Intensive Care Unit (S.A., G.M., A.M.S.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Anesthesia and Intensive Care (G.L., A.Z.), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy (E.A., P.G.C., G.L., F. Ciceri, A.Z.)
| | - Fabio Ciceri
- Hematology Department (F. Ciceri), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy (E.A., P.G.C., G.L., F. Ciceri, A.Z.)
| | - Alberto Zangrillo
- Anesthesia and Intensive Care (G.L., A.Z.), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy (E.A., P.G.C., G.L., F. Ciceri, A.Z.)
| | - Alberto Maria Cappelletti
- Cardiac Intensive Care Unit (M.G., L.B., L.P., G.F., F. Calvo, V.P., S.S., M.P., F.M., A.M.C.), IRCCS San Raffaele Scientific Institute, Milan, Italy
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47
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Abstract
Cardiac and cerebrovascular diseases are currently the leading causes of mortality and disability worldwide. Both the heart and brain display similar vascular anatomy, with large conduit arteries running on the surface of the organ providing tissue perfusion through an intricate network of penetrating small vessels. Both organs rely on fine tuning of local blood flow to match metabolic demand. Blood flow regulation requires adequate functioning of the microcirculation in both organs, with loss of microvascular function, termed small vessel disease (SVD) underlying different potential clinical manifestations. SVD in the heart, known as coronary microvascular dysfunction, can cause chronic or acute myocardial ischemia and may lead to development of heart failure. In the brain, cerebral SVD can cause an acute stroke syndrome known as lacunar stroke or more subtle pathological alterations of the brain parenchyma, which may eventually lead to neurological deficits or cognitive decline in the long term. Coronary microcirculation cannot be visualized in vivo in humans, and functional information can be deduced by measuring the coronary flow reserve. The diagnosis of cerebral SVD is largely based on brain magnetic resonance imaging, with white matter hyperintensities, microbleeds, and brain atrophy reflecting key structural changes. There is evidence that such structural changes reflect underlying cerebral SVD. Here, we review interactions between SVD and cardiovascular risk factors, and we discuss the evidence linking cerebral SVD with large vessel atheroma, atrial fibrillation, heart failure, and heart valve disease.
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Affiliation(s)
- Francesco Moroni
- Cardiothoracic and Vascular Department, Vita-Salute University and San Raffaele Hospital, Milan, Italy (F.M., P.G.C.)
| | - Enrico Ammirati
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (E.A.)
| | - Atticus H. Hainsworth
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, United Kingdom (A.H.H.)
- Department of Neurology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (A.H.H.)
| | - Paolo G. Camici
- Cardiothoracic and Vascular Department, Vita-Salute University and San Raffaele Hospital, Milan, Italy (F.M., P.G.C.)
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48
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Ferrari R, Pavasini R, Camici PG, Crea F, Danchin N, Pinto F, Manolis A, Marzilli M, Rosano GMC, Lopez-Sendon J, Fox K. Anti-anginal drugs-beliefs and evidence: systematic review covering 50 years of medical treatment. Eur Heart J 2020; 40:190-194. [PMID: 30165445 DOI: 10.1093/eurheartj/ehy504] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/23/2018] [Indexed: 11/14/2022] Open
Abstract
Chronic stable angina is the most prevalent symptom of ischaemic heart disease and its management is a priority. Current guidelines recommend pharmacological therapy with drugs classified as being first line (beta blockers, calcium channel blockers, short acting nitrates) or second line (long-acting nitrates, ivabradine, nicorandil, ranolazine, and trimetazidine). Second line drugs are indicated for patients who have contraindications to first line agents, do not tolerate them or remain symptomatic. Evidence that one drug is superior to another has been questioned. Between January and March 2018, we performed a systematic review of articles written in English over the past 50 years English-written articles in Medline and Embase following preferred reporting items and the Cochrane collaboration approach. We included double blind randomized studies comparing parallel groups on treatment of angina in patients with stable coronary artery disease, with a sample size of, at least, 100 patients (50 patients per group), with a minimum follow-up of 1 week and an outcome measured on exercise testing, duration of exercise being the preferred outcome. Thirteen studies fulfilled our criteria. Nine studies involved between 100 and 300 patients, (2818 in total) and a further four enrolled greater than 300 patients. Evidence of equivalence was demonstrated for the use of beta-blockers (atenolol), calcium antagonists (amlodipine, nifedipine), and channel inhibitor (ivabradine) in three of these studies. Taken all together, in none of the studies was there evidence that one drug was superior to another in the treatment of angina or to prolong total exercise duration. There is a paucity of data comparing the efficacy of anti-anginal agents. The little available evidence shows that no anti-anginal drug is superior to another and equivalence has been shown only for three classes of drugs. Guidelines draw conclusions not from evidence but from clinical beliefs.
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Affiliation(s)
- Roberto Ferrari
- Cardiology Centre, University of Ferrara, Via Aldo Moro 8, Cona, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, Ravenna, Italy
| | - Rita Pavasini
- Cardiology Centre, University of Ferrara, Via Aldo Moro 8, Cona, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, Ravenna, Italy
| | - Paolo G Camici
- Vita Salute University and San Raffaele Hospital, Via Olgettina Milano, 58-60, Milano, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Catholic University, Largo Francesco Vito, 1, Roma, Italy
| | - Nicolas Danchin
- Cardiology, European Hospital Georges-Pompidiou, 20 Rue Leblanc, Paris, France
| | - Fausto Pinto
- Lisbon University, Faculty of Medicine, Lisbon, Portugal
| | - Athanasios Manolis
- Department of Cardiology, Asklepeion General Hospital, 1 Vas. Pavlou Street, Voula Athens, Greece
| | - Mario Marzilli
- Cardiothoracic Department, Lugarno Antonio Pacinotti, 43, Pisa, Italy.,Nottola Cardiology Division, Località Nottola, Ospedali Riuniti Valdichiana Sudest, Siena, Italy
| | - Giuseppe M C Rosano
- Clinical Academic Group, St George's Hospital NHS Trust, University of London, Blackshaw Rd, London, UK.,Department of Medical Science IRCCS San Raffaele Rome, via della Pisana 235, Rome, Italy
| | - José Lopez-Sendon
- Cardiology Department, Hospital Universitario La Paz. IdiPaz, Universidad Aut?noma de Madrid, Paseo de la Castellana 261, Madrid, Spain
| | - Kim Fox
- National Heart and Lung Institute, Imperial College and Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Sydney Street, London, UK
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49
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Merlo M, Cannatà A, Pio Loco C, Stolfo D, Barbati G, Artico J, Gentile P, De Paris V, Ramani F, Zecchin M, Gigli M, Pinamonti B, Korcova R, Di Lenarda A, Giacca M, Mestroni L, Camici PG, Sinagra G. Contemporary survival trends and aetiological characterization in non‐ischaemic dilated cardiomyopathy. Eur J Heart Fail 2020; 22:1111-1121. [DOI: 10.1002/ejhf.1914] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 01/13/2020] [Revised: 04/23/2020] [Accepted: 05/22/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Marco Merlo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Antonio Cannatà
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine King's College London London UK
| | - Carola Pio Loco
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Davide Stolfo
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | | | - Jessica Artico
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Piero Gentile
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Valerio De Paris
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Federica Ramani
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Massimo Zecchin
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Marta Gigli
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Bruno Pinamonti
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Renata Korcova
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
| | - Andrea Di Lenarda
- Cardiovascular Centre Azienda Sanitaria Universitaria Integrata of Trieste (ASUITS), University of Trieste Trieste Italy
| | - Mauro Giacca
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine King's College London London UK
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Paolo G. Camici
- Vita Salute University and San Raffaele Hospital Milan Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), University of Trieste Trieste Italy
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Levy BI, Heusch G, Camici PG. The many faces of myocardial ischaemia and angina. Cardiovasc Res 2020; 115:1460-1470. [PMID: 31228187 DOI: 10.1093/cvr/cvz160] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 12/13/2022] Open
Abstract
Obstructive disease of the epicardial coronary arteries is the main cause of angina. However, a number of patients with anginal symptoms have normal coronaries or non-obstructive coronary artery disease (CAD) despite electrocardiographic evidence of ischaemia during stress testing. In addition to limited microvascular vasodilator capacity, the coronary microcirculation of these patients is particularly sensitive to vasoconstrictor stimuli, in a condition known as microvascular angina. This review briefly summarizes the determinants and control of coronary blood flow (CBF) and myocardial perfusion. It subsequently analyses the mechanisms responsible for transient myocardial ischaemia: obstructive CAD, coronary spasm and coronary microvascular dysfunction in the absence of epicardial coronary lesions, and variable combinations of structural anomalies, impaired endothelium-dependent and/or -independent vasodilation, and enhanced perception of pain. Lastly, we exemplify mechanism of angina during tachycardia. Distal to a coronary stenosis, coronary dilator reserve is already recruited and can be nearly exhausted at rest distal to a severe stenosis. Increased heart rate reduces the duration of diastole and thus CBF when metabolic vasodilation is no longer able to increase CBF. The increase in myocardial oxygen consumption and resulting metabolic vasodilation in adjacent myocardium without stenotic coronary arteries further acts to divert blood flow away from the post-stenotic coronary vascular bed through collaterals.
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Affiliation(s)
- Bernard I Levy
- Inserm U970 and Vessels and Blood Institute, 8 Rue Guy Patin, Paris, France
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, Universitätsklinikum Essen, Essen, Germany
| | - Paolo G Camici
- Vita Salute University and San Raffaele Hospital, Milan, Italy
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