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Nuzzi V, Manca P, Mulè M, Leone S, Fazzini L, Cipriani MG, Faletra FF. Contemporary clinical role of echocardiography in patients with advanced heart failure. Heart Fail Rev 2024; 29:1247-1260. [PMID: 39298044 DOI: 10.1007/s10741-024-10434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2024] [Indexed: 09/21/2024]
Abstract
Echocardiography represents an essential tool for imagers and clinical cardiologists in the management of patients with heart failure. Advanced heart failure (AdHF) is a more severe and, typically, later stage of HF that exposes patients to a high risk of adverse outcomes, with a 1-year mortality rate of around 50%. Currently, several therapies are available to improve the outcomes of these patients, reduce their mortality rate, and, possibly, delay the need for advanced therapies such as heart transplant and long-term mechanical circulatory support. When accurately performed and interpreted, echocardiography provides crucial information to properly tailor medical and device therapy of patients with AdHF and to identify those at even higher risk. In this review, we present the state of the art of echocardiography applications in the clinical management of patients with AdHF. We will discuss the role of echocardiography chronologically, beginning with the prediction of AdHF, proceeding through diagnosis, and detailing how echocardiography informs clinical decision-making, before concluding with indications for advanced therapies.
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Affiliation(s)
- Vincenzo Nuzzi
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy.
| | - Paolo Manca
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Massimiliano Mulè
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Simona Leone
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Luca Fazzini
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Manlio G Cipriani
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Francesco F Faletra
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
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Colombo D, Mercurio V, Klersy C, Temporelli P, Rossi A, Carluccio E, La Rovere MT, Dini FLL, Nappi R, Acquaro M, Greco A, Turco A, Schirinzi S, Scelsi L, Ghio S. The influence of sex on heart failure mortality. J Cardiovasc Med (Hagerstown) 2024; 25:693-699. [PMID: 39083064 DOI: 10.2459/jcm.0000000000001656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
AIMS Little research has investigated how sex may affect the prognosis of patients with chronic heart failure (HF). The present study was aimed at exploring sex-specific differences in prognosis in a cohort of patients with chronic HF, categorized according to severity of left ventricular dysfunction (HFrEF, HFmrEF and HFpEF), right ventricular (RV) dysfunction and ischemic (IHD) or nonischemic (no-IHD) etiology. METHODS This retrospective analysis included 1640 HF patients of whom 24% were females, 759 patients had IHD, 1110 patients had HFrEF, 147 patients had HFmrEF and 383 patients had HFpEF. The median follow-up period was 63 months (25th-75th 27-93). RESULTS In the no-IHD group, no statistically significant sex differences emerged regarding survival, regardless of age and severity of cardiac dysfunction. In contrast, in the IHD group, females had a significantly lower event rate than males in the age group between 65 and 79 years [hazard ratio (HR) 0.39; 95% confidence interval (CI): 0.86-0.18; P < 0.01]; in addition, a lower event rate was observed in females compared with males among patients with HFrEF (HR 0.47; 95% CI: 0.88-0.25; P < 0.01), among patients without RV dysfunction (HR 0.58; 95% CI: 1.02-0.33; P = 0.048) and among patients without diabetes (HR 0.44; 95% CI: 0.84-0.23; P < 0.01). CONCLUSION In nonischemic patients there was no difference between males and females in terms of survival whereas in patients with ischemic etiology survival was better in females among elderly patients, in HFrEF patients, in the absence of RV dysfunction and in the absence of diabetes.
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Affiliation(s)
- Davide Colombo
- Division of Cardiology - Fondazione IRCCS Policlinico S Matteo, Pavia
| | - Valentina Mercurio
- Department of Translational Medical Sciences, 'Federico II' University, Naples
| | - Catherine Klersy
- Biostatistics and Clinical Trial Center - Fondazione IRCCS Policlinico S Matteo
| | - Pierluigi Temporelli
- Istituti Clinici Scientifici Maugeri, IRCCS, Department of Cardiology, Istituto Scientifico di Veruno, Novara
| | | | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Department of Cardiology, Istituto Scientifico di Montescano, Pavia
| | | | - Rossella Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy. Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Mauro Acquaro
- Division of Cardiology - Fondazione IRCCS Policlinico S Matteo, Pavia
| | - Alessandra Greco
- Division of Cardiology - Fondazione IRCCS Policlinico S Matteo, Pavia
| | - Annalisa Turco
- Division of Cardiology - Fondazione IRCCS Policlinico S Matteo, Pavia
| | - Sandra Schirinzi
- Division of Cardiology - Fondazione IRCCS Policlinico S Matteo, Pavia
| | - Laura Scelsi
- Division of Cardiology - Fondazione IRCCS Policlinico S Matteo, Pavia
| | - Stefano Ghio
- Division of Cardiology - Fondazione IRCCS Policlinico S Matteo, Pavia
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Pei Z, Dong M, Meng X, Yao W, Guo Y, Wang F. Effects of Nicotinamide Adenine Dinucleotide on Older Patients with Heart Failure. Rev Cardiovasc Med 2024; 25:297. [PMID: 39228487 PMCID: PMC11366984 DOI: 10.31083/j.rcm2508297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 09/05/2024] Open
Abstract
Background Heart failure (HF) is the main cause of death in middle-aged and older people and is characterized by high morbidity, high mortality, a high rehospitalization rate, and many high-risk groups. Nicotinamide adenine dinucleotide (NAD+) is widely present in the mitochondria of cardiomyocytes and maintains the redox balance in the body, which can effectively treat HF. We sought to evaluate whether NAD+ therapy has some clinical efficacy in patients with HF. Methods Based on using conventional drugs to treat HF, patients (n = 60) were randomized 1:1 to saline and 50 mg NAD+ with 50 mL of normal saline for 7 days. The baseline characteristics of patients before and after treatment and cardiac function (N-terminal pro B-type natriuretic peptide (NT-proBNP) level and left ventricular ejection fraction (LVEF) value) were analyzed. Serological analysis (sirtuin-1 (SIRT1), sirtuin-3 (SIRT3), sirtuin-6 (SIRT6), reactive oxygen species (ROS), and endothelin) was also performed. Results Among the 60 patients with HF who were treated with NAD+ for 7 days, the improvement rate in NT-proBNP levels and LVEF values was better than in the saline group, although not statistically significant. These patients were more likely to benefit from NAD+ because of higher levels of anti-oxidative stress (SIRT1, SIRT3, SIRT6, and ROS) and anti-endothelial injury (endothelin) than those in the saline control group. Conclusions According to the results of this study, it is believed that 7 days of NAD+ injections has a positive effect on improving cardiac function, oxidative stress, and endothelial injury in patients with HF compared with the saline control. Clinical Trial Registration Chinese Clinical Trial Registry (http://www.chictr.org.cn/) ChiCTR2300074326; retrospectively registered on 3 August 2023.
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Affiliation(s)
- Zuowei Pei
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
- Department of Cardiology, Central Hospital of Dalian University of
Technology, 116033 Dalian, Liaoning, China
| | - Min Dong
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
| | - Xuyang Meng
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
| | - Wei Yao
- Department of Internal Medicine, Affiliated Zhong Shan Hospital of Dalian
University, 116001 Dalian, Liaoning, China
| | - Ying Guo
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of
Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, 100730 Beijing, China
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4
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Zhang S, Gao S, Tian Z, Zhang S. Characterization and Long-Term Prognosis of Patients with Different Phenotypes of Dilated Cardiomyopathy. J Cardiovasc Dev Dis 2024; 11:220. [PMID: 39057640 PMCID: PMC11277054 DOI: 10.3390/jcdd11070220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Long-term prognosis of dilated cardiomyopathy (DCM) in the Chinese population is lacking, and the left ventricular (LV) hypertrabeculation phenotype usually overlaps with DCM. OBJECTIVES The study aims to investigate whether the presence of the LV hypertrabeculation phenotype confers additional adverse prognostic information for DCM patients. METHODS We retrospectively reviewed all DCM patients (≥18 years of age at diagnosis) hospitalized in the Peking Union Medical College Hospital between September 2002 and September 2022. The eligible patients were divided into two groups based on echocardiography at diagnosis: the isolated DCM (n = 353), and DCM with the LV hypertrabeculation phenotype (n = 97). The primary endpoint was major adverse cardiac events (MACEs), and multivariate Cox hazards regression models were used to compare the endpoints between the two groups. RESULTS During a mean follow-up time of 4.6 years, there was no significant difference in the primary endpoint between the isolated DCM and DCM with the LV hypertrabeculation phenotype (p = 0.19). The risk of MACEs in the first 5 years was significantly higher in DCM with the LV hypertrabeculation phenotype than isolated DCM (adjusted HR [95%CI]: 1.83 [1.21-2.77]) and after 5 years the effect of the LV hypertrabeculation phenotype as a prognostic attenuated. Subgroup analysis found a significant interaction for the incidence of MACEs between sex and DCM subtypes (p for interaction = 0.01). CONCLUSIONS DCM with LV hypertrabeculation phenotypes had a higher early (first 5 years) risk of MACEs. For males, the presence of LV hypertrabeculation phenotypes might be an important clue for identifying high-risk DCM patients.
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Affiliation(s)
| | | | - Zhuang Tian
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (S.Z.); (S.G.)
| | - Shuyang Zhang
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (S.Z.); (S.G.)
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Attachaipanich T, Thiravetyan B, Tribuddharat N, Jaroonpipatkul S, Navaravong L. Premature Ventricular Contraction-Induced Cardiomyopathy: Contemporary Evidence from Risk Stratification, Pathophysiology, and Management. J Clin Med 2024; 13:2635. [PMID: 38731164 PMCID: PMC11084868 DOI: 10.3390/jcm13092635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Premature ventricular complexes (PVCs) are commonly encountered problems in clinical settings. The range of symptoms can be from asymptomatic to palpitations, fatigue, or heart failure symptoms. A higher burden of PVCs is a risk factor for development of PVC-induced cardiomyopathy (PIC). Rhythm evaluation by 12-lead ECG and an ambulatory monitoring device are essential. Currently, several imaging modalities, such as echocardiography and cardiac magnetic resonance imaging, are utilized to evaluate the underlying structure that may be related to PIC. Beta blockers and antiarrhythmic drugs are typically part of the initial management strategy. If these fail, catheter ablation of PVCs is typically the next step. The purpose of this article is to summarize the current evidence/knowledge about PIC.
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Affiliation(s)
- Tanawat Attachaipanich
- Cardiac Electrophysiology Research and Training Center, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Ben Thiravetyan
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | | | - Surachat Jaroonpipatkul
- Division of Cardiology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok 10400, Thailand;
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Iliuță L, Andronesi AG, Rac-Albu M, Rac-Albu ME, Scafa-Udriște A, Moldovan H, Furtunescu FL, Rădulescu BC, Panaitescu E. Importance of Tissue Doppler Evaluation in Dilated Cardiomyopathy: The Value of Diastolic Filling Pattern as a Prognostic Predictor. J Cardiovasc Dev Dis 2023; 10:237. [PMID: 37367402 PMCID: PMC10298846 DOI: 10.3390/jcdd10060237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/13/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
(1) Background: The presence of restrictive left ventricular diastolic filling pattern (LVDFP) is associated with an unfavorable prognosis in many cardiac diseases, but few data are available on the prognostic implications of this pattern in patients with dilated cardiomyopathy (DCM). We aimed to establish the main prognostic predictors at the 1- and 5-year follow-ups in DCM patients and the value of restrictive LVDFP in increasing morbidity and mortality. (2) Methods: A prospective study of 143 patients with DCM divided in non-restrictive LVDFP group (95 patients) and restrictive group (47 patients). The patients were evaluated at a 5-year follow-up through an in-patient visit during the pre-pandemic period and hybrid methods (face-to-face, teleconsultation and home monitoring with a telemedicine application) during the pandemic period. Statistical analysis compared the two groups in terms of NYHA class, quality of life, hospitalizations/emergency department (ED) visits due to HF exacerbation and total mortality. (3) Results: The mortality rate in the restrictive group was markedly higher than that in the non-restrictive group at 1 year (17.02% vs. 10.59%, respectively, p < 0.05) and at 5 years (68.08% vs. 50.53%, p < 0.05). In the restrictive group, hospitalizations/ED visits due to HF decompensations at 1 year were significantly higher (85.11% vs. 57.89%, p < 0.05), with hospitalizations for ventricular arrhythmia being almost three times higher (21.28% vs. 7.37%, respectively, p < 0.05). The percentage of patients with a favorable evolution (in terms of NYHA class and quality of life) at the 1- and 5-year follow-ups were higher in the non-restrictive LVDFP group. The main prognostic predictors in patients with DCM at the 1-year follow-up were: restrictive LVDFP, age > 75 years, markedly dilated LV, comorbidities (DM, COPD), 2nd-degree mitral regurgitation and severe pulmonary hypertension (p < 0.05). (4) Conclusions: At the 1- and 5-year follow-ups, the presence of the restrictive LVDFP in DCM patients was independently associated with a poor prognosis, being the best clinical predictor for unfavorable evolution, after adjustment for other well-established predictive parameters in DCM patients.
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Affiliation(s)
- Luminita Iliuță
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Andreea Gabriella Andronesi
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Marius Rac-Albu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Mădălina-Elena Rac-Albu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Alexandru Scafa-Udriște
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Horațiu Moldovan
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Academy of Romanian Scientists (AOSR), 050045 Bucharest, Romania
- Department of Cardiology, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Florentina Ligia Furtunescu
- Department of Public Health and Management, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Bogdan Constantin Rădulescu
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania
| | - Eugenia Panaitescu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
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Lalario A, Del Mestre E, Lo Casto M, Nuzzi V, Manca P, Bromage DI, Barbati G, Merlo M, Sinagra G, Cannatà A. Clinical characterization and natural history of chemotherapy-induced dilated cardiomyopathy. ESC Heart Fail 2022; 9:3052-3059. [PMID: 35735911 PMCID: PMC9715873 DOI: 10.1002/ehf2.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/11/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Chemotherapy-induced dilated cardiomyopathy (CI-DCM) is a well-recognized phenotype of non-ischemic dilated cardiomyopathy (DCM), characterized by poor outcomes. However, a detailed comparison between idiopathic DCM (iDCM) and CI-DCM is still lacking. METHODS AND RESULTS All consecutive DCM patients enrolled in the Trieste Muscle Heart Disease Registry were analysed. CI-DCM and iDCM were defined according to current recommendations. The primary study outcome measure was all-mortality death and secondary outcomes were a) a composite of cardiovascular death/heart-transplantation/ventricular-assist-device implantation, and b) major ventricular arrhythmias. The study included 551 patients (499 iDCM and 52 CI-DCM). At enrolment, compared with iDCM, CI-DCM patients were older (51 ± 14 years vs. 58 ± 3 years, respectively, P < 0.001) and had a higher left ventricular ejection fraction (32% ± 9 vs. 35% ± 10, respectively, P = 0.03). Over a median follow-up of 90 months (IQR 54-140 months), CI-DCM patients had a higher incidence of all-cause mortality compared with iDCM (36.5% vs. 8.4% in CI-DCM and iDCM respectively, P < 0.001), while the incidence of major ventricular arrhythmias was higher in the iDCM group compared with CI-DCM (4% vs. 0%, in CI-DCM and iDCM respectively, P = 0.03). The risk of the composite outcome was comparable between the two groups (P = 0.91). At Cox multivariable analysis, the diagnosis of CI-DCM emerged as independently associated to primary outcome (HR 6.42, 95% C.I. 2.52-16.31, P < 0.001). CONCLUSIONS In a well-selected DCM cohort, patients with a chemotherapy-induced aetiology had a higher incidence of all-cause mortality compared with iDCM. Conversely, the incidence of life-threatening ventricular arrhythmic events was higher among patients with iDCM.
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Affiliation(s)
- Andrea Lalario
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI)University of TriesteTriesteItaly
| | - Eva Del Mestre
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI)University of TriesteTriesteItaly
| | - Michele Lo Casto
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI)University of TriesteTriesteItaly
| | - Vincenzo Nuzzi
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI)University of TriesteTriesteItaly
| | - Paolo Manca
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI)University of TriesteTriesteItaly
| | - Daniel I. Bromage
- Department of Cardiovascular Science, Faculty of Life Science and MedicineKing's College LondonLondonUK
| | | | - Marco Merlo
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI)University of TriesteTriesteItaly
| | - Gianfranco Sinagra
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI)University of TriesteTriesteItaly
| | - Antonio Cannatà
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI)University of TriesteTriesteItaly
- Department of Cardiovascular Science, Faculty of Life Science and MedicineKing's College LondonLondonUK
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Wang L, Liu T, Wang C, Xuan H, Xu X, Yin J, Li X, Chen J, Li D, Xu T. Development and validation of a predictive model for adverse left ventricular remodeling in NSTEMI patients after primary percutaneous coronary intervention. BMC Cardiovasc Disord 2022; 22:386. [PMID: 36030211 PMCID: PMC9420298 DOI: 10.1186/s12872-022-02831-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction To develop and validate clinical evaluators that predict adverse left ventricular remodeling (ALVR) in non-ST-elevation myocardial infarction (NSTEMI) patients after primary percutaneous coronary intervention (PCI). Methods The retrospective study analyzed the clinical data of 507 NSTEMI patients who were treated with primary PCI from the Affiliated Hospital of Xuzhou Medical University and the Second Affiliated Hospital of Xuzhou Medical University, between January 1, 2019 and September 31, 2021. The training cohort consisted of patients admitted before June 2020 (n = 287), and the remaining patients (n = 220) were assigned to an external validation cohort. The endpoint event was the occurrence of ALVR, which was described as an increase ≥ 20% in left ventricular end-diastolic volume (LVEDV) at 3–4 months follow-up CMR compared with baseline measurements. The occurrence probability of ALVR stemmed from the final model, which embodied independent predictors recommended by logistic regression analysis. The area under the receiver operating characteristic curve (AUC), Calibration plot, Hosmer–Lemeshow method, and decision curve analysis (DCA) were applied to quantify the performance. Results Independent predictors for ALVR included age (odds ratio (OR): 1.040; 95% confidence interval (CI): 1.009–1.073), the level of neutrophil to lymphocyte ratio (OR: 4.492; 95% CI: 1.906–10.582), the cardiac microvascular obstruction (OR: 3.416; 95% CI: 1.170–9.970), peak global longitudinal strain (OR: 1.131; 95% CI: 1.026–1.246), infarct size (OR: 1.082; 95% CI: 1.042–1.125) and left ventricular ejection fraction (OR: 0.925; 95% CI: 0.872–0.980), which were screened by regression analysis then merged into the nomogram model. Both internal validation (AUC: 0.805) and external validation (AUC: 0.867) revealed that the prediction model was capable of good discrimination. Calibration plot and Hosmer–Lemeshow method showed high consistency between the probabilities predicted by the nomogram (P = 0.514) and the validation set (P = 0.762) and the probabilities of actual occurrence. DCA corroborated the clinical utility of the nomogram. Conclusions In this study, the proposed nomogram model enabled individualized prediction of ALVR in NSTEMI patients after reperfusion and conduced to guide clinical therapeutic schedules.
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Affiliation(s)
- Lili Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Tao Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Chaofan Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Haochen Xuan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Xianzhi Xu
- School of Stomatology, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Jie Yin
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Xiaoqun Li
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Junhong Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Dongye Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Tongda Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
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9
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Castrichini M, Porcari A, Baggio C, Gagno G, Maione D, Barbati G, Medo K, Mestroni L, Merlo M, Sinagra G. Sex differences in natural history of cardiovascular magnetic resonance- and biopsy-proven lymphocytic myocarditis. ESC Heart Fail 2022; 9:4010-4019. [PMID: 36000547 PMCID: PMC9773744 DOI: 10.1002/ehf2.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/04/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The role of sex in determining the profile and the outcomes of patients with myocarditis is largely unexplored. We evaluated the impact of sex as a modifier factor in the clinical characterization and natural history of patients with definite diagnosis of myocarditis. METHODS AND RESULTS We retrospectively analysed a single-centre cohort of consecutive patients with definite diagnosis of myocarditis (i.e. endomyocardial biopsy or cardiac magnetic resonance proven). Specific sub-analyses were performed in cohorts of patients with chest pain, ventricular arrhythmias, and heart failure as different main symptoms at presentation. The primary outcome measure was a composite of all-cause mortality or heart transplantation (HTx). We included 312 patients, of which 211, 68% of the whole population, were males. Despite no clinically relevant differences found at baseline presentation, males had a higher indexed left ventricular end-diastolic volume (62 ± 23 mL/m2 vs. 52 ± 20 mL/m2, P = 0.011 in males vs. females, respectively) at follow-up evaluation. At a median follow-up of 72 months, 36 (17%) males vs. 8 (8%) females experienced death or HTx (P = 0.033). Male sex emerged as predictors of all-cause mortality or HTx in every combination of covariates (HR 2.600; 1.163-5.809; P = 0.020). Results were agreeable regardless of the main symptom of presentation. CONCLUSIONS In a large cohort of patients with definite diagnosis of myocarditis, females experienced a more favourable long-term prognosis than males, despite a similar clinical profile at presentation.
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Affiliation(s)
- Matteo Castrichini
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly,Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Chiara Baggio
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Giulia Gagno
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Davide Maione
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical SciencesUniversity of TriesteTriesteItaly
| | - Kristen Medo
- Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Luisa Mestroni
- Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
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10
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Liu L, Qiao C, Zha JR, Qin H, Wang XR, Zhang XY, Wang YO, Yang XM, Zhang SL, Qin J. Early prediction of clinical scores for left ventricular reverse remodeling using extreme gradient random forest, boosting, and logistic regression algorithm representations. Front Cardiovasc Med 2022; 9:864312. [PMID: 36061535 PMCID: PMC9428443 DOI: 10.3389/fcvm.2022.864312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective At present, there is no early prediction model of left ventricular reverse remodeling (LVRR) for people who are in cardiac arrest with an ejection fraction (EF) of ≤35% at first diagnosis; thus, the purpose of this article is to provide a supplement to existing research. Materials and methods A total of 109 patients suffering from heart attack with an EF of ≤35% at first diagnosis were involved in this single-center research study. LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) from ≥10% to a final value of >35%, with analysis features including demographic characteristics, diseases, biochemical data, echocardiography, and drug therapy. Extreme gradient boosting (XGBoost), random forest, and logistic regression algorithm models were used to distinguish between LVRR and non-LVRR cases and to obtain the most important features. Results There were 47 cases (42%) of LVRR in patients suffering from heart failure with an EF of ≤35% at first diagnosis after optimal drug therapy. General statistical analysis and machine learning methods were combined to exclude a number of significant feature groups. The median duration of disease in the LVRR group was significantly lower than that in the non-LVRR group (7 vs. 48 months); the mean values of creatine kinase (CK) and MB isoenzyme of creatine kinase (CK-MB) in the LVRR group were lower than those in the non-LVRR group (80.11 vs. 94.23 U/L; 2.61 vs. 2.99 ng/ml; 27.19 vs. 28.54 mm). Moreover, AUC values for our feature combinations ranged from 97 to 94% and to 87% when using the XGBoost, random forest, and logistic regression techniques, respectively. The ablation test revealed that beats per minute (BPM) and disease duration had a greater impact on the model's ability to accurately forecast outcomes. Conclusion Shorter disease duration, slightly lower CK and CK-MB levels, slightly smaller right and left ventricular and left atrial dimensions, and lower mean heart rates were found to be most strongly predictive of LVRR development (BPM).
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Affiliation(s)
- Lu Liu
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Cen Qiao
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jun-Ren Zha
- School of Software Engineering, Dalian University, Dalian, China
| | - Huan Qin
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xiao-Rui Wang
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xin-Yu Zhang
- Medical College, Dalian University, Dalian, China
| | - Yi-Ou Wang
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xiu-Mei Yang
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Shu-Long Zhang
- Heart Centre, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jing Qin
- School of Software Engineering, Dalian University, Dalian, China
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11
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Leancă SA, Crișu D, Petriș AO, Afrăsânie I, Genes A, Costache AD, Tesloianu DN, Costache II. Left Ventricular Remodeling after Myocardial Infarction: From Physiopathology to Treatment. Life (Basel) 2022; 12:1111. [PMID: 35892913 PMCID: PMC9332014 DOI: 10.3390/life12081111] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/11/2022] Open
Abstract
Myocardial infarction (MI) is the leading cause of death and morbidity worldwide, with an incidence relatively high in developed countries and rapidly growing in developing countries. The most common cause of MI is the rupture of an atherosclerotic plaque with subsequent thrombotic occlusion in the coronary circulation. This causes cardiomyocyte death and myocardial necrosis, with subsequent inflammation and fibrosis. Current therapies aim to restore coronary flow by thrombus dissolution with pharmaceutical treatment and/or intravascular stent implantation and to counteract neurohormonal activation. Despite these therapies, the injury caused by myocardial ischemia leads to left ventricular remodeling; this process involves changes in cardiac geometry, dimension and function and eventually progression to heart failure (HF). This review describes the pathophysiological mechanism that leads to cardiac remodeling and the therapeutic strategies with a role in slowing the progression of remodeling and improving cardiac structure and function.
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Affiliation(s)
- Sabina Andreea Leancă
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independentei nr. 1, 700111 Iasi, Romania; (S.A.L.); (A.O.P.); (I.A.); (A.G.); (D.N.T.); (I.I.C.)
| | - Daniela Crișu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independentei nr. 1, 700111 Iasi, Romania; (S.A.L.); (A.O.P.); (I.A.); (A.G.); (D.N.T.); (I.I.C.)
| | - Antoniu Octavian Petriș
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independentei nr. 1, 700111 Iasi, Romania; (S.A.L.); (A.O.P.); (I.A.); (A.G.); (D.N.T.); (I.I.C.)
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Str. University nr. 16, 700083 Iasi, Romania;
| | - Irina Afrăsânie
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independentei nr. 1, 700111 Iasi, Romania; (S.A.L.); (A.O.P.); (I.A.); (A.G.); (D.N.T.); (I.I.C.)
| | - Antonia Genes
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independentei nr. 1, 700111 Iasi, Romania; (S.A.L.); (A.O.P.); (I.A.); (A.G.); (D.N.T.); (I.I.C.)
| | - Alexandru Dan Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Str. University nr. 16, 700083 Iasi, Romania;
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Dan Nicolae Tesloianu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independentei nr. 1, 700111 Iasi, Romania; (S.A.L.); (A.O.P.); (I.A.); (A.G.); (D.N.T.); (I.I.C.)
| | - Irina Iuliana Costache
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independentei nr. 1, 700111 Iasi, Romania; (S.A.L.); (A.O.P.); (I.A.); (A.G.); (D.N.T.); (I.I.C.)
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Str. University nr. 16, 700083 Iasi, Romania;
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12
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Manca P, Nuzzi V, Cannatà A, Castrichini M, Bromage DI, De Luca A, Stolfo D, Schulz U, Merlo M, Sinagra G. The right ventricular involvement in dilated cardiomyopathy: prevalence and prognostic implications of the often-neglected child. Heart Fail Rev 2022; 27:1795-1805. [PMID: 35315505 PMCID: PMC9388461 DOI: 10.1007/s10741-022-10229-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
Dilated cardiomyopathy (DCM) is a primary heart muscle disease characterized by left or biventricular systolic impairment. Historically, most of the clinical attention has been devoted to the evaluation of left ventricular function and morphology, while right ventricle (RV) has been for many years the forgotten chamber. Recently, progresses in cardiac imaging gave clinicians precious tools for the evaluation of RV, raising the awareness of the importance of biventricular assessment in DCM. Indeed, RV involvement is far from being uncommon in DCM, and the presence of right ventricular dysfunction (RVD) is one of the major negative prognostic determinants in DCM patients. However, some aspects such as the possible role of specific genetic mutations in determining the biventricular phenotype in DCM, or the lack of specific treatments able to primarily counteract RVD, still need research. In this review, we summarized the current knowledge on RV involvement in DCM, giving an overview on the epidemiology and pathogenetic mechanisms implicated in determining RVD. Furthermore, we discussed the imaging techniques to evaluate RV function and the role of RV failure in advanced heart failure.
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Affiliation(s)
- Paolo Manca
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Vincenzo Nuzzi
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Antonio Cannatà
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy.,Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Matteo Castrichini
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Daniel I Bromage
- Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Antonio De Luca
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
| | - Davide Stolfo
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy.,Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Uwe Schulz
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Marco Merlo
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy.
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata Giuliana Isontina (ASUGI), University of Trieste, Via Valdoni 7, 34149, Trieste, Italy
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13
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Manca P, Nuzzi V, Cannatà A, Merlo M, Sinagra G. Contemporary etiology and prognosis of dilated non-ischemic cardiomyopathy. Minerva Cardiol Angiol 2021; 70:171-188. [PMID: 34338487 DOI: 10.23736/s2724-5683.21.05736-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Non-ischemic dilated cardiomyopathy (NI-DCM) represents a specific etiology of systolic heart failure that usually affect young individuals with a genetic background in up to 40% of cases. Behind the term NI-DCM there is a spectrum of different diseases, and an accurate etiological classification appears pivotal for the clinical management and prognostic stratification of these patients. EVIDENCE ACQUISITION In the last years the prognosis of NI-DCM patients dramatically improved thanks to the progresses in medical treatment/ device therapy and earlier diagnosis especially in familial context. In this review we summarize the actual state of art in the management of these patients. EVIDENCE SYNTHESIS In the era of precision medicine, a lot of progresses have been made to expand our knowledge on the management of NI-DCM patients. A complex interaction between genotype and external triggers is the main determinant of the clinical phenotype in NI-DCM, and a lot of efforts must be done by clinicians to systematically rule out all the possible causes involved in the pathogenesis. Progresses in cardiac imaging and familial screening led us to detect subtle abnormalities in the initial phase of the disease and also helped us to furtherly stratify the prognosis and arrhythmic risk of these patients. It is plausible that a more precise etiological classification will be needed in the near future. CONCLUSIONS NI-DCM contains a spectrum of different diseases. Proper etiological classification, early diagnosis and strict follow-up are essential to tailor care of these patients.
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Affiliation(s)
- Paolo Manca
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Vincenzo Nuzzi
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Antonio Cannatà
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK
| | - Marco Merlo
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy -
| | - Gianfranco Sinagra
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
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14
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Dilated Cardiomyopathy: A Paradigm of Revolution in Medicine. J Clin Med 2020; 9:jcm9113385. [PMID: 33105590 PMCID: PMC7690260 DOI: 10.3390/jcm9113385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022] Open
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