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D'Ascenzo F, Fabris E, Gregorio C, Mittone G, De Filippo O, Wańha W, Leonardi S, Roubin SR, Chinaglia A, Truffa A, Huczek Z, Gaibazzi N, Ielasi A, Cortese B, Borin A, Pagliaro B, Núñez-Gil IJ, Ugo F, Marengo G, Barbieri L, Marchini F, Desperak P, Melendo-Viu M, Montalto C, Bianco M, Bruno F, Mancone M, Ferrandez-Escarabajal M, Morici N, Scaglione M, Tuttolomondo D, Gąsior M, Mazurek M, Gallone G, Campo G, Wojakowski W, Assi EA, Stefanini G, Sinagra G, Ferrari GM. Corrigendum to 'Forecasting the Risk of Heart Failure Hospitalization After Acute Coronary Syndromes: the CORALYS HF Score' [American Journal of Cardiology 206 (2023) 320-329]. Am J Cardiol 2023:S0002-9149(23)01390-5. [PMID: 38114059 DOI: 10.1016/j.amjcard.2023.12.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
| | - Enrico Fabris
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Caterina Gregorio
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gianluca Mittone
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Wojciech Wańha
- Department ofCardiologyandStructuralHeart Diseases, Medical University of Silesia, Katowice, Poland
| | - Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Alessandra Chinaglia
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed Interventistica, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, San Carlo Clinic, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Andrea Borin
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | | | - Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Fabrizio Ugo
- Division of Cardiology, Ospedale Sant'Andreadi Vercelli, Vercelli, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Departement of Informatica, University of Turin, Turin, Italy
| | - Lucia Barbieri
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Division of Cardiology, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Piotr Desperak
- Department ofCardiologyandStructuralHeart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Claudio Montalto
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Bianco
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Massimo Mancone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Nuccia Morici
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Scaglione
- Division of Cardiology, Ospedale Cardinal G. Massaia, Asti, Italy
| | | | - Mariusz Gąsior
- Departement of Informatica, University of Turin, Turin, Italy
| | - Maciej Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | | | - Emad Abu Assi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gaetano Mariade Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
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D'Ascenzo F, Fabris E, DeGregorio C, Mittone G, De Filippo O, Wańha W, Leonardi S, Roubin SR, Chinaglia A, Truffa A, Huczek Z, Gaibazzi N, Ielasi A, Cortese B, Borin A, Pagliaro B, Núñez-Gil IJ, Ugo F, Marengo G, Barbieri L, Marchini F, Desperak P, Melendo-Viu M, Montalto C, Bianco M, Bruno F, Mancone M, Ferrandez-Escarabajal M, Morici N, Scaglione M, Tuttolomondo D, Gąsior M, Mazurek M, Gallone G, Campo G, Wojakowski W, Abu Assi E, Stefanini G, Sinagra G, de Ferrari GM. Forecasting the Risk of Heart Failure Hospitalization After Acute Coronary Syndromes: the CORALYS HF Score. Am J Cardiol 2023; 206:320-329. [PMID: 37734293 DOI: 10.1016/j.amjcard.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/15/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 09/23/2023]
Abstract
The present study aimed to identify patients at a higher risk of hospitalization for heart failure (HF) in a population of patients with acute coronary syndrome (ACS) treated with percutaneous coronary revascularization without a history of HF or reduced left ventricular (LV) ejection fraction before the index admission. We performed a Cox regression multivariable analysis with competitive risk and machine learning models on the incideNce and predictOrs of heaRt fAiLure After Acute coronarY Syndrome (CORALYS) registry (NCT04895176), an international and multicenter study including consecutive patients admitted for ACS in 16 European Centers from 2015 to 2020. Of 14,699 patients, 593 (4.0%) were admitted for the development of HF up to 1 year after the index ACS presentation. A total of 2 different data sets were randomly created, 1 for the derivative cohort including 11,626 patients (80%) and 1 for the validation cohort including 3,073 patients (20%). On the Cox regression multivariable analysis, several variables were associated with the risk of HF hospitalization, with reduced renal function, complete revascularization, and LV ejection fraction as the most relevant ones. The area under the curve at 1 year was 0.75 (0.72 to 0.78) in the derivative cohort, whereas on validation, it was 0.72 (0.67 to 0.77). The machine learning analysis showed a slightly inferior performance. In conclusion, in a large cohort of patients with ACS without a history of HF or LV dysfunction before the index event, the CORALYS HF score identified patients at a higher risk of hospitalization for HF using variables easily accessible at discharge. Further approaches to tackle HF development in this high-risk subset of patients are needed.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
| | - Enrico Fabris
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Caterina DeGregorio
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gianluca Mittone
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Sergio Leonardi
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Alessandra Chinaglia
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed Interventistica, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, San Carlo Clinic, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| | - Andrea Borin
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | | | - Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Fabrizio Ugo
- Division of Cardiology, Ospedale Sant'Andrea di Vercelli, Vercelli, Italy
| | - Giorgio Marengo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Departement of Informatica, University of Turin, Turin, Italy
| | - Lucia Barbieri
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Piotr Desperak
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Claudio Montalto
- Coronary Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Bianco
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Massimo Mancone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Nuccia Morici
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Scaglione
- Division of Cardiology, Ospedale Cardinal G. Massaia, Asti, Italy
| | | | - Mariusz Gąsior
- Departement of Informatica, University of Turin, Turin, Italy
| | - Maciej Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | | | - Emad Abu Assi
- Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Gaetano Maria de Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
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Bruno F, Marengo G, De Filippo O, Wanha W, Leonardi S, Raposeiras Roubin S, Fabris E, Popovic M, Giannino G, Truffa A, Huczek Z, Gaibazzi N, Ielasi A, Cortese B, Borin A, Núñez‐Gil IJ, Melis D, Ugo F, Bianco M, Barbieri L, Marchini F, Desperak P, Montalto C, Melendo‐Viu M, Elia E, Mancone M, Buono A, Ferrandez‐Escarabajal M, Morici N, Scaglione M, Tuttolomondo D, Sardella G, Gasior M, Mazurek M, Gallone G, Pagliaro B, Lopiano C, Campo G, Wojakowski W, Abu‐Assi E, Sinagra G, De Ferrari GM, D'Ascenzo F. Impact of Complete Revascularization on Development of Heart Failure in Patients With Acute Coronary Syndrome and Multivessel Disease: A Subanalysis of the CORALYS Registry. J Am Heart Assoc 2023; 12:e028475. [PMID: 37489724 PMCID: PMC10492970 DOI: 10.1161/jaha.122.028475] [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: 04/04/2023] [Accepted: 06/02/2023] [Indexed: 07/26/2023]
Abstract
Background The impact of complete revascularization (CR) on the development of heart failure (HF) in patients with acute coronary syndrome and multivessel coronary artery disease undergoing percutaneous coronary intervention remains to be elucidated. Methods and Results Consecutive patients with acute coronary syndrome with multivessel coronary artery disease from the CORALYS (Incidence and Predictors of Heart Failure After Acute Coronary Syndrome) registry were included. Incidence of first hospitalization for HF or cardiovascular death was the primary end point. Patients were stratified according to completeness of coronary revascularization. Of 14 699 patients in the CORALYS registry, 5054 presented with multivessel disease. One thousand four hundred seventy-three (29.2%) underwent CR, while 3581 (70.8%) did not. Over 5 years follow-up, CR was associated with a reduced incidence of the primary end point (adjusted hazard ratio [HR], 0.66 [95% CI, 0.51-0.85]), first HF hospitalization (adjusted HR, 0.67 [95% CI, 0.49-0.90]) along with all-cause death and cardiovascular death alone (adjusted HR, 0.74 [95% CI, 0.56-0.97] and HR, 0.56 [95% CI, 0.38-0.84], respectively). The results were consistent in the propensity-score matching population and in inverse probability treatment weighting analysis. The benefit of CR was consistent across acute coronary syndrome presentations (HR, 0.59 [95% CI, 0.39-0.89] for ST-segment elevation myocardial infarction and HR, 0.71 [95% CI, 0.50-0.99] for non-ST-elevation acute coronary syndrome) and in patients with left ventricular ejection fraction >40% (HR, 0.52 [95% CI, 0.37-0.72]), while no benefit was observed in patients with left ventricular ejection fraction ≤40% (HR, 0.77 [95% CI, 0.37-1.10], P for interaction 0.04). Conclusions CR after acute coronary syndrome reduced the risk of first hospitalization for HF and cardiovascular death, as well as first HF hospitalization, and cardiovascular and overall death both in patients with ST-segment elevation myocardial infarction and non-ST-elevation acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04895176.
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Affiliation(s)
- Francesco Bruno
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Giorgio Marengo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Ovidio De Filippo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico San MatteoCoronary Care UnitPaviaItaly
| | | | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano IsontinaUniversity of TriesteItaly
| | - Maja Popovic
- Department of Medical SciencesUniversity of TurinItaly
| | - Giuseppe Giannino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | | | - Zenon Huczek
- 1st Department of CardiologyMedical University of WarsawWarszawaPoland
| | | | - Alfonso Ielasi
- U.O. di Cardiologia Clinica ed InterventisticaIstituto Clinico Sant’AmbrogioMilanItaly
| | - Bernardo Cortese
- Cardiovascular Research TeamSan Carlo ClinicMilanItaly
- Fondazione Ricerca e Innovazione CardiovascolareMilanItaly
| | - Andrea Borin
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | | | - Daniele Melis
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Fabrizio Ugo
- Department of CardiologySant’Andrea HospitalVercelliItaly
| | - Matteo Bianco
- Division of CardiologySan Luigi Gonzaga University Hospital, OrbassanoTurinItaly
| | - Lucia Barbieri
- Division of CardiologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- University of MilanMilanItaly
| | - Federico Marchini
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
| | - Piotr Desperak
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Claudio Montalto
- Fondazione IRCCS Policlinico San MatteoCoronary Care UnitPaviaItaly
| | | | - Edoardo Elia
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Massimo Mancone
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e CardiovascolariSapienza Università di RomaRomaItaly
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular DepartmentFondazione Poliambulanza Istituto OspedalieroBresciaItaly
| | | | - Nuccia Morici
- IRCCS S. Maria Nascente‐Fondazione Don Carlo Gnocchi ONLUSMilanItaly
| | | | | | - Gennaro Sardella
- Dipartimento di Scienze Cliniche Internistiche, Anestesiologiche e CardiovascolariSapienza Università di RomaRomaItaly
| | - Mariusz Gasior
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | - Maciej Mazurek
- 1st Department of CardiologyMedical University of WarsawWarszawaPoland
| | - Guglielmo Gallone
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Beniamino Pagliaro
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
- IRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Clara Lopiano
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
- IRCCS Humanitas Research HospitalRozzano‐MilanItaly
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di FerraraConaItaly
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart DiseasesMedical University of SilesiaKatowicePoland
| | | | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano IsontinaUniversity of TriesteItaly
| | - Gaetano Maria De Ferrari
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
| | - Fabrizio D'Ascenzo
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical SciencesUniversity of TurinItaly
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Del Monaco G, Tumminello F, Figliozzi S, Pagliaro B, Fumero A, Barbone A, Cuko E, Mantovani R, Fazzari F, Cannata F, Curzi M, Catapano F, Monti L, Francone M, Pini D, Stefanini GG, Torracca L, Condorelli G, Bragato RM. 28 CONSTRICTIVE PERICARDITIS: A ROOM FOR MULTI-MODALITY IMAGING. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
The diagnosis of constrictive pericarditis can be challenging through conventional imaging. Novel imaging techniques have been proposed to improve it.
Clinical Case
A 74-year-old man with a previous diagnosis of heart failure with preserved ejection fraction and permanent atrial fibrillation (AF) was admitted because of worsening dyspnea, peripheral edema, and ascites refractory to diuretics therapy. ECG revealed low QRS voltages and AF with normal heart rate and laboratory exams detected increased values of BNP and hepatic stasis indices; blood count and CRP were normal. Echocardiography revealed mildly reduced bi-ventricular pump function (left ventricular ejection fraction = 52%, right ventricular fractional area change = 25%) and slightly increased wall thickness. Atria were moderately dilated (left and right atrium 46 and 44 ml/mq, respectively) and mitral and tricuspid annuli were dilated too. There was inferior vena cava plethora, moderate atriogenic tricuspid regurgitation and mild-to-moderate atriogenic mitral regurgitation. A paradoxical interventricular septal motion and significant respiratory changes on trans-mitral (>25%) and trans-tricuspid (>30%) pulsed Doppler were noted; however, there was no "annulus reversus" (lateral and septal e’ 13 and 11 cm/sec, respectively) at TDI analysis. In contrast, 2D-speckle-tracking global longitudinal strain showed impaired deformation of the lateral segments with relative sparing of the septal segments. The latter pattern has been recently described as "strain reversus" or "hot septum sign". The findings were suspected of constrictive pericarditis, but a chest Computed Tomography excluded pericardial calcifications. Cardiac magnetic resonance (CMR) was then performed revealing a "septal shift" at cine-real time sequences analysis. The pericardium was slightly thickened (4-5 mm) with widespread late gadolinium enhancement but without signs of acute inflammation at T2-weighted imaging. Tricuspid regurgitation was confirmed to be "moderate" after phase-contrast imaging. Cardiac catheterization finally revealed normal coronary arteries and confirmed the diagnosis of constrictive pericarditis (square root sign, equalization of bi-ventricular end-diastolic pressures). The patient underwent pericardiectomy and tricuspid and mitral valve repair and was asymptomatic at 6-months follow-up.
Conclusions
Constrictive pericarditis represents a potentially reversible cause of heart failure but can be easily missed through conventional imaging. In the present case, advanced echocardiography and CMR were essential to come up with an accurate diagnosis, guiding the patient's clinical management with excellent outcome.
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Affiliation(s)
- Guido Del Monaco
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Fabio Tumminello
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
| | - Stefano Figliozzi
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
- Departement Of Radiology, Humanitas Research Hospital - Ircss , Rozzano (Milan) , Italy
| | - Beniamino Pagliaro
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Andrea Fumero
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Humanitas Research Hospital , Departement Of Cardiac Surgery - Ircss, Rozzano (Milan) Italy
| | - Alessandro Barbone
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Humanitas Research Hospital , Departement Of Cardiac Surgery - Ircss, Rozzano (Milan) Italy
| | - Enea Cuko
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Humanitas Research Hospital , Departement Of Cardiac Surgery - Ircss, Rozzano (Milan) Italy
| | - Riccardo Mantovani
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Fabio Fazzari
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Francesco Cannata
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Mirko Curzi
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Federica Catapano
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Departement Of Radiology, Humanitas Research Hospital - Ircss , Rozzano (Milan) , Italy
| | - Lorenzo Monti
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
- Departement Of Radiology, Humanitas Research Hospital - Ircss , Rozzano (Milan) , Italy
| | - Marco Francone
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Departement Of Radiology, Humanitas Research Hospital - Ircss , Rozzano (Milan) , Italy
| | - Daniela Pini
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Giulio Giuseppe Stefanini
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Lucia Torracca
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Humanitas Research Hospital , Departement Of Cardiac Surgery - Ircss, Rozzano (Milan) Italy
| | - Gianluigi Condorelli
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
| | - Renato Maria Bragato
- Humanitas Clinical And Research Hospital - Ircss,Rozzano (Milan) , Italy
- Cardio Center, Humanitas Research Hospital - Ircss , Rozzano (Milan) Italy
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Mangieri A, Sticchi A, Gohar A, Regazzoli D, Fazzari F, Pini D, Pellegrino M, Pagliaro B, Loiacono F, Chiarito M, Reimers B, Praz F, Latib A, Colombo A. Percutaneous Tricuspid Valve Repair. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2307220] [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: 11/06/2022] Open
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6
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Pugno Vanoni F, Biroli M, Cannata F, Pagliaro B, Pellegrino M, Villaschi A, Gasparini G, Ardino L, Vrinceanu E, Loiacono F, Pini D. C78 PREVALENCE AND MECHANISMS OF SEVERE MITRAL AND TRICUSPID REGURGITATION IN A HEART FAILURE OUTPATIENTS POPULATION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Mitral regurgitation (MR) and tricuspid regurgitation (TR) are a known cause of morbidity and mortality in heart failure (HF) patients. Maximal up–titration of guideline–directed medical therapy (GDMT) for HF may not be enough to reduce the severity of the valve’s incompetence and patients’ symptoms. The development and successful results of transcatheter therapies for mitral/tricuspid disease have opened new therapeutic opportunities when surgery is not feasible. Accurate valve regurgitation’s mechanisms evaluation is essential to choose the best treatment option. This study aims at evaluating the prevalence and underlying mechanisms of at least moderate–to–severe (≥3+/4+) MR and/or TR in a cohort of HF outpatients.
Methods
We retrospectively analyzed the medical records of 1260 outpatients evaluated by our HF unit between January 2020 and June 2021. All patients with echocardiographic evidence of ≥ 3+/4+ MR and/or TR were included (treated ones were excluded), and a thorough echocardiographic images review was conducted. A full collection of patients’ clinical, laboratory and therapy regimens details was performed as well.
Results
Of the 1260 analyzed patients, 173 (13.7%) exhibited ≥3+/4+ MR and/or TR and were included in the registry. Table 1 shows the main clinical/echocardiographic characteristics. Mean age was 80±7 years, median ejection fraction was 45% (IQR=33–55). All patients were treated with maximal tolerated doses of GDMT and, if appropriate, with cardiac devices/myocardial revascularization. ≥3+/4+ MR and/or TR was observed in 92 (7.3%) and 117 (9.3%) patients, respectively. Patients with isolated significant MR were 56 (4.4%), with isolated significant TR were 81 (6.4%); the remaining 36 (2.8%) had both MR/TR. Among patients with significant MR, 50 (54%) had functional/secondary valvular defect (details in Figure 2): the majority (41,82%) presented a ventricular etiology (asymmetric tethering in 18/41) while 9 (18%) an atrial one (atriogenic tethering in 3/9).
Conclusion
Despite optimized GDMT, the prevalence of patients with hemodynamically significant valvular defects was considerably high in our HF population. This is the first registry to comprehensively detail atrioventricular valve regurgitations’ mechanisms in a wide real–life cohort of HF outpatients. Further studies are needed to identify reasons for potential undertreatment and patients who would benefit the most from percutaneous correction of their valvular defects.
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Affiliation(s)
| | - M Biroli
- HUMANITAS RESEARCH HOSPITAL, MILANO
| | | | | | | | | | | | - L Ardino
- HUMANITAS RESEARCH HOSPITAL, MILANO
| | | | | | - D Pini
- HUMANITAS RESEARCH HOSPITAL, MILANO
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7
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Pellegrino M, Gasparini G, Ghianda D, Villaschi A, Oliva A, Loiacono F, Pagliaro B, Natali Testona N, Atuncar M, Pini D. P246 URINARY SODIUM–GUIDED I.V. DIURETIC THERAPY IN ACUTE HEART FAILURE: APPLICATION OF THE YALE DIURETIC PROTOCOL IN A REAL–WORLD ITALIAN SETTING. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Loop diuretics are the cornerstone of acutely decompensated heart failure (ADHF) treatment, but evidences on doses and administration modalities are still lacking. Veena S. et al have recently validated the Natriuretic Response Prediction Equation and applied it with the Yale Diuretic Protocol (YDP) in a clinical implementation cohort demonstrating its safety.
Objectives
Our purpose is to test the applicability and safety of YDP for titration of diuretic therapy in a real–world in–hospital setting, as compared to standard diuretic therapy. METHODS From 15th September 2021 patients hospitalized with ADHF, almost one sign of congestion and need of i.v. diuretics were enrolled. Patients with active bleeding, hematocrit < 21%, or on dialysis were excluded. Patients were treated with i.v. diuretic therapy guided by urinary sodium (YDP–group) or by weight changes and urinary output (control group) based on logistic in–hospital reasons.
Results
Thirty patients were included. Median age was 76.4 [IQR 68.3; 82.7] years old; median EF and glomerular filtration rate were 40% [IQR 30; 55] and 57.2 ml/min/m2 [IQR 44.9; 79.9], respectively. Nineteen (63.3%) patients were on chronic loop diuretic treatment. Ten (33.3%) patients were treated according to YDP. Main results are shown in the Table attached. YDP patients were younger (p = 0.02) and received shorter treatment with i.v. diuretics (YDP 36 [IQR 27; 48] hours, controls 48 [IQRS 38; 88] hours; p = 0.03). No differences in terms of total diuresis, weight loss at the end of i.v. diuretic therapy and length of hospitalization were shown. YDP patients experienced significant lower increase in creatinine during i.v. diuretic therapy (p = 0.02). The incidence of adverse events was comparable between groups, with equal hypotension rate (10%), and similar plasma levels of electrolytes at the end of i.v. diuretic therapy; YDP patients required less potassium supplementation. Reasons for i.v. diuretic therapy suspension were comparable between groups; 7 (70%) YDP patients concluded i.v. diuretic therapy for satisfactory decongestion, while only one patient because of hypotension and none because of worsening of renal function.
Conclusion
In our reality the YDP appeared to be applicable, safe and comparable to the standard i.v. diuretic therapy in terms of in–hospital outcomes. These preliminary results need to be confirmed in a larger cohort and longer term outcomes still need to be explored.
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Affiliation(s)
- M Pellegrino
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
| | - G Gasparini
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
| | - D Ghianda
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
| | - A Villaschi
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
| | - A Oliva
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
| | - F Loiacono
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
| | - B Pagliaro
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
| | - N Natali Testona
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
| | - M Atuncar
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
| | - D Pini
- ISTITUTO CLINICO HUMANITAS, MILANO; HUMANITAS UNIVERSITY, MILANO
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8
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Leone PP, Chiarito M, Regazzoli D, Pellegrino M, Monti L, Pagliaro B, Loiacono F, Stefanini G, Pini D, Reimers B, Colombo A, Latib A, Mangieri A. Prognostic value of tricuspid regurgitation. Rev Cardiovasc Med 2022; 23:76. [DOI: 10.31083/j.rcm2302076] [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: 12/26/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/06/2022] Open
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9
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Fazzari F, Cannata F, Banfi D, Pellegrino M, Pagliaro B, Loiacono F, Mantovani R, Donghi V, Curzi M, Maurina M, Condello F, Liccardo G, Francone M, Condorelli G, Stefanini GG, Pini D, Bragato RM. 491 Short-term prognostic implications of left ventricular myocardial work indices in advanced heart failure patients treated with repetitive Levosimendan infusions. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Repetitive Levosimendan treatment in advanced heart failure patients has not been investigated yet via myocardial work indices (MWI), which could more accurately detect the effects of this both inotropic and vasodilatory drug. The aims of this study were (1) to describe variations of myocardial work indices, as a consequence of repetitive Levosimendan infusions and (2) to assess the prognostic value of myocardial work parameters in these patients.
Methods and results
Fourteen patients with advanced heart failure treated with intermittent in-hospital levosimendan infusions were prospectively included. Clinical, laboratory, and echocardiographic assessment were performed before and after every Levosimendan infusion. The primary endpoint was a composite of any episode of decompensated HF, urgent HF rehospitalization, cardiogenic shock, cardiac arrest and cardiovascular death at 4–6 weeks follow-up after each planned infusion. During follow-up (mean: 150 ± 99 days) a total of 37 infusions were performed and a total of 11 cardiovascular events occurred. Global constructive work (GCW), global work efficiency (GWE), and global work index (GWI) increased after Levosimendan infusion in 62.2%, 73.0%, and 70.3% of cases, with significant differences between patients with and without outcomes [delta GCW: −7.36 mmHg% (134.12) vs. 113.81 mmHg% (204.41), P = 0.007; delta GWE: −3.27% (8.38) vs. 4.30% (5.58), P = 0.002]. Delta value of GWE showed the largest area under curve (AUC: 0.82, 95% CI: 0.64–1.00, P = 0.002) for outcome prediction with a cut-off point of 0.5%. Independent prognostic value of GWE variation was confirmed in multivariable regression models (OR: 0.825, 95% CI: 0.702–0.970, P = 0.02).
Conclusions
GWE and GCW provided incremental and independent prognostic value at short-term follow-up over traditional echocardiographic parameters. The differentiation of patients into ‘workers’, whose GWE improved after Levosimendan infusion, and ‘non-workers’, who failed to improve their GWE, permitted to identify patients at higher risk of forthcoming cardiovascular events. Monitoring these patients with MWI may have relevant clinical implications.
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10
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Pivato CA, Regazzoli D, Rossi A, Pagliaro B. Percutaneous Treatment of Paravalvular Leak in Rapid-Deployment Bioprosthetic Aortic Valve With Balloon Dilation. Cardiovascular Revascularization Medicine 2020; 21:47-49. [DOI: 10.1016/j.carrev.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
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11
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Krishnaswamy A, Sammour Y, Mangieri A, Kadri A, Karrthik A, Banerjee K, Kaur M, Giannini F, Pagliaro B, Ancona M, Pagnesi M, Laricchia A, Weisz G, Lyden M, Bazarbashi N, Gad M, Ahuja K, Mick S, Svensson L, Puri R, Reed G, Rickard J, Colombo A, Kapadia S, Latib A. The Utility of Rapid Atrial Pacing Immediately Post-TAVR to Predict the Need for Pacemaker Implantation. JACC Cardiovasc Interv 2020; 13:1046-1054. [DOI: 10.1016/j.jcin.2020.01.215] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 12/16/2022]
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12
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Barbone A, Pagliaro B, Basciu A, Iaccarino A, Droandi G, Romano G, Citterio E, Fumero A, Torracca L, Pini D. Single-center experience with partial support device in destination therapy for end-stage heart failure. Artif Organs 2020; 44:1044-1049. [PMID: 32324900 DOI: 10.1111/aor.13714] [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: 01/31/2020] [Revised: 03/20/2020] [Accepted: 04/16/2020] [Indexed: 11/27/2022]
Abstract
Ventricular assist devices (VADs) are considered the standard of care for end-stage heart failure (HF) patients. Despite increasing confidence in the technology, evidence data, endorsement by scientific societies and guidelines, the number of implants reached a steady state and is not increasing at the expected pace. This is most likely related to complications that are still burdening the technology and consequently excluding the most needy, ill, and fragile population. In this manuscript we are reporting a single-center experience in a very fragile, elderly and end-stage HF population, with a superficial, partial support device: the CircuLite Synergy. The patients were included in the pre-CE mark clinical study and consequently the device underwent technical adjustment during the support, based on the complications recorded. At our institution were implanted 6 patients overall: 3 patients survived to discharge and 2 survived up to 5 years. Most of the complications recorded were due to patients' frailty and overall clinical conditions. The initial experience with the CircuLite Synergy device is proving that a more "superficial" device might be more tolerable in an elderly, frail population. Partial support has proven hemodynamically efficacious and efficient in relieving heart failure symptoms, improving medical therapy tolerability, and improving quality of life. Unfortunately, the technology was not made available due to financial uncertainty and poor management, but we hope that once the concept has been proved someone will collect the legacy.
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Affiliation(s)
- Alessandro Barbone
- UO of Cardiac Surgery, IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
| | - Beniamino Pagliaro
- Heart Failure Division (UO of Cardiology), IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
| | - Alessio Basciu
- UO of Cardiac Surgery, IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
| | - Alessandra Iaccarino
- UO of Cardiac Surgery, IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
| | - Ginevra Droandi
- UO of Cardiac Surgery, IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
| | - Giorgio Romano
- UO of Cardiac Surgery, IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
| | - Enrico Citterio
- UO of Cardiac Surgery, IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
| | - Andrea Fumero
- UO of Cardiac Surgery, IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
| | - Lucia Torracca
- UO of Cardiac Surgery, IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
| | - Daniela Pini
- Heart Failure Division (UO of Cardiology), IRCCS Humanitas Clinical and Research Center, Via A. Manzoni 56, Rozzano (Mi), I-20089, Italy
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13
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Iannopollo G, Giannini F, Ponticelli F, Pagliaro B, Tzanis G, Gallone G, Montorfano M, Colombo A, Durante A. Percutaneous Coronary Intervention With the Agent Paclitaxel-Coated Balloon: A Real-World Multicenter Experience. J Invasive Cardiol 2020; 32:117-122. [PMID: 32045346] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Agent paclitaxel-coated balloon is a new drug-coated balloon (DCB) with few available real-world data. Our study sought to assess the safety and efficacy of the Agent DCB during percutaneous coronary intervention (PCI) in different coronary lesion types in a prospective registry. METHODS AND RESULTS All patients undergoing PCI with the Agent DCB at three Italian centers between September 2014 and March 2018 were included in this registry. Major adverse cardiac event (MACE) rate was defined as the composite of cardiac death, recurrent non-fatal myocardial infarction (MI), and target-lesion revascularization (TLR). Procedural success was also evaluated. Among the 354 patients included in the registry (450 lesions treated with 508 DCBs), Agent DCBs were used for the treatment of in-stent restenosis (ISR) in 34%, small-vessel disease (SVD) in 29%, bifurcation lesions in 26%, and "stent-like result" (SLR) lesions obtained after balloon predilation in 11%. The implantation of Agent DCBs was safe and had a high DCB lesion success rate of 92%. One-year MACE rate was 5.7% in the overall population. A higher MACE rate was observed in the ISR group (8.3%) vs the SVD group (3.6%; P=.03), with a trend toward higher event rates vs both BL (3.7%; P=.09) and SLR patients (5.5%; P=.54). CONCLUSIONS The use of Agent DCBs during PCI appears safe and effective in a large real-world registry. These results were maintained in all subgroups, with a slightly higher trend of events rates in the ISR setting, consistent with the higher-risk nature of this patient subset.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alessandro Durante
- Cardiology Division, Valduce Hospital, Via Dante Alighieri, 11, 22100 Como CO, Italy.
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14
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Mangieri A, Pagliaro B, Colombo A. [Tips and tricks: how to do a good coronary angioplasty? Instructions for use]. G Ital Cardiol (Rome) 2019; 19:22S-32S. [PMID: 30520462 DOI: 10.1714/3019.30159] [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
Percutaneous coronary angioplasty celebrated its 40th anniversary and gained an established role thanks to its remarkable results. The progressive development of techniques and materials together with a better understanding about the pharmacological treatment of patients with coronary artery disease contributed to this success. Nowadays percutaneous treatments have become a valid alternative to coronary artery bypass graft surgery in many patients. In this article we will highlight practical "tips and tricks" to improve the performance and the results of percutaneous coronary interventions.
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Affiliation(s)
- Antonio Mangieri
- Unità di Cardiologia interventistica, Ospedale San Raffaele, Milano
| | | | - Antonio Colombo
- Unità di Cardiologia interventistica, Ospedale San Raffaele, Milano
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15
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Rubattu S, De Giusti M, Farcomeni A, Abbolito S, Comito F, Cangianiello S, Greco ES, Dito E, Pagliaro B, Cotugno M, Stanzione R, Marchitti S, Bianchi F, Di Castro S, Battistoni A, Burocchi S, Caprinozzi M, Pierelli G, Sciarretta S, Volpe M. T2238C ANP gene variant and risk of recurrent acute coronary syndromes in an Italian cohort of ischemic heart disease patients. J Cardiovasc Med (Hagerstown) 2017; 17:601-7. [PMID: 25252038 DOI: 10.2459/jcm.0000000000000195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The role of C2238/atrial natriuretic peptide (ANP) minor allele, at the T2238C ANP gene variant, as a predisposing risk factor for acute cardiovascular events, has been previously reported. We aimed at evaluating, by a retrospective approach, the long-term impact of C2238/ANP-minor allele carrier status toward the risk of recurrent acute coronary syndromes (re-ACS) in an Italian cohort of ischemic heart disease patients. METHODS A total of 379 patients (males = 80.5%; mean age = 62.5 ± 9.2 years) presenting with ACS were retrospectively analyzed. Mean follow-up was 5.1 ± 3.5 years (range 1-26 years). Occurrence of new episodes of unstable angina, non-ST-segment elevation myocardial infarction and STE myocardial infarction over the years was recorded and compared between subjects not carrying and carrying C2238/ANP-minor allele. RESULTS At univariate analysis, C2238/ANP-minor allele carrier status and treatment with beta-blocker, aspirin and statin were associated with risk of re-ACS. Multivariate analysis confirmed that hypercholesterolemia (P < 0.0001) and C2238/ANP-minor allele carrier status (P < 0.05) were both significantly and independently associated with increased risk of re-ACS. Both treatments with beta-blocker and with statin were significantly associated with reduced risk of re-ACS (P = 0.01 and P < 0.01, respectively). Age above 55 years was associated with recurrence of ACS in C2238/ANP-minor allele carriers (hazard ratio 1.427, 95% confidence interval 1.066-1.911, P = 0.017). Kaplan-Meier curves confirmed highest risk of new events occurrence in C2238/ANP-minor allele carriers (P = 0.035). CONCLUSIONS The present results demonstrate that C2238/ANP-minor allele carrier status is an independent risk factor for ACS recurrence in an Italian cohort of ischemic heart disease patients over the long term, and they support the role of C2238/ANP-minor allele as a negative prognostic factor in coronary artery disease patients.
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Affiliation(s)
- Speranza Rubattu
- aIRCCS Neuromed, Pozzilli bDept. of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Ospedale S. Andrea, Rome cDept. of Science of Public Health and Infectious Diseases, School of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
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16
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Tocci G, Barbato E, Coluccia R, Modestino A, Pagliaro B, Mastromarino V, Giovannelli F, Berni A, Volpe M. Blood Pressure Levels at the Time of Percutaneous Coronary Revascularization and Risk of Coronary In-Stent Restenosis. Am J Hypertens 2016; 29:509-18. [PMID: 26271109 DOI: 10.1093/ajh/hpv131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND High blood pressure (BP) levels expose patients treated with percutaneous coronary interventions (PCI) to very high risk of 10-year cardiovascular morbidity and mortality. OBJECTIVE To investigate the role of BP levels at the time of PCI on the risk of in-stent restenosis (ISR). METHODS We retrospectively included 796 patients previously treated with PCI, who underwent repeated angiography for recurrent angina or reversible myocardial ischemia. Patients were stratified into either case (n = 354) and control (n = 442) groups in the presence or absence of ISR (defined as in-stent diameter stenosis ≥50%). BP levels were measured at the time of first and second procedures. Normal BP levels were defined for <140/90 mm Hg. RESULTS Patients with normal BP showed significantly higher ISR-free survival (Log-rank: 5.937; P = 0.015). Both systolic (HR (95% CI): 0.731 (0.590-0.906)) and systolic/diastolic BP (HR (95% CI): 0.757 (0.611-0.939)) were significantly and independently associated with lower risk of ISR at Cox-regression analysis, adjusted for potential confounding factors, including stent type and concomitant medications. Patients with ISR showed lower rates of normal systolic/diastolic BP values (166 (47%) vs. 254 (57%); P = 0.003) compared to controls. They also received higher stent number (1.40±0.74 vs. 1.24±0.51; P < 0.001) with higher stent length (24.3±15.6 vs. 21.7±13.9 mm; P = 0.012), and lower rate of drug-eluting stents (DESs) (210 (48%) vs. 139 (40%); P = 0.025) compared to controls. CONCLUSIONS Normal BP at the time of PCI is associated with nearly 24% risk reduction of ISR as evaluated in a new angiography in patients with coronary artery disease.
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Affiliation(s)
- Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Roberta Coluccia
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Anna Modestino
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Beniamino Pagliaro
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Vittoria Mastromarino
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Francesca Giovannelli
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Berni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy;
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17
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Pagliaro B, Santolamazza C, Rubattu S, Volpe M. New therapies for arterial hypertension. Panminerva Med 2016; 58:34-47. [PMID: 26730462] [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: 06/05/2023]
Abstract
Arterial hypertension is the most common chronic disease in developed countries and it is the leading risk factor for stroke, ischemic heart disease, congestive heart failure, chronic renal failure and peripheral artery disease. Its prevalence appears to be about 30-45% of the general population. Recent European guidelines estimate that up to 15-20% of the hypertensive patients are not controlled on a dual antihypertensive combination and they require three or more different antihypertensive drug classes to achieve adequate blood pressure control. The guidelines confirmed that diuretics, beta-blockers, calcium-channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are suitable for the initiation and maintenance of antihypertensive treatment, either as monotherapy or in combination therapy. Very few antihypertensive agents have reached the market over the last few years, but no new therapeutic class has really emerged. The long-term adherence to cardiovascular drugs is still low in both primary and secondary prevention of cardiovascular diseases. In particular, the issue of compliance is persistently high in hypertension, despite the fixed-dose combination therapy. As a consequence, a cohort of high-risk hypertensive population, represented by patients affected by refractory and resistant hypertension, can be identified. Therefore, the need of controlling BP in high-risk patients may be addressed, in part, by the development of new drugs, devices and procedures that are designed to treat hypertension and comorbidities. In this review we will comprehensively discuss the current literature on recent therapeutic advances in hypertension, including both medical therapy and interventional procedures.
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Affiliation(s)
- Beniamino Pagliaro
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, University Sapienza of Rome, Ospedale S. Andrea, Rome, Italy -
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Pagliaro B, Tocci G, Pagannone E, Musumeci MB, Testa M, Sensini I, Autore C, Ferrucci A, Volpe M. An atypical clinical presentation of renovascular hypertension. Int J Cardiol 2014; 177:e107-10. [PMID: 25300660 DOI: 10.1016/j.ijcard.2014.09.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/06/2014] [Accepted: 09/20/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Beniamino Pagliaro
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Erika Pagannone
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - M Beatrice Musumeci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - Marco Testa
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - Isabella Sensini
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - Camillo Autore
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - Andrea Ferrucci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
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De Giusti M, Dito E, Pagliaro B, Burocchi S, Laurino FI, Tocci G, Volpe M, Rubattu S. A survey on blood pressure levels and hypertension control in a sample of the Italian general population. High Blood Press Cardiovasc Prev 2012; 19:129-35. [PMID: 22994581 DOI: 10.2165/11632190-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hypertension represents a major cardiovascular risk factor with relevant consequences on morbidity and mortality in the general population. An optimal control of blood pressure (BP) is far from being achieved. AIM The objective of this study was to explore awareness of BP levels, prevalence of risk factors and status of hypertension control in a sample of the Italian general population. METHODS Subjects aged 18 years or older were enrolled on a voluntary basis during the 7th and 8th World Hypertension Days at our hospital centre, S. Andrea Hospital in Rome, and at other hospitals throughout the Italian Lazio region. Along with BP measurement, a short questionnaire was completed at the time of the interview. RESULTS Of 1165 individuals enrolled into the analysis, 71.7% were aware of their BP levels (82.5% among hypertensive patients). Within the whole cohort, 31.9% of subjects were under antihypertensive treatment, while the overall rate of subjects found to be hypertensive patients at our visit was 52.9% (n = 616). Among hypertensive patients taking antihypertensive drugs, 47.1% had controlled BP values with the remaining 52.9% showing uncontrolled hypertension. Mean systolic blood pressure (SBP) was 138.2 ± 20.7 mmHg and mean diastolic blood pressure (DBP) was 80.4 ± 11.3 mmHg in subjects receiving antihypertensive treatment. Among older hypertensive patients (71-94 years of age), only 76.9% were under treatment. Hypertensive males were more frequently treated than females in all age groups (p = 0.001). Smoking habit negatively affected efficacy of antihypertensive therapy in the age groups of 48-53 and 54-62 years (p = 0.008 and p = 0.01, respectively). Diabetic patients had higher mean SBP values than non-diabetic subjects (137.3 ± 22.1 vs 129.3 ± 18.2 mmHg, p = 0.02). CONCLUSION The results of our survey strongly support the need for a continuing educational effort aimed at providing correct advertisement of healthy lifestyles and awareness of adequate BP control. Based on our observations, particular attention has to be paid to women, younger subjects, elderly subjects and diabetic patients in order to reach appropriate BP control and reduction of cardiovascular risk in these subject categories.
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Affiliation(s)
- Marco De Giusti
- Division of Cardiology, Faculty of Medicine and Psychology, University Sapienza of Rome, Sant'Andrea Hospital, Via di Grottarossa 1039, Rome, Italy.
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