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Bursi F, Enriquez-Sarano M. The Left Atrium: Passive Receptacle or Active Contributor to Mitral Regurgitation Severity and Outcome. JACC Case Rep 2024; 29:102195. [PMID: 38361572 PMCID: PMC10865207 DOI: 10.1016/j.jaccas.2023.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Francesca Bursi
- University of Milan, Department of Health Sciences, Division of Cardiology, San Paolo Hospital, Milan, Italy
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Leonardi D, Bursi F, Fanti D, Dotto A, Ciceri L, Springhetti P, Bergamini C, Tafciu E, Maffeis C, Scarsini R, Enriquez-Sarano M, Ribichini FL, Benfari G. Outpatient tricuspid regurgitation in the community: Clinical context and outcome. Int J Cardiol 2024; 396:131443. [PMID: 37844668 DOI: 10.1016/j.ijcard.2023.131443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Epidemiology of tricuspid regurgitation (TR) is poorly known and its burden in the community is challenging to define. We aimed to evaluate the prevalence of TR in a geographically defined area and its outcome, in particular overall survival and hospitalization, considering different clinical contexts. METHODS We retrospectively analyzed consecutive outpatients referred between 2006 and 2013 for echocardiography and clinical evaluation. Patients with at least moderate TR were included and five different clinical settings were defined: concomitant significant left-sided valvular heart disease (LVHD-TR), heart failure (HF-TR), previous open-heart valvular surgery (postop-TR), pulmonary hypertension (PHTN-TR) and isolated TR (isolated-TR). Primary endpoint was a composite outcome of all-cause mortality or first hospitalization for HF. RESULTS Of 6797 consecutive patients with a clinical visit and echocardiograms performed in routine practice in a geographically defined community, moderate or severe TR was found in 4.8% of patients (327) . During median follow-up of 6.1 years, TR severity was a determinant of event-free survival. Analyzed for each clinical subset, eight-year event-free survival was 87 ± 7% for postop-TR subgroup, 75 ± 7% for isolated-TR, 67 ± 6% for PHTN-TR, 58 ± 6% for LHVD -TR and 52 ± 11% for HF-TR. CONCLUSION Moderate or more TR is a notable finding in the community and has impact on event-free survival in all clinical settings, with the worst outcomes when associated with relevant left-sided valvular heart disease and HF.
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Affiliation(s)
- Denis Leonardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesca Bursi
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Diego Fanti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Alberto Dotto
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Ciceri
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Springhetti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Elvin Tafciu
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Caterina Maffeis
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
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Simeoli PS, Moscardelli S, Urbani A, Santangelo G, Battaglia V, Guarino M, Bursi F, Guazzi M. Use and Implications of Echocardiography in the Hemodynamic Assessment of Cardiogenic Shock. Curr Probl Cardiol 2023; 48:101928. [PMID: 37422046 DOI: 10.1016/j.cpcardiol.2023.101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/10/2023]
Abstract
Cardiogenic shock (CS) is a complex multisystem syndrome due to pump failure, associated with high mortality and morbidity. Its hemodynamic characterization is key to the diagnostic algorithm and management. Pulmonary artery catheterization is the gold standard for the left and right hemodynamic evaluation, but some concerns exist for invasivity and untoward mechanical and infective complications. Transthoracic echocardiography is a robust noninvasive diagnostic tool for hemodynamic multiparametric assessment that well applies to the management of CS. Its applications expand from etiology definition to the choice of therapeutic intervention and their monitoring. The present review aims at detailing the role of ultrasounds in CS emphasizing the clinical implications of combining cardiac and non-cardiac ultrasounds examinations that may correlate with prognosis.
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Affiliation(s)
- Pasquale S Simeoli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Silvia Moscardelli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Andrea Urbani
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gloria Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Valeria Battaglia
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Mariachiara Guarino
- Division of Anesthesiology, Cardiothoracic and Vascular department, University of Milan-Bicocca, Milan, Italy
| | - Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Marco Guazzi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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Micaglio E, Santangelo G, Moscardelli S, Rusconi D, Musca F, Verde A, Campiglio L, Bursi F, Guazzi M. Case Report: A rare homozygous patient affected by TTR systemic amyloidosis with a prominent heart involvement. Front Cardiovasc Med 2023; 10:1164916. [PMID: 37711552 PMCID: PMC10497760 DOI: 10.3389/fcvm.2023.1164916] [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: 02/13/2023] [Accepted: 05/30/2023] [Indexed: 09/16/2023] Open
Abstract
Hereditary transthyretin amyloidosis is a severe, adult-onset autosomal dominant inherited systemic disease predominantly affecting the peripheral and autonomic nervous system, heart, kidney, and the eyes. We present a case of a Caucasian 65-year-old man with cardiac amyloidosis and the homozygous mutation Val142Ile (classically, Val122Ile) in the transthyretin gene. We provide a genotype-phenotype correlation regarding the genetic status of both heterozygous and homozygous individuals and their clinical conditions at the time of genetic testing.
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Affiliation(s)
- Emanuele Micaglio
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Gloria Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Silvia Moscardelli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Daniela Rusconi
- Pathological Anatomy, Cytogenetics, Molecular Pathology, San Paolo Hospital, ASST Santi Paolo and Carlo, Milan, Italy
| | - Francesco Musca
- UO Cardiologia 4, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Verde
- UO Cardiologia 4, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Campiglio
- Clinical Neurology Unit, ASST Santi Paolo e Carlo, Department of Neuroscience, University of Milan, Milan, Italy
| | - Francesca Bursi
- Clinical Neurology Unit, ASST Santi Paolo e Carlo, Department of Neuroscience, University of Milan, Milan, Italy
| | - Marco Guazzi
- Clinical Neurology Unit, ASST Santi Paolo e Carlo, Department of Neuroscience, University of Milan, Milan, Italy
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5
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Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Da Ros S, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Del Giudice C, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Bella G, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi RM, Inserra CA, Iori E, Izzo A, La Rosa G, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Picano E, Carerj S. Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:125-132. [PMID: 38161775 PMCID: PMC10756319 DOI: 10.4103/jcecho.jcecho_48_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 01/03/2024] Open
Abstract
Background The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and ≥40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). Conclusions This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Francesco Antonini-Canterin
- Department of Rehabilitative Cardiology, Rehabilitative Hospital High Speciality, Motta di Livenza, TV, Italy
| | - Andrea Barbieri
- Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo Della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Rehabilitative Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Department of Medicine and Surgery, University MIlano-Bicocca, Integrated Cardiovascular Diagnosi Unit, Istituto Auxologico Italiano, IRCCS, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Division, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Pisa, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina Degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Sciences, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Siena, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | | | - Angelo Di Gioia
- Cardiology Division, St. Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, Italy
| | - Federica Donati
- Pascia Center, Polyclinic, University Hospital Modena Polyclinic, Modena, Italy
| | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Cremona, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, Italy
| | - Annibale Izzo
- Cardiology Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiology and Rehabilitative Division, Azienda Sanitaria Friuli Occidentale (ASFO), Health Care, Sacile (Pd), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St. Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St. Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St. Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città Della Salute e Della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St. Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St. Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Division, Molinette Hospital - Città della Salute e Della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St. Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, University Hospital of Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St. Giovanni Evangelista Hospital, Tivoli, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, Italy
| | - Carlo Ratti
- Cardiology Division, St. Maria Bianca Hospital, Mirandola, Italy
| | | | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St. Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St. Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St. Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St. Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Department of Cardiovascular Sciences, Responsible Research Hospital, Campobasso, Italy
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
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6
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Ciampi Q, Cortigiani L, Rivadeneira Ruiz M, Barbieri A, Manganelli F, Mori F, D’Alfonso MG, Bursi F, Villari B. ABCDEG Stress Echocardiography in Aortic Stenosis. Diagnostics (Basel) 2023; 13:1727. [PMID: 37238211 PMCID: PMC10217228 DOI: 10.3390/diagnostics13101727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Rest and stress echocardiography (SE) plays a pivotal role in the evaluation of valvular heart disease. The use of SE is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms. In aortic stenosis (AS), rest echocardiographic analysis is a stepwise approach that begins with the evaluation of aortic valve morphology and proceeds to the measurement of the transvalvular aortic gradient and aortic valve area (AVA) using continuity equations or planimetry. The presence of the following three criteria suggests severe AS: AVA < 1.0 cm2, a peak velocity > 4.0 m/s, or a mean gradient > 40 mmHg. However, in approximately one in three cases, we can observe a discordant AVA < 1 cm2 with a peak velocity < 4.0 m/s or a mean gradient <40 mmHg. This is due to reduced transvalvular flow associated with LV systolic dysfunction (LVEF < 50%) defined as "classical" low-flow low-gradient (LFLG) AS or normal LVEF "paradoxical" LFLG AS. SE has an established role in evaluating LV contractile reserve (CR) patients with reduced LVEF. In classical LFLG AS, LV CR distinguished pseudo-severe AS from truly severe AS. Some observational data suggest that long-term prognosis in asymptomatic severe AS may not be as favorable as previously thought, offering a window of opportunity for intervention prior to the onset of symptoms. Therefore, guidelines recommend evaluating asymptomatic AS with exercise stress in physically active patients, particularly those younger than 70 years, and symptomatic classical LFLG severe AS with low-dose dobutamine SE. A comprehensive SE assessment includes evaluating valve function (gradients), the global systolic function of the LV, and pulmonary congestion. This assessment integrates considerations of blood pressure response, chronotropic reserve, and symptoms. StressEcho 2030 is a prospective, large-scale study that employs a comprehensive protocol (ABCDEG) to analyze the clinical and echocardiographic phenotypes of AS, capturing various vulnerability sources which support stress echo-driven treatment strategies.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
| | | | | | - Andrea Barbieri
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Fiore Manganelli
- Cardiology Division, San Giuseppe Moscati Hospital, 83100 Avellino, Italy;
| | - Fabio Mori
- Cardiology Division, Careggi Hospital, 50134 Florence, Italy; (F.M.); (M.G.D.)
| | | | - Francesca Bursi
- Department of Health Science, University of Milan, Cardiology Division, San Paolo Hospital, ASST Santi Paolo e Carlo, 20142 Milano, Italy;
| | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
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7
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Bursi F. Unmasking early heart failure with preserved ejection fraction: the role of exercise stress testing. Eur J Prev Cardiol 2023:7156579. [PMID: 37149884 DOI: 10.1093/eurjpc/zwad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Francesca Bursi
- Department of Health Sciences, University of Milan. Cardiology Division. ASST Santi Paolo e Carlo, Milano. Italy
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8
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Valli F, Bursi F, Santangelo G, Toriello F, Faggiano A, Rusconi I, Vella AM, Carugo S, Guazzi M. Long-Term Effects of Sacubitril-Valsartan on Cardiac Remodeling: A Parallel Echocardiographic Study of Left and Right Heart Adaptive Response. J Clin Med 2023; 12:2659. [PMID: 37048742 PMCID: PMC10094925 DOI: 10.3390/jcm12072659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
Sacubitril/Valsartan (S/V) carries potential anti-remodeling properties, however long-term effects and biventricular adaptive response are poorly described. 76 HFrEF patients who underwent progressive uptitration of S/V, completed the annual scheduled follow-up. After a median follow-up of 11 (8-13) months, left ventricular (LV) reverse remodeling (RR) is defined as (1) absolute increase in LV ejection fraction (EF) ≥ 10% or LVEF ≥ 50% at follow-up and (2) decrease in indexed LV end-diastolic diameter (LVEDDi) of at least 10% or indexed LVEDDi ≤ 33 mm/m2, occurred in 27.6%. Non-ischemic etiology, shorter duration of HF, and absence of a history of AF were independently associated with LVRR (p < 0.05). TAPSE and TAPSE/PASP, a non-invasive index of right ventricular (RV) coupling to the pulmonary circulation, significantly improved at follow-up (0.45 vs. 0.56, p = 0.02). 41% of patients with baseline RV dysfunction obtained favorable RV remodeling despite only a moderate correlation between RV and LV function was observed (r = 0.478, p = 0.002). Our data point to a potential long-term reverse global remodeling effect by S/V, especially in patients who start S/V at an early stage of the disease, and focus our attention on a possible direct effect of the drug in synergistic hemodynamics between RV and pulmonary circulation.
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Affiliation(s)
- Federica Valli
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Bursi
- Cardiology Division, San Paolo Hospital, 20142 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | | | - Filippo Toriello
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Irene Rusconi
- Cardiology Division, San Paolo Hospital, 20142 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Anna Maria Vella
- Montreal University Hospital Centre, Montreal, QC H2X 3E4, Canada
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Marco Guazzi
- Cardiology Division, San Paolo Hospital, 20142 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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9
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Battaglia V, Santangelo G, Bursi F, Simeoli P, Guazzi M. Arrhythmogenic Mitral Valve Prolapse and Sudden Cardiac Death: An Update and Current Perspectives. Curr Probl Cardiol 2023; 48:101724. [PMID: 36967070 DOI: 10.1016/j.cpcardiol.2023.101724] [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] [Received: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/22/2023]
Abstract
Mitral valve prolapse (MVP) affects about 2% to 3% of the general population, mostly women, and is the most common cause of primary chronic mitral regurgitation (MR) in western countries. The natural history is heterogeneous and widely determined by the severity of MR. Although most patients remain asymptomatic with a near-normal life expectancy, approximately 5% to 10 % progress to severe MR. As largely recognized, left ventricular (LV) dysfunction due to chronic volume overload per se identifies a subgroup at risk of cardiac death. However, there is rising evidence of a link between MVP and life threating ventricular arrhythmias (VAs)/sudden cardiac death (SCD) in a small subset of middle-aged patients without significant MR, heart failure and remodeled hearts. The present review focuses on the underlying mechanism of electric instability and unexpected cardiac death in this subset of young patients, from the myocardial scarring of the LV infero-lateral wall due to mechanical stretch exerted by the prolapsing leaflets and mitral annular disjunction, to the inflammation's impact on fibrosis pathways along with a constitutional hyperadrenergic state. The heterogeneity of clinical course reveals a necessity of risk stratification, preferably through noninvasive multimodality imaging, that will help to identify and prevent adverse scenarios in young MVP patients.
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Affiliation(s)
- Valeria Battaglia
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Gloria Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Pasquale Simeoli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Marco Guazzi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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10
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Santangelo G, Bursi F, Faggiano A, Moscardelli S, Simeoli PS, Guazzi M, Lorusso R, Carugo S, Faggiano P. The Global Burden of Valvular Heart Disease: From Clinical Epidemiology to Management. J Clin Med 2023; 12:2178. [PMID: 36983180 PMCID: PMC10054046 DOI: 10.3390/jcm12062178] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Valvular heart disease is a leading cause of cardiovascular morbidity and mortality and a major contributor of symptoms and functional disability. Knowledge of valvular heart disease epidemiology and a deep comprehension of the geographical and temporal trends are crucial for clinical advances and the formulation of effective health policy for primary and secondary prevention. This review mainly focuses on the epidemiology of primary (organic, related to the valve itself) valvular disease and its management, especially emphasizing the importance of heart valve centers in ensuring the best care of patients through a multidisciplinary team.
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Affiliation(s)
- Gloria Santangelo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Silvia Moscardelli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Pasquale Simone Simeoli
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Marco Guazzi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, 20122 Milan, Italy
| | - Roberto Lorusso
- Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), The Cardiovascular Research Institute Maastricht (CARIM), 6229 ER Maastricht, The Netherlands
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Pompilio Faggiano
- Cardiothoracic Department Unit, Fondazione Poliambulanza, Via Leonida Bissolati 57, 25100 Brescia, Italy
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11
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Affiliation(s)
- Francesca Bursi
- Department of Health Sciences, University of Milan, Milano, Italy
| | - Alex Pui-Wai Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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12
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Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Ros SD, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Giudice CD, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi R, Inserra CA, Iori E, Izzo A, Rosa GL, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Di Bella G, Carerj S. Organization and Activity of Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:1-9. [PMID: 37426716 PMCID: PMC10328129 DOI: 10.4103/jcecho.jcecho_16_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 07/11/2023] Open
Abstract
Background The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue Doppler imaging in 53% of the centers, and using fractional area change in 33% of the centers. When we divided into cardiology (179, 78%) and noncardiology (49, 22%) centers, we found significant differences in the SE (93% vs. 26%, P < 0.001), TEE (85% vs. 18%), UCA (67% vs. 43%, P < 0001), and STE (87% vs. 20%, P < 0.001). The incidence of LUS evaluation was similar between the cardiology and noncardiology centers (69% vs. 61%, P = NS). Conclusions This nationwide survey demonstrated that digital infrastructures and advanced echocardiography modalities, such as 3D and STE, are widely available in Italy with a notable diffuse uptake of LUS in the core TTE examination, a suboptimal diffusion of PACS recording, and conservative use of UCA, 3D, and strain. There are significant differences between northern and central-southern regions and echocardiographic laboratories that pertain to the cardiac unit. This inhomogeneous distribution of technology represents one of the main issues that must be solved to standardize the practice of echocardiography.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | - Andrea Barbieri
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Semi-Intensive Care Unit, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Integrated Cardiovascular Diagnostic Division, Auxologico San Luca IRCCS Hospital, Milano, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Department, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, MI, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Science, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Sassari, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo Nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Maria Di Fulvio
- Cardiology-ICCU Division, Ss. Annunziata Hospital, Chieti, Italy
| | | | | | - Angelo Di Gioia
- Cardiology Division, St Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, CN, Italy
| | | | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, NA, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Palermo, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Ferrara, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, MO, Italy
| | - Annibale Izzo
- Cardiology Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiological and Cardio Oncological Rehabilitation Department, Sacile (PN) CRO (PN) Hospital, Sacile (PN), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, PG, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, MI, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città della Salute e della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Department, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, St Anna University Hospital, Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, RM, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St Giovanni Evangelista Hospital, Tivoli, RM, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, VE, Italy
| | - Carlo Ratti
- Cardiology Division, St Maria Bianca Hospital, Mirandola, MO, Italy
| | - Sara Rettegno
- Cardiology Division, Hospital, Moncalieri, TO, Italy
| | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Cardiology Division, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Antonello Zugaro
- Department of Cardiology, Intensive Care Unit, St Salvatore Hospital, L’Aquila, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
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13
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Moscardelli S, Rusconi D, Santangelo G, Bursi F, Micaglio E, Bulfamante G, Saponaro M, Centola M, Guazzi M. 903 NOVEL MALIGNANT MUTATION IN HYPERTROPHIC CARDIOMYOPATHY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Hypertrophic cardiomyopathy (HCM) is a common inherited disease almost invariably caused by mutations in sarcomeric genes. The HCM phenotype is clinically heterogeneous with myocyte hypertrophy, disarray, and myocardial fibrosis as histological hallmarks. This condition is recognized as an important cause of sudden cardiac death (SCD) in the youth and of heart failure (HF) in the elderly. Current guidelines mandate genetic analysis as a class I indication in HCM. Indeed, the advent of the next generation sequencing in the medical practice has led to decipher the molecular etiology of HCM and to assess the disease risk in family members with relevant insights into the clinical course.
Clinical case
A 62-year-old man followed-up at another Hospital with a non-obstructive HCM diagnosis, was referred to our Hospital for therapy optimization and clinical follow-up. Past medical history included third degree atrioventricular block at age 40 treated with dual chamber pacemaker (PM) and, at age of 60, atrial flutter with high ventricular response complicated with cardiogenic shock and stroke. Due to worsening systolic function and ventricular sustained tachycardia he was upgraded to implantable cardioverter defibrillator which delivered appropriate shocks. Echocardiography performed during current hospitalization showed a moderate concentric hypertrophy (intraventricular septum 17 mm, cardiac mass index 258 g/m2), dilated ventricle with reduced ejection fraction (33%) and akinesis of the mid inferior and infero-septal walls of the left ventricle and of the apex, with a stratified thrombotic apposition. Magnetic resonance was contraindicated because of non-compatible PM. Due to alteration in serum proteins and free light chain, to rule out systemic disease, extensive imaging diagnosis was performed including bone scintigraphy and abdominal ultrasonography which resulted negative. While waiting for bone marrow aspiration and biopsy the patient rapidly deteriorated with worsening renal failure, ensuing proteinuria until exitus. After an appropriate pre-test counseling the family consented to genetic test in the proband. Clinical exome sequencing revealed the presence of a missense mutation in MYH7 gene. This new mutation is characterized by the substitution of cysteine residue by a serine in 905 codon of MYH7 gene. Cys905Ser results in a semi-conservative amino acid substitution which may impact disulfide bond formation in the MYH7 protein. To date no study has described this mutation as a cause of HCM. A mutation affecting this same codon, Cys905Phe was reported in only one patient with HCM. From a biological point of view, this variant lies in the head region of the protein where the majority of the missense variants are grouped and statistically associated to HCM phenotype. Several studies reported that the occurrence of atrial fibrillation (AF) tends to be more prevalent in patients carrying the MYH7 mutation. Furthermore, AF is associated with substantial risk for HF-related mortality, stroke, and severe functional disability.
Awareness regarding the spectrum of MYH7 mutations probably related to SCD or HF combined with a thorough patient characterization for molecular and clinical features, may help to improve the genotype and phenotype correlation. This important challenge could elucidate better the mechanism of HCM enabling cardiologists to a better clinical decision-making and patients’ care.
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Affiliation(s)
- Silvia Moscardelli
- Divisione Di Cardiologia, Dipartimento Cardio-Respiratorio , Asst-Santi Paolo Carlo, Milano
| | - Daniela Rusconi
- UOC Anatomia Patologica , Citogenetica, Patologia Molecolare, Asst-Santi Paolo Carlo, Milano
| | - Gloria Santangelo
- Divisione Di Cardiologia, Dipartimento Cardio-Respiratorio , Asst-Santi Paolo Carlo, Milano
| | - Francesca Bursi
- Divisione Di Cardiologia, Dipartimento Cardio-Respiratorio , Asst-Santi Paolo Carlo, Milano
| | - Emanuele Micaglio
- Unità Operativa Di Aritmologia Ed Elettrofisiologia, IRCCS Policlinico San Donato , Milano
| | - Gaetano Bulfamante
- Dipartimento Di Scienza Della Salute, Università Degli Studi Di Milano , Milano
| | - Maria Saponaro
- UOC Anatomia Patologica , Citogenetica, Patologia Molecolare, Asst-Santi Paolo Carlo, Milano
| | - Marco Centola
- Dipartimento Di Cardiologia , Asst Brianza, Ospedale Di Desio
| | - Marco Guazzi
- Divisione Di Cardiologia, Dipartimento Cardio-Respiratorio , Asst-Santi Paolo Carlo, Milano
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14
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Zito C, Manganaro R, De Sarro R, Licordari R, Bursi F, Mantovani F, Benfari G, Malagoli A, Bertolacelli Y, D'Angelo T, Antonini-Canterin F, Carerj S, Barbieri A. Multimodality imaging to assess severity and outcome in asymptomatic patients with aortic stenosis: a medium-long term follow-up study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.136] [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
Multimodality imaging approach is becoming more and more common in evaluating the severity and outcome of aortic stenosis (AS).
Aim
To assess the outcome of asymptomatic AS and the usefulness of aortic calcium score (CS) by computed tomography (CT) for solving the dilemma of low flow, low gradients (LFLG) severe AS.
Methods
70 (81.4±8.4 years) prospective asymptomatic patients with AS were followed for 2.77±2.01 years with a trans-thoracic echo (TTE) every 6 months. End-points were all cause mortality, aortic valve replacement (AVR or TAVR), aortic velocity and gradients progression and symptoms occurrence. Prevalence of LFLG-AS was investigated and these patients underwent CT for CS calculation at the end of follow-up (FU), Figure 1.
Results
Baseline TTE results from the 70 pts were: peak velocity 3.1±0.8m/sec; peak gradient 44±21mmHg; mean gradient 26±14 mmHg; AVA 1±0.3 cm2; DVI 0.31±0.1; Svi 33.8±18 ml/m2; EF: 55±9% with an AS being mild in 32.9%, moderate in 28.4%, severe in 27.1%; 36.8% of severe AS were LFLG. During FU, 23 (32.8%) pts died (5.7% LFLG) and 13 (18.5%) underwent AVR/TAVR. Predictors of mortality were aortic gradients (p=0.03), AVA (p=0.008), DVI (p<0.001), pulse pressure (p=0.005) and dilated ascending aorta (p<0001). Predictors of AVR/TAVR were: gradients (p=0.003), peak aortic velocity (p=0.02) and dilated ascendent aorta (p=0.01). The best cut-off to predict survival was AVA = 1 cm2 (100% sensitivity and 80% specificity). In 34 pts ending FU we found an overall progression of AS severity (peak velocity 3.6±0.9m/sec; peak gradient 50±24 mmHg; mean gradient 33±15 mmHg; AVA 0.7±0.3 cm2; DVI 0.25±0.08; Svi 36±10 ml/m2; EF 54±10%; p<0.05 for all vs baseline) with 24 (70.5%) pts with severe AS and 10 (29.5%) with not severe AS. 18 (75%) of progressive severe AS were LFLG, 12 asymptomatic and 6 symptomatic and all underwent CS revealing that AS was not severe in 6 (1233±1123 AU; 622±55 AU/m2) and true severe in 12 (3388±1188 AU; 1858±795 AU/m2; p=0.005 and p=0.002, respectively). Symptomatic severe LFLG AS were all true severe according to CS (Figure 1). Table 1 shows the main CS correlations.
Conclusions
Asymptomatic AS in elderly people is associated with high mortality risk and rapid progression. AVA remains the best predictor of outcome. In severe LFLG AS, calcium score correlates with symptoms occurrence, progression of valve disease, LV hypertrophy and function and also with RV function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Zito
- University of Messina, Department of Clinical and Experimental Medicine , Messina , Italy
| | - R Manganaro
- University of Messina, Department of Clinical and Experimental Medicine , Messina , Italy
| | - R De Sarro
- University of Messina, Department of Clinical and Experimental Medicine , Messina , Italy
| | - R Licordari
- University of Messina, Department of Clinical and Experimental Medicine , Messina , Italy
| | - F Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, ASST Santi Paolo and Car , Milano , Italy
| | - F Mantovani
- Division of Cardiology, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy , Reggio Emilia , Italy
| | - G Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy. , Verona , Italy
| | - A Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, 41126 Baggiovara, Ita , Boggiovara , Italy
| | - Y Bertolacelli
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and V , Bologna , Italy
| | - T D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging University of Messina , Messina , Italy
| | - F Antonini-Canterin
- Cardiac Prevention and Rehabilitation Unit, Highly Specialized Rehabilitation Hospital Motta di Live , Treviso , Italy
| | - S Carerj
- University of Messina, Department of Clinical and Experimental Medicine , Messina , Italy
| | - A Barbieri
- Department of Diagnostics, Division of Cardiology, Clinical and Public Health Medicine, Policlinico , Modena , Italy
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15
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Mondellini G, Rusconi I, Giustiniani A, Torta D, Novello G, Bursi F, Guazzi M. Exercise ventilation inefficiency and dynamic tricuspid regurgitation in heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.760] [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
Exercise ventilation inefficiency, i.e. increase slope of the relationship of ventilation (VE) vs carbon dioxide (VCO2) slope is a key prognostic indicator in heart failure (HF). Many determinants have been identified primarily related to the left heart and impaired reflexogenic control of VE. In parallel, the severity of tricuspid regurgitation (TR) at rest is increasingly recognized as an important determinant of functional status and prognosis. It is undefined whether VE inefficiency may be related to the dynamic TR during exercise.
Purpose
We tested the role of dynamic TR and its correlates to exercise VE inefficiency by combining cardiopulmonary exercise test (CPET) with echocardiography.
Methods
We prospectively studied stable HF patients with both reduced and preserved left ventricular ejection fraction (LVEF). Patients with severe pulmonary disease and those who underwent valve replacement or cardiac surgery were excluded. Mitral and tricuspid regurgitation degree were adjudicated accordingly to ESC Guidelines criteria.
Demographics and clinical characteristics along with laboratory parameters including electrolytes, biomarkers of congestion (NT-proBNP), renal and liver function, were collected at the time of CPET. Dynamic TR was defined as worsening of TR grade from rest to stress detected by Doppler analysis. VE/VCO2 slope and peak oxygen consumption (pVO2) were compared between patients with dynamic TR (Group 1) vs non-dynamic TR (Group 2).
Results
Among 56 patients (66±13 years, 64% men, mean LVEF of 50±14%, 35% ischemic) 12% showed at least moderate mitral regurgitation and 16% patients had at least moderate TR at rest.
TR jet velocity at rest and at peak exercise were associated with VE/VCO2 slope (r=0.36 and r=0.3 respectively, p value <0.05, Figure 1). A dynamic TR pattern (Group 1) appeared in 28 (50%) patients. No differences in clinical characteristics, laboratory parameters, LV ejection fraction, prevalence and degree of mitral regurgitation at rest and at peak were found between the two groups.
Group 1 compared to Group 2 exhibited a lower right ventricular fractional area change at peak exercise (45% [41–50] vs 52% [44–62] p=0.03), lower median pVO2 (13.3 [10.4–17.5] vs 16.3 [13.9–21.8], respectively (p=0.04)) and higher VE/VCO2 slope (40.3 [33.1–44] vs 34.1 [29.2–38.8], p=0.01; Figure 2A and B).
Conclusions
Patients with a dynamic TR pattern during CPET imaging exhibit a worse VE efficiency that correlates with TR extent. These data prospect, for the first time, an interaction between dynamic TR and ventilatory pattern during exercise in HF whose relevance may translate in targeting the right heart appropriately.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | | | - D Torta
- ASST Saints Paul and Charles, Cardiology , Milan , Italy
| | - G Novello
- ASST Saints Paul and Charles, Cardiology , Milan , Italy
| | - F Bursi
- University of Milan , Milan , Italy
| | - M Guazzi
- University of Milan , Milan , Italy
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16
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Abstract
Purpose of Review
Stress echocardiography is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms during activities of daily living. We describe the current methodology and the evidence supporting these applications. Recent Findings The comprehensive stress echo assessment includes valve function (gradients and regurgitation), left ventricular global systolic and diastolic function, left atrial volume, pulmonary congestion, pulmonary arterial pressure, and right ventricular function, integrated with blood pressure response with cuff sphygmomanometer, chronotropic reserve with heart rate, and symptoms. Summary Recent guidelines recommend the evaluation of asymptomatic severe or symptomatic non-severe mitral regurgitation or stenosis with exercise stress and suspected low-flow, low-gradient severe aortic stenosis with reduced ejection fraction with low dose (up to 20 mcg, without atropine) dobutamine stress. Prospective, large-scale studies based on a comprehensive protocol (ABCDE +) capturing the multiplicity of clinical phenotypes are needed to support stress echo-driven treatment strategies.
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Affiliation(s)
- Rodolfo Citro
- Division of Cardiology, Cardiovascular and Thoracic Department, San Giovanni Di Dio E Ruggi d, Aragona University Hospital, Salerno, Italy
- Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Francesca Bursi
- Dipartimento Di Scienze Della Salute, ASST Santi Paolo E Carlo Milano, Università Degli Studi Statale Di Milano, Ospedale San Paolo, Milan, Italy
| | - Michele Bellino
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, CNR Research Campus, Via Moruzzi, 1, Building C, First floor, Room 130, 56124, Pisa, Italy.
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17
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Barbieri A, Bursi F, Santangelo G, Mantovani F. Exercise Stress Echocardiography for Stable Coronary Artery Disease: Succumbed to the Modern Conceptual Revolution or Still Alive and Kicking? Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2308275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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18
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Sozzi FB, Iacuzio L, Belmonte M, Schiavone M, Bursi F, Gherbesi E, Levy F, Canetta C, Carugo S. Early diagnosis of cardiomyopathies by cardiac magnetic resonance. Overview of the main criteria. Monaldi Arch Chest Dis 2022; 92. [PMID: 35416001 DOI: 10.4081/monaldi.2022.2151] [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] [Received: 02/28/2022] [Accepted: 03/15/2022] [Indexed: 01/05/2023] Open
Abstract
Cardiomyopathies (CMPs) are diseases of the heart muscle. They include a variety of myocardial disorders that manifest with various structural and functional phenotypes and are frequently genetic. Myocardial disease caused by known cardiovascular causes (such as hypertension, ischemic heart disease, or valvular disease) should be distinguished from CMPs for classification and management purposes. Identification of various CMP phenotypes relies primarily upon echocardiographic evaluation. In selected cases, cardiac magnetic resonance imaging (CMR) or computed tomography may be useful to identify and localize fatty infiltration, inflammation, scar/fibrosis, focal hypertrophy, and better visualize the left ventricular apex and right ventricle. CMR imaging has emerged as a comprehensive tool for the diagnosis and follow-up of patients with CMPs. The accuracy and reproducibility in evaluating cardiac structures, the unique ability of non-invasive tissue characterization and the lack of ionizing radiation, make CMR very attractive as a potential "all-in-one technique". Indeed, it provides valuable data to confirm or establish the diagnosis, screen subclinical cases, identify aetiology, establish the prognosis. Additionally, it provides information for setting a risk stratification (based on evaluation of proved independent prognostic factors as ejection fraction, end-systolic-volume, myocardial fibrosis) and follow-up. Last, it helps to monitor the response to the therapy. In this review, the pivotal role of CMR in the comprehensive evaluation of patients with CMP is discussed, highlighting the key features guiding differential diagnosis and the assessment of prognosis.
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Affiliation(s)
- Fabiola B Sozzi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | | | - Marta Belmonte
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | | | - Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan.
| | - Elisa Gherbesi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | | | - Ciro Canetta
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
| | - Stefano Carugo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan.
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19
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Santangelo G, Bursi F, Toriello F, Tamagni ME, Fior G, Massironi L, Bertelli S, Fanin A, Gambini O, Carugo S, Benetti A. Echocardiographic changes in anorexia nervosa: a pathophysiological adaptation or a disease? Intern Emerg Med 2022; 17:777-787. [PMID: 34677790 DOI: 10.1007/s11739-021-02871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
Anorexia Nervosa is one of the most common form of eating disorders. Cardiac involvement occurs in approximately 80% of patients. Few reports focused on the association between body weight fluctuations and echocardiographic abnormalities, considering linear measurements. We describe echocardiographic and clinical features among male and female patients with anorexia nervosa and the effect of weight gain on these parameters. We performed a single center, retrospective study of patients followed at a dedicated multidisciplinary Unit. The study population consisted of 81 patients, mean age 25 ± 11 years, 94% female. Median body mass index was 14.4 kg/m2 (25th-75th percentile 12.7-15.6 kg/m2). Patients with body mass index below the median value had more often pericardial effusion, smaller left ventricular mass and left ventricular end-diastolic volume and thinner interventricular septum. However, when indexed to body surface area, left ventricular mass and volumes were within the normal range in 90% of population. Patients with pericardial effusion showed mitral valve abnormalities and lower values of white blood cells and platelets, although within normal limits. Presence of pericardial effusion was not related to inflammatory parameters or low plasma protein levels. In 39 patients who displayed weight gain during a median follow-up of 189 days (25th-75th percentile 47-471), increased left ventricular mass, interventricular septum thickness, white blood cells and platelet count and decreased pericardial effusion were observed. Patients with anorexia nervosa have a specific echocardiographic pattern which seems to be proportional to the body size, suggesting a pathophysiological adaptation to the lack of substrates.
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Affiliation(s)
- G Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
| | - F Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - F Toriello
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - M E Tamagni
- Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - G Fior
- Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - L Massironi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - S Bertelli
- Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - A Fanin
- Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - O Gambini
- Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - S Carugo
- Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A Benetti
- Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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20
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Bursi F, Santangelo G, Barbieri A, Vella AM, Toriello F, Valli F, Sansalone D, Carugo S, Guazzi M. Impact of Right Ventricular‐Pulmonary Circulation Coupling on Mortality in SARS‐CoV‐2 Infection. J Am Heart Assoc 2022; 11:e023220. [PMID: 35156389 PMCID: PMC9245834 DOI: 10.1161/jaha.121.023220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background The COVID‐19–related pulmonary effects may negatively impact pulmonary hemodynamics and right ventricular function. We examined the prognostic relevance of right ventricular function and right ventricular‐to‐pulmonary circulation coupling assessed by bedside echocardiography in patients hospitalized with COVID‐19 pneumonia and a large spectrum of disease independently of indices of pneumonia severity and left ventricular function. Methods and Results Consecutive COVID‐19 subjects who underwent full cardiac echocardiographic evaluation along with gas analyses and computed tomography scans were included in the study. Measurements were performed offline, and quantitative analyses were obtained by an operator blinded to the clinical data. We analyzed 133 patients (mean age 69±12 years, 57% men). During a mean hospital stay of 26±16 days, 35 patients (26%) died. The mean tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio was 0.48±0.18 mm/Hg in nonsurvivors and 0.72±0.32 mm/Hg in survivors (P=0.002). For each 0.1 mm/mm Hg increase in TAPSE/PASP, there was a 27% lower risk of in‐hospital death (hazard ratio [HR], 0.73 [95% CI, 0.59–0.89]; P=0.003). At multivariable analysis, TAPSE/PASP ratio remained a predictor of in‐hospital death after adjustments for age, oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen, left ventricular ejection fraction, and computed tomography lung score. Receiver operating characteristic analysis was used to identify the cutoff value of the TAPSE/PASP ratio, which best specified high‐risk from lower‐risk patients. The best cutoff for predicting in‐hospital mortality was TAPSE/PASP <0.57 mm/mm Hg (75% sensitivity and 70% specificity) and was associated with a >4‐fold increased risk of in‐hospital death (HR, 4.8 [95% CI, 1.7–13.1]; P=0.007). Conclusions In patients hospitalized with COVID‐19 pneumonia, the assessment of right ventricular to pulmonary circulation coupling appears central to disease evolution and prediction of events. TAPSE/PASP ratio plays a mainstay role as prognostic determinant beyond markers of lung injury.
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Affiliation(s)
- Francesca Bursi
- Division of Cardiology Department of Health Sciences University of Milan School of MedicineSan Paolo University HospitalAzienda Socio Sanitaria Territoriale Santi Paolo e Carlo Milan Italy
| | - Gloria Santangelo
- Division of Cardiology Department of Health Sciences University of Milan School of MedicineSan Paolo University HospitalAzienda Socio Sanitaria Territoriale Santi Paolo e Carlo Milan Italy
| | - Andrea Barbieri
- Division of Cardiology Department of Diagnostics, Clinical and Public Health Medicine Policlinico University Hospital of Modena Modena Italy
| | - Anna Maria Vella
- Division of Cardiology Department of Health Sciences University of Milan School of MedicineSan Paolo University HospitalAzienda Socio Sanitaria Territoriale Santi Paolo e Carlo Milan Italy
| | - Filippo Toriello
- Division of Cardiology Department of Health Sciences University of Milan School of MedicineSan Paolo University HospitalAzienda Socio Sanitaria Territoriale Santi Paolo e Carlo Milan Italy
- Department of Clinical Sciences and Community Health University of Milano and Fondazione IRCCS Policlinico di Milano Milan Italy
| | - Federica Valli
- Division of Cardiology Department of Health Sciences University of Milan School of MedicineSan Paolo University HospitalAzienda Socio Sanitaria Territoriale Santi Paolo e Carlo Milan Italy
| | - Dario Sansalone
- Division of Cardiology Department of Health Sciences University of Milan School of MedicineSan Paolo University HospitalAzienda Socio Sanitaria Territoriale Santi Paolo e Carlo Milan Italy
| | - Stefano Carugo
- Division of Cardiology Department of Health Sciences University of Milan School of MedicineSan Paolo University HospitalAzienda Socio Sanitaria Territoriale Santi Paolo e Carlo Milan Italy
- Department of Clinical Sciences and Community Health University of Milano and Fondazione IRCCS Policlinico di Milano Milan Italy
| | - Marco Guazzi
- Division of Cardiology Department of Health Sciences University of Milan School of MedicineSan Paolo University HospitalAzienda Socio Sanitaria Territoriale Santi Paolo e Carlo Milan Italy
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21
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Guazzi M, Bursi F, Rusconi F. Lung Biomarkers: a new route for distinguishing pulmonary hypertension due to HFpEF from pulmonary arterial hypertension. Int J Cardiol 2021; 351:91-92. [PMID: 34915079 DOI: 10.1016/j.ijcard.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Affiliation(s)
- M Guazzi
- Cardiology Division, San Paolo Hospital, University of Milano School of Medicine, Italy.
| | - F Bursi
- Cardiology Division, San Paolo Hospital, University of Milano School of Medicine, Italy
| | - F Rusconi
- Cardiology Division, San Paolo Hospital, University of Milano School of Medicine, Italy
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22
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Gentile D, Toriello F, Santangelo G, Bursi F, Carugo S. Spontaneous coronary dissection in a patient with Beals syndrome. J Cardiovasc Med (Hagerstown) 2021; 22:e18-e20. [PMID: 33927143 DOI: 10.2459/jcm.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Domitilla Gentile
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Cardiology, Department of Internal Medicine
| | - Filippo Toriello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Cardiology, Department of Internal Medicine
| | - Gloria Santangelo
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca Bursi
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Cardiology, Department of Internal Medicine
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23
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Valli F, Bursi F, Santangelo G, Toriello F, Rusconi I, Mondellini G, Vella A, Faggiano A, Persampieri S, Carugo S, Guazzi M. Sacubitril/Valsartan in heart failure with reduced ejection fraction: clinical and echocardiographic insights from a real world population. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0785] [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
Following the PARADIGM trial, some studies have identified cardiac remodeling as major background for hard end point benefits of Sacubitril/Valsartan (S/V), but few adopted a well described definition in the literature.
Purpose
We aimed at a comprehensive evaluation of the effects of S/V on echo-derived measures of cardiac remodeling along with clinical and laboratory data over a medium-term follow-up pointing to a real-world HFrEF population.
Methods
This is a prospective observational study of HFrEF patients on optimal medical therapy (OMT) initiated with S/V at Heart Failure Clinic of our institute (January 2017-January 2020). In 62 HFrEF, echocardiographic, laboratory and clinical data were collected at baseline and over 10 (Q1-Q3 8–13) months after S/V initiation. Mean age was 68±12 years, 79% men. Left ventricular reverse remodeling (LVRR) was defined as: 1) an absolute increase in LVEF ≥10 points or a LVEF ≥50% at follow-up and 2) a relative decrease in indexed left ventricular end-diastolic diameter of at least 10% or an indexed left ventricular end-diastolic diameter ≤33 mm/m2.
Results
Compared to baseline, S/V promoted a significant improvement of LV ejection fraction (LVEF, from 30% to 37%; p<0,0001) with an absolute median increase in LVEF of 8 points. Parallel significant reductions in left ventricular and atrial volumes, lower mitral regurgitation degree and a better diastolic dysfunction along with clinical improvement (NYHA class and NT-proBNP values) were observed at follow up. sPAP (systolic Pulmonary Arterial Pressure) was significantly decreased at follow-up evaluation (37 mmHg vs 31 mmHg p=0,005) (Table 1). Overall, LVRR as defined above was observed in 30% of patients. Younger age (64 vs 74 years, p=0,007), a shorter duration of the disease (7 vs 23 months, p=0,009), and non ischaemic etiology (79% vs 33% p=0,003), along with a smaller baseline LAESVi (Left Atrial End Systolic Volume, 41 vs 48 ml/m2 p=0,012) were more common in patients with LVRR. sPAP and Right Ventricular (RV) function estimated by tricuspid annular plane systolic excursion (TAPSE) were significantly better in LVRR patients along with TAPSE/sPAP ratio (Table 2).
Conclusions
Our data point to a remarkable medium-term reverse remodeling effect by S/V in HFrEF. Findings reinforce the concept that the main benefits of S/V on hard end-points are mediated by its cardiac-related effects. Both a left and right reverse remodeling occur in HFrEF patients who start S/V in the most adaptable phase of the disease supporting an early administration.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Valli
- ASST Santi Paolo e Carlo, Milan, Italy
| | - F Bursi
- ASST Santi Paolo e Carlo, Milan, Italy
| | | | - F Toriello
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - I Rusconi
- ASST Santi Paolo e Carlo, Milan, Italy
| | | | - A.M Vella
- ASST Santi Paolo e Carlo, Milan, Italy
| | - A Faggiano
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - S Carugo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Guazzi
- ASST Santi Paolo e Carlo, Milan, Italy
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24
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Casati M, Bursi F, Mondellini G, Santangelo G, Giustiniani A, Massironi L, Tarricone D, Carugo S, Guazzi M. Phenotyping the right heart according to left ventricular geometry patterns in severe HFrEF. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0783] [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
Right ventricular (RV) failure significantly impact on heart failure with reduced ejection fraction (HFrEF) prognosis. How and whether specific functional and geometrical phenotypes of the RV function adapt and combined with left ventricular (LV) geometry is unknown.
Purpose
To test the RV function across LV geometrical patterns looking at respective prognostic roles.
Methods
We retrospectively examined a population of patients homogenously diagnosed with chronic HFrEF (defined as LV ejection fraction (EF) less than 35%) and treated with optimal therapy (OT) and all implanted with ICD for primary prevention of sudden cardiac death. Patients were categorized by echocardiography according to remodeling pattern based on left ventricular mass index and relative wall thickness into four groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). RV parameters were: tricuspid annulus plane systolic excursion (TAPSE), TAPSE/pulmonary artery pressures (PAPs), RV basal diameter and fractional area change (FAC). Outcome variable was all-cause mortality, assessed with multivariable Cox proportional hazard (PH) models.
Results
Among 193 patients (age 66±11 years, 81% men, 74% with ischemic etiology of HF and EF 28±5%) 21% had NG, 3% had CR, 8% had CH, and 68% had EH. Distribution of RV echo parameters across LV remodeling groups is shown in table 1. Over a median follow-up time of 4 (1.9 – 6.1) years, 65 deaths occurred. In multivariable Cox PH models adjusted for age, LVEF, ischemic etiology and LV geometry, TAPSE, TAPSE/PAPs, RV basal diameter and FAC strongly and independently predicted the outcome variable [HR 0.92 (95% C.I. 0.86–0.98), HR 0.08 (95% C.I. 0.01–0.57), HR 1.87 (95% C.I. 1.29–2.71), HR 0.97 (95% C.I. 0.95–1.00), respectively all p-value <0.05].
Conclusion
In a homogeneously defined population of severe HFrEF outpatients receiving OT, the majority showed EH remodeling pattern, which did not predict the primary outcome. LV geometry did not further stratify patients in this high risk group. Conversely, RV dysfunction proved to be a strong predictor of mortality, independently of age, LV function and etiology of HF, regardless LV morphology.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Casati
- University of Milan, Cardiology, Milan, Italy
| | - F Bursi
- University of Milan, Cardiology, Milan, Italy
| | | | - G Santangelo
- ASST Santi Paolo e Carlo, Cardiology, Milan, Italy
| | | | - L Massironi
- ASST Santi Paolo e Carlo, Cardiology, Milan, Italy
| | | | - S Carugo
- University of Milan, Cardiology, Milan, Italy
| | - M Guazzi
- University of Milan, Cardiology, Milan, Italy
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25
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Vella AM, Bursi F, Santangelo G, Barbieri A, Toriello F, Valli F, Sansalone D, Carugo S, Guazzi M. Consequences on the right ventricular to pulmonary circulation coupling of COVID-19 infection. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0149] [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
Right Ventricular (RV) dysfunction and pulmonary hypertension (PH) are two very likely acute and long term targets of COVID-19 pneumonia, with a potential prognostic implications.
Purpose
To determine the COVID-19 pneumonia effects on the right ventricular to pulmonary circulation coupling through bedside echocardiography and extend its implications to prognostic assessment.
Methods
Single-centre study including consecutive subjects hospitalized for COVID-19 pneumonia who underwent a clinical indicated echocardiogram between March 2020 and December 2020. Extensive analysis of cardiac function was performed offline by an operator blinded to clinical data, laboratory findings and CT scans.
Results
133 patients were enrolled (mean age 69±12 years, 57% men), 38% of whom already had cardiac disease in their medical history. In-hospital mortality was 26% (35 pts), during a mean hospital stay of 26±16 days. Non survivors had higher pulmonary artery systolic pressure (PASP) and worse RV function, assessed with both standard parameters (i.e. TAPSE) and with the novel speckle tracking analysis by RV-Global Longitudinal Strain (RV-GLS) and RV-Free Wall Longitudinal Strain (RV-FWLS). The combination of these two variables in TAPSE/PASP ratio allows assessment of RV to pulmonary circulation (Pc) coupling and was strongly associated with in-hospital death (HR 0.73, 95% CI 0.59–0.89, p=0.003) and patients with TAPSE/PASP<0.57 mm/mmHg had a more than 4-fold increased risk of in-hospital death (HR 4.8, 95% CI 1.7–13.1, p=0.003). In patients where speckle tracking analysis was feasible, we examined RV-GLS/PASP and RV-FWLS/PASP and found that it was associated with in-hospital mortality. The best cut-offs for predicting in-hospital mortality was 0.51 for RV-GLS/PASP (94% sensitivity and 59% specificity) and 0.49 for RV-free wall LS (87% sensitivity and 70% specificity). At the multivariable analysis RV to Pc remained associated with in-hospital death after adjustments for age, PaO2/FiO2, LVEF, and severity of lung involvement at the CT.
Conclusions
Either PH and RV dysfunction predict in-hospital mortality in patients with COVID-19 pneumonia. The assessment of RV to Pc coupling, however, better describes the adaptive RV response to increased PASP and gives additional prognostic information in a population with a relevant prevalence of comorbidities.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A M Vella
- San Paolo University Hospital, Milano, Italy
| | - F Bursi
- San Paolo University Hospital, Milano, Italy
| | | | - A Barbieri
- Polyclinic Hospital of Modena, Modena, Italy
| | - F Toriello
- San Paolo University Hospital, Milano, Italy
| | - F Valli
- San Paolo University Hospital, Milano, Italy
| | - D Sansalone
- San Paolo University Hospital, Milano, Italy
| | - S Carugo
- Fondazione IRCCS Policlinico di Milano, Milano, Italy
| | - M Guazzi
- San Paolo University Hospital, Milano, Italy
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26
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Gentile D, Bursi F, Mangini A, Carugo S. Aortic pseudoaneurysm with fistula to pulmonary trunk causing recurrent pulmonary oedema: a rare late complication of ascending aorta replacement. Eur Heart J 2021; 42:2509. [PMID: 33026083 DOI: 10.1093/eurheartj/ehaa712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Domitilla Gentile
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca Bursi
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Andrea Mangini
- Division of Cardio-Vascular Surgery, Department of Cardio-Cerebro-Vascular, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Stefano Carugo
- Division of Cardiology, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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27
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Santangelo G, Faggiano A, Toriello F, Carugo S, Natalini G, Bursi F, Faggiano P. Risk of cardiovascular complications during non-cardiac surgery and preoperative cardiac evaluation. Trends Cardiovasc Med 2021; 32:271-284. [PMID: 34233205 DOI: 10.1016/j.tcm.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 12/21/2022]
Abstract
The preoperative evaluation of candidates to non-cardiac surgery requires a knowledge of factors related both to the type of surgery and to the risk of each patient, in order to predict the potential cardiovascular complications. Over the past several decades, the field of preoperative cardiac evaluation before non-cardiac surgery has evolved substantially on the basis of the current guidelines of international medical societies. The aim of this paper is to summarize available evidence on the risk of non-cardiac surgery, focusing on appropriate cardiovascular assessment prior to surgery.
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Affiliation(s)
- Gloria Santangelo
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Italy
| | - Andrea Faggiano
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Internal Medicine, Cardiology Unit, University of Milan, Milan, Italy
| | - Filippo Toriello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Internal Medicine, Cardiology Unit, University of Milan, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Internal Medicine, Cardiology Unit, University of Milan, Milan, Italy
| | | | - Francesca Bursi
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, Italy
| | - Pompilio Faggiano
- Fondazione Poliambulanza, Cardiovascular Department, Brescia, Italy.
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28
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Castini DC, Persampieri S, Sabatelli L, Valli F, Ferrante G, Zambelli D, Toriello F, Provenzale G, Gentile D, Bursi F, Centola M, Carugo S. Incremental Value of Renal Dysfunction Addition to the CHA2DS2-Vasc Score for Mortality Prediction in Patients with Acute Coronary Syndrome. Cardiology 2021; 146:538-546. [PMID: 33965936 DOI: 10.1159/000515986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 03/12/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study analyzes the usefulness of the CHA2DS2-VASc score for mortality prediction in patients with acute coronary syndromes (ACSs) and evaluates if the addition of renal functional status could improve its predictive accuracy. METHODS CHA2DS2-VASc score was calculated by using both the original scoring system and adding renal functional status using 3 alternative renal dysfunction definitions (CHA2DS2-VASc-R1: eGFR <60 mL/min/1.73 mq = 1 point; CHA2DS2-VASc-R2: eGFR <60 mL/min/1.73 mq = 2 points; and CHA2DS2-VASc-R3: eGFR <60 mL/min/1.73 mq = 1 point, <30 mL/min/1.73 mq = 2 points). Inhospital mortality (IHM) and post-discharge mortality (PDM) were recorded, and discrimination of the various risk models was evaluated. Finally, the net reclassification index (NRI) was calculated to compare the mortality risk classification of the modified risk models with that of the original score. RESULTS Nine hundred and eight ACS patients (median age 68 years, 30% female, 51% ST-elevation) composed the study population. Of the 871 patients discharged, 865 (99%) completed a 12-month follow-up. The IHM rate was 4.1%. The CHA2DS2-VASc score demonstrated a good discriminative performance for IHM (C-statistic 0.75). Although all the eGFR-modified risk models showed higher C-statistics than the original model, a statistically significant difference was observed only for CHA2DS2-VASc-R3. The PDM rate was 4.5%. The CHA2DS2-VASc C-statistic for PDM was 0.75, and all the modified risk models showed significantly higher C-statistics values than the original model. The NRI analysis showed similar results. CONCLUSIONS CHA2DS2-VASc score demonstrated a good predictive accuracy for IHM and PDM in ACS patients. The addition of renal dysfunction to the original score has the potential to improve identification of patients at the risk of death.
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Affiliation(s)
- Diego Carlo Castini
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Simone Persampieri
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Ludovico Sabatelli
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Federica Valli
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Giulia Ferrante
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Daniel Zambelli
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Filippo Toriello
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation, Internal Medicine Department, Cardiology Unit, Milan, Italy
| | - Giovanni Provenzale
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation, Internal Medicine Department, Cardiology Unit, Milan, Italy
| | - Domitilla Gentile
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation, Internal Medicine Department, Cardiology Unit, Milan, Italy
| | - Francesca Bursi
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Marco Centola
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation, Internal Medicine Department, Cardiology Unit, Milan, Italy
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Bursi F, Santangelo G, Ferrante G, Massironi L, Carugo S. Prevalence of left atrial thrombus by real time three-dimensional echocardiography in patients undergoing electrical cardioversion of atrial fibrillation: A contemporary cohort study. Echocardiography 2021; 38:518-524. [PMID: 33665895 DOI: 10.1111/echo.15015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prevalence of left atrial thrombi in patients scheduled for electrical cardioversion (ECV) of atrial fibrillation (AF) remains unknown in contemporary real-life practice. METHODS AND RESULTS Patients scheduled for ECV underwent transesophageal echocardiography (TEE) regardless of AF duration and type of anticoagulant. Of 277 consecutive patients (65% men, mean age 71 ± 10 years, CHA2 DS2 -VASc 3.1 ± 1.4), 92 were on direct oral anticoagulants (DOACs) and 99 on antivitamin K (AVK) oral agents for at least 3 weeks before and 4 after ECV. Eighty-five patients with paroxysmal AF on low-molecular-weight heparin were also considered. Real time three-dimensional TEE detected left atrial appendage (LAA) thrombus in 7% of patients, without significant difference among three groups (P = .334). Anticoagulation was ineffective in eight patients on AVK oral agents, two of them had thrombus. Eight patients assumed incorrectly DOACs, four of them had thrombus. Among the 175 patients on effective anticoagulation, five showed thrombus, three on AVK oral agents, and two on DOACs (P = .716). Effective anticoagulation was associated with reduced risk of thrombosis (OR: 0.16, 95%CI: 0.06-0.45, P = .001). In patients with correct anticoagulation, predictors of thrombus were CHA2 DS2 VASc (for each point of increment OR: 1.97, 95%CI: 1.08-3.61, P = .029), low left ventricular ejection fraction (OR: 0.92, 95%CI: 0.86-0.99, P = .026), and degree of spontaneous echo-contrast (for each point increase OR: 10, 95%CI: 2-39, P < .0001). CONCLUSION Patients with AF, on effective anticoagulation, had a prevalence of thrombus not negligible regardless of type of anticoagulant. TEE is prudent before ECV and mandatory if unsuccessful anticoagulation is proved or suspected.
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Affiliation(s)
- Francesca Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gloria Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Giulia Ferrante
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Laura Massironi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Stefano Carugo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.,Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Benfari G, Nistri S, Cerrito LF, Maritan L, Tafciu E, Setti M, Bursi F, Tadiello E, De Manna ND, Rossi A, Ribichini FL. Usefulness of the Right Parasternal Echocardiographic View to Improve the Hemodynamic Assessment After Valve Replacement for Aortic Stenosis. Am J Cardiol 2021; 142:103-108. [PMID: 33278359 DOI: 10.1016/j.amjcard.2020.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Right-parasternal-view (RPV) often provides the best hemodynamic assessment of the aortic-valve-stenosis by echocardiography. However, no detailed study on patients with aortic prosthesis is available. Thus, RPV usefulness is left as an anecdotical notion in this context. We aimed to define feasibility and clinical-impact of RPV before and soon-after percutaneous implantation (TAVI) or surgical (SAVR) aortic-valve-replacement (AVR) for AS. Patients with severe-AS electively referred for AVR between September-2019 and February-2020 were prospectively evaluated. Echocardiographic examinations inclusive of apical and RPV to measure aortic-peak-velocity , gradients and area (AVA) were performed the day before AVR and at hospital discharge and compared by matched-pair-analysis. Forty-seven patients (mean age 79 ± 8 years, 63% female, ejection-fraction 61 ± 6%) referred for SAVR (24 [51%]) or TAVI (23 [49%]) were enrolled. RPV was feasible in 45 patients (96%) before-AVR but in only 32 after-AVR (68%), particularly after SAVR (50%) than TAVI (87% p = 0.005). RPV remained the best acoustic window after TAVI in 75% of cases. Hemodynamic assessment of TAVI, but not SAVR, invariably benefit from RPV versus apical evaluation (aortic-peak-velocity: 2.57 ± 0.39 vs 2.23 ± 0.47 m/sec, p = 0.002; mean gradient: 15 ± 5 vs 12 ± 5 mm Hg, p = 0.01). Five (11%) patients presented severe patient-prosthesis-mismatch, 4 of which were detectable only by RPV. This pilot-experience demonstrates that RPV feasibility is slightly reduced after AVR. RPV can improve the hemodynamic assessment of the prosthetic valve versus apical view, including the detection of patient-prosthesis-mismatch. Furthermore, when RPV is the best acoustic windows in patients with severe AS, it generally remains so after-TAVI.
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Toriello F, Santangelo G, Bursi F, Epis E, Tamagni ME, Massironi L, Bertelli S, Benetti A, Cattaneo M, Carugo S. Echocardographic changes in anorexia nervosa: a pathophysiological adaptation or a disease? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Anorexia nervosa (AN) is one of the most common form of eating disorders and it is a severe and potentially fatal disease with high rates of morbidity and mortality especially in the population aged 15-25 years. Cardiac involvement occurs in approximately 80% of patients with AN. Cardiovascular complications include changes in the autonomic regulation (increased vagal tone, bradycardia, orthostatic hypotension, syncope), arrhythmias, congestive heart failure and sudden death. Few reports have described, in small series, a variety of echocardiographic abnormalities including decreased cardiac mass, mitral valve prolapse, pericardial effusion and reduced left ventricular (LV) dimensions. No previous studies, however, examined if there is a change in these abnormalities with weight fluctuations.
Purpose
To describe echocardiographic findings among male and female patients with AN and to examine the effect of weight gain on clinical and echocardiographic parameters.
Methods
We performed a single center, retrospective, study of patients diagnosed with AN using the diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Clinical, laboratory and ECG-graphic data were obtained by reviewing each patient’s medical records. Echocardiographic parameters were measured off-line.
Results
The study population consisted of 81 patients, mean age 24.5 ± 11.6 years, 92.6% females. 75% showed an extreme AN degree. Mean body mass index (BMI) was 15.2 ± 2.1 kg/m2. Mean heart rate was 57.2 ± 12.7 beats per minute. Some patients showed right bundle branch block (7.4%) or prolonged QT interval (14.8%). Patients with BMI below the mean value had more often pericardial effusion, smaller LV mass and LV end-diastolic volume and thinner interventricular septum (all p < 0.05). However, when index to BSA, LV mass and volumes were within normal range in the 90% of the population. They also showed mitral valve abnormalities and low values of white blood cells and platelets. The presence of pericardial effusion was not related to inflammatory parameters or protein deficiency. For 39 patients echocardiographic exams at the highest and the lowest weight were available. With weight gain, there was an improvement in LV mass, interventricular septum thickness, pericardial effusion and an increase in white blood cells and platelet count.
Conclusions
Our study showed that patients with AN have a specific echocardiographic pattern which seems to be proportional to the body size, suggesting a pathophysiological adaptation to the lack of substrates, hypothesis confirmed by the regression with weight gain. It is possible that pericardic effusion fills the gap left by mass loss.
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Affiliation(s)
- F Toriello
- ASST Santi Paolo e Carlo, Department of Health Sciences, Division of Cardiology, University of Milan, Milan, Italy
| | - G Santangelo
- ASST Santi Paolo e Carlo, Department of Health Sciences, Division of Cardiology, University of Milan, Milan, Italy
| | - F Bursi
- ASST Santi Paolo e Carlo, Department of Health Sciences, Division of Cardiology, University of Milan, Milan, Italy
| | - E Epis
- ASST Santi Paolo e Carlo, Department of Health Sciences, Division of Cardiology, University of Milan, Milan, Italy
| | - ME Tamagni
- ASST Santi Paolo e Carlo, Department of Health Sciences, Division of Internal Medicine, University of Milan, Milan, Italy
| | - L Massironi
- ASST Santi Paolo e Carlo, Department of Health Sciences, Division of Cardiology, University of Milan, Milan, Italy
| | - S Bertelli
- ASST Santi Paolo e Carlo, Department of Mental Health, Milan, Italy
| | - A Benetti
- ASST Santi Paolo e Carlo, Department of Health Sciences, Division of Internal Medicine, University of Milan, Milan, Italy
| | - M Cattaneo
- ASST Santi Paolo e Carlo, Department of Health Sciences, Division of Internal Medicine, University of Milan, Milan, Italy
| | - S Carugo
- ASST Santi Paolo e Carlo, Department of Health Sciences, Division of Cardiology, University of Milan, Milan, Italy
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Bonelli A, Lorusso R, Paris S, Troise G, Mohammed AH, Bursi F, Faggiano P. Active cancer and cardiac surgery: Possible scenarios in patient decision-making. Monaldi Arch Chest Dis 2021; 91. [PMID: 33550794 DOI: 10.4081/monaldi.2021.1655] [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] [Received: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022] Open
Abstract
Heart disease and cancer are often found simultaneously in the same patient, and may require cardiac and non-cardiac surgery. Cancer may be part of the past medical history; in other cases the presence of an active malignancy makes the clinical management more complex. No general evidence-based recommendations are available to help in the decision-making process. Because of the lack of specific guidelines we provided a series of possible scenarios describing not unusual cases. We focused on cases where the concomitant presence of heart disease and active malignancies involved a multidisciplinary team. Four real patients with active cancer referred to our Center were assessed. Three of them had valve disease requiring cardiac surgery. Defining the timing of surgery and choosing the surgical approach required a careful and comprehensive evaluation. In the last case, the complicated balance between the thrombotic and the hemorrhagic risk involved difficult decision. Several critical points, which characterized the management of this kind of patients, were identified. In particular, the hemodynamic status, the type and stage of the tumor, the need for cancer therapy, as well as the comorbidities of the patient, had to be taken into account. This narrative review shows the importance of submitting every challenging case to the assessment of a multidisciplinary team, which involves different clinical figures, in order to guarantee the most comprehensive evaluation. When clinical management deviates from the general recommendations, an individualized approach should be used.
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Affiliation(s)
- Andrea Bonelli
- Cardiology Unit, Spedali Civili and University of Brescia.
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht.
| | - Sara Paris
- Cardiology Unit, Spedali Civili and University of Brescia.
| | | | | | - Francesca Bursi
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan.
| | - Pompilio Faggiano
- Cardiology Unit, Spedali Civili and University of Brescia; Fondazione Poliambulanza, Brescia.
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Santangelo G, Bursi F, Negroni MS, Gentile D, Provenzale G, Turriziani L, Zambelli DL, Fiorista L, Bacchioni G, Massironi L, Tarricone DG, Carugo S. Arrhythmic event prediction in patients with heart failure and reduced ejection fraction. J Cardiovasc Med (Hagerstown) 2021; 22:110-117. [PMID: 32639331 DOI: 10.2459/jcm.0000000000001058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Implantable cardioverter defibrillator (ICD) is an effective treatment to reduce mortality in patients with symptomatic heart failure and left ventricular ejection fraction (LVEF) 35% or less. LVEF presents a low sensitivity for predicting arrhythmic events. Aim of this study was to identify predictors of sustained ventricular arrhythmias (SVAs), overall and according to the cause of heart failure. METHODS Single-center, retrospective, cohort study of 193 patients (51 nonischemic and 142 ischemic) with chronic heart failure and LVEF less than 35% who had received ICD for primary prevention of sudden cardiac death. We collected clinical data, echocardiographic parameters and SVAs detected by the ICD. RESULTS During a median follow-up of 1440 days, 32 (16.2%) patients had SVAs. SVAs incidence was similar in patients with nonischemic (15.6%) and ischemic cause of heart failure (16.9%). Hypertension, diabetes, chronic renal failure, atrial fibrillation, chronic obstructive pulmonary disease, New York Heart Association class at least III were predictors at univariate analysis of SVAs. A clinical score, assigning one point to each of these variables, was associated with a significantly increased risk of SVAs [odds ratio for each point increase = 1.92, 95% confidence interval 1.40-2.65, P < 0.0001, area under the curve (AUC) 0.73], with 72% sensitivity and 60% specificity for a cutoff at least three and remained significant in nonischemic (AUC 0.84) and ischemic (AUC 0.68) patients. CONCLUSION Our study shows the benefit of ICD implantation in primary prevention and its independency of cause. A simple clinical score, based on comorbidities, identifies patients with more benefits from ICD implantation.
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Affiliation(s)
- Gloria Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital; University of Milan, Italy
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Bursi F, Santangelo G, Sansalone D, Valli F, Vella AM, Toriello F, Barbieri A, Carugo S. Prognostic utility of quantitative offline 2D-echocardiography in hospitalized patients with COVID-19 disease. Echocardiography 2020; 37:2029-2039. [PMID: 32964483 PMCID: PMC7646664 DOI: 10.1111/echo.14869] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To assess the prognostic utility of quantitative 2D‐echocardiography, including strain, in patients with COVID‐19 disease. Methods COVID‐19‐infected patients admitted to the San Paolo University Hospital of Milan that underwent a clinically indicated echocardiographic examination were included in the study. To limit contamination, all measurements were performed offline. Quantitative measurements were obtained by an operator blinded to the clinical data. Results Among the 49 patients, nonsurvivors (33%) had worse respiratory parameters, index of multiorgan failure, and worse markers of lung involvement. Right ventricular (RV) dysfunction (as assessed by conventional and 2‐dimensional speckle tracking) was a common finding and a powerful independent predictor of mortality. At the ROC curve analyses, RV free wall longitudinal strain (LS) showed an AUC 0.77 ± 0.08 in predicting death, P = .008, and global RV LS (RV‐GLS) showed an AUC 0.79 ± 0.04, P = .004. This association remained significant after correction for age (OR = 1.16, 95%CI 1.01–1.34, P = .029 for RV free wall LS and OR = 1.20, 95%CI 1.01–1.42, P = .033 for RV‐GLS), for oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen (OR = 1.28, 95%CI 1.04–1.57, P = .021 for RV free wall‐LS and OR = 1.30, 95%CI 1.04–1.62, P = .020 for RV‐GLS) and for the severity of pulmonary involvement measured by a computed tomography lung score (OR = 1.27, 95%CI 1.02–1.19, P = .034 for RV free wall LS and OR = 1.30, 95%CI 1.04–1.63, P = .022 for RV‐GLS). Conclusions In patients hospitalized with COVID‐19, offline quantitative 2D‐echocardiographic assessment of cardiac function is feasible. Parameters of RV function are frequently abnormal and have an independent prognostic value over markers of lung involvement.
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Affiliation(s)
- Francesca Bursi
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Gloria Santangelo
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Dario Sansalone
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Federica Valli
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Anna Maria Vella
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Filippo Toriello
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Carugo
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
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Barbieri A, Antonini-Canterin F, Pepi M, Monte IP, Trocino G, Barchitta A, Ciampi Q, Cresti A, Miceli S, Petrella L, Benedetto F, Zito C, Benfari G, Bursi F, Malagoli A, Bartolacelli Y, Mantovani F, Clavel MA. Discordant Echocardiographic Grading in Low Gradient Aortic Stenosis (DEGAS Study) From the Italian Society of Echocardiography and Cardiovascular Imaging Research Network: Rationale and Study Design. J Cardiovasc Echogr 2020; 30:52-61. [PMID: 33282641 PMCID: PMC7706377 DOI: 10.4103/jcecho.jcecho_68_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 11/04/2022] Open
Abstract
Background Low-gradient aortic stenosis (LG-AS) is characterized by the combination of an aortic valve area compatible with severe stenosis and a low transvalvular mean gradient with low-flow state (i.e., indexed stroke volume <35 mL/m2) in the presence of reduced (classical low-flow AS) or preserved (paradoxical low-flow AS) ejection fraction. Furthermore, the occurrence of a normal-flow LG-AS is still advocated by many authors. Within this diagnostic complexity, the diagnosis of severe AS remains challenging. Objective The general objective of the Discordant Echocardiographic Grading in Low-gradient AS (DEGAS Study) study will be to assess the prevalence of true severe AS in this population and validate new parameters to improve the assessment and the clinical decision-making in patients with LG-AS. Methods and Analyses The DEGAS Study of the Italian Society of Echocardiography and Cardiovascular Imaging is a prospective, multicenter, observational diagnostic study that will enroll consecutively adult patients with LG-AS over 2 years. AS severity will be ideally confirmed by a multimodality approach, but only the quantification of calcium score by multidetector computed tomography will be mandatory. The primary clinical outcome variable will be 12-month all-cause mortality. The secondary outcome variables will be (i) 30-day mortality (for patients treated by Surgical aortic valve replacement or TAVR); (ii) 12-month cardiovascular mortality; (iii) 12-month new major cardiovascular events such as myocardial infarction, stroke, vascular complications, and rehospitalization for heart failure; and (iv) composite endpoint of cardiovascular mortality and hospitalization for heart failure. Data collection will take place through a web platform (REDCap), absolutely secure based on current standards concerning the ethical requirements and data integrity.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, Milano, Italy
| | - Francesco Antonini-Canterin
- Rehabilitative Cardiology, Ospedale Riabilitativo di Alta Specializzazione di Motta di Livenza (TV), Milano, Italy
| | - Mauro Pepi
- Monzino Cardiology Center, IRCCS, Milano, Italy
| | | | - Giuseppe Trocino
- Cardiology, Hospital of Desio, S. Antonio Hospital, AO Padova, Italy
| | | | | | - Alberto Cresti
- Cardiology, Dip. Cardio Neuro Vascolare Asl sudest Toscana, Hospital of Grosseto, Italy
| | | | | | - Frank Benedetto
- Cardiology, G.O.M. "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine - Section of Cardiology, G. Martino General Hospital, University of Messina, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Italy
| | - Francesca Bursi
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Italy
| | | | - Ylenia Bartolacelli
- Pediatric and Adult Congenital Heart Cardiac Surgery, S.Orsola Malpighi Hospital, University of Bologna, Italy
| | | | - Marie-Annick Clavel
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
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Barbieri A, Mantovani F, Bursi F, Faggiano A, Boriani G, Faggiano P. Optimal Use of Echocardiography in Management of Thrombosis After Anterior Myocardial Infarction. Echocardiography 2020; 37:1287-1295. [DOI: 10.1111/echo.14808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/09/2020] [Accepted: 07/16/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Andrea Barbieri
- Department of Cardiology Azienda Ospedaliera‐Universitaria di Modena Modena Italy
| | - Francesca Mantovani
- Department of Cardiology Azienda Unità Sanitaria Locale ‐ IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Francesca Bursi
- Department of Cardiology Division of Cardiology, Heart and Lung Department San Paolo Hospital, ASST Santi Paolo and Carlo University of Milan Milano Italy
| | | | - Giuseppe Boriani
- Department of Cardiology Azienda Ospedaliera‐Universitaria di Modena Modena Italy
| | - Pompilio Faggiano
- Cardiology Division Spedali Civili and University of Brescia Brescia Italy
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Barbieri A, Benfari G, Giubertoni E, Manicardi M, Bursi F, Rossi A, Maritan L, Venturi G, Boriani G. Degree of left ventricular dilatation at end-diastole: Correlation and prognostic utility of quantitative volumes by 2D-echocardiography versus linear dimensions in patients with asymptomatic aortic regurgitation. Echocardiography 2020; 37:1336-1344. [PMID: 32757465 DOI: 10.1111/echo.14815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/19/2020] [Accepted: 07/19/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Guideline recommendations for aortic valve replacement (AVR) in asymptomatic patients with chronic aortic regurgitation (AR) have historically focused on linear dimensions without normalization for the body surface area (BSA). Values for grading the severity of end-diastolic volume dilatation by 2D echocardiography remain to be established. METHODS AND RESULTS We retrospectively analyzed 543 consecutive asymptomatic patients with pure chronic moderate/severe AR (mean age 66 ± 17 years, 37.7% males). Applying the ASE/EACVI guidelines, BSA-indexed LV end-diastolic volume (LVEDVi) and indexed LV end-diastolic diameter (LVEDDi) were assessed. Then, we identified 192 patients with at least mild LV end-diastolic dilatation by volumetric or linear measurements. The outcome endpoint was the combination of cardiac death, hospitalization for acute heart failure or AVR during a median follow-up of 4.5 ± 3.6 years. Multivariable Cox regression analyses including age, LV ejection fraction (EF) and AR severity showed an independent prognostic value of the LVEDDi and LVEDVi (P < .001 and P < .01, respectively). Congruent severe LVEDDi and LVEDVi dilatation was associated with a higher event rate compared to discordant severe LV end-diastolic dilatation or nonsevere LV dilatation (P = .001) even after landmark analysis (P = .02). In patients with EF > 50%, only the LVEDVi showed and independent prognostic value (P < .001). CONCLUSIONS In a cohort of asymptomatic patients with AR, the presence of severe LV volume and diameter dilatation on the basis of the cutoff values proposed by current recommendations and normalized for BSA may be instrumental in the identification of patients at increased risk of clinical progression regardless of EF.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Elisa Giubertoni
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcella Manicardi
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Bursi
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.,Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Luca Maritan
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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Bursi F, Persampieri S, Sabatelli L, Bencini C, Santangelo G, Bosotti L, Tayar A, Valli F, Ferrante G, Caretta A, Torta D, Massironi L, Castini D, Carugo S. Diastolic dysfunction grade in acute coronary syndromes: Application of 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations. Int J Cardiol 2020; 305:18-24. [DOI: 10.1016/j.ijcard.2020.01.051] [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] [Received: 09/25/2019] [Revised: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
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Santangelo G, Bursi F, Toriello F, Valli F, Tombolini E, Torta D, Bosotti L, Massironi L, Carugo S. Sacubitril/valsartan improves medium-term reverse left ventricular remodeling: why wait? J Cardiovasc Med (Hagerstown) 2020; 20:727-729. [PMID: 31169634 DOI: 10.2459/jcm.0000000000000825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - Elisabetta Tombolini
- Division of Internal Medicine, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
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Galli F, Bursi F, Carugo S. Traumatic Events, Personality and Psychopathology in Takotsubo Syndrome: A Systematic Review. Front Psychol 2019; 10:2742. [PMID: 31920800 PMCID: PMC6914859 DOI: 10.3389/fpsyg.2019.02742] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/20/2019] [Indexed: 12/13/2022] Open
Abstract
Objective Takotsubo syndrome (TTS) is a transient heart disease that has been historically related to the occurrence of psychological (emotional) factors (“broken heart” syndrome). We aimed to conduct a systematic review analyzing the role of psychological factors in TTS. Methods All studies on TTS and psychological factors from January 1991 through April 2019 were scrutinized according to the Cochrane Collaboration and the PRISMA statements. Selected studies were additionally evaluated for the Risk of Bias according to the Newcastle-Ottawa Scale (NOS). Results Fifteen case-control studies (by Mayo Clinic criteria) were finally selected. Most studies analyzed stressful life-events or trauma, although with conflicting findings, while a likely role of long-lasting psychological distress seemed to be a homogenous result. Among life-time psychopathology, only anxiety appeared to have a significant role. Some studies outlined a likely role of personality, but findings are conflicting. Conclusion Our findings do not lead to any definitive assumption on the specific role of psychological factors in TTS, also for scant strong methodology of the most part of the studies. More studies with stronger research methodology are needed to better characterize psychological elements in TTS.
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Affiliation(s)
- Federica Galli
- Cardiology Unit and UCIC, UOC Cardiology, ASST Santi Paolo e Carlo, S. Paolo Hospital, Milan, Italy
| | - Francesca Bursi
- Cardiology Unit and UCIC, UOC Cardiology, ASST Santi Paolo e Carlo, S. Paolo Hospital, Milan, Italy
| | - Stefano Carugo
- Cardiology Unit and UCIC, UOC Cardiology, ASST Santi Paolo e Carlo, S. Paolo Hospital, Milan, Italy.,Department of Health Sciences, Università di Milano, Milan, Italy
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Negroni MS, Furia F, Bursi F, Canevini MP, Carugo S. A case of modern management of Morgagni-Adam-Stokes syndrome. Clin Case Rep 2019; 7:2295-2299. [PMID: 31893045 PMCID: PMC6935613 DOI: 10.1002/ccr3.2384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/27/2022] Open
Abstract
Transient loss of consciousness initially diagnosed as epileptic seizures and then documented as paroxysmal atrioventricular block. Cardiac resynchronization and defibrillator therapy guided by a multimodality approach.
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Affiliation(s)
- Maria Silvia Negroni
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and CarloUniversity of MilanMilanItaly
| | - Francesca Furia
- Regional Centre of Epilepsy, Department of Health Science, San Paolo Hospital, ASST Santi Paolo and CarloUniversity of MilanMilanItaly
| | - Francesca Bursi
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and CarloUniversity of MilanMilanItaly
| | - Maria Paola Canevini
- Regional Centre of Epilepsy, Department of Health Science, San Paolo Hospital, ASST Santi Paolo and CarloUniversity of MilanMilanItaly
| | - Stefano Carugo
- Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and CarloUniversity of MilanMilanItaly
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Grigioni F, Clavel MA, Vanoverschelde JL, Tribouilloy C, Pizarro R, Huebner M, Avierinos JF, Barbieri A, Suri R, Pasquet A, Rusinaru D, Gargiulo GD, Oberti P, Théron A, Bursi F, Michelena H, Lazam S, Szymanski C, Nkomo VT, Schumacher M, Bacchi-Reggiani L, Enriquez-Sarano M. The MIDA Mortality Risk Score: development and external validation of a prognostic model for early and late death in degenerative mitral regurgitation. Eur Heart J 2019; 39:1281-1291. [PMID: 29020352 DOI: 10.1093/eurheartj/ehx465] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 12/06/2016] [Accepted: 07/24/2017] [Indexed: 12/13/2022] Open
Abstract
Aims In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours misperception of individual patients' risk and inappropriate decision-making. Methods and results The Mitral Regurgitation International Database (MIDA) registries include 3666 patients (age 66 ± 14 years; 70% males; follow-up 7.8 ± 5.0 years) with pure, isolated, DMR consecutively diagnosed by echocardiography at tertiary (European/North/South-American) centres. The MIDA Score was derived from the MIDA-Flail-Registry (2472 patients with DMR and flail leaflet-Derivation Cohort) by weighting all guideline-provided prognostic markers, and externally validated in the MIDA-BNP-Registry (1194 patients with DMR and flail leaflet/prolapse-Validation Cohort). The MIDA Score ranged from 0 to 12 depending on accumulating risk factors. In predicting total mortality post-diagnosis, the MIDA Score showed excellent concordance both in Derivation Cohort (c = 0.78) and Validation Cohort (c = 0.81). In the whole MIDA population (n = 3666 patients), 1-year mortality with Scores 0, 7-8, and 11-12 was 0.4, 17, and 48% under medical management and 1, 7, and 14% after surgery, respectively (P < 0.001). Five-year survival with Scores 0, 7-8, and 11-12 was 98 ± 1, 57 ± 4, and 21 ± 10% under medical management and 99 ± 1, 82 ± 2, and 57 ± 9% after surgery (P < 0.001). In models including all guideline-provided prognostic markers and the EuroScoreII, the MIDA Score provided incremental prognostic information (P ≤ 0.002). Conclusion The MIDA Score may represent an innovative tool for DMR management, being able to position a given patient within a continuous spectrum of short- and long-term mortality risk, either under medical or surgical management. This innovative prognostic indicator may provide a specific framework for future clinical trials aiming to compare new technologies for DMR treatment in homogeneous risk categories of patients.
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Affiliation(s)
- Francesco Grigioni
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti n. 9, Bologna 40100, Italy
| | - Marie-Annick Clavel
- Mayo Clinic, Division of Cardiovascular Disease, Mayo Medical School, 200 First St. SW. Rochester, MN 55905, USA
| | - Jean-Louis Vanoverschelde
- Cardiovascular Department, University Catholic of Louvain, Avenue Hippocrates 10, 1200 Bruxelles, Belgium
| | - Christophe Tribouilloy
- University of Amiens, Cardiology, CHU Amiens-Picardie - SITE SUD, 80054 Amiens Cedex 1, France
| | - Rodolfo Pizarro
- Department of Cardiology, Hospital Italiano de Buenos Aires, Juan D. Péron 4190, Buenos Aires, Argentina
| | - Marianne Huebner
- Michigan State University, Department of Statistics and Probability, 619 Red Cedar Rd C413, East Lansing, MI 48824, USA
| | - Jean-Francois Avierinos
- University of Marseille, La Timone Hospital, Service de Cardiologie B, Boulevard Jean Moulin, 13005 Marseille, France
| | - Andrea Barbieri
- Department of Diagnostic Medicine, Clinical and Health Public, University of Modena, Via del Pozzo 71, 41124 Modena, Italy
| | - Rakesh Suri
- Cleveland Clinic, Department of Executive Administration, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | - Agnés Pasquet
- Cardiovascular Department, University Catholic of Louvain, Avenue Hippocrates 10, 1200 Bruxelles, Belgium
| | - Dan Rusinaru
- University of Amiens, Cardiology, CHU Amiens-Picardie - SITE SUD, 80054 Amiens Cedex 1, France
| | - Gaetano D Gargiulo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti n. 9, Bologna 40100, Italy
| | - Pablo Oberti
- Department of Cardiology, Hospital Italiano de Buenos Aires, Juan D. Péron 4190, Buenos Aires, Argentina
| | - Alexis Théron
- University of Marseille, La Timone Hospital, Service de Cardiologie B, Boulevard Jean Moulin, 13005 Marseille, France
| | - Francesca Bursi
- Department of Diagnostic Medicine, Clinical and Health Public, University of Modena, Via del Pozzo 71, 41124 Modena, Italy
| | - Hector Michelena
- Mayo Clinic, Division of Cardiovascular Disease, Mayo Medical School, 200 First St. SW. Rochester, MN 55905, USA
| | - Siham Lazam
- Cardiovascular Department, University Catholic of Louvain, Avenue Hippocrates 10, 1200 Bruxelles, Belgium
| | - Catherine Szymanski
- University of Amiens, Cardiology, CHU Amiens-Picardie - SITE SUD, 80054 Amiens Cedex 1, France
| | - Vuyisile T Nkomo
- Mayo Clinic, Division of Cardiovascular Disease, Mayo Medical School, 200 First St. SW. Rochester, MN 55905, USA
| | - Martin Schumacher
- Institute for Medical Biometry and Statistics, Medical Center-University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany
| | - Letizia Bacchi-Reggiani
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti n. 9, Bologna 40100, Italy
| | - Maurice Enriquez-Sarano
- Mayo Clinic, Division of Cardiovascular Disease, Mayo Medical School, 200 First St. SW. Rochester, MN 55905, USA
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Mantovani F, Bursi F, Di Giannuario G, Barbieri A. Echocardiographic prediction of surgical reparability in degenerative mitral regurgitation due to leaflet prolapse: a review. Expert Rev Cardiovasc Ther 2019; 17:653-662. [PMID: 31483165 DOI: 10.1080/14779072.2019.1664289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Despite current guidelines provide recommendations for the optimal management of degenerative mitral regurgitation (MR), this condition remains often undertreated with delay in surgical referral and dismal effect on outcomes. Areas covered: This review focuses on the role of echocardiography in guiding mitral valve (MV) surgical repair in degenerative MR due to leaflet prolapse. Expert opinion: A stepwise protocol-driven echocardiography shared by referring physician and surgeon may help to guide referral to surgical repair in degenerative MR. This protocol particularly is useful to identify the ideal patho-anatomy for a successful and durable repair especially when early surgery is proposed and to refer the patient to centers of excellence in case of complex anatomy. Nearly 100% repair rate can be achieved when the surgical technique is adapted to the lesions seen in each valve. Three-dimensional echocardiography predicts repair complexity may be useful and should therefore be implemented. However, the current literature is far from comprehensive deriving from small, single-center studies. Therefore, reproducibility and external validation, especially with newly developed quantitative automated software, are still needed.
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Affiliation(s)
- Francesca Mantovani
- Department of Cardiology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia , Reggio Emilia , Italy
| | - Francesca Bursi
- Department of Cardiology, Azienda Socio Sanitaria Territoriale (A.S.S.T.) SANTI PAOLO E CARLO - Presidio Ospedale San Paolo , Milano , Italy
| | | | - Andrea Barbieri
- Department of Cardiology, Azienda Ospedaliera-Universitaria di Modena , Modena , Italy
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Gaibazzi N, Barbieri A, Boriani G, Benatti G, Codazzo G, Manicardi M, Bursi F, Siniscalchi C. Imaging functional stress test for stable chest pain symptoms in patients at low pretest probability of coronary artery disease: Current practice and long-term outcome. Echocardiography 2019; 36:1095-1102. [PMID: 31038795 DOI: 10.1111/echo.14352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/29/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Stress testing in patients with low pretest probability (PTP) of coronary artery disease (CAD) has become an increasing practice, potentially leading to underestimation of its true clinical value. Our aim was to describe the current use of most employed imaging functional tests and their prognostic value. METHODS AND RESULTS We selected patients with low PTP of CAD (CAD consortium clinical score < 15%) who underwent exercise or dipyridamole stress echocardiography or single photon emission computed tomography for suspected angina. Main exclusions were age < 45, known CAD, and abnormal rest wall motion. Of the 2279 subjects undergoing stress test, 883 (39%) had low PTP, and 91 (10.3%) had a positive test for ischemia. After a median follow-up of 5.8 years, 36 patients had events (21 died, 14 had nonfatal myocardial infarction). The percentage of events in the abnormal and normal stress test groups were similar (5 [5.5%] vs 31 [3.9%], P = ns), as the annualized event rate (0.87% vs 0.62%, P = ns). Age was the only variable associated with outcome in the regression analysis (hazard ratio 1.072, 95% CI 1.034-1.113, P < 0.001). An abnormal result was not associated with worse outcome in each of the subgroups of functional tests. CONCLUSIONS In our geographical area, a considerable proportion of patients undergoing imaging functional tests for stable chest pain have a low estimated PTP of CAD. Of these, 1 in 10 resulted positive for inducible ischemia. However, none of the most common imaging functional tests, single photon emission computed tomography (SPECT), and stress echocardiography offer prognostic information in these patients.
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Affiliation(s)
- Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Andrea Barbieri
- Department of Cardiology, Modena University Hospital, Modena, Italy
| | - Giuseppe Boriani
- Department of Cardiology, Modena University Hospital, Modena, Italy
| | - Giorgio Benatti
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | | | | | - Francesca Bursi
- Department of Cardiology, Modena University Hospital, Modena, Italy
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Barbieri A, Bartolacelli Y, Bursi F, Manicardi M, Boriani G. Remodeling classification system considering left ventricular volume in patients with aortic valve stenosis: Association with adverse cardiovascular outcomes. Echocardiography 2019; 36:639-650. [PMID: 30834592 DOI: 10.1111/echo.14299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/27/2019] [Accepted: 02/05/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To assess prevalence and clinical implications of left ventricular (LV) remodeling considering: LV volume, mass and relative wall thickness at the time of aortic valve stenosis diagnosis. METHODS AND RESULTS We retrospectively analyzed 343 patients (age 79.2 ± 9.5 years, 48.1% males) with functional aortic valve area (AVA) ≤ 1.5 cm2 . LV geometric patterns and clinical outcomes (combined death, cardiac hospitalization, aortic valve replacement [AVR]) were evaluated. According to the new LV remodeling classification, 4.9% had normal geometry, 7.5% concentric remodeling, 39.3% concentric hypertrophy (LVH), 22.4% mixed LVH, 12.5% dilated LVH, 3.2% eccentric LVH and 4.3% eccentric remodeling, 5.5% had not classifiable LVH. Indexed stroke volume (SVi) was higher in patients with concentric LVH (40.3 ± 11.9 mL/m2 ) and mixed LVH (41.6 ± 13.4 mL/m2 ) and lower in patients with eccentric LVH (24.9 ± 7.7 mL/m2 ), concentric (36.6 ± 12.7 mL/m2 ) and eccentric remodeling (34.9 ± 9.5 mL/m2 ), P = 0.003. During a median follow-up of 2.2 years, 260 (75.8%) had the combined end point. A significant association between the combined end point and LV dilation (P = 0.010) or LV remodeling patterns (P = 0.0001) was found. After multivariable adjustment for AVR, concentric remodeling (HR 3.12, IC 95% 1.14-8.55; P = 0.02) and dilated LVH (HR 3.48, IC 95% 1.31-9.27; P = 0.01) were strongly associated with death or cardiac hospitalizations. CONCLUSIONS In patients with AVA ≤ 1.5 cm2 , when the new LV remodeling classification system is applied, only a minority had normal geometry and less than half had "classic" concentric LVH or remodeling. LV volume dilatation is frequent and associated with adverse outcome. Concentric remodeling, eccentric remodeling, dilated LVH had the worst noninvasive hemodynamic profile and prognosis.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ylenia Bartolacelli
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Bursi
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.,Division of Cardiology, Heart and Lung Department, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Marcella Manicardi
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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Malagoli A, Rossi L, Bursi F, Zanni A, Sticozzi C, Piepoli MF, Villani GQ. Left Atrial Function Predicts Cardiovascular Events in Patients With Chronic Heart Failure With Reduced Ejection Fraction. J Am Soc Echocardiogr 2019; 32:248-256. [DOI: 10.1016/j.echo.2018.08.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Indexed: 11/30/2022]
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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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Barbieri A, Giubertoni E, Bartolacelli Y, Bursi F, Manicardi M, Boriani G. New classification of geometric patterns considering left ventricular volume in patients with chronic aortic valve regurgitation: Prevalence and association with adverse cardiovascular outcomes. Echocardiography 2018; 36:38-46. [PMID: 30407661 DOI: 10.1111/echo.14190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/23/2018] [Accepted: 10/11/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Left ventricular (LV) remodeling due to aortic regurgitation (AR) often leads to maladaptive responses. We assessed the prevalence and clinical implications of LV remodeling considering LV volume, mass, and relative wall thickness at the time of AR diagnosis. METHODS AND RESULTS Between 2008 and 2017, 370 consecutive patients (mean age 67.3 ± 16.1 years, 56.5% males), with moderate or severe AR, were retrospectively analyzed. LV geometric patterns and clinical outcomes (cardiovascular death, hospitalization for heart failure, or aortic valve replacement) were evaluated. LV dilatation (LV end-diastolic volume >75 mL/m2 ) was present in 228 patients (61.6%). Applying the new LV remodeling classification system, 40 (10.8%) patients had normal geometry, 14 (3.8%) concentric remodeling, 43 (11.6%) concentric hypertrophy (LVH), 45 (12.2%) indeterminate LVH, 38 (10.3%) mixed LVH, 93 (25.1%) dilated LVH, 54 (14.6%) eccentric LVH, and 43 (11.6%) eccentric remodeling. During a median follow-up of 3.48 years (25th-75th percentile 0.91-5.57), 97 (26.2%) had the combined endpoint. LV dilation (P < 0.001), LVH (P < 0.001), and LV remodeling patterns were significantly associated with the combined endpoint. After multivariable adjustment for age, EF, aortic stenosis, CAD history, and moderate mitral regurgitation, dilated LVH (HR 7.61, IC 95% 1.82-31.80; P = 0.005) and eccentric LVH (HR 7.91, IC 95% 1.82-34.38; P = 0.006) were associated with adverse outcome compared to eccentric remodeling, that showed the best event-free survival rate. CONCLUSIONS In a contemporary cohort of patients with AR, applying the new LV remodeling classification system, only a minority had normal geometry. Dilated LVH and eccentric LVH showed distinct outcome penalty after adjustment for confounders.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Giubertoni
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ylenia Bartolacelli
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Bursi
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.,Division of Cardiology, San Paolo Hospital, Heart and Lung Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Marcella Manicardi
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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Barbieri A, Mantovani F, Bursi F, Bartolacelli Y, Manicardi M, Lauria MG, Boriani G. 12-year Temporal Trend in Referral Pattern and Test Results of Stress Echocardiography in a Tertiary Care Referral Center with Moderate Volume Activities and Cath-lab Facility. J Cardiovasc Echogr 2018; 28:32-38. [PMID: 29629257 PMCID: PMC5875133 DOI: 10.4103/jcecho.jcecho_48_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Data on stress echocardiography (SE) time-related changes in referral patterns and diagnostic yield for detection of inducible ischemia could enhance Echo Lab quality benchmarks and performance measures. Aim This study aims to evaluate temporal trends in SE test results among ambulatory patients with suspected or known coronary artery disease (CAD) in a tertiary care referral center with moderate (>100/year) volume SE activities and Cath-Lab facility. Methods From January 2004 to December 2015, 1954 patients (mean age 62 ± 12 years, 42% women, 27% with known CAD) underwent SE (1673 exercise SE, 86%, 246 pharmacological SE, 12%, 35 pacing SE, 2%). Time was grouped into three 4 year periods, where clinical data and test results were evaluated. Results Our series comprised low-to-intermediate pretest probability of CAD throughout the observation period (overall pretest probability of CAD 19% ± 15%). A progressive decline over time in the rate of pharmacological SE instead of a dramatic increment of exercise SE (79%-96%, P < 0.0001) was noted. The use of beta-blockers increased (from 43% to 66%, P < 0.0001), while the use of nitrates decreased (from 11% to 4%, P < 0.0001) over time. We noted a very uncommon occurrence of abnormal test results with a further decrease in the last period (from 11% to 3%, P < 0.0001). Conclusions We observed, over a 12-year period, a progressive decrease in the frequency of inducible myocardial ischemia among patients with known or suspected CADe referred to our Echo Lab for SE with Cath-Lab facility, and this trend was parallel to changes in SE referral practice. These findings are particularly relevant if we consider the practical implications on diagnostic SE accuracy and risk assessment.
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Affiliation(s)
- Andrea Barbieri
- Department of Cardiology, Azienda Ospedaliero-Univarsitaria Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Mantovani
- Department of Cardiology, Azienda Ospedaliero-Univarsitaria Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Bursi
- Department of Cardiology, Azienda Ospedaliero-Univarsitaria Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ylenia Bartolacelli
- Department of Cardiology, Azienda Ospedaliero-Univarsitaria Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcella Manicardi
- Department of Cardiology, Azienda Ospedaliero-Univarsitaria Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Giulia Lauria
- Department of Cardiology, Azienda Ospedaliero-Univarsitaria Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Boriani
- Department of Cardiology, Azienda Ospedaliero-Univarsitaria Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Barbieri A, Mantovani F, Lugli R, Bursi F, Fabbri M, Bartolacelli Y, Manicardi M, Stefanelli G, Mussini C, Boriani G. European Society of Cardiology-Proposed Diagnostic Echocardiographic Algorithm in Elective Patients with Clinical Suspicion of Infective Endocarditis: Diagnostic Yield and Prognostic Implications in Clinical Practice. J Cardiovasc Echogr 2018; 28:26-31. [PMID: 29629256 PMCID: PMC5875132 DOI: 10.4103/jcecho.jcecho_49_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Echocardiography plays a central role in diagnosing infective endocarditis (IE). Accordingly, the European Society of Cardiology (ESC) has proposed a diagnostic echocardiographic algorithm. However, new studies are still needed to evaluate the degree of implementation of these guidelines in clinical practice and their consequences on incidence and prognosis of IE. Aim: This study aims to investigate the diagnostic yield of the ESC proposed echocardiographic algorithm in patients with suspected IE. We also examined the association among IE diagnosis and clinical outcomes. Methods: Retrospective analysis of a series of patients undergoing the ESC algorithm for clinical suspicion of IE at our institution. Results: Between 2009 and 2013, 323 cases were managed by a multidisciplinary team for clinical suspicion of IE. Following ESC algorithm, 26 (8%) patients were diagnosed with IE and 297 (92%) had IE excluded. In 92% of patients with a good-quality negative transthoracic echocardiography (TTE) and low level of clinical suspicion, the first TTE was considered sufficient to rule out IE. During a mean follow-up of 2.3 ± 1.4 years, patients who had a final diagnosis of IE showed similar mortality (P = 0.2) and rates of combined endpoint (all-cause death, stroke/transient ischemic attack, advanced atrioventricular block, and heart failure) compared to patients without echocardiographic diagnosis of IE (P = 0.5). Only 1% of the patients who had IE excluded experienced IE in the following 3 months, none of them in the subgroup of patients, in which a first negative TTE was considered sufficient to rule out IE. Conclusions: In spite of the current ESC recommendation TTE is used as part of a routine fever screen. Consequently, only a minority of patients had a final echocardiographic diagnosis of IE. Although in patients with low clinical suspicion a first negative TTE is sufficient to rule out IE, the incidence of clinical events is similar regardless the final diagnosis of IE.
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Affiliation(s)
- Andrea Barbieri
- Department of Cardiology, Policlinico University Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Francesca Mantovani
- Department of Cardiology, Policlinico University Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Roberta Lugli
- Department of Cardiology, Policlinico University Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Francesca Bursi
- Department of Cardiology, Policlinico University Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Matteo Fabbri
- Department of Cardiology, Policlinico University Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Ylenia Bartolacelli
- Department of Cardiology, Policlinico University Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Marcella Manicardi
- Department of Cardiology, Policlinico University Hospital, Modena and Reggio Emilia University, Modena, Italy
| | | | - Cristina Mussini
- Infectious Diseases, Policlinico University Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Giuseppe Boriani
- Department of Cardiology, Policlinico University Hospital, Modena and Reggio Emilia University, Modena, Italy
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