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Szymanski M, Mirza K, De Jonge N, Schmidt T, Brahmbhatt D, Billia F, Hsu S, MacGowan G, Jakovljevic D, Agostoni P, Trombara F, Jorde U, Rochlani Y, Vandersmissen K, Reiss N, Russell S, Meyns B, Gustafsson F. Prognostic Value of Repeated Peak Oxygen Uptake Measurements in LVAD Patients - Follow Up on PRO-VAD Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Szymanski M, Mirza K, De Jonge N, Schmidt T, Brahmbhatt D, Billia F, Hsu S, MacGowan G, Jakovljevic D, Agostoni P, Trombara F, Jorde U, Rochlani Y, Vandersmissen K, Reiss N, Russell S, Meyns B, Gustafsson F. Improvement in Peak Oxygen Uptake During First Year of Mechanical Circulatory Support in End-Stage Heart Failure Patients - Follow Up on PRO-VAD Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Van Hemert N, Stella PR, Rozemeijer R, Kraaijeveld AO, Rittersma SZ, Leenders GEH, Stein M, Frambach P, Van Der Harst P, Agostoni P, Voskuil M. Stent length and -diameter and long-term clinical outcomes following percutaneous coronary intervention with drug-eluting stent implantation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2041] [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
Long total stent length and small stent diameter have been associated with adverse events following percutaneous coronary intervention (PCI).
Purpose
To assess whether stent length and -diameter influence long-term target-lesion failure (TLF) following implantation of contemporary drug-eluting stents (DES) in an all-comers population undergoing PCI.
Methods
Patients included in the ReCre8 trial were stratified for troponin status and diabetes and randomized to implantation of a permanent polymer (PP-ZES) or polymer-free stent (PF-AES). Troponin negative patients were treated with dual antiplatelet therapy for one month, and troponin positive patients for twelve months. For the analysis on stent length, patients were divided in the quartiles of total stent length implanted per patient. Group 1a had a stent length of ≤18mm, Group 2a had a total stent length between 18 and 30mm, Group 3a had a total stent length of ≥30mm and lower than 49mm, and Group 4a had a total stent length of 49mm or more. For the analysis on stent diameter, patients were divided in the quartiles of the smallest stent diameter implanted per patient. Group 1b had a minimal stent diameter of ≤2.5mm, Group 2b had a minimal stent diameter between 2.5 and 3mm, Group 3b had a minimal stent diameter of ≥3mm and lower than 3.5mm, and Group 4b had a minimal stent diameter of 3.5mm or higher. The primary endpoint of TLF and its components – cardiac death, target-vessel myocardial infarction and target-lesion revascularization (TLR) – were assessed after three years.
Results
After division of patients in subgroups based on stent length, Group 1a included 409 patients (27.6%), Group 2a included 322 patients (20.7%), Group 3a included 376 patients (25.3%) and Group 4a included 377 patients (25.4%). After three years, TLF occurred more frequently in Group 4a with 6.6% in Group 1a, 8.4% in Group 2a, 7.7% in Group 3a and 18.0% in Group 4a (p<0.001) as shown in Figure 1. This was driven by a higher rate of TLR (p<0.001) and target-vessel myocardial infarction (p<0.001) in Group 4a. After division of patients in subgroups based on stent diameter, Group 1b included 408 patients (27.5%), Group 2b included 214 patients (14.4%), Group 3b included 477 patients (32.1%) and Group 4b included 386 patients (26.0%). After three years, TLF occurred more frequently in Group 1b with 14.0% vs. 7.9% in Group 2b, 8.6% in Group 3b and 9.3% in Group 4b (p=0.0241) as shown in Figure 2. The difference in TLF was driven by a higher rate of TLR in Group 1b (8.6% vs. 3.7% vs. 4.4% vs. 4.9%; p=0.016).
Conclusion
In an all-comers population undergoing PCI with implantation of contemporary DES, a stent length ≥49mm and a stent diameter ≤2.5mm were associated with a higher rate of TLF after three years.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Van Hemert
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - P R Stella
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - R Rozemeijer
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - A O Kraaijeveld
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - S Z Rittersma
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - G E H Leenders
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - M Stein
- Zuyderland Medical Center, Cardiology , Heerlen , The Netherlands
| | - P Frambach
- Institut de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Cardiology , Luxembourg , Luxembourg
| | - P Van Der Harst
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - P Agostoni
- ZNA Middelheim Hospital, Cardiology , Antwerp , Belgium
| | - M Voskuil
- University Medical Center Utrecht , Utrecht , The Netherlands
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Mantegazza V, Muratori M, Ghulam Ali S, Garlasche' A, Gripari P, Fusini L, Vignati C, De Martino F, Agostoni P, Ferrari C, Bartorelli AL, Pontone G, Pepi M, Tamborini G. Utility and futility of MitraClip implantation in secondary mitral regurgitation in a real-world population: the role of 3D transthoracic echocardiography. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Two recent prospective trials have been published, reporting opposite results on the efficacy and utility of the MitraClip (MC) procedure in patients with secondary mitral regurgitation (SMR). A ratio between the effective regurgitant orifice area (EROA) and left ventricular end-diastolic volume (LVEDV) ≥0.150 by two-dimensional (2D) transthoracic echocardiography (TTE) has been proposed to identify patients with disproportionate SMR, who would benefit from MC.
Purpose
To assess the prognostic role of clinical and echocardiographic parameters in a real-world population of SMR patients undergoing the MC procedure at our Institute.
Methods
Ninety-two patients underwent MC implantation. We retrospectively reviewed their clinical, and laboratory data, as well as 2D and three-dimensional (3D) TTE, and intraoperative transoesophageal echocardiography (Figure 1). The primary endpoint was a composite of cardiovascular death and/or hospitalisation for heart failure within 12-months follow-up.
Results
Thirty-one patients reached the endpoint (EP+), 61 did not (EP−). Demographics and anti-remodelling drugs were similar in EP+ and EP. Among comorbidities and laboratory data, EP+ significantly differed from EP− in smoking history, and extracardiac artery disease prevalence (65% vs. 39%, and 39% vs. 16%, respectively); EuroScoreII (12.2% vs. 5.2%); NYHA class ≥3 (94% vs. 69%); haemoglobin (12±2 vs. 13±2 g/dL), and brain natriuretic peptide levels (855 [426–1500] vs. 357 [170–902] pg/mL). At 2D TTE no significant difference emerged, including the SMR grade, except for the tricuspid annular plane systolic excursion (Figure 2). Biventricular 3D ejection fraction was significantly lower in EP+ vs. EP− (Figure 2). Residual intraoperative SMR grade after MC deployment was 1.9±0.6 in EP+ vs. 1.3±0.5 in EP− (p<0.001).
Conclusion
The proposed cut-off for EROA/LVEDV ratio may be suboptimal for predicting the MC utility in real-world populations. Rather, prognosis may be more influenced by the patient's pre-operative clinical status, right ventricular systolic function, 3D left ventricular ejection fraction, and by the success of the procedure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Mantegazza
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - M Muratori
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - S Ghulam Ali
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - A Garlasche'
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - P Gripari
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - L Fusini
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - C Vignati
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - F De Martino
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - P Agostoni
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - C Ferrari
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | | | - G Pontone
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - M Pepi
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - G Tamborini
- IRCCS Centro Cardiologico Monzino , Milan , Italy
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Badagliacca R, Mercurio V, Romeo E, Correale M, Masarone D, Papa S, Tocchetti C, Agostoni P. Beta-blockers in pulmonary arterial hypertension: Time for a second thought? Vascul Pharmacol 2022; 144:106974. [DOI: 10.1016/j.vph.2022.106974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/19/2022] [Accepted: 02/26/2022] [Indexed: 11/29/2022]
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Mapelli M, Romani S, Magrì D, Merlo M, Cittar M, Masè M, Muratori M, Gallo G, Sclafani M, Carriere C, Zaffalon D, Salvioni E, Mattavelli I, Vignati C, De Martino F, Rovai S, Autore C, Sinagra G, Agostoni P. P295 EXERCISE OXYGEN KINETIC IN HYPERTROPHIC CARDIOMYOPATHY: RESULTS FROM A MULTICENTER CARDIOPULMONARY EXERCISE TESTING STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Reduced cardiac output (CO) has been considered crucial in symptoms’ genesis in hypertrophic cardiomyopathy (HCM). We evaluated the cardiopulmonary exercise testing (CPET) response in HCM focusing on parameters strongly associated with stroke volume (SV) and cardiac output (CO), such as oxygen uptake (VO2) and O2–pulse, considering both their absolute values and temporal behavior during physical exercise.
Methods and Results
We enrolled 312 non–end stage HCM patients, divided according to left ventricle outflow tract obstruction (LVOTO) at rest or during Valsalva maneuver (72% with LVOTO<30; 10% between 30 and 49 and 18% ≥ 50mmHg). Peak VO2 (percent of predicted), O2–pulse and ventilation to carbon dioxide production (VE/VCO2) slope did not change across LVOTO groups. Ninety–six (31%) HCM patients presented an abnormal O2–pulse temporal behavior, irrespective of LVOTO values. These patients showed lower peak systolic pressure, workload (106±45 vs. 130±49W), VO2 (74±17 vs. 80±20%) and O2–pulse (12 [9–14] vs. 14 [11–17]ml/beat), with higher VE/VCO2 slope (28 [25–31] vs. 27 [24–31]) (p < 0.005 for all). Only 2 patients had an abnormal VO2/work slope.
Conclusion
None of CPET parameters, either as absolute values or dynamic relationships, were associated with LVOTO. Differently, an abnormal O2–pulse exercise behavior, which is strongly related to inadequate SV during exercise, correlates with reduced functional capacity (peak and anaerobic threshold VO2 and workload) and increased VE/VCO2 slope, helping identifying more advanced disease irrespectively of LVOTO. Adding O2–pulse kinetics evaluation to standard CPET could lead to a potential incremental benefit in terms of HCM prognostic stratification and, then, therapeutic management.
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Affiliation(s)
- M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - S Romani
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - D Magrì
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Merlo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Cittar
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Masè
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Muratori
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - G Gallo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Sclafani
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - C Carriere
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - D Zaffalon
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - E Salvioni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - I Mattavelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - C Vignati
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - F De Martino
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - S Rovai
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - C Autore
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - G Sinagra
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
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7
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Brusamolino M, Muratori M, Apostolo A, Mapelli M, Bonalumi G, Nanci G, Werba J, Pepi M, Mantegazza V, Calligaris G, Formenti A, Agrifoglio M, Agostoni P. P330 A CASE OF SEVERE AORTIC STENOSIS IN A YOUNG PATIENT WITH BICUSPID AORTIC VALVE, FAMILIAL HYPERCHOLESTEROLEMIA AND CALCIFICATION AT THE SINOTUBULAR JUNCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Familial hypercholesterolemia (FH) is a disorder characterized by elevated LDL–C and premature vascular calcifications. Aortic stenosis (AS) is the most frequent complication of bicuspid aortic valve (BAV), often requiring aortic valve replacement. Cardiac surgery in patients with severely calcified ascending aorta is challenging.
Case Presentation
A 28 year old male from Albania presented to the ED for dyspnea and low–threshold angina. The patient had family history for CAD and a sister with known FH treated with PCSK9–i. He had BAV, known hypercholesterolemia (max cholesterol 660 mg/dL), treated since 2015 with rosuvastatin plus ezetimibe, with reported irregular intake. He was treated with PCI and bioresorbable vascular scaffold on LAD coronary artery. He underwent surgical removal of limb xanthomas. At admission, the patient was asymptomatic at rest. Cardiac auscultatory findings included an ejection murmur in the aortic area. He presented upper and inferior eyelid xanthelasmas, bilateral calcaneal tendon thickening, elbows and knee xanthoma removal scars. Blood tests were unremarkable, except for lipid profile (LDL–C 443 mg/dL, HDL 36 mg/dL, TG 73 mg/dL). The echocardiography showed BAV, severe AS (Vmax 4,2 m/s, MPG 41 mmHg, AVA 0.46 cm2/m2), EF 60%. A coronary angiography excluded significant stenosis in the epicardial coronary vessels. An aortic CT scan showed sinotubular junction with preserved diameters and severe multiple parietal calcifications, ascending aorta with diffuse atheromatous disease. The patient underwent mechanical aortic valve replacement, ascending aorta thromboendarterectomy, non–coronary sinus enlargement patch, double CABG (SVG–OM, SVG–LAD) due to diffuse hypokinesia of the left ventricle after the interruption of extracorporeal circulation. At a 3–month outpatient re–evaluation, due to the unsatisfactory response to the regular intake of rosuvastatin plus ezetimibe (TC 309 mg/dL, TG 52 mg/dL, HDL 34 mg/dL, LDL–C 264 mg/dL), a PCSK9–i was prescribed. Genetic studies for FH are ongoing.
Discussion
This case underlines the importance of aortic evaluation before aortic valve replacement, even in young FH patients, in which severe aortic calcification can influence surgical approach.
Conclusion
We described the multidisciplinary management of a severe symptomatic AS in a young male with FH and sinotubular junction parietal calcifications, which represented a challenging substrate for valve replacement.
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Affiliation(s)
- M Brusamolino
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - M Muratori
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - A Apostolo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - G Bonalumi
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - G Nanci
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - J Werba
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - M Pepi
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - V Mantegazza
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - G Calligaris
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - A Formenti
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - M Agrifoglio
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO CARDIOLOGICO MONZINO, IRCCS; CARDIOVASCULAR SECTION, DEPARTMENT OF CLINICAL SCIENCES AND COMMUNITY HEALTH, UNIVERSITY OF MILAN, MILANO
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8
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Palermo P, Apostolo A, Contini M, Mapelli M, Alessandra M, De Martino F, Salvioni E, Agostoni P. P251 PERIODIC BREATHING (EOV) ON CARDIORESPIRATORY STRESS TESTING: ARE THERE PROGNOSTIC DIFFERENCES BETWEEN PATIENTS WITH PERIODIC BREATHING THAT PERSISTS THROUGHOUT THE TEST AND PATIENTS TO WHOM IT DISAPPEARS? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Oscillatory exercise ventilation (EOV) is frequently seen in patients with severe heart failure (HF) and has a ne:gative prognostic value in both patients with reduced HF and those with average ejection fraction. Two types of EOV have been described one that lasts throughout exercise and one that disappears before the end of exercise, Figure 1
Aim of the Study
It is currently unknown whether there are differences in prognosis and functional capacity between HF patients with EOV that persists or disappears during exercise.
Population
Male and female patients, aged≥18 years, diagnosed with HF and LVEF<45% were enrolled.
Methods
The retrospective study enrolled patients who performed a cardiopulmonary exercise test (CPET) and presented with EOV during exercise (Monzino Heart Center Laboratory and patients included in the MECKI score registry, identified a total of 255 patients). A subset of 100 patients underwent measurement of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) before and after exercise (Table 2). All patients were treated at the top of therapy for HF. CPETs were performed and analyzed with a standard approach using a customized ramp protocol. The main parameters obtained are reported and compared in Table 1. EOV was defined according to as a cyclic fluctuation in ventilation as proposed by Corrà et al. Statistical analysis:Data are reported as mean ± standard deviation or median and interquartile range as appropriate. The two groups of patients were compared by t test for unpaired data in the case of data with normal distribution. Mortality was analyzed by Kaplan Meier curves and Log Rank test. Survival was considered using the composite end–point of cardiovascular death, urgent cardiac transplantation, or implantation of a left ventricular assist device. The median MECKI score of the total population was 5.5% (2.5–13.7) with no significant differences between the 2 groups. Figure 1 shows the Kaplan Meyer describing the 5–year survival analysis in both groups.
Conclusions
Patients with disappearing EOV demonstrated better exercise performance but no significant difference in survival and major prognostic parameters.
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9
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Gentile P, Merlo M, Peretto G, Ammirati E, Sala S, Della Bella P, Aquaro G, Imazio M, Potena L, Campodonico J, Foà A, Raafs A, Hazebroek M, Brambatti M, Cercek A, Nucifora G, Shrivastava S, Huang F, Schmidt M, Muser D, Van De Heyning C, Van Craenenbroeck E, Aoki T, Sugimura K, Shimokawa H, Cannatà A, Artico J, Porcari A, Colopi M, Bussani R, Barbati G, Garascia A, Cipriani M, Agostoni P, Pereira N, Heymans S, Adler E, Camici P, Frigerio M, Sinagra G. C65 POST–DISCHARGE ARRHYTHMIC RISK STRATIFICATION OF PATIENTS WITH ACUTE MYOCARDITIS AND LIFE–THREATENING VENTRICULAR TACHYARRHYTHMIAS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
The outcomes of patients presenting with acute myocarditis and life–threatening ventricular arrhythmias (LT–VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population.
Methods and Results
We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT–VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter–defibrillator therapy or synchronized external cardioversion. Median follow–up was 23months [first to third quartile (Q1–Q3) 7–60]. Fifty–eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1–Q3 2.5–24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38–6.11]; late gadolinium enhancement involving ≥2 myocardial segments (HR 4.51, 95% CI 2.39–8.53), and absence of positive short–tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40–4.79) at first CMR.
Conclusions
In this international multicentre study, patients discharged free from HTx or LVAD after an acute myocarditis complicated by LT–VA had a recurrence of MAEs during follow–up of 37.2%, after a median time of 8 months. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
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Affiliation(s)
- P Gentile
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Merlo
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Peretto
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - E Ammirati
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - S Sala
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - P Della Bella
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Aquaro
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Imazio
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - L Potena
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - J Campodonico
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Foà
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Raafs
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Hazebroek
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Brambatti
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Cercek
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Nucifora
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - S Shrivastava
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - F Huang
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Schmidt
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - D Muser
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - C Van De Heyning
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - E Van Craenenbroeck
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - T Aoki
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - K Sugimura
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - H Shimokawa
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Cannatà
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - J Artico
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Porcari
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Colopi
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - R Bussani
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Barbati
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Garascia
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Cipriani
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - P Agostoni
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - N Pereira
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - S Heymans
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - E Adler
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - P Camici
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Frigerio
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Sinagra
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
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Mapelli M, Pires I, Amelotti N, Guglielmo M, Conte E, Agostoni P. P315 A CASE OF TAKOTSUBO CARDIOMYOPATHY IN A PATIENT WITH TAKAYASU’S ARTERITIS: THE CORONARY VASOSPASM AS A MISSING LINK BETWEEN THE IMMUNE SYSTEM AND ACUTE PSYCHOLOGICAL STRESS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Takayasu’s arteritis (TA) is a systemic inflammatory disease that affects aorta and its major branches. There are several cardiac manifestations of TA and, recently, an association with Takotsubo syndrome (TTS) was reported
Case Presentation
A 58–year–old Caucasian female, with history of severe asymptomatic aortic regurgitation (AR) with a recently documented normal LV systolic function and TA in remission under corticosteroids, was admitted in the emergency department with chest pain following an acute intense stressful event. ECG showed sinus tachycardia, T wave inversion in left precordial and lateral leads, and a QTc of 487 ms (Figure 1). Laboratorial evaluation presented high–sensitivity troponin I of 3494 ng/L and B–type natriuretic peptide of 4759 pg/mL. The transthoracic echocardiogram revealed severe dilation of LV with moderate systolic dysfunction, due to apical and midventricular akinesia (“apical ballooning” pattern), and severe AR (Figure 2). The coronary angiography showed normal coronary arteries. An acetylcholine provocative test showed spasm of both the left anterior descending and circumflex arteries, accompanied by chest pain and ST depression in ECG, reverted after intracoronary nitrates administration (Figure 3). The patient was switched to diltiazem and heart failure drug therapy was started. A cardiac magnetic resonance revealed severe dilation of the LV, apical hypokinesia, ejection fraction to 53%, signs of myocardial edema and increased extracellular volume in apical and mid–ventricular anterior and anterolateral walls, and absence of myocardial late gadolinium enhancement, compatible with TTS. Patient was discharged clinically stable, without signs of HF, with progressive reduction of troponin and BNP. A final diagnosis of myocardial infarction with nonobstructive coronary arteries (MINOCA) due to TTS and coronary vasospasm in a patient with TA was done
Discussion
TA is a rare disease and there are reports of its association both with TTS and coronary vasospasm. Besides that, coronary vasospasm may also be involved in the pathophysiology of TTS. Moreover, in this patient we could not exclude the role coronary diastolic hypoperfusion due to AR in the elicitation of coronary vasospasm. Therefore, although the mechanisms behind these pathologies are not yet fully studied, this case supports their relationship
Conclusion
We presented a case of a patient with TA admitted with MINOCA due to TTS and coronary vasospasm
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Affiliation(s)
- M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA, VISEU
| | - I Pires
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA, VISEU
| | - N Amelotti
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA, VISEU
| | - M Guglielmo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA, VISEU
| | - E Conte
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA, VISEU
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA, VISEU
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11
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Amelotti N, Mapelli M, Pires I, Guglielmo M, Majocchi B, Catto V, Campodonico J, Vignati C, Baggiano A, Ribatti V, Moltrasio M, Vettor G, Sicuso R, Pontone G, Basso C, Agostoni P. C61 MULTIDISCIPLINARY MANAGEMENT IN A CASE OF EOSINOPHILIC MYOCARDITIS WITH CHURG STRAUSS SYNDROME: FROM ECG TO ENDOMYOCARDIAL BIOPSY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg–Strauss, is a rare multisystem disorder characterized by chronic rhinosinusitis, asthma, and prominent peripheral blood eosinophilia (PE). Cardiac involvement may include eosinophilic myocarditis and it is a serious manifestation of EGPA.
Case Presentation
A 67–year–old woman presented to the emergency department with 2–weeks history of dyspnea, orthopnea and asthenia. She had history of asthma, PE, adjuvant radiotherapy after right mastectomy (July 2021). The patient was diagnosed with new onset atrial fibrillation in the previous month. At admission, the patient was hemodynamically stable and with signs of congestion. Complementary exams showed sinus rhythm and T–wave inversion on lateral leads; PE (2010/uL), elevated troponin and BNP values; and severe biventricular systolic dysfunction with diffuse hypokinesia and apical akinesia. The patient was admitted to the ICU and was treated with intravenous diuretics and levosimendan. Optimal HF therapy was introduced. Serial echocardiography revealed partial recovery of LVEF and blood analysis showed a decrease in troponin levels, with persistent eosinophilia (6330/uL). Computed tomography (CT) excluded significant coronary disease, and showed bilateral basal ground–glass opacities, areas of air–space consolidation and bilateral reticular–nodular pattern. Cardiac magnetic resonance revealed increased T2 values/signs of myocardial edema in anterior wall, interventricular septum and apex and no late gadolinium enhancement, compatible with myocarditis. An endomyocardial biopsy (EMB) was performed and confirmed the diagnosis of eosinophilic myocarditis. Oral corticosteroids were started. Paranasal CT scan showed signs of chronic sinusitis, without polyposis, and antineutrophil cytoplasmic antibodies were positive, making the diagnosis of EGPA, according to ACR criteria.
Discussion
In a patient presenting with new onset heart failure and with history of asthma and eosinophilia, it is important to suspect eosinophilic myocarditis, as this is a rare but reversible life–threatening condition. EMB plays an important role in the diagnosis and should be done promptly.
Conclusion
We described a multidisciplinary management of a case of a patient with eosinophilic myocarditis and EGPA, presenting with severe acute biventricular dysfunction.
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Affiliation(s)
- N Amelotti
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - I Pires
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - M Guglielmo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - B Majocchi
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - V Catto
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - J Campodonico
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - C Vignati
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - A Baggiano
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - V Ribatti
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - M Moltrasio
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - G Vettor
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - R Sicuso
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - G Pontone
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - C Basso
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; CENTRO HOSPITALAR TONDELA–VISEU, EPE, VISEU; UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
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Mapelli M, Salvioni E, Paneroni M, Gugliandolo P, Bonomi A, Scalvini S, Raimondo R, Sciomer S, Mattavelli I, La Rovere M, Agostoni P. P244 BRISK WALKING CAN BE A MAXIMAL EFFORT IN HEART FAILURE PATIENTS. A COMPARISON OF CARDIOPULMONARY EXERCISE AND SIX–MINUTE WALKING TEST CARDIORESPIRATORY DATA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Cardiopulmonary exercise test (CPET) and six–minute walking test (6MWT) are frequently used in heart failure (HF). CPET is a maximal exercise, whereas 6MWT is a self–selected constant load test usually considered a submaximal, and therefore safer, exercise but this has not been tested previously. The aim of this study was to compare the cardiorespiratory parameters collected during CPET and 6MWT in a large group of healthy subjects and patients with HF of different severity.
Methods and Results
Subjects performed a standard maximal CPET and a 6MWT wearing a portable device allowing breath–by–breath measurement of cardiorespiratory parameters. HF Patients were grouped according to their CPET peak oxygen uptake (peakV̇O2). One–hundred and fifty–five subjects were enrolled, of whom 40 were healthy (59±8 years; male 67%) and 115 were HF patients (69±10 years; male 80%; left ventricular ejection fraction 34.6±12.0%). CPET peakV̇O2 was 13.5±3.5 ml/kg/min in HF patients and 28.1±7.4 ml/kg/min in healthy (p < 0.001). 6MWT–V̇O2 was 98±20% of the CPET peakV̇O2 values in HF patients, while 72±20% in healthy subjects (p < 0.001). 6MWT–V̇O2 was >110% of CPET peakV̇O2 in 42% of more severe HF patients (peakV̇O2<12ml/kg/min). Similar results have been found for ventilation and heart rate. Of note, the slope of the relationship between V̇O2 at 6MWT, reported as percentage of CPET peakV̇O2 vs. 6MWT V̇O2 reported as absolute value, progressively increased as exercise limitation did.
Conclusions
6MWT must be perceived as a maximal or even supra–maximal exercise activity at least in patients with severe exercise limitation from HF. Our findings should influence the safety procedures needed for the 6MWT in HF.
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Affiliation(s)
- M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - E Salvioni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - M Paneroni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - P Gugliandolo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - A Bonomi
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - S Scalvini
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - R Raimondo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - S Sciomer
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - I Mattavelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - M La Rovere
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, LUMEZZANE BRESCIA; RESPIRATORY REHABILITATION, ISTITUTI CLINICI SCIENTIFICI MAUGERI, IRCCS, TRADATE, VARESE, ITALY, TRADATE; DIPARTIMENTO DI SCIENZE CARDIOVASCOLARI, RESPIRATORIE, NEFROLOGICHE, ANESTESIOLOGICHE E GERIATRICHE, “SAPIENZA”, ROMA; DEPARTMENT OF CARDIAC REHABILITATION,
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Mapelli M, Amelotti N, Andreini D, Baggiano A, Campodonico J, Moltrasio M, Majocchi B, Mantegazza V, Vignati C, Ribatti V, Catto V, Sicuso R, Pontone G, Agostoni P. C89 A CASE OF MYOPERICARDITIS RECURRENCE AFTER THIRD DOSE OF BNT162B2 VACCINE AGAINST SARS–COV–2 IN A YOUNG SUBJECT: LINK OR CASUALITY? Eur Heart J Suppl 2022. [PMCID: PMC9384049 DOI: 10.1093/eurheartj/suac011.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The rate of post–vaccine myocarditis is being studied from the beginning of the massive vaccination campaign against Sars–Cov–2, reporting a very low incidence. Although a direct cause–effect relationship has been described, in most cases the vaccine pathophysiological role is doubtful. Moreover, it is not quite as clear as having had a previous myocarditis could be a risk factor for a post–vaccine disease relapse. Case Presentation A 27–year–old man presented to the ED for palpitations and pericardial chest pain radiated to the upper left limb, on the 4th day after the third dose of BNT162b2 vaccine. He experienced a previous myocarditis 3 years before, with full recovery and no other comorbidities. ECG showed a diffuse ST segment elevation and a cardiac echo showed lateral hypokinesia with preserved ejection fraction. Troponine–T was elevated (160ng/l), chest x–ray was normal, and the Sars–Cov–2 molecular buffer was negative. High–dose anti–inflammatory therapy with ibuprofen and colchicine was started; in the 3rd day high sensitivity Troponin I reached a peak (hsTnI) of 23000 ng/L. No heart failure or arrhythmias were observed. A cardiac MRI was performed showing normal biventricular systolic function, areas of LGE with non–ischemic subepicardial pattern at the level of the anterior wall with increased T2 signal, suggestive for a recurrence of myocarditis. A left ventricle electroanatomic voltage mapping was negative (both unipolar and bipolar), while the endomiocardial biopsy showed a picture consistent with active myocarditis. The patient was discharged in good shape, with normal hsTnI values on bisoprolol 1.25mg, ramipril 2.5mg, ibuprofen 600 mg three times a day, colchicine 0.5 mg twice a day. Discussion: We presented the case of a young man with history of previous myocarditis, admitted with a non–complicated acute myopericarditis relapse occurred 4 days after Sars–Cov–2 vaccination (3rd dose). Despite the observed very low incidence of cardiac complications following BNT162b2 administration, and the lack of a clear proof of a direct cause–effect relationship, we think that in our patient this link can be more than likely. In the probable need for additional Sars–Cov–2 vaccine doses in the next future, studies addressing the risk–benefit balance of this subset of patient are warranted. Conclusion We described a multidisciplinary management of a case of myocarditis recurrence after the third dose of Sars–Cov–2 BNT162b2 vaccine.
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Affiliation(s)
- M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | - N Amelotti
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | - D Andreini
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | - A Baggiano
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | | | | | - B Majocchi
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | | | - C Vignati
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | - V Ribatti
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | - V Catto
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | - R Sicuso
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | - G Pontone
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO
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14
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Elisabetta S, Mapelli M, Bonomi A, Mattavelli I, De Martino F, Vignati C, Gugliandolo P, Agostoni P. C73 PICK YOUR THRESHOLD! HOW TO CALCULATE THE ANAEROBIC THRESHOLD TO STRATIFY HEART FAILURE PROGNOSIS: A COMPARISON BETWEEN ABSOLUTE VALUE, PERCENTAGE OF PEAK VO2 OR PERCENTAGE OF PREDICTED MAXIMUM VO2 IN A LARGE MULTICENTER COHORT OF HFREF PATIENTS WHO UNDER. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The anaerobic threshold (AT), identifies the moment during a maximal exercise when hyperventilation occurs in response to the introduction of an anaerobic metabolism. Its value is indicative of the subject‘s training and/or health, it can be used to guide training, rehabilitation or to define appropriateness to undergo major thoracic or abdominal surgery, and it is related to heart failure (HF) prognosis. AT can be expressed as absolute value or as the percentage of predicted maximum VO2 (VO2AT%pred). However, it is not uncommon to find papers that refer AT to the peak VO2 value achieved (VO2AT%peak), rather than its predicted value, but a direct comparison of the prognostic power of these different variables is missing. In this work, we aim to compare the risk–identifying ability of the AT value when expressed in these three different ways in a large population of HF patients. This will help identify which is more correct to use in assessing patient prognosis, especially when peakVO2 is not reached appropriately.
Methods
The population analyzed counts 7746 patients with HF with history of reduced EF (<40%), recruited between 1998 and 2020 within the MECKI score project. All patients underwent a maximal cardiopulmonary exercise test (CPET), executed in using a ramp protocol on an electronically braked cycle ergometer.
Results
The present study considered 6157 HF patients with identified AT during the CPET, with a median follow up of 1528 days (689–1826). The main characteristics are reported in Figure 1. Figure 2 shows stratification of patients according to these 3 variables divided in tertiles, considering cardiovascular death (combination of cardiovascular death, urgent transplant or LVAD implantation) as an end point. Comparing the AUC of the three variables considered, we found similar values between VO2AT and VO2AT%pred, while the peak VO2AT% value was significantly lower (p < 0.001), as shown in Figure 3A. Moreover VO2AT%pred is the only variable to maintain a comparable ROC to the peakVO2 one, with the others being significantly lower (Figure 3B).
Conclusions
VO2 at AT should always be expressed as % of predicted maximal VO2 to be reliable in predicting prognosis in HF patients. Moreover, evaluating a sub–maximal exercise, VO2AT%pred is the only variable to maintain a comparable prognostic power to the peakVO2 one.
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Affiliation(s)
- S Elisabetta
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - A Bonomi
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - I Mattavelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - F De Martino
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | - C Vignati
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
| | | | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO, MILANO
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15
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Karsten M, Ribeiro GS, Deresz LF, Salvioni E, Silveira LS, Hansen D, Agostoni P. Would be the minute ventilation variability an alternative to the dichotomous diagnosis of exercise oscillatory ventilation? Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CAPES and FAPERGS.
Background
Exercise oscillatory ventilation (EOV) is an abnormal ventilatory phenomenon observed in chronic heart failure (HF) patients usually defined as EOV-positive or EOV-negative based on a dichotomous diagnosis. Minute ventilation variability (vVE) can quantify the presence of these oscillations and assist the prognosis of patients.
Purpose
To analyse the sensitivity and specificity of vVE to predict 2-year all-causes of death in HF patients.
Methods
Data from 233 cardiopulmonary exercise tests from HF patients performed between 2011 and 2014 at an Italian heart centre were analysed. The vVE was defined by the standard deviation (SD) of VE normalized by the number of respiratory cycles (SD/n) during the exercise tests. The cut-off to predict 2-year mortality was determined by the receiver-operating characteristic (ROC) curve.
Results
Thirty-five deaths were registered at 2-years. The ROC curve indicated ≤ 54.9 as the better cut-off for vVE (32 deaths were registered in follow-up; Figure 1). The relative risk was 3.9 (1.3 to 12.4) with a hazard ratio of 2.7 (1.3 to 5.6) for 2-year mortality.
Conclusion
The vVE appears to be a sensitive alternative to quantify EOV and stratify high-risk cases from 2-year all-cause mortality.
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Affiliation(s)
- M Karsten
- Santa Catarina State University, Florianopolis, Brazil
| | - GS Ribeiro
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - LF Deresz
- Federal University of Juiz de Fora, Physical Education, Juiz De Fora, Brazil
| | - E Salvioni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - LS Silveira
- Santa Catarina State University, Florianopolis, Brazil
| | - D Hansen
- Hasselt University, Faculty of Rehabilitation Sciences, Hasselt, Belgium
| | - P Agostoni
- Cardiology Center Monzino IRCCS, Milan, Italy
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16
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Ribeiro GS, Deresz LF, Salvioni E, Silveira LS, Hansen D, Agostoni P, Karsten M. Brain natriuretic peptide levels are associated with cycle length average and are different between Ben-Dov and Corra exercise oscillatory ventilation definitions in heart failure patients. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CAPES e FAPERGS.
Background
The brain natriuretic peptide (BNP) is a marker of ventricular dysfunction related to severity and prognosis in heart failure patients. Exercise oscillatory ventilation (EOV) is a phenomenon in the ventilatory pattern associated with a worse prognosis in heart failure patients. EOV diagnosis is defined by the interaction among amplitude, cycle length, and the total time of the oscillations. Ben-Dov and Corrà definitions are used to identify EOV-positive cases by different criteria, which may stratify EOV patients with distinct clinical characteristics.
Purpose
To assess the BPN levels in heart failure patients and to test BNP level correlation with amplitude, cycle length, and total oscillation time according to Ben-Dov and Corrà definitions.
Methods
Data from 242 cardiopulmonary exercise tests (CPETs) performed between 2011 and 2014 at an Italian heart centre were screened for EOV identification. CPETs were done in a cycle-ergometer with gas exchange analysed breath-by-breath. EOV cases were identified according to the definitions of Ben-Dov and Corrà. Mann-Whitney test was applied to compare BPN levels between the EOV-positive and negative in each definition and between EOV-positive from Ben-Dov and Corrà definitions. Spearman coefficient (rs) evaluated the association between amplitude and length average of the oscillatory cycle, percentage of total oscillation time, and BNP levels in each EOV definition. The BNP levels from EOV-positive identified by Corrà or Ben-Dov definition alone, and from patients who have met the criteria of both definitions were compared by the Kruskal-Wallis test.
Results
Sixty-seven patients were identified as EOV-positive. From them, 19 were identified exclusively by the Ben-Dov and 26 by Corrà. Twenty-two met the criteria for both definitions. Overall, no difference in EOV prevalence between Ben-Dov and Corrà definitions was found (20.4 vs 24.2%, p = 0.482). EOV-positive identified by the Ben-Dov definition have higher BNP levels than EOV-negative (p < 0.01) and the EOV-positive by Corrà definition (p = 0.025) (Table 1). Spearman correlation showed association just between BNP levels and cycle length average from EOV-positive by the Ben-Dov (rs = 0.566; p < 0.001) and by Corrà (rs = 0.339; p = 0.011) (Figure 1). When analysed by exclusive criteria identification, the BNP levels were higher in EOV-positive identified by Ben-Dov than Corrà (737 [562 to 1,178] vs 276 [221 to 603] pg/mL; p = 0.009). BNP levels in the EOV-positive identified by both definitions (475 [347 to 852] pg/mL) were not different from those identified by the Ben-Dov and Corrà definitions alone.
Conclusion
EOV-positive identified by the Ben-Dov have higher BNP levels than EOV-negative and the EOV-positive identified by Corrà, alone or not. BNP levels also are associated with the cycle length average, with a higher correlation for the Ben-Dov EOV-positive.
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Affiliation(s)
- GS Ribeiro
- Federal University of Health Sciences of Porto Alegre, Graduate Program in Rehabilitation Sciences, Porto Alegre, Brazil
| | - LF Deresz
- Federal University of Juiz de Fora, Physical Education, Juiz De Fora, Brazil
| | - E Salvioni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - LS Silveira
- Santa Catarina State University, Florianopolis, Brazil
| | - D Hansen
- Hasselt University, Faculty of Rehabilitation Sciences, Hasselt, Belgium
| | - P Agostoni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Karsten
- Santa Catarina State University, Florianopolis, Brazil
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17
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Pezzuto B, Badagliacca R, Muratori M, Farina S, Bussotti M, Correale M, Bonomi A, Vignati C, Sciomer S, Papa S, Palazzo Adriano E, Agostoni P. ROLE OF CARDIOPULMONARY EXERCISE TEST IN THE PREDICTION OF HEMODYNAMIC IMPAIRMENT IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION. Pulm Circ 2022; 12:e12044. [PMID: 35506106 PMCID: PMC9052996 DOI: 10.1002/pul2.12044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
Periodic repetition of right heart catheterization (RHC) in pulmonary arterial hypertension (PAH) can be challenging. We evaluated the correlation between RHC and cardiopulmonary exercise test (CPET) aiming at CPET use as a potential noninvasive tool for hemodynamic burden evaluation. One hundred and forty‐four retrospective PAH patients who had performed CPET and RHC within 2 months were enrolled. The following analyses were performed: (a) CPET parameters in hemodynamic variables tertiles; (b) position of hemodynamic parameters in the peak end‐tidal carbon dioxide pressure (PETCO2) versus ventilation/carbon dioxide output (VE/VCO2) slope scatterplot, which is a specific hallmark of exercise respiratory abnormalities in PAH; (c) association between CPET and a hemodynamic burden score developed including mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index, and right atrial pressure. VE/VCO2 slope and peak PETCO2 significantly varied in mPAP and PVR tertiles, while peak oxygen uptake (peak VO2) and O2 pulse varied in the tertiles of all hemodynamic parameters. PETCO2 versus VE/VCO2 slope showed a strong hyperbolic relationship (R2 = 0.7627). Patients with peak PETCO2 > median (26 mmHg) and VE/VCO2 slope < median (44) presented lower mPAP and PVR (p < 0.005) than patients with peak PETCO2 < median and VE/VCO2 slope > median. Multivariate analysis individuated peak VO2 (p = 0.0158) and peak PETCO2 (p = 0.0089) as hemodynamic score independent predictors; the formula 11.584 − 0.0925 × peak VO2 − 0.0811 × peak PETCO2 best predicts the hemodynamic score value from CPET data. A significant correlation was found between estimated and calculated scores (p < 0.0001), with a precise match for patients with mild‐to‐moderate hemodynamic burden (76% of cases). The results of the present study suggest that CPET could allow to estimate the hemodynamic burden in PAH patients.
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Affiliation(s)
- B Pezzuto
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - R Badagliacca
- Department of Cardiovascular and Respiratory Sciences Sapienza University of Rome Italy
| | - M Muratori
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - S Farina
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - M Bussotti
- Cardiac Rehabilitation Department IRCCS Istituti Clinici Scientifici Maugeri Milan Italy
| | - M Correale
- University Hospital Ospedali Riuniti Foggia Italy
| | - A Bonomi
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - C Vignati
- Centro Cardiologico Monzino IRCCS Milan Italy
| | - S Sciomer
- Department of Cardiovascular and Respiratory Sciences Sapienza University of Rome Italy
| | - S Papa
- Department of Cardiovascular and Respiratory Sciences Sapienza University of Rome Italy
| | - E Palazzo Adriano
- Cardiac Rehabilitation Department IRCCS Istituti Clinici Scientifici Maugeri Milan Italy
| | - P Agostoni
- Centro Cardiologico Monzino IRCCS Milan Italy
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
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18
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Moeliker LM, Nijenhuis VJ, Ten Berg JM, Swaans MJ, De Kroon TL, Heijmen RH, Agostoni P, Sonker U, Timmers L, Van Kuijk JP. Transcatheter paravalvular leak closure is an effective alternative to surgical repair with respect to 5-year outcomes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Paravalvular leakage (PVL) is a relatively common complication of heart valve replacement, associated with heart failure and increased mortality. Transcatheter PVL closure may be a promising alternative to surgical repair, especially in high-risk patients.
Purpose
Assessment of safety and efficacy of transcatheter PVL closure compared to surgical repair.
Methods
This is a retrospective single-centre study including all consecutive patients who underwent either transcatheter PVL closure between January 2013 and December 2020, or surgical repair between March 2015 and December 2020. Primary endpoints were 5-year all-cause mortality and the composite of 5-year cardiovascular mortality and rehospitalization for the underlying condition. Secondary endpoints were technical success and individual patient success at one year according to the PVL Academic Research Consortium.
Results
Of the 129 patients included, 85 went for transcatheter repair and 44 went for surgical repair. As compared to surgical repair, patients undergoing transcatheter PVL closure were older (71 years vs. 64,5 years; p≤0,01) and more symptomatic (NYHA class III & IV; 76,5% vs. 59,1%; p=0,04). At 5 years, transcatheter PVL closure was comparable to surgery in terms of the primary composite endpoint (HR: 1,20; 95% CI: 0,68–2,13; p=0,54), all-cause mortality (HR: 1,70; 95% CI: 0,82–3,50; p=0,15) and rehospitalization for the underlying condition (HR: 1,12; 95% CI: 0,54–2,89; p=0,780). Rates of technical success (92,9% vs. 95,5%; p=0,58) and individual patient success at one year (70,6% vs. 77,3%; p=0,87) were similar between transcatheter PVL closure and surgery respectively. Transcatheter PVL closure was associated with shorter in-hospital stay (7 days vs. 14 days; p≤0,01).
Conclusion
These findings support the use of transcatheter closure of PVL, especially in high-risk patients. Long term survival remains temperate in these challenging patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L M Moeliker
- St Antonius Hospital, Nieuwegein, Netherlands (The)
| | - V J Nijenhuis
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
| | - J M Ten Berg
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
| | - M J Swaans
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
| | - T L De Kroon
- St Antonius Hospital, Cardiothoracic surgery, Nieuwegein, Netherlands (The)
| | - R H Heijmen
- St Antonius Hospital, Cardiothoracic surgery, Nieuwegein, Netherlands (The)
| | - P Agostoni
- Middelheim, Cardiology, Antwerpen, Belgium
| | - U Sonker
- St Antonius Hospital, Cardiothoracic surgery, Nieuwegein, Netherlands (The)
| | - L Timmers
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
| | - J P Van Kuijk
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
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19
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Gallo G, Piepoli M, Corra' U, Salvioni E, Perrone Filardi P, Metra M, Limongelli G, Senni M, Parati G, Cicoira M, Sciomer S, Sinagra G, Volpe M, Agostoni P, Magri' D. Cardiovascular death risk in mid-range ejection fraction heart failure: insights from cardiopulmonary exercise test. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0802] [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
The pivotal role of cardiopulmonary exercise testing (CPET) in the assessment of functional capacity and prognosis of patients with heart failure with reduced ejection fraction (HFrEF), either as a single CPET parameter (i.e. peak oxygen uptake, peak VO2), as a combination of CPET parameters (i.e. oxygen uptake at the anaerobic threshold (AT) and ventilatory efficiency (VE/VCO2 slope), or as a part of more comprehensive scores (i.e. Metabolic Exercise combined with Cardiac and Kidney Indexes, MECKI) is well established. Just few studies are available with respect a possible role of CPET in risk stratification of patients in HF with midrange EF (HFmrEF) subset, namely HF patients with LVEF between 40% and 49%.
Purpose
The aim of the present large Italian multicenter study was to characterize and to compare stable HFmrEF and HFrEF patients in terms of exercise capacity as well as of instrumental and laboratory variables. We analyzed a possible independent and incremental prognostic value of CPET parameters in identifying those HFmrEF patients at high cardiovascular death risk.
Methods
We retrospectively analyzed clinical and CPET data of stable HF patients with HFrEF and HFmrEF from the MECKI Score database. Five-thousand-seven-hundred-eleven patients, 4,535 with HFrEF and 1,176 with HFmrEF, were considered for the study. The end-point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th–75th range, 627–2403 days).
Results
Cardiovascular death occurred in 552 HFrEF (12.2% event rate) and 61 HFmrEF (5.2% event rate) patients. At multivariate analysis, an independent role of variables included in the MECKI score (age, atrial fibrillation, LVEF, haemoglobin, sodium, MDRD, AT identification, VO2 at AT, peak VO2 also expressed as percentage of the maximum predicted, VE/VCO2 slope) was confirmed in HFrEF group (C-index=0.744) whereas, in the HFmrEF group, only age and peak VO2 remained outcome predictors (C-index=0.745).
We identified a peak VO2 <55% of predicted and a VE/VCO2 slope >31 as the most accurate cut-off values able to identify a HFmrEF subgroup with a cardiovascular mortality rate significantly higher than the overall HFmrEF (5.2% vs 8.5%) (Figure 1). By using both cut-off values contextually, we recognized a relatively small HFmrEF population with a cardiovascular risk quite similar to the HFrEF sample (11.4% vs 12.2%) (Figure 1).
Conclusions
Present data support the CPET as a useful tool in the HFmrEF management. Besides the peak VO2, which resulted as a strong independent outcome predictor, also a number of other CPET variables were associated to the cardiovascular death risk. Particularly, a peak VO2 ≤55% of the maximum and a VE/VCO2 slope ≥31 identified a HFmrEF subgroup of patients with a high cardiovascular death risk, similar to the one observed in the HFrEF group.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- G Gallo
- Sapienza University Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, Rome, Italy
| | - M Piepoli
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - U Corra'
- Istituti Clinici Scientifici Maugeri, Veruno, Italy
| | - E Salvioni
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | | | - M Metra
- University of Brescia, Brescia, Italy
| | | | - M Senni
- ASST Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | - G Parati
- University of Milan-Bicocca, Milan, Italy
| | | | - S Sciomer
- Umberto I Polyclinic of Rome, Rome, Italy
| | - G Sinagra
- University of Trieste, Trieste, Italy
| | - M.A Volpe
- Sapienza University Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, Rome, Italy
| | - P Agostoni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - D Magri'
- Sapienza University Sant'Andrea Hospital, Department of Clinical and Molecular Medicine, Rome, Italy
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20
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Mantegazza V, Volpato V, Mapelli M, Sassi V, Salvioni E, Mattavelli I, Tamborini G, Agostoni P, Pepi M. Cardiac reverse remodelling by 2D and 3D echocardiography in heart failure patients treated with sacubitril/valsartan: a prospective study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0776] [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
Left ventricular (LV) reverse remodelling induced by sacubitril/valsartan (S/V) has been shown in heart failure patients with reduced ejection fraction (HFrEF) by two-dimensional (2D) transthoracic echocardiography (TTE). Data about S/V effect on the right ventricle (RV) are scarce.
Aims
We aimed to evaluate S/V-induced changes in NT-proBNP levels, and cardiac remodelling indices by 2D and three-dimensional (3D) TTE in HFrEF patients, classifying patients according to aetiology.
Methods
We prospectively enrolled 51 HFrEF patients (24 ischaemic, 27 non-ischaemic). At baseline and at 6-months follow-up (6MFU) after S/V treatment optimization, we i) assessed NT-proBNP; ii) performed 2D TTE according to guidelines for the assessment of biventricular size and function, mitral regurgitation grade and LV diastolic function; and iii) performed 3D TTE, using the Dynamic HeartModel software for the evaluation of LV volumes and function, the 4D LV-Analysis software for the assessment of LV longitudinal strain, and the 4D RV-Analysis software for the assessment of RV volumes and function (Figure 1).
Results
In non-ischaemic patients, both 2D and 3D TTE showed an improvement in LV volumes and biventricular function, whereas only 3D detected a reduction in RV size at 6MFU vs baseline (Table 1). In ischaemic patients, only 3D TTE showed an improvement in biventricular size and LV function (Table 1). Finally, S/V induced a significant improvement in NT-proBNP (Table 1) and diastolic function both in ischaemic and non-ischaemic groups: patients with elevated left atrial pressure (as assessed by 2D parameters of diastolic function) decreased from 45% to 20% in ischaemic and from 40% to 10% in non-ischaemic patients (p<0.05).
Conclusions
S/V induced a significant improvement in NTproBNP and diastolic function in both aetiologic groups. A clinically significant improvement in biventricular function was shown only in non-ischaemic patients. 3D TTE may be advantageous to ascertain subtle changes in LV size and function, undetected by 2D imaging, and to evaluate RV dimensions and function, which have a major impact on HFrEF prognosis.
Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
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Affiliation(s)
- V Mantegazza
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - V Volpato
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - V Sassi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - E Salvioni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - I Mattavelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G Tamborini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - P Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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21
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Corona S, Naliato M, Apostolo A, Agostoni P, Salvi L, Alamanni F. Off-Pump Implant Strategy for the Jarvik 2000 LVAD. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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22
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Paolillo S, Salvioni E, Perrone Filardi P, Bonomi A, Sinagra G, Gentile P, Gargiulo P, Scoccia A, Cosentino N, Gugliandolo P, Badagliacca R, Lagioia R, Correale M, Frigerio M, Perna E, Piepoli M, Re F, Raimondo R, Minà C, Clemenza F, Bussotti M, Limongelli G, Gravino R, Passantino A, Magrì D, Parati G, Caravita S, Scardovi AB, Arcari L, Vignati C, Mapelli M, Cattadori G, Cavaliere C, Corrà U, Agostoni P. Corrigendum to "Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database" [Int J Cardiol. 2020 Oct 15; 317: 103-110. PMID: 32360652]. Int J Cardiol 2021; 333:252. [PMID: 33640418 DOI: 10.1016/j.ijcard.2021.02.045] [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: 11/17/2022]
Affiliation(s)
- S Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - E Salvioni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - P Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - A Bonomi
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - G Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - P Gentile
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - P Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - A Scoccia
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - N Cosentino
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | - R Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - R Lagioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - M Correale
- Department of Cardiology, University of Foggia, Foggia, Italy
| | - M Frigerio
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda - A.O. Niguarda, Milano, Italy
| | - E Perna
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda - A.O. Niguarda, Milano, Italy
| | - M Piepoli
- UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy
| | - F Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | - R Raimondo
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy
| | - C Minà
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - F Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - M Bussotti
- Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Milano, Italy
| | - G Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - R Gravino
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - A Passantino
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - D Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - G Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - S Caravita
- San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, BG, Italy
| | - A B Scardovi
- Cardiology Division, Santo Spirito Hospital, Roma, Italy
| | - L Arcari
- Cardiology Division, Santo Spirito Hospital, Roma, Italy
| | - C Vignati
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - M Mapelli
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - G Cattadori
- Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano, Italy
| | | | - U Corrà
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Italy
| | - P Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
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23
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Silvis MJM, Dekker M, Zivelonghi C, Agostoni P, Stella PR, Doevendans PA, de Kleijn DPV, van Kuijk JP, Leenders GE, Timmers L. The Coronary Sinus Reducer; 5-year Dutch experience. Neth Heart J 2020; 29:215-223. [PMID: 33284421 PMCID: PMC7991026 DOI: 10.1007/s12471-020-01525-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Refractory angina is a growing and major health-care problem affecting millions of patients with coronary artery disease worldwide. The Coronary Sinus Reducer (CSR) is a device that may be considered for the relief of symptoms of refractory angina. It causes increased venous pressure leading to a dilatation of arterioles and reduced arterial vascular resistance in the sub-endocardium. This study describes the 5‑year Dutch experience regarding safety and efficacy of the CSR. Methods One hundred and thirty-two patients with refractory angina were treated with the CSR. The primary efficacy endpoint of the study was Canadian Cardiovascular Society (CCS) class improvement between baseline and 6‑month follow-up. The primary safety endpoint was successful CSR implantation in the absence of any device-related events. Results Eighty-five patients (67%) showed improvement of at least 1 CCS class and 43 patients (34%) of at least 2 classes. Mean CCS class improved from 3.17 ± 0.61 to 2.12 ± 1.07 after implantation (P < 0.001). The CSR was successfully implanted in 99% of the patients and only minor complications during implantation were reported. Conclusion The CSR is a simple, safe, and effective option for most patients with refractory angina. However, approximately thirty percent of the patients showed no benefit after implantation. Future studies should focus on the exact underlying mechanisms of action and reasons for non-response to better identify patients that could benefit most from this therapy. Electronic supplementary material The online version of this article (10.1007/s12471-020-01525-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J M Silvis
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Dekker
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - C Zivelonghi
- Hart Centrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerpen, Belgium
| | - P Agostoni
- Hart Centrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerpen, Belgium
| | - P R Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D P V de Kleijn
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - J P van Kuijk
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - G E Leenders
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L Timmers
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
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24
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Rozemeijer R, van Bezouwen WP, van Hemert ND, Damen JA, Koudstaal S, Stein M, Leenders GE, Timmers L, Kraaijeveld AO, Roes K, Agostoni P, Doevendans PA, Stella PR, Voskuil M. Direct comparison of predictive performance of PRECISE-DAPT versus PARIS versus CREDO-Kyoto: a subanalysis of the ReCre8 trial. Neth Heart J 2020; 29:201-214. [PMID: 32955703 PMCID: PMC7991032 DOI: 10.1007/s12471-020-01486-y] [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] [Indexed: 12/13/2022] Open
Abstract
Background Multiple scores have been proposed to guide risk stratification after percutaneous coronary intervention. This study assessed the performance of the PRECISE-DAPT, PARIS and CREDO-Kyoto risk scores to predict post-discharge ischaemic or bleeding events. Methods A total of 1491 patients treated with latest-generation drug-eluting stent implantation were evaluated. Risk scores for post-discharge ischaemic or bleeding events were calculated and directly compared. Prognostic performance of both risk scores was assessed with calibration, Harrell’s c‑statistics net reclassification index and decision curve analyses. Results Post-discharge ischaemic events occurred in 56 patients (3.8%) and post-discharge bleeding events in 34 patients (2.3%) within the first year after the invasive procedure. C‑statistics for the PARIS ischaemic risk score was marginal (0.59, 95% confidence interval (CI) 0.51–0.68), whereas the CREDO-Kyoto ischaemic risk score was moderate (0.68, 95% CI 0.60–0.75). With regard to post-discharge bleeding events, CREDO-Kyoto displayed moderate discrimination (c-statistic 0.67, 95% CI 0.56–0.77), whereas PRECISE-DAPT (0.59, 95% CI 0.48–0.69) and PARIS (0.55, 95% CI 0.44–0.65) had a marginal discriminative capacity. Net reclassification index and decision curve analysis favoured CREDO-Kyoto-derived bleeding risk assessment. Conclusion In this contemporary all-comer population, PARIS and PRECISE-DAPT risk scores were not resilient to independent testing for post-discharge bleeding events. CREDO-Kyoto-derived risk stratification was associated with a moderate predictive capability for post-discharge ischaemic or bleeding events. Future studies are warranted to improve risk stratification with more focus on robustness and rigorous testing. Electronic supplementary material The online version of this article (10.1007/s12471-020-01486-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Rozemeijer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - W P van Bezouwen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N D van Hemert
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Koudstaal
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Farr Institute of Health Informatics, University College London, London, UK
| | - M Stein
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - G E Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Timmers
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A O Kraaijeveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K Roes
- Department of Biostatistics and Research Support, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Agostoni
- Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - P A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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25
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Mapelli M, Mantegazza V, Volpato V, Sassi V, De Martino F, Salvioni E, Mattavelli I, Fusini L, Vignati C, Paolillo S, Corrieri N, Alimento M, Magini A, Pepi M, Agostoni P. P638 Short term reverse remodeling and exercise capacity improvement in a patient with valvular heart failure treated with Sacubitril Valsartan. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1184] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sacubitril/valsartan is a first-in-class angiotensin receptor-neprilysin inhibitor (ARNI) recommended in the guidelines to reduce morbidity and mortality in patients with symptomatic heart failure (HF) with reduced ejection fraction (HFrEF). Although the recent widespread use of the drug, data on left ventricle (LV) reverse remodeling and improvement in functional capacity (FC) under treatment are still lacking.
Case presentation
A 73 years old man with a known HFrEF was admitted to the hospital for clinical review due to progressive worsening dyspnea in the last 6 months (NYHA class III) with high NTproBNP values. Echocardiography showed dilated LV (EDVi/ESVi 137/98 ml/m2) with severe reduction in ejection fraction (EF), moderate/severe aortic incompetence, moderate functional mitral regurgitation. A maximal, ramp-protocol, cardiopulmonary exercise test (CPET) showed a moderate reduction in FC with signs of cardiogenic limitation. He was started on Sacubitril/Valsartan 24/26mg b.i.d. with progressive up-titration of the dose until a maximum dose of 97/103mg b.i.d. and without any other change in the therapy. ARNI was well tolerated without hypotension, worsening renal function or hyperkaliemia. After 3 months the echocardiography showed a reduction in LV volumes (EDVi/ESVi 112/72 ml/m2) with mild improvement in EF (from 28% to 34%) and increased FC, leading to a 56% reduction in estimated HF mortality at 2 years assessed through MECKI Score (See tab. 1 and Fig. 1). NTproBNP value was also reduced compared to baseline.
Conclusion
We present a case of a short term improvement in LV and atrium volumes and FC after 3 months of treatment with Sacubitril/valsartan in a patient with HFrEF. More studies are needed to assess LV volumes and CPET values response to ARNI.
Tab.1 Basaline 3 months Δ NYHA Class II III - MECKI Score (%) 5.12 2.23 -56-4% Peak VO2 /% of predicted) 60 72 +20% Maximal Work (W) 68 83 +22.1% Mitral regurgitation ++ + - eGFR (ml/min/1,73m2) 64 65 +1.6% Potassium (mmol/L) 4.26 4.20 -1.4% Aortic regurgitation +++ ++ - Clinical changes after the 3 months follow-up
Abstract P638 Figure. Fig. 1
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Affiliation(s)
- M Mapelli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - V Volpato
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Sassi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - E Salvioni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - C Vignati
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S Paolillo
- Federico II University Hospital, Naples, Italy
| | - N Corrieri
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Alimento
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - A Magini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Agostoni
- Cardiology Center Monzino IRCCS, Milan, Italy
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26
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Klein P, Agostoni P, van Boven WJ, de Winter RJ, Swaans MJ. Transcatheter and minimally invasive surgical left ventricular reconstruction for the treatment of ischaemic cardiomyopathy: preliminary results†. Interact Cardiovasc Thorac Surg 2018; 28:441-446. [DOI: 10.1093/icvts/ivy259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 07/13/2018] [Accepted: 07/25/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrick Klein
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | | | - Wim-Jan van Boven
- Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands
| | - Rob J de Winter
- Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands
| | - Martin J Swaans
- Department of Cardiology, St Antonius Hospital, Nieuwegein, Netherlands
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27
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Baldetti L, Gallone G, Ponticelli F, Banai S, Konigstein M, Verheye S, Rosseel L, Timmers L, Leenders G, Agostoni P, Zivelonghi C, Colombo A, Giannini F. P6363Real world experience with Reducer implantation for refractory angina treatment. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6363] [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: 11/12/2022] Open
Affiliation(s)
- L Baldetti
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
| | - G Gallone
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
| | - F Ponticelli
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
| | - S Banai
- Tel Aviv University, Department of Cardiology, Tel Aviv, Israel
| | - M Konigstein
- Tel Aviv University, Department of Cardiology, Tel Aviv, Israel
| | - S Verheye
- ZNA Middelheim Hospital, Cardiovascular Center, Antwerp, Belgium
| | - L Rosseel
- ZNA Middelheim Hospital, Cardiovascular Center, Antwerp, Belgium
| | - L Timmers
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands
| | - G Leenders
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands
| | - P Agostoni
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | - C Zivelonghi
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | - A Colombo
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
| | - F Giannini
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
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28
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Zivelonghi C, Suttorp MJ, Benfari G, Vinco G, Teeuwen K, Van Kuijk JP, Eefting FD, Rensing BJ, Van Der Heyden JAS, Ribichini FL, Ten Berg JM, Henriques JPS, Agostoni P. P1688Natural history of coronary lesions in the distal segment of total occlusions after successful percutaneous recanalization. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Zivelonghi
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | - M J Suttorp
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | | | - G Vinco
- University of Verona, Verona, Italy
| | - K Teeuwen
- Catharina Hospital, Eindhoven, Netherlands
| | - J P Van Kuijk
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | - F D Eefting
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | - B J Rensing
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | | | | | - J M Ten Berg
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | - J P S Henriques
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - P Agostoni
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
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29
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Bottio T, Bejko J, Ocagli H, Carrozzini M, Pagnin C, Tarzia V, Agostoni P, Bacich D, Ortis H, Livi U, Maiani M, Apostolo A, Di Gianmarco G, Lanera C, Gregori D, Gerosa G. Sleep and Life Quality with Left Ventricle Assist Devices or Transplanted Heart: Results from a Multi-Center Observational Study. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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30
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Bonini N, Vignati C, Apostolo A, Paolillo S, Righini F, Gerosa G, Bottio T, Tarzia V, Bejko J, Agostoni P. Modification of Sleep Disordered Breathing after Increase in LVAD Pump Speed in HF Patients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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31
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Jansen R, Wind AM, Cramer MJ, Nijhoff F, Agostoni P, Ramjankhan FZ, Suyker WJ, Stella PR, Chamuleau SAJ. Evaluation of mitral regurgitation by an integrated 2D echocardiographic approach in patients undergoing transcatheter aortic valve replacement. Int J Cardiovasc Imaging 2018. [PMID: 29524077 DOI: 10.1007/s10554-018-1328-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate mitral regurgitation (MR) severity in patients undergoing transcatheter aortic valve replacement (TAVR) by standardized assessment of two-dimensional (2D) transthoracic echocardiography (TTE) and 1-year echocardiographic and clinical outcomes. Pre- and post-procedural TTE's of patients undergoing TAVR between 2008 and 2014 were analyzed. MR was graded according to current guidelines with a systematic and integrated approach. Longitudinal echocardiographic and clinical results were analyzed. Regression analysis was performed for change in MR grade at follow-up, using pre-determined variables and confounders. Pre- and post-procedural TTE were available in 213 subjects. Significant MR was seen in 22% at baseline and 15% at follow-up; MR grade ≥ 3 in < 10%. Severity did not change in 61%, and decreased in 20% of the patients. Overall, the prevalence of MR grades pre- and post TAVR was not significantly different, nor influenced by MR etiology or TAVR prosthesis type. However, higher MR grades and pacemaker absence at baseline, were independently correlated to more improvement of MR after TAVR. Regarding clinical outcomes, NYHA class improved in two-thirds of the patients, irrespective of the baseline MR grade. Overall survival was not significantly different amongst MR grades post-TAVR. MR grading using an systematic 2D echocardiographic approach in patients undergoing TAVR is feasible in clinical practice. Our data revealed a relatively frequent prevalence of significant MR (although grade ≥ 3 was scarce), overall no change in the MR grade at 1 year follow-up, improvement of functional NYHA class, and no significant differences in long-term survival amongst the post-TAVR MR grades.
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Affiliation(s)
- R Jansen
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A M Wind
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - F Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P Agostoni
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W J Suyker
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Abstract
In patients with severe congestive heart failure (CHF), removal of edema by hemofiltration is associated with significant clinical and hemodynamic improvement, correction of hyponatremia, restoration of urine output and diuretic responsiveness, and with a striking fall in neurohormonal activation. Through these effects, hemofiltration is able to interrupt the progression of CHF toward refractoriness, and to revert the clinical condition of CHF patients to a lower functional class. Fluid refilling from the overhydrated interstitium is the major compensatory mechanism in the prevention of hypovolemia during hemofiltration. Hemofiltration can also be beneficial in patients who have only moderate cardiac insufficiency (NYHA classes II and III) and in whom over-hydration is restricted to the pulmonary district significantly contributing to limiting patients functional capacity. In this setting, hemofiltration, differently from diuretics, is able to remove the increased lung water content and to improve clinical condition, exercise capacity and lung function.
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Affiliation(s)
- G Marenzi
- Centro Cardiologico Monzino, IRCCS, Institute of Cardiology, University of Milan, Milan, Italy.
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33
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Caravita S, Faini A, Vignati C, Cattadori G, Lombardi C, Bonino C, Vigano E, Pellegrini D, Revera M, Salvioni E, Malfatto G, Pelucchi S, Piperno A, Agostoni P, Parati G. P2425Effects of intravenous iron therapy on chemoreflex sensitivity and sleep disordered breathing in chronic heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Bakker E, Maeremans J, Faurie B, Avran A, Walsh S, Dens J, Agostoni P. P4219Transradial versus transfemoral approach for percutaneous intervention of coronary chronic total occlusions applying the hybrid algorithm: insights from RECHARGE registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E.J. Bakker
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands
| | - J. Maeremans
- Hospital Oost-Limburg (ZOL), Cardiology, Genk, Belgium
| | - B. Faurie
- Groupe Hospitalier Mutualiste, Cardiology, Grenoble, France
| | - A. Avran
- Clinique de Marignane, Cardiology, Marignane, France
| | - S. Walsh
- Belfast City Hospital Trust, Cardiology, Belfast, United Kingdom
| | - J. Dens
- Hospital Oost-Limburg (ZOL), Cardiology, Genk, Belgium
| | - P. Agostoni
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands
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Caravita S, Faini A, Pelucchi S, Piperno A, Vignati C, Cattadori G, Ciambellotti F, Torlasco C, Bonino C, Guida V, Sorropago A, Villani A, Salvioni E, Agostoni P, Parati G. P6157Hematinic predictors of hemoglobin response to intravenous iron supplementation in chronic heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pompilio G, Bassetti B, Catto V, Bestetti A, Righetti S, Celeste F, Parma M, Agostoni P, Atsma D, Scacciatella P, Achilli F, Gaipa G, Carbucicchio C. P4240Endocavitary injection of bone-marrow-derived CD133+ cells in ischemic REfractory CARDIOmyopathy (RECARDIO trial). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Van Den Brink F, Magan A, Noordzij P, Van Der Heyden J, Agostoni P, Eefting F, Ten Berg J, Rigter S, Suttorp M, Rensing B, Van Kuijk J, Daeter E, Zivelonghi C, Scholten E. P5593VA-ECMO in primary PCI for ST-elevation myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nijenhuis VJ, Sanchis L, van der Heyden JAS, Klein P, Rensing BJWM, Latib A, Maisano F, Ten Berg JM, Agostoni P, Swaans MJ. The last frontier: transcatheter devices for percutaneous or minimally invasive treatment of chronic heart failure. Neth Heart J 2017; 25:536-544. [PMID: 28741245 PMCID: PMC5612866 DOI: 10.1007/s12471-017-1018-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Heart failure has a high prevalence in the general population. Morbidity and mortality of heart failure patients remain high, despite improvements in drug therapy, implantable cardioverter-defibrillators and cardiac resynchronisation therapy. New transcatheter implantable devices have been developed to improve the treatment of heart failure. There has been a rapid development of minimally invasive or transcatheter devices used in the treatment of heart failure associated with aortic and mitral valve disease and these devices are being incorporated into routine clinical practice at a fast rate. Several other new transcatheter structural heart interventions for chronic heart failure aimed at a variety of pathophysiologic approaches are currently being developed. In this review, we focus on devices used in the treatment of chronic heart failure by means of left ventricular remodelling, left atrial pressure reduction, tricuspid regurgitation reduction and neuromodulation. The clinical evaluations of these devices are early-stage evaluations of initial feasibility and safety studies and additional clinical evidence needs to be gathered in appropriately designed clinical trials.
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Affiliation(s)
- V J Nijenhuis
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - L Sanchis
- Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | | | - P Klein
- Department of Cardio-Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - B J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - F Maisano
- University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P Agostoni
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Paolillo S, Vignati C, Apostolo A, Bonini N, Bruno N, Scuri S, Agostoni P. Cardiac Output and Oxygen Kinetic in Patients with Left Ventricular Assist Device. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Tarzia V, Di Giammarco G, Maccherini M, Maiani M, Agostoni P, Bagozzi L, Marinelli D, Tursi V, Apostolo A, Bernazzali S, Bejko J, Ortis H, Di Mauro M, Dokollari A, Bortolussi G, Alamanni F, Sani G, Bottio T, Livi U, Gerosa G. Technology and Techniques: Tools to Mitigate Adverse Events and Improve Survival in Left Ventricular Assist Device Patients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wassmuth R, Hristova K, Monney P, Olander RFW, Rodriguez Munoz D, Huayan X, Pagourelias E, Loardi C, Moreno J, Miljkovic T, Takase H, Latet SC, Henquin R, America R, Carter-Storch R, Panelo ML, Fernandez-Golfin C, Cho IJ, Petrini J, Buonauro A, Liu B, Mapelli M, Tamulenaite E, De Chiara B, Minden H, Kostova V, Nesheva N, Katova TZ, Bojadzhiev L, Crisinel V, Reverdin S, Conti L, Mach F, Mueller H, Jeanrenaud X, Bochud M, Ehret G, Sundholm JKM, Ojala T, Andersson S, Sarkola T, Moya Mur JL, Berlot B, Fernandez-Golfin C, Moreno Planas J, Casas Rojo E, Garcia Martin A, Jimenez Nacher JJ, Hernandez-Madrid A, Franco Diez E, Matia Frances R, Zamorano JL, Zhigang YANG, Yingkun GUO, Jing CHEN, Duchenne J, Mirea O, Triantafyllis A, Michalski B, Vovas G, Delforge M, Van Cleemput J, Bogaert J, Voigt JU, Saccocci M, Tamborini G, Veglia F, Pepi M, Alamanni F, Zanobini M, Zuniga Sedano JJ, Alexanderson E, Martinez C, Bjelobrk M, Pavlovic K, Ilic A, Colakovic S, Dodic S, Tanaka T, Machii M, Nonaka D, Van Herck PL, Claeys MJ, Haine SE, Miljoen HP, Segers VF, Vandendriessche TR, De Winter BY, Hoymans VY, Vrints CJ, Lombardero M, Perea G, Miele MM, De Amicis DAV, Mannacio VAM, Dahl JS, Christensen NL, Soendergaard EV, Marcussen N, Moeller JE, Fernandez-Palomeque C, Garcia-Vega D, Mont-Girbau L, Pardo A, Izurieta C, Boretti I, Hinojar R, Gonzalez-Gomez A, Garcia Martin A, Casas E, Salido L, Barrios V, Ruiz S, Moya JL, Hernandez Antolin R, Jimenez Nacher JL, Zamorano JL, Chang HJ, Choi HH, Lee SY, Shim CY, Ha JW, Chung N, Ring M, Caidahl K, Eriksson MJ, Esposito R, Santoro C, Monteagudo JM, Trimarco B, Galderisi M, Zamorano JL, Baig S, Hayer M, Steeds R, Edwards N, Fusini L, Zagni P, Muratori M, Agostoni P, Tamborini G, Gripari P, Ghulam Ali S, Pepi M, Fiorentini C, Valuckiene Z, Jurkevicius R, Peritore A, Botta L, Belli O, Musca F, Casadei F, Russo C, Giannattasio C, Moreo A. Poster Session 6Assessment of morphology and functionP1222Multimodality imaging for left atrial appendage occluder sizingP1223Longitudinal left atrial strain is a main predictor for long term prognosis on atrial fibrillation after CABG operation patientsP1224Comparison of 2D and 3D left ventricular volumes measurements: results from the SKIPOGH II studyP1225Adjusting for thoracic circumference is superior to body surface area in the assessment of neonatal cardiac dimensions in foetal growth abnormalityP1226Maximal vortex suction pressure: an equivocal marker for optimization of atrio-ventricular delayP1227Volume-time curve of cardiac magnetic resonance assessed left ventricular dysfunction in coronary artery disease patients with type 2 diabetes mellitusP1228Thickness matters, but not in the same way for all strain parametersP1229Digging deeper in postoperative modifications of right ventricular function: impact of pericardial approach and cardioplegiaP1230Left atrial function evaluated by 2D-speckle tracking echocardiography in diabetes mellitus populationP1231The influence of arterial hypertension duration on left ventricular diastolic parameters in patients with well regulated arterial blood pressureP1232Investigation of factors affecting left ventricular diastolic dysfunction determined using mitral annulus velocityP1233High regulatory T-lymphocytes after ST-elevation myocardial infarction relate with adverse left ventricular remodelling assessed by 3D-echocardiographyP1234Prevalence of paradoxical low flow/low gradient severe aortic stenosis measure with 3 dimensional transesophageal echocardiographyP1235Coronary microvascular and diastolic dysfunctions after aortic valve replacement: comparison between mechanical and biological prosthesesP1236Normal-flow, low gradient aortic stenosis is common in a population of patients with severe aortic valve stenosis undergoing aortic valve replacementP1237Analysis of validity and reproducibility of calcium burden visual estimation by echocardiographyP12383D full automatic software in the evaluation of aortic stenosis severity in TAVI patients. Preliminary resultsP1239Differential impact of net atrioventricular compliance on clinical outcomes in patients with mitral stenosis according to cardiac rhythmP1240Aortic regurgitation affects the intima-media thickness of the right and left common carotid artery differentlyP1241Global longitudinal strain: an hallmark of cardiac damage in mitral valve regurgitation. Experience from the european registry of mitral regurgitationP1242Echocardiographic characterisation of Barlow's disease versus fibroelastic deficiencyP1243Echocardiographic screening for rheumatic heart disease in a ugandan orphanage - feasibility and outcomesP1244Alterations in right ventricular mechanics upon follow-up period in patients with persistent ischemic mitral regurgitation after inferoposterior myocardial infarctionP1245Ten-years conventional mitral surgery in patients with mitral regurgitation and left ventricular dysfunction: clinical and echocardiographic outcomes. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Agostoni P, Abawi M. Reply to comments from Paz and Shinfeld to article entitled 'Safety and efficacy of a device to narrow the coronary sinus for the treatment of refractory angina: a single-centre real-world experience'. Neth Heart J 2016; 24:765. [PMID: 27785620 PMCID: PMC5120013 DOI: 10.1007/s12471-016-0904-9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- P Agostoni
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
| | - M Abawi
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Targher G, Dauriz M, Laroche C, Temporelli PL, Hassanein M, Seferovic PM, Drozdz J, Ferrari R, Anker S, Coats A, Filippatos G, Crespo‐Leiro MG, Mebazaa A, Piepoli MF, Maggioni AP, Tavazzi L, Crespo‐Leiro M, Anker S, Coats A, Ferrari R, Filippatos G, Maggioni A, Mebazaa A, Piepoli M, Amir O, Chioncel O, Dahlström U, Jimenez JD, Drozdz J, Erglis A, Fazlibegovic E, Fonseca C, Fruhwald F, Gatzov P, Goncalvesova E, Hassanein M, Hradec J, Kavoliuniene A, Lainscak M, Logeart D, Merkely B, Metra M, Otljanska M, Seferovic P, Kostovska ES, Temizhan A, Tousoulis D, Andarala M, Ferreira T, Fiorucci E, Gracia G, Laroche C, Pommier C, Taylor C, Cuculici A, Gaulhofer C, Casado EP, Szymczyk E, Ramani F, Mulak G, Schou IL, Semenka J, Stojkovic J, Mehanna R, Mizarienne V, Auer J, Ablasser K, Fruhwald F, Dolze T, Brandner K, Gstrein S, Poelzl G, Moertl D, Reiter S, Podczeck‐Schweighofer A, Muslibegovic A, Vasilj M, Fazlibegovic E, Cesko M, Zelenika D, Palic B, Pravdic D, Cuk D, Vitlianova K, Katova T, Velikov T, Kurteva T, Gatzov P, Kamenova D, Antova M, Sirakova V, Krejci J, Mikolaskova M, Spinar J, Krupicka J, Malek F, Hegarova M, Lazarova M, Monhart Z, Hassanein M, Sobhy M, El Messiry F, El Shazly A, Elrakshy Y, Youssef A, Moneim A, Noamany M, Reda A, Dayem TA, Farag N, Halawa SI, Hamid MA, Said K, Saleh A, Ebeid H, Hanna R, Aziz R, Louis O, Enen M, Ibrahim B, Nasr G, Elbahry A, Sobhy H, Ashmawy M, Gouda M, Aboleineen W, Bernard Y, Luporsi P, Meneveau N, Pillot M, Morel M, Seronde M, Schiele F, Briand F, Delahaye F, Damy T, Eicher J, Groote P, Fertin M, Lamblin N, Isnard R, Lefol C, Thevenin S, Hagege A, Jondeau G, Logeart D, Le Marcis V, Ly J, Coisne D, Lequeux B, Le Moal V, Mascle S, Lotton P, Behar N, Donal E, Thebault C, Ridard C, Reynaud A, Basquin A, Bauer F, Codjia R, Galinier M, Tourikis P, Stavroula M, Tousoulis D, Stefanadis C, Chrysohoou C, Kotrogiannis I, Matzaraki V, Dimitroula T, Karavidas A, Tsitsinakis G, Kapelios C, Nanas J, Kampouri H, Nana E, Kaldara E, Eugenidou A, Vardas P, Saloustros I, Patrianakos A, Tsaknakis T, Evangelou S, Nikoloulis N, Tziourganou H, Tsaroucha A, Papadopoulou A, Douras A, Polgar L, Merkely B, Kosztin A, Nyolczas N, Nagy AC, Halmosi R, Elber J, Alony I, Shotan A, Fuhrmann AV, Amir O, Romano S, Marcon S, Penco M, Di Mauro M, Lemme E, Carubelli V, Rovetta R, Metra M, Bulgari M, Quinzani F, Lombardi C, Bosi S, Schiavina G, Squeri A, Barbieri A, Di Tano G, Pirelli S, Ferrari R, Fucili A, Passero T, Musio S, Di Biase M, Correale M, Salvemini G, Brognoli S, Zanelli E, Giordano A, Agostoni P, Italiano G, Salvioni E, Copelli S, Modena M, Reggianini L, Valenti C, Olaru A, Bandino S, Deidda M, Mercuro G, Dessalvi CC, Marino P, Di Ruocco M, Sartori C, Piccinino C, Parrinello G, Licata G, Torres D, Giambanco S, Busalacchi S, Arrotti S, Novo S, Inciardi R, Pieri P, Chirco P, Galifi MA, Teresi G, Buccheri D, Minacapelli A, Veniani M, Frisinghelli A, Priori S, Cattaneo S, Opasich C, Gualco A, Pagliaro M, Mancone M, Fedele F, Cinque A, Vellini M, Scarfo I, Romeo F, Ferraiuolo F, Sergi D, Anselmi M, Melandri F, Leci E, Iori E, Bovolo V, Pidello S, Frea S, Bergerone S, Botta M, Canavosio F, Gaita F, Merlo M, Cinquetti M, Sinagra G, Ramani F, Fabris E, Stolfo D, Artico J, Miani D, Fresco C, Daneluzzi C, Proclemer A, Cicoira M, Zanolla L, Marchese G, Torelli F, Vassanelli C, Voronina N, Erglis A, Tamakauskas V, Smalinskas V, Karaliute R, Petraskiene I, Kazakauskaite E, Rumbinaite E, Kavoliuniene A, Vysniauskas V, Brazyte‐Ramanauskiene R, Petraskiene D, Stankala S, Switala P, Juszczyk Z, Sinkiewicz W, Gilewski W, Pietrzak J, Orzel T, Kasztelowicz P, Kardaszewicz P, Lazorko‐Piega M, Gabryel J, Mosakowska K, Bellwon J, Rynkiewicz A, Raczak G, Lewicka E, Dabrowska‐Kugacka A, Bartkowiak R, Sosnowska‐Pasiarska B, Wozakowska‐Kaplon B, Krzeminski A, Zabojszcz M, Mirek‐Bryniarska E, Grzegorzko A, Bury K, Nessler J, Zalewski J, Furman A, Broncel M, Poliwczak A, Bala A, Zycinski P, Rudzinska M, Jankowski L, Kasprzak J, Michalak L, Soska KW, Drozdz J, Huziuk I, Retwinski A, Flis P, Weglarz J, Bodys A, Grajek S, Kaluzna‐Oleksy M, Straburzynska‐Migaj E, Dankowski R, Szymanowska K, Grabia J, Szyszka A, Nowicka A, Samcik M, Wolniewicz L, Baczynska K, Komorowska K, Poprawa I, Komorowska E, Sajnaga D, Zolbach A, Dudzik‐Plocica A, Abdulkarim A, Lauko‐Rachocka A, Kaminski L, Kostka A, Cichy A, Ruszkowski P, Splawski M, Fitas G, Szymczyk A, Serwicka A, Fiega A, Zysko D, Krysiak W, Szabowski S, Skorek E, Pruszczyk P, Bienias P, Ciurzynski M, Welnicki M, Mamcarz A, Folga A, Zielinski T, Rywik T, Leszek P, Sobieszczanska‐Malek M, Piotrowska M, Kozar‐Kaminska K, Komuda K, Wisniewska J, Tarnowska A, Balsam P, Marchel M, Opolski G, Kaplon‐Cieslicka A, Gil R, Mozenska O, Byczkowska K, Gil K, Pawlak A, Michalek A, Krzesinski P, Piotrowicz K, Uzieblo‐Zyczkowska B, Stanczyk A, Skrobowski A, Ponikowski P, Jankowska E, Rozentryt P, Polonski L, Gadula‐Gacek E, Nowalany‐Kozielska E, Kuczaj A, Kalarus Z, Szulik M, Przybylska K, Klys J, Prokop‐Lewicka G, Kleinrok A, Aguiar CT, Ventosa A, Pereira S, Faria R, Chin J, De Jesus I, Santos R, Silva P, Moreno N, Queirós C, Lourenço C, Pereira A, Castro A, Andrade A, Guimaraes TO, Martins S, Placido R, Lima G, Brito D, Francisco A, Cardiga R, Proenca M, Araujo I, Marques F, Fonseca C, Moura B, Leite S, Campelo M, Silva‐Cardoso J, Rodrigues J, Rangel I, Martins E, Correia AS, Peres M, Marta L, Silva GF, Severino D, Durao D, Leao S, Magalhaes P, Moreira I, Cordeiro AF, Ferreira C, Araujo C, Ferreira A, Baptista A, Radoi M, Bicescu G, Vinereanu D, Sinescu C, Macarie C, Popescu R, Daha I, Dan G, Stanescu C, Dan A, Craiu E, Nechita E, Aursulesei V, Christodorescu R, Otasevic P, Seferovic P, Simeunovic D, Ristic A, Celic V, Pavlovic‐Kleut M, Lazic JS, Stojcevski B, Pencic B, Stevanovic A, Andric A, Iric‐Cupic V, Jovic M, Davidovic G, Milanov S, Mitic V, Atanaskovic V, Antic S, Pavlovic M, Stanojevic D, Stoickov V, Ilic S, Ilic MD, Petrovic D, Stojsic S, Kecojevic S, Dodic S, Adic NC, Cankovic M, Stojiljkovic J, Mihajlovic B, Radin A, Radovanovic S, Krotin M, Klabnik A, Goncalvesova E, Pernicky M, Murin J, Kovar F, Kmec J, Semjanova H, Strasek M, Iskra MS, Ravnikar T, Suligoj NC, Komel J, Fras Z, Jug B, Glavic T, Losic R, Bombek M, Krajnc I, Krunic B, Horvat S, Kovac D, Rajtman D, Cencic V, Letonja M, Winkler R, Valentincic M, Melihen‐Bartolic C, Bartolic A, Vrckovnik MP, Kladnik M, Pusnik CS, Marolt A, Klen J, Drnovsek B, Leskovar B, Anguita MF, Page JG, Martinez FS, Andres J, Genis A, Mirabet S, Mendez A, Garcia‐Cosio L, Roig E, Leon V, Gonzalez‐Costello J, Muntane G, Garay A, Alcade‐Martinez V, Fernandez SL, Rivera‐Lopez R, Puga‐Martinez M, Fernandez‐Alvarez M, Serrano‐Martinez J, Crespo‐Leiro M, Grille‐Cancela Z, Marzoa‐Rivas R, Blanco‐Canosa P, Paniagua‐Martin M, Barge‐Caballero E, Cerdena IL, Baldomero IFH, Padron AL, Rosillo SO, Gonzalez‐Gallarza RD, Montanes OS, Manjavacas AI, Conde AC, Araujo A, Soria T, Garcia‐Pavia P, Gomez‐Bueno M, Cobo‐Marcos M, Alonso‐Pulpon L, Cubero JS, Sayago I, Gonzalez‐Segovia A, Briceno A, Subias PE, Hernandez MV, Cano MR, Sanchez MG, Jimenez JD, Garrido‐Lestache EB, Pinilla JG, Villa BG, Sahuquillo A, Marques RB, Calvo FT, Perez‐Martinez M, Gracia‐Rodenas M, Garrido‐Bravo IP, Pastor‐Perez F, Pascual‐Figal D, Molina BD, Orus J, Gonzalo FE, Bertomeu V, Valero R, Martinez‐Abellan R, Quiles J, Rodrigez‐Ortega J, Mateo I, ElAmrani A, Fernandez‐Vivancos C, Valero DB, Almenar‐Bonet L, Sanchez‐Lazaro I, Marques‐Sule E, Facila‐Rubio L, Perez‐Silvestre J, Garcia‐Gonzalez P, Ridocci‐Soriano F, Garcia‐Escriva D, Pellicer‐Cabo A, Fuente Galan L, Diaz JL, Platero AR, Arias J, Blasco‐Peiro T, Julve MS, Sanchez‐Insa E, Aured‐Guallar C, Portoles‐Ocampo A, Melin M, Hägglund E, Stenberg A, Lindahl I, Asserlund B, Olsson L, Dahlström U, Afzelius M, Karlström P, Tengvall L, Wiklund P, Olsson B, Kalayci S, Temizhan A, Cavusoglu Y, Gencer E, Yilmaz M, Gunes H. In‐hospital and 1‐year mortality associated with diabetes in patients with acute heart failure: results from the
ESC‐HFA
Heart Failure Long‐Term Registry. Eur J Heart Fail 2016; 19:54-65. [DOI: 10.1002/ejhf.679] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [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: 05/10/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Cécile Laroche
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
| | | | | | | | | | - Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research E.S: Health Science Foundation Cotignola Italy
| | - Stephan Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Andrew Coats
- Monash University Australia and University of Warwick Coventry UK
| | | | - Maria G. Crespo‐Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna CHUAC La Coruna Spain
| | - Alexandre Mebazaa
- Inserm 942, Hôpital Lariboisière Université Paris Diderot Paris France
| | - Massimo F. Piepoli
- Department of Cardiology Polichirurgico Hospital G. da Saliceto Piacenza Italy
| | - Aldo Pietro Maggioni
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
- ANMCO Research Center Florence Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research E.S. Health Science Foundation Cotignola Italy
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Abawi M, Nijhoff F, Stella PR, Voskuil M, Benedetto D, Doevendans PA, Agostoni P. Safety and efficacy of a device to narrow the coronary sinus for the treatment of refractory angina: A single-centre real-world experience. Neth Heart J 2016; 24:544-51. [PMID: 27299456 PMCID: PMC5005194 DOI: 10.1007/s12471-016-0862-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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] [Indexed: 11/11/2022] Open
Abstract
Objective The coronary sinus Reducer is a recently introduced device to treat patients with severe angina symptoms refractory to optimal medical therapy and not amenable for conventional revascularisation. We aimed to assess the safety and efficacy of the Reducer in a real-world cohort of patients with refractory angina. Methods This is a single-centre retrospective registry. Patients with severe angina symptoms, objective evidence of myocardial ischaemia using any adequate non-invasive modality and without options for conventional revascularisation were regarded eligible for Reducer implantation. Results Twenty-three patients (74 % male, mean age 70 ± 8 years, 91.3 % previous bypass surgery, 82.6 % previous percutaneous intervention, 47.8 % previous myocardial infarction, 52.2 % diabetes mellitus) underwent Reducer implantation. The safety endpoint (successful implantation of the first device without device-related adverse events) was met in all patients. After a median follow-up of 9 (8–14) months the efficacy (any reduction in Canadian Cardiovascular Society (CCS) class and revascularisation-free survival) was reached in 17 patients (74 %): 8 patients (34.8 %) improved by 1 CCS class, 7 (30.4 %) by 2 CCS classes and 2 (8.7 %) by 3 CCS classes. One patient died 4 months after implantation because of progressive heart failure (not associated with Reducer implantation). Conclusion In this single-centre real-world experience, Reducer implantation was safe and demonstrated excellent clinical efficacy in the treatment of refractory angina at mid-term follow-up.
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Affiliation(s)
- M Abawi
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - P A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Agostoni
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
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Tarzia V, Di Mauro M, Bortolussi G, Bejko J, Marinelli D, Foschi M, Maccherini M, Bernazzali S, Maiani M, Tursi V, Agostoni P, Apostolo A, Alamanni F, Livi U, Sani G, Bottio T, Di Giammarco G, Gerosa G. Access Matters: Survival Advantage with Minimally Invasive Implantation of LVAD as Destination Therapy. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Musuraca G, Agostoni P, Terraneo C, Boldi E, Di Matteo I, Centonze M. Coronarographyc detection of double right coronary artery arising from two separated ostia in the right sinus of Valsalva. Minerva Cardioangiol 2015; 63:589-590. [PMID: 26373779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- G Musuraca
- Division of Cardiology, S. Maria del Carmine Hospital, Rovereto, Italy -
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Zhang XM, Sun XG, Agostoni P, Liu F, Zhou N, Tan XY, Song GQ, Gu L, Liu NH. [Circulatory breathing abnormality: Clinical observation on exercise induced oscillatory breathing pattern]. Zhongguo Ying Yong Sheng Li Xue Za Zhi 2015; 31:365-368. [PMID: 26775512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Exercise induced oscillatory ventilation (EIOB) during cardiopulmonary exercise testing (CPET) is associated with severity and prognosis of disease, but clinical approach for the character of EIOB due to circulatory dysfunction are seldom reported. METHODS This retrospective analysis of symptom-limited maximum CPET data with an increment of 10-20 W/min in 38 patients with CHF. We calculated the duration, frequency, amplitude and other parameters of EIOB. RESULTS There were 31 presenting with EIOB (82%) in all patients with CHF. In EIOB group, VE amplitude were (12.4 ± 4.4)L/min (accounting for 81% ± 30% of mean) and duration were (77.0 ± 20.0)s. The number of patients whose EIOB presenting at rest, exercise, recovery stage and the whole eriod were 24, 31, 4 and 4, respectively. Except VE, there were VO2, VCO2, RER and PETO2 presenting EIOB in all 31 patients; VE/VCO2, VO2/VE and breath frequency in 29 patients; PETCO2 in 26 patients; VT and VO2/HR in 25 patients; and HR in 2 patients. CONCLUSION EIOB may occur in any period of CPET, mostly in severe patient with CHF, and presenting in many variables. Due to it is resulted from the circulatory dysfunction, we should call it circulatory (cardiac) oscillatory breathing abnormality.
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Shahgaldi K, Hegner T, Da Silva C, Fukuyama A, Takeuchi M, Uema A, Kado Y, Nagata Y, Hayashi A, Otani K, Fukuda S, Yoshitani H, Otsuji Y, Morhy S, Lianza A, Afonso T, Oliveira W, Tavares G, Rodrigues A, Vieira M, Warth A, Deutsch A, Fischer C, Tezynska-Oniszk I, Turska-Kmiec A, Kawalec W, Dangel J, Maruszewski B, Bokiniec R, Burczynski P, Borszewska-Kornacka K, Ziolkowska L, Zuk M, Troshina A, Dzhalilova D, Poteshkina N, Hamitov F, Warita S, Kawasaki M, Tanaka R, Yagasaki H, Minatoguchi S, Wanatabe T, Ono K, Noda T, Wanatabe S, Minatoguchi S, Angelis A, Ageli K, Vlachopoulos C, Felekos I, Ioakimidis N, Aznaouridis K, Vaina S, Abdelrasoul M, Tsiamis E, Stefanadis C, Cameli M, Sparla S, D'ascenzi F, Fineschi M, Favilli R, Pierli C, Henein M, Mondillo S, Lindqvist P, Tossavainen E, Gonzalez M, Soderberg S, Henein M, Holmgren A, Strachinaru M, Catez E, Jousten I, Pavel O, Janssen C, Morissens M, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Tsai WC, Sun YT, Lee WH, Yang LT, Liu YW, Lee CH, Li WT, Mizariene V, Bieseviciene M, Karaliute R, Verseckaite R, Vaskelyte J, Lesauskaite V, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Hristova K, Cornelissen G, Singh R, Shiue I, Coisne D, Madjalian AM, Tchepkou C, Raud Raynier P, Degand B, Christiaens L, Baldenhofer G, Spethmann S, Dreger H, Sanad W, Baumann G, Stangl K, Stangl V, Knebel F, Azzaz S, Kacem S, Ouali S, Risos L, Dedobbeleer C, Unger P, Sinem Cakal S, Elif Eroglu E, Baydar O, Beytullah Cakal B, Mehmet Vefik Yazicioglu M, Mustafa Bulut M, Cihan Dundar C, Kursat Tigen K, Birol Ozkan B, Ali Metin Esen A, Tournoux F, Chequer R, Sroussi M, Hyafil F, Rouzet F, Leguludec D, Baum P, Stoebe S, Pfeiffer D, Hagendorff A, Fang F, Lau M, Zhang Q, Luo X, Wang X, Chen L, Yu C, Zaborska B, Smarz K, Makowska E, Kulakowski P, Budaj A, Bengrid TM, Zhao Y, Henein MY, Caminiti G, D'antoni V, Cardaci V, Conti V, Volterrani M, Warita S, Kawasaki M, Yagasaki H, Minatoguchi S, Nagaya M, Ono K, Noda T, Watanabe S, Houle H, Minatoguchi S, Gillebert TC, Chirinos JA, Claessens TC, Raja MW, De Buyzere ML, Segers P, Rietzschel ER, Kim K, Cha J, Chung H, Kim J, Yoon Y, Lee B, Hong B, Rim S, Kwon H, Choi E, Pyankov V, Aljaroudi W, Matta S, Al-Shaar L, Habib R, Gharzuddin W, Arnaout S, Skouri H, Jaber W, Abchee A, Bouzas Mosquera A, Peteiro J, Broullon F, Constanso Conde I, Bescos Galego H, Martinez Ruiz D, Yanez Wonenburger J, Vazquez Rodriguez J, Alvarez Garcia N, Castro Beiras A, Gunyeli E, Oliveira Da Silva C, Shahgaldi K, Manouras A, Winter R, Meimoun P, Abouth S, Martis S, Boulanger J, Elmkies F, Zemir H, Detienne J, Luycx-Bore A, Clerc J, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Garcia G, Galuppo V, Gruosso D, Teixido G, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Rechcinski T, Wierzbowska-Drabik K, Wejner-Mik P, Szymanska B, Jerczynska H, Lipiec P, Kasprzak J, El-Touny K, El-Fawal S, Loutfi M, El-Sharkawy E, Ashour S, Boniotti C, Carminati M, Fusini L, Andreini D, Pontone G, Pepi M, Caiani E, Oryshchyn N, Kramer B, Hermann S, Liu D, Hu K, Ertl G, Weidemann F, Ancona F, Miyazaki S, Slavich M, Figini F, Latib A, Chieffo A, Montorfano M, Alfieri O, Colombo A, Agricola E, Nogueira M, Branco L, Rosa S, Portugal G, Galrinho A, Abreu J, Cacela D, Patricio L, Fragata J, Cruz Ferreira R, Igual Munoz B, Erdociain Perales M, Maceira Gonzalez A, Estornell Erill Jordi J, Donate Bertolin L, Vazquez Sanchez Alejandro A, Miro Palau Vicente V, Cervera Zamora A, Piquer Gil M, Montero Argudo A, Girgis HYA, Illatopa V, Cordova F, Espinoza D, Ortega J, Khan U, Islam A, Majumder A, Girgis HYA, Bayat F, Naghshbandi E, Naghshbandi E, Samiei N, Samiei N, Malev E, Omelchenko M, Vasina L, Zemtsovsky E, Piatkowski R, Kochanowski J, Budnik M, Scislo P, Opolski G, Kochanowski J, Piatkowski R, Scislo P, Budnik M, Marchel M, Opolski G, Abid L, Ben Kahla S, Abid D, Charfeddine S, Maaloul I, Ben Jmaa M, Kammoun S, Hashimoto G, Suzuki M, Yoshikawa H, Otsuka T, Isekame Y, Yamashita H, Kawase I, Ozaki S, Nakamura M, Sugi K, Benvenuto E, Leggio S, Buccheri S, Bonura S, Deste W, Tamburino C, Monte IP, Gripari P, Fusini L, Muratori M, Tamborini G, Ghulam Ali S, Bottari V, Cefalu' C, Bartorelli A, Agrifoglio M, Pepi M, Zambon E, Iorio A, Di Nora C, Abate E, Lo Giudice F, Di Lenarda A, Agostoni P, Sinagra G, Timoteo AT, Galrinho A, Moura Branco L, Rio P, Aguiar Rosa S, Oliveira M, Silva Cunha P, Leal A, Cruz Ferreira R, Zemanek D, Tomasov P, Belehrad M, Kostalova J, Kara T, Veselka J, Hassanein M, El Tahan S, El Sharkawy E, Shehata H, Yoon Y, Choi H, Seo H, Lee S, Kim H, Youn T, Kim Y, Sohn D, Choi G, Mielczarek M, Huttin O, Voilliot D, Sellal J, Manenti V, Carillo S, Olivier A, Venner C, Juilliere Y, Selton-Suty C, Butz T, Faber L, Brand M, Piper C, Wiemer M, Noelke J, Sasko B, Langer C, Horstkotte D, Trappe H, Maysou L, Tessonnier L, Jacquier A, Serratrice J, Copel C, Stoppa A, Seguier J, Saby L, Verschueren A, Habib G, Petroni R, Bencivenga S, Di Mauro M, Acitelli A, Cicconetti M, Romano S, Petroni A, Penco M, Maceira Gonzalez AM, Cosin-Sales J, Igual B, Sancho-Tello R, Ruvira J, Mayans J, Choi J, Kim S, Almeida A, Azevedo O, Amado J, Picarra B, Lima R, Cruz I, Pereira V, Marques N, Chatzistamatiou E, Konstantinidis D, Manakos K, Mpampatseva Vagena I, Moustakas G, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Cho E, Kim J, Hwang B, Kim D, Jang S, Jeon H, Cho J, Chatzistamatiou E, Konstantinidis D, Memo G, Mpapatzeva Vagena I, Moustakas G, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Jedrzejewska I, Konopka M, Krol W, Swiatowiec A, Dluzniewski M, Braksator W, Sefri Noventi S, Sugiri S, Uddin I, Herminingsih S, Arif Nugroho M, Boedijitno S, Caro Codon J, Blazquez Bermejo Z, Valbuena Lopez SC, Lopez Fernandez T, Rodriguez Fraga O, Torrente Regidor M, Pena Conde L, Moreno Yanguela M, Buno Soto A, Lopez-Sendon JL, Stevanovic A, Dekleva M, Kim M, Kim S, Kim Y, Shim J, Park S, Park S, Kim Y, Shim W, Kozakova M, Muscelli E, Morizzo C, Casolaro A, Paterni M, Palombo C, Bayat F, Nazmdeh M, Naghshbandi E, Nateghi S, Tomaszewski A, Kutarski A, Brzozowski W, Tomaszewski M, Nakano E, Harada T, Takagi Y, Yamada M, Takano M, Furukawa T, Akashi Y, Lindqvist G, Henein M, Backman C, Gustafsson S, Morner S, Marinov R, Hristova K, Geirgiev S, Pechilkov D, Kaneva A, Katova T, Pilosoff V, Pena Pena M, Mesa Rubio D, Ruiz Ortin M, Delgado Ortega M, Romo Penas E, Pardo Gonzalez L, Rodriguez Diego S, Hidalgo Lesmes F, Pan Alvarez-Ossorio M, Suarez De Lezo Cruz-Conde J, Gospodinova M, Sarafov S, Guergelcheva V, Vladimirova L, Tournev I, Denchev S, Mozenska O, Segiet A, Rabczenko D, Kosior D, Gao S, Eliasson M, Polte C, Lagerstrand K, Bech-Hanssen O, Morosin M, Piazza R, Leonelli V, Leiballi E, Pecoraro R, Cinello M, Dell' Angela L, Cassin M, Sinagra G, Nicolosi G, Savu O, Carstea N, Stoica E, Macarie C, Moldovan H, Iliescu V, Chioncel O, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Jansen Klomp WW, Peelen L, Spanjersberg A, Brandon Bravo Bruinsma G, Van 'T Hof A, Laveau F, Hammoudi N, Helft G, Barthelemy O, Michel P, Petroni T, Djebbar M, Boubrit L, Le Feuvre C, Isnard R, Bandera F, Generati G, Pellegrino M, Alfonzetti E, Labate V, Villani S, Gaeta M, Guazzi M, Gabriels C, Lancellotti P, Van De Bruaene A, Voilliot D, De Meester P, Buys R, Delcroix M, Budts W, Cruz I, Stuart B, Caldeira D, Morgado G, Almeida A, Lopes L, Fazendas P, Joao I, Cotrim C, Pereira H, Weissler Snir A, Greenberg G, Shapira Y, Weisenberg D, Monakier D, Nevzorov R, Sagie A, Vaturi M, Bando M, Yamada H, Saijo Y, Takagawa Y, Sawada N, Hotchi J, Hayashi S, Hirata Y, Nishio S, Sata M, Jackson T, Sammut E, Siarkos M, Lee L, Carr-White G, Rajani R, Kapetanakis S, Ciobotaru V, Yagasaki H, Kawasaki M, Tanaka R, Minatoguchi S, Sato N, Amano K, Warita S, Ono K, Noda T, Minatoguchi S, Breithardt OA, Razavi H, Nabutovsky Y, Ryu K, Gaspar T, Kosiuk J, John S, Prinzen F, Hindricks G, Piorkowski C, Nemchyna O, Tovstukha V, Chikovani A, Golikova I, Lutai M, Nemes A, Kalapos A, Domsik P, Lengyel C, Orosz A, Forster T, Nordenfur T, Babic A, Giesecke A, Bulatovic I, Ripsweden J, Samset E, Winter R, Larsson M, Blazquez Bermejo Z, Lopez Fernandez T, Caro Codon J, Valbuena S, Caro Codon J, Mori Junco R, Moreno Yanguela M, Lopez-Sendon J, Pinto-Teixeira P, Branco L, Galrinho A, Oliveira M, Cunha P, Silva T, Rio P, Feliciano J, Nogueira-Silva M, Ferreira R, Shkolnik E, Vasyuk Y, Nesvetov V, Shkolnik L, Varlan G, Bajraktari G, Ronn F, Ibrahimi P, Jashari F, Jensen S, Henein M, Kang MK, Mun HS, Choi S, Cho JR, Han S, Lee N, Cho IJ, Heo R, Chang H, Shin S, Shim C, Hong G, Chung N. Poster session 3: Thursday 4 December 2014, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Parati G, Bilo G, Faini A, Bilo B, Revera M, Giuliano A, Lombardi C, Caldara G, Gregorini F, Styczkiewicz K, Zambon A, Piperno A, Modesti PA, Agostoni P, Mancia G. Changes in 24 h ambulatory blood pressure and effects of angiotensin II receptor blockade during acute and prolonged high-altitude exposure: a randomized clinical trial. Eur Heart J 2014; 35:3113-22. [DOI: 10.1093/eurheartj/ehu275] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Biondi-Zoccai G, Peruzzi M, Abbate A, Gertz ZM, Benedetto U, Tonelli E, D'Ascenzo F, Giordano A, Agostoni P, Frati G. Network meta-analysis on the comparative effectiveness and safety of transcatheter aortic valve implantation with CoreValve or Sapien devices versus surgical replacement. Heart Lung Vessel 2014; 6:232-43. [PMID: 25436205 PMCID: PMC4246842] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgical replacement for aortic stenosis is fraught with complications in high-risk patients. Transcatheter techniques may offer a minimally invasive solution, but their comparative effectiveness and safety is uncertain. We performed a network meta-analysis on this topic. METHODS Randomized trials on transcatheter aortic valve replacement vs surgery were searched. The primary outcome was all cause death. Risk estimates were obtained with Bayesian network meta-analytic methods. RESULTS Four trials with 1,805 patients were included. After a median of 8 months, risk of death and myocardial infarction was not different when comparing surgery versus transcatheter procedures, irrespective of device or access. Conversely, surgery was associated with higher rates of major bleeding (odds ratio vs CoreValve=3.03 [95% credible interval: 2.23-4.17]; odds ratio vs transfemoral Sapien =1.82 [1.21-2.70]; odds ratio vs transapical Sapien =2.08 [1.20-3.70]), and acute kidney injury (odds ratio vs CoreValve =2.08 [1.33-3.32]; odds ratio vs transapical Sapien =2.78 [2.21-99.80]), but lower rates of pacemaker implantation (odds ratio vs CoreValve =0.41 [0.28-0.59]), and moderate or severe aortic regurgitation (odds ratio vs CoreValve =0.06 [0.02-0.27]; odds ratio vs Sapien=0.17 [0.02-0.76]). Strokes were less frequent with CoreValve than with transfemoral Sapien (odds ratio =0.32 [0.13-0.73]) or transapical Sapien (odds ratio =0.33 [0.10-0.93]), whereas pacemaker implantation was more common with CoreValve (odds ratio vs surgery =2.46 [1.69-3.61]; odds ratio vs transfemoral Sapien =2.22 [1.27-3.85]). CONCLUSIONS Survival after transcatheter or surgical aortic valve replacement is similar, but there might be differences in the individual safety and effectiveness profile between the treatment strategies and the individual devices used in transcatheter aortic valve implantation.
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Affiliation(s)
- G Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - M Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - A Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Z M Gertz
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - U Benedetto
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | - E Tonelli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - F D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, University of Turin, Turin, Italy
| | - A Giordano
- Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, and Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, both in Italy
| | - P Agostoni
- Division of Cardiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - G Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy,Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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