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Simistiras A, Georgiopoulos G, Delialis D, Mavraganis G, Oikonomou E, Maneta E, Loutos C, Evangelou E, Stamatelopoulos K. Association of Lipoprotein(a) with arterial stiffness: A Mendelian randomization study. Eur J Clin Invest 2024; 54:e14168. [PMID: 38239089 DOI: 10.1111/eci.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/09/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND In this study we used Mendelian randomization (MR) to investigate the potential causal association of lipoprotein (a) [Lp(a)] levels with pulse wave velocity (PWV). METHODS Genetic variants associated with Lp(a) were retrieved from the UK Biobank GWAS (N = 290,497). A non- overlapping GWAS based on a European cohort (N = 7,000) was used to obtain genetic associations with PWV (outcome) and utilized two different measures for the same trait, brachial-ankle (baPWV) and carotid-femoral (cfPWV) PWV. We applied a two-sample MR using the inverse variance weighting method (IVW) and a series of sensitivity analyses for 170 SNPs that were selected as instrumental variables (IVs). RESULTS Our analyses do not support a causal association between Lp(a) and PWV for neither measurement [βiwv(baPWV) = -.0005, p = .8 and βiwv(cfPWV) = -.006, p = .16]. The above findings were consistent across sensitivity analyses including weighted median, mode-based estimation, MR-Egger regression and MR-PRESSO. CONCLUSION We did not find evidence indicating that Lp(a) is causally associated with PWV, the gold standard marker of arterial stiffness.
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Affiliation(s)
- Alexandros Simistiras
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, UK
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Ermioni Oikonomou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christos Loutos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Papakonstantinou E, Zacharodimos N, Georgiopoulos G, Athanasaki C, Bothou DL, Tsitsou S, Lympaki F, Vitsou-Anastasiou S, Papadopoulou OS, Delialis D, Alexopoulos EC, Petsiou E, Keramida K, Doulgeraki AI, Patsopoulou IM, Nychas GJE, Tassou CC. Two-Month Consumption of Orange Juice Enriched with Vitamin D3 and Probiotics Decreases Body Weight, Insulin Resistance, Blood Lipids, and Arterial Blood Pressure in High-Cardiometabolic-Risk Patients on a Westernized Type Diet: Results from a Randomized Clinical Trial. Nutrients 2024; 16:1331. [PMID: 38732578 PMCID: PMC11085203 DOI: 10.3390/nu16091331] [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] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
This study examined the effects of orange juice (OJ) supplemented with vitamin D3 (2000 IU) and probiotics (Lacticaseibacillus casei Shirota and Lacticaseibacillus rhamnosus GG, 108 cfu/mL) on cardiometabolic risk factors in overweight and obese adults following a Westernized-type diet. Fifty-three high-risk individuals were randomly assigned to one of two groups. Over 8 weeks, one group consumed a vitamin D3 and probiotic-enriched OJ and the other regular OJ (control). Diets remained unchanged and were documented through food diaries. Measures of metabolic and inflammatory markers and blood pressure were measured at the start and end of the study. Post-intervention, the enriched OJ group showed the following significant metabolic improvements (without changes in triglycerides, inflammation, or central blood pressure): reduced fasting insulin, peripheral blood pressure, body weight (-1.4 kg 95% CI: -2.4, -0.4), energy (-270 kcal 95% CI: -553.2, -13.7), macronutrient (dietary fat -238 kcal 95% CI: -11.9, -1.0; carbohydrates -155 kcal 95% CI: -282.4, -27.3; sugars -16.1 g 95% CI: -11.9, -1.0) intake, and better lipid profiles (total cholesterol -10.3 mg/dL 95% CI: -21.4, 0.9; LDL-C -7 mg/dL 95% CI: -13.5, -0.5). The enriched OJ led to weight loss, less energy/macronutrient consumption, improved lipid profiles, and increased insulin sensitivity after 8 weeks in those following a Westernized diet, thus indicating potential benefits for cardiometabolic risk. This study was a part of FunJuice-T2EDK-01922, which was funded by the EU Regional Development Fund and Greek National Resources.
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Affiliation(s)
- Emilia Papakonstantinou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Nikolaos Zacharodimos
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sophias Ave, 11528 Athens, Greece; (G.G.)
| | - Christina Athanasaki
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Dionysia-Lydia Bothou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Sofia Tsitsou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Foteini Lympaki
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (N.Z.); (C.A.); (D.-L.B.); (S.T.); (F.L.)
| | - Stamatia Vitsou-Anastasiou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DIMITRA”, 1, S. Venizelou, Lykovrissi, 14123 Attiki, Greece; (S.V.-A.); (O.S.P.); (C.C.T.)
- Laboratory of Microbiology and Biotechnology of Foods, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 75 Iera Odos, 11855 Athens, Greece;
| | - Olga S. Papadopoulou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DIMITRA”, 1, S. Venizelou, Lykovrissi, 14123 Attiki, Greece; (S.V.-A.); (O.S.P.); (C.C.T.)
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 80 Vasilissis Sophias Ave, 11528 Athens, Greece; (G.G.)
| | | | - Eleni Petsiou
- Henry Dunant Hospital, 107 Mesogeion Ave, 11526 Athens, Greece;
| | - Kalliopi Keramida
- Cardiology Department, General Anticancer Oncological Hospital Agios Savvas, 171 Alexandras Ave, 11522 Athens, Greece;
| | - Agapi I. Doulgeraki
- Laboratory of Food Microbiology and Hygiene, Department of Food Science and Technology, School of Agriculture, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Ismini-Maria Patsopoulou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DIMITRA”, 1, S. Venizelou, Lykovrissi, 14123 Attiki, Greece; (S.V.-A.); (O.S.P.); (C.C.T.)
| | - George-John E. Nychas
- Laboratory of Microbiology and Biotechnology of Foods, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 75 Iera Odos, 11855 Athens, Greece;
- Shandong Agricultural University, Tai’an 271002, China
| | - Chrysoula C. Tassou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DIMITRA”, 1, S. Venizelou, Lykovrissi, 14123 Attiki, Greece; (S.V.-A.); (O.S.P.); (C.C.T.)
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Räty S, Virtanen P, Ritvonen J, Georgiopoulos G, Sairanen T, Lindsberg PJ, Strbian D. IV Thrombolysis in Basilar Artery Occlusion: Outcomes and Comparison With Endovascular Thrombectomy. Neurology 2024; 102:e209249. [PMID: 38531004 DOI: 10.1212/wnl.0000000000209249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/08/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Recanalization is considered a prerequisite for favorable outcome in basilar artery occlusion (BAO). Intravenous thrombolysis (IVT) has been successfully used for eligible patients with BAO well beyond the 4.5-hour time window but has been largely underrepresented in the best medical management arms in recent randomized controlled trials of recanalization therapy in BAO. We aimed to analyze the outcomes of patients with BAO treated with IVT only and to compare IVT with endovascular thrombectomy (EVT). METHODS This observational single-center, retrospective cohort study included consecutive patients with BAO treated with IVT and/or EVT up to 48 hours of symptom onset during 1995-2022. The primary outcome was favorable functional outcome (modified Rankin Scale 0-3) at 3 months collected by a stroke physician by phone. In the first part, we described the outcomes and factors associated with functional outcome in the IVT-only cohort during 1995-2022. In the second part, we used doubly robust inverse probability-weighted regression adjustment models to compare functional outcome of patients treated with IVT vs EVT+/-IVT during 2010-2022. RESULTS In the whole cohort of 376 patients with acute BAO treated with recanalization therapy, 245 (65.2%) received only IVT. In the IVT-only cohort, most patients had moderate-to-severe clinical presentation (median NIH Stroke Scale 18) but no extensive early ischemic changes in the posterior circulation on admission. Half of them had onset-to-treatment time over 6 hours. 46.5% of the IVT-treated patients achieved 3-month favorable functional outcome, whereas mortality was 35.9%. sICH occurred in 11.1%. In a multivariable analysis, younger age, milder symptom severity, and less baseline ischemic changes predicted favorable functional outcome. In the 2010-2022 cohort, when compared with patients treated with EVT+/-IVT (n = 121), the IVT-only cohort (n = 122) had higher odds for favorable functional outcome (IVT 58.2% vs EVT 43.0% (aOR 2.82 [95% CI 1.31-6.05]). DISCUSSION IVT alone produced outcomes comparable with those in recent trials of endovascular BAO recanalization. Furthermore, in head-to-head comparison in our cohort, the IVT-only approach was more often associated with favorable outcome than EVT+/-IVT. Thus, it should not be overlooked as the first-line recanalization therapy in acute BAO, even in longer time windows. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that tPA is as effective as thrombectomy for basilar artery thrombosis.
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Affiliation(s)
- Silja Räty
- From the Departments of Neurology (S.R., J.R., T.S., P.J.L., D.S.) and Radiology (P.V.), Helsinki University Hospital and University of Helsinki, Finland; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece; School of Biomedical Engineering and Imaging Sciences (G.G.), King's College London; and Institute of Cardiovascular Science (G.G.), University College London, United Kingdom
| | - Pekka Virtanen
- From the Departments of Neurology (S.R., J.R., T.S., P.J.L., D.S.) and Radiology (P.V.), Helsinki University Hospital and University of Helsinki, Finland; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece; School of Biomedical Engineering and Imaging Sciences (G.G.), King's College London; and Institute of Cardiovascular Science (G.G.), University College London, United Kingdom
| | - Juhani Ritvonen
- From the Departments of Neurology (S.R., J.R., T.S., P.J.L., D.S.) and Radiology (P.V.), Helsinki University Hospital and University of Helsinki, Finland; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece; School of Biomedical Engineering and Imaging Sciences (G.G.), King's College London; and Institute of Cardiovascular Science (G.G.), University College London, United Kingdom
| | - Georgios Georgiopoulos
- From the Departments of Neurology (S.R., J.R., T.S., P.J.L., D.S.) and Radiology (P.V.), Helsinki University Hospital and University of Helsinki, Finland; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece; School of Biomedical Engineering and Imaging Sciences (G.G.), King's College London; and Institute of Cardiovascular Science (G.G.), University College London, United Kingdom
| | - Tiina Sairanen
- From the Departments of Neurology (S.R., J.R., T.S., P.J.L., D.S.) and Radiology (P.V.), Helsinki University Hospital and University of Helsinki, Finland; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece; School of Biomedical Engineering and Imaging Sciences (G.G.), King's College London; and Institute of Cardiovascular Science (G.G.), University College London, United Kingdom
| | - Perttu J Lindsberg
- From the Departments of Neurology (S.R., J.R., T.S., P.J.L., D.S.) and Radiology (P.V.), Helsinki University Hospital and University of Helsinki, Finland; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece; School of Biomedical Engineering and Imaging Sciences (G.G.), King's College London; and Institute of Cardiovascular Science (G.G.), University College London, United Kingdom
| | - Daniel Strbian
- From the Departments of Neurology (S.R., J.R., T.S., P.J.L., D.S.) and Radiology (P.V.), Helsinki University Hospital and University of Helsinki, Finland; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece; School of Biomedical Engineering and Imaging Sciences (G.G.), King's College London; and Institute of Cardiovascular Science (G.G.), University College London, United Kingdom
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Georgiopoulos G, Faconti L, Mohamed AT, Figliozzi S, Asher C, Keehn L, McNally R, Alfakih K, Vennin S, Chiribiri A, Lamata P, Chowienczyk P, Masci PG. Ethnicity Differences in Geometric Remodeling and Myocardial Composition in Hypertension unveiled by Cardiovascular Magnetic Resonance. Eur Heart J Cardiovasc Imaging 2024:jeae097. [PMID: 38597630 DOI: 10.1093/ehjci/jeae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024] Open
Abstract
AIMS Hypertensive patients of African-ancestry (Afr-a) have higher incidences of heart failure and worse clinical outcomes than hypertensive patients of European-ancestry (Eu-a), yet the underlying mechanisms remain misunderstood. This study investigated right (RV) and left (LV) ventricular remodeling alongside myocardial tissue derangements between Afr-a and Eu-a hypertensives. METHODS AND RESULTS Sixty-three Afr-a and forty-seven Eu-a hypertensives underwent multi-parametric cardiovascular-magnetic-resonance. Biventricular volumes, mass, function, mass/end-diastolic volume (M/V) ratios, T2- and pre/post-contrast T1-relaxation-times, synthetic-extracellular-volume (s-ECV) and myocardial fibrosis (MF) were measured. Three-dimensional shape modeling was implemented to delineate ventricular geometry.LV and RV-mass (indexed to body-surface-area) and M/V ratios were significantly greater in Afr-a than Eu-a hypertensives (67.1±21.7 vs. 58.3±16.7g/m2, 12.6±3.48 vs. 10.7±2.71g/m2, 0.79±0.21 vs. 0.70±0.14g/ml, 0.16±0.04 vs. 0.13±0.03g/ml, respectively; P<0.03) mirroring LV remodeling. Afr-a patients showed greater basal-interventricular-septum thickness than Eu-a patients, which may influence LV hypertrophy and RV cavity changes. This biventricular remodeling was associated with prolonged T2-relaxation-time (47.0±2.2 vs. 45.7±2.2ms, P=0.005) and higher prevalence (23% vs. 4%, P=0.001) and extent of MF (2.3[0.6-14.3] vs. 1.6[0.9-2.5] % of LV-mass, P=0.008) in Afr-a patients. Multivariable linear regression showed modifiable cardiovascular risk-factors and greater end-diastolic volume were independently associated with greater LV or RV-mass. Furthermore, ethnicity was independently associated with greater RV-mass, supporting our hypothesis of ethnic-specific hypertensive remodeling. CONCLUSIONS Afr-a hypertensives had distinctive biventricular remodeling, including increased RV-mass and septal thickening, and subtle myocardial tissue abnormalities compared to Eu-a hypertensives. From this study, modifiable cardiovascular risk-factors, and ventricular geometry, but not ethnicity, were independently associated with higher LV mass.
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Affiliation(s)
- Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London - United Kingdom
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens - Greece
| | - Luca Faconti
- British Heart Foundation Centre, Department of Clinical Pharmacology, King's College London, St Thomas' Hospital, London - United Kingdom
| | - Aqeel T Mohamed
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London - United Kingdom
- GKT School of Medical Education, King's College London, London - United Kingdom
| | | | - Clint Asher
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London - United Kingdom
| | - Louise Keehn
- British Heart Foundation Centre, Department of Clinical Pharmacology, King's College London, St Thomas' Hospital, London - United Kingdom
| | - Ryan McNally
- British Heart Foundation Centre, Department of Clinical Pharmacology, King's College London, St Thomas' Hospital, London - United Kingdom
| | - Khaled Alfakih
- Lewisham and Greenwich NHS Trust, London - United Kingdom
| | - Samuel Vennin
- British Heart Foundation Centre, Department of Clinical Pharmacology, King's College London, St Thomas' Hospital, London - United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London - United Kingdom
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London - United Kingdom
| | - Philip Chowienczyk
- British Heart Foundation Centre, Department of Clinical Pharmacology, King's College London, St Thomas' Hospital, London - United Kingdom
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London - United Kingdom
- Department of Imaging and Pathology, Translational MRI Research Group, KU Leuven, Leuven - Belgium
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Papadopoulou A, Tournas G, Georgiopoulos G, Antsaklis P, Daskalakis G, Coomarasamy A, Devall AJ. Preventing postpartum hemorrhage: A network meta-analysis on routes of administration of uterotonics. Eur J Obstet Gynecol Reprod Biol 2024; 295:172-180. [PMID: 38367391 DOI: 10.1016/j.ejogrb.2024.02.021] [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: 11/02/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
1. OBJECTIVE To perform a network meta-analysis to specify the route of administration that maximises the effectiveness of each of the available prophylactic uterotonics without increasing the risk for side effects. 2. DATA SOURCES Literature searches on 12th September 2022 included: CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. The reference lists of the retrieved study records were also searched. 3. STUDY ELIGIBILITY CRITERIA Population: Randomized controlled trials involving women in the third stage of labour after a vaginal or caesarean delivery in hospital or community settings. INTERVENTIONS Systemically administered prophylactic uterotonics of any route and dose for primary postpartum hemorrhage prevention. Comparison: Any other prophylactic uterotonic, or a different route or dose of a given uterotonic, or placebo, or no treatment. Outcomes (primary): postpartum hemorrhage ≥ 500 mL and ≥ 1000 mL. 4. STUDY APPRAISAL AND SYNTHESIS METHODS Risk of bias and trustworthiness assessments were performed, according to Cochrane's guidance. Direct, indirect and network meta-analyses were conducted, and results were summarized either as risk ratio or mean difference with 95% confidence intervals for dichotomous and continuous outcomes, respectively. The certainty of generated evidence was assessed according to the GRADE approach. Cumulative probabilities were calculated and the surface under the cumulative ranking curve was used to create a ranking of the available drugs. 5. RESULTS One hundred eighty-one studies involving 122,867 randomised women were included. Most studies were conducted in hospital settings in lower-middle income countries and involved women delivering vaginally. When compared with intramuscular oxytocin, carbetocin (RR 0.58, 95 % CI 0.40-0.84) and oxytocin (RR 0.75, 95 % CI 0.59-0.97) by an intravenous bolus, and intramuscular ergometrine plus oxytocin combination (RR 0.71, 95 % CI 0.56-0.91) are probably more effective in preventing primary postpartum hemorrhage. Intramuscularly administered oxytocin and carbetocin by an intravenous bolus have a favourable side effects profile. 6. CONCLUSIONS Generated evidence was generally moderate and global inconsistency was low. Carbetocin and oxytocin by an intravenous bolus, and intramuscular ergometrine plus oxytocin combination are probably the top uterotonics for primary postpartum hemorrhage prevention. Large scale studies exploring different routes of administration for available prophylactic uterotonics, and women's views should be conducted.
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Affiliation(s)
- Argyro Papadopoulou
- Institute of Metabolism and Systems Research, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham B15 2TH United Kingdom; Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece.
| | - Georgios Tournas
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece
| | - Panos Antsaklis
- Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece
| | - Georgios Daskalakis
- Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, 80 Vasilissis Sofias Avenue, Athens 11528, Greece
| | - Arri Coomarasamy
- Institute of Metabolism and Systems Research, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham B15 2TH United Kingdom
| | - Adam J Devall
- Institute of Metabolism and Systems Research, University of Birmingham, Heritage Building, Mindelsohn Way, Birmingham B15 2TH United Kingdom
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6
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Rios FJ, de Ciuceis C, Georgiopoulos G, Lazaridis A, Nosalski R, Pavlidis G, Tual-Chalot S, Agabiti-Rosei C, Camargo LL, Dąbrowska E, Quarti-Trevano F, Hellmann M, Masi S, Lopreiato M, Mavraganis G, Mengozzi A, Montezano AC, Stavropoulos K, Winklewski PJ, Wolf J, Costantino S, Doumas M, Gkaliagkousi E, Grassi G, Guzik TJ, Ikonomidis I, Narkiewicz K, Paneni F, Rizzoni D, Stamatelopoulos K, Stellos K, Taddei S, Touyz RM, Virdis A. Mechanisms of Vascular Inflammation and Potential Therapeutic Targets: A Position Paper From the ESH Working Group on Small Arteries. Hypertension 2024. [PMID: 38511317 DOI: 10.1161/hypertensionaha.123.22483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Inflammatory responses in small vessels play an important role in the development of cardiovascular diseases, including hypertension, stroke, and small vessel disease. This involves various complex molecular processes including oxidative stress, inflammasome activation, immune-mediated responses, and protein misfolding, which together contribute to microvascular damage. In addition, epigenetic factors, including DNA methylation, histone modifications, and microRNAs influence vascular inflammation and injury. These phenomena may be acquired during the aging process or due to environmental factors. Activation of proinflammatory signaling pathways and molecular events induce low-grade and chronic inflammation with consequent cardiovascular damage. Identifying mechanism-specific targets might provide opportunities in the development of novel therapeutic approaches. Monoclonal antibodies targeting inflammatory cytokines and epigenetic drugs, show promise in reducing microvascular inflammation and associated cardiovascular diseases. In this article, we provide a comprehensive discussion of the complex mechanisms underlying microvascular inflammation and offer insights into innovative therapeutic strategies that may ameliorate vascular injury in cardiovascular disease.
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Affiliation(s)
- Francisco J Rios
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada (F.J.R., L.L.C., A.C.M., R.M.T.)
| | - Carolina de Ciuceis
- Department of Clinical and Experimental Sciences, University of Brescia, National and Kapodistrian University of Athens. (C.d.C., C.A.-R., D.R.)
| | - Georgios Georgiopoulos
- Angiology and Endothelial Pathophysiology Unit, Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens. (G.G., G.M., K. Stamatelopoulos)
| | - Antonios Lazaridis
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Greece (A.L., E.G.)
| | - Ryszard Nosalski
- Centre for Cardiovascular Sciences; Queen's Medical Research Institute, University of Edinburgh, United Kingdom (R.N., T.J.G.)
- Department of Internal Medicine, Center for Medical Genomics OMICRON, Jagiellonian University Medical College, Krakow, Poland (R.N., T.J.G.)
| | - George Pavlidis
- Medical School, National and Kapodistrian University of Athens. (G.P., I.I.)
- Preventive Cardiology Laboratory and Clinic of Cardiometabolic Diseases, 2-Cardiology Department, Attikon Hospital, Athens, Greece (G.P., I.I.)
| | - Simon Tual-Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, United Kingdom (S.T.-C., K. Stellos)
| | - Claudia Agabiti-Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, National and Kapodistrian University of Athens. (C.d.C., C.A.-R., D.R.)
| | - Livia L Camargo
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada (F.J.R., L.L.C., A.C.M., R.M.T.)
| | - Edyta Dąbrowska
- Department of Hypertension and Diabetology, Center of Translational Medicine, Medical University of Gdansk, Poland. (E.D., J.W., K.N. and M.D.)
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (F.Q.-T., G.G.)
| | - Marcin Hellmann
- Department of Cardiac Diagnostics, Medical University of Gdansk, Poland. (M.H.)
| | - Stefano Masi
- Institute of Cardiovascular Science, University College London, United Kingdom (S.M.)
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (S.M., M.L., A.M., S.T., A.V.)
| | - Mariarosaria Lopreiato
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (S.M., M.L., A.M., S.T., A.V.)
| | - Georgios Mavraganis
- Angiology and Endothelial Pathophysiology Unit, Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens. (G.G., G.M., K. Stamatelopoulos)
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (S.M., M.L., A.M., S.T., A.V.)
- Center for Translational and Experimental Cardiology, Department of Cardiology, University Hospital Zurich, University of Zurich, Switzerland (A.M., F.P.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa (A.M.)
| | - Augusto C Montezano
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada (F.J.R., L.L.C., A.C.M., R.M.T.)
| | - Konstantinos Stavropoulos
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, Greece (K. Stavropoulos
| | - Pawel J Winklewski
- Department of Human Physiology, Medical University of Gdansk, Poland. (P.J.W.)
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Center of Translational Medicine, Medical University of Gdansk, Poland. (E.D., J.W., K.N. and M.D.)
| | - Sarah Costantino
- University Heart Center, University Hospital Zurich, Switzerland. (S.C., F.P.)
| | - Michael Doumas
- Department of Hypertension and Diabetology, Center of Translational Medicine, Medical University of Gdansk, Poland. (E.D., J.W., K.N. and M.D.)
| | - Eugenia Gkaliagkousi
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Greece (A.L., E.G.)
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (F.Q.-T., G.G.)
| | - Tomasz J Guzik
- Centre for Cardiovascular Sciences; Queen's Medical Research Institute, University of Edinburgh, United Kingdom (R.N., T.J.G.)
- Department of Internal Medicine, Center for Medical Genomics OMICRON, Jagiellonian University Medical College, Krakow, Poland (R.N., T.J.G.)
| | - Ignatios Ikonomidis
- Medical School, National and Kapodistrian University of Athens. (G.P., I.I.)
- Preventive Cardiology Laboratory and Clinic of Cardiometabolic Diseases, 2-Cardiology Department, Attikon Hospital, Athens, Greece (G.P., I.I.)
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Center of Translational Medicine, Medical University of Gdansk, Poland. (E.D., J.W., K.N. and M.D.)
| | - Francesco Paneni
- Center for Translational and Experimental Cardiology, Department of Cardiology, University Hospital Zurich, University of Zurich, Switzerland (A.M., F.P.)
- University Heart Center, University Hospital Zurich, Switzerland. (S.C., F.P.)
- Department of Research and Education, University Hospital Zurich, Switzerland. (F.P.)
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, National and Kapodistrian University of Athens. (C.d.C., C.A.-R., D.R.)
- Division of Medicine, Spedali Civili di Brescia, Italy (D.R.)
| | - Kimon Stamatelopoulos
- Angiology and Endothelial Pathophysiology Unit, Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens. (G.G., G.M., K. Stamatelopoulos)
| | - Konstantinos Stellos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, United Kingdom (S.T.-C., K. Stellos)
- Department of Cardiovascular Research, European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Germany. (K. Stellos)
- Department of Cardiology, University Hospital Mannheim, Heidelberg University, Germany. (K. Stellos)
- German Centre for Cardiovascular Research, Heidelberg/Mannheim Partner Site (K. Stellos)
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (S.M., M.L., A.M., S.T., A.V.)
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada (F.J.R., L.L.C., A.C.M., R.M.T.)
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Italy (S.M., M.L., A.M., S.T., A.V.)
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Khenkina N, Aimo A, Fabiani I, Masci PG, Sagris D, Williams SE, Mavraganis G, Chen HS, Wintermark M, Michel P, Ntaios G, Georgiopoulos G. Magnetic resonance imaging for diagnostic workup of embolic stroke of undetermined source: A systematic review. Int J Stroke 2024; 19:293-304. [PMID: 37435743 DOI: 10.1177/17474930231189946] [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] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Embolic stroke of undetermined source (ESUS) refers to ischemic stroke where the underlying cause of thromboembolism cannot be found despite the recommended diagnostic workup. Unidentified source of emboli hinders clinical decision-making and patient management with detrimental consequences on long-term prognosis. The rapid development and versatility of magnetic resonance imaging (MRI) make it an appealing addition to the diagnostic routine of patients with ESUS for the assessment of potential vascular and cardiac embolic sources. AIMS To review the use of MRI in the identification of cardiac and vascular embolic sources in ESUS and to assess the reclassification value of MRI examinations added to the conventional workup of ESUS. SUMMARY OF REVIEW We reviewed the use of cardiac and vascular MRI for the identification of a variety of embolic sources associated with ESUS, including atrial cardiomyopathy, left ventricular pathologies, and supracervical atherosclerosis in carotid and intracranial arteries and in distal thoracic aorta. The additional reclassification after MRI examinations added to the workup of patients with ESUS ranged from 6.1% to 82.3% and varied depending on the combination of imaging modalities. CONCLUSION MRI techniques allow us to identify additional cardiac and vascular embolic sources and may further decrease the prevalence of patients with the diagnosis of ESUS.
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Affiliation(s)
- Natallia Khenkina
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Milan, Italy
| | - Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Pier Giorgio Masci
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Dimitrios Sagris
- Liverpool Centre of Cardiovascular Sciences, University of Liverpool, Liverpool, UK
| | | | - George Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Max Wintermark
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Georgios Georgiopoulos
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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8
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Company Calabuig AM, Nunez E, Georgiopoulos G, Nicolaides KH, Charakida M, De Paco Matallana C. Three-dimensional echocardiography and strain cardiac imaging in women with pre-eclampsia with follow-up to 6 months postpartum. Ultrasound Obstet Gynecol 2023; 62:852-859. [PMID: 37550920 DOI: 10.1002/uog.27442] [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] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Epidemiological studies have established that women with pre-eclampsia (PE) are at increased long-term cardiovascular risk. Mild cardiac functional changes have been documented during pregnancy in women with PE, but their evolution from presentation to the postpartum period remains poorly defined. The aim of this study was to assess biventricular cardiovascular indices using novel and sensitive two-dimensional and three-dimensional (3D) echocardiographic modalities in pregnancy and to track alterations in both risk factors and cardiovascular indices in the postpartum period. METHODS A total of 59 women with PE were examined at 34 (interquartile range, 31-37) weeks' gestation and at 2-3 days, 3 months and 6 months postpartum. During pregnancy, 118 women with a normotensive pregnancy were also recruited as controls. Biventricular ejection fraction and left ventricular mass were measured by 3D echocardiography. Biventricular global longitudinal strain and strain of the left atrium were assessed using speckle-tracking imaging. RESULTS In women with PE, compared with controls, there was lower left ventricular diastolic function (left atrial reservoir strain, 44.1% vs 49.2%) and increased left ventricular mass index (148 vs 128 g/m2 ), but there was no significant difference in right ventricular functional indices. These alterations in cardiac indices were mostly explained by differences in maternal risk factors. In the postpartum period, most cardiac indices improved by 3 months. Multivariable linear mixed-model analysis demonstrated that this improvement was mostly attributed to reduction in weight and blood pressure. CONCLUSION In women with PE, there is postpartum improvement in cardiac functional and structural indices in parallel with improvement in their risk factor profile. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A M Company Calabuig
- Hospital Clinico Universitario Virgen de la Arrixaca, Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - E Nunez
- Hospital Clinico Universitario Virgen de la Arrixaca, Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - G Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - C De Paco Matallana
- Hospital Clinico Universitario Virgen de la Arrixaca, Institute for Biomedical Research of Murcia, IMIB-Arrixaca, Murcia, Spain
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9
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Virtanen P, Tomppo L, Georgiopoulos G, Brandstack N, Peltola E, Kokkonen T, Lappalainen K, Korvenoja A, Strbian D. Recanalization status and temporal evolution of early ischemic changes following stroke thrombectomy. Eur Stroke J 2023:23969873231214207. [PMID: 37991143 DOI: 10.1177/23969873231214207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Present-day computer tomography (CT) scanners have excellent spatial resolution and signal-to-noise ratio and are instrumental detecting early ischemic changes (EIC) in brain. We assessed the temporal changes of EIC based on the recanalization status after thrombectomy. PATIENTS AND METHODS The cohort comprises consecutive patients with acute ischemic stroke in anterior circulation treated with thrombectomy in tertiary referral hospital. All baseline and follow-up scans were screened for any ischemic changes and further classified using Alberta Stroke Program Early CT Score (ASPECTS). Generalized linear mixed models were used to analyze the impact of recanalization status using modified Thrombolysis in Cerebral Infarction (mTICI) on temporal evolution of ischemic changes. RESULTS We included 614 patients with ICA, M1, or M2 occlusions. Median ASPECTS score was 9 (IQR 7-10) at baseline and 7 (5-8) at approximately 24 h. mTICI 3 was achieved in 207 (33.8%), 2B 241 (39.3%), 2A in 77 (12.6%), and 0-1 in 88 (14.3%) patients. Compared to patients with mTICI 3, those with mTICI 0-1 and 2A had less favorable temporal changes of ASPECTS (p < 0.001). Effect of recanalization was noted in the cortical regions of ICA/M1 patients, but not in their deep structures or patients with M2 occlusions. All ischemic changes detected at baseline were also present at all follow-up images, regardless of the recanalization status. CONCLUSIONS Temporal evolution of the ischemic changes and ASPECTS are related to the success of the recanalization therapy in cortical regions of ICA/M1 patients, but not in their deep brain structures or M2 patients. In none of the patients did EIC revert in any brain region after successful recanalization.
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Affiliation(s)
- Pekka Virtanen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Nina Brandstack
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erno Peltola
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tatu Kokkonen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kimmo Lappalainen
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Korvenoja
- Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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10
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Akhtar Z, Kontogiannis C, Georgiopoulos G, Starck CT, Leung LWM, Lee SY, Lee BK, Seshasai SRK, Sohal M, Gallagher MM. Comparison of non-laser and laser transvenous lead extraction: a systematic review and meta-analysis. Europace 2023; 25:euad316. [PMID: 37882609 PMCID: PMC10638006 DOI: 10.1093/europace/euad316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/07/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
AIMS Transvenous lead extraction (TLE) is performed using non-laser and laser techniques with overall high efficacy and safety. Variation in outcomes between the two approaches does exist with limited comparative evidence in the literature. We sought to compare non-laser and laser TLE in a meta-analysis. METHODS AND RESULTS We searched Medline, Embase, Scopus, ClinicalTrials.gov, and CENTRAL databases for TLE studies published between 1991 and 2021. From the included 68 studies, safety and efficacy data were carefully evaluated and extracted. Aggregated cases of outcomes were used to calculate odds ratio (OR), and pooled rates were synthesized from eligible studies to compare non-laser and laser techniques. Subgroup comparison of rotational tool and laser extraction was also performed. Non-laser in comparison with laser had lower procedural mortality (pooled rate 0% vs. 0.1%, P < 0.01), major complications (pooled rate 0.7% vs. 1.7%, P < 0.01), and superior vena cava (SVC) injury (pooled rate 0% vs. 0.5%, P < 0.001), with higher complete success (pooled rate 96.5% vs. 93.8%, P < 0.01). Non-laser comparatively to laser was more likely to achieve clinical [OR 2.16 (1.77-2.63), P < 0.01] and complete [OR 1.87 (1.69-2.08), P < 0.01] success, with a lower procedural mortality risk [OR 1.6 (1.02-2.5), P < 0.05]. In the subgroup analysis, rotational tool compared with laser achieved greater complete success (pooled rate 97.4% vs. 95%, P < 0.01) with lower SVC injury (pooled rate 0% vs. 0.7%, P < 0.01). CONCLUSION Non-laser TLE is associated with a better safety and efficacy profile when compared with laser methods. There is a greater risk of SVC injury associated with laser sheath extraction.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George’s University Hospital, London, UK
| | | | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Lisa W M Leung
- Department of Cardiology, St George’s University Hospital, London, UK
| | - Sun Y Lee
- Department of Medicine, San Joaquin General Hospital, French Camp, CA, USA
| | - Byron K Lee
- Division of Cardiology, University of California, San Francisco, CA, USA
| | | | - Manav Sohal
- Department of Cardiology, St George’s University Hospital, London, UK
| | - Mark M Gallagher
- Department of Cardiology, St George’s University Hospital, London, UK
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11
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Delialis D, Georgiopoulos G, Aivalioti E, Konstantaki C, Oikonomou E, Bampatsias D, Mavraganis G, Vardavas C, Liberopoulos E, Stellos K, Stamatelopoulos K. Remnant cholesterol in atherosclerotic cardiovascular disease: A systematic review and meta-analysis. Hellenic J Cardiol 2023; 74:48-57. [PMID: 37116829 DOI: 10.1016/j.hjc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Accumulating evidence suggests a substantial contribution of remnant cholesterol (RC) to residual risk for the development or relapse of atherosclerotic cardiovascular disease (ASCVD). We aimed to evaluate the association of RC levels with ASCVD risk by different risk categories and methods of RC assessment. We also assessed available evidence of the effects of lipid-lowering therapies (LLTs) on RC levels. METHODS English-language searches of Medline, PubMed, and Embase (inception to 31 January 2023); ClinicalTrials.gov (October 2022); and reference lists of studies and reviews. Studies reporting on the risk of the composite endpoint [all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE)] by RC levels were included. Moreover, we searched for studies reporting differences in RC levels after the administration of LLT(s). RESULTS Among n = 29 studies with 257,387 participants, we found a pooled linear (pooled HR: 1.27 per 1-SD increase, 95% CI: 1.12-1.43, P < 0.001, I2 = 95%, n = 15 studies) and non-linear association (pooled HR: 1.59 per quartile increase, 95% CI: 1.35-1.85, P < 0.001, I2 = 87.9%, n = 15 studies) of RC levels and the risk of M ACE both in patients with and without established ASCVD. Interestingly, the risk of MACE was higher in studies with directly measured vs. calculated RC levels. In a limited number of studies and participants, LLTs reduced RC levels. CONCLUSION RC levels are associated with ASCVD risk both in primary and secondary prevention. Directly measured RC levels are associated with ASCVD risk more evidently. Available LLTs tend to decrease RC levels, although the clinical relevance of RC decrease merits further investigation. PROSPERO REGISTRATION CRD42022371346.
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Affiliation(s)
- Dimitrios Delialis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Evmorfia Aivalioti
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Christina Konstantaki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ermioni Oikonomou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Constantine Vardavas
- Department of Social Medicine, Faculty of Medicine, University of Crete, University Campus of Voutes, 700 13, Heraklion, Crete, Greece; Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Evangelos Liberopoulos
- 1(st) Department of Propedeutic Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Konstantinos Stellos
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
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12
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Bampatsias D, Theodorakakou F, Briasoulis A, Georgiopoulos G, Dimoula A, Papantoniou V, Papantoniou I, Skiadaresi C, Valsamaki P, Repasos E, Petropoulos I, Delialis D, Papathoma A, Koutsis G, Tselegkidi ME, Stamatelopoulos K, Kastritis E. Transthyretin Amyloidosis Cardiomyopathy in Greece: Clinical Insights from the National Referral Center. Hellenic J Cardiol 2023:S1109-9666(23)00190-2. [PMID: 37805173 DOI: 10.1016/j.hjc.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Clinical characteristics and outcomes of patients with transthyretin amyloidosis cardiomyopathy (ATTR-CM) vary by region, necessitating the acquisition of country-specific evidence for proper management. METHODS This is an observational study including sequential patients presenting in the Amyloidosis Reference Center of Greece, from 01/2014 to 12/2022. ATTR-CM was diagnosed by positive scintigraphy and exclusion of light-chain amyloidosis or positive biopsy typing. Genetic testing was performed in all cases. RESULTS One-hundred and nine ATTR-CM patients were included (median age, 81 years) of which 15 carried TTR mutations (27% Val30Met). Most patients (82%) presented with heart failure and 59% with atrial fibrillation, while 10% had aortic stenosis. Importantly, 78 (71.6%) had clinically significant extracardiac manifestations (45% musculoskeletal disorder, 40% peripheral neuropathy and 33% gastrointestinal symptoms). Sixty-five (60%) received disease-specific treatment with tafamidis. Estimated median survival was 48 months; advanced NYHA class, National Amyloidosis Center stage, eGFR<45 ml/kg/1.73m2, NT-pro-BNP>5000 pg/mL were associated with worse survival, while tafamidis treatment was associated with improved survival in patients with IVS≥ 12 mm. DISCUSSION These are the first data describing the characteristics, management, and outcomes of patients with ATTR-CM in Greece, which could influence local guidelines. SHORT TITLE Transthyretin cardiomyopathy in Greece.
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Affiliation(s)
- Dimitrios Bampatsias
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Foteini Theodorakakou
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandros Briasoulis
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Georgiopoulos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Anna Dimoula
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | - Chaido Skiadaresi
- Nuclear Medicine Department, Alexandra General Hospital, Athens, Greece
| | - Pipitsa Valsamaki
- Nuclear Medicine Department, Alexandra General Hospital, Athens, Greece; Nuclear Medicine Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelos Repasos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Petropoulos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Delialis
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Georgios Koutsis
- Neurogenetics Unit, 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Eirini Tselegkidi
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kimon Stamatelopoulos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Efstathios Kastritis
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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13
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Georgiopoulos G, Kraler S, Mueller-Hennessen M, Delialis D, Mavraganis G, Sopova K, Wenzl FA, Räber L, Biener M, Stähli BE, Maneta E, Spray L, Iglesias JF, Coelho-Lima J, Tual-Chalot S, Muller O, Mach F, Frey N, Duerschmied D, Langer HF, Katus H, Roffi M, Camici GG, Mueller C, Giannitsis E, Spyridopoulos I, Lüscher TF, Stellos K, Stamatelopoulos K. Modification of the GRACE Risk Score for Risk Prediction in Patients With Acute Coronary Syndromes. JAMA Cardiol 2023; 8:946-956. [PMID: 37647046 PMCID: PMC10469286 DOI: 10.1001/jamacardio.2023.2741] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023]
Abstract
Importance The Global Registry of Acute Coronary Events (GRACE) risk score, a guideline-recommended risk stratification tool for patients presenting with acute coronary syndromes (ACS), does not consider the extent of myocardial injury. Objective To assess the incremental predictive value of a modified GRACE score incorporating high-sensitivity cardiac troponin (hs-cTn) T at presentation, a surrogate of the extent of myocardial injury. Design, Setting, and Participants This retrospectively designed longitudinal cohort study examined 3 independent cohorts of 9803 patients with ACS enrolled from September 2009 to December 2017; 2 ACS derivation cohorts (Heidelberg ACS cohort and Newcastle STEMI cohort) and an ACS validation cohort (SPUM-ACS study). The Heidelberg ACS cohort included 2535 and the SPUM-ACS study 4288 consecutive patients presenting with a working diagnosis of ACS. The Newcastle STEMI cohort included 2980 consecutive patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Data were analyzed from March to June 2023. Exposures In-hospital, 30-day, and 1-year mortality risk estimates derived from an updated risk score that incorporates continuous hs-cTn T at presentation (modified GRACE). Main Outcomes and Measures The predictive value of continuous hs-cTn T and modified GRACE risk score compared with the original GRACE risk score. Study end points were all-cause mortality during hospitalization and at 30 days and 1 year after the index event. Results Of 9450 included patients, 7313 (77.4%) were male, and the mean (SD) age at presentation was 64.2 (12.6) years. Using continuous rather than binary hs-cTn T conferred improved discrimination and reclassification compared with the original GRACE score (in-hospital mortality: area under the receiver operating characteristic curve [AUC], 0.835 vs 0.741; continuous net reclassification improvement [NRI], 0.208; 30-day mortality: AUC, 0.828 vs 0.740; NRI, 0.312; 1-year mortality: AUC, 0.785 vs 0.778; NRI, 0.078) in the derivation cohort. These findings were confirmed in the validation cohort. In the pooled population of 9450 patients, modified GRACE risk score showed superior performance compared with the original GRACE risk score in terms of reclassification and discrimination for in-hospital mortality end point (AUC, 0.878 vs 0.780; NRI, 0.097), 30-day mortality end point (AUC, 0.858 vs 0.771; NRI, 0.08), and 1-year mortality end point (AUC, 0.813 vs 0.797; NRI, 0.056). Conclusions and Relevance In this study, using continuous rather than binary hs-cTn T at presentation, a proxy of the extent of myocardial injury, in the GRACE risk score improved the mortality risk prediction in patients with ACS.
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Affiliation(s)
- Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Matthias Mueller-Hennessen
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kateryna Sopova
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiovascular Research, European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Florian A. Wenzl
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Swiss Heart Center, Inselspital Bern, Bern, Switzerland
| | - Moritz Biener
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Barbara E. Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Eleni Maneta
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Luke Spray
- Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Juan F. Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jose Coelho-Lima
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Simon Tual-Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Olivier Muller
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - François Mach
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Norbert Frey
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Daniel Duerschmied
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Harald F. Langer
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hugo Katus
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Giovanni G. Camici
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel and University Hospital of Basel, Basel, Switzerland
| | - Evangelos Giannitsis
- Department of Cardiology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ioakim Spyridopoulos
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Royal Brompton and Harefield Hospitals and Imperial College and Kings College, London, United Kingdom
| | - Konstantinos Stellos
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiovascular Research, European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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14
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Theodorakakou F, Briasoulis A, Fotiou D, Petropoulos I, Georgiopoulos G, Lama N, Kelekis N, Repasos E, Migkou M, Stamatelopoulos K, Dimopoulos MA, Kastritis E. Outcomes for patients with systemic light chain amyloidosis and Mayo stage 3B disease. Hematol Oncol 2023; 41:725-732. [PMID: 36974438 DOI: 10.1002/hon.3135] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
Patients with cardiac light chain amyloidosis and Mayo stage 3b disease define a high-risk population with very poor prognosis. Here, we report treatment outcomes of 80 consecutive patients with newly diagnosed AL and Mayo 3b who received novel regimens. Early mortality (<1 month) rate was 12.5%. On intention-to-treat, overall hematologic response rate was 40%, with complete response (CR)/very good partial response (VGPR) in 25% and partial response (PR) in 15%. At 1- and 3- month landmark analysis CR or VGPR/PR rates were 25%/23.5% and 34%/25.5%, respectively. Among patients that were treated with daratumumab-based therapies, 52.6% and 85.7% achieved at least VGPR within one 1 and 3 months, respectively. Three-month cardiac response rate was 11.3% and 6-month was 18.8%. At least hemVGPR at 3 months was associated with cardiac response at 6 months (p = 0.034). Median overall survival (OS) was 6.3 months. At 1-month landmark at least hemPR was associated with better median OS (24.1 vs. 4.9 months, p = 0.017) and at 3-month landmark, at least hemVGPR was associated with a median OS of 40.7 versus 17 months for hemPR and 7.4 months for those without hematologic response (p = 0.028). Cardiac response at 3 months was associated with longer median OS (59.7 vs. 10.9 months, p = 0.044). Factors associated with poorer survival were κ-light chain amyloidosis (median OS 2.9 vs. 7.4 months, p = 0.028), peripheral nerve involvement (3.4 vs. 10.45 months, p = 0.024), systolic blood pressure <90 mmHg (2 vs. 8 months, p = 0.002), baseline LVEF <55% (median OS 3.4 vs. 32 months, p = 0.29) and New York Heart Association (NYHA) class (2.7 months for NYHA 3B-4 vs. 8 months for NYHA 2-3A, p = 0.02). Twenty-one patients (26.3%) received salvage therapy and ORR was 57.1%. Median OS for patients who received second line therapy was 24 months. In conclusion, patients with Mayo 3b disease benefit from early hematologic response but cardiac response rates remain low.
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Affiliation(s)
- Foteini Theodorakakou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Niki Lama
- 2nd Department of Radiology, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Research Unit of Radiology and Medical Imaging, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelos Repasos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Magdalini Migkou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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15
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Mengozzi A, de Ciuceis C, Dell'oro R, Georgiopoulos G, Lazaridis A, Nosalski R, Pavlidis G, Tual-Chalot S, Agabiti-Rosei C, Anyfanti P, Camargo LL, Dąbrowska E, Quarti-Trevano F, Hellmann M, Masi S, Mavraganis G, Montezano AC, Rios FJ, Winklewski PJ, Wolf J, Costantino S, Gkaliagkousi E, Grassi G, Guzik TJ, Ikonomidis I, Narkiewicz K, Paneni F, Rizzoni D, Stamatelopoulos K, Stellos K, Taddei S, Touyz RM, Triantafyllou A, Virdis A. The importance of microvascular inflammation in ageing and age-related diseases: a position paper from the ESH working group on small arteries, section of microvascular inflammation. J Hypertens 2023; 41:1521-1543. [PMID: 37382158 DOI: 10.1097/hjh.0000000000003503] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Microcirculation is pervasive and orchestrates a profound regulatory cross-talk with the surrounding tissue and organs. Similarly, it is one of the earliest biological systems targeted by environmental stressors and consequently involved in the development and progression of ageing and age-related disease. Microvascular dysfunction, if not targeted, leads to a steady derangement of the phenotype, which cumulates comorbidities and eventually results in a nonrescuable, very high-cardiovascular risk. Along the broad spectrum of pathologies, both shared and distinct molecular pathways and pathophysiological alteration are involved in the disruption of microvascular homeostasis, all pointing to microvascular inflammation as the putative primary culprit. This position paper explores the presence and the detrimental contribution of microvascular inflammation across the whole spectrum of chronic age-related diseases, which characterise the 21st-century healthcare landscape. The manuscript aims to strongly affirm the centrality of microvascular inflammation by recapitulating the current evidence and providing a clear synoptic view of the whole cardiometabolic derangement. Indeed, there is an urgent need for further mechanistic exploration to identify clear, very early or disease-specific molecular targets to provide an effective therapeutic strategy against the otherwise unstoppable rising prevalence of age-related diseases.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa
| | - Carolina de Ciuceis
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Raffaella Dell'oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Georgios Georgiopoulos
- Angiology and Endothelial Pathophysiology Unit, Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens
| | - Antonios Lazaridis
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Ryszard Nosalski
- Centre for Cardiovascular Sciences; Queen's Medical Research Institute; University of Edinburgh, University of Edinburgh, Edinburgh, UK
- Department of Internal Medicine
- Center for Medical Genomics OMICRON, Jagiellonian University Medical College, Krakow, Poland
| | - George Pavlidis
- Preventive Cardiology Laboratory and Clinic of Cardiometabolic Diseases, 2 Cardiology Department, Attikon Hospital, Athens
- Medical School, National and Kapodistrian University of Athens, Greece
| | - Simon Tual-Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Panagiota Anyfanti
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Livia L Camargo
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Research Institute of the McGill University Health Centre (RI-MUHC), McGill University, Montreal, Canada
| | - Edyta Dąbrowska
- Department of Hypertension and Diabetology, Center of Translational Medicine
- Center of Translational Medicine
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marcin Hellmann
- Department of Cardiac Diagnostics, Medical University, Gdansk, Poland
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, London, UK
| | - Georgios Mavraganis
- Angiology and Endothelial Pathophysiology Unit, Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens
| | - Augusto C Montezano
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Research Institute of the McGill University Health Centre (RI-MUHC), McGill University, Montreal, Canada
| | - Francesco J Rios
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Research Institute of the McGill University Health Centre (RI-MUHC), McGill University, Montreal, Canada
| | | | - Jacek Wolf
- Department of Hypertension and Diabetology, Center of Translational Medicine
| | - Sarah Costantino
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- University Heart Center, Cardiology, University Hospital Zurich
| | - Eugenia Gkaliagkousi
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Tomasz J Guzik
- Centre for Cardiovascular Sciences; Queen's Medical Research Institute; University of Edinburgh, University of Edinburgh, Edinburgh, UK
- Department of Internal Medicine
- Center for Medical Genomics OMICRON, Jagiellonian University Medical College, Krakow, Poland
| | - Ignatios Ikonomidis
- Preventive Cardiology Laboratory and Clinic of Cardiometabolic Diseases, 2 Cardiology Department, Attikon Hospital, Athens
- Medical School, National and Kapodistrian University of Athens, Greece
| | | | - Francesco Paneni
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- University Heart Center, Cardiology, University Hospital Zurich
- Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
- Division of Medicine, Spedali Civili di Brescia, Montichiari, Brescia, Italy
| | - Kimon Stamatelopoulos
- Angiology and Endothelial Pathophysiology Unit, Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens
| | - Konstantinos Stellos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University
- German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Heidelberg/Mannheim Partner Site
- Department of Cardiology, University Hospital Mannheim, Heidelberg University, Manheim, Germany
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Research Institute of the McGill University Health Centre (RI-MUHC), McGill University, Montreal, Canada
| | - Areti Triantafyllou
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Figliozzi S, Georgiopoulos G, Masci PG. Letter by Figliozzi et al Regarding Article, "The MIDA-Q Mortality Risk Score: A Quantitative Prognostic Tool for the Mitral Valve Prolapse Spectrum". Circulation 2023; 148:978-979. [PMID: 37721976 DOI: 10.1161/circulationaha.123.064780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Stefano Figliozzi
- Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Milan, Italy (S.F.)
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece (G.G.)
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK (G.G., P-G.M.)
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK (G.G., P-G.M.)
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Akyea RK, Ntaios G, Kontopantelis E, Georgiopoulos G, Soria D, Asselbergs FW, Kai J, Weng SF, Qureshi N. A population-based study exploring phenotypic clusters and clinical outcomes in stroke using unsupervised machine learning approach. PLOS Digit Health 2023; 2:e0000334. [PMID: 37703231 PMCID: PMC10499205 DOI: 10.1371/journal.pdig.0000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/19/2023] [Indexed: 09/15/2023]
Abstract
Individuals developing stroke have varying clinical characteristics, demographic, and biochemical profiles. This heterogeneity in phenotypic characteristics can impact on cardiovascular disease (CVD) morbidity and mortality outcomes. This study uses a novel clustering approach to stratify individuals with incident stroke into phenotypic clusters and evaluates the differential burden of recurrent stroke and other cardiovascular outcomes. We used linked clinical data from primary care, hospitalisations, and death records in the UK. A data-driven clustering analysis (kamila algorithm) was used in 48,114 patients aged ≥ 18 years with incident stroke, from 1-Jan-1998 to 31-Dec-2017 and no prior history of serious vascular events. Cox proportional hazards regression was used to estimate hazard ratios (HRs) for subsequent adverse outcomes, for each of the generated clusters. Adverse outcomes included coronary heart disease (CHD), recurrent stroke, peripheral vascular disease (PVD), heart failure, CVD-related and all-cause mortality. Four distinct phenotypes with varying underlying clinical characteristics were identified in patients with incident stroke. Compared with cluster 1 (n = 5,201, 10.8%), the risk of composite recurrent stroke and CVD-related mortality was higher in the other 3 clusters (cluster 2 [n = 18,655, 38.8%]: hazard ratio [HR], 1.07; 95% CI, 1.02-1.12; cluster 3 [n = 10,244, 21.3%]: HR, 1.20; 95% CI, 1.14-1.26; and cluster 4 [n = 14,014, 29.1%]: HR, 1.44; 95% CI: 1.37-1.50). Similar trends in risk were observed for composite recurrent stroke and all-cause mortality outcome, and subsequent recurrent stroke outcome. However, results were not consistent for subsequent risk in CHD, PVD, heart failure, CVD-related mortality, and all-cause mortality. In this proof of principle study, we demonstrated how a heterogenous population of patients with incident stroke can be stratified into four relatively homogenous phenotypes with differential risk of recurrent and major cardiovascular outcomes. This offers an opportunity to revisit the stratification of care for patients with incident stroke to improve patient outcomes.
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Affiliation(s)
- Ralph K. Akyea
- PRISM Research Group, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, St Thomas Hospital, King’s College London, London, United Kingdom
| | - Daniele Soria
- School of Computing, University of Kent, Canterbury, United Kingdom
| | - Folkert W. Asselbergs
- Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
| | - Joe Kai
- PRISM Research Group, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stephen F. Weng
- PRISM Research Group, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nadeem Qureshi
- PRISM Research Group, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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18
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Georgiopoulos G, Delialis D, Aivalioti E, Georgakis V, Mavraganis G, Angelidakis L, Bampatsias D, Armeni E, Maneta E, Patras R, Dimopoulou MA, Oikonomou E, Kanakakis I, Lambrinoudaki I, Lagiou A, Xenos P, Stamatelopoulos K. Implementation of risk enhancers in ASCVD risk estimation and hypolipidemic treatment eligibility: A sex-specific analysis. Hellenic J Cardiol 2023; 73:16-23. [PMID: 36805072 DOI: 10.1016/j.hjc.2023.02.006] [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: 12/01/2022] [Revised: 01/20/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE Sex-specific data are limited regarding eligibility for hypolipidemic treatment. We aim to explore the sex-specific clinical utility of high-sensitivity C-reactive protein (hsCRP) and carotid ultrasound as risk modifiers for hypolipidemic treatment in primary prevention of atherosclerotic cardiovascular disease (ASCVD). METHODS We aimed to explore these sex-specific trends in two pooled contemporary independent Greek cohorts (Athens Vascular Registry n = 698, 50.9% women and Menopause Clinic n = 373, 100% women) of individuals without overt ASCVD. Baseline ASCVD risk was estimated using the Systematic COronary Risk Evaluation-2 (SCORE2) tools. The presence of carotid plaque and hsCRP ≥2 mg/L were integrated as risk modifiers. RESULTS Men had increased odds to achieve target LDL-C levels based on ASCVD risk (23.8% vs. 17.7%, OR: 1.45 95% CI: 1.05-2.00, p = 0.023, for men vs. women). Additionally, considering carotid plaque or high hsCRP levels did not change this association but reduced on-target LDL-C rate in both sexes. Women had decreased odds of being eligible for hypolipidemic treatment by ASCVD risk estimation (11.5% vs. 26.4%, p < 0.001) compared with men. The addition of carotid plaque presence or high hsCRP levels and their combination resulted in a higher relative increase in hypolipidemic treatment eligibility in women (from 11.5% to 70.9% vs. 26.4% to 61.4% for carotid plaque, from 11.5% to 38.5% vs. 26.4% to 50.8% for hsCRP and from 11.5% to 79.1% vs. 26.4% to 75% for their combination, all for women vs. men, pforinteraction < 0.001 for all) than men. CONCLUSIONS Implementation of carotid plaque and hsCRP levels increases hypolipidemic treatment eligibility more prominently in women than in men. The impact on clinical outcomes in these untreated patients merits further investigation.
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Affiliation(s)
- Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Evmorfia Aivalioti
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Vasileios Georgakis
- Department of Statistics and Insurance Science, School of Finance and Statistics, University of Piraeus, Piraeus, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Lasthenis Angelidakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Elena Armeni
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Maria Angeliki Dimopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ermioni Oikonomou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Irene Lambrinoudaki
- Menopause Clinic, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Aretaeio Hospital, Athens, Greece
| | - Areti Lagiou
- Department of Public and Community Health, Faculty of Public Health, University of West Attica, Athens, Greece
| | - Panos Xenos
- Department of Statistics and Insurance Science, School of Finance and Statistics, University of Piraeus, Piraeus, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece.
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19
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Georgiou A, Georgiopoulos G, Delialis D, Maneta E, Masci PG, Neophytou O, Tsiachris D, Evangelou E. Causal Relationship Between Average Alcohol Consumption and Risk of Atrial Fibrillation: A Mendelian Randomization Study. Circ Genom Precis Med 2023; 16:406-408. [PMID: 37191011 DOI: 10.1161/circgen.122.003766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Andrea Georgiou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School (A.G., E.E.)
| | - Georgios Georgiopoulos
- Clinical Therapeutics, National & Kapodistrian University of Athens School of Medicine, Athens, Greece (G.G., D.D., E.M., O.N.)
- School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom (G.G., P.G.M.)
| | - Dimitrios Delialis
- Clinical Therapeutics, National & Kapodistrian University of Athens School of Medicine, Athens, Greece (G.G., D.D., E.M., O.N.)
| | - Eleni Maneta
- Clinical Therapeutics, National & Kapodistrian University of Athens School of Medicine, Athens, Greece (G.G., D.D., E.M., O.N.)
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, Kings College London, United Kingdom (G.G., P.G.M.)
| | - Onisiphoros Neophytou
- Clinical Therapeutics, National & Kapodistrian University of Athens School of Medicine, Athens, Greece (G.G., D.D., E.M., O.N.)
| | | | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School (A.G., E.E.)
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, United Kingdom (E.E.)
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20
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Aimo A, Teis A, Kasa G, Juncà G, Lupón J, Domingo M, Ferrer E, Vallejo N, Cediel G, Codina P, López-Ayerbe J, Georgiopoulos G, Martini N, Emdin M, Bayes-Genís A, Rapezzi C, Delgado V. Left-to-right ventricular volume ratio and outcome in heart failure with preserved ejection fraction. J Cardiovasc Med (Hagerstown) 2023; 24:552-560. [PMID: 37409600 DOI: 10.2459/jcm.0000000000001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Age-specific and gender-specific reference values for left ventricular (LV) and right ventricle volumes are available. The prognostic implications of the ratio between these volumes in heart failure and preserved ejection fraction (HFpEF) have never been evaluated. METHODS We examined all HFpEF outpatients undergoing a cardiac magnetic resonance from 2011 to 2021. The left-to-right ventricular volume ratio (LRVR) was defined as the ratio between the LV and right ventricle end-diastolic volume indexes (LVEDVi/RVEDVi). RESULTS Among 159 patients [median age 58 years (interquartile range 49-69), 64% men, LV ejection fraction 60% (54-70%)] the median LRVR was 1.21 (1.07-1.40). Over 3.5 years (1.5-5.0), 23 patients (15%) experienced all-cause death or heart failure hospitalization, and 22 (14%) cardiovascular death or heart failure hospitalization. The risk of all-cause death or heart failure hospitalization increased with an LRVR less than 1.0 or at least 1.4. An LRVR less than 1.0 was associated with a higher risk of all-cause death or heart failure hospitalization [hazard ratio 5.95, 95% confidence interval (CI) 1.67-21.28; P = 0.006] and cardiovascular death or heart failure hospitalization (hazard ratio 5.68, 95% CI 1.58-20.35; P = 0.008) as compared with LRVR 1.0-1.3. Furthermore, an LRVR at least 1.4 was associated with a higher risk of all-cause death or heart failure hospitalization (hazard ratio 4.10, 95% CI 1.58-10.61; P = 0.004) and cardiovascular death or heart failure hospitalization (hazard ratio 3.71, 95% CI 1.41-9.79; P = 0.008) as compared with LRVR 1.0-1.3. These results were confirmed in patients without dilation of either ventricle. CONCLUSION LRVR values less than 1.0 or at least 1.4 are associated with worse outcomes in HFpEF. LRVR may become a valuable tool for risk prediction in HFpEF.
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Affiliation(s)
- Alberto Aimo
- Scuola Superiore Sant'Anna
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Albert Teis
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
| | - Gizem Kasa
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
| | - Gladys Juncà
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
| | - Josep Lupón
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
| | - Mar Domingo
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
| | - Elena Ferrer
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
| | - Nuria Vallejo
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
| | - Germán Cediel
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
| | - Pau Codina
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
| | | | - Georgios Georgiopoulos
- Scuola Superiore Sant'Anna
- King's College, London, UK
- Cardiology Centre, University of Ferrara, Ferrara
| | - Nicola Martini
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Michele Emdin
- Scuola Superiore Sant'Anna
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Antoni Bayes-Genís
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
- CIBERCV, Carlos III Institute of Health, Madrid
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudio Rapezzi
- King's College, London, UK
- Cardiology Centre, University of Ferrara, Ferrara
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (Ravenna), Italy
| | - Victoria Delgado
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona
- Department of Cardiology, Leiden University Medical Center, the Netherlands
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21
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Anatürk M, Patel R, Ebmeier KP, Georgiopoulos G, Newby D, Topiwala A, de Lange AMG, Cole JH, Jansen MG, Singh-Manoux A, Kivimäki M, Suri S. Development and validation of a dementia risk score in the UK Biobank and Whitehall II cohorts. BMJ Ment Health 2023; 26:e300719. [PMID: 37603383 PMCID: PMC10577770 DOI: 10.1136/bmjment-2023-300719] [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] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/31/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Current dementia risk scores have had limited success in consistently identifying at-risk individuals across different ages and geographical locations. OBJECTIVE We aimed to develop and validate a novel dementia risk score for a midlife UK population, using two cohorts: the UK Biobank, and UK Whitehall II study. METHODS We divided the UK Biobank cohort into a training (n=176 611, 80%) and test sample (n=44 151, 20%) and used the Whitehall II cohort (n=2934) for external validation. We used the Cox LASSO regression to select the strongest predictors of incident dementia from 28 candidate predictors and then developed the risk score using competing risk regression. FINDINGS Our risk score, termed the UK Biobank Dementia Risk Score (UKBDRS), consisted of age, education, parental history of dementia, material deprivation, a history of diabetes, stroke, depression, hypertension, high cholesterol, household occupancy, and sex. The score had a strong discrimination accuracy in the UK Biobank test sample (area under the curve (AUC) 0.8, 95% CI 0.78 to 0.82) and in the Whitehall cohort (AUC 0.77, 95% CI 0.72 to 0.81). The UKBDRS also significantly outperformed three other widely used dementia risk scores originally developed in cohorts in Australia (the Australian National University Alzheimer's Disease Risk Index), Finland (the Cardiovascular Risk Factors, Ageing, and Dementia score), and the UK (Dementia Risk Score). CLINICAL IMPLICATIONS Our risk score represents an easy-to-use tool to identify individuals at risk for dementia in the UK. Further research is required to determine the validity of this score in other populations.
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Affiliation(s)
- Melis Anatürk
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Raihaan Patel
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | | | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Danielle Newby
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Anya Topiwala
- Department of Psychiatry, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, UK
| | - Ann-Marie G de Lange
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Clinical Neurosciences, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Oslo, Oslo, Norway
| | - James H Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Michelle G Jansen
- Donders Centre for Cognition, Donders Institute for Brain, Cognition and Behaviour, Radboud Universiteit, Nijmegen, The Netherlands
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université Paris Cité, Paris, France
- Faculty of Brain Sciences, University College London, London, UK
| | - Mika Kivimäki
- Faculty of Brain Sciences, University College London, London, UK
| | - Sana Suri
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
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22
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Sopova K, Tual-Chalot S, Mueller-Hennessen M, Vlachogiannis NI, Georgiopoulos G, Biener M, Sachse M, Turchinovich A, Polycarpou-Schwarz M, Spray L, Maneta E, Bennaceur K, Mohammad A, Richardson GD, Gatsiou A, Langer HF, Frey N, Stamatelopoulos K, Heineke J, Duerschmied D, Giannitsis E, Spyridopoulos I, Stellos K. Effector T cell chemokine IP-10 predicts cardiac recovery and clinical outcomes post-myocardial infarction. Front Immunol 2023; 14:1177467. [PMID: 37426649 PMCID: PMC10326041 DOI: 10.3389/fimmu.2023.1177467] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 07/11/2023] Open
Abstract
Background and aims Preclinical data suggest that activation of the adaptive immune system is critical for myocardial repair processes in acute myocardial infarction. The aim of the present study was to determine the clinical value of baseline effector T cell chemokine IP-10 blood levels in the acute phase of ST-segment elevation myocardial infarction (STEMI) for the prediction of the left ventricular function changes and cardiovascular outcomes after STEMI. Methods Serum IP-10 levels were retrospectively quantified in two independent cohorts of STEMI patients undergoing primary percutaneous coronary intervention. Results We report a biphasic response of the effector T cell trafficking chemokine IP-10 characterized by an initial increase of its serum levels in the acute phase of STEMI followed by a rapid reduction at 90min post reperfusion. Patients at the highest IP-10 tertile presented also with more CD4 effector memory T cells (CD4 TEM cells), but not other T cell subtypes, in blood. In the Newcastle cohort (n=47), patients in the highest IP-10 tertile or CD4 TEM cells at admission exhibited an improved cardiac systolic function 12 weeks after STEMI compared to patients in the lowest IP-10 tertile. In the Heidelberg cohort (n=331), STEMI patients were followed for a median of 540 days for major adverse cardiovascular events (MACE). Patients presenting with higher serum IP-10 levels at admission had a lower risk for MACE after adjustment for traditional risk factors, CRP and high-sensitivity troponin-T levels (highest vs. rest quarters: HR [95% CI]=0.420 [0.218-0.808]). Conclusion Increased serum levels of IP-10 in the acute phase of STEMI predict a better recovery in cardiac systolic function and less adverse events in patients after STEMI.
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Affiliation(s)
- Kateryna Sopova
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Cardiology, Royal Victoria Infirmary (RVI) and Freeman Hospitals, Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle Upon Tyne, United Kingdom
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
| | - Simon Tual-Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Matthias Mueller-Hennessen
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nikolaos I. Vlachogiannis
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Moritz Biener
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marco Sachse
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
| | - Andrey Turchinovich
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
| | - Maria Polycarpou-Schwarz
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
| | - Luke Spray
- Department of Cardiology, Royal Victoria Infirmary (RVI) and Freeman Hospitals, Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle Upon Tyne, United Kingdom
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Eleni Maneta
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Karim Bennaceur
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Ashfaq Mohammad
- Department of Cardiology, Royal Victoria Infirmary (RVI) and Freeman Hospitals, Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle Upon Tyne, United Kingdom
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Gavin David Richardson
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Aikaterini Gatsiou
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Harald F. Langer
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Norbert Frey
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kimon Stamatelopoulos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Joerg Heineke
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiovascular Physiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ioakim Spyridopoulos
- Translational and Clinical Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Cardiology, Royal Victoria Infirmary (RVI) and Freeman Hospitals, Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Konstantinos Stellos
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Heidelberg/Mannheim, Germany
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Cardiovascular Physiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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23
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Gatsiou A, Tual-Chalot S, Napoli M, Ortega-Gomez A, Regen T, Badolia R, Cesarini V, Garcia-Gonzalez C, Chevre R, Ciliberti G, Silvestre-Roig C, Martini M, Hoffmann J, Hamouche R, Visker JR, Diakos N, Wietelmann A, Silvestris DA, Georgiopoulos G, Moshfegh A, Schneider A, Chen W, Guenther S, Backs J, Kwak S, Selzman CH, Stamatelopoulos K, Rose-John S, Trautwein C, Spyridopoulos I, Braun T, Waisman A, Gallo A, Drakos SG, Dimmeler S, Sperandio M, Soehnlein O, Stellos K. The RNA editor ADAR2 promotes immune cell trafficking by enhancing endothelial responses to interleukin-6 during sterile inflammation. Immunity 2023; 56:979-997.e11. [PMID: 37100060 DOI: 10.1016/j.immuni.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 01/02/2023] [Accepted: 03/30/2023] [Indexed: 04/28/2023]
Abstract
Immune cell trafficking constitutes a fundamental component of immunological response to tissue injury, but the contribution of intrinsic RNA nucleotide modifications to this response remains elusive. We report that RNA editor ADAR2 exerts a tissue- and stress-specific regulation of endothelial responses to interleukin-6 (IL-6), which tightly controls leukocyte trafficking in IL-6-inflamed and ischemic tissues. Genetic ablation of ADAR2 from vascular endothelial cells diminished myeloid cell rolling and adhesion on vascular walls and reduced immune cell infiltration within ischemic tissues. ADAR2 was required in the endothelium for the expression of the IL-6 receptor subunit, IL-6 signal transducer (IL6ST; gp130), and subsequently, for IL-6 trans-signaling responses. ADAR2-induced adenosine-to-inosine RNA editing suppressed the Drosha-dependent primary microRNA processing, thereby overwriting the default endothelial transcriptional program to safeguard gp130 expression. This work demonstrates a role for ADAR2 epitranscriptional activity as a checkpoint in IL-6 trans-signaling and immune cell trafficking to sites of tissue injury.
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Affiliation(s)
- Aikaterini Gatsiou
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; RNA Metabolism and Vascular Inflammation Laboratory, Institute of Cardiovascular Regeneration and Department of Cardiology, JW Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Simon Tual-Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matteo Napoli
- Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine Biomedical Center (BMC), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Almudena Ortega-Gomez
- Institute for Cardiovascular Prevention (IPEK), LMU Munich Hospital, Munich, Germany
| | - Tommy Regen
- Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Rachit Badolia
- Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Valeriana Cesarini
- Department of Pediatric Hematology/Oncology and Cellular and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Raphael Chevre
- Institute for Cardiovascular Prevention (IPEK), LMU Munich Hospital, Munich, Germany; Institute for Experimental Pathology (ExPat), Center for Molecular Biology of Inflammation, WWU Muenster, Muenster, Germany
| | - Giorgia Ciliberti
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
| | - Carlos Silvestre-Roig
- Institute for Cardiovascular Prevention (IPEK), LMU Munich Hospital, Munich, Germany; Institute for Experimental Pathology (ExPat), Center for Molecular Biology of Inflammation, WWU Muenster, Muenster, Germany
| | - Maurizio Martini
- Fondazione Policlinico Universitario "A. Gemelli," IRCCS, UOC Anatomia Patologica, Rome, Italy; Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jedrzej Hoffmann
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Rana Hamouche
- Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joseph R Visker
- Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nikolaos Diakos
- Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Astrid Wietelmann
- Max-Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Domenico Alessandro Silvestris
- Department of Pediatric Hematology/Oncology and Cellular and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece; Translational Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ali Moshfegh
- Kancera AB, Stockholm, Sweden; Department of Oncology and Pathology at Karolinska Institutet, Stockholm, Sweden
| | - Andre Schneider
- Max-Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Wei Chen
- Department of Biology, Southern University of Science and Technology, Shenzhen, Guangdong, China; Medi-X Institute, SUSTech Academy for Advanced Interdisciplinary Studies, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Stefan Guenther
- Max-Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Johannes Backs
- Institute of Experimental Cardiology, University Hospital Heidelberg, Heidelberg, Germany; German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Heidelberg/Mannheim Partner Site, Heidelberg and Mannheim, Germany
| | - Shin Kwak
- Department of Molecular Neuropathogenesis, Tokyo Medical University, Tokyo, Japan
| | - Craig H Selzman
- Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece; Translational Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stefan Rose-John
- Institute of Biochemistry, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Christian Trautwein
- Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Ioakim Spyridopoulos
- Translational Research Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas Braun
- Max-Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Ari Waisman
- Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Angela Gallo
- Department of Pediatric Hematology/Oncology and Cellular and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stavros G Drakos
- Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah School of Medicine, Salt Lake City, UT, USA; Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stefanie Dimmeler
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, JW Goethe University Frankfurt, Frankfurt am Main, Germany; German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Frankfurt Partner Site, Germany
| | - Markus Sperandio
- Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine Biomedical Center (BMC), Ludwig-Maximilians-Universität München, Munich, Germany; German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Munich Heart Alliance Partner Site, Munich, Germany
| | - Oliver Soehnlein
- Institute for Cardiovascular Prevention (IPEK), LMU Munich Hospital, Munich, Germany; Institute for Experimental Pathology (ExPat), Center for Molecular Biology of Inflammation, WWU Muenster, Muenster, Germany; German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Munich Heart Alliance Partner Site, Munich, Germany; Department of Physiology and Pharmacology (FyFa), Karolinska Institutet, Stockholm, Sweden
| | - Konstantinos Stellos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; RNA Metabolism and Vascular Inflammation Laboratory, Institute of Cardiovascular Regeneration and Department of Cardiology, JW Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany; German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Heidelberg/Mannheim Partner Site, Heidelberg and Mannheim, Germany; Cardio-Pulmonary Institute (CPI), Frankfurt am Main, Germany.
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Kosmopoulos M, Liatsou Ε, Theochari C, Stavropoulos A, Chatzopoulou D, Mylonas KS, Georgiopoulos G, Schizas D. Updates on the Global Prevalence and Etiology of Constrictive Pericarditis: A Systematic Review. Cardiol Rev 2023; Publish Ahead of Print:00045415-990000000-00075. [PMID: 36883817 DOI: 10.1097/crd.0000000000000529] [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: 03/09/2023]
Abstract
Constrictive pericarditis is a rare disease with poorly understood epidemiology. A systematic literature search was adopted to assess the region- and period-specific traits of constrictive pericarditis through Pubmed, EMBASE, and Scopus. Case reports and studies including less than 20 patients were excluded. The risk of bias was assessed through the Study Quality Assessment Tools developed by the National Heart Lung Blood Institute by 4 reviewers. Patient demographics, disease etiology, and mortality were the primary assessed outcomes. One hundred thirty studies with 11,325 patients have been included in this systematic review and meta-analysis. The age at diagnosis of constrictive pericarditis has markedly increased after 1990. Patients from Africa and Asia are considerably younger compared with those from Europe and North America. Moreover, there are differences in etiology, as tuberculosis remains the dominant cause of constrictive pericarditis in Africa and Asia but has been surpassed by history of previous chest surgery in North America and Europe. The human immunodeficiency virus affects 29.1% of patients from Africa diagnosed with constrictive pericarditis, a feature that is not observed on any other continent. The early mortality rate after hospitalization has improved. The variances of age at diagnosis and etiology of constrictive pericarditis should be considered by the clinician during the work-up of cardiac and pericardial diseases. An underlying human immunodeficiency virus infection complicates a significant portion of constrictive pericarditis cases in Africa. Early mortality has improved across the world but remains high.
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Affiliation(s)
- Marinos Kosmopoulos
- From the Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Εfstathia Liatsou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Christina Theochari
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Thoracic Diseases General Hospital Sotiria, Athens, Greece
| | - Amalia Stavropoulos
- Department of Medicine, Internal Medicine, North Bristol NHS Trust, Bristol, United Kingdom
| | - Despoina Chatzopoulou
- Department of Surgery, General Surgery, Frimley Health NHS Trust, Frimley, Surrey, United Kingdom
| | | | - Georgios Georgiopoulos
- Department of Therapeutics, National and Kapodistrian University of Athens - Faculty of Medicine, Alexandra Hospital
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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25
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Akyea RK, Iyen B, Georgiopoulos G, Kai J, Qureshi N, Ntaios G. Cardiovascular outcomes and mortality after incident ischaemic stroke in patients with a recent cancer history. Eur J Intern Med 2023; 109:50-57. [PMID: 36549951 DOI: 10.1016/j.ejim.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Up to 10% of patients with ischaemic stroke have comorbid cancer and stroke in these patients is thought to have a poor short-term prognosis. There is little known about the long-term cardiovascular morbidity and mortality outcomes after incident ischaemic stroke in patients with recent cancer history. OBJECTIVE To assess the risk of subsequent cardiovascular morbidity and mortality outcomes in patients with an incident ischaemic stroke and recent cancer history. METHODS Patients aged ≥18 years with an incident ischaemic stroke between 1998 and 2017, with any diagnosis of cancer within 12 months before the stroke event, and no prior history of serious vascular event were identified from UK Clinical Practice Research Datalink (CPRD GOLD) linked to Hospital Episode Statistics (HES) data. To minimize selection bias, these patients were propensity-score matched with patients with incident ischaemic stroke and no history of cancer. Propensity-score matching was done using covariates such as demographic data, vascular risk factors, comorbid conditions, and prescribed medication. Multivariable models (Competing risks and Cox regression) were used to determine the risk of subsequent major adverse cardiovascular event (MACE) outcomes and all-cause mortality. RESULTS Our cohort included 22,460 patients with a median age of 75 (IQR 64-83) years and a follow-up of 12.3 (IQR 7.2-16.7) years. Recent cancer was identified in 1,149 patients (5.1%) at the time of incident ischaemic stroke. The patients with recent cancer history had a lower risk of composite MACE (sub-distribution hazard ratio (SHR) 0.83 [95% CI: 0.75-0.92]) and recurrent stroke (SHR 0.85 95% CI:0.75-0.96]) and a higher risk of all-cause mortality (hazard ratio 1.67 [95% CI:1.47-1.91]). The risk of coronary heart disease, peripheral vascular disease, heart failure, and CVD-related death outcomes did not differ significantly between the groups. CONCLUSIONS After incident ischaemic stroke, patients with recent cancer history have a lower risk of composite MACE and recurrent stroke outcomes but a higher risk of all-cause mortality when compared with patients without a prior history of cancer.
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Affiliation(s)
- Ralph K Akyea
- Primary Care Stratified Medicine, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Barbara Iyen
- Primary Care Stratified Medicine, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, St Thomas Hospital, King's College London, London, United Kingdom
| | - Joe Kai
- Primary Care Stratified Medicine, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nadeem Qureshi
- Primary Care Stratified Medicine, Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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26
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Marto JP, Strambo D, Ntaios G, Nguyen TN, Herzig R, Czlonkowska A, Demeestere J, Mansour OY, Salerno A, Wegener S, Baumgartner P, Cereda CW, Bianco G, Beyeler M, Arnold M, Carrera E, Machi P, Altersberger V, Bonati L, Gensicke H, Bolognese M, Peters N, Wetzel S, Magriço M, Ramos JN, Sargento-Freitas J, Machado R, Maia C, Machado E, Nunes AP, Ferreira P, Pinho e Melo T, Dias MC, Paula A, Correia MA, Castro P, Azevedo E, Albuquerque L, Alves JN, Ferreira-Pinto J, Meira T, Pereira L, Rodrigues M, Araujo AP, Rodrigues M, Rocha M, Pereira-Fonseca Â, Ribeiro L, Varela R, Malheiro S, Cappellari M, Zivelonghi C, Sajeva G, Zini A, Gentile M, Forlivesi S, Migliaccio L, Sessa M, La Gioia S, Pezzini A, Sangalli D, Zedde M, Pascarella R, Ferrarese C, Beretta S, Diamanti S, Schwarz G, Frisullo G, Marcheselli S, Seners P, Sabben C, Escalard S, Piotin M, Maïer B, Charbonnier G, Vuillier F, Legris L, Cuisenier P, Vodret FR, Marnat G, Liegey JS, Sibon I, Flottmann F, Broocks G, Gloyer NO, Bohmann FO, Schaefer JH, Nolte C, Audebert HJ, Siebert E, Sykora M, Lang W, Ferrari J, Mayer-Suess L, Knoflach M, Gizewski ER, Stolp J, Stolze LJ, Coutinho JM, Nederkoorn P, van den Wijngaard I, De Meris J, Lemmens R, De Raedt S, Vandervorst F, Rutgers MP, Guilmot A, Dusart A, Bellante F, Calleja-Castaño P, Ostos F, González-Ortega G, Martín-Jiménez P, García-Madrona S, Cruz-Culebras A, Vera R, Matute MC, Fuentes B, Alonso-de-Leciñana M, Rigual R, Díez-Tejedor E, Perez-Sanchez S, Montaner J, Díaz-Otero F, Pérez-de-la-Ossa N, Flores-Pina B, Muñoz-Narbona L, Chamorro A, Rodríguez-Vázquez A, Renú A, Ayo-Martin O, Hernández-Fernández F, Segura T, Tejada-Meza H, Sagarra-Mur D, Serrano-Ponz M, Hlaing T, See I, Simister R, Werring D, Kristoffersen ES, Nordanstig A, Jood K, Rentzos A, Šimůnek L, Krajíčková D, Krajina A, Mikulik R, Cviková M, Vinklárek J, Školoudík D, Roubec M, Hurtikova E, Hrubý R, Ostry S, Skoda O, Pernicka M, Jurak L, Eichlová Z, Jíra M, Kovar M, Panský M, Mencl P, Palouskova H, Tomek A, Janský P, Olšerová A, Sramek M, Havlicek R, Malý P, Trakal L, Fiksa J, Slovák M, Karlinski MA, Nowak M, Sienkiewicz-Jarosz H, Bochynska A, Wrona P, Homa T, Sawczynska K, Slowik A, Wlodarczyk E, Wiacek M, Tomaszewska-Lampart I, Sieczkowski B, Bartosik-Psujek H, Bilik M, Bandzarewicz A, Dorobek M, Zielinska-Turek J, Nowakowska-Kotas M, Obara K, Urbanowski P, Budrewicz S, Guziński M, Świtońska M, Rutkowska I, Sobieszak-Skura P, Labuz-Roszak BM, Debiec A, Staszewski J, Stępień A, Zwiernik J, Wasilewski G, Tiu C, Terecoasă EO, Radu RA, Negrila A, Dorobat B, Panea C, Tiu V, Petrescu S, Ozdemir A, Mahmoud M, El-Samahy H, Abdelkhalek H, Al-Hashel J, Ismail II, Salmeen A, Ghoreishi A, Sabetay SI, Gross H, Klein P, Abdalkader M, Jabbour P, El Naamani K, Tjoumakaris S, Abbas R, Mohamed GA, Chebl A, Min J, Hovingh M, Tsai JP, Khan M, Nalleballe K, Onteddu S, Masoud H, Michael M, Kaur N, Maali L, Abraham MG, Khandelwal P, Bach I, Ong M, Babici D, Khawaja AM, Hakemi M, Rajamani K, Cano-Nigenda V, Arauz A, Amaya P, Llanos N, Arango A, Vences MÁ, Barrientos Guerra JD, Caetano R, Martins RT, Scollo SD, Yalung PM, Nagendra S, Gaikwad A, Seo KD, Georgiopoulos G, Nogueira RG, Michel P. Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry. Neurology 2023; 100:e739-e750. [PMID: 36351814 PMCID: PMC9969910 DOI: 10.1212/wnl.0000000000201537] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION The study was registered under ClinicalTrials.gov identifier NCT04895462.
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Affiliation(s)
- João Pedro Marto
- Department of Neurology (J.P.M., M.M.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Stroke Centre (D.S., A.S., P.M.), Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Switzerland; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology, Radiology (T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Department of Neurology (R.H., L.S., D.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; 2nd Department of Neurology (A.C., M.A.K., M.N.), Institute of Psychiatry and Neurology, Warsaw, Poland; Neurology Department (J.D., R.L.), Leuven University Hospital, Belgium; Alexandria University Hospitals and Affiliated Stroke Network (O.Y.M.), Egypt; Department of Neurology (S.W., P.B.), University Hospital of Zurich, Switzerland; Stroke Center (C.W.C., G.B.), Neurocenter of Southern Switzerland, EOC, Lugano; Stroke Center (M.B, M.A.), Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland; Stroke Centre (E.C.), Geneva University Hospital, Switzerland; Department of Neuroradiology (P.M.), Geneva University Hospital, Switzerland; Stroke Centre (V.A, L.B., H.G.), University Hospital Basel and University of Basel, Switzerland; Stroke Centre (M.B.), Kantonsspital Lucerne, Switzerland; Stroke Centre (N.P., S.W.), Hirslanden Hospital, Zurich, Switzerland; Department of Neuroradiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Department of Neurology (J.S.-F., R.M., C.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Department of Neuroradiology (E.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Stroke Unit (A.P.N., P.F.), Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Stroke Unit (T.P.e.M., M.C.D., A.P.), Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neuroradiology (M.A.C.), Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neurology (P.C., E.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Department of Neuroradiology (L.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Departments of Neurology (J.N.A., J.F.-P.), and Neuroradiology (T.M.), Hospital de Braga, Portugal; Department of Neurology (L.P., M.R.), Hospital Garcia de Orta, Almada, Portugal; Department of Neuroradiology (A.P.A., M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (A.P.-F, L.R.), Unidade Local de Saúde de Matosinhos, Portugal; Department of Neurology (R.V., S.M.), Centro Hospitalar Universitário do Porto, Portugal; Stroke Unit (M.C., C.Z.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z., M.G., S.F., L.M.), Department of Neurology and Stroke Centre, Maggiore Hospital, Bologna, Italy; Department of Neurology (M.S., S.L.G.), ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology and Stroke Unit (D.S.), Azienda Socio Sanitaria Territoriale, Lecco, Italy; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Department of Neurology (C.F., S.B., S.D.), San Gerardo Hospital, Department of Medicine and Surgery and Milan Centre for Neuroscience, University of Milano Bicocca, Monza, Italy; Stroke Unit (G.S.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Neurology (G.F.), Policlinico Universitario Agostino Gemelli, Rome, Italy; Emergency Neurology and Stroke Unit (S.M.), IRCCS Humanitas Clinical and Research Center, Rozzano, Italy; Department of Neurology (C.S., S.E.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (M.P., B.M.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (G.C., F.V.), Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France; Neurology (F.L., P.C, F.R.V.), Stroke Unit, Centre Hospitalier Universitaire, Grenoble Alpes, France; Department of Interventional and Diagnostic Neuroradiology (J.-S.L., I.S.), Bordeaux University Hospital, France; Department of Diagnostic and Interventional Neuroradiology (F.F, G.B., N.-O.G.), University Medical Center-Hamburg-Eppendorf, Germany; Department of Neurology (F.O.B., J.H.S.), University Hospital Frankfurt, Goethe University, Germany; Department of Neurology and Centre for Stroke Research (H.J.A.), Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Germany; Department of Neuroradiology (E.S.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.S, W.L., J.F.), St. John's Hospital, Vienna, Austria; Departments of Neurology (L.M.-S., M.K.), and Neuroradiology (E.R.G.), Medical University of Innsbruck, Austria; Department of Neurology (J.S., L.J.S., J.M.C.), Amsterdam University Medical Centers, Netherlands; Department of Neurology (I.v.d.W., J.d.M.), Haaglanden Medical Centre, Hague and Department of Radiology, Leiden University Medical Centre, Netherlands; Department of Neurology (S.D.R., F.V.), Universitair Ziekenhuis Brussel, Centre for Neurosciences, Vrije Universiteit Brussel, Belgium; Department of Neurology (M.P.R, A.G.), Stroke Unit, Europe Hospitals, Brussels, Belgium; Department of Neurology (A.D., F.B.), Centre Hospitalier Universitaire de Charleroi, Belgium; Department of Neurology and Stroke Centre (P.C.-C., F.O., P.M.-J.), Hospital Universitario de OctubreInstituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Neurology and Stroke Centre (A.C.-C., R.V., M.C.M.), Hospital Universitario Ramón y Cajal, Ramon y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Department of Neurology and Stroke (B.F, M.A.d.L., R.R., E.D.D.), Centre Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain; Department of Neurology (S.P.-S., J.M.), Hospital Universitario Virgen Macarena, Seville, Spain; Stroke Centre (F.D-.O.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Stroke Unit (B.F.-P., J.M.-N.), Germans Trias Hospital, Barcelona, Spain; Department of Neurology (A.C, A.R.-V., A.R), Comprehensive Stroke Centre, Hospital Clinic from Barcelona, Spain; Department of Neurology (O.A.-M, F.H.-F.), Complejo Hospitalario Universitario de Albacete; Stroke Unit (H.T.-M.), Department of Neurology, and Interventional Neuroradiology Unit, Hospital Universitario Miguel Servet, Spain; Stroke Unit (D.S.-M, M.F.P.), Department of Neurology, Hospital Universitario Miguel Servet, Spain; Stroke and Geriatric Medicine (T.H.), Aintree University Hospital, United Kingdom; Comprehensive Stroke Service (I.S., R.S.), University College London Hospitals NHS Foundation Trust and Stroke Research Centre, University College London, United Kingdom.; University College London (D.W.), Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology (E.S.K.), Akershus University Hospital, Lørenskog and Department of General Practice, University of Oslo, Norway; Department of Clinical Neuroscience (A.N, K.J.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology (A.N, K.J.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.R.), Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg and Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; International Clinical Research Centre (R.M., M.C., J.V.) and Department of Neurology, St. Anne´s University Hospital and Faculty of Medicine at Masaryk University, Brno, Czech Republic; Center for Health Research (D.S., M.R, E.H.), Faculty of Medicine, University of Ostrava, Czech Republic; Department of Neurology (R.H, S.V.), České Budějovice Hospital, Czech Republic; Department of Neurology (O.S., M.P.), Jihlava Hospital, Czech Republic; Neurocenter (L.J., Z.E., M.J.), Regional Hospital Liberec, Czech Republic; Cerebrovascular Centre (M.K., M.P., P.M.), Na Homolce Hospital, Prague, Czech Republic; Department of Neurology (H.P.), Karviná Miners Hospital Inc., Czech Republic; Cerebrovascular Centre (A.T, P.J, A.O.), University Hospital in Motol, Prague, Czech Republic; Cerebrovascular Centre (M.S., R.H, P.M., L.T.), Central Military Hospital, Prague, Czech Republic; Cerebrovascular Centre (J.F., M.S.), General University Hospital, Prague, Czech Republic; 1th Department of Neurology (H.S.-J, A.B.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (P.W, T.H., K.S., A.S), University Hospital, Jagiellonian University, Cracow, Poland; Department of Neurology (M.W., L.T.-L., B.S.), Institute of Medical Sciences, Medical College of Rzeszow University, Poland; Department of Neurology and Stroke (M.B, A.B.), St. John Paul II Western Hospital, Grodzisk Mazowiecki, Poland; Department of Neurology (M.D, J.Z.), Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland; Departments of Neurology (M.N.-K., K.O., P.U.), and Radiology (M.G.), Wroclaw Medical University, Poland; Department of Neurosurgery and Neurology (M.S.), Nicolaus Copernicus University in Torun Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland; Stroke Intervention Centre (I.R., P.S.-S.), Department of Neurosurgery and Neurology, Jan Biziel University Hospital, Bydgoszcz, Poland; Department of Neurology (B.M.L.-R.), Institute of Medical Sciences, University of Opole, Poland; Clinic of Neurology (A.D., J.S., A.S.), Military Institute of Medicine, Warsaw, Poland; Department of Neurology (J.Z.), University of Warmia and Mazury, Olsztyn, Poland; Department of Radiology (C.W.), Provincial Specialist Hospital, Olsztyn, Poland; Department of Neurology (C.T., E.O.T., R.A.R., A.N.), University Emergency Hospital Bucharest, University of Medicine and Pharmacy "Carol Davila", Romania; Department of Radiology (B.D.), University Emergency Hospital Bucharest, Romania; Department of Neurology and Stroke Unit (C.P, V.T, S.P.), Elias University Emergency Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Neurology (A.O.), Eskisehir Osmangazi University, Turkey; Ain Shams University Affiliated Saudi German Hospital (M.M., H.E.-S.), Egypt; Neuropsychiatry Department (H.A.), Tanta University, Egypt; Department of Neurology (J.A.-H.), Ibn Sina Hospital, Kuwait; Department of Neurology (I.I.I.), Jaber Al-Ahmad Hospital, Kuwait; Department of Neurology (A.G.), School of Medicine, Zanjan University of Medical Sciences, Iran; Stroke Unit (S.I.S.), Neurology Department, Hillel Yaffe Medical Center, Hadera, Israel; Department of Neurosurgery (P.J., K.E.N, S.T., R.A.), Thomas Jefferson University Hospital, PA; Departments of Radiology (G.A.M., P.G.N.), Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, GA; Department of Neurology (A.C.), Henry Ford Hospital, Detroit, MI; Comprehensive Stroke Centre and Department of Neurosciences (J.M., M.H., M.K.), Spectrum Health and Michigan State University; Department of Neurology (K.N., S.O.), University of Arkansas for Medical Sciences, Little Rock, AR; Department of Neurology (M.K.), Upstate University Hospital, NY; Department of Neurology (L.M., M.G.A.), University of Kansas Medical Centre; Endovascular Neurological Surgery and Neurology (P.K., I.B, M.O., M.B.), Rutgers, The State University of New Jersey, Newark; Department of Neurology (A.M.K.), Wayne State University, Detroit Medical Center, MI; Stroke Clinic (V.C.-N, A.A.), Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico; Department of Neurology (P.A.), Fundación Valle del Lili, Cali, Colombia; Centro de Investigaciones Clínicas (N.L., A.A.), Fundación Valle del Lili, Cali, Colombia; Department of Neurology (M.A.V.), Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Péru; Hospital General San Juan de Dios (J.D.B.G.), Guatemala; Department of Neurology (R.C., R.T.M.), Hospital Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil; Ramos Mejía Hospital (S.D.S.), Stroke Unit, Buenos Aires, Argentina; St. Luke's Medical Center (P.M.Y.), Global City, Philippines; Department of Neurology (S.N., A.G.), Grant Medical College and Sir JJ Hospital, Mumbai, India; Department of Neurology (K.-D.S.), National Health Insurance Service Ilsan Hospital, Goyang, Korea; School of Biomedical Engineering and Imaging Sciences (G.G.), St Thomas Hospital, King's College London, UK; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece.
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Georgiopoulos G, Makris N, Laina A, Theodorakakou F, Briasoulis A, Trougakos IP, Dimopoulos MA, Kastritis E, Stamatelopoulos K. Cardiovascular Toxicity of Proteasome Inhibitors: Underlying Mechanisms and Management Strategies: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2023; 5:1-21. [PMID: 36875897 PMCID: PMC9982226 DOI: 10.1016/j.jaccao.2022.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023] Open
Abstract
Proteasome inhibitors (PIs) are the backbone of combination treatments for patients with multiple myeloma and AL amyloidosis, while also indicated in Waldenström's macroglobulinemia and other malignancies. PIs act on proteasome peptidases, causing proteome instability due to accumulating aggregated, unfolded, and/or damaged polypeptides; sustained proteome instability then induces cell cycle arrest and/or apoptosis. Carfilzomib, an intravenous irreversible PI, exhibits a more severe cardiovascular toxicity profile as compared with the orally administered ixazomib or intravenous reversible PI such as bortezomib. Cardiovascular toxicity includes heart failure, hypertension, arrhythmias, and acute coronary syndromes. Because PIs are critical components of the treatment of hematological malignancies and amyloidosis, managing their cardiovascular toxicity involves identifying patients at risk, diagnosing toxicity early at the preclinical level, and offering cardioprotection if needed. Future research is required to elucidate underlying mechanisms, improve risk stratification, define the optimal management strategy, and develop new PIs with safe cardiovascular profiles.
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Key Words
- ACE, angiotensin-converting enzyme
- ACS, acute coronary syndrome
- AE, adverse event
- AF, atrial fibrillation
- ARB, angiotensin receptor blocker
- ASCT, autologous stem cell transplantation
- BP, blood pressure
- CVAE, cardiovascular adverse event
- ESC, European Society of Cardiology
- FMD, flow-mediated dilatation
- GLS, global longitudinal strain
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- IHD, ischemic heart disease
- IMiD, immunomodulatory drug
- Kd, carfilzomib and dexamethasone
- LA, left atrial
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MM, multiple myeloma
- NO, nitric oxide
- NP, natriuretic peptide
- OS, overall survival
- PBMC, peripheral blood mononuclear cell
- PFS, progression-free survival
- PH, pulmonary hypertension
- PI, proteasome inhibitor
- PWV, pulse wave velocity
- PrA, proteasome activity
- RRMM, relapse or refractory multiple myeloma
- SBP, systolic blood pressure
- TMA, thrombotic microangiopathy
- UPP, ubiquitin proteasome pathway
- VTE, venous thromboembolism
- Vd, bortezomib and dexamethasone
- WM, Waldenström’s macroglobulinemia
- bortezomib
- cardiovascular toxicity
- carfilzomib
- eNOS, endothelial nitric oxide synthase
- ixazomib
- proteasome inhibition
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Affiliation(s)
- Georgios Georgiopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Nikolaos Makris
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ageliki Laina
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Trougakos
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens, Greece
| | | | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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28
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Vergaro G, Castiglione V, Aimo A, Prontera C, Masotti S, Musetti V, Nicol M, Cohen Solal A, Logeart D, Georgiopoulos G, Chubuchny V, Giannoni A, Clerico A, Buda G, Patel KN, Razvi Y, Patel R, Wechalekar A, Lachmann H, Hawkins PN, Passino C, Gillmore J, Emdin M, Fontana M. N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T hold diagnostic value in cardiac amyloidosis. Eur J Heart Fail 2023; 25:335-346. [PMID: 36597836 DOI: 10.1002/ejhf.2769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/20/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023] Open
Abstract
AIMS Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated. This study aimed to evaluate the diagnostic performance for CA of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT). METHODS AND RESULTS Patients with suspected CA (n = 1149) underwent a diagnostic work-up in three centres in Italy, France (n = 343, derivation cohort), and United Kingdom (n = 806, validation cohort). Biomarker values with either 100% sensitivity or ≥95% specificity were selected as rule-out/rule-in cut-offs, respectively. In the derivation cohort, 227 patients (66%) had CA, and presented with higher NT-proBNP and hs-TnT. NT-proBNP 180 ng/L and hs-TnT 14 ng/L were selected as rule-out cut-offs, and hs-TnT 86 ng/L as rule-in cut-off. NT-proBNP <180 ng/L or hs-TnT <14 ng/L were found in 7% of patients, and ruled out CA without false negatives. In the validation cohort, 20% of patients (2% false negatives) had NT-proBNP <180 ng/L or hs-TnT <14 ng/L, and 10% showed both biomarkers below cut-offs (0.5% false negatives). These cut-offs refined CA prediction when added to echocardiographic scores in patients with a haematologic disease or an increased wall thickness. In the validation cohort, the 86 ng/L hs-TnT cut-off ruled in 20% of patients (2% false positives). NT-proBNP and hs-TnT cut-offs retained their rule-out and rule-in performance also in cohorts with CA prevalence of 20%, 10%, 5% and 1% derived from the original cohort through bootstrap analysis. CONCLUSIONS Cardiac biomarkers can refine the diagnostic algorithm in patients with suspected CA. NT-proBNP <180 ng/L and hs-TnT <14 ng/L reliably exclude the diagnosis, both in the overall population and subgroups referred for either AL-CA or cardiac (pseudo)hypertrophy.
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Affiliation(s)
- Giuseppe Vergaro
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Alberto Aimo
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | - Martin Nicol
- Cardiology Department, Hôpital Lariboisière, Paris, France
| | | | - Damien Logeart
- Cardiology Department, Hôpital Lariboisière, Paris, France
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Alberto Giannoni
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Aldo Clerico
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Gabriele Buda
- Hematology Department, University of Pisa, Pisa, Italy
| | - Kiara N Patel
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Yousuf Razvi
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Rishi Patel
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Ashutosh Wechalekar
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Helen Lachmann
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Claudio Passino
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Julian Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Michele Emdin
- 'Health Science' Interdisciplinary Research Center, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
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29
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Figliozzi S, Georgiopoulos G, Lopes PM, Bauer KB, Moura-Ferreira S, Tondi L, Mushtaq S, Censi S, Pavon AG, Bassi I, Servato ML, Teske AJ, Biondi F, Filomena D, Pica S, Torlasco C, Muraru D, Monney P, Quattrocchi G, Maestrini V, Agati L, Monti L, Pedrotti P, Vandenberk B, Squeri A, Lombardi M, Ferreira AM, Schwitter J, Aquaro GD, Chiribiri A, Rodríguez Palomares JF, Yilmaz A, Andreini D, Florian A, Leiner T, Abecasis J, Badano LP, Bogaert J, Masci PG. Myocardial Fibrosis at Cardiac MRI Helps Predict Adverse Clinical Outcome in Patients with Mitral Valve Prolapse. Radiology 2023; 306:112-121. [PMID: 36098639 DOI: 10.1148/radiol.220454] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Patients with mitral valve prolapse (MVP) may develop adverse outcomes even in the absence of mitral regurgitation or left ventricular (LV) dysfunction. Purpose To investigate the prognostic value of mitral annulus disjunction (MAD) and myocardial fibrosis at late gadolinium enhancement (LGE) cardiac MRI in patients with MVP without moderate-to-severe mitral regurgitation or LV dysfunction. Materials and Methods In this longitudinal retrospective study, 118 144 cardiac MRI studies were evaluated between October 2007 and June 2020 at 15 European tertiary medical centers. Follow-up was from the date of cardiac MRI examination to June 2020; the minimum and maximum follow-up intervals were 6 months and 156 months, respectively. Patients were excluded if at least one of the following conditions was present: cardiomyopathy, LV ejection fraction less than 40%, ischemic heart disease, congenital heart disease, inflammatory heart disease, moderate or worse mitral regurgitation, participation in competitive sport, or electrocardiogram suggestive of channelopathies. In the remainder, cardiac MRI studies were reanalyzed, and patients were included if they were aged 18 years or older, MVP was diagnosed at cardiac MRI, and clinical information and electrocardiogram monitoring were available within 3 months from cardiac MRI examination. The end point was a composite of adverse outcomes: sustained ventricular tachycardia (VT), sudden cardiac death (SCD), or unexplained syncope. Multivariable Cox regression analysis was performed. Results A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 women) were included. Over a median follow-up of 3.3 years, 18 patients (4%) reached the study end point. LGE presence (hazard ratio, 4.2 [95% CI: 1.5, 11.9]; P = .006) and extent (hazard ratio, 1.2 per 1% increase [95% CI: 1.1, 1.4]; P = .006), but not MAD presence (P = .89), were associated with clinical outcome. LGE presence had incremental prognostic value over MVP severity and sustained VT and aborted SCD at baseline (area under the receiver operating characteristic curve, 0.70 vs 0.62; P = .03). Conclusion In contrast to mitral annulus disjunction, myocardial fibrosis determined according to late gadolinium enhancement at cardiac MRI was associated with adverse outcome in patients with mitral valve prolapse without moderate-to-severe mitral regurgitation or left ventricular dysfunction. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Gerber in this issue.
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Affiliation(s)
- Stefano Figliozzi
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Georgios Georgiopoulos
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Pedro M Lopes
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Klemens B Bauer
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Sara Moura-Ferreira
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Lara Tondi
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Saima Mushtaq
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Stefano Censi
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Anna Giulia Pavon
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Ilaria Bassi
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Maria Luz Servato
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Arco J Teske
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Federico Biondi
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Domenico Filomena
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Silvia Pica
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Camilla Torlasco
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Denisa Muraru
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Pierre Monney
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Giuseppina Quattrocchi
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Viviana Maestrini
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Luciano Agati
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Lorenzo Monti
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Patrizia Pedrotti
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Bert Vandenberk
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Angelo Squeri
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Massimo Lombardi
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - António M Ferreira
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Juerg Schwitter
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Giovanni Donato Aquaro
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Amedeo Chiribiri
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - José F Rodríguez Palomares
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Ali Yilmaz
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Daniele Andreini
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Anca Florian
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Tim Leiner
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - João Abecasis
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Luigi Paolo Badano
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Jan Bogaert
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
| | - Pier-Giorgio Masci
- From the Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy (S.F., L.M.); School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, Westminster Bridge Rd, London SE1 7EH, England (S.F., G.G., A.C., P.G.M.); Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece (G.G.); Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Lisbon, Portugal (P.M.L., A.M.F., J.A.); Department of Cardiology, University Hospital Muenster, Muenster, Germany (K.B.B., A.Y., A.F.); Department of Radiology, Gasthuisberg University Hospital, Leuven, Belgium (S.M.F., B.V., J.B.); Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Italy (L.T., S.P., M.L.); Department of Cardiovascular Imaging, Radiology and Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, Milan, Italy (S.M., D.A.); GVM Care&Research, Maria Cecilia Hospital, Cotignola, Italy (S.C., A.S.); Center for Cardiac MRI, Lausanne University Hospital, Lausanne, Switzerland (A.G.P., P.M., J.S.); Cardiologia-4, Dipartimento Cardio-toraco-vascolare A. De Gasperis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (I.B., G.Q., P.P.); Department of Cardiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain (M.L.S., J.F.R.P.); Centro de Investigación Biomédica en Red-CV, Barcelona, Spain (M.L.S., J.F.R.P.); Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands (A.J.T., T.L.); Unità Operativa Imaging Multimodale Cardiovascolare e Neuroradiologico, Fondazione CNR/Regione Toscana G. Monasterio, Pisa, Italy (F.B., G.D.A.); Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.F., V.M., L.A.); Institute of Sport Medicine, CONI, Rome, Italy (D.F., V.M.); Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy (C.T., D.M., L.P.B.); Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy (D.M., L.P.B.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy (D.A.)
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Delialis D, Dimopoulou MA, Papaioannou M, Kotsira G, Maneta E, Mavraganis G, Loutos C, Georgiopoulos G, Stamatelopoulos K. PCSK9 Inhibition in Atherosclerotic Cardiovascular Disease. Curr Pharm Des 2023; 29:1802-1824. [PMID: 37055909 DOI: 10.2174/1381612829666230412105238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 04/15/2023]
Abstract
Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) represent a novel class of hypolipidemic drugs, providing an additional therapeutic option over conventional hypolipidemic treatments. Given the constantly lowering recommended LDL-C goals, low goal achievement rate and low compliance with treatment, new hypolipidemic drug classes may substantially contribute to residual risk reduction for atherosclerotic cardiovascular disease (ASCVD). This review aims to summarize contemporary evidence on the clinical role of PCSK9i in ASCVD prevention. PubMed and MEDLINE databases were searched for keywords in studies on PCSK9i and ASCVD. Approved PCSK9i are the monoclonal antibodies (Mabs), evolocumab and alirocumab, targeting PCSK9, and inclisiran, a small interfering RNA inhibiting PSCK9 synthesis. Overall, PCSK9i effectively reduced LDL-C and other atherogenic lipoproteins, including apolipoprotein B and lipoprotein( a) primarily. PSCK9i Mabs improved imaging markers reflecting coronary atherosclerotic plaque vulnerability and reduced ASCVD events in high-risk patients after short-term treatment (< 3 years follow-up). They are currently indicated as a third-line treatment for secondary prevention and primary prevention in patients with familial hypercholesterolemia at high risk of not achieving their LDL-C goals. Patients with higher baseline ASCVD risk receive greater benefits from PCSK9i. Recent evidence suggests that evolocumab was effective and safe after long-term treatment. Ongoing trials investigate new therapeutic indications for PCSK9i while their cost-effectiveness is still being considered. PCSK9i is a novel hypolipidemic drug class currently indicated for reducing residual risk in secondary ASCVD prevention and high-risk patients.
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Affiliation(s)
- Dimitrios Delialis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Maria-Angeliki Dimopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Maria Papaioannou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Georgia Kotsira
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christos Loutos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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31
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Georgiopoulos G, Figliozzi S, Pateras K, Nicoli F, Bampatsias D, Beltrami M, Finocchiaro G, Chiribiri A, Masci PG, Olivotto I. Comparison of Demographic, Clinical, Biochemical, and Imaging Findings in Hypertrophic Cardiomyopathy Prognosis: A Network Meta-Analysis. JACC Heart Fail 2023; 11:30-41. [PMID: 36599547 DOI: 10.1016/j.jchf.2022.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite hypertrophic cardiomyopathy (HCM) being the most common inherited heart disease and conferring increased risk for heart failure (HF) and sudden cardiac death (SCD), risk assessment in HCM patients is still largely unresolved. OBJECTIVES This study aims to synthesize and compare the prognostic impact of demographic, clinical, biochemical, and imaging findings in patients with HCM. METHODS The authors searched PubMed, Embase, and Cochrane Library for studies published from 1955 to November 2020, and the endpoints were: 1) all-cause death; 2) an arrhythmic endpoint including SCD, sustained ventricular tachycardia, ventricular fibrillation, or aborted SCD; and 3) a composite endpoint including (1) or (2) plus hospitalization for HF or cardiac transplantation. The authors performed a pairwise meta-analysis obtaining the pooled estimate separately for the association between baseline variables and study endpoints. A random-effects network meta-analysis was subsequently used to comparatively assess the prognostic value of outcome associates. RESULTS A total of 112 studies with 58,732 HCM patients were included. Among others, increased brain natriuretic peptide/N-terminal pro-B-type natriuretic peptide, late gadolinium enhancement (LGE), positive genotype, impaired global longitudinal strain, and presence of apical aneurysm conferred increased risk for the composite endpoint. At network meta-analysis, LGE showed the highest prognostic value for all endpoints and was superior to all other associates except New York Heart Association functional class >class II. A multiparametric imaging-based model was superior in predicting the composite endpoint compared to a prespecified model based on conventional risk factors. CONCLUSIONS This network meta-analysis supports the development of multiparametric risk prediction algorithms, including advanced imaging markers additively to conventional risk factors, for refined risk stratification in HCM. (Long-term prognosis of hypertrophic cardiomyopathy according to genetic, clinical, biochemical and imaging findings: a systemic review and meta-analysis; CRD42020185219).
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Affiliation(s)
- Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom; Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece.
| | | | - Konstantinos Pateras
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece
| | - Matteo Beltrami
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children's Hospital and Careggi University Hospital, Florence, Italy
| | - Gherardo Finocchiaro
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children's Hospital and Careggi University Hospital, Florence, Italy.
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Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R, Leonardi-Bee J, Fernandez E, Carnicer-Pont D, Vestbo J, Semenza JC, Deogan C, Suk JE, Kramarz P, Lamb F, Penttinen P. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. Eur Respir Rev 2022; 31:220098. [PMID: 36323422 PMCID: PMC9724816 DOI: 10.1183/16000617.0098-2022] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. METHODS We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients. FINDINGS We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease. INTERPRETATION The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Dolors Carnicer-Pont
- Catalan Institute of Oncology, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), Barcelona, Spain
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Piotr Kramarz
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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Georgiopoulos G, Mavraganis G, Aimo A, Giorgetti A, Cavaleri S, Fabiani I, Giannoni A, Emdin M, Gimelli A. Sex-specific associations of myocardial perfusion imaging with outcomes in patients with suspected chronic coronary syndrome. Hellenic J Cardiol 2022; 71:8-15. [PMID: 36566838 DOI: 10.1016/j.hjc.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Myocardial perfusion scintigraphy (MPS) is an established diagnostic technique for inducible ischemia in patients with suspected chronic coronary syndrome (CCS). Some MPS findings, most notably an ischemia extent>10% of the left ventricle (LV), hold prognostic significance and support maximization of anti-ischemic treatment. We aimed to assess sex-specific associations of MPS findings with cardiovascular (CV) events in a population at high risk of CCS. METHODS In a prospective cohort study, 1,229 consecutive patients (age 70 ± 9.5 years, 73.5% males) without known CCS were referred to stress-rest MPS. All patients were followed for a median of 4.6 years for CV events. RESULTS Men and women had comparable risk profiles and incidence rates of CV events (6.6% vs. 4.6% respectively, P = 0.186). A summed stress score (SSS) > 7 was associated with the primary endpoint, including CV death and/or nonfatal myocardial infarction (MI) (adjusted hazard ratio [HR], 3.13; 95% confidence interval [CI], 1.79-5.46; P = 0.001), all-cause mortality (HR, 3.01; 95% CI, 1.31-6.93; P = 0.01), and incidence of late revascularization (HR, 1.84; 95% CI, 1.22-2.78; P = 0.004) in men but not women. A summed difference score (SDS) > 6 was related to a higher rate of the primary endpoint only in men (adjusted HR, 1.97; 95% CI, 1.18-3.30; P = 0.009). CONCLUSIONS Among patients undergoing a diagnostic workup for suspected CCS, stress perfusion and reversible ischemia abnormalities may independently predict worse survival and more CV events in men. However, the obtained results indicated the need for sex-specific cutoffs to refine risk stratification and assist in clinical decisions on anti-ischemic therapy beyond coronary artery anatomy.
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Affiliation(s)
- Georgios Georgiopoulos
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy; Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Vasilissis Sofias 80 str, 11528, Athens, Greece; School of Biomedical Engineering and Imaging Sciences, King's College, Strand, London WC2R 2LS, London, UK.
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Vasilissis Sofias 80 str, 11528, Athens, Greece
| | - Alberto Aimo
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy; Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Assuero Giorgetti
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Samuele Cavaleri
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Iacopo Fabiani
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Michele Emdin
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy; Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
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Aimo A, Fabiani I, Giannoni A, Mandoli GE, Pastore MC, Vergaro G, Spini V, Chubuchny V, Pasanisi EM, Petersen C, Poggianti E, Taddei C, Castiglione V, Latrofa S, Panichella G, Sciaccaluga C, Georgiopoulos G, Passino C, Cameli M, Emdin M. Multi-chamber speckle tracking imaging and diagnostic value of left atrial strain in cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2022; 24:130-141. [PMID: 35292807 DOI: 10.1093/ehjci/jeac057] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 07/27/2021] [Accepted: 03/04/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Cardiac amyloidosis (CA) affects the four heart chambers, which can all be evaluated through speckle-tracking echocardiography (STE). METHODS AND RESULTS We evaluated 423 consecutive patients screened for CA over 5 years at two referral centres. CA was diagnosed in 261 patients (62%) with either amyloid transthyretin (ATTR; n = 144, 34%) or amyloid light-chain (AL; n = 117, 28%) CA. Strain parameters of all chambers were altered in CA patients, particularly those with ATTR-CA. Nonetheless, only peak left atrial longitudinal strain (LA-PALS) displayed an independent association with the diagnosis of CA or ATTR-CA beyond standard echocardiographic variables and cardiac biomarkers (Model 1), or with the diagnosis of ATTR-CA beyond the validated IWT score in patients with unexplained left ventricular (LV) hypertrophy. Patients with the most severe impairment of LA strain were those most likely to have CA or ATTR-CA. Specifically, LA-PALS and/or LA-peak atrial contraction strain (PACS) in the first quartile (i.e. LA-PALS <6.65% and/or LA-PACS <3.62%) had a 3.60-fold higher risk of CA, and a 3.68-fold higher risk of ATTR-CA beyond Model 1. Among patients with unexplained LV hypertrophy, those with LA-PALS or LA-PACS in the first quartile had an 8.76-fold higher risk for CA beyond Model 1, and a 2.04-fold higher risk of ATTR-CA beyond the IWT score. CONCLUSIONS Among STE measures of the four chambers, PALS and PACS are the most informative ones to diagnose CA and ATTR-CA. Patients screened for CA and having LA-PALS and/or LA-PACS in the first quartile have a high likelihood of CA and ATTR-CA.
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Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy.,Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy.,Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy.,Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Valentina Spini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Vladyslav Chubuchny
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Emilio Maria Pasanisi
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Christina Petersen
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Elisa Poggianti
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudia Taddei
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Vincenzo Castiglione
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy
| | - Sara Latrofa
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy
| | - Giorgia Panichella
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy
| | - Carlotta Sciaccaluga
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Georgios Georgiopoulos
- School of Biomedical Engineering & Imaging Sciences, King's College London, St. Thomas' Hospital Campus, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy.,Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124 Pisa, Italy.,Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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35
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Beltrami M, Olivotto I, Figliozzi S, Pateras K, Niccoli F, Bampatsias D, Finocchiaro G, Chiribiri A, Masci PG, Georgiopoulos G. 983 COMPARISON OF DEMOGRAPHIC, CLINICAL, BIOCHEMICAL AND IMAGING AND IMAGING FINDINGS IN HYPERTROPHIC CARDIOMYOPATHY PROGNOSIS: A NETWORK META-ANALYSES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Despite hypertrophic cardiomyopathy (HCM) being the most common inherited heart disease and conferring increased risk for heart failure (HF) and sudden cardiac death (SCD), risk assessment in HCM patients is still largely unresolved.
Objective
To synthesize and compare the prognostic impact of demographic, clinical, biochemical, and imaging findings in patients with HCM.
Methods
We searched PubMed, Embase, and Cochrane Library for studies published from inception to November 2020, and the endpoints were: i) all-cause death; ii) an arrhythmic endpoint including SCD, sustained ventricular tachycardia, ventricular fibrillation, or aborted SCD; iii) a composite endpoint including i) or ii) plus hospitalization for HF or cardiac transplantation. We performed a pairwise meta-analysis obtaining the pooled estimate separately for the association between baseline variables and study endpoints. A random-effects network meta-analysis (NMA) was subsequently used to comparatively assess the prognostic value of outcome predictors.
Results
One-hundred-eleven studies with 56,792 HCM patients were included. Among others, increased BNP/NT-proBNP, late-gadolinium-enhancement (LGE), positive genotype, impaired global longitudinal strain and presence of apical aneurysm conferred increased risk for the composite endpoint. At NMA, LGE showed the highest prognostic value for all endpoints and was superior to all other predictors except NYHA class≥II. A multiparametric imaging-based model was superior in predicting the composite endpoint compared to a pre-specified model based on conventional risk factors.
Conclusions
This network meta-analysis supports the development of multiparametric risk prediction algorithms, including advanced imaging markers additively to conventional risk factors, for refined risk stratification in HCM.
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Affiliation(s)
- Matteo Beltrami
- San Giovanni Di Dio Hospital, Florence, Cardiomyopathy Unit, University Of Florence
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36
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Castiglione V, Aimo A, Prontera C, Masotti S, Musetti V, Nicol M, Cohen-solal A, Logeart D, Georgiopoulos G, Chubuchny V, Giannoni A, Clerico A, Buda G, Patel KN, Razvi Y, Patel R, Wechalekar A, Lachman H, Hawkins PN, Passino C, Gillmore J, Emdin M, Fontana M, Vergaro G. 490 NT-PROBNP AND HIGH-SENSITIVITY TROPONIN T HOLD DIAGNOSTIC VALUE IN CARDIAC AMYLOIDOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Cardiac amyloidosis (CA) is associated with an elevation of natriuretic peptides and troponins, predicting outcome. Nevertheless, the diagnostic yield of these biomarkers has not been extensively investigated.
Aim
To evaluate the diagnostic performance for CA of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT).
Methods
Patients with suspected CA (n=1,149) underwent a diagnostic work-up in 3 Centers in Italy, France (n=343, derivation cohort), and United Kingdom (n=806, validation cohort). Biomarker values with either 100% sensitivity or ≥95% specificity were selected as rule-out/rule-in cut-offs, respectively.
Results
In the derivation cohort, 227 patients (66%) had CA, and presented with higher NT-proBNP and hs-TnT. NT-proBNP 180 ng/L and hs-TnT 14 ng/L were selected as rule-out cut-offs, and hs-TnT 86 ng/L as rule-in cut-off. NT-proBNP <180 ng/L or hs-TnT <14 ng/L were found in 7% of patients, ruled out without false negatives. In the validation cohort, 20% of patients (2% false negatives) had NT-proBNP <180 ng/L or hs-TnT <14 ng/L, and 10% showed both biomarkers below cut-offs (0.5% false negatives). These cut-offs refined CA prediction when added to echocardiographic scores in patients with a hematologic disease or an increased wall thickness. In the validation cohort, the 86 ng/L hs-TnT cut-off ruled in 20% of patients (2% false positives).
Conclusions
Cardiac biomarkers can refine the diagnostic algorithm in patients with suspected CA. NT-proBNP <180 ng/L and hs-TnT <14 ng/L reliably exclude the diagnosis (Figure), both in the overall population and subgroups referred for either AL-CA or cardiac (pseudo)hypertrophy.
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Affiliation(s)
- Vincenzo Castiglione
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Cardiology Division, University Of Pisa - Pisa - Italy
| | - Alberto Aimo
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | | | | | - Veronica Musetti
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Martin Nicol
- Hopital Lariboisiere, Cardiology Department - Paris - France
| | | | - Damien Logeart
- Hopital Lariboisiere, Cardiology Department - Paris - France
| | - Georgios Georgiopoulos
- School Of Biomedical Engineering And Imaging Sciences , King’s College - London - United Kingdom
- Department Of Clinical Therapeutics, National And Kapodistrian University Of Athens - Athens - Greece
| | | | - Alberto Giannoni
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Aldo Clerico
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Gabriele Buda
- Haematology Department, University Of Pisa - Pisa - Italy
| | - Kiara N Patel
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Yousuf Razvi
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Rishi Patel
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Ashutosh Wechalekar
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Helen Lachman
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Claudio Passino
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Julian Gillmore
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Michele Emdin
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London - London - United Kingdom
| | - Giuseppe Vergaro
- Health Science Interdisciplinary Research Center , Scuola Superiore Sant’anna - Pisa - Italy
- Fondazione Toscana Gabriele Monasterio - Pisa - Italy
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37
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Figliozzi S, Georgiopoulos G, Stankowski KM, Camporeale A, Pieroni M. 1080 EFFECTS OF ENZYME REPLACEMENT THERAPY ON CMR PARAMETERS IN PATIENTS WITH FABRY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Cardiovascular death is the leading cause of mortality in patients affected by Fabry Disease (FD). Cardiac magnetic resonance (CMR) is the gold-standard imaging modality to assess FD heart involvement and enzyme replacement therapy (ERT) has the potential to slow or revert FD organ involvement and dysfunction. However, the effect of ERT on cardiac disease progression remains undefined. Thus, we performed a systematic review and meta-analysis to assess the impact of ERT on CMR parameters in FD patients.
Methods
Data search was conducted from inception through June 1, 2022, using the following Medical Subject Heading terms: “Fabry Disease” AND (“Cardiac MRI” OR “Cardiac Magnetic Resonance” OR “Cardiovascular Magnetic Resonance” OR “CMR”) AND (“ERT” OR “Enzyme Replacement Therapy”. Studies were included if contemplated FD patients undergoing baseline and follow-up CMR after ERT. Pre-defined study outcomes were the change of i) left ventricular wall mass (LVM; grams); ii) LVM indexed (grams/mq); iii) maximum left ventricular wall thickness (MLVWT, mm), iv) Late gadolinium enhancement (LGE; % of LVM) and v) native-T1 mapping (msec) between baseline and follow-up CMR. The study protocol was registered in the PROSPERO database (CRD42022336223).
Results
Ten studies including 517 FD patients were included. Between baseline and follow-up CMR, there was a significant decrease in LVM (pooled hazard ratio: -19.5 grams [95% CIs, -34.3; -4.63]), LVM indexed (-2.84 grams/mq [95% CIs, -5.24; -0.44]), MLVWT (-0.96 mm [95% CIs -1.9; -0.02]), and an increase in LGE (0.8% [95% CIs, 0.47; 1.14). T1-mapping did not significantly change (pooled hazard ratio: 6.12 msec [95% CIs -2.39; 14.62]). There was publication bias in LVM (Egger test: p-value = 0.047) but not in LVM index, MLVWT, T1-mapping and LGE.
Conclusion
In a pooled-analysis including 427 FD patients treated with ERT undergoing baseline and follow-up CMR, there was a significant decrease in LVM, LVM indexed, and LVMWT. In contrast, there was an increase in LGE extent whereas native-T1 mapping values did not significantly change.
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38
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Cirillo C, Nakou E, Georgiopoulos G, Tountas C, Victor K, Marvaki A, Desai N, Fisher R, Ryan M, Demir OM, Corcoran E, O'Gallagher K, Sinclair H, Pericao A, Dhariwal A, Stylianidis V, Hua A, Nabeebaccus AA, Pearson P, Fonseca T, Osborne A, Toth E, Zuckerman M, Shah AM, Perera D, Monaghan M, Carr-White G, Papachristidis A. Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study. BMJ Open 2022; 12:e059358. [PMID: 36456009 PMCID: PMC9716800 DOI: 10.1136/bmjopen-2021-059358] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the relationship of echocardiographic parameters, laboratory findings and clinical characteristics with in-hospital mortality in adult patients with COVID-19 admitted to the intensive care units (ICU) in two large collaborating tertiary UK centres. DESIGN Observational retrospective study. SETTING The study was conducted in patients admitted to the ICU in two large tertiary centres in London, UK. PARTICIPANTS Inclusion criteria were: (1) patients admitted to the ICU with a COVID-19 diagnosis over a period of 16 weeks. and (2) underwent a transthoracic echocardiogram on the first day of ICU admission as clinically indicated.No exclusion criteria applied.Three hundred patients were enrolled and completed the follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome measure in this study was in-hospital mortality in patients admitted to the ICU with COVID-19 infection. RESULTS Older age (HR: 1.027, 95% CI 1.007 to 1.047; p=0.008), left ventricular (LV) ejection fraction<35% (HR: 5.908, 95% CI 2.609 to 13.376; p<0.001), and peak C reactive protein (CRP) (HR: 1.002, 95% CI 1.001 to 1.004, p=0.001) were independently correlated with mortality in a multivariable Cox regression model. Following multiple imputation of variables with more than 5% missing values, random forest analysis was applied to the imputed data. Right ventricular (RV) basal diameter (RVD1), RV mid-cavity diameter (RVD2), tricuspid annular plane systolic excursion, RV systolic pressure, hypertension, RV dysfunction, troponin level on admission, peak CRP, creatinine level on ICU admission, body mass index and age were found to have a high relative importance (> 0.7). CONCLUSIONS In patients with COVID-19 in the ICU, both severely impaired LV function and impaired RV function may have adverse prognostic implications, but older age and inflammatory markers appear to have a greater impact. A combination of echocardiographic and laboratory investigations as well as demographic and clinical characteristics appears appropriate for risk stratification in patients with COVID-19 who are admitted to the ICU.
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Affiliation(s)
- Chiara Cirillo
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eleni Nakou
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Christos Tountas
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Kelly Victor
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Apostolia Marvaki
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nishita Desai
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard Fisher
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Ozan M Demir
- Cardiovascular Division, King's College London, London, UK
| | - Eleanor Corcoran
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Kevin O'Gallagher
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Hannah Sinclair
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ana Pericao
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anender Dhariwal
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Alina Hua
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Adam Abner Nabeebaccus
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Peter Pearson
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Tiago Fonseca
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Osborne
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Eva Toth
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Mark Zuckerman
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Ajay M Shah
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, British Heart Foundation Centre, London, UK
| | - Divaka Perera
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Mark Monaghan
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Gerald Carr-White
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Alexandros Papachristidis
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
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39
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Aimo A, Merlo M, Porcari A, Georgiopoulos G, Pagura L, Vergaro G, Sinagra G, Emdin M, Rapezzi C. Redefining the epidemiology of cardiac amyloidosis. A systematic review and meta-analysis of screening studies. Eur J Heart Fail 2022; 24:2342-2351. [PMID: 35509173 PMCID: PMC10084346 DOI: 10.1002/ejhf.2532] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [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: 12/28/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS An algorithm for non-invasive diagnosis of amyloid transthyretin cardiac amyloidosis (ATTR-CA) and novel disease-modifying therapies have prompted an active search for CA. We examined the prevalence of CA in different settings based on literature data. METHODS AND RESULTS We performed a systematic search for screening studies on CA, focusing on the prevalence, sex and age distribution in different clinical settings. The prevalence of CA in different settings was as follows: bone scintigraphy for non-cardiac reasons (n = 5 studies), 1% (95% confidence interval [CI] 0%-1%); heart failure with preserved ejection fraction (n = 6), 12% (95% CI 6%-20%); heart failure with reduced or mildly reduced ejection fraction (n = 2), 10% (95% CI 6%-15%); conduction disorders warranting pacemaker implantation (n = 1), 2% (95% CI 0%-4%); surgery for carpal tunnel syndrome (n = 3), 7% (95% CI 5%-10%); hypertrophic cardiomyopathy phenotype (n = 2), 7% (95% CI 5%-9%); severe aortic stenosis (n = 7), 8% (95% CI 5%-13%); autopsy series of 'unselected' elderly individuals (n = 4), 21% (95% CI 7%-39%). The average age of CA patients in the different settings ranged from 74 to 90 years, and the percentage of men from 50% to 100%. Many patients had ATTR-CA, but the average percentage of patients with amyloid light-chain (AL) CA was up to 18%. CONCLUSIONS Searching for CA in specific settings allows to identify a relatively high number of cases who may be eligible for treatment if the diagnosis is unequivocal. ATTR-CA accounts for many cases of CA across the different settings, but AL-CA is not infrequent. Median age at diagnosis falls in the eighth or ninth decades, and many patients diagnosed with CA are women.
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Affiliation(s)
- Alberto Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marco Merlo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Aldostefano Porcari
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Georgios Georgiopoulos
- Scuola Superiore Sant'Anna, Pisa, Italy.,School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital Campus, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Linda Pagura
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Giuseppe Vergaro
- Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Gianfranco Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Michele Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudio Rapezzi
- Cardiology Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, (RA), Italy
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Delialis D, Mavraganis G, Dimoula A, Patras R, Dimopoulou AM, Sianis A, Ajdini E, Maneta E, Kokras N, Stamatelopoulos K, Georgiopoulos G. A systematic review and meta-analysis on the effect of selective serotonin reuptake inhibitors on endothelial function. J Affect Disord 2022; 316:71-75. [PMID: 35944740 DOI: 10.1016/j.jad.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/16/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022]
Abstract
AIMS Depression and atherosclerotic cardiovascular disease (ASCVD) are commonly clustered in affected patients. Endothelial dysfunction is an early marker of ASCVD while also reported in patients with depression. Emerging evidence suggests that selective serotonin receptor inhibitors (SSRIs) may improve endothelial function. However, clinical studies assessing flow-mediated dilation (FMD), the gold-standard method to evaluate conduit artery endothelial function, in response to SSRIs treatment included limited number of patients and did not provide consistent results. In the present study we aim to evaluate the effect of SSRIs treatment on endothelial function assessed by longitudinal changes in FMD. METHODS AND RESULTS We performed a systematic review to retrieve and subsequently meta-analyze eligible studies in patients with depression who received SSRIs and had available measurements of FMD change before and after treatment. In 5 studies and 323 individuals in total, SSRIs were associated with increased FMD at the end of follow-up compared to baseline measurement (pooled mean change 1.97 %, 95 % CI 0.17, 3.77, P = 0.032, I2 = 87.4 %). These results did not substantially change when analysis was restricted to patients with history of atherosclerotic cardiovascular disease (ASCVD). Similarly, FMD changes were higher in individuals receiving SSRIs compared to not-treated subjects (pooled mean difference 2.5 %. 95 % CI 0.7, 4.2, P < 0.001, I2 = 82.7 %). LIMITATIONS Substantial heterogeneity regarding with respect to follow-up duration, demographics, and SSRIs agents. CONCLUSION SSRIs significantly improve FMD, the gold-standard marker of endothelial function. Further investigation is warranted for the role of FMD as a possible therapeutic biomarker in patients with depression and established or subclinical ASCVD. PROSPERO REGISTRATION CRD42021252241.
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Affiliation(s)
- Dimitrios Delialis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Anna Dimoula
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Angeliki-Maria Dimopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandros Sianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Erold Ajdini
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Kokras
- First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece; Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK.
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41
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Mavraganis G, Dimopoulou MA, Delialis D, Bampatsias D, Patras R, Sianis A, Maneta E, Stamatelopoulos K, Georgiopoulos G. Clinical implications of vascular dysfunction in acute and convalescent COVID-19: A systematic review. Eur J Clin Invest 2022; 52:e13859. [PMID: 35986716 PMCID: PMC9539033 DOI: 10.1111/eci.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/10/2022] [Accepted: 08/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accumulating evidence suggests that endothelial dysfunction is implicated in the pathogenesis and severity of coronavirus disease 2019 (COVID-19). In this context, vascular impairment in COVID-19 might be associated with clinical manifestations and could refine risk stratification in these patients. METHODS This systematic review aims to synthesize current evidence on the frequency and the prognostic value of vascular dysfunction during acute and post-recovery COVID-19. After systematically searching the MEDLINE, clinicaltrials.gov and the Cochrane Library from 1 December 2019 until 05 March 2022, we identified 24 eligible studies with laboratory confirmed COVID-19 and a thorough examination of vascular function. Flow-mediated dilation (FMD) was assessed in 5 and 12 studies in acute and post-recovery phase respectively; pulse wave velocity (PWV) was the marker of interest in three studies in the acute and four studies in the post-recovery phase. RESULTS All studies except for one in the acute and in the post-recovery phase showed positive association between vascular dysfunction and COVID-19 infection. Endothelial dysfunction in two studies and increased arterial stiffness in three studies were related to inferior survival in COVID-19. DISCUSSION Overall, a detrimental effect of COVID-19 on markers of endothelial function and arterial stiffness that could persist even for months after the resolution of the infection and provide prognostic value was congruent across published studies. Further research is warranted to elucidate clinical implications of this association.
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Affiliation(s)
- Georgios Mavraganis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Maria-Angeliki Dimopoulou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Raphael Patras
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandros Sianis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Eleni Maneta
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.,Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
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42
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Georgiopoulos G, Delialis D, Aimo A. Inflammation in heart failure: causal determinant or bystander? J Cardiovasc Med (Hagerstown) 2022; 23:736-737. [DOI: 10.2459/jcm.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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43
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Patras R, Georgiopoulos G, Petropoulos I, Theodorakakou F, Delialis D, Angelidakis L, Gavriatopoulou M, Dimopoulou MA, Sianis A, Maneta E, Neofytou O, Terpos E, Dimopoulos MA, Kastritis E, Stamatelopoulos K. Sustained vasodilation after cold pressor test is an independent predictor of poor survival in primary AL amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1790] [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
Primary AL amyloidosis is a rare yet lethal systemic disorder. Dysfunction of the autonomous nervous system due to disease-related nerve infiltration is a common manifestation of AL amyloidosis. Previously published own work indicated that AL patients present sustained paradoxical vasodilation in response to sympathetic stimulus, as assessed by cold pressor test (CPT). The clinical relevance of this finding is unknown.
Purpose
We sought to investigate the relationship between CPT-induced vascular response and mortality in AL amyloidosis.
Methods
We consecutively recruited 97 newly diagnosed patients with AL amyloidosis. CPT of the brachial artery was performed before treatment initiation. All measurements were assessed using high resolution ultrasonography (14.0Mhz multifrequency linear array probe, Vivid 7 Pro; General Electric Healthcare, Milwaukee, Wisconsin, USA). The maximum vasodilation of the brachial artery was measured during the sympathetic stimulus and 3 minutes after withdrawal (sustained response). All-cause mortality was defined as the primary end-point of the study.
Results
Mean age was 66 years with prevalence of male gender. Sustained vasodilation (but not vasodilation during CPT) was associated with heart failure, NYHA stage, BNP and peripheral vascular involvement (p<0.05 for all). Sustained vasodilation after withdrawal of the sympathetic stimulus was significantly associated with mortality as assessed by Cox regression analysis (HR: 1.149, 95% CI 1.042–1.269, p=0.005). This association remained significant after adjustment for age, sex, systolic blood pressure (SBP), nerve involvement and Mayo stage (HR: 1.123, 95% CI 1.014–1.243, p=0.026). A sustained vasodilation ≥3.35% from pre-stimulus diameter was associated with shorter survival (log-rank test, p=0.022, Figure 1). No association between vasodilation during sympathetic stress and mortality was observed.
Conclusions
In AL amyloidosis, sustained paradoxical vasodilation in response to sympathetic stimulus was associated with poor survival. The clinical utility of this index of vascular autonomic dysfunction as a potential prognostic and therapeutic biomarker in AL amyloidosis merits further investigation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Patras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - F Theodorakakou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M Gavriatopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M A Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Terpos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M A Dimopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Kastritis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
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Simistiras A, Delialis D, Georgiopoulos G, Bampatsias D, Maneta E, Dimoula A, Petropoulos I, Neofytou O, Oikonomou E, Kontogiannis C, Ioannou S, Miliotou A, Kanakakis I, Evangelou E, Stamatelopoulos K. Lp(a) is not associated with arterial stiffness: a Mendelian randomization study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2310] [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
Deeper understanding of the potential causal relationship between Lp(a) and vascular injury will provide further insight to related pathways to be monitored and targeted by emerging treatments. Accumulating evidence supports the causal association of lipoprotein(a) [Lp(a)] with cardiovascular disease and calcific aortic valve disease (AVD). Arterial stiffening is mechanistically linked with cardiovascular disease and AVD severity. We hypothesized that Lp(a) may be causally associated with pulse-wave velocity (PWV) as the gold-standard marker of arterial stiffness.
Aim
To investigate the potential causal association of Lp(a) levels with PWV.
Methods
We performed a two sample Mendelian randomization (MR) analysis of LP(a) on PWV by combining the summary data of two independent Genetic-Wide Association Study (GWASs). Genetic variants associated with Lp(a) were retrieved from the UK Biobank (N=220,497). A GWAS based on a cohort in Germany (N=7,000) was used to obtain genetic associations for PWV index (outcome). We assessed two different measures of arterial stiffness, brachial ankle (baPWV) and carotid femoral pulse (cfPWV) wave velocity. In total, we used 170 SNPs as Instrument Variables (IV's) and applied a two sample MR with the main technique of Inverse Variance Weighting method (IVW). We conducted sensitivity analyses (MR-Egger and Median based) to detect pleiotropy of the causal variants and to test for robustness of our findings.
Results
Our analyses based on all 170 SNP's did not find evidence for causal relationship between Lp(a) and PWV for neither measurement [bivw (baPWV) = −0.0005, CI (−0.0043, 0.0034), P=0.8 and bivw (cfPWV) = −0.006, CI (−0.013, 0.002), P=0.16 for brachial ankle and carotid-femoral PWV, respectively]. Sensitivity analyses, including weighted median and mode-based estimation, did not show significant association of Lp (a) with neither baPWV nor cfPWV.
Conclusions
Lp(a) is not causally associated with arterial stiffness. These findings suggest that arterial stiffening is not involved Lp(a)-mediated cardiovascular and aortic valve disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Simistiras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Oikonomou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - C Kontogiannis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - S Ioannou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Miliotou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Evangelou
- University of Ioannina Medical School, Department of Hygiene and Epidemiology , Ioannina , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
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45
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Mavraganis G, Georgiopoulos G, Sakelliou A, Delialis D, Patras R, Sianis A, Dimopoulou AM, Oikonomou E, Athanasopoulos S, Kanakakis I, Fatouros I, Mitrakou A, Stamatelopoulos K. Protective effect of N-acetyl cysteine on vascular function of young individuals after a bout of resistance exercise: a randomized placebo-controlled study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
High intensity resistance exercise may temporarily induce vascular dysfunction mediated by pro-oxidant and pro-inflammatory pathways. Whether antioxidant supplements ameliorate this dysfunction has not been clarified.
Purpose
In the present study we aimed to evaluate the effect of the antioxidant N-acetyl cysteine (NAC) on vascular function after a bout of high-intensity resistance exercise in healthy young individuals.
Methods
In this randomized, cross-over, placebo-controlled study, ten healthy male volunteers (mean age 24.2±2.1 years) who exercised regularly were randomized to a daily oral administration of NAC or placebo during an 8-day recovery after an acute intense eccentric exercise protocol. In order to estimate changes in vascular parameters of interest -pulse wave velocity (PWV) and flow-mediated dilation (FMD)-, measurements were performed pre-exercise and across 6 pre-specified time points post-exercise (from 2 to 120 hours) in both arms. Blood samples were collected at baseline, immediately after exercise, 2 hours after exercise, and daily for eight consecutive days thereafter for the measurement of cellular components of the immune system.
Results
Muscle exercise induced a significant decrease in FMD in the placebo arm (F=2.74, p=0.017). This phenomenon was evident until 48 hours after exercise while FMD progressively returned to baseline values thereafter. In contrast, in the NAC arm, FMD did not decrease significantly (p>0.05 for all time-points). By linear mixed model analysis, a higher increase in CD4 cells levels correlated with preserved FMD (coefficient=0.025, p=0.046) in the placebo arm whereas this association was not significant (coefficient=0.004, p=0.811) in the NAC arm. PWV did not present significant fluctuations before and after exercise in either arm (p>0.05 for all comparisons).
Conclusion
A bout of eccentric exercise in young regularly training individuals induced endothelial dysfunction peaking at 48 hours, possibly partly mediated by an attenuated CD4 response. NAC exerted protective action on FMD, indicating that oxidative stress may be implicated in vivo in this setting.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sakelliou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Oikonomou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - S Athanasopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Kanakakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Fatouros
- University of Thessaly, School of Physical Education and Sport Sciences , Trikala , Greece
| | - A Mitrakou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
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Mohamed AT, Georgiopoulos G, Faconti L, Asher C, Vennin S, McNally R, Vasileios S, Alfakih K, Lamata P, Keehn L, Chowienczyk P, Masci PG. Ethnicity-specific myocardial remodelling in hypertensive heart disease by multi-parametric cardiovascular magnetic resonance. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.251] [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
Patients with systemic hypertension (HTN) of African ancestry (Afr-a) are at greater risk of incident heart failure (HF), hospitalisation and death than those of European ancestry (Eu-a). This has been related to higher prevalence of HTN-related target organ damage, including high level of circulating cardiac troponins, which is not fully explained by blood pressure level. Thus, one may speculate that Afr-a hypertensives have a higher tendency to develop myocardial damage in response to arterial afterload. However, myocardial composition differences between Afr-a and Eu-a hypertensives remain speculative.
Purpose
To investigate ethnic-specific differences in myocardial tissue composition in Eu-a and Afr-a hypertensives by multi-parametric cardiovascular magnetic resonance (CMR).
Methods
This cross-sectional study included 63 Afr-a and 47 Eu-a hypertensive patients. All patients underwent multi-parametric CMR (1.5-Tesla Aera, Siemens-Healthcare, Erlangen-Germany). Left (LV) and right ventricular (RV) volumes, mass and function, atrial dimensions, and myocardial tissue characterisation (including T1- and T2-mapping) were measured using a standardised imaging protocol, and post-processing recommendations from international scientific societies. Analysis was completed using a commercially available cardiac-software (CVI-42, Calgary-Canada). Central pulse-wave-velocity (PWV) between the ascending and proximal descending thoracic aorta was measured by high-temporal, resolution 2D phase-contrast velocity-encoded parasagittal cine images, using in-house MATLAB software.
Results
Although Afr-a were 5 years older than Eu-a hypertensives, cardiovascular risk factors, anthropometric, body composition and haemodynamic measures were similar between the two groups (Figure 1). Segmental PWV was greater in Afr-a than Eu-a patients (8.16±2.71 vs 6.97±2.82 m/s, P=0.044), underlying higher aortic stiffness in Afr-a hypertensives. Afr-a hypertensives also had greater LV mass and LV-mass/end-diastolic volume ratio than Eu-a (Figure 2), whilst no difference was observed in LV systolic/diastolic function. Native T1 relaxation time and synthetic extracellular volume were also similar between the two ethnicities, though T2 relaxation time was significantly higher in Afr-a hypertensives. Late gadolinium enhancement (LGE), a well-established metric of replacement fibrosis (scarring), was more prevalent in Afr-a than Eu-a hypertensives (14% vs 4%, P=0.001). In patients with LGE, the extent of LGE was higher in Afr-a than Eu-a hypertensives (Figure 2).
Conclusion
Afr-a hypertensives have higher arterial afterload, LV mass and remodelling than Eu-a, despite comparable mean blood pressure, body-mass-index, and body composition. These changes in LV structure and geometry were associated with higher T2 relaxation time, likely reflecting low-grade inflammation, as well as higher prevalence and extent of replacement myocardial fibrosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A T Mohamed
- King's College London, GKT School of Medical Education , London , United Kingdom
| | - G Georgiopoulos
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
| | - L Faconti
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - C Asher
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
| | - S Vennin
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - R McNally
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - S Vasileios
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
| | - K Alfakih
- Lewisham and Greenwich NHS Trust , London , United Kingdom
| | - P Lamata
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
| | - L Keehn
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - P Chowienczyk
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - P G Masci
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
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47
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Mohamed AT, Georgiopoulos G, Faconti L, Asher C, Vennin S, McNally R, Vasileios S, Alfakih K, Lamata P, Keehn L, Chowienczyk P, Masci PG. Racial differences of right ventricular remodelling in systemic hypertension unveiled by multiparametric cardiovascular magnetic resonance. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2168] [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
Patients with systemic hypertension (HTN) of African ancestry (Afr-a) are at greater risk of heart failure (HF), hospitalisation and death than those of European ancestry (Eu-a). Compelling evidence suggests that left ventricular (LV) remodelling and hypertrophy are more prevalent in Afr-a than Eu-a hypertensives due to either a high clustering of cardiovascular risk-factors and/or a difference in genetic background. Prior studies in Eu-a subjects have shown that uncomplicated HTN is associated with right ventricular (RV) hypertrophy and remodelling which may contribute to development of HF. However, the impact of ethnicity on RV remodelling in HTN remains speculative.
Purpose
To investigate the influence of ethnicity on RV remodelling/hypertrophy in patients with HTN using cardiovascular magnetic resonance (CMR).
Methods
In this cross-sectional study we included 16 Afr-a and 32 Eu-a age- and sex-matched healthy-volunteers, and 63 Afr-a and 47 Eu-a hypertensives. All participants underwent a CMR exam (1.5-Tesla, Aera, Siemens-Healthcare, Erlangen-Germany). LV and RV volumes, masses and function were measured according to the current recommendations. Blood pressure was recorded during the CMR.
Results
Age- and sex-matched Afr-a and Eur-a healthy-volunteers (37±10 vs 37±12 years, P=0.975; male 53% vs 44%; P=0.539) exhibited closely comparable LV and RV volumes, masses, and end-diastolic volume/mass ratios. In the HTN group, despite Afr-a hypertensives being roughly 5 years older than Eu-a, baseline characteristics including cardiovascular risk factors, mean blood pressure, body-mass-index, and body composition metrics were similar between the two groups (Figure 1). Afr-a hypertensives also had greater LV and RV masses and mass/end-diastolic volume ratios than Eur-a hypertensives (Figure 2). RV mass correlated with LV mass in both ethnic groups (r=0.593 in Eu-a and r=0.569 in Afr-a; both P<0.001). Multivariable linear regression analysis showed that RV mass was independently associated with African descendance after correction for major confounders including LV mass, biventricular volumes, and body composition.
Conclusion
Our findings support the notion that Afr-a and Eur-a healthy-volunteers have comparable left and right ventricular geometry and masses, arguing against genetic-determinate ventricular geometry and myocardial mass in this population. However, Afr-a individuals exhibit higher sensitivity to myocardial hypertrophy in response to HTN which translates into greater biventricular masses and remodelling, compared to Eu-a hypertensives.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A T Mohamed
- King's College London, GKT School of Medical Education , London , United Kingdom
| | - G Georgiopoulos
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
| | - L Faconti
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - C Asher
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
| | - S Vennin
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - R McNally
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - S Vasileios
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
| | - K Alfakih
- Lewisham and Greenwich NHS Trust , London , United Kingdom
| | - P Lamata
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
| | - L Keehn
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - P Chowienczyk
- King's College London, British Heart Foundation Centre, Department of Clinical Pharmacology, St Thomas' Hospital , London , United Kingdom
| | - P G Masci
- King's College London, School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital , London , United Kingdom
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48
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Delialis D, Mavraganis G, Dimoula A, Ajdini E, Bampatsias D, Dimopoulou AM, Sianis A, Maneta E, Neofytou O, Petropoulos I, Konstantinou G, Misegiannidis A, Kokras N, Stamatelopoulos K, Georgiopoulos G. A systematic review and meta-analysis on the effect of selective serotonin reuptake inhibitors on endothelial function. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2630] [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
Depression and atherosclerotic cardiovascular disease (ASCVD) are commonly clustered in affected patients. Endothelial dysfunction is an early marker of ASCVD while also reported in patients with depression. Emerging evidence suggests that selective serotonin receptor inhibitors (SSRIs) may improve endothelial function. However, clinical studies assessing flow-mediated dilation (FMD), the gold-standard method to evaluate conduit artery endothelial function, in response to SSRIs treatment included limited number of patients and did not provide consistent results.
Purpose
In the present study we aim to evaluate the effect of SSRIs treatment on endothelial function assessed by longitudinal changes in FMD.
Methods
We performed a systematic review to retrieve and subsequently meta-analyze eligible studies in patients with depression who received SSRIs and had available measurements of FMD change before and after treatment.
Results
In 5 studies and 323 individuals in total, SSRIs were associated with increased FMD at the end of follow-up compared to baseline measurement (pooled mean change 1.97%, 95% CI 0.17, 3.77, P=0.032, I2=87.4%). These results did not substantially change when analysis was restricted to patients with history of atherosclerotic cardiovascular disease (ASCVD). Similarly, FMD changes were higher in individuals receiving SSRIs compared to not-treated subjects (pooled mean difference 2.5%. 95% CI 0.7, 4.2, P<0.001, I2=82.7%). Substantial heterogeneity regarding with respect to follow-up duration, demographics, and SSRIs agents.
Conclusion
SSRIs significantly improve FMD, the gold-standard marker of endothelial function. Further investigation is warranted for the role of FMD as a possible therapeutic biomarker in patients with depression and established or subclinical ASCVD.
Prospero registration: CRD42021252241
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Ajdini
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - O Neofytou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Konstantinou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Misegiannidis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - N Kokras
- National & Kapodistrian University of Athens , Athens , Greece
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
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49
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Mavraganis G, Georgiopoulos G, Delialis D, Aivalioti E, Patras R, Petropoulos I, Dimopoulou AM, Angelidakis L, Sianis A, Bampatsias D, Dimoula A, Maneta E, Kosmopoulos M, Stellos K, Stamatelopoulos K. Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established.
Purpose
In the present study we aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratification in guidelines-defined high ASCVD risk patients.
Methods
We consecutively analysed high or very high ASCVD risk patients from a cardiovascular (CV) prevention registry (n=751, derivation cohort) and from the Atherosclerosis Risk in Communities (ARIC) study (n=2,897, validation cohort). Baseline ASCVD risk was defined using the 2021 European Society of Cardiology (ESC) guidelines (clinical ESCrisk). Intima-media thickness (IMT) excluding plaque, average maximal (avg.maxWT), maximal wall thickness (maxWT) and number of sites with carotid plaque were assessed. As endpoint of the study was defined the composite of CV death, acute myocardial infarction (MI) and revascularization after a median of 3.4 years in both cohorts and additionally for 16.7 years in the ARIC cohort.
Results
MaxWT >2.00mm and avg.maxWT >1.39mm provided incremental prognostic value, improved discrimination and correctly reclassified risk over the clinical ESCrisk both in the derivation and the validation cohort (p<0.05 for net reclassification index, integrated discrimination index and Delta Harrell's C index). MaxWT <0.9mm predicted very low probability of CV events (negative predictive value = 97% and 92% in the derivation and validation cohort, respectively). These findings were additionally confirmed for very long-term events in the validation cohort.
Conclusion
Integration of carotid ultrasonography in guidelines-defined risk stratification may identify very high risk patients in need for further residual risk reduction or at very low probability
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Mavraganis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - G Georgiopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Delialis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Aivalioti
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - R Patras
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - I Petropoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A M Dimopoulou
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - L Angelidakis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Sianis
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - D Bampatsias
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - A Dimoula
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - E Maneta
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - M Kosmopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
| | - K Stellos
- University of Heidelberg , Heidelberg , Germany
| | - K Stamatelopoulos
- University of Athens Medical School, Department of Clinical Therapeutics , Athens , Greece
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50
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Mengozzi A, Costantino S, Paneni F, Duranti E, Nannipieri M, Mancini R, Lai M, La Rocca V, Puxeddu I, Antonioli L, Fornai M, Ghionzoli M, Georgiopoulos G, Ippolito C, Bernardini N, Ruschitzka F, Pugliese NR, Taddei S, Virdis* A, Masi S. Targeting SIRT1 Rescues Age- and Obesity-Induced Microvascular Dysfunction in Ex Vivo Human Vessels. Circ Res 2022; 131:476-491. [PMID: 35968712 PMCID: PMC9426744 DOI: 10.1161/circresaha.122.320888] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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] [Indexed: 01/26/2023]
Abstract
BACKGROUND Experimental evidence suggests a key role of SIRT1 (silent information regulator 1) in age- and metabolic-related vascular dysfunction. Whether these effects hold true in the human microvasculature is unknown. We aimed to investigate the SIRT1 role in very early stages of age- and obesity-related microvascular dysfunction in humans. METHODS Ninety-five subjects undergoing elective laparoscopic surgery were recruited and stratified based on their body mass index status (above or below 30 kg/m2) and age (above or below 40 years) in 4 groups: Young Nonobese, Young Obese, Old Nonobese, and Old Obese. We measured small resistance arteries' endothelial function by pressurized micromyography before and after incubation with a SIRT1 agonist (SRT1720) and a mitochondria reactive oxygen species (mtROS) scavenger (MitoTEMPO). We assessed vascular levels of mtROS and nitric oxide availability by confocal microscopy and vascular gene expression of SIRT1 and mitochondrial proteins by qPCR. Chromatin immunoprecipitation assay was employed to investigate SIRT1-dependent epigenetic regulation of mitochondrial proteins. RESULTS Compared with Young Nonobese, obese and older patients showed lower vascular expression of SIRT1 and antioxidant proteins (FOXO3 [forkhead box protein O3] and SOD2) and higher expression of pro-oxidant and aging mitochondria proteins p66Shc and Arginase II. Old Obese, Young Obese and Old Nonobese groups endothelial dysfunction was rescued by SRT1720. The restoration was comparable to the one obtained with mitoTEMPO. These effects were explained by SIRT1-dependent chromatin changes leading to reduced p66Shc expression and upregulation of proteins involved in mitochondria respiratory chain. CONCLUSIONS SIRT1 is a novel central modulator of the earliest microvascular damage induced by age and obesity. Through a complex epigenetic control mainly involving p66Shc and Arginase II, it influences mtROS levels, NO availability, and the expression of proteins of the mitochondria respiratory chain. Therapeutic modulation of SIRT1 restores obesity- and age-related endothelial dysfunction. Early targeting of SIRT1 might represent a crucial strategy to prevent age- and obesity-related microvascular dysfunction.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Sarah Costantino
- Center for Molecular Cardiology, University of Zürich, Switzerland (S.C., F.P.)
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Switzerland (S.C., F.P.).,Department of Cardiology, University Heart Center (F.P., F.R.), University Hospital Zurich, Switzerland.,Department of Research and Education (F.P.), University Hospital Zurich, Switzerland
| | - Emiliano Duranti
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Rudj Mancini
- Unit of Bariatric Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (R.M.)
| | - Michele Lai
- Retrovirus Center and Virology Section, Department of Translational Research and New Technologies in Medicine and Surgery (M.L., V.L.R.), University of Pisa, Italy
| | - Veronica La Rocca
- Retrovirus Center and Virology Section, Department of Translational Research and New Technologies in Medicine and Surgery (M.L., V.L.R.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Ilaria Puxeddu
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Luca Antonioli
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Matteo Fornai
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Marco Ghionzoli
- Paediatric Surgery Unit, Meyer Children’s Hospital, Florence, Italy (M.G.)
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (G.G.).,Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Greece (G.G.)
| | - Chiara Ippolito
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Nunzia Bernardini
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center (F.P., F.R.), University Hospital Zurich, Switzerland
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Agostino Virdis*
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Institute of Cardiovascular Science, University College London, United Kingdom (S.M.)
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