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Donia D, Stankowski K, Figliozzi S, Pivato CA, Regazzoli D, Mangieri A, Reimers B, Bragato RM, Stefanini G, Cannata F. Bileaflet Tethering With Preserved LV Geometry and Function: An Unusual Mechanism of Functional Mitral Regurgitation. JACC Case Rep 2024; 29:102191. [PMID: 38361557 PMCID: PMC10865136 DOI: 10.1016/j.jaccas.2023.102191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 02/17/2024]
Abstract
An 81-year-old woman presented with acute pulmonary edema. Echocardiography revealed severe functional mitral regurgitation, the mechanism of which was unusual. An atypical bileaflet tethering caused by disharmonic annular remodeling, concomitant aortic dilatation, and reduced aorto-mitral angle without left ventricular dysfunction or dilatation was found. A transcatheter edge-to-edge repair was nonetheless successfully performed.
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Affiliation(s)
- Dario Donia
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Carlo Andrea Pivato
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | | | | | | | | | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Francesco Cannata
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Cannata F, Stankowski K, Donia D, Figliozzi S, Fazzari F, Regazzoli D, Reimers B, Bragato RM, Pontone G, Trabattoni D, Colombo A, De Marco F, Mangieri A. Percutaneous suture-based patent foramen ovale closure: A state-of-the-art review. Trends Cardiovasc Med 2023:S1050-1738(23)00095-6. [PMID: 37931791 DOI: 10.1016/j.tcm.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
Percutaneous closure of a patent foramen ovale (PFO), a common variation of interatrial septum anatomy, is a commonly performed procedure in the catheterization laboratory to reduce the risk of recurrent stroke in selected patients and to treat other PFO-related syndromes. In the last twenty years, disc-based devices have represented the armamentarium of the interventional cardiologist; recently, suture-based devices have become an attractive alternative, despite limited data regarding their long-term performance. The present review gives an overview of the current evidence regarding suture-based PFO closure, the device's characteristics, the echocardiographic evaluation of the PFO anatomy, and recommendations for patient selection. A detailed procedural guide is then provided, and potential complications and future developments in the field are discussed.
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Affiliation(s)
- Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy; Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Dario Donia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Stefano Figliozzi
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Damiano Regazzoli
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Bernhard Reimers
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Renato Maria Bragato
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniela Trabattoni
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Federico De Marco
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Mangieri
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy.
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3
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Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Da Ros S, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Del Giudice C, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Bella G, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi RM, Inserra CA, Iori E, Izzo A, La Rosa G, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Picano E, Carerj S. Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:125-132. [PMID: 38161775 PMCID: PMC10756319 DOI: 10.4103/jcecho.jcecho_48_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 01/03/2024] Open
Abstract
Background The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and ≥40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). Conclusions This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Francesco Antonini-Canterin
- Department of Rehabilitative Cardiology, Rehabilitative Hospital High Speciality, Motta di Livenza, TV, Italy
| | - Andrea Barbieri
- Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo Della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Rehabilitative Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Department of Medicine and Surgery, University MIlano-Bicocca, Integrated Cardiovascular Diagnosi Unit, Istituto Auxologico Italiano, IRCCS, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Division, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Pisa, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina Degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Sciences, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Siena, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | | | - Angelo Di Gioia
- Cardiology Division, St. Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, Italy
| | - Federica Donati
- Pascia Center, Polyclinic, University Hospital Modena Polyclinic, Modena, Italy
| | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Cremona, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, Italy
| | - Annibale Izzo
- Cardiology Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiology and Rehabilitative Division, Azienda Sanitaria Friuli Occidentale (ASFO), Health Care, Sacile (Pd), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St. Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St. Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St. Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città Della Salute e Della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St. Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St. Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Division, Molinette Hospital - Città della Salute e Della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St. Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, University Hospital of Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St. Giovanni Evangelista Hospital, Tivoli, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, Italy
| | - Carlo Ratti
- Cardiology Division, St. Maria Bianca Hospital, Mirandola, Italy
| | | | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St. Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St. Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St. Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St. Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Department of Cardiovascular Sciences, Responsible Research Hospital, Campobasso, Italy
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
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4
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Stankowski K, Figliozzi S, Lisi C, Catapano F, Panico C, Cannata F, Mantovani R, Frontera A, Bragato RM, Stefanini G, Monti L, Condorelli G, Francone M. Solving the Riddle of Sudden Cardiac Death in Hypertrophic Cardiomyopathy: The Added Role of Cardiac Magnetic Resonance. J Cardiovasc Dev Dis 2023; 10:226. [PMID: 37367391 DOI: 10.3390/jcdd10060226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Cardiac magnetic resonance (CMR) has been recently implemented in clinical practice to refine the daunting task of establishing the risk of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). We present an exemplificative case highlighting the practical clinical utility of this imaging modality in a 24-year-old man newly diagnosed with an apical HCM. CMR was essential in unmasking a high risk of SCD, which appeared low-intermediate after traditional risk assessment. A discussion examines the essential role of CMR in guiding the patient's therapy and underlines the added value of CMR, including novel and potential CMR parameters, compared to traditional imaging assessment for SCD risk stratification.
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Affiliation(s)
- Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Stefano Figliozzi
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Cristina Panico
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Riccardo Mantovani
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Antonio Frontera
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Renato Maria Bragato
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Lorenzo Monti
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
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5
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Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Ros SD, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Giudice CD, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi R, Inserra CA, Iori E, Izzo A, Rosa GL, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Di Bella G, Carerj S. Organization and Activity of Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:1-9. [PMID: 37426716 PMCID: PMC10328129 DOI: 10.4103/jcecho.jcecho_16_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 07/11/2023] Open
Abstract
Background The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue Doppler imaging in 53% of the centers, and using fractional area change in 33% of the centers. When we divided into cardiology (179, 78%) and noncardiology (49, 22%) centers, we found significant differences in the SE (93% vs. 26%, P < 0.001), TEE (85% vs. 18%), UCA (67% vs. 43%, P < 0001), and STE (87% vs. 20%, P < 0.001). The incidence of LUS evaluation was similar between the cardiology and noncardiology centers (69% vs. 61%, P = NS). Conclusions This nationwide survey demonstrated that digital infrastructures and advanced echocardiography modalities, such as 3D and STE, are widely available in Italy with a notable diffuse uptake of LUS in the core TTE examination, a suboptimal diffusion of PACS recording, and conservative use of UCA, 3D, and strain. There are significant differences between northern and central-southern regions and echocardiographic laboratories that pertain to the cardiac unit. This inhomogeneous distribution of technology represents one of the main issues that must be solved to standardize the practice of echocardiography.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | - Andrea Barbieri
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Semi-Intensive Care Unit, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Integrated Cardiovascular Diagnostic Division, Auxologico San Luca IRCCS Hospital, Milano, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Department, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, MI, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Science, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Sassari, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo Nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Maria Di Fulvio
- Cardiology-ICCU Division, Ss. Annunziata Hospital, Chieti, Italy
| | | | | | - Angelo Di Gioia
- Cardiology Division, St Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, CN, Italy
| | | | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, NA, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Palermo, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Ferrara, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, MO, Italy
| | - Annibale Izzo
- Cardiology Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiological and Cardio Oncological Rehabilitation Department, Sacile (PN) CRO (PN) Hospital, Sacile (PN), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, PG, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, MI, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città della Salute e della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Department, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, St Anna University Hospital, Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, RM, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St Giovanni Evangelista Hospital, Tivoli, RM, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, VE, Italy
| | - Carlo Ratti
- Cardiology Division, St Maria Bianca Hospital, Mirandola, MO, Italy
| | - Sara Rettegno
- Cardiology Division, Hospital, Moncalieri, TO, Italy
| | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Cardiology Division, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Antonello Zugaro
- Department of Cardiology, Intensive Care Unit, St Salvatore Hospital, L’Aquila, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
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Cannata F, Pinto G, Chiarito M, Maurina M, Condello F, Bombace S, Villaschi A, Novelli L, Stankowski K, Liccardo G, Gasparini G, Donia D, Celata A, My I, Kallikourdis M, Figliozzi S, Mantovani R, Fazzari F, Bragato RM, Condorelli G, Stefanini GG. 144 LONG-TERM PROGNOSTIC IMPACT OF SUBCLINICAL MYOCARDIAL DYSFUNCTION IN PATIENTS RECOVERED FROM COVID-19. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Aims
Cardiovascular sequelae may occur in patients recovered from COVID-19. Recent studies have detected a considerable incidence of subclinical myocardial dysfunction – assessed with speckle-tracking echocardiography – and of long-COVID symptoms in these patients. This study aimed to define the long-term prognostic role of subclinical myocardial dysfunction and long-COVID condition in patients recovered from COVID-19 pneumonia.
Methods and Results
We prospectively followed-up 110 patients hospitalized at our Institution due to COVID-19 pneumonia in April 2020 and then recovered from SARS-CoV-2 infection. A 6-month clinical and echocardiographic evaluation was performed, followed by a 21-month clinical follow-up. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction, stroke, heart failure hospitalization and all-cause mortality. A subclinical myocardial dysfunction – defined as an impairment of left ventricular global longitudinal strain (≥ -18%) - was identified at 6-month follow-up in 37 patients (34%), was associated with an increased risk of long-term MACE with a good discriminative power (AUC: 0.73) and resulted a strong independent predictor of extended MACE in a multivariate regression analysis (OR 9.29, 95%CI 2.20–39.3, p=0.002). Long-COVID condition was not associated with a worse long-term prognosis, instead.
Conclusion
In patients recovered from COVID-19 pneumonia, a subclinical myocardial dysfunction is present in one third of the whole population at 6-month follow-up and is associated with a higher risk of MACE at long-term follow-up. Speckle-tracking echocardiography is a promising tool to optimise the risk-stratification in patients recovered from COVID-19 pneumonia, while the definition of a long-COVID condition has not prognostic relevance.
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Affiliation(s)
- Francesco Cannata
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Giuseppe Pinto
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Mauro Chiarito
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Matteo Maurina
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Francesco Condello
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Sara Bombace
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Alessandro Villaschi
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Laura Novelli
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Kamil Stankowski
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Gaetano Liccardo
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Gaia Gasparini
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Dario Donia
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Anastasia Celata
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Ilaria My
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
| | - Marinos Kallikourdis
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
| | | | | | - Fabio Fazzari
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | | | - Gianluigi Condorelli
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
| | - Giulio Giuseppe Stefanini
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele - Milan , Italy
- IRCCS Humanitas Research Hospital , Rozzano - Milan , Italy
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Figliozzi S, Francone M, Bragato RM, Stefanini GG, Condorelli G, Monti L. 1076 AN UNUSUAL PAPILLARY MUSCLE PRESENTATION AT CARDIAC-MRI. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Cardiac-MRI is the gold-standard non-invasive imaging modality to evaluate cardiac masses.
Case Summary
A 58-year-old man underwent surgical excision of a sacral chordoma. At the time of surgery, there was neoplastic infiltration of bones and soft tissues (immunophenotype: CKMNF116+, EMA+, S100 +/-) and radiotherapy was performed. The patient underwent superior-lobectomy of the left lung six years later because of pulmonary metastasis of the chordoma. Nine years later, the patient was asymptomatic and referred to us for Cardiac-MRI because a suspected cardiac mass at echocardiography. At Cardiac-MRI, we found normal bi-ventricular volumes, wall thickness, wall motion and ejection fraction. Atria, heart valves and pericardium were normal too. In ssFP-cine images, an oval, hypointense mass with sharp margins (26×18 mm) was evident in the context of the posteromedial papillary muscle (Panel, A-B). Compared to the myocardium, the lesion was hyperintense at T2-weighted (Panel, C), native T1-(Panel, D) and T2-mapping sequences (Panel, E). After contrast injection, there was no increased mass signal at first-pass perfusion (Panel, F), whereas the late sequences revealed a soft, heterogeneous enhancement of the central core of the lesion, and a bright peripheral rim (Panel, G-H). These findings were interpreted as a cardiac metastasis of the chordoma and systematic treatment with imatinib was started.
Discussion
Six cases of cardiac metastasis secondary to chordoma were previously described. The present case is the first to provide advanced, multiparametric Cardiac-MRI assessment and represents the first description of a location within the context of a papillary muscle. Cardiac-MRI was essential to identify cardiac metastasis, leading patient's management and targeting appropriate treatment.
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8
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Del Monaco G, Tumminello F, Figliozzi S, Pagliaro B, Fumero A, Barbone A, Cuko E, Mantovani R, Fazzari F, Cannata F, Curzi M, Catapano F, Monti L, Francone M, Pini D, Stefanini GG, Torracca L, Condorelli G, Bragato RM. 28 CONSTRICTIVE PERICARDITIS: A ROOM FOR MULTI-MODALITY IMAGING. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
The diagnosis of constrictive pericarditis can be challenging through conventional imaging. Novel imaging techniques have been proposed to improve it.
Clinical Case
A 74-year-old man with a previous diagnosis of heart failure with preserved ejection fraction and permanent atrial fibrillation (AF) was admitted because of worsening dyspnea, peripheral edema, and ascites refractory to diuretics therapy. ECG revealed low QRS voltages and AF with normal heart rate and laboratory exams detected increased values of BNP and hepatic stasis indices; blood count and CRP were normal. Echocardiography revealed mildly reduced bi-ventricular pump function (left ventricular ejection fraction = 52%, right ventricular fractional area change = 25%) and slightly increased wall thickness. Atria were moderately dilated (left and right atrium 46 and 44 ml/mq, respectively) and mitral and tricuspid annuli were dilated too. There was inferior vena cava plethora, moderate atriogenic tricuspid regurgitation and mild-to-moderate atriogenic mitral regurgitation. A paradoxical interventricular septal motion and significant respiratory changes on trans-mitral (>25%) and trans-tricuspid (>30%) pulsed Doppler were noted; however, there was no "annulus reversus" (lateral and septal e’ 13 and 11 cm/sec, respectively) at TDI analysis. In contrast, 2D-speckle-tracking global longitudinal strain showed impaired deformation of the lateral segments with relative sparing of the septal segments. The latter pattern has been recently described as "strain reversus" or "hot septum sign". The findings were suspected of constrictive pericarditis, but a chest Computed Tomography excluded pericardial calcifications. Cardiac magnetic resonance (CMR) was then performed revealing a "septal shift" at cine-real time sequences analysis. The pericardium was slightly thickened (4-5 mm) with widespread late gadolinium enhancement but without signs of acute inflammation at T2-weighted imaging. Tricuspid regurgitation was confirmed to be "moderate" after phase-contrast imaging. Cardiac catheterization finally revealed normal coronary arteries and confirmed the diagnosis of constrictive pericarditis (square root sign, equalization of bi-ventricular end-diastolic pressures). The patient underwent pericardiectomy and tricuspid and mitral valve repair and was asymptomatic at 6-months follow-up.
Conclusions
Constrictive pericarditis represents a potentially reversible cause of heart failure but can be easily missed through conventional imaging. In the present case, advanced echocardiography and CMR were essential to come up with an accurate diagnosis, guiding the patient's clinical management with excellent outcome.
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Affiliation(s)
- Guido Del Monaco
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Fabio Tumminello
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
| | - Stefano Figliozzi
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
- Departement Of Radiology, Humanitas Research Hospital - Ircss , Rozzano (Milan) , Italy
| | - Beniamino Pagliaro
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Andrea Fumero
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Humanitas Research Hospital , Departement Of Cardiac Surgery - Ircss, Rozzano (Milan) Italy
| | - Alessandro Barbone
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Humanitas Research Hospital , Departement Of Cardiac Surgery - Ircss, Rozzano (Milan) Italy
| | - Enea Cuko
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Humanitas Research Hospital , Departement Of Cardiac Surgery - Ircss, Rozzano (Milan) Italy
| | - Riccardo Mantovani
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Fabio Fazzari
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Francesco Cannata
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Mirko Curzi
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Federica Catapano
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Departement Of Radiology, Humanitas Research Hospital - Ircss , Rozzano (Milan) , Italy
| | - Lorenzo Monti
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
- Departement Of Radiology, Humanitas Research Hospital - Ircss , Rozzano (Milan) , Italy
| | - Marco Francone
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Departement Of Radiology, Humanitas Research Hospital - Ircss , Rozzano (Milan) , Italy
| | - Daniela Pini
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Giulio Giuseppe Stefanini
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Lucia Torracca
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Humanitas Research Hospital , Departement Of Cardiac Surgery - Ircss, Rozzano (Milan) Italy
| | - Gianluigi Condorelli
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Renato Maria Bragato
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
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Latini AC, Poggio L, Riccardo M, Bragato RM, Frontera A. 539 GOING BEYOND CRT NON-RESPONSE: ECHO-GUIDED LEFT BUNDLE-BRANCH PACING. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
We present the case of a 56-year-old man affected by heart failure (HF) with reduced ejection fraction (HFrEF) and permanent atrial fibrillation, who previously underwent a CRT-D implant with left ventricular stimulation delivered by an epicardial pacing lead due to an unfavourable CS anatomy. We upgraded this system to left bundle branch pacing. The LBB lead was connected to the atrial plug in of the device in order to deliver multisite left ventricular pacing. The device was programmed in DDDR mode and the delay between the two LV pacing sites was chosen (modifying atrioventricular delay) after multimodality assessment (both electrocardiographic and echocardiographic) to obtain the best resynchronization and systolic performance.
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10
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Monaco ML, Stankowski K, Oliva A, Figliozzi S, Fazzari F, Mantovani R, Curzi M, Cannata F, Marconi M, Fumero AD, Stefanini GG, Torracca L, Bragato RM, Volpe M, Condorelli G. 898 ROLE OF 3D ECHOCARDIOGRAPHY IN AORTIC VALVE ABNORMALITIES: TWO CASES REPORT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
Aortic valves with a number of cusps different from two or three are infrequent congenital anomalies that might manifest with valvular disease in young patients. We present two cases of unicuspid and quadricuspid aortic valve diagnosed in our Center.
Clinical Cases
Case 1. A 23-year-old asymptomatic male was admitted to our Hospital because of the necessity of bone marrow transplantation for Hodgkin lymphoma. He had a previous diagnosis of bicuspid aortic valve and presented a 5/6 mid-systolic harsh murmur, heard best at the right upper sternal border and radiating to the neck. ECG showed sinus rhythm with left ventricular hypertrophy. BNP was in normal range (31 pg/ml).
At trans-thoracic echocardiography, there was severe aortic stenosis [peak/mean gradient of 100/67 mmHg with an aortic valve area of 1.04 cm2 (0.54 cm2/m2); V max was 5 m/s] without regurgitation and dilation of the ascending aorta (39 mm), however the morphology of the aortic valve remained undefined. Left ventricle showed hypertrophy (maximum wall thickness = 13 mm) with normal volumes and systolic function. Thus, the patient underwent to 3D-Transesophageal echocardiography, which demonstrated unicuspid aortic valve with a lone commissure between L-NC and anterior calcification. After multidisciplinary discussion, the patient underwent close follow-up and aortic valve replacement was planned after the bone marrow transplantation.
Case 2. A 21-year-old male was referred by general practitioner to our outpatient clinic for palpitations. Cardiovascular physical examination and ECG were normal with no evidence of arrhyhtmia or cardiac murmurs.
Transthoracic echocardiography revealed central mild aortic valve regurgitation in a suspected quadricuspid aortic valve (i.e., an X-shaped commissure pattern during diastole and a rectangular appearance during systole in the parasternal short-axis view). Left ventricular size and function and ascending aorta dimensions were normal. There was no associated congenital cardiovascular abnormality. 3D-Transesophageal echocardiography confirmed the evidence of a quadricuspid aortic valve. The cusps appeared to be of different size: two equal larger cusps and two equal smaller cusps (Type C, Hurwitz and Robert's classification), thin and mobile. The patient was advised to echocardiographic follow-up at intervals of 12 months.
Conclusions
We describe two cases of aortic valve congenital anomalies in two coetaneous patients with completely different impacts on hemodynamics. Severe aortic stenosis complicated unicuspid aortic valve whereas quadricuspid aortic valve was associated with mild aortic regurgitation. 3D-Transesophageal echocardiography was essential for accurate morphological characterization of the aortic valves.
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Affiliation(s)
- Maria Lo Monaco
- Cardiology, Clinical And Molecular Medicine Department, Faculty Of Medicine And Psychology, Sapienza University Of Rome , Rome , Italy
| | - Kamil Stankowski
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Angelo Oliva
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Stefano Figliozzi
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Fabio Fazzari
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Riccardo Mantovani
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Mirko Curzi
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Francesco Cannata
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Manuel Marconi
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Andrea Davide Fumero
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | | | - Lucia Torracca
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Renato Maria Bragato
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
| | - Massimo Volpe
- Cardiology, Clinical And Molecular Medicine Department, Faculty Of Medicine And Psychology, Sapienza University Of Rome , Rome , Italy
| | - Gianluigi Condorelli
- Cardio Center, Humanitas Clinical An Research Center-Irccs , Rozzano, Milan , Italy
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11
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Stankowski KM, Figliozzi S, Cannata F, Fazzari F, Mantovani R, Curzi M, Panico C, Catapano F, Ceriotti C, Galimberti P, Giuseppe Stefanini G, Frontera A, Monti L, Francone M, Maria Bragato R, Condorelli G. 113 RIGHT VENTRICULAR FREE WALL LONGITUDINAL STRAIN AS THE SOLE MARKER OF RIGHT VENTRICLE SYSTOLIC DYSFUNCION IN HYPERTROPHIC CARDIOMYOPATHY: A CLINICAL CASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.236] [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: 12/23/2022]
Abstract
Abstract
Background
The introduction of Cardiac-MRI (cMRI) in clinical practice has considerably improved risk stratification of patients with hypertrophic cardiomyopathy (HCM). However, the prediction of adverse outcome based on imaging markers remains suboptimal. Right ventricular (RV) involvement is an emerging finding in this disease of unknown clinical value. The identification of accurate and sensible imaging markers to detect morpho-functional alterations of the RV is therefore essential to establish, in the future, any prognostic impact of RV involvement in HCM in order to improve risk stratification. RV free wall longitudinal strain (RV-FWLS) is a promising marker to unveil subclinical RV dysfunction despite normal conventional indices of RV systolic function; however, RV-FWLS has been scarcely explored in HCM patients.
Case Summary
A 29-year-old man with sarcomeric HCM due to MYBPC3 mutation was referred to our Institution. Trans-Thoracic Echocardiography (TTE) showed left ventricular (LV) apical hypertrophy (27 mm) with an ace of spades morphology and mid-ventricular obstruction (peak gradient 38 mmHg). LV-EF was normal (62%) while LV global longitudinal strain was significantly impaired (-9.3% with a reverse apical sparing pattern). 2nd-degree diastolic dysfunction and left atrial enlargement (maximum volume: 42 ml/m2) were observed. No LV apical aneurysm nor paradoxical diastolic flow at the apex were noted. RV hypertrophy was present (maximum thickness 8 mm) with normal conventional indices of RV systolic function: TAPSE 26 mm, S’ TDI 12 cm/s, FAC 50%. In contrast, RV-FWLS was significantly reduced (–16%). cMRI confirmed normal bi-ventricular function in presence of left and right hypertrophy (maximum wall thickness 28 and 12 mm, respectively) and LV apical thinning. At tissue characterization, elevated native T1 and T2 values were evident in the apex (1071 +/- 45 ms and 54 +/- 6 ms, respectively) and a significant amount of patchy LGE was present in the mid-apical segments of the LV (28% of LV mass) and of the RV. After consideration of clinical and imaging data, an s-ICD for primary prevention was implanted.
Discussion
The present case highlights known issues and poses new challenges in managing HCM patients. First, it confirms the central role of cMRI, demonstrating its unique capability to spot myocardial fibrosis, guiding our decision to implant an s-ICD in our patient. Second, it draws attention to RV involvement in HCM, an emerging finding in this condition. MYBPC3 mutation has been associated with RV hypertrophy. Both of these conditions, together with patchy RV-LGE, were found in our patient. Notably, RV-FWLS was the only RV systolic index to be impaired and might represent an early and more accurate marker of RV systolic dysfunction compared to other conventional indices, including RV-EF by cMRI. Future studies assessing the prognostic value of RV involvement, including RV-LGE and RV-FWLS, are needed in HCM patients to potentially refine risk stratification in this challenging population.
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Affiliation(s)
- Kamil Mateusz Stankowski
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
- Humanitas University , Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano , Italy
| | - Stefano Figliozzi
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
| | - Francesco Cannata
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
- Humanitas University , Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano , Italy
| | - Fabio Fazzari
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
| | - Riccardo Mantovani
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
| | - Mirko Curzi
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
| | - Cristina Panico
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
- Humanitas University , Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano , Italy
| | - Federica Catapano
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
| | - Carlo Ceriotti
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
| | - Paola Galimberti
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
| | - Giulio Giuseppe Stefanini
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
- Humanitas University , Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano , Italy
| | - Antonio Frontera
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
| | - Lorenzo Monti
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
- Humanitas University , Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano , Italy
| | - Marco Francone
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
- Humanitas University , Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano , Italy
| | - Renato Maria Bragato
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
| | - Gianluigi Condorelli
- Humanitas Research Hospital Irccs , Via Alessandro Manzoni, 56, 20089 Rozzano, Milano , Italy
- Humanitas University , Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano , Italy
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12
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Pivato CA, Liccardo G, Sanz‐Sanchez J, Pelloni E, Pujdak K, Xuareb RG, Cruz‐Gonzalez I, Pisano F, Scotti A, Tarantini G, Cook S, Regazzoli D, Reimers B, Condorelli G, Bragato RM, Stefanini GG, Pagnotta P. Left atrial appendage closure with the II generation Ultraseal device: An international registry. The LIGATE study. Catheter Cardiovasc Interv 2022; 100:620-627. [PMID: 35842775 PMCID: PMC9796275 DOI: 10.1002/ccd.30336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/31/2022] [Accepted: 07/02/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To assess feasibility and safety of second-generation left atrial appendage closure (LAAC) Ultraseal device in patients with nonvalvular atrial fibrillation (NVAF). BACKGROUND LAAC with first-generation Ultraseal device (Cardia, Eagan, Minnesota) has been shown to be a feasible therapeutic option in patients with NVAF. However, there is a paucity of data regarding the novel second-generation Ultraseal device. METHODS All patients with NVAF undergoing second-generation Ultraseal device implantation between February 2018 and September 2020 were included in a multicenter international registry. Periprocedural and post-discharge events were collected through 6-month follow-up. Co-primary efficacy endpoints were device success and technical success while primary safety endpoint was in-hospital major adverse event (MAE) occurrence. RESULTS A total of 52 patients were included: mean age 75 ± 8, 30.8% women, mean HAS-BLED 3 ± 1. The device was successfully implanted in all patients. Technical success was achieved in 50 patients (96.1%). In-hospital MAEs occurred in three patients (5.8%). The incidence of 6-month all-cause death and major bleeding was 11.6% and 2.1%, respectively. No strokes, transient ischemic attacks, systemic embolisms, or device embolization were reported after discharge. CONCLUSIONS Second-generation Ultraseal device implantation was associated with high success rates and a low incidence of peri-procedural complications. Larger studies with longer follow-up are warranted to further evaluate the safety and the efficacy of this device, especially at long-term follow-up.
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Affiliation(s)
- Carlo A. Pivato
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele‐MilanItaly,Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Gaetano Liccardo
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele‐MilanItaly,Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Jorge Sanz‐Sanchez
- Cardiology DepartmentHospital Universitari i Politècnic La FeValenciaSpain,Centro de Investigación Biomedica en Red (CIBERCV)MadridSpain
| | | | | | | | | | | | - Andrea Scotti
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, del PoliclinicoUniversitario di PadovaPadovaItaly
| | - Giuseppe Tarantini
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, del PoliclinicoUniversitario di PadovaPadovaItaly
| | | | | | - Bernhard Reimers
- Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Gianluigi Condorelli
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele‐MilanItaly,Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | | | - Giulio G. Stefanini
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele‐MilanItaly,Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Paolo Pagnotta
- Cardio CenterIRCCS Humanitas Research HospitalRozzano‐MilanItaly
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13
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Fazzari F, Cannata F, Maurina M, Bragato RM, Francone M. Multi-Modality Imaging of the Tricuspid Valve: From Tricuspid Valve Disease to Catheter-Based Interventions. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2306199] [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: 11/06/2022] Open
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14
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Figliozzi S, Georgiopoulos G, Pateras K, Sianis A, Previtero M, Tondi L, Petropoulos Ι, Bragato RM, Papachristidis A, Condorelli G, Takeuchi M. Normal ranges of left atrial volumes and ejection fraction by 3D echocardiography in adults: a systematic review and meta-analysis. Int J Cardiovasc Imaging 2022; 38:10.1007/s10554-021-02520-9. [PMID: 34994882 DOI: 10.1007/s10554-021-02520-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
Abstract
Increased sizes and dysfunction of the left atrium have been related to adverse outcomes. 3D-echocardiography is more accurate than 2D-echocardiography in estimating LA volumes and ejection fraction. However, the use of 3DE for LA analysis is limited by the absence of established reference values. We performed a systematic review and meta-analysis to provide reference ranges of LA maximum and minimum volumes indexed for body surface area (LAVi max and LAVi min, respectively), and LA-EF assessed by 3DE in healthy adults. Data search was conducted from inception through September 15, 2021, using the following Medical Subject Heading terms: left atrial/atrium, three-dimensional/3D echocardiography. The study protocol was registered in the PROSPERO database (CRD42021252428). 15 studies including 4,226 healthy adults (51% males) and reporting 3DE values of LAVi max, LAVi min and LA-EF were selected. LAVi max, LAVi min and LA-EF mean and reference values were equal to 25.18 ml/m2 (95% CI 23.10, 27.26), 11.10 ml/m2 (10.01, 12.18) and 55.94% (51.92, 59.96), respectively. No influential studies were identified. Pooled estimates per age group- and sex were also estimated. By meta-regression analyses, we identified variability in LA volumes and LA-EF depending on participants' age, ethnicity and number of heart cycles at 3D multi-beat acquisition. At individual patient data analysis conducted on 374 subjects, a software effect on LA-EF was shown. This systematic review and meta-analysis provides reference values of LAVi max, LAVi min and LA-EF assessed by 3DE in healthy adults, encouraging 3DE evaluation of the LA evaluation in daily practice.
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Affiliation(s)
- Stefano Figliozzi
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kostantinos Pateras
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Faculty of Public Health, University of Thessaly, Volos, Greece
| | - Alexandros Sianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Lara Tondi
- Multimodality Imaging Section IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ιoannis Petropoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Renato Maria Bragato
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
| | | | - Gianluigi Condorelli
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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Baggio S, Lancini DR, Bragato RM, Reimers B, Pagnotta PA, Colombo A. 26 Procedural planning and tip-to-base lampoon to succeed in a complex valve-in-valve TMVR procedure. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.001] [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
Left ventricle outflow tract (LVOT) obstruction is a feared complication of transcatheter mitral valve replacement (TMVR) procedures. Multimodal imaging evaluation is the key to identify at-risk patient and select the best management.
Methods and results
An 83-year-old woman with a history of mitral valve replacement with a 27-mm Carpentier-Edwards bioprosthesis (Edwards Lifesciences, Irvine, CA) for rheumatic heart disease was admitted to our department complaining worsening effort dyspnoea. Clinical evaluation revealed a grade 3/6 holosystolic murmur. She underwent combined transthoracic and transesophageal echocardiography (TEE) which demonstrated mitral bioprosthesis degeneration leading to severe stenosis (mean gradient = 13 mmHg, PHT-derived area = 0.9 cm2) and moderate regurgitation, with preserved biventricular function, and severe pulmonary hypertension (pulmonary artery systolic pression = 65 mmHg). The patient presented a high estimated risk for redo-surgery (Society of Thoracic Surgeons score estimated mortality: 6%) due to her complex medical history, including advanced chronic kidney disease and permanent atrial fibrillation; therefore, she underwent evaluation for valve-in-valve TMVR. Cardiac computed tomography (CT) revealed bioprosthetic anterior leaflet in tight contact with the septum in systole; predicted neo-LVOT using virtual 26-mm Sapien S3 (Edwards Lifesciences, Irvine, CA) valve was 150 mm2, conferring a high risk of fixed LVOTO. A 26-mm Sapien S3 valve was selected based on CT derived surgical valve ID of 24 mm. After Heart Team discussion, we performed a modified LAMPOON technique to achieve tip-to-base laceration of the bioprosthetic leaflet beside the LVOT, in order to prevent LVOT obstruction. Briefly, after transseptal puncture through right femoral vein access (16 Fr), we crossed the mitral prosthesis using a balloon wedge end-hole catheter, through which we advanced a 300 cm 0.014-inch wire into the ascending aorta, where it was snared from left arterial femoral access (8 Fr) and covered by a micro-catheter. The wire was previously kinked mid-shaft to form a ‘flying-V’ that was focally denuded and positioned at the target bioprosthetic leaflet’s tip using TEE and fluoroscopy. The guidewire was pulled toward the valve ring and electrified at 70 W with continuous 5% dextrose flush until adequate tip-to-base leaflet laceration. Thereafter, we successfully implant a 26-mm Sapien S3 valve. Maximal LVOT gradient post implant was 5 mmHg. The patient was discharged on post-operative day two and she recovered well, reporting functional and symptomatic improvement at 6-month follow-up.
Conclusions
our case highlights the importance of multimodality imaging and careful procedural planning to succeed even in complex valve-in-valve TMVR procedures. Transcatheter electrosurgery is an emerging tool for percutaneous structural heart interventions.
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Affiliation(s)
- Sara Baggio
- Cardiovascular Department, IRCCS Humanitas Clinical and Research Institute, Rozzano, Italy
- Humanitas University, Pieve Emanuele, Italy
| | - Damiano Regazzoli Lancini
- Cardiovascular Department, IRCCS Humanitas Clinical and Research Institute, Rozzano, Italy
- Humanitas University, Pieve Emanuele, Italy
| | - Renato Maria Bragato
- Cardiovascular Department, IRCCS Humanitas Clinical and Research Institute, Rozzano, Italy
- Humanitas University, Pieve Emanuele, Italy
| | - Bernhard Reimers
- Cardiovascular Department, IRCCS Humanitas Clinical and Research Institute, Rozzano, Italy
- Humanitas University, Pieve Emanuele, Italy
| | - Paolo Antonio Pagnotta
- Cardiovascular Department, IRCCS Humanitas Clinical and Research Institute, Rozzano, Italy
| | - Antonio Colombo
- Cardiovascular Department, IRCCS Humanitas Clinical and Research Institute, Rozzano, Italy
- Humanitas University, Pieve Emanuele, Italy
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16
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Fazzari F, Cannata F, Banfi D, Pellegrino M, Pagliaro B, Loiacono F, Mantovani R, Donghi V, Curzi M, Maurina M, Condello F, Liccardo G, Francone M, Condorelli G, Stefanini GG, Pini D, Bragato RM. 491 Short-term prognostic implications of left ventricular myocardial work indices in advanced heart failure patients treated with repetitive Levosimendan infusions. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.016] [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
Repetitive Levosimendan treatment in advanced heart failure patients has not been investigated yet via myocardial work indices (MWI), which could more accurately detect the effects of this both inotropic and vasodilatory drug. The aims of this study were (1) to describe variations of myocardial work indices, as a consequence of repetitive Levosimendan infusions and (2) to assess the prognostic value of myocardial work parameters in these patients.
Methods and results
Fourteen patients with advanced heart failure treated with intermittent in-hospital levosimendan infusions were prospectively included. Clinical, laboratory, and echocardiographic assessment were performed before and after every Levosimendan infusion. The primary endpoint was a composite of any episode of decompensated HF, urgent HF rehospitalization, cardiogenic shock, cardiac arrest and cardiovascular death at 4–6 weeks follow-up after each planned infusion. During follow-up (mean: 150 ± 99 days) a total of 37 infusions were performed and a total of 11 cardiovascular events occurred. Global constructive work (GCW), global work efficiency (GWE), and global work index (GWI) increased after Levosimendan infusion in 62.2%, 73.0%, and 70.3% of cases, with significant differences between patients with and without outcomes [delta GCW: −7.36 mmHg% (134.12) vs. 113.81 mmHg% (204.41), P = 0.007; delta GWE: −3.27% (8.38) vs. 4.30% (5.58), P = 0.002]. Delta value of GWE showed the largest area under curve (AUC: 0.82, 95% CI: 0.64–1.00, P = 0.002) for outcome prediction with a cut-off point of 0.5%. Independent prognostic value of GWE variation was confirmed in multivariable regression models (OR: 0.825, 95% CI: 0.702–0.970, P = 0.02).
Conclusions
GWE and GCW provided incremental and independent prognostic value at short-term follow-up over traditional echocardiographic parameters. The differentiation of patients into ‘workers’, whose GWE improved after Levosimendan infusion, and ‘non-workers’, who failed to improve their GWE, permitted to identify patients at higher risk of forthcoming cardiovascular events. Monitoring these patients with MWI may have relevant clinical implications.
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17
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Liccardo G, Pivato CA, Sanz-sanchez J, Pelloni E, Pudjak K, Xuareb RG, Gonzalez IC, Pisano F, Tarantini G, Cook S, Regazzoli D, Reimers B, Condorelli G, Bragato RM, Stefanini GG, Pagnotta P. 349 Left atrial appendage closure with the II generation ultraseal device: an international registry. The ligate study. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.026] [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
Aims
Left atrial appendage (LAA) occlusion with first generation Ultraseal device (Cardia, Eagan, Minnesota) has been shown to be a feasible therapeutic option in patients with non-valvular atrial fibrillation (NVAF). However, there is a paucity of data regarding the novel Ultraseal device. To assess feasibility and safety of second generation LAA closure Ultraseal device in patients with NVAF.
Methods and results
All patients with NVAF undergoing second generation Ultraseal device implantation between February 2018 and September 2020 were included in a multicentre international registry. Periprocedural and post-discharge events were collected up to 6-months follow-up. Primary efficacy endpoints of interest were device success and technical success; primary safety endpoint was in-hospital major adverse events occurrence. A total of 52 patients were included: mean age 75 ± 8, 69.2% male, mean HAS-BLED 3 ± 1. The device was successfully implanted in all patients. Technical success was achieved in 51 patients (98.0%). In-hospital major adverse event occurred in three patients (5.8%). The incidence of 6-months all-cause death and major bleeding was 11.6% and 2.1%, respectively. No strokes, transient ischaemic attacks, systemic embolisms or device embolization were reported.
Conclusions
Second generation Ultraseal Device implantation was associated with high procedural success rate and a low incidence of peri-procedural complications. Larger studies with longer follow-up are warranted to evaluate the safety and the efficacy of this device, especially at medium and long term follow-up.
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Affiliation(s)
- Gaetano Liccardo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Carlo A Pivato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Jorge Sanz-sanchez
- Cardiology Department, Hospital Universitari I Politecnic la Fe, Valencia, Spain
| | | | | | | | | | | | - Giuseppe Tarantini
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari del Policlinico Universitario di Padova, Italy
| | | | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Renato Maria Bragato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Paolo Pagnotta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
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18
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Liccardo G, Cannata F, Chiarito M, Bombace S, Maccallini M, Villaschi A, Pinto G, Fazzari F, Pini D, Bragato RM, Condorelli G, Cappato R, Stefanini GG. 480 Catheter pulmonary vein ablation vs. medical therapy or atrioventricular node ablation and resynchronization in patients with atrial fibrillation and heart failure: a systematic review and meta-analysis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab127.013] [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
Atrial fibrillation (AF) and heart failure (HF) are increasing in prevalence worldwide and, when present altogether, are associated with significant mortality and morbidity. Several and recent randomized clinical trials have reported an improvement of clinical outcomes in patients with HF and AF with catheter ablation. To provide a comprehensive and updated synthesis of effect estimates of the available randomized and observational clinical trials comparing pulmonary vein isolation with optimal medical therapy (rate or rhythm) or atrioventricular node ablation and resynchronization.
Methods and results
MEDLINE database was searched from inception to 4 March 2021 by two reviewers (F.C. and M.C.) for relevant studies. The following key words were used: ‘atrial fibrillation’, ‘heart failure’, ‘ablation’, ‘medical’, ‘drug’, ‘rate’, ‘rhythm’, ‘resynchronization’, and ‘atrial flutter’. The co-primary outcomes were all-cause death and hospitalization for HF. A total of 16 studies enrolling 42 908 patients were included; of these, 9 were randomized controlled trials, 3 unadjusted observational studies, and 4 adjusted observational trials. Patients treated with catheter ablation had a statistically significant reduction for the risk of all-cause death {Figure on the left: odds ratio [OR]: 0.51, [95% confidence interval (CI): 0.31–0.84], P = 0.008, NNT 33} and hospitalization for HF [Figure on the right: OR: 0.52, (95% CI: 0.31–0.87), P 0.014, NNT 24]. Subgroup analysis confirmed these results only in HF with reduced ejection fraction subgroup. Meta-regression analyses showed a direct correlation between a higher burden of persistent/long-standing persistent AF and the positive impact of catheter ablation of AF. Moreover, the age of 70 years emerged as the cut-off age for a greater impact of catheter ablation.
Conclusions
Catheter ablation of AF is associated with a lower risk of all-cause death and HF hospitalizations in patients with AF and HF, as compared to medical therapy or atrioventricular node ablation and resynchronization. These results are mainly applicable for HF with reduced ejection fraction.
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Affiliation(s)
- Gaetano Liccardo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sara Bombace
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Maccallini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandro Villaschi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Pinto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Fabio Fazzari
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniela Pini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Riccardo Cappato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Arrhythmia and Clinical Electrophysiology Center, IRCCS, Multimedica Group, Sesto San Giovanni, Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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19
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Fazzari F, Cozzi O, Maurina M, Donghi V, Indolfi E, Curzi M, Leone PP, Cannata F, Stefanini GG, Chiti A, Bragato RM, Monti L, Rossi A. In-hospital prognostic role of coronary atherosclerotic burden in COVID-19 patients. J Cardiovasc Med (Hagerstown) 2021; 22:818-827. [PMID: 34261078 DOI: 10.2459/jcm.0000000000001228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Currently, there are few available data regarding a possible role for subclinical atherosclerosis as a risk factor for mortality in Coronavirus Disease 19 (COVID-19) patients. We used coronary artery calcium (CAC) score derived from chest computed tomography (CT) scan to assess the in-hospital prognostic role of CAC in patients affected by COVID-19 pneumonia. METHODS Electronic medical records of patients with confirmed diagnosis of COVID-19 were retrospectively reviewed. Patients with known coronary artery disease (CAD) were excluded. A CAC score was calculated for each patient and was used to categorize them into one of four groups: 0, 1-299, 300-999 and at least 1000. The primary endpoint was in-hospital mortality for any cause. RESULTS The final population consisted of 282 patients. Fifty-seven patients (20%) died over a follow-up time of 40 days. The presence of CAC was detected in 144 patients (51%). Higher CAC score values were observed in nonsurvivors [median: 87, interquartile range (IQR): 0.0-836] compared with survivors (median: 0, IQR: 0.0-136). The mortality rate in patients with a CAC score of at least 1000 was significantly higher than in patients without coronary calcifications (50 vs. 11%) and CAC score 1-299 (50 vs. 23%), P < 0.05. After adjusting for clinical variables, the presence of any CAC categories was not an independent predictor of mortality; however, a trend for increased risk of mortality was observed in patients with CAC of at least 1000. CONCLUSION The correlation between CAC score and COVID-19 is fascinating and under-explored. However, in multivariable analysis, the CAC score did not show an additional value over more robust clinical variables in predicting in-hospital mortality. Only patients with the highest atherosclerotic burden (CAC ≥1000) could represent a high-risk population, similarly to patients with known CAD.
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Affiliation(s)
- Fabio Fazzari
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Ottavia Cozzi
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Matteo Maurina
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Valeria Donghi
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Eleonora Indolfi
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Mirko Curzi
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Pier Pasquale Leone
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Francesco Cannata
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Giulio G Stefanini
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Arturo Chiti
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Renato Maria Bragato
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University
| | - Lorenzo Monti
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alexia Rossi
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, Rozzano
- Department of Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
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20
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Pinto G, Villaschi A, Sanz-Sanchez J, Fazzari F, Regazzoli D, Mangieri A, Pini D, Bragato RM, Colombo A, Reimers B, Condorelli G, Stefanini GG, Chiarito M, Cannata F. Transcatheter aortic valve replacement in severe aortic stenosis and cardiac amyloidosis: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical degenerative diseases of the elderly. According to recent studies, up to 16% of patients referred to transcatheter aortic valve replacement (TAVR) have a concomitant diagnosis of CA. Until recently, TAVR in patients with CA and AS has been considered futile, following the results of small observational studies. However, few studies recently suggested a beneficial impact of TAVR in patients with AS and CA as compared with medical therapy alone.
Purpose
To clarify the efficacy and safety profile of TAVR in CA-AS patients.
Methods
We performed a systematic review and meta-analysis of studies evaluating the risk of mortality after TAVR in CA-AS patients as compared with medical therapy. Moreover, we performed a systematic review and descriptive meta-analysis of studies reporting outcomes and complication rates of TAVR in CA-AS patients as compared with patients with AS alone.
Results
We identified 4 observational studies reporting data on mortality in CA-AS patients treated with either TAVR or medical therapy. Mortality was significantly lower in patients undergoing TAVR (OR 0.23, 95% CI 0.07–0.73, I2=0%, NNT=2.6) as compared with medical therapy. A sensitivity analysis with hazard ratio as effect estimate showed consistent results. Then, we identified 4 observational studies reporting data on mortality, re-hospitalizations and periprocedural complications of TAVR in CA-AS patients as compared with patients with AS alone. We found higher rates of mortality, cardiovascular hospitalization and need for permanent pacemaker implantation in CA-AS patients as compared to lone AS patients undergoing TAVR. Conversely, no differences were found in terms of stroke, acute kidney injury and vascular complications.
Conclusions
Our analysis rejects the idea of futility of TAVR in CA-AS patients showing a clear survival benefit of CA-AS patients undergoing TAVR as compared with medical therapy. Moreover, these patients may undergo TAVR with an acceptable procedural risk, that is substantially comparable to lone AS patients, except for a higher incidence of permanent pacemaker implantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Pinto
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - A Villaschi
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - J Sanz-Sanchez
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - F Fazzari
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - D Regazzoli
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - A Mangieri
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - D Pini
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - R M Bragato
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - A Colombo
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - B Reimers
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - G Condorelli
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - G G Stefanini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - M Chiarito
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - F Cannata
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
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21
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Fazzari F, Mantovani R, Donghi V, Curzi M, Bragato RM. From EACVI recommendations to the real-world experience: safety of performing echocardiography in the pandemic era. Eur Heart J Cardiovasc Imaging 2021; 22:e82-e83. [PMID: 33491077 DOI: 10.1093/ehjci/jeab010] [Citation(s) in RCA: 1] [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] [Received: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Fabio Fazzari
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089 Milano, Italy
| | - Riccardo Mantovani
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089 Milano, Italy
| | - Valeria Donghi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089 Milano, Italy
| | - Mirko Curzi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089 Milano, Italy
| | - Renato Maria Bragato
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089 Milano, Italy
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22
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Fazzari F, Figliozzi S, Bragato RM, Monti L. A huge atrial thrombus in a patient with bioprosthetic valve and atrial fibrillation: something went wrong with anticoagulation therapy. Eur Heart J 2021; 42:2315. [PMID: 33241319 DOI: 10.1093/eurheartj/ehaa804] [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)
- Fabio Fazzari
- Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Italy
| | - Stefano Figliozzi
- Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Italy
| | - Renato Maria Bragato
- Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Italy
| | - Lorenzo Monti
- Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Italy
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23
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Fazzari F, Rossetto L, Maria Bragato R, Curzi M, Donghi V, Mantovani R, Novo G, Fazzari F. Apparently Spontaneous Partial Rupture of Anterolateral Papillary Muscle Requiring Urgent Surgery. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.11.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Papillary muscle rupture is a rare complication of myocardial infarction. Here we describe a case of an
apparently spontaneous rupture of papillary muscle, not associated with coronary obstruction. The patient
was a 73-year-old man admitted to our hospital for diabetic ketoacidosis complicated by acute pulmonary
edema and cardiogenic shock. Transthoracic and transesophageal echocardiography showed partial rupture
of papillary muscle leading to severe mitral regurgitation. Urgent cardiac surgery with mitral valve
replacement was performed.
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24
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Giustiniano E, Padua E, Negri K, Bragato RM, Cecconi M. Echocardiography during Prone-Position Mechanical Ventilation in Patients with COVID-19: A Proposal for a New Approach. J Am Soc Echocardiogr 2020; 33:905-906. [PMID: 32448649 PMCID: PMC7191291 DOI: 10.1016/j.echo.2020.04.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Enrico Giustiniano
- Department of Anesthesia and Intensive Care Units, Humanitas Clinical and Research Hospital, IRCCS, Milan, Italy
| | - Eleonora Padua
- Department of Anesthesia and Intensive Care Units, Humanitas Clinical and Research Hospital, IRCCS, Milan, Italy
| | - Katerina Negri
- Department of Anesthesia and Intensive Care Units, Humanitas Clinical and Research Hospital, IRCCS, Milan, Italy
| | - Renato Maria Bragato
- Echocardiography Unit, Humanitas Clinical and Research Hospital, IRCCS, Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Units, Humanitas Clinical and Research Hospital, IRCCS, Milan, Italy; Humanitas University, Department of Biomedical Science, Milan, Italy
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25
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Lavanco V, Curzi M, Giustiniano E, Raspante D, Di Lisi D, Bragato RM. Perforated giant mycotic aneurysm of mitral valve in a drug-addicted young man: Rare complication of infective endocarditis. Echocardiography 2017; 35:129-131. [PMID: 29178314 DOI: 10.1111/echo.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Infective endocarditis (IE) affects patients at high clinical risk and may present as an acute and rapidly progressive, subacute or chronic infection. Transthoracic and transesophageal echocardiography represent the key diagnostic method in IE diagnosis. In particular, three-dimensional transesophageal echocardiography represents the imaging technique that allows to establish with adequate accuracy dimensions, shape, and localization of endocarditis vegetations. In our case, we show a huge vermiform mycotic aneurysm in an immunodeficient young drug-addicted man with severe mitral valve regurgitation and the additive value of three-dimensional transesophageal echocardiography in this specific clinical setting.
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Affiliation(s)
- Vincenzo Lavanco
- Cardiac Center Echo-lab, Humanitas Research Hospital, Rozzano, Italy
| | - Mirko Curzi
- Cardiac Center Echo-lab, Humanitas Research Hospital, Rozzano, Italy
| | - Enrico Giustiniano
- General Intensive Care Unit, Humanitas Research Hospital, Rozzano, Italy
| | | | - Daniela Di Lisi
- Cardiac Center Echo-lab, Humanitas Research Hospital, Rozzano, Italy
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26
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Fazzari F, Mantovani R, Curzi M, Raspante D, Bragato RM. Real-time three-dimensional trans-oesophageal echocardiography: a guidance in challenging endomyocardial biopsy-cardiac angiosarcoma involving upper and lower vena cava. Eur Heart J Cardiovasc Imaging 2016; 17:891. [PMID: 27099277 DOI: 10.1093/ehjci/jew080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabio Fazzari
- Division of Cardiology II, Section of Intensive Coronary Care Unit, Department of Internal Medicine and Cardiovascular Diseases, University Hospital 'Paolo Giaccone', Palermo, Italy
| | | | - Mirko Curzi
- IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
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27
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Cavallero E, Curzi M, Cioccarelli SA, Papalia G, Ornaghi D, Bragato RM. An Unusual Left Ventricular Apical Mass. J Cardiovasc Echogr 2014; 24:95-96. [PMID: 28465915 PMCID: PMC5353448 DOI: 10.4103/2211-4122.143986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Left ventricular apical masses constitute a rare finding. Imaging properties together with the clinical history of the patient usually allow an etiologic definition. We report a challenging case of an ambiguous left ventricular apical mass of uncertain nature till histological examination. Points of interest were singular clinical history and echocardiographic findings, although not conclusive in hypothesis generating. Furthermore to the best of our knowledge, this is one of the rare attempt to excise a deep left ventricular mass with a mini-invasive surgical approach.
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Affiliation(s)
- Erika Cavallero
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mirko Curzi
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Sara Anna Cioccarelli
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giulio Papalia
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Diego Ornaghi
- Heart Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Renato Maria Bragato
- Division of Echocardiography, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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28
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Bragato RM, La Marchesina U, Grimaldi A, Faletra F. [Clinical usefulenss of a saggital ultrasonography study of the left atrium: report of a case]. Ital Heart J Suppl 2001; 2:1117-20. [PMID: 11723616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Multiplane transesophageal echocardiography allows a more complete image of the complex anatomy of the left atrial appendage. In this study we describe a clinical case in which a "sagittal echocardiographic section" revealed a thrombus not imaged with the usual horizontal and longitudinal echocardiographic planes.
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Affiliation(s)
- R M Bragato
- Unità Operativa di Ecocardiografia, Istituto Clinico Humanitas, Rozzano, Via Manzoni, 56 20089 Rozzano
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29
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La Marchesina U, Bragato RM, Grimaldi A, Melzi G, Armino F, Faletra F. [Posterior echocardiography windows: usefulness in clinical practice]. Ital Heart J Suppl 2001; 2:158-60. [PMID: 11255884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Posterior cardiac structures cannot always be imaged by means of standard transthoracic echocardiography. Left pleural effusion leading to pulmonary atelectasis and/or to displacement of air-filled pulmonary tissue displacement, allows ultrasound transmission from a patient's back to his heart through a liquid interface. In this study we present the clinical usefulness of echocardiographic posterior windows for the diagnosis of constrictive pericarditis and aortic dissection in 2 patients in whom the standard transthoracic approach did not permit diagnostic imaging. We conclude that, in the case of left pleural effusion, the use of posterior windows should be encouraged.
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Affiliation(s)
- U La Marchesina
- Unità Operativa di Ecocardiografia, Istituto Clinico Humanitas, Via Manzoni, 56 20089 Rozzano, MI.
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