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Delogu AB, Aliberti C, Birritella L, De Rosa G, De Rose C, Morello R, Cambise N, Marino AG, Belmusto A, Tinti L, Di Renzo A, Lanza GA, Buonsenso D. Autonomic cardiac function in children and adolescents with long COVID: a case-controlled study. Eur J Pediatr 2024; 183:2375-2382. [PMID: 38446228 PMCID: PMC11035407 DOI: 10.1007/s00431-024-05503-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
Although the mechanisms underlying the pathophysiology of long COVID condition are still debated, there is growing evidence that autonomic dysfunction may play a role in the long-term complications or persisting symptoms observed in a significant proportion of patients after SARS-CoV-2 infection. However, studies focused on autonomic dysfunction have primarily been conducted in adults, while autonomic function has not yet been investigated in pediatric subjects. In this study, for the first time, we assessed whether pediatric patients with long COVID present abnormalities in autonomic cardiac function. Fifty-six long COVID pediatric patients (mean age 10.3 ± 3.8 y) and 27 age-, sex-, and body surface area-matched healthy controls (mean age 10.4 ± 4.5y) underwent a standard 12-lead electrocardiography (ECG) and 24-h ECG Holter monitoring. Autonomic cardiac function was assessed by time-domain and frequency-domain heart rate variability parameters. A comprehensive echocardiographic study was also obtained by two-dimensional echocardiography and tissue Doppler imaging. Data analysis showed that pediatric patients with long COVID had significant changes in HRV variables compared to healthy controls: significantly lower r-MSSD (root mean square of successive RR interval differences, 47.4 ± 16.9 versus 60.4 ± 29.1, p = 0.02), significant higher values VLF (very low frequency, 2077.8 ± 1023.3 versus 494.3 ± 1015.5 ms, p = 0.000), LF (low frequency, 1340.3 ± 635.6 versus 354.6 ± 816.8 ms, p = 0.000), and HF (high frequency, 895.7 ± 575.8 versus 278.9 ± 616.7 ms, p = 0.000). No significant differences were observed between the two groups both in systolic and diastolic parameters by echocardiography. Conclusion: These findings suggest that pediatric patients with long COVID have an imbalance of cardiac autonomic function toward a relative predominance of parasympathetic tone, as already reported in adult patients with long COVID. Further studies are needed to clarify the clinical significance of this autonomic dysfunction and demonstrate its role as a pathophysiological mechanism of long COVID, paving the way for effective therapeutic and preventive strategies. What is Known: • Long Covid in children has been described globally, but studies have mostly focused on collecting the temporal evolution of persisting symptoms. What is New: • Cardiac autonomic imbalance toward a relative predominance of parasympathetic tone is a mechanism underlying Long Covid in children, as also described in adults.
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Affiliation(s)
- A B Delogu
- Institute of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Aliberti
- Institute of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Birritella
- Institute of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G De Rosa
- Institute of Pediatrics, Pediatric Cardiology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - C De Rose
- Università Cattolica del Sacro Cuore, Rome, Italy
- Institute of Pediatrics, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - R Morello
- Università Cattolica del Sacro Cuore, Rome, Italy
- Institute of Pediatrics, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - N Cambise
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A G Marino
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Belmusto
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Tinti
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Di Renzo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G A Lanza
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Buonsenso
- Università Cattolica del Sacro Cuore, Rome, Italy.
- Institute of Pediatrics, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome, 00168, Italy.
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Grandinetti M, Locorotondo G, Leccisotti L, Guarneri A, Bruno P, Marcolini A, Farina P, Gaudino MF, Lanza GA, Crea F, Giordano A, Massetti M. Quantitative analysis of myocardial blood flow in surgically revascularized and not revascularized myocardial segments. A pilot PET study. Eur J Nucl Med Mol Imaging 2024; 51:1632-1638. [PMID: 38105304 DOI: 10.1007/s00259-023-06563-z] [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] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To prospectively compare changes in myocardial blood flow (MBF) and myocardial flow reserve (MFR) in multivessel coronary artery disease (MVCAD) patients undergoing incomplete revascularization (IR) versus complete revascularization (CR) by coronary artery bypass grafting (CABG). METHODS Seven male patients (age 68 ± 9 years) with MVCAD underwent myocardial perfusion PET/CT with [13N]ammonia before and at least 4 months after CABG. Segmental resting and stress MBF as well as MFR were measured. Resting and during stress left ventricle ejection fraction (LVEF) were also calculated. RESULTS Three patients (43%) underwent CR and four (57%) IR. Among 119 myocardial segments, 101 (85%) were revascularized, and 18 (15%) were not. After CABG, stress MBF (mL/min/gr) and MFR are significantly increased in all myocardial segments, with a greater increase in the revascularized segments (p = 0.013). In both groups, LVEF significantly decreased during stress at baseline PET (p = 0.04), but not after CABG. CONCLUSION Stress MBF and MFR significantly improve after CABG in both revascularized and not directly revascularized myocardial segments. IR strategy may be considered in patients with high surgical risk for CR.
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Affiliation(s)
- M Grandinetti
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Locorotondo
- Non Invasive Cardiac Diagnostics Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Leccisotti
- Section of Nuclear Medicine, Department of Radiological and Haematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - A Guarneri
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - P Bruno
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Marcolini
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - P Farina
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M F Gaudino
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - G A Lanza
- Non Invasive Cardiac Diagnostics Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Unit of Cardiology, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Crea
- Unit of Cardiology, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Giordano
- Section of Nuclear Medicine, Department of Radiological and Haematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - M Massetti
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
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Rinaldi R, Colucci M, Torre I, Ausiello D, Bonanni A, Basile M, Salzillo C, Sanna T, Liuzzo G, Leone AM, Burzotta F, Trani C, Lanza GA, Niccoli G, Crea F, Montone RA. Predicting the response to acetylcholine in ischemia or infarction with non-obstructive coronary arteries: The ABCD score. Atherosclerosis 2024; 391:117503. [PMID: 38447435 DOI: 10.1016/j.atherosclerosis.2024.117503] [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: 11/19/2023] [Revised: 01/19/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND AIMS Acetylcholine (ACh) provocation testing can detect vasomotor disorders in patients with ischemia and non-obstructed coronary arteries (INOCA) or myocardial infarction and non-obstructed coronary arteries (MINOCA). We aimed to derive and validate a simple risk score to predict a positive ACh test response. METHODS We prospectively enrolled consecutive INOCA and MINOCA patients undergoing ACh provocation testing. Patients were split in two cohorts (derivation and validation) according to time of enrolment. The score was derived in 386 patients (derivation cohort) and then validated in 165 patients (validation cohort). RESULTS 551 patients were enrolled, 371 (67.3%) INOCA and 180 (32.7%) MINOCA. ACh test was positive in 288 (52.3%) patients. MINOCA, myocardial bridge (MB), C-reactive protein (CRP) and dyslipidaemia were independent predictors of a positive ACh test in the derivation cohort. The ABCD (Acute presentation, Bridge, CRP, Dyslipidaemia) score was derived: 2 points were assigned to MINOCA, 3 to MB, 1 to elevated CRP and 1 to dyslipidaemia. The ABCD score accurately identified patients with a positive ACh test response with an AUC of 0.703 (CI 95% 0.652-0.754,p < 0.001) in the derivation cohort, and 0.705 (CI 95% 0.626-0.784, p < 0.001) in the validation cohort. In the whole population, an ABCD score ≥4 portended 94.3% risk of a positive ACh test and all patients with an ABCD score ≥6 presented a positive test. CONCLUSIONS The ABCD score could avoid the need of ACh provocation testing in patients with a high score, reducing procedural risks, time, and costs, and allowing the implementation of a tailored treatment strategy. These results are hypothesis generating and further research involving larger cohorts and multicentre trials is needed to validate and refine the ABCD score.
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Affiliation(s)
- Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Colucci
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Ilaria Torre
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Davide Ausiello
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Alice Bonanni
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mattia Basile
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmine Salzillo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Ravenna E, Locorotondo G, Manfredonia L, Diana G, Filice M, Graziani F, Leone AM, Aurigemma C, Romagnoli E, Burzotta F, Trani C, Massetti M, Lombardo A, Lanza GA. Global longitudinal strain for prediction of mortality in ST-segment elevation myocardial infarction and aortic stenosis patients: two sides of the same coin. Eur Rev Med Pharmacol Sci 2023; 27:10736-10748. [PMID: 37975399 DOI: 10.26355/eurrev_202311_34354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Global longitudinal strain (GLS) predicts major adverse events in ST-segment elevation myocardial infarction (STEMI) and aortic stenosis (AS). Different cut-off values and different end-points have been proposed for prognostic stratification. We aimed to verify whether a single GLS cut-off value can be used to identify increased risk of all-cause death in STEMI and AS. PATIENTS AND METHODS One-hundred- seventeen successfully treated first STEMI (age 63.8±12.5 yrs, 70% men) and 64 AS (age 80.3±6.9 yrs, 44% men) patients, undergoing echocardiography before discharge and before AS treatment, respectively, were retrospectively analyzed. GLS was analyzed, together with pulmonary artery systolic pressure (PASP), Killip class and Genereux stage. End-point was all-cause death at 6-month follow-up. RESULTS All-cause death occurred in 4 (3.4%) STEMI and 5 (7.8%) AS patients (p=ns). AS patients who died had GLS similar to died STEMI patients (9.7±2.1 vs. 11.3±1.7, p=ns). GLS cut-off ≤12% predicted death with 89% sensitivity and 70% specificity (AUC 0.84, p=0.001): STEMI and AS patients with GLS ≤12% had worse survival than STEMI and AS patients with GLS >12% (log-rank p=0.001). At multivariate Cox regression analysis, lower GLS values independently predicted death (HR 0.667, 95% CI 0.451-0.986, p=0.042), and the prediction model was improved when GLS was added to old age, significant comorbidities, PASP and Killip/Genereux stage (χ2 6.691 vs. 1.364, p=0.010). CONCLUSIONS Died patients with STEMI and AS show similar values of GLS. A unique cut-off value of GLS can reliably be used to stratify the risk of all-cause death at 6-month follow-up in both two clinical settings.
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Affiliation(s)
- E Ravenna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Meucci MC, Lillo R, Lombardo A, Lanza GA, Bootsma M, Butcher SC, Massetti M, Manna R, Bax JJ, Crea F, Ajmone Marsan N, Graziani F. Comparative analysis of right ventricular strain in Fabry cardiomyopathy and sarcomeric hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:542-551. [PMID: 35900225 PMCID: PMC10029843 DOI: 10.1093/ehjci/jeac151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/22/2022] [Accepted: 07/15/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS To perform a comparative analysis of right ventricle (RV) myocardial mechanics, assessed by 2D speckle-tracking echocardiography (2D-STE), between patients with Fabry disease and patients with sarcomeric disease. METHODS AND RESULTS Patients with Fabry cardiomyopathy (FC) (n = 28) were compared with patients with sarcomeric hypertrophic cardiomyopathy (HCM), matched for degree of left ventricle hypertrophy (LVH) and demographic characteristics (n = 112). In addition, patients with Fabry disease and no LVH [phenotype-negative carriers of pathogenic α-galactosidase gene mutations (GLA LVH-)] (n = 28) were compared with age and sex-matched carriers of sarcomeric gene mutations without LVH [Phenotype-negative carriers of pathogenic sarcomeric gene mutations (Sarc LVH-)] (n = 56). Standard echocardiography and 2D-STE were performed in all participants. Despite a subtle impairment of RV global longitudinal strain (RV-GLS) was common in both groups, patients with FC showed a more prominent reduction of RV free wall longitudinal strain (RV-FWS) and lower values of difference between RV-FWS and RV-GLS (ΔRV strain), in comparison to individuals with HCM (P < 0.001 and P = 0.002, respectively). RV-FWS and ΔRV strain demonstrated an independent and additive value in discriminating FC from HCM, over the presence of symmetric LVH, systolic anterior motion of the mitral valve and RV hypertrophy. Similar results were found in GLA LVH- patients: they had worse RV-FWS and lower values of ΔRV strain as compared to Sarc LVH- patients (both P < 0.001). CONCLUSION Patients with FC show a specific pattern of RV myocardial mechanics, characterized by a larger impairment of RV-FWS and lower ΔRV strain in comparison to patients with HCM, which may be helpful in the differential diagnosis between these two diseases.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands
- Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
| | - Rosa Lillo
- Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonella Lombardo
- Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Gaetano A Lanza
- Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands
- Department of Cardiology, Royal Perth Hospital, Victoria Square, 6000 Perth WA, Australia
| | - Massimo Massetti
- Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Raffaele Manna
- Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
- Institute of Internal Medicine, Periodic Fever and Rare Diseases Research Centre, Fondazione Policlinico A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands
- Heart Center, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Filippo Crea
- Catholic University of the Sacred Heart, Largo F. Vito 1, Rome 00168, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands
| | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
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Meucci MC, Lillo R, Mango F, Lombardo A, Lanza GA, Parisi V, Grandinetti M, Massetti M, Ajmone Marsan N, Crea F, Graziani F. Right ventricular strain in Fabry disease: Prognostic implications. Int J Cardiol 2023; 374:79-82. [PMID: 36586515 DOI: 10.1016/j.ijcard.2022.12.047] [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: 11/19/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Left ventricular (LV) hypertrophy is the main feature of cardiac involvement in Anderson-Fabry disease (FD), but the right ventricle (RV) is also frequently affected. Previous studies failed to demonstrate an independent association between conventional parameters of RV performance and outcomes in FD. Nevertheless, if RV free wall strain (RV-FWS), assessed by 2D speckle tracking analysis, may provide a better prognostication is currently unknown. METHODS We retrospectively evaluated the association between RV-FWS and the occurrence of cardiovascular events in a cohort of 56 patients with FD. The study endpoint comprises cardiovascular mortality, severe heart failure symptoms, new-onset atrial fibrillation and major arrhythmias requiring device implantation. RESULTS Reduced RV-FWS, defined by values lower than 23%, was found in 25 (45%) patients. During a median follow-up of 47 months, 16 (29%) patients met the study endpoint. A ROC-curve analysis confirmed the threshold of reduced RV-FWS (<23%) as the best cut-off for predicting cardiovascular events, but with a lower power compared to left-sided parameters. On univariable Cox regression analysis, RV-FWS, expressed as continuous variable, was significantly associated with the study endpoint (HR: 0.795, 95% CI: 0.710-0.889, p < 0.001). However, RV-FWS did not retain a significant association with outcomes, after adjustment for LV global longitudinal strain or indexed left atrial volume (p = 0.340 and p = 0.289 respectively). CONCLUSIONS RV-FWS was not independently associated with the occurrence of cardiovascular events in FD, confirming previous observations that prognosis is mainly driven by the severity of LV cardiomyopathy.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Rosa Lillo
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Mango
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Grandinetti
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Filippo Crea
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Graziani
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Lanza GA, Bisignani A, Melita V, Telesca A, Tremamunno S, Cambise N, De Vita A, Lanza O, Mollo R. Prognostic Assessment of Early Repolarization/J Wave Electrocardiographic Pattern in Patients With Stable Ischemic Heart Disease. Am J Cardiol 2023; 186:236-242. [PMID: 36328833 DOI: 10.1016/j.amjcard.2022.10.008] [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] [Received: 05/04/2022] [Revised: 08/31/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
Recent studies suggested that early repolarization (ER)/J wave at the electrocardiogram (ECG) is associated with increased risk of sudden death and ventricular arrhythmias in patients with acute myocardial infarction. In this study, we prospectively assessed whether ER/J wave has any long-term prognostic implications in patients with stable ischemic heart disease (IHD). We enrolled consecutive clinically stable patients with documented IHD, referred to undergo a routine ECG. ER (typical concave ST-segment elevation) and J wave were diagnosed according to prospectively defined criteria. The final population included 617 patients with documented IHD (455 men; age 68.1 ± 11 years). ER/J wave was found in 138 patients (22.4%), 13 of whom (2.1%) showed ER and 133 (21.6%) a J wave. At a follow-up of 8.1±2.9 years, 160 deaths occurred (25.9%), 60 (9.7%) attributed to cardiovascular causes. Total mortality was lower in patients with versus those without ER/J wave (18.8% vs 28.0%; hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40 to 0.93, p = 0.02). The difference, however, was not significant after adjustment for confounding clinical variables (HR 0.78, 95% CI 0.51 to 1.19, p = 0.25). No significant difference was found in cardiovascular death between patients with (7.2%) and those without (10.4%) ER/J wave (adjusted HR 0.78, 95% CI 0.40 to 1.55, p = 0.48). Similar results were obtained for ER and J wave separately, and for ECG location of ER/J wave (inferior or lateral/precordial) and type of J wave (notched or slurred). The ER/J wave pattern at the ECG is not associated with increased risk of long-term mortality in clinically stable patients with a documented history of IHD.
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Affiliation(s)
- Gaetano A Lanza
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | | | | | - Antonio De Vita
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Oreste Lanza
- and Department of Clinical and Molecular Medicine and Psychology, Università La Sapienza, Rome, Italy
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Meucci MC, Lillo R, Lombardo A, Lanza GA, Parisi V, Grandinetti M, Massetti M, Marsan NA, Crea F, Graziani F. 332 RIGHT VENTRICULAR STRAIN IN FABRY CARDIOMYOPATHY: PROGNOSTIC IMPLICATIONS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.213] [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
Left ventricular (LV) hypertrophy is the main feature of Fabry cardiomyopathy (FC), but the right ventricle (RV) is also frequently affected. Previous studies failed to demonstrate an independent association between RV hypertrophy or conventional parameters of RV function and the occurrence of adverse outcomes in patients with FC. Nevertheless, if RV free wall strain (RV-FWS), assessed by 2D speckle tracking analysis, may provide a better prognostication is currently unexplored.
We retrospectively evaluated the association between RV-FWS and the occurrence of cardiovascular events in a cohort of 28 patients with FC. The study endpoint comprises the occurrence of cardiovascular mortality, severe heart failure symptoms, new-onset atrial fibrillation, bradyarrhythmias requiring pacemaker implantation and sustained ventricular tachyarrhythmias.
The median value of RV-FWS was 21.4% (interquartile range:17.1-23.9%) and a total of 18 (64%) patients showed reduced RV-FWS (<23%). During a median follow-up of 49 (IQR: 37-51) months, 17 (61%) patients met the study endpoint. A ROC-curve analysis confirmed the previously defined threshold of reduced RV-FWS (23%) as the best cut-off for predicting cardiovascular outcomes at 4 years (area under curve: 0.76; p-value=0.018), but with a lower predictive value in comparison to left-sided parameters (Panel A). Kaplan-Meier survival curves showed significantly lower event-free survival at 4 years in patients with impaired RV-FWS as compared to patients with preserved RV-FWS (log rank p=0.013) (Panel B). On univariable Cox regression analysis, RV-FWS expressed as continuous variable was significantly associated with the study endpoint (Hazard ratio [HR]: 0.85, 95% CI: 0.75-0.96, p=0.009). RV-FWS retained an independent association with outcomes after alternative adjustment for age (p=0.048) or indexed LV mass (p=0.036). Conversely, RV-FWS was not significantly associated with cardiovascular events, after correcting for LV global longitudinal strain or indexed left atrial volume (p=0.401 and p=0.208; respectively).
In Conclusion, impaired RV-FWS was not independently associated with the occurrence of cardiovascular events in FC, confirming previous observations that prognosis is mainly driven by the severity of LV cardiomyopathy.
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Affiliation(s)
- Maria Chiara Meucci
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Ircss , Rome , Italy
- Department Of Cardiology, Leiden University Medical Center , Leiden , The Netherlands
| | - Rosa Lillo
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Ircss , Rome , Italy
| | - Antonella Lombardo
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Ircss , Rome , Italy
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Gaetano A Lanza
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Ircss , Rome , Italy
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Valentina Parisi
- Department Of Translational Medical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Maria Grandinetti
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Ircss , Rome , Italy
| | - Massimo Massetti
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Ircss , Rome , Italy
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Nina Ajmone Marsan
- Department Of Cardiology, Leiden University Medical Center , Leiden , The Netherlands
| | - Filippo Crea
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Ircss , Rome , Italy
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Francesca Graziani
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Ircss , Rome , Italy
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Montone RA, Niccoli G, Russo M, Giaccari M, Del Buono MG, Meucci MC, Gurgoglione F, Vergallo R, D’Amario D, Buffon A, Leone AM, Burzotta F, Aurigemma C, Trani C, Liuzzo G, Lanza GA, Crea F. Correction: Clinical, angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries. Clin Res Cardiol 2022; 112:570. [PMID: 36326842 DOI: 10.1007/s00392-022-02110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Iannaccone G, Graziani F, Del Buono MG, Camilli M, Lillo R, Caffe' A, La Vecchia G, Rinaldi R, Pedicino D, Sanna T, Trani C, Lombardo A, Lanza GA, Montone RA, Crea F. Left atrial strain analysis improves non-invasive estimation of left ventricular filling pressures in takotsubo syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.051] [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
Takotsubo syndrome (TTS) is associated with a non-negligible risk of in-hospital (IH) complications. Elevated left ventricular filling pressures (LVFP), measured invasively as LV end-diastolic pressure (LVEDP), showed to predict adverse IH outcomes in this population.
Recently, novel indexes of left atrial (LA) function, including LA reservoir and LA pump strain, demonstrated a close correlation with increased LVFP in unselected patients.
Purpose
To assess the ability of LA reservoir and LA pump strain to improve non-invasive estimation of LVFP and to predict IH complications in TTS patients.
Methods
We retrospectively enrolled patients with confirmed TTS diagnosis at invasive left heart catheterization and coronary angiography. LVEDP was assessed invasively at the time of catheterization. Transthoracic echocardiography was performed with 48 hours from hospital admission. IH complications were collected, including occurrence of acute heart failure (pulmonary oedema/cardiogenic shock; Killip class III/IV), death from any cause and life-threatening arrhythmias.
Results
A total of 62 patients were analysed (72.2±10.1 years, female 80%). IH complications occurred in 25 (40.3%). Patients who experienced IH complications had higher LVEDP and lower LVEF, LA reservoir strain and LA pump strain values compared to patients without IH complications (all P≤0.001). At multivariate analysis, EF and LVEDP were independent predictors of worse IH outcomes (P≤0.001 and P=0.004 respectively). Correlation analysis proved that lower values of both LA reservoir and pump strain were associated with increasingly higher LVEDP (r −0.859, P≤0.001 and r −0.848, P≤0.001 respectively). Receiving operating characteristic (ROC) curve analysis showed that the AUC for LVEDP to predict IH complications was 0.814 (95% CI 0.679–0.949, P≤0.001) with an optimal cut-off value of 24.5 mmHg (sensitivity 77%, specificity 53%).
Therefore, we performed ROC curve analysis to compare the ability of LA strain values and standard echocardiographic parameters currently used for non-invasive LVFP assessment to predict LVEDP ≥24.5 mmHg. As a result, we obtained higher AUC for LA reservoir and pump strain [0.909 (95% CI 0.818–0.999, P≤0.001) and 0.889 (95% CI 0.789–0.988, P≤0.001), respectively] vs E/e' 0.800 (95% CI 0.663–0.937, P≤0.001), LAVi 0.666 (P=0.092) and tricuspid regurgitation (TR) peak velocity 0.582 (P=0.596). The incorporation of LA strain values in a multivariable model including E/e' ratio, LAVi and TR peak velocity to predict a LVEDP ≥24.5 mmHg led to a significant incremental predictive value (changes in χ2=11.99; P=0.002).
Conclusion
In patients with TTS, lower LA reservoir and pump strain values correlate with increased LVEDP and improve non-invasive estimation of LVFP. LA strain analysis may be an easy tool to individuate subjects at higher risk of IH complications.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Iannaccone
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - F Graziani
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - M G Del Buono
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - M Camilli
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - R Lillo
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - A Caffe'
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - G La Vecchia
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - R Rinaldi
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - D Pedicino
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - T Sanna
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - C Trani
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - A Lombardo
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - G A Lanza
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - R A Montone
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
| | - F Crea
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University , Rome , Italy
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11
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Filice M, Golino M, Denora M, Ruscio E, Ingrasciotta G, Lamendola P, Manfredonia L, Villano A, Bisignani A, Ravenna SE, DE Vita A, Lanza O, Crea F, Lanza GA. Coronary microvascular dysfunction and findings of heart failure with preserved ejection fraction in patients with microvascular angina. Minerva Med 2022; 113:838-845. [PMID: 35166097 DOI: 10.23736/s0026-4806.21.07135-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) may cause symptoms of myocardial ischemia (microvascular angina [MVA]), but recent studies suggested that it might also contribute to the syndrome of heart failure with preserved ejection fraction (HFpEF). In this study we assessed the relation of CMD with findings of HFpEF in MVA patients. METHODS We enrolled 36 consecutive patients with MVA, in whom we assessed: 1) coronary blood flow (CBF) response to adenosine and cold pressor test (CPT) by color-Doppler echocardiography of the left anterior descending coronary artery; 2) complete echocardiographic examination; 3) N-terminal-pro-B-natriuretic peptide (NT-proBNP); 4) grade of dyspnea by the modified Medical Research Scale. RESULTS Among patients, 15 had definite HFpEF findings (group 1), 12 had equivocal HFpEF findings (group 2) and 9 had no evidence of HFpEF findings (group 3). Group 1 patients were older, had more cardiovascular risk factors and higher NT-proBNP levels (P=0.018), and showed a higher prevalence of diastolic dysfunction. Left ventricle dimensions and systolic function, however, did not differ among groups. Dyspnea was also not significantly different among groups (P=0.19). CBF to adenosine was 1.85±0.47, 1.78±0.40 1.49±0.32 in group 1, 2 and 3, respectively (P=0.13). Similarly, CBF response to CPT was 1.57±0.4, 1.49±0.2 and 1.45±0.3 in the 3 groups, respectively (P=0.74). Both CBF response to adenosine and CPT showed no relation with the severity of dyspnea symptoms. CONCLUSIONS Our data suggest that in patients with MVA there is no relation between the grade of impairment of coronary microvascular dilatation and findings of HFpEF.
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Affiliation(s)
- Monica Filice
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Michele Golino
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Marialessia Denora
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Eleonora Ruscio
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Gessica Ingrasciotta
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Priscilla Lamendola
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Laura Manfredonia
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Angelo Villano
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonio Bisignani
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Salvatore E Ravenna
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonio DE Vita
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Oreste Lanza
- Department of Clinical and Molecular Medicine and Psychology, Sapienza University, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular Sciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
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12
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Di Mario C, Genovese S, Lanza GA, Mannucci E, Marenzi G, Sciatti E, Pitocco D. Role of continuous glucose monitoring in diabetic patients at high cardiovascular risk: an expert-based multidisciplinary Delphi consensus. Cardiovasc Diabetol 2022; 21:164. [PMID: 36030229 PMCID: PMC9420264 DOI: 10.1186/s12933-022-01598-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background Continuous glucose monitoring (CGM) shows in more detail the glycaemic pattern of diabetic subjects and provides several new parameters (“glucometrics”) to assess patients’ glycaemia and consensually guide treatment. A better control of glucose levels might result in improvement of clinical outcome and reduce disease complications. This study aimed to gather an expert consensus on the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk or with heart disease. Methods A list of 22 statements concerning type of patients who can benefit from CGM, prognostic impact of CGM in diabetic patients with heart disease, CGM use during acute cardiovascular events and educational issues of CGM were developed. Using a two-round Delphi methodology, the survey was distributed online to 42 Italian experts (21 diabetologists and 21 cardiologists) who rated their level of agreement with each statement on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement. Results Forty experts (95%) answered the survey. Every statement achieved a positive consensus. In particular, the panel expressed the feeling that CGM can be prognostically relevant for every diabetic patient (70%) and that is clinically useful also in the management of those with type 2 diabetes not treated with insulin (87.5%). The assessment of time in range (TIR), glycaemic variability (GV) and hypoglycaemic/hyperglycaemic episodes were considered relevant in the management of diabetic patients with heart disease (92.5% for TIR, 95% for GV, 97.5% for time spent in hypoglycaemia) and can improve the prognosis of those with ischaemic heart disease (100% for hypoglycaemia, 90% for hyperglycaemia) or with heart failure (87.5% for hypoglycaemia, 85% for TIR, 87.5% for GV). The experts retained that CGM can be used and can impact the short- and long-term prognosis during an acute cardiovascular event. Lastly, CGM has a recognized educational role for diabetic subjects. Conclusions According to this Delphi consensus, the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk is promising and deserves dedicated studies to confirm the experts’ feelings.
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Affiliation(s)
- Carlo Di Mario
- Cardiology Unit, AOU Careggi and University of Florence, Florence, Italy
| | - Stefano Genovese
- Diabetes, Endocrine and Metabolic Diseases Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Gaetano A Lanza
- Noninvasive Diagnostic Cardiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Mannucci
- Diabetology Unit, AOU Careggi and University of Florence, Florence, Italy
| | - Giancarlo Marenzi
- Intensive Cardiac Care Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Dario Pitocco
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Cambise N, Telesca A, Tremamunno S, Felici T, De Vita A, Filice M, Ingrasciotta G, Ruscio E, Crea F, Lanza GA. Clinical features and outcomes of patients with stable or unstable chest pain and no-obstructive coronary artery disease. Front Cardiovasc Med 2022; 9:951183. [PMID: 36082130 PMCID: PMC9445270 DOI: 10.3389/fcvm.2022.951183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoronary microvascular dysfunction can be responsible for both stable angina and acute coronary syndrome (ACS). There are scarce data, however, about comparisons of clinical characteristics and outcomes of these 2 groups of patients.Materials and methodsWe studied 47 consecutive patients who underwent coronary angiography for angina syndromes and showed no obstructive stenosis. Patients were divided in 2 groups, according to their clinical presentation, i.e., stable angina (n = 21) or non-ST segment elevation ACS (NSTE-ACS; n = 26). An intracoronary acetylcholine (Ach) test was performed in 12 and 17 patients of the 2 groups, respectively. Angina status, assessed by Seattle Angina Questionnaire (SAQ), and clinical events were assessed after 1, 6, and 30 months. An exercise stress test was performed 1 month after discharge.ResultsClinical characteristics and exercise test results of the 2 groups were largely similar. Ach testing induced epicardial or microvascular spasm in 6 (50.0%) and 10 (58.8%) stable and NSTE-ACS patients, respectively (p = 0.72). Stable patients reported higher rates of angina, compared to NSTE-ACS patients, both at 1 (p = 0.04) and 30 months (81 vs. 50%, p = 0.036) of follow-up. SAQ scores were also lower in stable vs. NSTE-ACS patients. Ach testing results showed no association with clinical outcomes.ConclusionClinical characteristics and exercise and Ach testing results are similar in angina patients with no-obstructive coronary artery disease with a stable or NSTE-ACS presentation. Stable patients show a worse symptomatic outcome irrespective of Ach test results.
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De Vita A, Pizzi C, Tritto I, Morrone D, Villano A, Bergamaschi L, Lanza GA. Clinical outcomes of patients with coronary microvascular dysfunction in absence of obstructive coronary atherosclerosis. J Cardiovasc Med (Hagerstown) 2022; 23:421-426. [PMID: 35763761 DOI: 10.2459/jcm.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Up to 50% of patients presenting with stable, mainly exercise-induced, chest pain and 10-20% of those admitted to hospital with chest pain suggesting an acute coronary syndrome show normal or near-normal coronary arteries at angiography. Coronary microvascular dysfunction (CMD) is a major cause of symptoms in these patients. However, controversial data exist about their prognosis. In this article, we critically review characteristics and results of the main studies that assessed clinical outcome of patients with angina chest pain and nonobstructive coronary artery disease presenting with either a stable angina pattern or an acute coronary syndrome. Published data indicate that the patients included in most studies are heterogeneous and a major determinant of clinical outcome is the presence of atherosclerotic, albeit not obstructive, coronary artery disease. Long-term prognosis seems instead excellent in patients with totally normal coronary arteries and a syndrome of CMD-related stable angina (microvascular angina). On the other hand, the prognostic impact of CMD in patients presenting with an acute coronary syndrome needs to be better assessed in future studies.
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Affiliation(s)
- Antonio De Vita
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina Cardiovascolare, Rome
| | - Carmine Pizzi
- Università di Bologna, Alma Mater Studiorum, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Bologna
| | - Isabella Tritto
- Università di Perugia, Dipartimento di Medicina, Sezione di Cardiologia e Fisiopatologia Cardiovascolare, Perugia
| | - Doralisa Morrone
- Università di Pisa, Dipartimento di patologia chirurgica, medica, molecolare e dell'area critica, Pisa, Italy
| | - Angelo Villano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina Cardiovascolare, Rome
| | - Luca Bergamaschi
- Università di Bologna, Alma Mater Studiorum, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Bologna
| | - Gaetano A Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina Cardiovascolare, Rome
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Montone R, Rinaldi R, Buono MGD, Gurgoglione FL, Vecchia GL, D’Amario D, Leone AM, Romagnoli E, Lanza GA, Trani C, Niccoli G, Crea F. SAFETY AND PROGNOSTIC RELEVANCE OF ACETYLCHOLINE TESTING IN MYOCARDIAL ISCHEMIA AND NON-OBSTRUCTIVE CORONARY ARTERIES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01986-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Graziani F, Lillo R, Leccisotti L, Bruno I, Ingrasciotta G, Marano R, Rovere G, Manna R, Pieroni M, Camporeale A, Lanza GA, Crea F. The presence and extent of coronary microvascular dysfunction is associated to the severity of cardiomyopathy in patients with Fabry disease. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Coronary microvascular dysfunction (CMD) occurs before left ventricular hypertrophy (LVH) in Anderson Fabry Disease (AFD). Few data exist about the role of CMD in Fabry cardiomyopathy, when overt LVH has already established.
Purpose
Aim of our study was to assess the relationship between CMD and clinical and echocardiographic features in a cohort of Fabry cardiomyopathy patients.
Methods
We performed coronary CT scan to exclude epicardial coronary artery disease (CAD) in 27 AFD cardiomyopathy patients with angina and/or evidence of silent ischemia at treadmill stress test. All consenting patients with no CAD (n = 17) were submitted to resting and stress 13N-Ammonia myocardial perfusion PET/CT to assess the presence of CMD. All patients also underwent complete echocardiography. Patients were followed-up for 17.3 ± 12.5 months.
Results
Global coronary flow reserve (CFR) resulted <2.5 in 7 (41%) patients. Global stress myocardial blood flow (MBF) was <1.85 mL/min/g in 5 (29%) patients. Global transmural perfusion gradient (TPG, subendocardial MBF/subepicardial MBF) during stress was <1.0 in 13/17 (76.5%) patients. Resting global TPG was ≥1 in 16 (94%) patients. Patients with CFR < 2.5 were older (p = 0.02), had more severe LVH (maximal wall thickness p = 0.04), worst global longitudinal strain (p = 0.03) and E/e’ (p = 0.04) and higher troponin levels (p = 0.002) as compared to patients with CFR ≥ 2.5. They also performed less at treadmill stress (METs p = 0.045). No variables were associated to major cardiovascular events at multivariable analysis.
Conclusions
In Fabry cardiomyopathy patients with angina and/or evidence of silent ischemia, the prevalence of CMD is high and it is associated to a more severe cardiac phenotype, including cardiac biomarker and functional capacity. We are not able to draw any conclusion on the possible prognostic role of CMD in Fabry cardiomyopathy.
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Affiliation(s)
- F Graziani
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - R Lillo
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Emergency Medicine Department, Rome, Italy
| | - L Leccisotti
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Nuclear Medicine Unit, Rome, Italy
| | - I Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Nuclear Medicine Unit, Rome, Italy
| | - G Ingrasciotta
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - R Marano
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Department of Radiological and Hematological Sciences, Section of Radiology, Rome, Italy
| | - G Rovere
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Radiological and Hematological Sciences, Section of Radiology, Rome, Italy
| | - R Manna
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Department of Internal Medicine, Rare Diseases and Periodic Fevers Research Centre, Rome, Italy
| | - M Pieroni
- San Donato Hospital of Arezzo, Cardiovascular Department, Arezzo, Italy
| | - A Camporeale
- IRCCS Policlinico San Donato, Multimodality Cardiac Imaging Unit, San Donato Milanese, Italy
| | - GA Lanza
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - F Crea
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
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Panaioli E, Birritella L, Graziani F, Lillo R, Grandinetti M, Di Molfetta A, Przybylek B, Lombardo A, Lanza GA, Secinaro A, Perri G, Amodeo A, Massetti M, Crea F, Delogu AB. Right ventricle-pulmonary artery coupling in repaired tetralogy of Fallot with pulmonary regurgitation: Clinical implications. Arch Cardiovasc Dis 2022; 115:67-77. [DOI: 10.1016/j.acvd.2021.12.006] [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: 10/03/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022]
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18
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Lanza GA. Autonomic dysfunction and post-COVID-19 syndrome: a still elusive link. Heart Rhythm 2021; 19:621-622. [PMID: 34968741 PMCID: PMC8712711 DOI: 10.1016/j.hrthm.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Gaetano A Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma Department of Cardiovascular Disease.
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19
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Montone RA, Rinaldi M, Del Buono M, Camilli M, Gurgoglione F, La Vecchia G, Iannaccone G, Russo M, Caffe' A, Trani C, Lanza GA, Niccoli G, Crea F. Incidence, predictors and prognostic role of complications occurring during provocative testing with acetylcholine in patients with myocardial ischemia and non-obstructive coronary arteries. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1067] [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
Coronary provocative test with acetylcholine (ACh) is of utmost importance and increasingly used in patients with myocardial ischemia and non-obstructive coronary arteries. However, data on safety, predictors and prognostic role of complications during intracoronary provocative testing are scarce.
Purpose
We assessed the safety of ACh provocative test in patients with myocardial ischemia and non-obstructive coronary arteries. Moreover, we evaluated the predictors and the prognostic implications of complications occurring during the provocative test.
Methods
We prospectively enrolled consecutive patients undergoing intracoronary ACh provocative test for suspected myocardial ischaemia with angiographic evidence of non-obstructive coronary arteries. Complications during the ACh test were collected. Occurrence of major adverse cardiac events (MACE), arrhythmic events at 24-hours ECG dynamic Holter monitoring and angina status were assessed at follow-up.
Results
We enrolled 310 patients (mean age 60.6±11.9; 169 [54.5%] chronic coronary syndromes [CCS] and 141 [45.5%] with myocardial infarction and non-obstructive coronary arteries [MINOCA]). The overall incidence of complications was low (9%) with a similar incidence in MINOCA and CCS (10 [7.1%] vs 18 [10.7%], p=0.276, respectively). At multivariate logistic regression analysis, a previous history of paroxysmal atrial fibrillation (Odds Ratio [OR] 12.324, Confidence Interval [CI] 95% [4.641; 32.722], p=0.015) and moderate/severe diastolic dysfunction (OR 3.827, CI95% [1.296; 11.304], p=0.015) were independent predictors for occurrence of complications. The occurrence of complications was not associated with a worse clinical outcome at follow-up (median follow-up 22 months) in terms of both MACE, arrhythmic events and angina burden.
Conclusion
Intracoronary provocative testing with ACh test is safe in patients with myocardial ischemia and non-obstructive coronary arteries, without differences between MINOCA and CCS. History of paroxysmal atrial fibrillation and moderate/severe diastolic dysfunction predicted the occurrence of complications during ACh test. Of importance, our data can reassure clinicians, as the occurrence of complications did not portend a worse prognosis at follow-up in terms of MACE, arrhythmic events and angina burden.
Funding Acknowledgement
Type of funding sources: None. Complications and clinical presentationClinical outcome at follow-up
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Affiliation(s)
- R A Montone
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - M Rinaldi
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - M Del Buono
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - M Camilli
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - F Gurgoglione
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - G La Vecchia
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - G Iannaccone
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - M Russo
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - A Caffe'
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - C Trani
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - G A Lanza
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - G Niccoli
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - F Crea
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
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20
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Masi S, Rizzoni D, Taddei S, Widmer RJ, Montezano AC, Lüscher TF, Schiffrin EL, Touyz RM, Paneni F, Lerman A, Lanza GA, Virdis A. Assessment and pathophysiology of microvascular disease: recent progress and clinical implications. Eur Heart J 2021; 42:2590-2604. [PMID: 33257973 PMCID: PMC8266605 DOI: 10.1093/eurheartj/ehaa857] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/23/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022] Open
Abstract
The development of novel, non-invasive techniques and standardization of protocols to assess microvascular dysfunction have elucidated the key role of microvascular changes in the evolution of cardiovascular (CV) damage, and their capacity to predict an increased risk of adverse events. These technical advances parallel with the development of novel biological assays that enabled the ex vivo identification of pathways promoting microvascular dysfunction, providing novel potential treatment targets for preventing cerebral-CV disease. In this article, we provide an update of diagnostic testing strategies to detect and characterize microvascular dysfunction and suggestions on how to standardize and maximize the information obtained from each microvascular assay. We examine emerging data highlighting the significance of microvascular dysfunction in the development CV disease manifestations. Finally, we summarize the pathophysiology of microvascular dysfunction emphasizing the role of oxidative stress and its regulation by epigenetic mechanisms, which might represent potential targets for novel interventions beyond conventional approaches, representing a new frontier in CV disease reduction.
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Affiliation(s)
- Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Institute of Cardiovascular Science, University College London, London, UK
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Division of Medicine, Istituto Clinico Città di Brescia, Brescia, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Robert Jay Widmer
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Augusto C Montezano
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Thomas F Lüscher
- Heart Division, Royal Brompton and Harefield Hospital and Imperial College, London, UK.,Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Rhian M Touyz
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zürich, Switzerland.,Department of Research and Education, University Hospital Zurich, Zürich, Switzerland
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Gaetano A Lanza
- Department of Cardiovascular and Thoracic Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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21
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Attia ZI, Kapa S, Dugan J, Pereira N, Noseworthy PA, Jimenez FL, Cruz J, Carter RE, DeSimone DC, Signorino J, Halamka J, Chennaiah Gari NR, Madathala RS, Platonov PG, Gul F, Janssens SP, Narayan S, Upadhyay GA, Alenghat FJ, Lahiri MK, Dujardin K, Hermel M, Dominic P, Turk-Adawi K, Asaad N, Svensson A, Fernandez-Aviles F, Esakof DD, Bartunek J, Noheria A, Sridhar AR, Lanza GA, Cohoon K, Padmanabhan D, Pardo Gutierrez JA, Sinagra G, Merlo M, Zagari D, Rodriguez Escenaro BD, Pahlajani DB, Loncar G, Vukomanovic V, Jensen HK, Farkouh ME, Luescher TF, Su Ping CL, Peters NS, Friedman PA. Rapid Exclusion of COVID Infection With the Artificial Intelligence Electrocardiogram. Mayo Clin Proc 2021; 96:2081-2094. [PMID: 34353468 PMCID: PMC8327278 DOI: 10.1016/j.mayocp.2021.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To rapidly exclude severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using artificial intelligence applied to the electrocardiogram (ECG). METHODS A global, volunteer consortium from 4 continents identified patients with ECGs obtained around the time of polymerase chain reaction-confirmed COVID-19 diagnosis and age- and sex-matched controls from the same sites. Clinical characteristics, polymerase chain reaction results, and raw electrocardiographic data were collected. A convolutional neural network was trained using 26,153 ECGs (33.2% COVID positive), validated with 3826 ECGs (33.3% positive), and tested on 7870 ECGs not included in other sets (32.7% positive). Performance under different prevalence values was tested by adding control ECGs from a single high-volume site. RESULTS The area under the curve for detection of acute COVID-19 infection in the test group was 0.767 (95% CI, 0.756 to 0.778; sensitivity, 98%; specificity, 10%; positive predictive value, 37%; negative predictive value, 91%). To more accurately reflect a real-world population, 50,905 normal controls were added to adjust the COVID prevalence to approximately 5% (2657/58,555), resulting in an area under the curve of 0.780 (95% CI, 0.771 to 0.790) with a specificity of 12.1% and a negative predictive value of 99.2%. CONCLUSION Infection with SARS-CoV-2 results in electrocardiographic changes that permit the artificial intelligence-enhanced ECG to be used as a rapid screening test with a high negative predictive value (99.2%). This may permit the development of electrocardiography-based tools to rapidly screen individuals for pandemic control.
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Key Words
- ace2, angiotensin-converting enzyme 2
- ai, artificial intelligence
- ai-ecg, artificial intelligence–enhanced electrocardiogram
- auc, area under the curve
- covid-19, coronavirus infectious disease 19
- npv, negative predictive value
- pcr, polymerase chain reaction
- ppv, positive predictive value
- redcap, research electronic data capture
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- who, world health organization
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Affiliation(s)
- Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Jennifer Dugan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Naveen Pereira
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Jessica Cruz
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Jacksonville, FL
| | - Daniel C DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN; Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN
| | - John Signorino
- Department of Compliance, Mayo Clinic College of Medicine, Rochester, MN
| | - John Halamka
- Mayo Clinic Platform, Mayo Clinic College of Medicine, Rochester, MN
| | | | | | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Fahad Gul
- Division of Cardiology, Heart and Vascular Institute, Einstein Healthcare Network, Philadelphia, PA
| | - Stefan P Janssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Sanjiv Narayan
- Cardiovascular Institute and Department of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - Gaurav A Upadhyay
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL
| | - Francis J Alenghat
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL
| | - Marc K Lahiri
- Henry Ford Hospital, Heart and Vascular Institute, Detroit, MI
| | - Karl Dujardin
- Department of Cardiology, AZ Delta Hospital, AZ Delta Campus Rumbeke, Deltalaan, Belgium
| | - Melody Hermel
- Scripps Health and the Scripps Clinic Division of Cardiology, La Jolla, CA
| | - Paari Dominic
- Louisiana State University Health Sciences Center, Shreveport, LA
| | | | | | - Anneli Svensson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University Hospital, Linköping, Sweden
| | - Francisco Fernandez-Aviles
- Hospital General Universitario Gregorio Maranon, Instituto de Investigacion Sanitaria Gregorio Maranon, Universidad Complutense, Madrid, Spain
| | - Darryl D Esakof
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA
| | | | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, KS
| | - Arun R Sridhar
- Section of Cardiac Electrophysiology, University of Washington Medical Center, Seattle, WA
| | - Gaetano A Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Cardiology Institute, Rome, Italy
| | - Kevin Cohoon
- Division of Cardiovascular Medicine Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | | | - Gianfranco Sinagra
- Cardiovascular Department "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Domenico Zagari
- Electrophysiology and Cardiac Pacing Unit, Humanitas Mater Domini Clinical Institute, Castellanza, Italy
| | | | | | - Goran Loncar
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje (ICVDD), Belgrade, Serbia
| | - Vladan Vukomanovic
- University Hospital Center "Dr Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN.
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22
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Montone RA, Meucci MC, De Vita A, Lanza GA, Niccoli G. Coronary provocative tests in the catheterization laboratory: Pathophysiological bases, methodological considerations and clinical implications. Atherosclerosis 2020; 318:14-21. [PMID: 33360263 DOI: 10.1016/j.atherosclerosis.2020.12.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/13/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022]
Abstract
The paradigm for the management of patients presenting with angina and/or myocardial ischemia has been historically centered on the detection and treatment of obstructive coronary artery disease (CAD). However, in a considerable proportion (30-50%) of patients undergoing coronary angiography, obstructive CAD is excluded. Thus, functional mechanisms may be involved in determining myocardial ischemia and should be investigated. In particular, coronary vasomotor disorders both at epicardial and at microvascular level may play a crucial role, but a definitive diagnosis of these disorders can at times be difficult, given the transience of symptoms, and often requires the use of coronary provocative tests. Of importance, these tests may provide relevant information on the pathogenic mechanism of myocardial ischemia, allowing physicians to tailor the therapies of their patients. Furthermore, several studies underscored the important prognostic information deriving from the use of coronary provocative tests. Nevertheless, their use in clinical practice is currently limited and mainly restricted to specialized centers, with only a minority of patients receiving a benefit from this diagnostic approach. In this review, we explain the pathophysiological bases for the use of provocative tests, along with their clinical, prognostic and therapeutic implications.
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Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Maria Chiara Meucci
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio De Vita
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Division of Cardiology, Parma University Hospital, Parma, Italy
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23
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Lamendola P, Lanza GA, Melita V, Villano A, Palermo C, Leone D, Lombardo A, Pennestrì F, Crea F, Mercuri EM, Pane M. Duchenne muscular dystrophy: preliminary experience with sacubitril-valsartan in patients with asymptomatic left ventricular dysfunction. Eur Rev Med Pharmacol Sci 2020; 24:9112-9115. [PMID: 32965001 DOI: 10.26355/eurrev_202009_22857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Duchenne muscular dystrophy (DMD) is an inherited X-linked recessive neuromuscular disease caused by mutations of the dystrophin gene, leading to early and progressive muscle deterioration and dilated cardiomyopathy. The aim of this investigation was to assess whether treatment with sacubitril/valsartan (S/V) is well tolerated and may have beneficial effects in DMD patients with left ventricle (LV) dysfunction. PATIENTS AND METHODS We administered S/V to 3 DMD patients (19-29 yeard old) with LV ejection fraction <35% at echocardiography but no symptoms of heart failure. All patients were on optimal medical therapy. S/V was initiated at a very low dose of 12/13 mg/die, after withdrawal of angiotensin-converting enzyme inhibitor therapy, and slowly titrated to the dose of 49/51 mg twice daily or the maximally tolerated dose. Clinical and echocardiographic follow-up was performed after 3, 6 and 12 months. RESULTS At baseline, the LV ejection fraction was 32±1%. A significant improvement of LV ejection fraction was observed at 3 months (44.0±6.0%; p<0.05), which was maintained at 6 (45.7±5.0%) and 12 (43.3±3.2%) months (p<0.05 for both). No relevant side effects were reported throughout the period of the study. CONCLUSIONS Our preliminary data suggest that, in DMD patients with reduced LV ejection fraction, S/V is safe and may improve LV function.
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Affiliation(s)
- P Lamendola
- Department of Cardiovascular Medicine and 2Department of Pediatrics; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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24
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Graziani F, Lillo R, Panaioli E, Pieroni M, Locorotondo G, Lombardo A, Sicignano LL, Manna R, Lanza GA, Crea F. P956 Prognostic role of right ventricular hypertrophy in anderson fabry disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.589] [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
Right ventricular hypertrophy (RVH) is a common finding in Anderson Fabry disease (AFD). In other infiltrative and storage cardiomyopathies right ventricular (RV) involvement may influence prognostic stratification. Nevertheless, the prognostic implications of right ventricle involvement in AFD have never been assessed.
Purpose
Evaluation of the prognostic significance of RVH and RV systolic function in AFD cardiomyopathy.
Methods
Forty-five AFD patients (56% male) with extensive baseline evaluation, including assessment of RVH and RV systolic function, were followed-up for an average of 44.9 ± 8.5 months. RV systolic function was assessed by standard and tissue Doppler echocardiography and quantified using RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and Systolic tissue Doppler velocity of the tricuspid annulus (RV Sa). Cardiovascular events were defined as new-onset atrial fibrillation, heart failure or pace-maker implantation; renal events were defined as progression to dialysis and/or renal transplantation or significant worsening of glomerular filtration rate; cerebrovascular events were defined as stroke or transient ischemic attack. The outcome was defined as the time to death or the first event in any of the above predefined categories.
Results
Fourteen patients (31.1%) presented RVH, while RV systolic function was normal in all cases. During the follow-up period, 13 patients (28.8%, 11 male) experienced major events including two deaths. Pace-maker implantation (6 cases) was the most common type of event. At univariate analysis several variables were associated with the occurrence of events, including RVH and indexes of RV systolic function. However, at multivariate analysis only proteinuria (HR:8.3, 95% CI: 2.88 to 23.87, p ˂0.001) and LV mass indexed (HR: 1.01, 95% CI: 1.00 to 1.03, p = 0.03) were independent predictors of outcome.
Conclusions
The presence and extension of RVH is not associated with outcome in AFD. Our study confirms that at variance with other infiltrative or storage cardiomyopathies, RV involvement in AFD is an innocent bystander and does not influence prognosis.
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Affiliation(s)
- F Graziani
- Polyclinic Agostino Gemelli, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - R Lillo
- Polyclinic Agostino Gemelli, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - E Panaioli
- Polyclinic Agostino Gemelli, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - M Pieroni
- San Donato Hospital of Arezzo, Dipartimento Cardiovascolare e Neurologico , Arezzo, Italy
| | - G Locorotondo
- Polyclinic Agostino Gemelli, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - A Lombardo
- Polyclinic Agostino Gemelli, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | | | - R Manna
- Polyclinic Agostino Gemelli, Rome, Italy
| | - G A Lanza
- Polyclinic Agostino Gemelli, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - F Crea
- Polyclinic Agostino Gemelli, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
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25
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Manfredonia L, Locorotondo G, Graziani F, Ravenna SE, Ruscio E, Filice M, Ingrasciotta G, Palma F, Addamo E, Lombardo A, Lanza GA, Crea F. P1590 Regional differences in longitudinal strain and response to adenosine stress in patients with myocardial infarction and ST-segment elevation. Results from Extreme trial. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1010] [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
Global longitudinal strain (LS) is a sensitive marker of ischemic myocardial damage and predicts adverse left ventricular (LV) remodeling and outcome, independently of infarct size. In healthy subjects, regional LS increases from LV base to apex and enhances under physical or pharmacological stress, while in ST-elevation myocardial infarction (STEMI), response to dobutamine depends on transmurality of necrosis. It is known that coronary flow reserve during adenosine (ADN) is impaired both in ischemic and remote myocardium, but effect of ADN on strain reserve has never been investigated. Similarly, LS response to ADN in ischemic (iLS) and remote (rLS) myocardium and their relative contribution to LV function and remodeling are still unknown.
Methods
61 consecutive patients with first STEMI (26 anterior, 29 inferior, 6 lateral), treated by successful primary percutaneous coronary intervention (PCI) followed by PCI of non-culprit coronary arteries, underwent rest and stress ADN (140 mcg/kg/minutes in 90 seconds) echocardiography at discharge (7 ± 2 days after admission). LV end-diastolic volume indexed for body surface area (EDV), ejection fraction (EF) and wall motion score index (WMSI) were measured at rest, while GLS, iLS and rLS analysis was performed both at rest and during stress. Ischemic and remote myocardium was allocated, by standard LV segmentation, basing on the culprit coronary artery.
Results
Significant differences existed among anterior, inferior and lateral STEMI in median (iQr) EDV [52 (45-59) vs 45 (36-51) vs 48 (45–56) ml, respectively, p=.034 overall], EF [47 (37-58) vs 58 (53–61) vs 56 (46-60)%, respectively, p=.002 overall], WMSI [1.63 (1.38–2) vs 1.25 (1.19-1.47) vs 1.41 (1.30-1.75), respectively, p=.001 overall]. GLS differed among anterior, inferior and lateral STEMI both at rest [13.75 (11.63-16.1) vs 19.5 (17.15-22.4) vs 17.85 (17.02-19), respectively, p<.001 overall] and during ADN [14 (12.35-16.15) vs 19.5 (17.9–22.05) vs 15.95 (14.40-19.48), respectively, p<.001], but did not change within groups. No differences were found between rest and stress iLS in any group. Similarly, rLS remained unchanged in anterior and inferior STEMI, and impaired after ADN in lateral STEMI [15.90 (11.45-18) at stress vs 16.8 (15.25-19.2) at rest, p=.043]. Inferior STEMI showed better iLS than anterior STEMI both at rest [17 (15.1–19.9) vs 13.75 (11.46-16.92), respectively, p=.001] and during stress [16.2 (15–20.4) vs 14.42 (12.67-15.83), respectively, p=.001].
Conclusions
In the subacute phase of STEMI, GLS, iLS and rLS are heterogeneous and depend on infarct site. After ADN, there is no strain reserve in ischemic neither in remote myocardium. This may reflect regional differences in the response of microcirculation and myocardium to ischemia or may underlie pre-existing pathophysiological differences in the coronary circulation
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Affiliation(s)
- L Manfredonia
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - G Locorotondo
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - F Graziani
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - S E Ravenna
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - E Ruscio
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - M Filice
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - G Ingrasciotta
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - F Palma
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - E Addamo
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - A Lombardo
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - G A Lanza
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
| | - F Crea
- Fondazione Policlinico Univesitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Institute of Cardiology, Rome, Italy
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Golino M, Spera FR, Manfredonia L, De Vita A, Di Franco A, Lamendola P, Villano A, Melita V, Mencarelli E, Lanza GA, Crea F. Microvascular ischemia in patients with successful percutaneous coronary intervention: effects of ranolazine and isosorbide-5-mononitrate. Eur Rev Med Pharmacol Sci 2019; 22:6545-6550. [PMID: 30338825 DOI: 10.26355/eurrev_201810_16070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE About one-third of patients undergoing percutaneous coronary interventions (PCIs) for flow-limiting coronary stenosis continue to develop signs of myocardial ischemia (MI) during exercise stress test [EST], despite successful coronary revascularization. Coronary microvascular dysfunction is a likely major cause of the persistence of EST-induced MI in these patients. PATIENTS AND METHODS We studied 15 patients (14 men, age 67±5 years) fulfilling the following strict inclusion criteria: (1) recent PCI (<6 months), with drug-eluting stent, of coronary artery stenoses for stable angina, with evidence of full success (no residual stenosis >20% in any vessel); (2) persistence of ST-segment depression induction during EST. After a basal investigation, patients received either ranolazine (375 mg bid) or isosorbide-5-mononitrate (ISMN, 20 mg bid) for 3 weeks in a single-blind, randomized crossover study. Clinical assessment, symptom-limited EST, echocardiographic color-Doppler, with tissue-Doppler examination, and coronary microvascular dilator response to adenosine (CFR-ADO) and cold pressor test (CFR-CPT), assessed by transthoracic echo-Doppler, were obtained at baseline and the end of the 3-week therapy with each drug. RESULTS Compared to both baseline and ISMN, ranolazine showed a longer time to 1 mm ST-segment depression (404±116 s vs. 317±98 and 322±70 s, respectively; p<0.01). No differences were observed in coronary microvascular function and diastolic left ventricular function between the 2 drugs and compared to baseline. CONCLUSIONS Our data show that ranolazine, but not ISMN, improved time to ischemia during EST. This effect, however, was independent of any effects on coronary microvascular and diastolic function.
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Affiliation(s)
- M Golino
- Institute of Cardiology, Catholic University of the Sacred Heart, A. Gemelli Foundation, Rome, Italy.
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27
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Montone RA, Niccoli G, Fracassi F, Russo M, Gurgoglione F, Cammà G, Lanza GA, Crea F. Patients with acute myocardial infarction and non-obstructive coronary arteries: safety and prognostic relevance of invasive coronary provocative tests. Eur Heart J 2019; 39:91-98. [PMID: 29228159 DOI: 10.1093/eurheartj/ehx667] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022] Open
Abstract
Aims Functional alterations of epicardial coronary arteries or coronary microcirculation represent a frequent cause of myocardial infarction and non-obstructive coronary arteries (MINOCA). We aimed at assessing the prognostic value of intracoronary provocative tests in patients presenting with MINOCA and in which other causes of MINOCA have been excluded. Methods and results We prospectively evaluated patients with a diagnosis of MINOCA, excluding patients with aetiologies other than suspected coronary vasomotor abnormalities. Immediately after coronary angiography, an invasive provocative test using acetylcholine or ergonovine was performed. The incidence of death from any cause, cardiac death, and recurrence of acute coronary syndrome (ACS) was assessed at follow-up. We also assessed angina status using Seattle Angina Questionnaires (SAQ). We enrolled 80 consecutive patients [mean age 63.0 ± 10.7 years, 40 (50%) male]. Provocative test was positive in 37 (46.2%) patients without any complication. Among patients with a positive test, epicardial spasm was detected in 24 (64.9%) patients and microvascular spasm in 13 (35.1%) patients. After a median follow-up of 36.0 (range 12.0-60.0) months, patients with a positive test had a significantly higher occurrence of death from any cause [12 (32.4%) vs. 2 (4.7%); P = 0.002], cardiac death [7 (18.9%) vs. 0 (0.0%); P = 0.005], and readmission for ACS [10 (27.0%) vs. 3 (7.0%); P = 0.015] as well as a worse angina status as assessed by SAQ [Seattle score: 88.0 (33.0-100.0) vs. 100.0 (44.0-100.0); P = 0.001] when compared with patients with a negative test. Conclusions We demonstrate that in patients presenting with MINOCA and suspected coronary vasomotor abnormalities, a positive provocative test for spasm is safe and identifies a high-risk subset of patients.
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Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Francesco Fracassi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Michele Russo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Filippo Gurgoglione
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Giulia Cammà
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go A. Gemelli, 8, 00168 Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go A. Gemelli, 8, 00168 Rome, Italy
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28
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Montone RA, Niccoli G, Russo M, Giaccari M, Del Buono MG, Meucci MC, Gurguglione F, Vergallo R, D’Amario D, Buffon A, Leone AM, Burzotta F, Aurigemma C, Trani C, Liuzzo G, Lanza GA, Crea F. Clinical, angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries. Clin Res Cardiol 2019; 109:435-443. [DOI: 10.1007/s00392-019-01523-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/27/2019] [Indexed: 01/05/2023]
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29
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Lanza GA, Melita V, Mencarelli E, De Vita A, Bisignani A, Manfredonia L, Covino M, Crea F. Characteristics and in-hospital outcome of patients with no ST-segment elevation acute coronary syndrome and no obstructive coronary artery disease in the era of high-sensitivity troponins. J Cardiovasc Med (Hagerstown) 2019; 20:210-214. [DOI: 10.2459/jcm.0000000000000771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Affiliation(s)
- Angelo Villano
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
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31
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Manfredonia L, Lanza GA, Crudo F, Lamendola P, Graziani F, Villano A, Locorotondo G, Melita V, Mencarelli E, Pennestrì F, Lombardo A, De Vita A, Ravenna SE, Bisignani A, Crea F. Diagnostic role of echocardiography in patients admitted to the emergency room with suspect no-ST-segment elevation acute myocardial infarction. Eur Rev Med Pharmacol Sci 2019; 23:826-832. [PMID: 30720191 DOI: 10.26355/eurrev_201901_16897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We investigated whether echocardiography may help identify, among patients admitted with a suspect of non-ST-segment elevation acute myocardial infarction (NSTEMI), those with athero-thrombotic coronary artery disease (CAD). PATIENTS AND METHODS We studied consecutive patients admitted with a clinical suspect of first NSTEMI. Echocardiography was assessed within 24 hours from admission. Patients were divided into two groups, according to the results of coronary angiography: 1) patients with obstructive stenosis (≥ 50%) and/or images of thrombosis in one or more coronary arteries (CAD group); 2) patients with no evidence of obstructive coronary arteries (NOCAD group). RESULTS Of 101 patients enrolled in the study, 53 (52.5%) showed obstructive CAD and 48 (47.5%) NOCAD. At echocardiographic examination, regional wall motion abnormalities were found in 52.8% of patients in the CAD group and 43.7% in the NOCAD group (p=0.43). Left ventricle ejection fraction was 56.4±6.8 vs. 54.7±9.8% (p=0.30) and wall motion score index was 1.16±0.26 vs. 1.21±0.32 (p=0.39) in the two groups, respectively. A multivariable logistic regression independent predictors of obstructive CAD included age, male gender, typical angina, diabetes and hypertension. CONCLUSIONS Our data showed that, in patients with acute chest pain and increased serum troponin T concentration, routine standard echocardiography does not significantly improve the diagnostic accuracy for the presence of obstructive CAD.
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Affiliation(s)
- L Manfredonia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Institute of Cardiology, Rome, Italy.
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32
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Montone RA, Niccoli G, Lanza GA, Crea F. Reconsidering aetiologies of type 2 myocardial infarction: when a classification is a simplistic approach for a complex reality. Eur Heart J 2018; 39:3826. [PMID: 30203043 DOI: 10.1093/eurheartj/ehy537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS; Catholic University of the Sacred Heart, Rome, Italy
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33
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Montone RA, Niccoli G, Lanza GA, Crea F. Personalized treatment of myocardial infarction and non-obstructive coronary arteries: an unmet need in a high-risk population. Eur Heart J 2018; 39:3335. [PMID: 29850804 DOI: 10.1093/eurheartj/ehy305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go F. Vito 1, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go F. Vito 1, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go F. Vito 1, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, L.go F. Vito 1, Rome, Italy
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Cristiano E, De Vita A, Villano A, Mencarelli E, Melita V, Manfredonia L, Stazi A, Bisignani A, Lanza GA, Crea F. P1696Effect of remote ischemic preconditioning on vascular dilator function in patient undergoing invasive coronary procedure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Cristiano
- Catholic University of the Sacred Heart, Rome, Italy
| | - A De Vita
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Villano
- Catholic University of the Sacred Heart, Rome, Italy
| | - E Mencarelli
- Catholic University of the Sacred Heart, Rome, Italy
| | - V Melita
- Catholic University of the Sacred Heart, Rome, Italy
| | - L Manfredonia
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Stazi
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Bisignani
- Catholic University of the Sacred Heart, Rome, Italy
| | - G A Lanza
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart, Rome, Italy
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35
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Mencarelli E, Tota A, Melita V, Gabrielli M, Villano A, De Vita A, Manfredonia L, Caccamo G, Vitale G, Sarullo F, Crea F, Franceschi F, Lanza GA. P5548Exercise-induced increase of serum cardiac troponin T levels in patients with suspected acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Mencarelli
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Tota
- Catholic University of the Sacred Heart, Rome, Italy
| | - V Melita
- Catholic University of the Sacred Heart, Rome, Italy
| | - M Gabrielli
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Villano
- Catholic University of the Sacred Heart, Rome, Italy
| | - A De Vita
- Catholic University of the Sacred Heart, Rome, Italy
| | - L Manfredonia
- Catholic University of the Sacred Heart, Rome, Italy
| | - G Caccamo
- Hospital Buccheri La Ferla, Palermo, Italy
| | - G Vitale
- Hospital Buccheri La Ferla, Palermo, Italy
| | - F Sarullo
- Hospital Buccheri La Ferla, Palermo, Italy
| | - F Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Franceschi
- Catholic University of the Sacred Heart, Rome, Italy
| | - G A Lanza
- Catholic University of the Sacred Heart, Rome, Italy
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36
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Villano A, Manfredonia L, Mencarelli E, Melita V, De Vita A, Stazi A, Rizzi A, Pitocco D, Lanza GA, Crea F. P4484Prognostic value of endothelial dysfunction in asymptomatic type 2 diabetic patients with no evidence of cardiac disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Villano
- Catholic University of the Sacred Heart, Rome, Italy
| | - L Manfredonia
- Catholic University of the Sacred Heart, Rome, Italy
| | - E Mencarelli
- Catholic University of the Sacred Heart, Rome, Italy
| | - V Melita
- Catholic University of the Sacred Heart, Rome, Italy
| | - A De Vita
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Stazi
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Rizzi
- Catholic University of the Sacred Heart, Rome, Italy
| | - D Pitocco
- Catholic University of the Sacred Heart, Rome, Italy
| | - G A Lanza
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart, Rome, Italy
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37
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Montone RA, Niccoli G, Vergni F, Vetrugno V, Russo M, Mangiacapra F, Fracassi F, Porto I, Leone AM, Burzotta F, D'Amario D, Aurigemma C, Trani C, Lanza GA, Crea F. Endothelial dysfunction as predictor of angina recurrence after successful percutaneous coronary intervention using second generation drug eluting stents. Eur J Prev Cardiol 2018; 25:1360-1370. [PMID: 29785885 DOI: 10.1177/2047487318777435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The role of endothelial dysfunction in predicting angina recurrence after percutaneous coronary intervention is unknown. Design We assessed the role of peripheral endothelial dysfunction measured by reactive-hyperaemia peripheral-artery tonometry (RH-PAT) in predicting recurrence of angina after percutaneous coronary intervention. Methods We enrolled consecutive patients undergoing percutaneous coronary intervention with second-generation drug-eluting stents. RH-PAT was measured at discharge. The endpoint was repeated coronary angiography for angina recurrence and/or evidence of myocardial ischaemia at follow-up. Patients with in-stent restenosis and/or significant de novo stenosis were defined as having angina with obstructed coronary arteries (AOCA); all other patients as having angina with non-obstructed coronary arteries (ANOCA). Results Among 100 patients (mean age 66.7 ± 10.4 years, 80 (80.0%) male, median follow-up 16 (3-20) months), AOCA occurred in 14 patients (14%), ANOCA in nine patients (9%). Repeated coronary angiography occurred more frequently among patients in the lower RH-PAT index tertile compared with middle and upper tertiles (14 (41.2%) vs. 6 (18.2%) vs. 3 (9.1%), p = 0.006, respectively). ANOCA was more frequent in the lower RH-PAT index tertile compared with middle and upper tertiles. In the multivariate regression analysis, the RH-PAT index only predicted angina recurrence. The receiver operating characteristic curve of the RH-PAT index to predict the angina recurrence demonstrated an area under the curve of 0.79 (95% confidence interval: 0.69-0.89; p < 0.001), with a cut-off value of 1.705, having sensitivity 74% and specificity 70%. Conclusions Non-invasive assessment of peripheral endothelial dysfunction using RH-PAT might help in the prediction of recurrent angina after percutaneous coronary intervention, thus identifying patients who may need more intense pharmacological treatment and risk factor control.
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Affiliation(s)
- Rocco A Montone
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Federico Vergni
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Vincenzo Vetrugno
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Russo
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Fabio Mangiacapra
- 2 Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Francesco Fracassi
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Italo Porto
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio M Leone
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico D'Amario
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Cristina Aurigemma
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano A Lanza
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
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38
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Lanza GA, De Vita A. Aggressive management of non-ST-segment elevation acute coronary syndrome: Evidence or faith? Int J Cardiol 2017; 245:59-60. [DOI: 10.1016/j.ijcard.2017.07.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 07/24/2017] [Indexed: 01/07/2023]
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Abstract
BACKGROUND A sizeable proportion of patients with primary stable microvascular angina (MVA; exercise-induced angina, positive exercise stress test [EST], normal coronary arteries) have recurrent symptoms during follow-up. There have been no previous studies, however, on the long-term results of EST and their correlation with symptom outcome.Methods and Results:Follow-up EST was performed in 71 MVA patients at an average of 16.2 years (range, 5-25 years) from the first EST. Angina status was assessed on weekly frequency of angina episodes and nitroglycerin consumption and by whether symptoms had worsened, improved, or remained unchanged over time. At follow-up EST, 41 patients (group 1) had exercise-induced ischemia, whereas 30 patients (group 2) had negative EST. Compared to group 2, group 1 patients more frequently had exercise-induced dyspnea, and had a greater maximum ST-segment depression and a lower coronary blood flow response to adenosine and cold pressor test, but group 2 patients had a more frequent history of rest angina. No differences between the 2 groups were found at follow-up in angina status or change in symptom status during follow-up. CONCLUSIONS Electrocardiogram results improve significantly in a sizeable proportion of patients with MVA. Changes in EST results, however, were not associated with clinical outcome.
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Affiliation(s)
- Gaetano A Lanza
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation
| | - Monica Filice
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation
| | - Antonio De Vita
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation
| | - Angelo Villano
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation
| | - Laura Manfredonia
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation
| | - Priscilla Lamendola
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, University Hospital Policlinic A. Gemelli Foundation
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Costantino S, Paneni F, Battista R, Castello L, Capretti G, Chiandotto S, Tanese L, Russo G, Pitocco D, Lanza GA, Volpe M, Lüscher TF, Cosentino F. Impact of Glycemic Variability on Chromatin Remodeling, Oxidative Stress, and Endothelial Dysfunction in Patients With Type 2 Diabetes and With Target HbA 1c Levels. Diabetes 2017. [PMID: 28634176 DOI: 10.2337/db17-0294] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Intensive glycemic control (IGC) targeting HbA1c fails to show an unequivocal reduction of macrovascular complications in type 2 diabetes (T2D); however, the underlying mechanisms remain elusive. Epigenetic changes are emerging as important mediators of cardiovascular damage and may play a role in this setting. This study investigated whether epigenetic regulation of the adaptor protein p66Shc, a key driver of mitochondrial oxidative stress, contributes to persistent vascular dysfunction in patients with T2D despite IGC. Thirty-nine patients with uncontrolled T2D (HbA1c >7.5%) and 24 age- and sex-matched healthy control subjects were consecutively enrolled. IGC was implemented for 6 months in patients with T2D to achieve a target HbA1c of ≤7.0%. Brachial artery flow-mediated dilation (FMD), urinary 8-isoprostaglandin F2α (8-isoPGF2α), and epigenetic regulation of p66Shc were assessed at baseline and follow-up. Continuous glucose monitoring was performed to determine the mean amplitude of glycemic excursion (MAGE) and postprandial incremental area under the curve (AUCpp). At baseline, patients with T2D showed impaired FMD, increased urinary 8-isoPGF2α, and p66Shc upregulation in circulating monocytes compared with control subjects. FMD, 8-isoPGF2α, and p66Shc expression were not affected by IGC. DNA hypomethylation and histone 3 acetylation were found on the p66Shc promoter of patients with T2D, and IGC did not change such adverse epigenetic remodeling. Persistent downregulation of methyltransferase DNMT3b and deacetylase SIRT1 may explain the observed p66Shc-related epigenetic changes. MAGE and AUCpp but not HbA1c were independently associated with the altered epigenetic profile on the p66Shc promoter. Hence, glucose fluctuations contribute to chromatin remodeling and may explain persistent vascular dysfunction in patients with T2D with target HbA1c levels.
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Affiliation(s)
- Sarah Costantino
- Cardiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Cardiology, University of Zurich, and University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Paneni
- Cardiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Cardiology, University of Zurich, and University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Lorenzo Castello
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuliana Capretti
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Sergio Chiandotto
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Luigi Tanese
- Diabetes Care Unit, Internal Medicine, Catholic University, Rome, Italy
| | - Giulio Russo
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Internal Medicine, Catholic University, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | - Massimo Volpe
- Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, and University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
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Tarzia P, Lanza GA, Sestito A, Villano A, Russo G, Figliozzi S, Lamendola P, De Vita A, Crea F. Long-term effects of bariatric surgery on peripheral endothelial function and coronary microvascular function. Obes Res Clin Pract 2017; 11:114-117. [PMID: 28057417 DOI: 10.1016/j.orcp.2016.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/21/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND We previously demonstrated that bariatric surgery (BS) leads to a short-term significant improvement of endothelial function and coronary microvascular function. In this study we assessed whether BS maintains its beneficial effect at long-term follow up. DESIGN We studied 19 morbidly obese patients (age 43±9years, 12 women) without any evidence of cardiovascular disease who underwent BS. Patients were studied before BS, at 3 months and at 4.0±1.5years follow up. METHODS Peripheral vascular function was assessed by flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD), i.e., brachial artery diameter changes in response to post-ischemic forearm hyperhaemia and to nitroglycerin administration, respectively. Coronary microvascular function was assessed by measuring coronary blood flow (CBF) response to intravenous adenosine and to cold pressor test (CPT) in the left anterior descending coronary artery. RESULTS Together with improvement of anthropometric and metabolic profile, at long-term follow-up patients showed a significant improvement of FMD (6.43±2.88 vs. 8.21±1.73%, p=0.018), and CBF response to both adenosine (1.73±0.48 vs. 2.58±0.54; p<0.01) and CPT (1.43±0.30 vs. 2.23±0.48; p<0.01), compared to basal values. No differences in vascular end-points were shown at 3-month and 4-year follow-up after BS. CONCLUSIONS Our data show that, in morbidly obese patients, BS exerts beneficial and long lasting effects on peripheral endothelial function and on coronary microvascular dilator function.
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Affiliation(s)
- Pierpaolo Tarzia
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gaetano A Lanza
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Alfonso Sestito
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Angelo Villano
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giulio Russo
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Stefano Figliozzi
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Antonio De Vita
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Filippo Crea
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy
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De Vita A, Milo M, Sestito A, Lamendola P, Lanza GA, Crea F. Association of coronary microvascular dysfunction with restenosis of left anterior descending coronary artery disease treated by percutaneous intervention. Int J Cardiol 2016; 219:322-5. [DOI: 10.1016/j.ijcard.2016.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
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Lanza GA, Careri G, Stazi A, Villano A, De Vita A, Aurigemma C, Crea F. Clinical Spectrum and Outcome of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome and No Obstructive Coronary Atherosclerosis. Circ J 2016; 80:1600-6. [DOI: 10.1253/circj.cj-16-0145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Giulia Careri
- Institute of Cardiology, Università Cattolica del Sacro Cuore
| | | | - Angelo Villano
- Institute of Cardiology, Università Cattolica del Sacro Cuore
| | - Antonio De Vita
- Institute of Cardiology, Università Cattolica del Sacro Cuore
| | | | - Filippo Crea
- Institute of Cardiology, Università Cattolica del Sacro Cuore
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Figliozzi S, Stazi A, Pinnacchio G, Laurito M, Parrinello R, Villano A, Russo G, Milo M, Mollo R, Lanza GA, Crea F. Use of T-wave alternans in identifying patients with coronary artery disease. J Cardiovasc Med (Hagerstown) 2016; 17:20-5. [DOI: 10.2459/jcm.0000000000000080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gevaert AB, Borizanova A, Graziani F, Galuszka OM, Stathogiannis K, Lervik Nilsen LC, Nishino S, Willis J, Venner C, Luo XX, Van De Heyning CM, Castaldi B, Michalski BW, Wang TL, Aktemur T, Dorlet S, Verseckaite R, Amzulescu MS, Brecht A, Brand M, Galli E, Murzilli R, Bica R, Teixeira R, Schmid J, Miglioranza MH, Cherneva ZH, Gheghici S, Pernigo M, Rafael D, Van Craenenbroeck AH, Shivalkar B, Lemmens K, Vrints CJ, Van Craenenbroeck EM, Somleva D, Zlatareva- Gronkova N, Kinova E, Goudev A, Camporeale A, Pieroni M, Pedicino D, Laurito MP, Verrecchia E, Lanza GA, Manna R, Crea F, Reinthaler M, Rutschow S, Gross M, Landmesser U, Kasner M, Toutouzas K, Drakopoulou M, Latsios G, Synetos A, Kaitozis O, Trantalis G, Mastrokostopoulos A, Kotronias R, Tousoulis D, Brekke BB, Aase SA, Lonnebakken MT, Stensvag D, Amundsen B, Torp H, Stoylen A, Watanabe N, Kimura T, Nakama T, Furugen M, Koiwaya H, Ashikaga K, Kuriyama N, Shibata Y, Augustine DX, Knight D, Sparey J, Coghlan G, Easaw J, Huttin O, Voilliot D, Mercy M, Villemin T, Olivier A, Mandry D, Chaouat A, Juilliere Y, Selton-Suty C, Fang F, Li S, Zhang ZH, Yu CM, Bertrand PB, De Maeyer C, De Bock D, Paelinck BP, Vrints CJ, Claeys MJ, Reffo E, Balzarin M, Zulian F, Milanesi O, Miskowiec D, Kupczynska K, Peczek L, Nawrot B, Lipiec P, Kasprzak JD, Li H, Jin XY, Poci N, Kaymaz C, Huttin O, Voilliot D, Venner C, Villemin T, Manenti V, Carillo S, Chabot F, Juilliere Y, Selton-Suty C, Mizariene V, Rimkeviciute D, Bieseviciene M, Jonkaitiene R, Jurkevicius R, Roy C, Slimani A, Boileau L, De Meester C, Vancraeynest D, Pasquet A, Vanoverschelde JL, Pouleur AC, Gerber BL, Oertelt-Prigione S, Seeland U, Ruecke M, Regitz-Zagrosek V, Stangl V, Knebel F, Laux D, Roeing J, Butz T, Christ M, Grett M, Wennemann R, Trappe HJ, Fournet M, Leclercq C, Samset E, Daubert JC, Donal E, Leo LA, Pasotti E, Klersy C, Moccetti T, Faletra FF, Dobre D, Darmon S, Dumitrescu S, Calistru P, Monteiro R, Ribeiro M, Garcia J, Cardim N, Goncalves L, Kaufmann R, Grubler MR, Verheyen N, Weidemann F, Binder JS, Santanna RT, Rover MM, Leiria T, Kalil R, Picano E, Gargani L, Kuneva ZK, Vasilev DV, Ianula R, Dasoveanu M, Calin C, Homentcovsci C, Siliste R, Bergamini C, Mantovani A, Bonapace S, Lipari P, Barbieri E, Bonora E, Targher G, Camarozano AC, Pereira Da Cunha CL, Padilha SL, Souza AM, Freitas AKE. HIT Poster session 1P154Preclinical diastolic dysfunction is related to impaired endothelial function in patients with chronic kidney diseaseP155Early detection of left atrial and left ventricular abnormalities in hypertensive and obese womenP156Right ventricle preserved systolic function irrespective of right ventricular hypertrophy and disease severity in anderson fabry diseaseP157Left atrial volume and function in patients undergoing percutaneous mitral valve repairP158Impact of left ventricular dysfunction on outcomes of patients undergoing direct TAVI with a self-expanding bioprosthesisP159Anatomic Doppler spectrum – retrospective spectral tissue Doppler from ultra high frame rate tissue Doppler imaging for evaluation of tissue deformationP160Phasic dynamics of ischaemic mitral regurgitation after primary coronary intervention in acute myocardial infarction: serial echocardiographic assessment from emergency room to long-term follow-upP161Reproducibility of 3DE RV volumes - novel insights at a regional levelP162Pulmonary vascular capacitance as assessed by echocardiography in pulmonary arterial hypertensionP163Three-dimensional endocardial area strain: a novel parameter for quantitative assessment of global left ventricular systolic functionP164Role of exercise hemodynamics assessed by echocardiography on symptom reduction after MitraClipP165Early identification of ventricular dysfunction in patients with juvenile systemic sclerosisP166Heart failure with and without preserved ejection fraction - the role of biomarkers in the aspect of global longitudinal strainP167Complex systolic deformation of aortic root: insights from two dimensional speckle tracking imageP168Volumetric and deformational imaging usind 2d strain and 3d echocardiography in patients with pulmonary hypertensionP169Influence of pressure load and right ventricular morphology and function on tricuspid regurgitation in pulmonary arterial hypertensionP170Left ventricular myocardial diastolic deformation analysis by 2D speckle tracking echocardiography and relationship with conventional diastolic parameters in chronic aortic regurgitationP171Extracellular volume, and not native T1 time, distinguishes diffuse fibrosis in dilated or hypertrophic cardiomyopathy at 3TP172Left atrial strain is significantly reduced in arterial hypertensionP173Symptomatic severe secondary mitral regurgitation: LV enddiastolic diameter (LVEDD) as preferable parameter for risk stratificationP174Left ventricular mechanics in isolated left bundle branch block at rest and when exercising: exploration of the concept of conductive cardiomyopathyP175Assessment of myocardial scar by 2D contrast echocardiographyP176Chronic pericarditis - expression of a rare disease: Erdheim Chester diseaseP177Aortic arch mechanics with two-dimensional speckle tracking echocardiography to estimate the left ventricular remodelling in hypertensive patientsP178Strain analysis by tissue doppler imaging: comparison of conventional manual measurement with a semi-automated approachP179Distribution of extravascular lung water in heart failure patients assessed by lung ultrasoudP180Surrogate markers for obstructive coronary artery diseaseP181LA deformation and LV longitudinal strain by two-dimensional speckle tracking echocardiography as predictors of postoperative AF development after aortic valve replacement in ASP182Left ventricular diastolic dysfunction in type 2 diabetic patients with non alcoholic fatty liver diseaseP183Myocardial strain by speckle-tracking and evaluation of 3D ejection fraction in drug-induced cardiotoxicity's approach in breast cancer. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Gaetano A Lanza
- From the Department of Cardiologic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Crea
- From the Department of Cardiologic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
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Di Franco A, Lanza GA, Valeriani M, Villano A, Russo G, Virdis D, Pazzaglia C, Sarullo FM, Rossini PM, Crea F, Vollono C. Impaired pain processing in patients with silent myocardial ischemia. Int J Cardiol 2015; 186:204-6. [PMID: 25828115 DOI: 10.1016/j.ijcard.2015.03.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Antonino Di Franco
- Dpt. of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, Italy
| | - Gaetano A Lanza
- Dpt. of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, Italy.
| | - Massimiliano Valeriani
- Neurology Division, Pediatric Hospital "Bambino Gesù" IRCCS, Rome, Italy; Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Angelo Villano
- Dpt. of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, Italy
| | - Giulio Russo
- Dpt. of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, Italy
| | - Daniela Virdis
- Dpt. of Geriatrics, Neuroscience & Orthopedics, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, Italy
| | | | - Filippo M Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Paolo M Rossini
- Dpt. of Geriatrics, Neuroscience & Orthopedics, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, Italy
| | - Filippo Crea
- Dpt. of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, Italy
| | - Catello Vollono
- Dpt. of Geriatrics, Neuroscience & Orthopedics, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, Rome, Italy
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Wu M, Villano A, Russo G, Di Franco A, Stazi A, Lauria C, Sestito A, Lanza GA, Crea F. Poor Tolerance and Limited Effects of Isosorbide-5-Mononitrate in Microvascular Angina. Cardiology 2015; 130:201-6. [DOI: 10.1159/000370027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/18/2014] [Indexed: 11/19/2022]
Abstract
Objectives: To assess the effects of isosorbide-5-mononitrate (ISMN) in patients with microvascular angina (MVA). Methods: We randomized 20 MVA patients, treated with a β-blocker or a calcium antagonist, to 60 mg slow-release ISMN (halved to 30 mg if not tolerated) or placebo once a day for 4 weeks; the patients were then switched to the other treatment for another 4 weeks. Their clinical status was assessed with the Seattle Angina Questionnaire (SAQ) and the EuroQoL score for quality of life. The exercise stress test (EST), coronary blood flow (CBF) response to nitrate and the cold pressor test (CPT), brachial artery flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) were also assessed. Results: Nine patients (45%) did not complete the ISMN phase due to side effects; 2 patients refused a follow-up. Nine patients completed the study. The SAQ and EuroQoL scores were significantly better with ISMN than with placebo, although the differences were small. No differences were found between the treatments in the EST results, CBF response to nitroglycerin (p = 0.55) and the CPT (p = 0.54), FMD (p = 0.26) and NMD (p = 0.35). Conclusions: In this study, a high proportion of MVA patients showed an intolerance to ISMN; in those tolerating the drug, significant effects on their angina status were observed, but the benefit appeared to be modest and independent of effects on coronary microvascular function.
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Sarullo FM, Vitale G, Di Franco A, Sarullo S, Salerno Y, Vassallo L, Baviera EP, Marazia S, Mandalà G, Lanza GA. Nemaline myopathy and heart failure: role of ivabradine; a case report. BMC Cardiovasc Disord 2015; 15:5. [PMID: 25597856 PMCID: PMC4373120 DOI: 10.1186/1471-2261-15-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/12/2015] [Indexed: 11/18/2022] Open
Abstract
Background Nemaline myopathy (NM) is a rare congenital myopathy characterized by muscle weakness, hypotonia and the presence in muscle fibers of inclusions known as nemaline bodies and a wide spectrum of clinical phenotypes, ranging from severe forms with neonatal onset to asymptomatic forms. The adult-onset form is heterogeneous in terms of clinical presentation and disease progression. Cardiac involvement occurs in the minority of cases and little is known about medical management in this subgroup of NM patients. We report a rare case of heart failure (HF) in a patient with adult-onset NM in whom ivabradine proved to be able to dramatically improve the clinical picture. Case presentation We report a case of a 37-year-old man with adult-onset NM, presenting with weakness and hypotonia of the proximal limb muscles and shoulder girdle, severely limiting daily activities. He developed progressive HF over a period of 6 months while attending a rehabilitation program, with reduced left ventricular ejection fraction (LVEF = 20%), manifested by dyspnea and signs of systemic congestion. The patient was started HF therapy with enalapril, carvedilol, spironolactone and loop diuretics. Target HF doses of these drugs (including carvedilol) were not reached because of symptomatic hypotension causing a high resting heart rate (HR) ≥70 beats per minute (bpm). Further deterioration of the clinical picture occurred with several life-threatening arrhythmic episodes requiring external defibrillation. An implantable cardioverter defibrillator (ICD) was then implanted. Persistent high resting HR was successfully treated with ivabradine with HR lowering from 90 bpm to 55 bpm at 1 month follow up, LVEF rising to 50% at 3 month follow up and to 54% at 2,5 year follow up. To date no more hospitalizations for heart failure occurred. A single hospitalization due to aspiration pneumonia required insertion of a tracheostomy tube to protect airways from further aspiration. At present, the patient is attending a regular rehabilitation program with net improvement in neuromotor control and less limitations in daily activities. Conclusions HF is a rare feature of NM, but it can negatively influence prognosis. Conventional HF therapy and/or heart transplant are the only reasonable strategy in these patients. Ivabradine is a useful, effective and safe drug for therapy in NM patients with HF and should be considered when resting HR remains high despite beta-blockers’ full titration or beta-blockers’ underdosing due to intolerance or side effects.
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Affiliation(s)
- Filippo M Sarullo
- Cardiovascular Rehabilitation Unit - Buccheri la Ferla Fatebenefratelli Hospital, Via Salvatore Puglisi n, 15, Palermo, Italy.
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Villano A, Lanza GA. Cardiac Rehabilitation in the Elderly after a Recent Acute Coronary Syndrome: A Useful or Mandatory Tool? Cardiology 2015; 132:71-73. [DOI: 10.1159/000431034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 11/19/2022]
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