1
|
Pasceri V, Pelliccia F, Mehran R, Dangas G, Porto I, Radico F, Biancari F, D'Ascenzo F, Saia F, Luzi G, Bedogni F, Amat Santos IJ, De Marzo V, Dimagli A, Mäkikallio T, Stabile E, Blasco-Turrión S, Testa L, Barbanti M, Tamburino C, Fabiocchi F, Chilmeran A, Conrotto F, Costa G, Stefanini G, Spaccarotella C, Macchione A, La Torre M, Bendandi F, Juvonen T, Wańha W, Wojakowski W, Benedetto U, Indolfi C, Hildick-Smith D, Zimarino M. Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2024; 13:e032955. [PMID: 38533944 DOI: 10.1161/jaha.123.032955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk. METHODS AND RESULTS A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C-statistic 0.78 for TRITAVIpre and C-statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C-statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1-year mortality (from 6.9% to 54.4%; P=0.0001). CONCLUSIONS A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement.
Collapse
Affiliation(s)
| | | | | | | | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS Ospedale Policlinico San Martino Genoa Italy
| | | | - Fausto Biancari
- Department of Medicine South Karelia Central Hospital, University of Helsinki Lappeenranta Finland
| | - Fabrizio D'Ascenzo
- Department of Internal Medicine Città della Salute e della Scienza Turin Italy
| | - Francesco Saia
- Department of Cardiothoracic Vascular Surgery University Hospital Bologna Italy
| | - Giampaolo Luzi
- Cardiovascular Department Azienda Ospedaliera Regionale "San Carlo" Potenza Italy
| | - Francesco Bedogni
- Department of Cardiology IRCCS Policlinico San Donato, San Donato Milanese Milan Italy
| | - Ignacio J Amat Santos
- CIBERCV, Interventional Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | - Vincenzo De Marzo
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS Ospedale Policlinico San Martino Genoa Italy
- Department of Cardiology ASL2 Abruzzo Chieti Italy
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
| | - Timo Mäkikallio
- Department of Medicine South Karelia Central Hospital, University of Helsinki Lappeenranta Finland
| | - Eugenio Stabile
- Cardiovascular Department Azienda Ospedaliera Regionale "San Carlo" Potenza Italy
| | - Sara Blasco-Turrión
- CIBERCV, Interventional Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | - Luca Testa
- Department of Cardiology IRCCS Policlinico San Donato, San Donato Milanese Milan Italy
| | | | - Corrado Tamburino
- Division of Cardiology A.O.U. Policlinico "G. Rodolico-San Marco" Catania Italy
| | - Franco Fabiocchi
- Centro Cardiologico Monzino, IRCCS Milan Italy
- Galeazzi-Sant'Ambrogio Hospital, I.R.C.C.S Milan Italy
| | - Ahmed Chilmeran
- Department of Cardiology Royal Sussex County Hospital Brighton UK
| | - Federico Conrotto
- Department of Internal Medicine Città della Salute e della Scienza Turin Italy
| | - Giuliano Costa
- Division of Cardiology A.O.U. Policlinico "G. Rodolico-San Marco" Catania Italy
| | | | | | - Andrea Macchione
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Michele La Torre
- Department of Internal Medicine Città della Salute e della Scienza Turin Italy
| | - Francesco Bendandi
- Department of Cardiothoracic Vascular Surgery University Hospital Bologna Italy
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Central Hospital University of Helsinki Finland
| | - Wojciech Wańha
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia Katowice Poland
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases Medical University of Silesia Katowice Poland
| | - Umberto Benedetto
- Department of Cardiac Surgery University "G. d'Annunzio" Chieti Italy
| | - Ciro Indolfi
- Division of Cardiology University Magna Graecia Catanzaro Italy
| | | | - Marco Zimarino
- Department of Cardiology ASL2 Abruzzo Chieti Italy
- Department of Neuroscience, Imaging and Clinical Sciences 'G. D'Annunzio' University of Chieti-Pescara Italy
| |
Collapse
|
2
|
De Marzo V, Zimarino M. The value of transaxillary access for TAVI. Int J Cardiol 2024; 397:131448. [PMID: 37863435 DOI: 10.1016/j.ijcard.2023.131448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Vincenzo De Marzo
- Cardiology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Marco Zimarino
- Department of Cardiology, "SS.Annunziata Hospital", ASL 2 Abruzzo, Chieti, Italy; Department of Neuroscience, Imaging, and Clinical Sciences, University of Chieti-Pescara, Italy.
| |
Collapse
|
3
|
Canepa M, De Marzo V, Ameri P, Ferrari R, Tavazzi L, Rapezzi C, Porto I, Maggioni AP. Temporal trends in evidence supporting therapeutic interventions in heart failure and other European Society of Cardiology guidelines. ESC Heart Fail 2023; 10:3019-3027. [PMID: 37550897 PMCID: PMC10567640 DOI: 10.1002/ehf2.14459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/20/2023] [Accepted: 06/21/2023] [Indexed: 08/09/2023] Open
Abstract
AIMS This study aimed to determine whether any change occurred over time in level of evidence (LoE) of therapeutic interventions supporting heart failure (HF) and other European Society of Cardiology guideline recommendations. METHODS AND RESULTS We selected topics with at least three documents released between 2008 and April 2022. Classes of recommendations (CoR) and supporting LoE related to therapeutic interventions within each document were collected and compared over time. A total of 1822 recommendations from 18 documents on 6 topics [median number per document = 112, 867 (48%) CoR I] were included in the analysis. There was a trend towards a reduction over time in the percentage of CoR I in HF (46-36-34%), non-ST elevation myocardial infarction (NSTEMI; 78-58-54%), and pulmonary embolism (PE; 65-50-39%) guidelines, with a decrease in the total number of recommendations for HF only. Percentage of CoR I was stable over time around 40% for valvular heart disease (VHD) and atrial fibrillation (AF), and around 60% for cardiovascular prevention (CVP), with an increase in the total number of recommendations for VHD and CVP and a decrease for AF. Among CoR I, 319 (37%) were supported by LoE A, with a decrease over time for HF (56-46-42%), an increase for NSTEMI (29-38-48%) and AF (28-31-36%), a bimodal distribution for PE and CVP, and a lack for VHD. CONCLUSIONS LoE supporting therapeutic recommendations in contemporary European guidelines is generally low. Physicians should be aware of these limitations, and scientific societies promote a greater understanding of their significance and drive future research directions.
Collapse
Affiliation(s)
- Marco Canepa
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | | | - Pietro Ameri
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | - Roberto Ferrari
- Scientific DepartmentMTA GroupLuganoSwitzerland
- Azienda Ospedaliero‐Universitaria di Ferrara ‘Arcispedale S. Anna’FerraraItaly
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | - Claudio Rapezzi
- Azienda Ospedaliero‐Universitaria di Ferrara ‘Arcispedale S. Anna’FerraraItaly
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | - Italo Porto
- Cardiology UnitOspedale Policlinico San Martino IRCCSGenoaItaly
- Department of Internal MedicineUniversity of GenovaGenoaItaly
| | - Aldo Pietro Maggioni
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
- Centro Studi ANMCO, Heart Care FoundationFlorenceItaly
| |
Collapse
|
4
|
Rheude T, Costa G, Ribichini FL, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Ribeiro HB, Saia F, Bunc M, Tchétché D, Garot P, Mylotte D, Burzotta F, Watanabe Y, Bedogni F, Tesorio T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Xhepa E, Kargoli F, Tamburino C, Joner M, Barbanti M. Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2023; 19:589-599. [PMID: 37436190 PMCID: PMC10495747 DOI: 10.4244/eij-d-23-00186] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown. AIMS We sought to compare different PCI timing strategies in TAVI patients. METHODS The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method. RESULTS A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days. CONCLUSIONS In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.
Collapse
Affiliation(s)
- Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ignacio J Amat Santos
- CIBERCV, Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Matjaz Bunc
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Philippe Garot
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | | | - Francesco Burzotta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Tullio Tesorio
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | | | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Italo Porto
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Caterina Gandolfo
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda ospedaliera-universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Alessandro S Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | - Luigi Biasco
- Azienda Sanitaria Locale di Ciriè, Chivasso e Ivrea, ASL TO4, Ivrea, Italy
| | | | - Marco Zimarino
- Department of Cardiology, SS. Annunziata Hospital Chieti, ASL 2 Abruzzo, Chieti, Italy and Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | | | | | - Alexandre Gautier
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Galway University Hospital, Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Vincenzo De Marzo
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Elisa Piredda
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Stefano Cannata
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | | | | | | | | | | | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Erion Xhepa
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Michael Joner
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
- Università degli Studi di Enna "Kore", Enna, Italy
| |
Collapse
|
5
|
De Marzo V, Savarese G, Porto I, Metra M, Ameri P. Efficacy of SGLT2-inhibitors across different definitions of heart failure with preserved ejection fraction. J Cardiovasc Med (Hagerstown) 2023; 24:537-543. [PMID: 37409599 DOI: 10.2459/jcm.0000000000001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
AIMS Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been evaluated in phase 3 randomized-controlled trials (RCTs) that enrolled individuals with heart failure and preserved ejection fraction (HFpEF) based on detailed clinical, biochemical, and echocardiographic criteria (hereafter HF-RCTs), and in cardiovascular outcomes trials (CVOTs) in diabetic patients, in which the diagnosis of HFpEF relied on medical history. METHODS AND RESULTS We performed a study-level meta-analysis of the efficacy of SGLT2i across different definitions of HFpEF. Three HF-RCTs (EMPEROR-Preserved, DELIVER, and SOLOIST-WHF) and four CVOTs (EMPA-REG OUTCOME, DECLARE-TIMI 58, VERTIS-CV, and SCORED) were included, for a total of 14 034 patients. SGLT2i reduced the risk of cardiovascular death or heart failure hospitalization (HFH) in all RCTs pooled together [risk ratio 0.75, 95% confidence interval (95% CI) 0.63-0.89, NNT 19], in HF-RCTs (risk ratio 0.71, 95% CI 0.52-0.97, NNT 13), and in CVOTs (risk ratio 0.78, 95% CI 0.60-0.99, NNT 26). SGLT2i also decreased the risk of HFH in all RCTs (risk ratio 0.81, 95% CI 0.73-0.90, NNT 45), in HF-RCTs (risk ratio 0.81, 95% CI 0.72-0.93, NNT 37), and in CVOTs (risk ratio 0.78, 95% CI 0.61-0.99, NNT 46). By contrast, SGLT2i were not superior to placebo for cardiovascular death or all-cause death in all RCTs, HF-RCTs, or CVOTs. Results were comparable after excluding one RCT at a time. Meta-regression analysis confirmed that the type of RCT (HF-RCT vs. CVOT) did not influence the SGLT2i effect. CONCLUSIONS In RCTs, SGLT2i improved the outcomes of patients with HFpEF regardless of how the latter was diagnosed.
Collapse
Affiliation(s)
- Vincenzo De Marzo
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Italo Porto
- Department of Internal Medicine, University of Genova, Genova, Italy
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova
| | - Marco Metra
- Cardiology Unit, ASST Spedali Civili
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova
| |
Collapse
|
6
|
De Marzo V, Viglino U, Zecchino S, Matos JG, Piredda E, Pigati M, Vercellino M, Crimi G, Balbi M, Seitun S, Porto I. Supra-renal aortic atheroma extent and composition predict acute kidney injury after transcatheter aortic valve replacement: A three-dimensional computed tomography study. Int J Cardiol 2023; 381:8-15. [PMID: 37001646 DOI: 10.1016/j.ijcard.2023.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Acute kidney injury (AKI) may complicate transcatheter aortic valve replacement (TAVR) and could be linked to atheroembolization associated with catheter manipulation in the supra-renal (SR) aorta. We sought to determine the impact of SR aortic atheroma burden (SR-AAB) and composition, as well as of the aortic valve calcium score (AV-CS), measured at pre-operative multislice computed tomography (PO-MSCT), on AKI-TAVR. METHODS All TAVR-patients 3 January-2018 to December-2020 were included. A three-dimensional analysis of PO-MSCT was performed, calculating percentage SR-AAB (%SR-AAB) as [(absolute SR-AAB volume)*100/vessel volume]. Types of plaque were defined according to Hounsfield unit (HU) intensity ranges. Calcified plaque was subcategorized into 3 strata: low- (351-700 HU), mid- (701-1000 HU), and high‑calcium (>1000 HU, termed 1 K-plaque). RESULTS The study population included 222 patients [mean age 83.3 ± 5.7 years, 95 (42.8%) males], AKI-TAVR occurred in 67/222 (30.2%). Absolute SR-AAB (41.3 ± 16.4 cm3 vs. 32.5 ± 10.7 cm3,p < 0.001) and %SR-AAB (17.6 ± 5.1% vs. 13.9 ± 4.3%,p < 0.001) were significantly higher in patients developing AKI-TAVR. Patients who developed AKI-TAVR had higher mid‑calcium (6.9 ± 3.8% vs. 4.2 ± 3.5%,p < 0.001) and 1 K-plaque (5.4 ± 3.7% vs. 2.4 ± 2.4%,p < 0.001) with no difference in AV-CS (p = 0.691). Adjusted multivariable logistic regression analysis showed that %SR-AAB [OR (x%increase): 1.12, 95%CI: 1.04-1.22,p = 0.006] and %SR-calcified plaque [OR (x%increase): 5.60, 95%CI: 2.50-13.36,p < 0.001] were associated with AKI-TAVR. Finally, 3-knots spline analyses identified %SR-AAB >15.0% and %SR-calcified plaque >7.0% as optimal thresholds to predict an increased risk of AKI-TAVR. CONCLUSIONS Suprarenal aortic atheroma, when highly calcified, is associated with AKI-TAVR. Perioperative-MSCT assessment of aortic atherosclerosis may help in identification of patients at high-risk for AKI-TAVR, who could benefit from higher peri-operative surveillance.
Collapse
Affiliation(s)
- Vincenzo De Marzo
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Umberto Viglino
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Zecchino
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Joao Gavina Matos
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Piredda
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Maria Pigati
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Vercellino
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Gabriele Crimi
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy
| | - Manrico Balbi
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy; Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Seitun
- Radiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Italy; Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| |
Collapse
|
7
|
De Marzo V, Savarese G, Porto I, Metra M, Ameri P. 1113 EFFICACY OF SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS IN HEART FAILURE WITH PRESERVED EJECTION FRACTION ACROSS DIFFERENT DEFINITIONS: A META-ANALYSIS OF PHASE 3 RANDOMIZED CONTROLLED TRIALS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.452] [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
Sodium glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve the prognosis of heart failure with preserved ejection fraction (HFpEF) in phase 3 randomized controlled trials (RCTs). However, a granular definition of HF was adopted only in the most recent RCTs (hereafter, HF RCTs). In earlier studies, which assessed cardiovascular (CV) outcomes in patients with type 2 diabetes (CV outcomes trials, CVOTs), HF status was assigned based on medical history.
Methods
We searched for RCTs evaluating SGLT2i vs placebo in HFpEF and published from inception to Aug. 31st 2022, irrespective of whether additional criteria were used to define HFpEF besides left ventricular ejection fraction ≥50%. Heterogeneity between studies was examined by the Cochran's Q test and Higgins and Thompsons’ I2 statistics. Risk ratios (RRs) with 95% confidence intervals (95%CI) and number needed to treat (NNT) were calculated with a random-effects model (moderate-to-high heterogeneity) or a Mantel-Haenszel fixed-effect model (low heterogeneity) using R 4.2.1.
Results
Seven RCTs were included in the meta-analysis: 3 HF RCTs (EMPEROR-Preserved, DELIVER, and SOLOIST-WHF) and 4 CVOTs (EMPA-REG OUTCOME, DECLARE-TIMI58, VERTIS-CV, and SCORED). The overall population included 14,644 patients, and the mean follow-up was 29.8±14.5 months (range: 9.0-50.4 months). The risk of the composite outcome of CV death or HF hospitalization (HFH) was significantly reduced by SLGT2i as compared with placebo (RR 0.75, 95%CI 0.63-0.89, I2=59.7%, NNT 19). The benefit was confirmed in HF RCTs (RR and 95%CI displayed in the Figure; I2=75.7%, NNT 13) and CVOTs (Figure; I2=56.9%, NNT 26). Based on the available data (i.e., only some of the selected studies), SGLT2i also had a positive effect on HFH (RR 0.81, 95%CI 0.73-0.90, I2=18.1%, NNT 45), which was maintained in both HF RCTs (Figure; I2=18.1%, NNT 37) and CVOTs (Figure; I2=0.0% and NNT 46, respectively). The effect on CV or all-cause death was neutral in all RCTs (RR 0.94, 95%CI 0.85-1.04, I2=36.0%; and RR 1.00, 95%CI 0.92-1.08, I2=0.0%, respectively), and in HF RCTs or CVOTs considered separately (Figure).
Conclusions
The efficacy of SGLT2i was consistent across RCTs with a stricter or simpler definition of HFpEF, supporting an extensive clinical use.
Collapse
Affiliation(s)
- Vincenzo De Marzo
- Department Of Internal Medicine, University Of Genova , Genova , Italy
| | - Gianluigi Savarese
- Division Of Cardiology, Department Of Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Italo Porto
- Department Of Internal Medicine, University Of Genova , Genova , Italy
- Cardiology Unit, Cardio-Thoracic And Vascular Department, Irccs Ospedale Policlinico San Martino , Genova , Italy
| | - Marco Metra
- Division Of Cardiology, Department Of Medical And Surgical Specialties, Radiological Sciences And Public Health, University Of Brescia , Brescia , Italy
| | - Pietro Ameri
- Department Of Internal Medicine, University Of Genova , Genova , Italy
- Cardiology Unit, Cardio-Thoracic And Vascular Department, Irccs Ospedale Policlinico San Martino , Genova , Italy
| |
Collapse
|
8
|
Ameri P, De Marzo V, Zoccai GB, Tricarico L, Correale M, Brunetti ND, Canepa M, De Ferrari GM, Castagno D, Porto I. Efficacy of new medical therapies in patients with heart failure, reduced ejection fraction, and chronic kidney disease already receiving neurohormonal inhibitors: a network meta-analysis. Eur Heart J Cardiovasc Pharmacother 2022; 8:768-776. [PMID: 34928347 DOI: 10.1093/ehjcvp/pvab088] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022]
Abstract
AIMS We assessed the efficacy of the drugs developed after neurohormonal inhibition (NEUi) in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant chronic kidney disease (CKD). METHODS AND RESULTS The literature was systematically searched for phase 3 randomized controlled trials (RCTs) involving ≥90% patients with left ventricular ejection fraction <45%, of whom <30% were acutely decompensated, and with published information about the subgroup of estimated glomerular filtration rate <60 mL/min/1.73 m2. Six RCTs were included in a study-level network meta-analysis evaluating the effect of NEUi, ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter-2 inhibitors (SGLT2i), vericiguat, and omecamtiv mecarbil (OM) on a composite outcome of cardiovascular death or hospitalization for HF. In a fixed-effects model, SGLT2i [hazard ratio (HR) 0.78, 95% credible interval (CrI) 0.69-0.89], ARNI (HR 0.79, 95% CrI 0.69-0.90), and ivabradine (HR 0.82, 95% CrI 0.69-0.98) decreased the risk of the composite outcome vs. NEUi, whereas OM did not (HR 0.98, 95% CrI 0.89-1.10). A trend for improved outcome was also found for vericiguat (HR 0.90, 95% CrI 0.80-1.00). In indirect comparisons, both SLGT2i (HR 0.80, 95% CrI 0.68-0.94) and ARNI (HR 0.80, 95% CrI 0.68-0.95) reduced the risk vs. OM; furthermore, there was a trend for a greater benefit of SGLT2i vs. vericiguat (HR 0.88, 95% CrI 0.73-1.00) and ivabradine vs. OM (HR 0.84, 95% CrI 0.68-1.00). Results were comparable in a random-effects model and in sensitivity analyses. Surface under the cumulative ranking area scores were 81.8%, 80.8%, 68.9%, 44.2%, 16.6%, and 7.8% for SGLT2i, ARNI, ivabradine, vericiguat, OM, and NEUi, respectively. CONCLUSION Expanding pharmacotherapy beyond NEUi improves outcomes in HFrEF with CKD.
Collapse
Affiliation(s)
- Pietro Ameri
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.,Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Vincenzo De Marzo
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.,Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Lucia Tricarico
- Cardiology Unit, Ospedali Riuniti di Foggia, Foggia, Italy.,University of Foggia, Foggia, Italy
| | | | - Natale Daniele Brunetti
- Cardiology Unit, Ospedali Riuniti di Foggia, Foggia, Italy.,University of Foggia, Foggia, Italy
| | - Marco Canepa
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.,Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy.,Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| |
Collapse
|
9
|
Costa G, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Barbosa Ribeiro H, Saia F, Bunc M, Tchetche D, Garot P, Ribichini FL, Mylotte D, Burzotta F, Watanabe Y, De Marco F, Tesorio T, Rheude T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Joner M, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Kargoli F, Tamburino C, Barbanti M. Management of Myocardial Revascularization in Patients With Stable Coronary Artery Disease Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2022; 15:e012417. [PMID: 36538579 DOI: 10.1161/circinterventions.122.012417] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The best management of stable coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear due to the marked inconsistency of the available evidence. METHODS The REVASC-TAVI registry (Management of Myocardial Revascularization in Patients Undergoing Transcatheter Aortic Valve Implantation With Coronary Artery Disease) collected data from 30 centers worldwide on patients undergoing TAVI who had significant, stable CAD at preprocedural work-up. For the purposes of this analysis, patients with either complete or incomplete myocardial revascularization were compared in a propensity score matched analysis, to take into account of baseline confounders. The primary and co-primary outcomes were all-cause death and the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure, respectively, at 2 years. RESULTS Among 2407 patients enrolled, 675 pairs of patients achieving complete or incomplete myocardial revascularization were matched. The primary (21.6% versus 18.2%, hazard ratio' 0.88 [95% CI, 0.66-1.18]; P=0.38) and co-primary composite (29.0% versus 27.1%, hazard ratio' 0.97 [95% CI, 0.76-1.24]; P=0.83) outcome did not differ between patients achieving complete or incomplete myocardial revascularization, respectively. These results were consistent across different prespecified subgroups of patients (< or >75 years of age, Society of Thoracic Surgeons score > or <4%, angina at baseline, diabetes, left ventricular ejection fraction > or <40%, New York Heart Association class I/II or III/IV, renal failure, proximal CAD, multivessel CAD, and left main/proximal anterior descending artery CAD; all P values for interaction >0.10). CONCLUSIONS The present analysis of the REVASC-TAVI registry showed that, among TAVI patients with significant stable CAD found during the TAVI work-up, completeness of myocardial revascularization achieved either staged or concomitantly with TAVI was similar to a strategy of incomplete revascularization in reducing the risk of all cause death, as well as the risk of death, stroke, myocardial infarction, and rehospitalization for heart failure at 2 years, regardless of the clinical and anatomical situations.
Collapse
Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Ignacio J Amat Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.C.)
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Won-Keun Kim
- Kerckhoff Heart Center, Bad Nauheim, Germany (W.-K.K.)
| | | | - Francesco Saia
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Matjaz Bunc
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Philippe Garot
- Institute cardiovasculaire Paris Sud, Massy, France (P.G., A.G.)
| | - Flavio Luciano Ribichini
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | | | - Francesco Burzotta
- IRCSS Policlinico Universitario "Agostino Gemelli," Università Cattolica del Sacro Cuore, Roma, Italy (F.B.)
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Federico De Marco
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Tullio Tesorio
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy (M.T.)
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Roberto Valvo
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Italo Porto
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, UOSA Cardiologia Interventistica, Policlinico Le Scotte, Siena, Italy (A.I.)
| | - Alessandro Santo Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | - Markus Mach
- Wien University Hospital, Austria (M.M., M.A.)
| | - Azeem Latib
- Montefiore Medical Center, New York (A.L., F.K.)
| | - Luigi Biasco
- Azienda sanitaria locale di Ciriè, Chivasso e Ivrea, ASLTO4, Italy (L.B.)
| | - Maurizio Taramasso
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Switzerland (M.T.)
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Switzerland (T.P., D.T.)
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copehagen University Hospital, Denmark (O.D.B., P.N., L.S.)
| | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Brazil (H.B.R., S.F.C.)
| | - Tullio Palmerini
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | - Mateusz Orzalkiewicz
- Dipartimento Cardiovascolare, Policlinico S. Orsola, University of Bologna, Italy (F.S., T.P., M.O.)
| | | | | | | | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.)
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Italy (F.L.R., P.A.D.S., A.M., M.P., M.L.).,Galway University Hospital, Ireland (D.M., M.L.)
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W., H.K.)
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Vincenzo Cesario
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese (MI), Italy (F.D.M., E.C., V.C.)
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano (AV), Italy (T.T., F.B., F.Z.)
| | | | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Germany (H.W., M.A., E.G., S.B.)
| | - Vincenzo De Marzo
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Elisa Piredda
- CardioThoracic and Vascular department, San Martino Policlinico Hospital, Genova, Italy (I.P., V.D.M., E.P.)
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy (C.G., S.C.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy (A.S.B., F.I.)
| | | | | | - Elena Dipietro
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | | | | | - Silvia Motta
- University of Catania, Italy (R.V., E.D., C.R., O.S., S.M.)
| | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Italy (A.F., G.E., D.A.)
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy (G.C., C.S., C.T., M.B.)
| | - Marco Barbanti
- University Medical Centre Ljubljana, Slovenia (M.B., K.S.)
| | | |
Collapse
|
10
|
Di Fusco SA, Maggioni AP, Bernelli C, Perone F, De Marzo V, Conte E, Musella F, Uccello G, Luca LD, Gabrielli D, Gulizia MM, Oliva F, Colivicchi F. Inclisiran: A New Pharmacological Approach for Hypercholesterolemia. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2311375] [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
|
11
|
Crimi G, De Marzo V, De Marco F, Conrotto F, Oreglia J, D'Ascenzo F, Testa L, Gorla R, Esposito G, Sorrentino S, Spaccarotella C, Soriano F, Bruno F, Vercellino M, Balbi M, Morici N, Indolfi C, De Ferrari GM, Bedogni F, Porto I. Acute Kidney Injury After Transcatheter Aortic Valve Replacement Mediates the Effect of Chronic Kidney Disease. J Am Heart Assoc 2022; 11:e024589. [PMID: 36172945 DOI: 10.1161/jaha.121.024589] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. However, it is controversial whether AKI affects prognosis per se, being linked to baseline chronic kidney disease (CKD) and bleeding complications. The aim of this study was to disentangle, applying mediation analysis, the association between AKI and clinical outcome, considering CKD and bleedings. Methods and Results Consecutive patients undergoing TAVR were prospectively enrolled at 5 high-volume centers in Italy. AKI was defined according to Valve Academic Research Consortium-3 consensus, whereas bleeding with Bleeding Academic Research Consortium. Primary outcome was all-cause mortality after 1-year follow-up. Among 2621 patients undergoing TAVR, AKI occurrence was associated with 1-year mortality. This association of AKI with the primary end points remained significant after adjusting for baseline risk estimators, either Society of Thoracic Surgeons score (hazard ratio [HR], 2.78 [95% CI, 1.95-3.80], P<0.001) or EuroSCORE-II (HR, 1.85 [95% CI, 1.35-2.56], P<0.001). Both AKI and CKD significantly and independently affected primary outcome (HR, 3.06 [95% CI, 2.01-4.64], P<0.001 and HR, 1.82 [95% CI 1.27-2.65], P<0.01, respectively). The estimated proportion of the total effect of CKD mediated via AKI was, on average, 15%, 95% CI, 4%-29%, P<0.001. The significant effect of Bleeding Academic Research Consortium 2-5 bleedings on the primary outcome was not mediated by AKI. Conclusions AKI occurs in 1 out of 6 patients and significantly mediates one fifth of the effect of baseline CKD on all-cause mortality after TAVR. Our analysis supports a systematic effort to prevent AKI during TAVR, which may potentially translate into improved patients' 1-year survival.
Collapse
Affiliation(s)
- Gabriele Crimi
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy
| | - Vincenzo De Marzo
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy.,Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
| | - Federico De Marco
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Federico Conrotto
- Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Città della Salute e della Scienza Turin Italy
| | - Jacopo Oreglia
- Cardiology I, "A. De Gasperis" Department Ospedale Niguarda Ca' Granda Milan Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Città della Salute e della Scienza Turin Italy
| | - Luca Testa
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Riccardo Gorla
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Giuseppe Esposito
- Cardiology I, "A. De Gasperis" Department Ospedale Niguarda Ca' Granda Milan Italy
| | - Sabato Sorrentino
- Division of Cardiology, Department of Medical and Surgical Sciences, Catanzaro Italian Society of Cardiology (SIC) Magna Graecia University Catanzaro Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, Catanzaro Italian Society of Cardiology (SIC) Magna Graecia University Catanzaro Italy
| | - Francesco Soriano
- Cardiology I, "A. De Gasperis" Department Ospedale Niguarda Ca' Granda Milan Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Città della Salute e della Scienza Turin Italy
| | - Matteo Vercellino
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy
| | - Manrico Balbi
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy.,Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
| | - Nuccia Morici
- Cardiology I, "A. De Gasperis" Department Ospedale Niguarda Ca' Granda Milan Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Catanzaro Italian Society of Cardiology (SIC) Magna Graecia University Catanzaro Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department University of Turin, Città della Salute e della Scienza Turin Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa Italy.,Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties University of Genoa Italy
| |
Collapse
|
12
|
De Marzo V, Savarese G, Tricarico L, Hassan S, Iacoviello M, Porto I, Ameri P. Network meta-analysis of medical therapy efficacy in more than 90,000 patients with heart failure and reduced ejection fraction. J Intern Med 2022; 292:333-349. [PMID: 35332595 PMCID: PMC9546056 DOI: 10.1111/joim.13487] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND Following the availability of new drugs for chronic heart failure (HF) with reduced ejection fraction (HFrEF), we sought to provide an updated and comparative synthesis of the evidence on HFrEF pharmacotherapy efficacy. METHODS We performed a Bayesian network meta-analysis of phase 2 and 3 randomized controlled trials (RCTs) of medical therapy in HFrEF patient cohorts with more than 90% of the participants with left ventricular ejection fraction less than 45% and all-cause mortality reported. RESULTS Sixty-nine RCTs, accounting for 91,741 subjects, were evaluated. The step-wise introduction of new drugs progressively decreased the risk of all-cause death, up to reaching a random-effects hazard ratio (HR) of 0.43 (95% credible intervals [CrI] 0.27-0.63) with beta blockers (BB), angiotensin-converting enzyme inhibitors (ACEi), and mineralocorticoid receptor antagonist (MRA) versus placebo. The risk was further reduced by adding sodium-glucose cotransporter-2 inhibitors (SGLT2i; HR 0.38, 95% CrI 0.22-0.60), ivabradine (HR 0.39, 95% CrI 0.21-0.64), or vericiguat (HR 0.40, 95% CrI 0.22-0.65) to neurohormonal inhibitors, and by angiotensin receptor-neprilysin inhibitor (ARNI), BB, and MRA (HR 0.36, 95% CrI 0.20-0.60). In a sensitivity analysis considering the ARNI and non-ARNI subgroups of SGLT2i RCTs, the combination SGLT2i + ARNI + BB + MRA was associated with the lowest HR (0.28, 95% CrI 0.16-0.45 vs. 0.40, 95% CrI 0.24-0.60 for SGLT2i + BB + ACEi + MRA). Consistent results were obtained in sensitivity analyses and by calculating surface under the cumulative ranking area, as well as for cardiovascular mortality (information available for 56 RCTs), HF hospitalization (45 RCTs), and all-cause hospitalization (26 RCTs). CONCLUSIONS Combination medical therapy including neurohormonal inhibitors and newer drugs, especially ARNI and SGLT2i, confers the maximum benefit with regard to HFrEF prognosis.
Collapse
Affiliation(s)
- Vincenzo De Marzo
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lucia Tricarico
- Cardiology Unit, Ospedali Riuniti di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Sofia Hassan
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Ospedali Riuniti di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genova, Genova, Italy.,Cardiology Unit, Cardio-Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy.,Cardiology Unit, Cardio-Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| |
Collapse
|
13
|
Licordari R, Sticchi A, Mancuso F, Caracciolo A, Muscoli S, Iacovelli F, Ruggiero R, Scoccia A, Cammalleri V, Pavani M, Loffi M, Scordino D, Ferro J, Rognoni A, Buono A, Nava S, Albani S, Colaiori I, Zilio F, Borghesi M, Regazzoni V, Benenati S, Pescetelli F, De Marzo V, Mannarini A, Spione F, Baldassarre D, De Benedictis M, Bonmassari R, Danzi GB, Galli M, Ielasi A, Musumeci G, Tomai F, Pasceri V, Porto I, Patti G, Campo G, Colombo A, Micari A, Giannini F, Costa F. The Incidence and Impact of In-Hospital Bleeding in Patients with Acute Coronary Syndrome during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11102926. [PMID: 35629052 PMCID: PMC9146584 DOI: 10.3390/jcm11102926] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The COVID-19 pandemic increased the complexity of the clinical management and pharmacological treatment of patients presenting with an Acute Coronary Syndrome (ACS). Aim: to explore the incidence and prognostic impact of in-hospital bleeding in patients presenting with ACS before and during the COVID-19 pandemic. Methods: We evaluated in-hospital Thrombolysis In Myocardial Infarction (TIMI) major and minor bleeding among 2851 patients with ACS from 17 Italian centers during the first wave of the COVID-19 pandemic (i.e., March–April 2020) and in the same period in the previous two years. Results: The incidence of in-hospital TIMI major and minor bleeding was similar before and during the COVID-19 pandemic. TIMI major or minor bleeding was associated with a significant threefold increase in all-cause mortality, with a similar prognostic impact before and during the COVID-19 pandemic. Conclusions: the incidence and clinical impact of in-hospital bleeding in ACS patients was similar before and during the COVID-19 pandemic. We confirmed a significant and sizable negative prognostic impact of in-hospital bleeding in ACS patients.
Collapse
Affiliation(s)
- Roberto Licordari
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Alessandro Sticchi
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
- Centro per la Lotta Contro L’Infarto (CLI) Foundation, 00182 Rome, Italy
- Department of Cardiology, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | - Filippo Mancuso
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, 00133 Rome, Italy; (S.M.); (V.C.)
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 072006 Bari, Italy; (F.I.); (A.M.); (F.S.)
| | - Rossella Ruggiero
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 30010 Cona, Italy;
| | - Alessandra Scoccia
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 30010 Cona, Italy;
| | - Valeria Cammalleri
- Department of Cardiovascular Disease, Tor Vergata University, 00133 Rome, Italy; (S.M.); (V.C.)
| | - Marco Pavani
- Department of Cardiology, Ospedale Civile SS Annunziata, 12038 Savigliano, Italy; (M.P.); (D.B.); (M.D.B.)
| | - Marco Loffi
- Department of Cardiology, Ospedale di Cremona, 26100 Cremona, Italy; (M.L.); (V.R.); (G.B.D.)
| | - Domenico Scordino
- Division of Cardiology, Aurelia Hospital, 00165 Rome, Italy; (D.S.); (F.T.)
| | - Jayme Ferro
- U.O.S.D. Cardiologia-Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, 22100 Como, Italy; (J.F.); (M.G.)
| | - Andrea Rognoni
- Department of Cardiology, Azienda Ospedaliero–Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.R.); (G.P.)
| | - Andrea Buono
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (A.B.); (A.I.)
| | - Stefano Nava
- Division of Invasive Cardiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Stefano Albani
- Department of Cardiology, Mauriziano Hospital, 10128 Turin, Italy; (S.A.); (G.M.)
| | - Iginio Colaiori
- Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Filippo Zilio
- U.O.C. Cardiologia, Ospedale Santa Chiara, 38121 Trento, Italy; (F.Z.); (M.B.); (R.B.)
| | - Marco Borghesi
- U.O.C. Cardiologia, Ospedale Santa Chiara, 38121 Trento, Italy; (F.Z.); (M.B.); (R.B.)
| | - Valentina Regazzoni
- Department of Cardiology, Ospedale di Cremona, 26100 Cremona, Italy; (M.L.); (V.R.); (G.B.D.)
| | - Stefano Benenati
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Fabio Pescetelli
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Vincenzo De Marzo
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Antonia Mannarini
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 072006 Bari, Italy; (F.I.); (A.M.); (F.S.)
| | - Francesco Spione
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, 072006 Bari, Italy; (F.I.); (A.M.); (F.S.)
| | - Doronzo Baldassarre
- Department of Cardiology, Ospedale Civile SS Annunziata, 12038 Savigliano, Italy; (M.P.); (D.B.); (M.D.B.)
| | - Michele De Benedictis
- Department of Cardiology, Ospedale Civile SS Annunziata, 12038 Savigliano, Italy; (M.P.); (D.B.); (M.D.B.)
| | - Roberto Bonmassari
- U.O.C. Cardiologia, Ospedale Santa Chiara, 38121 Trento, Italy; (F.Z.); (M.B.); (R.B.)
| | - Gian Battista Danzi
- Department of Cardiology, Ospedale di Cremona, 26100 Cremona, Italy; (M.L.); (V.R.); (G.B.D.)
| | - Mario Galli
- U.O.S.D. Cardiologia-Laboratorio di Emodinamica, Dipartimento di Emergenza, Rianimazione e Anestesia, ASST Lariana, Ospedale S. Anna, 22100 Como, Italy; (J.F.); (M.G.)
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant’Ambrogio, 20149 Milan, Italy; (A.B.); (A.I.)
| | - Giuseppe Musumeci
- Department of Cardiology, Mauriziano Hospital, 10128 Turin, Italy; (S.A.); (G.M.)
| | - Fabrizio Tomai
- Division of Cardiology, Aurelia Hospital, 00165 Rome, Italy; (D.S.); (F.T.)
| | - Vincenzo Pasceri
- Department of Cardiology, San Filippo Neri Roma, 00135 Rome, Italy;
| | - Italo Porto
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (S.B.); (F.P.); (V.D.M.); (I.P.)
| | - Giuseppe Patti
- Department of Cardiology, Azienda Ospedaliero–Universitaria Maggiore della Carità, 28100 Novara, Italy; (A.R.); (G.P.)
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 30010 Cona, Italy;
| | - Antonio Colombo
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
| | - Antonio Micari
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
| | - Francesco Giannini
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (A.S.); (R.R.); (A.S.); (A.C.); (F.G.)
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic “G Martino”, University of Messina, 98124 Messina, Italy; (R.L.); (F.M.); (A.C.); (A.M.)
- Correspondence:
| |
Collapse
|
14
|
Barbara C, Clavario P, De Marzo V, Lotti R, Guglielmi G, Porcile A, Russo C, Griffo R, Mäkikallio T, Hautala AJ, Porto I. Effects of exercise rehabilitation in patients with long COVID-19. Eur J Prev Cardiol 2022; 29:e258-e260. [PMID: 35078233 PMCID: PMC8807301 DOI: 10.1093/eurjpc/zwac019] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Cristina Barbara
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Piero Clavario
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Vincenzo De Marzo
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa Italy
| | - Roberta Lotti
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa Italy
| | - Giulia Guglielmi
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa Italy
| | - Annalisa Porcile
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Carmelo Russo
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Raffaele Griffo
- Cardiac Rehabilitation Center of Genoa,Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Timo Mäkikallio
- Faculty of Sports and Health Sciences, University of Jyväskylä, Finland
| | - Arto Jorma Hautala
- Cardiovascular Research Group, Division of Cardiology, Oulu University Hospital,University of Oulu, Finland
| | - Italo Porto
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa Italy
| |
Collapse
|
15
|
Gilad V, De Marzo V, Guglielmi G, Bona RD, Giovinazzo S, Pescetelli F, Valbusa A, Bezante GP, De Maria A, Patroniti N, Ferone D, Pelosi P, Bassetti M, Porto I. Cardiac point-of-care ultrasound in hospitalized coronavirus disease-2019 patients: findings and association with outcome. J Cardiovasc Med (Hagerstown) 2022; 23:e3-e7. [PMID: 34690260 PMCID: PMC8654100 DOI: 10.2459/jcm.0000000000001177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Vered Gilad
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
| | - Vincenzo De Marzo
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
- Department of Internal Medicine and Medical Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa
| | - Giulia Guglielmi
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
- Department of Internal Medicine and Medical Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa
| | - Roberta Della Bona
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
| | - Stefano Giovinazzo
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
| | - Fabio Pescetelli
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
- Department of Internal Medicine and Medical Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa
| | - Alberto Valbusa
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
| | - Gian Paolo Bezante
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
| | - Andrea De Maria
- Infectious Diseases Unit, San Martino Hospital, IRCCS for Oncology and Neurosciences
- Department of Health Sciences (DISSAL), University of Genoa
| | - Nicolò Patroniti
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa
| | - Diego Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DIMI) and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa
| | - Matteo Bassetti
- Infectious Diseases Unit, San Martino Hospital, IRCCS for Oncology and Neurosciences
- Department of Health Sciences (DISSAL), University of Genoa
| | - Italo Porto
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
- Department of Internal Medicine and Medical Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa
| |
Collapse
|
16
|
Barca L, De Marzo V, Toma M, Guglielmi G, Crimi G, Porto I, Ameri P. 654 Fragility of functional/symptomatic endpoints to assess the efficacy of drugs for pulmonary arterial hypertension. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab133.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Drugs for pulmonary arterial hypertension (PAH) have historically been evaluated for their efficacy in improving functional capacity and decreasing symptoms. However, these measures of treatment effect are approximate and subject to substantial variability, and therapeutic choices based on them may be aleatory.
Methods and results
We reviewed the articles reporting the results of phase 3 PAH randomized controlled trials (RCTs) and calculated the fragility index (FI) for the outcomes exploring functional capacity and symptoms. The FI corresponds to the number of events that need to be added to the arm with the smallest number of events to make a significant result non-significant: the lower the FI, the fragile the trial with respect to the endpoint examined. For RCTs with non-significant results, we calculated the FI as the number of events that need to be removed from the investigational drug (ID) group to reach a P-value <0.05. When possible, we also computed the FI for PAH hospitalization. Data about the rate of functional/symptomatic improvement were available for 22 (63%) of 35 RCTs (Table). The ID was superior to placebo or comparator with P < 0.05 in 10 (45%) of these 22 studies. The median FI was 2 [interquartile range (IQR): 6.5], with 4 RCTs having a FI = 1 and only 2 > 10 (Table). For the 12 RCTs in which the effect of the ID was neutral (P > 0.05), the median FI was 6 (IQR 4.25) (Table). The hospitalization FI was determined for 17 (77%) of the 22 RCTs and was overall higher than the one for the functional/symptomatic outcome (median 6, IQR 8).
Conclusions
Accessible information about the effects of PAH drugs on functional capacity and/or symptoms is published for 6 in 10 RCTs, in which very few events in one arm could have flipped the results from non-significant to significant or, more remarkably, from significant to non-significant. The evidence supporting the reduction of PAH hospitalizations as a treatment goal appears to be more robust.
Collapse
Affiliation(s)
- Luca Barca
- Cattedra di Cardiologia, Dipartimento di Medicina Interna e Delle Specialità (DIMI), Università di Genova, Italy
| | - Vincenzo De Marzo
- Cattedra di Cardiologia, Dipartimento di Medicina Interna e Delle Specialità (DIMI), Università di Genova, Italy
| | - Matteo Toma
- Cattedra di Cardiologia, Dipartimento di Medicina Interna e Delle Specialità (DIMI), Università di Genova, Italy
| | - Giulia Guglielmi
- Cattedra di Cardiologia, Dipartimento di Medicina Interna e Delle Specialità (DIMI), Università di Genova, Italy
| | - Gabriele Crimi
- Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Italo Porto
- Cattedra di Cardiologia, Dipartimento di Medicina Interna e Delle Specialità (DIMI), Università di Genova, Italy
- Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pietro Ameri
- Cattedra di Cardiologia, Dipartimento di Medicina Interna e Delle Specialità (DIMI), Università di Genova, Italy
- Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy
| |
Collapse
|
17
|
Sticchi A, Gallo F, Marzo VD, Won-keun K, Khokhar AA, Zeus T, Toggweiler S, Marco FD, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 607 Comparison of incidence and predictors of new left bundle branch block and permanent pacemaker implantation in a large multicentre contemporary TAVI registry using the Evolut R/pro system vs. the accurate neo valve. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Conduction disorders and permanent pacemaker implantation (PPI) continue to be an important issue in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the incidence and clinical outcomes of new left bundle branch block (LBBB) and PPI after TAVI in a comparison between two self-expandable supra-annular transcatheter valves.
Methods and results
We report the data from an international, retrospective registry including 3862 consecutive patients who underwent TAVI with two self-expanding transcatheter heart valves (Medtronic Evolut R/PRO and Boston ACURATE neo). Patients with pre-existing left or right bundle branch block, any atrioventricular blocks or previous pacemaker implantation were excluded. Finally, we performed a propensity score matched analysis (PSM) to match the patients and overcome pre-procedural differences reaching 427 couples. New-onset Left Bundle Branch Block (LBBB) occurred with a rate of 13.1% (56/427) in the ACURATE group and 18.7% (80/427) in the Evolut group (P = 0.031). The incidence of new permanent pacemaker implantation was 16.4% (70/427) in the Evolut group and 6.8% (29/427) in the ACURATE group, respectively (P < 0.001). In the multivariate regression analysis, we found the valve recapture [odds ratio (OR): 4.66, 95% confidence interval (CI): 1.08–23.75, P = 0.042] as significant predictors for LBBB, and male sex (OR: 1.59, CI: 1.03–2.46, P = 0.036), ACURATE valve (OR: 0.34, CI: 0.20–0.57, P < 0.001) and post-procedure LBBB (OR: 4.38, CI: 2.78–6.85, P < 0.001) for PPI.
Conclusions
In our large multi-centre contemporary cohort of patients, new LBBB and PPI occurred more frequently in patients following TAVI with Evolut R/PRO vs. ACURATE valve. However, the choice of the valve seemed to influence only the rate of pacemaker implantation and not the incidence of new LBBB. Further data is required to clarify the impact of valve design on conduction abnormalities.
Collapse
Affiliation(s)
- Alessandro Sticchi
- Centro per la Lotta Contro L’Infarto (CLI) Foundation, Unicamillus—Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Vincenzo De Marzo
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Kim Won-keun
- Department of Cardiology Kerckoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center—IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut D’Investigacions Biomèdiques August Pi i Sunyer (Idibaps), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Italy
| | - Josep Rodes-cabau
- Quebec Heart and Lung Insitute, Laval University, Quebec City, Quebec, Canada
| | - Italo Porto
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Cardio Center, Humanitas Research Hospital IRCCS, Humanitas University, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| |
Collapse
|
18
|
Sticchi A, Gallo F, Marzo VD, Won-keun K, Zeus T, Toggweiler S, Marco FD, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 612 Comparison of two self-expandable supra-annular bioprosthesis: a propensity score-matched analysis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Limited data reported the comparison of bioprostheses for transcatheter aortic valve implantation (TAVI) among devices of supra-annular design. The aim of this study is to compare the clinical outcomes of the ACURATE neo and Evolut R/PRO valves for TAVI in a propensity score-matched analysis (PSM).
Methods and results
We performed a propensity score-matched analysis equalizing almost all the patient’s risk factors, anatomical and procedural characteristics, and assessing the predictive value of the remaining features. Our data were derived from a large, real-world, contemporary, multicentre, international, retrospective registry of 3862 consecutive patients undergoing TAVI using two different self-expandable supra-annular valves (Medtronic Evolut R/PRO and Boston ACURATE neo). We reached a matched population of 713 couples for each device group with a medium follow-up of 456.5 days. In the comparison of the clinical outcomes between the Evolut and the ACURATE patients, no difference occurred in mortality (9.8% vs. 9.0%, P = 0.650), heart failure hospitalization (9.6% vs. 6.0%, P = 0.076), myocardial infarction (0.7% vs. 0.4%, P = 0.718), stroke (2.4% vs. 1.4%, P = 0.239), major bleeding (3.3% vs. 3.4%, P = 1.000), vascular complications (13.7% vs. 10.9%, P = 0.126), endocarditis (1.1% vs. 0.6%, P = 0.568), sepsis (0.9% vs. 0.5%, P = 0.605), acute kidney injury (0.9% vs. 0.5%, P = 0.605), and new left bundle branch block (17% vs. 13.5%, P = 0.187). The only outcome with a significant difference between the groups was the need of pacemaker implantation in favour of the ACURATE valve (5.3% vs. 12.9% for the Evolut, P < 0.001).
Conclusions
In our PSM cohort, the comparison between the Evolut and the ACURATE valve showed no significant differences in the multiple outcomes evaluated, except for the rate of new pacemaker implantation. This data confirmed the recent literature, but it needs further dedicated investigation using the following devices generations.
Collapse
Affiliation(s)
- Alessandro Sticchi
- Centro per la Lotta Contro L’Infarto (CLI) Foundation, Unicamillus—Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Vincenzo De Marzo
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Kim Won-keun
- Department of Cardiology Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center—IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut D’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Italy
| | - Josep Rodes-cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Italo Porto
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Cardio Center, Humanitas Research Hospital IRCCS, Humanitas University, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| |
Collapse
|
19
|
Marzo VD, Seitun S, Viglino U, Matos JG, Pigati M, Vercellino M, Crimi G, Balbi M, Porto I. 579 Pre-operative computed tomography evaluation of suprarenal aortic burden predicts post-procedural acute kidney injury after transcatheter aortic valve replacement: the spread-AKI study. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.013] [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: 11/15/2022]
Abstract
Abstract
Aims
Acute kidney injury (AKI) is a potential complication of transcatheter aortic valve replacement (TAVR). Athero-embolization linked to catheter manipulation in the supra-renal aorta is a possible pathogenetic mechanism of AKI after TAVR. We sought to determine the impact of supra-renal aortic atheroma burden (AB) on AKI, and the potential role of pre-operative multislice computed tomography (PO-MSCT) in evaluating the supra-renal aortic atherosclerosis and the pre-operative risk of AKI.
Methods and results
We collected PO-MSCT, as well as baseline, procedural, and post-procedural characteristics of 222 consecutive patients who underwent TAVR from January 2018 to December 2020 at a single, high-volume, Italian centre. PO-MSCT was performed using a dedicated TAVR protocol with an ECG-triggered high-pitch spiral acquisition. The non-contrast aortic valve calcium score (AV-CS) was calculated by a dedicated software. Angiographic data were analysed on a dedicated 3D workstation. Bidimensional measurements, total renal volume (TRV), and presence of significant (≥50%) renal artery stenosis (RAS) were recorded. The supra-renal AB was quantified using a ‘plaque analysis’ module that automatically segments the entire aortic root, from the sino-tubular junction to the renal arteries, by drawing a centreline across the aortic lumen and delineating the inner and outer vessel walls (including the plaque). Manual correction was applied. A set of Hounsfield unit (HU) intensity ranges were defined and mapped to a color overlay to visualize the various elements of atherosclerotic lesion by using the plaque density classification of the Society of Cardiovascular Computed Tomography (necrotic core, fibro-fatty, fibrous, and calcified plaque); calcified plaque were subcategorized on a voxel-level basis into three strata: low- (351–700 HU), mid- (701–1000 HU), and high-calcium (>1000 HU, termed 1K plaque). Post-procedural complications were defined according to Valve Academic Research Consortium (VARC-3) criteria. Mean age was 83.3 ± 5.7 years, and 95 (42.8%) patients were males. AKI occurred in 67/222 (30.2%). Patients who developed AKI had higher supra-renal AB (17.6 ± 5.1% vs. 13.9 ± 4.3%, P < 0.001), TRV indexed for body surface area (TRVBSA; 153.7 ± 43.1 vs. 134.9 ± 38.7, P = 0.002), mid-calcium plaque (2.2 ± 1.5% vs. 1.3 ± 1.1%, P < 0.001), 1K plaque (5.4 ± 3.7% vs. 2.4 ± 2.4%, P < 0.001) and suffered more post-procedural major/life-threatening (severe) bleedings [9/67 (13.4%) vs. 5/155 (3.2%), P = 0.004], whereas there was no difference in AV-CS (P = 0.691) and RAS (P = 0.077). Multivariate logistic regression analysis adjusted for other univariate predictors (male sex, baseline eGFR, baseline ejection fraction, baseline mean aortic gradient, and RAS) showed percent supra-renal AB (HR: 1.15, 95% CI: 1.06–1.26, P = 0.002), mid-to-high calcium plaque (HR: 5.67, 95% CI: 2.49–13.77, P < 0.001), severe bleedings (HR: 4.93, 95% CI: 1.09–24.69, P = 0.043), and TRVBSA (HR: 1.015, 95% CI: 1.01–1.02, P = 0.021) as independent predictors of AKI. Finally, a 3-knots spline curve analysis identified percent of supra-renal AB > 15.0% as the optimal threshold to predict an increased risk of AKI.
Conclusions
Suprarenal AB is associated with the occurrence of AKI, and this association is strengthened as the percentage of calcified plaque increases. Quantitative and qualitative pre-operative MSCT assessment of aortic atherosclerosis may help in early identification of patients at high-risk for AKI who could benefit from higher peri-operative surveillance.
Collapse
Affiliation(s)
- Vincenzo De Marzo
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (DIMI), University of Genoa, Italy
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Seitun
- Radiodiagnostic Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Umberto Viglino
- Radiodiagnostic Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Joao Gavina Matos
- Radiodiagnostic Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Pigati
- Radiodiagnostic Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Vercellino
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (DIMI), University of Genoa, Italy
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gabriele Crimi
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (DIMI), University of Genoa, Italy
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Manrico Balbi
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (DIMI), University of Genoa, Italy
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (DIMI), University of Genoa, Italy
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
20
|
Marzo VD, Tricarico L, Zoccai GB, Correale M, Brunetti ND, Canepa M, Ferrari GMD, Castagno D, Porto I, Ameri P. 633 Efficacy of additional medical therapies in patients with heart failure, reduced ejection fraction, and chronic kidney disease already receiving neurohormonal inhibitors: a network meta-analysis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
We assessed the efficacy of add-on drugs in patients with heart failure with reduced ejection fraction (HFrEF) and concomitant chronic kidney disease (CKD) already receiving neurohormonal inhibition (NEUi).
Methods and results
The literature was systematically searched for phase 3 randomized controlled trials (RCTs) involving ≥90% patients with left ventricular ejection fraction <45%, of whom <30% were acutely decompensated, and with published information about the subgroup of estimated glomerular filtration rate <60 ml/min/1.73 m2. Six RCTs were included in a study-level network meta-analysis evaluating the effect of NEUi, ivabradine, angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter-2 inhibitors (SGLT2i), vericiguat, and omecamtiv mecarbil (OM) on a composite outcome of cardiovascular death or hospitalization for heart failure. In a fixed-effects model, SGLT2i (HR: 0.78, 95% CrI: 0.69–0.89), ARNI (HR: 0.79, 95% CrI: 0.69–0.90), and ivabradine (HR: 0.82, 95% CrI: 0.69–0.98) decreased the risk of the composite outcome vs. NEUi, whereas OM did not (HR: 0.98, 95% CrI: 0.89–1.10). A trend for improved outcome was also found for vericiguat (HR: 0.90, 95% CrI: 0.80–1.00). In indirect comparisons, both SLGT2i (HR: 0.80, 95% CrI: 0.68–0.94) and ARNI (HR: 0.80, 95% CrI: 0.68–0.95) reduced the risk vs. OM; furthermore, there was a trend for a greater benefit of SGLT2i vs. vericiguat (HR: 0.88, 95% CrI: 0.73–1.00) and ivabradine vs. OM (HR: 0.84, 95% CrI: 0.68–1.00). Results were comparable in a random-effects model and in sensitivity analyses. SUCRA scores were 81.8%, 80.8%, 68.9%, 44.2%, 16.6%, and 7.8% for SGLT2i, ARNI, ivabradine, vericiguat, OM, and NEUi, respectively.
Conclusions
Expanding pharmacotherapy beyond NEUi improves outcomes in HFrEF with CKD.
633 Figure
Collapse
Affiliation(s)
- Vincenzo De Marzo
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Italy
| | - Lucia Tricarico
- Cardiology Unit, Ospedali Riuniti, University of Foggia, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical–Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | | | | | - Marco Canepa
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Italy
| | - Pietro Ameri
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Italy
| |
Collapse
|
21
|
Zecchino S, De Marzo V, Licordari R, Costa F, Caracciolo A, Pescetelli F, Muscoli S, Iacovelli F, Ruggiero R, Scoccia A, Cammalleri V, Pavani M, Loffi M, Scordino D, Ferro J, Rognoni A, Buono A, Nava S, Albani S, Zilio F, Colaiori I, Borghesi M, Regazzoni V, Mannarini A, Spione F, Doronzo B, De Benedictis M, Bonmassari R, Danzi GB, Galli M, Ielasi A, Musumeci G, Tomai F, Micari A, Pasceri V, Patti G, Campo G, Colombo A, Porto I, Sticchi A, Giannini F. 692 Impact of COVID-19 pandemic on in-hospital outcomes for patients with acute coronary syndrome: a propensity-weighted, multicentre study. Eur Heart J Suppl 2021. [PMCID: PMC8689766 DOI: 10.1093/eurheartj/suab135.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Aims Coronavirus disease 19 (COVID-19) pandemic has dramatically changed the management and the prognosis of patients experiencing acute coronary syndrome (ACS). Several scientific societies have highlighted the need for dedicated paths to deliver better and faster care to improve outcomes. Nevertheless, data depicting the impact of COVID-19 pandemic on ACS in Italy are still poor. To perform a propensity weighted analysis on a multicentre Italian registry involving patients with ACS managed before vs. during COVID-19 pandemic, taking into account baseline patients characteristics, clinical presentation, procedural aspects, and in-hospital outcomes (death, bleeding, stent thrombosis, myocardial infarction, stroke/transient ischaemic attack, mechanical complication, and arrhythmic complication). Methods and results We included all consecutive patients who have suffered from ACS during two periods before (March/April 2018, March/April 2019) vs. the period of COVID-19 pandemic (March/April 2020). A generalized boosted non-parsimonious regression was used to estimate the propensity scores of having an ACS in 2020 (year of COVID-19) vs. 2018/2019 using an average treatment effect and balancing for all baseline confounders. We included 2851 patients admitted to hospital with ACS in 17 Italian centres: 1079 (37.8%) during 2018, 1056 (37.0%) in 2019, and 716 (25.1%) during the first COVID-19 wave of 2020. Seventy (2.5%) patients had a positive swab for SARS-CoV-2 at admission. During 2020 there were higher time-to-emergency-call (P = 0.028) and less diagnosis of unstable angina (P = 0.029) and MINOCA (P = 0.004); none of the admission symptoms differ significantly across the years (P > 0.05) except for fever that was more prevalent in 2020 (P < 0.001). Patients suffering from ACS had lower admission EF (P = 0.006). After PS weighting, multivariate Cox regression analysis showed age (P < 0.001), night admission (P = 0.017), cardiocirculatory arrest before cath-lab (P = 0.041), worst Killip class (P = 0.039), admission EF (P = 0.026), and need for left-ventricle mechanical support (P = 0.011) as independent predictors of in-hospital death. After propensity weighted analysis none of the in-hospital outcomes differed significantly across the years of investigation (all P > 0.05). Conclusions During COVID-19 pandemic in Italy the characteristics and management of ACS was slightly different than the past. However, the rates of ‘hard’, in-hospital outcomes (e.g. deaths) are almost similar to the past, suggesting appropriate care and well-organized emergency-paths for ACS.
Collapse
Affiliation(s)
- Simone Zecchino
- Dipartimento Cardiotoracovascolare, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Vincenzo De Marzo
- Dipartimento Cardiotoracovascolare, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, Policlinico G. Martino, University of Messina, Italy
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinico G. Martino, University of Messina, Italy
| | - Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinico G. Martino, University of Messina, Italy
| | - Fabio Pescetelli
- Dipartimento Cardiotoracovascolare, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Italy
| | | | | | | | | | - Marco Pavani
- Ospedale Civile SS Annunziata, Savigliano, Italy
| | - Marco Loffi
- Department of Cardiology, Ospedale di Cremona, Italy
| | | | | | - Andrea Rognoni
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | | | - Stefano Nava
- Invasive Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Filippo Zilio
- UOC Cardiologia, Ospedale Santa Chiara, Trento, Italy
| | | | | | | | - Antonia Mannarini
- Cardiotohoracic Department, Policlinico University Hospital, Bari, Italy
| | - Francesco Spione
- Cardiotohoracic Department, Policlinico University Hospital, Bari, Italy
| | | | | | | | | | | | | | | | | | - Antonio Micari
- Department of Clinical and Experimental Medicine, Policlinico G. Martino, University of Messina, Italy
| | | | - Giuseppe Patti
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Antonio Colombo
- Humanitas Clinical and Research Center IRCCS, Humanitas University, Pieve Emanuele (MI), Rozzano, Italy
| | - Italo Porto
- Dipartimento Cardiotoracovascolare, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | | | | |
Collapse
|
22
|
Sticchi A, Gallo F, De Marzo V, Won-keun K, Zeus T, Ruggiero R, Toggweiler S, De Marco F, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 599 Gender-based differences in TAVI outcomes: report from a large contemporary real-world population of self-expandable valves. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.025] [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
Small sub-study data derived from randomized clinical trials suggest a gender-based disparity in TAVI outcomes. However, large real-world contemporary data is missing. The aim of this study is to compare the risk factors, procedural characteristics and clinical outcomes of male and female patients who underwent transcatheter aortic valve implantation (TAVI) using two next-generation self-expandable bioprostheses (ACURATE neo and Evolut R/Pro valves).
Methods
We performed a first unmatched comparison and a propensity score-matched analysis (PSM) to assess the outcomes derived by the sex difference beyond the impact of pre-procedural risk factors in a large, contemporary, real-world, multicentre, international, retrospective registry of 3862 consecutive patients. The primary endpoint was a composite of all-cause death or any stroke (disabling and non-disabling) at 1 year.
Results
Sixty-four per cent (2162/3353 patients) of the study cohort was female and was older (mean age 82.3 years vs. 81.1 years for men (P<0.001)) had a higher BMI (27.7±5.7 for women vs. 27.2±4.5 for men), and lower prevalence of dyslipidaemia (50.2% vs. 54.7, P=0.037), diabetes (26.8% vs. 33.7, P<0.001), smoking (10.0% vs. 24.3%, P<0.001), COPD (17.4% vs. 21.9%, P=0.002), pacemaker/ICD (9.6% vs. 14.0%, P<0.001), previous cardiac surgery (8.6% vs. 18.8%, P<0.001), previous PCI (23.0% vs. 36.8%, P<0.001). Mean STS score for women was higher 5.2±3.9% vs. 4.5±3.4% (P<0.001). Women had higher mean valve gradients (45.4±17.1 vs. 42.7±14.7 mmHg; P<0.001), smaller valve areas (mean 0.7 cm2 vs. 0.9 cm2, P=0.037) and smaller annular perimeters (56.8±23.0 vs. 62.0±23.8, P<0.001). The primary endpoint was resulted in a rate of 7.9% vs. 6.9% (P=0.337) in the unmatched population and 9.4% vs. 6.0% (P=0.014) after the PSM, respectively for women and for men. Independently, there was no difference in mortality (5.9% vs. 5.6%; P=0.786) and stroke (2.5% vs. 1.8%; P=0.243) rates between women and men in the un-matched groups. Rates of cardiac tamponade (1.5% vs. 0.4%, P=0.008), major vascular complications (7.7% vs. 4.1%, P<0.001), life-threatening bleeding (2.8% vs. 1.4%, P=0.016), major bleeding (5.1% vs. 2.9%, P=0.004), need of transfusion (8.9% vs. 4.6%, P<0.001) and acute kidney injury (8.5% vs. 5.7%, P=0.009), were all significantly higher in women. After PSM, mortality was similar between the two groups (11.3% for women vs. 9.5% for men, P=0.264) but strokes were more prevalent in women (2.8% vs. 1.2%, P<0.024). Furthermore, in the matched population, major vascular complications (6.8% vs. 4.1%, P=0.024), need of transfusion (9.1% vs. 4.6%, P<0.001) and acute kidney injury (8.7% vs. 5.6%, P=0.009) remained significantly different between women and men, respectively.
Conclusions
In this large real-world contemporary TAVI registry, female gender was associated with higher rates of stroke, vascular complications, major bleeding, and acute kidney injury. Further studies are required to explore the underlying pathophysiological mechanisms for these observations.
Collapse
Affiliation(s)
- Alessandro Sticchi
- Centro Per La Lotta Contro L’infarto (CLI) Foundation, Rome, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Vincenzo De Marzo
- Cattedra Di Malattie Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino Irccs, Genova
| | - Kim Won-keun
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (Idibaps), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti Di Ancona, Italy
| | - Josep Rodes-cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Italo Porto
- Cattedra Di Malattie Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino Irccs, Genova
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| |
Collapse
|
23
|
Bruno F, Crimi G, Ascenzo FD, Marzo VD, Scudeler L, Marco FD, Oreglia J, Testa L, Gorla R, Esposito G, Spaccarotella C, Soriano F, Vercellino M, Balbi M, Morici N, Indolfi C, Conrotto F, Bedogni F, Porto I, Ferrari GMD. 426 Percutaneous or surgical access for transfemoral transcatheter aortic valve implantation: a propensity matched analysis of a multicentre registry. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
The transfemoral (TF) approach appeared to be the safest and the broadest used approach in TAVI, characterized by a lower rate of periprocedural bleedings and vascular complications and is currently recommended by the guidelines as a first line approach when feasible. If in the early experience TF access was achieved using a surgical cutdown approach, through the last years, there has been increasing evidence of the safety and efficacy of a fully percutaneous approach over a surgical access, albeit available evidences are controverting and mostly including first generation prostheses and high risk patients. The aim of the study is to compare percutaneous and surgical access in a large, real-word, multicentre of TF TAVI.
Methods and results
Consecutive patients undergoing successful TF TAVI were prospectively enrolled in local clinical registries of five high volume centres in Italy: IRCCS Ospedale Policlinico San Martino (Genoa), IRCCS Policlinico San Donato (Milan), Città Della Salute e della Scienza, (Turin), Ospedale Niguarda Ca’ Granda (Milan), Magna Graecia University, (Catanzaro), between January 2014 to December 2019. Univariate and multivariate analysis using IPTW were performed. A total of 1946 TF TAVI patients (female 42.8%) were prospectively included. Patients underwent surgical access had a significantly higher surgical risk (STS score of 8.9 vs. 6.4, P < 0.001, and EuroSCORE of 15.1 vs. 8.7, P < 0.001, respectively). Overall survival was comparable between the two groups (HR: 1.14, 95% CI: 0.76–1.71). Patients who underwent surgical access experienced more VARC-2 major and VARC-2 minor vascular complications (13% vs. 7%, P = 0.003 and 11% vs. 6.1%, P = 0.007, respectively) and more VARC-2 major/life threatening and minor bleeding (27.4% vs. 17.8, P = 0.001, and 9.6% vs. 2.1%, P < 0.001, respectively). After IPTW adjustment, surgical access was associated with an increased risk of major vascular complications (HR: 3.32, 95% CI: 1.84–5.97), minor bleeding (HR: 4.24, 95% CI: 1.16–15.54) and stage 2–3 AKI (HR: 2.60, 95% CI: 1.07–6.33).
Conclusions
The performance of the percutaneous transfemoral TAVI approach was safe and feasible and resulted in fewer major vascular complications, bleedings and AKI than the surgical femoral isolation. Procedural time and hospital length were also lower in the percutaneous group. Routine application of the percutaneous approach might reduce acute complications in patients undergoing transfemoral TAVI and reduce procedural time and hospital length.
Collapse
Affiliation(s)
- Francesco Bruno
- Division of Cardiology, University of Turin, Città della Salute e della Scienza, Italy
| | - Gabriele Crimi
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS, Ospedale Policlinico San Martino Genova, Italy
| | - Fabrizio D’ Ascenzo
- Division of Cardiology, University of Turin, Città della Salute e della Scienza, Italy
| | - Vincenzo De Marzo
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS, Ospedale Policlinico San Martino Genova, Italy
| | - Luca Scudeler
- Division of Cardiology, University of Turin, Città della Salute e della Scienza, Italy
| | - Federico De Marco
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Jacopo Oreglia
- Cardiology Unit, A. De Gasperis Department, Ospedale Niguarda Ca’Granda, Milano, Italy
| | - Luca Testa
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Riccardo Gorla
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giuseppe Esposito
- Cardiology Unit, A. De Gasperis Department, Ospedale Niguarda Ca’Granda, Milano, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco Soriano
- Cardiology Unit, A. De Gasperis Department, Ospedale Niguarda Ca’Granda, Milano, Italy
| | - Matteo Vercellino
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS, Ospedale Policlinico San Martino Genova, Italy
| | - Manrico Balbi
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS, Ospedale Policlinico San Martino Genova, Italy
| | - Nuccia Morici
- Cardiology Unit, A. De Gasperis Department, Ospedale Niguarda Ca’Granda, Milano, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Federico Conrotto
- Division of Cardiology, University of Turin, Città della Salute e della Scienza, Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Italo Porto
- Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS, Ospedale Policlinico San Martino Genova, Italy
| | | |
Collapse
|
24
|
Clavario P, De Marzo V, Lotti R, Barbara C, Porcile A, Russo C, Beccaria F, Bonavia M, Bottaro LC, Caltabellotta M, Chioni F, Santangelo M, Hautala AJ, Griffo R, Parati G, Corrà U, Porto I. Cardiopulmonary exercise testing in COVID-19 patients at 3 months follow-up. Int J Cardiol 2021; 340:113-118. [PMID: 34311011 PMCID: PMC8302817 DOI: 10.1016/j.ijcard.2021.07.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/29/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022]
Abstract
Background Long-term effects of Coronavirus Disease of 2019 (COVID-19) are of utmost relevance. We aimed to determine: 1) the functional capacity of COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2) the characteristics associated with cardiopulmonary exercise testing (CPET) performance; 3) the safety and tolerability of CPET. Methods We prospectively enrolled consecutive patients with laboratory-confirmed COVID-19 from Azienda Sanitaria Locale 3, Genoa. Three months after hospital discharge a complete clinical evaluation, trans-thoracic echocardiography, CPET, pulmonary function tests, and dominant leg extension (DLE) maximal strength measurement were performed. Results From the 225 patients discharged alive from March to November 2020, we excluded 12 incomplete/missing cases and 13 unable to perform CPET, leading to a final cohort of 200. Median percent-predicted peak oxygen uptake (%pVO2) was 88% (78.3–103.1). Ninety-nine (49.5%) patients had %pVO2 below, whereas 101 (50.5%) above the 85% predicted value. Among the 99 patients with reduced %pVO2, 61 (61%) had a normal anaerobic threshold: of these, 9(14.8%) had respiratory, 21(34.4%) cardiac, and 31(50.8%) non-cardiopulmonary reasons for exercise limitation. Inerestingly, 80% of patients experienced at least one disabling symtpom, not related to %pVO2 or functional capacity. Multivariate linear regression showed percent-predicted forced expiratory volume in one-second(β = 5.29,p = 0.023), percent-predicted diffusing capacity of lungs for carbon monoxide(β = 6.31,p = 0.001), and DLE maximal strength(β = 14.09,p = 0.008) to be independently associated with pVO2. No adverse event was reported during or after CPET, and no involved health professional developed COVID-19. Conclusions At three months after discharge, about 1/3rd of COVID-19 survivors show functional limitations, mainly explained by muscular impairment, calling for future research to identify patients at higher risk of long-term effects that may benefit from careful surveillance and targeted rehabilitation.
Collapse
Affiliation(s)
- Piero Clavario
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Vincenzo De Marzo
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Roberta Lotti
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Cristina Barbara
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Annalisa Porcile
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Carmelo Russo
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Federica Beccaria
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Marco Bonavia
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Luigi Carlo Bottaro
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Marta Caltabellotta
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Flavia Chioni
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Monica Santangelo
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Arto J Hautala
- Faculty of Sports and Health Sciences, University of Jyväskylä, Finland
| | - Raffaele Griffo
- Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ugo Corrà
- IRCCS, Istituti Clinici Scientifici Maugeri, Care and Research Institute, Department of Cardiac Rehabilitation, Veruno-Novara, Italy
| | - Italo Porto
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, IRCCS San Martino Hospital, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy.
| |
Collapse
|
25
|
Benenati S, Canale C, De Marzo V, Della Bona R, Rosa GM, Porto I. Atrial fibrillation and Alzheimer's disease: A conundrum. Eur J Clin Invest 2021; 51:e13451. [PMID: 33219514 DOI: 10.1111/eci.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 12/01/2022]
Abstract
During ageing, the prevalence of Alzheimer's disease (AD) and of cardiovascular disease CVD) increases. Our aim is to investigate the relationship between AD and CVD and its risk factors, with a view to explaining the underlying mechanisms of this association. This review is based on the material obtained via MEDLINE (PubMed), Embase and Clinical Trials databases, from January 1980 until May 2019. The search term used was "Alzheimer's disease", combined with "cardiovascular disease", "hypertension", "dyslipidaemia", "diabetes mellitus", "atrial fibrillation", "coronary artery disease", "heart valve disease", "heart failure". Out of the 1328 papers initially retrieved, 431 duplicates and 216 records in languages other than English were removed; thus, only 98 papers were included in our research material. We have found that AD and CVD are frequently associated, while both of them, alone may be considered deleterious to health, the study of their combination constitutes a clinical challenge. Further research will help to clarify the real impact of CVD and its risk factors on AD, in order to better comprehend the effects of subclinical and clinical cardiovascular diseases on the brain. It may be hypothesized that there are various mechanisms underlying the association between AD and CVD, the main ones being: hypoperfusion and emboli, atherosclerosis, furthermore in both the heart and brain of AD patients, amyloid deposits may be present, thus causing damage to these organs. We need to clarify the real impact of these underlying hypothesized mechanisms and to investigate gender issues.
Collapse
Affiliation(s)
- Stefano Benenati
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Claudia Canale
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Vincenzo De Marzo
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Roberta Della Bona
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Gian Marco Rosa
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy.,Department of Internal Medicine, University of Genoa, Genova, Italy
| |
Collapse
|
26
|
De Marzo V, Crimi G, Benenati S, Buscaglia A, Pescetelli F, Vercellino M, Della Bona R, Sarocchi M, Canepa M, Ameri P, Balbi M, Porto I. BMI and acute kidney injury post transcatheter aortic valve replacement: unveiling the obesity paradox. J Cardiovasc Med (Hagerstown) 2021; 22:579-585. [PMID: 34076605 DOI: 10.2459/jcm.0000000000001178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Acute kidney injury (AKI) may complicate transcatheter aortic valve replacement (TAVR) leading to higher mortality. The relationship between AKI, obesity, and mortality, however, is controversial. We sought to investigate the impact of body habitus on the prognostic value of AKI in TAVR. METHODS Among the 645 patients who underwent successful TAVR in a single high-volume centre, we retrospectively evaluated the association between AKI-TAVR and 30-day, 6-month, and 1-year mortality, and whether this relationship was affected by BMI. AKI was defined according to the Valve Academic Research Consortium-2 criteria. Patients were categorized into three groups by BMI: low-to-normal weight (<25 kg/m2), overweight (25-30 kg/m2), obese (>30.0 kg/m2). RESULTS Three-hundred and twenty-four (50.2%) patients were low-to-normal weight, 223 (34.6%) overweight, and 98 (15.2%) obese. AKI occurred in 141 (21.9%), similarly across BMI groups. Thirty-day, 6-month, and 1-year mortality rates were 2.2, 3.7, and 7.9%, without differences across BMI groups. Among patients who developed AKI-TAVR, 30-day (8.7 vs. 2.0 vs. 0.0%), 6-month (13.0 vs. 6.1 vs. 4.3%), and 1-year (20.3 vs. 12.2 vs. 4.3%) mortality showed a decreasing trend across increasing BMI categories (all P < 0.05); the same trend was not observed for patients without AKI-TAVR. In multivariate models, AKI was associated with 30-day [odds ratio (OR): 2.46, 95% confidence interval (CI): 1.70-8.67], 6-month (OR: 2.75, 95% CI: 1.32-7.59), and 1-year mortality (OR: 1.84, 95% CI: 1.22-3.71, all P < 0.05). The interaction between AKI and BMI, when added to the models, was consistently significant (all P < 0.05). CONCLUSION Higher BMI is associated with better survival in TAVR patients who develop AKI.
Collapse
Affiliation(s)
- Vincenzo De Marzo
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences.,Department of Internal Medicine and Medical Specialties (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa
| | - Gabriele Crimi
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
| | - Stefano Benenati
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences.,Department of Internal Medicine and Medical Specialties (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa
| | - Angelo Buscaglia
- Cardiology Department, Santa Corona Hospital, Pietra Ligure, Italy
| | - Fabio Pescetelli
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences.,Department of Internal Medicine and Medical Specialties (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa
| | - Matteo Vercellino
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
| | - Roberta Della Bona
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
| | - Matteo Sarocchi
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences
| | - Marco Canepa
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences.,Department of Internal Medicine and Medical Specialties (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa
| | - Pietro Ameri
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences.,Department of Internal Medicine and Medical Specialties (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa
| | - Manrico Balbi
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences.,Department of Internal Medicine and Medical Specialties (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa
| | - Italo Porto
- DICATOV, Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences.,Department of Internal Medicine and Medical Specialties (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa
| |
Collapse
|
27
|
De Marzo V, Della Bona R, Seitun S, Masoero G, Porto I. Iatrogenic aortic valve haematoma after emergency coronary angiography: location, location, location! Eur Heart J Cardiovasc Imaging 2021; 22:e156. [PMID: 34089592 DOI: 10.1093/ehjci/jeab104] [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)
- Vincenzo De Marzo
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Viale Benedetto XV, 10, 16132 Genoa, Italy
| | - Roberta Della Bona
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 10, 16132 Genoa, Italy
| | - Sara Seitun
- Department of Radiodiagnostic, San Martino Hospital, IRCCS for Oncology and Neurosciences, Viale Benedetto XV, 10, 16132 Genoa, Italy
| | - Giovanni Masoero
- Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 10, 16132 Genoa, Italy
| | - Italo Porto
- Chair of Cardiovascular Disease, Department of Internal Medicine and Specialties (Di.M.I.), University of Genoa, Viale Benedetto XV, 10, 16132 Genoa, Italy.,Cardiology Unit, Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Viale Benedetto XV, 10, 16132 Genoa, Italy
| |
Collapse
|
28
|
Troccolo A, De Marzo V, Della Bona R, Seitun S, Santini F, Porto I. [Bileaflet mechanical valve dysfunction related to fibrous pannus: the role of cine-fluoroscopy]. G Ital Cardiol (Rome) 2021; 22:490-493. [PMID: 34037593 DOI: 10.1714/3612.35933] [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: 06/12/2023]
Abstract
We report the case of a 72-year-old female patient admitted for worsening heart failure. The patient had undergone aortic valve replacement with a mechanical prosthesis 28 years before and since then she had several acute heart failure episodes, with a progressive increase in transprosthetic gradients, without identifying a specific cause.We describe the diagnostic tools used to reach a diagnosis, with particular emphasis on the use of cine-fluoroscopy that allowed to make the decisively diagnosis of prosthetic valve dysfunction, subsequently confirmed by cardiac computed tomography (CT). By cine-fluoroscopy, a widespread, easy, low-cost, and safe tool (no need for medium contrast and low radiation dose), it is possible to precisely define the function of the valve leaflets and measure their opening and closing angles, comparing them to the specific reference angles. To make the correct diagnosis we also performed a cardiac CT demonstrating a sub-aortic fibrous pannus. However, although cardiac CT is highly accurate for the identification of valve leaflet neoformations and abnormalities and for the discrimination between thrombotic formations and fibrous pannus, it is burdened by high costs, use of contrast medium, and limited available dedicated devices.
Collapse
Affiliation(s)
- Alessandro Troccolo
- Divisione di Cardiologia, DICATOV-Dipartimento Cardio-Toraco-Vascolare, Ospedale Policlinico San Martino IRCCS per l'Oncologia, Genova - Scuola di Scienze Mediche e Farmaceutiche, Università degli Studi, Policlinico San Martino IRCCS, Genova
| | - Vincenzo De Marzo
- Divisione di Cardiologia, DICATOV-Dipartimento Cardio-Toraco-Vascolare, Ospedale Policlinico San Martino IRCCS per l'Oncologia, Genova - Scuola di Scienze Mediche e Farmaceutiche, Università degli Studi, Policlinico San Martino IRCCS, Genova
| | - Roberta Della Bona
- Divisione di Cardiologia, DICATOV-Dipartimento Cardio-Toraco-Vascolare, Ospedale Policlinico San Martino IRCCS per l'Oncologia, Genova - Scuola di Scienze Mediche e Farmaceutiche, Università degli Studi, Policlinico San Martino IRCCS, Genova
| | - Sara Seitun
- Dipartimento di Radiodiagnostica, Ospedale Policlinico San Martino IRCCS per l'Oncologia, Genova
| | - Francesco Santini
- Divisione di Cardiochirurgia, DICATOV-CardioThoracic and Vascular Department, Ospedale Policlinico San Martino IRCCS per l'Oncologia, Genova
| | - Italo Porto
- Divisione di Cardiologia, DICATOV-Dipartimento Cardio-Toraco-Vascolare, Ospedale Policlinico San Martino IRCCS per l'Oncologia, Genova - Scuola di Scienze Mediche e Farmaceutiche, Università degli Studi, Policlinico San Martino IRCCS, Genova
| |
Collapse
|
29
|
De Marzo V, Crimi G, Vercellino M, Benenati S, Pescetelli F, Della Bona R, Sarocchi M, Canepa M, Balbi M, Porto I. Impact of bioprosthetic valve type on peri-procedural myocardial injury and mortality after transcatheter aortic valve replacement. Heart Vessels 2021; 36:1746-1755. [PMID: 33963455 PMCID: PMC8481174 DOI: 10.1007/s00380-021-01861-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
Peri-procedural myocardial injury (PPMI) is a common complication after transcatheter valve replacement (TAVR), often remaining clinically silent. The role of valve type on PPMI and the association between PPMI and mortality are still unclear. We sought to evaluate predictors and outcome of PPMI after TAVR, and the impact of self-expandable valve (SEV) vs. balloon-expandable valve (BEV) deployment on PPMI. Consecutive patients who underwent successful TAVR in a single-center from January 2014 to December 2019 were included. PPMI was defined according to a modified Valve Academic Research Consortium (VARC)-2 definition as a post-procedure elevation of troponin (with a peak value ≥ 15-times the upper-reference limit) < 72 h after TAVR. We included 596 patients, of whom 258 (43.3%) were men. Mean age was 83.4 ± 5.5 years. We deployed 368 (61.7%) BEV and 228 (38.3%) SEV. PPMI was observed in 471 (79.0%) patients. At multivariable analysis, SEV (OR 2.70, 95% CI 1.64-4.55, p < 0.001), creatinine clearance (OR 0.98, 95% CI 0.97-1.00, p = 0.011), and baseline ejection fraction (OR 1.05, 95% CI 1.02-1.07, p < 0.001) were independent predictors of PPMI; these findings were also confirmed using a propensity-weighted analysis. Thirty-day and 1-year all-cause mortality rates were 2.5% and 8.1%, respectively. No associations between PPMI and 30-day (p = 0.488) or 1-year (p = 0.139) all-cause mortality were found. Independent predictors of 30-day mortality were increasing EUROSCORE II (HR 1.16 per score point, 95% CI 1.08-1.19, p < 0.001) and life-threatening/major bleeding complications (HR 5.87, 95% CI 1.28-26.58, p = 0.019), whereas EUROSCORE II (HR 1.08, 95% CI 1.04-1.13, p = 0.031) and acute kidney injury (HR 2.59, 95% CI 1.20-5.35, p = 0.020) were related to 1-year mortality. PPMI is frequent after TAVR, but it does not affect 30-day or 1-year all-cause mortality. SEV implantation is associated with an increased frequency of PPMI.
Collapse
Affiliation(s)
- Vincenzo De Marzo
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Gabriele Crimi
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Vercellino
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Stefano Benenati
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Fabio Pescetelli
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Roberta Della Bona
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Sarocchi
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Marco Canepa
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Manrico Balbi
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy
| | - Italo Porto
- DICATOV-Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy. .,Department of Internal Medicine and Specialties (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Viale Benedetto XV, 10, 16132, Genoa, Italy.
| |
Collapse
|
30
|
De Marzo V, Dettori S, Nicolini LA, Crimi G, Vercellino M, Benenati S, Pescetelli F, Della Bona R, Sarocchi M, Mikulska M, Balbi M, Bassetti M, Porto I. Early infections after successful transcatheter aortic valve replacement are associated with increased short- and long-term mortality: A single-center study. Int J Cardiol 2021; 332:48-53. [PMID: 33785390 DOI: 10.1016/j.ijcard.2021.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We reviewed frequency, microbiological pattern, predictors, and outcomes of early infections following transcatheter aortic valve replacement (TAVR). METHODS Five hundred thirty-nine patients who underwent successful TAVR at a single, high-volume center between January 2014 and December 2019 were enrolled. We defined early infections as occurring within 30-day from TAVR. RESULTS Mean age was 83.5 ± 5.4 years; 230 (42.7%) patients were men. Median follow-up was 12.0 (5.7-18.3) months; 30-day and 1-year death rates were 8/539 (1.5%) and 30/539 (5.6%), respectively. Early infections occurred in 61/539 (11.3%) patients, of whom 2 had infections in two sites. Of the 63 infections, 10 were bloodstream infections (BSI), 5 urinary tract, 27 pulmonary (2 with sepsis), 6 access site infections, 1 enterocolitis, and 14 were clinically diagnosed (no specific site). We observed 31/63 (49.2%) microbiologically-documented infections: Gram+ bacteria were isolated in 12/31 (38.7%), Gram- in 17/31 (54.3%), both Gram+ and Gram- in 2/31 (6.5%); in thirty-two infections no specific pathogen could be isolated (clinically-documented infections). Early infections were more prevalent in patients who died within 30-day (8.2% vs. 0.6%, p < 0.001) or 1-year (14.8% vs. 4.4%, p < 0.001) from TAVR. At multivariable analysis, early infections were independently associated with 30-day (HR: 8.82, 95% CI: 1.11-19.83, p = 0.035) and 1-year mortality (HR: 2.10, 95%CI: 1.28-6.21, p = 0.041). The predictive value for 1-year mortality was maintained even restricting the analysis to documented infections only, or to more severe infections (BSI and pneumonia only) (all p < 0.05). CONCLUSIONS Early infections occur in 1/10th of TAVR and are associated with increased short- and long-term mortality. Whereas a causal relationship between early infections and the risk of death cannot be unequivocally proven, careful surveillance of infected patients may improve TAVR results.
Collapse
Affiliation(s)
- Vincenzo De Marzo
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Silvia Dettori
- Infectious Diseases Unit San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Ambra Nicolini
- Infectious Diseases Unit San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Gabriele Crimi
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Vercellino
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Stefano Benenati
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Fabio Pescetelli
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Roberta Della Bona
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Sarocchi
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Manrico Balbi
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Italo Porto
- DICATOV - Cardiothoracic and Vascular Department, San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Internal Medicine and Medical Specialties (Di.M.I.), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy.
| |
Collapse
|
31
|
De Marzo V, Parisi R, Caruso M, D'Amario D, Annibali G, Manganiello V, Vergallo R, Donahue M, Cialdella P, Ielasi A, Misuraca L, Altamura L, Cortese B, Larosa C, Canepa M, Porto I. Hard Events AfteR Orsiro Sirolimus-Eluting Stent (HEROES) in STEMI: A Multicenter Registry. J Invasive Cardiol 2020; 32:E331-E337. [PMID: 33221731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of the Orsiro sirolimus-eluting stent (Biotronik) in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Specific drug-eluting stent (DES) platforms might influence pPCI success rate in the mid-to-long term. Orsiro, a hybrid sirolimus DES with thin struts and a biodegradable polymer, may potentially cause less stent malapposition, stent-induced inflammation, and mechanical damage, improving clinical outcomes. METHODS We retrospectively enrolled all patients who received 1 or more Orsiro DES in the target vessel of pPCI at 9 Italian centers from January 2012 to March 2016. The primary endpoint was a device-oriented composite endpoint (DOCE) of cardiac death, any myocardial infarction clearly attributable to the intervention culprit vessel (TVMI), and ischemic-driven target-lesion revascularization (ID-TLR) at 1-year follow-up. Secondary endpoints were: (1) DOCE at 6-month and 3-year follow-up; (2) any definite/probable stent thrombosis; and (3) any major bleeding. RESULTS The study cohort comprised 353 patients. At 1-year follow-up, we observed a 3.7% cumulative incidence of DOCE, consisting of 11 cardiac deaths (3.1%), 2 TVMIs (0.6%), and 2 ID-TLRs (0.6%). There was only 1 definite stent thrombosis (0.3%) and 8 bleedings (2.4%). Kaplan-Meier analysis showed DOCE-free survival rates of 96.6% at 6 months, 96.3% at 1 year, and 93.8% at 3 years. CONCLUSIONS Our findings support the real-world safety and efficacy of the Orsiro stent for pPCI.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Italo Porto
- University of Genoa, Cardiovascular Unit, Department of Internal Medicine and Specialties (DIMI) Viale Benedetto XV, 10, 16132 Genoa, Italy.
| |
Collapse
|
32
|
Benenati S, Crimi G, Canale C, Pescetelli F, De Marzo V, Vergallo R, Galli M, Della Bona R, Canepa M, Ameri P, Crea F, Porto I. Duration of dual antiplatelet therapy and subsequent monotherapy type in patients undergoing drug eluting stent implantation: a network Meta-analysis. Eur Heart J Cardiovasc Pharmacother 2020; 8:56-64. [PMID: 33135064 DOI: 10.1093/ehjcvp/pvaa127] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/14/2023]
Abstract
AIMS To compare safety and efficacy of very short (≤3 months), short (6 months), standard (12 months) and extended (>12 months) DAPT, and subsequent monotherapies, after DES. METHODS AND RESULTS Twenty-two RCT (n = 110059 patients/year) were selected and included in a Bayesian network meta-analysis. The primary efficacy endpoint (PEP) was a composite of cardiac death, myocardial infarction (MI) and stent thrombosis (ST), the primary safety endpoint was major bleeding. Compared to standard, we found lower rate of MI (OR 0.56, 95% CI 0.44-0.77) in extended DAPT; lower rate of major bleeding (OR 0.61, 95% CI 0.39-0.87) in very short and lower rate of any bleeding (OR 0.61, 95% CI 0.38-0.90) in short DAPT. All DAPT durations were comparable regarding the secondary efficacy endpoints. Very short followed by P2Y12 inhibition was the treatment of choice to reduce both major bleeding and myocardial infarction. In the ACS subgroup, extended (as compared to standard DAPT) reduced PEP and ST (but not MI). CONCLUSION The efficacy of short and very short is comparable with that of standard DAPT after DES implantation, whereas extended DAPT reduces MI rate. Very short DAPT reduces haemorrhagic events and, followed by a P2Y12 inhibitor monotherapy, may be preferred in order to pursue a trade-off between major bleeding and ischemia.
Collapse
Affiliation(s)
- Stefano Benenati
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italia
| | - Gabriele Crimi
- Italian IRCCS Cardiovascular Network, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - Claudia Canale
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italia
| | - Fabio Pescetelli
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italia
| | - Vincenzo De Marzo
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italia
| | | | - Mattia Galli
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Roberta Della Bona
- Italian IRCCS Cardiovascular Network, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - Marco Canepa
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italia.,Italian IRCCS Cardiovascular Network, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - Pietro Ameri
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italia.,Italian IRCCS Cardiovascular Network, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - Filippo Crea
- Università Cattolica del Sacro Cuore, Roma, Italia
| | - Italo Porto
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italia.,Italian IRCCS Cardiovascular Network, IRCCS Ospedale Policlinico San Martino, Genova, Italia
| |
Collapse
|
33
|
Benenati S, Galli M, De Marzo V, Pescetelli F, Toma M, Andreotti F, Della Bona R, Canepa M, Ameri P, Crea F, Porto I. Very short vs. long dual antiplatelet therapy after second generation drug-eluting stents in 35 785 patients undergoing percutaneous coronary interventions: a meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother 2020; 7:86-93. [PMID: 31942965 DOI: 10.1093/ehjcvp/pvaa001] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/24/2019] [Accepted: 01/09/2020] [Indexed: 12/21/2022]
Abstract
AIM To provide an updated assessment of the efficacy-safety profile of very short (1 or 3 months) dual antiplatelet therapy (DAPT) compared with long (12 months) DAPT in patients undergoing percutaneous coronary interventions (PCIs). METHODS AND RESULTS Seven randomized controlled trials (RCTs) comparing very short vs. long DAPT in 35 785 patients undergoing PCI were selected. The primary efficacy endpoint was major adverse cardiovascular events (MACE) and the primary safety endpoint trial-defined major bleeding through at least 1 year. Compared with longer duration, very short DAPT yielded comparable rates of MACE [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.84-1.03, P = 0.19], all-cause mortality (OR 0.92, 95% CI 0.80-1.06, P = 0.25), myocardial infarction (OR 1.01, 95% CI 0.88-1.15, P = 0.91), stroke (OR 1.04, 95% CI 0.72-1.50, P = 0.83), stent thrombosis (OR 1.05, 95% CI 0.80-1.37, P = 0.73), target vessel revascularization (OR 0.99, 95% CI 0.82-1.18, P = 0.89), and comparable net clinical benefit (OR 0.92, 95% CI 0.84-1.01, P = 0.08). Very short DAPT was associated with reduced rates of major bleeding (OR 0.61, 95% CI 0.40-0.94, P = 0.03) or any bleeding (OR 0.65, 95% CI 0.47-0.90, P = 0.009). Subgroup analyses showed consistent results for 1 vs. 3 month DAPT and for aspirin vs. P2Y12 inhibitor monotherapy following very short DAPT. CONCLUSIONS Compared with long DAPT, very short DAPT did not increase the odds of ischaemic complications, while reducing the odds of major or any bleeding by over 30%.
Collapse
Affiliation(s)
- Stefano Benenati
- Dipartimento of Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Viale Benedetto XV 6, 16132, Genova, Italia
| | - Mattia Galli
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Vincenzo De Marzo
- Dipartimento of Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Viale Benedetto XV 6, 16132, Genova, Italia
| | - Fabio Pescetelli
- Dipartimento of Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Viale Benedetto XV 6, 16132, Genova, Italia
| | - Matteo Toma
- Dipartimento of Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Viale Benedetto XV 6, 16132, Genova, Italia
| | - Felicita Andreotti
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.,Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Roberta Della Bona
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, Largo Rosanna Benzi 10, 16132, Genova, Italia
| | - Marco Canepa
- Dipartimento of Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Viale Benedetto XV 6, 16132, Genova, Italia.,Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, Largo Rosanna Benzi 10, 16132, Genova, Italia
| | - Pietro Ameri
- Dipartimento of Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Viale Benedetto XV 6, 16132, Genova, Italia.,Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, Largo Rosanna Benzi 10, 16132, Genova, Italia
| | - Filippo Crea
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.,Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Italo Porto
- Dipartimento of Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Viale Benedetto XV 6, 16132, Genova, Italia.,Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, Largo Rosanna Benzi 10, 16132, Genova, Italia
| |
Collapse
|
34
|
De Marzo V, D'amario D, Galli M, Vergallo R, Porto I. High-risk percutaneous coronary intervention: how to define it today? Minerva Cardioangiol 2018; 66:576-593. [DOI: 10.23736/s0026-4725.18.04679-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|