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Ait Ali L, Martini N, Listo E, Valenti E, Sotelo J, Salvadori S, Passino C, Monteleone A, Stagnaro N, Trocchio G, Marrone C, Raimondi F, Catapano G, Festa P. Impact of 4D-Flow CMR Parameters on Functional Evaluation of Fontan Circulation. Pediatr Cardiol 2024; 45:998-1006. [PMID: 38519622 PMCID: PMC11056328 DOI: 10.1007/s00246-024-03446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/06/2024] [Indexed: 03/25/2024]
Abstract
We sought to evaluate the potential clinical role of 4D-flow cardiac magnetic resonance (CMR)-derived energetics and flow parameters in a cohort of patients' post-Fontan palliation. In patients with Fontan circulation who underwent 4D-Flow CMR, streamlines distribution was evaluated, as well a 4D-flow CMR-derived energetics parameters as kinetic energy (KE) and energy loss (EL) normalized by volume. EL/KE index as a marker of flow efficiency was also calculated. Cardiopulmonary exercise test (CPET) was also performed in a subgroup of patients. The population study included 55 patients (mean age 22 ± 11 years). The analysis of the streamlines revealed a preferential distribution of the right superior vena cava flow for the right pulmonary artery (62.5 ± 35.4%) and a mild preferential flow for the left pulmonary artery (52.3 ± 40.6%) of the inferior vena cave-pulmonary arteries (IVC-PA) conduit. Patients with heart failure (HF) presented lower IVC/PA-conduit flow (0.75 ± 0.5 vs 1.3 ± 0.5 l/min/m2, p = 0.004) and a higher mean flow-jet angle of the IVC-PA conduit (39.2 ± 22.8 vs 15.2 ± 8.9, p < 0.001) than the remaining patients. EL/KE index correlates inversely with VO2/kg/min: R: - 0.45, p = 0.01 peak, minute ventilation (VE) R: - 0.466, p < 0.01, maximal voluntary ventilation: R:0.44, p = 0.001 and positively with the physiological dead space to the tidal volume ratio (VD/VT) peak: R: 0.58, p < 0.01. From our data, lower blood flow in IVC/PA conduit and eccentric flow was associated with HF whereas higher EL/KE index was associated with reduced functional capacity and impaired lung function. Larger studies are needed to confirm our results and to further improve the prognostic role of the 4D-Flow CMR in this challenging population.
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Affiliation(s)
- Lamia Ait Ali
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100, Massa, Pisa, Italy.
- Gabriele Monasterio Foundation, Pisa, Massa, Italy.
| | | | - Elisa Listo
- Azienda Ospedaliera ASL, 3-Ospedale Villascassi, Genoa, Italy
| | - Elisa Valenti
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100, Massa, Pisa, Italy
| | - Julio Sotelo
- Departamento de Informática, Universidad Técnica Federico Santa María, Santiago, Chile
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council, Via Aurelia Sud, 54100, Massa, Pisa, Italy
| | | | | | | | - Gianluca Trocchio
- ASST Ospedale Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo BG, Bergamo, Italy
| | | | - Francesca Raimondi
- ASST Ospedale Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo BG, Bergamo, Italy.
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Ait-Ali L, Leonardi B, Alaimo A, Baccano G, Bennati E, Bucciarelli V, Clemente A, Favilli S, Ferroni F, Inserra MC, Lovato L, Maiorano A, Marcora SA, Marrone C, Martini N, Mirizzi G, Pasqualin G, Peritore G, Puppini G, Sandrini C, Raimondi F, Secchi F, Spaziani G, Stagnaro N, Salvadori S, Secinaro A, Tchana B, Trocchio G, Galetti D, Pieroni F, Dalmiani S, Bianco F, Festa P. Overcoming Underpowering in the Outcome Analysis of Repaired-Tetralogy of Fallot: A Multicenter Database from the CMR/CT Working Group of the Italian Pediatric Cardiology Society (SICPed). Diagnostics (Basel) 2023; 13:3255. [PMID: 37892076 PMCID: PMC10606799 DOI: 10.3390/diagnostics13203255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/13/2023] [Accepted: 08/19/2023] [Indexed: 10/29/2023] Open
Abstract
Background: Managing repaired tetralogy of Fallot (TOF) patients is still challenging despite the fact that published studies identified prognostic clinical or imaging data with rather good negative predictive accuracy but weak positive predictive accuracy. Heterogeneity of the initial anatomy, the surgical approach, and the complexity of the mechanism leading to dilation and ventricular dysfunction explain the challenge of predicting the adverse event in this population. Therefore, risk stratification and management of this population remain poorly standardized. Design: The CMR/CT WG of the Italian Pediatric Cardiology Society set up a multicenter observational clinical database of repaired TOF evaluations. This registry will enroll patients retrospectively and prospectively assessed by CMR for clinical indication in many congenital heart diseases (CHD) Italian centers. Data collection in a dedicated platform will include surgical history, clinical data, imaging data, and adverse cardiac events at 6 years of follow-up. Summary: The multicenter repaired TOF clinical database will collect data on patients evaluated by CMR in many CHD centers in Italy. The registry has been set up to allow future research studies in this population to improve clinical/surgical management and risk stratification of this population.
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Affiliation(s)
- Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Institute, 56123 Pisa, Italy; (L.A.-A.); (S.S.)
- Pediatric Cardiology and GUCH Unit, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (C.M.); (N.M.); (P.F.)
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00100 Rome, Italy;
| | - Annalisa Alaimo
- U.O.C. Cardiologia Pediatrica, P.O. “G. Di Cristina”, ARNAS Civico, 90123 Palermo, Italy;
| | - Giovanna Baccano
- Department of Pediatric Cardiology, Centro Cardiologico Pediatrico Mediterraneo, 98039 Taormina, Italy;
| | - Elena Bennati
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria Meyer, 50100 Florence, Italy; (E.B.); (S.F.); (F.R.); (G.S.)
| | - Valentina Bucciarelli
- Department of Pediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona “Umberto I, G. M. Lancisi, G. Salesi”, 60123 Ancona, Italy;
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56123 Pisa, Italy;
| | - Silvia Favilli
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria Meyer, 50100 Florence, Italy; (E.B.); (S.F.); (F.R.); (G.S.)
| | - Francesca Ferroni
- Department of Radiology, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Maria Cristina Inserra
- Department of Radiology, University Hospital Vittorio Emanuele Catania, 95100 Catania, Italy;
| | - Luigi Lovato
- Pediatric and Adult Cardiovascular, Thoraco-Abdominal and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Antonella Maiorano
- Cardiologia Pediatrica, Ospedale Pediatrico Giovanni XXIII di Bari, Via Amendola 207, 70100 Bari, Italy;
| | - Simona Anna Marcora
- USSD Cardiologia Pediatrica, ASST Grande Ospedale Metropolitano Niguarda, 20126 Milano, Italy;
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (C.M.); (N.M.); (P.F.)
| | - Nicola Martini
- Pediatric Cardiology and GUCH Unit, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (C.M.); (N.M.); (P.F.)
| | - Gianluca Mirizzi
- Division of Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, 56123 Pisa, Italy;
| | - Giulia Pasqualin
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milano, Italy; (G.P.); (F.S.)
| | - Giuseppe Peritore
- U.O.C. di Radiodiagnostica, P.O. “G. Di Cristina”, ARNAS Civico, 90123 Palermo, Italy;
| | - Giovanni Puppini
- Department of Radiology, University of Verona, 37100 Verona, Italy;
| | - Camilla Sandrini
- Division of Cardiology, Department of Medicine, University of Verona, 37100 Verona, Italy;
| | - Francesca Raimondi
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria Meyer, 50100 Florence, Italy; (E.B.); (S.F.); (F.R.); (G.S.)
- Department of Cardiology and Cardiovascular Surgery, Papa Giovanni XXIII Hospital, 24100 Bergamo, Italy
| | - Francesco Secchi
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milano, Italy; (G.P.); (F.S.)
| | - Gaia Spaziani
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria Meyer, 50100 Florence, Italy; (E.B.); (S.F.); (F.R.); (G.S.)
| | - Nicola Stagnaro
- Radiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Institute, 56123 Pisa, Italy; (L.A.-A.); (S.S.)
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00100 Rome, Italy;
| | - Bertrand Tchana
- Pediatric Cardiology Unit, General and University Hospital, 43121 Parma, Italy;
| | - Gianluca Trocchio
- Pediatric Cardiology Department, Giannina Gaslini Research Institute and Children Hospital, 16100 Genova, Italy;
| | - Davide Galetti
- Inf Department, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (D.G.); (F.P.); (S.D.)
| | - Federica Pieroni
- Inf Department, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (D.G.); (F.P.); (S.D.)
| | - Stefano Dalmiani
- Inf Department, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (D.G.); (F.P.); (S.D.)
| | - Francesco Bianco
- Department of Pediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona “Umberto I, G. M. Lancisi, G. Salesi”, 60123 Ancona, Italy;
| | - Pierluigi Festa
- Pediatric Cardiology and GUCH Unit, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (C.M.); (N.M.); (P.F.)
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3
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Ali LA, Marrone C, Festa P. Looking beyond the established cut-off. Int J Cardiol 2023:S0167-5273(23)00614-9. [PMID: 37127147 DOI: 10.1016/j.ijcard.2023.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Lamia Ait Ali
- Institute of Clinical Physiology, CNR, Massa, Italy; Tuscany G. Monasterio Foundation Massa, Italy.
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Simonini L, Sbrana S, Foffa I, Baroni M, Catapano G, Chiappino D, Grigoratos C, Marrone C, Losi P, Mannucci F, Salvadori S, Todiere G, Valenti E, Ait-Ali L, Aquaro GD. Relationships between plasma cytokine balance and cardiac magnetic resonance imaging in long-term post-COVID follow-up: a cross-sectional preliminary study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.245] [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
COVID-19 infection can lead to a constellation of long-lasting post-infectious sequelae, including myocardial dysfunction, whose outcome is strongly affected by a fine-tuned balance between pro- and anti-inflammatory systemic immune responses. Plasma cytokines are key mediators of this immunological balance. In this preliminary study we evaluated the cross-sectional association between the circulating levels of the main pro- and anti-inflammatory cytokines and cardiac magnetic resonance (CMR) abnormalities.
Methods
71 subjects (59% female, mean age 52±14) with previous diagnosis of COVID-19 infection were enrolled at our institution for MULTICOVID protocol, comprehensive of CMR and biomarkers assessment performed >3 months and <1 year following the first negative swab test. CMR protocols consisted of conventional sequences (cine, T2-weighted imaging, and late gadolinium enhancement [LGE]) and quantitative mapping sequences (T1, T2, and extracellular volume [ECV] mapping). Plasma levels of cytokines TNF-α, IL-1β, IL-1α, IFN-α2, IL-6, IL-8, IL-13, IL-10, IL-17A, IL-18, IP-10, MIG and MCP-1 were quantified by Multiplex Immunoassays on the Luminex technology platform. Soluble cardiologic and biochemical biomarkers were measured by routine laboratory analysis.
Results
After a median of 9 (IQR 6–11) months following negative swab, CMR was normal in 48 subjects, while in 23 (32%) it revealed tissue characterization abnormalities (myocardial late enhancement and/or edema). By multivariate regression analysis (adjusted for age, sex, vaccination, severity degrees of the initial COVID disease, presence of comorbidities, smoke, time interval between COVID diagnosis and CMR assessment) the cytokine ratio TNF-α/(IL-10+IL-13) was independently associated (OR=2.89, 95% CI 1.19–7.04, p=0.02) with CMR abnormalities. Interestingly, the cumulative pro-/anti-inflammatory cytokine ratio (IL-1β+TNF-α+IFN-α2+IL-6+IL-17A+IL-8)/(IL-10+IL-13) showed a positive (OR=1.70, 95% CI: 1.04–2.75) and significant (p=0.03) association with CMR imaging aspects. Also, the ratio IFN-α2/(IL-10+IL-13), although without achieving a complete statistical significance (p=0.09), was associated positively with CMR findings.
Conclusions
The preliminary results of this cross-sectional study suggest that the systemic inflammatory environment, long-lasting unbalanced towards a prevalent cytokine-driven pro-inflammatory condition following COVID infection, could affect the development of CMR-detectable myocardial edema and fibrosis in long-term post-COVID subjects.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Tuscany Region
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Affiliation(s)
- L Simonini
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - S Sbrana
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - I Foffa
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - M Baroni
- Fondazione Toscana Gabriele Monasterio , Massa , Italy
| | - G Catapano
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - D Chiappino
- Fondazione Toscana Gabriele Monasterio , Massa , Italy
| | - C Grigoratos
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Marrone
- Fondazione Toscana Gabriele Monasterio , Massa , Italy
| | - P Losi
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - F Mannucci
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - S Salvadori
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - G Todiere
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - E Valenti
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - L Ait-Ali
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - G D Aquaro
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
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Santoro G, Pizzuto A, Cuman M, Haxhiademi D, Marchese P, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. Transcatheter closure of "Surgical" ostium secundum atrial septal defects with GORE® Cardioform ASD Occluder. J Card Surg 2022; 37:3200-3206. [PMID: 35900295 DOI: 10.1111/jocs.16786] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCA)(WL Gore & Associates) device for closure of ostium secundum atrial septal defects (ASDs) with predicted indication for surgical correction. BACKGROUND Closure of large ASD in small children by transcatheter approach is still challenging. This study evaluated the results of GCA in this subset of patients in a tertiary referral center. METHODS Between January 2020 and March 2022, 97 children underwent transcatheter ASD closure at our Institution. Of them, 38 had a large defect (diameter/weight > 1.2 or diameter/body surface area > 20 mm/m2 ), predicted suitable for surgery and underwent closure with GCA. Procedure results and midterm outcome are reported. RESULTS Patients' age and weight were 5.5 ± 1.5 years and 19.7 ± 4.7 kg, respectively. Absolute and relative ASD size was 21.5 ± 3.6 mm, 1.1 ± 0.2 mm/kg, and 27.7 ± 4.6 mm/m2 , respectively, resulting in QP/QS of 2.0 ± 0.8. Three patients were sent to surgery after balloon sizing. Four of the remaining 35 patients who underwent device deployment, needed rescue or elective surgery due to device embolization (n = 1), device instability (n = 2) or new-onset tricuspid valve regurgitation (n = 1). Procedure feasibility was 88.6%. Major complications were recorded in two patients (5.7%). Minor complications were recorded in five patients (14.3%). Complete closure at discharge was 90.3% (28/31 pts) rising to 100% at the last follow-up evaluation. Wireframe fracture rate at the 6 months examination was 52%, without clinical and instrumental consequences. CONCLUSIONS Percutaneous treatment with GCA device is effective and safe in a high percentage of ASD children with predicted indications for surgical correction.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Pietro Marchese
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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6
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Ali LA, Marrone C, Martins DS, Khraiche D, Festa P, Martini N, Santoro G, Todiere G, Panaioli E, Bonnet D, Boddaert N, Aquaro GD, Raimondi F. Prognostic factors in hypertrophic cardiomyopathy in children: An MRI based study. Int J Cardiol 2022; 364:141-147. [PMID: 35718011 DOI: 10.1016/j.ijcard.2022.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/07/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical and prognostic role of cardiac magnetic resonance (CMR) in adult population with hypertrophic cardiomyopathy (HCM) have been largely assessed. We sought to investigate the role of CMR for predicting cardiovascular events in children with HCM. METHODS CMR was performed in 116 patients with HCM (37 sarcomeric mutations, 31 other mutations, mean age 10.4 ± 4.3 yrs). CMR protocol included cine imaging for evaluation of morphology and function and late gadolinium enhancement (LGE). Hard cardiac events (sustained VT, resuscitated cardiac arrest, sudden cardiac death, end-stage heart failure, heart transplant and appropriate ICD intervention) were recorded through a median follow-up of 4 (1-7) years. RESULTS During follow-up 21 heart cardiac events occurred. At maximal-rank statistic the optimal cut-point for LGE extent for predicting events was ≥2%. Syncope, non-sustained ventricular tachycardia (NSVT) and LGE extent ≥2% were independent predictors of events. At Harrel's C statistic combination of LGE extent ≥2% and syncope was the strongest model for predicting events. HR of patients with LGE extent ≥2% and no history of syncope was 3.6 (1.1-12.2) that increased to 37.6 (5.4-161) in those with LGE extent ≥2% and syncope. The median time dependent AUC of LGE extent (0.88, 95% CI 0.86-0.89) was significantly higher than that of syncope (0.63, 95% CI 0.61-0.66, p < 0.0001) and NSVT (0.52, 95% CI 0.50-0.53, p < 0.0001). CONCLUSIONS In children with HCM, LGE and syncope were independent predictors of hard cardiac events at follow-up.
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Affiliation(s)
- Lamia Ait Ali
- Institute of Clinical Physiology CNR, UO Massa and Fondazione G. Monasterio. CNR-Regione Toscana. Italy
| | | | - Duarte Saraiva Martins
- Pediatric Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Diala Khraiche
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | | | | | | | | | - Elena Panaioli
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | - Damien Bonnet
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France
| | | | - Francesca Raimondi
- Unité médico-chirurgicale de cardiologie congénitale et pédiatrique, centre de référence des maladies cardiaques congénitales complexes - M3C, Hôpital universitaire Necker-Enfants Malades, Université de Paris, France and Azienda Ospedaliero Universitaria Meyer, Florence, Italy.
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7
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Norrish G, Cleary A, Field E, Cervi E, Boleti O, Ziółkowska L, Olivotto I, Khraiche D, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernandez A, Marrone C, Bökenkamp R, Baban A, Kubus P, Daubeney PE, Sarquella-Brugada G, Cesar S, Klaassen S, Ojala TH, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Sinagra G, Castro FJ, Stuart G, Yamazawa H, Barriales-Villa R, Garcia-Guereta L, Adwani S, Linter K, Bharucha T, Gonzales-Lopez E, Siles A, Rasmussen TB, Calcagnino M, Jones CB, De Wilde H, Kubo T, Felice T, Popoiu A, Mogensen J, Mathur S, Centeno F, Reinhardt Z, Schouvey S, Elliott PM, Kaski JP. Clinical Features and Natural History of Preadolescent Nonsyndromic Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2022; 79:1986-1997. [PMID: 35589160 PMCID: PMC9125690 DOI: 10.1016/j.jacc.2022.03.347] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Up to one-half of childhood sarcomeric hypertrophic cardiomyopathy (HCM) presents before the age of 12 years, but this patient group has not been systematically characterized. OBJECTIVES The aim of this study was to describe the clinical presentation and natural history of patients presenting with nonsyndromic HCM before the age of 12 years. METHODS Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children diagnosed with HCM younger than 12 years were collected and compared with those from 568 children diagnosed between 12 and 16 years. RESULTS At baseline, 339 patients (53.6%) had family histories of HCM, 132 (20.9%) had heart failure symptoms, and 250 (39.2%) were prescribed cardiac medications. The median maximal left ventricular wall thickness z-score was 8.7 (IQR: 5.3-14.4), and 145 patients (27.2%) had left ventricular outflow tract obstruction. Over a median follow-up period of 5.6 years (IQR: 2.3-10.0 years), 42 patients (6.6%) died, 21 (3.3%) underwent cardiac transplantation, and 69 (10.8%) had life-threatening arrhythmic events. Compared with those presenting after 12 years, a higher proportion of younger patients underwent myectomy (10.5% vs 7.2%; P = 0.045), but fewer received primary prevention implantable cardioverter-defibrillators (18.9% vs 30.1%; P = 0.041). The incidence of mortality or life-threatening arrhythmic events did not differ, but events occurred at a younger age. CONCLUSIONS Early-onset childhood HCM is associated with a comparable symptom burden and cardiac phenotype as in patients presenting later in childhood. Long-term outcomes including mortality did not differ by age of presentation, but patients presenting at younger than 12 years experienced adverse events at younger ages.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom,Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Aoife Cleary
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Olga Boleti
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | | | | | | | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, AO dei Colli Monaldi Hospital, Universita della Campania “Luigi Vanvitelli,” Naples, Italy
| | | | | | - Elena Biagini
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedalierao–Universitaria di Bologna, Bologna, Italy
| | - Luca Ragni
- Cardiology Unit, St Orsola Hospital, IRCCS Azienda Ospedalierao–Universitaria di Bologna, Bologna, Italy
| | | | | | - Karen McLeod
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Chiara Marrone
- Papa Giovanni XXIII Hospital, Bergamo, Italy,Fondazione Toscana G. Monasterio, Massa-Pisa, Italy
| | | | | | - Peter Kubus
- University Hospital Motol, Prague, Czech Republic
| | | | | | | | - Sabine Klaassen
- Department of Pediatric Cardiology, Charite–Universitatsmedizin Berlin, Berlin, Germany,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine, Charite–Universitatsmedizin Berlin, Berlin, Germany,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H. Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vinay Bhole
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | | | - Orhan Uzun
- University Hospital of Wales, Cardiff, United Kingdom
| | | | - Ferran Gran
- Vall d’Hebron University Hospital, Barcelona, Spain
| | | | | | - Graham Stuart
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | | | | | | | - Tara Bharucha
- Southampton General Hospital, Southampton, United Kingdom
| | | | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Margherita Calcagnino
- Fondazione IRCCS Ca Granda – Ospedale Maggiore Policlinico Milano, Department di Medicina Interna – UOC Cardiologica, Milan, Italy
| | | | | | - Toru Kubo
- Kochi Medical School Hospital, Kochi, Japan
| | | | - Anca Popoiu
- University of Medicine and Pharmacy “Victor Babes” Timisoara, Department of Pediatrics, Children’s Hospital “Louis Turcanu,” Timisoara, Romania
| | | | | | | | | | | | - Perry M. Elliott
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom,St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
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8
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Norrish G, Ding T, Field E, Cervi E, Ziółkowska L, Olivotto I, Khraiche D, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernández A, Marrone C, Bökenkamp R, Baban A, Kubus P, Daubeney PEF, Sarquella-Brugada G, Cesar S, Klaassen S, Ojala TH, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Sinagra G, Castro FJ, Stuart G, Vignati G, Yamazawa H, Barriales-Villa R, Garcia-Guereta L, Adwani S, Linter K, Bharucha T, Garcia-Pavia P, Siles A, Rasmussen TB, Calcagnino M, Jones CB, De Wilde H, Kubo T, Felice T, Popoiu A, Mogensen J, Mathur S, Centeno F, Reinhardt Z, Schouvey S, O'Mahony C, Omar RZ, Elliott PM, Kaski JP. Relationship Between Maximal Left Ventricular Wall Thickness and Sudden Cardiac Death in Childhood Onset Hypertrophic Cardiomyopathy. Circ Arrhythm Electrophysiol 2022; 15:e010075. [PMID: 35491873 PMCID: PMC7612749 DOI: 10.1161/circep.121.010075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Maximal left ventricular wall thickness (MLVWT) is a risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). In adults, the severity of left ventricular hypertrophy has a nonlinear relationship with SCD, but it is not known whether the same complex relationship is seen in childhood. The aim of this study was to describe the relationship between left ventricular hypertrophy and SCD risk in a large international pediatric HCM cohort. METHODS The study cohort comprised 1075 children (mean age, 10.2 years [±4.4]) diagnosed with HCM (1-16 years) from the International Paediatric Hypertrophic Cardiomyopathy Consortium. Anonymized, noninvasive clinical data were collected from baseline evaluation and follow-up, and 5-year estimated SCD risk was calculated (HCM Risk-Kids). RESULTS MLVWT Z score was <10 in 598 (58.1%), ≥10 to <20 in 334 (31.1%), and ≥20 in 143 (13.3%). Higher MLVWT Z scores were associated with heart failure symptoms, unexplained syncope, left ventricular outflow tract obstruction, left atrial dilatation, and nonsustained ventricular tachycardia. One hundred twenty-two patients (71.3%) with MLVWT Z score ≥20 had coexisting risk factors for SCD. Over a median follow-up of 4.9 years (interquartile range, 2.3-9.3), 115 (10.7%) had an SCD event. Freedom from SCD event at 5 years for those with MLVWT Z scores <10, ≥10 to <20, and ≥20 was 95.6%, 87.4%, and 86.0, respectively. The estimated SCD risk at 5 years had a nonlinear, inverted U-shaped relationship with MLVWT Z score, peaking at Z score +23. The presence of coexisting risk factors had a summative effect on risk. CONCLUSIONS In children with HCM, an inverted U-shaped relationship exists between left ventricular hypertrophy and estimated SCD risk. The presence of additional risk factors has a summative effect on risk. While MLVWT is important for risk stratification, it should not be used either as a binary variable or in isolation to guide implantable cardioverter defibrillator implantation decisions in children with HCM.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
| | - Tao Ding
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.)
| | | | | | | | | | | | | | - Elena Biagini
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | - Luca Ragni
- Cardiology Unit, S. Orsola-Malpighi Hospital, IRCCS Azienda Ospedalierao-Universitaria di Bologna, Italy (E.B., L.R.)
| | | | - Sophie Duignan
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Karen McLeod
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Maria Ilina
- Royal Hospital for Children, Glasgow, United Kingdom (K.M., M.I.)
| | - Adrián Fernández
- Fundación Favaloro University Hospital, Buenos Aires, Argentina (A.F.)
| | | | | | | | - Peter Kubus
- University Hospital Motol, Prague, Czech Republic (P.K.)
| | - Piers E F Daubeney
- Royal Brompton and Harefield NHS Trust, London, United Kingdom (P.E.F.D.)
| | | | - Sergi Cesar
- Sant Joan de Deu, Barcelona, Spain (G.S.-B., S.C.)
| | - Sabine Klaassen
- Department of Pediatric Cardiology (S.K.), Charite-Universitatsmedizin Berlin, Germany.,Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine (S.K.), Charite-Universitatsmedizin Berlin, Germany.,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (S.K.)
| | - Tiina H Ojala
- Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Finland (T.H.O.)
| | - Vinay Bhole
- Birmingham Children's Hospital, United Kingdom (V.B.)
| | - Constancio Medrano
- Fondazione Toscana G. Monasterio, Massa-Pisa, Italy (C.M.).,Hospital General Universitario Gregorio Marañón, Madrid, Spain (C.M.)
| | - Orhan Uzun
- University Hospital of Wales, Cardiff (O.U.)
| | | | - Ferran Gran
- Val d'Hebron University Hospital, Barcelona, Spain (F.G.)
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Italy (G.S.)
| | | | - Graham Stuart
- Bristol Royal Hospital for Children, United Kingdom (G.S.)
| | | | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Hospital, Sapporo, Japan (H.Y.)
| | | | | | | | | | - Tara Bharucha
- Southampton General Hospital, Southampton, United Kingdom (T.B.)
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain (P.G.-P., A.S.)
| | | | - Margherita Calcagnino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Dept di Medicina Interna, UOC Cardiologica, Milano, Italy (M.C.)
| | - Caroline B Jones
- Alder Hey Children's Hospital, Liverpool, United Kingdom (C.B.J.)
| | | | - Toru Kubo
- Kochi Medical School Hospital, Japan (T.K.)
| | | | - Anca Popoiu
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes" Timisoara, Children's Hospital 'Louis Turcanu,' Romania (A.P.)
| | | | - Sujeev Mathur
- Evelina Children's Hospital, London, United Kingdom (S.M.)
| | | | | | | | - Costas O'Mahony
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Rumana Z Omar
- Department of Statistical Science (T.D., R.Z.O.), University College London, United Kingdom
| | - Perry M Elliott
- Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, United Kingdom (C.O., P.M.E.)
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., E.C., J.P.K.).,Institute of Cardiovascular Sciences (G.N., C.O., P.M.E., J.P.K.), University College London, United Kingdom
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9
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Clemente A, Viganò G, Festa L, Remoli E, Marrone C, Federici D, Pak V, Chiappino D, Santoro G, Ait-Ali L. Multimodality Approach to a Complex Scimitar Syndrome. JACC Case Rep 2022; 4:596-603. [PMID: 35615212 PMCID: PMC9125519 DOI: 10.1016/j.jaccas.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/17/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
We report an unusual association of scimitar syndrome with right diaphragmatic hernia, left-sided aortic arch with "aberrant right subclavian artery” in a 2-year-old boy who underwent stepwise transcatheter occlusion of a significant aortopulmonary collateral followed by surgical treatment for the repair of the diaphragmatic hernia and esophageal compression. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Gaia Viganò
- Pediatric Cardiac Surgery, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
- Address for correspondence: Dr Gaia Viganò, CNR/Tuscany Region "Gabriele Monasterio" Foundation, Via Giuseppe Moruzzi, 1, 56124 Pisa PI, Italy. @gaiavigano85
| | - Luigi Festa
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Ettore Remoli
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Duccio Federici
- Pediatric Cardiac Surgery, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Dante Chiappino
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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10
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Norrish G, Qu C, Field E, Cervi E, Khraiche D, Klaassen S, Ojala TH, Sinagra G, Yamazawa H, Marrone C, Popoiu A, Centeno F, Schouvey S, Olivotto I, Day SM, Colan S, Rossano J, Wittekind SG, Saberi S, Russell M, Helms A, Ingles J, Semsarian C, Elliott PM, Ho CY, Omar RZ, Kaski JP. External validation of the HCM Risk-Kids model for predicting sudden cardiac death in childhood hypertrophic cardiomyopathy. Eur J Prev Cardiol 2022; 29:678-686. [PMID: 34718528 PMCID: PMC8967478 DOI: 10.1093/eurjpc/zwab181] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Indexed: 11/24/2022]
Abstract
AIMS Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). The newly developed HCM Risk-Kids model provides clinicians with individualized estimates of risk. The aim of this study was to externally validate the model in a large independent, multi-centre patient cohort. METHODS AND RESULTS A retrospective, longitudinal cohort of 421 patients diagnosed with HCM aged 1-16 years independent of the HCM Risk-Kids development and internal validation cohort was studied. Data on HCM Risk-Kids predictor variables (unexplained syncope, non-sustained ventricular tachycardia, maximal left ventricular wall thickness, left atrial diameter, and left ventricular outflow tract gradient) were collected from the time of baseline clinical evaluation. The performance of the HCM Risk-Kids model in predicting risk at 5 years was assessed. Twenty-three patients (5.4%) met the SCD end-point within 5 years, with an overall incidence rate of 2.03 per 100 patient-years [95% confidence interval (CI) 1.48-2.78]. Model validation showed a Harrell's C-index of 0.745 (95% CI 0.52-0.97) and Uno's C-index 0.714 (95% 0.58-0.85) with a calibration slope of 1.15 (95% 0.51-1.80). A 5-year predicted risk threshold of ≥6% identified 17 (73.9%) SCD events with a corresponding C-statistic of 0.702 (95% CI 0.60-0.81). CONCLUSIONS This study reports the first external validation of the HCM Risk-Kids model in a large and geographically diverse patient population. A 5-year predicted risk of ≥6% identified over 70% of events, confirming that HCM Risk-Kids provides a method for individualized risk predictions and shared decision-making in children with HCM.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | | | - Sabine Klaassen
- Department of Paediatric Cardiology, Charite – Universitatsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Centre (ECRC), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Centre for Molecular Medicine (MDC), Charite – Universitatsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H Ojala
- Department of Paediatric Cardiology, New Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Trieste, Italy
| | - Hirokuni Yamazawa
- Department of Paediatrics, Faculty of Medicine and Graduate school of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Anca Popoiu
- Department of Paediatrics, Children’s Hospital ‘Louis Turcanu’, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
| | | | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Sharlene M Day
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steve Colan
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Rossano
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA
| | - Sara Saberi
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Russell
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Adam Helms
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Perry M Elliott
- Institute of Cardiovascular Sciences, University College London, London, UK
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Juan P Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
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11
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Pezzoli L, Pezzani L, Bonanomi E, Marrone C, Scatigno A, Cereda A, Bedeschi MF, Selicorni A, Gasperini S, Bini P, Maitz S, Maccioni C, Pedron C, Colombo L, Marchetti D, Bellini M, Lincesso AR, Perego L, Pingue M, Della Malva N, Mangili G, Ferrazzi P, Iascone M. Not Only Diagnostic Yield: Whole-Exome Sequencing in Infantile Cardiomyopathies Impacts on Clinical and Family Management. J Cardiovasc Dev Dis 2021; 9:jcdd9010002. [PMID: 35050212 PMCID: PMC8780486 DOI: 10.3390/jcdd9010002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/26/2022] Open
Abstract
Whole-exome sequencing (WES) is a powerful and comprehensive tool for the genetic diagnosis of rare diseases, but few reports describe its timely application and clinical impact on infantile cardiomyopathies (CM). We conducted a retrospective analysis of patients with infantile CMs who had trio (proband and parents)-WES to determine whether results contributed to clinical management in urgent and non-urgent settings. Twenty-nine out of 42 enrolled patients (69.0%) received a definitive molecular diagnosis. The mean time-to-diagnosis was 9.7 days in urgent settings, and 17 out of 24 patients (70.8%) obtained an etiological classification. In non-urgent settings, the mean time-to-diagnosis was 225 days, and 12 out of 18 patients (66.7%) had a molecular diagnosis. In 37 out of 42 patients (88.1%), the genetic findings contributed to clinical management, including heart transplantation, palliative care, or medical treatment, independent of the patient’s critical condition. All 29 patients and families with a definitive diagnosis received specific counseling about recurrence risk, and in seven (24.1%) cases, the result facilitated diagnosis in parents or siblings. In conclusion, genetic diagnosis significantly contributes to patients’ clinical and family management, and trio-WES should be performed promptly to be an essential part of care in infantile cardiomyopathy, maximizing its clinical utility.
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Affiliation(s)
- Laura Pezzoli
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Lidia Pezzani
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
- Pediatria ad Alta Intensità di Cura, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Ezio Bonanomi
- Terapia Intensiva Pediatrica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Chiara Marrone
- Cardiologia Pediatrica, Fondazione G. Monasterio, 54100 Massa, Italy;
| | - Agnese Scatigno
- Pediatria, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (A.S.); (A.C.)
| | - Anna Cereda
- Pediatria, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (A.S.); (A.C.)
| | - Maria Francesca Bedeschi
- Genetica Medica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | | | - Serena Gasperini
- Malattie Metaboliche Rare, Dipartimento di Pediatria, Fondazione MBBM, ASST, 20900 Monza, Italy;
| | - Paolo Bini
- Terapia Intensiva Neonatale, ASST Lariana, 22100 Como, Italy;
| | - Silvia Maitz
- Ambulatorio di Genetica Pediatrica, Clinica Pediatrica, Fondazione MBBM, Ospedale S. Gerardo, 20900 Monza, Italy;
| | - Carla Maccioni
- Terapia Intensiva Neonatale, Ospedale A. Manzoni, ASST, 23900 Lecco, Italy;
| | - Cristina Pedron
- Cardiologia, Ospedale di Bolzano, Azienda Sanitaria dell’Alto Adige, 39100 Bolzano, Italy;
| | - Lorenzo Colombo
- NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | - Daniela Marchetti
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Matteo Bellini
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Anna Rita Lincesso
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Loredana Perego
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Monica Pingue
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Nunzia Della Malva
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
| | - Giovanna Mangili
- Patologia Neonatale, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Paolo Ferrazzi
- Centro Cardiomiopatia Ipertrofica, Policlinico di Monza, 20900 Monza, Italy;
| | - Maria Iascone
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (L.P.); (L.P.); (D.M.); (M.B.); (A.R.L.); (L.P.); (M.P.); (N.D.M.)
- Correspondence: ; Tel.: +39-0352678112
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12
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Santoro G, Cuman M, Pizzuto A, Haxhiademi D, Lunardini A, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. GORE® Cardioform ASD Occluder experience in transcatheter closure of "complex" atrial septal defects. Catheter Cardiovasc Interv 2021; 99:E22-E30. [PMID: 34652048 DOI: 10.1002/ccd.29977] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/25/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCO) (WL Gore & Associates, Flagstaff, AZ) device for "complex" atrial septal defects (ASD) closure. BACKGROUND Transcatheter ASD closure is still challenging in "complex" clinical/anatomic settings. This study evaluated the results of GCO in closure of "complex" ASD in a tertiary referral center. METHODS Between January 2020 and March 2021, 72 patients with significant ASD were submitted to transcatheter closure with GCO at our Institution. Based on clinical/anatomic characteristics, they were classified as "complex" (n = 36, Group I) or "simple" (n = 36, Group II). We considered as "complex", defects with rim deficiency (< 5 mm) other than antero-superior, relatively large (diameter/patient weight > 1.2 or diameter/patient BSA > 20 mm/m2 ) or within a multifenestrated septum. Procedure results and early outcome were compared between the groups. RESULTS Absolute and relative ASD size (20 ± 4 vs. 15 ± 3 mm, p < 0.0001; 0.9 ± 0.3 vs. 0.4 ± 0.2 mm/kg, p < 0.0001; 23 ± 7 vs. 12 ± 5 mm/m2 , p < 0.0001), QP/QS (2.0 ± 0.8 vs. 1.4 ± 0.3, p < 0.001), procedure and fluoroscopy times (73 ± 36 vs. 43 ± 21 min, p < 0.0001; 16 ± 9 vs. 9 ± 4 min, p < 0.0001, procedure feasibility (94.4 vs. 100%, p < 0.0001) and overall complication rate (13.9 vs. 0%, p < 0.0001) were significantly different between the groups. Successful closure of "surgical" ASDs was achieved in 92% of cases. Complete closure at last follow-up evaluation did not significantly differ between the groups (97.1 vs. 100%, p = NS), as was wireframe fractures rate (49.1% in the overall population), without clinical, EKG and echocardiographic consequences. CONCLUSIONS Percutaneous treatment with GCO device is effective and safe in high percentage of "complex" ASDs.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessia Lunardini
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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13
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Ali LA, Gentili F, Festa P, Perrone MA, Curione D, Caputo M, Wald R, Secinaro A, Carotti A, Chinali M, Marrone C, Pak V, Federici D, Gagliardi MG, Bianco M, Galletti L, Drago F, Leonardi B. Long-term assessment of clinical outcomes and disease progression in patients with corrected Tetralogy of Fallot. Eur Rev Med Pharmacol Sci 2021; 25:6300-6310. [PMID: 34730210 DOI: 10.26355/eurrev_202110_27000] [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] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Understanding changes of right ventricular (RV) geometry and function in repaired Tetralogy of Fallot (rToF) patients can improve decision-making for pulmonary valve replacement. Therefore, we aimed to assess the magnitude and clinical correlations of RV changes in rToF patients. PATIENTS AND METHODS Clinical and MRI data of rToF patients who underwent repeated cardiac magnetic resonance imaging (MRI) at two centers between December 2003 and September 2020 were analyzed together with anatomical factors, including RV outflow tract obstruction, pulmonary artery branch stenosis, and tricuspid regurgitation. Adverse cardiac events and/or NYHA class worsening were documented and correlated with MRI changes. QRS length was reported at each MRI. RESULTS Two-hundred-and-nineteen rToF patients (53% males, aged 20.2 ± 10.1 years) were enrolled. An increase of ventricular dimensions, except LVEDVi, and worsening of right and left ejection fractions were found over an average period of 5 years of follow-up. These changes were statistically significant but within 10% of the initial value. No significant changes were reported on a year-to-year basis, except in a small group of patients (6%) in whom no predictive factors were identified. Despite similar RV dimensions at the first examination, younger patients had a higher RV ejection fraction and a different annual rate of change of ventricular dimensions compared to older ones. Patients with arrhythmias (20%) were more frequently older and had larger RV dimensions but showed no significant correlations with MRI changes/years. CONCLUSIONS Changes in RV dimensions and function occur rarely and very slowly in rToF patients. A small percentage of patients experience a significant worsening in a short time interval without any recognized risk factors. Arrhythmias appear to occur in a small percentage of cases in the late follow-up.
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Affiliation(s)
- L A Ali
- Institut of Clinical Physiology IFC-CNR, Massa-Pisa, Italy.
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14
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Spaziani G, Bennati E, Marrone C, Lucà F, Iorio A, Rao CM, Di Fusco SA, Russo MG, Colivicchi F, Gabrielli D, Santoro G, Favilli S, Gulizia MM. Pathophysiology and clinical presentation of paediatric heart failure related to congenital heart disease. Acta Paediatr 2021; 110:2336-2343. [PMID: 33948967 DOI: 10.1111/apa.15904] [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] [Received: 01/22/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
Congenital heart disease (CHD) and cardiomyopathies represent the two most important causes of paediatric heart failure (HF) in developed countries. We made a review of the literature on pathophysiology and clinical presentation of paediatric HF in children with CHD. Two main pathophysiologic models can be identified: the 'over-circulation failure', characterised by signs and symptoms of congestion or hypoperfusion, due respectively to volume or pressure overload, and the 'pump failure'. CONCLUSIONS: The comprehension of the HF pathophysiology in paediatric patients with CHD is of paramount importance for the optimal management and for addressing the best therapeutic choices.
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Affiliation(s)
- Gaia Spaziani
- Pediatric Cardiology Azienda Ospedaliera Universitaria Meyer Florence Italy
| | - Elena Bennati
- Pediatric Cardiology Azienda Ospedaliera Universitaria Meyer Florence Italy
| | - Chiara Marrone
- Pediatric Cardiology Fondazione G. Monasterio CNR‐Regione Toscana Massa Italy
| | - Fabiana Lucà
- Division of Cardiology Big Metropolitan Hospital Reggio Calabria Italy
| | - Annamaria Iorio
- Division of Cardiology Azienda Ospedaliera Papa Giovanni XXIII Bergamo Italy
| | | | | | - Maria Giovanna Russo
- Pediatric Cardiology Department of Cardiology Monaldi Hospital, “L. Vanvitelli” University Naples Italy
| | - Furio Colivicchi
- UOC Cardiologia Clinica e Riabilitativa San Filippo Neri Hospital Rome Italy
| | | | - Giuseppe Santoro
- Pediatric Cardiology Fondazione G. Monasterio CNR‐Regione Toscana Massa Italy
| | - Silvia Favilli
- Pediatric Cardiology Azienda Ospedaliera Universitaria Meyer Florence Italy
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15
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Ravaglioli A, Ait-Ali L, Federici D, Salvadori S, Pllumi A, Pak V, Marrone C, Pizzuto A, Bonhoeffer P, Festa P. The impact of native Fallot anatomy on future therapeutic requirements and outcomes at follow-up. Cardiovasc Ultrasound 2021; 19:23. [PMID: 34147117 PMCID: PMC8214257 DOI: 10.1186/s12947-021-00249-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background In patients with repaired Fallot, subsequent surgical or interventional procedures and adverse cardiac events are frequent. We aimed to evaluate the impact of a simple pre-operative anatomic classification based on the size of the pulmonary valve (PV) annulus and branches on future therapeutic requirements and outcomes. Method This is a single-center retrospective analysis of patients operated for Fallot before the age of 2 years, from January 1990. Pre-operative anatomy, surgical and interventional procedures and adverse events were extrapolated from clinical records. Results Among the 312 patients, a description of the PV and pulmonary arteries (PAs) native anatomy was known in 239 patients (male:147, 61.5%), which were divided in the following 3 groups: group 1 (65 patients) with normal size of both PV and PAs; group 2 (108 patients) with PV hypoplasia but normal size PAs; group 3 (66 patients) with concomitant hypoplasia of the PV and PAs. During the 12.7 years (IQR 6.7–17) follow-up time, 23% of patients required at least one surgical or interventional procedure. At Kaplan–Meier analysis, there was a significant difference in requirement of future surgical or interventional procedures among the 3 groups (p < 0,001). At multivariate Cox regression analysis, hypoplasia of PV and PAs was an independent predictor of subsequent procedures (HR:3.1,CI:1.06–9.1, p = 0.03). Conclusion Native anatomy in Tetralogy of Fallot patients affects surgical strategy and follow-up. It would be therefore advisable to tailor patient’s counseling and follow-up according to native anatomy, rather than following a standardized protocol. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-021-00249-y.
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Affiliation(s)
- Antonio Ravaglioli
- Division of Pediatric Cardiac Surgery, Fondazione G. Monasterio, Massa, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Council (CNR), Via Aurelia Sud, 54100, Massa, Italy.
| | - Duccio Federici
- Division of Pediatric Cardiac Surgery, Fondazione G. Monasterio, Massa, Italy
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council (CNR), Via Aurelia Sud, 54100, Massa, Italy
| | | | - Vitali Pak
- Division of Pediatric Cardiac Surgery, Fondazione G. Monasterio, Massa, Italy
| | - Chiara Marrone
- Division of Pediatric Cardiology, Fondazione G. Monasterio, Massa, Italy
| | - Alessandra Pizzuto
- Division of Pediatric Cardiology, Fondazione G. Monasterio, Massa, Italy
| | | | - Pierluigi Festa
- Division of Pediatric Cardiology, Fondazione G. Monasterio, Massa, Italy
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16
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Norrish G, Topriceanu C, Qu C, Field E, Walsh H, Ziółkowska L, Olivotto I, Passantino S, Favilli S, Anastasakis A, Vlagkouli V, Weintraub R, King I, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernández A, Bökenkamp R, Baban A, Drago F, Kubuš P, Daubeney PEF, Chivers S, Sarquella-Brugada G, Cesar S, Marrone C, Medrano C, Alvarez Garcia-Roves R, Uzun O, Gran F, Castro FJ, Gimeno JR, Barriales-Villa R, Rueda F, Adwani S, Searle J, Bharucha T, Siles A, Usano A, Rasmussen TB, Jones CB, Kubo T, Mogensen J, Reinhardt Z, Cervi E, Elliott PM, Omar RZ, Kaski JP. The role of the electrocardiographic phenotype in risk stratification for sudden cardiac death in childhood hypertrophic cardiomyopathy. Eur J Prev Cardiol 2021; 29:645-653. [PMID: 33772274 PMCID: PMC8967480 DOI: 10.1093/eurjpc/zwab046] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/09/2021] [Indexed: 11/13/2022]
Abstract
AIMS The 12-lead electrocardiogram (ECG) is routinely performed in children with hypertrophic cardiomyopathy (HCM). An ECG risk score has been suggested as a useful tool for risk stratification, but this has not been independently validated. This aim of this study was to describe the ECG phenotype of childhood HCM in a large, international, multi-centre cohort and investigate its role in risk prediction for arrhythmic events. METHODS AND RESULTS Data from 356 childhood HCM patients with a mean age of 10.1 years (±4.5) were collected from a retrospective, multi-centre international cohort. Three hundred and forty-seven (97.5%) patients had ECG abnormalities at baseline, most commonly repolarization abnormalities (n = 277, 77.8%); left ventricular hypertrophy (n = 240, 67.7%); abnormal QRS axis (n = 126, 35.4%); or QT prolongation (n = 131, 36.8%). Over a median follow-up of 3.9 years (interquartile range 2.0-7.7), 25 (7%) had an arrhythmic event, with an overall annual event rate of 1.38 (95% CI 0.93-2.04). No ECG variables were associated with 5-year arrhythmic event on univariable or multivariable analysis. The ECG risk score threshold of >5 had modest discriminatory ability [C-index 0.60 (95% CI 0.484-0.715)], with corresponding negative and positive predictive values of 96.7% and 6.7. CONCLUSION In a large, international, multi-centre cohort of childhood HCM, ECG abnormalities were common and varied. No ECG characteristic, either in isolation or combined in the previously described ECG risk score, was associated with 5-year sudden cardiac death risk. This suggests that the role of baseline ECG phenotype in improving risk stratification in childhood HCM is limited.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | | | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Helen Walsh
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK
| | - Lidia Ziółkowska
- Department of Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | | | | | - Silvia Favilli
- Cardiology Unit, A Meyer Pediatric Hospital, Florence, Italy
| | | | | | - Robert Weintraub
- The Royal Children's Hospital, Melbourne, Australia.,The Murdoch Children's Research Institute.,University of Melbourne, Australia
| | | | | | - Luca Ragni
- S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | | | | | | | - Adrian Fernández
- Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | | | | | | | - Peter Kubuš
- University Hospital Motol, Prague, Czech Republic
| | | | - Sian Chivers
- Royal Brompton and Harefield NHS Trust, London, UK
| | - Georgia Sarquella-Brugada
- Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Spain.,Medical Sciences Department, School of Medicine, University of Girona
| | - Sergi Cesar
- Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Spain
| | | | | | | | - Orhan Uzun
- University Hospital of Wales, Cardiff, UK
| | - Ferran Gran
- Val d'Hebron University Hospital, Barcelona, Spain
| | | | - Juan R Gimeno
- University Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Fernando Rueda
- Complexo Hospitalario Universitario A Coruña, CIBERCV, A Coruña, Spain
| | | | | | | | - Ana Siles
- Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain.,University Francisco de Vitoria, Pozuelo de Alarcon, Spain
| | - Ana Usano
- Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain.,University Francisco de Vitoria, Pozuelo de Alarcon, Spain
| | | | | | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | | | | | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Perry M Elliott
- Institute of Cardiovascular Sciences, University College London, London, UK.,St Bartholomew's Centre for Inherited Cardiovascular Diseases, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Juan P Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
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17
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Spinelli V, Girolami F, Marrone C, Consigli V, Iascone M, Passantino S, Porcedda G, Calabri GB, De Simone L, Olivotto I, Santoro G, Favilli S. A rare case of pediatric cardiomyopathy: Alström syndrome identified by gene panel analysis. Clin Case Rep 2020; 8:3369-3373. [PMID: 33363936 PMCID: PMC7752570 DOI: 10.1002/ccr3.3327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 11/09/2022] Open
Abstract
Genetic investigation of early-onset Dilatative cardiomyopathy phenotype, including molecular autopsy, is the key to appropriate recognition and management of rare etiologies and atypical presentations and to offer genetic counseling to the family.
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Affiliation(s)
| | | | - Chiara Marrone
- Department of CardiologyFondazione Toscana Gabriele MonasterioMassaItaly
| | - Veronica Consigli
- Department of CardiologyFondazione Toscana Gabriele MonasterioMassaItaly
| | - Maria Iascone
- Department of GeneticsASST Papa Giovanni XXIIIBergamoItaly
| | | | | | | | | | | | - Giuseppe Santoro
- Department of CardiologyFondazione Toscana Gabriele MonasterioMassaItaly
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18
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Cantinotti M, Giordano R, Marrone C, Franchi E, Koestenberger M, Assanta N. Double Orifice Mitral Valve in Tricuspid Atresia: A Rare Association. Pediatr Cardiol 2019; 40:1761-1762. [PMID: 31506732 DOI: 10.1007/s00246-019-02204-1] [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] [Received: 08/03/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
We here report a neonate with prenatal echocardiographic diagnosis of tricuspid atresia, with normally related great vessels, and large ventricular septal defect. This diagnosis could be confirmed with echocardiography at birth. An additional double mitral orifice was also seen. This is a very rare association.
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Affiliation(s)
| | - Raffaele Giordano
- Department of Advanced Biomedical Sciences, Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy.
| | - Chiara Marrone
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
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19
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Norrish G, Ding T, Field E, Ziółkowska L, Olivotto I, Limongelli G, Anastasakis A, Weintraub R, Biagini E, Ragni L, Prendiville T, Duignan S, McLeod K, Ilina M, Fernández A, Bökenkamp R, Baban A, Kubuš P, Daubeney PEF, Sarquella-Brugada G, Cesar S, Marrone C, Bhole V, Medrano C, Uzun O, Brown E, Gran F, Castro FJ, Stuart G, Vignati G, Barriales-Villa R, Guereta LG, Adwani S, Linter K, Bharucha T, Garcia-Pavia P, Rasmussen TB, Calcagnino MM, Jones CB, De Wilde H, Toru-Kubo J, Felice T, Mogensen J, Mathur S, Reinhardt Z, O’Mahony C, Elliott PM, Omar RZ, Kaski JP. Development of a Novel Risk Prediction Model for Sudden Cardiac Death in Childhood Hypertrophic Cardiomyopathy (HCM Risk-Kids). JAMA Cardiol 2019; 4:918-927. [PMID: 31411652 PMCID: PMC6694401 DOI: 10.1001/jamacardio.2019.2861] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/19/2019] [Indexed: 12/16/2022]
Abstract
Importance Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM), but there is no validated algorithm to identify those at highest risk. Objective To develop and validate an SCD risk prediction model that provides individualized risk estimates. Design, Setting, and Participants A prognostic model was developed from a retrospective, multicenter, longitudinal cohort study of 1024 consecutively evaluated patients aged 16 years or younger with HCM. The study was conducted from January 1, 1970, to December 31, 2017. Exposures The model was developed using preselected predictor variables (unexplained syncope, maximal left-ventricular wall thickness, left atrial diameter, left-ventricular outflow tract gradient, and nonsustained ventricular tachycardia) identified from the literature and internally validated using bootstrapping. Main Outcomes and Measures A composite outcome of SCD or an equivalent event (aborted cardiac arrest, appropriate implantable cardioverter defibrillator therapy, or sustained ventricular tachycardia associated with hemodynamic compromise). Results Of the 1024 patients included in the study, 699 were boys (68.3%); mean (interquartile range [IQR]) age was 11 (7-14) years. Over a median follow-up of 5.3 years (IQR, 2.6-8.3; total patient years, 5984), 89 patients (8.7%) died suddenly or had an equivalent event (annual event rate, 1.49; 95% CI, 1.15-1.92). The pediatric model was developed using preselected variables to predict the risk of SCD. The model's ability to predict risk at 5 years was validated; the C statistic was 0.69 (95% CI, 0.66-0.72), and the calibration slope was 0.98 (95% CI, 0.59-1.38). For every 10 implantable cardioverter defibrillators implanted in patients with 6% or more of a 5-year SCD risk, 1 patient may potentially be saved from SCD at 5 years. Conclusions and Relevance This new, validated risk stratification model for SCD in childhood HCM may provide individualized estimates of risk at 5 years using readily obtained clinical risk factors. External validation studies are required to demonstrate the accuracy of this model's predictions in diverse patient populations.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Tao Ding
- Department of Statistical Science, University College London, London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Lidia Ziółkowska
- Department of Cardiology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Iacopo Olivotto
- Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Giuseppe Limongelli
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Department of Cardiothoracic Sciences, Monaldi Hospital, Naples, Italy
| | | | - Robert Weintraub
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Australia
- Department of Clinical Sciences, The Murdoch Children’s Research Institute, Parkville, Australia
- Department of Medical and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Elena Biagini
- Department of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luca Ragni
- Department of Cardiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Terence Prendiville
- The Children’s Heart Centre, Our Lady’s Children’s Hospital, Dublin, Ireland
| | - Sophie Duignan
- The Children’s Heart Centre, Our Lady’s Children’s Hospital, Dublin, Ireland
| | - Karen McLeod
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Adrián Fernández
- Department of Ambulatory Cardiology, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Regina Bökenkamp
- Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anwar Baban
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesu Hospital, Rome, Italy
| | - Peter Kubuš
- Children’s Heart Centre, University Hospital Motol, Prague, Czech Republic
| | - Piers E. F. Daubeney
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Georgia Sarquella-Brugada
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Medical Sciences Department, School of Medicine, University of Girona, Girona, Spain
| | - Sergi Cesar
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Arrhythmia and Inherited Cardiac Diseases Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Chiara Marrone
- Department of Paediatric Cardiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Vinay Bhole
- The Heart Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Constancio Medrano
- Department of Paediatric Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Orhan Uzun
- Children’s Heart Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Elspeth Brown
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Ferran Gran
- Paediatric Cardiology Department, Val d’Hebron University Hospital, Barcelona, Spain
| | - Francisco J. Castro
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Graham Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | | | - Roberto Barriales-Villa
- Department of Cardiology, Complexo Hospitalario Universitario A Coruña, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, A Coruña, Spain
| | - Luis G. Guereta
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Satish Adwani
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Katie Linter
- Department of Paediatric Cardiology, Glenfield Hospital, Leicester, United Kingdom
| | - Tara Bharucha
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Pablo Garcia-Pavia
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
- Department of Cardiology, University Francisco de Vitoria, Pozuelo de Alarcon, Spain
| | | | - Margherita M. Calcagnino
- Department of Cardiology, University Hospitals Parma, Parma, Italy
- Cardiology Unit, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Caroline B. Jones
- Department of Cardiology, Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Hans De Wilde
- Department of Paediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - J. Toru-Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tiziana Felice
- Department of Paediatric Cardiology, Mater Dei Hospital, Msida, Malta
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Sujeev Mathur
- Children’s Heart Service, Evelina Children’s Hospital, London, United Kingdom
| | - Zdenka Reinhardt
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, United Kingdom
| | - Constantinos O’Mahony
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Perry M. Elliott
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Rumana Z. Omar
- Department of Statistical Science, University College London, London, United Kingdom
| | - Juan P. Kaski
- Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Great Ormond Street Hospital, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
- European Reference Network for Rare and Complex Diseases of the Heart, Amsterdam, the Netherlands
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Marrone C, Galletti L. On rough road of hypoplastic left heart syndrome after Norwood procedure. J Thorac Dis 2019; 11:S465-S467. [PMID: 30997249 DOI: 10.21037/jtd.2018.11.27] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chiara Marrone
- Cardiology Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo Galletti
- Cardiac Surgery Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
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Cadonati C, Seddio F, Ferrero P, Uricchio N, Marcora S, Sadou Y, Marrone C, Bonanomi E, Mangili G, Galletti L. RF45 LOW BIRTH WEIGHT NEONATES AND CHD. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000550052.88803.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Uricchio N, Seddio F, Marcora S, Marrone C, Ferrero P, Preda L, Papa M, Ciuffreda M, Didedda G, Sadou Y, Galletti L. MORE THAN 10 YEARS SINGLE CENTRE EXPERIENCE WITH NORWOOD STAGE I PROCEDURE. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549873.02815.ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Marrone C, Ferrero P, Uricchio N, Sebastiani R, Vittori C, Ciuffreda M, Terzi A, Galletti L. The unnatural history of failing univentricular hearts: outcomes up to 25 years after heart transplantation. Interact Cardiovasc Thorac Surg 2017; 25:892-897. [DOI: 10.1093/icvts/ivx352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 09/19/2017] [Indexed: 11/12/2022] Open
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Quarta G, Iacovoni A, Marrone C, Grosu A, Brambilla P, Olivotto I, Gavazzi A, Senni M. Microvascular ischaemia after cardiac arrest in a patient with hypertrophic cardiomyopathy. Glob Cardiol Sci Pract 2015. [DOI: 10.5339/gcsp.2015.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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25
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Marrone C, Galasso G, Piccolo R, de Leva F, Paladini R, Piscione F, Santoro G. Antiplatelet versus anticoagulation therapy after extracardiac conduit Fontan: a systematic review and meta-analysis. Pediatr Cardiol 2011; 32:32-9. [PMID: 20967441 DOI: 10.1007/s00246-010-9808-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 09/18/2010] [Indexed: 12/01/2022]
Abstract
The benefits of prophylactic anticoagulation or antiplatelet therapy for patients undergoing extracardiac conduit (ECC) Fontan procedure still are a matter of debate. Through a systematic review and meta-analysis, this study aimed to determine the incidence of thromboembolism among patients undergoing ECC Fontan who received anticoagulation or antiplatelet therapy. Until February 2010, MEDLINE studies describing the incidence of thromboembolic events after ECC Fontan were reviewed. Information on type of drugs and clinical outcome was extracted. The 20 studies analyzed involved 1,075 patients: 220 (20.4%) in the antiplatelet group and 855 (79.5%) in the anticoagulation group. The mean follow-up period ranged from 2 to 144 months. The overall thromboembolism rate was 5.2% (95% confidence interval [CI], 3.8-7%; I(2) = 0%; p(het) = 0.32). The effect of different therapeutic strategies on the occurrence of thromboembolic and bleeding events was analyzed. Interestingly, the anticoagulation therapy compared with the antiplatelet therapy was not associated with a significant reduction in the incidence of overall thromboembolic complications (5% vs 4.5%, respectively; I(2) = 0%; p(het) = 0.80). Only two cases of bleeding were observed among patients receiving anticoagulant therapy at the time of the event. For patients undergoing ECC Fontan, the rate of thromboembolic and bleeding events associated with antiplatelet therapy is similar to that associated with anticoagulation therapy.
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Affiliation(s)
- Chiara Marrone
- Pediatric Cardiology Unit, Santobono-Pausilipon Hospital, Via M. Fiore 6, Naples, Italy.
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Santoro G, Caianiello G, Gaio G, Palladino MT, Marrone C, Russo MG, Calabrò R. Late percutaneous re-canalization of arterial duct-dependent isolated pulmonary artery. J Cardiovasc Med (Hagerstown) 2010; 11:196-8. [PMID: 19786887 DOI: 10.2459/jcm.0b013e32832e0ab3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
A critical infant with unrestrictive ventricular septal defect and absence of the left pulmonary artery underwent transcatheter re-canalization of the occluded arterial duct-left pulmonary artery complex and surgical banding of the right pulmonary artery. After this hybrid approach, the baby was discharged under mild anticongestive therapy in view of a later surgical repair.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and Cardiac Surgery, A.O. Monaldi, 2nd University of Naples, Naples, Italy.
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Santoro G, Capozzi G, Caianiello G, Palladino MT, Marrone C, Farina G, Russo MG, Calabrò R. Pulmonary Artery Growth After Palliation of Congenital Heart Disease With Duct-Dependent Pulmonary Circulation. J Am Coll Cardiol 2009; 54:2180-6. [DOI: 10.1016/j.jacc.2009.07.043] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 07/13/2009] [Accepted: 07/20/2009] [Indexed: 10/20/2022]
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Morisco C, Marrone C, Galeotti J, Shao D, Vatner DE, Vatner SF, Sadoshima J. Endocytosis machinery is required for beta1-adrenergic receptor-induced hypertrophy in neonatal rat cardiac myocytes. Cardiovasc Res 2008; 78:36-44. [PMID: 18194989 DOI: 10.1093/cvr/cvn008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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: 01/08/2023] Open
Abstract
AIMS Cardiac hypertrophy by activation of the beta-adrenergic receptor (beta AR) is mediated more efficiently by the beta1-AR than by the beta2-AR. We investigated the signalling mechanism by which the beta1-AR mediates cardiac hypertrophy. METHODS AND RESULTS Experiments were performed in cultured neonatal rat cardiomyocytes. Hypertrophy was determined by the protein/DNA content and atrial natriuretic factor transcription. Phosphorylation of Akt and Src was assessed by immunoblotting. Isoproterenol (ISO, 10 microM), a non-selective beta-AR agonist, caused selective downregulation of the beta1-AR (control beta1 vs. beta2: 35 vs. 65%, Bmax 78 +/- 4 fmol/mg; 4 h, 10 vs. 90%, 61 +/- 5 fmol/mg). Concanavalin A (Con A, 0.5 microg/mL), an inhibitor of endocytosis, prevented downregulation of beta1-ARs by ISO treatment (4 h, 35 vs. 65%, 73 +/- 8 fmol/mg), suggesting that beta1-ARs selectively undergo endocytosis. Interference with beta1-AR endocytosis by Con A, carboxyl terminal peptide of beta-AR kinase-1, dominant negative (DN) beta-arrestin-1, or DN dynamin inhibited beta-adrenergic hypertrophy, suggesting that the endocytosis machinery plays a key role in mediating beta-adrenergic hypertrophy. Activation of Akt by the beta1-AR was blocked by inhibition of the endocytosis machinery, suggesting that endocytosis mediates activation of Akt. Akt plays a critical role in beta-adrenergic hypertrophy, since DN Akt blocked ISO-induced hypertrophy. beta-Adrenergic activation of Akt is mediated by Src, which associates with the endocytosis machinery and is necessary and sufficient to mediate beta-adrenergic hypertrophy. CONCLUSION Activation of the endocytosis machinery is required for activation of Akt, which, in turn, critically mediates beta1-AR-induced cardiac hypertrophy.
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Affiliation(s)
- Carmine Morisco
- Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, UMDNJ, New Jersey Medical School, 185 South Orange Avenue, MSB G-609, Newark, NJ 07103, USA
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Morisco C, Marrone C, Trimarco V, Crispo S, Monti MG, Sadoshima J, Trimarco B. Insulin resistance affects the cytoprotective effect of insulin in cardiomyocytes through an impairment of MAPK phosphatase-1 expression. Cardiovasc Res 2007; 76:453-64. [PMID: 17698050 DOI: 10.1016/j.cardiores.2007.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 04/19/2007] [Accepted: 07/18/2007] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Insulin protects cardiomyocytes from apoptosis. Insulin resistance usually refers to a defect in the ability of insulin to stimulate glucose uptake. It is unknown, however, whether or not insulin resistance compromises the cell-protective effect of the hormone. Caspases are a family of cysteine proteases that regulate apoptosis. We explored the effects of insulin resistance on hypoxia-induced caspase-3 activation in cardiomyocytes. METHODS Experiments were performed in cultured neonatal rat cardiomyocytes. Insulin resistance was induced by treating cardiac myocytes with isoproterenol, a beta-adrenergic receptor agonist. RESULTS Twelve hours of hypoxia-induced caspase-3 cleavage, which was inhibited by treatment with insulin, while pre-treatment with isoproterenol abolished the insulin effect. Hypoxia-induced cleavage of caspase-3 was mediated by p38 mitogen-activated protein kinase (MAPK). Insulin inhibited hypoxia-induced phosphorylation of p38 through MAPK phosphatase-1 (MKP-1). Insulin-induced MKP-1 expression was mediated by extracellular signal-regulated protein kinases (ERK) 1/2, c-Jun NH2-terminal kinases (JNK) MAPK, and phosphatidylinositol 3-kinase (PI3K)/Akt pathways. Isoproterenol stimulation failed to induce expression of MKP-1; moreover, insulin resistance induced by long-term beta-adrenergic stimulation inhibited insulin-evoked expression of MKP-1 by impairing insulin-induced phosphorylation of both ERK1/2 and JNK without affecting Akt kinase activity. Furthermore, concomitant activation of Akt, ERK 1/2, and JNK was required for insulin to exert its protective effect against the hypoxia-induced cleavage of caspase-3. CONCLUSIONS The results of this study lead to the conclusions that, in cardiac myocytes, antiapoptotic signals induced by insulin are mediated by more than one signaling pathway, and that long-term beta-adrenergic receptor stimulation impairing some of these pathways affects the cytoprotective action of insulin.
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Affiliation(s)
- Carmine Morisco
- Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy.
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Marrone C, Suely M, Shinjo S, Silva R, Gabellini G, Blanco M, Amartino H. M.P.2.01 Late-onset Pompe disease: A report of three cases in Rio Grande do Sul State, Brazil and identification of novel mutations. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Suely M, Porta G, Carvalho M, Martins A, Santarosa A, Marrone C, Berditchevesky C, Horovitz D, Llerena J, Machado M, Albuquerque R, Pecchini R, Souza M. M.P.5.02 Enzymatic replacement therapy with rhGAA in Brazilian Pompe patients. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Orlando A, Marrone C, Nicoli N, Tamburello G, Rizzo A, Pagliaro L, Cottone M, D'Amico G. Fatal necrotising fasciitis associated with intramuscular injection of nonsteroidal anti-inflammatory drugs after uncomplicated endoscopic polypectomy. J Infect 2007; 54:e145-8. [DOI: 10.1016/j.jinf.2006.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 08/23/2006] [Accepted: 09/09/2006] [Indexed: 11/26/2022]
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Andriani A, Zullo A, Di Raimondo F, Patti C, Tedeschi L, Recine U, Caruso L, Bonanno G, Chiarenza A, Lizzani G, Miedico A, Romanelli A, Costa A, Linea C, Marrone C, Mirto S, Mistretta A, Montalbano L, Restivo G, Vinci M, Bibas M, Hassan C, Stella F, Cottone M, Morini S. Clinical and endoscopic presentation of primary gastric lymphoma: a multicentre study. Aliment Pharmacol Ther 2006; 23:721-6. [PMID: 16556173 DOI: 10.1111/j.1365-2036.2006.02826.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although the stomach is the most frequent site of intestinal lymphomas, few data are available on both clinical endoscopic presentation of gastric lymphoma and possible differences between low-grade and high-grade lymphomas. METHODS Clinical, histological and endoscopic records of consecutive patients with primary low-grade or high-grade lymphoma diagnosed were retrieved. Symptoms were categorized as 'alarm' or 'not alarm'. The endoscopic findings were classified as 'normal' or 'abnormal'. RESULTS Overall, 144 patients with primary gastric lymphoma were detected, including 74 low-grade and 70 high-grade lymphoma. Alarm symptoms, particularly persistent vomiting and weight loss, were more frequently present in patients with high-grade lymphoma than in those with low-grade lymphoma (54% vs. 28%; P = 0.002). Low-grade lymphomas presented as 'normal' appearing mucosa (20% vs. 0%; P = 0.0004) or petechial haemorrhage in the fundus (9% vs. 0%; P = 0.02) more frequently than high-grade lymphomas, being also more often confined to the antrum (47% vs. 27%, P = 0.03) and associated with Helicobacter pylori infection (88% vs. 52%, P < 0.0001). On the contrary, high-grade lymphomas presented more commonly as ulcerative type (70% vs. 52%; P = 0.03), being also more frequently diagnosed in stage >I when compared with low-grade lymphomas (70% vs. 21%, P < 0.0001). CONCLUSIONS The overall prevalence of alarm symptoms is quite low and may be absent in more than 70% of patients with low-grade lymphoma.
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Affiliation(s)
- A Andriani
- Department of Haematology and Gastroenterology, 'San Giacomo' and 'Nuovo Regina Margherita' Hospitals, Rome, Italy
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Pasta L, Marrone C, D'amico M, Virdone R, D'amico G, Sammarco P, Fabiano C, Pagliaro L. MTHFR C677T mutations in liver cirrhosis with and without portal vein thrombosis. Liver Int 2006; 26:269-70. [PMID: 16448467 DOI: 10.1111/j.1478-3231.2005.01215.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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35
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Orlando A, Modesto I, Castiglione F, Scala L, Scimeca D, Rispo A, Teresi S, Mocciaro F, Criscuoli V, Marrone C, Platania P, De Falco T, Maisano S, Nicoli N, Cottone M. The role of calprotectin in predicting endoscopic post-surgical recurrence in asymptomatic Crohn's disease: a comparison with ultrasound. Eur Rev Med Pharmacol Sci 2006; 10:17-22. [PMID: 16494106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Faecal calprotectin is predictive of clinical relapse in inflammatory bowel disease and ultrasound is sensitive in detecting its post-surgical recurrence. However, no data regarding the role of calprotectin in predicting post-surgical recurrence in asymptomatic Crohn's disease are available. The aim of this study was to prospectively evaluate the role of calprotectin as a predictive marker for one year post-surgical endoscopic recurrence in comparison with ultrasound in patients with asymptomatic Crohn's disease. MATERIAL AND METHODS We consecutively enlisted 50 patients who had undergone a resection for Crohn's disease. Faecal calprotectin was analysed and ultrasound were performed at the third month, and a colonoscopy after one year. The sensitivity and specificity of these two techniques were evaluated using endoscopic findings as a golden standard. A Receiver Operator Curve (ROC) curve was plotted, in order to identify the best-cut off value for calprotectin. RESULTS 39 out of 50 patients were evaluated by performing a colonoscopy after one year; 19 patients had an endoscopic recurrence after one year. Calprotectin sensitivity and specificity were calculated for 5 different cut-off values; the best cut-off value for calprotectin sensitivity (63%) and specificity (75%) was > 200 mg/L. The US sensitivity and specificity at the third month were 26% and 90% respectively. CONCLUSIONS When performed three months after surgery ultrasound is more specific than calprotectin in predicting endoscopic recurrence. Faecal calprotectin at a dosage > 200 mg/L seems to have a better sensitivity than ultrasound. Values of calprotectin > 200 mg can be an indication to colonoscopy in the group of patients with negative ultrasound in order to detect early recurrence.
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Affiliation(s)
- A Orlando
- Department of Internal Medicine, V Cervello Hospital, Palermo, Italy
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Morisco C, Condorelli G, Trimarco V, Bellis A, Marrone C, Condorelli G, Sadoshima J, Trimarco B. Akt mediates the cross-talk between beta-adrenergic and insulin receptors in neonatal cardiomyocytes. Circ Res 2004; 96:180-8. [PMID: 15591229 DOI: 10.1161/01.res.0000152968.71868.c3] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Upregulation of the sympathetic nervous system plays a key role in the pathogenesis of insulin resistance. Although the heart is a target organ of insulin, few studies have examined the mechanisms by which beta-adrenergic stimulation affects insulin sensitivity in cardiac muscle. In this study, we explored the molecular mechanisms involved in the regulation of the cross-talk between beta adrenergic and insulin receptors in neonatal rat cardiomyocytes and in transgenic mice with cardiac overexpression of a constitutively active mutant of Akt (E40K Tg). The results of this study show that beta-adrenergic receptor stimulation has a biphasic effect on insulin-stimulated glucose uptake. Short-term stimulation induces an additive effect on insulin-induced glucose uptake, and this effect is mediated by phosphorylation of Akt in threonine 308 through PKA/Ca2+-dependent and PI3K-independent pathway, whereas insulin-evoked threonine phosphorylation of Akt is exclusively PI3K-dependent. On the other hand, long-term stimulation of beta-adrenergic receptors inhibits both insulin-stimulated glucose uptake and insulin-induced autophosphorylation of the insulin receptor, and at the same time promotes threonine phosphorylation of the insulin receptor. This is mediated by serine 473 phosphorylation of Akt through PKA/Ca2+ and PI3K-dependent pathways. Under basal conditions, E40K Tg mice show increased levels of threonine phosphorylation of the beta subunit of the insulin receptor and blunted tyrosine autophosphorylation of the beta-subunit of the insulin receptor after insulin stimulation. These results indicate that, in cardiomyocytes, beta-adrenergic receptor stimulation impairs insulin signaling transduction machinery through an Akt-dependent pathway, suggesting that Akt is critically involved in the regulation of insulin sensitivity.
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MESH Headings
- Adrenergic beta-Agonists/pharmacology
- Adrenergic beta-Agonists/toxicity
- Amino Acid Substitution
- Animals
- Animals, Newborn
- Cells, Cultured/drug effects
- Cells, Cultured/metabolism
- Cyclic AMP-Dependent Protein Kinases/physiology
- Deoxyglucose/metabolism
- Enzyme Activation
- Insulin Resistance/physiology
- Isoproterenol/pharmacology
- Isoproterenol/toxicity
- Mice
- Mice, Transgenic
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/metabolism
- Phosphatidylinositol 3-Kinases/physiology
- Phosphorylation
- Phosphoserine/metabolism
- Phosphothreonine/metabolism
- Protein Processing, Post-Translational/drug effects
- Protein Processing, Post-Translational/physiology
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/physiology
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/physiology
- Proto-Oncogene Proteins c-akt
- Rats
- Receptor Cross-Talk/drug effects
- Receptor Cross-Talk/physiology
- Receptor, Insulin/physiology
- Receptors, Adrenergic, beta/drug effects
- Receptors, Adrenergic, beta/physiology
- Signal Transduction/physiology
- Structure-Activity Relationship
- Sympathetic Nervous System/physiology
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Affiliation(s)
- Carmine Morisco
- Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università Federico II, Napoli, Italy
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Pasta L, Pietrosi G, Marrone C, D'Amico G, D'Amico M, Licata A, Misiano G, Madonia S, Mercadante F, Pagliaro L. C4BQ0: a genetic marker of familial HCV-related liver cirrhosis. Dig Liver Dis 2004; 36:471-7. [PMID: 15285527 DOI: 10.1016/j.dld.2004.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND METHODS Host may have a role in the evolution of chronic HCV liver disease. We performed two cross-sectional prospective studies to evaluate the prevalence of cirrhosis in first degree relatives of patients with cirrhosis and the role of two major histocompatibility complex class III alleles BF and C4 versus HCV as risk factors for familial clustering. FINDINGS Ninety-three (18.6%) of 500 patients with cirrhosis had at least one cirrhotic first degree relative as compared to 13 (2.6%) of 500 controls, (OR 7.38; CI 4.21-12.9). C4BQ0 was significantly more frequent in the 93 cirrhotic patients than in 93 cirrhotic controls without familiarity (Hardy-Weinberg equilibrium: chi2 5.76, P = 0.016) and in 20 families with versus 20 without aggregation of HCV related cirrhosis (29.2% versus 11.3%, P = 0.001); the association C4BQ0-HCV was found almost only in cirrhotic patients with a family history of liver cirrhosis. CONCLUSIONS Our studies support the value of C4BQ0 as a risk indicator of familial HCV related cirrhosis.
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Affiliation(s)
- L Pasta
- Department of Medicine and Pneumology, V Cervello Hospital, Via Trabucco 180, 90146 Palermo, Italy.
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Di Stefano L, Patacchiola F, Palermo P, Marrone C, Mascaretti G. [Ectropion of the uterine cervix in adolescence. Study of a topical drug as an alternative to surgical treatment]. Clin Ter 2002; 153:381-3. [PMID: 12645394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The Authors, studied the ectropion of the uterine cervix in the teen-agers (young ladies) and the effect of the desossiribonucleic acid therapy in topic way by 5 mg/die for 20 days in 80 patients with an ectropion of the I degree and the II degree portion of the uterine cervix. The patients were separated in two groups. 40 patients treated by desossiribonucleic acid therapy, 40 patients didn't take any medicament. In conclusion the results show that the desossiribonucleic therapy could be an alternative way for the treatment of the ectropion of the uterine cervix.
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Affiliation(s)
- L Di Stefano
- Facoltà di Medicina e Chirurgia, Clinica Ginecologica ed Ostetrica, Dipartimento di Scienze Chirurgiche, Università degli Studi de L'Aquila, Via Vetoio, Blocco 11, 67010, Coppito, L'Aquila, Italia
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Cottone M, Termini A, Oliva L, Magliocco A, Marrone C, Orlando A, Pinzone F, Di Mitri R, Rosselli M, Rizzo A, Pagliaro L. Mortality and causes of death in celiac disease in a Mediterranean area. Dig Dis Sci 1999; 44:2538-41. [PMID: 10630509 DOI: 10.1023/a:1026655609906] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
No data on mortality in celiac disease are currently available in southern Europe. Our aim was to evaluate mortality and the cause of death in adult celiac disease in a Mediterranean area. In all, 228 adults with celiac disease were histologically diagnosed in our department from 1980 to 1997. Full information on their state of health was obtained in 216 of 228 patients. A tabulation of patient-years at risk was constructed in terms of age at diagnosis and the interval from diagnosis. Standardized mortality ratio was calculated by dividing the number of observed deaths by the number of expected deaths. Twelve deaths were observed, whereas 3.12 deaths were expected (SMR = 3.8; 95% CI 2-7). The increased mortality was mainly observed within four years from diagnosis (8 observed; 1.4 expected) (SMR = 5.8; 95% CI 2.5-11.5). Twelve tumors were observed (six lymphomas). In conclusion, mortality from adult celiac disease in our geographical area is increased compared with the general population, and this increased risk seems due to non-Hodgkin's lymphoma.
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Affiliation(s)
- M Cottone
- Clinica Medica R, Università di Palermo, Ospedale V. Cervello, Sanità, Italy
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Reverchon E, Daghero J, Marrone C, Mattea M, Poletto M. Supercritical Fractional Extraction of Fennel Seed Oil and Essential Oil: Experiments and Mathematical Modeling. Ind Eng Chem Res 1999. [DOI: 10.1021/ie990015+] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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