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Jiménez-López J, Bazan V, Gonzalez-Matos CE, Di Marco A, Bottoni N, Battista A, Giacoman S, Sanchez-Millán PJ, Lozano JM, Álvarez-López M, Belarte-Tornero LC, Anguera I, Casteigt BJ, Sarrias-Mercé A, Weidmann ZM, Alonso-Martín C, Llorca L, Vallés-Gras E. "Targeting Confluent Areas of Slow Conduction and Electrogram Fragmentation for AV node Re-entrant Tachycardia ablation". Europace 2024:euae094. [PMID: 38606815 DOI: 10.1093/europace/euae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Jesús Jiménez-López
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar. Universitat Autònoma de Barcelona. Barcelona. Spain
| | - Victor Bazan
- Electrophysiology Unit, Cardiology Department. Hospital Universitari Germans Trias i Pujol. Badalona, Spain
| | - Carlos E Gonzalez-Matos
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar. Universitat Autònoma de Barcelona. Barcelona. Spain
| | - Andrea Di Marco
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Nicola Bottoni
- Electrophysiology Unit, Cardiology Department. Azienda USL - IRCSS of Reggio Emilia. Italy
| | - Antonella Battista
- Electrophysiology Unit, Cardiology Department. Azienda USL - IRCSS of Reggio Emilia. Italy
| | - Sebastian Giacoman
- Arrhythmia Unit. Cardiology deparment. Hospital Universitario Clínico San Cecilio. Granada. Spain
| | | | - Jose Miguel Lozano
- Arrhythmia Unit. Cardiology deparment. Hospital Universitario Clínico San Cecilio. Granada. Spain
| | | | - Laia C Belarte-Tornero
- Heart Diseases Biomedical Research Group, Hospital del Mar Medical Research Institute (IMIM). Barcelona. Spain
| | - Ignasi Anguera
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Benjamin Jacques Casteigt
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar. Universitat Autònoma de Barcelona. Barcelona. Spain
| | - Axel Sarrias-Mercé
- Electrophysiology Unit, Cardiology Department. Hospital Universitari Germans Trias i Pujol. Badalona, Spain
| | - Zoraida Moreno Weidmann
- Electrophysiology Unit. Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona. Spain
| | - Concepción Alonso-Martín
- Electrophysiology Unit. Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona. Spain
| | | | - Ermengol Vallés-Gras
- Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar. Universitat Autònoma de Barcelona. Barcelona. Spain
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Di Marco A, Artioli G, Favaretto A, Cavasin N, Basso U. Multiorgan failure caused by pembrolizumab and axitinib in a woman affected by metastatic clear cell renal cell carcinoma: A case report and literature review. Medicine (Baltimore) 2024; 103:e37606. [PMID: 38552059 PMCID: PMC10977559 DOI: 10.1097/md.0000000000037606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/23/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Treatment with a combination of immune checkpoint inhibitors (ICIs) (pembrolizumab or nivolumab) and oral Tyrosine Kinase Inhibitors (TKI) targeting angiogenesis (axitinib, cabozantinib or lenvatinib) has shown benefits in terms of efficacy and survival in metastatic renal cell carcinoma (mRCC), with a favorable toxicity profile. However, some rare and serious treatment-related adverse events can be difficult to manage. PATIENT CONCERNS Here we report the first case of an mRCC patient who, after only 2 administrations of pembrolizumab-axitinib, experienced severe multiorgan failure (MOF) with heart failure, oliguria and acute hepatitis requiring aggressive supportive treatment in intensive care unit. DIAGNOSES A diagnosis of severe MOF induced by pembrolizumab plus axitinib was considered. INTERVENTIONS The patient was treated with dobutamine, levosimendan along with high-dose steroids under continuous cardiologic monitoring. OUTCOMES After treatment, the patient had a full recovery and was discharged from the hospital. LESSONS We reviewed all the other cases of MOF reported during treatment with combined ICI-TKI in cancer patients in order to summarize incidence, clinical manifestations and management with a specific focus on the need for prompt recognition and aggressive management under multidisciplinary care.
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Affiliation(s)
- Andrea Di Marco
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Grazia Artioli
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca’ Foncello Hospital, Treviso, Italy
| | - Adolfo Favaretto
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca’ Foncello Hospital, Treviso, Italy
| | - Nicolò Cavasin
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Umberto Basso
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
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3
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Brown PF, Di Marco A, Tsoumani Z, Reid A, Bradley J, Nucifora G, Anguera I, Miller C, Schmitt M. Predictive value of a comprehensive atrial assessment with cardiac magnetic resonance in non-ischemic cardiomyopathy: keep it simple. Int J Cardiovasc Imaging 2024; 40:557-567. [PMID: 38064141 DOI: 10.1007/s10554-023-03024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/22/2023] [Indexed: 03/20/2024]
Abstract
Cardiac magnetic resonance (CMR) can provide a multi-parametric evaluation of left atrial (LA) size and function. A complete CMR-based LA assessment might improve the risk stratification of patients with non-ischemic dilated cardiomyopathy (DCM). We performed a comprehensive CMR-based evaluation of LA size and function, in order to assess the prognostic impact of specific LA parameters in DCM. Secondary analysis of a prospective registry (UHSM-CMR study, NCT02326324) including 648 consecutive patients with DCM and CMR evaluation of LA area and LA length. Of these, 456 had complete LA assessment covering reservoir, conduit and booster pump function and including LA reservoir strain evaluated with feature tracking. The heart failure (HF) endpoint included HF hospitalizations, HF death and heart transplant. The arrhythmic endpoint included ventricular arrhythmias (VA) (sustained or treated by implantable defibrillator) and sudden death (SD). At median follow-up of 23 months, 34 patients reached the HF endpoint; in a multivariable model including NYHA class and LVEF, LA length had incremental predictive value. LA length ≥ 69 mm was the best cut-off to predict HF events (adjusted HR 2.3, p = 0.03). Among the 456 patients with comprehensive LA assessment, only LA length was independently associated with the HF endpoint after adjusting for LVEF and NYHA class. By contrast, no LA parameter independently predicted the arrhythmic risk. In DCM patients, LA length is an independent predictor of HF events, showing stronger association than other more complex parameters of LA function. No atrial parameter predicts the risk of VA and SD.
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Affiliation(s)
- Pamela Frances Brown
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
| | - Andrea Di Marco
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
- Bio Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
- Cardiology department, Bellvitge University Hospital, carrer feixa llarga sin número, Hospitalet de Llobregat, Barcelona, 08907, Spain.
| | - Zoi Tsoumani
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Anna Reid
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Joshua Bradley
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Gaetano Nucifora
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Bio Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christopher Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Cardiac Imaging Department, North West Heart Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
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4
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Carrick RT, De Marco C, Gasperetti A, Bosman LP, Gourraud JB, Trancuccio A, Mazzanti A, Murray B, Pendleton C, Tichnell C, Tandri H, Zeppenfeld K, Wilde AAM, Davies B, Seifer C, Roberts JD, Healey JS, MacIntyre C, Alqarawi W, Tadros R, Cutler MJ, Targetti M, Calò L, Vitali F, Bertini M, Compagnucci P, Casella M, Dello Russo A, Cappelletto C, De Luca A, Stolfo D, Duru F, Jensen HK, Svensson A, Dahlberg P, Hasselberg NE, Di Marco A, Jordà P, Arbelo E, Moreno Weidmann Z, Borowiec K, Delinière A, Biernacka EK, van Tintelen JP, Platonov PG, Olivotto I, Saguner AM, Haugaa KH, Cox M, Tondo C, Merlo M, Krahn AD, te Riele ASJM, Wu KC, Calkins H, James CA, Cadrin-Tourigny J. Implantable cardioverter defibrillator use in arrhythmogenic right ventricular cardiomyopathy in North America and Europe. Eur Heart J 2024; 45:538-548. [PMID: 38195003 PMCID: PMC11024811 DOI: 10.1093/eurheartj/ehad799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND AIMS Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death (SCD) in arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to identify cross-continental differences in utilization of primary prevention ICDs and survival free from sustained ventricular arrhythmia (VA) in ARVC. METHODS This was a retrospective analysis of ARVC patients without prior VA enrolled in clinical registries from 11 countries throughout Europe and North America. Patients were classified according to whether they received treatment in North America or Europe and were further stratified by baseline predicted VA risk into low- (<10%/5 years), intermediate- (10%-25%/5 years), and high-risk (>25%/5 years) groups. Differences in ICD implantation and survival free from sustained VA events (including appropriate ICD therapy) were assessed. RESULTS One thousand ninety-eight patients were followed for a median of 5.1 years; 554 (50.5%) received a primary prevention ICD, and 286 (26.0%) experienced a first VA event. After adjusting for baseline risk factors, North Americans were more than three times as likely to receive ICDs {hazard ratio (HR) 3.1 [95% confidence interval (CI) 2.5, 3.8]} but had only mildly increased risk for incident sustained VA [HR 1.4 (95% CI 1.1, 1.8)]. North Americans without ICDs were at higher risk for incident sustained VA [HR 2.1 (95% CI 1.3, 3.4)] than Europeans. CONCLUSIONS North American ARVC patients were substantially more likely than Europeans to receive primary prevention ICDs across all arrhythmic risk strata. A lower rate of ICD implantation in Europe was not associated with a higher rate of VA events in those without ICDs.
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MESH Headings
- Humans
- Defibrillators, Implantable/adverse effects
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/epidemiology
- Arrhythmogenic Right Ventricular Dysplasia/therapy
- Retrospective Studies
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Risk Factors
- North America/epidemiology
- Europe/epidemiology
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Affiliation(s)
- Richard T Carrick
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Corrado De Marco
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Alessio Gasperetti
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laurens P Bosman
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Jean-Baptiste Gourraud
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, Centre Hospitalier Universitaire Nantes, Nantes, France
| | | | - Andrea Mazzanti
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri (IRCCS), Pavia, Italy
| | - Brittney Murray
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | | | - Crystal Tichnell
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Harikrishna Tandri
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur A M Wilde
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Amsterdam UMC, Heart Center Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, University of Amsterdam, Amsterdam, The Netherlands
| | - Brianna Davies
- Center for Cardiac Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colette Seifer
- St.Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason D Roberts
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jeff S Healey
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ciorsti MacIntyre
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saudi University, Riyadh, Saudi Arabia
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Michael J Cutler
- Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Francesco Vitali
- Cardiology Unit, Sant’Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Matteo Bertini
- Cardiology Unit, Sant’Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Chiara Cappelletto
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Antonio De Luca
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Henrik K Jensen
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Anneli Svensson
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pia Dahlberg
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nina E Hasselberg
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Andrea Di Marco
- Arrhythmia Unit, Department ofCardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- BioHeartCardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paloma Jordà
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
- Arrhythmia Section, Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Elena Arbelo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Arrhythmia Section, Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Karolina Borowiec
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
- Outpatient Department of Genetic Arrhythmias, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Antoine Delinière
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, National Reference Center for Inherited Arrhythmias of Lyon, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Claude Bernard Lyon 1 University, MeLiS, CNRS UMR 5284, INSERM U1314, Institut NeuroMyoGène, Lyon, France
| | - Elżbieta K Biernacka
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
- Outpatient Department of Genetic Arrhythmias, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - J Peter van Tintelen
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Moniek Cox
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Marco Merlo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Andrew D Krahn
- Center for Cardiac Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anneline S J M te Riele
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Katherine C Wu
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh Calkins
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia A James
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
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5
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Argentiero A, Carella MC, Mandunzio D, Greco G, Mushtaq S, Baggiano A, Fazzari F, Fusini L, Muscogiuri G, Basile P, Siena P, Soldato N, Napoli G, Santobuono VE, Forleo C, Garrido EC, Di Marco A, Pontone G, Guaricci AI. Cardiac Magnetic Resonance as Risk Stratification Tool in Non-Ischemic Dilated Cardiomyopathy Referred for Implantable Cardioverter Defibrillator Therapy-State of Art and Perspectives. J Clin Med 2023; 12:7752. [PMID: 38137821 PMCID: PMC10743710 DOI: 10.3390/jcm12247752] [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: 10/31/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Non-ischemic dilated cardiomyopathy (DCM) is a disease characterized by left ventricular dilation and systolic dysfunction. Patients with DCM are at higher risk for ventricular arrhythmias and sudden cardiac death (SCD). According to current international guidelines, left ventricular ejection fraction (LVEF) ≤ 35% represents the main indication for prophylactic implantable cardioverter defibrillator (ICD) implantation in patients with DCM. However, LVEF lacks sensitivity and specificity as a risk marker for SCD. It has been seen that the majority of patients with DCM do not actually benefit from the ICD implantation and, on the contrary, that many patients at risk of SCD are not identified as they have preserved or mildly depressed LVEF. Therefore, the use of LVEF as unique decision parameter does not maximize the benefit of ICD therapy. Multiple risk factors used in combination could likely predict SCD risk better than any single risk parameter. Several predictors have been proposed including genetic variants, electric indexes, and volumetric parameters of LV. Cardiac magnetic resonance (CMR) can improve risk stratification thanks to tissue characterization sequences such as LGE sequence, parametric mapping, and feature tracking. This review evaluates the role of CMR as a risk stratification tool in DCM patients referred for ICD.
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Affiliation(s)
- Adriana Argentiero
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Maria Cristina Carella
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Donato Mandunzio
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Giulia Greco
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
| | - Fabio Fazzari
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
| | - Laura Fusini
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
| | | | - Paolo Basile
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Paola Siena
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Nicolò Soldato
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Gianluigi Napoli
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Vincenzo Ezio Santobuono
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Cinzia Forleo
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
| | - Eduard Claver Garrido
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.C.G.); (A.D.M.)
- Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Andrea Di Marco
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (E.C.G.); (A.D.M.)
- Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (A.B.); (F.F.); (L.F.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy; (A.A.); (M.C.C.); (D.M.); (G.G.); (P.B.); (P.S.); (N.S.); (G.N.); (V.E.S.); (C.F.)
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Di Marco A. Cardiac Magnetic Resonance and Ventricular Arrhythmias: An Indissoluble Liaison. JACC Cardiovasc Imaging 2023; 16:1550-1551. [PMID: 37452822 DOI: 10.1016/j.jcmg.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
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Abstract
Left ventricular ejection fraction-based arrhythmic risk stratification in nonischemic cardiomyopathy (NICM) is insufficient and has led to the failure of primary prevention implantable cardioverter defibrillator trials, mainly due to the inability of selecting patients at high risk for sudden cardiac death (SCD). Cardiac magnetic resonance offers unique opportunities for tissue characterization and has gained a central role in arrhythmic risk stratification in NICM. The presence of myocardial scar, denoted by late gadolinium enhancement, is a significant, independent, and strong predictor of ventricular arrhythmias and SCD with high negative predictive value. T1 maps and extracellular volume fraction, which are able to quantify diffuse fibrosis, hold promise as complementary tools but need confirmatory results from large studies.
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Di Marco A, Brown P, Mateus G, Faga V, Nucifora G, Claver E, Viedma J, Galvan F, Bradley J, Dallaglio PD, de Frutos F, Miller CA, Comín-Colet J, Anguera I, Schmitt M. Late gadolinium enhancement and the risk of ventricular arrhythmias and sudden death in NYHA class I patients with non-ischaemic cardiomyopathy. Eur J Heart Fail 2023; 25:740-750. [PMID: 36781200 DOI: 10.1002/ejhf.2793] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
AIM To compare the risk of ventricular arrhythmias (VA) and sudden death (SD) between New York Heart Association (NYHA) class I and NYHA class II-III patients with non-ischaemic cardiomyopathy (NICM). METHODS AND RESULTS Observational retrospective cohort study including patients with NICM who underwent cardiac magnetic resonance at two hospitals. The primary endpoint included appropriate implantable cardioverter defibrillator (ICD) therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. The secondary endpoint included heart failure (HF) hospitalizations, heart transplant, left ventricular assist device implant or HF death. Overall, 698 patients were included, 33% in NYHA class I. During a median follow-up of 31 months, the primary endpoint occurred in 57 patients (8%), with no differences between NYHA class I and NYHA class II-III cases (7% vs. 9%, p = 0.62). Late gadolinium enhancement (LGE) was the only independent predictor of the primary outcome both in NYHA class I and NYHA class II-III patients. LGE+ NYHA class I patients had a similar cumulative incidence of the primary endpoint as compared to LGE+ NYHA class II-III (p = 0.92) and a significantly higher risk as compared to LGE- NYHA class II-III cases (p < 0.001). The risk of the secondary endpoint was significantly higher in patients in NYHA class II-III as compared to those in NYHA class I (hazard ratio 3.2, p = 0.001). CONCLUSIONS Patients with NICM in NYHA class I are not necessarily at low risk of VA and SD. Actually, LGE+ NYHA class I patients have a high risk. NYHA class I patients with high-risk factors, such as LGE, could benefit from primary prevention ICD at least as much as those in NYHA class II-III with the same risk factors.
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MESH Headings
- Humans
- Contrast Media
- Gadolinium
- Retrospective Studies
- Heart Failure/therapy
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/therapy
- Myocardial Ischemia/diagnostic imaging
- Myocardial Ischemia/epidemiology
- Myocardial Ischemia/complications
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Risk Factors
- Defibrillators, Implantable/adverse effects
- Cardiomyopathies
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Pamela Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gemma Mateus
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Valentina Faga
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Jisela Viedma
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Francisco Galvan
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Paolo D Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Fernando de Frutos
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Josep Comín-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Di Marco A, Brown PF, Bradley J, Nucifora G, Anguera I, Miller CA, Schmitt M. Extracellular volume fraction improves risk-stratification for ventricular arrhythmias and sudden death in non-ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:512-521. [PMID: 35877070 DOI: 10.1093/ehjci/jeac142] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate whether cardiac magnetic resonance (CMR)-based parametric mapping and strain analysis can improve the risk-stratification for ventricular arrhythmias (VA) and sudden death (SD) in non-ischaemic cardiomyopathy (NICM). METHODS AND RESULTS Secondary analysis of a prospective single-centre-registry (NCT02326324), including 703 consecutive NICM patients, 618 with extracellular volume (ECV) available. The combined primary endpoint included appropriate implantable cardioverter defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. During a median follow-up of 21 months, 14 patients (2%) experienced the primary endpoint. Native T1 was not associated with the primary endpoint. Left ventricular global longitudinal strain lost its significant association after adjustment for left ventricular ejection fraction (LVEF). Among patients with ECV available, 11 (2%) reached the primary endpoint. Mean ECV was significantly associated with the primary endpoint and the best cut-off was 30%. ECV ≥ 30% was the strongest independent predictor of the primary endpoint (hazard ratio 14.1, P = 0.01) after adjustment for late gadolinium enhancement (LGE) and LVEF. ECV ≥ 30% discriminated the arrhythmic risk among LGE+ cases and among those with LVEF ≤ 35%. A simple clinical risk-stratification model, based on LGE, LVEF ≤ 35% and ECV ≥ 30%, achieved an excellent predictive ability (Harrell's C 0.82) and reclassified the risk of 32% of the study population as compared to LVEF ≤ 35% alone. CONCLUSIONS Comprehensive CMR evaluation in NICM showed that ECV was the only parameter with an independent and strong predictive value for VA/SD, on top of LGE and LVEF. A risk-stratification model based on LGE, LVEF ≤ 35% and ECV ≥ 30% achieved an excellent predictive ability for VA/SD. CLINICAL TRIAL REGISTRATION UHSM CMR study (NCT02326324) https://clinicaltrials.gov/ct2/show/NCT02326324.
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Pamela F Brown
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
| | - Joshua Bradley
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
| | - Gaetano Nucifora
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona 08907, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Matthias Schmitt
- Manchester University Foundation Trust-Wythenshawe Site, Southmoor Road, Wythenshawe, Manchester M239LT, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9NQ, UK
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Claver E, Di Marco A, Brown PF, Bradley J, Nucifora G, Ruiz-Majoral A, Dallaglio PD, Rodriguez M, Comin-Colet J, Anguera I, Miller CA, Schmitt M. Prognostic impact of late gadolinium enhancement at the right ventricular insertion points in non-ischaemic dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:346-353. [PMID: 35699462 DOI: 10.1093/ehjci/jeac109] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate the baseline characteristics and the prognostic implications associated with late gadolinium enhancement limited to the right ventricular insertion points (IP-LGE) or present at both the right ventricular insertion points and the left ventricle (IP&LV-LGE) in non-ischaemic dilated cardiomyopathy (DCM). METHODS AND RESULTS This is a retrospective observational multicentre cohort study including 1165 consecutive patients with DCM evaluated by cardiac magnetic resonance. The primary endpoint included appropriate defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest, or sudden death. The secondary outcome encompassed heart failure hospitalizations, heart transplant, left ventricular assist device implantation, and end-stage heart failure death. IP-LGE was found in 72 patients (6%), who had clinical characteristics closer to LGE- than to LGE+ patients. During follow-up (median 36 months), none of the IP-LGE patients experienced the primary endpoint. The cumulative incidence of the primary endpoint was similar between IP-LGE and LGE- patients (P = 1), while IP-LGE had significantly lower cumulative incidence when compared with LGE+ patients (P < 0.001). When compared with IP-LGE patients, the cumulative incidence of the secondary endpoint was similar in LGE- cases (P = 0.86) but tended to be higher in LGE+ patients (P = 0.06). Both clinical characteristics and outcomes were similar between IP&LV-LGE patients and the rest of LGE+ cases. CONCLUSIONS In a large cohort of DCM patients, IP-LGE was associated with similar outcome when compared with LGE- patients and with significant lower risk of ventricular arrhythmias and sudden death when compared with LGE+ cases. Patients with IP&LV-LGE had clinical characteristics and outcomes similar to the rest of LGE+ cases.
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Affiliation(s)
- Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Pamela Frances Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
| | - Alejandro Ruiz-Majoral
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Paolo Domenico Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcos Rodriguez
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
- Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Calle feixa llarga s/n, Barcelona 08907, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, UK
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11
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Di Marco A, Brown P, Anguera I, Claver E, Schmitt M. Further Insights Into the Prognostic Value of Left Atrial Strain in Dilated Cardiomyopathy? JACC Cardiovasc Imaging 2022; 15:2155-2156. [PMID: 36481087 DOI: 10.1016/j.jcmg.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 12/12/2022]
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12
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Jordà P, Bosman LP, Gasperetti A, Mazzanti A, Gourraud JB, Davies B, Frederiksen TC, Moreno Weidmann Z, Di Marco A, Roberts JD, MacIntyre C, Seifer C, Delinière A, Alqarawi W, Kukavica D, Minois D, Trancuccio A, Arnaud M, Targetti M, Martino A, Oliviero G, Pipilas DC, Carbucicchio C, Compagnucci P, Dello Russo A, Olivotto I, Calò L, Lubitz SA, Cutler MJ, Chevalier P, Arbelo E, Priori SG, Healey JS, Calkins H, Casella M, Jensen HK, Tondo C, Tadros R, James CA, Krahn AD, Cadrin-Tourigny J. Arrhythmic risk prediction in arrhythmogenic right ventricular cardiomyopathy: external validation of the arrhythmogenic right ventricular cardiomyopathy risk calculator. Eur Heart J 2022; 43:3041-3052. [PMID: 35766180 PMCID: PMC9392650 DOI: 10.1093/eurheartj/ehac289] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/16/2022] [Accepted: 05/18/2022] [Indexed: 12/17/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) causes ventricular arrhythmias (VAs) and sudden cardiac death (SCD). In 2019, a risk prediction model that estimates the 5-year risk of incident VAs in ARVC was developed (ARVCrisk.com). This study aimed to externally validate this prediction model in a large international multicentre cohort and to compare its performance with the risk factor approach recommended for implantable cardioverter-defibrillator (ICD) use by published guidelines and expert consensus. METHODS AND RESULTS In a retrospective cohort of 429 individuals from 29 centres in North America and Europe, 103 (24%) experienced sustained VA during a median follow-up of 5.02 (2.05-7.90) years following diagnosis of ARVC. External validation yielded good discrimination [C-index of 0.70 (95% confidence interval-CI 0.65-0.75)] and calibration slope of 1.01 (95% CI 0.99-1.03). Compared with the three published consensus-based decision algorithms for ICD use in ARVC (Heart Rhythm Society consensus on arrhythmogenic cardiomyopathy, International Task Force consensus statement on the treatment of ARVC, and American Heart Association guidelines for VA and SCD), the risk calculator performed better with a superior net clinical benefit below risk threshold of 35%. CONCLUSION Using a large independent cohort of patients, this study shows that the ARVC risk model provides good prognostic information and outperforms other published decision algorithms for ICD use. These findings support the use of the model to facilitate shared decision making regarding ICD implantation in the primary prevention of SCD in ARVC.
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Affiliation(s)
- Paloma Jordà
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada.,Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laurens P Bosman
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.,Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | | | - Brianna Davies
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Zoraida Moreno Weidmann
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Andrea Di Marco
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.,Division of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Ciorsti MacIntyre
- Cardiac Electrophysiology Service, Quenn Elisabeth II Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Colette Seifer
- St-Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Antoine Delinière
- National Reference Center for Inherited Arrhythmias of Lyon, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
| | - Wael Alqarawi
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Deni Kukavica
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.,Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Damien Minois
- Department of Cardiology, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Alessandro Trancuccio
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.,Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Marine Arnaud
- Department of Cardiology, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Mattia Targetti
- Cardiomyopathy Unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Giada Oliviero
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Daniel C Pipilas
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Corrado Carbucicchio
- Department of Clinical Electrophysiology and Cardiac Pacing Centro Cardiologico Monzino, IRCCSC, Milan, Italy
| | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital Umberto I-Salesi-Lancisi, Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital Umberto I-Salesi-Lancisi, Marche Polytechnic University, Ancona, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Steven A Lubitz
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Cutler
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - Philippe Chevalier
- National Reference Center for Inherited Arrhythmias of Lyon, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,European Reference Network for rare, low prevalence and complex diseases of the heart - ERN GUARD-Heart
| | - Silvia Giuliana Priori
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.,Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.,Division of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michela Casella
- Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital Umberto I-Salesi-Lancisi, MarchePolytechnic University, Ancona, Italy
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing Centro Cardiologico Monzino, IRCCSC, Milan, Italy.,Department of Biomedical, Surgical and Dentistry Sciences, University of Milan, Milan, Italy
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
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13
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Di Marco A, Anguera I, Schmitt M. Additional Predictive Value of Gray Zone Fibrosis in Nonischemic Cardiomyopathy? J Am Coll Cardiol 2022; 79:e467. [PMID: 35654499 DOI: 10.1016/j.jacc.2022.03.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/24/2022]
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14
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Iannaccone M, Nombela-Franco L, Gallone G, Annone U, Di Marco A, Giannini F, Ayoub M, Sardone A, Amat-Santos I, Fernandez-Lozano I, Barbero U, Dusi V, Toselli M, Petretta A, de Salvia A, Boccuzzi G, Colangelo S, Anguera I, D'Ascenzo F, Colombo A, De Ferrari GM, Escaned J, Garbo R, Mashayekhi K. Impact of successful chronic coronary total occlusion recanalization on recurrence of ventricular arrhythmias in implantable cardioverter-defibrillator recipients for ischemic cardiomyopathy (VACTO PCI study). Cardiovascular Revascularization Medicine 2022; 43:104-111. [DOI: 10.1016/j.carrev.2022.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/11/2022]
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15
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Faga V, Anguera I, Oloriz T, Nombela-Franco L, Teruel L, Dallaglio P, Guerrero AP, Salazar CH, Escaned J, Abadía AA, Hospital JAG, García JR, García MR, Colet JC, Di Marco A. Improved prediction of electrical storm in patients with prior myocardial infarction and implantable cardioverter defibrillator. Int J Cardiol 2022; 355:9-14. [PMID: 35176405 DOI: 10.1016/j.ijcard.2022.02.016] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 12/12/2022]
Abstract
AIMS To evaluate predictors of electrical storm (ES), including chronic total occlusion in an infarct-related coronary artery (infarct-related artery CTO, IRACTO), in a cohort of patients with prior myocardial infarction (MI) and implantable cardioverter-defibrillators (ICD). METHODS Multicenter observational cohort study including 643 consecutive patients with prior MI and a first ICD implanted between 2005 and 2018 at three tertiary hospitals. All the patients included in the study had undergone a diagnostic coronary angiography before ICD implantation. The variable prior ventricular arrhythmias (VA+) was positive in patients with secondary prevention ICDs and in those with at least one appropriate ICD therapy after primary prevention implantation. RESULTS During a median follow-up of 42 months 59 patients (9%) suffered ES. The presence of at least one IRACTO not revascularized (IRACTO-NR) was associated with a significantly higher cumulative incidence of ES (14.5% vs 4.8%, p < 0.001). IRACTO-NR maintained a significant association with ES after adjustment for potential confounders (HR 2.3, p = 0.005) and was an independent predictor of ES together with VA+ and LVEF. The best cut-off of LVEF to predict ES was ≤38%. A risk-prediction model based on IRACTO-NR, VA+ and LVEF≤38% identified three categories of ES risk (low, intermediate and high), with progressively increasing cumulative incidence of ES (2.2%, 9% and 20%). CONCLUSION In a cohort of patients with prior MI and ICD, IRACTO-NR is an independent predictor of ES. A new risk-prediction model allowed the identification of three categories of risk, with potentially important clinical implications.
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Affiliation(s)
- Valentina Faga
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Ignasi Anguera
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Teresa Oloriz
- Cardiology Department, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Luis Teruel
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Paolo Dallaglio
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | | | | | - Javier Escaned
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Joan Antoni Gomez Hospital
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Julián Rodriguez García
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Marcos Rodriguez García
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Josep Comin Colet
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Andrea Di Marco
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain; BIOHEART-Cardiovascular diseases group; Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain.
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16
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Di Marco A, Brown PF, Bradley J, Nucifora G, Claver E, de Frutos F, Dallaglio PD, Comin-Colet J, Anguera I, Miller CA, Schmitt M. Improved Risk Stratification for Ventricular Arrhythmias and Sudden Death in Patients With Nonischemic Dilated Cardiomyopathy. J Am Coll Cardiol 2021; 77:2890-2905. [PMID: 34112317 DOI: 10.1016/j.jacc.2021.04.030] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Risk stratification for ventricular arrhythmias (VA) and sudden death in nonischemic dilated cardiomyopathy (DCM) remains suboptimal. OBJECTIVES The goal of this study was to provide an improved risk stratification algorithm for VA and sudden death in DCM. METHODS This was a retrospective cohort study of consecutive patients with DCM who underwent cardiac magnetic resonance with late gadolinium enhancement (LGE) at 2 tertiary referral centers. The combined arrhythmic endpoint included appropriate implantable cardioverter-defibrillator therapies, sustained ventricular tachycardia, resuscitated cardiac arrest, and sudden death. RESULTS In 1,165 patients with a median follow-up of 36 months, LGE was an independent and strong predictor of the arrhythmic endpoint (hazard ratio: 9.7; p < 0.001). This association was consistent across all strata of left ventricular ejection fraction (LVEF). Epicardial LGE, transmural LGE, and combined septal and free-wall LGE were all associated with heightened risk. A simple algorithm combining LGE and 3 LVEF strata (i.e., ≤20%, 21% to 35%, >35%) was significantly superior to LVEF with the 35% cutoff (Harrell's C statistic: 0.8 vs. 0.69; area under the curve: 0.82 vs. 0.7; p < 0.001) and reclassified the arrhythmic risk of 34% of patients with DCM. LGE-negative patients with LVEF 21% to 35% had low risk (annual event rate 0.7%), whereas those with high-risk LGE distributions and LVEF >35% had significantly higher risk (annual event rate 3%; p = 0.007). CONCLUSIONS In a large cohort of patients with DCM, LGE was found to be a significant, consistent, and strong predictor of VA or sudden death. Specific high-risk LGE distributions were identified. A new clinical algorithm integrating LGE and LVEF significantly improved the risk stratification for VA and sudden death, with relevant implications for implantable cardioverter-defibrillator allocation.
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MESH Headings
- Aged
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/mortality
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Female
- Follow-Up Studies
- Humans
- Incidence
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardium/pathology
- Retrospective Studies
- Risk Assessment/methods
- Risk Factors
- Spain/epidemiology
- Survival Rate/trends
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/mortality
- United Kingdom/epidemiology
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Affiliation(s)
- Andrea Di Marco
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Pamela Frances Brown
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
| | - Joshua Bradley
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
| | - Gaetano Nucifora
- Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
| | - Eduard Claver
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando de Frutos
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paolo Domenico Dallaglio
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignasi Anguera
- Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bioheart-Cardiovascular Diseases Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Matthias Schmitt
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Department of Cardiology, North West Heart Centre, Manchester University NHS Foundation Trust, Wythenshawe Campus, Manchester, United Kingdom
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Domenico Dallaglio P, Rodríguez Garcia J, Aceña M, Di Marco A, Faga V, Garrido L, Llorca L, Anguera I. Multipolar Mapping for Ventricular Tachycardia Ablation in a Patient with Left Ventricular Assist Device. J Innov Card Rhythm Manag 2021; 12:60-64. [PMID: 33604127 PMCID: PMC7885956 DOI: 10.19102/icrm.2021.120123s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | | | - Marta Aceña
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Andrea Di Marco
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Valentina Faga
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | | | | | - Ignasi Anguera
- Arrhythmias Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
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18
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Di Marco A, Ruiz‐Cueto M, Salazar‐Mendiguchía J, Claver E, Roura G, Dallaglio PD, Anguera I. Genotype-phenotype correlation of LMNA variants involving the Arg541 residue: a case report with multimodality imaging and literature review. ESC Heart Fail 2020; 7:3169-3173. [PMID: 32667740 PMCID: PMC7524116 DOI: 10.1002/ehf2.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/15/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022] Open
Abstract
We present a case of atypical LMNA cardiomyopathy associated with the pathogenic variant p.Arg541Ser. The patient had early-onset severe ventricular arrhythmias but atrioventricular conduction was normal. Segmental motion abnormalities and a large transmural scar, mainly apical and lateral, were found at cardiac magnetic resonance, corresponding to areas of severe wall thinning at computed tomography and of low voltages at electroanatomic mapping. Ventricular tachycardia ablation was successful in controlling ventricular arrhythmias. Few other cases described patients with pathogenic variants in the Arg541 residue, and they displayed similar atypical features, suggesting a genotype-phenotype correlation which may have specific prognostic and therapeutic implications.
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Affiliation(s)
- Andrea Di Marco
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | - María Ruiz‐Cueto
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | | | - Eduard Claver
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | - Gerard Roura
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
| | | | - Ignasi Anguera
- Department of CardiologyHospital Universitari de BellvitgeBarcelonaSpain
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19
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Di Marco A, Rodriguez M, Cinca J, Bayes-Genis A, Ortiz-Perez JT, Ariza-Solé A, Sanchez-Salado JC, Sionis A, Rodriguez J, Toledano B, Codina P, Solé-González E, Masotti M, Gómez-Hospital JA, Cequier Á, Anguera I. New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block. J Am Heart Assoc 2020; 9:e015573. [PMID: 32627643 PMCID: PMC7660719 DOI: 10.1161/jaha.119.015573] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre‐2015 patients formed the derivation cohort (n=163, 61 with AMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm (BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS, in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS, ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%–95%), negative predictive value (96%–97%), efficiency (91%–94%) and area under the receiver operating characteristic curve (0.92–0.93), significantly higher than previous electrocardiographic rules (P<0.01); the specificity was good in both groups (89%–94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred for primary percutaneous coronary intervention, the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI, leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block.
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Affiliation(s)
- Andrea Di Marco
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
| | - Marcos Rodriguez
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
| | - Juan Cinca
- Cardiology Department Hospital de la Santa Creu I Sant Pau IIB-Santpau CIBERCV Universitat Autonoma de Barcelona Spain
| | - Antoni Bayes-Genis
- Cardiology Department Germans Trias i Pujol University Hospital CIBERCV Badalona Spain
| | | | - Albert Ariza-Solé
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
| | | | - Alessandro Sionis
- Cardiology Department Hospital de la Santa Creu I Sant Pau IIB-Santpau CIBERCV Universitat Autonoma de Barcelona Spain
| | - Jany Rodriguez
- Cardiology Department Hospital Clinic CIBERCV Barcelona Spain
| | - Beatriz Toledano
- Cardiology Department Germans Trias i Pujol University Hospital CIBERCV Badalona Spain
| | - Pau Codina
- Cardiology Department Germans Trias i Pujol University Hospital CIBERCV Badalona Spain
| | - Eduard Solé-González
- Cardiology Department Hospital de la Santa Creu I Sant Pau IIB-Santpau CIBERCV Universitat Autonoma de Barcelona Spain
| | - Monica Masotti
- Cardiology Department Hospital Clinic CIBERCV Barcelona Spain
| | | | - Ángel Cequier
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
| | - Ignasi Anguera
- Heart Disease Institute Bellvitge University Hospital Barcelona Spain
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20
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Di Marco A, Anguera I, Nombela‐Franco L, Oloriz T, Teruel L, Rodriguez Mañero M, Toquero J, León V, Dallaglio P, Perez Guerrero A, Salazar CH, Escaned J, Asso Abadía A, Gomez Hospital JA, Cequier A. Revascularization of coronary chronic total occlusions in an infarct‐related artery and recurrence of ventricular arrhythmias among patients with secondary prevention implantable cardioverter defibrillator. Catheter Cardiovasc Interv 2020; 97:E1-E11. [DOI: 10.1002/ccd.28915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/28/2020] [Revised: 03/27/2020] [Accepted: 04/04/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Andrea Di Marco
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | - Ignasi Anguera
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | | | - Teresa Oloriz
- Cardiology Department Hospital Miguel Servet Zaragoza Spain
| | - Luis Teruel
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | - Moisés Rodriguez Mañero
- Cardiology Department Hospital Universitario Santiago de Compostela Santiago de Compostela Spain
| | - Jorge Toquero
- Cardiology Department Hospital Puerta del Hierro, Majadahonda Madrid Spain
| | - Valentina León
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | - Paolo Dallaglio
- Cardiology Department Bellvitge University Hospital Barcelona Spain
| | | | | | - Javier Escaned
- Cardiology Department Hospital Clínico San Carlos Madrid Spain
| | | | | | - Angel Cequier
- Cardiology Department Bellvitge University Hospital Barcelona Spain
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21
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Anguera I, Aceña M, Moreno-Weidmann Z, Dallaglio PD, Di Marco A, Rodríguez M. Acceso epicárdico para ablación de taquicardia ventricular: experiencia con la técnica de micropunción. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.01.009] [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: 11/30/2022]
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22
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Di Marco A, Claver E, Anguera I. Ablación de taquicardia ventricular guiada por cardiorresonancia magnética. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.05.011] [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: 10/28/2022]
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Anguera I, Aceña M, Moreno-Weidmann Z, Dallaglio PD, Di Marco A, Rodríguez M. Epicardial Access for Ventricular Tachycardia Ablation: Experience With the Needle-in-needle Technique. ACTA ACUST UNITED AC 2019; 72:873-874. [PMID: 30956036 DOI: 10.1016/j.rec.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Ignasi Anguera
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Marta Aceña
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Zoraida Moreno-Weidmann
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paolo D Dallaglio
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Di Marco
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marcos Rodríguez
- Unidad de Arritmias, Servicio de Cardiología, Área del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Brown PF, Miller C, Di Marco A, Schmitt M. Towards cardiac MRI based risk stratification in idiopathic dilated cardiomyopathy. Heart 2018; 105:270-275. [PMID: 30377260 DOI: 10.1136/heartjnl-2018-313767] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 12/29/2022] Open
Abstract
Sudden cardiac death (SCD) secondary to arrhythmia remains a risk in those with dilated cardiomyopathy (DCM), an implantable cardiac defibrillator (ICD) is an effective strategy to prevent SCD. Current guidelines recommend selection for ICD based on ejection fraction (EF) less than 35%, however, most SCD occurs in those with EF>35%. Although meta-analysis has demonstrated a survival benefit for primary prevention ICD in DCM, no randomised trial has shown a significant reduction in overall mortality including the most recent 'Danish Study to Assess the Efficacy of ICDs in Patients With Non-Ischemic Systolic Heat Failure on Mortality' study. Clearly, a more sophisticated selection strategy is required. Cardiac MRI (CMR) is an ideal non-invasive imaging technique which allows calculation of EF as well as tissue characterisation with gadolinium contrast, parametric mapping and feature tracking. Late gadolinium enhancement detects mid-wall fibrosis in approximately 30% of those with DCM, three meta-analyses have demonstrated an association between fibrosis in DCM and SCD, and those without fibrosis are at low risk of SCD. T1 mapping and extracellular volume (ECV) calculation are methods of demonstrating diffuse fibrosis in the myocardium. Raised ECV and native T1 have been associated with worse outcomes but the relationship to SCD has not been well studied. Undoubtedly, more research is required but CMR has several tools which offer incremental value above EF to improve risk stratification and consequent outcomes and resource utilisation in those with DCM.
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Affiliation(s)
- Pamela Frances Brown
- Cardiac MRI Department, North West Heart Centre, Manchester University Foundation Trust-Wythenshawe Site, Manchester, UK
| | - Chris Miller
- Cardiac MRI Department, North West Heart Centre, Manchester University Foundation Trust-Wythenshawe Site, Manchester, UK
| | - Andrea Di Marco
- Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Matthias Schmitt
- Cardiac MRI Department, North West Heart Centre, Manchester University Foundation Trust-Wythenshawe Site, Manchester, UK
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Di Marco A, Claver E, Anguera I. Ventricular Tachycardia Ablation Guided by Cardiac Magnetic Resonance. ACTA ACUST UNITED AC 2018; 72:418. [PMID: 29884584 DOI: 10.1016/j.rec.2018.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 05/04/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Andrea Di Marco
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Eduard Claver
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ignasi Anguera
- Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Di Marco A, Oloriz Sanjuan T, Paglino G, Baratto F, Vergara P, Bisceglia C, Trevisi N, Sala S, Marzi A, Gulletta S, Cireddu M, Anguera I, Della Bella P. Late potentials abolition reduces ventricular tachycardia recurrence after ablation especially in higher-risk patients with a chronic total occlusion in an infarct-related artery. J Cardiovasc Electrophysiol 2018. [DOI: 10.1111/jce.13488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andrea Di Marco
- Arrhythmia Unit, Heart Disease Institute; Bellvitge University Hospital; Barcelona Spain
| | - Teresa Oloriz Sanjuan
- Arrhythmia Unit; Hospital Miguel Servet; Zaragoza Spain
- Arrhythmia Unit; San Raffaele Hospital; Milán Italy
| | | | | | | | | | | | - Simone Sala
- Arrhythmia Unit; San Raffaele Hospital; Milán Italy
| | | | | | | | - Ignasi Anguera
- Arrhythmia Unit, Heart Disease Institute; Bellvitge University Hospital; Barcelona Spain
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Dallaglio PD, Claver E, Di Marco A, Alió J, Hidalgo A, Cequier A. Double-chambered left ventricle: coronary embolism as the first presentation of an extremely unusual cardiac anomaly. J Cardiovasc Med (Hagerstown) 2018; 18:790-792. [PMID: 23549276 DOI: 10.2459/jcm.0b013e32836028a3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paolo D Dallaglio
- aHeart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat bCardiac Imaging Unit, Clínica Creu Blanca, Barcelona, Spain
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Di Marco A, Anguera I, Dallaglio P. Letter by Di Marco et al Regarding Article, “Electrical and Structural Substrate of Arrhythmogenic Right Ventricular Cardiomyopathy Determined Using Noninvasive Electrocardiographic Imaging and Late Gadolinium Magnetic Resonance Imaging”. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005687. [DOI: 10.1161/circep.117.005687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Di Marco
- From the Department of Cardiology, Arrhythmia Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Ignasi Anguera
- From the Department of Cardiology, Arrhythmia Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Paolo Dallaglio
- From the Department of Cardiology, Arrhythmia Unit, Bellvitge University Hospital, Barcelona, Spain
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Di Marco A, Anguera I, Teruel L, Muntane G, Campbell NG, Fox DJ, Brown B, Skene C, Davidson N, Leon V, Dallaglio P, Elzein H, Garcia-Romero E, Gomez-Hospital JA, Cequier A. Chronic total occlusion in an infarct-related coronary artery and the risk of appropriate ICD therapies. J Cardiovasc Electrophysiol 2017; 28:1169-1178. [DOI: 10.1111/jce.13290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 04/19/2017] [Revised: 05/08/2017] [Accepted: 05/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea Di Marco
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Ignasi Anguera
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Luis Teruel
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Guillem Muntane
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Niall G. Campbell
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - David J. Fox
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Benjamin Brown
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Chris Skene
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Neil Davidson
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | - Valentina Leon
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Paolo Dallaglio
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
| | - Hind Elzein
- Department of Cardiology; University Hospital of South Manchester; Manchester United Kingdom
| | | | | | - Angel Cequier
- Heart Diseases Institute; Bellvitge University Hospital; Barcelona Spain
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Di Marco A, Anguera I, Rodríguez M, Sionis A, Bayes-Genis A, Rodríguez J, Ariza-Solé A, Sánchez-Salado JC, Díaz-Nuila M, Masotti M, Villuendas R, Dallaglio P, Gómez-Hospital JA, Cequier Á. Evaluación de los algoritmos de Smith para el diagnóstico de infarto agudo de miocardio en presencia de bloqueo de rama izquierda del haz de His. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Di Marco A, Anguera I, Rodríguez M, Sionis A, Bayes-Genis A, Rodríguez J, Ariza-Solé A, Sánchez-Salado JC, Díaz-Nuila M, Masotti M, Villuendas R, Dallaglio P, Gómez-Hospital JA, Cequier Á. Assessment of Smith Algorithms for the Diagnosis of Acute Myocardial Infarction in the Presence of Left Bundle Branch Block. Rev Esp Cardiol (Engl Ed) 2017; 70:559-566. [PMID: 28027906 DOI: 10.1016/j.rec.2016.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/02/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Recently, a new electrocardiography algorithm has shown promising results for the the diagnosis of acute myocardial infarction in the presence of left bundle branch block (LBBB). We aimed to assess these new electrocardiography rules in a cohort of patients referred for primary percutaneous coronary intervention (pPCI). METHODS Retrospective observational cohort study that included all patients with suspected myocardial infarction and LBBB on the presenting electrocardiogram, referred for pPCI to 4 tertiary hospitals in Barcelona, Spain. RESULTS A total of 145 patients were included. Fifty four (37%) had an ST-segment elevation myocardial infarction (STEMI) equivalent. Among patients with STEMI, 25 (46%) presented in Killip class III or IV, and in-hospital mortality was 15%. Smith I and II rules performed better than Sgarbossa algorithms and showed good specificity (90% and 97%, respectively) but their sensitivity was 67% and 54%, respectively. In a strategy guided by Smith I or Smith II rules, 18 (33%) or 25 (46%) patients with STEMI would have not received a pPCI, respectively. Moreover, the severity and prognosis of STEMI patients was similar regardless of the positivity of Smith rules. Cardiac biomarkers were positive in 54% of non-STEMI patients, limiting their usefulness for initial diagnostic screening. CONCLUSIONS Diagnosis of STEMI in the presence of LBBB remains a challenge. Smith rules can be useful but are limited by suboptimal sensitivity. The search for new electrocardiography algorithms should be encouraged to avoid unnecessary aggressive treatments in the majority of patients, while providing timely reperfusion to a high-risk subgroup of patients.
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Affiliation(s)
- Andrea Di Marco
- Área del Corazón, Servicio de Cardiología, Hospital Universitario de Bellvitge, Barcelona, Spain.
| | - Ignasi Anguera
- Área del Corazón, Servicio de Cardiología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Marcos Rodríguez
- Área del Corazón, Servicio de Cardiología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Antoni Bayes-Genis
- Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jany Rodríguez
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Albert Ariza-Solé
- Área del Corazón, Servicio de Cardiología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | | | - Mónica Masotti
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Roger Villuendas
- Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Paolo Dallaglio
- Área del Corazón, Servicio de Cardiología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Ángel Cequier
- Área del Corazón, Servicio de Cardiología, Hospital Universitario de Bellvitge, Barcelona, Spain
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Di Marco A. Editorial commentary: Non-invasive assessment of myocardial fibrosis: Focus on the substrate of ventricular arrhythmias to improve risk stratification. Trends Cardiovasc Med 2017; 27:373-375. [DOI: 10.1016/j.tcm.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/19/2017] [Indexed: 10/20/2022]
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Di Marco A, Schmitt M, Anguera I. Reply: Risk Stratification in Dilated Cardiomyopathy: Is the Arrhythmogenic Substrate Stable Over Time? JACC Heart Fail 2017; 5:394-395. [PMID: 28449802 DOI: 10.1016/j.jchf.2017.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 06/07/2023]
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Nombela-Franco L, Iannaccone M, Anguera I, Amat-Santos IJ, Sanchez-Garcia M, Bautista D, Calvelo MN, Di Marco A, Moretti C, Pozzi R, Scaglione M, Cañadas V, Sandin-Fuentes M, Arenal A, Bagur R, Perez-Castellano N, Fernandez-Perez C, Gaita F, Macaya C, Escaned J, Fernández-Lozano I. Impact of Chronic Total Coronary Occlusion on Recurrence of Ventricular Arrhythmias in Ischemic Secondary Prevention Implantable Cardioverter-Defibrillator Recipients (VACTO Secondary Study). JACC Cardiovasc Interv 2017; 10:879-888. [DOI: 10.1016/j.jcin.2017.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/30/2017] [Accepted: 02/09/2017] [Indexed: 01/14/2023]
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Di Marco A, Anguera I, Schmitt M, Klem I, Neilan TG, White JA, Sramko M, Masci PG, Barison A, Mckenna P, Mordi I, Haugaa KH, Leyva F, Rodriguez Capitán J, Satoh H, Nabeta T, Dallaglio PD, Campbell NG, Sabaté X, Cequier Á. Late Gadolinium Enhancement and the Risk for Ventricular Arrhythmias or Sudden Death in Dilated Cardiomyopathy: Systematic Review and Meta-Analysis. JACC Heart Fail 2016; 5:28-38. [PMID: 28017348 DOI: 10.1016/j.jchf.2016.09.017] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/29/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging and ventricular arrhythmias or sudden cardiac death (SCD) in patients with dilated cardiomyopathy (DCM). BACKGROUND Risk stratification for SCD in DCM needs to be improved. METHODS A systematic review and meta-analysis were conducted. A systematic search of PubMed and Ovid was performed, and observational studies that analyzed the arrhythmic endpoint (sustained ventricular arrhythmia, appropriate implantable cardioverter-defibrillator [ICD] therapy, or SCD) in patients with DCM, stratified by the presence or absence of LGE, were included. RESULTS Twenty-nine studies were included, accounting for 2,948 patients. The studies covered a wide spectrum of DCM, with a mean left ventricular ejection fraction between 20% and 43%. LGE was significantly associated with the arrhythmic endpoint both in the overall population (odds ratio: 4.3; p < 0.001) and when including only those studies that performed multivariate analysis (hazard ratio: 6.7; p < 0.001). The association between LGE and the arrhythmic endpoint remained significant among studies with mean left ventricular ejection fractions >35% (odds ratio: 5.2; p < 0.001) and was maximal in studies that included only patients with primary prevention ICDs (odds ratio: 7.8; p = 0.008). CONCLUSIONS Across a wide spectrum of patients with DCM, LGE is strongly and independently associated with ventricular arrhythmia or SCD. LGE could be a powerful tool to improve risk stratification for SCD in patients with DCM. These results raise 2 major questions to be addressed in future studies: whether patients with LGE could benefit from primary prevention ICDs irrespective of their left ventricular ejection fractions, while patients without LGE might not need preventive ICDs despite having severe left ventricular dysfunction.
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Affiliation(s)
- Andrea Di Marco
- Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain.
| | - Ignasi Anguera
- Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | | | - Igor Klem
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
| | - Tomas G Neilan
- Division of Cardiology and Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, Massachusetts
| | - James A White
- Stephenson CMR Centre at the Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - Marek Sramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Pier Giorgio Masci
- Centre for Cardiovascular Magnetic Resonance, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrea Barison
- Fondazione "G. Monasterio," CNR-Regione Toscana, Pisa, Italy
| | - Peter Mckenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Ify Mordi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Francisco Leyva
- Department of Cardiology, The Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Tokyo, Japan
| | | | | | - Xavier Sabaté
- Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Ángel Cequier
- Arrhythmia Unit, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
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Di Marco A, Anguera I, Teruel L, Dallaglio P, González-Costello J, León V, Nuñez E, Manito N, Gómez-Hospital JA, Sabaté X, Cequier Á. Chronic total occlusion of an infarct-related artery: a new predictor of ventricular arrhythmias in primary prevention implantable cardioverter defibrillator patients. Europace 2016; 19:267-274. [DOI: 10.1093/europace/euw009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/06/2016] [Indexed: 01/09/2023] Open
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Di Marco A, Anguera I, Mckenna P, Dallaglio P, Sabate X, Cequier A. 136-42: Association between late gadolinium enhancement and sudden death or ventricular arrhythmias in patients with non ischemic dilated cardiomyopathy: a systematic review and metanalysis. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i100c] [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: 11/13/2022] Open
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Di Marco A, Anguera I, Teruel L, Muntane G, Dallaglio P, Sabate X, Cequier A. 136-45: Chronic total occlusion in an infarct related artery: a new predictor of ventricular arrhythmias in patients with ICD. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i101b] [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: 11/12/2022] Open
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Dallaglio PD, Anguera I, Jiménez-Candil J, Peinado R, García-Seara J, Arcocha MF, Macías R, Herreros B, Quesada A, Hernández-Madrid A, Alvarez M, Di Marco A, Filgueiras D, Matía R, Cequier A, Sabaté X. Impact of previous cardiac surgery on long-term outcome of cavotricuspid isthmus-dependent atrial flutter ablation. Europace 2015; 18:873-80. [PMID: 26506836 DOI: 10.1093/europace/euv237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 04/25/2015] [Accepted: 06/10/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) in adults with and without previous cardiac surgery (PCS), and predictors of these outcomes. Structural alterations of the anatomical substrate of the CTI-AFL are observed in post-operative patients, and these may have an impact on the acute success of the ablation and in the long-term. METHODS AND RESULTS Clinical records of consecutive adults undergoing RFCA of CTI-AFL were analysed. Two main groups were considered: No PCS and PCS patients, who were further subdivided into acquired heart disease (AHD: ischaemic heart disease and valvular/mixed heart disease) and congenital heart disease [CHD: ostium secundum atrial septal defect (OS-ASD) and complex CHD]. Multivariate analysis identified clinical and procedural factors that predicted acute and long-term outcomes. A total of 666 patients (73% men, age 65 ± 12 years) were included: 307 of them with PCS. Ablation was successful in 647 patients (97%), 96% in the PCS group and 98% in the No PCS group (P = 0.13). Regression analysis showed that surgically corrected complex CHD was related to failure of the procedure [odds ratio 5.6; 95% confidence interval (CI) 1.6-18, P = 0.008]. After a follow-up of 45 ± 15 months, recurrences were observed in 90 patients (14%), more frequently in the PCS group: absolute risk of recurrence 18 vs. 10.5%, relative risk 1.71, 95% CI: 1.2-2.5, P = 0.006. Multivariate analysis indicated that the types of PCS [OS-ASD vs. No PCS: hazard ratio (HR) 2.57; 95% CI: 1.1-6.2, P = 0.03 and complex CHD vs. No PCS: HR 2.75; 95% CI: 1.41-5.48, P = 0.004], female gender (HR 1.55; 95% CI: 1.04-2.4, P = 0.048), and severe LV dysfunction (HR 1.36; 95% CI: 1.06-1.67, P = 0.04) were independent predictors of long-term recurrence. CONCLUSION Radiofrequency catheter ablation of CTI-AFL after surgical correction of AHD and CHD is associated with high acute success rates. The severity of the structural alterations of the underlying heart disease and consequently the type of surgical correction correlates with higher risk for recurrence.
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Affiliation(s)
- Paolo D Dallaglio
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | - Ignasi Anguera
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | - Javier Jiménez-Candil
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Hospital Universitario de Salamanca, Salamanca, Spain
| | | | - Javier García-Seara
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Rosa Macías
- Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain
| | - Benito Herreros
- Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | | | | | - Miguel Alvarez
- Hospital Universitario Virgen de las Nieves de Granada, Granada, Spain
| | - Andrea Di Marco
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | | | - Roberto Matía
- Hospital Universitario 'Ramón y Cajal' de Madrid, Madrid, Spain
| | - Angel Cequier
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
| | - Xavier Sabaté
- Electrophysiology and Arrhythmias Unit, Heart Disease Institute, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, C/Feixa Llarga s/n, L'Hospitalet, Barcelona 08907, Spain
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Di Marco A, Paglino G, Oloriz T, Maccabelli G, Baratto F, Vergara P, Bisceglia C, Anguera I, Sala S, Sora N, Dallaglio P, Marzi A, Trevisi N, Mazzone P, Della Bella P. Impact of a chronic total occlusion in an infarct-related artery on the long-term outcome of ventricular tachycardia ablation. J Cardiovasc Electrophysiol 2015; 26:532-9. [PMID: 25598359 DOI: 10.1111/jce.12622] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/01/2015] [Accepted: 01/12/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION In patients with a prior myocardial infarction (MI), angiographic predictors of ventricular tachycardia (VT) recurrence after ablation are lacking. Recently, a proarrhythmic effect of a chronic total occlusion (CTO) in a coronary artery has been suggested. METHODS AND RESULTS A total of 191 patients with prior MI were referred to our Hospital between 2010 and June 2013 for a first ablation of VT. Of these, 84 patients (44%) with stable coronary artery disease that underwent a coronary angiography during the index hospitalization were included in this study. A CTO in an infarct-related artery (IRA-CTO) was present in 47 patients (56%). Patients with and without IRA-CTO did not differ in terms of comorbidities, severity of heart failure, presentation of VT or acute outcome of ablation, that was completely successful in 93% of cases. At electroanatomic mapping, IRA-CTO was associated with greater scar and especially with greater area of border zone (34 cm(2) vs. 19 cm(2) , P = 0.001). Median follow-up was 19 months (IQR 18). At follow-up, patients with IRA-CTO had a significantly higher rate of VT recurrence (47% vs. 16%, P = 0.003). At multivariate analysis, IRA-CTO resulted to be an independent predictor of VT recurrence after ablation (HR 4.05, P = 0.004). CONCLUSIONS IRA-CTO is an independent predictor of VT recurrence after ablation and identifies a subgroup of patients with high recurrence rate despite a successful procedure. IRA-CTO is associated with greater scars and border zone area; however, this association does not completely justify its proarrhythmic effect.
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Affiliation(s)
- Andrea Di Marco
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy.,Arrhythmia Unit, Heart Diseases Institute, Bellvitge Universisty Hospital, Barcelona, Spain
| | - Gabriele Paglino
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Teresa Oloriz
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Maccabelli
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Francesca Baratto
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Pasquale Vergara
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Caterina Bisceglia
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Ignasi Anguera
- Arrhythmia Unit, Heart Diseases Institute, Bellvitge Universisty Hospital, Barcelona, Spain
| | - Simone Sala
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Nicoleta Sora
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Paolo Dallaglio
- Arrhythmia Unit, Heart Diseases Institute, Bellvitge Universisty Hospital, Barcelona, Spain
| | - Alessandra Marzi
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Nicola Trevisi
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Patrizio Mazzone
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
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Di Marco A, Nuñez E, Osorio K, Dallaglio P, Anguera I, Toscano J, Sabaté X, Cequier A. Aortic perforation by active-fixation atrial pacing lead: an unusual but serious complication. Tex Heart Inst J 2014; 41:327-8. [PMID: 24955055 DOI: 10.14503/thij-13-3219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Perforation of a cardiac chamber is an infrequent but serious sequela of pacemaker lead implantation. An even rarer event is the perforation of the aorta by a protruding right atrial wire. We present here the first case in the medical literature of aortic perforation as a sequela to the implantation of a cardiac resynchronization therapy defibrillator. The patient was a 54-year-old man with idiopathic dilated cardiomyopathy who underwent the implantation of a defibrillator, with no apparent sequelae. Six hours after the procedure, he experienced cardiac tamponade and required urgent open-chest surgery. The pericardial effusion was found to be caused by mechanical friction of a protruding right atrial wire on the aortic root. The aortic root and the atrial wall were both repaired with Prolene suture, which achieved complete control of the bleeding. There was no need to reposition the atrial wire. The patient had a good postoperative recovery.
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Affiliation(s)
- Andrea Di Marco
- Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Elaine Nuñez
- Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Karina Osorio
- Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Paolo Dallaglio
- Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Ignasi Anguera
- Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Jacobo Toscano
- Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Xavier Sabaté
- Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain
| | - Angel Cequier
- Arrhythmia Unit (Drs. Anguera, Dallaglio, Di Marco, Nuñez, and Sabaté), Cardiac Surgery (Drs. Osorio and Toscano), and Cardiology (Dr. Cequier), Heart Disease Institute, Bellvitge University Hospital, IDIBELL, University of Barcelona, 08907 L'Hospitalet de Llobregat (Barcelona), Spain
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Ingallinella P, Marco AD, Taliani M, Fattori D, Pessi A. A new method for chemoselective conjugation of unprotected peptides to dauno- and doxorubicin. Bioorg Med Chem Lett 2001; 11:1343-6. [PMID: 11392551 DOI: 10.1016/s0960-894x(01)00223-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A new approach for chemoselective ligation of peptides to dauno- and doxorubicin through an oxime bond is presented. The method does not require protecting groups on the peptide moiety.
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Affiliation(s)
- P Ingallinella
- Istituto di Ricerche di Biologia Molecolare P. Angeletti, Pomezia, Rome, Italy
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Bonucci E, Marco AD, Nicoletti B, Petrinelli P, Pozzi L. Histological and histochemical investigations of achondroplastic mice: a possible model of human achondroplasia. Growth 1976; 40:241-51. [PMID: 976768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Histological and histochemical investigations of tibial epiphyses, costo-chondral junctions and caudal vertebrae of achondroplastic (cn) mice have shown that, in spite of conspicuous reduction of bone length, endochondrial ossification occurs in much the same way as in controls. Moreover, the histological structure of seriated cartilage, and the distribution of proteoglycans in resting cartilage are the same in cn/cn mice and in controls. The only difference betweeen the two types of animals is represented by the occurence of early aging-like changes of chondrocytes and cartilage matrix in achondroplastic mice, leading to premature shortening of the cell columns and to early reduction of the proteoglycan concentration. The premature "aging" of the cartilage, the consequent inhibition of the calcification process and bone growth, and the normal rate of perichondral ossification give to long bones, vertebrae and ribs a typical achondroplastic appearance. The cn/cn mice seem to represent a useful model for studying the pathogenesis and therapy of human achondroplasia.
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