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Boccanelli A, Scardovi AB. Sudden death in ischemic heart disease: looking for new predictors: polygenic risk. Eur Heart J Suppl 2023; 25:B31-B33. [PMID: 37091639 PMCID: PMC10120966 DOI: 10.1093/eurheartjsupp/suad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The phenomenon of sudden death (SD) occurs, in 70% of cases, in people who do not fall within the indications of the guidelines relating to the implantation of the defibrillator. There is a way of inheriting the risk condition by genetic means, the polygenic one, in which mutations are not found, but an increase in alleles of common variations called polymorphisms. The PRE-DETERMINE cohort study has the primary objective of determining whether biological markers, and electrocardiogram can be used to identify individuals more likely to experience SD. Within the study, we investigated the utility of the genome-wide polygenic score for coronary artery disease (GPSCAD) for SD risk stratification in an intermediate-risk population with stable coronary artery disease without severe systolic dysfunction and/or indication for an implantable cardioverter defibrillator in primary prevention. Over a mean follow-up period of 8.0 years, patients in the top decile of GPSCAD were at higher absolute (8.0% vs. 4.8%; P < 0.005) and relative (29% vs. 16%; P < 0.0003) risk of SD compared to the rest of the cohort. No association was found between the highest decile of GPSCAD and other forms of death, cardiac, and non-cardiac. The data on the increase in absolute and relative terms of SD can be used, at this stage, only for a theoretical estimate on the possible efficacy of the defibrillator in the population with chronic coronary artery disease and moderately depressed left ventricular function as number needed to treat and possible reduction of mortality in high-risk patients (those included in the top decile of GPSCAD).
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Francese GM, Aspromonte N, Valente S, Geraci G, Pavan D, Bisceglia I, Caforio ALP, Colavita AR, Cutolo A, De Angelis MC, Di Fusco SA, Enea I, Fiscella D, Frongillo D, Gil Ad V, Giubilato S, Giuffrida C, Ingianni N, Lucà F, Marcantoni L, Martinis F, Marzullo R, Masciocco G, Parrini I, Rakar S, Resta M, Riva L, Rossini R, Russo D, Russo G, Russo MG, Scardovi AB, De Luca L, Gabrielli D, Gulizia MM, Oliva F, Colivicchi F. [ANMCO Position paper: Cardiovascular disease in women - prevention, diagnosis, treatment and organization of care]. G Ital Cardiol (Rome) 2022; 23:775-792. [PMID: 36169129 DOI: 10.1714/3881.38644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cardiovascular diseases are still the main cause of death among women despite the improvements in treatment and prognosis achieved in the last 30 years of research. The determinant factors and causes have not been completely identified but the role of "gender" is now recognized. It is well known that women tend to develop cardiovascular disease at an older age than men, and have a high probability of manifesting atypical symptoms not often recognized. Other factors may also co-exist in women, which may favor the onset of specific cardiac diseases such as those with a sex-specific etiology (differential effects of estrogens, pregnancy pathologies, etc.) and those with a different gender expression of specific and prevalent risk factors, inflammatory and autoimmune diseases and cancer. Whether the gender differences observed in cardiovascular outcomes are influenced by real biological differences remains a matter of debate.This ANMCO position paper aims at providing the state of the research on this topic, with particular attention to the diagnostic aspects and to care organization.
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Affiliation(s)
- Giuseppina Maura Francese
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Nadia Aspromonte
- U.O.S. Scompenso Cardiaco, Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Serafina Valente
- Cardiologia Clinico-Chirurgica (UTIC), Ospedale Santa Maria alle Scotte, A.O.U. Senese, Siena
| | - Giovanna Geraci
- U.O.C. Cardiologia-UTIC ed Emodinamica, P.O. "V. Cervello", Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo
| | - Daniela Pavan
- S.O.C. Cardiologia, Ospedale di San Vito al Tagliamento, Azienda Sanitaria Friuli Occidentale, San Vito al Tagliamento (PN)
| | - Irma Bisceglia
- Servizi Cardiologici Integrati, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | | | | | - Ada Cutolo
- U.O. Cardiologia, Ospedale dell'Angelo, Venezia-Mestre, Azienda ULSS 3 Serenissima
| | - Maria Carmen De Angelis
- U.O.C. Cardiologia-UTIC-Emodinamica-Elettrofisiologia-Elettrostimolazione, Ospedale del Mare, Napoli
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, Roma, ASL Roma 1
| | - Iolanda Enea
- U.O.C. Medicina e Chirurgia d'Urgenza, A.O.R.N. Sant'Anna e San Sebastiano, Caserta
| | - Damiana Fiscella
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Doriana Frongillo
- U.O.C. Cardiologia, Ospedale San Sebastiano Martire, Frascati (RM), ASL Roma 6
| | - Vered Gil Ad
- U.O. Cardiologia, Ospedale Policlinico San Martino, Genova
| | - Simona Giubilato
- U.O.C. Cardiologia con UTIC ed Emodinamica, Azienda Ospedaliera Cannizzaro, Catania
| | - Clea Giuffrida
- Psicologa e Psicoterapeuta Cognitivo Comportamentale, Catania
| | - Nadia Ingianni
- U.O.C. di Cardiologia e UTIC, P.O. Sant'Antonio Abate, Erice (TP), ASP Trapani
| | - Fabiana Lucà
- Cardiologia-UTIC, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria
| | - Lina Marcantoni
- U.O.C. Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo, ULSS 5 Polesana
| | - Flavia Martinis
- S.O.C. Cardiologia, Ospedale di San Vito al Tagliamento, Azienda Sanitaria Friuli Occidentale, San Vito al Tagliamento (PN)
| | - Raffaella Marzullo
- U.O.C. Cardiologia Pediatrica, Università della Campania "L. Vanvitelli", Ospedale Monaldi, Napoli
| | - Gabriella Masciocco
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Iris Parrini
- Dipartimento di Cardiologia, Ospedale Mauriziano, Torino
| | - Serena Rakar
- S.C. Cardiologia, Dipartimento CardioToracoVascolare, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste
| | | | - Letizia Riva
- U.O.C. Cardiologia, Ospedale Maggiore, Azienda USL di Bologna, Bologna
| | | | | | - Giulia Russo
- S.C. Cardiovascolare e Medicina dello Sport, Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste
| | - Maria Giovanna Russo
- U.O.C. Cardiologia Pediatrica, Università della Campania "L. Vanvitelli", Ospedale Monaldi, Napoli
| | | | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, Roma, ASL Roma 1
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Arcari L, Scardovi AB. Diabetic cardiomyopathy as a diffuse myocardial disease: Is it just fibrosis? Int J Cardiol 2022; 365:58-59. [PMID: 35868356 DOI: 10.1016/j.ijcard.2022.07.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Luca Arcari
- Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy.
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Paolillo S, Salvioni E, Perrone Filardi P, Bonomi A, Sinagra G, Gentile P, Gargiulo P, Scoccia A, Cosentino N, Gugliandolo P, Badagliacca R, Lagioia R, Correale M, Frigerio M, Perna E, Piepoli M, Re F, Raimondo R, Minà C, Clemenza F, Bussotti M, Limongelli G, Gravino R, Passantino A, Magrì D, Parati G, Caravita S, Scardovi AB, Arcari L, Vignati C, Mapelli M, Cattadori G, Cavaliere C, Corrà U, Agostoni P. Corrigendum to "Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database" [Int J Cardiol. 2020 Oct 15; 317: 103-110. PMID: 32360652]. Int J Cardiol 2021; 333:252. [PMID: 33640418 DOI: 10.1016/j.ijcard.2021.02.045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- S Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - E Salvioni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - P Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - A Bonomi
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - G Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - P Gentile
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - P Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - A Scoccia
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - N Cosentino
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | - R Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - R Lagioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - M Correale
- Department of Cardiology, University of Foggia, Foggia, Italy
| | - M Frigerio
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda - A.O. Niguarda, Milano, Italy
| | - E Perna
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda - A.O. Niguarda, Milano, Italy
| | - M Piepoli
- UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy
| | - F Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | - R Raimondo
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy
| | - C Minà
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - F Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy
| | - M Bussotti
- Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Milano, Italy
| | - G Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - R Gravino
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - A Passantino
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - D Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - G Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - S Caravita
- San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, BG, Italy
| | - A B Scardovi
- Cardiology Division, Santo Spirito Hospital, Roma, Italy
| | - L Arcari
- Cardiology Division, Santo Spirito Hospital, Roma, Italy
| | - C Vignati
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - M Mapelli
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - G Cattadori
- Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano, Italy
| | | | - U Corrà
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Italy
| | - P Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy.
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Ghio S, Carluccio E, Scardovi AB, Dini FL, Rossi A, Falletta C, Scelsi L, Greco A, Temporelli PL. Prognostic relevance of Doppler echocardiographic re-assessment in HFrEF patients. Int J Cardiol 2020; 327:111-116. [PMID: 33220364 DOI: 10.1016/j.ijcard.2020.11.025] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current guidelines do not recommend periodically repeating echocardiograms in the follow-up of stable heart failure patients with reduced ejection fraction (HFrEF). The objective of the study was to verify the additional prognostic information provided by a comprehensive re-assessment of their cardiac function and hemodynamic profile at Doppler echocardiography in HFrEF patients. METHODS Retrospective analysis of 769 stable HFrEF outpatients who underwent two complete echocardiograms, at baseline and at re-assessment. Main candidate predictors of prognosis were: left ventricular (LV) filling pattern, pulmonary artery systolic pressure (PASP) and right ventricular function (TAPSE). Age, LV ejection fraction, mitral regurgitation severity, NYHA class, brain natriuretic peptide plasma levels at baseline, and their changes at 12 months, were used as covariates. Median follow-up was 30 months. All-cause death was the study end-point. RESULTS At baseline, restrictive filling pattern and low TAPSE were significant predictors of poor prognosis. At re-evaluation, persistently restrictive/worsened filling pattern, persistently-low/worsened TAPSE and worsened PASP, were associated with poorer survival. A significant interaction between changes in TAPSE, PASP and LV filling pattern was observed: in the restrictive pattern subgroup, survival was poorer in worsened/persistently low TAPSE (p < 0.01); in non-restrictive pattern subgroup, survival was poorer in worsened/persistently elevated PASP (p = 0.01). The re-assessment model improved the C-index from 0.69 to 0.74 (P < 0.01) compared to baseline model. CONCLUSIONS Doppler echocardiographic re-assessment of LV filling pattern, PASP and TAPSE allows a better prognostic stratification of HFrEF outpatients than baseline evaluation and is additional to changes in BNP and NYHA class.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S.Maria della Misericordia", Perugia, Italy
| | | | - Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Italy
| | - Andrea Rossi
- Department of Biomedical and Surgical Sciences, Cardiology Section, University of Verona, Verona, Italy
| | - Calogero Falletta
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, I.R.C.C.S. - ISMETT, Palermo, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Alessandra Greco
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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Scardovi AB, De Maria R, Galeotti GG, Faggiano P, Arcari L, Ghio S, Temporelli PL, Rossi A, Magni G, Simioniuc A, Ricci R, Dini FL. Similar predictive value of six-minute walking distance and B-type natriuretic peptide in heart failure with reduced to mid-range ejection fraction. Monaldi Arch Chest Dis 2019; 89. [DOI: 10.4081/monaldi.2019.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/19/2019] [Indexed: 11/23/2022] Open
Abstract
The prognostic insights of heart failure (HF) with mid-range (40-49%) ejection fraction (HFmrEF) are not fully elucidated. We investigated whether the six-minutes walking test (6MWT) and brain natriuretic peptide (BNP) are predictive of outcome across the spectrum of LV systolic dysfunction and whether the HFmrEF cut-off impacts the risk stratification abilities of these tests. We studied 538 outpatients, aged 70±12 years, 28% females, with stable chronic HF and EF<50%, 349 with HFmrEF and 189 with HFrEF. End-points were all-cause and cardiac death. HFrEF patients were more often male, with ischemic etiology, severe symptoms, higher BNP levels, and cardiac mortality than HFmrEF subjects. During 32 (15-46) months follow-up, 123 (23%) patients died, 95 (18%) for cardiac causes. Cut-offs of 125 pg/ml for BNP and 360 meters for 6MWT distance were associated with lower all-cause (10% vs 38%, p<0.001 and 10% vs 26%, p<0.001, respectively) and cardiac mortality (6% vs 36%, p<0.001 and 8% vs 23%, p<0.001, respectively). BNP (HR 2.144, 95%CI, 1.403-3.276) and 6MWT walked distance (HR 1.923, 95%CI, 1.195-3.096) independently predicted outcome, after adjustment for age, gender, obesity, kidney dysfunction, ischemic etiology, NYHA class, unlike the 40% LVEF threshold. Model discrimination and survival differences were significant across LVEF strata. Higher BNP levels and shorter walked distance combined identified patients (26% overall) at particularly poor prognosis in both phenotype groups. Despite differences between HFmrEF and HFrEF patients in clinical and biomarker profile, BNP levels and 6MWT walked distance retain prognostic value over the entire spectrum of LV systolic dysfunction.
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Boccanelli A, Mureddu GF, Cesaroni G, Prati F, Rangoni F, Agabiti N, Davoli M, Scardovi AB, Latini R. Predictive value of interatrial block for atrial fibrillation in elderly subjects enrolled in the PREDICTOR study. J Electrocardiol 2019; 54:22-27. [DOI: 10.1016/j.jelectrocard.2019.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/12/2019] [Accepted: 02/27/2019] [Indexed: 12/28/2022]
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Scardovi AB, De Maria R. [Peripartum cardiomyopathy: a little known disease]. G Ital Cardiol (Rome) 2018; 19:209-221. [PMID: 29912235 DOI: 10.1714/2898.29215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests itself in the final stage of pregnancy and in the first months after delivery in women with no previous history of cardiovascular disease. The incidence of PPCM varies widely across geographic areas and seems to be on the rise as a result of increased awareness and socioeconomic changes. PPCM recognizes a still partially undefined multifactorial etiology. Various pathogenetic hypotheses have been proposed, that range from autoimmune mechanisms to myocarditis to the hormonal hypothesis for aberrant, antiangiogenic and cardiotoxic prolactin (PRL) production, apoptosis, prolonged exposure to tocolytic drugs, malnutrition and genetic predisposition.The diagnosis of PPCM is still made by exclusion of other etiologies. Although some specific biomarkers with pregnancy-related kinetics have been proposed as diagnostic tools, their value remains questionable and they are not yet available in clinical practice.The prognosis of the disease is variable and not always predictable: both complete functional recovery and poor response to therapy and development of dilated cardiomyopathy and chronic heart failure (HF) may occur, although outcomes appears to have improved slightly in recent years.The acute phase of PPCM may require the use of inotropes and vasodilators as well as mechanical circulatory support and in some cases heart transplant may be indicated. Beta1-adrenergic agonists are contraindicated due to the possible induction of permanent damage due to loss of myocytes, with evolution towards chronic HF. The recent demonstration of the cardiotoxic effect of aberrant PRL has led to successful testing of the therapeutic effects of bromocriptine, a 2D dopamine agonist that blocks PRL. This treatment appears specific to PPCM, as it is targeted at 16k Da PRL, its mediator miR-146a and/or vascular endothelial growth factor.The long-term prognosis, once the acute phase is over, is a function of myocardial damage, and varies from complete functional recovery to chronic HF. Subsequent pregnancies always present a risk of recurrence and hence should be avoided. Even in cases with full functional recovery, relapses in the case of a new pregnancy may occur in 20% of cases. Women who wish a further pregnancy must be adequately informed and, in case of pregnancy, should undergo close monitoring. Treatment of chronic HF does not differ from that from other etiologies, according to international guidelines.
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Affiliation(s)
| | - Renata De Maria
- Istituto di Fisiologia Clinica del CNR, Dipartimento Cardiotoracovascolare, ASST Grande Ospedale Metropolitano Niguarda, Milano
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Tarantini L, Gulizia MM, Di Lenarda A, Maurea N, Abrignani MG, Bisceglia I, Bovelli D, De Gennaro L, Del Sindaco D, Macera F, Parrini I, Radini D, Russo G, Scardovi AB, Inno A. [ANMCO/AICO/AIOM Consensus document: Clinical and management pathways in cardio-oncology]. G Ital Cardiol (Rome) 2017; 18:14-66. [PMID: 28287211 DOI: 10.1714/2628.27023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In Italy, cardiovascular diseases and cancer are the leading causes of death. Both diseases share the same risk factors and, having the highest incidence and prevalence in the elderly, they often coexist in the same individual. Furthermore, the enhanced survival of cancer patients registered in the last decades and linked to early diagnosis and improvement of care, not infrequently exposes them to the appearance of ominous cardiovascular complications due to the deleterious effects of cancer treatment on the heart and circulatory system. The above considerations have led to the development of a new branch of clinical cardiology based on the principles of multidisciplinary collaboration between cardiologists and oncologists: Cardio-oncology, which aims to find solutions to the prevention, monitoring, diagnosis and treatment of heart damage induced by cancer care in order to pursue, in the individual patient, the best possible care for cancer while minimizing the risk of cardiac toxicity. In this consensus document we provide practical recommendations on how to assess, monitor, treat and supervise the candidate or patient treated with potentially cardiotoxic cancer therapy in order to treat cancer and protect the heart at all stages of the oncological disease.
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Affiliation(s)
- Luigi Tarantini
- S.C. Cardiologia, Ospedale San Martino, Azienda ULSS 1, Belluno
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Andrea Di Lenarda
- S.C. Centro Cardiovascolare, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Nicola Maurea
- S.C. Cardiologia, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Napoli
| | | | | | | | | | | | - Francesca Macera
- S.C. Cardiologia 2, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | - Donatella Radini
- S.C. Centro Cardiovascolare, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Giulia Russo
- S.C. Centro Cardiovascolare, Azienda Sanitaria Universitaria Integrata, Trieste
| | | | - Alessandro Inno
- S.C. Oncologia, Ospedale Sacro Cuore Don Calabria, Negrar (VR)
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Tarantini L, Gulizia MM, Di Lenarda A, Maurea N, Giuseppe Abrignani M, Bisceglia I, Bovelli D, De Gennaro L, Del Sindaco D, Macera F, Parrini I, Radini D, Russo G, Beatrice Scardovi A, Inno A. ANMCO/AIOM/AICO Consensus Document on clinical and management pathways of cardio-oncology: executive summary. Eur Heart J Suppl 2017; 19:D370-D379. [PMID: 28751851 PMCID: PMC5520757 DOI: 10.1093/eurheartj/sux019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cardiovascular disease and cancer are leading causes of death. Both diseases share the same risk factors and, having the highest incidence and prevalence in the elderly, they often coexist in the same individual. Furthermore, the enhanced survival of cancer patients registered in the last decades and linked to early diagnosis and improvement of care, not infrequently exposes them to the appearance of ominous cardiovascular complications due to the deleterious effects of cancer treatment on the heart and circulatory system. The above considerations have led to the development of a new branch of clinical cardiology based on the principles of multidisciplinary collaboration between cardiologists and oncologists: Cardio-oncology, which aims to find solutions to the prevention, monitoring, diagnosis and treatment of heart damage induced by cancer care in order to pursue, in the individual patient, the best possible care for cancer while minimizing the risk of cardiac toxicity. In this consensus document we provide practical recommendations on how to assess, monitor, treat and supervise the candidate or patient treated with potentially cardiotoxic cancer therapy in order to treat cancer and protect the heart at all stages of the oncological disease. Cardiovascular diseases and cancer often share the same risk factors and can coexist in the same individual. Such possibility is amplified by the deleterious effects of cancer treatment on the heart. The above considerations have led to the development of a new branch of clinical cardiology, based on multidisciplinary collaboration between cardiologist and oncologist: the cardio-oncology. It aims to prevent, monitor, and treat heart damages induced by cancer therapies in order to achieve the most effective cancer treatment, while minimizing the risk of cardiac toxicity. In this paper, we provide practical recommendations on how to assess, monitor, treat and supervise patients treated with potential cardiotoxic cancer therapies.
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Affiliation(s)
- Luigi Tarantini
- Cardiology Department, Ospedale San Martino, S.C. Cardiologia, Ospedale San Martino, Azienda ULSS 1, Viale Europa 22, 32100 Belluno, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Nicola Maurea
- Cardiology Department, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Napoli, Italy
| | | | - Irma Bisceglia
- Cardiology Unit, A.O. San Camillo-Forlanini, Roma, Italy
| | | | | | | | - Francesca Macera
- Cardiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Iris Parrini
- Cardiology Unit, Ospedale Mauriziano, Torino, Italy
| | - Donatella Radini
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Giulia Russo
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | | | - Alessandro Inno
- Oncology Department, Ospedale Sacro Cuore Don Calabria, Negrar, VR, Italy
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Ghio S, Guazzi M, Scardovi AB, Klersy C, Clemenza F, Carluccio E, Temporelli PL, Rossi A, Faggiano P, Traversi E, Vriz O, Dini FL. Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction. Eur J Heart Fail 2016; 19:873-879. [DOI: 10.1002/ejhf.664] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [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: 04/04/2016] [Revised: 08/12/2016] [Accepted: 08/29/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione IRCCS; Policlinico San Matteo; Piazza Golgi 1 27100 Pavia Italy
| | - Marco Guazzi
- Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology, IRCCS; Policlinico San Donato University Hospital; Milano Italy
| | | | - Catherine Klersy
- Biometry & Statistics, Fondazione IRCCS; Policlinico San Matteo; Pavia Italy
| | - Francesco Clemenza
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation; IRCCS-ISMETT; Palermo Italy
| | - Erberto Carluccio
- Division of Cardiology; University of Perugia, School of Medicine; Perugia Italy
| | | | - Andrea Rossi
- Department of Biomedical and Surgical Sciences, Cardiology Section; University of Verona; Verona Italy
| | - Pompilio Faggiano
- Department of Cardiology; Spedali Civili Hospital and University of Brescia; Italy
| | - Egidio Traversi
- Division of Cardiology, Fondazione Salvatore Maugeri; IRCCS; Montescano Italy
| | - Olga Vriz
- Cardiology and Emergency Department; San Antonio Hospital; San Daniele del Friuli Italy
| | - Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department; University of Pisa; Pisa, Italy
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Casazza F, Becattini C, Rulli E, Pacchetti I, Floriani I, Biancardi M, Scardovi AB, Enea I, Bongarzoni A, Pignataro L, Agnelli G. Clinical presentation and in-hospital death in acute pulmonary embolism: does cancer matter? Intern Emerg Med 2016; 11:817-24. [PMID: 27023066 DOI: 10.1007/s11739-016-1431-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/14/2015] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
Cancer is one of the most common risk factors for acute pulmonary embolism (PE), but only few studies report on the short-term outcome of patients with PE and a history of cancer. The aim of the study was to assess whether a cancer diagnosis affects the clinical presentation and short-term outcome in patients hospitalized for PE who were included in the Italian Pulmonary Embolism Registry. All-cause and PE-related in-hospital deaths were also analyzed. Out of 1702 patients, 451 (26.5 %) of patients had a diagnosis of cancer: cancer was known at presentation in 365, or diagnosed during the hospital stay for PE in 86 (19 % of cancer patients). Patients with and without cancer were similar concerning clinical status at presentation. Patients with cancer less commonly received thrombolytic therapy, and more often had an inferior vena cava filter inserted. Major or intracranial bleeding was not different between groups. In-hospital all-cause death occurred in 8.4 and 5.9 % of patients with and without cancer, respectively. At multivariate analysis, cancer (OR 2.24, 95 % CI 1.27-3.98; P = 0.006) was an independent predictor of in-hospital death. Clinical instability, PE recurrence, age ≥75 years, recent bed rest ≥3 days, but not cancer, were independent predictors of in-hospital death due to PE. Cancer seems a weaker predictor of all-cause in-hospital death compared to other factors; the mere presence of cancer, without other risk factors, leads to a probability of early death of 2 %. In patients with acute PE, cancer increases the probability of in-hospital all-cause death, but does not seem to affect the clinical presentation or the risk of in-hospital PE-related death.
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Affiliation(s)
- Franco Casazza
- Cardiology Division, Ospedale San Carlo Borromeo, Milan, Italy
| | - Cecilia Becattini
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Via G Dottori 1, Perugia, Italy.
| | - Eliana Rulli
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Ilaria Pacchetti
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Irene Floriani
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Marco Biancardi
- Division of Internal Medicine, Ospedale San Carlo Borromeo, Milan, Italy
| | | | - Iolanda Enea
- UO Medicina d'Urgenza, AORN S. Anna e S. Sebastiano, Caserta, Italy
| | | | - Luigi Pignataro
- Cardiology Division, Ospedale San Carlo Borromeo, Milan, Italy
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Via G Dottori 1, Perugia, Italy
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Scardovi AB, De Maria R, De Feo S, Petruzzi MA, Camerini A, Cipriani M, Di Tano G, Feola M, Iacovoni A, Pulignano G, Russo G, Misuraca G. The Italian Network for Heart Failure five years after the publication of the Italian “Consensus conference on the management of heart failure”. Monaldi Arch Chest Dis 2015; 78:40-8. [DOI: 10.4081/monaldi.2012.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the year 2006 the Italian Association of Hospital Cardiologists (ANMCO) promoted a Consensus Conference among professional Scientific Societies in order to redefine the role and core responsibilities of each health professionals involved in heart failure management in a novel integrated network. Five years later, a questionnaire has been proposed to each Italian Regional President of the Association, in order to assess the implementation of the proposed management strategies in the different clinical scenarios of the Italian Regions. Although the Document utilization is not homogeneous through Italy, it is still considered a valuable tool of work.
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Mureddu GF, Tarantini L, Agabiti N, Faggiano P, Masson S, Latini R, Cesaroni G, Miceli M, Forastiere F, Scardovi AB, Uguccioni M, Boccanelli A. Evaluation of different strategies for identifying asymptomatic left ventricular dysfunction and pre-clinical (stage B) heart failure in the elderly. Results from ‘PREDICTOR’, a population based-study in central Italy. Eur J Heart Fail 2014; 15:1102-12. [DOI: 10.1093/eurjhf/hft098] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 01/02/2023] Open
Affiliation(s)
- Gian Francesco Mureddu
- Department of Cardiovascular Diseases; S. Giovanni-Addolorata Hospital; Via Amba Aradam 9 00184 Roma Italy
| | | | - Nera Agabiti
- Department of Epidemiology; Lazio Regional Health Service; Roma Italy
| | | | - Serge Masson
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milano Italy
| | - Roberto Latini
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milano Italy
| | - Giulia Cesaroni
- Department of Epidemiology; Lazio Regional Health Service; Roma Italy
| | | | | | | | | | - Alessandro Boccanelli
- Department of Cardiovascular Diseases; S. Giovanni-Addolorata Hospital; Via Amba Aradam 9 00184 Roma Italy
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Scardovi AB, Petruzzi M, Rosano A, Lucia AR, De Maria R. [Heart failure phenotype in women]. G Ital Cardiol (Rome) 2012; 13:6S-11S. [PMID: 23678528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although one half of patients affected by heart failure (HF) are women, the clinical phenotype differs between genders. In women HF develops later in life, is more often associated with preserved systolic function and is less frequently attributable to ischemic heart disease. Although survival tends to be better in women than in men, females are more symptomatic, have a worse quality of life and a longer length of stay during acute HF admissions. Italian data from institutional databases of the Lazio, Basilicata and Veneto regions are in agreement with international evidences on this topic. Gender differences in clinical phenotypes are based on different structural and functional patterns: the female heart undergoes more often concentric remodeling, with thicker walls, smaller volumes and greater chamber stiffness. There are no specific therapeutic evidences for the elderly, prevalently female, HF population. Treatment strategies are derived from studies carried out in relatively young male populations with left ventricular systolic dysfunction. Therapeutic strategies tailored to the peculiar female HF phenotype should be better explored in future treatment trials.
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Scardovi AB, De Maria R, Ferraironi A, Gatto L, Celestini A, Forte S, Parolini M, Sciarretta S, Ricci R, Guazzi M. A case for assessment of oscillatory breathing during cardiopulmonary exercise test in risk stratification of elderly patients with chronic heart failure. Int J Cardiol 2011; 155:115-9. [PMID: 21402422 DOI: 10.1016/j.ijcard.2011.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 02/10/2011] [Indexed: 01/26/2023]
Abstract
UNLABELLED The prognostic value of exercise oscillatory breathing (EOB) during cardiopulmonary test (CPX) has been described in young chronic heart failure (HF) patients. We assessed the prognostic role of EOB vs other clinical and ventilatory parameters in elderly HF patients performing a maximal CPX. METHODS AND RESULTS We prospectively followed-up 370 HF outpatients ≥ 65 years after a symptom limited CPX. We tested the predictive value of clinical and ventilatory parameters for all-cause mortality and a composite of all-cause mortality and HF hospitalizations. Median age was 74 years, 51% had ischemic heart disease, 25% NYHA class III; ejection fraction was 41% [34-50]. Peak oxygen consumption (PVO(2)) was 11.9 [9.9-14] mL/kg/min, the slope of the regression line relating ventilation to CO(2) output, (VE/VCO(2) slope) was 33.9 [29.8-39.2]. EOB was found in 58% of patients. At follow-up, 84 patients died and overall 158, using a time-to-first event approach, met the composite end-point. Independent predictors of all-cause mortality were CPX EOB and the ratio of VE/VCO(2) slope to peak VO(2), hemoglobin, creatinine and body mass index. The area under the ROC curve (AUC) of the Cox multivariable model was 0.80 (95% CI 0.73 to 0.87). Independent predictors of the composite end-point were EOB, VE/VCO(2) slope, hemoglobin and HF admissions in the previous year (Model AUC 0.75) (95% CI 0.69 to 0.81). CONCLUSIONS Among elderly HF patients, EOB prevalence is higher than middle-aged cohorts. EOB and the ratio of VE/VCO(2) slope to peak VO(2) resulted the strongest ventilatory predictor of all-cause mortality, independent of ventricular function.
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Gavazzi A, Cicoira MA, Piepoli M, Pulignano G, Scardovi AB, Volterrani M, Senni M. [Role of clinical evaluation and functional testing in the tailored follow-up of chronic heart failure patients]. G Ital Cardiol (Rome) 2010; 11:8S-16S. [PMID: 20873463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Clinical assessment is crucial to monitor chronic heart failure (HF) patients. It allows to tailor follow-up based on clinical severity, symptoms, quality of life and life expectancy. Risk scores, a useful tool for synthetic assessment of patients and intercenter standardization, should be easy to calculate and consider both cardiac conditions and comorbidities. In the elderly, clinical assessment should include indexes of disability and frailty, mandatory to tailor follow-up appropriately. Clinical data should be complemented by objective measures of functional capacity using exercise testing. Exercise tolerance, a comprehensive index of body function, is a pivotal prognostic predictor. The 6-min walking test is simple, well accepted by patients, and provides an objective documentation of exercise tolerance in subjects who cannot perform a maximal stress test. However, there is no evidence to support its role for risk stratification. While the cardiopulmonary exercise test has a definite role in the selection of heart transplant candidates, it also provides important information for risk stratification of the general HF population, the main prognostic predictors being maximal oxygen consumption, periodic breathing, and an enhanced ventilatory response to exercise.
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Affiliation(s)
- Antonello Gavazzi
- Dipartimento Cardiovascolare Clinico e di Ricerca, Ospedali Riuniti, Bergamo.
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Campione A, Terzi A, Bobbio M, Rosso GL, Scardovi AB, Feola M. Oxygen Pulse as a Predictor of Cardiopulmonary Events in Lung Resection. Asian Cardiovasc Thorac Ann 2010; 18:147-52. [DOI: 10.1177/0218492310361792] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traditional algorithms suggest a stepwise approach to the functional evaluation of candidates for lung resection. A cardiopulmonary exercise test is incorporated as a supplementary test for patients with borderline pulmonary predicted values, and sometimes as a first screening test for cardiac risk evaluation. To assess the predictive weight of exercise tests in noncardiac thoracic surgery, we retrospectively analyzed 99 patients (80 males) aged 67.8 ± 8.1 years who underwent lung resection after a cardiopulmonary exercise test. During basal spirometry, the mean predicted forced expiratory volume in the first second was 69.9% ± 18.6%, and predicted carbon monoxide diffusing capacity was 71.6% ± 20.5%. Peak oxygen consumption was 11.1 ± 3.2 mL·kg−1·min−1, oxygen pulse was 9 ± 2.8 mL·beat−1, and minute ventilation/CO2 output was 45.2 ± 7.7. Mean hospital stay was 10.4 days, and intensive care unit stay was 0.3 days. Postoperative complications occurred in 20 (20%) patients. On multivariate analysis, body mass index, a high level of exercise achieved during the cardiopulmonary exercise test, lower heart rate at peak exercise, and oxygen pulse correlated significantly with better postoperative outcome. Cardiopulmonary exercise tests are helpful for stratifying patients undergoing thoracic surgery. Perioperative complications seem to be strongly related to left ventricular function and physical performance.
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Affiliation(s)
| | | | - Marco Bobbio
- Department of Cardiovascular Diseases Cuneo Hospital, Cuneo, Italy
| | - Gian Luca Rosso
- Department of Cardiovascular Diseases Cuneo Hospital, Cuneo, Italy
| | | | - Mauro Feola
- Department of Cardiovascular Diseases Cuneo Hospital, Cuneo, Italy
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Scardovi AB, De Maria R, Ferraironi A, Celestini A, Forte S, Parolini M, Gatto L, Bordi L, Sciarretta S, Ricci R, Guazzi M, Ricci R. ROLE OF OSCILLATORY BREATHING DURING CARDIOPULMONARY EXERCISE TEST FOR PROGNOSTIC STRATIFICATION OF ELDERLY PATIENTS WITH CHRONIC HEART FAILURE. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60324-5] [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] [Indexed: 11/26/2022]
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Scardovi AB, De Maria R. The ugly duckling and the swan. Intern Emerg Med 2009; 4:265-6. [PMID: 19434375 DOI: 10.1007/s11739-009-0256-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 04/15/2009] [Indexed: 11/28/2022]
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Scardovi AB, De Maria R, Celestini A, Coletta C, Aspromonte N, Perna S, Parolini M, Ricci R. Prognostic value of brain natriuretic peptide and enhanced ventilatory response to exercise in patients with chronic heart failure. Intern Emerg Med 2008; 3:331-7. [PMID: 18560771 DOI: 10.1007/s11739-008-0163-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 05/05/2008] [Indexed: 10/21/2022]
Abstract
Whether brain natriuretic peptide (BNP), combined with a cardiopulmonary exercise test (CPx) parameters or echocardiography improves prognostic stratification in mild-to-moderate systolic heart failure (HF) is currently unclear. In 156 consecutive stable outpatients with mild to moderate HF and left ventricular ejection fraction (LVEF) <40%, we assessed the impact of BNP assay, Doppler echocardiography and CPx on survival. Median BNP plasma levels were 207 [90-520] pg/mL. Mean LVEF was 33 +/- 7%. Left bundle branch block (LBBB) was present in 52 patients (33%) and a restrictive filling pattern in 35 (22%). The slope of the relation between minute ventilation and carbon dioxide production (VE/VCO(2) slope) averaged 35 +/- 8; an enhanced ventilatory response (EVR) to exercise (VE/VCO(2) slope >35) was found in 67 patients (43%). During 759 +/- 346 days of follow-up, 24 patients died. By multivariate analysis, the strongest independent predictors of all-cause death among clinical, echocardiographic variables and BNP were LBBB and beta-blocker treatment. When CPx variables were added, the best predictors of mortality were LBBB, beta-blockade and VE/VCO(2) slope. This study highlights the value of a sequential approach, based on clinical, laboratory and functional data to identify high-risk HF patients. BNP assay might constitute a simple alternative tool for patients with an inability or with clinical contraindications to exercise, advanced physical deconditioning and unreliable CPx results. However, whenever feasible, CPx with assessment of EVR is recommended for a more accurate prediction of prognosis.
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Scardovi AB, Coletta C, De Maria R, Perna S, Aspromonte N, Feola M, Rosso G, Greggi M, Ceci V. The cardiopulmonary exercise test is safe and reliable in elderly patients with chronic heart failure. J Cardiovasc Med (Hagerstown) 2007; 8:608-12. [PMID: 17667032 DOI: 10.2459/01.jcm.0000281698.53983.4e] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To assess safety and feasibility of cardiopulmonary exercise test (CPX) in elderly patients with chronic heart failure (CHF) and left ventricular dysfunction. METHODS AND RESULTS We analysed 395 cardiopulmonary exercise tests (CPXs) performed in 227 clinically stable patients with CHF [mean age 76 years, males 70%, mean New York Heart Association (NYHA) class 2.2 +/- 0.5] and impaired left ventricular function (mean ejection fraction 43 +/- 12%). Ninety-eight out of 395 CPXs (25%) were performed in patients older than 80 years. A standard bicycle exercise ramp protocol was used, with increments of 10 W/min. An expiratory exchange ratio (RER) >or= 1.05 at the peak of CPX was considered as the index of maximal exercise. Average workload was 65 +/- 23 W. No adverse reactions were observed, although one test was stopped for non-sustained ventricular tachycardia. The main reasons for stopping were exhaustion (50%), dyspnoea (30%), maximal predicted heart rate (17%), orthopaedic problems (2.5%) and significant ST segment depression (0.5%). In the overall cohort, 80% of patients achieved an RER >or= 1.05 and, in 56% of them, the RER was >or= 1.15. The anaerobic threshold (AT) was detectable in 80% of CPXs, and mean oxygen consumption (VO2) at AT was 9 +/- 6 ml/kg per min, whereas mean peak VO2 was 11 +/- 3 ml/kg per min. In the cohort of patients aged > 80 years, 71% reached an RER >or= 1.05 and 47% reached an RER >or= 1.15. In these older patients, AT was detectable in 68% of CPXs performed, and the mean peak VO2 was 10 +/- 3 ml/kg per min. CONCLUSIONS In elderly patients with CHF, the CPX is safe, feasible and able to provide basic information for individual risk assessment. These findings potentially extend the indications of CPX, which is currently applied to selected middle-aged patients with CHF, to the elderly population.
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Scardovi AB, De Maria R, Coletta C, Aspromonte N, Perna S, Cacciatore G, Parolini M, Ricci R, Ceci V. Multiparametric Risk Stratification in Patients With Mild to Moderate Chronic Heart Failure. J Card Fail 2007; 13:445-51. [PMID: 17675058 DOI: 10.1016/j.cardfail.2007.03.003] [Citation(s) in RCA: 9] [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] [Received: 10/21/2006] [Revised: 02/05/2007] [Accepted: 03/06/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Whether brain natriuretic peptide (BNP) combined with cardiopulmonary exercise test (CPx) and echocardiographic findings improves prognostic stratification in mild-to-moderate systolic heart failure (HF) is unclear. METHODS AND RESULTS A total of 244 consecutive stable outpatients, median age of 71 (62-76) years, with New York Heart Association (NYHA) Class I-III HF and left ventricular ejection fraction (LVEF) < 45% underwent BNP measurement, Doppler echocardiography, and a maximal CPx. Median BNP was 166 (70-403) pg/mL, median LVEF 35% (28%-40%). A restrictive filling pattern (RFP) was present in 44 patients (18%). At CPx, peak oxygen uptake was 12 (9.7, 14.4) mL/kg/min and an enhanced ventilatory response to exercise (EVR, slope of the ventilation to CO2 production ratio, > or = 35) was found in 90 patients (37%) During 18 (9-37) follow-up months, 80 patients died or were admitted for worsening HF (33%). In addition to simple bedside clinical variables (NYHA Class III, creatinine clearance, hemoglobin), BNP levels were predictive of outcome (HR 1.35 [1.12-1.63]). However, both RFP (HR 3.36 [2.09-5.41]) and a steeper minute ventilation-carbon dioxide output slope (HR 1.50 [1.19-1.88]) outperformed BNP as prognostic markers. Patients with both RFP and EVR had a 7.30 (95% CI 4.02-13.25) HR for death or HF-admission versus subjects with neither predictor. CONCLUSIONS This study highlights the importance of a multiparametric approach for optimal risk stratification in the elderly with mild-to-moderate HF. Patients at high risk should undergo closer follow-up and be carefully evaluated for different therapeutic options, including nonpharmacologic treatment.
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Aspromonte N, Feola M, Milli M, Scardovi AB, Coletta C, Carbonieri E, Giovinazzo P, Di Giacomo T, Barro S, Rosso GL, Ceci V, Milani L, Valle R. Prognostic role of B-type natriuretic peptide in patients with diabetes and acute decompensated heart failure. Diabet Med 2007; 24:124-30. [PMID: 17257273 DOI: 10.1111/j.1464-5491.2007.02070.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several studies have reported the prognostic value of natriuretic peptides, but their predictive value in patients with diabetes mellitus is unknown. The aim of the study was to test the hypothesis that measurement of brain natriuretic peptide (BNP) levels in ambulatory patients with congestive heart failure (CHF) and diabetes can predict the occurrence of cardiovascular events at 6-month follow-up. METHODS We enrolled 145 consecutive patient with diabetes [age 72 +/- 9 years, hypertension (21%), ischaemic heart disease (52%), atrial fibrillation (22%), preserved left ventricular function (29%)] seen in the outpatient heart failure clinic after an acute episode of cardiac failure. RESULTS The median (25th/75th interquartile range) BNP concentrations at discharge were 186 (75-348) pg/ml. At 6-month clinical follow-up 10/145 (7%) subjects had died and 31/145 (21%) had been readmitted because of cardiac decompensation. BNP values of 200 and 500 pg/ml were found to have the best compromise between sensitivity (88 and 46%, respectively) and specificity (71 and 89%, respectively) for predicting events at 6 months. Multivariate Cox regression analysis identified only two parameters as predictors of events: serum creatinine [hazard ratio (HR) = 3.3; P = 0.02], and BNP plasma level BNP cut-off values (HR = 3.8; P = 0.03 for 201-499 pg/ml and HR = 7.7; P = 0.001 for > or = 500 pg/ml). CONCLUSION These results suggest that BNP and serum creatinine are strong predictors of clinical events in patients with diabetes and CHF. In these patients, clinical outcome might be stratified by plasma BNP levels.
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Affiliation(s)
- N Aspromonte
- Heart Failure Unit, Department of Cardiology, Ospedale S Croce-Carle, Cuneo, Italy.
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Scardovi AB, Coletta C, Aspromonte N, Perna S, Greggi M, D'Errigo P, Sestili A, Ceci V. Brain natriuretic peptide plasma level is a reliable indicator of advanced diastolic dysfunction in patients with chronic heart failure. European Journal of Echocardiography 2007; 8:30-6. [PMID: 16476572 DOI: 10.1016/j.euje.2005.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2005] [Revised: 10/13/2005] [Accepted: 12/15/2005] [Indexed: 10/25/2022]
Abstract
The aim of the study was to determine the value of brain natriuretic peptide for the identification of diastolic dysfunction status in congestive heart failure. We studied 204 patients with stable heart failure. Brain natriuretic peptide plasma levels were correlated with echocardiographic parameters of diastolic dysfunction. Diastolic dysfunction was classified as mild (abnormal echocardiographic relaxation pattern) and severe (pseudo-normal or restrictive pattern). A significant correlation between brain natriuretic peptide levels and the other parameters was detected. Brain natriuretic peptide dosage, then, seems to be a reliable tool for the assessment of diastolic dysfunction status in patients with congestive heart failure.
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Aspromonte N, Ceci V, Chiera A, Coletta C, D'Eri A, Feola M, Giovinazzo P, Milani L, Noventa F, Scardovi AB, Sestili A, Valle R. Rapid brain natriuretic peptide test and Doppler echocardiography for early diagnosis of mild heart failure. Clin Chem 2006; 52:1802-8. [PMID: 16873293 DOI: 10.1373/clinchem.2005.064386] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 11/06/2022]
Abstract
BACKGROUND The early identification of patients at risk for the development of clinical heart failure (HF) is a new challenge in an effort to improve outcomes. METHODS We prospectively evaluated whether the combination of brain natriuretic peptide (BNP) measurements (Triage BNP test, Biosite Diagnostics) and echocardiography would effectively stratify patients with new symptoms in a cost-effective HF program aimed at early diagnosis of mild HF. A total of 252 patients were referred by 100 general practitioners. RESULTS Among the study population, the median BNP value was 78 ng/L (range, 5-1491 ng/L). BNP concentrations were lower among patients without heart disease [median 15 ng/L (range, 5-167 ng/L); n = 96] than among patients with confirmed HF [median, 165 ng/L (22-1491 ng/L); n = 157; Mann-Whitney U-test, 12.3; P <0.001]. Patients were grouped into diastolic dysfunction [BNP, 195 (223) ng/L], systolic dysfunction [BNP, 290 (394) ng/L], and both systolic and diastolic dysfunction [BNP, 776 (506) ng/L]. In this model, a cutoff value of 50 ng/L BNP increases the diagnostic accuracy in predicting mild HF, avoiding 41 echocardiograms per 100 patients studied, with a net saving of 14% of total costs. CONCLUSIONS Blood BNP concentrations, in a cost effective targeted screening, can play an important role in diagnosing mild HF and stratifying patients into risk groups of cardiac dysfunction.
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Affiliation(s)
- Nadia Aspromonte
- Heart Failure Unit and Department of Cardiology, Santo Spirito Hospital, Rome, Italy.
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Aspromonte N, Feola M, Scardovi AB, Coletta C, D'Eri A, Giovinazzo P, Carunchio A, Chiera A, Fanelli R, Di Giacomo T, Ricci R, Ceci V, Milani L, Valle R. Early diagnosis of congestive heart failure: clinical utility of B-type natriuretic peptide testing associated with Doppler echocardiography. J Cardiovasc Med (Hagerstown) 2006; 7:406-13. [PMID: 16721202 DOI: 10.2459/01.jcm.0000228690.40452.d3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 11/05/2022]
Abstract
OBJECTIVE B-type natriuretic peptide (BNP) has emerged as an important diagnostic serum marker of congestive heart failure (CHF). The aim of this study was to evaluate whether BNP measurement associated with echocardiography could effectively stratify patients with new symptoms as part of a cost-effective heart failure programme based on cooperation between hospital cardiologists and primary care physicians. METHODS Patients were referred to the cardiology clinic by general practitioners in case of clinical suspect of CHF. All patients underwent clinical examination, transthoracic echocardiography and plasma determination of BNP. Systolic dysfunction was defined as a left ventricular ejection fraction < 45%; diastolic dysfunction was defined as a preserved systolic function with signs of diastolic impairment. RESULTS Three hundred and fifty-seven subjects were examined (50% males, mean age 73 years). BNP concentration was 469 +/- 505 pg/ml in the 240 patients diagnosed with CHF, compared with 43 +/- 105 pg/ml in the 117 patients without CHF (P = 0.001). CHF patients were grouped into those with diastolic dysfunction (n = 110; BNP 373 +/- 335 pg/ml), systolic dysfunction (n = 108; BNP 550 +/- 602 pg/ml), and both systolic and diastolic dysfunction (n = 22; BNP 919 +/- 604 pg/ml). At receiver operating characteristic analysis, the optimal BNP cut-off level for diagnosing CHF was 80 pg/ml (sensitivity 84%, specificity 91%). According to cost analysis, this cut-off level might provide a cost saving of 31% without affecting diagnostic accuracy. CONCLUSIONS In patients referred by general practitioners for suspected CHF, plasma BNP levels might help to stratify subjects into different groups of cardiac dysfunction.
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Affiliation(s)
- Nadia Aspromonte
- Heart Failure Unit, Department of Cardiology, Santo Spirito Hospital, Rome, Italy.
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Scardovi AB, De Maria R, Colettat C, Aspromonte N, Perna S, Infusino T, D'Errigo P, Rosato S, Greggi M, Di Giacomo T, Riccio R, Cec V. Brain natriuretic peptide is a reliable indicator of ventilatory abnormalities during cardiopulmonary exercise test in heart failure patients. Med Sci Monit 2006; 12:CR191-5. [PMID: 16641874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Accepted: 03/15/2006] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Whether brain natriuretic peptide (BNP), a neurohormone marker of ventricular dysfunction, correlates with an enhanced ventilatory response (EVR) during cardiopulmonary exercise test, a well-known predictor of prognosis, in systolic heart failure (HF) is currently unknown. MATERIAL/METHODS Resting BNP was measured in 134 consecutive stable outpatients aged 69 +/- 11 years with mild to moderate HF and LV ejection fraction (LVEF) < 40% who performed a maximal exercise test. EVR was assessed as the slope of the relation between minute ventilation and carbon dioxide production (VE/VCO2 slope) > or = 35. RESULTS LVEF averaged 33 +/- 7%, BNP 350 +/- 396 pg/ml, and the VE/VCO2 slope 36 +/- 8. Fifty-six of 123 patients (45%) had EVR. BNP correlated with VE/VCO2 slope (r = 0.453; p < 0.01). By multivariate logistic regression, plasma BNP was the only independent predictor of EVR (RR: 1.004 per unit increment, 95% CI: 1.002-1.006, p < 0.0001). A BNP > or = 160 pg/ml had 86% sensitivity, 67% specificity, and 76% overall accuracy for the prediction of EVR (chi square: 37.4, RR 12.2, 95% CI: 4.96-30.3, p < 0.0001, AUC 0.815 (95%CI. 0.738-0.892)). CONCLUSIONS In systolic HF, plasma BNP is related to an enhanced ventilatory response to exercise and offers a simple and reliable alternative to the cardiopulmonary exercise test in patients with inability or contraindications to exercise.
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Feola M, Aspromonte N, Canali C, Ceci V, Giovinazzo P, Milani L, Quarta G, Ricci R, Scardovi AB, Uslenghi E, Valle R. Prognostic value of plasma brain natriuretic peptide, urea nitrogen, and creatinine in outpatients >70 years of age with heart failure. Am J Cardiol 2005; 96:705-9. [PMID: 16125500 DOI: 10.1016/j.amjcard.2005.04.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 04/11/2005] [Accepted: 04/11/2005] [Indexed: 11/21/2022]
Abstract
This study analyzed the relevance of plasma brain natriuretic peptide (BNP) and echocardiography in predicting cardiovascular events in a large population >70 years old with heart failure (HF). Three hundred four outpatients with HF (51.6% men, mean age 78.6) underwent transthoracic echocardiography and plasma BNP testing shortly before hospital discharge. Echocardiography was intended to reveal systolic dysfunction (left ventricular [LV] ejection fraction [EF] <50%) or diastolic dysfunction (EF > or =50% and abnormalities of ventricular relaxation). During 6-month follow-up, all-cause death and readmission were assessed. One hundred seventeen patients had diastolic dysfunction with preserved systolic LV function, and 187 had systolic dysfunction. At 6-month clinical follow-up, 33 subjects (10.9%) had died, and 62 (20.4%) needed readmission for cardiac decompensation. In all patients, univariate logistic regression demonstrated significant correlations between age (r = 0.14, p = 0.01), plasma BNP (r = 0.36, p = 0.0001), the EF (r = 0.16, p = 0.003), urea nitrogen (r = 0.35, p = 0.0001), serum creatinine (r = 0.27, p = 0.0001), and New York Heart Association (NYHA) class (r = 0.35, p = 0.0001) and the occurrence of cardiovascular events. In patients with HF in NYHA class III or IV, a BNP cut-off level of 200 pg/ml identified different outcomes (BNP <200 pg/ml in 1 of 20 events vs BNP >200 pg/ml in 55 of 85 events, p = 0.0001). In patients with HF who were >70 years old, BNP, NYHA class, and renal function predicted adverse outcome. In patients with severe HF, BNP was better than NYHA class in predicting future events.
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Affiliation(s)
- Mauro Feola
- Department of Cardiovascular Diseases, Ospedale S. Croce, Carle Cuneo, Italy.
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Scardovi AB, Coletta C, Aspromonte N, Perna S, Infusino T, Carunchio A, D'Errigo P, Seccareccia F, De Maria R, Greggi M, Di Giacomo T, Ricci R, Ceci V. Relationship between B-type natriuretic peptide levels and ventilatory response during cardiopulmonary exercise test in patients with chronic heart failure. Minerva Cardioangiol 2005; 53:313-20. [PMID: 16177675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIM Aim of the study was to evaluate if brain natriuretic peptide (BNP) levels, a cardiac neurohormone well correlated with prognosis in chronic heart failure (CHF), are associated with enhanced ventilatory response to exercise, in ambulatory patients with intermediate peak oxygen uptake (PVO2). METHODS Resting BNP was measured in 129 consecutive stable CHF patients with mild to moderate heart failure (90% New York Heart Association (NYHA) class II or III) and intermediate (10-18 mL/kg/min) PVO2, assessed during cardiopulmonary exercise test. Mean (SD) left ventricular ejection fraction (EF) and pulmonary systolic pressure (PAP) were 41 +/- 3% and 47 +/- 14 mmHg, respectively. The enhanced ventilatory response to exercise (EVR) was assessed as a slope of the relation between minute ventilation and carbon dioxide production (VE/VCO2 slope) > 35. RESULTS Thirty-three over 129 patients (26%) had EVR. Mean BNP plasma level was 394 +/- 347 pg/mL. A significant correlation between BNP and EVR (r = 0.310; p < 0.01), was observed. In the logistic multivariate model, a BNP plasma level > 100 pg/mL had an independent predictive value for EVR (95% IC 1.68 to 10.5, Odds Ratio 4.23, p = 0.02). We found a significant correlation between BNP and PAP (r = 0.390; p < 0.001), and between PAP and EVR (r = 0.511; p < 0.01). CONCLUSIONS In CHF patients with intermediate PVO2, plasma BNP is clearly related to the enhanced ventilatory response to exercise. In this subset, BNP levels could represent an effective alternative tool for the clinical assessment in patients with unreliable cardiopulmonary exercise test.
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Affiliation(s)
- A B Scardovi
- Division of Cardiology, S. Spirito Hospital, Rome, Italy.
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Scardovi AB. [Clinical applications of brain natriuretic peptide testing]. Ital Heart J Suppl 2004; 5:343-56. [PMID: 15182061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Natriuretic peptide hormones are a family of vasoactive peptides with many favorable physiological properties and have emerged as useful markers in cardiovascular disease. In particular, brain natriuretic peptide (BNP) is a cardiac neurohormone secreted by the cardiac ventricles as a response to ventricular volume expansion, pressure overload and resultant increased wall tension, directly correlated with both left ventricular filling and pulmonary wedge pressure. It is nowadays considered an important diagnostic tool, adding information to clinical judgment in the evaluation of patients with acute dyspnea, and a useful guide to the treatment of chronic heart failure. Moreover, the prognostic value of BNP has been established in several studies, both in postmyocardial infarction patients with asymptomatic left ventricular dysfunction and in patients with overt heart failure. Furthermore it has been shown that BNP could also predict sudden death and offer an additive and easily obtainable tool for risk stratification of patients with chronic heart failure. This paper summarizes the current evidence concerning the use of this peptide in a variety of clinical scenarios.
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Boccanelli A, Scardovi AB. Clinical issues in the management of heart failure. G Ital Cardiol 1999; 29:1195-8. [PMID: 10546133] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- A Boccanelli
- S. Giovanni Hospital, Department of Cardiology, Rome
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Carboni GP, Saltarocchi ML, Risa AL, Scardovi AB, Zanchi E, Prati PL. Combined Gallopamil and Isosorbide-5-Mononitrate in “Mixed” Angina Pectoris. J Cardiovasc Pharmacol 1992. [DOI: 10.1097/00005344-199200207-00012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Carboni GP, Saltarocchi ML, Risa AL, Scardovi AB, Zanchi E, Prati PL. Combined Gallopamil and Isosorbide-5-Mononitrate in “Mixed” Angina Pectoris. J Cardiovasc Pharmacol 1992. [DOI: 10.1097/00005344-199206207-00011] [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] [Indexed: 11/25/2022]
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Carboni GP, Scardovi AB, D'Ermo M, Prati PL. Bopindolol in chronic stable angina pectoris: duration and extent of antianginal action. Br J Clin Pharmacol 1991; 32:755-7. [PMID: 1685090 PMCID: PMC1368558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The effects of bopindolol, a new beta-adrenoceptor blocker, on the exercise tolerance of 12 in-patients, mean age 57 (5 years), with stable angina pectoris and documented coronary artery disease were evaluated. All patients received on 4 different days a single oral dose of bopindolol 0.5 mg, bopindolol 1.0 mg, bopindolol 2.0 mg and placebo according to a double-blind latin square design. Treadmill symptoms-limited exercise tests were performed using a Bruce protocol, 3, 12 and 24 h after dosing. Bipindolol improved (P less than 0.05) exercise tolerance in comparison with placebo (by a maximum of 33%, 52% and 26% after the 2.0 mg dose) with no adverse effect on ischaemia. The primary action of bopindolol appeared to be to reduce myocardial oxygen consumption (mainly by its negative chronotropic effect) for up to the 24th hour after oral administration. Eight (66%) patients were angina free at the 3rd, 12th and 24th h exercise test. The effects of bopindolol were not dose-related. A short period of inactivity due to hospitalization may have influenced the exercise performance and led us to underestimate the presence of a dose-response. The results of this report suggest that bopindolol has a long lasting effect in the treatment of patients with chronic stable angina pectoris.
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Affiliation(s)
- G P Carboni
- Divisione Cardiologia A, Ospedale S. Camillo, Roma
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