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Silverio A, Bellino M, Scudiero F, Attisano T, Baldi C, Catalano A, Centore M, Cesaro A, Di Maio M, Esposito L, Granata G, Maiellaro F, Muraca I, Musumeci G, Parodi G, Personeni D, Valenti R, Vecchione C, Calabrò P, Galasso G. Intravenous antiplatelet therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention : A report from the INVEST-STEMI group. J Thromb Thrombolysis 2024:10.1007/s11239-024-02970-7. [PMID: 38615155 DOI: 10.1007/s11239-024-02970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/15/2024]
Abstract
The use of intravenous antiplatelet therapy during primary percutaneous coronary intervention (PPCI) is not fully standardized. The aim is to evaluate the effectiveness and safety of periprocedural intravenous administration of cangrelor or tirofiban in a contemporary ST-segment elevation myocardial infarction (STEMI) population undergoing PPCI. This was a multicenter prospective cohort study including consecutive STEMI patients who received cangrelor or tirofiban during PPCI at seven Italian centers. The primary effectiveness measure was the angiographic evidence of thrombolysis in myocardial infarction (TIMI) flow < 3 after PPCI. The primary safety outcome was the in-hospital occurrence of BARC (Bleeding Academic Research Consortium) 2-5 bleedings. The study included 627 patients (median age 63 years, 79% males): 312 received cangrelor, 315 tirofiban. The percentage of history of bleeding, pulmonary edema and cardiogenic shock at admission was comparable between groups. Patients receiving cangrelor had lower ischemia time compared to tirofiban. TIMI flow before PPCI and TIMI thrombus grade were comparable between groups. At propensity score-weighted regression analysis, the risk of TIMI flow < 3 was significantly lower in patients treated with cangrelor compared to tirofiban (adjusted OR: 0.40; 95% CI: 0.30-0.53). The risk of BARC 2-5 bleeding was comparable between groups (adjusted OR:1.35; 95% CI: 0.92-1.98). These results were consistent across multiple prespecified subgroups, including subjects stratified for different total ischemia time, with no statistical interaction. In this real-world multicenter STEMI population, the use of cangrelor was associated with improved myocardial perfusion assessed by coronary angiography after PPCI without increasing clinically-relevant bleedings compared to tirofiban.
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Affiliation(s)
- Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy.
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | - Fernando Scudiero
- Cardiology Unit, Medical Sciences Departement, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Tiziana Attisano
- Interventional Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Cesare Baldi
- Interventional Cardiology Unit, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Angelo Catalano
- Cardiology Unit, Hospital Maria SS. Addolorata, Eboli, Italy
| | - Mario Centore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
- Cardiology Unit, Hospital Maria SS. Addolorata, Eboli, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | - Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giovanni Granata
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | | | - Iacopo Muraca
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Giuseppe Musumeci
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin, Italy
| | - Guido Parodi
- Cardiology Unit, Department of Medicine, Lavagna Hospital, Lavagna, Italy
| | - Davide Personeni
- Cardiology Unit, Medical Sciences Departement, ASST Bergamo Est, Seriate, Bergamo, Italy
| | - Renato Valenti
- Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081, Baronissi, Salerno, Italy
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Corcione N, Ferraro P, Finizio F, Cimmino M, Albanese M, Biondi-Zoccai G, Denti P, Rubbio AP, Bartorelli AL, Mongiardo A, Giordano S, De Felice F, Adamo M, Montorfano M, Baldi C, Tarantini G, Giannini F, Ronco F, Monteforte I, Villa E, Ferrario M, Fiocca L, Castriota F, Squeri A, Tamburino C, Bedogni F, Giordano A. Transcatheter mitral valve repair with MitraClip: comparison of NT, NTr, and XTr Devices. J Invasive Cardiol 2024. [PMID: 38598251 DOI: 10.25270/jic/24.00020] [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] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Transcatheter edge-to-edge repair (TEER) has become an established minimally invasive treatment for significant mitral regurgitation. Ongoing refinements and the availability of different clipping devices have expanded the indications for and effectiveness of TEER, but comprehensive comparative data on this issue are lacking. In this study, we compared NT, NTr, and XTr MitraClip devices (Abbot) for TEER. METHODS Details on patient, imaging, and procedural details, as well as short- and long-term outcomes, were sought from a national prospective clinical registry on TEER with MitraClip. The primary outcome of interest was discharge after procedural success without major clinical complications. RESULTS A total of 2236 patients were included, 1228 (54.9%) in whom NT implantation only was attempted, 233 (10.4%) in whom NTr but not XTr implantation was attempted, and 775 (34.7%) in whom XTr implantation was attempted. Clinical and imaging features differed substantially across the groups, reflecting expanding indications with NTr and XTr devices. In-hospital outcomes were largely similar among the 3 groups, including death. Long-term unadjusted estimates of effect showed significant differences in several outcomes, including death, rehospitalization, and their composite, which demonstrated that NT was associated with more unfavorable outcomes compared with the other devices (all P less than .05). However, most differences depended on baseline features, as adjusted analysis showed no significant differences for early as well as long-term outcomes, including long-term death, rehospitalization, and their composite (all P greater than .05). CONCLUSIONS New-generation MitraClip devices are associated with favorable procedural and clinical outcomes, despite being used in patients with more adverse features, when compared with patients treated with previous devices.
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Affiliation(s)
- Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Paolo Ferraro
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Filippo Finizio
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Cimmino
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Albanese
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Cardiology Unit, Santa Maria Goretti Hospital, Latina, Italy.
| | - Paolo Denti
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy, and Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University
| | - Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia, both in Brescia, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Cesare Baldi
- Heart Department, University Hospital 'Scuola Medica Salernitana', Salerno, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Francesco Giannini
- Division of Cardiology, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Federico Ronco
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Ida Monteforte
- Divisione di Cardiologia, A.O. dei Colli, Ospedale Monaldi, Napoli
| | - Emmanuel Villa
- Cardiac Surgery Unit and Valve Center, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Luigi Fiocca
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Angelo Squeri
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
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Giordano A, Pepe M, Biondi-Zoccai G, Corcione N, Finizio F, Ferraro P, Denti P, Popolo Rubbio A, Petronio S, Bartorelli AL, Nestola PL, Mongiardo A, DE Felice F, Adamo M, Montorfano M, Baldi C, Tarantini G, Giannini F, Ronco F, Monteforte I, Villa E, Ferrario Ormezzano M, Fiocca L, Castriota F, Bedogni F, Tamburino C. Impact of coronary artery disease on outcome after transcatheter edge-to-edge mitral valve repair with the MitraClip system. Panminerva Med 2023; 65:443-453. [PMID: 37259492 DOI: 10.23736/s0031-0808.23.04827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The clinical impact of coronary artery disease (CAD) on the prognosis of patients undergoing MitraClip implantation is still unclear. METHODS One thousand nine hundred fifty-three patients undergoing MitraClip implantation included in the multicenter GIOTTO Registry were stratified according to CAD. Endpoints were all-cause death, cardiac death, and re-hospitalization for heart failure at follow-up (median 15.8 months). RESULTS Although younger, CAD patients were more symptomatic, had worse cardiovascular risk profile, higher burden of comorbidities, more frequently affected by functional MR, with higher left ventricle (LV) diameters and lower ejection fraction (EF). At follow-up, CAD patients showed higher rates of all-cause death (25.4% vs. 19.6%; P=0.002), cardiovascular death (14.0% vs. 10.1%; P=0.007) and re-hospitalization for heart failure (13.9% vs. 10.2%; P=0.011). Dividing the population according to mitral regurgitation (MR) etiology (functional vs. non-functional MR), no differences were observed between CAD and no-CAD patients. At multivariate logistic regression, NYHA III/IV class, prior heart failure hospitalization, severe chronic kidney disease, atrial fibrillation, LV end-diastolic diameter and LVEF<30% but not CAD resulted independent predictors of all-cause death. The same finding was confirmed even after propensity score adjustment. CONCLUSIONS CAD did not show a relevant impact on mid-term prognosis per se, but seemed to identify a more complex and diseased cohort of patients with worse clinical and functional status.
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Affiliation(s)
- Arturo Giordano
- Unit of Invasive Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Martino Pepe
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy -
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Nicola Corcione
- Unit of Invasive Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Filippo Finizio
- Unit of Invasive Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Paolo Ferraro
- Department of Invasive Cardiology, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Naples, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Sonia Petronio
- Cardiac Catheterization Laboratory, Department of Cardiothoracic and Vascular, University Hospital of Pisa, Pisa, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Palma L Nestola
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | | | - Francesco DE Felice
- Unit of Interventional Cardiology, S. Camillo Forlanini Hospital, Rome, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Baldi
- Department of Interventional Cardiology, San Giovanni e Ruggi University Hospital, Salerno, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Federico Ronco
- Department of Interventional Cardiology, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - Ida Monteforte
- Unit of Interventional Cardiology, AORN dei Colli, Naples, Italy
| | - Emmanuel Villa
- Cardiac Surgery and Transcatheter Valve Therapy Group, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Luigi Fiocca
- Unit of Interventional Cardiology, Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Castriota
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Corrado Tamburino
- Division of Cardiology, G. Rodolico - San Marco Polyclinic Univeristy Hospital, University of Catania, Catania, Italy
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Piccolo R, Calabrò P, Varricchio A, Baldi C, Napolitano G, De Simone C, Mauro C, Stabile E, Caiazzo G, Tesorio T, Boccalatte M, Tuccillo B, Bottiglieri G, Russolillo E, Di Lorenzo E, Carrara G, Cassese S, Leonardi S, Biscaglia S, Costa F, McFadden E, Heg D, Franzone A, Stefanini GG, Capodanno D, Esposito G. Rationale and design of the PARTHENOPE trial: A two-by-two factorial comparison of polymer-free vs biodegradable-polymer drug-eluting stents and personalized vs standard duration of dual antiplatelet therapy in all-comers undergoing PCI. Am Heart J 2023; 265:153-160. [PMID: 37572785 DOI: 10.1016/j.ahj.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Over the past few decades, percutaneous coronary intervention (PCI) has undergone significant advancements as a result of the combination of device-based and drug-based therapies. These iterations have led to the development of polymer-free drug-eluting stents. However, there is a scarcity of data regarding their clinical performance. Furthermore, while various risk scores have been proposed to determine the optimal duration of dual antiplatelet therapy (DAPT), none of them have undergone prospective validation within the context of randomized trials. DESIGN The PARTHENOPE trial is a phase IV, prospective, randomized, multicenter, investigator-initiated, assessor-blind study being conducted at 14 centers in Italy (NCT04135989). It includes 2,107 all-comers patients with minimal exclusion criteria, randomly assigned in a 2-by-2 design to receive either the Cre8 amphilimus-eluting stent or the SYNERGY everolimus-eluting stent, along with either a personalized or standard duration of DAPT. Personalized DAPT duration is determined by the DAPT score, which accounts for both bleeding and ischemic risks. Patients with a DAPT score <2 (indicating higher bleeding than ischemic risk) receive DAPT for 3 or 6 months for chronic or acute coronary syndrome, respectively, while patients with a DAPT score ≥2 (indicating higher ischemic than bleeding risk) receive DAPT for 24 months. Patients in the standard DAPT group receive DAPT for 12 months. The trial aims to establish the noninferiority between stents with respect to a device-oriented composite end point of cardiovascular death, target-vessel myocardial infarction, or clinically-driven target-lesion revascularization at 12 months after PCI. Additionally, the trial aims to demonstrate the superiority of personalized DAPT compared to a standard approach with respect to a net clinical composite of all-cause death, any myocardial infarction, stroke, urgent target-vessel revascularization, or type 2 to 5 bleeding according to the Bleeding Academic Research Consortium criteria at 24-months after PCI. SUMMARY The PARTHENOPE trial is the largest randomized trial investigating the efficacy and safety of a polymer-free DES with a reservoir technology for drug-release and the first trial evaluating a personalized duration of DAPT based on the DAPT score. The study results will provide novel insights into the optimizing the use of drug-eluting stents and DAPT in patients undergoing PCI.
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Affiliation(s)
- Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Attilio Varricchio
- Division of Cardiology, P.O.S. Anna e SS. Madonna della Neve di Boscotrecase, Ospedali Riuniti Area Vesuviana, Naples, Italy
| | - Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Giovanni Napolitano
- Division of Cardiology, "San Giuliano" Hospital of Giugliano in Campania, Giugliano in Campania, Italy
| | - Ciro De Simone
- Division of Cardiology, Clinica Villa Dei Fiori, Acerra, Italy
| | - Ciro Mauro
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy; Division of Cardiology, Azienda Ospedaliera Regionale "San Carlo", Potenza, Italy
| | - Gianluca Caiazzo
- Division of Cardiology, San Giuseppe Moscati Hospital, Aversa, Italy
| | - Tullio Tesorio
- Department of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy
| | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | | | | | | | | | | | - Salvatore Cassese
- Division of Cardiology, Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Sergio Leonardi
- Department of Molecular Medicine, University of Pavia, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Francesco Costa
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinic 'G. Martino', Messina, Italy
| | - Eugene McFadden
- Division of Cardiology, Cork University Hospital, Cork, Ireland
| | - Dik Heg
- Department of Clinical Research, CTU Bern, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Division of Cardiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
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Poma S, Bonomo MC, Gazzaniga G, Pizzulli M, De Silvestri A, Baldi C, Broglia F, Ciceri M, Fuardo M, Morgante F, Pellicori S, Roldi EM, Delmonte MP, Mojoli F, Locatelli A. Complications of unintentional dural puncture during labour epidural analgesia: a 10-year retrospective observational study. J Anesth Analg Crit Care 2023; 3:42. [PMID: 37880725 PMCID: PMC10601237 DOI: 10.1186/s44158-023-00127-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Unintentional dural puncture (UDP) occurs in 0.5-1.5% of labour epidural analgesia cases. To date, little is known about evidence of UDP-related complications. This work aimed to assess the incidence of intrapartum and postpartum complications in parturients who experienced UDP. METHODS This is a 10-year retrospective observational study on parturients admitted to our centre who presented UDP. Data collection gathered UDP-related complications during labour and postpartum. All women who displayed UDP received medical therapy and bed rest. An epidural blood patch (EBP) was not used in this population. Once asymptomatic, patients were discharged from the hospital. RESULTS Out of 7718 neuraxial analgesia cases, 97 cases of UDP occurred (1.25%). During labour, complications appeared in a small percentage of analgesia procedures performed, including total spinal anaesthesia (1.0%), extended motor block (3%), hypotension (4.1%), abnormal foetal heart rate (2%), inadequate analgesia (14.4%), and general anaesthesia following neuraxial anaesthesia failure (33.3% of emergency caesarean sections). During the postpartum period, 53.6% of parturients exhibited a postdural puncture headache, 13.4% showed neurological symptoms, and 14.4% required neurological consultation and neuroimaging. No patient developed subdural hematoma or cerebral venous sinus thrombosis; one woman presented posterior reversible encephalopathy syndrome associated with eclampsia. Overall, 82.5% of women experienced an extension of hospital stay. CONCLUSION Major complications occurred in a small percentage of patients during labour. However, since they represent high-risk maternal and neonatal health events, a dedicated anaesthesiologist and a trained obstetric team are essential. No major neurological complications were registered postpartum, and EBP was not performed. Nevertheless, all patients with UDP were carefully monitored and treated until complete recovery before discharge, leading to an extension of their hospitalization.
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Affiliation(s)
- S Poma
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy.
| | - M C Bonomo
- Department of Anaesthesia and Intensive Care, ASST Bergamo EST, Seriate Hospital, Seriate, Italy
| | - G Gazzaniga
- Department of Anaesthesia and Intensive Care 1, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, Italy
| | - M Pizzulli
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - A De Silvestri
- Clinical Epidemiology and Biostatistics, Scientific Direction, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, Italy
| | - C Baldi
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - F Broglia
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - M Ciceri
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - M Fuardo
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - F Morgante
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - S Pellicori
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - E M Roldi
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - M P Delmonte
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
| | - F Mojoli
- Department of Anaesthesia and Intensive Care 1, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, Italy
| | - A Locatelli
- Anaesthesia and Postoperative Intensive Care, Department of Anaesthesia and Intensive Care 3, I.R.C.C.S. Policlinic San Matteo Hospital Foundation, Pavia, 27100, Italy
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Ferruzzi GJ, Silverio A, Giordano A, Corcione N, Bellino M, Attisano T, Baldi C, Morello A, Biondi‐Zoccai G, Citro R, Vecchione C, Galasso G. Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low-Flow, Low-Gradient Aortic Stenosis. J Am Heart Assoc 2023; 12:e029553. [PMID: 37646211 PMCID: PMC10547324 DOI: 10.1161/jaha.123.029553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/13/2023] [Indexed: 09/01/2023]
Abstract
Background There is little evidence about the prognostic role of mitral regurgitation (MR) in patients with low-flow, low-gradient aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). The aim of this study was to assess the prevalence and outcome implications of MR severity in patients with low-flow, low-gradient aortic stenosis undergoing TAVR, and to evaluate whether MR improvement after TAVR could influence clinical outcome. Methods and Results This study included consecutive patients with low-flow, low-gradient aortic stenosis undergoing TAVR at 2 Italian high-volume centers. The study population was categorized according to the baseline MR severity and to the presence of MR improvement at discharge. The primary outcome was the composite of all-cause death and hospitalization for worsening heart failure up to 1 year. The study included 268 patients; 57 (21%) patients showed MR >2+. Patients with MR >2+ showed a lower 1-year survival free from the primary outcome (P<0.001), all-cause death (P<0.001), and heart failure hospitalization (P<0.001) compared with patients with MR ≤2+. At multivariable analysis, baseline MR >2+ was an independent predictor of the primary outcome (P<0.001). Among patients with baseline MR >2+, MR improvement was reported in 24 (44%) cases after TAVR. The persistence of MR was associated with a significantly reduced survival free from the primary outcome, all-cause death, and heart failure hospitalization up to 1 year. Conclusions In this study, the presence of moderately severe to severe MR in patients with low-flow, low-gradient aortic stenosis undergoing TAVR portends a worse clinical outcome at 1 year. TAVR may improve MR severity in nearly half of the patients, resulting in a potential outcome benefit after discharge.
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Affiliation(s)
| | - Angelo Silverio
- Department of Medicine, Surgery and DentistryUniversity of SalernoBaronissi (Salerno)Italy
| | - Arturo Giordano
- Interventional Cardiology UnitPineta Grande HospitalCasertaItaly
| | - Nicola Corcione
- Interventional Cardiology UnitPineta Grande HospitalCasertaItaly
| | - Michele Bellino
- Department of Medicine, Surgery and DentistryUniversity of SalernoBaronissi (Salerno)Italy
| | - Tiziana Attisano
- Interventional Cardiology UnitUniversity Hospital San Giovanni di Dio e Ruggi d'AragonaSalernoItaly
| | - Cesare Baldi
- Interventional Cardiology UnitUniversity Hospital San Giovanni di Dio e Ruggi d'AragonaSalernoItaly
| | - Alberto Morello
- Interventional Cardiology UnitPineta Grande HospitalCasertaItaly
| | - Giuseppe Biondi‐Zoccai
- Department of Medical‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
- Mediterranea CardiocentroNaplesItaly
| | - Rodolfo Citro
- Cardiovascular and Thoracic DepartmentUniversity Hospital San Giovanni di Dio e Ruggi d’AragonaSalernoItaly
- Vascular Pathophysiology Unit, IRCCS NeuromedIserniaItaly
| | - Carmine Vecchione
- Department of Medicine, Surgery and DentistryUniversity of SalernoBaronissi (Salerno)Italy
- Vascular Pathophysiology Unit, IRCCS NeuromedIserniaItaly
| | - Gennaro Galasso
- Department of Medicine, Surgery and DentistryUniversity of SalernoBaronissi (Salerno)Italy
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7
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De Felice F, Paolucci L, Musto C, Cifarelli A, Coletta S, Pennacchi M, Stio R, Gabrielli D, Grasso C, Tamburino C, Adamo M, Denti P, Giordano A, De Marco F, Montorfano M, Baldi C, Mongiardo A, Monteforte I, Maffeo D, Giannini C, Crimi G, Tarantini G, Popolo Rubbio A, Bedogni F. Postprocedural trans-mitral gradient in patients with degenerative mitral regurgitation undergoing mitral valve transcatheter edge-to-edge repair. Catheter Cardiovasc Interv 2023. [PMID: 37232290 DOI: 10.1002/ccd.30698] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/01/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The relationship between high postprocedural mean gradient (ppMG) and clinical events following mitral valve transcatheter edge-to-edge repair (MV-TEER) in patients with degenerative mitral regurgitation (DMR) is still debated. AIM The purpose of this study was to evaluate the effect of elevated ppMG after MV-TEER on clinical events in patients with DMR at 1-year follow-up. METHODS The study included 371 patients with DMR treated with MV-TEER enrolled in the "Multi-center Italian Society of Interventional Cardiology (GISE) registry of trans-catheter treatment of mitral valve regurgitation" (GIOTTO) registry. Patients were stratified in tertiles according to ppMG. Primary endpoint was a composite of all-cause death and hospitalization due to heart failure at 1-year follow-up. RESULTS Patients were stratified as follows: 187 with a ppMG ≤ 3 mmHg, 77 with a ppMG > 3/=4 mmHg, and 107 with a ppMG > 4 mmHg. Clinical follow-up was available in all subjects. At multivariate analysis, neither a ppMG > 4 mmHg nor a ppMG ≥ 5 mmHg were independently associated with the outcome. Notably, the risk of elevated residual MR (rMR > 2+) was significantly higher in patients belonging to the highest tertile of ppMG (p = 0.009). The association of ppMG > 4 mmHg and rMR ≥ 2+ was strongly and independently associated with adverse events (hazard ratio: 1.98; 95% confidence interval: [1.10-3.58]). CONCLUSIONS In a real-world cohort of patients suffering DMR and treated with MV-TEER, isolated ppMG was not associated with the outcome at 1-year follow-up. A high proportion of patients showed both elevated ppMG and rMR and their combination appeared to be a strong predictor of adverse events.
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Affiliation(s)
- Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Luca Paolucci
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Carmine Musto
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Alberta Cifarelli
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Silvio Coletta
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Mauro Pennacchi
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Rocco Stio
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Domenico Gabrielli
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
| | - Marianna Adamo
- Laboratory of Cardiology and Cardiac Catheterization, ASST Spedali Civili Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | | | - Matteo Montorfano
- Interventional Cardiology Unit, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Baldi
- Department of Cardio-Thoracic-Vascular, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | | - Ida Monteforte
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Cristina Giannini
- Laboratory of Cardiac Catheterization, Department of Cardiothoracic and Vascular, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Science, University of Padua, Padua, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Migliarino S, Cristiano M, Iuliano G, Ferruzzi GJ, Loria F, Bellino M, Silverio A, Attisano T, Baldi C, Ciccarelli M, Galasso G, Vecchione C, Citro R. 992 EVALUATION OF MYOCARDIAL WORK INDEX IN PREDICTING IN-HOSPITAL COMPLICATION IN PATIENTS WITH TAKOTSUBO SYNDROME. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Backgrounds
Tako-tsubo syndrome (TTS) is a reversible heart failure pathology characterized by transient myocardial left ventricular (LV) dysfunction. Although traditionally considered a benign condition in-hospital complications are frequent in this cohort. Non-invasive myocardial work (MW) parameters are considered as emerging indexes in evaluating global and regional myocardial systolic function.
Objective
to investigate the potential association of MW compared to standard echocardiography parameters, such as LV ejection fraction (EF) with in-hospital complications, in TTS patients.
Methods
thirty-eight patients (mean age, 68 ± 12 years, 35 women) with TTS diagnosed with Takotsubo Italian Network criteria were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 24 hours from hospital admission. MW is derived from the non-invasive strain-pressure loop obtained from the 2D strain data, integrating into its calculation the non-invasive brachial arterial pressure. Constructive MW (CMW), MW index (MWI), MW efficiency (MWE), and wasted myocardial work (WMW) were measured. In hospital complications (HC) were defined as a composite of apical LV thrombosis, hypokinetic arrhythmias (HA), supraventricular tachycardia (SVT), acute heart failure (AHF), ventricular tachycardia/fibrillation (VT/VF), cardiogenic shock (CS), respiratory arrest (RA), stroke and cardiac death (CD).
The normal values for the echocardiographic parameters are reported in the Table. Odds ratio, sensitivity and specificity were used to quantify the ability of EF and MW (abnormal vs normal values) in predicting HC.
Results
HC occurred in 16 TTS patients (26% with AHF; 10% with SVT; 8% with CS; 5% with apical LV thrombosis; 5% with HA; 2,6% with RA; 2,6% with stroke; 2% with VT/VF). The MWI and CMW parameters appear to have the best performance in predicting in-hospital complications (odds ratio for having HC: 10.4 (95% confidence interval: 1.2 to 93.3); 8.6 (0.9 to 77.6) respectively, Table), followed by EF (odds ratio 7.0 (0.8 to 64.1)) and WMW (odds ratio 4.8 (0.9 to 26.7)). MWI has the same sensitivity (94%) as CMW and EF, but higher specificity (41% vs 32%). Of note, the highest specificity was obtained by the WMW parameter (41%).
Conclusion
global and regional myocardial performance is transiently impaired in TTS and significantly associated with HC. Although limited by the low number of patients, these results suggest that myocardial work parameters have a good sensistivity and may have a better performance than the EF value in predicting intra-hospital complications. Larger studies will be necessary to confirm these preliminary results.
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Affiliation(s)
- Serena Migliarino
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | - Mario Cristiano
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | - Giuseppe Iuliano
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | | | - Francesco Loria
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | - Michele Bellino
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | - Angelo Silverio
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | - Tiziana Attisano
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | - Cesare Baldi
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | | | - Gennaro Galasso
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | - Carmine Vecchione
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
| | - Rodolfo Citro
- Department Of Medicine And Surgery, University Of Salerno (Sa) , Italy
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Ferruzzi GJ, Cristiano M, Peluso AP, Migliarino S, Bellino M, Iuliano G, Silverio A, Attisano T, Baldi C, Vigorito F, Giordano A, Vecchione C, Ciccarelli M, Galasso G, Citro R. 1044 CHARACTERISTIC AND OUTCOME IN PATIENTS WITH LOW FLOW, LOW GRADIENT AORTIC STENOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Aim
The aim of this study was to assess the prevalence and outcome in patients with severe low flow, low gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve intervention (TAVI).
Methods
Patients with LFLG AS undergoing TAVI from 2013 to 2022 were prospectively collected.
Clinical, imaging data and procedural parameters were collected. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient <40 mmHg and stroke volume index <36 ml/m2. Overall population was classified in due subgroups: classical LFLG AS if left ventricular ejection fraction (LVEF) was <50%, and paradoxical in patients with preserved LVEF. The major comorbidities and primary outcome defined as a composite of all-cause mortality and rehospitalization for worsening heart failure (HF) up to 1 year in the different subtypes of severe LFLG AS undergoing TAVI were evaluated.
Results
The study included 268 patients [81±6 years; 142 (53%) females]; of these, 155 patients (58%) had paradoxical LFLG AS and 113 patients (42%) had LFLG AS with low LVEF. Regarding echocardiography parameters, in the overall population the mean transaortic gradient was 31±6 mmHg, the mean iAVA 0.38±0.08 cm/m2, and the median LVEF 50% (IQR 38-55).
Compared with paradoxical LFLG AS, the patients with classical form were characterized by a lower percentage of women (43% vs. 60% p 0.07), worse renal function (46% vs. 30%, p 0.012), and a significantly higher number of cardiovascular disease as coronary artery disease (52% vs. 29%, p <0.001) and atrial fibrillation (37% vs. 23%, p 0.018), resulting in higher Society of Thoracic Surgeons scores [7,34% (IQR: 4.96 to 13,25) versus 5,36% (IQR: 3,22 to 11); p value 0.037]. Higher percentage of patients of New York Heart Association functional class III or IV (61% vs. 27%; p 0.037) was observed in classical LFLG AS.
At one-year follow-up, the composite outcome was reported in 49 patients (18%), 21 patients (13%) had paradoxical LFLG AS and 28 patients (24%) had classical form.
Kaplan-Meier survival free from the composite outcome was significantly lower in patients with classical LFLG AS compared to those paradoxical LFLG AS (Log-Rank 0,022, Figure 1).
Conclusion
LFLG AS is a complex population with significant incidence of adverse event at one years. Patients with classical LFLG AS have higher number of risk factor and cardiovascular disease and lower survival compared paradoxical form.
Figure 1
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Affiliation(s)
| | - Mario Cristiano
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Angela Pamela Peluso
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Serena Migliarino
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Michele Bellino
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Giuseppe Iuliano
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Angelo Silverio
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Tiziana Attisano
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Cesare Baldi
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Francesco Vigorito
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | | | - Carmine Vecchione
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Michele Ciccarelli
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Gennaro Galasso
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Rodolfo Citro
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
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Junior Ferruzzi G, Pamela Peluso A, Migliarino S, Cristiano M, Bellino M, Iuliano G, Silverio A, Attisano T, Baldi C, Giordano A, Vecchione C, Ciccarelli M, Galasso G, Citro R. 1110 PROGNOSTIC IMPACT OF SIGNIFICANT MITRAL REGURGITATION IN PATIENTS WITH SEVERE LOW FLOW, LOW GRADIENT AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Aim
This study sought to determinate the prevalence, clinical impact, and clinical outcome of significant moderate-to-severe mitral regurgitation (MR) in patients with severe low flow, low gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve replacement (TAVR).
Methods
All consecutive patients with severe LFLG-AS undergoing TAVI in two high-volume Italian centres from 2013 to 2022 were prospectively included. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient <40 mmHg and stroke volume index <36 ml/m2. LFLG-AS was classified as classical if left ventricular ejection fraction (LVEF) was <50%, and paradoxical in patients with preserved LVEF >50%. Demographic, clinical, instrumental, and procedural features were systematically collected by using an electronic case report form. MR severity was graded according to the current guidelines, and patients were categorized based on the MR severity at baseline in two groups: mild and moderate-to-severe MR. The primary study outcome was the composite of all-cause mortality and rehospitalization for worsening heart failure (HF) up to 1 year; secondary outcomes were the single components of the primary outcome.
Results
The study included 268 patients [81±6 years; 142 (53%) females]; moderate-to-severe MR was reported in 57 patients (21%). At baseline moderate-to-severe MR compared to those with mild MR showed statistically significant differences between age (p 0.008), female sex (p 0.007), hypertension (p 0.036), diabetes (p 0.001) atrial fibrillation/flutter (p 0.018) and chronic kidney disease (p 0.012). In the overall population, only one patient died during the hospitalization and at one-year follow-up, the primary outcome was reported in 49 patients (18%); all-cause death occurred in 26 (10%), and HF rehospitalization in 24 (9%).
Regarding the two subgroups, Kaplan-Meier curves showed that survival free from the composite outcome was significantly lower in patients with moderate-to-severe MR compared to those with mild MR (Log Rank <0.001, Figure 1A). Survival free from all-cause mortality and HF rehospitalization was also significantly lower in patients with moderate-to-severe MR (Log-Rank <0.001 and Log-Rank=0.002, respectively; Figure 1B and 1C).
Conclusion
In this study, many patients with LFLG-AS undergoing TAVR had coexisting moderate-to-severe MR. TAVI confirmed a high safety profile, LFLG-AS patients showed a high incidence of adverse events up to 1 year, especially those with coexisting moderate-to-severe MR. Moderate-to-severe MR should be duly considered for better prognostic stratification and clinical management of these particular TAVR patients during follow-up.
Figure 1
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Affiliation(s)
| | - Angela Pamela Peluso
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Serena Migliarino
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Mario Cristiano
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Michele Bellino
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Giuseppe Iuliano
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Angelo Silverio
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Tiziana Attisano
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Cesare Baldi
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | | | - Carmine Vecchione
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Michele Ciccarelli
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Gennaro Galasso
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
| | - Rodolfo Citro
- Department Of Medicine, Surgery And Dentistry, University Of Salerno , Salerno , Italy
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11
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Silverio A, Parodi G, Scudiero F, Bossone E, Di Maio M, Vriz O, Bellino M, Zito C, Provenza G, Radano I, Baldi C, D'Andrea A, Novo G, Mauro C, Rigo F, Innelli P, Salerno-Uriarte J, Cameli M, Vecchione C, Antonini Canterin F, Galasso G, Citro R. Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome. Heart 2022; 108:1369-1376. [PMID: 35361673 DOI: 10.1136/heartjnl-2021-320543] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 11/04/2021] [Accepted: 03/07/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The advantage of beta-blockers has been postulated in patients with Takotsubo syndrome (TTS) given the pathophysiological role of catecholamines. We hypothesised that beta-blocker treatment after discharge may improve the long-term clinical outcome in this patient population. METHODS This was an observational, multicentre study including consecutive patients with TTS diagnosis prospectively enrolled in the Takotsubo Italian Network (TIN) register from January 2007 to December 2018. TTS was diagnosed according to the TIN, Heart Failure Association and InterTAK Diagnostic Criteria. The primary study outcome was the occurrence of all-cause death at the longest available follow-up; secondary outcomes were TTS recurrence, cardiac and non-cardiac death. RESULTS The study population included 825 patients (median age: 72.0 (63.0-78.0) years; 91.9 % female): 488 (59.2%) were discharged on beta-blockers and 337 (40.8%) without beta-blockers. The median follow-up was 24.0 months. The adjusted Cox regression analysis showed a significantly lower risk for all-cause death (adjusted HR: 0.563; 95% CI: 0.356 to 0.889) and non-cardiac death (adjusted HR: 0.525; 95% CI: 0.309 to 0.893) in patients receiving versus those not receiving beta-blockers, but no significant differences in terms of TTS recurrence (adjusted HR: 0.607; 95% CI: 0.311 to 1.187) and cardiac death (adjusted HR: 0.699; 95% CI: 0.284 to 1.722). The positive survival effect of beta-blockers was higher in patients with hypertension than in those without (pinteraction=0.014), and in patients who developed cardiogenic shock during the acute phase than in those who did not (pinteraction=0.047). CONCLUSIONS In this real-world register population, beta-blockers were associated with a significantly higher long-term survival, particularly in patients with hypertension and in those who developed cardiogenic shock during the acute phase.
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Affiliation(s)
- Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Guido Parodi
- Department of Cardiology, ASL4 Liguria, Lavagna, Italy
| | - Fernando Scudiero
- Cardiology Department, Azienda Ospedaliera Bolognini Seriate, Seriate, Italy
| | - Eduardo Bossone
- Department of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Olga Vriz
- Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine - Cardiology, University of Messina, Messina, Italy
| | - Gennaro Provenza
- Cardiovascular Department, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Ilaria Radano
- Cardiovascular Department, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Cesare Baldi
- Cardiovascular Department, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | | | - Giuseppina Novo
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza (PROMISE), Università degli Studi di Palermo, Palermo, Italy
| | - Ciro Mauro
- Department of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Fausto Rigo
- Department of Cardiology, Ospedale dell'Angelo Mestre-Venice, Mestre, Italy
| | - Pasquale Innelli
- Department of Cardiovascular Imaging, San Carlo Hospital, Potenza, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy
| | - Francesco Antonini Canterin
- Department of Cardiology, High Specialization Rehabilitation Hospital Motta di Livenza, Motta di Livenza, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Rodolfo Citro
- Cardiovascular Department, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy
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Conticini E, Falsetti P, D’alessandro M, Grazzini S, Baldi C, Bardelli M, Gentileschi S, Bellisai F, Biasi G, D’alessandro R, Garcia Gonzales E, Volpi N, Mazzei MA, Bargagli E, Cantarini L, Frediani B. POS0871 DIAGNOSTIC ACCURACY OF POWER DOPPLER ULTRASONOGRAPHY FOR THE DIAGNOSIS OF IDIOPATHIC INFLAMMATORY MYOPATHIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundNo clear-cut guidelines exist about the use of imaging procedures for the diagnosis of idiopathic inflammatory myopathies (IIM). Similarly, conflicting, and scanty data exist about Power Doppler Ultrasonography (PDUS) in this subset of patients. In this regard, we recently proposed (1) a 0-3 grey scale (GS) and Power Doppler (PD) score in a cohort of patients affected by IIM, evidencing a positive, statistically significant, correlation for PD and oedema and disease activity.ObjectivesThe aim of this study was to assess the diagnostic accuracy of our score in IIM patients compared to a control group.MethodsWe prospectively collected, since July 2020 to December 2021, all patients evaluated in Vasculitis and Myositis clinic, Rheumatology Unit, University of Siena, with a recent diagnosis of IIM, as well as patients with a previous, definite diagnosis of IIM and evaluated during follow-up or referred from other centres for a second opinion. As control group, we collected all patients affected by amyopathic dermatomyositis (DM) or who underwent myositis immunoblot or muscle biopsy for proximal limbs weakness but eventually received a diagnosis other than IIM. All patients underwent US examination of both thighs in axial and longitudinal scans.ResultsForty-five IIM patients (11 anti-synthetase syndrome, 20 DM, 12 PM, 2 scleromyositis) and twenty-six controls were included. During the observational period, 7, 8, 1 and 1 patients underwent PDUS twice, three, four and five times, respectivelyAssessing area under the receiver operating characteristic (AUROC) curve analysis, IIM patients and control group were distinguished according to PD sum, Oedema sum, atrophy sum and CRP values (Figure 1a). The best cut-off value for PD sum values was 0.5 (70.2% SE and 83.3% SP), for Oedema sum 1.5 (74.5% SE and 79.2% SP), atrophy sum 0.5 (63.4% SE and 65.4% SP) and CRP was 0.22 mg/dL (61.5% SE and 75% SP).Figure 1.Stratifying IIM population into two groups according to disease activity (PhGA≥2), AUROC curve analysis allow to distinguish these groups according to PD and oedema sum and CRP values (Figure 1b) and the best cut-off values was 1.5 (69.6% SE and 76.9% SP), 2.5 (52.2% SE and 92.3% SP) and 0.55 mg/dL (66.7% SE and 88.9% SP), respectively.Testing the IIM group versus control as dependent variable by logistic regression, with PD sum, oedema sum, atrophy sum, CRP, CPK and myoglobin as independent variables, the AUROC was 0.976. From the probability associated with the Chi-square tests, the Type II analysis showed the variable that most influences the IIM diagnosis was PD sum and oedema sum (p=0.017 and p=0.013, respectively) (Figure 1c).ConclusionGS and PDUS have proven an overall good diagnostic accuracy in distinguishing between IIM and myositis mimicker. In particular, even low values of PD (sum 1.5) display a good sensitivity and specificity and, together with oedema, elevated CRP values and myositis-specific and associated antibodies, may be considered a reliable tool for a definite diagnosis of IIM.References[1]Conticini E, Falsetti P, Al Khayyat SG et al. A novel grey scale and Power Doppler ultrasonographic score for idiopathic inflammatory myopathies: Siena Myositis Ultrasound Grading Scale. Rheumatology (Oxford). 2021 Dec 24;61(1):185-194.Disclosure of InterestsNone declared
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Esposito L, Baldi C, Silverio A, Di Maio M, Cancro F, Buccheri S, De Luca G, Sarno G, Bellino M, Verdoia M, Vecchione C, Galasso G. P97 VALIDATION OF THE ACADEMIC RESEARCH CONSORTIUM HIGH BLEEDING RISK CRITERIA IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: A SYSTEMATIC REVIEW AND METANALYSIS OF 10 STUDIES AND 67,862 PATIENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The Academic Research Consortium for High Bleeding Risk (ARC–HBR) has recently proposed, by consensus, twenty clinical criteria for the assessment of the bleeding risk after percutaneous coronary intervention (PCI). A major criterion was defined as any individual clinical condition conferring in isolation a risk for major bleeding ≥4% up to 1 year after PCI; instead, a minor criterion was considered to confer a bleeding risk of < 4%. The aim of this meta–analysis was to assess the performance of the ARC–HBR criteria in stratifying the risk of bleeding and ischemic events after PCI.
Methods
MEDLINE, COCHRANE, Web of Sciences, and SCOPUS were searched for studies aimed at validating the ARC–HBR criteria in patients treated with PCI. The primary outcome measure of this meta–analysis was major bleeding.
Results
The analysis included 10 studies encompassing 67,862 patients undergoing PCI; the HBR definition was fulfilled in 44.7% of the cases. The risk of major bleeding was significantly higher in HBR vs. Non–HBR group (RR, 2.56, 95% CI 2.28–2.89). The average C–statistic was 0.64 (95% CI 0.60–0.68), indicating modest discrimination. The risk of intracranial hemorrhage, gastrointestinal bleeding, fatal bleeding, ischaemic stroke, cardiac death and all–cause death was higher in HBR vs. Non–HBR group. Despite a higher incidence of myocardial infarction and stent thrombosis in patients deemed at HBR, the rate of target lesion revascularization was comparable between groups (RR, 1.01, 95% CI 0.88–1.16). When assessed in isolation, the mean cumulative incidence of major bleeding at 1 year exceeded the cut–off value of 4% for all the major criteria and for two out of six minor criteria, including age ≥75 years and moderate chronic kidney disease (CKD) (Figure).
Conclusion
The ARC–HBR definition identifies patients at higher risk of major bleeding and other adverse cardiovascular events after PCI. Almost all major criteria, but also two of the minor criteria, were individually associated with rates of major bleeding above 4% thus fulfilling the definition of major HBR criteria. These findings corroborate the ability of ARC–HBR major criteria in identifying PCI patients who are more likely to develop adverse events, but also suggest caution in the decision making of patients with isolated minor criteria, including age≥75 years and moderate CKD.
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Affiliation(s)
- L Esposito
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - C Baldi
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - A Silverio
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Di Maio
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - F Cancro
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - S Buccheri
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - G De Luca
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - G Sarno
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Bellino
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Verdoia
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - C Vecchione
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - G Galasso
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICAL SCIENCES, CARDIOLOGY AND UPPSALA CLINICAL RESEARCH CENTER, UPPSALA UNIVERSITY, UPPSALA, SWEDEN; AOU MAGGIORE DELLA CARITA‘, NOVARA; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
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Cancro F, Baldi C, Silverio A, Di Maio M, Esposito L, Tedeschi M, Cristiano M, Sabatino M, Romei S, Vecchione C, Galasso G. P192 LONG TERM PROGNOSTIC EFFECT OF LIPROTEIN(A) IN PATIENTS WITH AND WITHOUT DIABETES MELLITUS AFTER MYOCARDIAL INFARCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
To describe the baseline clinical, laboratory and angiographic characteristics of patients with acute myocardial infarction (MI) according to the presence or not of diabetes mellitus (DM), and to evaluate if DM may influence the effect of lipoprotein(a) [Lp(a)] serum level on long–term outcome in this very high–risk population.
Methods
This was a retrospective, single–center, study including consecutive patients admitted with MI diagnosis between January 1, 2017, and December 31, 2020. The availability of data on baseline Lp(a) serum level was considered as an inclusion criterion. The study population was divided into two groups according to the presence or not of DM. The Lp(a) value of 50 mg/dL was used to test the hypothesis of a different effect of Lp(a) on the clinical outcome of patients with or without DM. The primary study outcome was all–cause death at 3–year follow–up.
Results
The study population included 997 patients (mean age 63.7±13.5 years; 75.7% were males). Diabetes was reported in 280 (28.1%) patients. DM patients were older than those without DM (67.8±12.1 vs. 62.0±13.7 years, p < 0.001) and showed a significantly higher prevalence of dyslipidemia, hypertension, obesity, prior MI and prior coronary revascularization (p < 0.001). DM patients showed higher SYNTAX score value (19.8 vs. 15.1, p < 0.001) and a higher prevalence of left main involvement (6.3 vs. 3.1, p = 0.023). At Kaplan–Meier analysis, in the group without DM, patients with Lp(a)≥50 mg/dL showed a significantly lower long–term survival compared with those with Lp(a)<50 mg/dL (Log–Rank=0.004). In DM patients DM, conversely, no survival difference was found between patients with Lp(a)≥50 mg/dL vs. those with Lp(a)<50 mg/dL. At multivariable Cox regression analysis, in patients without DM, Lp(a) serum level (HR: 2.68, 95% CI 1.23–5.83; p = 0.013) and age (HR: 1.06, 95% CI 1.04–1.09; p < 0.001) were independent predictors of mortality at 3–year follow–up. Among DM patients, only age was independently associated with 3–year mortality (HR: 1.07, 95% CI 1.03–1.10; p < 0.001) (Table).
Conclusion
In this MI population, Lp(a) was independently associated with long–term mortality in patients without DM, but not in patients with DM. Whether DM can modify the effect of Lp(a) on clinical outcome after MI requires confirmation by larger prospective studies.
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Affiliation(s)
- F Cancro
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - C Baldi
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - A Silverio
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Di Maio
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - L Esposito
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Tedeschi
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Cristiano
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Sabatino
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - S Romei
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - C Vecchione
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - G Galasso
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
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Iuliano G, Silverio A, Bellino M, Esposito L, Di Feo F, Cristiano M, Radano I, Provenza G, Galasso G, Baldi C, Citro R. Negative prognostic impact of right ventricular free wall strain in patients with functional mitral regurgitation undergoing transcatheter edge-to-edge repair. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.247] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Backgrounds
although right ventricular (RV) systolic dysfunction seems to be associated with adverse outcome after transcatheter edge-to-edge mitral valve repair (TEER) with the MitraClip system, the prognostic value of RV free wall strain in this setting has not been yet investigated.
Purpose
aim of this study is to evaluate RV free wall strain as predictor of outcome in patients with severe or moderate-to-severe functional MR undergoing TEER and its prognostic role compared with tricuspid annular plane systolic excursion (TAPSE).
Methods
102 patients [73 (IQR 66.8-77.0) years, 73 males (71.6%)] were retrospectively selected from March 2012 to February 2021. Echocardiograms were performed by using General Electric machines. RV free wall strain was assessed through RV modified apical 4-chamber view, setting the region of interest to minimum size (Figure 1). Values of RV free wall strain >-20% were recognized as abnormal. We considered a composite endpoint including rehospitalization for heart failure (HF) and overall death as primary outcome. Secondary outcomes were overall death, cardiac death and rehospitalization for HF. All patients were assessed at the longest available follow-up [median 22.1 (IQR 9.7-49.3) months].
Results
primary outcome was found in 60 (58.8%) patients, while secondary outcomes, i.e. overall death, cardiac death and rehospitalization for HF, were found respectively in 50 (50.0%), 31 (30.4%) and 36 (35.3%) patients. Mean TAPSE was 16.7 ± 4.0 mm and mean RV free wall strain was -16.9 ± 6.0%. At univariable analysis both TAPSE (HR 0.907, CI 0.848-0.970, p value 0.004) and RV free wall strain (HR 0.937, CI 0.897-0.979, p value 0.004) were significantly associated with the primary outcome. Kaplan-Meier survival curves showed that patients with TAPSE <17 mm had a lower survival free from the composite outcome compared with those with TAPSE ≥17 mm (Log-Rank = 0.030); patients with RV free wall strain value > -20% also showed a lower survival free from the composite outcome compared with patients with RV free wall strain ≤-20% (Log Rank 0.004). Among patients with preserved RV systolic longitudinal function as indicated by TAPSE ≥17 mm, subjects with RV free wall strain >-20% had a significantly higher incidence of the composite outcome compare with those with RV free wall strain ≤-20% (Log-Rank = 0.008, Figure 2). Conversely, no difference was found among patients with TAPSE <17 mm.
Conclusions
RV dysfunction assessed either by TAPSE and RV free wall strain is associated with poorer outcome in patients with severe or moderate-to-severe functional MR undergoing TEER. Compared with TAPSE, RV free wall strain seems to be superior in identifying patients at higher risk of adverse events during follow-up. Our data encourage the use of this speckle tracking-derived echocardiographic parameter in routinely evaluation of patients with functional MR candidate for TEER. Abstract Figure. Abstract Figure 2
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Affiliation(s)
- G Iuliano
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - A Silverio
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - M Bellino
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - L Esposito
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - F Di Feo
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - M Cristiano
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - I Radano
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - G Provenza
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - G Galasso
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - C Baldi
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - R Citro
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
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Ferruzzi GJ, Peluso AP, Attisano T, Migliarino S, Vigorito F, Bellino M, Iuliano G, Silverio A, Provenza G, Cristiano M, Galasso G, Baldi C, Citro R. Mitral regurgitation and in-hospital mortality in patients with heart failure and low flow low gradient aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.249] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Aim
this study sought to determine the prevalence, clinical impact, and in-hospital outcome of moderate to severe mitral regurgitation (MR) in patients with low-flow, low-gradient aortic stenosis (LFLG-AS) hospitalized for heart failure (HF).
Methods
Patients with aortic valve thickness and aortic velocities >2.5 m/s hospitalized for heart failure in a single referral center were prospectively enrolled from 2013 to 2021.
LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient <40 mmHg and stroke volume index <36 ml/m2. Complete demographic, clinical characteristics and echocardiographic data were collected. Mitral regurgitation severity was graded according to current guidelines. Patients were divided into two subgroups according to MR severity: no/mild MR vs moderate/severe MR. In hospital all cause death has been considered as the primary outcome.
Results
A total of 136 patients (78 ± 9 yy; 68 (50%) male) hospitalized for HF with a new diagnosis of LFLG-AS were included in the study.
The most frequent comorbidities were hypertension (121, 89%), dyslipidemia (106, 78%), chronic kidney disease (85, 63%), diabetes (56, 41%) and obesity (44, 32%). Atrial fibrillation/flutter was detected in 61 (45%) patients. Moderate to severe MR was detected in 33%. Mean functional NYHA class was 2,8 ± 0,8.
Concerning echocardiographic evaluation, the mean gradient of the aortic valve was 26 ± 7 mmHg and the mean iAVA was 0.42 ± 0.10 cm2/m2. The mean left ventricular ejection fraction (LV EF) was 46 ± 13%. Paradoxical LFLG-AS with a preserved LV EF was detected in 73 patients (54%) and the LFLG-AS with a low LV EF was detected in 63 (46%).
In this population, 26 patients (19%) underwent surgical valvular replacement, 15 patients (11%) had aortic percutaneous valvuloplasty and 33 patients (24%) underwent TAVI. The remaining patients (45%, n = 62) were maintained under optimized medical therapy.
In-hospital death occurred in 17 (12,5%) patients (just 1 for non-cardiovascular causes).
Moderate/severe MR was detected in 44 (33%) patients.
When comparing the two subgroups statistically significant differences between age (p = 0,035), male sex (p = 0,028), atrial fibrillation/flutter (p = 0,003), obesity (p = 0,040) and in-hospital mortality (p = 0,013) were detected. In the overall population the multivariate regression analysis showed that only the presence of moderate /severe MR was a significant independent predictor of all-cause in-hospital death (p = 0.017 ; OR 3.571 ; IC 1.257-10.151).
Conclusion. Moderate to severe MR is frequently detected in patients with LFLG AS and HF. In this peculiar cohort significant MR has a negative impact on outcome and is independently associated with in-hospital mortality.
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Affiliation(s)
- GJ Ferruzzi
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - AP Peluso
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - T Attisano
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - S Migliarino
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - F Vigorito
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - M Bellino
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - G Iuliano
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - A Silverio
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - G Provenza
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - M Cristiano
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - G Galasso
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - C Baldi
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
| | - R Citro
- San Giovanni di Dio and Ruggi d"Aragona University Hospital, Salerno, Italy
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17
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Esposito L, Di Maio M, Silverio A, Cancro FP, Bellino M, Attisano T, Tarantino FF, Esposito G, Vecchione C, Galasso G, Baldi C. Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma. Front Cardiovasc Med 2022; 8:805727. [PMID: 35187112 PMCID: PMC8854288 DOI: 10.3389/fcvm.2021.805727] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Coronary artery ectasia (CAE) is defined as a diffuse or focal dilation of an epicardial coronary artery, which diameter exceeds by at least 1. 5 times the normal adjacent segment. The term ectasia refers to a diffuse dilation, involving more than 50% of the length of the vessel, while the term aneurysm defines a focal vessel dilation. CAE is a relatively uncommon angiographic finding and its prevalence ranges between 0.3 and 5% of patients undergoing coronary angiography. Although its pathophysiology is still unclear, atherosclerosis seems to be the underlying mechanism in most cases. The prognostic role of CAE is also controversial, but previous studies reported a high risk of cardiovascular events and mortality in these patients after percutaneous coronary intervention. Despite the availability of different options for the interventional management of patients with CAE, including covered stent implantation and stent-assisted coil embolization, there is no one standard approach, as therapy is tailored to the individual patient. The abnormal coronary dilation, often associated with high thrombus burden in the setting of acute coronary syndromes, makes the interventional treatment of CAE patients challenging and often complicated by distal thrombus embolization and stent malapposition. Moreover, the optimal antithrombotic therapy is debated and includes dual antiplatelet therapy, anticoagulation, or a combination of them. In this review we aimed to provide an overview of the pathophysiology, classification, clinical presentation, natural history, and management of patients with CAE, with a focus on the challenges for both clinical and interventional cardiologists in daily clinical practice.
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Affiliation(s)
- Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- *Correspondence: Luca Esposito
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Tiziana Attisano
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Vascular Pathophysiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
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18
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Peluso AP, Ferruzzi GJ, Attisano T, Migliarino S, Vigorito F, Bellino M, Iuliano G, Silverio A, Cristiano M, Provenza G, Baldi C, Ciccarelli M, Galasso G, Vecchione C, Citro R. 535 Right ventricular dysfunction is independent predictor of in-hospital mortality in patients with low flow low gradient aortic stenosis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.013] [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
Aim of the study is to assess the prevalence and in-hospital death in patients with low flow low gradient aortic stenosis (LFLG-AS) and right ventricular dysfunction (RVD) hospitalized for heart failure in a single referral centre.
Methods and results
Complete demographic, clinical characteristics, and imaging data were collected. Patients with LFLG AS hospitalized for heart failure were prospectively enrolled from 2013 to 2021. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient < 40 mmHg, and stroke volume index <36 ml/m2. RVD was defined as tricuspid annular plane systolic excursion (TAPSE) < 16 mm at baseline in apical four chamber view according to current guidelines. Patients were divided into two subgroups according to the presence or absence of RVD. In hospitals all cause death has been considered as the primary outcome. A total of 130 patients [78 ± 10 yy; 67 (51%) male] with new diagnosis of LF-LG AS were included in the study. The most frequent comorbidities were hypertension (88.5%; n = 114), dyslipidaemia (74%; n = 96), and diabetes (38%; n = 49). Concomitant coronary artery disease and history of stroke were reported in 19% (n = 24) and 9% (n = 11), respectively. Society of thoracic surgeons score in overall population was 12.6 ± 4.5. Regarding echocardiographic evaluation, the mean transaortic gradient was 25.81 ± 7.42 mmHg and the mean iAVA was 0.42 ± 0.10 cm/m2. The mean left ventricular ejection fraction (LV EF) was 46 ± 13%. LFLG AS with a preserved LV EF was detected in 69 patients (53%) and the LFLG AS with a low LV EF was detected in 61 patients (47%). 26 patients (20%) underwent surgical valve replacement, 14 patients (11%) had aortic percutaneous valvuloplasty and 31 patients (24%) underwent TAVI. The remaining patients (45%, n = 59) were maintained under optimized medical therapy. In-hospital death occurred in 16 patients. When compared patients with RVD with those without a higher prevalence of atrial fibrillation/flutter (n = 21, 36%; P = 0.042) and in hospital death was observed (n = 8; 28%; n = 8, 8%; P = 0.026). In the overall population at multivariate regression analysis only RVD was a significant independent predictor of all-cause in-hospital death (P = 0.028; OR: 3.44; CI: 1.146–10.334).
Conclusions
RVD can be detected in more than one quarter of patient with new diagnosis of LFLG AS and is an independent predictor of all-cause in-hospital death. Quantification of right ventricular systolic function in these complex population give important information in identifying patients and higher risk requiring more aggressive therapy.
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Affiliation(s)
| | | | - Tiziana Attisano
- Cardio-Thoracic-Vascular-Department, University Hospital ‘San Giovanni di Dio e Ruggi D’Aragona’, Italy
| | | | - Francesco Vigorito
- Cardio-Thoracic-Vascular-Department, University Hospital ‘San Giovanni di Dio e Ruggi D’Aragona’, Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Giuseppe Iuliano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Mario Cristiano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Gennaro Provenza
- Cardio-Thoracic-Vascular-Department, University Hospital ‘San Giovanni di Dio e Ruggi D’Aragona’, Italy
| | - Cesare Baldi
- Cardio-Thoracic-Vascular-Department, University Hospital ‘San Giovanni di Dio e Ruggi D’Aragona’, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular-Department, University Hospital ‘San Giovanni di Dio e Ruggi D’Aragona’, Italy
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19
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Iuliano G, Silverio A, Baldi C, Bellino M, Esposito L, Di Feo F, Cristiano M, Radano I, Maiellaro F, Provenza G, Ciccarelli M, Galasso G, Vecchione C, Citro R. 490 Right ventricular free wall longitudinal strain negatively impacts prognosis of patients with functional mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Although right ventricular (RV) systolic dysfunction seems to be associated with adverse outcome after transcatheter edge-to-edge mitral valve repair (TEER) with the MitraClip system, the prognostic value of RV free wall longitudinal strain (RVFWLS) in this setting has not been yet investigated. The aim of this study is to evaluate RVFWLS as predictor of outcome in patients with severe or moderate-to-severe functional MR undergoing TEER and its prognostic role compared with tricuspid annular plane systolic excursion (TAPSE).
Methods and results
102 patients [73 (IQR: 66.8–77.0) years, 73 males (71.6%)] were retrospectively selected from March 2012 to February 2021. Echocardiograms were performed by using General Electric machines. RVFWLS was assessed through RV modified apical 4-chamber view, setting the region of interest to minimum size. Values of RVFWLS > −20% were recognized as abnormal. We considered a composite endpoint including rehospitalization for heart failure (HF) and overall death as primary outcome. Secondary outcomes were overall death, cardiac death and rehospitalization for HF. All patients were assessed at the longest available follow-up [median 22.1 (IQR: 9.7–49.3) months]. Baseline clinical and echocardiographic characteristics are listed in Table 1. Primary outcome was found in 60 (58.8%) patients, while secondary outcomes, i.e. overall death, cardiac death and rehospitalization for HF, were found respectively in 50 (50.0%), 31 (30.4%), and 36 (35.3%) patients. Mean TAPSE was 16.7 ± 4.0 mm and mean RVFWLS was −16.9 ± 6.0%. At univariable analysis both TAPSE (HR: 0.907, CI: 0.848–0.970, P-value: 0.004) and RVFWLS (HR: 0.937, CI: 0.897–0.979, P-value: 0.004) were significantly associated with the primary outcome. Kaplan–Meier survival curves showed that patients with TAPSE <17 mm had a lower survival free from the composite outcome compared with those with TAPSE ≥17 mm (Log-Rank = 0.030); patients with RVFWLS value > −20% also showed a lower survival free from the composite outcome compared with patients with RVFWLS ≤ −20% (Log Rank 0.004). Among patients with preserved RV systolic longitudinal function as indicated by TAPSE ≥ 17 mm, subjects with RVFWLS > −20% had a significantly higher incidence of the composite outcome compare with those with RVFWLS ≤ −20% (Log-Rank = 0.008). Conversely, no difference was found among patients with TAPSE <17 mm.
Conclusions
RV dysfunction assessed either by TAPSE and RVFWLS is associated with poorer outcome in patients with severe or moderate-to-severe functional MR undergoing TEER. Compared with TAPSE, RVFWLS seems to be superior in identifying patients at higher risk of adverse events during follow-up. Our data encourage the use of this speckle tracking-derived echocardiographic parameter in routinely evaluation of patients with functional MR candidate for TEER.
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Affiliation(s)
- Giuseppe Iuliano
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Angelo Silverio
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Cesare Baldi
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Michele Bellino
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Luca Esposito
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Federica Di Feo
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Mario Cristiano
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Ilaria Radano
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Francesco Maiellaro
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Gennaro Provenza
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Michele Ciccarelli
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Gennaro Galasso
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Carmine Vecchione
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Rodolfo Citro
- Dipartimento Cardio-Toraco-Vascolare, A.O.U. San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
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20
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Ferruzzi GJ, Peluso AP, Attisano T, Migliarino S, Vigorito F, Bellino M, Iuliano G, Silverio A, Provenza G, Cristiano M, Baldi C, Ciccarelli M, Galasso G, Vecchione C, Citro R. 454 Mitral regurgitation and in-hospital mortality in patients with heart failure and low flow low gradient aortic stenosis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.011] [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
This study sought to determine the prevalence, clinical impact, and in-hospital outcome of moderate to severe mitral regurgitation (MR) in patients with low-flow, low-gradient aortic stenosis (LFLG-AS) hospitalized for heart failure (HF).
Methods and results
Patients with aortic valve thickness and aortic velocities >2.5 m/s hospitalized for heart failure in a single referral centre were prospectively enrolled from 2013 to 2021. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient <40 mmHg, and stroke volume index <36 ml/m2. Complete demographic, clinical characteristics, and echocardiographic data were collected. Mitral regurgitation severity was graded according to current guidelines. Patients were divided into two subgroups according to MR severity: no/mild MR vs. moderate/severe MR. In hospital all cause death has been considered as the primary outcome. A total of 136 patients [78 ± 9 yy; 68 (50%) male] hospitalized for HF with a new diagnosis of LFLG-AS were included in the study. The most frequent comorbidities were hypertension (121, 89%), dyslipidemia (106, 78%), chronic kidney disease (85, 63%), diabetes (56, 41%), and obesity (44, 32%). Atrial fibrillation/flutter was detected in 61 (45%) patients. Moderate to severe MR was detected in 33%. Mean functional NYHA class was 2.8 ± 0.8. Concerning echocardiographic evaluation, the mean gradient of the aortic valve was 26 ± 7 mmHg and the mean iAVA was 0.42 ± 0.10 cm2/m2. The mean left ventricular ejection fraction (LV EF) was 46 ± 13%. Paradoxical LFLG-AS with a preserved LV EF was detected in 73 patients (54%) and the LFLG-AS with a low LV EF was detected in 63 (46%). In this population, 26 patients (19%) underwent surgical valvular replacement, 15 patients (11%) had aortic percutaneous valvuloplasty, and 33 patients (24%) underwent TAVI. The remaining patients (45%, n = 62) were maintained under optimized medical therapy. In-hospital death occurred in 17 (12.5%) patients (just 1 for non-cardiovascular causes). Moderate/severe MR was detected in 44 (33%) patients. When comparing the two subgroups statistically significant differences between age (P = 0.035), male sex (P = 0.028), atrial fibrillation/flutter (P = 0.003), obesity (P = 0.040), and in-hospital mortality (P = 0.013) were detected. In the overall population the multivariate regression analysis showed that only the presence of moderate/severe MR was a significant independent predictor of all-cause in-hospital death (P = 0.017; OR: 3.571; CI: 1.257–10.151).
Conclusions
Moderate to severe MR is frequently detected in patients with LFLG AS and HF. In this peculiar cohort significant MR has a negative impact on outcome and is independently associated with in-hospital mortality.
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Affiliation(s)
| | | | - Tiziana Attisano
- Cardio-Thoracic-Vascular Department, University Hospital ‘San Giovanni di Dio E Ruggi D’Aragona’, Italy
| | | | - Francesco Vigorito
- Cardio-Thoracic-Vascular Department, University Hospital ‘San Giovanni di Dio E Ruggi D’Aragona’, Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Giuseppe Iuliano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Gennaro Provenza
- Cardio-Thoracic-Vascular Department, University Hospital ‘San Giovanni di Dio E Ruggi D’Aragona’, Italy
| | - Mario Cristiano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Cesare Baldi
- Cardio-Thoracic-Vascular Department, University Hospital ‘San Giovanni di Dio E Ruggi D’Aragona’, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital ‘San Giovanni di Dio E Ruggi D’Aragona’, Italy
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21
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Pizzuto A, Santoro G, Baldi C, Celi S, Cuman M, Anees AJ, Berti S, Gasparotti E, Capellini K, Clemente A. 3D model-guided transcatheter closure of left ventricular pseudoaneurysm: a case series. J Cardiovasc Med (Hagerstown) 2021; 22:e1-e7. [PMID: 32941328 DOI: 10.2459/jcm.0000000000001114] [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: 11/05/2022]
Abstract
Left ventricular pseudoaneurysm (LVPsA) is a rare complication of myocardial infarction, cardiac surgery, chest trauma, infection or transcatheter interventions. It may cause arrhythmias, mass effect, thromboembolism and life-threatening rupture. The transcatheter approach is nowadays considered a cost-effective alternative to surgery. In this setting, 3D printing could be an emerging, powerful tool to plan transcatheter closure and choose the best occluding device. This study reports on three cases of complex LVPsA successfully treated by transcatheter device implantation guided by printed 3D heart models.
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Affiliation(s)
- Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Cardiology, National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa
| | - Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Cardiology, National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa
| | - Cesare Baldi
- Invasive Cardiology, 'S. Giovanni di Dio e Ruggi D'Aragona' Hospital, University of Salerno, Salerno
| | | | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Cardiology, National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa
| | | | | | | | | | - Alberto Clemente
- Radio-diagnostic Unit, National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa, Italy
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22
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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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23
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Giordano A, Ferraro P, Finizio F, Biondi-Zoccai G, Denti P, Bedogni F, Rubbio AP, Petronio AS, Bartorelli AL, Mongiardo A, Giordano S, DE Felice F, Adamo M, Montorfano M, Baldi C, Tarantini G, Giannini F, Ronco F, Monteforte I, Villa E, Ferrario M, Fiocca L, Castriota F, Tamburino C. Implantation of one, two or multiple MitraClips for transcatheter mitral valve repair: insights from a 1824-patient multicenter study. Panminerva Med 2021; 64:1-8. [PMID: 34309332 DOI: 10.23736/s0031-0808.21.04497-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) with the MitraClip device is an established treatment for mitral regurgitation (MR). More than one MitraClip may be implanted if a single one does not reduce MR adequately. We aimed at appraising the outlook of patients undergoing implantation of one, two or multiple MitraClips for TMVR. METHODS Exploiting the ongoing prospective GIse registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) Study dataset, we compared patients, procedural details and outcomes distinguishing those receiving one, two or multiple MitraClips. The primary endpoint was the composite of 1-year cardiac death or rehospitalization for heart failure. Additional endpoints included all cause death, surgical mitral repair, and functional class. Multivariable adjusted Cox proportional hazard analysis was used for confirmatory purposes. RESULTS As many as 1824 patients were included: 718 (39.4%) treated with a single MitraClip, and 940 (51.5%) receiving two MitraClips, and 166 (9.1%) receiving three or more. Significant differences were found for baseline features, including age, female gender, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, atrial fibrillation, permanent pacemaker, cardiac resynchronization therapy, implantable cardioverter defibrillator, and prior mitral valve repair (all p<0.05). Several imaging features were also different, including left ventricular dimensions, MR severity and proportionality, mitral valve area, flail leaflet, and pulmonary vein flow (all p<0.05). Among procedural features, significant differences were found for anesthesia type, MitraClip type, fluoroscopy, device, and operating room times, postprocedural mitral gradient, residual MR, smoke-like effect, device success partial detachment and surgical conversion (all p<0.05). In-hospital death occurred more frequently in patients receiving multiple MitraClips, and the same applied severe residual MR (all p<0.05). Mid-term follow-up (15±13 months) showed significant difference in the risk of death, cardiac death, rehospitalization for heart failure, and their composites, mainly, but not solely, associated with multiple MitraClips (all p<0.05). Adjusted analysis confirmed the significantly increased risk of composite adverse events when comparing the multiple vs single MitraClip groups (p=0.014 for death and rehospitalization, p=0.013 for cardiac death or rehospitalization). CONCLUSIONS Implantation of one or two MitraClips is associated with favorable clinical outcomes. Conversely, bail-out implantation of three or more MitraClips may portend a worse long-term prognosis.
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Affiliation(s)
- Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Paolo Ferraro
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Napoli, Italy
| | - Filippo Finizio
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio P Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anna S Petronio
- Cardiothoracic and Vascular Department, University Hospital Pisa, Pisa, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco DE Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Cesare Baldi
- Heart Department, University Hospital Scuola Medica Salernitana, Salerno, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Federico Ronco
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Ida Monteforte
- Divisione di Cardiologia, A.O. dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Emmanuel Villa
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Luigi Fiocca
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Castriota
- Cardiovascular Department of Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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D’alessandro R, Garcia Gonzales E, Falsetti P, Baldi C, Bellisai F, Selvi E, Frediani B. AB0450 PERIPHERAL MACROVASCULAR INVOLVEMENT IN SYSTEMIC SCLEROSIS AS COMPARED WITH HEALTHY CONTROLS: A SMALL COHORT STUDY BY COLOR AND SPECTRAL DOPPLER ULTRASONOGRAPHY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Together with autoimmune-inflammation and fibrosis, microvasculopathy is a hallmark of SSc. However, also macrovascular changes may occur including peripheral proliferative vasculopathy. Whether this changes may represent a specific SSc marker with a predictive value remains a matter of debate.[1,2,3]Objectives:To study peripheral macrovascular involvement by color doppler ultrasound (CDUS) with spectral wave analysis (SWA) in a cohort of 40 SSc patients as compared to healthy controls. To further analyze any differences among the SSc population.Methods:Forty SSc patients and 36 healthy controls were examined by CDUS with SWA of both hands. Macrovascular involvement was assessed by measuring the resistivity index (RI) of distal ulnar and radial arteries. Examinations were performed with an Esaote MyLab Twice machine equipped with a linear 10-22 MHz probe. Ultrasound examination was carried out by two independent rheumatologists blinded to clinical conditions of the patients. Statistical analysis was performed by using MaxStat software.Results:The RI index resulted increased in the SSc cohort as compared with healthy controls (left ulnar RI 0.977 vs 0.715; right ulnar RI 0.996 vs 0.699; left radial RI 0.988 vs 0.706; right radial RI 0.999 vs 0.688; p<0.001). SSc patients with an increased RI in one artery were more probable to have an increased RI in the other vessels too (r 2 = 0.35; p<0.01). In addition, 8 out of 40 SSc patients presented left ulnar artery occlusion (UAO) and 7 out of 40 SSc patients presented right UAO, of which 6 presented bilateral UAO. Awaiting to enlarge the cohort for further analysis, descriptive data regarding increased RI at CDUS/SWA and clinical features, including years from onset of the disease, subtype of SSc, mRSS, history of digital ulcers, interstitial lung disease and PAH are described in Table 1.Conclusion:Peripheral macrovascular involvement was observed in SSc patients as compared with healthy controls. Further studies will determine whether this feature may have specificity for diagnosis/prognosis in SSc.References:[1]Lescoat A, Yelnik CM, Coiffier G et al. Ulnar Artery Occlusion and Severity Markers of Vasculopathy in Systemic Sclerosis: A Multicenter Cross-Sectional Study. Arthritis Rheumatol. 2019;71:983-990.[2]Lescoat A, Coiffier G, Rouil A et al. Vascular Evaluation of the Hand by Power Doppler Ultrasonography and New Predictive Markers of Ischemic Digital Ulcers in Systemic Sclerosis: Results of a Prospective Pilot Study. Arthritis Care Res (Hoboken). 2017;69:543-551.[3]Schioppo T, Orenti A, Boracchi P, De Lucia O, Murgo A, Ingegnoli F. Evidence of macro- and micro-angiopathy in scleroderma: An integrated approach combining 22-MHz power Doppler ultrasonography and video-capillaroscopy. Microvasc Res. 2019;122:125-130.Table 1.Main clinical features of the SSc cohort (n=40) studied by CDUS for macrovascular involvement.SSc cohort (n = 40)Years from onsetrange (35 y – 0 y)mean = 10.5 yAutoantibodiesACA 13/40Anti-TopoI 14/40Other 13/40mRSSrange (0 -30)mean = 3ILD17/40PAH7/40Capillaroscopy patternEarly 10/40Active 11/40Late 6/40History of digital ulcers16/40Left ulnar IR0.977Left radial IR0.988Right ulnar IR0.996Right radial IR0.999Disclosure of Interests:None declared.
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Conticini E, Falsetti P, Al Khayyat SG, Baldi C, Bellisai F, Bardelli M, Cantarini L, Frediani B. POS0832 A NOVEL GREY SCALE AND POWER DOPPLER ULTRASONOGRAPHIC SCORE FOR IDIOPATHIC INFLAMMATORY MYOPATHIES: SIENA MYOSITIS ULTRASOUND GRADING SCALE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:No clear-cut guidelines exist about the use of diagnostic procedures for idiopathic inflammatory myopathies (IIM) and only scanty and conflicting data report the use of ultrasound (US).Objectives:We aimed to assess if grey-scale (GS) and Power Doppler (PD) US, graded with a 0-3-points-scale, may be a reliable tool in a cohort of patients affected by IIM.Methods:We prospectively collected, since July to October 2020, all patients referred to Vasculitis and Myositis clinic, Rheumatology Unit, University of Siena, for suspected IIM, as well as patients with a previous, definite diagnosis of IIM and evaluated during follow-up or referred from other centers for a second opinion. All patients underwent US examination of both thighs in axial and longitudinal scans. Edema and atrophy, both assessed in GS, and PD, were graded with a 0-3-points-scale. Spearman test was used to identify the correlations between US and clinical and serological variables.Results:A total of 18 patients was included. Four of them were evaluated twice, at baseline and within 3 months of therapy. Muscle edema was found to be directly correlated with physician global assessment (PhGA), serum myoglobin and PD and negatively with disease duration. PD score was positively correlated to PhGA and negatively to disease duration. Muscle atrophy directly correlated with Myositis Damage Index and patients’ age. The single-thigh sub-analysis evidenced a direct correlation between PD score and Manual Muscle Test.Conclusion:In our cohort, we found that edema and PD are strictly related to early, active myositis, suggesting that an inflamed muscle should appear swollen, thickened and with Doppler signal. Conversely, muscle atrophy reflects the age of the patient and the overall severity of the disease. Such findings shed a new, promising, light in the role of US in diagnosis and monitoring of IIMs.Table 1.Siena Myositis Ultrasound Grading Scale (SMUGS).Grey-scale edemaGrey-scale atrophyPower Doppler0Normal muscle echotexture with hyperechoic septa and hypoechoic muscle fibers, conserved thickness.Normal muscle echotexture, with hyperechoic septa and hypoechoic muscle fibers, conserved thickness.No PD signal.1Focal hypoechoic areas, where septa are less evident. Conserved thickness.Focal heterogeneously hyperechoic areas, where septa are thicker and more evident, and muscle fibers are thinner. Conserved muscle thickness.One or two PD signals in at least one muscle (PD vascular spots, small vessels of homogenous diameters, vessel diameters approximately not superior to fibrous intramuscular septa)2Diffuse and heterogeneous hypo echogenicity (rectus femoris as hypoechoic or more than vastus intermedius), septa diffusely less evident. Conserved thickness.Diffuse and heterogeneously hyperechoic muscle, with thicker septa and thinner muscle fibers. Conserved muscle thickness.More than 2 PD signals for each muscle (as vascular spots, small vessels of homogenous diameters, vessel diameters approximately not superior to fibrous intramuscular septa).3Diffuse and heterogeneous hypo echogenicity (rectus femoris as hypoechoic or more than vastus intermedius), septa diffusely less evident. Increased thickness (rectus femoris became thicker than vastus intermedius).Diffuse and heterogeneously hyperechoic muscle, with thicker septa and thinner muscle fibers. Reduced muscle thickness.More than 2 PD signals for each muscle with larger diameter of the vessel (at least superior to fibrous intramuscular septa), or vessels with different diameters or branched vessels.Figure 1.Different PD findings (clockwise) in longitudinal anterior scans of the thigh: PD 3 in a patient with a recent diagnosis of anti-Mi2 DM; PD 2 in the same patient after one month of treatment with steroids and Methotrexate; PD 1 in a patient affected by anti-SAE DM, with a suspected disease flare; PD 0 in a patient affected by an advanced polymyositis diagnosed in 2000, currently not in treatment.Disclosure of Interests:None declared
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Falsetti P, Conticini E, Baldi C, Bardelli M, D’alessandro R, Al Khayyat SG, Mazzei MA, Cantarini L, Frediani B. POS0963 POWER AND SPECTRAL DOPPLER ULTRASOUND AS A SCREENING TOOL IN THE DIAGNOSTIC COURSE OF SUSPECTED AXIAL SPONDYLOARTHRITIS: PRELIMINARY DATA FROM A LARGE MONOCENTRIC COHORT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Sacroiliac joints (SIJs) involvement is a characteristic feature of Spondylarthritis (SpA). Magnetic resonance imaging (MRI) has been included in the new Assessment of SpA International Society (ASAS) criteria for the classification of non-radiographic axial SpA. Power Doppler ultrasound (PDUS) and spectral Doppler US have been used in few works, also from our group, to evaluate the inflammatory activity of the SIJs, in comparison with MRI, with different results.Objectives:We aimed to evaluate the value of PDUS with spectral wave analysis (SWA) in the assessment of suspected active sacroiliitis (SI). PDUS of SIJs was used as a screening tool alongside the routine PDUS assessment of peripheral joints.Methods:143 patients (114 females and 29 males, mean age 46,2 years, mean BMI 25.9) with new onset of inflammatory back pain (IBP), were included. Peripheral symptoms were allowed. Every patient underwent a PDUS examination of SIJs as previously reported. The sonographer was blinded to the clinical data. An Esaote Twice US machine, with convex 1-8 MHz and linear 6-18 MHz probes, was used, with standardized parameters. PD signals detected in the SIJs, were scored with a 3-points scale: 0= absence of signals, 1= isolate vessels, 2= more than one vessel. The signals were also classified as intra-articular (vascularity from deep joint and inter-osseous ligament) or peri-articular (vascularity along posterior sacroiliac ligament). SWA was applied to the same vessels calculating the Resistive Index (RI) (Figure 1). A PDUS diagnosis of active SI was made with a grade 1 of vascularity and RI<0,60, or grade 2 of vascularity and RI<0,70. PDUS multi-site examination of peripheral joints and entheses was also performed; entheseal involvement was scored with Belgrade Ultrasound Enthesitis Score (BUSES) and as global enthesitic charge (GEC). Every patient underwent MRI of SIJs within 2 weeks, and before to start pharmacologic treatment. The non-parametric Spearman rank test and univariate linear regression analysis was applied using InStat GraphPad statistical package.Results:A time of 5-8 minutes was sufficient to set and to complete PDUS/SWA examination on both SJJs. All patients considered this examination quick, not painful and substantially comfortable. PD signals were detected in 124 patients (mean RI 0,56). Bone marrow edema (BME) lesions (active SI on MRI) were detected in 94 patients. A final diagnosis of SpA was made in 103 patients (81 females, 22 males). Among SpA patients 24 had psoriasis, 3 inflammatory bowel disease, 3 uveitis, 5 were B27+, and they had mean BUSES of 4,1 and GEC of 1,2. The mean SIJs PDUS score was 1,3 in SpA and 0,52 in not-SpA patients. The mean SIJs RI was 0,53 in SpA and 0,68 in not-SpA patients. A significant correlation was demonstrated between MRI and PDUS diagnosis of SI (r=0,6486, p<0,0001), between MRI diagnosis and PD grading (r=0,4937, p<0,0001). The split analysis of peculiar parameters of imaging between the two methods also showed significant correlation: periarticular vascularity showed correlation with post-contrast MRI evidence of posterior capsulitis and enthesitis (p=0,001), as SIJs BME correlated with intra-articular PD signals (p<0,001). RI from SWA analysis was inversely correlated with MRI diagnosis of active SI (p<0.0001). SIJs PD demonstrated a significant correlation with SIJs pain (p<0,001), but not with inflammatory reactants, GEC, peripheral synovitis, and a weak correlation with BUSES (p=0,038).Conclusion:SIJs PDUS/SWA may be an optional method for preliminary screening of active SI, as a feasible, cheap and an accurate diagnostic tool, compared with MRI as a gold standard for nr-Axial SpA. PD US in SI. Right SI joint with a PD signal within inter-osseous ligament (curved arrow), where spectral PD analysis shows a RI of 0,62. Normal vessels (with high RI, unshowed) can be observed into the first sacral foramen (arrowhead). The first sacral apophysis (arrow) protrudes from the sacrum profile.Disclosure of Interests:None declared.
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Baldi C, Falsetti P, Conticini E, Khayyat SG, Bardelli M, Gentileschi S, Cantarini L, Frediani B. POS0661 RAPID RESPONSE TO BARICITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS AND AN INADEQUATE RESPONSE TO METHOTREXATE AND AT LEAST ONE BIOLOGIC DMARD: A CLINICAL AND POWER DOPPLER ULTRASOUND STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Baricitinib, an oral Janus kinase (JAK) 1-2 inhibitor, is currently used among biologic DMARDs (bDMARDs) after the failure of methotrexate (MTX) in rheumatoid arthritis (RA). Power Doppler ultrasound (PDUS) is a promising, non-invasive imaging method to assess synovitis in RA: results from numerous studies suggest that it provides additional information to clinical and conventional radiographic examinations.Objectives:The main objective of our study was to evaluate short-term efficacy of Baricitinib in reducing synovitis, using the composite semi quantitative scale (0–3 grades) PDUS synovitis score, developed by the Outcome Measures in Rheumatology– European League Against Rheumatism (OMERACT– EULAR)-Ultrasound Task Force. Moreover both synovial hyperplasia and intrasynovial power Doppler (PD) signal were also scored as single components/parameters on 0-3 scales. Secondary objective was to assess the concordance between patient reported outcomes (PROs), markers of inflammation, physical examination and US.Methods:We enrolled 30 patients fulfilling 2010 ACR and EULAR criteria for RA. All patients had failed at least one anti-TNF. Each patient was prescribed Baricitinib 4 mg/daily at T0, in addition to MTX and/or oral steroids at a dosage ≤ 7, 5 mg/day of Prednisone or equivalent, at T’. All patients were evaluated at baseline (T0) and then after one month (T1), 3 months (T2) and 6 months (T3) of treatment. Swollen and tender joints (out of 28)were evaluated and recorded, as well as patient (PGA) and physician global assessment (PhGA) and pain, expressed in a visual analog scale (VAS). Disease activity was evaluated at each visit using DAS28 (Disease activity score 28), CDAI (Clinical disease activity index)and SDAI(Simplified disease activity index), accompanied by a complete blood count, Erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) collection. Statistical analysis was performed using GraphPad version 9.0.0. PDUS examination, was carried out by two rheumatologists (PF and CB) blinded to clinical conditions of the patients, using an Esaote Mylab Twice (Genoa, Italy), equipped with a high-frequency (6-18 MHz) linear probe. With standardised Doppler parameters (pulse repetition frequency between 500-750 Hz; Doppler frequency between 7–11.1 MHz). PDUS was performed at each visit bilaterally for 22 joint sites [MCPs 1–5, proximal interphalangeal joints (PIPs) 1–5, wrist, elbow, glenohumeral, knee, tibiotalar, talonavicular and calcaneocuboidal and metatarsophalangeal joints (MTPs) 1–5] for a total of 44 joints for each patient.Results:we observed a reduction of VAS pain (T0 vs, T6<0,0001) PDUS composite score (T0 vs. T6 p<0,0001), Power Doppler (T0 vs. T6 p<0,0001) synovial hyperplasia (T0 vs. T6 p=0,0002), CRP (T0 vs. T6 p<0,0001) and ESR (T0 vs. T6 p <0,0001) was observed in our patients. Accordingly, DAS-28, CDAI and SDAI displayed a significant reduction too (DAS-28: T0 vs. T6 p< 0, 0001; CDAI: T0 vs. T6 p< <0, 0001; SDAI: T0 vs. T6 p= 0, 0003).Conclusion:We investigated the efficacy of Baricitinib in real life, evaluating both from a clinimetric and ultrasound point of view. Baricitinib, demonstrated a significant parallel and fast improvement in VAS, PDUS and CRP was found at follow up assessment as early as one month of therapy. In conclusion, these results demonstrated the short term efficacy of Baricitinib 4mg for up to 6 months and providing a prompt improvement of PROs within the first weeks of treatment.Figure 1.The difference between the means of PD and of the VAS pain over time (T0, T1, T3 and T6). Power Doppler (T0 vs. T6** p<0,0001), VAS: (T0 vs. T1 *p<0,0098;T0 vs. T3 **** p<0,0001; T0 vs. T6 ****p<0,0001)Disclosure of Interests:None declared
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Baldi C, Silverio A, Esposito L, Di Maio M, Tarantino F, De Angelis E, Fierro G, Attisano T, Di Muro MR, Maione A, Pierri A, Vigorito F, Vecchione C, Galasso G. Clinical outcome of patients with ST-elevation myocardial infarction and angiographic evidence of coronary artery ectasia. Catheter Cardiovasc Interv 2021; 99:340-347. [PMID: 33949766 DOI: 10.1002/ccd.29738] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/08/2021] [Accepted: 04/15/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The aim of this study was to describe the prevalence of coronary artery ectasia (CAE) in patients with ST-elevation myocardial infarction (STEMI) and to compare the long-term outcome of subjects with and without CAE undergoing emergent coronary angiography. BACKGROUND The prognostic impact of CAE in STEMI patients has been poorly investigated. METHODS This retrospective, single-center, study included consecutive patients with STEMI undergoing emergent coronary angiography from January 2012 to December 2017. The primary endpoint was the assessment of recurrent myocardial infarction (MI) in patients with versus those without CAE at the longest available follow-up. The propensity score weighting technique was employed to account for potential selection bias between groups. RESULTS From 1,674 patients with STEMI, 154 (9.2%) had an angiographic evidence of CAE; 380 patients were included in the no CAE group. CAE patients were more often males and smokers, and showed a lower prevalence of diabetes than no CAE patients. After percutaneous coronary intervention, the corrected thrombolysis in MI frame count (p < .001) and the myocardial blush grade (p < .001) were significantly lower in CAE than in no CAE patients. The mean follow-up was 1,218.3 ± 574.8 days. The adjusted risk for the primary outcome resulted significantly higher in patients with CAE compared to those without (adjusted HR: 1.84; p = .017). No differences in terms of all-cause and cardiac death were found between groups. CONCLUSIONS In this study, STEMI patients with CAE had a distinct clinical and angiographic profile, and showed a significantly higher risk of recurrent MI than those without CAE.
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Affiliation(s)
- Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Luca Esposito
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Fabio Tarantino
- Cath Lab Unit, Cardiovascular Department, Morgagni Hospital, Vecchiazzano-Forlì, Italy
| | - Elena De Angelis
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Giuseppe Fierro
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Tiziana Attisano
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Michele Roberto Di Muro
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Antongiulio Maione
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Adele Pierri
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Francesco Vigorito
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy.,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
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Silverio A, Di Maio M, Citro R, Esposito L, Iuliano G, Bellino M, Baldi C, De Luca G, Ciccarelli M, Vecchione C, Galasso G. Cardiovascular risk factors and mortality in hospitalized patients with COVID-19: systematic review and meta-analysis of 45 studies and 18,300 patients. BMC Cardiovasc Disord 2021; 21:23. [PMID: 33413093 PMCID: PMC7789083 DOI: 10.1186/s12872-020-01816-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A high prevalence of cardiovascular risk factors including age, male sex, hypertension, diabetes, and tobacco use, has been reported in patients with Coronavirus disease 2019 (COVID-19) who experienced adverse outcome. The aim of this study was to investigate the relationship between cardiovascular risk factors and in-hospital mortality in patients with COVID-19. METHODS MEDLINE, Cochrane, Web of Sciences, and SCOPUS were searched for retrospective or prospective observational studies reporting data on cardiovascular risk factors and in-hospital mortality in patients with COVID-19. Univariable and multivariable age-adjusted analyses were conducted to evaluate the association between cardiovascular risk factors and the occurrence of in-hospital death. RESULTS The analysis included 45 studies enrolling 18,300 patients. The pooled estimate of in-hospital mortality was 12% (95% CI 9-15%). The univariable meta-regression analysis showed a significant association between age (coefficient: 1.06; 95% CI 1.04-1.09; p < 0.001), diabetes (coefficient: 1.04; 95% CI 1.02-1.07; p < 0.001) and hypertension (coefficient: 1.01; 95% CI 1.01-1.03; p = 0.013) with in-hospital death. Male sex and smoking did not significantly affect mortality. At multivariable age-adjusted meta-regression analysis, diabetes was significantly associated with in-hospital mortality (coefficient: 1.02; 95% CI 1.01-1.05; p = 0.043); conversely, hypertension was no longer significant after adjustment for age (coefficient: 1.00; 95% CI 0.99-1.01; p = 0.820). A significant association between age and in-hospital mortality was confirmed in all multivariable models. CONCLUSIONS This meta-analysis suggests that older age and diabetes are associated with higher risk of in-hospital mortality in patients infected by SARS-CoV-2. Conversely, male sex, hypertension, and smoking did not independently correlate with fatal outcome.
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Affiliation(s)
- Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Rodolfo Citro
- Division of Cardiology, Cardiovascular and Thoracic Department, University Hospital ''San Giovanni di Dio e Ruggi d'Aragona'', Salerno, Italy
| | - Luca Esposito
- Division of Cardiology, Cardiovascular and Thoracic Department, University Hospital ''San Giovanni di Dio e Ruggi d'Aragona'', Salerno, Italy
| | - Giuseppe Iuliano
- Division of Cardiology, Cardiovascular and Thoracic Department, University Hospital ''San Giovanni di Dio e Ruggi d'Aragona'', Salerno, Italy
| | - Michele Bellino
- Division of Cardiology, Cardiovascular and Thoracic Department, University Hospital ''San Giovanni di Dio e Ruggi d'Aragona'', Salerno, Italy
| | - Cesare Baldi
- Division of Cardiology, Cardiovascular and Thoracic Department, University Hospital ''San Giovanni di Dio e Ruggi d'Aragona'', Salerno, Italy
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria ''Maggiore della Carità'', Eastern Piedmont University, Novara, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy.,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy.
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Chivasso P, Miele M, Romano R, Frunzo F, Presutto O, Colombino M, Cafarelli F, Baldi C, Fiore E, Masiello P, Mastrogiovanni G, Iesu S. Impella CP and ProtekDuo as a bridge to recovery following surgical revascularization complicated by electrical storm. Gen Thorac Cardiovasc Surg 2021; 69:877-881. [PMID: 33400196 DOI: 10.1007/s11748-020-01571-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/18/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
Short-term mechanical circulatory support (MCS) devices are designed to provide hemodynamic support for a wide range of clinical conditions such as high-risk cardiac surgery or interventional procedures, post-cardiotomy cardiogenic shock, acute decompensated heart failure. Electrical storm (defined as three or more sustained episodes of ventricular fibrillation-VF- in a 24-h period) is a rare but critical complication following revascularization in patients with ischemic heart disease and it is associated with a very high mortality (80-90%) both during the incident alone and during further observation. Here we report the case of a 38-year-old patient affected by coronary artery disease with moderate to severe left ventricular systolic dysfunction (EF 30-35%) who underwent emergency coronary artery bypass grafting (CABG) complicated by electrical storm and severe haemodynamic instability, successfully managed with a novel approach of biventricular mechanical circulatory support with extracorporeal life support (ECLS) in first instance, subsequently switched to Impella CP and ProtekDuo.
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Affiliation(s)
- Pierpaolo Chivasso
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy.
| | - Mario Miele
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Rosalba Romano
- Department of Cardiac Anaethesia, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Francesco Frunzo
- Department of Cardiac Anaethesia, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Oreste Presutto
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Mario Colombino
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Francesco Cafarelli
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Cesare Baldi
- Department of Interventional Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Emanuele Fiore
- Department of Cardiac Anaethesia, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Paolo Masiello
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Generoso Mastrogiovanni
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
| | - Severino Iesu
- Department of Emergency Cardiac Surgery, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Via San Leonardo, 84125, Salerno, Italy
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Attisano T, Ferraioli M, Silverio A, Bellino M, Esposito L, Di Muro FM, Baldi C, Coscioni E, Galasso G. 234 The role of preprocedural assessment of aortic valve calcium volume for the optimization of percutaneous aortic bioprosthesis implantation (TAVI). Eur Heart J Suppl 2020. [DOI: 10.1093/eurheartj/suaa197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Paravalvular leaks (PVL) and conduction disorders requiring permanent pacemaker implantation (PPI) in patients with severe Aortic Valvular Stenosis (SA) undergoing percutaneous aortic valve prosthesis (TAVI) still have a significant and unacceptable incidence for patients at medium and low surgical risk, who represent, with increasing scientific evidence, the prevalent population. The appearance of these complications seems to be related to clinical, anatomical and procedural factors, which influence the decision-making process of the type and size of bioprosthesis to be implanted. Particular attention has been paid to the role of the volume of calcium present at the native aortic valve (VCA) as a predictor of these complications, in order to optimize the percutaneous procedure. The VCA can be quantified using algorithms derived from Multilayer Computed Computed Axial Tomography (MSCT), an examination that has become a pivotal element in the evaluation of the patient's eligibility for TAVI.The aim of our study was to document the pre-procedural added value of VCA in terms of possible containment of adverse events and how much it may affect the choice of the type of bioprosthesis to be implanted.
Methods and results
111 patients underwent TAVIs at the Interventional Cardiology Unit of the AOU S. Giovanni di Dio and Ruggi D'Aragona, between 2017 and 2020, subsequently divided into 2 groups: group A (self-expandable bioprosthesis, Medtronic Evolut R or Evolut Pro) and group B (balloon expandable bioprosthesis, Edward Sapien 3).The clinical, electrocardiographic, echocardiographic and anatomical parameters of the enrolled patients were analyzed, and the VCA in the preprocedural phase was quantified for each of them, using an algorithm extracted from the MSCT reading software, OsiriX (OsiriX-MD v.2.8.2 64-bit).
A univariate logistic regression analysis was performed for the risk of developing the composite event of significant PVL and IPP.In Group B, no significant variables were found, while in Group A, the VCA (OR: 1.001; 95% CI, 1.000-1.002; p < 0.043) and incomplete left branch block (OR: 5.781; 95% CI, 0.013-32.988; p < 0.048) were significant. Subsequently, these two variables were tested in a multivariate regression model according to which only the VCA emerged as an independent predictor for the composite event (OR: 1.001; 95% CI, 1.000-1.002; p < 0.039).
Conclusion
VCA is significantly associated with the risk of moderate to severe PVL and rhythm disturbances requiring PPI, in the group of patients in whom a self-expandable bioprosthesis was implanted, unlike patients who received a balloon-expandable bioprosthesis where this association is not significant.
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Affiliation(s)
- Tiziana Attisano
- Interventional Cardiology Unit Heart Department AOU S. Giovanni di dio e Ruggi D’Aragona
| | - Mario Ferraioli
- Interventional Cardiology Unit Heart Department AOU S. Giovanni di dio e Ruggi D’Aragona
| | - Angelo Silverio
- Interventional Cardiology Unit Heart Department AOU S. Giovanni di dio e Ruggi D’Aragona
| | - Michele Bellino
- Interventional Cardiology Unit Heart Department AOU S. Giovanni di dio e Ruggi D’Aragona
| | - Luca Esposito
- Interventional Cardiology Unit Heart Department AOU S. Giovanni di dio e Ruggi D’Aragona
| | | | - Cesare Baldi
- Interventional Cardiology Unit Heart Department AOU S. Giovanni di dio e Ruggi D’Aragona
| | - Enrico Coscioni
- Cardiothoracic Surgery Unit. Heart Department AOU S. Giovanni di dio e Ruggi D’Aragona
| | - Gennaro Galasso
- Interventional Cardiology Unit Heart Department AOU S. Giovanni di dio e Ruggi D’Aragona
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Falsetti P, Conticini E, Baldi C, Acciai C, D'Alessandro R, Bardelli M, Cantarini L, Frediani B. Observations about subcalcaneal adventitial bursitis (heel fat pad inflammatory lesion) in rheumatoid arthritis. Comment on the article of Suzuki and Shirai. Reumatismo 2020; 72:182-183. [DOI: 10.4081/reumatismo.2020.1282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Not available
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Radano I, Prota C, Silverio A, Ferraioli D, Benvenga R, Iuliano G, Bellino M, Provenza G, Trotta R, Bottiglieri P, Baldi C, Ciccarelli M, Galasso G, Vecchione C, Citro R. Clinical profile and in-hospital course of patients with primary and secondary takotsubo syndrome: single center experience. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2154] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Takotsubo syndrome (TTS) is an acute cardiac disease increasingly recognized in a variety of clinical scenarios. Heart Failure Association of the ESC classified TTS in primary (occurring in the setting of psychological or emotional trigger or without clear identifiable stressors) and secondary (triggered by physical stressors or other critical illnesses). However, the clinical profile and outcome of these different subtypes is still controversial.
Aim of the study
To compare baseline features, clinical presentation and in-hospital outcomes in patients with primary or secondary TTS in a single referral center.
Methods
Overall study population included 210 patients (mean age 66.1±12.2 years, 14 male); 165 and 45 with primary and secondary TTS, respectively; consecutively enrolled from 2012 to 2019 in our center. Clinical, instrumental and laboratory data and in-hospital events were also recorded in both groups.
Results
Compared to patients with primary TTS, patients with secondary form were older (70.6±14.6 vs 64.9±11.2 years; p=0.006) and more frequently man (13.3% vs 4.8%; p=0.043). Several comorbidities such as diabetes (23.8% vs 8.9%; p=0.008); pulmonary (45.2% vs 12.9%; p<0.001); neurologic (23.8% vs 9.7%; p=0.015); nephro-urologic (31% vs 13.5%; p=0.008); psychiatric (42.9% vs 26.5%; p=0.039) and orthopedic (28.6% vs 13.5%; p=0.020) diseases were prevalent in secondary TTS patients. Atypical presentation with higher incidence of dyspnea was significantly prevalent (42.2% vs 19.4%; p=0.002) in secondary group. The number of patients with ST-T elevation on admission was similar (80% vs 77%; p=0.5) in both groups. Prolonged QT interval in a majority of secondary TTS patients (46.3% vs 28.4%; p=0.029) was detected. Peak levels of troponin, creatine-kinase and myoglobin did not differ between the two groups. Echocardiography revealed larger left ventricular end-diastolic and end-systolic volumes (62.7±25.3 vs 50.6±14.3 ml/mq; p=0.024 and 35.1±14.5 vs 28.7±9 ml/mq; p=0.048) at presentation in secondary TTS, however no differences in baseline left ventricular ejection fraction were detected. Furthermore, the prevalence of apical ballooning was similar between the two groups. Of note, secondary TTS patients experienced more frequently acute heart failure (40.5% vs 23.1%; p=0.024), hyperkinetic arrhythmia (9.1% vs 1.9%; p=0.022), cardiogenic shock (15.9% vs 3.2%; p=0.002), and mechanical ventilation use (9.3% vs 1.3%; p=0.006) during the acute phase. In-hospital stay (10.8±6.9 vs 7.4±6.2 days, p=0.004) was longer in this cohort.
Conclusion
Our results demonstrate that to classify TTS patients in primary or secondary form is clinically relevant. Secondary form generally is associated to higher rate of comorbidities and to atypical presentation. Owing to the worse in-hospital outcome of the secondary TTS patients a tailored and more intensive treatment should be adopted in this cohort.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- I Radano
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - C Prota
- Fatebenefratelli Hospital of Benevento, Cardiology Department, Benevento, Italy
| | - A Silverio
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - D Ferraioli
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - R.M Benvenga
- Betania Evangelical Hospital, Cardiology Department, Napoli, Italy
| | - G Iuliano
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - M Bellino
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - G Provenza
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - R Trotta
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - P Bottiglieri
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - C Baldi
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - M Ciccarelli
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - G Galasso
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - C Vecchione
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - R Citro
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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Silverio A, Esposito L, Fierro G, Di Maio M, Di Feo F, Iannicelli A, Varone M, Vigorito F, Maione A, Di Muro M, Attisano T, Vecchione C, Galasso G, Baldi C. Clinical outcome of patients with ST-elevation myocardial infarction and angiographic evidence of coronary artery ectasia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1618] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary artery ectasia (CAE) is a relatively frequent finding in patient with ST-elevation myocardial infarction (STEMI) who undergo emergent coronary angiography. However, the long-term outcome of STEMI patients with CAE as compared to Non-CAE has been poorly investigated.
Purpose
To compare the baseline features and outcome of patients with and without CAE in the clinical setting of STEMI.
Methods
All patients with STEMI who underwent emergent coronary angiography from January 2012 to December 2017 at our Institution were retrospectively enrolled. Baseline demographic, clinical, instrumental, angiographic and percutaneous coronary intervention (PCI) findings were collected for patients with and without CAE. The study outcome measures were recurrent myocardial infarction (MI) and all-cause death. The propensity score weighting (PSW) technique was used to take into account for potential selection bias in treatment assignment between CAE and Non-CAE groups.
Results
The study included 534 patients with STEMI (mean age 62.9±12.0 years), 154 were CAE and 380 Non-CAE. The two groups were significantly different in terms of sex (90.9% in CAE vs 72,6% in Non-CAE, p<0.001), diabetes (11.7% vs. 25.8%; p=0.009) and smoking status (72.1% vs. 62.4%; p=0.042). The right coronary artery was more commonly treated in CAE patients (41.6% vs. 30.8%, p=0.023) and, as expected, the stent diameter (p<0.001) and the TIMI frame count (p<0.001) were significantly higher in CAE group. The myocardial blush grade was higher in Non-CAE (p<0.001). The Kaplan-Meyer analysis showed a comparable rate of all-cause death among the two groups (3.4/100 person/years in CAE vs. 3.5 per 100 person/years in Non-CAE, Log-Rank = 0.86).
The survival free from recurrent MI was lower, although not statistically significant, in CAE vs. Non-CAE patients (3.1/100 person/years vs. 4.8/100 person/years; Log-Rank = 0.068).
After PSW, an optimal balance was obtained as demonstrated by a standardized mean difference <0.1 for all the variables included in the model. The adjusted Cox regression analysis showed a significantly higher risk of recurrent MI in CAE vs. Non-CAE groups (HR = 1.93; p=0.009). No difference in the risk of all-cause death was observed (HR = 0.83, p=0.501).
Conclusions
Patient with STEMI and angiographic evidence of CAE have a different clinical profile compared to Non-CAE. In this analysis focused on STEMI patients, CAE was associated with a higher risk of recurrent MI at long-term follow-up.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Silverio
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - L Esposito
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - G Fierro
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - M Di Maio
- Maria SS Addolorata Hospital, Eboli, Italy
| | - F Di Feo
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - A Iannicelli
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - M Varone
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - F Vigorito
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - A Maione
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - M.R Di Muro
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - T Attisano
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - C Vecchione
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - G Galasso
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - C Baldi
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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Attisano T, Silverio A, Bellino M, Tumscitz C, Tarantino FF, Santarelli A, Baldi C, Citro R, Galasso G. Balloon aortic valvuloplasty for urgent treatment of severe aortic stenosis during coronavirus disease 2019 pandemic: a case report. ESC Heart Fail 2020; 7:4348-4352. [PMID: 32949219 PMCID: PMC7537034 DOI: 10.1002/ehf2.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Abstract
An 86‐year‐old man affected by severe aortic stenosis (AS) was referred to our institution owing to decompensated heart failure. Three months before, the patient was scheduled for transcatheter aortic valve implantation (TAVI), which was postponed owing to the coronavirus disease 2019 (COVID‐19) outbreak. Owing to COVID‐19 suspicion, he underwent nasopharyngeal swab and was temporarily isolated. However, the rapid deterioration of clinical and haemodynamic conditions prompted us to perform balloon aortic valvuloplasty (BAV) as bridge to TAVI. The patient's haemodynamics improved; and the next day, the reverse transcriptase–polymerase chain reaction for COVID‐19 was negative. At Day 5, he underwent TAVI procedure. Subsequent clinical course was uneventful. During COVID‐19 pandemic, the deferral of TAVI procedure should be assessed on a case‐by‐case basis to avoid delay in patients at high risk for adverse events. BAV may be an option when TAVI is temporarily contraindicated such as in AS patients suspected for COVID‐19.
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Affiliation(s)
- Tiziana Attisano
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Angelo Silverio
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Michele Bellino
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Carlo Tumscitz
- Department of Cardiology, University Hospital of Ferrara, Ferrara, Italy
| | | | - Andrea Santarelli
- Interventional Cath Lab Unit, Cardiovascular Department, Infermi Hospital, Rimini, Italy
| | - Cesare Baldi
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Rodolfo Citro
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gennaro Galasso
- Interventional Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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Silverio A, Benvenga RM, Piscione F, Gulizia MM, Meessen JMTA, Colivicchi F, Nardi F, Baldi C, Galasso G, Vecchione C, Di Lenarda A, Gabrielli D, De Luca L. Prevalence and Predictors of Out-of-Target LDL Cholesterol 1 to 3 Years After Myocardial Infarction. A Subanalysis From the EYESHOT Post-MI Registry. J Cardiovasc Pharmacol Ther 2020; 26:149-157. [PMID: 32757779 DOI: 10.1177/1074248420947633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is an incomplete understanding of the prevalence and predictors of attainment of low-density lipoprotein cholesterol (LDL-C) goal after myocardial infarction (MI). AIM To evaluate the prevalence of achievement of LDL-C goal of 70 mg/dL, to identify the baseline features associated with suboptimal lipid control, and to assess the use of LDL-C-lowering drug therapies (LLT) beyond the first year after MI. METHODS The EYESHOT Post-MI was a prospective, cross-sectional, Italian registry, which enrolled patients presenting to cardiologist 1 to 3 years after MI. In this retrospective post-hoc analysis, patients were categorized in 2 groups according to the achievement or not of the LDL-C goal of 70 mg/dL. Univariable and multivariable logistic regression analyses were performed to identify the baseline features associate with LDL-C≥70 mg/dL. RESULTS The study population included 903 patients (mean age 65.5 ± 11.5 years). Among them, LDL-C was ≥70 mg/dL in 474 (52.5%). Male sex (P = 0.031), hypertension (P = 0.024), prior percutaneous coronary intervention (P = 0.016) and high education level (P = 0.008) were higher in the LDL-C <70 group. At multivariable analysis, low education level was an independent predictor of LDL-C≥70 mg/dL (OR:1.582; 95%CI, 1.156-2.165; P = 0.004). Conversely, hypertension increased the probability to achieve the LDL-C goal (OR:0.650; 95%CI, 0.443-0.954; P = 0.028). Among off-target patients, LLT was not modified in the majority of cases (67.3%), intensified in 85 (18.6%), and actually reduced in 63 patients (13.8%). CONCLUSIONS In patients presenting to cardiologists 1 to 3 years from the last MI event, LDL-C is not under control in a large proportion of patients, particularly in those with a low education level or without hypertension. LLT is underused in this very-high-risk setting.
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Affiliation(s)
- Angelo Silverio
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Rossella Maria Benvenga
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Federico Piscione
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Michele M Gulizia
- Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy.,Fondazione per il Tuo cuore-HCF onlus, Florence, Italy
| | - Jennifer M T A Meessen
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Federico Nardi
- Division of Cardiology, 18526Santo Spirito Hospital, Casale Monferrato, Alessandria, Italy
| | - Cesare Baldi
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gennaro Galasso
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Carmine Vecchione
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Andrea Di Lenarda
- Division of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
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Conticini E, Falsetti P, Acciai C, Baldi C, Bardelli M, Gentileschi S, Cantarini L, Frediani B. AB0939 POLYMYALGIA RHEUMATICA FOLLOWING INFECTIVE TRIGGERS OR VACCINATIONS: A DIFFERENT SUBSET OF DISEASE? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Polymyalgia rheumatica (PMR) is the most common inflammatory disorder of elderly; an association with environmental triggers and deregulated immune response has been described.Objectives:The aim of this study was to investigate the presence of environmental triggers before the onset of PMR and its association to a particular subset of disease.Methods:The database of 58 consecutive PMR patients recruited from a single rheumatology secondary care setting was retrospectively analyzed to investigate the frequency of environmental triggers and correlations with clinical characteristics. Patients underwent multidistrict ultrasound examination of both proximal and distal sites. Laboratory tests were repeated after one month from first visit, when steroids were started, and about every three months during follow-up (for at least 24 months)Results:Fifteen PMR patients (26%) described a connection with environmental agents: six PMR patients reported a vaccination, 3 an upper respiratory tract infection and 1 pneumonia before the onset of disease. Five patients reported seasonal influenza as trigger of PMR. The model of multivariate linear regression which better predicted a shorter time to normalize inflammatory reactants (R squared 27,46%, p=0,0042) comprised the presence of an environmental trigger and a higher CRP. A linear regression analysis confirmed an inverse correlation between CRP at onset ant time to normalize inflammatory reactant (r= -0,3031, p=0,0208). A significant correlation was demonstrated between presence of environmental trigger and shorter time to normalize inflammation (r=-0,5215, p<0,0001), lesser frequency of gleno-humeral synovitis on US (r=-0,3774, p=0,0038).Conclusion:Our work describes a correlation between environmental triggers in PMR and higher CRP at diagnosis and faster response to therapy. We may suppose that these patients belong to a more specific subtype of PMR, in whom external stimuli, such as vaccinations or infections, may lead to a deregulated response within the context of an impaired immune and endocrine system. We recommend a systematic research of previous infections or vaccination in recent onset PMRDisclosure of Interests:None declared
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Falsetti P, Conticini E, Baldi C, Bardelli M, Gentileschi S, Cantarini L, Frediani B. THU0520 DIFFUSE ENTHESITIS AND LOW-GRADE INFLAMMATION IN PATIENTS WITH METABOLIC SYNDROME: A CLINICAL AND ULTRASOUND STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Metabolic syndrome (MS) is a clinical condition characterized by central obesity and additional factors such dyslipidemia, hypertension, raised fasting plasma. Scanty observations describe the association of MS with musculoskeletal conditions, such as enthesopathies and diffuse idiopathic hyperostosis syndrome (DISH). Musculoskeletal ultrasound (US) has been applied to the study of entheses, but the real prevalence and characteristics of entheseal involvement in MS has yet to be clarified.Objectives:The aim of our work was to study the US-defined entheseal changes in MS, to correlates the US enthesitis scores to clinical characteristics, and to define a relation between MS-related enthesitis and the presence of concurrent DISHMethods:Sixty consecutive outpatients (24 males, 36 females, mean age 60 years), all fullfilling International Diabetes Foundation (IDF) criteria for MS, were also evaluated with multi-site bilateral US entheseal examination. Each patient underwent power Doppler (PD) US examination of twelve entheseal sites, using Esaote MyLab Twice with 6–18 MHz transducer. Enthesitis was defined on the basis of OMERACT’s filter. Inflammatory and structural changes were scored as a whole when present (score 1) or absent (score 0). The sum of entheses with inflammatory and structural damage was defined as “global inflammatory score” (GIs) and “global structural damage score” (GSDs) for each patient. The Leeds Enthesitis Index (LEI) was also applied, and a spinal radiography was obtained for each patient to research concurrent signs of DISH satisfying Resnick and Niwayama criteria.Results:Patients showed moderate overweight (mean BMI 29) and a diagnosis of type 2 diabetes was present in 24 (40%). A low-grade inflammatory state was demonstrated in MS (mean CRP 0,58 md/dL, mean ESR 21,9 mm/h). A high prevalence of US-defined enthesitis was noted in 52 patients (86%) and 127/720 entheses (17,6%). PD signals, were reported in 11 patients (18%) and 11/720 entheses (1,52%), and they were associated to clinical symptoms expressed as LEI (p=0,0138). Erosions, although rare (0.3% of entheses), were more frequent in males (p= 0.001). Moreover, in 57 patients (95%) and 217 entheses (30%) structural damages were found. A correlation was found between GIs and GSDs and both BMI (p=0.0233 and p=0.0068 respectively), LEI (p=0.03 and p=0.0099 respectively), and type 2 diabetes (p=0.0248 and p=0.0156 respectively). In 28 patients (46%) a concurrent diagnosis of DISH was made. In multivariate regression analysis the best predictors for DISH were higher levels of CRP (p=0,038) and older age (p<0,0001). DISH correlated with older age (p<0,0001), CRP and ESR (p= 0,0428 p=0,0069 respectively) and US global scores for enthesitis (p=0,0312 for GIs, p=0,0071 for GSDs).Conclusion:This is the first study where diffuse enthesitis and entheseal structural damage are demonstrated with high prevalences in MS, comparable or also higher than those reported for SpA-related enthesitis. Our data, obtained using the most recent OMERACT’s definition for US-detected enthesitis (proposed for SpA), also suggest a low specificity of this definition, in consideration of the high prevalence of MS-associated enthesitis. Moreover PD was associated to entheseal pain expressed as LEI. Both GIs and GSDs showed a correlation with overweight and type 2 diabetes. As secondary result, this study demonstrated that almost half of patients with MS could have a concurrent diagnosis of DISH. Patients with DISH were older, with higher levels of inflammation, and higher scores of US-defined enthesitis. Our results suggest that MS and DISH could be strictly related; diffuse enthesitis with a low-grade inflammatory state should be regarded as potential factor of progression from MS towards a conclamed DISH.Disclosure of Interests:None declared
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Bruni C, Gentileschi S, Capassoni M, Pacini G, Bardelli M, Baldi C, Tofani L, Cometi L, Nacci F, Bartoli F, Fiori G, Cantarini L, Guiducci S, Frediani B, Matucci-Cerinic M. AB0281 SAFETY AND RETENTION RATE AFTER SWITCHING FROM ETANERCEPT ORIGINATOR (ETN) TO ETANERCEPT BIOSIMILAR (SB4) IN INFLAMMATORY JOINT DISEASES: DATA FROM REAL LIFE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:SB4 in now commonly used in the treatment of inflammatory joint diseases, with evidence of efficacy and persistence up to 12 months from switching in both randomized controlled trials in Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS).Objectives:we investigated the safety and retention rate of SB4 at 6, 12 and 18 months after switching from ETN in two rheumatology departments in our region.Methods:adult patients with RA, PsA, AS, Juvenile Idiopathic Arthritis (JIA) and other rheumatic diseases treated with ETN for at least 6 months, switched to SB4 in stable clinical conditions, were eligible for this retrospective evaluation. Data on adverse events (in particular infectious events), loss of efficacy (articular, cutaneous, ocular or intestinal disease re-activation) and persistence on treatment were collected since latest available follow-up. Retention rate, reason for discontinuation and subsequent management data were collected at 6, 12, 18 months.Results:220 patients (142 females, mean age 58+-7 years, disease duration 12+-4 years, ETN duration 7+-4 years) were enrolled, with median follow up of 12.1 (9.7-15.8) months duration; ETN was used in different biologic DMARDs treatment lines (first 76.8%, second 17.7%, third 3.2 %, fourth 2.3%). Study population was composed of 85 RA, 81 PsA, 33 AS, 14 JIA and 7 other conditions (mostly scleroderma). In the follow-up, 50 patients (22.7%) presented with at least one non-serious adverse event, with 36 (16,4%) disease re-activation (mostly articular) and 30 (13,6% - 11 for safety and 19 loss of efficacy) SB4 interruptions. Retention rates were 99.1 (210/212) at 6, 90.9% (150/165) at 12 and 81.5% (53/65) at 18 months respectively. Back-switch to ETN was performed in 17/30 cases, the remaining cases were managed with change of bDMARD or csDMARD). Age was the only significant predictor of SB4 interruption at 6 months (OR 1.058, 95%CI 1.007-1.112, p=0.026), while disease, bDMARD line, csDMARD combination, gender, disease duration or ETN duration did not influence retention rates at 6, 12 or 18 months.Conclusion:our real-life data confirm the safety profile of switching from ETN to SB4. In our patients, the data show a higher retention rate, when compared to other-real life registries data (1,2)References:[1]Ebbers HC et al. Real-World evidence on Etanercept Biosimilar SB4 in Etanercept-Naïve or Switching Patients: A Systematic Review. Rheumatol Ther. 2019 Sep;6(3):317-338.Disclosure of Interests:Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Stefano Gentileschi: None declared, Marco Capassoni: None declared, Giovanni Pacini: None declared, Marco Bardelli: None declared, Caterina Baldi: None declared, Lorenzo Tofani: None declared, Laura Cometi: None declared, Francesca Nacci: None declared, Francesca Bartoli: None declared, Ginevra Fiori: None declared, Luca Cantarini: None declared, Serena Guiducci: None declared, Bruno Frediani: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim
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Falsetti P, Conticini E, Baldi C, Bardelli M, Gentileschi S, D’alessandro R, Cantarini L, Frediani B. AB1086 POWER DOPPLER AND SPECTRAL DOPPLER ULTRASOUND IN SUSPECTED ACTIVE SACROILIITIS: A COMPARISON WITH MAGNETIC RESONANCE IMAGING AS GOLD STANDARD. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:SIJ involvement is a characteristic feature of Spondylarthritis (SpA). Magnetic Resonance imaging (MRI) has been included in the new Assessment of SpA International Society (ASAS) criteria for the classification of Axial SpA. Gray scale US, Color Doppler ultrasound (CDUS), contrast-enhanced CDUS, and spectral Doppler (SD) US has been used in few works to evaluate the inflammatory activity of the SIJ with not conclusive results. Power Doppler ultrasound (PDUS) was not yet applied to the study of SIJ with active SI.Objectives:The aim of this work was to study with PDUS and SD US the SIJ of patients with suspected active SI, to describe inflammatory flows with spectral wave analysis (SWA) in duplex Doppler US, and to correlate US data with clinical characteristics and the presence of bone marrow edema (BME) in MRI.Methods:22 patients (18 females and 4 males, mean age 35 years) with new onset of inflammatory back pain (IBP), were included. Every patient underwent an US examination in prone position. The sonographers were blinded to the clinical data of the patient. A Esaote Twice US machine, equipped with a convex multifrequency 1-8 MHz probe, was used, with standardized parameters: 1-5 MHz for gray scale, 1.9-2.3 MHz frequency for Doppler with Pulse Repetition Frequency (PRF) of 1.0 KHz and a color gain just under the artifact limit. SIJ was located as the hypoechoic triangle delimited between the sacrum and iliac bone, and the posterior SI ligament as the upper margin. The first sacral foramen was always localized to avoid measurement of the normal pre-sacral arteries. The PDUS was applied, and if any signals were detected in the SIJ, they were scored with a 3-points scale: 0= absence of signals, 1= isolate vessels, 2= more than one vessel. The signals were also classified as intra-articular or peri-articular. The same vessels were also evaluated using quantitative SD calculating the Resistive Index (RI=peak of systolic flow- end diastolic flow/peak systolic flow), ranging between 0 and 1. Every patient underwent MRI of SIJ within the same week, before treatment. A statistical analysis was performed, estimating the sensitivity and specificity against the gold standard (presence of BME in the same SIJ according to ASAS criteria). The Spearman rank not-parametric test was applied to correlate the presence and grading of BME with PDUS grading and RI. A regression analysis was applied between PDUS results and clinical characteristics.Results:In 14/22 SIJ MRI revealed BME. In 13 of them, PDUS confirmed abnormal hypervascularisation in the intrarticular portion of SI, and in 3 in the periarticular site too. Two SIJ showed hypervascularisation at PD with no BME in MRI. A significant correlation was demonstrated between positivity and grading of PD and presence of BME in MRI (p=0.0005). SD analysis demonstrated low Resistance Index (RI) values in 14 SIJ (mean 0.57). An inverse correlation was demonstrated between RI and grading of BME in MRI (r= -0,6229, p= 0,044). The diagnostic accuracy of SD for detection of active SI varied on the basis of RI cut-off value. The best values of sensitivity (62,5%) and specificity (61,5%) were obtained with a RI cut-off values of 0.60. A multiple regression model demonstrated a significant relationship between PDUS signals and ASDAS (p=0.0382), but not with inflammatory reactants.Conclusion:PDUS and SD US of SIJ can be useful as first imaging assessment in suspected active SI, demonstrating a good diagnostic accuracy compared with MRI. Intra-articular low RI values (<0.60) on SD indicate active SI with good accuracy. Moreover, PDUS signals into the SIJ correlate with clinical symptoms but not with inflammation reactants.Figure 1.Doppler US in SI.Right SIJ with a Doppler signal along the posterior SIJ ligament, and another Doppler signal into the joint, where SD analysis gave a RI of 0,62.Disclosure of Interests:None declared
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Piccolo R, Bruzzese D, Mauro C, Aloia A, Baldi C, Boccalatte M, Bottiglieri G, Briguori C, Caiazzo G, Calabrò P, Cappelli-Bigazzi M, De Simone C, Di Lorenzo E, Golino P, Monda V, Perrotta R, Quaranta G, Russolillo E, Scherillo M, Tesorio T, Tuccillo B, Valva G, Villari B, Tarantini G, Varricchio A, Esposito G. Population Trends in Rates of Percutaneous Coronary Revascularization for Acute Coronary Syndromes Associated With the COVID-19 Outbreak. Circulation 2020; 141:2035-2037. [PMID: 32352318 PMCID: PMC7294593 DOI: 10.1161/circulationaha.120.047457] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [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: 11/16/2022]
Affiliation(s)
- Raffaele Piccolo
- Division of Cardiology, Department of Advanced Biomedical Sciences (R. Piccolo, G.E.), University of Naples Federico II, Italy
| | - Dario Bruzzese
- Department of Public Health (D.B.), University of Naples Federico II, Italy
| | - Ciro Mauro
- Interventional Cardiology and Cardiological Care Unit, A.O.R.N. Cardarelli, Naples, Italy (C.M.)
| | - Antonio Aloia
- Division of Cardiology, Presidio Ospedaliero di Vallo della Lucania, Italy (A.A.)
| | - Cesare Baldi
- Interventional Cardiology Unit. A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy (C. Baldi)
| | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy (M.B.)
| | | | | | - Gianluca Caiazzo
- Division of Cardiology, Ospedale San Giuseppe Moscati, Aversa, Italy (G.C.)
| | - Paolo Calabrò
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C.)
| | - Maurizio Cappelli-Bigazzi
- Division of Cardiology, Luigi Vanvitelli University (M.C.-B., P.G.), Monaldi Hospital, Naples, Italy
| | | | | | - Paolo Golino
- Division of Cardiology, Luigi Vanvitelli University (M.C.-B., P.G.), Monaldi Hospital, Naples, Italy
| | - Vittorio Monda
- Division of Cardiology, AORN Ospedali dei Colli (V.M.), Monaldi Hospital, Naples, Italy
| | - Rocco Perrotta
- Division of Clinical Cardiology, A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy (R. Perrotta)
| | - Gaetano Quaranta
- Cardiology Unit, Umberto I Hospital, Nocera Inferiore, Italy (G.Q.)
| | - Enrico Russolillo
- Division of Cardiology, Ospedale San Giovanni Bosco, Naples, Italy (E.R.)
| | | | - Tullio Tesorio
- Division of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy (T.T.)
| | | | - Giuseppe Valva
- Department of Cardiology and Cardiac Surgery, Casa di Cura S. Michele, Maddaloni, Italy (G.V.)
| | - Bruno Villari
- Ospedale Sacro Cuore di Gesù, Benevento, Italy (B.V.)
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences, University of Padua, Italy (G.T.)
| | | | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences (R. Piccolo, G.E.), University of Naples Federico II, Italy.,UNESCO Chair on Health Education and Sustainable Development, University of Naples Federico II, Italy (G.E.)
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Prota C, Bellino M, Pucci M, Ferraioli D, Radano I, Benvenga RM, Silverio A, Iuliano G, Provenza G, Trotta R, Attisano T, Ciccarelli M, Baldi C, Galasso G, Citro R. P322 Dynamic changes of left ventricular cardiac mechanics in takotsubo syndrome: a preliminary study. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.175] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Takotsubo syndrome (TTS) is a transient left ventricular (LV) heart failure due to a reversible systolic dysfunction, usually recovering within days or weeks.
Purpose
To assess the dynamic changes of LV cardiac mechanics in a small cohort of TTS patients through the estimation of myocardial work, a newly developed non-invasive approach which allows correction of global longitudinal strain (GLS) for systolic blood pressure.
Methods
Twenty-four patients (mean age, 63.8 ± 8.4 yy; all female) with TTS diagnosis were retrospectively enrolled. Data from transthoracic two-dimensional and speckle-tracking echocardiography on admission and at 3 months follow-up were collected. Global myocardial work index (GWI, mmHg%) was calculated as the area of the LV pressure (LVP)-strain loop, where LVP was estimated noninvasively using a standard waveform fitted to valvular events and scaled to systolic blood pressure. From GWI we also assessed: global constructive work (GCW, mmHg%: work performed during shortening in systole + negative work during lenghtening in isovolumetric relaxation, IVR), global wasted work (GWW, mmHg%: negative workperformed by a segment during lengthening in systole + work performed during shortening in IVR) and global work efficiency (GWE, %: constructive work divided by the sum of constructive and wasted work). Baseline demographic and clinical features, including in-hospital adverse events as acute heart failure, cardiogenic shock and cardiac death, were also assessed.
Results
On overall population, a reduced ejection fraction (EF) and GLS were detected at hospital admission, with a substantial improvement at discharge and at follow-up (from 41.7 ± 8.3% to 54.5 ± 6.5% to 60.2 ± 4.6% for EF and from -11.7 ± 4.5% to -16.2 ± 4.2 to -21.3 ± 2.8% for GLS, respectively). Similarly, global MWI and MWE both showed a positive trend during the hospital course and at follow-up: MWI increased from 1048.8 ± 580.5 to 1522.4 ± 695.4 to 2021.1 ± 388.6 mmHg% and MWE from 78.7 ± 10.2 to 91.1 ± 4.6 to 94.5 ± 3.8 %. Increasing in MWE has been obtained through an improvement of GCW (from 1195.9 ± 537.2 to 1651.3 ± 700.3 to 2316.8 ± 490.6 mmHg%) and a contemporary decreasing in GWW (from 237.9 ± 137.2 to 106 ± 37.2 to 131.8 ± 150.8 mmHg%).
In-hospital adverse events occurred in 8 (50%) patients. Of note, despite EF and GLS at admission showed no significant differences, patients experiencing in-hospital adverse events showed lower value of acute MWI (725.6 ± 289.6 vs 1371.9 ± 632.1 mmHg%; p= 0.02) and MWE (73.6 ± 3.4 vs 83.8 ± 12.4%; p= 0.04) compared to patients without in-hospital complications.
Conclusion
Non-invasive assessment of myocardial work through echocardiographic strain-based technique could be useful to demonstrate the peculiar dynamic changes of cardiac mechanics and for a better risk stratification in TTS patients.
Abstract P322 Figure.
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Affiliation(s)
- C Prota
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - M Bellino
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - M Pucci
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - D Ferraioli
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - I Radano
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - R M Benvenga
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - A Silverio
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - G Iuliano
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - G Provenza
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - R Trotta
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - T Attisano
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - M Ciccarelli
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - C Baldi
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - G Galasso
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | - R Citro
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
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Silverio A, Citro R, Bossone E, Bellino M, Zito C, Provenza G, Prota C, Iuliano G, Radano I, Polito MV, Baldi C, Novo G, Antonini-Canterin F, Galasso G, Parodi G. 5037Drug treatment with beta-blockers and long-term outcome in patients with takotsubo syndrome: results from the takotsubo Italian network. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0040] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although generally considered a benign disease, Takotsubo syndrome (TTS) has recently been associated to a substantially comparable long-term outcome than acute coronary syndrome (ACS). The use of beta-blockers (BB) has been advocated in these patients for secondary prevention after the index event, considering the presumed role of catecholamine in TTS pathophysiology. However, the effect of BB on long-term outcome remains controversial due to the paucity of data and the lack of evidence from randomized studies.
Purpose
To investigate the impact of BB therapy on long-term outcome in patients with TTS.
Methods
The study included all TTS patients enrolled in the Takotsubo Italian Network multicenter registry. Patients were divided in two study groups according to the BB therapy after discharge. The following major adverse cardiac events (MACE) were assessed at the longest available follow-up: cardiac death, TTS recurrence, rehospitalization for cardiac cause, acute or worsening heart failure (HF) and ACS. Also, the composite of cardiac death and rehospitalization as well as the overall MACE were analyzed
Results
The study population included 548 patients (mean age 68.7±11.4 years; 44 males, 8%). Among them, BB treatment was reported in 368 (BB group, 67.2%) and 180 (no-BB group, 32.8%) patients, respectively. The baseline clinical characteristics were substantially comparable among groups with the only exception of COPD, which was prevalent in the no-BB group (10.3% vs 21.7%, p=0.001).
During follow-up (median 18 months 25–75% c.i. 6–29), TTS recurrence was reported in 26 patients (4.7%), ACS in 10 (1.8%), acute or worsening HF in 39 (7.1%), cardiac hospitalization in 71 (13.0%) and cardiac death in 18 (3.3%). The rate of TTS recurrence and ACS was comparable between groups. Conversely, no-BB patients experienced more frequently acute or worsening HF (5.4% vs 10.6%, p=0.034), cardiac rehospitalization (10.9% vs 17.2%, p=0.042) and cardiac death (1.9% vs 6.1, p=0.018) than BB patients. Therefore, the MACE composite endpoint was significantly prevalent in the no-BB group (12.0% vs 20.6%, p=0.010).
Kaplan-Meier curves for the composite of cardiac death and rehospitalization showed a statistically lower survival in the no-BB patients compared to the BB group (p=0.006). Moreover, landmark analysis showed a wider survival benefit in the BB patients after 2 years.
Conclusions
Although in absence of a secondary preventive effect on TTS recurrence, BB may improve the long-term cardiac outcome in patients with TTS. Prospective randomized studies are advisable to confirm these findings.
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Affiliation(s)
- A Silverio
- University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Department of Cardiology, Salerno, Italy
| | - R Citro
- University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Department of Cardiology, Salerno, Italy
| | - E Bossone
- Cardarelli Hospital, Department of Cardiology, Naples, Italy
| | - M Bellino
- University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Department of Cardiology, Salerno, Italy
| | - C Zito
- University of Messina, Division of Cardiology, Messina, Italy
| | - G Provenza
- University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Department of Cardiology, Salerno, Italy
| | - C Prota
- Fatebenefratelli Hospital of Benevento, Department of Cardiology, Benevento, Italy
| | - G Iuliano
- University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Department of Cardiology, Salerno, Italy
| | - I Radano
- University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Department of Cardiology, Salerno, Italy
| | - M V Polito
- University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Department of Cardiology, Salerno, Italy
| | - C Baldi
- University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Department of Cardiology, Salerno, Italy
| | - G Novo
- University of Palermo, Department of Cardiology, Palermo, Italy
| | | | - G Galasso
- University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, Department of Cardiology, Salerno, Italy
| | - G Parodi
- University Hospital of Sassari, Division of Interventional Cardiology, Sassari, Italy
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Baldi C, Bertoli-Avella AM, Al-Sannaa N, Alfadhel M, Al-Thihli K, Alameer S, Elmonairy AA, Al Shamsi AM, Abdelrahman HA, Al-Gazali L, Shawli A, Al-Hakami F, Yavuz H, Kandaswamy KK, Rolfs A, Brandau O, Bauer P. Expanding the clinical and genetic spectra of NKX6-2-related disorder. Clin Genet 2019; 93:1087-1092. [PMID: 29388673 DOI: 10.1111/cge.13221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
Abstract
Hypomyelinating leukodystrophies (HLDs) affect the white matter of the central nervous system and manifest as neurological disorders. They are genetically heterogeneous. Very recently, biallelic variants in NKX6-2 have been suggested to cause a novel form of autosomal recessive HLD. Using whole-exome or whole-genome sequencing, we identified the previously reported c.196delC and c.487C>G variants in NKX6-2 in 3 and 2 unrelated index cases, respectively; the novel c.608G>A variant was identified in a sixth patient. All variants were homozygous in affected family members only. Our patients share a primary diagnosis of psychomotor delay, and they show spastic quadriparesis, nystagmus and hypotonia. Seizures and dysmorphic features (observed in 2 families each) represent an addition to the phenotype, while developmental regression (observed in 3 families) appears to be a notable and previously underestimated clinical feature. Our findings extend the clinical and mutational spectra associated with this novel form of HLD. Comparative analysis of our 10 patients and the 15 reported previously did, however, not reveal clear evidence for a genotype-phenotype correlation.
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Affiliation(s)
- C Baldi
- Centogene AG, Rostock, Germany
| | | | - N Al-Sannaa
- John Hopkins Aramco Health Care, Pediatric Services, Dhahran, Saudi Arabia
| | - M Alfadhel
- King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, Division of Genetics, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - K Al-Thihli
- Department of Genetics, Sultan Qaboos University Hospital, Muscat, Oman
| | - S Alameer
- King Saud Bin Abdulaziz University for Health Sciences, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia
| | | | - A M Al Shamsi
- Department of Paediatrics, Tawam Hospital, Al-Ain, United Arab Emirates
| | - H A Abdelrahman
- Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University Al Ain, Al-Ain, United Arab Emirates
| | - L Al-Gazali
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University Al Ain, United Arab Emirates
| | - A Shawli
- King Saud Bin Abdulaziz University for Health Sciences, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia.,Molecular Medicine Section, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - F Al-Hakami
- Molecular Medicine Section, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,Molecular Medicine Section, King Abdulaziz Medical City-WR, Jeddah, Saudi Arabia
| | - H Yavuz
- Centogene AG, Rostock, Germany
| | | | - A Rolfs
- Centogene AG, Rostock, Germany.,Albrecht-Kossel-Institute for Neuroregeneration, Medical University Rostock, Rostock, Germany
| | | | - P Bauer
- Centogene AG, Rostock, Germany
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Affiliation(s)
- Rodolfo Citro
- Cardiovascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Heart Tower, Room 807, Largo Città d'Ippocrate, Salerno, Italy
| | - Giuseppe Iuliano
- Cardiovascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Heart Tower, Room 807, Largo Città d'Ippocrate, Salerno, Italy
| | - Cesare Baldi
- Cardiovascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Heart Tower, Room 807, Largo Città d'Ippocrate, Salerno, Italy
| | - Severino Iesu
- Cardiovascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Heart Tower, Room 807, Largo Città d'Ippocrate, Salerno, Italy
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46
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Bougouin W, Piazza O, Dumas F, Baldi C, Cariou A, De Robertis E. Coronary angiogram after cardiac arrest? Reasonably and sensibly. Minerva Anestesiol 2019; 85:554-558. [DOI: 10.23736/s0375-9393.19.13425-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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47
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Turner K, Zambrelli E, Lavolpe S, Baldi C, Furia F, Canevini MP. Obstructive sleep apnea: neurocognitive and behavioral functions before and after treatment. Funct Neurol 2019; 34:71-78. [PMID: 31556386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a sleep disorder characterized by repetitive episodes of upper airway obstruction. The aim of this study was to evaluate whether continuous positive airway pressure (CPAP) treatment is linked to improvements in cognitive abilities and emotional functions of patients with OSAS. Following the exclusion of four subjects for non-adherence to CPAP treatment, the final study sample was composed of 16 patients with moderate-to-severe OSAS, who were assessed both prior to and after 3 months of CPAP treatment, using a neuropsychological battery and questionnaires to assess mood and anxiety disorders, irritability, quality of life, quality of sleep and daytime sleepiness. We observed significant improvements in Digit Span Backward, Short Story and Corsi Span performances after 3 months of CPAP treatment. Questionnaires showed a significant reduction in daytime sleepiness and improvements in the subjective perception of sleep quality and sleep efficiency, and reduced daytime dysfunction. CPAP treatment has significant effects on different cognitive domains in patients with OSAS, especially working memory, long-term verbal memory, and short-term visuospatial memory.
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48
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De Rosa R, Silverio A, Baldi C, Di Maio M, Prota C, Radano I, Rey J, Herrmann E, Citro R, Piscione F, Galasso G. Transcatheter Repair of Functional Mitral Regurgitation in Heart Failure Patients ― A Meta-Analysis of 23 Studies on MitraClip Implantation ―. Circ J 2018; 82:2800-2810. [DOI: 10.1253/circj.cj-18-0571] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Roberta De Rosa
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Angelo Silverio
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Cesare Baldi
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Marco Di Maio
- Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, AORN “Ospedali dei Colli”
| | - Costantina Prota
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Ilaria Radano
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Julia Rey
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt
| | - Eva Herrmann
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt
| | - Rodolfo Citro
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Federico Piscione
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
| | - Gennaro Galasso
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”
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49
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Silverio A, Baldi C, Di Maio M, Bonadies D, Verolino G, Esposito L, Cogliani FM, Fierro G, Di Muro MR, De Rosa R, Giudice P, Citro R, Piscione F, Galasso G. P2648Predictors of outcome in heart failure patients with functional mitral regurgitation undergoing mitraclip treatment. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2648] [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: 11/14/2022] Open
Affiliation(s)
- A Silverio
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - C Baldi
- Department of Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy
| | - M Di Maio
- Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, A.O.R.N. “Ospedali dei Colli”, Naples, Italy
| | - D Bonadies
- Department of Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy
| | - G Verolino
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - L Esposito
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - F M Cogliani
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - G Fierro
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - M R Di Muro
- Department of Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy
| | - R De Rosa
- Chair of Cardiology, J.W. Goethe University Hospital of Frankfurt, Frankfurt, Germany
| | - P Giudice
- Department of Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy
| | - R Citro
- Department of Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy
| | - F Piscione
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - G Galasso
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
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50
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Silverio A, De Rosa R, Baldi C, Di Maio M, Prota C, Radano I, Herrmann E, Rey J, Citro R, Piscione F, Galasso G. P5098Percutaneous repair of functional mitral regurgitation in heart failure patients: a meta-analysis of 23 studies on mitraclip implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5098] [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: 11/14/2022] Open
Affiliation(s)
- A Silverio
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - R De Rosa
- Chair of Cardiology, J.W. Goethe University Hospital of Frankfurt, Frankfurt, Germany
| | - C Baldi
- Department of Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy
| | - M Di Maio
- Division of Cardiology, Department of Cardiothoracic and Respiratory Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, A.O.R.N. “Ospedali dei Colli”, Naples, Italy
| | - C Prota
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - I Radano
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - E Herrmann
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt, Germany
| | - J Rey
- Department of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt, Germany
| | - R Citro
- Department of Cardiology, A.O.U. “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy
| | - F Piscione
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
| | - G Galasso
- University of Salerno. Department of Medicine and Surgery, Salerno, Italy
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