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Sacco A, Pagnesi M, Frea S, Briani M, Dini CS, Bertaina M, Marini M, Trombara F, Villanova L, Ravera A, Tavazzi G, Pappalardo F, Morici N, Potena L. Transitioning to Palliative Care in an Italian Cardiac Intensive Care Unit Network. Am J Crit Care 2024; 33:145-148. [PMID: 38424013 DOI: 10.4037/ajcc2024535] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Recent data indicate that end-of-life management for patients affected by acute decompensated heart failure in cardiac intensive care units is aggressive, with late or no engagement of palliative care teams. OBJECTIVE To assess current palliative care and end-of-life practices in a contemporary Italian multicenter registry of patients with cardiogenic shock due to acute decompensated heart failure. METHODS A survey-based approach was used to collect data on palliative care and end-of-life management practices. The AltShock-2 registry enrolled patients with cardiogenic shock from 12 participating centers. A subset of 153 patients with cardiogenic shock due to acute decompensated heart failure enrolled between March 2020 and March 2023 was analyzed, with a focus on early engagement of palliative care teams and deactivation of implantable cardioverter-defibrillators (ICDs). RESULTS "Do not resuscitate" orders were documented in patient records in only 5 of 12 centers (42%). Palliative care teams were engaged for 21 of 153 enrolled patients (13.7%). Among the 51 patients with ICDs, 6 of 17 patients who died (35%) had defibrillator deactivation. Of the 17 patients who died, 13 died in the hospital and 4 died within 6 months after discharge; 1 patient had ICD deactivation supported by palliative care services at home. CONCLUSIONS Therapy-limiting practices, including ICD deactivation, are not routine in the Italian centers participating in this study. The results emphasize the importance of integrating palliative care as a simultaneous process with intensive care to address the unmet needs of these patients and their families.
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Affiliation(s)
- Alice Sacco
- Alice Sacco is a physician, Cardiac Intensive Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Pagnesi
- Matteo Pagnesi is a physician, Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Simone Frea
- Simone Frea is a physician, Intensive Cardiac Care Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Martina Briani
- Martina Briani is a physician, IRCCS Humanitas Research Hospital Rozzano, Milan, Italy
| | - Carlotta Sorini Dini
- Carlotta Sorini Dini is a physician, Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maurizio Bertaina
- Maurizio Bertaina is a physician, Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Marco Marini
- Marco Marini is a physician, Department of Cardiovascular Sciences, Clinic of Cardiology, Ospedali Riuniti, Ancona, Italy
| | - Filippo Trombara
- Filippo Trombara is a physician, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Luca Villanova
- Luca Villanova is a physician, Cardiac Intensive Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Amelia Ravera
- Amelia Ravera is a physician, Department of Cardiology, "San Giovanni di Dio e Ruggi D'Aragona" Hopital-University, Salerno, Italy
| | - Guido Tavazzi
- Guido Tavazzi is a physician, Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia Italy Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, Pavia, Italy
| | - Federico Pappalardo
- Federico Pappalardo is a physician, Cardiothoracic and Vascular Anesthesia and Intensive Care, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Nuccia Morici
- Nuccia Morici is a physician, IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Luciano Potena
- Luciano Potena is a physician, Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
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Sciaccaluga C, Natali BM, Righini FM, Sorini Dini C, Landra F, Mandoli GE, Sisti N, Menci D, D'Errico A, D'Ascenzi F, Focardi M, Bernazzali S, Maccherini M, Valente S, Cameli M. Heart transplantation and anti-HLA antibodY: myocardial dysfunction and prognosis - HeartLAy study. ESC Heart Fail 2023; 10:2853-2864. [PMID: 37415291 PMCID: PMC10567642 DOI: 10.1002/ehf2.14442] [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: 04/29/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
AIMS The presence of anti-human leucocyte antigen (HLA) antibodies has been implicated in a higher incidence of complications as well as mortality rate in heart transplantation. The aim of the study was to identify through non-invasive parameters early signs of myocardial dysfunction in the presence of anti-HLA antibodies but without evidence of antibody-mediated rejection (AMR) and its possible prognostic impact. METHODS AND RESULTS A total of 113 heart-transplanted patients without acute cellular rejection (ACR) and AMR or cardiac allograft vasculopathy (CAV) were prospectively enrolled and divided into two groups ['HLA+' (50 patients) and 'HLA-' (63 patients)], based on the presence of anti-HLA antibodies. Each patient was followed for 2 years after the enrolment, recording episodes of AMR, ACR, CAV, and mortality. Clinical characteristics were similar between the two groups. Among laboratory data, N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin values were significantly higher in the presence of anti-HLA antibodies (P < 0.001 and P = 0.003, respectively). The echocardiographic parameters that showed a statistically significant difference between the two groups were deceleration time of E wave (DecT E, P < 0.001), left ventricular global longitudinal strain (P < 0.001), tricuspid annular plane systolic excursion (P = 0.011), tricuspid S' wave (P = 0.002), and free wall right ventricular longitudinal strain (fwRVLS, P = 0.027), whereas left atrial strain did not differ significantly (P = 0.408). Univariate analysis showed that anti-HLA antibodies were associated with the development of CAV at both 1 and 2 year follow-up [odds ratio (OR) 11.90, 95% confidence interval (CI) 1.43-90.79, P = 0.022 and OR 3.37, 95% CI 1.78-9.67, P = 0.024, respectively]. Bivariate analysis demonstrated that both fwRVLS and DecT E were predictors of CAV development independently from HLA status. CONCLUSIONS The presence of circulating anti-HLA antibodies is correlated with a mild cardiac dysfunction, even in the absence of AMR, and CAV development. Interestingly, reduced values of DecT E and fwRVLS were predictors of future development of CAV, independently from anti-HLA antibody.
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Affiliation(s)
- Carlotta Sciaccaluga
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Benedetta Maria Natali
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | | | - Carlotta Sorini Dini
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Federico Landra
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Nicolò Sisti
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Daniele Menci
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | | | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Marta Focardi
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | | | | | - Serafina Valente
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Matteo Cameli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
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Gasparetto N, Trambaiolo P, Sorini Dini C, Scotton P, Chiappetta D, Ferlini M, Giubilato S, Rossini R, Valente S, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. [Practical approach to the patient with fever in the intensive cardiac care unit: diagnostic framework and therapy notes]. G Ital Cardiol (Rome) 2023; 24:800-809. [PMID: 37767832 DOI: 10.1714/4100.40980] [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: 09/29/2023]
Abstract
The management of the patient with fever in the intensive cardiac care unit begins with a thorough evaluation of the patient, particularly symptoms, clinical history and physical examination, to provide information regarding the origin of the fever. The global evaluation of the patient should be integrated with blood and microbiological tests, in particular blood culture and swab. The laboratory, microbiologic or radiologic tests could be more or less detailed and targeted depending on the type of suspected infection and clinical conditions of the patient. When therapy is necessary, it is crucial to switch, as soon as possible, from broad spectrum antibiotic therapy to antibiotic therapy based on the results of the microbiological exams. Antibiotic therapy could be associated with antipyretic and specific organ support therapy when necessary.
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Affiliation(s)
| | - Paolo Trambaiolo
- U.O.S. Terapia Intensiva Cardiologia, Presidio Ospedaliero Sandro Pertini, Roma
| | - Carlotta Sorini Dini
- U.O.C. Cardiologia Clinico-Chirurgica-UTIC, Azienda Ospedaliero-Universitaria Senese Ospedale Santa Maria alle Scotte, Siena
| | | | | | - Marco Ferlini
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Simona Giubilato
- U.O.C. Cardiologia con UTIC ed Emodinamica, Azienda Ospedaliera Cannizzaro, Catania
| | - Roberta Rossini
- Dipartimento Emergenza e Aree Critiche, Azienda Ospedaliera Santa Croce e Carle, Cuneo
| | - Serafina Valente
- U.O.C. Cardiologia Clinico-Chirurgica-UTIC, Azienda Ospedaliero-Universitaria Senese Ospedale Santa Maria alle Scotte, Siena
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
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4
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Favilli S, Assanta N, Carluccio M, Ricciardi G, Segreti L, Canale ML, Grippo G, Selvaggia Magnaghi GC, Misuraca L, Orso F, Sorini Dini C, Talini E, Mirizzi G, Spaziani G, Garibaldi S, Viacava C, Porcedda G, Casolo G. [Arrhythmias in adult congenital heart disease at the emergency department: ANMCO Tuscany clinical pathway]. G Ital Cardiol (Rome) 2023; 24:604-611. [PMID: 37492867 DOI: 10.1714/4068.40528] [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: 07/27/2023]
Abstract
Arrhythmias are a common complication in the adult population with congenital heart disease (ACHD). Arrhythmias often lead to hemodynamic instability and, on the other hand, may be a marker of hemodynamic impairment in ACHD patients, both in natural history and after cardiac surgery. Treatment requires knowledge of basic anatomy and any previous cardiac surgery; the availability of patient's health records, if possible, is therefore crucial for therapeutic choices. In the emergency setting, the first target is represented by the patient's hemodynamic stabilization; mainly in moderate or high complexity ACHD, the connection with the referral center is recommended, to which patients should be entrusted for follow-up. A regional epidemiological observatory, aiming to assess the number, type and outcomes of emergency admissions of ACHD patients could be a useful tool for analyzing the effectiveness of the collaboration network between the different structures involved and for implementing organizational pathways.
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Affiliation(s)
- Silvia Favilli
- S.O.C. Cardiologia Pediatrica e della Transizione, IRCSS Azienda Ospedaliero-Universitaria Meyer, Firenze
| | - Nadia Assanta
- Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa
| | - Marisa Carluccio
- U.O. Cardiologia 2, SSN Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - Giuseppe Ricciardi
- S.O.C. Elettrofisiologia, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Luca Segreti
- U.O. Cardiologia 2, SSN Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - Maria Laura Canale
- Cardiologia, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU)
| | | | | | - Leonardo Misuraca
- U.O.S.D. Cardiologia Interventistica, Ospedale della Misericordia, Grosseto
| | - Francesco Orso
- S.O.D.c. Geriatria-UTIG, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Carlotta Sorini Dini
- Cardiologia Clinica-Chirurgia/UTIC, Azienda Ospedaliero-Universitaria Senese, Siena
| | | | - Gianluca Mirizzi
- Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa
| | - Gaia Spaziani
- S.O.C. Cardiologia Pediatrica e della Transizione, IRCSS Azienda Ospedaliero-Universitaria Meyer, Firenze
| | - Silvia Garibaldi
- Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa
| | - Cecilia Viacava
- Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa
| | - Giulio Porcedda
- S.O.C. Cardiologia Pediatrica e della Transizione, IRCSS Azienda Ospedaliero-Universitaria Meyer, Firenze
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5
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Sorini Dini C, Valente S, Trambaiolo P, Ebert AG, Tizzani E, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. [The hypoxic patient in the intensive cardiac care unit: from nasal cannulas to oro-tracheal intubation]. G Ital Cardiol (Rome) 2023; 24:538-546. [PMID: 37392119 DOI: 10.1714/4060.40433] [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: 07/02/2023]
Abstract
Acute respiratory failure is a frequent complication of patients admitted to the intensive cardiac care unit and it is associated with a poor short- and long-term outcome. Acute respiratory failure can be managed with traditional oxygen therapy, with high-flow nasal cannula, continuous positive airway pressure, non-invasive ventilation or invasive ventilation according to clinical and blood gas condition. The use of advanced respiratory therapies is associated with both respiratory and hemodynamic effects, therefore the intensivist cardiologist should know deeply these respiratory devices. The intensivist cardiologist should perform an early diagnosis of acute respiratory failure, an appropriate selection of the respiratory device, and accurate monitoring and management to obtain clinical improvement and to avoid mechanical invasive ventilation.
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Affiliation(s)
| | | | - Paolo Trambaiolo
- U.O.S. Terapia Intensiva Cardiologia, Presidio Ospedaliero Sandro Pertini, Roma
| | | | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO)
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
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6
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Spaziani G, Monti S, Misuraca L, Airò E, Traini AM, Bauleo C, Canale ML, Carluccio M, Grippo G, Selvaggia Magnaghi GC, Orso F, Sorini Dini C, Talini E, Poddighe R, Picchi A, Limbruno U, Favilli S, Casolo G. [Pulmonary hypertension clinical pathway: ANMCO Tuscany Board model]. G Ital Cardiol (Rome) 2023; 24:178-187. [PMID: 36853154 DOI: 10.1714/3980.39620] [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: 03/01/2023]
Abstract
Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure >20 mmHg at rest during right heart catheterization. PH prevalence is about 1% of the global population. The PH clinical classification includes five groups: pulmonary arterial hypertension, PH associated with left heart disease, PH associated with lung disease, PH associated with pulmonary artery obstructions, PH with unclear and/or multifactorial mechanisms. In case of clinical suspicion, echocardiography is the first-line tool to start the diagnostic process. Right heart catheterization is the gold standard for diagnosis of PH, requires great experience and should be performed in expert centers. The classification of the PH patient in a specific subgroup requires multidisciplinary clinical and instrumental skills that only a reference center can provide. This document proposes a clinical pathway for the management of PH patients in the Tuscany region in order to standardize access to specialized care.
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Affiliation(s)
| | - Simonetta Monti
- Fondazione Toscana Gabriele Monasterio, Pisa - Istituto di Fisiologia Clinica del CNR, Pisa
| | - Leonardo Misuraca
- U.O.S.D. Cardiologia Interventistica, Ospedale della Misericordia, Grosseto
| | | | | | | | - Maria Laura Canale
- Cardiologia, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU)
| | - Marisa Carluccio
- U.O. Cardiologia 2, Azienda Ospedaliero Universitaria Pisana, Pisa
| | | | | | - Francesco Orso
- S.O.D.c. Geriatria-UTIG, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Carlotta Sorini Dini
- Cardiologia Clinica-Chirurgia/UTIC, Azienda Ospedaliero Universitaria Senese, Siena
| | | | - Rosa Poddighe
- Cardiologia, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU)
| | - Andrea Picchi
- U.O.S.D. Cardiologia Interventistica, Ospedale della Misericordia, Grosseto
| | - Ugo Limbruno
- U.O.C. Cardiologia, Ospedale della Misericordia, Grosseto
| | | | - Giancarlo Casolo
- Cardiologia, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU)
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7
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Valente S, Ghionzoli N, Sorini Dini C, Rossini R, Gabrielli D, Oliva F, Colivicchi F. [Circulatory shock: early diagnosis and therapy]. G Ital Cardiol (Rome) 2023; 24:110-121. [PMID: 36735309 DOI: 10.1714/3963.39418] [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: 02/04/2023]
Abstract
Circulatory shock is a clinical condition characterized by hypotension and organ hypoperfusion, potentially fatal if the underlying cause is not promptly identified and corrected. Circulatory shock outcome is certainly conditioned from early diagnosis and early and adequate therapy. The aim of this review is to provide a tool for a rapid differential diagnosis among the various phenotypes of circulatory shock, based on the clinical, hemodynamic and biochemical profile. We also prompt to emphasize the role of multiparametric monitoring from the early phases of the management and the need to implement the time-dependent network to improve the outcome of these critical patients.
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Affiliation(s)
- Serafina Valente
- Cardiologia Clinico-Chirurgica (UTIC), A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena
| | - Nicolò Ghionzoli
- Sezione Cardiologia, Dipartimento di Biotecnologie Mediche, Università degli Studi, Siena
| | - Carlotta Sorini Dini
- Cardiologia Clinico-Chirurgica (UTIC), A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena
| | | | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
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8
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Morici N, Frea S, Bertaina M, Sacco A, Corrada E, Dini CS, Briani M, Tedeschi M, Saia F, Colombo C, Rota M, Oliva F, Iannaccone M, De Ferrari GM, Sionis A, Kapur NK, Tavazzi G, Pappalardo F. SCAI stage reclassification at 24 h predicts outcome of cardiogenic shock: Insights from the Altshock-2 registry. Catheter Cardiovasc Interv 2023; 101:22-32. [PMID: 36378673 PMCID: PMC10100478 DOI: 10.1002/ccd.30484] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 07/15/2022] [Revised: 09/27/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) includes several phenotypes with heterogenous hemodynamic features. Timely prognostication is warranted to identify patients requiring treatment escalation. We explored the association of the updated Society for Cardiovascular Angiography and Interventions (SCAI) stages classification with in-hospital mortality using a prospective national registry. METHODS Between March 2020 and February 2022 the Altshock-2 Registry has included 237 patients with CS of all etiologies at 11 Italian Centers. Patients were classified according to their admission SCAI stage (assigned prospectively and independently updated according to the recently released version). In-hospital mortality was evaluated for association with both admission and 24-h SCAI stages. RESULTS The overall in-hospital mortality was 38%. Of the 237 patients included and staged according to the updated SCAI classification, 20 (8%) had SCAI shock stage B, 131 (55%) SCAI stage C, 61 (26%) SCAI stage D and 25 (11%) SCAI stage E. In-hospital mortality stratified according to the SCAI classification at 24 h was 18% for patients in SCAI stage B, 27% for SCAI stage C, 63% for SCAI stage D and 100% for SCAI stage E. Both the revised SCAI stages on admission and at 24 h were associated with in-hospital mortality, but the classification potential slightly increased at 24-h. After adjusting for age, sex, lactate level, eGFR, CVP, inotropic score and mechanical circulatory support [MCS], SCAI classification at 24 h was an independent predictor of in-hospital mortality. CONCLUSIONS In the Altshock-2 registry the utility of SCAI shock stages to identify risk of in-hospital mortality increased at 24 h after admission. Escalation of treatment (either pharmacological or with MCS) should be tailored to achieve prompt clinical improvement within the first 24 h after admission. Registration: http://www. CLINICALTRIALS gov; Unique identifier: NCT04295252.
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Affiliation(s)
- Nuccia Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Simone Frea
- Intensive Cardiac Care Unit, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maurizio Bertaina
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Torino, Italy
| | - Alice Sacco
- Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elena Corrada
- Humanitas Research Hospital IRCCS Rozzano, Milan, Italy
| | - Carlotta Sorini Dini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Michele Tedeschi
- Cardiology Department, Intensive Care Unit, S. Giovanni Di Dio e Ruggi D'Aragona Hospital, Salerno, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Costanza Colombo
- Intensive Cardiac Care Unit, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, Units of Biostatistics and Biomathematics and Bioinformatics, University of Brescia, Brescia, Italy
| | - Fabrizio Oliva
- Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Torino, Italy
| | - Gaetano M De Ferrari
- Intensive Cardiac Care Unit, Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Navin K Kapur
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia Italy.,Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, Pavia, Italy
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Di Fusco SA, Di Pasquale G, Mistrulli R, Sorini Dini C, Gasparetto N, De Luca L, Gabrielli D, Oliva F, Scherillo M, Colivicchi F. [The network for myocardial infarction in Italy: ANMCO role in 20 years of progresses and prospects]. G Ital Cardiol (Rome) 2022; 23:821-825. [PMID: 36300384 DOI: 10.1714/3900.38820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma
| | - Giuseppe Di Pasquale
- Coordinamento Rete Cardiologica e Chirurgica Cardiovascolare, Regione Emilia-Romagna
| | - Raffella Mistrulli
- Dipartimento di Cardiologia, Sapienza Università di Roma, Azienda Ospedaliera Sant'Andrea, Roma
| | - Carlotta Sorini Dini
- Cardiologia Clinica e Chirurgica/UTIC, Azienda Ospedaliera Universitaria Senese, Siena
| | | | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento di Scienze Cardio-Toraco-Vascolari, A.O. San Camillo Forlanini, Roma
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento di Scienze Cardio-Toraco-Vascolari, A.O. San Camillo Forlanini, Roma
| | - Fabrizio Oliva
- Unità di Cure Intensive Cardiologiche, Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Marino Scherillo
- Cardiologia Interventistica e UTIC, A.O. San Pio, Presidio Ospedaliero Gaetano Rummo, Benevento
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma
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10
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Rossini R, Chiappetta D, Ferlini M, Giubilato S, Gasparetto N, Sorini Dini C, Trambaiolo P, Oliva F, Valente S, Colivicchi F. [Management of elderly patients in the cardiac intensive care unit: how to balance between appropriateness and futility]. G Ital Cardiol (Rome) 2022; 23:686-702. [PMID: 36039719 DOI: 10.1714/3860.38452] [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: 06/15/2023]
Abstract
The number of elderly patients admitted to cardiac intensive care units (CICU) is significantly increasing. Nowadays, novel diagnostic and therapeutic tools allow to treat the vast majority of cardiac acute diseases, nonetheless care of elderly patients requires a careful clinical evaluation. A favorable proportion of cost-effectiveness is warranted, aimed at avoiding futile procedures or treatments. On the other hand, the availability of minimally invasive procedures carries forward old limits to treatments in elderly patients in CICU. It appears evident that age cannot per se represent a limit in the care of elderly people. The present review gives insights in the management of the most common cardiovascular disease settings in elderly patients in the CICUs, thus providing important tools in complex decision-making.
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Affiliation(s)
- Roberta Rossini
- U.O.C. Cardiologia, Azienda Ospedaliera Santa Croce e Carle, Cuneo
| | | | - Marco Ferlini
- U.O.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Simona Giubilato
- U.O.C. Cardiologia con UTIC ed Emodinamica, Azienda Ospedaliera Cannizzaro, Catania
| | | | - Carlotta Sorini Dini
- U.O.C. Cardiologia Clinico-Chirurgica-UTIC, Azienda Ospedaliero-Universitaria Senese Ospedale Santa Maria alle Scotte, Siena
| | - Paolo Trambaiolo
- U.O.S. Terapia Intensiva Cardiologia, Presidio Ospedaliero Sandro Pertini, Roma
| | - Fabrizio Oliva
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Serafina Valente
- U.O.C. Cardiologia Clinico-Chirurgica-UTIC, Azienda Ospedaliero-Universitaria Senese Ospedale Santa Maria alle Scotte, Siena
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
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11
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Canale ML, Camerini A, Orso F, Misuraca L, Carluccio M, Talini E, Sorini Dini C, Grippo G, Simonetti F, Amoroso D, Allegrini G, Bengala C, Casolo G. [A clinical cardio-oncology pathway for the cardiology management of cancer outpatients: a joint proposal by ANMCO and AIOM Tuscany]. G Ital Cardiol (Rome) 2022; 23:437-443. [PMID: 35674034 DOI: 10.1714/3810.37940] [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: 06/15/2023]
Abstract
Cardio-oncology is now part of the standard clinical approach for patients with cancer and cannot be overlooked anymore. While its scientific background is solid and its clinical relevance is well known, its application in daily practice varies greatly among hospitals. To provide the best cardio-oncology care to cancer patients and to make cardio-oncology's clinical use uniform, we developed a shared multidisciplinary proposal for a dedicated clinical pathway. Our proposition presents the minimum requirements needed to which this path caters for, identifies patient categories to be entered into the path, highlights the role of a specific inter-hospital clinical and imaging network and indicates follow-up strategies during and after oncological treatments. The proposed pathway is based on some key elements and is easily adaptable to different hospitals with minimal changes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Federico Simonetti
- Ematologia, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU)
| | - Domenico Amoroso
- Oncologia Medica, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Lido di Camaiore (LU)
| | - Giacomo Allegrini
- Oncologia Medica, Ospedale di Livorno, Azienda USL Toscana Nord Ovest, Livorno
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12
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Rossini R, Valente S, Colivicchi F, Baldi C, Caldarola P, Chiappetta D, Cipriani M, Ferlini M, Gasparetto N, Gilardi R, Giubilato S, Imazio M, Marini M, Roncon L, Scotto di Uccio F, Somaschini A, Sorini Dini C, Trambaiolo P, Usmiani T, Gulizia MM, Gabrielli D. ANMCO POSITION PAPER: Role of intra-aortic balloon pump in patients with acute advanced heart failure and cardiogenic shock. Eur Heart J Suppl 2021; 23:C204-C220. [PMID: 34456647 PMCID: PMC8387780 DOI: 10.1093/eurheartj/suab074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.
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Affiliation(s)
- Roberta Rossini
- Division of Cardiology, Emergency Department and Critical Areas, Azienda Ospedaliera Santa Croce e Carle, Via Michele Coppino 26, 12100 Cuneo, Italy
| | - Serafina Valente
- Clinical-Surgical-CCU Cardiology Department, Azienda Ospedaliero-Universitaria Senese Ospedale Santa Maria alle Scotte, Siena, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, Presidio Ospedaliero San Filippo Neri-, ASL Roma 1, Roma, Italy
| | - Cesare Baldi
- Interventional Cardiology-Cath Lab Department, Azienda Ospedaliera Universitaria San Giovanni di Dio-Ruggi d'Aragona, Salerno, Italy
| | | | | | - Manlio Cipriani
- Cardiology 2-Heart Failure and Transplants, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Rossella Gilardi
- Department of Cardiac Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Simona Giubilato
- Cardiology-CCU -Cath Lab Department, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Massimo Imazio
- Division of Cardiology, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Marini
- Cardiology-CCU -Cath Lab Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Loris Roncon
- U.O.C. Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo, Italy
| | | | - Alberto Somaschini
- Department of Cardiology and Cardiac Intensive Care Unit, Ospedale San Paolo, Savona, Italy
| | | | - Paolo Trambaiolo
- Cardiology-ICU Department, Presidio Ospedaliero Sandro Pertini, Roma, Italy
| | - Tullio Usmiani
- Division of Cardiology, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy.,Fondazione per il Tuo cuore-Heart Care Foundation, Firenze, Italy
| | - Domenico Gabrielli
- Cardiology Unit, Cardiotoracovascular Department, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
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13
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Porto I, Mattesini A, D'Amario D, Sorini Dini C, Della Bona R, Scicchitano M, Vergallo R, Martellini A, Caporusso S, Trani C, Burzotta F, Bruno P, Di Mario C, Crea F, Valente S, Massetti M. Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry. Intern Emerg Med 2021; 16:463-470. [PMID: 32772282 PMCID: PMC7952335 DOI: 10.1007/s11739-020-02459-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022]
Abstract
Refractory cardiogenic shock (RCS) or refractory cardiac arrest (RCA) complicating acute coronary syndrome (ACS) is associated with extremely high mortality rate. Veno-arterial extracorporeal life support (VA-ECLS) represents a valuable therapeutic option to stabilize patients' condition before or at the time of emergency revascularization. We analyzed 29 consecutive patients with RCS or RCA complicating ACS, and implanted with VA-ECLS in two centers who have adopted a similar, structured approach to ECLS implantation. Data were collected from January 2010 to December 2015 and ECLS had to be percutaneously implanted either before (within 48 h) or at the time of attempted percutaneous coronary revascularization (PCI). We investigated in-hospital outcome and factors associated with survival. Twenty-one (72%) were implanted for RCA, whereas 8 (28%) were implanted on ECLS for RCS. All RCA were witnessed and no-flow time was shorter than 5 min in all cases but one. All patients underwent attempted emergency PCI, using radial access in ten cases (34.5%), whereas in three patients a subsequent CABG was performed. Overall, ten patients (34.5%) survived, nine of them with a good neurological outcome. Life threatening complications, including stroke (4 pts), leg ischemia (4 pts), intestinal ischemia (5 pts), and deep vein thrombosis 2 pts), occurred frequently, but were not associated with in-hospital death. Main cause of death was multi-organ failure. PCI variables did not predict survival. Survivors were younger, with shorter low-flow time, and with ECLS mainly implanted for RCS. At multivariate analysis, levels of lactate at ECLS implantation (OR 4.32, 95%CI 1.01-18.51, p = 0.049) emerged as the only variable that independently predicted survival. In patients with RCA or RCS complicating ACS who are percutaneously implanted with ECLS before or at the time of coronary revascularization, in hospital survival rate is higher than 30%. Level of lactate at ECLS implantation appears to be the most important factor to predict survival.
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Affiliation(s)
- Italo Porto
- Dipartimento CardioToracoVascolare, IRCCS Ospedale Policlinico San Martino, Genova, Italy, Italian IRCCS Cardiovascular Network, Genoa, Italy
- Dipartimento di Medicina Interna e Specialità Mediche (DiMI), Università di Genova, Genoa, Italy
| | - Alessio Mattesini
- Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | | | - Roberta Della Bona
- Dipartimento CardioToracoVascolare, IRCCS Ospedale Policlinico San Martino, Genova, Italy, Italian IRCCS Cardiovascular Network, Genoa, Italy
| | | | - Rocco Vergallo
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Antonio Martellini
- Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Piergiorgio Bruno
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Carlo Di Mario
- Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Serafina Valente
- U.O.C. Cardiologia Ospedaliera, A.O.U. Senese Ospedale Santa Maria Alle Scotte, Siena, Italy
| | - Massimo Massetti
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy.
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14
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Valente S, Anselmi F, Sorini Dini C, Iadanza A, Casolo G. [Clinical pathway for cardiogenic shock. A proposal from ANMCO Tuscany]. G Ital Cardiol (Rome) 2021; 22:122-136. [PMID: 33470228 DOI: 10.1714/3514.35027] [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
Cardiogenic shock is a clinical syndrome characterized by hypotension and hypoperfusion due to the inability of the heart to provide adequate cardiac output. It is an infrequent clinical condition still burdened by high mortality rates. In patients with cardiogenic shock rapid diagnosis, multiparameter monitoring and timely therapeutic strategies with pharmacological agents or mechanical circulatory support are necessary to provide adequate peripheral tissue perfusion and to improve outcome. Recent investigations reported lower mortality rates to be associated with clinical pathways based on a well-organized network, and on admission in high-volume specialized hospitals (Shock Center) with a dedicated multidisciplinary team (Shock Team). The aim of this clinical pathway for cardiogenic shock is to describe the best organization to ensure to Tuscan citizens an equal access to care independently of the site where they suffer from cardiogenic shock.
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Affiliation(s)
- Serafina Valente
- Cardiologia Clinico-Chirurgica (UTIC), A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena
| | - Francesca Anselmi
- Cardiologia Clinico-Chirurgica (UTIC), A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena
| | | | - Alessandro Iadanza
- Cardiologia Interventistica, A.O.U. Senese, Ospedale Santa Maria alle Scotte, Siena
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15
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Mattesini A, Nardi G, Martellini A, Sorini Dini C, Hamiti B, Stolcova M, Meucci F, Di Mario C. Intravascular Imaging to Guide Lithotripsy in Concentric and Eccentric Calcific Coronary Lesions. Cardiovasc Revasc Med 2020; 21:1099-1105. [PMID: 32471713 DOI: 10.1016/j.carrev.2020.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/18/2019] [Revised: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Calcified coronary lesions still represent a challenge for coronary angioplasty, with sub-optimal acute PCI results causing more frequent late stent failure. PURPOSE The study aimed at the evaluation of the immediate procedural outcome in a real-world consecutive population of a selective use of lithotripsy based on the intravascular imaging assessment with IVUS or OCT. METHODS AND RESULTS Thirty-one calcified stenoses (28 patients) out of a total of 455 lesions (370 patients) treated between November 2018 and May 2019 received IVL under intravascular imaging guidance. The majority of the IVL lesions had angiographically severe calcifications and were selected after intravascular imaging. A smaller group was identified by poor expansion after high-pressure balloon dilatation, in one case despite preliminary small burr Rotablation. After IVL, when OCT was performed calcium fractures were observed in 71% of cases. After OCT/IVUS guided stent optimization a satisfactory lumen enlargement (minimal stent area 7.09 ± 2.77 mm2) was observed with good stent expansion (residual area stenosis<20% in 29 lesions, 93.5%) Peri-procedural complications were limited to one dissection at the distal edge requiring an additional stent and 3 peri-procedural myocardial infarctions. There were no periprocedural coronary perforations or pericardial effusions, and no in-hospital or 30 days stent thrombosis. When patients were divided into two subgroups according to a calcium arc ≤180° (Group A: 10 lesions, calcium arc 140 ± 24°; Group B: 21 lesions, calcium arc 289 ± 53°), at OCT Group B presented also a higher number of calcium fractures post IVL than group A (group A: 38% vs group B: 92%, p = 0.03). The in-stent minimum lumen diameter (MSD), the in stent minimal lumen area (MSA) and the acute gain, however, were similar between the two groups (acute gain group A: 1.22 ± 0.29 mm; group B: 1.31 ± 0.52 mm, p = 0.63). CONCLUSIONS A standardized algorithm applying intravascular imaging guidance of IVL facilitated second generation DES expansion delivers excellent immediate lumen expansion and patient outcome, both in concentric and eccentric calcifications.
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Affiliation(s)
- Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Giulia Nardi
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Antonio Martellini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Carlotta Sorini Dini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Brunilda Hamiti
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy.
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16
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Sorini Dini C, Nardi G, Ristalli F, Mattesini A, Hamiti B, Di Mario C. Contemporary Approach to Heavily Calcified Coronary Lesions. ACTA ACUST UNITED AC 2019; 14:154-163. [PMID: 31867062 PMCID: PMC6918474 DOI: 10.15420/icr.2019.19.r1] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 07/02/2019] [Accepted: 09/30/2019] [Indexed: 12/17/2022]
Abstract
Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.
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Affiliation(s)
- Carlotta Sorini Dini
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy.,Cardiology Division, Spedali Riuniti Livorno, Italy
| | - Giulia Nardi
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Francesca Ristalli
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Brunilda Hamiti
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital Florence, Italy
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17
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Dini CS, Tomberli B, Mattesini A, Ristalli F, Valente S, Stolcova M, Meucci F, Baldereschi G, Fanelli F, Shlofmitz RA, Ali ZA, Di Mario C. Intravascular lithotripsy for calcific coronary and peripheral artery stenoses. EUROINTERVENTION 2019; 15:714-721. [DOI: 10.4244/eij-d-18-01056] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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18
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Agostini C, Stolcova M, Bernardo P, Cappelli F, Sori A, Mattesini A, Meucci F, Sorini Dini C, Cianchi G, Peris A, Di Mario C, Valente S. [Tips and tricks for using extracorporeal life support devices in the intensive cardiac care unit]. G Ital Cardiol (Rome) 2019; 19:14S-22S. [PMID: 29989607 DOI: 10.1714/2939.29546] [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
In patients with severe cardiac dysfunction refractory to conventional therapies, extracorporeal membrane oxygenation used in veno-arterious modality can provide temporary circulatory assistance (extracorporeal life support, ECLS). Since it is an invasive and complex technique, its use is potentially burdened by severe complications, thus requiring careful nursing and medical care during intensive cardiac care unit stay. The use of ECLS requires specific skills such as knowledge of protective mechanical invasive ventilation, specific echocardiographic evaluation, accurate monitoring of hemodynamics and laboratory tests. A patient on ECLS is at high risk of thrombotic and hemorrhagic complications that could be fatal, hence specific pro- and anti-hemostatic therapy is needed. Moreover, the knowledge of some peculiar aspects of ECLS system and management can help doctors to avoid several complications such as limb ischemia, left ventricular overload and regional perfusion discrepancy. In conclusion, careful management by adequately trained personnel is required.
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Affiliation(s)
- Cecilia Agostini
- SOD Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Miroslava Stolcova
- SOD Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Pasquale Bernardo
- SOD Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Francesco Cappelli
- SOD Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Andrea Sori
- SOD Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Alessio Mattesini
- SOD Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Francesco Meucci
- SOD Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | | | - Giovanni Cianchi
- SOD Cure Intensive del Trauma e delle Gravi Insufficienze d'Organo, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Adriano Peris
- SOD Cure Intensive del Trauma e delle Gravi Insufficienze d'Organo, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Carlo Di Mario
- SOD Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Serafina Valente
- SOD Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
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19
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Valente S, Marini M, Battistoni I, Sorini Dini C, Di Mario C, De Maria R, Aspromonte N, Cacciavillani L, Ferraiuolo G, Iacoviello M, Casolo G, Di Lenarda A, Gulizia MM. [Cardiogenic shock is a rare disease: the dedicated network]. G Ital Cardiol (Rome) 2019; 18:719-726. [PMID: 29105686 DOI: 10.1714/2790.28261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiogenic shock (CS) is a rare disease that needs a rapid and multiparameter diagnosis and a timely, aggressive and multidisciplinary goal-oriented treatment. Recently published epidemiological studies and registries underline how SC represents an infrequent clinical entity still burdened by high mortality rates, substantially unchanged over the years. Currently, only few patients with CS are treated with circulatory assistance in dedicated centers. Some consensus documents and expert recommendations emphasize the importance of early diagnosis of CS, immediate pharmacological support, and treatment of precipitating causes, and stress the need for hospitalization in high-volume intensive care centers. The aim of this review is to show the instructions for the creation of a SC network, emphasizing the necessary elements, in agreement with available resources and existing health regulations for giving the same care opportunities to all the patients.
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Affiliation(s)
- Serafina Valente
- S.O.D. Interventistica Cardiologica Strutturale, AOU Careggi, Firenze - Area Emergenza-Urgenza ANMCO
| | - Marco Marini
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona - Area Giovani ANMCO
| | - Ilaria Battistoni
- S.O.D. Cardiologia-Emodinamica-UTIC, Dipartimento di Scienze Cardiovascolari, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona - Consiglio Direttivo ANMCO
| | - Carlotta Sorini Dini
- S.O.D. Interventistica Cardiologica Strutturale, AOU Careggi, Firenze - Area Emergenza-Urgenza ANMCO
| | - Carlo Di Mario
- S.O.D. Interventistica Cardiologica Strutturale, AOU Careggi, Firenze - Area Emergenza-Urgenza ANMCO
| | - Renata De Maria
- Istituto di Fisiologia Clinica del CNR, Dipartimento Cardiotoracovascolare, Grande Ospedale Metropolitano Niguarda, Milano - Area Giovani ANMCO
| | - Nadia Aspromonte
- U.O.C. Cardiologia, Presidio Ospedaliero San Filippo Neri, ASL RME, Roma - Consiglio Direttivo ANMCO
| | - Luisa Cacciavillani
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Azienda Ospedaliero-Universitaria, Padova - Area Emergenza-Urgenza ANMCO
| | | | - Massimo Iacoviello
- U.O.C. Cardiologia Universitaria, Dipartimento Cardiotoracico, AOU Policlinico Consorziale, Bari - Area Scompenso Cardiaco ANMCO
| | - Giancarlo Casolo
- S.C. Cardiologia, Nuovo Ospedale Versilia, Lido di Camaiore (LU) - Consiglio Direttivo ANMCO
| | - Andrea Di Lenarda
- S.C. Centro Cardiovascolare, Azienda Sanitaria Universitaria Integrata, Trieste - Presidente ANMCO
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Boudou N, Avran A, Garbo R, Lefèvre T, Hildick-Smith D, Reifart N, Galassi AR, Mattesini A, Dini CS, Brilakis ES, Yamane M, Sianos G, Mashayekhi K, Karmpaliotis D, DeMartini T, Werner GS, Di Mario C. EuroCTO Club 2018 meeting: "Experts Live" in Toulouse. EUROINTERVENTION 2019; 14:e1814-e1817. [PMID: 30956181 DOI: 10.4244/eijv14i18a319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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21
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Bufe A, Di Mario C, Landmesser U, Gessner MM, Sianos G, Garbo R, Dini CS, Lauer B, Boudou N, Grancini L, Avran A, Lauten A, Mashayekhi K, Hildick-Smith D, Escaned J, Buettner HJ, Reifart N, Lapp H, Galassi AR, Werner GS. The Experts "Live" Workshop of the EuroCTO Club 2017, Berlin. EUROINTERVENTION 2018; 13:1987-1990. [PMID: 29674299 DOI: 10.4244/eijv13i17a324] [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]
Affiliation(s)
- Alexander Bufe
- Division of Cardiology, Krefeld Hospital, Krefeld, Germany
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22
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Sorini Dini C, Landi D, Meucci F, Di Mario C. Unexpected delayed complete atrioventricular block after Cardioband implantation. Catheter Cardiovasc Interv 2018; 92:1201-1204. [DOI: 10.1002/ccd.27519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/18/2017] [Accepted: 01/06/2018] [Indexed: 11/06/2022]
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23
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Di Mario C, Sorini Dini C. Maximal efficiency is required to minimize complications and hospital stay after TAVR. Catheter Cardiovasc Interv 2018; 91:354-355. [PMID: 29405594 DOI: 10.1002/ccd.27511] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 11/07/2022]
Abstract
When TAVR is performed with transfemoral percutaneous approach, local anesthesia, no routine post-procedural intensive care admission, an early discharge (<3 days) can be adopted in most TAVR patients Avoiding peri-procedural complications and minimizing pace-maker implantation rate are key to allow early patient discharge When properly selected, patients discharged early have low discharge have low risk of adverse events and readmissions in the first 30 days.
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Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Carlotta Sorini Dini
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
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24
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Stolcova M, Ristalli F, Sorini Dini C, Valente S. The perks of being a female in the TAVI era. Int J Cardiol 2018; 250:104-105. [PMID: 29169747 DOI: 10.1016/j.ijcard.2017.09.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/11/2017] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Miroslava Stolcova
- Structural Heart Interventions Unit, Cardio-Thoraco-Vascular Department, Careggi Hospital, Florence, Italy.
| | - Francesca Ristalli
- Structural Heart Interventions Unit, Cardio-Thoraco-Vascular Department, Careggi Hospital, Florence, Italy
| | - Carlotta Sorini Dini
- Structural Heart Interventions Unit, Cardio-Thoraco-Vascular Department, Careggi Hospital, Florence, Italy
| | - Serafina Valente
- Structural Heart Interventions Unit, Cardio-Thoraco-Vascular Department, Careggi Hospital, Florence, Italy
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25
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Sorini Dini C, Valente S, Di Mario C. Age and comorbidities should not preclude a liberal use of PCI in myocardial infarction. Int J Cardiol 2017; 249:138-139. [PMID: 29121717 DOI: 10.1016/j.ijcard.2017.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/28/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Carlotta Sorini Dini
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Serafina Valente
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy.
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26
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Valente S, Mattesini A, Rossini R, Berti S, Sorini Dini C, Politi A, Golino L, Romeo F, Musumeci G, Gensini GF, Di Mario C. [Fractional flow reserve: a practical guide for interventional cardiologists and the cardiologist's point of view]. G Ital Cardiol (Rome) 2017; 18:2S-8S. [PMID: 28845857 DOI: 10.1714/2743.27964] [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
Fractional flow reserve (FFR) is considered the gold standard for functional assessment of coronary stenosis in stable coronary artery disease. The use of FFR enables an ischemia-guided revascularization with improvement of clinical outcomes in a cost-effective fashion. Both clinical and interventional cardiologists should be aware of the advantages and potential pitfalls of this technique. We focus on FFR with the aim to provide the clinical cardiologist with information on indications and technical aspects to confirm a correct execution of FFR in different coronary anatomical settings.
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Affiliation(s)
- Serafina Valente
- Unità di Cardiologia Interventistica Strutturale, AOU Careggi, Firenze
| | - Alessio Mattesini
- Unità di Cardiologia Interventistica Strutturale, AOU Careggi, Firenze - Ospedale Moriggia-Pelascini, Gravedona ed Uniti, Como
| | - Roberta Rossini
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Sergio Berti
- U.O. Cardiologia Interventistica, G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio, Massa
| | | | | | - Luca Golino
- Ospedale Moriggia-Pelascini, Gravedona ed Uniti, Como
| | - Francesco Romeo
- U.O.C. Cardiologia e Cardiologia Interventistica, Policlinico "Tor Vergata", Roma
| | | | | | - Carlo Di Mario
- Unità di Cardiologia Interventistica Strutturale, AOU Careggi, Firenze
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Di Mario C, Sorini Dini C, Werner GS. Thousand Registries Are Not Worth a Randomized Trial. JACC Cardiovasc Interv 2017; 10:1535-1537. [DOI: 10.1016/j.jcin.2017.06.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 11/26/2022]
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28
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Mattesini A, Bartolini S, Sorini Dini C, Valente S, Parodi G, Stolcova M, Meucci F, Di Mario C. The DESolve novolimus bioresorbable Scaffold: from bench to bedside. J Thorac Dis 2017; 9:S950-S958. [PMID: 28894601 PMCID: PMC5583086 DOI: 10.21037/jtd.2017.07.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/29/2017] [Indexed: 11/06/2022]
Abstract
The DESolve (Elixir Medical Corporation, Sunnyvale, California, USA) is a poly-L lactide-based polymer scaffold coated with the antiproliferative and anti-inflammatory drug novolimus. The scaffold biodegrades within one year with a complete resorption in two years and in vitro bench test have shown the ability to supply the necessary radial strength to support the vessel for the critical 3- to 4-month period after implant. The DESolve showed the unique self-correction property, which may reduce the incidence of minor malapposition after deployment. Overexpansion with DESolve is safe since a high capability resistance to fracture has been demonstrated with this scaffold. The aim of this review is to provide a comprehensive overview of the available preclinical and clinical data regarding the DESolve.
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Affiliation(s)
- Alessio Mattesini
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Simone Bartolini
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Carlotta Sorini Dini
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Serafina Valente
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Guido Parodi
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Unit, University Of Florence, AOU Careggi, Florence, Italy
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Mattesini A, Valente S, Sorini Dini C, Bartolini S, Caiazzo G, Baldereschi G, Galassi A, Di Mario C. [Percutaneous treatment of coronary chronic total occlusions: state of the art]. G Ital Cardiol (Rome) 2017; 18:3S-11S. [PMID: 28652627 DOI: 10.1714/2718.27729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Successful percutaneous coronary intervention of chronic total occlusions (CTO) is associated with favorable clinical outcomes in selected subsets of patients. The success rate of CTO interventions greatly increased over the last decades, thanks to the development of dedicated materials and interventional strategies. Nevertheless, CTO interventions are still challenging with higher complication rates and lower success rates compared to standard percutaneous coronary interventions. Dedicated CTO operators are warranted in order to minimize the rate of complications and to achieve a success rate near to 90%. This state of the art paper is aimed to provide updated evidences on the clinical benefit of CTO recanalization and to describe specific interventional techniques for CTO recanalization.
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Affiliation(s)
| | - Serafina Valente
- SODc Cardiologia Interventistica Strutturale, AOU Careggi, Firenze
| | | | - Simone Bartolini
- SODc Cardiologia Interventistica Strutturale, AOU Careggi, Firenze
| | | | | | - Alfredo Galassi
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi, Catania
| | - Carlo Di Mario
- SODc Cardiologia Interventistica Strutturale, AOU Careggi, Firenze
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30
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Di Mario C, Sorini Dini C, Wijns W. The year in cardiology 2016: coronary interventions. Eur Heart J 2017; 38:1017-1027. [PMID: 28043975 DOI: 10.1093/eurheartj/ehw649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.,National Heart and Lung Institute, Imperial College, Sydney Street, Chelsea, London SW3 6NP, London
| | - Carlotta Sorini Dini
- Structural Interventional Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - William Wijns
- Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, University Road, Galway, Ireland
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31
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Di Mario C, Sorini Dini C. Conquering CTO revascularisation: the summit is near with 90% of the ascent behind us. EUROINTERVENTION 2016; 12:e1319-e1321. [PMID: 27934607 DOI: 10.4244/eijv12i11a218] [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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Dini CS, Lazzeri C, Chiostri M, Gensini GF, Valente S. A local network for extracorporeal membrane oxygenation in refractory cardiogenic shock. ACTA ACUST UNITED AC 2016; 17:49-54. [DOI: 10.3109/17482941.2016.1174272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Carlotta Sorini Dini
- Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Lazzeri
- Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Chiostri
- Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gian Franco Gensini
- Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Serafina Valente
- Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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33
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Attanà P, Lazzeri C, Picariello C, Dini CS, Gensini GF, Valente S. Lactate and lactate clearance in acute cardiac care patients. Eur Heart J Acute Cardiovasc Care 2013; 1:115-21. [PMID: 24062898 DOI: 10.1177/2048872612451168] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 05/19/2012] [Indexed: 12/12/2022]
Abstract
Hyperlactataemia is commonly used as a diagnostic and prognostic tool in intensive care settings. Recent studies documented that serial lactate measurements over time (or lactate clearance), may be clinically more reliable than lactate absolute value for risk stratification in different pathological conditions. While the negative prognostic role of hyperlactataemia in several critical ill diseases (such as sepsis and trauma) is well established, data in patients with acute cardiac conditions (i.e. acute coronary syndromes) are scarce and controversial. The present paper provides an overview of the current available evidence on the clinical role of lactic acid levels and lactate clearance in acute cardiac settings (acute coronary syndromes, cardiogenic shock, cardiac surgery), focusing on its prognostic role.
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Affiliation(s)
- Paola Attanà
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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34
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Lazzeri C, Valente S, Chiostri M, Attanà P, Mattesini A, Dini CS, Gensini GF. Comorbidities in stemi patients submitted to primary PCI: temporal trends and impact on mortality: a 6-year single center experience. Int J Cardiol 2012. [PMID: 23200270 DOI: 10.1016/j.ijcard.2012.11.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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35
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Valente S, Lazzeri C, Chiostri M, Giglioli C, Attanà P, Picariello C, Dini CS, Gensini GF. The impact of blood transfusion on short and long term prognosis in STEMI patients treated with primary percutaneous coronary intervention. Int J Cardiol 2012; 157:281-3. [DOI: 10.1016/j.ijcard.2012.03.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/05/2012] [Accepted: 03/08/2012] [Indexed: 10/28/2022]
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