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Parisi V, Baldassarre R, Ferrara V, Ditaranto R, Barlocco F, Lillo R, Re F, Marchi G, Chiti C, Di Nicola F, Catalano C, Barile L, Schiavo MA, Ponziani A, Saturi G, Caponetti AG, Berardini A, Graziosi M, Pasquale F, Salamon I, Ferracin M, Nardi E, Capelli I, Girelli D, Gimeno Blanes JR, Biffi M, Galiè N, Olivotto I, Graziani F, Biagini E. Electrocardiogram analysis in Anderson-Fabry disease: a valuable tool for progressive phenotypic expression tracking. Front Cardiovasc Med 2023; 10:1184361. [PMID: 37416917 PMCID: PMC10320218 DOI: 10.3389/fcvm.2023.1184361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/09/2023] [Indexed: 07/08/2023] Open
Abstract
Background Electrocardiogram (ECG) has proven to be useful for early detection of cardiac involvement in Anderson-Fabry disease (AFD); however, little evidence is available on the association between ECG alterations and the progression of the disease. Aim and Methods To perform a cross sectional comparison of ECG abnormalities throughout different left ventricular hypertrophy (LVH) severity subgroups, providing ECG patterns specific of the progressive AFD stages. 189 AFD patients from a multicenter cohort underwent comprehensive ECG analysis, echocardiography, and clinical evaluation. Results The study cohort (39% males, median age 47 years, 68% classical AFD) was divided into 4 groups according to different degree of left ventricular (LV) thickness: group A ≤ 9 mm (n = 52, 28%); group B 10-14 mm (n = 76, 40%); group C 15-19 mm (n = 46, 24%); group D ≥ 20 mm (n = 15, 8%). The most frequent conduction delay was right bundle branch block (RBBB), incomplete in groups B and C (20%,22%) and complete RBBB in group D (54%, p < 0.001); none of the patients had left bundle branch block (LBBB). Left anterior fascicular block, LVH criteria, negative T waves, ST depression were more common in the advanced stages of the disease (p < 0.001). Summarizing our results, we suggested ECG patterns representative of the different AFD stages as assessed by the increases in LV thickness over time (Central Figure). Patients from group A showed mostly a normal ECG (77%) or minor anomalies like LVH criteria (8%) and delta wave/slurred QR onset + borderline PR (8%). Differently, patients from groups B and C exhibited more heterogeneous ECG patterns: LVH (17%; 7% respectively); LVH + LV strain (9%; 17%); incomplete RBBB + repolarization abnormalities (8%; 9%), more frequently associated with LVH criteria in group C than B (8%; 15%). Finally, patients from group D showed very peculiar ECG patterns, represented by complete RBBB + LVH and repolarization abnormalities (40%), sometimes associated with QRS fragmentation (13%). Conclusions ECG is a sensitive tool for early identification and long-term monitoring of cardiac involvement in patients with AFD, providing "instantaneous pictures" along the natural history of AFD. Whether ECG changes may be associated with clinical events remains to be determined.
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Affiliation(s)
- V. Parisi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - R. Baldassarre
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - V. Ferrara
- Unità Ospedaliera Cardiologia, Azienda Sanitaria Territoriale Pesaro Urbino, Fano, Italy
| | - R. Ditaranto
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - F. Barlocco
- Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - R. Lillo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F. Re
- Cardiology Department, San Camillo-Forlanini Hospital, Rome, Italy
| | - G. Marchi
- Internal Medicine Unit and MetabERN Health Care Provider, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - C. Chiti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - F. Di Nicola
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - C. Catalano
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - L. Barile
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - M. A. Schiavo
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - A. Ponziani
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - G. Saturi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - A. G. Caponetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - A. Berardini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - M. Graziosi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - F. Pasquale
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - I. Salamon
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - M. Ferracin
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - E. Nardi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - I. Capelli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Rare Kidney Disease Reference Network-ERKNet, Bologna, Italy
| | - D. Girelli
- Internal Medicine Unit and MetabERN Health Care Provider, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - J. R. Gimeno Blanes
- Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - M. Biffi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - N. Galiè
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
| | - I. Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer University Children Hospital and Careggi University Hospital, Florence, Italy
| | - F. Graziani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E. Biagini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Bologn, Italy
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Porcari A, Pagura L, Canepa M, Biagini E, Cappelli F, Tini G, Dore F, Longhi S, Sciagra' R, Fontana M, Gillmore J, Rapezzi C, Merlo M, Sinagra G. Prognostic implications of biventricular uptake of bone tracers at planar scintigraphy in transthyretin cardiac amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The prognostic role of bone tracer uptake in transthyretin cardiac amyloidosis (ATTR-CA) is controversial. A further characterization of cardiac retention measured by Perugini scale with differentiation between biventricular (BiV) and isolated left ventricle (LV) uptake has never been attempted previously.
Purpose
The study investigated the potential prognostic significance of BiV uptake in ATTR-CA.
Methods
In this multicentre, observational study, we analysed data of ATTR-CA patients who underwent bone tracer scintigraphy with acquisition of both planar and single photon emission computed tomography (SPECT) imaging. Cardiac uptake was defined according to the Perugini visual scale. Planar BiV uptake was defined according to right ventricle (RV) uptake: 0= absent, 1= < bone, 2= equal to bone, and 3= > bone and confirmed by SPECT imaging. The primary outcome was a composite of cardiac death or hospitalization for heart failure. The secondary outcome was all-cause mortality.
Results
All 124 ATTR-CA patients enrolled had LV and RV free wall uptake on SPECT images. Of them, 93 (75%) had BiV uptake visible on planar scintigraphy. BiV uptake was found in 14%, 70%, and 92% of Perugini grade 1, 2 and 3 respectively. Compared to those with isolated LV uptake, patients with BiV uptake were older (81 vs 77 years, p=0.006) and more frequently in NYHA≥3 (32% vs 10%, p=0.018). During a median follow-up of 21 months, BiV uptake was associated with a greater occurrence of the primary outcome compared to isolated LV uptake (40% vs 19%, p=0.021), whereas the Perugini scale was not (p=0.2) (Figure 1). At multivariable analysis, NYHA class ≥3 (hazard ratio [HR] 8.1, p=0.007), eGFR <60 ml/min (HR 2.1, p=0.025) and higher degree of RV uptake (HR 1.69, p=0.007) emerged as independent prognostic parameters. In an external cohort of 463 ATTR-CA patients with a median follow-up of 30 months, planar BiV uptake was independently associated with all-cause mortality, with an incremental risk in higher grades of RV uptake (p<0.001) (Figure 1).
Conclusions
The presence of BiV uptake at planar scintigraphy identified ATTR-CA patients with worse cardiovascular and global outcomes (Figure 2), potentially serving as a novel prognostic marker.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - L Pagura
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - M Canepa
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - E Biagini
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit , Bologna , Italy
| | - F Cappelli
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - G Tini
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - F Dore
- Giuliano Isontina University Health Authority, Department of Nuclear Medicine , Trieste , Italy
| | - S Longhi
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit , Bologna , Italy
| | - R Sciagra'
- Careggi University Hospital, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio” , Florence , Italy
| | - M Fontana
- Royal Free London NHS Foundation Trust, National Amyloidosis Centre, Division of Medicine , London , United Kingdom
| | - J Gillmore
- Royal Free London NHS Foundation Trust, National Amyloidosis Centre, Division of Medicine , London , United Kingdom
| | - C Rapezzi
- University Hospital of Ferrara, Cardiothoracic Department , Ferrara , Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
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3
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Di Nicola F, Ditaranto R, Barlocco F, Lillo R, Re F, Marchi G, Baldassarre R, Parisi V, Ferrara V, Chiti C, Gimeno Blanes JR, Graziani F, Galie' N, Olivotto I, Biagini E. Electrocardiographic findings in Anderson-Fabry patients on disease specific therapy: can treatment prevent ECG changes? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder that have gained attention due to the availability of therapeutic options. Disease specific therapy (DST), either by enzyme replacement therapy or oral pharmacological chaperone, is the mainstay for AFD treatment. Although its widespread use, few data are available on the electrocardiographic variations associated with DST.
Purpose
To evaluate ECG findings and variations in AFD according to time duration of DST, comparing patients under long-term therapy with naïve patients starting therapy during follow-up.
Methods
One-hundred-seventy-nine AFD patients, ≥18 years old, with 2 readable ECGs, were recruited in the present multicentre study cohort. Two patients were excluded due to pacemaker (PM) implantation. Only patients on DST (n=107) were considered for final cohort and divided into 2 groups according to therapy duration: Group A (n=42) included patients treated for ≥12 months at the time of first evaluation, whereas Group B patients (n=65) started therapy during follow-up.
Results
Group A and Group B had no significant difference in terms of age at presentation (48 [39–60] vs 48 [36–56] years; p=0.856) and maximal wall thickness (13 [11–15] vs 13 [11–18] mm; p=0.090) whereas they differed for male prevalence (61% vs 38%; p=0.029) and classic phenotype (86% vs 29%; p<0.0001). At baseline, more than half of both groups had ECG abnormalities (61% vs 61%; p=1.000). The prevalence among Group A and Group B of atrial fibrillation (AF, 5% vs 6%; p=1.000), first degree atrioventricular block (AVB, 7% vs 5%; p=0.677), right bundle branch block (RBBB, complete 7% vs 8%; p=1.000; incomplete RBBB 14% vs 12%; p=0.776), left anterior fascicular block (LAFB, 10% vs 9%; p=1.000) and repolarization abnormalities (48% vs 38%; p=0.423) was not significantly different. Conversely, left ventricular hypertrophy (LVH) was more prevalent in Group A (64% vs 37%; p=0.010).
During the follow-up period (57 [60–28] months for Group A vs 70 (37–85) months for Group B; p=0.152), both groups developed electrocardiographic alterations (38% vs 23%; p=0.127). In particular, in Group A, 4 (10%) patients presented AF, 1 (2%) AVB, 7 (17%) complete or incomplete RBBB, 4 (10%) LAFB, 1 (2%) LVH and 8 (19%) repolarization abnormalities. In Group B, 2 (3%) developed AF, 1 (2%) AVB, 7 (11%) complete or incomplete RBBB, 2 (3%) LVH and 11 (17%) repolarization abnormalities; none developed LAFB.
Conclusions
In this AFD cohort, both patients on chronic DST (Group A) and patients who started treatment during follow-up (Group B) developed ECG alterations. ECG changes during the follow-up were more frequent in Group A (38% vs 23%), mainly composed by classic phenotype and male patients, suggesting a prompt start of therapy at an early stage.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Di Nicola
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - R Ditaranto
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - F Barlocco
- University of Florence, Department of Experimental and Clinical Medicine , Florence , Italy
| | - R Lillo
- IRCCS Foundation Agostino Gemelli University Hospital, Department of Cardiovascular and Thoracic Sciences , Rome , Italy
| | - F Re
- S. Camillo-Forlanini Hospital, Cardiology Department , Rome , Italy
| | - G Marchi
- University of Verona, Department of Medicine, Section of Internal Medicine , Verona , Italy
| | - R Baldassarre
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - V Parisi
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - V Ferrara
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - C Chiti
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | | | - F Graziani
- IRCCS Foundation Agostino Gemelli University Hospital, Department of Cardiovascular and Thoracic Sciences , Rome , Italy
| | - N Galie'
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - I Olivotto
- University of Florence, Department of Experimental and Clinical Medicine , Florence , Italy
| | - E Biagini
- IRCCS – Azienda Ospedaliera Universitaria – Policlinico Sant'Orsola, Cardiology Department , Bologna , Italy
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Protonotarios A, Barriales-Villa R, Antoniades L, Mogensen J, Garcia-Pavia P, Wahbi K, Biagini E, Anastasakis A, Tsatsopoulou A, Zorio E, Gimeno JR, Garcia-Pinilla JM, Sinagra G, Bauce B, Elliott PM. Risk stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: the impact of genotype on the 2019 ARVC risk calculator. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is associated with sudden cardiac death (SCD). The 2019 ARVC risk model has been proposed as a method to quantify arrhythmic risk, but the impact of genotype its performance has not been addressed.
Purpose
To study arrhythmic outcomes in patients with ARVC and the performance of the 2019 ARVC risk model in predefined genetic subgroups.
Methods
This is an international, retrospective observational cohort study on consecutively evaluated patients with ARVC recruited from 17 centres in 7 countries. Inclusion criteria were: (i) a definite diagnosis of ARVC according to the 2010 Task Force Criteria; (ii) no history of sustained ventricular arrhythmia (VA) prior to first assessment at the participating centre; (iii) a follow up period of ≥1 month; (iv) age of diagnosis ≥14 years. Sustained ventricular arrhythmia (sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator intervention, aborted SCD, or SCD) comprised the primary outcome (VA). Discriminative ability was assessed by Uno's concordance index (c-statistic) and calibration with the calibration plot slope. Fine-Gray regression was used to model the impact of clinical predictors on the arrhythmic outcome, in the context of competing risks (heart transplantation and non-arrhythmic death). The cumulative probability and 95% confidence intervals (95% CI) for the occurrence of an outcome were estimated using the Aalen-Johansen estimate in order to take into account competing risks.
Results
The study cohort comprised 554 ARVC patients. During a median follow-up of 6.0 [3.1,12.5] years, 100 patients (18%) experienced VA (Figure). Risk estimates for VA using the 2019 ARVC risk model showed good discriminative ability (c-statistic 0.75 (95% CI 0.70–0.81)) but with overestimation of risk (slope 0.46 (95% CI 0.33–0.63)). The ARVC risk model was compared in 4 gene groups: PKP2 (n=118, 21%); DSP (n=79, 14%); other desmosomal (n=59, 11%); and gene elusive (n=160, 29%). Discrimination and calibration were highest for PKP2 [c-statistic 0.83 (95% CI 0.75–0.91); calibration slope 0.67 (95% CI 0.40–1.04)] and lowest for the gene elusive group [c-statistic 0.65 (95% CI 0.57–0.74); calibration slope 0.26 (95% CI 0.06–0.49)]. Univariable analyses revealed variable performance of individual clinical risk markers in the different gene groups (see heatmap of hazard ratios and statistical significance in Figure). For example, RV dimensions and systolic function are significant risk markers in PKP2 but not in DSP patients and the opposite is true of LV systolic function (Figure).
Conclusion
The 2019 ARVC risk model performs reasonably well in gene positive ARVC, (particularly for PKP2) but is more limited in gene elusive patients. Genotype specific risk factors should be considered in ARVC patients.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
| | - R Barriales-Villa
- Institute of Biomedical Research of La Coruna (INIBIC) , A Coruna , Spain
| | | | - J Mogensen
- Aalborg University Hospital , Aalborg , Denmark
| | - P Garcia-Pavia
- Puerta de Hierro Majadahonda University Hospital, Majadahonda , Madrid , Spain
| | - K Wahbi
- Cochin APHP Site of Paris Centre University Hospital , Paris , France
| | - E Biagini
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic , Bologna , Italy
| | | | - A Tsatsopoulou
- Yannis Protonotarios Medical Center of Naxos , Naxos , Greece
| | - E Zorio
- University Hospital y Politecnico La Fe , Valencia , Spain
| | - J R Gimeno
- Virgin of the Arrixaca University Clinical Hospital , Murcia , Spain
| | | | - G Sinagra
- University of Trieste , Trieste , Italy
| | - B Bauce
- University of Padova , Padua , Italy
| | - P M Elliott
- University College London , London , United Kingdom
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5
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Parisi V, Graziosi M, Ditaranto R, Chiti C, Caponetti AG, Minnucci M, Baldassarre R, Di Nicola F, Catalano C, Saturi G, Berardini A, Pasquale F, Leone O, Galie' N, Biagini E. Diagnostic pathways leading to arrhythmogenic left ventricular cardiomyopathy in a single center cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite major advances, the recognition of arrhythmogenic left ventricular cardiomyopathy (ALVC) remains challenging, since this clinical entity is often concealed in different clinical settings both in terms of clinical onset and imaging phenotype, resulting in significant delays in diagnosis with prognostic implications.
Purpose
To describe a single Center cohort of ALVC patients, focusing on the spectrum of clinical presentation and diagnostic pathways.
Methods
Patients were retrospectively evaluated between January 2012 and January 2022. Diagnosis was based on 1) ≥3 contiguous segments with subepicardial/midwall LGE in the LV at cardiac magnetic resonance (CMR) plus a likely pathogenic/pathogenic arrhythmogenic cardiomyopathy (ACM) associated genetic mutation and/or familial history of ACM and/or red flags for ALVC (i.e, negative T waves in V4–6/aVL, low voltages in limb leads) or 2) pathology examination of explanted hearts/autoptic cases suffering from sudden cardiac death (SCD). Patients with significant right ventricular involvement were excluded.
Results
Sixty-six patients were evaluated for suspected ALVC: 8 phenocopies were excluded (6 acute myocarditis and 2 sarcoidosis) after a comprehensive clinical and multi-modality instrumental evaluation. The final study cohort was composed by 56 patients (55% males, median age 45 years), from 36 families. Diagnostic pathways leading to diagnosis were: SCD in 4 (7%), ventricular arrhythmias in 11 (20%), chest pain in 9 (16%), heart failure in 7 (12%), and familial screening in 25 (45%) (Figure 1). An echocardiogram was available for all but 2 patients with SCD: 25 (46%) had normal phenotype, 17 (32%) had a hypokinetic non dilated cardiomyopathy, and 12 (22%) had a dilated cardiomyopathy (DCM). Of the 49 tested patients, 31 (63%) had a pathogenic/likely pathogenic DNA variant: desmoplakin (DSP, N=21), filamin C (FLNC, N=4), SCN5A (N=3) were the most frequently involved genes; 8 patients had a double gene mutation. Twenty-four patients (43%) had previously received a diagnosis other than ALVC: 10 idiopathic DCM, 9 acute myocarditis, 4 post-myocarditis DCM, 2 acute myocardial injury/non-ST elevated myocardial infarction. In 13 patients ALVC was diagnosed with the introduction of CMR in the diagnostic work-up of a DCM, in 2 cases the diagnosis was done with the pathology examination after heart transplantation. The median diagnostic delay was of 8 years, with a maximum of 20 years. It is worth nothing that patients from the same family might have different diagnostic pathways and phenotypes of ALVC (Figure 2).
Conclusions
ALVC is a challenging diagnosis, hidden in different clinical scenarios. Five main clinical pathways leading to ALVC diagnosis may be identified: ventricular arrhythmias, chest pain, heart failure, SCD at first presentation, and clinical/instrumental familial screening.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Parisi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - M Graziosi
- IRCCS - Azienda Ospedaliera Universitaria - Policlinico di Sant'Orsola, Cardiology Department , Bologna , Italy
| | - R Ditaranto
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - C Chiti
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - A G Caponetti
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - M Minnucci
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - R Baldassarre
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - F Di Nicola
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - C Catalano
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - G Saturi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - A Berardini
- IRCCS - Azienda Ospedaliera Universitaria - Policlinico di Sant'Orsola, Cardiology Department , Bologna , Italy
| | - F Pasquale
- IRCCS - Azienda Ospedaliera Universitaria - Policlinico di Sant'Orsola, Cardiology Department , Bologna , Italy
| | - O Leone
- IRCCS - Azienda Ospedaliera Universitaria - Policlinico di Sant'Orsola, Pathology Department , Bologna , Italy
| | - N Galie'
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - E Biagini
- IRCCS - Azienda Ospedaliera Universitaria - Policlinico di Sant'Orsola, Cardiology Department , Bologna , Italy
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6
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Baldassarre R, Ditaranto R, Barlocco F, Lillo R, Re F, Marchi G, Parisi V, Ferrrara V, Di Nicola F, Chiti C, Gimeno Blanes JR, Graziani F, Galie' N, Zancarano A, Biagini E. Electrocardiographic evolution in Anderson-Fabry disease patients on and off specific therapy: a potential marker to study the therapeutic cardiac goal. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Anderson Fabry disease (AFD) is an X-linked lysosomal storage disorder leading to a deficiency in α-galactosidase A and globotriasylceramide (Gb3) deposition in different organs, including the heart. In AFD patients electrocardiogram (ECG) represents an important tool to detect cardiac involvement. AFD specific therapy (enzyme replacement or chaperon therapy) has shown to modify the natural history of the disease and to decrease Gb3 levels, but so far there are no data on its influence on ECG evolution.
Purpose
To assess the progression of ECG features in AFD patients on and off specific disease therapy and to evaluate the potential role of ECG in studying the cardiac specific response to therapy.
Methods
We recruited 170 patients with an established AFD diagnosis, ≥18 years old (64 males 38%, median age 46±15 years) in a multicentre study cohort. We analysed their ECG evolution for a median follow-up of 64±48 months in patients off (group A, N=63) and on (group B, N=107) specific therapy.
Results
AFD patients off specific disease therapy (group A) had similar age at baseline compared to those on therapy (47±14 vs 44±12 years; p=0,171), however significantly differed for males prevalence [13 (21%) vs 51 (48%); p≤0,001], classic phenotype [36 (57%) vs 82 (77%); p<0,001)] and maximal wall thickness [11±3 vs 13±4 mm; p≤0,0001]. As regards ECG features at baseline, group A showed a lower prevalence of repolarization anomalies [16 (25%) vs 51 (48%), p=0,005], left ventricular hypertrophy [14 (22%) vs 51 (48%), p=0,001], pseudo necrosis [4 (6%) vs 18 (17%) vs, p≤0,060] and short PR [2 (3%) vs 12 (11%), p=0.0845]. During the follow-up ECG progression was observed in 9 patients in group A (14%), characterized by the development of repolarization anomalies (N=5; 8%), incomplete right bundle block (N=4; 6%), shortening of PR interval (N=2; 3%), left ventricular hypertrophy (N=2; 3%), left atrial enlargement (N=2; 3%) and complete right bundle block (N=1; 2%). Differently, in group B an ECG evolution was observed in 31 patients (29%) characterized by the development of repolarization anomalies (N=19; 18%), left atrial enlargement (N=12; 12%), complete right bundle block (N=8; 8%), left anterior fascicular hemiblock (N=4; 4%), left bundle block (N=4, 4%) and left ventricular hypertrophy (N=3; 3%). Among patients off therapy we observed an improvement of ECG in 1 patient characterized by regression of repolarization anomalies, which could be explained with the presence of transient overload anomalies.
Conclusion
In AFD patients off and on specific disease therapy, ECG evolution was detected in 14% and 29% respectively, consistently with the more advanced cardiac involvement in patients on therapy (higher prevalence of male sex, classic phenotype and higher maximum wall thickness). The fact that one third of the patients showed ECG changes progression despite being on specific disease therapy could be relevant to better defined the therapeutic cardiac goal.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Baldassarre
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - R Ditaranto
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - F Barlocco
- University of Florence, Department of Experimental and Clinical Medicine , Florence , Italy
| | - R Lillo
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences , Rome , Italy
| | - F Re
- San Camillo Forlanini Hospital, Cardiology Department , Rome , Italy
| | - G Marchi
- University of Verona, Department of Medicine, Section of Internal Medicine , Verona , Italy
| | - V Parisi
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - V Ferrrara
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - F Di Nicola
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - C Chiti
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | | | - F Graziani
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences , Rome , Italy
| | - N Galie'
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) , Bologna , Italy
| | - A Zancarano
- University of Florence, Department of Experimental and Clinical Medicine , Florence , Italy
| | - E Biagini
- S. Orsola-Malpighi Policlinic, Cardiology Department , Bologna , Italy
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7
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Chiti C, Ditaranto R, Barlocco F, Lillo R, Re F, Marchi G, Parisi V, Ferrara V, Baldassarre R, Di Nicola F, Gimeno Blanes JR, Graziani F, Galie' N, Olivotto I, Biagini E. ECG as a storytelling of cardiac involvement evolution in Anderson Fabry disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac involvement in Anderson-Fabry disease (AFD) is related to a progressive glycosphingolipid storage over time and is characterized by left ventricular hypertrophy (LVH), conduction abnormalities and myocardial fibrosis. ECG is useful for early recognition of AFD, however evidence is limited on the association between ECG alterations and disease stage.
Purpose
To assess the relationship between ECG characteristics and progressive cardiac involvement, from the pre-hypertrophic phase to phenotypes with increasing degree of LVH.
Methods
In a multicenter cohort, 183 AFD patients (40% male, age 47±12 years, 60% affected by “classical AFD”) underwent ECG and transthoracic echocardiography. Patients were divided into 4 groups according to the different degree of LV thickness measured in parasternal short axis view: group A ≤9 mm (N=46, 25%), group B 10–14 mm (N=77, 42%), group C 15–19 mm (N=45, 25%) and group D ≥20 mm (N=15, 8%). Patients with pacemaker and under 18 years of age were excluded.
Results
A normal ECG was present in 89% in group A, 59% in group B, 11% in group C and it was absent in group D. Short PR (<120 ms) was more frequent in group A, whereas with LVH increasing, median PR interval duration significantly prolonged among the 4 groups (136 [125–150]vs 141 [130–160] vs 160 [130–180] vs 170 [130–180] ms, p=0.002 respectively). Median P-wave duration was shorter in group A and B compared to group C and D (80 m vs 100 ms, p<0.001), while both QRS and QTc gradually increased. Median Sokolow-Lyon voltage criteria statistically augmented among the groups (22 [18–26] vs 27 [20–33] vs 32 [25–45] vs 35 [18–40] mm, p<0.001 respectively), along with right ventricular hypertrophy (0%, 1%, 11%, 8%, p=0.02). Right bundle branch block (RBBB) had a higher frequency in advanced stages (0%, 34%, 34%, 40%, p<0.001), with a prevalence of complete RBBB of 46% in group D. Similarly, left anterior fascicular block (0%, 7%, 18%, 46%, p<0.001) and QRS fragmentation (2%, 11%, 25%, 23%, p=0.009) were more common in advanced stages. No differences were found in left bundle branch block (LBBB), in low QRS voltages or in LV pre-excitation prevalence. According with the wall thickness increase, negative T waves were more frequent in lateral (4%, 21%, 70%, 77%, p<0.001) and inferior leads (6%, 15%, 32%, 46%, p 0.001), as well as their association with ST-T depression (4%, 17%, 64%, 46%, p<0.001). Giant negative T waves were present only in group C and D (16% and 31%) mainly representing a LVH distribution toward the apex.
Conclusions
ECG is a very useful tool to stage cardiac involvement evolution in AFD. Peculiar ECG characteristics evolve together with LV wall thickness: incomplete and progressively complete RBBB usually associated (preceding or following) LVH and/or typical repolarization abnormalities in inferior or lateral leads and giant negative T waves in the more advanced stages are the most frequent and typical ECG patterns.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Chiti
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - R Ditaranto
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - F Barlocco
- Department of Experimental and Clinical Medice, University of Florence , Florence , Italy
| | - R Lillo
- IRCCS - Fondazione Policlinico Universitario A. Gemelli, Department of Cardiovascular and Thoracic Sciences , Rome , Italy
| | - F Re
- San Camillo-Forlanini Hospital, Cardiology Department , Rome , Italy
| | - G Marchi
- Department of Medicine, Section of Internal Medicine, University of Verona , Verona , Italy
| | - V Parisi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - V Ferrara
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - R Baldassarre
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - F Di Nicola
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | | | - F Graziani
- IRCCS - Fondazione Policlinico Universitario A. Gemelli, Department of Cardiovascular and Thoracic Sciences , Rome , Italy
| | - N Galie'
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy , Bologna , Italy
| | - I Olivotto
- Department of Experimental and Clinical Medice, University of Florence , Florence , Italy
| | - E Biagini
- IRCCS - Azienda Ospedaliera Universitaria - Policlinico di Sant'Orsola, Cardiology Department , Bologna , Italy
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8
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Merlo M, Pagura L, Porcari A, Cameli M, Vergaro G, Musumeci B, Biagini E, Canepa M, Crotti L, Imazio M, Forleo C, Cappelli F, Favale S, Di Bella G, Dore F, Girardi F, Tomasoni D, Pavasini R, Rella V, Palmiero G, Caiazza M, Albanese M, Igoren Guarrucci A, Branzi G, Caponetti A, Saturi G, La Malfa G, Merlo A, Andreis A, Bruno F, Longo F, Rossi M, Varra‘ G, Saro R, Di Ienno L, De Carli G, Giacomin E, Spini V, Limongelli G, Autore C, Olivotto I, Badano L, Parati G, Perlini S, Metra M, Emdin M, Rapezzi C, Sinagra G. C64 UNMASKING THE PREVALENCE OF AMYLOID CARDIOMYOPATHY IN THE REAL WORLD: RESULTS FROM PHASE 2 OF AC–TIVE STUDY, AN ITALIAN NATIONWIDE SURVEY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.062] [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
Background
Clinicians need to identify patients with amyloid cardiomyopathy (AC) at an early stage, due to the availability of disease–modifying therapies. Some echocardiographic findings may rise the suspicion of AC, also in patients with mild or no symptoms, addressing second level diagnostic tests.
Aim
To investigate the prevalence of AC in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram in Italy and presenting echocardiographic signs suggestive of AC.
Methods
This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) a recording phase consisting in a national survey on prevalence of possible echocardiographic red flags of AC in consecutive unselected patients ≥55 years undergoing routine echocardiogram (previously published) and 2) an AC diagnostic phase involving a diagnostic work–up for AC to investigate AC prevalence among patients with at least one echocardiographic red flag (herein presented). Patients that in Phase 1 presented an “AC suggestive” echocardiogram (i.e., at least one red flag of AC in hypertrophic, non–dilated left ventricles with preserved ejection fraction) underwent clinical evaluation, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related–AC (ATTR–AC) was made in presence of grade 2–3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov (#NCT04738266).
Results
Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as “AC suggestive” and proceeded to Phase 2. 217 patients completed Phase 2 investigations. Main reasons for the 164 non–entering patients into Phase 2 were death (n = 49) and refusal to participate (n = 66). A final diagnosis of AC was made in 62 patients with an estimated prevalence of 28,6% (95% CI: 22,5%–34,7%). ATTR–AC was diagnosed in 51 and AL–AC in 11 patients, ascertaining a prevalence of 23,5% (95% CI: 17,8%–29,2%) and 5,1% (95% CI: 2,2%–8,0%), respectively.
Conclusion
Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of AC, the prevalence of AC ranged from 23% up to 35%. Although ATTR–AC was predominant, AL–AC was diagnosed in a significant number of cases. Echocardiography has a fundamental role in screening patients, raising the suspicion of disease and orienting diagnostic work–up for AC.
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Affiliation(s)
- M Merlo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Pagura
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Porcari
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Cameli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Vergaro
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - B Musumeci
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - E Biagini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Canepa
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Crotti
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Imazio
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Forleo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Cappelli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - S Favale
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Di Bella
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Dore
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Girardi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - D Tomasoni
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - R Pavasini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - V Rella
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Palmiero
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Caiazza
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Albanese
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Igoren Guarrucci
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Branzi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Caponetti
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Saturi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G La Malfa
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Merlo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Andreis
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Bruno
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Longo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Rossi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Varra‘
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - R Saro
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Di Ienno
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G De Carli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - E Giacomin
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - V Spini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Limongelli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Autore
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - I Olivotto
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Badano
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Parati
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - S Perlini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Metra
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Emdin
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Rapezzi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Sinagra
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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10
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Saturi G, Santona L, Sguazzotti MS, Caponetti AG, Massa P, Ponziani A, Gagliardi C, Giovannetti AG, Lovato L, Attina D, Bonfiglioli R, Saia F, Galie N, Biagini E, Longhi S. Different aortic valve calcium scores by computed tomography scan in patients with severe aortic stenosis and concomitant cardiac amyloidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The coexistence of cardiac amyloidosis (CA) and degenerative aortic stenosis (AS) is increasing but the diagnosis is challenging because these two conditions share a common echocardiographic phenotype (1). Different predictors have been proposed in the last few years, including clinical, ECG-graphic and echocardiographic features (2–3).
Purpose
To identify a new marker of concomitant CA in patients with severe AS analyzing computed tomography scan (CT).
Methods
55 patients with severe AS and suspicion of concomitant CA were retrospectively enrolled. Patients with a bicuspid aortic valve, previous aortic valve replacement, or an incomplete diagnostic workup for CA were excluded. 33 patients underwent CT-scan and were included in the final analysis.
Results
None of the patients presented laboratory suspicion for AL amyloidosis; 12 patients (AS-CA) had positive 99m Tc-DPD bone scintigraphy (two with visual score 1, eight score 2 and two score 3), 21 patients (AS-alone) had negative bone scintigraphy. AS-CA patients had a median age of 85,5 years (versus 81,5) with only one female patient (versus 8 in the AS-alone group). AVA indexed were comparable between AS-CA and AS-alone groups (0,4 versus 0, 3 mm2/m2, p: 0.25). Stroke volume evaluated by pulsed Doppler, maximum and mean gradient were significatively lower in AS-CA group (respectively 30 versus 41 ml/m2, p: 0.017, 62 versus 74 mmHg, 0.038 and 33 versus 46 mmHg, p:0.022) with a higher percentage of low flow-low gradient aortic stenosis in AS-CA group (7 patients, 58% vs 3 patients in AS-alone 14%, p: 0.027), in line with the literature. ECG at first presentation in AS-CA group showed atrial fibrillation in 8 patients (67%), versus 2 patients in the AS-alone group (10%), and lower QRS voltages (peripheral QRS score 40 mV vs 51 mV, p-value:0.017; total QRS score 113 mV versus 155 mV, p-value: 0.005). The echocardiogram showed a more thickened IVS and PW in AS-CA patients (17 versus 15 mm, p: 0.05 and 15 versus 14 mm, p: 0.013), an augmented left ventricular mass (441 versus 356 g, p: 0.036) with a decreases longitudinal systolic function (septal S wave at TDI 4.4 versus 5.2 cm/s, p: 0.026, lateral S wave 4.1 versus 5.6 cm/s, p: 0.024) and a reduction in myocardial contraction fraction (12 versus 14%, p: 0.036).
CT- aortic valve calcium was quantified by an experienced operator. A statistically significant difference between AS-CA and AS-alone groups was observed in calcium score (3345 versus 4785 Hounsfield units, p: 0.037) calcium volume (2411 versus 3626 mm2, p: 0.03) and calcium mass (687 versus 1147 g, p: 0.023)
Conclusions
This study is the first to our knowledge to use relative aortic valve calcium score evaluation from CT imaging to characterize patients with severe AS with or without concomitant CA in addition to the classical clinical, ECG graphic, echocardiographic parameters. CT-aortic valve calcium burner was significatively lower in patients with concomitant CA.
Funding Acknowledgement
Type of funding sources: None. CT scan and bone scintigraphy
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Affiliation(s)
- G Saturi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - L Santona
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - M S Sguazzotti
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A G Caponetti
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - P Massa
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A Ponziani
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - C Gagliardi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A G Giovannetti
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - L Lovato
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - D Attina
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - R Bonfiglioli
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - F Saia
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - N Galie
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - E Biagini
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - S Longhi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
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11
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Sguazzotti M, Caponetti AG, Saturi G, Ponziani A, Massa P, Dal Passo B, Accietto A, Longhi S, Bonfiglioli R, Mattana F, Guaraldi P, Cortelli P, Galie N, Biagini E, Gagliardi C. Analysis of characteristics and prognostic impact of phenotypes in hereditary ATTR. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hereditary transthyretin-related amyloidosis (h-ATTR) is a systemic infiltrative disease caused by a single amino acid mutation on the transthyretin (TTR) gene, which destabilizes the protein and can determine its deposition on multiple organs, including heart and peripheral nervous system.
Purpose
We aimed to characterize and compare clinical, instrumental, and prognostic features of patients affected by h-ATTR by dividing the population into the disease's main phenotypes (unaffected carriers, cardiac, neurological or mixed phenotype).
Methods
Two hundred and eighty-five subjects of a single-centre cohort with a recognized pathogenic mutation on TTR gene were retrospectively included in the analysis. Phenotypes of disease were defined at baseline. Neurological phenotype (NP) was defined according to sensorimotor and/or autonomic dysfunction, while cardiac phenotype (CP) was defined in the presence of unexplained maximum wall thickness >12 mm and other typical echocardiographic findings. Unaffected carriers (UC) and mixed phenotypes (MP) presented none or both of the above-mentioned features, respectively.
Results
Two hundred and ten patients showed clinical signs of the disease, 37 (13%) with CP, 65 (23%) with NP and 108 (38%) with MP, while 75 subjects (26%) were UC. Ile68Leu was the most represented mutation (96 subjects, 34%), followed by Val30Met (21%) and Glu89Gln (13%). NP patients (mostly Val30Met) had mPND score >1 in 45% of patients, were younger at diagnosis (mean 47 years, p<0,001 vs CP/MP), and sex was equally distributed. In contrast, CP patients were older at diagnosis (mean 70 years, p<0,001 vs CP/MP), predominantly male (as well as in MP) with a higher incidence of tunnel carpal syndrome and a shorter time interval between onset of symptoms and diagnosis (mean 17 months, p<0,001 vs CP/MP). NYHA class, ECG findings, left ventricular wall thickness and ejection fraction did not significantly differ between CP and MP. After a mean follow-up of 59 months, 98 (34%) patients died. On a Kaplan-Meier survival analysis, mean survival times were 208, 123, 150 and 95 months for UC, CP, NP and MP, respectively, with a statistically significant difference in affected patients between NP and MP (p=0.012).
Conclusions
H-ATTR is a rare systemic disorder whose natural history, including age of onset, clinical characteristics and instrumental findings, is strongly influenced by primary phenotypes, ranging from the excellent prognosis of unaffected carriers to the inauspicious outcome of mixed phenotypes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Sguazzotti
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A G Caponetti
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - G Saturi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A Ponziani
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - P Massa
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - B Dal Passo
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - A Accietto
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - S Longhi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - R Bonfiglioli
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - F Mattana
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | | | | | - N Galie
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - E Biagini
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - C Gagliardi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
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12
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Caiffa T, Castrichini M, Biagini E, De Luca A, Compagnone M, Berardini A, Merlo M, Fabris E, Vitrella G, Pinamonti B, Korcova R, Barbati G, Saia F, Stolfo D, Sinagra G. Impact on clinical outcomes of right ventricular response to percutaneous correction of secondary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Right ventricular function (RVF) is a strong determinant of prognosis in patients with reduced ejection fraction heart failure (HFrEF) and secondary mitral regurgitation (SMR). Percutaneous mitral valve repair (pMVR) can promote the recovery of RVF.
Purpose. We sought to characterize the RV response to pMVR in HFrEF with SMR and to assess the influence of improved RVF after pMVR in this specific setting of patients.
Methods. We included all the patients with HFrEF and SMR≥3+ successfully treated with pMVR between April 2012 and January 2020 in two tertiary care centers for HF. Improved RVF was defined as DRVFAC≥5% at early follow-up (median time 4 months). The primary endpoint was a composite of death/heart transplant (D/HT).
Results. In total, 110 patients were included. Mean age was 67 ± 12 years, mean LVEF was 31 ± 8% and mean RVFAC was 31 ± 10%. DRVFAC≥5% occurred in 54 (49%) patients and was independent from the measures of left ventricle recovery. During a median follow-up of 36 months (IQR 19-52), 40 patients (36%) died or were transplanted. After adjustment for other significant covariates, DRVFAC≥5% was significantly associated with lower risk of D/HT (HR 0.49, 95% CI 0.24 – 0.98 p < 0.042) along with M2+ at follow-up (HR 0.36; 95% CI 0.17-0.74 p 0.005).
Conclusions. In patients with HFrEF and SMR, the improvement of RVF is frequent after pMVR and is associated with better long-term survival free from HT.
Abstract Figure.
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Affiliation(s)
- T Caiffa
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - M Castrichini
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - E Biagini
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A De Luca
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - M Compagnone
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A Berardini
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - M Merlo
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - E Fabris
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - G Vitrella
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - B Pinamonti
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - R Korcova
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - G Barbati
- University of Trieste, Trieste, Italy
| | - F Saia
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - D Stolfo
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - G Sinagra
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
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Gimeno J, Elliott P, Tavazzi L, Tendera M, Kaski J, Laroche C, Barriales R, Seferovic P, Biagini E, Arbustini E, Rochas Lopes L, Linhart A, Mogensen J, Hagège A, Espinosa M, Saad A, Maggioni A, Caforio A, Charron P. Prospective follow-up in various subtypes of cardiomyopathies: Insights from the EORP Cardiomyopathy Registry of the ESC. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Caponetti A, Longhi S, Saturi G, Ponziani A, Sguazzotti M, Massa P, Milandri A, Salvi F, Biagini E, Rapezzi C, Galie' N, Gagliardi C. A clinical and instrumental study of heart failure in amyloidotic cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is one of the main features of amyloidotic cardiomyopathy (AC) and it is supposed to carry important prognostic implications. Despite the intrinsic etiologic heterogeneity of AC, HF has been mainly attributed to diastolic dysfunction, but the role played by the different amyloid subtypes of AC and by the clinical and hemodynamic factors in the pathophysiology of HF remains unclear.
Objectives
We aimed to assess the hemodynamic profile and outcome of patients with or without advanced HF (defined as NYHA class III-IV) at the time of first evaluation in light-chain (AL), hereditary transthyretin-related (h-ATTR) and non-mutant transthyretin-related (wt-ATTR) AC.
Methods
Among the 411 patients diagnosed with AC (156 AL, 131 h-ATTR, 124 wt-ATTR) at our Centre between 1990–2019, we analyzed central hemodynamic data, echocardiographic, clinical, ECG details and survival of the whole cohort. Cox regression analysis was used to stratify prognosis.
Results
112 (27%) patients presented advanced HF at first evaluation and frequently showed severe symmetric left ventricle wall thickening (higher values in h-ATTR), non-dilated left ventricle, preserved ejection fraction and pathological global longitudinal strain and/or myocardial contraction fraction.
At ECG, a significantly lower QRS voltage was present in advanced HF patients. Hemodynamically, elevated filing pressures on both cardiac sides were present in patients in NYHA III-IV class of the three etiologies. Overall survival at 2 years was 35% for AL, 83% for h-ATTR, 65% for wt-TTR. H-ATTR and wt-TTR were favorable predictors of survival, while reduced cardiac index and elevated filling pressures were indepedently associated with higher mortality.
Conclusions
The characterization of hemodynamic profile plays a central role in predicting the natural history of AC, since reduced stroke volume and elevated filling pressures are the best predictors of mortality, reflecting a physiopathological restrictive model of the disease. Conversely, left ventricular ejection fraction is rarely abnormal and it is not a reliable marker of poor prognosis, especially in the early stages of the disease. AL amyloidosis shows the worst outcome probably due to a combination of the underlying illness and light chains cardiotoxicity.
LVEF and cardiac index in HF
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A.G Caponetti
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
| | - S Longhi
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
| | - G Saturi
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
| | - A Ponziani
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
| | - M Sguazzotti
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
| | - P Massa
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
| | - A Milandri
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
| | - F Salvi
- Bellaria Hospital, Neurology, Bologna, Italy
| | - E Biagini
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
| | - C Rapezzi
- University of Ferrara, Cardiology, Ferrara, Italy
| | - N Galie'
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
| | - C Gagliardi
- Alma Mater Studiorum, University of Bologna, Cardiology, Bologna, Italy
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15
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Vitale G, Di Nicola F, Tanini I, Camporeale A, Graziani F, Ditaranto R, Zanoni R, Ferrara V, Lombardi M, Olivotto I, Rapezzi C, Galie N, Biagini E. Electrocardiographic differences between Anderson-Fabry and sarcomeric hypertrophic cardiomyopathy and correlation with cardiac magnetic resonance. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Differential diagnosis between Anderson-Fabry (AF) and sarcomeric hypertrophic cardiomyopathy (HCM) is often very challenging particularly in AF patients with late onset cardiac involvement.
Purpose
To gain new insights from standard electrocardiogram (ECG) in AF disease for differential diagnosis from sarcomeric HCM. Additionally, to better understand ECG features in AF patients, a correlation substudy ECG-cardiac magnetic resonance (CMR) has been performed.
Methods
From 162 patients with definite diagnosis of AF disease, 111 [65 males, median age 57 (51–67) years] with pathologic left ventricular hypertrophy (LVH) (Group A) were compared with 111 sarcomeric HCM patients (Group B) sex, age and maximal wall thickness matched by 1:1 propensity score.
Results
AF patients showed shorter PR interval [155 (140–180) vs 163 (149–184) msec; p=0.005) and wider QRS interval [110 (100–134) vs 100 (90–106) msec; p<0.0001). Additionally AF patients had a higher prevalence of complete (22% vs 3%; p<0.0001) and incomplete (13% vs 1%; p<0.0001) right bundle branch block (RBBB) and a higher percentage of ST segment depression (12% vs 1%; p=0.001) and inferior negative T waves (34% vs 19%; p=0.01). No differences in terms of Sokolow-Lyon and Cornell scores were found whereas total QRS score was higher in Group A [20 (16–27) vs 18 [14–22] mV; p=0.0004). Low QRS voltages and inferior Q waves were not present in AF patients. Among the 69 AF patients who underwent MRI, the 44 with late gadolinium enhancement (LGE) were older [59 (52–66) vs 53 (40–59) years; p=0.017] and had more frequently negative T waves on ECG, particularly in the inferior leads (64% vs 8%; p<0.0001), compared to the 25 without LGE. At multivariate analysis, age and negative T waves were independently associated to the presence of LGE on CMR.
Conclusions
Compared to matched sarcomeric HCM, AF patients had a shorter PR, wider QRS and a higher percentage of RBBB in relation to to the different aetiology (storage vs “pure” hypertrophy). The higher total QRS score and the absence of inferior Q waves could reflect the more frequent concentric distribution of LVH. Additionally negative T waves, especially in inferior leads, are related to the presence of LGE on CMR (often in the postero-lateral wall).
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Vitale
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - F Di Nicola
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - I Tanini
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - A Camporeale
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section (A.C., S.P., M.L.), San Donato Milanese, Italy
| | - F Graziani
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences, Roma, Italy
| | - R Ditaranto
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - R Zanoni
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - V Ferrara
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - M Lombardi
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Section (A.C., S.P., M.L.), San Donato Milanese, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - C Rapezzi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - N Galie
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - E Biagini
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
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16
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Paolisso P, Saturi G, Bergamaschi L, D"angelo EC, Coriano M, Foa A, Rinaldi A, Magnani I, Graziosi M, Biagini E, Ferlito M, Pacini D, Pizzi C, Galie N, Rapezzi C. P1248 What are the suspicious echocardiographic features of a malignant cardiac mass? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Cardiac Masses (CM) represent a rare and heterogeneous group with a prevalence of 0.3% at autopsy, divided in benign masses - primary tumors and pseudotumors - and malignant ones - primitive tumors and metastasis, either directly invading the heart and pericardium or as a consequence of hematologic spread. 2-D Echocardiography is nowadays the first line approach to define nature and management of CM, but is it enough to guide a therapeutic strategy?
PURPOSE
To evaluate echocardiographic CM malignancy features in patients admitted to our Centre between 1997 and 2017.
MATERIALS AND METHODS
We retrospectively evaluated a population of 180 consecutive patients (45% males; mean age 60 ± 16 years; BMI 25 ± 5 Kg/m2), referred to our echocardiographic lab with suspicion CM. All patients were examined in both left lateral and supine position, and heart was visualized from all available echocardiographic windows. Definite diagnosis was obtained by histologic examination of biopsy, surgical samples or, in cases of cardiac thrombi, by radiological evidence of thrombus resolution after adequate anticoagulant treatment. We excluded normal anatomical variants in the group of pseudotumors due to the impossibility of obtaining histological examination. Comparisons between categorical variables were performed by Chi-square or Fisher exact test. P values ≤ 0.05 were considered significant. Variables with statistical signification lower than p ≤ 0.05 in univariable analysis were included in logistic regression analysis to determinate independent predictors of malignant masses.
RESULTS
We detected 129 benign CM (76% primitive tumors and 24% pseudotumors) and 51 malignant cardiac tumors (45% primitive tumors and 55% metastasis). In 7 cases a poor acoustic window did not allow an optimal examination; in remaining 173 patients, the classical 2-D echocardiogram identified 157 masses with a diagnostic accuracy of 91%. Benign tumors and pseudotumours were localized predominantly in left heart chambers, while malignant primitive tumors and metastasis were mainly detected in right heart, in pericardium or in pulmonary artery branches (p < 0.001). The largest ecocardiographic diameter appeared greater for the malignant masses (mean of 49 ± 26 mm) than benign ones (30 ± 16 mm, p = 0.003). The occurrance of any pericardial effusion (p < 0.001), extension to pericardium (p = 0.01) or to main vessels (p = 0.006) were also associated with malignant masses. Finally, multivariate analysis showed only largest diameter (p = 0.001) and pericardial effusion (p < 0.001) were independent predictors of malignancy.
CONCLUSION
2D Echocardiography is an excellent, non invasive technique for first line evaluation of patients with suspicion CM. It is safe, accurate and have high diagnostic accuracy in identifying CM and their benign or malignant nature. In particular, a large mass associated with any pericardial effusion must pose suspect of malignancy.
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Affiliation(s)
- P Paolisso
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - G Saturi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - L Bergamaschi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - E C D"angelo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - M Coriano
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Foa
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Rinaldi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - I Magnani
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - M Graziosi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - E Biagini
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - M Ferlito
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - D Pacini
- University Hospital Policlinic S. Orsola-Malpighi, Cardiac Surgery Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - C Pizzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - N Galie
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - C Rapezzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
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17
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Paolisso P, D"angelo EC, Bergamaschi L, Foa A, Coriano M, Vitale G, Saturi G, Magnani I, Leone O, Pasquale F, Biagini E, Ferlito M, Pizzi C, Rapezzi C, Galie N. P663 Is echocardiogram alone sufficient for cardiac masses characterization? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Cardiac Masses (CM) represent an heterogeneous group with a prevalence of 0.3% at autopsy, divided in benign masses (primary tumors and pseudotumors) and malignant ones (primitive tumors and metastasis). 2-D Echocardiography is nowadays the first line approach to define nature and management of CM, but is it enough to guide a therapeutic strategy?
PURPOSE
To evaluate echocardiographic diagnosis accuracy for CM in patients admitted to our Centre between 1997 and 2017.
MATERIALS AND METHODS
We retrospectively evaluated a population of 180 consecutive patients (45% males; mean age 60 ± 16 years; BMI 25 ± 5 Kg/m2), referred to our echocardiographic lab with suspicion CM. All patients were examined in both left lateral and supine position, and heart was visualized from all available echocardiographic windows. Definite diagnosis was obtained by histologic examination of biopsy, surgical samples or, in cases of cardiac thrombi, by radiological evidence of thrombus resolution after adequate anticoagulant treatment. We excluded normal anatomical variants in the group of pseudotumors due to the impossibility of obtaining histological examination. Sensitivity, specificity, predictive accuracy for a positive test, and predictive accuracy for a negative test were calculated by standard formulas (corrected for prevalence by Bayes theorem).
RESULTS
We detected 129 benign CM and 51 malignant cardiac tumors. In 7 cases a poor acoustic window did not allow an optimal examination; in remaining 173 patients, the classical 2-D echocardiogram identified 157 masses with a diagnostic accuracy of 91%. Of 173 CM diagnosed, 146 were classified by echocardiographer as benign masses (125 true benign on histological examination) and 27 as malignant ones (all malignant after histological confirmation); the results showed 56% sensitivity, 100% specificity, 100% positive predictive value, 98% negative predictive value, with 88% overall diagnostic accuracy in identifying the nature of masses. 23 cases were undetermined and needed second level instrumental investigations to be characterized. Diagnostic accuracy for distinguishing primary benign tumors and pseudotumors decreased to 80%, with a significant increase in both "false" benign tumors (9 out of 91) and "false" pseudotumors (15 out of 34) with 85% sensitivity, 68% specificity, 10% positive predictive value, 99% negative predictive value.
CONCLUSION
2D Echocardiography is an excellent, non invasive technique for first line evaluation of patients with suspicion CM. It is safe, reliable with a high predictive value and diagnostic accuracy in identifying CM and their benign or malignant nature. In contrast, these results were insufficient to start an anticoagulant in suspicion thrombus or cardiac surgery for primary tumor, since second level instrumental examinations needed. 2D Echocardiography alone seems unuseful for classifying malignant masses in primitive or metastasis.
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Affiliation(s)
- P Paolisso
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - E C D"angelo
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - L Bergamaschi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - A Foa
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - M Coriano
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - G Vitale
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - G Saturi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - I Magnani
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - O Leone
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - F Pasquale
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - E Biagini
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - M Ferlito
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - C Pizzi
- University of Bologna, Bologna, Italy
| | - C Rapezzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
| | - N Galie
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Bologna, Italy
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18
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Ditaranto R, Rapezzi C, Boriani G, Pasquale F, Graziosi M, Vitale G, Berardini A, Lanati G, Corsini A, Caponetti G, Lattanzi G, Potena L, Ziacchi M, Leone O, Biagini E. P6455Differences in cardiac phenotype and natural history of laminopathies with and without neuromuscular presentation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
To look for differences in cardiac phenotype and natural history of patients affected by laminopathy, according to the presence or less of neuromuscular involvement at clinical presentation.
Methods
We prospectively analyzed 47 consecutive pts with a genetic diagnosis of laminopathy followed at a single centre between 1994 and 2017. Additionally, reports of clinical and instrumental evaluations before referral at our centre were retrospectively evaluated.
Results
Neuromuscular presentation, mainly as Emery-Dreifuss muscular dystrophy (EDMD), was present in 21 (46%) cases (14 LMNA and 7 EMD gene mutations). These pts had symptoms earlier (9 vs 39 years, p<0.001) in life compared to pts without neuromuscular onset (26 LMNA gene mutations), and clinical manifestations anticipated the first evidence of cardiac disease by a mean time of 15±8 years (maximum time gap of 38 years). Despite a similar prevalence of atrial fibrillation/flutter (AF) (71% vs 65%, p=0.758) and atrio-ventricular blocks (48% vs 65%, p=0.250), pts with neuromuscular onset experienced AF and pace-maker implantation at a significantly younger age (27 vs 41 yrs, p=0.015 and 23 vs 44 yrs, p=0.027 respectively). Differently a higher prevalence of sinus node dysfunction (33% vs 4%; p=0.015) and atrial paralysis (14% vs 4%; p=0.311) was reported in pts with neuromuscular onset. Prevalence of cardiomyopathy (CMP) (73% vs 33%, p=0.008) and sustained ventricular tachyarrhythmias were higher among pts with cardiac onset (23% vs 4%, p=0.111) whereas the prevalence of heart transplantations and median age of recipients were similar in the two groups (24% vs 20%, p=1.000 and 46 vs 43, p=0.592 years respectively). All pts with neuromuscular onset who received a diagnosis of CMP had a previous history of rhythm disturbance except 2 cases, where a concomitant diagnosis of the 2 disorders was formulated. On the contrary a strict temporal progression from rhythm disturbances to CMP (or viceversa) was not appreciable in the other group: AF and AVBs could precede the diagnosis of CMP be diagnosed at the same time or later.
Conclusions
In pts affected by laminopathy neuromuscular involvement, when present, was most often the first clinical manifestation and preceded cardiological involvement, with a long time frame in some cases. Except for sinus node dysfunction, much more frequent in patients with EDMD, a similar prevalence of rhythm disturbances was reported, although pts with neuromuscular clinical onset were younger at diagnosis of AF and at PM implantation. Pts without neuromuscular presentation had a higher prevalence of CMP and ventricular arrhythmias, albeit a similar rate of heart transplantation. In pts with neuromuscular onset, cardiac involvement was characterized by a stepwise progression from rhythm disturbances to CMP, where a strict temporal progression from rhythm disturbances to CMP was not observed in the group of pts without neuromuscular clinical onset.
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Affiliation(s)
- R Ditaranto
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - C Rapezzi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - F Pasquale
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Graziosi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Vitale
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - A Berardini
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Lanati
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - A Corsini
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Caponetti
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Lattanzi
- University of Bologna, Italian National Research Council
- CNR • Institute of Molecular Genetics IGM Bologna, Bologna, Italy
| | - L Potena
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Ziacchi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - O Leone
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - E Biagini
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
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19
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Vitale G, Biagini E, Ziacchi M, Di Nicola F, Graziosi M, Ditaranto R, Pasquale F, Berardini A, Tanini I, Lanati G, Foa A, Caponetti G, Leone O, Olivotto I, Rapezzi C. P900Electrocardiographic findings in Anderson-Fabry disease versus sarcomeric hypertrophic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac involvement is one of the most frequent and disabling organ damage in Anderson-Fabry (AF) disease, causing hypertrophic cardiomyopathy (HCM), conduction disturbances, arrhythmias and coronary disease. Differential diagnosis from sarcomeric HCM is often very challenging, especially for patients with exclusive cardiac involvement.
Purpose
To gain new insights from standard electrocardiogram (ECG) in AF disease, and identify ECG differences from sarcomeric HCM.
Methods
Sixty-two consecutive patients (27 males, mean age: 62±16 years) with definite diagnosis of AF disease from 2 Italian centres were evaluated for ECG analysis and divided in 2 groups, according to the presence (Group A, N=39) or the absence (Group B, N=26) of cardiac involvement [hypertrophy detected at echocardiogram or cardiac magnetic resonance (CMR)]. All ECGs were analysed by 2 independent investigators. For Group A, when CMR was performed, a correlation between CMR and ECG was assessed. Patients with cardiac involvement were matched with 78 sarcomeric HCM patients according to sex, age and septal wall thickness on echocardiogram.
Results
Two AF patients out 39 with cardiac involvement (5%) had normal ECG. Short PR and I degree atrio-ventricular (AV) block were both reported in 6 (15%) cases. Twenty-six (67%) patients showed left ventricular hypertrophy and the majority (85%) had abnormal repolarization. CMR was performed in 22 patients (56%); the 11 (50%) patients with replacement fibrosis had a higher mean Sokolow-Lyon score (4.1±1.8 vs 2.9±1.0 mV; p=0.05), more frequent ST segment depression (82 vs 27%; p=0.03) and negative T waves (91 vs 36%; p=0.027; sensitivity: 90%; specificity: 63%), compared with the 11 without replacement fibrosis.
When compared with sarcomeric HCM, AF patients with cardiac involvement had a significantly wider QRS (120±30 vs 100±16 msec; p<0.0001), a higher frequency of right bundle branch block (RBBB) (18 vs 3%; p=0.01), ST segment depression (54 vs 20%; p<0.0001) and negative T waves (72 vs 46%; p=0.01), typically in the inferior leads (44 vs 14%; p<0.0001). No significant differences in terms of pseudo-necrosis and QRS voltages were found.
Among Group B AF patients (26, mean age: 36±12 years), 4 had short PR and 5 incomplete RBBB. Four had an abnormal ECG (1 left atrial enlargement, 2 unspecific repolarization abnormalities, 1 Sokolow score of 3.5 mV).
Conclusions
Standard ECG can detect cardiac involvement in AF disease. A good correlation was reported between repolarization abnormalities and replacement fibrosis on CMR. Wide QRS and RBBB were more frequent among AF patients compared to age-sex-matched sarcomeric HCM ones, probably due to the different aetiology of the diseases (infiltrative disease vs pure hypertrophy).
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Affiliation(s)
- G Vitale
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - E Biagini
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Ziacchi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - F Di Nicola
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Graziosi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - R Ditaranto
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - F Pasquale
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - A Berardini
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - I Tanini
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - G Lanati
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - A Foa
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Caponetti
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - O Leone
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - C Rapezzi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
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20
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Grigioni F, Benfari G, Vanoverschelde JL, Tribouilloy C, Avierinos JF, Bursi F, Suri RM, Guerra F, Pasquet A, Rusinaru D, Marcelli E, Théron A, Barbieri A, Michelena H, Lazam S, Szymanski C, Nkomo VT, Capucci A, Thapa P, Enriquez-Sarano M, Suri R, Clavel M, Maalouf J, Michelena H, Nkomo VT, Enriquez-Sarano M, Tribouilloy C, Trojette F, Szymanski C, Rusinaru D, Touati G, Remadi J, Guerra F, Capucci A, Grigioni F, Russo A, Biagini E, Pasquale F, Ferlito M, Rapezzi C, Savini C, Marinelli G, Pacini D, Gargiulo G, Di Bartolomeo R, Boulif J, de Meester C, El Khoury G, Gerber B, Lazam S, Pasquet A, Noirhomme P, Vancraeynest D, Vanoverschelde JL, Avierinos J, Collard F, Théron A, Habib G, Barbieri A, Bursi F, Mantovani F, Lugli R, Modena M, Boriani G, Bacchi-Reggiani L. Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation. J Am Coll Cardiol 2019; 73:264-274. [DOI: 10.1016/j.jacc.2018.10.067] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/15/2022]
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21
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Foa A, Rapezzi C, Olivotto I, Cecchi F, Coppini R, Ferrantini C, Stefano P, Agostini V, Vitale G, Ditaranto R, Biagini E, Leone O. 1473Microvascular coronary disease and myocardial fibrosis within the spectrum of hypertrophic cardiomyopathy: a histopathologic study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1473] [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)
- A Foa
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Bologna, Italy
| | - C Rapezzi
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Bologna, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiology, Florence, Italy
| | - F Cecchi
- Careggi University Hospital (AOUC), Cardiology, Florence, Italy
| | - R Coppini
- Careggi University Hospital (AOUC), Cardiology, Florence, Italy
| | - C Ferrantini
- Careggi University Hospital (AOUC), Cardiology, Florence, Italy
| | - P Stefano
- Careggi University Hospital (AOUC), Florence, Italy
| | - V Agostini
- University Hospital Policlinic S. Orsola-Malpighi, Pathology, Bologna, Italy
| | - G Vitale
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Bologna, Italy
| | - R Ditaranto
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Bologna, Italy
| | - E Biagini
- University Hospital Policlinic S. Orsola-Malpighi, Cardiology, Bologna, Italy
| | - O Leone
- University Hospital Policlinic S. Orsola-Malpighi, Pathology, Bologna, Italy
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22
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Galati G, Pasquale F, Leone O, Olivotto I, Grigioni F, Pilato E, Biagini E, Cecchi F, Rapezzi C. P4497Accuracy of LGE-CMR compared with histometric quantification of myocardial fibrosis in transplanted hearts of end-stage HCM. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Lazam S, Vanoverschelde JL, Tribouilloy C, Grigioni F, Suri RM, Avierinos JF, de Meester C, Barbieri A, Rusinaru D, Russo A, Pasquet A, Michelena HI, Huebner M, Maalouf J, Clavel MA, Szymanski C, Enriquez-Sarano M, Michelina H, Poulain H, Remadi JP, Touati G, Trojette F, Biagini E, Di Bartolomeo R, Ferlito F, Marinelli G, Pacini D, Pasquale F, Rapezzi C, Savini C, Boulif J, El Khoury G, Gerber B, Noirhomme P, Vancraeynest D, Collard F, Habib G, Metras D, Riberi A, Tafanelli L, Bursi F, Lugli R, Mantovani F, Manicardi C, Grazia M, Bacchi-Reggiani L. Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation. Circulation 2017; 135:410-422. [DOI: 10.1161/circulationaha.116.023340] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Background:
Mitral valve (MV) repair is preferred over replacement in clinical guidelines and is an important determinant of the indication for surgery in degenerative mitral regurgitation. However, the level of evidence supporting current recommendations is low, and recent data cast doubts on its validity in the current era. Accordingly, the aim of the present study was to analyze very long-term outcome after MV repair and replacement for degenerative mitral regurgitation with a flail leaflet.
Methods:
MIDA (Mitral Regurgitation International Database) is a multicenter registry enrolling patients with degenerative mitral regurgitation with a flail leaflet in 6 tertiary European and US centers. We analyzed the outcome after MV repair (n=1709) and replacement (n=213) overall, by propensity score matching, and by inverse probability-of-treatment weighting.
Results:
At baseline, patients undergoing MV repair were younger, had more comorbidities, and were more likely to present with a posterior leaflet prolapse than those undergoing MV replacement. After propensity score matching and inverse probability-of-treatment weighting, the 2 treatments groups were balanced, and absolute standardized differences were usually <10%, indicating adequate match. Operative mortality (defined as a death occurring within 30 days from surgery or during the same hospitalization) was lower after MV repair than after replacement in both the entire population (1.3% versus 4.7%;
P
<0.001) and the propensity-matched population (0.2% versus 4.4%;
P
<0.001). During a mean follow-up of 9.2 years, 552 deaths were observed, of which 207 were of cardiovascular origin. Twenty-year survival was better after MV repair than after MV replacement in both the entire population (46% versus 23%;
P
<0.001) and the matched population (41% versus 24%;
P
<0.001). Similar superiority of MV repair was obtained in patient subsets on the basis of age, sex, or any stratification criteria (all
P
<0.001). MV repair was also associated with reduced incidence of reoperations and valve-related complications.
Conclusions:
Among patients with degenerative mitral regurgitation with a flail leaflet referred to mitral surgery, MV repair was associated with lower operative mortality, better long-term survival, and fewer valve-related complications compared with MV replacement.
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Affiliation(s)
- Siham Lazam
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Jean-Louis Vanoverschelde
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Christophe Tribouilloy
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Francesco Grigioni
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Rakesh M. Suri
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Jean-Francois Avierinos
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Christophe de Meester
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Andrea Barbieri
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Dan Rusinaru
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Antonio Russo
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Agnès Pasquet
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Hector I. Michelena
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Marianne Huebner
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Joseph Maalouf
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Marie-Annick Clavel
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Catherine Szymanski
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
| | - Maurice Enriquez-Sarano
- From Université Catholique de Louvain, Brussels, Belgium (S.L., J.-L.V., C.d.M., A.P.); Mayo Clinic College of Medicine, Rochester, MN (H.I.M., M.H., J.M., M.-A.C., M.E.-S.); University of Bologna, Italy (F.G., A.R.); Inserm, ERI-12, University Hospital, Amiens, France (C.T., D.R., C.S.); Aix-Marseille Université, Marseille, France (J.-F.A.); University of Modena, Italy (A.B.); and Cleveland Clinic, Department of Thoracic and Cardiac Surgery, OH (R.M.S.)
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- Université Catholique de Louvain, Belgium
| | | | - B. Gerber
- Université Catholique de Louvain, Belgium
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Graziosi M, Leone O, Berardini A, Lorenzini M, Rotundo MG, Biagini E, Potena L, Grigioni F, Boriani G, Rapezzi C. Arrhythmogenic right ventricular cardiomyopathy as cause of severe heart failure leading to heart transplantation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leone O, Biagini E, Pacini D, Rapezzi C. Reply to Della Corte et al. Eur J Cardiothorac Surg 2012. [DOI: 10.1093/ejcts/ezs008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lattanzi G, Basso A, Benedetti S, Bertini E, Biagini E, Boriani G, Carboni N, Cenacchi G, D'Amico A, D'Apice M, Fontana M, Gambineri A, Liguori R, Mazzanti L, Mercuri E, Mongini T, Morandi L, Nigro G, Palladino A, Pasquali R, Pini A, Politano L, Previtali S, Rapezzi C, Ricci G, Siciliano G. O-4
The Italian Network for Laminopathies. ACTA MYOLOGICA 2011; 30. [PMCID: PMC3235868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - A. Basso
- The Italian Network for Laminopathies
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- The Italian Network for Laminopathies
| | | | | | - A. Pini
- The Italian Network for Laminopathies
| | | | | | | | - G. Ricci
- The Italian Network for Laminopathies
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Leone O, Biagini E, Pacini D, Zagnoni S, Ferlito M, Graziosi M, Di Bartolomeo R, Rapezzi C. The elusive link between aortic wall histology and echocardiographic anatomy in bicuspid aortic valve: implications for prophylactic surgery. Eur J Cardiothorac Surg 2011; 41:322-7. [DOI: 10.1016/j.ejcts.2011.05.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Rizzello V, Poldermans D, Biagini E, Schinkel AFL, Boersma E, Boccanelli A, Marwick T, Roelandt JRTC, Bax JJ. Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: relation to viability and improvement in left ventricular ejection fraction. Heart 2009; 95:1273-7. [PMID: 19443475 DOI: 10.1136/hrt.2008.163972] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In patients with ischaemic cardiomyopathy and viable myocardium, left ventricular ejection fraction (LVEF) does not always improve after revascularisation. Whether this may affect prognosis is unclear. OBJECTIVE To evaluate the prognosis of viable patients with and without improvement of LVEF after coronary revascularisation. METHODS Before revascularisation, radionuclide ventriculography (RNV) and dobutamine stress echocardiography were performed to assess LVEF and myocardial viability, respectively. Nine to 12 months after revascularisation, LVEF improvement was assessed by RNV. Patients were divided into three groups: group 1, viable patients with LVEF improvement (n = 27); group 2, viable patients without LVEF improvement (n = 15), group 3, non-viable patients (n = 48). Cardiac events were evaluated during a 4-year follow-up. RESULTS After revascularisation, the mean (SD) LVEF improved from 32 (9)% to 42 (10)% in group 1, but did not change significantly in group 2 and in group 3, p<0.001 by analysis of variance (ANOVA). Heart failure symptoms improved in both groups 1 (mean (SD) NYHA class from 3.1 (0.9) to 1.7 (0.7)) and 2 (from 3.2 (0.7) to 1.7 (0.9)), but not in group 3 (from 2.8 (1.0) to 2.7 (0.5)), p<0.001 by ANOVA. During follow-up, the cardiac event rate was low (4%) in group 1, intermediate (21%) in group 2 and high (33%) in group 3 (p = 0.01). CONCLUSION The best prognosis after revascularisation may be expected in those viable patients whose LVEF improves. Conversely, viable patients without functional improvement have an intermediate prognosis.
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Affiliation(s)
- V Rizzello
- Department of Cardiovascular Disease, San Giovanni-Addolorata Hospital, Via dell' Amba Aradam 8, 00184 Rome, Italy.
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Faggioli G, Ferri M, Serra C, Biagini E, Manzoli L, Lodi R, Rapezzi C, Stella A. The Residual Risk of Cerebral Embolism after Carotid Stenting: The Complex Interplay between Stent Coverage and Aortic Arch Atherosclerosis. Eur J Vasc Endovasc Surg 2009; 37:519-24. [DOI: 10.1016/j.ejvs.2008.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Accepted: 12/25/2008] [Indexed: 11/29/2022]
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Rocchi G, Bertini M, Biffi M, Ziacchi M, Biagini E, Gallelli I, Martignani C, Cervi E, Ferlito M, Rapezzi C, Branzi A, Boriani G. Exercise stress echocardiography is superior to rest echocardiography in predicting left ventricular reverse remodelling and functional improvement after cardiac resynchronization therapy. Eur Heart J 2008; 30:89-97. [DOI: 10.1093/eurheartj/ehn483] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Fattori R, Botta L, Lovato L, Biagini E, Russo V, Casadei A, Buttazzi K. Malperfusion syndrome in type B aortic dissection: role of the endovascular procedures. Acta Chir Belg 2008; 108:192-7. [PMID: 18557142 DOI: 10.1080/00015458.2008.11680201] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- R. Fattori
- Cardiovascular Radiology, Cardiothoracovascular Department,S. Orsola University Hospital, Bologna, Italy
| | - L. Botta
- Cardiac Surgery, Cardiothoracovascular Department,S. Orsola University Hospital, Bologna, Italy
| | - L. Lovato
- Cardiovascular Radiology, Cardiothoracovascular Department,S. Orsola University Hospital, Bologna, Italy
| | - E. Biagini
- Cardiology, Cardiothoracovascular Department,S. Orsola University Hospital, Bologna, Italy
| | - V. Russo
- Cardiovascular Radiology, Cardiothoracovascular Department,S. Orsola University Hospital, Bologna, Italy
| | - A. Casadei
- Cardiovascular Radiology, Cardiothoracovascular Department,S. Orsola University Hospital, Bologna, Italy
| | - K. Buttazzi
- Cardiovascular Radiology, Cardiothoracovascular Department,S. Orsola University Hospital, Bologna, Italy
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Rizzello V, Poldermans D, Schinkel AFL, Biagini E, Boersma E, Elhendy A, Sozzi FB, Palazzuoli A, Maat A, Crea F, Bax JJ. Outcome after redo coronary artery bypass grafting in patients with ischaemic cardiomyopathy and viable myocardium. Heart 2006; 93:221-5. [PMID: 16905627 PMCID: PMC1861379 DOI: 10.1136/hrt.2006.088146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Repeat coronary artery bypass grafting (redo-CABG) in patients with ischaemic cardiomyopathy is associated with high perioperative risk and worse long-term outcome compared with patients undergoing their first CABG. OBJECTIVE To assess whether patients with viable myocardium undergoing redo-CABG have a better outcome. METHODS 18 patients with ischaemic cardiomyopathy underwent redo-CABG and 34 underwent their first CABG; all had substantial viability (> or =25% of the left ventricle) on dobutamine stress echocardiography (DSE). Left ventricular ejection fraction (LVEF) and heart failure symptoms were assessed before and 9-12 months after revascularisation. Cardiac event rate was assessed during the follow-up period (median 4 years, 25-75th centile 2.8-4.9 years). RESULTS The extent of viable myocardium on DSE was comparable in the two groups (11.3 (3.9) segments in patients who underwent redo-CABG v 12.8 (3.0) in patients who underwent their first CABG; p = NS). LVEF improved from 32% (9%) to 39% (12%); p = 0.01, in patients who underwent redo-CABG and from 30% (7%) to 36% (7%); p<0.01, in those who underwent their first CABG; New York Heart Association class improved from 2.5 (1.1) to 1.9 (0.8); p = 0.03, and from 2.7 (1.0) to 1.8 (0.70); p<0.01, respectively. In patients who underwent redo-CABG, the perioperative mortality was 0, post-surgery inotropic support was needed in 11% of the patients and mid-term (4-year) survival was 100%, with a total event rate of 28%. All these variables were not statistically different from patients who underwent their first CABG (p = 0.50, 0.90, 0.08 and 0.81, respectively). CONCLUSION Patients with ischaemic cardiomyopathy and substantial viability undergoing redo-CABG benefit from revascularisation in terms of improvement in LVEF, heart failure symptoms, angina and mid-term prognosis.
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Affiliation(s)
- V Rizzello
- Department of Cardiology, Thorax Center Room Ba 300, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Lofiego C, Biagini E, Pasquale F, Ferlito M, Rocchi G, Perugini E, Bacchi-Reggiani L, Boriani G, Leone O, Caliskan K, ten Cate FJ, Picchio FM, Branzi A, Rapezzi C. Wide spectrum of presentation and variable outcomes of isolated left ventricular non-compaction. Heart 2006; 93:65-71. [PMID: 16644854 PMCID: PMC1861346 DOI: 10.1136/hrt.2006.088229] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.3] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate diagnostic routes, echocardiographic substrates, outcomes and prognostic factors in patients with isolated ventricular non-compaction (IVNC) identified by echocardiographic laboratories with referral from specialists and primary care physicians. PATIENTS AND DESIGN Since 1991, all patients with suspected IVNC were flagged and followed up on dedicated databases. Patients were divided into symptom-based and non-symptom-based diagnostic subgroups. RESULTS 65 eligible patients were followed up for 6-193 months (mean 46 (SD 44). In 53 (82%) patients, IVNC was associated with variable degrees of left ventricular (LV) dilatation and hypokinesia, and in the remaining 12 (18%) LV volumes were normal. Diagnosis was symptom based in 48 (74%) and non-symptom based in 17 (26%) (familial referral in 10). The non-symptom-based subgroup was characterised by younger age, lower prevalence of ECG abnormalities, better systolic function and lower left atrial size, whereas the extent of non-compaction was not different. No major cardiovascular events occurred in the non-symptom-based group, whereas 15 of 48 (31%) symptomatically diagnosed patients experienced cardiovascular death or heart transplantation (p = 0.01, Kaplan-Meier analysis). Independent predictors of cardiovascular death or heart transplantation were New York Heart Association class III-IV, sustained ventricular arrhythmias and left atrial size. CONCLUSIONS IVNC is associated with a broad spectrum of clinical and pathophysiological findings, and the overall natural history and prognosis may be better than previously thought. Adult patients with incidental or familial discovery of IVNC have an encouraging outlook, whereas those who have symptoms of heart failure, a history of sustained ventricular tachycardia or an enlarged left atrium have an unstable course and more severe prognosis.
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Affiliation(s)
- C Lofiego
- Institute of Cardiology, University of Bologna, Bologna, Italy
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Biagini E, Schinkel AFL, Bax JJ, Rizzello V, van Domburg RT, Krenning BJ, Bountioukos M, Pedone C, Vourvouri EC, Rapezzi C, Branzi A, Roelandt JRTC, Poldermans D. Long term outcome in patients with silent versus symptomatic ischaemia during dobutamine stress echocardiography. Heart 2005; 91:737-42. [PMID: 15894765 PMCID: PMC1768946 DOI: 10.1136/hrt.2004.041087] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To compare the long term prognosis of patients having silent versus symptomatic ischaemia during dobutamine stress echocardiography (DSE). DESIGN Observational study. SETTING Tertiary referral centre. PATIENTS 931 patients who experienced stress induced myocardial ischaemia during DSE. RESULTS Silent ischaemia was present in 643 of 931 patients (69%). The number of dysfunctional segments at rest (mean (SD) 9.6 (5.1) v 8.8 (5.0), p = 0.1) and of ischaemic segments (3.5 (2.2) v 3.8 (2.1), p = 0.2) was comparable in both groups. During a mean (SD) follow up of 5.5 (3.3) years, there were 169 (18%) cardiac deaths and 86 (9%) non-fatal infarctions. Multivariable Cox regression analysis showed age (hazard ratio (HR) 1.1, 95% confidence interval (CI) 1.02 to 1.05), previous myocardial infarction (HR 1.4, 95% CI 1.1 to 2.0), and number of ischaemic segments during the test (HR 2.0, 95% CI 1.0 to 3.7) as independent predictors of cardiac death and myocardial infarction. For every additional ischaemic segment there was a twofold increment in risk of late cardiac events. The annual cardiac death or myocardial infarction rate was 3.0% in patients with symptomatic ischaemia and 4.6% in patients with silent ischaemia (p < 0.01). Silent induced ischaemia was an independent predictor of cardiac death and myocardial infarction (HR 1.7, 95% CI 1.1 to 2.0). During follow up symptomatic patients were treated more often with cardioprotective therapy (p < 0.01) and coronary revascularisation (145 of 288 (50%) v 174 of 643 (27%), p < 0.001). CONCLUSIONS Patients with silent ischaemia had a similar extent of myocardial ischaemia during DSE compared to patients with symptomatic ischaemia but received less cardioprotective treatment and coronary revascularisation and experienced a higher cardiac event rate.
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Affiliation(s)
- E Biagini
- Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands
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Rizzello V, Poldermans D, Schinkel AFL, Biagini E, Boersma E, Elhendy A, Sozzi FB, Maat A, Crea F, Roelandt JRTC, Bax JJ. Long term prognostic value of myocardial viability and ischaemia during dobutamine stress echocardiography in patients with ischaemic cardiomyopathy undergoing coronary revascularisation. Heart 2005; 92:239-44. [PMID: 15814593 PMCID: PMC1860784 DOI: 10.1136/hrt.2004.055798] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the relative merits of viability and ischaemia for prognosis after revascularisation. METHODS Low-high dose dobutamine stress echocardiography (DSE) was performed before revascularisation in 128 consecutive patients with ischaemic cardiomyopathy (mean (SD) left ventricular ejection fraction (LVEF) 31 (8)%). Viability (defined as contractile reserve (CR)) and ischaemia were assessed during low and high dose dobutamine infusion, respectively. Cardiac death was evaluated during a five year follow up. Clinical, angiographic, and echocardiographic data were analysed to identify predictors of events. RESULTS Univariable predictors of cardiac death were the presence of multivessel disease (hazard ratio (HR) 0.21, p < 0.001), baseline LVEF (HR 0.90, p < 0.0001), wall motion score index (WMSI) at rest (HR 4.02, p = 0.0006), low dose DSE (HR 7.01, p < 0.0001), peak dose DSE (HR 4.62, p < 0.0001), the extent of scar (HR 1.39, p < 0.0001), and the presence of CR in > or = 25% of dysfunctional segments (HR 0.34, p = 0.02). The best multivariable model to predict cardiac death included the presence of multivessel disease, WMSI at low dose DSE, and the presence of CR in > or = 25% of the severely dysfunctional segments (HR 9.62, p < 0.0001). Inclusion of ischaemia in the model did not provide additional predictive value. CONCLUSION The findings of the present study illustrate that in patients with ischaemic cardiomyopathy, the extent of viability (CR) is a strong predictor of long term prognosis after revascularisation. Ischaemia did not add significantly in predicting outcome.
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Affiliation(s)
- V Rizzello
- Department of Cardiology, Thoraxcentre, Erasmus MC, The Netherlands
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Rizzello V, Poldermans D, Biagini E, Schinkel AFL, van Domburg R, Elhendy A, Vourvouri EC, Bountioukos M, Lombardo A, Krenning B, Roelandt JRTC, Bax JJ. Improvement of stress LVEF rather than rest LVEF after coronary revascularisation in patients with ischaemic cardiomyopathy and viable myocardium. Heart 2005; 91:319-23. [PMID: 15710710 PMCID: PMC1768736 DOI: 10.1136/hrt.2004.037119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate prospectively the response of left ventricular ejection fraction (LVEF) to high dose dobutamine infusion in patients showing substantial viability, with and without improved resting LVEF after revascularisation. METHODS Before and 9-12 months after revascularisation, 50 patients with ischaemic cardiomyopathy (LVEF 32 (8)%) and substantial myocardial viability (> or = 4 viable segments) underwent radionuclide ventriculography and dobutamine stress echocardiography. Patients were divided into group 1, patients with, and group 2, patients without significant improvement in resting LVEF (> or = 5% by radionuclide ventriculography) after revascularisation. The response of LVEF during dobutamine stress echocardiography was compared in these two groups. RESULTS Groups 1 and 2 were comparable in baseline characteristics, resting LVEF, and number of viable segments (mean (SD) 7 (4) v 6 (2), not significant). After revascularisation, the LVEF response during dobutamine stress echocardiography improved significantly in both groups (group 1, 34 (10)% to 56 (8)%; group 2, 32 (10)% to 46 (11)%; both p < 0.001). Interestingly, although resting LVEF did not improve in group 2, peak stress LVEF after revascularisation did (p < 0.001). Group 1 patients had, however, a greater increase in peak stress LVEF (group 1, 22 (10)%; group 2, 13 (9)%; p < 0.01). New York Heart Association and Canadian Cardiovascular Society classes decreased in both groups. CONCLUSIONS Although patients with viable myocardium did not always have improved rest LVEF after revascularisation, peak stress LVEF improved. Assessment of improvement of resting function may not be the ideal end point to evaluate successful revascularisation.
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Affiliation(s)
- V Rizzello
- Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands
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Bountioukos M, Elhendy A, van Domburg RT, Schinkel AFL, Bax JJ, Krenning BJ, Biagini E, Rizzello V, Simoons ML, Poldermans D. Prognostic value of dobutamine stress echocardiography in patients with previous coronary revascularisation. Heart 2004; 90:1031-5. [PMID: 15310692 PMCID: PMC1768408 DOI: 10.1136/hrt.2003.029025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the prognostic value of dobutamine stress echocardiography (DSE) in patients with previous myocardial revascularisation. DESIGN Prospective study. SETTING Tertiary referral centre in Rotterdam, the Netherlands. PATIENTS 332 consecutive patients with previous percutaneous or surgical coronary revascularisation underwent DSE. Follow up was successful for 331 (99.7%) patients. Thirty eight patients who underwent early revascularisation (<or= 3 months) after the test were excluded from analysis. MAIN OUTCOME MEASURES Cox proportional hazards regression models were used to identify independent predictors of the composite of cardiac events (cardiac death, non-fatal myocardial infarction, and late revascularisation). RESULTS During a mean (SD) of 24 (20) months, 37 (13%) patients died and 89 (30%) had at least one cardiac event (21 (7%) cardiac deaths, 11 (4%) non-fatal myocardial infarctions, and 68 (23%) late revascularisations). In multivariate analysis of clinical data, independent predictors of late cardiac events were hypertension (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1 to 2.6) and congestive heart failure (HR 2.1, 95% CI 1.3 to 3.2). Reversible wall motion abnormalities (ischaemia) on DSE were incrementally predictive of cardiac events (HR 2.1, 95% CI 1.3 to 3.2). CONCLUSIONS Myocardial ischaemia during DSE is independently predictive of cardiac events among patients with previous myocardial revascularisation, after controlling for clinical data.
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Affiliation(s)
- M Bountioukos
- Thoraxcentre, Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Bountioukos M, Schinkel AFL, Bax JJ, Rizzello V, Valkema R, Krenning BJ, Biagini E, Vourvouri EC, Roelandt JRTC, Poldermans D. Pulsed wave tissue Doppler imaging for the quantification of contractile reserve in stunned, hibernating, and scarred myocardium. Heart 2004; 90:506-10. [PMID: 15084544 PMCID: PMC1768236 DOI: 10.1136/hrt.2003.018531] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess whether quantification of myocardial systolic velocities by pulsed wave tissue Doppler imaging can differentiate between stunned, hibernating, and scarred myocardium. DESIGN Observational study. SETTING Tertiary referral centre. PATIENTS 70 patients with reduced left ventricular function caused by chronic coronary artery disease. METHODS Pulsed wave tissue Doppler imaging was done close to the mitral annulus at rest and during low dose dobutamine; systolic ejection velocity (Vs) and the difference in Vs between low dose dobutamine and the resting value (DeltaVs) were assessed using a six segment model. Assessment of perfusion (with Tc-99m-tetrofosmin SPECT) and glucose utilisation (by 18F-fluorodeoxyglucose SPECT) was used to classify dysfunctional regions (by resting cross sectional echocardiography) as stunned, hibernating, or scarred. RESULTS 253 of 420 regions (60%) were dysfunctional. Of these, 132 (52%) were classified as stunned, 25 (10%) as hibernating, and 96 (38%) as scarred. At rest, Vs in stunned, hibernating, and scar tissue was, respectively, 6.3 (1.8), 6.6 (2.2), and 5.5 (1.5) cm/s (p = 0.001 by ANOVA). There was a gradual decline in Vs during low dose dobutamine infusion between stunned, hibernating, and scar tissue (8.3 (2.6) v 7.8 (1.5) v 6.8 (1.9) cm/s, p < 0.001 by ANOVA). DeltaVs was higher in stunned (2.1 (1.9) cm/s) than in hibernating (1.2 (1.4) cm/s, p < 0.05) or scarred regions (1.3 (1.2) cm/s, p = 0.001). CONCLUSIONS Quantitative tissue Doppler imaging showed a gradual reduction in regional velocities between stunned, hibernating, and scarred myocardium. Dobutamine induced contractile reserve was higher in stunned regions than in hibernating and scarred myocardium, reflecting different severities of myocardial damage.
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Affiliation(s)
- M Bountioukos
- Thoraxcenter, Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
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Schinkel AFL, Vourvouri EC, Bax JJ, Boomsma F, Bountioukos M, Rizzello V, Biagini E, Agricola E, Elhendy A, Roelandt JRTC, Poldermans D. Relation between left ventricular contractile reserve during low dose dobutamine echocardiography and plasma concentrations of natriuretic peptides. Heart 2004; 90:293-6. [PMID: 14966050 PMCID: PMC1768093 DOI: 10.1136/hrt.2002.003822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In ischaemic cardiomyopathy, raised plasma concentrations of natriuretic peptides are associated with a poor long term prognosis, while the presence of contractile reserve is a favourable sign. OBJECTIVE To assess the relation between plasma natriuretic peptides and contractile reserve. DESIGN Prospective observational study. SETTING Tertiary referral centre. PATIENTS 66 consecutive patients undergoing low dose dobutamine stress echocardiography to evaluate contractile reserve in regions with contractile dysfunction at rest, divided into two groups: group 1, 31 patients with ischaemic cardiomyopathy (left ventricular ejection fraction < or = 40%) and heart failure symptoms; group 2, 35 patients with normal left ventricular function. MAIN OUTCOME MEASURES Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), measured using immunoradiometric assays. Contractile reserve was defined as an improvement in segmental wall motion score during infusion of low dose dobutamine. RESULTS Plasma ANP and BNP concentrations were higher in group 1 than in group 2 (mean (SD): ANP, 17.8 (32.8) v 7.2 (9.7), p < 0.005; BNP, 24.4 (69.0) v 5.0 (14.3) pmol/l, respectively; p < 0.001). In group 1, the presence of contractile reserve was inversely related to ANP and BNP levels; however, patients with contractile reserve had lower ANP and BNP concentrations than patients without contractile reserve (ANP, 14.2 (9.1) v 24.2 (44.2), p < 0.05; BNP, 20.2 (25.5) v 37.5 (93.8) pmol/l, respectively; p < 0.05). CONCLUSIONS Plasma natriuretic peptide concentrations are raised in patients with left ventricular dysfunction, but in the presence of preserved myocardial contractile reserve, relatively low levels of ANP and BNP are present.
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Affiliation(s)
- A F L Schinkel
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, Netherlands
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Castello G, Biagini E, Munari S. The quantitative determination of hydrogen in gases, by gas chromatography with helium as the carrier gas. J Chromatogr A 1965; 20:447-51. [PMID: 5881182 DOI: 10.1016/s0021-9673(01)97446-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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