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Merlo M, Pagura L, Porcari A, Cameli M, Vergaro G, Musumeci B, Biagini E, Canepa M, Crotti L, Imazio M, Forleo C, Cappelli F, Favale S, Di Bella G, Dore F, Girardi F, Tomasoni D, Pavasini R, Rella V, Palmiero G, Caiazza M, Albanese M, Igoren Guarrucci A, Branzi G, Caponetti A, Saturi G, La Malfa G, Merlo A, Andreis A, Bruno F, Longo F, Rossi M, Varra‘ G, Saro R, Di Ienno L, De Carli G, Giacomin E, Spini V, Limongelli G, Autore C, Olivotto I, Badano L, Parati G, Perlini S, Metra M, Emdin M, Rapezzi C, Sinagra G. C64 UNMASKING THE PREVALENCE OF AMYLOID CARDIOMYOPATHY IN THE REAL WORLD: RESULTS FROM PHASE 2 OF AC–TIVE STUDY, AN ITALIAN NATIONWIDE SURVEY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Clinicians need to identify patients with amyloid cardiomyopathy (AC) at an early stage, due to the availability of disease–modifying therapies. Some echocardiographic findings may rise the suspicion of AC, also in patients with mild or no symptoms, addressing second level diagnostic tests.
Aim
To investigate the prevalence of AC in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram in Italy and presenting echocardiographic signs suggestive of AC.
Methods
This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) a recording phase consisting in a national survey on prevalence of possible echocardiographic red flags of AC in consecutive unselected patients ≥55 years undergoing routine echocardiogram (previously published) and 2) an AC diagnostic phase involving a diagnostic work–up for AC to investigate AC prevalence among patients with at least one echocardiographic red flag (herein presented). Patients that in Phase 1 presented an “AC suggestive” echocardiogram (i.e., at least one red flag of AC in hypertrophic, non–dilated left ventricles with preserved ejection fraction) underwent clinical evaluation, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related–AC (ATTR–AC) was made in presence of grade 2–3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov (#NCT04738266).
Results
Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as “AC suggestive” and proceeded to Phase 2. 217 patients completed Phase 2 investigations. Main reasons for the 164 non–entering patients into Phase 2 were death (n = 49) and refusal to participate (n = 66). A final diagnosis of AC was made in 62 patients with an estimated prevalence of 28,6% (95% CI: 22,5%–34,7%). ATTR–AC was diagnosed in 51 and AL–AC in 11 patients, ascertaining a prevalence of 23,5% (95% CI: 17,8%–29,2%) and 5,1% (95% CI: 2,2%–8,0%), respectively.
Conclusion
Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of AC, the prevalence of AC ranged from 23% up to 35%. Although ATTR–AC was predominant, AL–AC was diagnosed in a significant number of cases. Echocardiography has a fundamental role in screening patients, raising the suspicion of disease and orienting diagnostic work–up for AC.
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Affiliation(s)
- M Merlo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Pagura
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Porcari
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Cameli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Vergaro
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - B Musumeci
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - E Biagini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Canepa
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Crotti
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Imazio
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Forleo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Cappelli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - S Favale
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Di Bella
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Dore
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Girardi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - D Tomasoni
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - R Pavasini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - V Rella
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Palmiero
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Caiazza
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Albanese
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Igoren Guarrucci
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Branzi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Caponetti
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Saturi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G La Malfa
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Merlo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Andreis
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Bruno
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Longo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Rossi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Varra‘
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - R Saro
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Di Ienno
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G De Carli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - E Giacomin
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - V Spini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Limongelli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Autore
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - I Olivotto
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Badano
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Parati
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - S Perlini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Metra
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Emdin
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Rapezzi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Sinagra
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
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2
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Gallone G, Bongiovanni F, Bruno F, Scudeler L, Landra F, Andreis A, Casoni R, Fava A, Pidello S, Raineri C, Usmiani T, Alunni G, Conrotto F, D‘ascenzo F, De Ferrari G. P316 TRANSTHYRETIN CARDIAC AMYLOIDOSIS IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: A SINGLE CENTER EXPERIENCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Even if prevalent among patients with severe aortic stenosis (AS), the clinical suspicion for transthyretin cardiac amyloidosis (ATTR–CA) remains difficult in this subset.
Methods
Consecutive severe AS patients undergoing transcatheter aortic valve replacement (TAVR) evaluation at a single center were prospectively included. Those with suspected ATTR–CA based on clinical assessment underwent 99mTc–DPD cardiac scintigraphy. The RAISE score, a novel screening tool with high sensitivity for ATTR–CA in AS, was retrospectively calculated to rule–out ATTR–CA in the remaining patients. Patients were categorized as follow: “ATTR–CA +”: patients with confirmed ATTR–CA at 99mTc–DPD cardiac scintigraphy; “ATTR–CA –”: patients with negative 99mTc–DPD cardiac scintigraphy or a negative RAISE score; c) “ATTR–CA indeterminate”: patients not undergoing ATTR–CA assessment with a positive RAISE score. The characteristics and outcomes of ATTR–CA + and ATTR–CA – patients were compared.
Results
Of 107 included patients, ATTR–CA suspicion was posed in 13 patients and confirmed in 6. Patients were categorized as follow: 6 (5.6%) ATTR–CA +, 79 (73.8%) ATTR–CA –, 22 (20.6%) ATTR–CA indeterminate. Excluding ATTR–CA indeterminate patients, the prevalence of ATTR–CA was 7.1%. As compared to ATTR–CA – patients, ATTR–CA + patients were older, had higher procedural risk and more extensive myocardial and renal damage. They had higher left ventricle mass index and lower ECG voltages, translating into a lower voltage to mass ratio. Moreover, bifascicular block was more common. No difference in procedural outcomes and 1–year mortality was observed between groups.
Conclusions
Among severe AS patients, ATTR–CA is prevalent and presents with phenotypic features that may aid to differentiate it from lone AS. The procedural and mid–term outcomes following TAVR seems unaffected by ATTR–CA status.
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Affiliation(s)
- G Gallone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - F Bongiovanni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - F Bruno
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - L Scudeler
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - F Landra
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - A Andreis
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - R Casoni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - A Fava
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - S Pidello
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - C Raineri
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - T Usmiani
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - G Alunni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - F Conrotto
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - F D‘ascenzo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
| | - G De Ferrari
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO, TORINO; UNIVERSITÀ DI SIENA, SIENA
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3
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Porcari A, Merlo M, Baggio C, Gagno G, Andreis A, Rosmini S, Raafs A, Bromage D, Cannata' A, Di Bella G, Nucifora G, Perazzolo Marra M, Heymans S, Imazio M, Sinagra G. Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular ejection fraction (LVEF) relies mostly on late gadolinium enhancement (LGE) characterization (1).
Purpose
Left ventricular peak global longitudinal strain (LV-GLS) measured by feature tracking analysis might improve prognostication of AM presenting with normal LVEF (2,3).
Methods
Data of patients undergoing cardiac magnetic resonance (CMR) for clinically suspected AM in seven European Centres (2013-2020) were retrospectively analysed. Patients with AM confirmed by CMR and LVEF ≥50% were included. LGE was visually characterized: localized vs. diffuse, subepicardial vs midwall. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including cardiac death, life-threatening arrhythmias, development of heart failure or of LVEF <50%.
Results
Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV-GLS -17.3%. CMR was performed at 4 [2-12] days from hospitalization. At 27 months, 24 (9%) patients experienced ≥1 ACE (71% developed LVEF <50%). Compared to the others, patients experiencing ACEs had lower median LV-GLS values (-13.9% vs -17.5%, p=0.001). At Kaplan-Meier analysis, impaired LV-GLS (both considered as >-20% or quartiles), diffuse and midwall LGE were associated with ACEs (Figure 1). Patients with LV-GLS ≤-20% did not experience ACEs. LV-GLS remained associated with ACEs after adjustment for diffuse and midwall LGE.
Conclusions
In AM presenting with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE characterization, improving risk stratification and representing a rationale for further studies of therapy in this cohort (Figure 2).
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - C Baggio
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - G Gagno
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, University Cardiology A.O.U., Turin, Italy
| | - S Rosmini
- King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Raafs
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - D Bromage
- King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Cannata'
- King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - G Di Bella
- University of Messina, Department of Cardiology, Messina, Italy
| | - G Nucifora
- Manchester University NHS Foundation Trust, NorthWest Cardiac Imaging Centre, Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua, Italy
| | - S Heymans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - M Imazio
- Hospital Santa Maria della Misericordia, Cardiology, Cardiothoracic Department, Udine, Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
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4
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Levis M, Botto B, Andreis A, Gastino A, Blasi L, Bartoncini S, Giorgi M, Fava A, Cavallo F, Ferrero S, Boccomini C, Orsucci L, Ricardi U. OC-0293 Early detection of chemo and RT-related heart toxicity in lymphoma patients: The CARDIOCARE Project. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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5
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Brucato A, Lim-Watson MZ, Imazio M, Klein A, Andreis A, Andreis A, Cella D, Cremer P, Lewinter M, Luis SA, Lin D, Lotan D, Trotta L, Zou L, Wheeler A, Paolini JF. Health-related quality of life in patients with recurrent pericarditis: results from RHAPSODY, a phase 3 study of rilonacept. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1834] [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
Recurrent pericarditis (RP) patients report that painful, debilitating flares negatively impact their health-related quality of life (HRQoL). RHAPSODY, the Phase 3 trial of rilonacept (IL-1α/IL-1β cytokine trap), included a daily pain diary and patient-reported outcome SF-36v2 to measure HRQoL throughout the trial.
Purpose
The purpose of this research is to evaluate the effect of rilonacept on HRQoL in relation to changes in pain for RP patients who have a recurrence.
Methods
RHAPSODY enrolled 86 patients with acute symptomatic RP to receive weekly rilonacept for a 12-week run-in (RI) period and randomized 61 patients (1:1) to receive placebo (n=31) or continue rilonacept (n=30) for the event-driven randomized-withdrawal (RW) period. Patients on placebo who experienced a qualifying recurrence during RW (return of pericarditis pain and increase in C-reactive protein) were rescued with bailout rilonacept. Patients reported daily pericarditis pain electronically, using a 0–10 numeric rating scale (NRS), and completed the SF-36v2 at study visits prior to clinician interaction. Scores from RI Baseline (BL), RI Week 12 (RW BL), Recurrence visit, and RW up to Week 24 (or end of study; EOS) were evaluated for patients who experienced recurrence in RW. Analyses exclude one patient randomized to placebo who had a recurrence after Week 24 of the RW period.
Results
Analyses focused on the 22 of 30 patients (73%) in the placebo group who experienced a recurrence before Week 24 of RW (median time from RW BL to recurrence: 8.6 weeks). During RI, daily pain scores decreased while on rilonacept (Cohen's effect size [ES] d=−2.0), and SF-36v2 scores improved, with scores at RI BL (Fig. 1 red line) below the general population average of 50 and near or above average at RI Week 12 (Fig. 1 blue line); ES were all large (d>0.8), ranging from 0.917 (Mental Component Summary) to 2.021 (Bodily Pain). At recurrence, pain scores increased (d=6.5; Fig. 2) and SF-36v2 scores were below the population average (Fig. 1 orange line), with largest reductions between RI Week 12 (RW BL) and recurrence for Bodily Pain (−13.4) and Physical Component Summary (−10.6). Following rilonacept bailout, average pain decreased (d=−2.1; Fig. 2), and by RW Week 24/EOS, SF-36v2 scores returned to similar levels as at the end of the RI period (Fig. 1 green line).
Conclusion
Impaired RI BL SF-36v2 scores indicate negative impact of RP on HRQOL in RP patients. While receiving rilonacept, HRQoL scores improved to near or above population averages, in conjunction with patient-reported pain. After discontinuing rilonacept during RW, HRQoL scores worsened at recurrence and improved upon receipt of bail-out rilonacept, similar to pain. These results provide support for the broader benefit of rilonacept treatment beyond pain, when administered on top of conventional therapies and as mono-therapy, providing evidence of its potential to improve HRQoL in this patient population.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Kiniksa Pharmaceuticals, Ltd.
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Affiliation(s)
- A Brucato
- Fatebenefratelli Hospital, Milan, Italy
| | - M Z Lim-Watson
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
| | - M Imazio
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - A Klein
- Cleveland Clinic, Cleveland, United States of America
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - D Cella
- Northwestern University, Evanston, Illinois, United States of America
| | - P Cremer
- Cleveland Clinic, Cleveland, United States of America
| | - M Lewinter
- The University of Vermont Medical Center, Burlington, United States of America
| | - S A Luis
- Mayo Clinic, Rochester, United States of America
| | - D Lin
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - D Lotan
- Sheba Medical Center, Tel Aviv, Israel
| | - L Trotta
- Fatebenefratelli Hospital, Milan, Italy
| | - L Zou
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
| | - A Wheeler
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
| | - J F Paolini
- Kiniksa Pharmaceuticals Corp, Lexington, Massachusetts, United States of America
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6
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Bocchino PP, Angelini F, Vairo A, Andreis A, Fortuni F, Franchin L, Frea S, Raineri C, Pidello S, Conrotto F, Montefusco A, Alunni G, De Ferrari GM. Clinical outcomes following isolated transcatheter tricuspid valve repair: a meta-analysis and meta-regression study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2222] [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
Significant tricuspid regurgitation (TR) is a common valvular heart disease worldwide.
Purpose
We aimed to assess the pooled clinical and echocardiographic outcomes of different isolated transcatheter tricuspid valve repair (ITTVR) strategies for significant (≥ moderate) TR.
Methods
We systematically searched the literature for studies evaluating the efficacy and safety of ITTVR for significant TR in adult. The primary outcomes were the improvement of New York Heart Association (NYHA) functional class and 6-minutes walking distance (6MWD) and the presence of severe or greater TR at the last available follow-up of each individual study. Random-effect meta-analysis was performed comparing outcomes before and after ITTVR.
Results
14 studies with 771 patients were included. Mean age was 77±8 years and mean EuroScore II was 6.8%±5.4%. At a weighted mean follow-up of 212 days, 209 (35%) patients had a NYHA III to IV functional class compared to 586 (84%) patients at baseline (risk ratio: 0.23, 95% CI 0.13 to 0.40, P-value<0.001). 6MWD significantly improved from 237±113 meters to 294±105 meters (mean difference: +50 meters, 95% CI +34 to +66 meters, P-value<0.001). 147 (24%) patients showed severe or greater TR after ITTVR compared to 616 (96%) at baseline (risk ratio: 0.29, 95% CI 0.20 to 0.42, P-value<0.001).
Conclusion
Patients undergoing ITTVR for significant TR experienced a significant improvement in NYHA functional status and 6MWD and a significant reduction in TR severity at mid-term follow-up.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P P Bocchino
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - F Angelini
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - A Vairo
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - F Fortuni
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - L Franchin
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - S Frea
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - C Raineri
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - S Pidello
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - F Conrotto
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - A Montefusco
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - G Alunni
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
| | - G M De Ferrari
- Hospital Citta Della Salute e della Scienza di Torino, Turin, Italy
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7
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Imazio M, Andreis A, Piroli F, Casula M, Paneva E, Avondo S, De Ferrari GM. Is colchicine safe for cardiovascular indications? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1209] [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
Colchicine has an emerging role in the cardiovascular field (e.g. acute and chronic coronary syndromes, pericarditis, atrial fibrillation), although, concerns for side effects, especially gastrointestinal, may limit its prescription.
Aims
We aimed at evaluating reported side effects of colchicine for cardiovascular indications.
Methods
We performed a meta-analysis of published randomized controlled trials on colchicine for the treatment of cardiovascular diseases. Random-effects meta-analysis was used to assess the risk of adverse events and drug withdrawal. Publication bias was assessed using the Egger test, and meta-regression was performed to assess sources of heterogeneity.
Results
Among 14 188 patients, 7136 patients received colchicine while the other 7052 received placebo. The occurrence of any adverse event with colchicine was reported in 15.3 vs. 13.9% patients [relative risk (RR) 1.26, 95% confidence interval (CI) 0.96–1.64, P=0.09, see figure]. Gastrointestinal events were reported in 16.1 vs. 12.2% (RR 2.16, 95% CI 1.50–3.12, P<0.001), while diarrhoea was reported in 12.5 vs. 8.1% (RR 2.77, 95% CI 1.55–4.94, P<0.001). The risk of gastrointestinal events increased with daily dose and shorter treatment duration. Myalgias were observed in 21 vs. 18% patients (RR 1.16, 95% CI 1.02–1.32, P=0.03). Other adverse events such as myotoxicity, hepatic adverse events, hematologic adverse events, cutaneous adverse events, infection or death were not increased by colchicine treatment. Colchicine discontinuation was reported in 4.8 vs. 3.4% patients (RR 1.54, 95% CI 1.20–1.99, P<0.001).
Conclusions
Colchicine is associated with increased risk of gastrointestinal events and myalgias, but not of other adverse events. The risk of gastrointestinal events may be avoided with lower dose (0.5 mg/daily) and is inversely related to treatment duration, possibly due to early drug discontinuation or drug tolerance.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Imazio
- University Hospital Santa Maria della Misericordia, Cardiology, Cardiothoracic Department, Udine, Italy
| | - A Andreis
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - F Piroli
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - M Casula
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - E Paneva
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - S Avondo
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - G M De Ferrari
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
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8
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Imazio M, Pivetta E, Andreis A, Serra C, Ottino M, Brucato A, Giustetto C, Rinaldi M, Lupia E, De Ferrari GM, Adler Y. Incessant pericarditis as a risk factor for complicated pericarditis and hospital admission. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1826] [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
Incessant pericarditis is defined as pericarditis with persistent symptoms without a symptom-free interval of 4 to 6 weeks despite therapy. On the contrary, recurrent pericarditis is characterized by recurring symptoms after a symptom-free interval of at least 4 to 6 weeks, allowing the completion of therapy.
Aims
The aim of this study is to assess the risk of complicated pericarditis and related hospitalizations according to the clinical pattern of incessant or recurrent pericarditis.
Methods
From January 2017 to December 2018, all consecutive patients admitted to AOU Città della Salute (Turin, IT) for pericarditis were included in a prospective cohort study with a clinical and echocardiographic follow-up at 1, 3, and 6 months, and then every 6 months.
Results
We included 147 patients (median age, 50.9 years [IQR, 28.5]; 49.7% women, 89% had idiopathic aetiology, 11% had pericarditis related to systemic inflammatory disease/postcardiac injury syndrome, 80% had pericardial effusion, and 62% had elevated C-reactive protein >5 mg/L). Patients were treated according to ESC guidelines. After a median follow-up of 14 months (IQR, 9 months), adverse events were recorded in 54/147 patients (36.7%): nonidiopathic/viral aetiology in 16 of 147 cases (10.9%), recurrent pericarditis/persistent symptoms in 53 of 147 cases (36.1%), cardiac tamponade in 4/147 cases (2.7%), persistent CP in 4/147 cases (2.7%), and hospitalization related to pericarditis in 38/147 cases (25.9%). An incessant course was reported in 18 of 147 cases (12%). The risk of complications was higher in patients with incessant pericarditis (Figure) – especially CP – compared to nonincessant course (22.2% versus 0%, respectively; P<0.001). Patients with incessant pericarditis more commonly had echocardiographic evidence of CP (77.8% vs. 9.3%; P<0.001) and thickened pericardium on multimodality imaging (66.7% vs. 4.7%; P<0.001). These findings were reversible with medical therapy with the use of anakinra (100 mg/d) and colchicine in all but 4 cases that progressed to persistent CP, which were referred for pericardiectomy. An analysis of risk factors for complicated pericarditis and hospitalization using Cox proportional hazards regression analysis identified the following risk factors: large pericardial effusion (hazard ratio, 7.63 [95% CI, 3.09–18.83]), elevated C-reactive protein >5 mg/L (hazard ratio, 5.55 [95% CI, 1.87–16.44]), and incessant course (HR, 17.10 [95% CI, 7.63–38.33]).
Conclusions
This study highlights that an incessant course of pericarditis is a possible new risk factor for complications and especially for developing constriction. In clinical practice, the detection of an incessant course, as well as imaging findings of constriction and pericardial thickening, should prompt more diagnostic testing, a close follow-up, and more aggressive therapy to prevent complications and persistent constriction.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- M Imazio
- University Hospital Santa Maria della Misericordia, Cardiology, Cardiothoracic Department, Udine, Italy
| | - E Pivetta
- A.O.U. Citta della Salute e della Scienza di Torino, Emergency Medicine Department, Turin, Italy
| | - A Andreis
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - C Serra
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - M Ottino
- A.O.U. Citta della Salute e della Scienza di Torino, Emergency Medicine Department, Turin, Italy
| | - A Brucato
- Fatebenefratelli Hospital, Dipartimento Scienze Biomediche e Cliniche, Milan, Italy
| | - C Giustetto
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - M Rinaldi
- A.O.U. Citta della Salute e della Scienza di Torino, University Cardiac Surgery, Cardiovascular Department, Turin, Italy
| | - E Lupia
- A.O.U. Citta della Salute e della Scienza di Torino, Emergency Medicine Department, Turin, Italy
| | - G M De Ferrari
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - Y Adler
- Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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9
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Bruno F, Elia E, D'Ascenzo F, Marengo G, De Filippo O, Gallone G, Andreis A, Fortuni F, Salizzoni S, Rinaldi M, La Torre M, Conrotto F, De Ferrari GM. Valve-in-valve transcatheter aortic valve replacement or re-surgical aortic valve replacement in degenerated bioprostheses: a systematic review and meta-analysis of short and mid-term results. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2188] [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
Introduction
Despite limited to short and mid-term outcomes, Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a less invasive alternative to redo surgery for high and intermediate-risk patients with good outcomes across different surgical risk profiles.
Purpose
The aim of the resent meta-analysis is to compare short and mid-term outcomes of VIV and surgical redo fo patients with a degenerative aortic bioprosthesis.
Methods
All studies comparing with multivariate adjustment between ViV TAVI and re-SAVR were screened. All-cause mortality at 30-day and at follow-up were the primary endpoints, while Valve Academy research Consortium (VARC) endpoints at 30 days including stroke, myocardial infarction (MI), major vascular complications, major bleeding, new onset atrial fibrillation (AF) and permanent pacemaker implantation (PPI) during the index hospitalization were the secondary endpoints. Subgroup analysis were performed according to the surgical risk. All the analyses were stratified according to the design of the study (observational vs propensity-matched study).
Results
We obtained data from 11 studies, encompassing 8570 patients, 4224 undergoing ViV TAVI and 4346 re-SAVR. Four studies included intermediate-risk patients and seven high-risk patients. Mean age was 76 and 71.5 years in the ViV and re-SAVR group respectively, with a 60.2% and 61.3% of male. For the ViV procedure, BE prostheses were used in the 49.6% of patients and SE prostheses in the 45.8%. The ViV group have higher prevalence of previous CAD (53.8% vs 41.1%) and CABG (35% vs 23.6%) and more history of HF (72.1% vs 65.6%), CKD (26.6% vs 14.8%) and COPD (25.4 vs 14.8%). 30-day all-cause and CV mortality were significantly lower in ViV (OR 0.43, 0.29–0.64 and OR 0.44, 0.26–0.73 respectively), while after a mean follow-up of 717 (180–1825) days, there were no difference between the two groups (OR 1.04, 0.87–1.25 and OR 1.05, 0.78–1.43 respectively). The result were consistent both in intermediate and high-risk classes. The risk of stroke (OR 1.03, 0.59–1.82), MI (OR 0.70, 0.34–1.44), major vascular complications (OR 0.92, 0.50–1.67) and permanent pacemaker implantation (OR 0.67, 0.36–1.25) at 30 days did not differ, while major bleedings and new onset atrial fibrillation were significantly lower in ViV patients (OR 0.41, 0.25–0.67 and OR 0.23, 0.12–0.42 respectively, all CI 95%).
Conclusions
In patients with a degenerated aortic bioprosthesis, ViV TAVI is associated with better short-term outcomes, including all-cause mortality, without any difference in all-cause and cardiovascular mortality at mid-term follow-up compared to surgical redo.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Bruno
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - E Elia
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - F D'Ascenzo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - G Marengo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - O De Filippo
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - G Gallone
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - A Andreis
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - F Fortuni
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - S Salizzoni
- A.O.U. Citta della Salute e della Scienza di Torino, Cardiosurgery, Turin, Italy
| | - M Rinaldi
- A.O.U. Citta della Salute e della Scienza di Torino, Cardiosurgery, Turin, Italy
| | - M La Torre
- A.O.U. Citta della Salute e della Scienza di Torino, Cardiosurgery, Turin, Italy
| | - F Conrotto
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - G M De Ferrari
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
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10
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Abstract
Abstract
Background
Corticosteroid-dependent and colchicine-resistant recurrent pericarditis (RP) is a challenging management problem, in which conventional anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids) is unable to control the disease. Recent data suggest a potential role for anti-interleukin-1 (IL-1) agents for this condition.
Purpose
This study was designed to assess the safety and efficacy of anti-IL-1 agents in this setting.
Methods
We performed a systematic review and meta-analysis of randomised controlled trials and observational studies assessing pericarditis recurrences and drug-related adverse events in patients receiving anti-IL-1 drugs for pericarditis.
Results
The meta-analysis assessed 7 studies including 397 pooled patients with RP. The median age was 42 years, 60% were women and the aetiology was idiopathic in 87%. After a median follow-up of 14 months (IQR,12–39), patients receiving anti-IL-1 agents (anakinra or rilonacept) had a significantly reduction in pericarditis recurrences (incidence rate ratio 0.06, 95% CI 0.03 to 0.14, see figure), compared with placebo and/or standard medical therapy. Anti-IL-1 agents were associated with increased risk of adverse events compared with placebo (risk ratio (RR) 5.38, 95% CI 2.08 to 13.92): injection-site reactions occurred in 15/41 (36.6%) vs. none (RR 14.98, 95% CI 2.09 to 107.09), infections occurred in 13/51 (25.5%) vs. 3/41 (7.3%; RR 3.65, 95% CI 1.23 to 10.85). Anti-IL-1 agents were not associated with increased risk of severe adverse events.
Conclusions
In patients with RP, anti-IL-1 agents (anakinra and rilonacept) are efficacious for prevention of recurrences, without severe adverse events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Imazio
- University Hospital Santa Maria della Misericordia, Cardiology, Cardiothoracic Department, Udine, Italy
| | - A Andreis
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - F Piroli
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - G Lazaros
- Hippokration General Hospital, University Cardiology, Athens, Greece
| | - M Lewinter
- The Robert Larner, M.D. College of Medicine at The University of Vermont, Burlington, United States of America
| | - A Klein
- Cleveland Clinic, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - A Brucato
- Fatebenefratelli Hospital, Department of Biomedical and Clinical Sciences, Milan, Italy
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11
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Andreis A, Imazio M, Brucato A, De Ferrari G, Rinaldi M, Adler Y. Interleukin-1 blockade in patients with pericardial constriction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2162] [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
Recurrent pericarditis is very difficult to treat, especially when symptoms become refractory to conventional treatments (nonsteroidal anti-inflammatory drugs,colchicine,corticosteroids). Interleukin-1 (IL-1) blockade with anakinra has been proved to be useful in this setting. Indeed, persistent inflammation of the pericardium may lead to pericardial constriction, worsening prognosis.
Purpose
This study was aimed to assess the incidence and clinical course of pericardial constriction in patients with corticosteroid-dependent, colchicine-resistant recurrent pericarditis (CCRP) undergoing anti IL-1 treatment.
Methods
We selected patients included in the IRAP (International Registry of Anakinra for Pericarditis). A subgroup of 39 CCRP patients enrolled at the coordinating center underwent echocardiographic and clinical assessment for pericardial constriction.
Results
Thirty-nine patients were assessed, aged 42±12 years old, 67% females, 74% idiopathic etiology, with a median disease duration of 12 months (IQR 9–20) and a recurrence rate of 2.79 flares-patient/year before starting anakinra. Echocardiographic signs of pericardial constriction were demonstrated in 8 patients (21%). After starting anakinra, in 5/8 patients (63%) a complete resolution of pericardial constriction was observed within a median of 1.2 months,IQR 1–4. In other 3/8 patients (37%) pericardial constriction persisted and became chronic, requiring pericardiectomy within a median of 2.8 months, IQR 2–5.
Compared with others, the 8 patients with pericardial constriction hadn't had a greater burden of pericardial flares before anakinra (3.87 flares-patient/year vs. 2.62/patient-year, p=0.07) and after anakinra (0.71 flares-patient/year vs. 0.72/patient-year, p=0.99). However, among 11 patients (28%) with incessant symptoms, an higher incidence of pericardial constriction was observed, compared with patients with recurrent symptoms (respectively 64% vs. 3.6%, RR=47, 95% CI 4.5–492, p<0.01).
Conclusions
In CCRP patients, pericardial constriction may be reversed by anti IL-1 agents. The risk of pericardial constriction is associated with incessant symptoms rather than simple recurrent course.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Andreis
- Città della Salute e della Scienza di Torino Hospital, Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Imazio
- Città della Salute e della Scienza di Torino Hospital, Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - A Brucato
- ASST Fatebenefratelli - Sacco, University of Milan, Department of Biomedical and Clinical Sciences “L. Sacco”, Milan, Italy
| | - G.M De Ferrari
- Città della Salute e della Scienza di Torino Hospital, Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Rinaldi
- Città della Salute e della Scienza di Torino Hospital, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Y Adler
- Leviev Heart Center, Chaim Sheba Medical Center (affiliated to Tel Aviv University), Israel, Tel Aviv, Israel
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12
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Votava-Raić A, Andreis I, Tjesić-Drinković D, Andreis A. [The intestinal immune system in children and their disorders]. Lijec Vjesn 1998; 120:72-9. [PMID: 9769631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The specificities of arrangement and normal function of the intestinal immunological system are presented, and non-immunological and immunological gastrointestinal defense mechanisms are described. Of immunological defense mechanisms, cellular and humoral mechanisms are described separately, and their characteristics in childhood are highlighted. After a general survey of the intestinal immunological system disorders and their role in various diseases, three most frequent such diseases are described in detail: food intolerance, gluten enteropathy and chronic inflammatory bowel disease.
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Affiliation(s)
- A Votava-Raić
- Klinika za pedijatriju, Klinicki bolnicki centar, Medicinski fakultet, Salata
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13
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Soljaćić M, Andreis A. The renal gluconeogenesis and blood glucose concentration in intact and uninephrectomized rats. Clin Nutr 1990. [DOI: 10.1016/0261-5614(90)90134-e] [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: 11/29/2022]
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14
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Andreis A, Soljaćić M. The jnfluence of energy and protein-nitrogen intake on body and kidney mass in uninephrectomized rats. Clin Nutr 1990. [DOI: 10.1016/0261-5614(90)90135-f] [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: 11/28/2022]
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