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Belfioretti L, Francioni M, Battistoni I, Angelini L, Matassini MV, Pongetti G, Shkoza M, Piangerelli L, Piva T, Nicolini E, Maolo A, Muçaj A, Compagnucci P, Munch C, Dello Russo A, Di Eusanio M, Marini M. Evolution of Cardiogenic Shock Management and Development of a Multidisciplinary Team-Based Approach: Ten Years Experience of a Single Center. J Clin Med 2024; 13:2101. [PMID: 38610866 PMCID: PMC11012883 DOI: 10.3390/jcm13072101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The management of cardiogenic shock (CS) after ACS has evolved over time, and the development of a multidisciplinary team-based approach has been shown to improve outcomes, although mortality remains high. Methods: All consecutive patients with ACS-CS admitted at our CICU from March 2012 to July 2021 were included in this single-center retrospective study. In 2019, we established a "shock team" consisting of a cardiac intensivist, an interventional cardiologist, an anesthetist, and a cardiac surgeon. The primary outcome was in-hospital mortality. Results: We included 167 patients [males 67%; age 71 (61-80) years] with ischemic CS. The proportion of SCAI shock stages from A to E were 3.6%, 6.6%, 69.4%, 9.6%, and 10.8%, respectively, with a mean baseline serum lactate of 5.2 (3.1-8.8) mmol/L. Sixty-six percent of patients had severe LV dysfunction, and 76.1% needed ≥ 1 inotropic drug. Mechanical cardiac support (MCS) was pursued in 91.1% [65% IABP, 23% Impella CP, 4% VA-ECMO]. From March 2012 to July 2021, we observed a significative temporal trend in mortality reduction from 57% to 29% (OR = 0.90, p = 0.0015). Over time, CS management has changed, with a significant increase in Impella catheter use (p = 0.0005) and a greater use of dobutamine and levosimendan (p = 0.015 and p = 0.0001) as inotropic support. In-hospital mortality varied across SCAI shock stages, and the SCAI E profile was associated with a poor prognosis regardless of patient age (OR 28.50, p = 0.039). Conclusions: The temporal trend mortality reduction in CS patients is multifactorial, and it could be explained by the multidisciplinary care developed over the years.
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Affiliation(s)
- Leonardo Belfioretti
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Matteo Francioni
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Ilaria Battistoni
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Luca Angelini
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Maria Vittoria Matassini
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Giulia Pongetti
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Matilda Shkoza
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Luca Piangerelli
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Tommaso Piva
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Elisa Nicolini
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Alessandro Maolo
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Andi Muçaj
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (P.C.); (A.D.R.)
| | - Christopher Munch
- Cardiac Anaesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy;
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (P.C.); (A.D.R.)
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy;
| | - Marco Marini
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
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Marzullo R, Capestro A, Muçaj A, Piva T. Percutaneous rheolytic thrombectomy and cerebral embolic protection in a massive thrombosis of a fenestrated Fontan conduit: a case report. Eur Heart J Case Rep 2023; 7:ytad238. [PMID: 37215519 PMCID: PMC10199720 DOI: 10.1093/ehjcr/ytad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
Background Clinical thromboembolism in Fontan patients is often a catastrophic event resulting in death and adverse long-term outcomes. The treatment of acute thromboembolic complications in these patients is very controversial. Case summary We describe the use of rheolytic thrombectomy in a Fontan patient with life-threatening pulmonary embolism, employing a cerebral protection system to reduce the risk of stroke through the fenestration. Discussion Rheolytic thrombectomy may be a successful alternative to systemic thrombolytic therapy and open surgical resection for the treatment of acute high-risk pulmonary embolism in the Fontan population. Embolic protection device to capture and remove thrombus/debris may be an innovative tool to reduce the risk of stroke through the fenestration while performing a percutaneous procedure in fenestrated Fontan patient.
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Affiliation(s)
| | - Alessandro Capestro
- Department of Pediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria—Ospedali Riuniti Ancona ‘Umberto I—G.M.Lancisi—G.Salesi’, Ancona, Italy
| | - Andi Muçaj
- Department of Cardiology, Azienda Ospedaliero-Universitaria—Ospedali Riuniti Ancona ‘Umberto I—G.M.Lancisi—G.Salesi’, Ancona, Italy
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Piva T, Nicolini E, Muçaj A, Maolo A, Terracciano F, Beltrame M, Schicchi N, Boscarato P, Aprile A, Serenelli M, Dello Russo A, Perna G, Gabrielli G. [Management of access site vascular complications in transcatheter aortic valve implantation]. G Ital Cardiol (Rome) 2020; 21:4S-12S. [PMID: 33295329 DOI: 10.1714/3487.34667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since its advent, transcatheter aortic valve implantation (TAVI) has experienced a continuous expansion, thanks to extraordinary clinical results and to the dramatic increase of safety, enabled by improvements of prosthesis and delivery systems, refinement of implantation techniques, increasing operator experience, and use of computed tomography scan for procedural planning. However, complications rates are still not negligible. As vascular complications, and, particularly, access-related complications are among the most frequent adverse events, all TAVI operators should know how to prevent and how to manage those potentially catastrophic situations. Here we provide an overview of the most frequent access site vascular complications and the respective treatment options.
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Affiliation(s)
- Tommaso Piva
- SOSD Emodinamica Interventistica Strutturale e Pediatrica
| | - Elisa Nicolini
- SOSD Emodinamica Interventistica Strutturale e Pediatrica
| | - Andi Muçaj
- SOSD Emodinamica Interventistica Strutturale e Pediatrica
| | | | | | - Mirko Beltrame
- SOSD Emodinamica Interventistica Strutturale e Pediatrica
| | | | | | | | | | | | - Gianpiero Perna
- SOD Cardiologia Ospedaliera e UTIC, AOU Ospedali Riuniti di Ancona
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Navarese EP, Frediani L, Kandzari DE, Caiazzo G, Cenname AM, Cortese B, Piva T, Muçaj A, Tumscitz C, Paparoni F, Larosa C, Bisceglia T, Menozzi M, Gurbel PA, Kubica J. Efficacy and safety of intracoronary epinephrine versus conventional treatments alone in STEMI patients with refractory coronary no‐reflow during primary PCI: The RESTORE observational study. Catheter Cardiovasc Interv 2020; 97:602-611. [DOI: 10.1002/ccd.29113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Eliano P. Navarese
- Department of Cardiology, Collegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
- SIRIO MEDICINE Network Bydgoszcz Poland
- Faculty of Medicine University of Alberta Edmonton Canada
| | - Lara Frediani
- Department of Cardiology Livorno Hospital, Azienda Usl Toscana Nord‐Ovest, Ospedali Riuniti di Livorno Livorno Italy
| | | | | | | | | | - Tommaso Piva
- Department of Cardiologic Azienda Ospedaliero Universitaria "Ospedali Riuniti" Ancona Italy
| | - Andi Muçaj
- Department of Cardiologic Azienda Ospedaliero Universitaria "Ospedali Riuniti" Ancona Italy
| | | | | | - Claudio Larosa
- Department of Cardiology Azienda Ospedaliera Bonomo Andria Italy
| | - Teodoro Bisceglia
- Department of Cardiology Santa Maria della Misericordia Hospital Udine Italy
| | | | - Paul A. Gurbel
- Sinai Center form Thrombosis Research Sinai Hospital of Baltimore Baltimore Maryland USA
| | - Jacek Kubica
- Department of Cardiology, Collegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
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Cassese S, Galasso G, Sciahbasi A, Scacciatella P, Muçaj A, Piccolo R, D'Anna C, Pangrazi A, Lioy E, Marra S, Piscione F. Antiplatelet theRapy after Genous EPC-capturing coroNary stenT implantatiOn. Int J Cardiol 2013; 167:757-61. [DOI: 10.1016/j.ijcard.2012.03.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/30/2012] [Accepted: 03/03/2012] [Indexed: 11/30/2022]
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Abstract
AIMS There is evidence that plasma coenzyme Q(10) (CoQ(10)) levels decrease in patients with advanced chronic heart failure (CHF). However, it is not known whether oral CoQ(10) supplementation may improve cardiocirculatory efficiency and endothelial function in patients with CHF. METHODS AND RESULTS We studied 23 patients in NYHA class II and III (20 men, three women, mean age 59+/-9 years) with stable CHF secondary to ischaemic heart disease [ejection fraction 37+/-7%], using a double-blind, placebo-controlled cross-over design. Patients were assigned to each of the following treatments: oral CoQ(10) (100 mg tid), CoQ(10) plus supervised exercise training (ET) (60% of peak VO(2), five times a week), placebo, and placebo plus ET. Each phase lasted 4 weeks. Both peak VO(2) and endothelium-dependent dilation of the brachial artery (EDDBA) improved significantly after CoQ(10) and after ET as compared with placebo. CoQ(10) main effect was: peak VO(2)+9%, EDDBA +38%, systolic wall thickening score index (SWTI) -12%; ET produced comparable effects. CoQ(10) supplementation resulted in a four-fold increase in plasma CoQ(10) level, whereas the combination with ET further increased it. No side effects were reported with CoQ(10). CONCLUSIONS Oral CoQ(10) improves functional capacity, endothelial function, and LV contractility in CHF without any side effects. The combination of CoQ(10) and ET resulted in higher plasma CoQ(10) levels and more pronounced effects on all the abovementioned parameters. However, significant synergistic effect of CoQ(10) with ET was observed only for peak SWTI suggesting that ET amplifies the already described effect of CoQ(10) on contractility of dysfunctional myocardium.
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Belardinelli R, Muçaj A, Lacalaprice F, Solenghi M, Principi F, Tiano L, Littarru GP. Coenzyme Q10 improves contractility of dysfunctional myocardium in chronic heart failure. Biofactors 2005; 25:137-45. [PMID: 16873938 DOI: 10.1002/biof.5520250115] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is evidence that plasma CoQ(10) levels decrease in patients with advanced chronic heart failure (CHF). OBJECTIVE To investigate whether oral CoQ(10) supplementation could improve cardiocirculatory efficiency in patients with CHF. METHODS We studied 21 patients in NYHA class II and III (18M, 3W, mean age 59 +/- 9 years) with stable CHF secondary to ischemic heart disease (ejection fraction 37 +/- 7%), using a double-blind, placebo-controlled cross-over design. Patients were assigned to oral CoQ(10) (100 mg tid) and to placebo for 4 weeks, respectively. RESULTS CoQ(10) supplementation resulted in a threefold increase in plasma CoQ(10) level (P < 0.0001 vs placebo). Systolic wall thickening score index (SWTI) was improved both at rest and peak dobutamine stress echo after CoQ(10) supplementation (+12.1 and 15.6%, respectively, P < 0.05 vs placebo). Left ventricular ejection fraction improved significantly also at peak dobutamine (15% from study entry P < 0.0001) in relation to a decrease in LV end-systolic volume index (from 57 +/- 7 mL/m(2) to 45 mL/m(2), P < 0.001). Improvement in the contractile response was more evident among initially akinetic (+33%) and hypokinetic (+25%) segments than dyskinetic ones (+6%). Improvement in SWTI was correlated with changes in plasma CoQ(10) levels (r = -0.52, P < 0.005). Peak VO(2) was also improved after CoQ(10) as compared with placebo (+13%, <0.005). No side effects were reported with CoQ(10). CONCLUSIONS Oral CoQ(10) improves LV contractility in CHF without any side effects. This improvement is associated with an enhanced functional capacity.
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Affiliation(s)
- Romualdo Belardinelli
- Lancisi Heart Institute, Department of Cardiology and Cardiac Surgery, Ancona, Italy.
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Minardi D, Dessì-Fulgheri P, Sarzani R, Onesta M, Muçaj A, Branchi A, Giangiacomi M, Mantovani P, Muzzonigro G. Massive spontaneous perirenal hematoma and accelerated hypertension in a patient with polyarteritis nodosa. Urol Int 2003; 70:227-31. [PMID: 12660463 DOI: 10.1159/000068755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2000] [Indexed: 11/19/2022]
Abstract
A 43-year-old Albanian man is presented who underwent nephrectomy for a huge right spontaneous perirenal hematoma. The diagnosis of polyarteritis nodosa as the etiology of the hematoma has been made only by histological examination, because of the quick and unforeseeable onset of this complication and the nonspecificity of symptoms. We hypothesize a relationship between reactivation of polyarteritis nodosa and treatment with rifampicin and isoniazid.
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Affiliation(s)
- D Minardi
- Institute of Urology, University of Ancona Medical School, Umberto I Hospital, Piazza Cappelli 1, I-60121 Ancona, Italy.
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Tomasetti M, Alleva R, Piva R, Pancrazi A, Solenghi MD, Muçaj A, Littarru GP. Evaluation of ischemia-reperfusion damage during coronary angioplasty. Electrocardiographic assessment and biochemical modifications in blood from the coronary sinus. Ital Heart J 2000; 1:216-20. [PMID: 10806989] [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: 02/16/2023]
Abstract
BACKGROUND Percutaneous transluminal coronary angioplasty (PTCA) constitutes a clinical model of reperfusion following a short period of ischemia connected to balloon inflation during the procedure. During the procedure some ischemic damage and oxidative injury related to free radical attack might occur. In the present study we investigated the extent of ischemic damage and some biochemical indexes of reperfusion damage in patients undergoing PTCA. METHODS Twenty-five patients who underwent PTCA because of angiographically detected occlusion of the coronary artery were enrolled. Balloon inflation lasted from 30 to 60 s. ECG changes were monitored throughout the procedure and blood samples were taken from the coronary artery and coronary sinus before balloon inflation, and again from coronary sinus at the peak of ischemia, 2 and 10 min after reperfusion. RESULTS During PTCA procedure angina pectoris appeared in 62.7% of patients, whereas ST-segment elevation was present in 87% of patients, regressing completely after balloon deflation. Plasma malonyldialdehyde, an index of lipid peroxidation, did not change; coenzyme Q10 (in its oxidized and reduced forms), vitamin E and beta-carotene were also unchanged. Total antioxidant capacity and uric acid decreased upon reperfusion. CONCLUSIONS Myocardial ischemia occurring during balloon inflation is brief and regresses completely after balloon deflation. Reperfusion following a short period of acute ischemia such as in PTCA does not constitute an oxidative event detectable through a common marker of lipid peroxidation nor does it alter the concentration of lipophilic antioxidants. It only lowers hydrosoluble antioxidants therefore representing a mild oxidative insult.
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Affiliation(s)
- M Tomasetti
- Institute of Biochemistry, University of Ancona, Italy
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