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Genovese D, De Michieli L, Prete G, De Lazzari M, Previtero M, Mele D, Cernetti C, Tarantini G, Iliceto S, Perazzolo Marra M. Left atrial expansion index measured with cardiovascular magnetic resonance estimates pulmonary capillary wedge pressure in dilated cardiomyopathy. J Cardiovasc Magn Reson 2023; 25:71. [PMID: 38031092 PMCID: PMC10688459 DOI: 10.1186/s12968-023-00977-2] [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] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Pulmonary capillary wedge pressure (PCWP) assessment is fundamental for managing dilated cardiomyopathy (DCM) patients. Although cardiovascular magnetic resonance (CMR) has become the gold-standard imaging technique for evaluating cardiac chamber volume and function, PCWP is not routinely assessed with CMR. Therefore, this study aimed to validate the left atrial expansion index (LAEI), a LA reservoir function parameter able to estimate filling pressure with echocardiography, as a novel CMR-measured parameter for non-invasive PCWP estimation in DCM patients. METHODS We performed a retrospective, single-center, cross-sectional study. We included electively admitted DCM patients referred to our tertiary center for further diagnostic evaluation that underwent a clinically indicated right heart catheterization (RHC) and CMR within 24 h. PCWP invasively measured during RHC was used as the reference. LAEI was calculated from CMR-measured LA maximal and minimal volumes as LAEI = ( (LAVmax-LAVmin)/LAVmin) × 100. RESULTS We enrolled 126 patients (47 ± 14 years; 68% male; PCWP = 17 ± 9.3 mmHg) randomly divided into derivation (n = 92) and validation (n = 34) cohorts with comparable characteristics. In the derivation cohort, the log-transformed (ln) LAEI showed a strong linear correlation with PCWP (r = 0.81, p < 0.001) and remained a strong independent PCWP determinant over clinical and conventional CMR parameters. Moreover, lnLAEI accurately identified PCWP ≥ 15 mmHg (AUC = 0.939, p < 0.001), and the optimal cut-off identified (lnLAEI ≤ 3.85) in the derivation cohort discriminated PCWP ≥ 15 mmHg with 82.4% sensitivity, 88.2% specificity, and 85.3% accuracy in the validation cohort. Finally, the equation PCWP = 52.33- (9.17xlnLAEI) obtained from the derivation cohort predicted PCWP (-0.1 ± 5.7 mmHg) in the validation cohort. CONCLUSIONS In this cohort of DCM patients, CMR-measured LAEI resulted in a novel and useful parameter for non-invasive PCWP evaluation.
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Affiliation(s)
- Davide Genovese
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy.
| | - Laura De Michieli
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giacomo Prete
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel De Lazzari
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Donato Mele
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Carlo Cernetti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
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De Mattia L, Crosato M, Rebellato L, Nalli C, Calzolari V, Cernetti C. A storm in the desert: Ablation of a left atrial tachycardia in a heart transplant recipient. HeartRhythm Case Rep 2023; 9:720-722. [PMID: 38047187 PMCID: PMC10691953 DOI: 10.1016/j.hrcr.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Luca De Mattia
- Cardiology Department, “Ca’ Foncello” Hospital, Treviso, Italy
| | - Martino Crosato
- Cardiology Department, “Ca’ Foncello” Hospital, Treviso, Italy
| | - Luca Rebellato
- Cardiology Department, “Santa Maria della Misericordia” Hospital, Udine, Italy
| | - Chiara Nalli
- Cardiology Department, “Santa Maria della Misericordia” Hospital, Udine, Italy
| | | | - Carlo Cernetti
- Cardiology Department, “Ca’ Foncello” Hospital, Treviso, Italy
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Genovese D, Previtero M, Prete G, Carrer A, De Michieli L, Badano LP, Muraru D, Cernetti C, Mele D, Tarantini G, Iliceto S, Perazzolo Marra M. Non-invasive evaluation of pulmonary capillary wedge pressure using the left atrial expansion index in mitral valve stenosis, prosthesis and repair. Int J Cardiovasc Imaging 2023; 39:967-975. [PMID: 36763208 DOI: 10.1007/s10554-023-02807-z] [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: 08/16/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
Pulmonary capillary wedge pressure (PCWP) non-invasive evaluation is limited in patients with mitral valve (MV) stenosis, prosthesis, and surgical repair. This study aimed to assess the left atrial expansion index (LAEI) measured through transthoracic echocardiography (TTE) as a novel parameter for estimating PCWP in these challenging cardiac conditions. We performed a retrospective, cross-sectional study, including chronic cardiac patients receiving within 24 h a clinically indicated right heart catheterization (RHC) and transthoracic echocardiographic (TTE) exam. PCWP measured during RHC was used as the reference. TTE measurements were performed offline, blinded to RHC results. LAEI was calculated as LAEI = [(LAmaxVolume-LAminVolume)/LAminVolume] × 100. We included 167 patients (age = 73 ± 11.5 years; PCWP = 18 ± 7.7 mmHg) with rheumatic mitral valve (MV) stenosis (16.2%), degenerative MV stenosis (51.2%), MV prosthesis (18.0%), and MV surgical repair (13.8%). LAEI correlated logarithmically with PCWP, and the log-transformed LAEI (lnLAEI) showed a good linear association with PCWP (r = - 0.616; p < 0.001). lnLAEI was an independent PCWP determinant, providing added predictive value over conventional clinical (age, atrial fibrillation, heart rate, MV subgroups) and echocardiographic variables (LVEF, MV effective orifice area, MV mean gradient, net atrioventricular compliance, and pulmonary arterial systolic pressure). lnLAEI identified PCWP > 12 mmHg with AUC = 0.870, p < 0.001; and PCWP > 15 mmHg with AUC = 0.797, p < 0.001, with an optimal cut-off of lnLAEI < 3.69. The derived equation PCWP = 36.8-5.5xlnLAEI estimated the invasively measured PCWP ± 6.1 mmHg. In this cohort of patients with MV stenosis, prosthesis, and surgical repair, lnLAEI resulted in a helpful echocardiographic parameter for PCWP estimation.
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Affiliation(s)
- Davide Genovese
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy.
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy.
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera di Padova, University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Giacomo Prete
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Anna Carrer
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Laura De Michieli
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Luigi Paolo Badano
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Carlo Cernetti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Donato Mele
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
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Polimeni A, Spaccarotella C, Ielapi J, Esposito G, Ravera A, Martuscelli E, Ciconte V, Menichelli M, Varbella F, Imazio M, Navazio A, Sinagra G, Oberhollenzer R, Sibilio G, Cacciavillani L, Meloni L, Dominici M, Tomai F, Amico F, Corda M, Musumeci G, Lupi A, Zezza L, De Caterina R, Cernetti C, Metra M, Rossi L, Calabrò P, Murrone A, Volpe M, Caldarola P, Carugo S, Cortese B, Valenti R, Boriani G, Fedele F, Ventura G, Manes MT, Colavita AR, Feola M, Versaci F, Assennato P, Arena G, Ceravolo R, Amodeo V, Tortorici G, Nassiacos D, Antonicelli R, Esposito N, Favale S, Licciardello G, Tedesco L, Indolfi C. The impact of UEFA Euro 2020 football championship on Takotsubo Syndrome: Results of a multicenter national registry. Front Cardiovasc Med 2022; 9:951882. [PMID: 36247479 PMCID: PMC9554214 DOI: 10.3389/fcvm.2022.951882] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The UEFA 2020 European Football Championship held in multiple cities across Europe from June 11 to July 11, 2021, was won by Italy, providing an opportunity to examine the relationship between emotional stress and the incidence of acute cardiovascular events (ACE). Methods and results Cardiovascular hospitalizations in the Cardiac Care Units of 49 hospital networks in Italy were assessed by emergency physicians during the UEFA Euro 2020 Football Championship. We compared the events that occurred during matches involving Italy with events that occurred during the remaining days of the championship as the control period. ACE was assessed in 1,235 patients. ACE during the UEFA Euro 2020 Football Championship semifinal and final, the most stressful matches ended with penalties and victory of the Italian team, were assessed. A significant increase in the incidence of Takotsubo Syndrome (TTS) by a factor of 11.41 (1.6-495.1, P < 0.003), as compared with the control period, was demonstrated during the semifinal and final, whereas no differences were found in the incidence of ACS [IRR 0.93(0.74-1.18), P = 0.57]. No differences in the incidence of ACS [IRR 0.98 (0.87-1.11; P = 0.80)] or TTS [IRR 1.66(0.80-3.4), P = 0.14] were found in the entire period including all matches of the UEFA Euro 2020 compared to the control period. Conclusions The data of this national registry demonstrated an association between the semifinal and final of UEFA Euro 2020 and TTS suggesting that it can be triggered by also positive emotions such as the victory in the European Football Championship finals.
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Affiliation(s)
- Alberto Polimeni
- Division of Cardiology and Center for Cardiovascular Research, University Magna Graecia, Catanzaro, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Jessica Ielapi
- Division of Cardiology and Center for Cardiovascular Research, University Magna Graecia, Catanzaro, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Amelia Ravera
- San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno, Italy
| | - Eugenio Martuscelli
- Dipartimento di Medicina Interna, Divisione Cardiologia, Università degli Studi di Roma Tor Vergata, Rome, Italy
| | | | | | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital “Santa Maria della Misericordia”, ASUFC, Udine, Italy
| | - Alessandro Navazio
- IRCCS Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
| | - Gianfranco Sinagra
- Dipartimento Cardiotoracovascolare, Università degli Studi di Trieste, Trieste, Italy
| | | | | | - Luisa Cacciavillani
- Dipartimento Cardiotoracovascolare, Università degli Studi di Padova, Padua, Italy
| | - Luigi Meloni
- Dipartimento di Cardiologia, Università degli Studi di Cagliari, Cagliari, Italy
| | | | | | | | - Marco Corda
- SC Cardiologia UTIC, ARNAS “G. Brotzu”, Cagliari, Italy
| | | | - Alessandro Lupi
- Dipartimento di Cardiologia, Università degli Studi dell'Insubria, Varese, Italy
| | | | | | | | - Marco Metra
- Divisione di Cardiologia, Università degli Studi di Brescia, Brescia, Italy
| | - Lidia Rossi
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Paolo Calabrò
- Università degli Studi della Campania Luigi Vanvitelli, AORN Sant'Anna e San Sebastiano Caserta, Caserta, Italy
| | - Adriano Murrone
- Ospedali di Città di Castello e Gubbio - Gualdo Tadino Azienda USL Umbria 1, Perugia, Italy
| | - Massimo Volpe
- University of Rome Sapienza and Sant'Andrea Hospital, Rome, Italy
| | | | - Stefano Carugo
- Cardiology Unit, Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Bernardo Cortese
- Cardiac Department Clinica Polispecialistica San Carlo, Milan, Italy,Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | | | - Giuseppe Boriani
- Divisione di Cardiologia, Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università degli Studi di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | - Giorgio Ventura
- Istituto Ninetta Rosano - Casa di Cura Polispecialistica Tricarico, Belvedere Marittimo, Italy
| | | | | | - Mauro Feola
- Regina Montis Regalis Hospital, Mondovi, Italy
| | - Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy,Dipartimento di Medicina, University of Rome Tor Vergata, Rome, Italy
| | - Pasquale Assennato
- Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | | | | | | | | | | | | | - Nicolino Esposito
- Divisione di Cardiologia, Ospedale Evangelico Betania, Naples, Italy
| | | | | | - Luigi Tedesco
- Presidio Ospedaliero S. Maria della Speranza, Battipaglia, Italy
| | - Ciro Indolfi
- Division of Cardiology and Center for Cardiovascular Research, University Magna Graecia, Catanzaro, Italy,Mediterranea Cardiocentro, Naples, Italy,*Correspondence: Ciro Indolfi
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Lanza G, Orso M, Alba G, Bevilacqua S, Capoccia L, Cappelli A, Carrafiello G, Cernetti C, Diomedi M, Dorigo W, Faggioli G, Giannace V, Giannandrea D, Giannetta M, Lanza J, Lessiani G, Marone EM, Mazzaccaro D, Migliacci R, Nano G, Pagliariccio G, Petruzzellis M, Plutino A, Pomatto S, Pulli R, Reale N, Santalucia P, Sirignano P, Ticozzelli G, Vacirca A, Visco E. Guideline on carotid surgery for stroke prevention: updates from the Italian Society of Vascular and Endovascular Surgery. A trend towards personalized medicine. J Cardiovasc Surg (Torino) 2022; 63:471-491. [PMID: 35848869 DOI: 10.23736/s0021-9509.22.12368-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND This guideline (GL) on carotid surgery as updating of "Stroke: Italian guidelines for Prevention and Treatment" of the ISO-SPREAD Italian Stroke Organization-Group, has recently been published in the National Guideline System and shared with the Italian Society of Vascular and Endovascular Surgery (SICVE) and other Scientific Societies and Patient's Association. METHODS GRADE-SIGN version, AGREE quality of reporting checklist. Clinical questions formulated according to the PICO model. Recommendations developed based on clinical questions by a multidisciplinary experts' panel and patients' representatives. Systematic reviews performed for each PICO question. Considered judgements filled by assessing the evidence level, direction, and strength of the recommendations. RESULTS The panel provided indications and recommendations for appropriate, comprehensive, and individualized management of patients with carotid stenosis. Diagnostic and therapeutic processes of the best medical therapy, carotid endarterectomy (CEA), carotid stenting (CAS) according to the evidences and the judged opinions were included. Symptomatic carotid stenosis in elective and emergency, asymptomatic carotid stenosis, association with ischemic heart disease, preoperative diagnostics, types of anesthesia, monitoring in case of CEA, CEA techniques, comparison between CEA and CAS, post-surgical carotid restenosis, and medical therapy are the main topics, even with analysis of uncertainty areas for risk-benefit assessments in the individual patient (personalized medicine [PM]). CONCLUSIONS This GL updates on the main recommendations for the most appropriate diagnostic and medical-surgical management of patients with atherosclerotic carotid artery stenosis to prevent ischemic stroke. This GL also provides useful elements for the application of PM in good clinical practice.
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Affiliation(s)
- Gaetano Lanza
- Department of Vascular Surgery, IRCCS MultiMedica, Castellanza Hospital, Castellanza, Varese, Italy
| | - Massimiliano Orso
- Experimental Zooprophylactic Institute of Umbria and Marche, Perugia, Italy
| | - Giuseppe Alba
- Unit of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Sergio Bevilacqua
- Department of Cardiac Anesthesia and Resuscitation, Careggi University Hospital, Florence, Italy
| | - Laura Capoccia
- Department of Vascular and Endovascular Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Alessandro Cappelli
- Unit of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giampaolo Carrafiello
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Carlo Cernetti
- Department of Cardiology and Hemodynamics, San Giacomo Apostolo Hospital, Castelfranco Veneto, Treviso, Italy
- Cardiology and Hemodynamics Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Marina Diomedi
- Stroke Unit, Tor Vergata Polyclinic Hospital, Tor Vergata University, Rome, Italy
| | - Walter Dorigo
- Department of Vascular Surgery, Careggi Polyclinic Hospital, University of Florence, Florence, Italy
| | - Gianluca Faggioli
- Department of Vascular Surgery, Alma Mater Studiorum University, Bologna, Italy
| | - Vanni Giannace
- Unit of Vascular Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - David Giannandrea
- Department of Neurology, USL Umbria 1, Hospitals of Gubbio, Gualdo Tadino and Città di Castello, Perugia, Italy
| | - Matteo Giannetta
- Department of Vascular Surgery, IRCCS San Donato Hospitals, San Donato Polyclinic Hospital, Milan, Italy
| | - Jessica Lanza
- Department of Vascular Surgery, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy -
| | - Gianfranco Lessiani
- Unit of Vascular Medicine and Diagnostics, Department of Internal Medicine, Villa Serena Hospital, Città Sant'Angelo, Pesaro, Italy
| | - Enrico M Marone
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Daniela Mazzaccaro
- Department of Vascular Surgery, IRCCS San Donato Hospitals, San Donato Polyclinic Hospital, Milan, Italy
| | - Rino Migliacci
- Department of Internal Medicine, Valdichiana S. Margherita Hospital, USL Toscana Sud-Est, Cortona, Arezzo, Italy
| | - Giovanni Nano
- Department of Vascular Surgery, IRCCS San Donato Hospitals, San Donato Polyclinic Hospital, Milan, Italy
| | - Gabriele Pagliariccio
- Department of Emergency Vascular Surgery, Ospedali Riuniti University of Ancona, Ancona, Italy
| | | | - Andrea Plutino
- Stroke Unit, Ospedali Riuniti Marche Nord, Ancona, Italy
| | - Sara Pomatto
- Department of Vascular Surgery, Sant'Orsola Malpighi Polyclinic Hospital, University of Bologna, Bologna, Italy
| | - Raffaele Pulli
- Department of Vascular Surgery, University of Bari, Bari, Italy
| | | | | | - Pasqualino Sirignano
- Department of Vascular and Endovascular Surgery, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Giulia Ticozzelli
- First Department of Anesthesia and Resuscitation, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Andrea Vacirca
- Unit of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), IRCSS Sant'Orsola Polyclinic Hospital, University of Bologna, Bologna, Italy
| | - Emanuele Visco
- Department of Cardiology and Hemodynamics, San Giacomo Apostolo Hospital, Castelfranco Veneto, Treviso, Italy
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6
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Ardissino M, Nelson AJ, Maglietta G, Malagoli Tagliazucchi G, Disisto C, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Ignone G, Campana C, Moschini L, Ponte E, Pozzi R, Fetiveau R, Buratti S, Paraboschi EM, Asselta R, Botti A, Tuttolomondo D, Barocelli F, Bricoli S, Biagi A, Bonura R, Moccetti T, Crocamo A, Benatti G, Paoli G, Solinas E, Notarangelo MF, Moscarella E, Calabrò P, Duga S, Magnani G, Ardissino D. Sex-Related Differences in Long-Term Outcomes After Early-Onset Myocardial Infarction. Front Cardiovasc Med 2022; 9:863811. [PMID: 35859592 PMCID: PMC9289186 DOI: 10.3389/fcvm.2022.863811] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
Importance There is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure. Methods A nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, n = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1–22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Results ST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a greater baseline coronary atherosclerotic burden (median Duke Coronary Artery Disease Index: 48 vs. 23; median Syntax score 9 vs. 7; both p < 0.001). The primary composite endpoint occurred less frequently among women (25.7% vs. 37.0%; adjusted hazard ratio: 0.69, 95% CI 0.52–0.91; p = 0.01) despite being less likely to receive treatment with most secondary prevention medications during follow up. Conclusions There are significant sex-related differences in baseline risk factors and outcomes among patients with early-onset MI: women present with a lower atherosclerotic disease burden and, although they are less frequently prescribed secondary prevention measures, experience better long-term outcomes. Trial Registration 4272/98 Ospedale Niguarda, Ca' Granda 03/09/1998.
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Affiliation(s)
| | - Adam J. Nelson
- Duke Clinical Research Institute, Durham, NC, United States
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Caterina Disisto
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Celli
- Division of Cardiology, Ospedale San Camillo, Rome, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Umberto Canosi
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
| | - Carlo Cernetti
- Cardiothoracic Department, University Hospital “Santa Maria della Miserciordia”, Udine, Italy
| | - Francesco Negri
- Cardiothoracic Department, University Hospital “Santa Maria della Miserciordia”, Udine, Italy
| | - Piera Angelica Merlini
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
- Division of Cardiology, Azienda Ospedaliera, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Marco Tubaro
- ICCU, Intensive and Interventional Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Carlo Berzuini
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Chiara Manzalini
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Gianfranco Ignone
- Department of Cardiology, Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Brindisi, Italy
| | - Carlo Campana
- Department of Cardiology, Sant'Anna Hospital, Como, Italy
| | - Luigi Moschini
- Division of Cardiology, Istituti Ospitalieri, Cremona, Italy
| | - Elisabetta Ponte
- Hospital Universitario de Toledo, Servizio di Radiologia, Toledo, Spain
| | - Roberto Pozzi
- Division of Cardiology, San Luigi Gonzaga University Hospital, Turin, Italy
| | | | - Silvia Buratti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elvezia Maria Paraboschi
- Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University, Milan, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University, Milan, Italy
| | - Andrea Botti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Federico Barocelli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Serena Bricoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Biagi
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rosario Bonura
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Antonio Crocamo
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgio Benatti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgia Paoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Emilia Solinas
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Elisabetta Moscarella
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Paolo Calabrò
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefano Duga
- Department of Biomedical Sciences, Humanitas Clinical and Research Center IRCCS, Humanitas University, Milan, Italy
| | - Giulia Magnani
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- *Correspondence: Giulia Magnani ;
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
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7
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De Luca L, Calabrò P, Chirillo F, Rolfo C, Menozzi A, Capranzano P, Menichelli M, Nicolini E, Mauro C, Trani C, Versaci F, Tomai F, Musumeci G, Di Mario C, Pepe M, Berti S, Cernetti C, Cirillo P, Maffeo D, Talanas G, Ferlini M, Contarini M, Lanzilotti V, Scherillo M, Tarantini G, Muraglia S, Rossini R, Bolognese L. Use of cangrelor in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Study design and interim analysis of the ARCANGELO study. Clin Cardiol 2022; 45:913-920. [PMID: 35733352 PMCID: PMC9451664 DOI: 10.1002/clc.23878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The itAlian pRospective Study on CANGrELOr (ARCANGELO) was aimed to assess the safety of using cangrelor during percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) in the daily practice. HYPOTHESIS The safety of cangrelor after the transition to oral P2Y12 inhibitors was evaluated as the incidence of bleeding outcomes in the 30 days following PCI according to postauthorization safety study guidelines. METHODS Adults with ACS who were treated with cangrelor in one of the 28 centers involved in the study. Patients who consented to participate were followed in the 30 days following their PCI. Bleedings (Bleeding Academic Research Consortium [BARC] classification), major adverse cardiac events (MACEs), and adverse events were recorded. The interim results at two-thirds of the enrollment period are presented. RESULTS A total of 17 bleedings were observed in the 320 patients who completed the study at this stage. All bleedings were classified as BARC Type 1-2, except for one case of Type 3a (vessel puncture site hematoma). Four patients experienced MACEs (2 acute myocardial infarctions, 1 sudden cardiac death, 1 noncardiovascular death due to respiratory distress, and multiorgan failure). None of the bleedings was rated as related to cangrelor. CONCLUSIONS The interim results of the ARCANGELO study provide a preliminary confirmation that the use of cangrelor on patients with ACS undergoing PCI is not associated with severe bleedings.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, Division of Cardiology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Paolo Calabrò
- U.O.C. Cardiologia Clinica con UTIC. A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
| | - Fabio Chirillo
- U.O.C. Cardiologia Ospedale San Bassiano, Bassano del Grappa (VI), Italy
| | - Cristina Rolfo
- S.C. Cardiologia Ospedale degli Infermi di Rivoli ASLTO3, Rivoli, Italy
| | - Alberto Menozzi
- S.C. Cardiologia, Ospedale S. Andrea, ASL5 Liguria, La Spezia, Italy
| | | | | | - Elisa Nicolini
- U.O. Cardiologia Interventistica, strutturale e pediatrica, Ospedali Riuniti, Ancona, Italy
| | - Ciro Mauro
- Cardiologia UTIC con emodinamica AORN Cardarelli Napolii, Napoli, Italy
| | - Carlo Trani
- U.O.C. Interventistica Cardiologica e diagnostica invasiva Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Versaci
- Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | | | | | - Carlo Di Mario
- Interventistica Cardiologica Strutturale A.O.U. Careggi, Firenze, Italy
| | - Martino Pepe
- Cardiologia Universitaria A.O.U. Consorziale Policlinico, Bari, Italy
| | - Sergio Berti
- Fondazione C.N.R. Reg. Toscana G. Monasterio, Pisa, Italy
| | | | - Plinio Cirillo
- Dipartimento di Scienze Biomediche Avanzate, Cardiologia, A.O.U.P. "Federico II", Napoli, Italy
| | - Diego Maffeo
- Cardiologia Emodinamica Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Talanas
- U.O.C. Cardiologia Clinica ed Interventistica, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Marco Ferlini
- U.O.C. Cardiologia Fondazione IRCCS Policlinico San Matteo, San Matteo, Italy
| | - Marco Contarini
- U.O.C. di Cardiologia con UTIC ed Emodinamica Ospedale Umberto I di Siracusa Azienda Sanitaria Provinciale di, Siracusa, Italy
| | | | - Marino Scherillo
- U.O.C. Cardiologia interventistica e UTIC Azienda Ospedaliera San Pio, Benevento, Italy
| | - Giuseppe Tarantini
- U.O.S.D. Emodinamica e Cardiologia Interventistica Azienda Ospedale Università, Padova, Italy
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8
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Bevilacqua S, Ticozzelli G, Orso M, Alba G, Capoccia L, Cappelli A, Cernetti C, Diomedi M, Dorigo W, Faggioli G, Giannace G, Giannandrea D, Giannetta M, Lessiani G, Marone EM, Mazzaccaro D, Migliacci R, Nano G, Pagliariccio G, Petruzzellis M, Plutino A, Pomatto S, Pulli R, Sirignano P, Vacirca A, Visco E, Moghadam SP, Lanza G, Lanza J. Anesthetic management of carotid endarterectomy: an update from Italian guidelines. J Anesth Analg Crit Care 2022; 2:24. [PMID: 37386522 PMCID: PMC10245611 DOI: 10.1186/s44158-022-00052-9] [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] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/12/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND AIMS In order to systematically review the latest evidence on anesthesia, intraoperative neurologic monitoring, postoperative heparin reversal, and postoperative blood pressure management for carotid endarterectomy. The present review is based on a single chapter of the Italian Health Institute Guidelines for diagnosis and treatment of extracranial carotid stenosis and stroke prevention. METHODS AND RESULTS A systematic article review focused on the previously cited topics published between January 2016 and October 2020 has been performed; we looked for both primary and secondary studies in the extensive archive of Medline/PubMed and Cochrane library databases. We selected 14 systematic reviews and meta-analyses, 13 randomized controlled trials, 8 observational studies, and 1 narrative review. Based on this analysis, syntheses of the available evidence were shared and recommendations were indicated complying with the GRADE-SIGN version methodology. CONCLUSIONS From this up-to-date analysis, it has emerged that any type of anesthesia and neurological monitoring method is related to a better outcome after carotid endarterectomy. In addition, insufficient evidence was found to justify reversal or no-reversal of heparin at the end of surgery. Furthermore, despite a low evidence level, a suggestion for blood pressure monitoring in the postoperative period was formulated.
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Affiliation(s)
- Sergio Bevilacqua
- Department of Anesthesia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Giulia Ticozzelli
- Anesthesiology and Intensive Care Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Massimiliano Orso
- Società Italiana di Chirurgia Vascolare ed Endovascolare (SICVE), Roma, Italy
| | - Giuseppe Alba
- Department of Vascular Surgery, University of Siena, Siena, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Division, Policlinico Umberto I La Sapienza University of Rome, Rome, Italy
| | - Alessandro Cappelli
- Vascular Surgery Unit, Policlinico Le Scotte Hospital University of Siena, Siena, Italy
| | - Carlo Cernetti
- Division of Cardiology and and Interventional Hemodynamics, Ca' Foncello Hospital, Azienda USLL2 Marca Trevigiana, Treviso, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Walter Dorigo
- Vascular Surgery Unit, University of Florence, Florence, Italy
| | - Gianluca Faggioli
- Vascular Surgery Unit, Policlinico Sant'Orsola, Alma Mater Studiorum University, Bologna, Italy
| | - Giovanni Giannace
- Vascular Surgery Unit, Arcispedale Snata Maria Nuova, Reggio Emilia, Italy
| | - David Giannandrea
- Stroke Unit, Neurology Department, USL Umbria 1, Cittá di Castello, Perugia, Italy
| | - Matteo Giannetta
- Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy
| | | | - Enrico Maria Marone
- Vascular Surgery Unit, Department of Policlinico Monaza, Monza, Italy
- Pavia University, Pavia, Italy
| | - Daniela Mazzaccaro
- Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy
| | - Rino Migliacci
- Angiology and Internal Medicine, Valdichiana S.Margherita Hospital, Cortona, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy
| | | | | | | | - Sara Pomatto
- Vascular Surgery Unit, Policlinico Sant'Orsola, Alma Mater Studiorum University, Bologna, Italy
| | - Raffaele Pulli
- Vascular Surgery Unit, Policlinico Careggi Hospital University, Florence, Italy
| | - Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Sant'andrea Hospital , "La sapienza" University of Rome, Rome, Italy
| | - Andrea Vacirca
- Vascular Surgery Unit, Policlinico San'Orsola-Alma Mater Studiorum University, Bologna, Italy
| | - Emanuele Visco
- Division of Cardiology and Interventional Hemodynamic, San Giacomo Apostolo Hospital, Azienda ULSS2 Marca Trevigiana, Castelfranco Veneto, Italy
| | | | - Gaetano Lanza
- Vascular Surgery Department, Multimedica Hospital-IRCCS, Castellanza, Italy
| | - Jessica Lanza
- Vascular Surgery Department, IRCSS Ospedale Policlinico, San Martino Genova, Italy
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9
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Pagliani L, Rattazzi M, Buso R, Rivaben D, Nicolosi E, Di Naro A, Cernetti C, Antonini–canterin F. P328 L‘ INSUFFICIENZA RENALE CRONICA NELLA PROGRESSIONE DELLA STENOSI VALVOLARE AORTICA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.315] [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: 11/13/2022]
Abstract
Abstract
Background
Calcific aortic valve disease (CAVD) is the western world’s leading degenerative valve disease affecting nearly 2% of the general population. Considered for a long time as the result of a passive process, nowadays CAVD is referred as an active process mediated by different cell types and involving several molecular mediators and cellular pathways.
Aim of the Study
The aim of this study was to investigate the role played by renal function during the progression of CAVD. Materials and Methods – We enrolled 116 patients affected by CAVD from the Cardiology departments of the Treviso Hospital and the High Specialization Rehabilitative Hospital of Motta di Livenza (TV). For each patient at the time of the recruitment a clinical visit was carried out that included the collection of anamnestic, anthropometric and echocardiographic data. Blood samples were collected from each subject at the recruitment to measure the following biochemical parameters: creatinine, lipidic profile, phospho–calcium metabolism. The GFR was estimated by using the CKD–EPI 2009 equation. To investigate the predictive role of renal function in the progression of CAVD, only patients (n = 49) with at least two transthoracic echocardiograms (TTE) were selected for the prospective analysis. These patients were followed for an average of 18.9 ± 11 months. The rate of progression of valvular disease was assessed in terms of difference in indexed valve area per month (ΔAVA/month).
Results
We observed that fast progressors had a significant reduction of eGFR at baseline as compared to slow progressors (60.62 ± 18.83 ml/min/1.73m2 vs. 77.22 ± 11.46 ml/min/1.73m2, p = 0.001). An increased risk of rapid progression of valvulopathy was found in patients with eGFR < 60 ml/min/1.73m2 (RR = 2.64, IC95%=1.50–4.60, p = 0.001) compared to subjects with normal renal function. A close to significance correlation was also found between values of circulating Pi and ΔAVA/month (r = –0.252, p = 0.084).
Conclusions
The present study showed that reduction of renal function, and in particular the presence of CKD (eGFR values <60 ml/min/1.73m2), is significantly associated with an increased risk of rapid progression of calcified aortic valvulopathy; this risk is further increased by the concomitant presence of increased levels of phosphatemia. Overall, these data indicate the potential predictive role of eGFR on the risk of accelerated calcific valvulopathy in non–dialysed patients.
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Affiliation(s)
| | - M Rattazzi
- MEDICINE DEPARTMENT–DIMED–UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; I° MEDICINA–CA’ FONCELLO TREVISO HOSPITAL, TREVISO; CARDIAC REHABILITATION. HIGHLY SPECIALIZED REHABILITATION HOSPITAL (ORAS). MOTTA DI LIVENZA (TV), MOTTA DI LIVENZA; CARDIOLOGY UNIT –CA’ FONCELLO TREVISO HOSPITAL, TREVISO
| | - R Buso
- MEDICINE DEPARTMENT–DIMED–UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; I° MEDICINA–CA’ FONCELLO TREVISO HOSPITAL, TREVISO; CARDIAC REHABILITATION. HIGHLY SPECIALIZED REHABILITATION HOSPITAL (ORAS). MOTTA DI LIVENZA (TV), MOTTA DI LIVENZA; CARDIOLOGY UNIT –CA’ FONCELLO TREVISO HOSPITAL, TREVISO
| | - D Rivaben
- MEDICINE DEPARTMENT–DIMED–UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; I° MEDICINA–CA’ FONCELLO TREVISO HOSPITAL, TREVISO; CARDIAC REHABILITATION. HIGHLY SPECIALIZED REHABILITATION HOSPITAL (ORAS). MOTTA DI LIVENZA (TV), MOTTA DI LIVENZA; CARDIOLOGY UNIT –CA’ FONCELLO TREVISO HOSPITAL, TREVISO
| | - E Nicolosi
- MEDICINE DEPARTMENT–DIMED–UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; I° MEDICINA–CA’ FONCELLO TREVISO HOSPITAL, TREVISO; CARDIAC REHABILITATION. HIGHLY SPECIALIZED REHABILITATION HOSPITAL (ORAS). MOTTA DI LIVENZA (TV), MOTTA DI LIVENZA; CARDIOLOGY UNIT –CA’ FONCELLO TREVISO HOSPITAL, TREVISO
| | - A Di Naro
- MEDICINE DEPARTMENT–DIMED–UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; I° MEDICINA–CA’ FONCELLO TREVISO HOSPITAL, TREVISO; CARDIAC REHABILITATION. HIGHLY SPECIALIZED REHABILITATION HOSPITAL (ORAS). MOTTA DI LIVENZA (TV), MOTTA DI LIVENZA; CARDIOLOGY UNIT –CA’ FONCELLO TREVISO HOSPITAL, TREVISO
| | - C Cernetti
- MEDICINE DEPARTMENT–DIMED–UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; I° MEDICINA–CA’ FONCELLO TREVISO HOSPITAL, TREVISO; CARDIAC REHABILITATION. HIGHLY SPECIALIZED REHABILITATION HOSPITAL (ORAS). MOTTA DI LIVENZA (TV), MOTTA DI LIVENZA; CARDIOLOGY UNIT –CA’ FONCELLO TREVISO HOSPITAL, TREVISO
| | - F Antonini–canterin
- MEDICINE DEPARTMENT–DIMED–UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA; I° MEDICINA–CA’ FONCELLO TREVISO HOSPITAL, TREVISO; CARDIAC REHABILITATION. HIGHLY SPECIALIZED REHABILITATION HOSPITAL (ORAS). MOTTA DI LIVENZA (TV), MOTTA DI LIVENZA; CARDIOLOGY UNIT –CA’ FONCELLO TREVISO HOSPITAL, TREVISO
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10
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Magnani G, Bricoli S, Ardissino M, Maglietta G, Nelson A, Tagliazucchi GM, Disisto C, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Ignone G, Campana C, Moschini L, Ponte E, Pozzi R, Fetiveau R, Buratti S, Paraboschi E, Asselta R, Botti A, Tuttolomondo D, Barocelli F, Biagi A, Bonura R, Moccetti T, Crocamo A, Benatti G, Paoli G, Solinas E, Notarangelo MF, Moscarella E, Calabrò P, Duga S, Niccoli G, Ardissino D. Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease (MINOCA). Int J Cardiol 2022; 354:7-13. [PMID: 35176406 DOI: 10.1016/j.ijcard.2022.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 01/12/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting. METHODS The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation. RESULTS MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57-1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08-0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52-1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87-3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43-1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15-0.47;p < 0.001). CONCLUSIONS MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death,the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.
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Affiliation(s)
- Giulia Magnani
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Serena Bricoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Giuseppe Maglietta
- Division of Research and Innovation, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | - Adam Nelson
- Duke Clinical Research Institute, Durham, NC, USA; South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | | | - Caterina Disisto
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Patrizia Celli
- Division of Cardiology, Ospedale San Camillo, Rome, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Umberto Canosi
- Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy; Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
| | - Carlo Cernetti
- Cardio-neurovascular Department, Cà Foncello and San Giacomo Hospital Azienda No. 2, Marca Trevigiana Treviso, Treviso, Italy
| | - Francesco Negri
- Cardio-neurovascular Department, Cà Foncello and San Giacomo Hospital Azienda No. 2, Marca Trevigiana Treviso, Treviso, Italy
| | - Piera Angelica Merlini
- Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy; Division of Cardiology, Azienda Ospedaliera, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Marco Tubaro
- Division of Cardiology, San Filippo Neri Hospital, ASL, Roma 1, Rome, Italy
| | - Carlo Berzuini
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Chiara Manzalini
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giancarlo Ignone
- Department of Cardiology, Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Brindisi, Italy
| | - Carlo Campana
- Department of Cardiology, Sant'Anna Hospital, Como, Italy
| | - Luigi Moschini
- Division of Cardiology, Istituti Ospitalieri, Cremona, Italy
| | | | - Roberto Pozzi
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - Silvia Buratti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elvezia Paraboschi
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Rosanna Asselta
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Andrea Botti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Federico Barocelli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Andrea Biagi
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Rosario Bonura
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Antonio Crocamo
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgio Benatti
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giorgia Paoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Emilia Solinas
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Elisabetta Moscarella
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, and Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Paolo Calabrò
- University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, and Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefano Duga
- Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Giampaolo Niccoli
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Diego Ardissino
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy
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11
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Magnani G, Bricoli S, Ardissino M, Maglietta G, Nelson A, Tagliazzuccchi GM, Disisto C, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Ignone G, Campana C, Moschini L, Ponte E, Pozzi R, Fetiveau R, Buratti S, Paraboschi E, Asselta R, Botti A, Tuttolomondo D, Barocelli F, Biagi A, Bonura R, Moccetti T, Crocamo A, Benatti G, Paoli G, Solinas E, Notarangelo MF, Moscarella E, Calabrò P, Duga S, Niccoli G, Ardissino D. 189 Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.030] [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: 11/13/2022]
Abstract
Abstract
Aims
Data regarding long-term prognosis of MINOCA are very limited and conflicting.
Methods and results
The Italian Genetic Study on early-onset MI enrolled 2000 patients who had a first MI before they were 45. The median follow-up was 19.9 years, the equivalent of 39 535 person-years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalization for coronary revascularization. MINOCA was experienced by 317 patients (15.9%). The risk of MACE was not significantly different between MINOCA patients and those with obstructive coronary artery disease (MICAD, 27.8% vs. 37.5%; adj. HR: 0.79, 95% CI: 0.57–1.09; P = 0.15, Figure 1). There was no between-group difference in the rate of non-fatal MI (17.3% vs. 25.4%; adj. HR: 0.76, 95% CI: 0.52–1.13; P = 0.18), non-fatal ischaemic stroke (9.5% vs. 3.7%; adj. HR: 1.79, 95% CI: 0.87–3.70; P = 0.12), or all-cause mortality (14.1% vs. 20.7%; adj. HR: 0.73, 95% CI: 0.43–1.25; P = 0.26), but the rates of CV death (6.2% vs. 8.4%; adj. HR: 0.26, 95% CI: 0.08–0.86; P = 0.03) and coronary revascularization (6.7% vs. 27.7%; HR: 0.27, 95% CI: 0.15–0.47; P < 0.001) were lower in the MINOCA group.
Conclusions
MINOCA is frequent in early-onset MI patients and is not benign with a long-term risk of MACE and overall mortality not significantly different from that of the MICAD patients.
189 Figure 1 Composite primary endpoint of CV death, non-fatal MI, and non-fatal stroke
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giancarlo Ignone
- Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Italy
| | | | | | | | | | | | | | - Elvezia Paraboschi
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Italy
| | - Rosanna Asselta
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Italy
| | - Andrea Botti
- Azienda Ospedaliero Universitaria di Parma, Italy
| | | | | | - Andrea Biagi
- Azienda Ospedaliero Universitaria di Parma, Italy
| | | | | | | | | | | | | | | | | | - Paolo Calabrò
- AORN Sant’Anna e San Sebastiano Caserta, University of Campania, Italy
| | - Stefano Duga
- Humanitas University and Humanitas Clinical and Research Center IRCCS, Italy
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12
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Savo MT, Balducci E, Calzolari V, Cernetti C. 179 ICD or not ICD? A difficult choice for a young patient presenting with palpitations in emergency department. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab127.040] [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: 11/13/2022]
Abstract
Abstract
A fit-and-well 52-year-old worker, with negative familiar story, was admitted to Emergency Department (ED) with haemodynamically unstable but well bore broad complex tachycardia of 180 b.p.m. (Figure 1). Twenty years before the patient had heart-surgery to repair atrial septal venous sinus defect with patch. The defect determined anomalous pulmonary venous return in right atrium with left to right shunt and moderate pulmonary hypertension. The surgery, 20 years before, was complicated by a single event of supraventricular tachycardia pharmacology resolved. Next follow-up was normal although at transthoracic echocardiography severe right ventricular (RV) dilation was reported. In the ED the patient had palpitation but not chest pain or dyspnoea. General clinical examination was normal but he was hypertensive (170/137 mmHg) and with heart rate of 180 b.p.m. Valsalva manoeuver was performed and adenosine (6 mg–12 mg–12 mg) was administered without benefit. Eventually, the patient was cardioverted to sinus rhythm with a single 100 J shock. His baseline ECG (Figure 2) showed sinus rhythm, normal axis, as well as right bundle branch block and T-wave inversion in leads V1–V4 and a waves with a small spike upward in lead V1 which represent characteristic epsilon waves.
Successively patient was admitted to Cardiology Department where transthoracic echocardiography showed severe RV dilation and moderate hypokinesia with a tricuspid annular plane excursion of 15 mm, TAV 9.6 cm/s, fractional area change of 29%. The right atrium was moderate dilated (volume 70 ml, indexed volume 35.53 ml/m2). Left chambers were normal. No shunts were observed. An electrophysiology study with isoprenaline infusion was performed but no arrhythmias were induced. Cardiac magnetic resonance imaging (MRI) was normal save for global RV dilatation, increased RV end diastolic volume (156 ml/m2), and global RV systolic dysfunction (reduction of RV ejection fraction 31%). Arrhythmogenic cardiomyopathy was excluded as patient’s background suggested RV dilation was due the overload caused by the history of left–right shunt. Blood tests and personal history negative initially exclude myocarditis and cardiac MRI confirmed the absence of oedema. An accurate ECG analysis excluded Brugada syndrome. Following discussion between electrophysiologists, clinical cardiologists, and the patient who first need to be informed, trans-venous ICD was implanted. 179 Figure 1ECG in ED. Figure 2 Baseline ECG. Figure 3 Cardiac MRI.
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Affiliation(s)
| | - Elisa Balducci
- Ospedale Ca’ Foncello Treviso—Marca Trevigiana ULSS 2, Italy
| | | | - Carlo Cernetti
- Ospedale Ca’ Foncello Treviso—Marca Trevigiana ULSS 2, Italy
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13
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Violini R, De Rosa S, Leonardi S, Doronzo B, Cremonesi A, Callea G, Spandonaro F, Tarantini G, Esposito G, Cernetti C, Indolfi C, Berti S, Marchese A, Saia F, Monti F. [GISE (Italian Society of Interventional Cardiology) Position paper: Short-term hospitalization for percutaneous coronary intervention; a helpful tool to manage post-COVID-19 backlogs]. G Ital Cardiol (Rome) 2021; 22:4-15. [PMID: 35343485 DOI: 10.1714/3723.37134] [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: 06/14/2023]
Abstract
Minimization of hospital lengths of stay has always been a key goal for healthcare systems. More so during the current COVID-19 pandemic. In fact, we have faced a reduction in no-COVID-19 admissions with the generation of huge backlogs. Low-risk patients undergoing elective percutaneous coronary intervention (PCI) can be candidate for short-term hospitalization, with consequent reduction of waiting lists. Several single-center and multicenter observational studies, multiple randomized trials and some meta-analyses have addressed this topic.In this position paper, we present a proposal for short hospitalization for elective PCI procedures in selected patients who present complications only exceptionally and exclusively immediately after the procedure, if the inclusion and exclusion criteria are met. Each Center can choose between admission in day surgery or one day surgery, extending hospital length of stay only for patients who present complications or who are candidate for urgent surgery. Short-term hospitalization considerably reduces costs even if, with the current model, it generally results in a parallel reduction in reimbursement. Hence, we present an actual model, already tested successfully in an Italian hospital, that warrants sustainability. This approach can then be tailored to single Centers.
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Affiliation(s)
| | - Salvatore De Rosa
- U.O.C. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro
| | - Sergio Leonardi
- Università di Pavia e Terapia Intensiva Coronarica, Fondazione IRCCS, Policlinico San Matteo, Pavia
| | | | | | - Giuditta Callea
- Centro di Ricerche sulla Gestione dell'Assistenza Sanitaria e Sociale, SDA Bocconi School of Management, Milano
| | | | - Giuseppe Tarantini
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Carlo Cernetti
- U.O.C. Cardiologia, Dipartimento Cardioneurovascolare, Ospedale Ca' Foncello, ASL 2 Marca Trevigiana, Treviso
| | - Ciro Indolfi
- U.O.C. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro - Mediterranea Cardiocentro, Napoli
| | - Sergio Berti
- Fondazione CNR Regione Toscana "G. Monasterio", Pisa
| | | | - Francesco Saia
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna
| | - Francesco Monti
- U.O.C. Cardiologia, Ospedale San Pietro Fatebenefratelli, Roma
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14
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Barioli A, Pellizzari N, Favero L, Cernetti C. Unconventional treatment of a giant coronary aneurysm presenting as ST-elevation myocardial infarction: a case report. Eur Heart J Case Rep 2021; 5:ytab385. [PMID: 34738061 PMCID: PMC8564704 DOI: 10.1093/ehjcr/ytab385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/13/2021] [Accepted: 09/14/2021] [Indexed: 11/12/2022]
Abstract
Background The optimal treatment of aneurysmal or ectatic culprit vessels in the setting of acute myocardial infarction is still matter of debate, as revascularization with either percutaneous intervention or surgery is associated with low procedural success and poor outcomes. Case summary We report the case of a 55-year-old male patient, admitted for inferior ST-elevation myocardial infarction, who underwent successful percutaneous implantation of a micro-mesh self-expanding nitinol carotid stent in a right coronary aneurysm with intravascular ultrasonography measured diameter of 9 mm and massive thrombus apposition. Discussion The technical characteristics of the micro-mesh self-expanding nitinol carotid stent allow for adequate plaque coverage and good apposition even in large vessels, making this device particularly suitable for the treatment of coronary lesions with high thrombus burden, when severe coronary ectasia or aneurysms are present.
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Affiliation(s)
- Alberto Barioli
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Via Sant'Ambrogio, 37, 31100 Treviso, Italy
- Corresponding author. Tel: +39 0423 731900, Fax: +39 0423 731901,
| | - Nicola Pellizzari
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Via Sant'Ambrogio, 37, 31100 Treviso, Italy
| | - Luca Favero
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Via Sant'Ambrogio, 37, 31100 Treviso, Italy
| | - Carlo Cernetti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Via Sant'Ambrogio, 37, 31100 Treviso, Italy
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15
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Genovese D, Gasparetto N, Favero L, Carrer A, Balestriero G, Calzolari V, De Mattia L, Zecchel R, Minniti G, Cernetti C. Proarrhythmic Side of Cardiac Lipoma. Circ Cardiovasc Imaging 2021; 14:e013301. [PMID: 34711078 DOI: 10.1161/circimaging.121.013301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Davide Genovese
- Cardiology Unit (D.G., N.G., L.F., A.C., V.C., L.D.M., R.Z., C.C.), Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy.,Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Italy (D.G.)
| | - Nicola Gasparetto
- Cardiology Unit (D.G., N.G., L.F., A.C., V.C., L.D.M., R.Z., C.C.), Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Luca Favero
- Cardiology Unit (D.G., N.G., L.F., A.C., V.C., L.D.M., R.Z., C.C.), Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Anna Carrer
- Cardiology Unit (D.G., N.G., L.F., A.C., V.C., L.D.M., R.Z., C.C.), Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | | | - Vittorio Calzolari
- Cardiology Unit (D.G., N.G., L.F., A.C., V.C., L.D.M., R.Z., C.C.), Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Luca De Mattia
- Cardiology Unit (D.G., N.G., L.F., A.C., V.C., L.D.M., R.Z., C.C.), Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Roberto Zecchel
- Cardiology Unit (D.G., N.G., L.F., A.C., V.C., L.D.M., R.Z., C.C.), Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Giuseppe Minniti
- Cardiac Surgery Unit (G.M.), Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Carlo Cernetti
- Cardiology Unit (D.G., N.G., L.F., A.C., V.C., L.D.M., R.Z., C.C.), Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
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16
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Montorsi P, Cortese B, Cernetti C, Lanzellotti D, Di Palma G, Marchese A, Cremonesi A. Transradial approach for carotid artery stenting: A position paper from the Italian Society of Interventional Cardiology (SICI-GISE). Catheter Cardiovasc Interv 2021; 97:1440-1451. [PMID: 33844439 DOI: 10.1002/ccd.29677] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/14/2021] [Accepted: 03/19/2021] [Indexed: 12/24/2022]
Abstract
Carotid artery stenting (CAS) is a valid and effective alternative to endoatherectomy when performed by experienced operators. The conventional approach used is the transfemoral one, but in the last 10 years a transradial (TR) approach, the standard access for cardiac catheterization, became widely adopted for peripheral vascular interventions, included the extracranial carotids. Preliminary experiences suggest this approach as safe and effective, especially in specific anatomical and clinical settings that have been shown to be associated with high risk of complications from the femoral route. Lacking international guidelines, this document, promoted by the Italian Society of Interventional Cardiology - Gruppo Italiano Studi Emodinamici (SICI-GISE), was drawn-up by a panel of interventional cardiologists with a documented experience on the subject, focusing on the indications, techniques and materials that should be used for this type of intervention and the most recent literature on the subject.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, Fondazione Ricerca e Innovazione Cardiovascolare, San Carlo Clinic, Paderno Dugnano-Milano, Italy
| | - Carlo Cernetti
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto, Treviso, Italy
| | - Davide Lanzellotti
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto, Treviso, Italy
| | - Gaetano Di Palma
- Cardiovascular Research Team, Fondazione Ricerca e Innovazione Cardiovascolare, San Carlo Clinic, Paderno Dugnano-Milano, Italy
| | - Alfredo Marchese
- U.O.C. Cardiologia Interventistica, Anthea Hospital-GVM Care & Research, Bari, Italy
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17
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Giacomin E, Barioli A, Favero L, Lanzellotti D, Calzolari D, Daniotti A, Cernetti C. Safety and Feasibility of Transcatheter Aortic Valve Replacement in COVID-19 Patients: A Case Series. Cardiovasc Revasc Med 2021; 28S:68-71. [PMID: 33840619 PMCID: PMC8023787 DOI: 10.1016/j.carrev.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/27/2022]
Abstract
In 2020, the coronavirus disease 2019 (COVID-19) pandemic has led to a decrease in interventional treatment for structural heart disease worldwide. In this context, the management of patients with symptomatic severe aortic stenosis (AS) or bioprosthetic valve dysfunction (BVD) represents a clinical challenge, as a delay in aortic valve replacement procedures may increase short-term morbidity and mortality. We report four cases of TAVR performed in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. All of them were discharged in good clinical conditions and no adverse events were reported at 30 days follow-up. Our experience suggests that in selected patients with mild SARS-CoV-2 infection and symptomatic native AS or BVD, TAVR has a favorable short-term outcome.
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Affiliation(s)
- Enrico Giacomin
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy; Department of Cardiac, Vascular, Thoracic Sciences and Public Health, University of Padua, Italy.
| | - Alberto Barioli
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Luca Favero
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Davide Lanzellotti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Diego Calzolari
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Alessandro Daniotti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Carlo Cernetti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
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18
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Genovese D, Zecchel R, Daniotti A, Piovesana P, Cernetti C. Persistent Left Superior Vena Cava Associated with an Anomalous Drainage of Right Superior Vena Cava into the Left Atrium. Korean Circ J 2021; 51:710-711. [PMID: 34327885 PMCID: PMC8326212 DOI: 10.4070/kcj.2021.0146] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Davide Genovese
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy.,Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Roberto Zecchel
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Alessandro Daniotti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Piergiuseppe Piovesana
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
| | - Carlo Cernetti
- Cardiology Unit, Cardio-Neuro-Vascular Department, Ca' Foncello Hospital, Treviso, Italy
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19
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Tarantini G, Mojoli M, Varbella F, Caporale R, Rigattieri S, Andò G, Cirillo P, Pierini S, Santarelli A, Sganzerla P, De Cesare N, Limbruno U, Lupi A, Ricci R, Cernetti C, Favero L, Saia F, Roncon L, Gasparetto V, Ferlini M, Ronco F, Ferri L, Trabattoni D, Russo A, Guiducci V, Penzo C, Tarantino F, Mauro C, Marchese A, Castiglioni B, La Manna A, Martinato M, Gregori D, Angiolillo DJ, Musumeci G. Downstream or upstream administration of P2Y12 receptor blockers in non-ST elevated acute coronary syndromes: study protocol for a randomized controlled trial. Trials 2020; 21:966. [PMID: 33234137 PMCID: PMC7686679 DOI: 10.1186/s13063-020-04859-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background The optimal timing to administer a P2Y12 inhibitor in patients presenting with a non-ST elevation acute coronary syndrome remains a topic of debate. Pretreatment with ticagrelor before coronary anatomy is known as a widely adopted strategy. However, there is poor evidence on how this compares with administration of a P2Y12 inhibitor after defining coronary anatomy (i.e., downstream administration). Moreover, there are limited head-to-head comparisons of the two P2Y12 inhibitors—ticagrelor and prasugrel—currently recommended by the guidelines. Study design DUBIUS is a phase 4, multicenter, parallel-group, double randomized study conducted in NSTE-ACS patients designed to compare a pretreatment strategy (including only ticagrelor) versus a downstream strategy (including prasugrel or ticagrelor) and to compare downstream prasugrel with downstream ticagrelor. A total of 2520 patients will be randomly assigned to pretreatment with ticagrelor or to no pretreatment. The PCI group of the downstream arm will be further randomized to receive prasugrel or ticagrelor. The two primary hypotheses are that the downstream strategy is superior to the upstream strategy and that downstream ticagrelor is non-inferior to downstream prasugrel, both measured by the incidence of a composite efficacy and safety endpoint of death from vascular causes, non-fatal MI, or non-fatal stroke, and Bleeding Academic Research Consortium (BARC) type 3, 4, and 5 bleedings. Conclusions The DUBIUS study will provide important evidence related to the benefits and risks of pretreatment with ticagrelor compared with a strategy of no pretreatment. Moreover, the clinical impact of using downstream ticagrelor compared with downstream prasugrel will be assessed. Trial registration ClinicalTrials.gov NCT02618837. Registered on 1 December 2015. Supplementary information Supplementary information accompanies this paper at 10.1186/s13063-020-04859-1.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, Policlinico Universitario, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Marco Mojoli
- Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | | | | | | | - Giuseppe Andò
- Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", Messina, Italy
| | | | | | | | | | | | | | - Alessandro Lupi
- Ospedale Universitario "Maggiore della Carità", Novara, Italy
| | | | | | | | - Francesco Saia
- University Hospital of Bologna Sant'Orsola-Malpighi, Bologna, Italy
| | - Loris Roncon
- Hospital Santa Maria della Misericordia, Rovigo, Italy
| | | | | | | | | | | | | | | | - Carlo Penzo
- Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | | | - Ciro Mauro
- Antonio Cardarelli Hospital, Naples, Italy
| | | | | | | | - Matteo Martinato
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, Policlinico Universitario, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, Policlinico Universitario, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Giuseppe Musumeci
- Division of Cardiology, Azienda Sanitaria Ospedaliera Ordine Mauriziano, Torino, Italy
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20
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Calzolari V, De Mattia L, Basso F, Crosato M, Scalon A, Squasi PAM, Del Favero S, Cernetti C. Ablation catheter orientation: In vitro effects on lesion size and in vivo analysis during PVI for atrial fibrillation. Pacing Clin Electrophysiol 2020; 43:1554-1563. [PMID: 33111985 DOI: 10.1111/pace.14106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Catheter-delivered radiofrequency (RF) lesion formation is a complex phenomenon, and few studies have explored the effect of catheter orientation on lesion size and catheter orientation behavior during pulmonary vein isolation (PVI) procedures. We evaluated the influence of catheter orientation on lesion dimensions in an in vitro experimental setting and investigated the catheter orientation behavior during PVI. METHODS AND RESULTS 72 lesions were created in vitro on a porcine heart using a contact force catheter in a parallel, oblique, and perpendicular tip to tissue orientation. The superficial lesion length (SLL) increased shifting the catheter from perpendicular to parallel orientation. The intratissue absolute maximal lesion length (AML) was greater with an oblique catheter orientation. The lesion depth (LD) and the superficial lesion width (SLW) resulted similar with any orientation. Data from 21 PVI procedures in patients with paroxysmal atrial fibrillation using the "wide antral circumferential RF ablation" (WACA) technique were retrospectively analyzed. The mean contact angle among 1130 RF lesions was 28 ± 20°. A prevalent parallel orientation was noted in the anterior WACA segments, whereas it resulted more perpendicular in the posterior segments. Significant differences in catheter orientation between the three operators were found only in few WACA segments. CONCLUSIONS In an in vitro setting, catheter orientation affects SLL and AML, but not LD and SLW. During PVI procedures, catheter orientation resulted mostly parallel to the endocardium. Catheter orientation varied among different WACA segments, but only small differences were found between three operators when considering similar WACA segments.
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Affiliation(s)
| | - Luca De Mattia
- Department of Cardiology, Cà Foncello Hospital, Treviso, Italy
| | | | - Martino Crosato
- Department of Cardiology, Cà Foncello Hospital, Treviso, Italy
| | | | | | | | - Carlo Cernetti
- Department of Cardiology, Cà Foncello Hospital, Treviso, Italy
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21
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Simonetto F, Purita PAM, Malerba M, Barbierato M, Pascotto A, Mangino D, Zanchettin C, Tarantini G, Gerosa G, D'Onofrio A, Cernetti C, Favero L, Daniotti A, Minniti G, Caprioglio F, Erente G, Hinna Danesi T, Frigo AC, Ronco F. Surgical redo versus transseptal or transapical transcatheter mitral valve‐in‐valve implantation for failed mitral valve bioprosthesis. Catheter Cardiovasc Interv 2020; 97:714-722. [DOI: 10.1002/ccd.29324] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/15/2020] [Revised: 08/31/2020] [Accepted: 09/28/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Federico Simonetto
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Paola A. M. Purita
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
- Cardiology Division Ospedale Civile di Mirano Mirano Italy
| | | | - Marco Barbierato
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Andrea Pascotto
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Domenico Mangino
- Cardiac Surgery, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Chiara Zanchettin
- Cardiac Surgery, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health University of Padua Padua Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health University of Padua Padua Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health University of Padua Padua Italy
| | - Carlo Cernetti
- Department of Cardiology Ca' Foncello Hospital Treviso Italy
| | - Luca Favero
- Department of Cardiology Ca' Foncello Hospital Treviso Italy
| | | | | | | | | | | | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health University of Padua Padua Italy
| | - Federico Ronco
- Interventional Cardiology, Department of Cardiothoracic and Vascular Science Ospedale dell'Angelo Venice Italy
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22
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De Mattia L, Martini B, Calzolari V, Genovese D, Cernetti C, Buja G. Sudden and significant R-wave sensing variation detected on remote monitoring of ICD: What is the mechanism? Pacing Clin Electrophysiol 2020; 43:1020-1023. [PMID: 32715483 DOI: 10.1111/pace.14017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Luca De Mattia
- Department of Cardiology, Presidio Ospedaliero di Treviso, Treviso, Italy
| | - Bortolo Martini
- Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
| | - Vittorio Calzolari
- Department of Cardiology, Presidio Ospedaliero di Treviso, Treviso, Italy
| | - Davide Genovese
- Department of Cardiology, Presidio Ospedaliero di Treviso, Treviso, Italy
| | - Carlo Cernetti
- Department of Cardiology, Presidio Ospedaliero di Treviso, Treviso, Italy
| | - Gianfranco Buja
- Department of Cardiac, Thoracic and Vascular Science, University of Padova School of Medicine and Surgery, Padova, Italy
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23
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Migliore F, Zorzi A, Gregori D, Del Monte A, Falzone PV, Verlato R, Siciliano M, Themistoclakis S, China P, Marchese D, Pasquetto G, Ignatiuk B, Cernetti C, Giacomin E, Calzolari V, Bilato C, Dalla Valle C, Frigo GM, Marinaccio L, Saccà S, Lupo A, Roncon L, Marcantoni L, Tosi A, Turiano G, Folino F, Perazzolo Marra M, Cacciavillani L, Iliceto S. Urgent Pacemaker Implantation Rates in the Veneto Region of Italy After the COVID-19 Outbreak. Circ Arrhythm Electrophysiol 2020; 13:e008722. [PMID: 32434373 PMCID: PMC7299094 DOI: 10.1161/circep.120.008722] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Alvise Del Monte
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Pasquale Valerio Falzone
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Roberto Verlato
- Cardiology Division, Hospital of Cittadella, Italy (R.V., M.S., G.M.F.).,Cardiology Division, Hospital of Camposampiero, Padova, Italy (R.V.)
| | | | | | - Paolo China
- Department of Cardiology, Dell' Angelo Hospital, Mestre, Italy (S.T., P.C.)
| | - Domenico Marchese
- Cardiology Division, Hospital of Piove di Sacco, Padova, Italy (D.M., L. Marinaccio)
| | - Giampaolo Pasquetto
- Division of Cardiology, Riuniti Hospital Padova Sud, Monselice, Italy (PD) (G.P., B.I.)
| | - Barbara Ignatiuk
- Division of Cardiology, Riuniti Hospital Padova Sud, Monselice, Italy (PD) (G.P., B.I.)
| | - Carlo Cernetti
- Department of Cardiology, Hospital of Treviso, Italy (C.C., E.G., V.C.)
| | - Enrico Giacomin
- Department of Cardiology, Hospital of Treviso, Italy (C.C., E.G., V.C.)
| | | | - Claudio Bilato
- Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Arzignano, Vicenza, Italy (C.B., C.D.V.)
| | - Chiara Dalla Valle
- Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Arzignano, Vicenza, Italy (C.B., C.D.V.)
| | | | - Leonardo Marinaccio
- Cardiology Division, Hospital of Piove di Sacco, Padova, Italy (D.M., L. Marinaccio)
| | - Salvatore Saccà
- Cardiology Department, Public Hospital of Mirano, Venezia, Italy (S.S., A.L.)
| | - Antonio Lupo
- Cardiology Department, Public Hospital of Mirano, Venezia, Italy (S.S., A.L.)
| | - Loris Roncon
- Cardiology Department, Arrhythmia & Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy (L.R., L. Marcantoni)
| | - Lina Marcantoni
- Cardiology Department, Arrhythmia & Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy (L.R., L. Marcantoni)
| | - Alberto Tosi
- Department of Cardiology, Civil Hospital, Belluno, Italy (A.T., G.T.)
| | - Giovanni Turiano
- Department of Cardiology, Civil Hospital, Belluno, Italy (A.T., G.T.)
| | - Franco Folino
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Luisa Cacciavillani
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Italy (F.M., A.Z., D.G., A.D.M., P.V.F., F.F., M.P.M., L.C., S.I.)
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24
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Negri F, De Luca A, Fabris E, Korcova R, Cernetti C, Grigoratos C, Aquaro GD, Nucifora G, Camici PG, Sinagra G. Left ventricular noncompaction, morphological, and clinical features for an integrated diagnosis. Heart Fail Rev 2020; 24:315-323. [PMID: 30612215 DOI: 10.1007/s10741-018-9763-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Indexed: 12/12/2022]
Abstract
The presence of myocardial noncompaction (NC), regardless of the criterion used, does not identify cardiomyopathy per se. The distinction between a morphological variant and the presence of an NC cardiomyopathy is challenging. However, thanks to larger cohorts of patients and longer periods of follow-up, better clinical characterization and prognostic evaluation are becoming available. Indeed, the physician is required to integrate the evidence of NC with the clinical history of the patient, which is supplemented by necessary advanced instrumental investigations before a definite diagnosis of NC cardiomyopathy can be made. Therefore, we extensively revised the current literature in order to help the clinicians to identify clinical features which are pivotal supporting diagnostic element for the correct recognition of Left ventricular noncompaction cardiomyopathy and thus highlighting the difference between a form of cardiomyopathy and a mere intraventricular hypertrabeculation.
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Affiliation(s)
- Francesco Negri
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.
| | - Antonio De Luca
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Enrico Fabris
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Renata Korcova
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Carlo Cernetti
- Head of Cardio-Neuro-Vascular Department Ca' Foncello and San Giacomo Hospital Azienda N 2, Marca Trevigiana, Treviso, Italy
| | - Chrysanthos Grigoratos
- Fondazione G. Monastiero CNR-Regione Toscana, Pisa, Italy.,Scuola Superiore Sant'Anna, Institute of Life Sciences, Pisa, Italy
| | | | - Gaetano Nucifora
- Northwest Heart Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Flinders University, Bedford Park, Adelaide, Australia
| | - Paolo G Camici
- Vita-Salute University and San Raffaele Hospital, Milan, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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25
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Ardissino M, Nelson AJ, Maglietta G, Tagliazucchi GM, Disisto C, Canosi U, Cernetti C, Merlini PA, Berzuini C, Ponte E, Fetiveau R, Buratti S, Paraboschi E, Duga S, Tuttolomondo D, Crocamo A, Barocelli F, Bricoli S, Botti A, Bonura R, Magnani G, Biagi A, Paoli G, Solinas E, Ardissino D. SEX-BASED DIFFERENCES IN LONG-TERM OUTCOMES AFTER EARLY-ONSET MYOCARDIAL INFARCTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30833-0] [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: 11/27/2022]
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26
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Negri F, Cernetti C, Favero L, Minniti G, De Leo A, De Simone G, Sinagra G. Transcatheter Closure of Left Ventricular Apical Pseudoaneurysm with an Amplatzer Vascular Plug. Cardiovasc Revasc Med 2019; 20:1033-1035. [PMID: 30655010 DOI: 10.1016/j.carrev.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/27/2018] [Revised: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
We report the case of a 66-year-old man, with a history of previous chest radiation therapy admitted to ED for heart failure. The patient was diagnosed with severe aortic stenosis and multivessel coronary disease and underwent surgical aortic valve replacement and coronary artery by pass grafts. Cardiac surgery was complicated by a left ventricular perforation by a venting catheter. The laceration was repaired with a Teflon patch apparently successful. Four months later, a CT scan performed for oncological follow-up demonstrated the complete detachment of the Teflon patch and the formation of a left ventricular pseudoaneurysm. The pseudoaneurysm was effectively treated percutaneously using an Amplatzer Vascular Plug 4.
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Affiliation(s)
- Francesco Negri
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy; Postgraduate School in Cardiovascular Diseases, University of Trieste, Italy.
| | - Carlo Cernetti
- Cardiology Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy; Head of Cardio-Neuro-Vascular Department Ca' Foncello and San Giacomo Hospital Azienda N 2, Marca Trevigiana, Treviso, Italy
| | - Luca Favero
- Cardiology Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Giuseppe Minniti
- Cardiosurgery Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Alessandro De Leo
- Cardiology Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Giovanna De Simone
- Cardiology Department, Ca' Foncello Hospital Azienda N 2 Marca Trevigiana, Treviso, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy; Postgraduate School in Cardiovascular Diseases, University of Trieste, Italy
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27
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Affiliation(s)
- Francesco Negri
- Cardiovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Postgraduate School in Cardiovascular Diseases, University of Trieste, Trieste, Italy
| | - Antonio De Luca
- Cardiovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Postgraduate School in Cardiovascular Diseases, University of Trieste, Trieste, Italy
| | - Aniello Pappalardo
- Cardiosurgery Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Rossana Bussani
- Pathology Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Lorenzo Pagnan
- Radiology Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Carlo Cernetti
- Head of Cardio-Neuro-Vascular Department Ca' Foncello and San Giacomo Hospital Azienda N 2, Marca Trevigiana Treviso, Veneto Region, Treviso, Italy
| | - Giuseppe Gatti
- Cardiosurgery Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Postgraduate School in Cardiovascular Diseases, University of Trieste, Trieste, Italy
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28
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Tarantini G, Esposito G, Musumeci G, Fraccaro C, Franzone A, Castiglioni B, La Manna A, Limbruno U, Marchese A, Mauro C, Rigattieri S, Tarantino F, Gandolfo C, Santoro G, Violini R, Airoldi F, Albiero R, Balbi M, Baralis G, Bartorelli AL, Bedogni F, Benassi A, Berni A, Bonzani G, Bortone AS, Braito G, Briguori C, Brscic E, Calabrò P, Calchera I, Cappelli Bigazzi M, Caprioglio F, Castriota F, Cernetti C, Cicala C, Cioffi P, Colombo A, Colombo V, Contegiacomo G, Cremonesi A, D'Amico M, De Benedictis M, De Leo A, Di Biasi M, Di Girolamo D, Di Lorenzo E, Di Mario C, Dominici M, Ettori F, Ferrario M, Fioranelli M, Fischetti D, Gabrielli G, Giordano A, Giudice P, Greco C, Indolfi C, Leonzi O, Lettieri C, Loi B, Maddestra N, Marchionni N, Marrozzini C, Medda M, Missiroli B, My L, Oreglia JA, Palmieri C, Pantaleo P, Paparoni SR, Parodi G, Petronio AS, Piatti L, Piccaluga E, Pierli C, Perkan A, Pitì A, Poli A, Ramondo AB, Reale MA, Reimers B, Ribichini FL, Rosso R, Saccà S, Sacra C, Santarelli A, Sardella G, Satullo G, Scalise F, Siviglia M, Spedicato L, Stabile A, Tamburino C, Tesorio TNM, Tolaro S, Tomai F, Trani C, Valenti R, Valsecchi O, Valva G, Varbella F, Vigna C, Vignali L, Berti S. [Updated SICI-GISE position paper on institutional and operator requirements for transcatheter aortic valve implantation]. G Ital Cardiol (Rome) 2018; 19:519-529. [PMID: 30087514 DOI: 10.1714/2951.29672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with symptomatic severe aortic stenosis and has become the standard of care for inoperable patients and the preferred therapy for those at increased surgical risk with peculiar clinical and anatomic features. Technology advances, growing experience and accumulating data prompted the update of the 2011 Italian Society of Interventional Cardiology (SICI-GISE) position paper on institutional and operator requirements to perform TAVI. The main objective of this document is to provide a guidance to assess the potential of institutions and operators to initiate and maintain an efficient TAVI program.
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Affiliation(s)
| | | | | | - Chiara Fraccaro
- A.O. Policlinico Universitario di Padova, Centro Gallucci, Padova
| | | | | | - Alessio La Manna
- Cardiologia Centro Alte Specialità e Trapianti, Ospedale Gaspare Rodolico, Catania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ciro Indolfi
- Policlinico Universitario Mater Domini, Catanzaro
| | | | | | | | | | | | - Cinzia Marrozzini
- A.O. Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna
| | | | | | - Luigi My
- Casa di Cura Villa Verde, Taranto
| | | | | | | | | | | | | | | | | | | | - Andrea Perkan
- Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale di Cattinara, Trieste
| | | | | | | | | | | | | | | | | | - Cosimo Sacra
- Università Cattolica del Sacro Cuore, Campobasso
| | | | | | | | | | | | | | | | - Corrado Tamburino
- Cardiologia Centro Alte Specialità e Trapianti, Ospedale Gaspare Rodolico, Catania
| | | | | | | | - Carlo Trani
- Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | | | | | | | | | - Carlo Vigna
- Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo (FG)
| | | | - Sergio Berti
- Ospedale del Cuore, Fondazione CNR Toscana G. Monasterio, Pisa
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29
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Tabilio A, Falini B, Aversa F, Zuccaccia M, Cernetti C, Gerli R, Rutili D, Grignani F, Martelli MF. Intracytoplasmic Lysozyme in Malignant Hematologic Disorders: An Immunoperoxidase Study. Tumori 2018; 68:417-25. [PMID: 6758256 DOI: 10.1177/030089168206800511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intracytoplasmic lysozynie was studied by the peroxidase antiperoxidase (PAP) and protein A-peroxidase methods in 130 cases of various myeloproliferative and lymphoproliferative disorders and 21 lymph nodes and bone marrow metastases from solid primary tumors. This marker, which can be identified in formalin or Zenker-fixed tissues, as well as in peripheral blood and bone marrow smears, proved useful to distinguish malignant myeloid and histiocytic tumors from malignant lymphoid and undifferentiated epithelial metastases. The diagnostic application of these findings are discussed.
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30
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Pellizzari N, Ferretto L, Lanzellotti D, Marzot F, Irsara S, Cernetti C. [Endovascular treatment of a celiac trunk aneurysm: a case report and review of the literature]. G Ital Cardiol (Rome) 2017; 18:796-800. [PMID: 29105676 DOI: 10.1714/2803.28367] [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
Celiac trunk aneurysms are uncommon vascular lesions; treatment is usually an open surgical operation; in the medical literature, only few cases of celiac aneurysm treated with endovascular technique are reported; coil positioning or stent-graft placement are described using a femoral vascular access as first choice.Here we describe the case of a 57-year-old man with an asymptomatic large celiac trunk aneurysm involving the origin of the splenic, left gastric and hepatic arteries. The patient was treated in an elective clinical setting with a totally endovascular procedure performed through the left radial artery. First, two vascular plugs were put into splenic and gastric artery, respectively, to prevent type II endoleak, then the aneurysm was closed using a balloon expandable stent-graft into the celiac trunk-hepatic axis. The procedure was completed without any complication. The computed tomography angiography scan confirmed total occlusion of the aneurysm and normal blood flow in the visceral arteries.This case shows that endovascular technique is effective and safe also for the treatment of very complex vascular lesions, and radial access could be considered the preferred choice to minimize access-related vascular complications.
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Affiliation(s)
| | - Luca Ferretto
- U.O. Chirurgia Vascolare, Ospedale Civile San Giacomo Apostolo, Castelfranco Veneto (TV)
| | | | | | - Sandro Irsara
- U.O. Chirurgia Vascolare, Ospedale Civile San Giacomo Apostolo, Castelfranco Veneto (TV)
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31
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Nicosia A, Cernetti C, Cremonesi A, Goktekin O, Sauguet A, Wijns W, Musumeci G. PCR Peripheral @ GISE: a unique educational link between peripheral endovascular solutions and interventional cardiologists. EUROINTERVENTION 2017; 13:e1013-e1017. [PMID: 29033385 DOI: 10.4244/eijv13i9a154] [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: 11/23/2022]
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32
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Mojoli M, Musumeci G, Berti S, Limbruno U, Marchese A, Mauro C, Tarantino F, Fineschi M, Lettieri C, Menozzi A, My L, Attisano T, Cernetti C, Favero L, Napodano M, Pasquetto G, Pavei A, La Manna A, Parodi G, Santarelli A, Trabattoni D, Varbella F, Signore N, Soriani N, Gregori D, Figliozzi S, Tarantini G. [Current practice and changing trends in the percutaneous treatment of structural heart disease. Results of a multicenter survey promoted by the Italian Society of Interventional Cardiology in six Italian Regions including Tuscany, Lombardy, Veneto, Emilia-Romagna, Campania and Puglia]. G Ital Cardiol (Rome) 2016; 17:13S-20. [PMID: 27384601 DOI: 10.1714/2292.24640] [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
BACKGROUND Significant developments have occurred in the field of percutaneous interventions for structural heart disease over the last decade. The introduction of several innovations has expanded significantly the spectrum of therapeutic applications of structural interventional cardiology. However, the translation of the most recent scientific evidence into clinical practice and the adoption of new technologies may be susceptible to large variability, even within the same geographic area. This study aimed at describing current status and changing trends of structural heart interventions within 6 Regions in Italy. METHODS Between July 2015 and October 2015, 6 regional delegations of the Italian Society of Interventional Cardiology (SICI-GISE) promoted a web-based multicenter survey concerning structural heart interventions. An ad hoc questionnaire was administered to head physicians of the cath-labs of 4 Regions of Northern Italy (Tuscany, Lombardy, Veneto and Emilia-Romagna) and 2 Regions of Southern Italy (Puglia and Campania). Also, in this study we considered previous data from a similar survey that involved Tuscany, Lombardy, Veneto and Emilia-Romagna between April 2014 and May 2014. Data from the two surveys were compared, observing the changing trends between 2014 and 2015. RESULTS The 2015 survey was completed in more than two thirds (68%) of the 145 eligible cath-labs. According to the survey, the application of percutaneous structural heart interventions and the availability of devices were wide and homogeneous within the 6 Regions involved. The main factors perceived as limiting the execution of structural heart interventions resulted economic (e.g. cost of procedures and devices) or organizational (e.g. limited diffusion of hybrid operating rooms). CONCLUSIONS In this study, which was based on the results of a recent survey conducted in 6 Italian Regions, structural heart interventions resulted widely growing throughout the investigated area. The indications for treatment and the availability of devices were relatively homogeneous between the regions involved, as well as the limiting factors, which appear to be mainly economic-organizational.
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Affiliation(s)
- Marco Mojoli
- Clinica Cardiologica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
| | | | - Sergio Berti
- U.O. Cardiologia Diagnostica ed Interventistica, Fondazione Toscana "Gabriele Monasterio", Ospedale del Cuore, Massa
| | - Ugo Limbruno
- U.O.C. Cardiologia, Azienda USL Toscana Sudest, Grosseto
| | - Alfredo Marchese
- U.O.C. Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari
| | - Ciro Mauro
- Dipartimento Cardiovascolare, Ospedale Cardarelli, Napoli
| | - Fabio Tarantino
- Laboratorio di Emodinamica, U.O. Cardiologia, Ospedale G.B. Morgagni-L. Pierantoni, Forlì
| | - Massimo Fineschi
- Dipartimento Cardiovascolare, Policlinico S. Maria alle Scotte, Siena
| | - Corrado Lettieri
- Dipartimento Cardiotoracovascolare, Azienda Socio-Sanitaria Territoriale di Mantova, Mantova
| | - Alberto Menozzi
- U.O. Cardiologia, Azienda Ospedaliero-Universitaria di Parma, Parma
| | - Luigi My
- Casa di Cura Villa Verde, Taranto
| | - Tiziana Attisano
- Emodinamica, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno
| | - Carlo Cernetti
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto (TV)
| | - Luca Favero
- Dipartimento Cardiovascolare, Ospedale Ca' Foncello, Treviso
| | - Massimo Napodano
- Clinica Cardiologica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
| | | | - Andrea Pavei
- Laboratorio di Emodinamica, Ospedale S. Maria dei Battuti, Conegliano (TV)
| | - Alessio La Manna
- Divisione di Cardiologia, Ospedale Ferrarotto, A.O.U. Policlinico Vittorio Emanuele, Catania
| | - Guido Parodi
- Cardiologia Invasiva, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | | | - Daniela Trabattoni
- U.O. Cardiologia Invasiva, Dipartimento di Scienze Cardiovascolari, Centro Cardiologico Monzino, IRCCS, Milano
| | | | - Nicola Signore
- Cardiologia Ospedaliera, A.O.U. Policlinico di Bari, Bari
| | - Nicola Soriani
- Unità di Biostatistica, Epidemiologia e Salute Pubblica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
| | - Dario Gregori
- Unità di Biostatistica, Epidemiologia e Salute Pubblica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
| | - Stefano Figliozzi
- Clinica Cardiologica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
| | - Giuseppe Tarantini
- Clinica Cardiologica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Policlinico Universitario, Padova
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Abstract
Coronary artery aneurysms are defined as coronary dilations as greater than 1.5 times the largest diameter of the adjacent coronary segment. They are a relatively rare finding on coronary angiography, with prevalence ranging from 0.3% to 5% depending on case series. The identification of a coronary artery aneurysm is often a dilemma for both the clinician and the interventionist in terms of diagnosis, treatment and follow-up. This review summarizes the etiologic, pathogenetic, clinical and therapeutic aspects of coronary artery aneurysms in the light of the latest research on this topic.
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Affiliation(s)
| | - Luca Favero
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto (TV)
| | | | | | - Carlo Cernetti
- U.O.C. Cardiologia, Ospedale San Giacomo, Castelfranco Veneto (TV)
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Favero L, Saccà S, Cernetti C, Pasquetto G, Nikas D, Reimers B. Superselective embolization of renal hemorrhage occurring after percutaneous coronary intervention. Cardiovasc Revasc Med 2009; 10:62-5. [PMID: 19159859 DOI: 10.1016/j.carrev.2007.11.008] [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] [Received: 11/23/2007] [Accepted: 11/29/2007] [Indexed: 10/21/2022]
Abstract
A 69-year-old female was hospitalized for acute coronary syndrome and received full antiplatelet and anticoagulant therapy. The patient underwent angioplasty and stent implantation on right coronary and left circumflex arteries with good angiographic result. After the procedure, the patient developed hemorrhagic shock due to massive left renal hemorrhage. An emergent digital subtraction angiography showed bleeding from a left segmental renal artery. The hemorrhage was successfully managed with transcatheter superselective embolization. The patient was discharged after 22 days in good general condition with normal renal function. One-year follow-up was uneventful.
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Affiliation(s)
- Luca Favero
- Department of Cardiology, Mirano Hospital, Mirano, Italy.
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Ming JE, Cernetti C, Steinman RM, Granelli-Piperno A. Development of cytolytic T lymphocytes in thymus culture requires a cytokine sharing homology with IL-6 alpha. Ann N Y Acad Sci 2008; 557:396-403; discussion 403-4. [PMID: 2660698 DOI: 10.1111/j.1749-6632.1989.tb24032.x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J E Ming
- Rockefeller University, New York, New York
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Setacci C, de Donato G, Chisci E, Setacci F, Stella A, Faggioli G, Reimers B, Cernetti C, Lopera Quijada M, Cappi B, Sangiorgi G. Deferred Urgency Carotid Artery Stenting in Symptomatic Patients: Clinical Lessons and Biomarker Patterns from a Prospective Registry. J Vasc Surg 2008. [DOI: 10.1016/j.jvs.2008.04.020] [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: 11/27/2022]
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Setacci C, de Donato G, Chisci E, Setacci F, Stella A, Faggioli G, Reimers B, Cernetti C, Lopera Quijada M, Cappi B, Sangiorgi G. Deferred Urgency Carotid Artery Stenting in Symptomatic Patients: Clinical Lessons and Biomarker Patterns from a Prospective Registry. Eur J Vasc Endovasc Surg 2008; 35:644-51. [DOI: 10.1016/j.ejvs.2008.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 02/17/2008] [Indexed: 11/28/2022]
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Nikas DN, Rampazzo D, Cernetti C, Favero L, Abdel Chany M, Pasquetto G, Sacca S, Reimers B. Long-term ultrasound follow-up in patients undergoing carotid stenting: differences in ultrasound parameters between closed-cell vs open-cell designed stents. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schlüter M, Reimers B, Castriota F, Tübler T, Cernetti C, Cremonesi A, Berger J, Colombo A, Schofer J. Impact of Diabetes, Patient Age, and Gender on the 30-Day Incidence of Stroke and Death in Patients Undergoing Carotid Artery Stenting with Embolus Protection: A Post-Hoc Subanalysis of a Prospective Multicenter Registry. J Endovasc Ther 2007; 14:271-8. [PMID: 17723014 DOI: 10.1583/06-2036.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 10/23/2022]
Abstract
PURPOSE To assess the impact of diabetes, patient age, and gender on major periprocedural (30-day) complications (major and minor strokes, all-cause deaths) following carotid artery stenting (CAS). METHODS An exploratory analysis was performed of 695 patients (516 men; mean age 69.9+/-8.4 years) enrolled consecutively between September 1999 and September 2002 in a multicenter Italian/German registry of routine CAS using cerebral protection devices. There were 535 nondiabetic patients and 160 diabetic patients in the analysis. RESULTS Logistic regression analysis revealed that diabetes and age, but not gender, impacted the cumulative 30-day incidence of any stroke and death (OR 2.1, 95% CI 1.0 to 4.8, p = 0.068 and OR 1.06, 95% CI 1.01 to 1.12, p = 0.031, respectively), as well as the 30-day incidence of major strokes and deaths (OR 5.9, 95% CI 1.6 to 21.8, p = 0.007 and OR 1.13, 95% CI 1.02 to 1.25, p = 0.018, respectively). According to receiver-operating characteristic analysis, age had no discriminatory power to predict complications in nondiabetic patients, but an age of 75 years was identified as the optimal cut point to predict complications in diabetic patients. Compared with nondiabetic patients, diabetics > or =75 years had a 4.3 greater risk of experiencing any stroke or death (95% CI 1.3 to 12.3, p = 0.016) and a 12.0 greater risk of a major stroke or death (95% CI 2.1 to 66.5, p = 0.005). Diabetics <75 years had no increase in risk over that of nondiabetic patients. CONCLUSION Diabetic patients > or =75 years carry a significantly increased risk for strokes or death after protected CAS. The findings should be taken into consideration when treating elderly diabetic patients.
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Nikas D, Reimers B, Elisabetta M, Saccá S, Cernetti C, Pasquetto G, Favero L, Fattorello C, Pascotto P. Percutaneous Interventions in Patients with Acute Ischemic Stroke Related to Obstructive Atherosclerotic Disease or Dissection of the Extracranial Carotid Artery. J Endovasc Ther 2007; 14:279-88. [PMID: 17723015 DOI: 10.1583/06-2040.1] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the safety, feasibility, and efficacy of carotid artery stenting (CAS) in patients with acute stroke who underwent angioplasty of the extracranial internal carotid artery (ICA). METHODS Patients were eligible for CAS if they presented within 6 hours of symptom onset and had a National Institutes of Health Stroke Scale (NIHSS) score >4. The records of all 18 acute stroke patients (11 men; mean age 68.3+/-14.3 years) who underwent endovascular intervention in the stroke-related extracranial ICA between May 2003 and February 2006 were reviewed. Fourteen (77.8%) had atheromatous obstructions and 4 (22.2%) had dissection of the extracranial ICA. Major adverse cerebral and cardiac events (MACCEs) and neurological status, including NIHSS and the modified Rankin Scale (mRS) scores, were recorded for all patients. RESULTS Successful revascularization was achieved in 83.3% (15/18) of the patients. Cerebral protection devices were applied successfully in 13 (72.2%). At discharge, a neurological improvement (NIHSS reduction > or =4) was observed in 77.8% (14/18) of patients. The clinical success rate was 72.2% (13/18). The median NIHSS was 8.5 on admission versus 4.5 at discharge (p<0.01). The 30-day death and stroke rate was 11.1%. During the 14.6+/-9.3-month follow-up, the MACCE and the death/stroke rates were 33.3% and 27.8%, respectively. The median mRS scores at 30 days and at midterm follow-up were 1 and 2.5, respectively (p = NS). CONCLUSION Endovascular revascularization of the extracranial ICA in patients with acute ischemic stroke is associated with high procedural success rates and favorable midterm outcome.
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MESH Headings
- Acute Disease
- Aged
- Aged, 80 and over
- Angioplasty, Balloon/instrumentation
- Atherosclerosis/complications
- Atherosclerosis/diagnostic imaging
- Atherosclerosis/mortality
- Atherosclerosis/therapy
- Brain Ischemia/complications
- Brain Ischemia/diagnostic imaging
- Brain Ischemia/etiology
- Brain Ischemia/mortality
- Brain Ischemia/therapy
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal, Dissection/complications
- Carotid Artery, Internal, Dissection/diagnostic imaging
- Carotid Artery, Internal, Dissection/mortality
- Carotid Artery, Internal, Dissection/therapy
- Carotid Stenosis/complications
- Carotid Stenosis/diagnostic imaging
- Carotid Stenosis/etiology
- Carotid Stenosis/mortality
- Carotid Stenosis/therapy
- Feasibility Studies
- Female
- Follow-Up Studies
- Humans
- Intracranial Embolism/complications
- Intracranial Embolism/etiology
- Intracranial Embolism/mortality
- Intracranial Embolism/prevention & control
- Male
- Middle Aged
- Radiography, Interventional
- Research Design
- Retrospective Studies
- Severity of Illness Index
- Stents
- Stroke/diagnostic imaging
- Stroke/etiology
- Stroke/mortality
- Stroke/therapy
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Dimitrios Nikas
- Department of Cardiology, Mirano General Hospital, Mirano, Italy
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Reimers B, Tübler T, de Donato G, Della Barbera M, Cernetti C, Schlüter M, Mistrorigo F, Saccà S, Favero L, Setacci F, Setacci C, Thiene G, Schofer J, Angelini A. Endovascular Treatment of In-Stent Restenosis After Carotid Artery Stenting: Immediate and Midterm Results. J Endovasc Ther 2006; 13:429-35. [PMID: 16928155 DOI: 10.1583/06-1811.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the immediate and midterm outcome and analyze the debris captured after repeat endovascular intervention for the treatment of in-stent restenosis after carotid artery stenting (CAS). METHODS Thirty-one consecutive patients (27 men; mean age 63.7+/-13.0 years, range 53- 81) underwent repeat endovascular intervention (balloon angioplasty and provisional stenting) for the treatment of 32 in-stent restenoses following CAS. RESULTS Procedural success was achieved in all patients. An additional stent was implanted in 10 (31%) cases. No procedural complication was observed. Filter analysis was performed in 17 (53%) procedures; on 12 (71%), macroscopically visible material was captured. The histomorphometric analysis performed on 6 (19%) filters showed fibrin nets entrapping erythrocytes, leucocytes, platelets, and in 2 cases, fibrous hypercellular tissue fragments. At 30 days and during follow-up (mean 17+/-5 months), no deaths, transient ischemic attacks, or strokes were observed. In 1 (3.1%) patient, asymptomatic recurrence of ISR was found on Doppler ultrasonography and successfully treated with balloon angioplasty. CONCLUSION Repeat endovascular intervention using balloon angioplasty with provisional stenting and routine cerebral protection appears to be a feasible, safe, and clinically effective strategy for the treatment of in-stent restenosis after CAS.
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Favero L, Pasquetto G, Cernetti C, Saccà S, Reimers B. High-tech primary percutaneous coronary intervention. Ital Heart J 2005; 6:465-74. [PMID: 16008151] [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: 05/03/2023]
Abstract
Coronary recanalization by means of primary percutaneous coronary intervention is actually the treatment of choice in patients with ST-elevation myocardial infarction. However, conventional primary percutaneous coronary intervention still presents several limitations. In recent years sophisticated new devices and techniques have been developed to further improve the results of primary percutaneous coronary intervention: it seems to be appropriate to refer to their utilization using the definition "high-tech primary percutaneous coronary intervention". Although the study data available are controversial and clinical benefits have not clearly been shown, adjunctive devices have been used in many procedures. Patient and lesion selection appears to be crucial and the health economics as well as the safety of high-tech devices should be carefully evaluated.
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Affiliation(s)
- Luca Favero
- Cardiology Department, Civic Hospital, Mirano (VE), Italy
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Reimers B, Schlüter M, Castriota F, Tübler T, Corvaja N, Cernetti C, Manetti R, Picciolo A, Liistro F, Di Mario C, Cremonesi A, Schofer J, Colombo A. Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients. Am J Med 2004; 116:217-22. [PMID: 14969648 DOI: 10.1016/j.amjmed.2003.09.043] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [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: 04/02/2003] [Revised: 08/29/2003] [Accepted: 09/18/2003] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the short-term outcome of patients who underwent carotid stenting with the routine use of cerebral protection devices. METHODS In five centers, 808 successful stent procedures (of 815 attempted) were performed in 753 patients (557 [74%] men; mean [+/- SD] age, 70 +/- 8 years). Cerebral protection involved distal filter devices (n=640), occlusive distal balloons (n=144), or proximal balloon protection (n=24). RESULTS The protection device was positioned successfully in 793 (98.2%) of the 808 attempted vessels. Neurologic complications occurred within 30 days after 46 procedures (5.6%), including seven major strokes, 17 minor strokes, and 22 transient ischemic attacks. There were four deaths (one following a major stroke). The 30-day incidence of stroke and death was 3.3% (27/815). The rate of stroke or death was 3.8% (8/213) for symptomatic lesions and 3.2% (19/602) for asymptomatic lesions (P=0.87), and 3.4% (25/729) in patients aged <80 years and 2% (2/86) in those aged > or =80 years (P=0.81). Protection device-related vascular complications, none of which led to neurologic symptoms, occurred after nine procedures (1.1%). CONCLUSION In this uncontrolled study, routine cerebral protection during carotid artery stenting was technically feasible and clinically safe. The incidence of major neurologic complications in this study was lower than in previous reports of carotid artery stenting without cerebral protection.
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Napodano M, Pasquetto G, Saccà S, Cernetti C, Scarabeo V, Pascotto P, Reimers B. Intracoronary thrombectomy improves myocardial reperfusion in patients undergoing direct angioplasty for acute myocardial infarction. J Am Coll Cardiol 2003; 42:1395-402. [PMID: 14563581 DOI: 10.1016/s0735-1097(03)01041-6] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We sought to evaluate the effects of mechanical thrombectomy on myocardial reperfusion during direct angioplasty for acute myocardial infarction (AMI). BACKGROUND Embolization of thrombus and plaque debris may occur during direct angioplasty for AMI. This may lead to distal vessel or side branch occlusion and to obstructions in the microvascular system, resulting in impaired myocardial reperfusion. Mechanical thrombectomy is used to reduce distal embolization. METHODS Ninety-two patients with AMI and angiographic evidence of intraluminal thrombus were randomized to either intracoronary thrombectomy followed by stenting or to a conventional strategy of stenting. Thrombectomy was performed using the X-Sizer catheter (EndiCOR Inc., San Clemente, California). Myocardial reperfusion was assessed by myocardial blush and ST resolution. RESULTS Postprocedure Thrombolysis in Myocardial Infarction-3 flow was not different between groups (93.5% vs. 95.7%, p = 0.39). Myocardial blush-3 was observed in 71.7% of patients undergoing thrombectomy and in 36.9% of patients undergoing conventional strategy (p = 0.006). ST-segment resolution >or=50% occurred more often in patients undergoing thrombectomy (82.6% vs. 52.2%, p = 0.001). By multivariate analysis, adjunctive thrombectomy was an independent predictor of blush-3 (odds ratio, 3.27; 95% confidence interval, 1.06 to 10.05; p = 0.039). CONCLUSIONS Intracoronary thrombectomy as adjunct to stenting during direct angioplasty for AMI improves myocardial reperfusion as assessed by myocardial blush and ST resolution.
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Cernetti C, Reimers B, Picciolo A, Saccà S, Pasquetto G, Piccolo P, Favero L, Bonanome A, Dell'Olivo I, Pascotto P. Carotid artery stenting with cerebral protection in 100 consecutive patients: immediate and two-year follow-up results. Ital Heart J 2003; 4:695-700. [PMID: 14664282] [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: 04/27/2023]
Abstract
BACKGROUND Carotid artery stenting is emerging as an alternative to surgical endarterectomy for the treatment of extracranial carotid artery disease. However, few data are available on the long-term clinical efficacy of carotid artery stenting and on the incidence of restenosis. METHODS Stent implantation with the routine use of cerebral protection devices was attempted in a single center experience including 100 consecutive patients (104 lesions) with significant stenosis of the internal carotid artery (mean stenosis 82.8 +/- 9%). The mean age of the patients was 70.8 +/- 14 years, 27 lesions were symptomatic (26.0%) with a lesion related to a previous stroke or transient ischemic attack. RESULTS Procedural success was achieved in 103 lesions (99%) and the cerebral protection was successfully applied in 102 procedures (98%). The 30-day incidence of stroke and death was 4% (4 patients). Complications consisted of one major stroke (1%) with persistent ipsilateral amaurosis, two minor strokes (2%), and one (1%) fatal myocardial infarction occurring 4 days after the stent procedure. During follow-up (minimum 24 months; mean 31 +/- 6 months) no further neurological events occurred, 6 patients died of non-neurological causes (6%) and 2 (2%) presented with a non-fatal myocardial infarction. Echo color Doppler scan control (minimum 24 months) was carried out in all surviving patients showing a restenosis classified as moderate (50-69%) in 2 cases and as critical (> or = 70%) in another 2 cases (1.8%). Both critical restenotic lesions were successfully treated by repeating balloon angioplasty. CONCLUSIONS The present study demonstrates that carotid artery stenting with routine cerebral protection can be performed with an acceptable procedural complication rate. At the 2-year follow-up carotid artery stenting appeared effective in stroke prevention and durable with a low incidence of restenosis.
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Affiliation(s)
- Carlo Cernetti
- Cardiovascular Department, Civic Hospital, Mirano, VE, Italy
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Pasquetto G, Reimers B, Favero L, Saccà S, Cernetti C, Napodano M, Piccolo P, Pascotto P. Distal filter protection during percutaneous coronary intervention in native coronary arteries and saphenous vein grafts in patients with acute coronary syndromes. Ital Heart J 2003; 4:614-9. [PMID: 14635379] [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: 04/27/2023]
Abstract
BACKGROUND Percutaneous coronary interventions on saphenous vein grafts (SVG) and in patients with acute coronary syndromes (ACS) have been associated with the distal embolization of the thrombus and plaque and to the no-reflow phenomenon. We report on the safety and feasibility of a new distal emboli protection filter. METHODS Angioplasty using distal filter protection (Angioguard, Cordis, Warren, NJ, USA) was attempted in 38 patients (mean age 65 +/- 11 years, 79% males) affected by ACS. A percutaneous coronary intervention was performed in 27 native coronary arteries, in 10 SVG and in one arterial graft (mean diameter stenosis 88 +/- 9%). Patients with vessels presenting severe proximal tortuosity, more than mild calcification, a diameter < 3.0 mm and a lesion length > 15 mm were excluded. RESULTS It was possible to position the device in all patients (100%); in 7 patients (18%) the lesion could be crossed with the filter only after balloon predilation. Procedural success with final TIMI flow 3 was obtained in all patients and the mean residual diameter stenosis after stent implantation was 5 +/- 8%. Transient procedural complications without clinical sequelae included the no-reflow phenomenon (2 patients, 5%) and vessel perforation (1 patient, 2.5%). In no case was distal embolization observed. As regards the device-related complications, one occlusive dissection (2.5%) occurred and was successfully treated with stent implantation. In-hospital and 30-day major adverse cardiac events consisted of two non-Q wave myocardial infarctions (5%), both occurring during SVG interventions. CONCLUSIONS The use of the Angioguard filter for preselected lesions in patients with ACS had a high technical success and carried a low rate of device-related complications. The clinical efficacy of the device needs further evaluation.
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Pellizzari N, Reimers B, Saccà S, Pasquetto G, Cernetti C, Napodano M, Calò M, Michielon P, Pascotto P. Percutaneous endovascular stent-graft placement for the treatment of acute rupture of an aneurysm of the thoracic aorta. Ital Heart J 2002; 3:427-30. [PMID: 12189973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A 68-year-old male patient presented with massive hematemesis following the acute rupture of an aneurysm of the descending thoracic aorta into the esophagus. In view of the important cardiac and pulmonary comorbidities, surgical treatment was excluded and successful percutaneous implantation of an endovascular stent-graft in the descending aorta was performed. In selected patients endovascular treatment may constitute an alternative to the surgical repair of ruptured aortic aneurysms.
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Reimers B, Castriota F, Corvaja N, Manetti R, Cernetti C, Di Mario C, Pascotto P, Cremonesi A, Colombo A. Carotid artery stent implantation with cerebral protection: a multicenter experience of 320 procedures. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80130-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Angelini A, Reimers B, Della Barbera M, Saccà S, Pasquetto G, Cernetti C, Valente M, Pascotto P, Thiene G. Cerebral protection during carotid artery stenting: collection and histopathologic analysis of embolized debris. Stroke 2002; 33:456-61. [PMID: 11823652 DOI: 10.1161/hs0202.102337] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Histopathologic analysis was performed to better understand quantity, particle size, and composition of embolized debris collected in protection filters during carotid artery stent implantation. METHODS Elective carotid stent implantation with the use of a distal filter protection was attempted in 38 consecutive lesions (36 patients) of the internal carotid artery presenting >70% diameter stenosis (mean, 82.1+/-11.1%). Mean age of the patients was 70.7+/-7.7 years; 75% were men, and 50% of patients had previous neurological symptoms. RESULTS In 37 lesions (97.4%) it was possible to position the filter device, and in all lesions a stent was successfully implanted. The only complication occurring in the hospital and during the 30-day follow-up was 1 death due to acute myocardial infarction. Neurological sequelae did not occur. Histomorphometric analysis was performed on the filters. Presence of debris was detected in 83.7% of filters. The mean surface area of the polyurethane membrane filter covered with material was 53.2+/-19.8%. Particle size ranged from 1.08 to 5043.5 microm (mean, 289.5+/-512 microm) in the major axis and 0.7 to 1175.3 microm (mean, 119.7+/-186.7 microm) in the minor axis. Collected debris consisted predominantly of thrombotic material, foam cells, and cholesterol clefts. CONCLUSIONS By the use of distal protection filters during carotid artery stenting, it was possible to collect particulate debris potentially leading to distal vessel occlusion in a high percentage of cases. Qualitative analysis of embolized material showed debris dislocated during the percutaneous intervention from atheromatous plaques.
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Desideri A, Suzzi GL, Terlizzi R, Canel F, Cernetti C, Celegon L. Dipyridamole stress echocardiography and exercise testing for risk stratification after uncomplicated myocardial infarction. G Ital Cardiol 1998; 28:754-9. [PMID: 9773299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Risk stratification for subsequent cardiac events after an acute infarction can be obtained by exercise testing or dipyridamole stress echocardiography. It remains to be determined whether these modalities are equivalent and provide incremental information on top of clinical evaluation. The aim of our study was to compare the prognostic information obtained early after an acute uncomplicated myocardial infarction of high dose dipyridamole coupled with echocardiography (stress echo) or maximal symptom-limited exercise testing. METHODS AND RESULTS Ninety patients underwent dipyridamole stress echo and exercise testing at a mean +/- SD of 9 +/- 4 days after admission for acute uncomplicated first myocardial infarction. All patients were prospectively followed for 22 +/- 16 months. There were 9 hard events (3 cardiac deaths and 6 acute myocardial infarctions) and 12 soft events due to post MI angina (6 angioplasty and 6 bypass surgery procedures). Univariate predictor of hard events was rest-stress wall motion score index variation (p = 0.009); univariate predictors of all events (hard + soft) were: positive exercise testing (p = 0.001), positive stress echo (p = 0.001), rest-stress wall motion score index variation (p = 0.002), extent of ischemia at echo (p = 0.008). Multivariate analysis by Cox selected a non-Q wave infarction and rest-stress wall motion score index variation as predictors of death or reinfarction (overall chi-square for the model 12.2, p = 0.0022). CONCLUSIONS Stress echo is superior to ergometric variables for predicting events after uncomplicated myocardial infarction.
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Affiliation(s)
- A Desideri
- Coronary Care Unit, S. Giacomo Hospital, Castelfranco Veneto, TV
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