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Mancusi C, Basile C, Spaccarotella C, Gargiulo G, Fucile I, Paolillo S, Gargiulo P, Santoro C, Manzi L, Marzano F, Ambrosino P, De Luca N, Esposito G. Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review. High Blood Press Cardiovasc Prev 2024; 31:127-140. [PMID: 38489152 PMCID: PMC11043114 DOI: 10.1007/s40292-024-00629-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/26/2024] [Indexed: 03/17/2024] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition.
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Affiliation(s)
- Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmen Spaccarotella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ilaria Fucile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, Telese, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
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2
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Di Lisi D, Cadeddu Dessalvi C, Zito C, Madaudo C, Manganaro R, Mercurio V, Deidda M, Santoro C, Penna C, Monte IP, Spallarossa P, Tocchetti CG, Novo G. Management of cancer patients at high and very-high risk of cardiotoxicity: Main questions and answers. Curr Probl Cardiol 2024; 49:102229. [PMID: 38154703 DOI: 10.1016/j.cpcardiol.2023.102229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
In recent years, important advances have been made in the field of Cardio-Oncology. The 2022 ESC Guidelines on Cardio-Oncology proposed a baseline cardiovascular risk stratification for cancer patients and preventive strategies in patients at high and very-high risk of cardiotoxicity. Cardiovascular toxic effects of anti-cancer drugs are being extensively studied; surveillance programs have been proposed, based on the baseline cardiovascular risk. On the other hand, there is little data on Cardio-Oncological management of patients at high and very-high cardiovascular risk with previous cardiovascular diseases. For example, little is known about management of cancer patients with heart failure with reduced ejection fraction (HFrEF), patients with a recent myocardial infarction or other cardiovascular diseases; when to resume anti-cancer drugs after a cardiovascular toxic event. Collaboration between Cardiologists and Oncologists and multidisciplinary team evaluations are certainly essential to decide the best therapeutic strategy for cancer patients, to treat cancer while saving the heart. Therefore, in the present review, we attempt to provide a useful guide to clinicians in treating patients with high and very-high risk of cardiotoxicity by enucleating main questions and answering them based on the evidence available as well as expert opinion and our clinical experience.
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Affiliation(s)
- Daniela Di Lisi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy..
| | | | - Concetta Zito
- Department of Clinical and Experimental Medicine - Cardiology Unit, University of Messina, Messina, Italy
| | - Cristina Madaudo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Roberta Manganaro
- Department of Clinical and Experimental Medicine - Cardiology Unit, University of Messina, Messina, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy; Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy; Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Martino Deidda
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italy-IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, 16121 Genova, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Claudia Penna
- Department of Clinical and Biological Sciences of Turin University, Orbassano, Turin, I-10043, Italy
| | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialities- Cardiology, University of Catania, Catania, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italy-IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, 16121 Genova, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy; Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Naples, Italy; Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
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3
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Manzi L, Sperandeo L, Forzano I, Castiello DS, Florimonte D, Paolillo R, Santoro C, Mancusi C, Di Serafino L, Esposito G, Gargiulo G. Contemporary Evidence and Practice on Right Heart Catheterization in Patients with Acute or Chronic Heart Failure. Diagnostics (Basel) 2024; 14:136. [PMID: 38248013 PMCID: PMC10814482 DOI: 10.3390/diagnostics14020136] [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: 11/13/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Heart failure (HF) has a global prevalence of 1-2%, and the incidence around the world is growing. The prevalence increases with age, from around 1% for those aged <55 years to >10% for those aged 70 years or over. Based on studies in hospitalized patients, about 50% of patients have heart failure with reduced ejection fraction (HFrEF), and 50% have heart failure with preserved ejection fraction (HFpEF). HF is associated with high morbidity and mortality, and HF-related hospitalizations are common, costly, and impact both quality of life and prognosis. More than 5-10% of patients deteriorate into advanced HF (AdHF) with worse outcomes, up to cardiogenic shock (CS) condition. Right heart catheterization (RHC) is essential to assess hemodynamics in the diagnosis and care of patients with HF. The aim of this article is to review the evidence on RHC in various clinical scenarios of patients with HF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy; (L.M.); (L.S.); (I.F.); (D.S.C.); (D.F.); (R.P.); (C.S.); (C.M.); (L.D.S.); (G.E.)
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4
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Chistolini A, Serrao A, Assanto GM, Genoese A, Baldacci E, Ligia S, Breccia M, Santoro C. Antithrombotic secondary prophylaxis with low dose of apixaban or rivaroxaban in the onco-hematologic patients: comparison with non-neoplastic patients. Ann Hematol 2023; 102:2599-2605. [PMID: 37479891 DOI: 10.1007/s00277-023-05369-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
Management of cancer-associated thrombosis (CAT) is usually performed employing low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs). Low-intensity DOACs are the mainstay for extended duration therapy for VTE in non-oncologic patients. The aim of our study was to evaluate the efficacy and the safety of low doses of apixaban or rivaroxaban as secondary prophylaxis in patients affected by hematological malignancies with follow-up > 12 months. We report an observational, retrospective, single-center study that evaluated consecutive patients referred to our center between January 2016 and January 2023. The DOACs were administered at full dose during the acute phase of VTE and then at low dose for the extended phase. We included 154 patients: 53 patients affected by hematological malignancies compared to 101 non-neoplastic patients. During full-dose treatment, no thrombotic recurrences were observed in the two groups. During low-dose therapy, 2 (1.9%) thrombotic events (tAE) were observed in the control group. During full-dose treatment, the rate of bleeding events (bAE) was 9/154 (5.8%): 6/53 (11%) in hematological patients and 3/101 (2.9%) in non-hematological patients (p = 0.0003). During low-dose therapy, 4/154 (2.6%) bAE were observed: 3/53 (5.5%) in the hematologic group and 1 (1%) in the control group (p = 0.07). We found encouraging data on the safety and efficacy of low doses of DOACs as secondary prophylaxis in the onco-hematologic setting; no thrombotic complications were observed, and the incidence of hemorrhagic events was low.
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Affiliation(s)
- A Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy.
| | - A Serrao
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - G M Assanto
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - A Genoese
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - S Ligia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - M Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, 00161, Rome, Italy
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5
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Santoro C, Donal E, Magne J, Sade LE, Penicka M, Katbeh A, Cosyns B, Cameli M, Hanzevacki JS, Luksic VR, Agricola E, Citro R, Hagendorff A, Lancellotti P, Habib G, Moreo A, Cardim N, Parato VM, Neskovic A, Rosca M, Galli E, Motoc A, Mandoli G, Ingallina G, Prota C, Stoebe S, Piette C, Mouhat B, Carbone A, Chiara BD, Ilardi F, Stankovic I, Zamorano JL, Popescu BA, Edvardsen T, Galderisi M. Inter-center reproducibility of standard and advanced echocardiographic parameters in the EACVI-AFib echo registry. Echocardiography 2023; 40:775-783. [PMID: 37351556 DOI: 10.1111/echo.15640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/31/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023] Open
Abstract
AIM we sought to test the inter-center reproducibility of 16 echo laboratories involved in the EACVI-Afib Echo Europe. METHODS This was done on a dedicated setting of 10 patients with sinus rhythm (SR) and 10 with persistent atrial fibrillation (AF), collected by the Principal Investigator. Images and loops of echo-exams were stored and made available for labs. The tested measurements included main echo-Doppler parameters, global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS). RESULTS Single measures interclass correlation coefficients (ICCs) of left ventricular mass and ejection fraction were suboptimal in both patients with SR and AF. Among diastolic parameters, ICCs of deceleration time were poor, in particular in AF (=.50). ICCs of left atrial size and function, besides optimal in AF, showed an acceptable despite moderate concordance in SR. ICC of GLS was .81 and .78 in SR and AF respectively. ICCs of PALS were suitable but lower in 4-chamber than in 2-chamber view. By depicting the boxplot of the 16 laboratories, GLS distribution was completely homogeneous in SR, whereas GLS of AF and PALS of both SR and AF presented a limited number of outliers. GLS mean ± SE of the 16 labs was 19.7 ± .36 (95% CI: 18.8-20.4) in SR and 16.5 ± .29 (95% CI: 15.9-17.1) in AF, whereas PALS mean ± SE was 43.8 ± .70 (95% CI: 42.3-45.3) and 10.2 ± .32 (95% CI: 9.5-10.9) respectively. CONCLUSION While the utilization of some standard-echo variables should be discouraged in registries, the application of GLS and PALS could be largely promoted because their superior reproducibility, even in AF.
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Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, Rennes, France
| | - Julien Magne
- Service Cardiologie, CHU Limoges, Hopital Dupuytren, Limoges, France
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | | | - Asim Katbeh
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Centrum voor hart -en Vaatziekten, UZ Brussel, Brussel, Belgium
| | - Matteo Cameli
- Department of Cardiovascular Disease, University of Siena, Siena, Italy
| | | | | | - Eustachio Agricola
- Echocardiographic Laboratory, Vita Salute University, San Raffaele Hospital, IRCSS Milan, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
- Department of Vascular Physiology, IRCCS Neuromed, Pozzilli, Italy
| | - Andreas Hagendorff
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, University of Liege Hospital, Liege, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Gilbert Habib
- Aix Marseille University, APHM La Timone Hospital, Cardiology Department, Marseille, France
| | - Antonella Moreo
- Cardio-thoracic-vascular Department De Gasperis, ASST GOM Niguarda and Bicocca University, Milan, Italy
| | | | - Vito Maurizio Parato
- Cardiology Unit of Emergency Dept, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Alexsandar Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | - Monica Rosca
- University of Medicine and Pharmacy "Carol Davila", Emergency Institute of Cardiovascular Diseases "Prof. Dr. CC. Iliescu" Hospital, Bucharest, Romania
| | - Elena Galli
- Service Cardiologie, CHU Limoges, Hopital Dupuytren, Limoges, France
| | - Andreea Motoc
- Department of Cardiology, Centrum voor hart -en Vaatziekten, UZ Brussel, Brussel, Belgium
| | - Giulia Mandoli
- Department of Cardiovascular Disease, University of Siena, Siena, Italy
| | - Giacomo Ingallina
- Echocardiographic Laboratory, Vita Salute University, San Raffaele Hospital, IRCSS Milan, Italy
| | - Costantina Prota
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Stephen Stoebe
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Caroline Piette
- GIGA Cardiovascular Sciences, University of Liege Hospital, Liege, Belgium
| | - Basile Mouhat
- Aix Marseille University, APHM La Timone Hospital, Cardiology Department, Marseille, France
| | - Andreina Carbone
- Aix Marseille University, APHM La Timone Hospital, Cardiology Department, Marseille, France
- Unit of Cardiology, University Hospital "Luigi Vanvitelli", Naples, Italy
| | - Benedetta De Chiara
- Cardio-thoracic-vascular Department De Gasperis, ASST GOM Niguarda and Bicocca University, Milan, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ivan Stankovic
- Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | - Jose Luis Zamorano
- Cardiology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Bogdan Alexandru Popescu
- University of Medicine and Pharmacy "Carol Davila", Emergency Institute of Cardiovascular Diseases "Prof. Dr. CC. Iliescu" Hospital, Bucharest, Romania
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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6
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Manzo R, Ilardi F, Nappa D, Mariani A, Angellotti D, Immobile Molaro M, Sgherzi G, Castiello DS, Simonetti F, Santoro C, Canonico ME, Avvedimento M, Piccolo R, Franzone A, Esposito G. Echocardiographic Evaluation of Aortic Stenosis: A Comprehensive Review. Diagnostics (Basel) 2023; 13:2527. [PMID: 37568890 PMCID: PMC10417789 DOI: 10.3390/diagnostics13152527] [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: 06/26/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Echocardiography represents the most important diagnostic tool in the evaluation of aortic stenosis. The echocardiographic assessment of its severity should always be performed through a standardized and stepwise approach in order to achieve a comprehensive evaluation. The latest technical innovations in the field of echocardiography have improved diagnostic accuracy, guaranteeing a better and more detailed evaluation of aortic valve anatomy. An early diagnosis is of utmost importance since it shortens treatment delays and improves patient outcomes. Echocardiography plays a key role also in the evaluation of all the structural changes related to aortic stenosis. Detailed evaluation of subtle and subclinical changes in left ventricle function has a prognostic significance: scientific efforts have been addressed to identify the most accurate global longitudinal strain cut-off value able to predict adverse outcomes. Moreover, in recent years the role of artificial intelligence is increasingly emerging as a promising tool able to assist cardiologists in aortic stenosis screening and diagnosis, especially by reducing the rate of aortic stenosis misdiagnosis.
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Affiliation(s)
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
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7
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Pucci M, Iadevaia V, Gammaldi V, Iervolino A, Capece LM, Sciascia D, Cuomo V, Iacono M, Paoletta D, Santoro C, Esposito R. Right Ventricular Myocardial Involvement in Anderson-Fabry Disease at Diagnosis: Evaluation with Three-Dimensional Strain Imaging. Life (Basel) 2023; 13:1571. [PMID: 37511946 PMCID: PMC10381814 DOI: 10.3390/life13071571] [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: 06/20/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Background: Right ventricular (RV) involvement in Anderson-Fabry disease (AFD) is well known in the advanced stages of the disease RV hypertrophies, but little is known about the early involvement. The aim of our study was to assess RV function in AFD patients at diagnosis. Methods: A total of 23 AFD patients and 15 controls comparable for age and sex were recruited. A complete 2D standard echo with 3D volumetric and strain analysis of RV was performed. Results: Two patient populations, comparable for clinical baseline characteristics were considered. RV free wall thickness was significantly increased in the AFD group. No significant differences in standard RV indices (TAPSE, transverse diameter, tissue Doppler velocities of the lateral tricuspid annulus) were found. A 3D volumetric analysis showed reduced RV ejection fraction and lower values of longitudinal septal, free wall and global longitudinal strain (GLS) in AFD patients. RV free wall thickness significantly correlated with both free wall RV LS and RV GLS. In multiple linear regression analysis, RV free wall thickness was independently associated with RV GLS even after correction for age and heart rate. Conclusions: In AFD patients, 3D echocardiography allows for the identification of early subclinical functional impairment of RV. RV dysfunction is independently associated with RV hypertrophy.
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Affiliation(s)
- Martina Pucci
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Velia Iadevaia
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Vittoria Gammaldi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Adelaide Iervolino
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Luca Maria Capece
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Domenico Sciascia
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Vittoria Cuomo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Marina Iacono
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Daniele Paoletta
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
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8
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Ligia S, Musiu P, Serrao A, Santoro C, Taglietti A, Capriata M, Faccini A, Molinari MC, Baldacci E, Chistolini A. Low-dose apixaban or rivaroxaban as secondary prophylaxis of upper extremity deep vein thrombosis. J Thromb Thrombolysis 2023:10.1007/s11239-023-02842-6. [PMID: 37341894 DOI: 10.1007/s11239-023-02842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
Upper extremity deep vein thrombosis (UEDVT) may occur without inciting factor or may be secondary to malignancy, surgery, trauma, central venous catheter or related to thoracic outlet syndrome (TOS). International guidelines recommend anticoagulant treatment for at least three months, in particular the use of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). No data on extended anticoagulant therapy and reduced dose of DOACs have been reported in patients affected by UEDVT with persistent thrombotic risk (active cancer, major congenital thrombophilia) or without affected vein recanalization. In our retrospective observational study, including 43 patients, we treated secondary UEDVT with DOACs. In the acute phase of thrombosis (median time of 4 months), we used therapeutic dose of DOACs; the 32 patients with permanent thrombotic risk factors or without recanalization of the UEDVT were shifted to low-dose DOACs (apixaban 2.5 mg twice daily or rivaroxaban 10 mg daily). During therapy with full-dose DOACs, 1 patient presented recurrence of thrombosis; no thromboembolic events were observed during treatment with low-dose DOACs. During full-dose treatment, 3 patients presented minor hemorrhagic complications; no hemorrhagic events were observed during DOACs at low dose. We think our preliminary data could support the indication to extend the anticoagulation with dose reduction of DOACs in patients affected by UEDVT and no-transient thrombotic risk. These data should be confirmed in randomized controlled prospective study.
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Affiliation(s)
- S Ligia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - P Musiu
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Serrao
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - C Santoro
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Taglietti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - M Capriata
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - A Faccini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - M C Molinari
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - E Baldacci
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy
| | - Antonio Chistolini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Via Benevento 6, Rome, 00161, Italy.
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Mandoli GE, Cameli M, Pastore MC, Benfari G, Malagoli A, D'Andrea A, Sperlongano S, Bandera F, Esposito R, Santoro C, Pedrinelli R, Mercuro G, Indolfi C. Speckle tracking echocardiography in early disease stages: a therapy modifier? J Cardiovasc Med (Hagerstown) 2023; 24:e55-e66. [PMID: 37052222 DOI: 10.2459/jcm.0000000000001422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Echocardiography has been included as a first-line tool in several international guidelines for the management of patients with various cardiac diseases. Beyond diagnosis, echocardiographic examination helps in characterizing the severity of the condition since the very first stages. In particular, the application of second-level techniques, speckle tracking echocardiography in particular, can also reveal a subclinical dysfunction, while the standard parameters are in the normality range. The present review describes the potentialities of advanced echocardiography in different settings, including arterial hypertension, atrial fibrillation, diastolic dysfunction, and oncological patients, thus opening up potential starting points for its application as a clinical routine changer.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena
| | | | - Simona Sperlongano
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, Naples
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milano
- Cardiology University Department, IRCCS Policlinico San Donato, Milan
| | | | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples
| | - Roberto Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy
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10
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Mandoli GE, Pastore MC, Giannoni A, Benfari G, Dini FL, Rosa G, Pugliese NR, Taddei C, Correale M, Brunetti ND, Mazzeo P, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, De Carli G, Degiovanni A, Patti G, Santoro C, Moderato L, Cicoira M, Canepa M, Malagoli A, Emdin M, Cameli M. Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry. ESC Heart Fail 2023; 10:846-857. [PMID: 36448244 PMCID: PMC10053272 DOI: 10.1002/ehf2.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS Sacubitril/valsartan has changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects on morbidity and mortality, partly mediated by left ventricular (LV) reverse remodelling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration. METHODS AND RESULTS Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included. Echocardiographic parameters including LV global longitudinal strain (GLS) and global peak atrial longitudinal strain by speckle tracking echocardiography were measured to find the predictors of LVRR [= LV end-systolic volume reduction ≥10% and ejection fraction (LVEF) improvement ≥10% at follow-up] at 6 month follow-up as the primary endpoint. Changes in symptoms [New York Heart Association (NYHA) class] and neurohormonal activations [N-terminal pro-brain natriuretic peptide (NT-proBNP)] were also evaluated as secondary endpoints; 341 patients (excluding patients with poor acoustic windows and missing data) were analysed (mean age: 65 ± 10 years; 18% female, median LVEF 30% [inter-quartile range: 25-34]). At 6 month follow-up, 82 (24%) patients showed early complete response (LVRR and LVEF ≥ 35%), 55 (16%) early incomplete response (LVRR and LVEF < 35%), and 204 (60%) no response (no LVRR and LVEF < 35%). Non-ischaemic aetiology, a lower left atrial volume index, and a higher GLS were all independent predictors of LVRR at multivariable logistic analysis (all P < 0.01). A baseline GLS < -9.3% was significantly associated with early response (area under the curve 0.75, P < 0.0001). Left atrial strain was the best predictor of positive changes in NYHA class and NT-proBNP (all P < 0.05). CONCLUSIONS Speckle tracking echocardiography parameters at baseline could be useful to predict LVRR and clinical response to sacubitril-valsartan and could be used as a guide for treatment in patients with HFrEF.
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Affiliation(s)
- Giulia Elena Mandoli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine DepartmentFondazione Toscana G. MonasterioPisaItaly
- Institute of Life SciencesScuola Superiore Sant'AnnaPisaItaly
| | - Giovanni Benfari
- Section of Cardiology, Department of MedicineUniversity of VeronaVeronaItaly
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical SpecialitiesUniversity of GenoaGenoaItaly
| | | | - Claudia Taddei
- Cardiology and Cardiovascular Medicine DepartmentFondazione Toscana G. MonasterioPisaItaly
| | - Michele Correale
- Cardiology DepartmentPoliclinico Riuniti University HospitalFoggiaItaly
| | | | - Pietro Mazzeo
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ HospitalUniversity of PerugiaPerugiaItaly
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ HospitalUniversity of PerugiaPerugiaItaly
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic DepartmentPolyclinic University HospitalBariItaly
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic DepartmentPolyclinic University HospitalBariItaly
| | - Rodolfo Citro
- Cardio‐Thoracic‐Vascular DepartmentUniversity Hospital San Giovanni di Dio e Ruggi d'AragonaSalernoItaly
| | - Michele Ciccarelli
- Department of Medicine, Surgery and DentistryUniversity of SalernoBaronissiItaly
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic SciencesFondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro CuoreRomeItaly
| | - Valentina Loria
- Department of Cardiovascular and Thoracic SciencesFondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro CuoreRomeItaly
| | - Giuseppe De Carli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular DiseasesMaggiore della Carità HospitalNovaraItaly
| | - Giuseppe Patti
- Department of Thoracic, Heart and Vascular DiseasesMaggiore della Carità HospitalNovaraItaly
- Department of Translational MedicineUniversity of Piemonte OrientaleNovaraItaly
| | - Ciro Santoro
- Department of Advanced Biomedical ScienceFederico II University HospitalNaplesItaly
| | - Luca Moderato
- Cardiology DepartmentOspedale Guglielmo da SalicetoPiacenzaItaly
| | | | - Marco Canepa
- Cardiovascular Disease UnitIRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular NetworkGenoaItaly
- Department of Internal MedicineUniversity of GenoaGenoaItaly
| | - Alessandro Malagoli
- Division of Cardiology, Nephro‐Cardiovascular Department, Baggiovara HospitalUniversity of Modena and Reggio EmiliaModenaItaly
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine DepartmentFondazione Toscana G. MonasterioPisaItaly
- Institute of Life SciencesScuola Superiore Sant'AnnaPisaItaly
| | - Matteo Cameli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
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11
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Negishi T, Thavendiranathan P, Penicka M, Lemieux J, Murbraech K, Miyazaki S, Shirazi M, Santoro C, Cho GY, Popescu BA, Kosmala W, Costello B, la Gerche A, Mottram P, Thomas L, Seldrum S, Hristova K, Bansal M, Kurosawa K, Fukuda N, Yamada H, Izumo M, Tajiri K, Sinski M, Vinereanu D, Shkolnik E, Banchs J, Kutty S, Negishi K, Marwick TH. Cardioprotection Using Strain-Guided Management of Potentially Cardiotoxic Cancer Therapy: 3-Year Results of the SUCCOUR Trial. JACC Cardiovasc Imaging 2023; 16:269-278. [PMID: 36435732 DOI: 10.1016/j.jcmg.2022.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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: 07/13/2022] [Revised: 08/27/2022] [Accepted: 10/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Global longitudinal strain (GLS) can predict cancer therapeutics-related cardiac dysfunction and guide initiation of cardioprotection (CPT). OBJECTIVES In this study, the authors sought to determine whether echocardiography GLS-guided CPT provides less cardiac dysfunction in survivors of potentially cardiotoxic chemotherapy, compared with usual care at 3 years. METHODS In this international multicenter prospective randomized controlled trial, patients were enrolled from 28 international sites. All patients treated with anthracyclines with another risk factor for heart failure were randomly allocated to GLS-guided (>12% relative reduction in GLS) or ejection fraction (EF)-guided (>10% absolute reduction of EF to <55%) CPT. The primary end point was the change in 3-dimensional (3D) EF (ΔEF) from baseline to 3 years. RESULTS Among 331 patients enrolled, 255 (77%, age 54 ± 12 years, 95% women) completed 3-year follow-up (123 in the EF-guided group and 132 in the GLS-guided group). Most had breast cancer (n = 236; 93%), and anthracycline followed by trastuzumab was the most common chemotherapy regimen (84%). Although 67 (26%) had hypertension and 32 (13%) had diabetes mellitus, left ventricular function was normal at baseline (EF: 59% ± 6%, GLS: 20.7% ± 2.3%). CPT was administered in 18 patients (14.6%) in the EF-guided group and 41 (31%) in the GLS-guided group (P = 0.03). Most patients showed recovery in EF and GLS after chemotherapy; 3-year ΔEF was -0.03% ± 7.9% in the EF-guided group and -0.02% ± 6.5% in the GLS-guided (P = 0.99) group; respective 3-year EFs were 58% ± 6% and 59% ± 5% (P = 0.06). At 3 years, 17 patients (5%) had cancer therapeutics-related cardiac dysfunction (11 in the EF-guided group and 6 in the GLS guided group; P = 0.16); 1 patient in each group was admitted for heart failure. CONCLUSIONS Among patients taking potentially cardiotoxic chemotherapy for cancer, the 3-year data showed improvement of LV dysfunction compared with 1 year, with no difference in ΔEF between GLS- and EF-guided CPT. (Strain Surveillance of Chemotherapy for Improving Cardiovascular Outcomes [SUCCOUR]; ACTRN12614000341628).
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Affiliation(s)
- Tomoko Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Sydney Medical School Nepean, Charles Perkins Centre Nepean, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Canada
| | | | - Julie Lemieux
- Centre des Maladies du Sein, Hôpital du Saint-Sacrement, Centre Hospitalier Universitaire de Québec and Université Laval Research Center and Faculty of Medicine, Laval University, Québec City, Québec, Canada
| | | | | | - Mitra Shirazi
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Goo-Yeong Cho
- Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bogdan A Popescu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Wojciech Kosmala
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Cardiology Department, Wroclaw Medical University, Wroclaw, Poland; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ben Costello
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Alfred Hospital, Melbourne, Victoria, Australia
| | - Andre la Gerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Phil Mottram
- Monash Medical Center, Melbourne, Victoria, Australia
| | - Liza Thomas
- Westmead Hospital, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | | | | | | | | | - Evgeny Shkolnik
- Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Jose Banchs
- MD Anderson Cancer Hospital, Houston, Texas, USA
| | | | - Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Sydney Medical School Nepean, Charles Perkins Centre Nepean, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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12
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Spitaleri G, Trillo Aliaga P, Catania C, Signore ED, Attili I, Santoro C, Giugliano F, Berton Giachetti PPM, Curigliano G, Passaro A, de Marinis F. Safety of mRNA-COVID-19 Vaccines in Patients With Thoracic Cancers. Clin Lung Cancer 2023; 24:e19-e26. [PMID: 36372676 PMCID: PMC9584758 DOI: 10.1016/j.cllc.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pivotal trials of COVID-19 vaccines did not include cancer patients with questions remaining in this population. Particularly in patients with thoracic malignancies receiving anticancer treatments, the safety of these vaccines has so far been little investigated. METHODS This is a prospective trial of patients with thoracic cancer receiving anticancer treatments and COVID-19 vaccines at the Division of Thoracic Oncology of European Institute of Oncology between February and September 2021. RESULTS A total 207 patients affected by thoracic cancers (199 lung cancers and 8 mesotheliomas) had received Covid-19 vaccines (206 mRNA vaccines and 1 virus-vectored vaccine). The majority of patients had at least one comorbidity (76.3%). They were concomitantly treating with targeted therapy (TT) (45.9%), immunotherapy (IO) (22.7%), and chemotherapy (CT) (14%). A total of 64 AEs (15.6%) were observed after administration of Sars-Cov-2 vaccine. The majority of AEs were grade 1 [G1] (6.3%) and G2 (8.8%), only two events were G3 (0.5%). The median follow-up was 9 months (range 1-22 months), during this follow-up 21 patients (10.1%) had a positive nasal swab, most of the patients were asymptomatic (67%) and the symptomatic ones (33%) had mild symptoms and fewer complications and hospitalizations. CONCLUSIONS COVID-19 m-RNA vaccines appear to be safe in the cohort of patients with thoracic malignances in active treatment, including those receiving immunotherapy. Considering the high morbidity and mortality associated with COVID-19 in patients with lung cancer receiving active treatments, our study supports the current vaccine prioritization, third and/or fourth dose, of all cancer patients with active treatment.
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Affiliation(s)
- G Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - P Trillo Aliaga
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Del Signore
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - I Attili
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Santoro
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - F Giugliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - P P M Berton Giachetti
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - G Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology (DIPO), University of Milan, Milan, Italy
| | - A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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13
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Pastore MC, Ilardi F, Stefanini A, Mandoli GE, Palermi S, Bandera F, Benfari G, Esposito R, Lisi M, Pasquini A, Santoro C, Valente S, D’Andrea A, Cameli M. Bedside Ultrasound for Hemodynamic Monitoring in Cardiac Intensive Care Unit. J Clin Med 2022; 11:jcm11247538. [PMID: 36556154 PMCID: PMC9785677 DOI: 10.3390/jcm11247538] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/03/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Thanks to the advances in medical therapy and assist devices, the management of patients hospitalized in cardiac intensive care unit (CICU) is becoming increasingly challenging. In fact, Patients in the cardiac intensive care unit are frequently characterized by dynamic and variable diseases, which may evolve into several clinical phenotypes based on underlying etiology and its complexity. Therefore, the use of noninvasive tools in order to provide a personalized approach to these patients, according to their phenotype, may help to optimize the therapeutic strategies towards the underlying etiology. Echocardiography is the most reliable and feasible bedside method to assess cardiac function repeatedly, assisting clinicians not only in characterizing hemodynamic disorders, but also in helping to guide interventions and monitor response to therapies. Beyond basic echocardiographic parameters, its application has been expanded with the introduction of new tools such as lung ultrasound (LUS), the Venous Excess UltraSound (VexUS) grading system, and the assessment of pulmonary hypertension, which is fundamental to guide oxygen therapy. The aim of this review is to provide an overview on the current knowledge about the pathophysiology and echocardiographic evaluation of perfusion and congestion in patients in CICU, and to provide practical indications for the use of echocardiography across clinical phenotypes and new applications in CICU.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
- Correspondence: (M.C.P.); (M.C.); Tel.: +39-057-758-5377 (M.C.P.)
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Andrea Stefanini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Francesco Bandera
- Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milano, 20122 Milan, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37129 Verona, Italy
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Matteo Lisi
- Department of Cardiovascular Disease—AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121 Ravenna, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
- Correspondence: (M.C.P.); (M.C.); Tel.: +39-057-758-5377 (M.C.P.)
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14
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Chirico A, Basile C, Mancusi C, Fucile I, Mosca M, Migliaccio B, Gargiulo G, Santoro C, Paolillo S, Perrone-filardi P, Gargiulo P. 473 LUNG ULTRASOUND IN CORONARY CARE UNIT, AN IMPORTANT DIAGNOSTIC TOOL FOR CONCOMITANT PNEUMONIA. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
In the setting of coronary care unit (CCU), early detection of pneumonia is of para-mount important to prevent severe complications. This study was designed aiming to evaluate the diagnostic accuracy of lung ultrasound (LUS) in detection of pneumonia and compared with chest x-ray (CXR).
Method
We enrolled 110 consecutive patients admitted to CCU of Federico II University Hospital. Each patient underwent CXR and bedside LUS on admission. The final diagnosis (pneumonia vs no-pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT (n=34).
Results
Mean age was 70 ± 11 years old, 68% males. Pneumonia was clinically diagnosis in 26 (23%) patients. LUS was positive for pneumonia in 24 patients (sensitivity 92% specificity 81%). Chest radiography was positive in 9 patients (sensitivity 43% specificity 95%). Using CT scan as referee LUS exhibit 92% of sensibility and a specificity of 96%. In ROC curve analysis diagnostic accuracy of CXR and LUS for diagnosis of pneumonia was 0.86 (95% CI 0.77-0.94), higher than CXR 0.68 (95% CI 0.55-0.84), p<0.05 (Figure).
Conclusion
Based on the findings of the present study, accuracy of LUS in detection of pneumonia was significantly higher than chest x-ray, with comparable sensibility to CT scan.
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Affiliation(s)
- Alfonsina Chirico
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Christian Basile
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Costantino Mancusi
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Ilaria Fucile
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Mariangela Mosca
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Biagio Migliaccio
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Giuseppe Gargiulo
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Ciro Santoro
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Stefania Paolillo
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | | | - Paola Gargiulo
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
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15
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Buongiorno F, Buonauro A, Canora A, Canonico ME, Esposito R, Sanduzzi A, Bocchino M, Esposito G, Santoro C. 766 NON-INVASIVE ASSESSMENT OF RIGHT VENTRICLE TO ARTERIAL COUPLING FOR PROGNOSIS STRATIFICATION OF FIBROTIC INTERSTITIAL LUNG DISEASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance non-invasively estimable by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD).
Methods
Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF), (M=37; mean age 67±7 yrs) were studied with standard and speckle tracking echocardiography and compared to 30 age-matched healthy volunteers. Mean patients follow-up was of 70±4 months.
Results
Fibrotic-ILD patients had a larger right ventricle (RV) and a worst diastolic function as RV-global longitudinal strain (GLS) was significantly lower along with higher systolic pulmonary artery pressure (sPAP) estimates in comparison with controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV-GLS/sPAP were significantly reduced in f-ILDs patients (p<0.0001). Patients with a RV-GLS/sPAP below the median value had a shorter survival (61 vs. 74 months, p=0.01), this parameter being an independent predictor of worse outcome.
Conclusion
Low estimates of RV-GLS/sPAP are predictive of worse outcome in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis repercussions.
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Santoro C, Buonauro A, Canora A, Rea G, Canonico ME, Esposito R, Sanduzzi A, Esposito G, Bocchino M. Non-Invasive Assessment of Right Ventricle to Arterial Coupling for Prognosis Stratification of Fibrotic Interstitial Lung Diseases. J Clin Med 2022; 11:jcm11206115. [PMID: 36294435 PMCID: PMC9605359 DOI: 10.3390/jcm11206115] [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: 09/16/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance that can be non-invasively estimated by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD). Methods: Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF) (M = 37; mean age 67 ± 7 years), were studied with standard and speckle-tracking echocardiography and compared with 30 age-matched healthy volunteers. The mean patient follow-up was 70 ± 4 months. Results: Fibrotic ILD patients had a larger right ventricle (RV) and worse diastolic function because the RV global longitudinal strain (GLS) was significantly lower and the systolic pulmonary artery pressure (sPAP) estimates were higher in comparison with those of controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV GLS/sPAP were significantly reduced in f-ILD patients (p < 0.0001). Patients with an RV GLS/sPAP below the median value had a shorter survival time (61 vs. 74 months, p = 0.01); this parameter was an independent predictor of a worse outcome. Conclusion: Low estimates of RV GLS/sPAP are predictive of worse outcomes in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis implications.
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Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Agostino Buonauro
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Angelo Canora
- Respiratory Medicine Unit at the Monaldi Hospital, AO dei Colli, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, AO dei Colli, 80131 Naples, Italy
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Alessandro Sanduzzi
- Respiratory Medicine Unit at the Monaldi Hospital, AO dei Colli, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Marialuisa Bocchino
- Respiratory Medicine Unit at the Monaldi Hospital, AO dei Colli, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-770-2773
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Lubrano F, Fucile I, Conte M, Santoro C, Rozza F, De Luca N, Mancusi C. Adherence to Mediterranean diet among patients with acute cardiovascular events admitted in Cardiac Rehabilitation unit. Monaldi Arch Chest Dis 2022. [PMID: 36259577 DOI: 10.4081/monaldi.2022.2391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023] Open
Abstract
The Mediterranean Diet plays a critical role in the prevention of primary cardiovascular disease (CVD). Actually, there is a scarcity of evidence for secondary prevention. The current study aims to assess adherence to the Mediterranean diet (MD) in patients recently admitted to the Cardiac Rehabilitation Unit following acute cardiovascular disease. Adherence to MD was assessed in 111 patients admitted to the Cardiac Rehabilitation Unit of the Federico II Hospital in Naples. The Medi-Lite score was used to assess adherence to MD. The main determinant of reduced MD compliance was assessed using Pearson's correlation analysis and a multivariable regression model. The population had a median MD adherence score of 11 and a mean score of 10.9. The lowest possible score was 5 (indicating poor adherence), and the highest possible score was 15 (excellent adherence index). There were 3 participants with a poor score (<7), 82 with a good score (7-12), and 26 with an excellent score (³13). Lower Medi-Lite score was associated with younger age and being an active worker in a multivariate regression model (both p<0.05). Our findings show that among patients admitted to the Cardiac Rehabilitation Unit after a major CV event, young active workers have the lowest adherence to MD, requiring an individualized and multidisciplinary approach to improve their adherence to MD for secondary CV prevention.
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Affiliation(s)
- Fortuna Lubrano
- Cardiac Rehabilitation Unit, Federico II University Hospital, Naples.
| | - Ilaria Fucile
- Cardiac Rehabilitation Unit, Federico II University Hospital, Naples.
| | | | - Ciro Santoro
- Cardiac Rehabilitation Unit, Federico II University Hospital, Naples.
| | - Francesco Rozza
- Cardiac Rehabilitation Unit, Federico II University Hospital, Naples.
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Prastaro M, Nardi E, Paolillo S, Santoro C, Parlati ALM, Gargiulo P, Basile C, Buonocore D, Esposito G, Filardi PP. Cardiorenal syndrome: Pathophysiology as a key to the therapeutic approach in an under-diagnosed disease. J Clin Ultrasound 2022; 50:1110-1124. [PMID: 36218199 PMCID: PMC9828083 DOI: 10.1002/jcu.23265] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 06/09/2023]
Abstract
Cardiorenal syndrome is a clinical condition that impacts both the heart and the kidneys. One organ's chronic or acute impairment can lead to the other's chronic or acute dysregulation. The cardiorenal syndrome has been grouped into five subcategories that describe the etiology, pathophysiology, duration, and pattern of cardiac and renal dysfunction. This classification reflects the large spectrum of interrelated dysfunctions and underlines the bidirectional nature of heart-kidney interactions. However, more evidence is needed to apply these early findings in medical practice. Understanding the relationship between these two organs during each organ's impairment has significant clinical implications that are relevant for therapy in both chronic and acute conditions. The epidemiology, definition, classification, pathophysiology, therapy, and outcome of each form of cardiorenal syndrome are all examined in this review.
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Affiliation(s)
- Maria Prastaro
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Ermanno Nardi
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Stefania Paolillo
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Ciro Santoro
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Antonio L. M. Parlati
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Paola Gargiulo
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Christian Basile
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Davide Buonocore
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Giovanni Esposito
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
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19
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Sanna GD, Moccia E, Canonico ME, Sanna S, De Toni C, Santoro C, Masia SL, Saderi L, Sotgiu G, Parodi G. Left atrial remodeling in heart failure: the role of sphericity index (the SPHERICAT-HF study). Int J Cardiovasc Imaging 2022; 38:1723-1732. [PMID: 35212852 DOI: 10.1007/s10554-022-02562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
Left atrial sphericity index (LASI) is an echocardiographic index easily obtained; its use in patients with heart failure (HF) has never been investigated so far. This single-centre study aimed to investigate the usefulness of LASI in an unselected cohort of patients hospitalized for acute HF, and its potential correlation with the amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) levels and with New York Heart Association (NYHA) functional class. Ninety-four consecutive HF patients underwent a transthoracic echocardiogram with a detailed study of the left atrium (LA) including LASI (calculated from the apical four-chamber view as the ratio between the transverse and longitudinal diameters), and blood tests (including NT-proBNP) on the same day. Median age was 75.5 (interquartile range-IQR 62-82) years and 55% were males, 58.5% had a NYHA class III-IV, and median NT-proBNP was 3284 (IQR 1215-7055) pg/ml. The LA was dilated in 94%, and median biplane LA volume index was 62 ml/m2. Patients with advanced NYHA class showed more advanced LA remodeling. Mean LASI was 0.78 ± 0.09 and did not correlate with NT-proBNP levels (r 0.03; p 0.75) or with patient NYHA class (R2 0.011; p 0.287). None of the echocardiographic indices of LA structural and functional remodeling proved to be independently associated with a high NYHA class on multivariate regression analysis. In conclusion, LA remodeling is almost invariably present in patients with HF. LASI does not correlate with NT-proBNP levels or with NYHA functional class. Further studies are needed to describe the complex patterns of atrial remodeling in HF.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy.
| | - Eleonora Moccia
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mario Enrico Canonico
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Silvia Sanna
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Chiara De Toni
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Stefano L Masia
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico De Nicola, 07100, Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Guido Parodi
- The Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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20
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Santoro C, Ilardi F, Esposito R, Mandoli GE, Canonico ME, Buongiorno F, Canciello G, Prastaro M, Losi MA, Esposito G. Impact of Age and Heart Rate on Strain-Derived Myocardial Work in a Population of Healthy Subjects. Diagnostics (Basel) 2022; 12:diagnostics12071697. [PMID: 35885601 PMCID: PMC9325020 DOI: 10.3390/diagnostics12071697] [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: 06/13/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The influence of age and gender on strain-imaging-derived myocardial work (MW) was recently investigated in healthy subjects. No information is available on the impact of heart rate (HR) on MW. Methods: 177 healthy subjects (47% men, mean age 42 years) underwent an echo-Doppler exam, including quantification of global longitudinal strain (GLS). Cuff blood pressure was used as a surrogate of left ventricular peak pressure to estimate global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Statistical analyses were performed according to age and HR tertiles. Results: GWW was higher in the third HR tertile, i.e., ≥74 bpm (74.7 ± 33.6 mmHg %) than in the first HR tertile (<66 bpm) (61.0 ± 32.5 mmHg %) (p < 0.02). In the pooled population, by adjusting for systolic blood pressure, GLS, E/e’ ratio and left atrial volume index, age was independently associated with GCW (β = 0.748) and GWI (β = 0.685) (both p < 0.0001) and HR with GWW (β = 0.212, p = 0.006) and GWE (β = −0.204, p = 0.007). Conclusions: In healthy subjects age shows a mild influence on GCW. HR exerts an independent negative impact on GWW and GWE: the higher HR the greater wasted work and lower myocardial efficiency.
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Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
- Correspondence: ; Tel.: +39-081-746-3663
| | - Federica Ilardi
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy;
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy;
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Federica Buongiorno
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Grazia Canciello
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Maria Prastaro
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Maria-Angela Losi
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital, 80131 Naples, Italy; (F.I.); (M.E.C.); (F.B.); (G.C.); (M.P.); (M.-A.L.); (G.E.)
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21
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Attili I, Valenza C, Santoro C, Antonarelli G, Trillo Aliaga P, Del Signore E, Catania C, Spitaleri G, Passaro A, de Marinis F. 42P Comparative real-world analysis of pembrolizumab plus chemo vs platinum-doublet alone in metastatic non-squamous NSCLC with PD-L1 low. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.051] [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: 11/16/2022] Open
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22
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Yu C, Negishi T, Thavendiranathan P, Penicka M, Côté MA, Massey R, Miyazaki S, Shirazi MG, Santoro C, Cho GY, Popescu BA, Vinereanu D, Kosmala W, Marwick TH, Negishi K. INCREMENTAL PROGNOSTIC VALUE OF LEFT ATRIAL STRAIN IN PREDICTING CARDIOTOXICITY AFTER CHEMOTHERAPY: SUB-ANALYSIS FROM THE SUCCOUR STUDY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Benfari G, Mandoli GE, Magne J, Miglioranza M, Ancona R, Reskovic Luksic V, Pastore MC, Santoro C, Michalski B, Muraru D, Donal E, Cosyns B, Edvardsen T, Popescu B, Cameli M. Left atrial strain determinants across heart failure stages; insight from MASCOT registry. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.078] [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
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
MASCOT investigators
Background
Few studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large international prospective registry.
Methods
This is a multicenter prospective observational study enrolling 745 patients with HF stages 0-C from July to October 2018. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window.
Results
Median global PALS was 17% [24-32]. 29% of patients were in HF-stage 0/A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R²=0.50, p < 0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta:-3.60 ± 0.20, p < 0.0001). Among HF-stages (Figure 1), LV-GLS remained the most important PALS predictor (p < 0.0001) whereas age was only associated with PALS in lower HF-stage 0/A or B (R=-0.26 p < 0.0001, R=-0.23 p = 0.0001). LA volume increased its association to PALS moving from stage 0-A (R=-0.11; P = 0.1) to C (R=-0.42; P < 0.0001). PALS was the single most potent echocardiographic parameter in predicting HF stage (AUC for B vs. 0/A 0.81, and AUC vs. 0/A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e’ ratio and mitral regurgitation grade (p < 0.0001).
Conclusion
Although influenced by LV-GLS and LA size across HF-stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction. Abstract Figure 1
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Affiliation(s)
- G Benfari
- University of Verona, Cardiology, Verona, Italy
| | - GE Mandoli
- University of Siena, Cardiovascular Disease, Siena, Italy
| | - J Magne
- University Hospital of Limoges, Limoges, France
| | | | - R Ancona
- Santa Maria delle Grazie Hospital, Pozzuoli, Italy
| | | | - MC Pastore
- University of Siena, Cardiovascular Disease, Siena, Italy
| | | | | | - D Muraru
- Universita Milano-Bicocca, Milan, Italy
| | - E Donal
- University of Rennes 1, Rennes, France
| | - B Cosyns
- University of Brussels, Brussels, Belgium
| | | | - B Popescu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - M Cameli
- University of Siena, Cardiovascular Disease, Siena, Italy
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Yu C, Negishi T, Thavendiranathan P, Pathan F, Penicka M, Côté M, Massey R, Miyazaki S, Shirazi M, Santoro C, Cho G, Popescu B, Vinereanu D, Kosmala W, Thomas L, Marwick T, Negishi K. Baseline Left Atrial Strain is Predictive of Chemotherapy Induced Cardiotoxicity in High-Risk Cancer Patients. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.227] [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: 11/16/2022]
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25
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Pastore MC, Mandoli GE, Giannoni A, Benfari G, Dini FL, Pugliese NR, Taddei C, Correale M, Brunetti ND, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, Degiovanni A, Patti G, Santoro C, Moderato L, Malagoli A, Emdin M, Cameli M, Rosa G, Magnesa M, Mazzeo P, De Carli G, Bellino M, Iuliano G, Casciano O, Binno S, Canepa M, Tondi S, Cicoira M, Mega S. Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register. Eur Heart J Open 2022; 2:oeab046. [PMID: 35919657 PMCID: PMC9242049 DOI: 10.1093/ehjopen/oeab046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/03/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Abstract
Aims This sub-study deriving from a multicentre Italian register [Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry (DISCOVER)-ARNI] investigated whether sacubitril/valsartan in addition to optimal medical therapy (OMT) could reduce the rate of implantable cardioverter-defibrillator (ICD) indications for primary prevention in heart failure with reduced ejection fraction (HFrEF) according to European guidelines indications, and its potential predictors. Methods and results In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centres were included. Lack of follow-up or speckle tracking data represented exclusion criteria. Demographic, clinical, biochemical, and echocardiographic data were collected at baseline and after 6 months from sacubitril/valsartan initiation. Of 351 patients, 225 (64%) were ICD carriers and 126 (36%) were not ICD carriers (of whom 13 had no indication) at baseline. After 6 months of sacubitril/valsartan, among 113 non-ICD carriers despite having baseline left ventricular (LV) ejection fraction (EF) ≤ 35% and New York Heart Association (NYHA) class = II-III, 69 (60%) did not show ICD indications; 44 (40%) still fulfilled ICD criteria. Age, atrial fibrillation, mitral regurgitation > moderate, left atrial volume index (LAVi), and LV global longitudinal strain (GLS) significantly varied between the groups. With receiver operating characteristic curves, age ≥ 75 years, LAVi ≥ 42 mL/m2 and LV GLS ≥-8.3% were associated with ICD indications persistence (area under the curve = 0.65, 0.68, 0.68, respectively). With univariate and multivariate analysis, only LV GLS emerged as significant predictor of ICD indications at follow-up in different predictive models. Conclusions Sacubitril/valsartan may provide early improvement of NYHA class and LVEF, reducing the possible number of implanted ICD for primary prevention in HFrEF. Baseline reduced LV GLS was a strong marker of ICD indication despite OMT. Early therapy with sacubitril/valsartan may save infective/haemorrhagic risks and unnecessary costs deriving from ICDs.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Frank Lloyd Dini
- Centro Medico Sant’Agostino, via Temperanza 6, 20127 Milano, Italy
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy
| | - Claudia Taddei
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Michele Correale
- Cardiology Department, Policlinico Riuniti University Hospital Foggia, Viale Pinto, 1 71100 Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Via Antonio Gramsci, 89, 71122 Foggia, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Policlinico Bari, piazza Giulio Cesare n.11, 70120 Bari, Italy
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Policlinico Bari, piazza Giulio Cesare n.11, 70120 Bari, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84125 Salerno, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Salerno, Italy
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo Giaccone, University of Palermo, Via del Vespro, 129 , 90127 Palermo, Italy
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo Giaccone, University of Palermo, Via del Vespro, 129 , 90127 Palermo, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Valentina Loria
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Roma, Italy
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular Diseases, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100 Novara, Italy
| | - Giuseppe Patti
- Department of Thoracic, Heart and Vascular Diseases, Maggiore Della Carità Hospital, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Via Paolo Solaroli, 17, 28100 Novara, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131 Napoli, Italy
| | - Luca Moderato
- Cardiology Department, Ospedale Guglielmo da Saliceto—Piacenza, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio-Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Modena, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa, Via Balbi 5, 16126 Genova, Italy
| | - Michele Magnesa
- Cardiology Department, Policlinico Riuniti University Hospital Foggia, Viale Pinto, 1 71100 Foggia, Italy
| | - Pietro Mazzeo
- Department of Medical and Surgical Sciences, University of Foggia, Via Antonio Gramsci, 89, 71122 Foggia, Italy
| | - Giuseppe De Carli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100, Siena, Italy
| | - Michele Bellino
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84125 Salerno, Italy
| | - Giuseppe Iuliano
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84125 Salerno, Italy
| | - Ofelia Casciano
- Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini, 5, 80131 Napoli, Italy
| | - Simone Binno
- Cardiology Department, Ospedale Guglielmo da Saliceto—Piacenza, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Largo Rosanna Benzi, 10, 16132 Genova, Italy
- Department of Internal Medicine, University of Genova, Via Balbi 5, 16126 Genova, Italy
| | - Stefano Tondi
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio-Emilia, Via Pietro Giardini, 1355, 41126, Baggiovara, Modena, Italy
| | - Mariantonietta Cicoira
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Simona Mega
- Cardiocenter and Unit of Cardiology, University Campus Bio-Medico of Rome, Via Álvaro del Portillo, 21, 00128 Roma, Italy
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Henein MY, Mandoli GE, Pastore MC, Ghionzoli N, Hasson F, Nisar MK, Islam M, Bandera F, Marrocco-Trischitta MM, Baroni I, Malagoli A, Rossi L, Biagi A, Citro R, Ciccarelli M, Silverio A, Biagioni G, Moutiris JA, Vancheri F, Mazzola G, Geraci G, Thomas L, Altman M, Pernow J, Ahmed M, Santoro C, Esposito R, Casas G, Fernández-Galera R, Gonzalez M, Rodriguez Palomares J, Bytyçi I, Dini FL, Cameli P, Franchi F, Bajraktari G, Badano LP, Cameli M. Biomarkers Predict In-Hospital Major Adverse Cardiac Events in COVID-19 Patients: A Multicenter International Study. J Clin Med 2021; 10:jcm10245863. [PMID: 34945166 PMCID: PMC8703972 DOI: 10.3390/jcm10245863] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19. METHODS We retrospectively included patients hospitalized for COVID-19 from 10 centers. Clinical, biochemical, electrocardiographic, and imaging data at admission and medications were collected. Primary endpoint was a composite of in-hospital CV death, acute heart failure (AHF), acute myocarditis, arrhythmias, acute coronary syndromes (ACS), cardiocirculatory arrest, and pulmonary embolism (PE). RESULTS Of the 748 patients included, 141(19%) reached the set endpoint: 49 (7%) CV death, 15 (2%) acute myocarditis, 32 (4%) sustained-supraventricular or ventricular arrhythmias, 14 (2%) cardiocirculatory arrest, 8 (1%) ACS, 41 (5%) AHF, and 39 (5%) PE. Patients with CV events had higher age, body temperature, creatinine, high-sensitivity troponin, white blood cells, and platelet counts at admission and were more likely to have systemic hypertension, renal failure (creatinine ≥ 1.25 mg/dL), chronic obstructive pulmonary disease, atrial fibrillation, and cardiomyopathy. On univariate and multivariate analysis, troponin and renal failure were associated with the composite endpoint. Kaplan-Meier analysis showed a clear divergence of in-hospital composite event-free survival stratified according to median troponin value and the presence of renal failure (Log rank p < 0.001). CONCLUSIONS Our findings, derived from a multicenter data collection study, suggest the routine use of biomarkers, such as cardiac troponin and serum creatinine, for in-hospital prediction of CV events in patients with COVID-19.
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Affiliation(s)
- Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (F.L.D.); (G.B.)
- St George London and Brunel Universities, London SW17 0QT, UK
- Correspondence: (M.Y.H.); (M.C.P.)
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
- Correspondence: (M.Y.H.); (M.C.P.)
| | - Nicolò Ghionzoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
| | - Fouhad Hasson
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton LU4 0DZ, UK; (F.H.); (M.K.N.); (M.I.)
| | - Muhammad K. Nisar
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton LU4 0DZ, UK; (F.H.); (M.K.N.); (M.I.)
| | - Mohammed Islam
- Luton and Dunstable University Hospital, NHS Foundation Trust, Luton LU4 0DZ, UK; (F.H.); (M.K.N.); (M.I.)
| | - Francesco Bandera
- Department for Biomedical Sciences for Health, University of Milano, 20133 Milan, Italy;
- Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | | | - Irene Baroni
- Clinical Research Unit, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy; (M.M.M.-T.); (I.B.)
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Luca Rossi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (L.R.); (A.B.)
| | - Andrea Biagi
- Division of Cardiology, Cardiovascular and Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (L.R.); (A.B.)
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi d’Aragona, 84125 Salerno, Italy;
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.C.); (A.S.)
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (M.C.); (A.S.)
| | - Giulia Biagioni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
| | | | - Federico Vancheri
- Department of Internal Medicine, S. Elia Hospital, 93100 Caltanissetta, Italy; (F.V.); (G.M.); (G.G.)
| | - Giovanni Mazzola
- Department of Internal Medicine, S. Elia Hospital, 93100 Caltanissetta, Italy; (F.V.); (G.M.); (G.G.)
| | - Giulio Geraci
- Department of Internal Medicine, S. Elia Hospital, 93100 Caltanissetta, Italy; (F.V.); (G.M.); (G.G.)
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital and Westmeead Clinical School, University of Sydney, Sydney, NSW 2145, Australia; (L.T.); (M.A.)
| | - Mikhail Altman
- Department of Cardiology, Westmead Hospital and Westmeead Clinical School, University of Sydney, Sydney, NSW 2145, Australia; (L.T.); (M.A.)
| | - John Pernow
- Department of Medicine, Division of Cardiology, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Mona Ahmed
- Department of Molecular Medicine and Surgery, Division of Cardiology, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy;
| | - Guillem Casas
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (G.C.); (R.F.-G.); (M.G.); (J.R.P.)
| | - Rubén Fernández-Galera
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (G.C.); (R.F.-G.); (M.G.); (J.R.P.)
| | - Maribel Gonzalez
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (G.C.); (R.F.-G.); (M.G.); (J.R.P.)
| | - Jose Rodriguez Palomares
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (G.C.); (R.F.-G.); (M.G.); (J.R.P.)
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (F.L.D.); (G.B.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo
| | - Frank Lloyd Dini
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (F.L.D.); (G.B.)
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical Sciences, Siena University Hospital, 53100 Siena, Italy;
| | - Federico Franchi
- Department of Medical Biotechnologies, Anesthesia and Intensive Care, University of Siena, 53100 Siena, Italy;
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (F.L.D.); (G.B.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
| | - Luigi Paolo Badano
- Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy;
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (N.G.); (G.B.); (M.C.)
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Mandoli GE, Pastore MC, Giannoni A, Benfari G, Dini FL, Rosa G, Pugliese NR, Taddei C, Correale M, Brunetti ND, Mazzeo P, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, Carli GD, Degiovanni A, Patti G, Santoro C, Moderato L, Cicoira M, Canepa M, Malagoli A, Emdin M, Cameli M. 266 Deformation imaging by strain in chronic heart failure over sacubitril–valsartan: a multicentre echocardiographic registry (discover)—ARNI. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Sacubitril/valsartan have changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects morbidity and mortality partly mediated by left ventricular reverse remodelling (LVRR). The aim of this multicentre study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration.
Methods and results
Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included. Echocardiographic indexes including speckle tracking echocardiography (STE) indexes were used to predict LVRR [defined as LV end-systolic volume reduction and ejection fraction (LVEF) improvement > 10% at follow-up] at 6 months follow-up as the primary endpoint. Changes in symptoms (NYHA class) and neurohormonal activations [N-terminal-pro-brain natriuretic peptide (NTproBNP)] were also evaluated as secondary endpoints. The final population (excluding patients with poor acoustic windows and missing data) consists of 341 patients [mean age: 65 ± 10 years; 18% female, median LVEF 30% (interquartile range: 25–34)]. At 6 months follow-up, 82 (24%) patients showed early complete response (LVRR and LVEF ≥35%), 55 (16%) early incomplete response (LVRR and LVEF <35%), 204 (60%) no response (no LVRR and LVEF <35%). Non-ischaemic etiology, a lower left atrial volume index and a higher global longitudinal strain were all independent predictors of LVRR at multivariable logistic analysis (all P < 0.01). LA strain was the best predictor of positive changes in NYHA class and NT-proBNP (all P < 0.05) (Figure 1).
Conclusions
STE parameters at baseline could be useful to predict LVRR and clinical response to sacubitril-valsartan, and thus could be used as a guide for treatment in patients with HFrEF.
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Affiliation(s)
- Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa, Genoa, Italy
| | | | - Claudia Taddei
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Michele Correale
- Cardiology Department, Policlinico Riuniti University Hospital Foggia, Italy
| | | | - Pietro Mazzeo
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Italy
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ Hospital, University of Perugia, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University Hospital Paolo Giaccone, University of Palermo, Italy
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University Hospital Paolo Giaccone, University of Palermo, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinical Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Loria
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinical Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe De Carli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Luca Moderato
- Cardiology Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | | | - Marco Canepa
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Emdin
- Scuola Superiore Sant’Anna, Institute of Life Sciences, Pisa, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Pastore MC, Mandoli GE, Giannoni A, Benfari G, Dini FL, Rosa G, Pugliese NR, Taddei C, Correale M, Brunetti ND, Magnesa M, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, Carli GD, Degiovanni A, Patti G, Santoro C, Moderato L, Cicoira M, Canepa M, Malagoli A, Emdin M, Cameli M. 279 Medical treatment with ARNI may reduce indications for primary prevention of sudden cardiac death in heart failure with reduced ejection fraction: insights from discover-ARNI, a multicentre Italian register. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
This sub-study deriving from a multicentre Italian register (DISCOVER-ARNI) investigated whether sacubitril/valsartan in adjunction of optimal medical therapy (OMT) could reduce the rate of implantable cardioverter-defibrillator(ICD) indications for primary prevention in heart failure with reduced ejection fraction (HFrEF) according to European guidelines indications, and its potential predictors.
Methods and results
In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centres were included. Lack of follow-up or speckle tracking data represented exclusion criteria. Demographic, clinical, biochemical and echocardiographic data were collected at baseline and after 6 months of therapy. Of 351 patients, 225 (64%) were ICD carriers and 126 (36%) were not ICD carriers (of whom 13 had not indication) at baseline. After 6 months of sacubitril/valsartan, among 113 non-ICD carriers despite having baseline left ventricular (LV)EF ≤ 35% and New York Heart Association (NYHA) class = II–III, 69(60%) did not show ICD indications; 44(40%) still fulfilled ICD criteria (Figure 1). Age, atrial fibrillation, mitral regurgitation>moderate, left atrial volume index (LAVi), and LV global longitudinal strain (GLS) significantly varied between the groups. With ROC curves, age ≥ 75 years, LAVi ≥ 42 ml/m2 and LV GLS ≥ −8.3% were associated with ICD indications persistence (AUC = 0.65, 0.68, and 0.68, respectively). With univariate and multivariate analysis, age and LV GLS emerged as the only significant predictors of ICD indications at follow-up.
Conclusions
Sacubitril/valsartan provided early improvement of NYHA class and LVEF, reducing the possible number of implanted ICD for primary prevention in HFrEF. Baseline advanced age and reduced LV GLS were markers of ICD indication despite OMT. Early therapy with sacubitril/valsartan may save infective/haemorrhagic risks and unnecessary costs deriving from ICDs.
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Affiliation(s)
- Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa, Genoa, Italy
| | | | - Claudia Taddei
- Scuola Superiore Sant’Anna, Institute of Life Sciences, Pisa, Italy
| | - Michele Correale
- Cardiology Department, Policlinico Riuniti University Hospital, Foggia, Italy
| | | | - Michele Magnesa
- Cardiology Department, Policlinico Riuniti University Hospital, Foggia, Italy
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, Heart Failure Unit, ‘Santa Maria Della Misericordia’ Hospital, University of Perugia, Italy
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology, Heart Failure Unit, ‘Santa Maria Della Misericordia’ Hospital, University of Perugia, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic Department, Polyclinic University Hospital, Bari, Italy
| | - Rodolfo Citro
- Cardio-Thoracic-Vascular Department, University Hospital San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University Hospital Paolo Giaccone, University of Palermo, Italy
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University Hospital Paolo Giaccone, University of Palermo, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Loria
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe De Carli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Luca Moderato
- Cardiology Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | | | - Marco Canepa
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio-Emilia, Modena, Italy
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Sorrentino R, Santoro C, Bardi L, Rigolin V, Gentile F. Non-cardiac surgery in patients with valvular heart disease. Heart 2021; 108:1171-1178. [PMID: 34815334 DOI: 10.1136/heartjnl-2021-319160] [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: 08/13/2021] [Accepted: 11/02/2021] [Indexed: 12/30/2022] Open
Abstract
In patients with significant valvular heart disease (VHD) undergoing non-cardiac surgery (NCS), perioperative adverse cardiac events are a relevant issue. Although postoperative outcomes can be adversely affected by valve-related haemodynamic instability, recommended perioperative risk scores prioritise the risk of the surgical procedure and the presence of cardiovascular risk factors, neglecting the presence or extent of VHD. Perioperative management and anaesthetic approach should focus on the underlying type and severity of VHD, the compensatory mechanisms deployed by left ventricle and right ventricle and the type and risk of NCS. Due to the lack of randomised trials investigating different therapeutic approaches of valvular intervention prior to NCS, recommendations mainly rely on consensus opinion and inference based on large observational registries. As a general rule, valvular intervention is recommended prior to NCS in symptomatic patients or in those who meet standard criteria for cardiac intervention. In the absence of such conditions, it is reasonable to perform NCS with tailored anaesthetic management and close invasive perioperative haemodynamic monitoring. However, patient-specific management strategies should be discussed with the heart team preoperatively. Symptomatic patients with severe VHD or those undergoing high-risk NCS should ideally be treated at a high-volume medical centre that is equipped to manage haemodynamically complex patients during the perioperative period.
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Affiliation(s)
- Regina Sorrentino
- Department of Advanced Biomedical Science, Federico II University Hospital, Napoli, Italy.,Centro Cardiologico Gentile, Napoli, Campania, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital, Napoli, Italy
| | - Luca Bardi
- Department of Advanced Biomedical Science, Federico II University Hospital, Napoli, Italy
| | - Vera Rigolin
- Medicine/Cardiology, Northwestern University, Chicago, Illinois, USA
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D'Andrea A, Ilardi F, D'Ascenzi F, Bandera F, Benfari G, Esposito R, Malagoli A, Mandoli GE, Santoro C, Russo V, D'Alto M, Cameli M. Impaired myocardial work efficiency in heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2021; 22:1312-1320. [PMID: 34410362 DOI: 10.1093/ehjci/jeab153] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 02/06/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is a growing public health problem. Impairment in left ventricular (LV) diastolic function has been proposed as a key pathophysiologic determinant. However, the role of concomitant systolic dysfunction despite preserved LV ejection fraction (LVEF) has not been well characterized. To analyse LV myocardial deformation, diastolic function, and contractile reserve (CR) in patients with HFpEF at rest and while during exercise, as well as their correlation with functional capacity. METHODS AND RESULTS Standard echo, lung ultrasound, LV 2D speckle-tracking strain, and myocardial work efficiency (MWE) were performed at rest and during exercise in 230 patients with HFpEF (female sex 61.2%; 71.3 ± 5.3 years) in 150 age- and sex-comparable healthy controls. LV mass index and LAVI were significantly increased in HFpEF. Conversely, global longitudinal strain (GLS) and MWE were consequently reduced in HFpEF patients. During effort, HFpEF showed reduced exercise time, capacity, and VO2 peak. Increase in LVEF and LV GLS was significantly lower in HFpEF patients, while LV E/e' ratio, pulmonary pressures, and B-lines by lung ultrasound rose. A multivariable analysis outlined that LV MWE at rest was closely related to maximal Watts reached (beta coefficient: 0.43; P < 0.001), peak VO2 (beta: 0.50; P < 0.001), LV E/e' (beta: 0.52, P < 0.001), and number of B-lines during effort (beta: -0.36; P < 0.01). CONCLUSIONS The lower resting values of LV GLS and MWE in HFpEF patients suggest an early subclinical myocardial damage, which seems to be closely associated with lower exercise capacity, greater pulmonary congestion, and blunted LV contractile reserve during effort.
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Affiliation(s)
- Antonello D'Andrea
- Department of Traslational Medical Sciences, Unit of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy.,Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giovanni Benfari
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Vincenzo Russo
- Department of Traslational Medical Sciences, Unit of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Michele D'Alto
- Department of Traslational Medical Sciences, Unit of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Mandoli G, Pastore M, Giannoni A, Benfari G, Dini F, Correale M, Carluccio E, Guaricci A, Citro R, Novo G, Pasquini A, Degiovanni A, Santoro C, Malagoli A, Cameli M. Deformation imaging by strain in chronic heart failure over sacubitril/valsartan: a multicenter echocardiographic registry (DISCOVER) ARNI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sacubitril/valsartan changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects morbidity and mortality partly mediated by left ventricular reverse remodeling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration.
Methods
Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centers were included. Echocardiographic indexes including speckle tracking echocardiography (STE) were used to predict LVRR (defined as LV end-systolic volume reduction and ejection fraction [LVEF] improvement >10% at follow-up) at 6 months follow-up as the primary endpoint. Changes in symptoms (NYHA class) and neurohormonal activations (N-terminal-pro-brain natriuretic peptide [NTproBNP]) were also evaluated as secondary endpoints. Patients with poor acoustic windows and missing data were excluded.
Results
The final population consisted of 341 patients (mean age: 65±10 years; 18% female, median LVEF 30% [interquartile range:25; 34]. At 6 months follow-up, cardiac dimensions and function, including left heart STE parameters, improved (Table 1). Moreover, 82 (24%) patients showed early complete response (LVRR and LVEF ≥35%), 55 (16%) early incomplete response (LVRR and LVEF <35%), 204 (60%) no response (no LVRR and LVEF <35%) after 6 months of sacubitril/valsartan. Among patients with ischemic etiology, 68% (108) did not develop LV RR. Age, sex, general characteristics, baseline NYHA class and NT-pro BNP did not significantly differ between the groups.Conversely, baseline LV dimensions and LVEF showed significant differences between the groups (p<0.0001). Also, STE parameters were considerably better in group 1 compared to group 2 and 3 both at baseline and follow-up. Non-ischemic etiology, a lower left atrial volume index and a higher global longitudinal strain were all independent predictors of LVRR at multivariable logistic analysis (all p<0.01). With ROC and spline curves, LV GLS >−9.3% showed a good accuracy in predicting LV RR (Figure 1). LA strain was the best predictor of positive changes in NYHA class and NT-proBNP (all p<0.05).
Conclusions
STE parameters at baseline could be useful to predict LVRR and early clinical response to sacubitril-valsartan, and thus could be used as a guide for treatment in patients with HFrEF.
Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
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Affiliation(s)
- G.E Mandoli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - M.C Pastore
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
| | - A Giannoni
- Fondazione Toscana Gabriele Monasterio, Cardiology and Cardiovascular Medicine Department, Pisa, Italy
| | - G Benfari
- University of Verona, Division of Cardiology, Department of Medicine, Verona, Italy
| | - F.L Dini
- Major Hospital, Centro Medico Sant'Agostino, Milano, Italy, Milano, Italy
| | - M Correale
- University Hospital Ospedali Riuniti, Cardiology Department, Foggia, Italy
| | - E Carluccio
- Hospital Santa Maria Della Misericordia, Cardiology and Cardiovascular Pathophysiology - Heart Failure Unit, Perugia, Italy
| | - A.I Guaricci
- Polyclinic Hospital of Bari, University Cardiology Unit, Cardiothoracic Department, Bari, Italy
| | - R Citro
- AOU San Giovanni di Dio e Ruggi dAragona, Cardio-Thoracic-Vascular Department, Salerno, Italy
| | - G Novo
- University Hospital Paolo Giaccone, Division of Cardiology, Department ProMISE, Palermo, Italy
| | - A Pasquini
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - A Degiovanni
- Hospital Maggiore Della Carita, Department of Thoracic, Heart and Vascular Diseases, Novara, Italy
| | - C Santoro
- Federico II University Hospital, Department of Advanced Biomedical Science, Naples, Italy
| | - A Malagoli
- University of Modena & Reggio Emilia, Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, Modena, Italy
| | - M Cameli
- University of Siena, Department of Medical Biotechnologies, Division of Cardiology, Siena, Italy
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32
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Bertolone DT, De Colle C, Rozza F, Fucile I, Santoro C, Conte M, De Luca N, Mancusi C. Lung ultrasound: a narrative review and proposed protocol for patients admitted to Cardiac Rehabilitation Unit. Monaldi Arch Chest Dis 2021; 92. [PMID: 34461698 DOI: 10.4081/monaldi.2021.1753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/26/2021] [Indexed: 11/23/2022] Open
Abstract
Lung ultrasonography (LUS) has become in the last 10 years a technique that has reduced the need of second level diagnostic methods such as chest X-ray (CXR) and computerize tomography (CT) for the diagnostic imaging of lung and pleural space, throughout its diagnostic accuracy, radiation free, low cost, real time and bedside approach. The common use of LUS has been recently extend to cardiac and pulmonary disease even in context of Cardiac Rehabilitation Unit and it could be an additional tool for physiotherapist for the management of patients during Rehabilitation course. The authors performed a literature review in PubMed and suggested a new standardize protocol for LUS, based on guidelines and expert consensus document, for patients admitted to Cardiac Rehabilitation Unit. In this protocol, LUS should be performed in six scan each hemithorax, covering twelve imagine regions. For each scan will be noted a specific physiologic or pathological patterns. Furthermore, we suggest for each patient, the use of the Lung Ultrasound Score (LUS score) to obtain a global view of lung aeration and to monitor any changes during the hospitalization. An increase in score range indicates a more severe condition. This Lung Ultrasonography Protocol should be performed in all patients at the time of admission to Cardiac Rehabilitation Unit to monitoring the aeration of the lungs and the possible lung and/or pleura complications after a cardiac disease avoiding the use of second level surveys.
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Affiliation(s)
- Dario Tino Bertolone
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Cristina De Colle
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Francesco Rozza
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Ilaria Fucile
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Ciro Santoro
- Hypertension Research Center & Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy.
| | - Maurizio Conte
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Nicola De Luca
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Costantino Mancusi
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
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Sanna GD, Canonico ME, Santoro C, Esposito R, Masia SL, Galderisi M, Parodi G, Nihoyannopoulos P. Echocardiographic Longitudinal Strain Analysis in Heart Failure: Real Usefulness for Clinical Management Beyond Diagnostic Value and Prognostic Correlations? A Comprehensive Review. Curr Heart Fail Rep 2021; 18:290-303. [PMID: 34398411 DOI: 10.1007/s11897-021-00530-1] [Citation(s) in RCA: 12] [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] [Accepted: 06/14/2021] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a highly prevalent clinical syndrome characterized by considerable phenotypic heterogeneity. The traditional classification based on left ventricular ejection fraction (LVEF) is widely accepted by the guidelines and represents the grounds for patient enrollment in clinical trials, even though it shows several limitations. Ejection fraction (EF) is affected by preload, afterload, and contractility, it being problematic to express LV function in several conditions, such as HF with preserved EF (HFpEF), valvular heart disease, and subclinical HF, and in athletes. Over the last two decades, developments in diagnostic techniques have provided useful tools to overcome EF limitations. Strain imaging analysis (particularly global longitudinal strain (GLS)) has emerged as a useful echocardiographic technique in patients with HF, as it is able to simultaneously supply information on both systolic and diastolic functions, depending on cardiac anatomy and physiology/pathophysiology. The use of GLS has proved helpful in terms of diagnostic performance and prognostic value in several HF studies. Universally accepted cutoff values and variability across vendors remain an area to be fully explored, hence limiting routine application of this technique in clinical practice. In the present review, the current role of GLS in the diagnosis and management of patients with HF will be discussed. We describe, by critical analysis of the pros and cons, various clinical settings in HF, and how the appropriate use and interpretation of GLS can provide important clues.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy.
| | - Mario E Canonico
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Stefano L Masia
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100, Sassari, Italy
| | - Petros Nihoyannopoulos
- Imperial College London (National Heart and Lung Institute), Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK
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34
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Santoro C, Capone V, Canonico ME, Gargiulo G, Esposito R, Sanna GD, Parodi G, Esposito G. Single, Dual, and Triple Antithrombotic Therapy in Cancer Patients with Coronary Artery Disease: Searching for Evidence and Personalized Approaches. Semin Thromb Hemost 2021; 47:950-961. [PMID: 34261150 DOI: 10.1055/s-0041-1726298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Improvement in life expectancy of patients suffering from oncohematologic disorders has turned cancer from an acute into a chronic condition, making the management of comorbidities problematic, especially when it comes to both acute and chronic cardiovascular diseases. Treatment-related adverse events and drug-drug interactions often influence the therapeutic approach of patients with active malignancies and cardiovascular disease. Furthermore, tumor cells and platelets maintain a complex crosstalk that on one hand enhances tumor dissemination and on the other hand induces hemostasis abnormalities. Hence, clinicians should move carefully in the intricate land mines established by patients with active cancer under antithrombotic therapy. To date, there is no consensus on the antithrombotic treatment of patients with cardiovascular diseases and concomitant malignancies. The aim of this review is to collect the available scientific evidence, including the latest clinical trials and guidelines, in order to provide guidance on the management of antithrombotic treatment (both antiplatelet and anticoagulant therapy) in cancer patients with either pre-existent or new-onset coronary artery disease. Randomized-controlled trials on antithrombotic treatment in oncologic populations, which by far have thus far been excluded, have to be promoted to supply recommendations in the oncohematologic setting.
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Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Valentina Capone
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.,Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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35
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Pastore MC, Mandoli GE, Sannino A, Dokollari A, Bisleri G, D'Ascenzi F, Cavigli L, Pasquini A, Lisi M, Ghionzoli N, Santoro C, Miglioranza MH, Focardi M, Patti G, Valente S, Mondillo S, Cameli M. Two and Three-Dimensional Echocardiography in Primary Mitral Regurgitation: Practical Hints to Optimize the Surgical Planning. Front Cardiovasc Med 2021; 8:706165. [PMID: 34307510 PMCID: PMC8295501 DOI: 10.3389/fcvm.2021.706165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Primary mitral regurgitation (MR) is the second most common valvular disease, characterized by a high burden in terms of quality of life, morbidity, and mortality. Surgical treatment is considered the best therapeutic strategy for patients with severe MR, especially if they are symptomatic. However, pre-operative echocardiographic evaluation is an essential step not only for surgical candidate selection but also to avoid post-operative complications. Therefore, a strong collaboration between cardiologists and cardiac surgeons is fundamental in this setting. A meticulous pre-operative echocardiographic exam, both with transthoracic or transesophageal echocardiography, followed by a precise report containing anatomical information and parameters should always be performed to optimize surgical planning. Moreover, intraoperative transesophageal evaluation is often required by cardiac surgeons as it may offer additive important information with different hemodynamic conditions. Three-dimensional echocardiography has recently gained higher consideration and availability for the evaluation of MR, providing more insights into mitral valve geometry and MR mechanism. This review paper aims to realize a practical overview on the main use of basic and advanced echocardiography in MR surgical planning and to provide a precise checklist with reference parameters to follow when performing pre-operative echocardiographic exam, in order to aid cardiologists to provide a complete echocardiographic evaluation for MR operation planning from clinical and surgical point-of-view.
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Affiliation(s)
- Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Sannino
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy.,Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, TX, United States
| | | | | | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Luna Cavigli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Division of Cardiology, Department of Cardiovascular Diseases - Azienda Unità Sanitaria Locale (AUSL) Romagna, "Santa Maria delle Croci" Hospital, Ravenna, Italy
| | - Nicolò Ghionzoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | | | - Marta Focardi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giuseppe Patti
- Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Serafina Valente
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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36
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Manganaro R, Marchetta S, Dulgheru R, Sugimoto T, Tsugu T, Ilardi F, Cicenia M, Ancion A, Postolache A, Martinez C, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Hagendorff A, Hristova K, Lopez T, de la Morena G, Popescu BA, Penicka M, Ozyigit T, Rodrigo Carbonero JD, van de Veire N, Von Bardeleben RS, Vinereanu D, Zamorano JL, Rosca M, Calin A, Moonen M, Magne J, Cosyns B, Galli E, Donal E, Carerj S, Zito C, Santoro C, Galderisi M, Badano LP, Lang RM, Lancellotti P. Correlation between non-invasive myocardial work indices and main parameters of systolic and diastolic function: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2021; 21:533-541. [PMID: 31408147 DOI: 10.1093/ehjci/jez203] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS The present study sought to evaluate the correlation between indices of non-invasive myocardial work (MW) and left ventricle (LV) size, traditional and advanced parameters of LV systolic and diastolic function by 2D echocardiography (2DE). METHODS AND RESULTS A total of 226 (85 men, mean age: 45 ± 13 years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. Global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE) were estimated from LV pressure-strain loops using custom software. Peak LV pressure was estimated non-invasively from brachial artery cuff pressure. LV size, parameters of systolic and diastolic function and ventricular-arterial coupling were measured by echocardiography. As advanced indices of myocardial performance, global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained. On multivariable analysis, GWI was significantly correlated with GLS (standardized beta-coefficient = -0.23, P < 0.001), ejection fraction (EF) (standardized beta-coefficient = 0.15, P = 0.02), systolic blood pressure (SBP) (standardized beta-coefficient = 0.56, P < 0.001) and GRS (standardized beta-coefficient = 0.19, P = 0.004), while GCW was correlated with GLS (standardized beta-coefficient = -0.55, P < 0.001), SBP (standardized beta-coefficient = 0.71, P < 0.001), GRS (standardized beta-coefficient = 0.11, P = 0.02), and GCS (standardized beta-coefficient = -0.10, P = 0.01). GWE was directly correlated with EF and inversely correlated with Tei index (standardized beta-coefficient = 0.18, P = 0.009 and standardized beta-coefficient = -0.20, P = 0.004, respectively), the opposite occurred for GWW (standardized beta-coefficient =--0.14, P = 0.03 and standardized beta-coefficient = 0.17, P = 0.01, respectively). CONCLUSION The non-invasive MW indices show a good correlation with traditional 2DE parameters of myocardial systolic function and myocardial strain.
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Affiliation(s)
- Roberta Manganaro
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Stella Marchetta
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Raluca Dulgheru
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Tadafumi Sugimoto
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium.,Department of Clinical Laboratory, Mie University Hospital, Mie, 2-174 Edobashi, 514-8507 Tsu, Japan
| | - Toshimitsu Tsugu
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium.,Department of Cardiology, School of Medicine, Keio University, 160-8582 Tokyo, Japan
| | - Federica Ilardi
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S.Pansini, 5, 80131 Napoli, Italy
| | - Marianna Cicenia
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Arnaud Ancion
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Adriana Postolache
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Christophe Martinez
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - George Kacharava
- Department of Cardiology, Tbilisi Institute of Medicine (TIM), 16 Tsintsadze, 0160 Tbilisi, Georgia
| | - George D Athanassopoulos
- Noninvasive Diagnostics Department, Onassis Cardiac Surgery Center, Leof. Andrea Siggrou 356, 176 74 Kallithea, Athens, Greece
| | - Daniele Barone
- Cardiology Department, Laboratory of Cardiovascular Ecography, S. Andrea Hospital, La Spezia, Italy
| | - Monica Baroni
- Laboratorio Di Ecocardiografia Adulti, Fondazione Toscana "G.Monasterio" - Ospedale Del Cuore, Via Giuseppe Moruzzi, 1, 56124 Pisa, Massa, Italy
| | - Nuno Cardim
- Echocardiography Laboratory, Hospital da Luz, Av. Lusíada 100, 1500-650 Lisboa, Portugal
| | - Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Krasimira Hristova
- Department of Noninvasive Functional Diagnostic and Imaging, University National Heart Hospital, ul. 'Konyovitsa' 65, 1309 g.k. Ilinden, Sofia, Bulgaria
| | - Teresa Lopez
- Cardiology Department, La Paz Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Gonzalo de la Morena
- Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan 164, 9300 Aalst, Belgium
| | - Tolga Ozyigit
- VKV Amerikan Hastanesi, Kardiyoloji Bölümü, Tes v¸ikiye, Güzelbahçe Sok, No: 20, 34365 Nişantaşı Istanbul Turkey
| | | | - Nico van de Veire
- Echocardiography Unit, AZ Maria Middelares Gent, Buitenring-Sint-Denijs 30, 9000 Gent, Belgium
| | - Ralph Stephan Von Bardeleben
- Medical Department Cardiology, Universitätsmedizin of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Dragos Vinereanu
- Cardiovascular Research Unit, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Sector 1, Strada Dionisie Lupu 37, 030167 Bucureşti, Romania
| | - Jose Luis Zamorano
- University Alcala, Hospital Ramón y Cajal, Ctra. De Colmenar Viejo, km. 9, 100, 28034 Madrid, Spain
| | - Monica Rosca
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
| | - Andreea Calin
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
| | - Marie Moonen
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges F-87042, France.,INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France
| | - Bernard Cosyns
- CHVZ (Centrum voor Hart en Vaatziekten), Universitair ziekenhuis Brussel and ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Avenue du Laerbeek 101, 1090 Jette, Brussels, Belgium
| | - Elena Galli
- CIC-IT U 1414, CHU Rennes, Université Rennes 1, Service de Cardiologie, CHU Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Erwan Donal
- CIC-IT U 1414, CHU Rennes, Université Rennes 1, Service de Cardiologie, CHU Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, 1, Via Consolare Valeria - 98125 Messina (IT), Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, 1, Via Consolare Valeria - 98125 Messina (IT), Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S.Pansini, 5, 80131 Napoli, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Via S.Pansini, 5, 80131 Napoli, Italy
| | - Luigi P Badano
- Department of Medicine and Surgery, University Milano-Bicocca, and Istituto Auxologico Italiano, IRCCS, Cardiology Unit and Dept of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, P.le Brescia 20, 20149 Milano, Italy
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, 60637 IL, USA
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU du Sart Tilman, Domaine Universitaire du Sart Tilman, Batiment B35, 4000 Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Via Camillo Rosalba, 35, 70124 Bari, Italy
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37
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Malagoli A, Albini A, Mandoli GE, Baggiano A, Vinco G, Bandera F, D'Andrea A, Esposito R, D'Ascenzi F, Sorrentino R, Santoro C, Benfari G, Contorni F, Cameli M. Multimodality imaging of the ischemic right ventricle: an overview and proposal of a diagnostic algorithm. Int J Cardiovasc Imaging 2021; 37:3343-3354. [PMID: 34114150 DOI: 10.1007/s10554-021-02309-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Right ventricular (RV) involvement is frequently detected in patients presenting with acute left ventricular myocardial infarction. The ischemic right ventricle carries a dismal outcome by predisposing the heart to arrhythmic events and mechanical or hemodynamic complications. A comprehensive RV evaluation by multimodality imaging could guide clinical practice but has always been a conundrum for the imagers. Two-dimensional echocardiography is the best first-line tool due to its availability of bedside capabilities. More advanced imaging techniques provide a more comprehensive evaluation of the complex RV geometry but are mostly reserved for the post-acute setting. Three-dimensional echocardiography has improved the evaluation of RV volumes and function. The recent application of speckle-tracking echocardiography to the right ventricle appears promising, allowing the earlier detection of subtle RV dysfunction. Cardiac magnetic resonance imaging is considered the gold standard for the RV assessment. Cardiac multidetector computed tomography could be a reliable alternative. The aim of this review is to focus on the growing importance of multimodality imaging of the ischemic right ventricle and to propose a diagnostic algorithm, in order to reach a comprehensive assessment of this too frequently neglected chamber.
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Affiliation(s)
- A Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy.
| | - A Albini
- Division of Cardiology, Nephro-Cardiovascular Department, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - G E Mandoli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - A Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Vinco
- Department of Medicine, University of Verona, Verona, Italy
| | - F Bandera
- Cardiology University Department, Heart Failure Unit, Department of Biomedical Sciences for Health, IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - A D'Andrea
- Division of Cardiology, Umberto I' Hospital Nocera Inferiore (Salerno), Luigi Vanvitelli University, Caserta, Italy
| | - R Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - F D'Ascenzi
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - R Sorrentino
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - C Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - G Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - F Contorni
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - M Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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38
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Esposito R, Fedele T, Orefice S, Cuomo V, Prastaro M, Canonico ME, Ilardi F, De Stefano F, Fiorillo L, Santoro C, Esposito G. An Emergent Form of Cardiotoxicity: Acute Myocarditis Induced by Immune Checkpoint Inhibitors. Biomolecules 2021; 11:biom11060785. [PMID: 34067474 PMCID: PMC8224544 DOI: 10.3390/biom11060785] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 01/22/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. ICIs have shown great promise in the treatment of several advanced malignancies. However, therapy with these immunomodulatory antibodies may lead to a wide spectrum of immune-related adverse events in any organ and any tissue. Cardiologic immune-related events include pericarditis, pericardial effusion, various types of arrhythmias including the occurrence of complete atrioventricular block, myocardial infarction, heart failure, and myocarditis. Although relatively rare, myocarditis is associated with a very high reported mortality in comparison to other adverse events. Myocarditis often presents significant diagnostic complexity and may be under-recognized. When confronted with an unexpected change in the clinical picture, the physician must differentiate between immune-related adverse events, cancer worsening, or other causes unrelated to the cancer or its therapy. However, this is not always easy. Therefore, with the increasing use of checkpoint inhibitors in cancer, all providers who care for patients with cancer should be made aware of this rare, but potentially fatal, cardiologic immune-related adverse event, and able to recognize when prompt consultation with a cardiologist specialist is indicated. In this review, we evaluate currently available scientific evidence and discuss clinical manifestations and new potential approaches to the diagnosis and therapy of acute myocarditis induced by ICIs. Temporary or permanent discontinuation of the ICIs and high-dose steroids have been administered to treat myocarditis, but symptoms may worsen in some patients despite therapy.
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Affiliation(s)
- Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
- Mediterranea Cardiocentro, 80122 Naples, Italy;
- Correspondence: ; Tel.: +39-817-464-749
| | - Teresa Fedele
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Silvia Orefice
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Vittoria Cuomo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | - Federica Ilardi
- Mediterranea Cardiocentro, 80122 Naples, Italy;
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | | | - Ludovica Fiorillo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy; (T.F.); (S.O.); (V.C.); (L.F.)
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (M.P.); (M.E.C.); (C.S.); (G.E.)
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Carbone A, D'Andrea A, Sperlongano S, Tagliamonte E, Mandoli GE, Santoro C, Evola V, Bandera F, Morrone D, Malagoli A, D'Ascenzi F, Bossone E, Cameli M. Echocardiographic assessment of coronary microvascular dysfunction: Basic concepts, technical aspects, and clinical settings. Echocardiography 2021; 38:993-1001. [PMID: 33948990 PMCID: PMC8252466 DOI: 10.1111/echo.15059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 01/06/2023] Open
Abstract
Coronary flow reserve is the capacity of the coronary circulation to augment the blood flow in response an increase in myocardial metabolic demands and has a powerful prognostic significance in different clinical situations. It might assess with invasive and noninvasive technique. Transthoracic echocardiography Doppler is an emerging diagnostic technique, noninvasive, highly feasible, safe for patient and physician, without radiation, and able to detect macrovascular and microvascular anomalies in the coronary circulation. This review aims to describe the benefit and limits of echocardiographic assessment of coronary flow reserve.
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Affiliation(s)
- Andreina Carbone
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology and Intensive Coronary Unit, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Simona Sperlongano
- Department of Cardiology and Intensive Coronary Unit, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Ercole Tagliamonte
- Department of Cardiology and Intensive Coronary Unit, "Umberto I" Hospital, Nocera Inferiore (SA), Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Evola
- Department of Clinical and Experimental Medicine, University of Palermo, Palermo, Italy
| | - Francesco Bandera
- Heart Failure Unit, Chair of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Health Science, University of Milan, Milan, Italy
| | - Doralisa Morrone
- Cardiothoracic Department, Cisanello Hospital, University of Pisa, Pisa, Italy
| | | | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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40
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Mandoli GE, D'Ascenzi F, Vinco G, Benfari G, Ricci F, Focardi M, Cavigli L, Pastore MC, Sisti N, De Vivo O, Santoro C, Mondillo S, Cameli M. Novel Approaches in Cardiac Imaging for Non-invasive Assessment of Left Heart Myocardial Fibrosis. Front Cardiovasc Med 2021; 8:614235. [PMID: 33937354 PMCID: PMC8081830 DOI: 10.3389/fcvm.2021.614235] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
In the past, the identification of myocardial fibrosis was only possible through invasive histologic assessment. Although endomyocardial biopsy remains the gold standard, recent advances in cardiac imaging techniques have enabled non-invasive tissue characterization of the myocardium, which has also provided valuable insights into specific disease processes. The diagnostic accuracy, incremental yield and prognostic value of speckle tracking echocardiography, late gadolinium enhancement and parametric mapping modules by cardiac magnetic resonance and cardiac computed tomography have been validated against tissue samples and tested in broad patient populations, overall providing relevant clinical information to the cardiologist. This review describes the patterns of left ventricular and left atrial fibrosis, and their characterization by advanced echocardiography, cardiac magnetic resonance and cardiac computed tomography, allowing for clinical applications in sudden cardiac death and management of atrial fibrillation.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Vinco
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Department of Clinical Sciences, Lund University, Malmö, Sweden.,Casa di Cura Villa Serena, Città Sant'Angelo, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicolò Sisti
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Oreste De Vivo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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41
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Pastore MC, Mandoli GE, Dokollari A, Bisleri G, D'Ascenzi F, Santoro C, Miglioranza MH, Focardi M, Cavigli L, Patti G, Valente S, Mondillo S, Cameli M. Speckle tracking echocardiography in primary mitral regurgitation: should we reconsider the time for intervention? Heart Fail Rev 2021; 27:1247-1260. [PMID: 33829389 PMCID: PMC9197800 DOI: 10.1007/s10741-021-10100-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Accepted: 03/26/2021] [Indexed: 12/15/2022]
Abstract
Thanks to the improvement in mitral regurgitation (MR) diagnostic and therapeutic management, with the introduction of minimally invasive techniques which have considerably reduced the individual surgical risk, the optimization of the timing for MR “open” or percutaneous surgical treatment has become a main concern which has highly raised scientific interest. In fact, the current indications for intervention in MR, especially in asymptomatic patients, rely on echocardiographic criteria with high severity cut-offs that are fulfilled only when not only mitral valve apparatus but also the cardiac chambers’ structure and function are severely impaired, which results in poor benefits for post-operative clinical outcome. This led to the need of new indices to redefine the optimal surgical timing in these patients. Speckle tracking echocardiography provides early markers of cardiac dysfunction due to subtle myocardial impairment; therefore, it could offer pivotal information in this setting. In fact, left ventricular and left atrial strains have already shown evidence about their usefulness in recognizing MR impact not only on symptoms and quality of life but also on cardiovascular events and new-onset atrial fibrillation in these patients. Moreover, right ventricular strain could be used to identify those patients with advanced cardiac damage and different grades of right ventricular dysfunction, which entails higher risks for cardiac surgery that could overweigh surgical benefits. This review aims to describe the importance of reconsidering the timing of intervention in MR and to analyze the potential additive value of speckle tracking echocardiography in this clinical setting.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy. .,Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy.
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | | | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | | | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Giuseppe Patti
- Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
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42
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Cadeddu Dessalvi C, Deidda M, Noto A, Madeddu C, Cugusi L, Santoro C, López-Fernández T, Galderisi M, Mercuro G. Antioxidant Approach as a Cardioprotective Strategy in Chemotherapy-Induced Cardiotoxicity. Antioxid Redox Signal 2021; 34:572-588. [PMID: 32151144 DOI: 10.1089/ars.2020.8055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Significance: Chemotherapy-induced cardiotoxicity (CTX) has been associated with redox signaling imbalance. In fact, redox reactions are crucial for normal heart physiology, whereas excessive oxidative stress can cause cardiomyocyte structural damage. Recent Advances: An antioxidant approach as a cardioprotective strategy in this setting has shown encouraging results in preventing anticancer drug-induced CTX. Critical Issues: In fact, traditional heart failure drugs as well as many other compounds and nonpharmacological strategies, with a partial effect in reducing oxidative stress, have been shown to counterbalance chemotherapy-induced CTX in this setting to some extent. Future Directions: Given the various pathways of toxicity involved in different chemotherapeutic schemes, interactions with redox balance need to be fine-tuned and a personalized cardioprotective approach seems to be required.
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Affiliation(s)
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Noto
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Lucia Cugusi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Teresa López-Fernández
- Cardiology Service, Cardio-Oncology Unit, La Paz University Hospital, IdiPAz Research Institute, Ciber CV, Madrid, Spain
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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43
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Luciano F, Santoro C, Capone V, Casciano O, Canonico ME, Fedele T, Orefice S, Fiorillo L, Esposito R. Usefulness of myocardial work assessment for the understanding of mechanisms underlying sacubitril/valsartan efficacy in patients with heart failure and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sacubitril/valsartan has shown the ability in reducing the risk of death and of hospitalization in patients with HF (heart failure) and is recommended in patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite conventional therapies. Strain imaging derived myocardial work (MW) is an emerging tool for the evaluation of left ventricular (LV) mechanics by incorporating both systolic deformation and afterload burden in the analysis.
Aim of the study
To evaluate in a prospective fashion the impact of sacubitril/valsartan therapy in HF patients on MW derived parameters in relation with standard echocardiographic indices.
Methods
We recruited thirteen HF patients with indication to sacubitril/valsartan therapy according to current guidelines. Sacubitril/valsartan therapy titrated at the maximum tolerated dose. A comprehensive echo-Doppler exam, including speckle tracking derived assessment of global longitudinal strain (GLS) (in absolute value), was performed before and after a three months therapy with sacubitril/valsartan. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were calculated according to standardized procedures. Patients with more than mild aortic and mitral stenosis and/or regurgitation were excluded. Other exclusion criteria included permanent and/or persistent atrial fibrillation and inadequate echo images.
Results
The 13 patients (M/F = 11/2, age: 57 ± 8.2 years, aetiology: idiopathic in 3 patients, ischaemic in 7 patients and chemotherapy related cardiotoxicity in 3 patients, NYHA Class: II in 7 and III in 6 patients). All patients tolerated sacubitril/valsartan therapy. After the three months therapy an improvement of LVEF (from 32.3 ± 2% to 36.2± 6%, p = 0.015), GLS (from 9.8 ± 1% to 11.6 ± 2%, p = 0.019), GWI (from 845.0 ± 175.0 mmHg% to 1091.6 ± 336.8 mmHg%, p = 0.003), GCW (from 993.4± 211.6 mmHg% to 1262.7 ± 404 mmHg%, p = 0.002) and GWE (from 77 ± 11% to 81 ± 10%, p = 0.002) was observed, without significant changes in GWW (from 190 ± 121 mmHg% to 211 ± 145 mmHg%, p = 0.307). We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.66, p = 0.014). This relation remained significant even after adjusting for the extent of systolic blood pressure reduction (r = 0.54, p = 0.033).
Conclusion
Three months sacubitril/valsartan therapy significantly improves standard and advanced indices of LV systolic function. This improvement is due to the increase of constructive work more than to the reduction of wasted work and the increase of LVEF can be predicted by the global constructive work levels at baseline. MW assessment may help to understand the mechanisms underlying the sacubitril/valsartan therapy efficacy in HF patients.
Abstract Figure.
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Affiliation(s)
- F Luciano
- Federico II University of Naples, Naples, Italy
| | - C Santoro
- Federico II University of Naples, Naples, Italy
| | - V Capone
- Federico II University of Naples, Naples, Italy
| | - O Casciano
- Federico II University of Naples, Naples, Italy
| | - ME Canonico
- Federico II University of Naples, Naples, Italy
| | - T Fedele
- Federico II University of Naples, Naples, Italy
| | - S Orefice
- Federico II University of Naples, Naples, Italy
| | - L Fiorillo
- Federico II University of Naples, Naples, Italy
| | - R Esposito
- Federico II University of Naples, Naples, Italy
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44
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Santoro C, Soloperto R, Casciano O, Esposito R, Lembo M, Canonico M, Arpino G, Giuliano M, De Placido S, Esposito G. Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure.
Purpose
To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography.
Methods
Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction < 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%.
Results
None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p < 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p < 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p < 0.0001).
Conclusions
Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients.
Abstract Figure.
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Affiliation(s)
- C Santoro
- Federico II University of Naples, Naples, Italy
| | - R Soloperto
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - O Casciano
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - R Esposito
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Lembo
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Canonico
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - G Arpino
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Giuliano
- Federico II University of Naples, Naples, Italy
| | | | - G Esposito
- Federico II University of Naples, Naples, Italy
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Fernández-Golfín C, Hinojar-Baydes R, González-Gómez A, Monteagudo JM, Esteban A, Alonso-Salinas G, Fernández MA, García-Martín A, Santoro C, Pascual-Izco M, Jiménez-Nacher JJ, Zamorano JL. Prognostic implications of cardiac magnetic resonance feature tracking derived multidirectional strain in patients with chronic aortic regurgitation. Eur Radiol 2021; 31:5106-5115. [PMID: 33449184 DOI: 10.1007/s00330-020-07651-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/25/2020] [Accepted: 12/18/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Speckle-tracking echocardiography (STE) deformation parameters detect latent LV dysfunction in chronic aortic regurgitation (AR) and are associated with outcomes. The aim of the study was to evaluate cardiac magnetic resonance (CMR) feature tracking (FT) deformation parameters in asymptomatic patients with AR and implications in outcomes. METHODS Fifty-five patients with AR and 54 controls were included. Conventional functional CMR parameters, aortic regurgitant volume, and fraction were assessed. CMR-FT analysis was performed with a dedicated software. Clinical data was obtained from hospital records. A combined endpoint included all-cause mortality, cardiovascular mortality, aortic valve surgery, or cardiovascular hospital admission due to heart failure. RESULTS Left ventricular (LV) mechanics is impaired in patients with significant AR. Significant differences were noted in global longitudinal strain (GLS) between controls and AR patients (- 19.1 ± 2.9% vs - 16.5 ± 3.2%, p < 0.001) and among AR severity groups (- 18.3 ± 3.1% vs - 16.2 ± 1.6% vs - 15 ± 3.5%; p = 0.02 for AR grades I-II, III, and IV). In univariate and multivariate analyses, circumferential strain (GCS) and global radial strain (GRS) but not GLS were associated with and increased risk of the end point with a HR of 1.26 (p = 0.016, 1.04-1.52) per 1% worsening for GCS and 0.90 (p = 0.012, 0.83-0.98) per 1% worsening for GRS. CONCLUSIONS CMR-FT myocardial deformation parameters are impaired in patients with AR not meeting surgical criteria. GLS decreases early in the course of the disease and is a marker of AR severity while GCS and GRS worsen later but predict a bad prognosis, mainly the need of aortic valve surgery. KEY POINTS • CMR feature tracking LV mechanic parameters may be reduced in significant chronic AR with normal EF. • LV mechanics, mainly global longitudinal strain, worsens as AR severity increases. • LV mechanics, specially global radial and circumferential strain, is associated with a worse prognosis in AR patients.
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Affiliation(s)
- Covadonga Fernández-Golfín
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain.
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Majadahonda, Spain.
| | - Rocío Hinojar-Baydes
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain
| | - Ariana González-Gómez
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain
| | - Juan Manuel Monteagudo
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain
| | - Amparo Esteban
- Radiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Gonzalo Alonso-Salinas
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain
| | | | - Ana García-Martín
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain
| | - Ciro Santoro
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain
| | - Marina Pascual-Izco
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain
| | - Jose Julio Jiménez-Nacher
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain
| | - Jose Luis Zamorano
- Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar km 9, 100 28034, Madrid, Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII), Majadahonda, Spain
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46
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Cennamo G, Montorio D, Santoro C, Cocozza S, Spinelli L, Di Risi T, Riccio E, Russo C, Pontillo G, Esposito R, Imbriaco M, Pisani A. The Retinal Vessel Density as a New Vascular Biomarker in Multisystem Involvement in Fabry Disease: An Optical Coherence Tomography Angiography Study. J Clin Med 2020; 9:jcm9124087. [PMID: 33352849 PMCID: PMC7766384 DOI: 10.3390/jcm9124087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/30/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
In this study, we evaluated the possible relationship between the changes in retinal vessel density (VD) by optical coherence tomography angiography (OCTA) and the vascular alterations involving renal, cardiovascular and central nervous systems in patients affected by Fabry disease (FD). In 50 FD patients, the retinal superficial capillary plexus (SCP) and deep capillary plexus (DCP) in macular region were evaluated by OCTA examination. The patients also underwent a brain magnetic resonance imaging scan, renal and echocardiographic examinations with quantification of systolic pulmonary arterial pressure (PAPs) and left atrial volume index (LAVi). The VD of SCP and DCP was inversely related with E/e’ ratio, LAVi, interventricular septal thickness, global longitudinal strain (GLS) and PAPs (p < 0.05). No relationship was found, with a multivariate analysis, between OCTA parameters and kidney function and neuroradiological signs of central nervous system involvement. OCTA could be a new vascular biomarker in FD, revealing a strong correlation between retinal capillary damage and myocardial impairment, possibly preceding both renal dysfunction and cerebrovascular involvement.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples “Federico II”, 80131 Naples, Italy
- Correspondence:
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Letizia Spinelli
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Teodolinda Di Risi
- CEINGE—Advanced Biotechnologies, 80145 Naples, Italy;
- Department of Public Medicine, University Federico II, 80131 Naples, Italy; (E.R.); (A.P.)
| | - Eleonora Riccio
- Department of Public Medicine, University Federico II, 80131 Naples, Italy; (E.R.); (A.P.)
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy; (C.S.); (S.C.); (L.S.); (C.R.); (G.P.); (R.E.); (M.I.)
| | - Antonio Pisani
- Department of Public Medicine, University Federico II, 80131 Naples, Italy; (E.R.); (A.P.)
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47
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D'Ascenzi F, Valentini F, Anselmi F, Cavigli L, Bandera F, Benfari G, D'Andrea A, Di Salvo G, Esposito R, Evola V, Malagoli A, Elena Mandoli G, Santoro C, Galderisi M, Mondillo S, Cameli M. Bicuspid aortic valve and sports: From the echocardiographic evaluation to the eligibility for sports competition. Scand J Med Sci Sports 2020; 31:510-520. [PMID: 33260267 DOI: 10.1111/sms.13895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/23/2020] [Accepted: 11/27/2020] [Indexed: 12/19/2022]
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart defect in adults. Although a BAV may remain without clinical consequences for a lifetime, it can deteriorate in aortic valve stenosis and regurgitation and aortic dilatation. Unfortunately, the impact of regular training on patients with BAV and its natural course is not fully understood, although preliminary evidence suggests that the progression of valvular disease occurs primarily in an independent manner from sports practice. The current review aims to report how to perform a comprehensive echocardiographic examination in athletes with BAV and analyze the current literature on the influence of sports practice and how it impacts the aortic valve in athletes with BAV. The article also summarizes the current recommendations on sports eligibility and disqualification for competitive athletes with BAV.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesca Valentini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giovanni Benfari
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I° Hospital Nocera Inferiore, Salerno, Italy
| | | | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Vincenzo Evola
- Department of Clinical and Experimental Medicine, University of Palermo, Palermo, Italy
| | | | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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48
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Fedele T, Orefice S, Fiorillo L, Cuomo V, Capone V, Casciano O, Luciano F, Canonico ME, Santoro C, Esposito R. 77 Routine outpatients visits during SARS-CoV2 global pandemic. Eur Heart J Suppl 2020; 22:N135-N137. [PMID: 38626258 PMCID: PMC7799053 DOI: 10.1093/eurheartj/suaa208] [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] [Indexed: 11/13/2022]
Abstract
Aims The inability to carry office visits was collateral damage caused by the Coronavirus (COVID-19) pandemic. Tele-health is a relatively new, and yet fundamental amid the current crisis, resource to bridge the gap between phisicians and patients. Methods and results We report our experience with telemedicine and describe the major events occured in our patients. 121 consecutive adult patients with arterial hypertension (F/M: 56/65; mean age: 66.8 years) were enrolled. 33 patients (27%) had also diabetes, 94 (78%) were also affected from dyslipidemia and 11 (9%) had CAD. They all referred to our ambulatory of hypertension, in most of case for several years. Given the impossibility to continue routine outpatient visits during lockdown, they were all phone called by three residents in order to detect their state of health or any events they could have experienced over this period. They were all asked about their own blood pressure values, the occurrence of new symptoms and of new-onset both cardiovascular and non cardiovascular events. We also followed a self-made preset form. 31 of them (26%) experienced cardiovascular symptoms/events during this period: 11 had hypertensive peaks, in one case associated with nausea and vomiting while 2 of them had hypotensive episodes; 10 had typical angina and/or dyspnoea while 4 had atypical angina; 6 had palpitations; 1 of them developed new onset atrial fibrillation resolved with pharmacologic cardioversion during hospitalization; 1 had syncope; 1 patient reported new onset peripheral oedema; 2 patients died during lockdown for non cardiovascular causes. 17 of them also developed non cardiovascular symptoms, 7 of whom were severe anxiety and/or panic attacks. Almost all patients had important lifestyle changes, in 15 cases (12.3%) associated with weight increase. Conclusion The impossibility to access to routine outpatient visits during lockdown due to global pandemic of SARS-CoV2, has brought out the risk of underestimating consequences of chronic disease, in absence of appropriate Follow-up. Nevertheless, the two deaths we report were not related to cardiovascular disease. The risk is that both the missing of cardiovascular control visit and the extension of the waiting list, could provoke serious complications in patients suffering from chronic cardiovascular disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Roberta Esposito
- Departement of Clinical Medicine and Surgery, Federico II Univerisity, Naples, Italy
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49
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Novo G, Santoro C, Manno G, Di Lisi D, Esposito R, Mandoli GE, Evola V, Pastore MC, Sperlongano S, D'Andrea A, Cameli M, Galderisi M. Usefulness of Stress Echocardiography in the Management of Patients Treated with Anticancer Drugs. J Am Soc Echocardiogr 2020; 34:107-116. [PMID: 33223357 DOI: 10.1016/j.echo.2020.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/28/2022]
Abstract
In recent years, the survival of patients with cancer has improved thanks to advances in antineoplastic therapeutic protocols. This has led to an increasing burden of cardiovascular complications related to cancer treatment. Therefore, a new branch of cardiology has been created, "cardio-oncology," with the aims of preventing cardiovascular complications related to antineoplastic treatment, achieving early diagnosis and treatment of any complications, and allowing completion of the expected antineoplastic treatment. Stress echocardiography has a pivotal role in achieving a timely diagnosis of coronary artery disease and thus is the best management approach in this clinical setting. Atherosclerotic processes can be exacerbated by both chemotherapy and chest irradiation in patients with cancer, even several years after anticancer treatment completion. Moreover, stress echocardiography has many other potential applications, such as in the evaluation of subclinical left ventricular dysfunction and contractile reserve in patients treated with anticancer drugs that have the potential to induce myocardial damage, as well as evaluating valve disease. The objective of this review is to delineate the role of stress echocardiography in cardio-oncology.
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Affiliation(s)
- Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital Paolo Giaccone, Palermo, University of Palermo, Palermo, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Girolamo Manno
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital Paolo Giaccone, Palermo, University of Palermo, Palermo, Italy.
| | - Daniela Di Lisi
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital Paolo Giaccone, Palermo, University of Palermo, Palermo, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Vincenzo Evola
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital Paolo Giaccone, Palermo, University of Palermo, Palermo, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Simona Sperlongano
- Unit of Cardiology, Department of Translational Medical Sciences, Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore, Salerno, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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50
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Cameli M, Miglioranza MH, Magne J, Mandoli GE, Benfari G, Ancona R, Sibilio G, Reskovic Luksic V, Dejan D, Griseli L, Van De Heyning CM, Mortelmans P, Michalski B, Kupczynska K, Di Giannuario G, Devito F, Dulgheru R, Ilardi F, Salustri A, Abushahba G, Morrone D, Fabiani I, Penicka M, Katbeh A, Sammarco G, Esposito R, Santoro C, Pastore MC, Comenale Pinto S, Kalinin A, Pičkure Ž, Ažman Juvan K, Zupan Mežnar A, Coisne A, Coppin A, Opris MM, Nistor DO, Paakkanen R, Biering-Sørensen T, Olsen FJ, Lapinskas T, Vaškelyté JJ, Galian-Gay L, Casas G, Motoc AI, Papadopoulos CH, Loizos S, Ágoston G, Szabó I, Hristova K, Tsonev SN, Galli E, Vinereanu D, Mihaila Baldea S, Muraru D, Mondillo S, Donal E, Galderisi M, Cosyns B, Edvardsen T, Popescu BA. Multicentric Atrial Strain COmparison between Two Different Modalities: MASCOT HIT Study. Diagnostics (Basel) 2020; 10:diagnostics10110946. [PMID: 33202837 PMCID: PMC7696899 DOI: 10.3390/diagnostics10110946] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference.
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Affiliation(s)
- Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
- Correspondence: ; Tel.: +39-0577585377
| | - Marcelo Haertel Miglioranza
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre 90620-000, Brazil; (M.H.M.); (L.G.)
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, F-87042, 87042 Limoges, France;
- Cardiology Department, INSERM U1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy;
| | - Roberta Ancona
- UOC Cardiologia/UTIC—“Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Pozzuoli, Italy; (R.A.); @gmail.it (G.S.); (S.C.P.)
| | - Gerolamo Sibilio
- UOC Cardiologia/UTIC—“Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Pozzuoli, Italy; (R.A.); @gmail.it (G.S.); (S.C.P.)
| | - Vlatka Reskovic Luksic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (V.R.L.); (D.D.)
| | - Dosen Dejan
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (V.R.L.); (D.D.)
| | - Leonardo Griseli
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre 90620-000, Brazil; (M.H.M.); (L.G.)
| | | | - Philippe Mortelmans
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium; (C.M.V.D.H.); (P.M.)
| | - Blazej Michalski
- Department of Cardiology, Medical University of Lodz, 91347 Lodz, Poland; (B.M.); (K.K.)
| | - Karolina Kupczynska
- Department of Cardiology, Medical University of Lodz, 91347 Lodz, Poland; (B.M.); (K.K.)
| | | | | | - Raluca Dulgheru
- Cardiology Department—Heart Valve Clinic—University Hospital Liege, B-4000 Liege, Belgium; (R.D.); (F.I.)
| | - Federica Ilardi
- Cardiology Department—Heart Valve Clinic—University Hospital Liege, B-4000 Liege, Belgium; (R.D.); (F.I.)
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Alessandro Salustri
- Non-Invasive Department, Heart Hospital—Hamad Medical Corporation, Doha 3050, Qatar; (A.S.); (G.A.)
| | - Galal Abushahba
- Non-Invasive Department, Heart Hospital—Hamad Medical Corporation, Doha 3050, Qatar; (A.S.); (G.A.)
| | - Doralisa Morrone
- Cardiothoracic and Vascular Department, Pisa University, 56126 Pisa, Italy; (D.M.); (I.F.)
| | - Iacopo Fabiani
- Cardiothoracic and Vascular Department, Pisa University, 56126 Pisa, Italy; (D.M.); (I.F.)
- Cardiologia e Medicina Cardiovascolare—Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Martin Penicka
- Cardiovascular Research Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (M.P.); (A.K.)
| | - Asim Katbeh
- Cardiovascular Research Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (M.P.); (A.K.)
| | - Giuseppe Sammarco
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35122 Padua, Italy; (G.S.); (D.M.)
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
| | - Salvatore Comenale Pinto
- UOC Cardiologia/UTIC—“Santa Maria delle Grazie” Hospital Pozzuoli, 80078 Pozzuoli, Italy; (R.A.); @gmail.it (G.S.); (S.C.P.)
| | - Artem Kalinin
- Department “Gailezers”, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (A.K.); (Z.P.)
| | - Žanna Pičkure
- Department “Gailezers”, Riga East Clinical University Hospital, LV-1038 Riga, Latvia; (A.K.); (Z.P.)
| | - Katja Ažman Juvan
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Anja Zupan Mežnar
- Cardiology Department, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Augustine Coisne
- Department of Clinical Physiology and Echocardiography—Heart Valve Clinic, Lille University Hospital, 59800 Lille, France; (A.C.); (A.C.)
| | - Amandine Coppin
- Department of Clinical Physiology and Echocardiography—Heart Valve Clinic, Lille University Hospital, 59800 Lille, France; (A.C.); (A.C.)
| | - Mihaela Maria Opris
- Institute for Emergency Cardiovascular Diseases and Transplant of Targu Mures, 540136 Targu Mures, Romania; (M.M.O.); (D.O.N.)
| | - Dan Octavian Nistor
- Institute for Emergency Cardiovascular Diseases and Transplant of Targu Mures, 540136 Targu Mures, Romania; (M.M.O.); (D.O.N.)
| | - Riitta Paakkanen
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, 00100 Helsinki, Finland;
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Copenhagen, Denmark; (T.B.-S.); (F.J.O.)
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Copenhagen, Denmark; (T.B.-S.); (F.J.O.)
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (J.J.V.)
| | - Jolanta Justina Vaškelyté
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (J.J.V.)
| | - Laura Galian-Gay
- Department of Cardiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.-G.); (G.C.)
| | - Guillem Casas
- Department of Cardiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (L.G.-G.); (G.C.)
| | - Andreea Iulia Motoc
- Centre for Cardiovascular Diseases, University Hospital of Brussels, B-1090 Brussels, Belgium; (A.I.M.); (B.C.)
| | | | - Savvas Loizos
- Korgialenio Benakio—Red Cross Hospital, 115 26 Athens, Greece; (C.H.P.); (S.L.)
| | - Gergely Ágoston
- Department of Family Medicine, University of Szeged, H-6725 Szeged, Hungary; (G.A.); (I.S.)
| | - Istvan Szabó
- Department of Family Medicine, University of Szeged, H-6725 Szeged, Hungary; (G.A.); (I.S.)
| | - Krasimira Hristova
- Department of Noninvasive Functional Diagnostic and Imaging, National Heart Hospital, 1309 Sofia, Bulgaria; (K.H.); (S.N.T.)
| | - Svetlin Netkov Tsonev
- Department of Noninvasive Functional Diagnostic and Imaging, National Heart Hospital, 1309 Sofia, Bulgaria; (K.H.); (S.N.T.)
| | - Elena Galli
- Centre Hospitalier Universitaire de Rennes, Inserm, University of Rennes, LTSI—UMR 1099, F-35000 Rennes, France; (E.G.); (E.D.)
| | - Dragos Vinereanu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila—Emergency and University Hospital, 050474 Bucharest, Romania; (D.V.); (S.M.B.)
| | - Sorina Mihaila Baldea
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila—Emergency and University Hospital, 050474 Bucharest, Romania; (D.V.); (S.M.B.)
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35122 Padua, Italy; (G.S.); (D.M.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (S.M.)
| | - Erwan Donal
- Centre Hospitalier Universitaire de Rennes, Inserm, University of Rennes, LTSI—UMR 1099, F-35000 Rennes, France; (E.G.); (E.D.)
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II, University Hospital, 80131 Naples, Italy; (R.E.); (C.S.); (M.G.)
| | - Bernard Cosyns
- Centre for Cardiovascular Diseases, University Hospital of Brussels, B-1090 Brussels, Belgium; (A.I.M.); (B.C.)
| | - Thor Edvardsen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0372 Oslo, Norway;
- Faculty of Medicine, University of Oslo, 0315 Oslo, Norway
| | - Bogdan A. Popescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”—Euroecolab, Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Sos. Fundeni 258, 022328 Bucharest, Romania;
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