1
|
Perillo A, Basile C, Fucile I, Rozza F, De Luca N, Mancusi C. Lung ultrasound at discharge predicts outcomes in heart failure: a pilot study. J Cardiovasc Med (Hagerstown) 2024; 25:394-396. [PMID: 38526933 PMCID: PMC10990019 DOI: 10.2459/jcm.0000000000001613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/07/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Andrea Perillo
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | | | | | | | | | | |
Collapse
|
2
|
Lembo M, Strisciuglio T, Fonderico C, Mancusi C, Izzo R, Trimarco V, Bellis A, Barbato E, Esposito G, Morisco C, Rubattu S. Obesity: the perfect storm for heart failure. ESC Heart Fail 2024. [PMID: 38491741 DOI: 10.1002/ehf2.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 03/18/2024] Open
Abstract
Obesity condition causes morphological and functional alterations involving the cardiovascular system. These can represent the substrates for different cardiovascular diseases, such as atrial fibrillation, coronary artery disease, sudden cardiac death, and heart failure (HF) with both preserved ejection fraction (EF) and reduced EF. Different pathogenetic mechanisms may help to explain the association between obesity and HF including left ventricular remodelling and epicardial fat accumulation, endothelial dysfunction, and coronary microvascular dysfunction. Multi-imaging modalities are required for appropriate recognition of subclinical systolic dysfunction typically associated with obesity, with echocardiography being the most cost-effective technique. Therapeutic approach in patients with obesity and HF is challenging, particularly regarding patients with preserved EF in which few strategies with high level of evidence are available. Weight loss is of extreme importance in patients with obesity and HF, being a primary therapeutic intervention. Sodium-glucose co-transporter-2 inhibitors have been recently introduced as a novel tool in the management of HF patients. The present review aims at analysing the most recent studies supporting pathogenesis, diagnosis, and management in patients with obesity and HF.
Collapse
Affiliation(s)
- Maria Lembo
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Teresa Strisciuglio
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Celeste Fonderico
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Valentina Trimarco
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Alessandro Bellis
- Emergenza Accettazione Department, Azienda Ospedaliera 'Antonio Cardarelli', Naples, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanni Esposito
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biochemical Sciences, Federico II University, Naples, Italy
| | - Speranza Rubattu
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| |
Collapse
|
3
|
Fucile I, Attanasio F, Conte M, Tesone M, Fiorillo F, Rozza F, Mancusi C, De Luca N. Nursing Counseling in Patients Recently Admitted in Cardiac Rehabilitation Unit: A Pilot Study-Brief Letter for Publication. High Blood Press Cardiovasc Prev 2024; 31:221-223. [PMID: 38557856 DOI: 10.1007/s40292-024-00637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Ilaria Fucile
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Filomena Attanasio
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
| | - Maurizio Conte
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
| | - Maddalena Tesone
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Fulvio Fiorillo
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Rozza
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Costantino Mancusi
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy.
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Nicola De Luca
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Napoletano S, Fucile I, Perillo A, De Luca N, Mancusi C. Giant aortic aneurism diagnosed by lung ultrasound. Intern Emerg Med 2024:10.1007/s11739-023-03503-5. [PMID: 38216842 DOI: 10.1007/s11739-023-03503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/02/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Serena Napoletano
- Emergency Medicine School, Federico II University of Naples, via S. Pansini 5 - bld #2, 80131, Naples, Italy
| | - Ilaria Fucile
- Emergency Medicine School, Federico II University of Naples, via S. Pansini 5 - bld #2, 80131, Naples, Italy
| | - Andrea Perillo
- Emergency Medicine School, Federico II University of Naples, via S. Pansini 5 - bld #2, 80131, Naples, Italy
| | - Nicola De Luca
- Emergency Medicine School, Federico II University of Naples, via S. Pansini 5 - bld #2, 80131, Naples, Italy
| | - Costantino Mancusi
- Emergency Medicine School, Federico II University of Naples, via S. Pansini 5 - bld #2, 80131, Naples, Italy.
| |
Collapse
|
6
|
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.
Collapse
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.)
| |
Collapse
|
7
|
Mancusi C, Manzi MV, Lembo M, Fucile I, Basile C, Bardi L, Morisco C, De Luca N, Bossone E, Trimarco B, Izzo R, de Simone G, Esposito G. Normalization of ascending aorta dimension for body size influences pathophysiologic correlation in hypertensive patients: the Campania Salute Network. Eur J Prev Cardiol 2023; 30:1774-1780. [PMID: 37409686 DOI: 10.1093/eurjpc/zwad224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/07/2023]
Abstract
AIMS In the present study, we assessed correlates and their consistency of ascending aorta (AscAo) measurement in treated hypertensive patients. METHODS AND RESULTS A total of 1634 patients ≥ 18 years old with available AscAo ultrasound were included. Ascending aorta was measured at end-diastole with leading edge to leading edge method, perpendicular to the long axis of the aorta in parasternal long-axis view at its maximal identifiable dimension. Correlations of AscAo and AscAo normalized for height (AscAo/HT) or body surface area (AscAo/BSA) with demographics and metabolic profile were explored. Multi-variable regression was also used to identify potential confounders influencing univariate correlations. Sensitivity analysis was performed using cardiovascular (CV) outcome. Correlations with age, estimated glomerular filtration rate, systolic blood pressure (BP), and heart rate (HR) were similar among the three aortic measures. Women exhibited smaller AscAo but larger AscAo/BSA than men with AscAo/HT offsetting the sex difference. Obesity and diabetes were associated with greater AscAo and AscAo/HT but with smaller AscAo/BSA (all P < 0.001). In multi-variable regression model, all aortic measure confirmed the sign of their relations with sex and metabolic profile independently of age, BP, and HR. In Kaplan-Mayer analysis, only dilated AscAo and AscAo/HT were significantly associated with increased risk of CV events (both P < 0.008). CONCLUSIONS Among patients with long-standing controlled systemic hypertension, magnitude of aortic remodelling is influenced by the type of the measure adopted, with physiological consistency only for AscAo and AscAo/HT, but not for AscAo/BSA.
Collapse
Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Maria Virginia Manzi
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Maria Lembo
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Ilaria Fucile
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Christian Basile
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Luca Bardi
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Carmine Morisco
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Nicola De Luca
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Eduardo Bossone
- Department of Public Health, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| | - Giovanni Esposito
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University, Via S. Pansini 5, Naples 80131, Italy
| |
Collapse
|
8
|
de Simone G, Mancusi C. Diastolic function in chronic kidney disease. Clin Kidney J 2023; 16:1925-1935. [PMID: 37915916 PMCID: PMC10616497 DOI: 10.1093/ckj/sfad177] [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: 03/26/2023] [Indexed: 11/03/2023] Open
Abstract
Chronic kidney disease (CKD) is characterized by clustered age-independent concentric left ventricular (LV) geometry, geometry-independent systolic dysfunction and age and heart rate-independent diastolic dysfunction. Concentric LV geometry is always associated with echocardiographic markers of abnormal LV relaxation and increased myocardial stiffness, two hallmarks of diastolic dysfunction. Non-haemodynamic mechanisms such as metabolic and electrolyte abnormalities, activation of biological pathways and chronic exposure to cytokine cascade and the myocardial macrophage system also impact myocardial structure and impair the architecture of the myocardial scaffold, producing and increasing reactive fibrosis and altering myocardial distensibility. This review addresses the pathophysiology of diastole in CKD and its relations with cardiac mechanics, haemodynamic loading, structural conditions, non-haemodynamic factors and metabolic characteristics. The three mechanisms of diastole will be examined: elastic recoil, active relaxation and passive distensibility and filling. Based on current evidence, we briefly provide methods for quantification of diastolic function and discuss whether diastolic dysfunction represents a distinct characteristic in CKD or a proxy of the severity of the cardiovascular condition, with the potential to be predicted by the general cardiovascular phenotype. Finally, the review discusses assessment of diastolic function in the context of CKD, with special emphasis on end-stage kidney disease, to indicate whether and when in-depth measurements might be helpful for clinical decision making in this context.
Collapse
Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center and Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| |
Collapse
|
9
|
Maloberti A, Intravaia RCM, Mancusi C, Cesaro A, Golia E, Ilaria F, Coletta S, Merlini P, De Chiara B, Bernasconi D, Algeri M, Ossola P, Ciampi C, Riccio A, Tognola C, Ardissino M, Inglese E, Scaglione F, Calabrò P, De Luca N, Giannattasio C. Secondary Prevention and Extreme Cardiovascular Risk Evaluation (SEVERE-1), Focus on Prevalence and Associated Risk Factors: The Study Protocol. High Blood Press Cardiovasc Prev 2023; 30:573-583. [PMID: 38030852 PMCID: PMC10721661 DOI: 10.1007/s40292-023-00607-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Despite significant improvement in secondary CardioVascular (CV) preventive strategies, some acute and chronic coronary syndrome (ACS and CCS) patients will suffer recurrent events (also called "extreme CV risk"). Recently new biochemical markers, such as uric acid (UA), lipoprotein A [Lp(a)] and several markers of inflammation, have been described to be associated with CV events recurrence. The SEcondary preVention and Extreme cardiovascular Risk Evaluation (SEVERE-1) study will accurately characterize extreme CV risk patients enrolled in cardiac rehabilitation (CR) programs. AIM Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors. AIM Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors. METHODS We will prospectively enrol 730 ACS/CCS patients at the beginning of a CR program. Extreme CV risk will be retrospectively defined as the presence of a previous (within 2 years) CV events in the patients' clinical history. UA, Lp(a) and inflammatory markers (interleukin-6 and -18, tumor necrosis factor alpha, C-reactive protein, calprotectin and osteoprotegerin) will be assessed in ACS/CCS patients with extreme CV risk and compared with those without extreme CV risk but also with two control groups: 1180 hypertensives and 765 healthy subjects. The association between these biomarkers and extreme CV risk will be assessed with a multivariable model and two scoring systems will be created for an accurate identification of extreme CV risk patients. The first one will use only clinical variables while the second one will introduce the biochemical markers. Finally, by exome sequencing we will both evaluate polygenic risk score ability to predict recurrent events and perform mendellian randomization analysis on CV biomarkers. CONCLUSIONS Our study proposal was granted by the European Union PNRR M6/C2 call. With this study we will give definitive data on extreme CV risk prevalence rising attention on this condition and leading cardiologist to do a better diagnosis and to carry out a more intensive treatment optimization that will finally leads to a reduction of future ACS recurrence. This will be even more important for cardiologists working in CR that is a very important place for CV risk definition and therapies refinement.
Collapse
Affiliation(s)
- Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.
| | | | - Costantino Mancusi
- Cardiac Rehabilitation Unit, Federico II° University Hospital, Naples, Italy
| | | | - Enrica Golia
- S. Anna e S. Sebastiano Hospital, Caserta, Italy
| | - Fucile Ilaria
- Cardiac Rehabilitation Unit, Federico II° University Hospital, Naples, Italy
| | | | - Piera Merlini
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Benedetta De Chiara
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Davide Bernasconi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinical Research and Innovation, Niguarda Hospital, Milan, Italy
| | - Michela Algeri
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Paolo Ossola
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Ciampi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alfonso Riccio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Chiara Tognola
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Maddalena Ardissino
- Cambridge University Hospitals NHS Trust, Cambridge, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Elvira Inglese
- Department of Laboratory Medicine, ASST "Grande Ospedale Metropolitano" Niguarda, 20162, Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
| | - Francesco Scaglione
- Department of Laboratory Medicine, ASST "Grande Ospedale Metropolitano" Niguarda, 20162, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | | | - Nicola De Luca
- Cardiac Rehabilitation Unit, Federico II° University Hospital, Naples, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| |
Collapse
|
10
|
Ambrosino P, Marcuccio G, Lombardi C, D’Anna SE, Sanduzzi Zamparelli S, Mancusi C, Spedicato GA, Motta A, Maniscalco M. Cardiovascular Risk Associated with Alpha-1 Antitrypsin Deficiency (AATD) Genotypes: A Meta-Analysis with Meta-Regressions. J Clin Med 2023; 12:6490. [PMID: 37892629 PMCID: PMC10607733 DOI: 10.3390/jcm12206490] [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: 08/31/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) can result in severe liver and respiratory disorders. The uninhibited elastase activity on the elastic tissue of arterial walls suggests that AATD may also impact vascular health. Thus, we performed a meta-analysis of the studies evaluating cardiovascular risk in individuals with AATD and non-AATD controls. METHODS A systematic literature search was conducted in the main scientific databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Differences between cases and controls were expressed as odds ratios (OR) with 95% confidence intervals (95%CI). The protocol was registered on PROSPERO under the identification number CRD42023429756. RESULTS The analysis of eight studies showed that, with a prevented fraction of disease of 15.0% and a corresponding OR of 0.779 (95%CI: 0.665-0.912; p = 0.002), a total of 24,428 individuals with AATD exhibited a significantly lower risk of ischemic heart disease compared to 534,654 non-AATD controls. Accordingly, given a prevented fraction of disease of 19.5%, a lower risk of acute myocardial infarction was documented when analyzing four studies on 21,741 cases and 513,733 controls (OR: 0.774; 95%CI: 0.599-0.999; p = 0.049). Sensitivity and subgroup analyses substantially confirmed results. Meta-regression models suggested that these findings were not influenced by AATD genotypes or prevalence of chronic obstructive pulmonary disease (COPD) among cases and controls, while higher differences in the prevalence of male sex (Z-score: 3.40; p < 0.001), hypertension (Z-score: 2.31; p = 0.021), and diabetes (Z-score: 4.25; p < 0.001) were associated with a lower effect size. CONCLUSIONS Individuals with AATD may exhibit a reduced risk of ischemic heart disease, even in the presence of mild deficiency of the serine protease inhibitor. Although caution is warranted due to the observational nature of the data, future pharmacological and rehabilitation strategies should also take this controversial relationship into account.
Collapse
Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Giuseppina Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.L.); (S.E.D.)
| | - Carmen Lombardi
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.L.); (S.E.D.)
| | - Silvestro Ennio D’Anna
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.L.); (S.E.D.)
| | | | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II University, 80131 Naples, Italy;
| | | | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli, Italy;
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.L.); (S.E.D.)
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| |
Collapse
|
11
|
De Colle C, Paolisso P, Gallinoro E, Bertolone DT, Mileva N, Fabbricatore D, Valeriano C, Herman R, Beles M, De Oliveira EK, Mancusi C, Heggermont W, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. Association of Mild-to-Moderate Aortic Regurgitation With Outcomes in Heart Failure With Preserved Ejection Fraction. Mayo Clin Proc 2023; 98:1469-1481. [PMID: 37793725 DOI: 10.1016/j.mayocp.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To assess aortic regurgitation (AR) prevalence, its hemodynamic effect, and long-term prognostic implications in patients admitted with de novo or worsened heart failure with preserved ejection fraction (HFpEF). METHODS Consecutive patients hospitalized with de novo or worsened HFpEF between 2014 and 2020 were enrolled. Patients with more than moderate aortic and/or mitral valve disease were excluded. Based on the presence and degree of AR, patients were divided into those without AR, those with mild, and those with moderate AR. Data on cardiovascular death, heart failure (HF) rehospitalization, and their composite (major adverse cardiovascular events) were collected. RESULTS The final study population consisted of 458 HFpEF patients: 156 (34.1%) with mild-AR, 153 (33.4%) with moderate-AR, and the remaining 149 (32.5%) with no AR. Mild-to-moderate AR patients were older, with larger left atrium-left ventricle (LV) volumes, greater LV mass index, higher filling pressure, and prevalence of diastolic dysfunction compared with the no-AR group (all P<.05). During 5-year follow-up, 113 patients died of cardiovascular causes, 124 patients were rehospitalized for HF, whereas 196 experienced the composite endpoint. Mild-to-moderate AR was identified as an independent predictor of all-cause death (HR, 1.62; 95% CI, 1.14 to 1.58; P=.04) and major adverse cardiovascular event occurrence (HR, 1.48; 95% CI, 1.05 to 2.09; P=.02). A total of 126 (35.5%) of 355 patients showed progression of AR at follow-up echocardiography. CONCLUSION Mild-to-moderate AR is common among patients hospitalized for HFpEF. It is associated with adverse LV remodeling and worse long-term outcomes. These findings warrant further prospective studies addressing the importance of AR in prognostic stratification and exploring therapeutic strategies to mitigate its hemodynamic effect on HF.
Collapse
Affiliation(s)
- Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Clinic, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Robert Herman
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Monika Beles
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
| |
Collapse
|
12
|
Ambrosino P, Di Minno MND, D'Anna SE, Formisano R, Pappone N, Mancusi C, Molino A, Motta A, Maniscalco M. Pulmonary rehabilitation and endothelial function in patients with chronic obstructive pulmonary disease: A prospective cohort study. Eur J Intern Med 2023; 116:96-105. [PMID: 37349204 DOI: 10.1016/j.ejim.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/19/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with subclinical atherosclerosis and endothelial dysfunction, thereby leading to increased cardiovascular risk. In the present study, we evaluated the changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of severe COPD patients undergoing pulmonary rehabilitation. METHODS Consecutive COPD patients referred to our Pulmonary Rehabilitation Unit were screened for inclusion. All study procedures were performed at hospital admission and discharge. RESULTS Of 78 patients screened for eligibility, a total of 40 participants (67.5% males, median age 72.5 years) were included. After pulmonary rehabilitation, a significant improvement in functional parameters, exercise capacity, and measures of disability and quality of life were documented. FMD changed from 3.25% (IQR: 2.31-4.26) to 4.95% (IQR: 3.57-6.02), corresponding to a 52.3% increase of its median value (P < 0.001). Significantly lower changes in FMD were documented in COPD patients with hypercholesterolemia as compared to those without (+0.33% ± 1.61 vs. +1.62% ± 1.59, P = 0.037). Changes in FMD (ΔFMD) were positively associated with changes in forced expiratory volume in 1 s (FEV1), when expressed both as absolute values (ΔFEV1) (r = 0.503, P = 0.002) and as percentages of predicted values (ΔFEV1%) (r = 0.608; P < 0.001). In multiple linear regressions, after adjusting for major cardiovascular risk factors, ΔFEV1 (β=0.342; P = 0.049) and ΔFEV1% (β=0.480; P = 0.015) were both confirmed as independent predictors of ΔFMD. CONCLUSIONS Results of our study suggest that endothelial function may improve in COPD after pulmonary rehabilitation. The potential beneficial effect in terms of cardiovascular risk prevention should be evaluated in ad hoc designed studies.
Collapse
Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, Italy
| | | | - Silvestro Ennio D'Anna
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Italy
| | - Roberto Formisano
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, Italy
| | - Nicola Pappone
- Istituti Clinici Scientifici Maugeri IRCCS, Neuromotor Rehabilitation Unit of Telese Terme Institute, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Italy
| | - Mauro Maniscalco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Italy.
| |
Collapse
|
13
|
Ambrosino P, Marcuccio G, Manzo F, Mancusi C, Merola C, Maniscalco M. The Clinical Application of Established and Emerging Biomarkers for Chronic Respiratory Diseases. J Clin Med 2023; 12:6125. [PMID: 37834769 PMCID: PMC10573548 DOI: 10.3390/jcm12196125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Biomarkers are indicators of a pathological or physiological state, and they are essential for facilitating the diagnosis of a subclinical condition, understanding the origin or progression of a disease, stratifying the risk, and assessing the response to a specific therapeutic approach [...].
Collapse
Affiliation(s)
- Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Giuseppina Marcuccio
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.M.)
| | - Fabio Manzo
- Fleming Clinical Laboratory, 81020 Casapulla, Italy;
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy;
| | - Claudia Merola
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.M.)
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy; (G.M.); (C.M.)
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| |
Collapse
|
14
|
Seekircher L, Tschiderer L, Lind L, Safarova MS, Kavousi M, Ikram MA, Lonn E, Yusuf S, Grobbee DE, Kastelein JJP, Visseren FLJ, Walters M, Dawson J, Higgins P, Agewall S, Catapano A, de Groot E, Espeland MA, Klingenschmid G, Magliano D, Olsen MH, Preiss D, Sander D, Skilton M, Zozulińska-Ziółkiewicz DA, Grooteman MPC, Blankestijn PJ, Kitagawa K, Okazaki S, Manzi MV, Mancusi C, Izzo R, Desvarieux M, Rundek T, Gerstein HC, Bots ML, Sweeting MJ, Lorenz MW, Willeit P. Intima-media thickness at the near or far wall of the common carotid artery in cardiovascular risk assessment. Eur Heart J Open 2023; 3:oead089. [PMID: 37840587 PMCID: PMC10575622 DOI: 10.1093/ehjopen/oead089] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/03/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023]
Abstract
Aims Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive values. Methods and results We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02 mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [r = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; I² = 30.7%) and 1.20 (1.18-1.23; I² = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; I² = 8.4%) and 1.14 (1.12-1.16; I²=1.3%) upon multivariable adjustment (all P < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near (P < 0.001), +0.0037 for far wall (P = 0.006)]. Conclusions The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls.
Collapse
Affiliation(s)
- Lisa Seekircher
- Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Lena Tschiderer
- Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Lars Lind
- Department of Medicine, Uppsala University, Uppsala, Sweden
| | - Maya S Safarova
- Division of Cardiovascular Medicine, Department of Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eva Lonn
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter Higgins
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stefan Agewall
- Department of Clinical Sciences, Division of Cardiology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- IRCCS Multimedica, Milan, Italy
| | - Eric de Groot
- Imagelabonline & Cardiovascular, Erichem, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC-Academic Medical Centre, Amsterdam, The Netherlands
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Dianna Magliano
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital, University of Southern Denmark, Odense, Denmark
| | - David Preiss
- Nuffield Department of Population Health, MRC Population Health Research Unit, Clinical Trial Service Unit, University of Oxford, Oxford, UK
| | - Dirk Sander
- Department of Neurology, Benedictus Hospital Tutzing & Feldafing, Feldafing, Germany
- Department of Neurology, Technische Universität München, Munich, Germany
| | - Michael Skilton
- Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Muriel P C Grooteman
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Shuhei Okazaki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Maria V Manzi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- METHODS Core, Centre de Recherche Epidémiologie et Statistique Paris Sorbonne Cité (CRESS), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Paris, France
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hertzel C Gerstein
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael J Sweeting
- Department of Health Sciences, University of Leicester, Leicester, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Papworth Road, Cambridge CB2 0BB, UK
| | - Matthias W Lorenz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
- Klinik für Neurologie, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Peter Willeit
- Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Papworth Road, Cambridge CB2 0BB, UK
| |
Collapse
|
15
|
Arnone MI, Sforza A, Carlino MV, Guarino M, Candido R, Bertolone D, Fucile I, De Luca N, Mancusi C. Assessment of E/A ratio helps emergency clinicians in the management of patients with acute dyspnea. Intern Emerg Med 2023; 18:1823-1830. [PMID: 37103762 PMCID: PMC10504390 DOI: 10.1007/s11739-023-03279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
Acute dyspnea (AD) is one of the main reasons for admission to the Emergency Department (ED). In the last years integrated ultrasound examination (IUE) of lung, heart and inferior vena cava (IVC) has become an extension of clinical examination for a fast differential diagnosis. The aim of present study is to assess the feasibility and diagnostic accuracy of E/A ratio for diagnosing acute heart failure (aHF) in patients with acute dyspnea. We included 92 patients presenting to the ED of CTO Hospital in Naples (Italy) for AD. All patients underwent IUE of lung-heart-IVC with a portable ultrasound device. Left ventricle diastolic function was assessed using pulse wave doppler at the tips of the mitral valve and E wave velocity and E/A ratio were recorded. The FINAL diagnosis was determined by two expert reviewers: acute HF or non-acute HF (non-aHF). We used 2 × 2 contingency tables to analyze sensitivity, specificity, positive predictive and negative predictive value of ultrasound parameters for the diagnosis of AD, comparing with the FINAL diagnosis. Lung ultrasound (LUS) showed high sensitivity, good specificity and accuracy in identification of patients with aHF. However, the highest accuracy was obtained by diastolic function parameters. The E/A ratio showed the highest diagnostic performance with an AUC for aHF of 0.93. In patients presenting with AD, E/A ratio is easy to obtain in a fast ultrasound protocol and showed an excellent accuracy for diagnosis of aHF.
Collapse
Affiliation(s)
| | - Alfonso Sforza
- Cardiology Department and Cardiology Intensive Care Unit, Santa Maria Delle Grazie, Pozzuoli, Italy
| | - Maria Viviana Carlino
- Cardiology Department and Cardiology Intensive Care Unit, San Giuliano Hospital, Giugliano, Italy
| | | | | | - Dario Bertolone
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Ilaria Fucile
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Nicola De Luca
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Costantino Mancusi
- Emergency Medicine School & Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy.
| |
Collapse
|
16
|
Lembo M, Pacella D, Manzi MV, Morisco C, La Mura L, Mancusi C, Bardi L, Trimarco V, Trimarco B, Izzo R, Esposito G. Hypertension-mediated organ damage involving multiple sites is an independent risk factor for cardiovascular events. Eur Heart J Open 2023; 3:oead102. [PMID: 37881599 PMCID: PMC10597657 DOI: 10.1093/ehjopen/oead102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/15/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
Aims Chronic pressure overload determines functional and structural alterations, leading to hypertension-mediated organ damage (HMOD), affecting multiple districts. We aim at evaluating the prognostic impact of the absence vs. presence of HMOD in one or more sites and of blood pressure (BP) and metabolic control in hypertensive patients. Methods and results The study included 7237 hypertensive patients from the Campania Salute Network Registry, followed up for 5.3 ± 4.5 years. As HMOD, we analysed the presence of left ventricular hypertrophy, carotid plaques, and chronic kidney disease (CKD-EPI ≥3 stage) and evaluated the impact of zero vs. one vs. two vs. three sites of HMOD on the occurrence of major adverse cardiovascular events (MACEs). Blood pressure control and Metabolic Score for Insulin Resistance (METS-IR) were also considered. Optimal BP control was achieved in 57.3% patients. Major adverse cardiovascular events occurred in 351 (4.8%) patients. The MACE rate in patients without HMOD was 2.7%, whereas it was 4.7, 7.9, and 9.8% in patients with one, two, and three sites with HMOD, respectively. By using Cox multivariate models, adjusted for age, BP control, mean heart rate, mean METS-IR, number of HMOD sites, and drugs, MACE was found to be significantly associated with ageing, mean METS-IR, anti-platelet therapy, and multiple sites with HMOD, whereas a negative association was found with renin-angiotensin system inhibitor drugs. Conclusion In hypertensive patients, the risk of MACE increases with the incremental number of districts involved by HMOD, independent of BP control and despite the significant impact of metabolic dysregulation. Hypertension-mediated organ damage involving multiple sites is the deleterious consequence of hypertension and dysmetabolism but, when established, it represents an independent cardiovascular risk factor for MACE occurrence.
Collapse
Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Daniela Pacella
- Department of Public Health, ‘Federico II’ University, Via S. Pansini 5, 80131 Napoli, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Luca Bardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Valentina Trimarco
- Department of Neuroscience, Reproductive Sciences and Dentistry, ‘Federico II’ University, Via S. Pansini 5, 80131 Napoli, Italy
| | - Bruno Trimarco
- International Translational Research and Medical Education (ITME) Consortium, 80131 Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, 80131 Napoli, Italy
| |
Collapse
|
17
|
Basile C, Mancusi C, Franzone A, Avvedimento M, Bardi L, Angellotti D, Castiello DS, Mariani A, Manzo R, De Luca N, Cirillo P, De Simone G, Esposito G. Renin-angiotensin system inhibitors reduce cardiovascular mortality in hypertensive patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: insights from the EffecTAVI registry. Front Cardiovasc Med 2023; 10:1234368. [PMID: 37692038 PMCID: PMC10491454 DOI: 10.3389/fcvm.2023.1234368] [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: 06/04/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives Arterial hypertension is associated with the triggering of the renin-angiotensin system, leading to left ventricle fibrosis and worse cardiovascular outcomes. In this study, patients with comorbid arterial hypertension and severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) were selected from the EffecTAVI registry to evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on cardiovascular mortality. Methods We enrolled 327 patients undergoing TAVI from the EffecTAVI registry. Using Kaplan-Meier event rates and study-stratified multivariable Cox proportional hazards regression models, we evaluated 2-year clinical outcomes according to the ACEI/ARB therapy status at enrollment. Results Among the included patients, 222 (67.9%) were on ACEIs/ARBs at baseline, whereas 105 (32.1%) were not. Treatment with ACEIs/ARBs was significantly associated with a 2-year decrease in the rate of cardiovascular mortality (HR = 0.44, 95% CI: 0.23-0.81, p = 0.009). This association remained stable after both multivariable adjustment and propensity score matching. Conclusion In a cohort of hypertensive patients with severe AS who were selected from the EffecTAVI registry, ACEI/ARB treatment at baseline was found to be independently associated with a lower risk of 2-year cardiovascular mortality, suggesting a potential benefit of this treatment. More trials are needed to validate this finding and to understand the full benefit of this treatment.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| |
Collapse
|
18
|
Airale L, Borrelli F, Arrivi A, Baracchi A, Bertacchini F, Cartella I, Curcio R, Izzo R, Lembo M, Mancusi C, Manzi MV, Milani M, Moreo A, Paini A, Pucci G, Ruscelli F, Salvetti M, Soldati M, Milan A. Ascending aorta dilatation is associated to hard cardiovascular events, follow-up from multicentric ARGO-Perspective project. Hypertens Res 2023; 46:2016-2023. [PMID: 37328694 DOI: 10.1038/s41440-023-01340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/30/2023] [Accepted: 05/18/2023] [Indexed: 06/18/2023]
Abstract
Aortic root dilatation has been proposed as hypertension-mediated organ damage (HMOD). Nevertheless, the role of the aortic root dilatation as a possible additional HMOD is still unclear since studies conducted so far are quite heterogeneous regarding the type of population analyzed, the aortic tract considered, and the type of outcomes accounted for. The aim of the present study is to assess whether the presence of aortic dilatation is associated with strong cardiovascular (CV) events (MACE: heart failure, CV death, stroke, acute coronary syndrome, myocardial revascularization) in a population of patients affected by essential hypertension. Four hundred forty-five hypertensive patients from six Italian hospitals were recruited as part of ARGO-SIIA study1. For all centers, follow-up was obtained by re-contacting all patients by telephone and through the hospital's computer system. Aortic dilatation (AAD) was defined through absolute sex-specific thresholds as in previous studies (41 mm for males, 36 mm for females). Median follow-up was 60 months. AAD was found to be associated with the occurrence of MACE (HR = 4.07 [1.81-9.17], p < 0.001). This result was confirmed after correction for main demographic characteristics such as age, sex and BSA (HR = 2.91 [1.18-7.17], p = 0.020). At penalized Cox regression, age, left atrial dilatation, left ventricular hypertrophy and AAD were identified as best predictor of MACEs and AAD resulted a significant predictor of MACEs even after correction for these confounders (HR = 2.43 [1.02-5.78], p = 0.045). The presence of AAD was found to be associated with an increased risk of MACE independently of for major confounders, including established HMODs. AAD ascending aorta dilatation, LAe left atrial enlargement, LVH left ventricular hypertrophy, MACEs major adverse cardiovascular events, SIIA Società Italiana dell'Ipertensione Arteriosa (Italian Society for Arterial Hypertension).
Collapse
Affiliation(s)
- Lorenzo Airale
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Borrelli
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessio Arrivi
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Alessandro Baracchi
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fabio Bertacchini
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Iside Cartella
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Rosa Curcio
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Maria Lembo
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Maria Virgina Manzi
- Hypertension Research Center, Federico II University Hospital, Napoli, Italy
| | - Martina Milani
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Antonella Moreo
- Echo Lab, Cardiologia IV, De Gasperis Department, ASST Niguarda Ca Granda e Dip Medicina e Chirurgia, Università Milano Bicocca, Milano, Italy
| | - Anna Paini
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giacomo Pucci
- SC Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy
| | - Federico Ruscelli
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Massimo Salvetti
- Department of Internal Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mario Soldati
- Cardiothoracic and Vascular Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alberto Milan
- Department of Medical Sciences, Hypertension Center-University of Torino-AOU Città della Salute e della Scienza di Torino, Torino, Italy.
| |
Collapse
|
19
|
Visco V, Izzo C, Bonadies D, Di Feo F, Caliendo G, Loria F, Mancusi C, Chivasso P, Di Pietro P, Virtuoso N, Carrizzo A, Vecchione C, Ciccarelli M. Interventions to Address Cardiovascular Risk in Obese Patients: Many Hands Make Light Work. J Cardiovasc Dev Dis 2023; 10:327. [PMID: 37623340 PMCID: PMC10455377 DOI: 10.3390/jcdd10080327] [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: 05/29/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Obesity is a growing public health epidemic worldwide and is implicated in slowing improved life expectancy and increasing cardiovascular (CV) risk; indeed, several obesity-related mechanisms drive structural, functional, humoral, and hemodynamic heart alterations. On the other hand, obesity may indirectly cause CV disease, mediated through different obesity-associated comorbidities. Diet and physical activity are key points in preventing CV disease and reducing CV risk; however, these strategies alone are not always sufficient, so other approaches, such as pharmacological treatments and bariatric surgery, must support them. Moreover, these strategies are associated with improved CV risk factors and effectively reduce the incidence of death and CV events such as myocardial infarction and stroke; consequently, an individualized care plan with a multidisciplinary approach is recommended. More precisely, this review explores several interventions (diet, physical activity, pharmacological and surgical treatments) to address CV risk in obese patients and emphasizes the importance of adherence to treatments.
Collapse
Affiliation(s)
- Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Davide Bonadies
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Federica Di Feo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Giuseppe Caliendo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Francesco Loria
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Pierpaolo Chivasso
- Department of Emergency Cardiac Surgery, Cardio-Thoracic-Vascular, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, 84131 Salerno, Italy;
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| | - Nicola Virtuoso
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy;
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (V.V.); (C.I.); (D.B.); (F.D.F.); (G.C.); (F.L.); (P.D.P.); (A.C.); (C.V.)
| |
Collapse
|
20
|
Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Da Ros S, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Del Giudice C, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Bella G, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi RM, Inserra CA, Iori E, Izzo A, La Rosa G, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Picano E, Carerj S. Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:125-132. [PMID: 38161775 PMCID: PMC10756319 DOI: 10.4103/jcecho.jcecho_48_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 01/03/2024] Open
Abstract
Background The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and ≥40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). Conclusions This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers.
Collapse
Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Francesco Antonini-Canterin
- Department of Rehabilitative Cardiology, Rehabilitative Hospital High Speciality, Motta di Livenza, TV, Italy
| | - Andrea Barbieri
- Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo Della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Rehabilitative Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Department of Medicine and Surgery, University MIlano-Bicocca, Integrated Cardiovascular Diagnosi Unit, Istituto Auxologico Italiano, IRCCS, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Division, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Pisa, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina Degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Sciences, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Siena, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | | | - Angelo Di Gioia
- Cardiology Division, St. Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, Italy
| | - Federica Donati
- Pascia Center, Polyclinic, University Hospital Modena Polyclinic, Modena, Italy
| | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Cremona, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, Italy
| | - Annibale Izzo
- Cardiology Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiology and Rehabilitative Division, Azienda Sanitaria Friuli Occidentale (ASFO), Health Care, Sacile (Pd), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St. Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St. Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St. Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città Della Salute e Della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St. Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St. Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Division, Molinette Hospital - Città della Salute e Della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St. Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, University Hospital of Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St. Giovanni Evangelista Hospital, Tivoli, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, Italy
| | - Carlo Ratti
- Cardiology Division, St. Maria Bianca Hospital, Mirandola, Italy
| | | | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St. Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St. Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St. Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St. Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Department of Cardiovascular Sciences, Responsible Research Hospital, Campobasso, Italy
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| |
Collapse
|
21
|
Cioffi G, Battiston R, Mancusi C, Di Lenarda A, Faganello G, Aurigemma GP, Tarantini L, Pulignano G, Cioffi V, de Simone G. Prognostic Stratification of Clinically Stable Patients with Heart Failure by Echocardiographic Pressure/Volume Loop Model. J Am Soc Echocardiogr 2023; 36:746-759. [PMID: 36791831 DOI: 10.1016/j.echo.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 01/08/2023] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Pressure/volume (P/V) loops provide useful information on left ventricular performance and prognosis in patients with heart failure (HF) but do not lend themselves to routine clinical practice. The authors developed a noninvasive method to compute individualized P/V loops to predict adverse clinical outcomes in patients with stable HF, which the authors believe can be used clinically. METHODS A derivation cohort (n = 443 patients) was used to develop an echocardiography P/V loop model, using brachial arterial pressure and trans-thoracic two-dimensional Doppler echocardiographic data. Each patient's P/V loop was depicted as an irregular pentagon, and a centroid was derived for each loop. The centroid distance (CD) from a reference centroid (derived from 101 healthy control subjects) was computed. This model was prospectively applied to 435 patients who constituted the validation cohort. The study end point was a composite of cardiac death or hospitalization for HF among study patients. RESULTS In the derivation cohort, CD was threefold greater among patients who experienced adverse events than those who did not. During a follow-up period of 30 months (15-45 months), event rates were 35% (72 of 206 patients) and 12% (29 of 237 patients P < .001), respectively, among patients with CD > 33 mL/mm Hg and those with CD ≤33 mL/mm Hg (prognostic cutoff derived by receiver operating characteristic analysis). Multivariate Cox analysis identified CD as an independent predictor of adverse outcome (hazard ratio, 1.61; 95% CI, 1.03-2.50) independently of left ventricular end-diastolic volume, pulmonary capillary wedge pressure, and left ventricular ejection fraction. These conclusions were confirmed in the validation cohort. CONCLUSIONS The authors propose a method to create a noninvasive P/V loop and its centroid. These data provide useful pathophysiologic and prognostic information in patients with HF.
Collapse
Affiliation(s)
- Giovanni Cioffi
- Cardiac Rehabilitation Centre, San Pancrazio Hospital, Trento, Italy; Rheumatology Section, Department of Internal Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Roberto Battiston
- Department of Experimental Physics, University of Trento, Trento, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | | | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
| | | | - Giovanni Pulignano
- Department of Cardiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Viola Cioffi
- Department of Experimental Physics, University of Trento, Trento, Italy
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| |
Collapse
|
22
|
Tschiderer L, Seekircher L, Izzo R, Mancusi C, Manzi MV, Baldassarre D, Amato M, Tremoli E, Veglia F, Tuomainen TP, Kauhanen J, Voutilainen A, Iglseder B, Lind L, Rundek T, Desvarieux M, Kato A, de Groot E, Aşçi G, Ok E, Agewall S, Beulens JWJ, Byrne CD, Calder PC, Gerstein HC, Gresele P, Klingenschmid G, Nagai M, Olsen MH, Parraga G, Safarova MS, Sattar N, Skilton M, Stehouwer CDA, Uthoff H, van Agtmael MA, van der Heijden AA, Zozulińska-Ziółkiewicz DA, Park HW, Lee MS, Bae JH, Beloqui O, Landecho MF, Plichart M, Ducimetiere P, Empana JP, Bokemark L, Bergström G, Schmidt C, Castelnuovo S, Calabresi L, Norata GD, Grigore L, Catapano A, Zhao D, Wang M, Liu J, Ikram MA, Kavousi M, Bots ML, Sweeting MJ, Lorenz MW, Willeit P. Association of Intima-Media Thickness Measured at the Common Carotid Artery With Incident Carotid Plaque: Individual Participant Data Meta-Analysis of 20 Prospective Studies. J Am Heart Assoc 2023:e027657. [PMID: 37301757 DOI: 10.1161/jaha.122.027657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023]
Abstract
Background The association between common carotid artery intima-media thickness (CCA-IMT) and incident carotid plaque has not been characterized fully. We therefore aimed to precisely quantify the relationship between CCA-IMT and carotid plaque development. Methods and Results We undertook an individual participant data meta-analysis of 20 prospective studies from the Proof-ATHERO (Prospective Studies of Atherosclerosis) consortium that recorded baseline CCA-IMT and incident carotid plaque involving 21 494 individuals without a history of cardiovascular disease and without preexisting carotid plaque at baseline. Mean baseline age was 56 years (SD, 9 years), 55% were women, and mean baseline CCA-IMT was 0.71 mm (SD, 0.17 mm). Over a median follow-up of 5.9 years (5th-95th percentile, 1.9-19.0 years), 8278 individuals developed first-ever carotid plaque. We combined study-specific odds ratios (ORs) for incident carotid plaque using random-effects meta-analysis. Baseline CCA-IMT was approximately log-linearly associated with the odds of developing carotid plaque. The age-, sex-, and trial arm-adjusted OR for carotid plaque per SD higher baseline CCA-IMT was 1.40 (95% CI, 1.31-1.50; I2=63.9%). The corresponding OR that was further adjusted for ethnicity, smoking, diabetes, body mass index, systolic blood pressure, low- and high-density lipoprotein cholesterol, and lipid-lowering and antihypertensive medication was 1.34 (95% CI, 1.24-1.45; I2=59.4%; 14 studies; 16 297 participants; 6381 incident plaques). We observed no significant effect modification across clinically relevant subgroups. Sensitivity analysis restricted to studies defining plaque as focal thickening yielded a comparable OR (1.38 [95% CI, 1.29-1.47]; I2=57.1%; 14 studies; 17 352 participants; 6991 incident plaques). Conclusions Our large-scale individual participant data meta-analysis demonstrated that CCA-IMT is associated with the long-term risk of developing first-ever carotid plaque, independent of traditional cardiovascular risk factors.
Collapse
Affiliation(s)
- Lena Tschiderer
- Institute of Health Economics Medical University of Innsbruck Innsbruck Austria
| | - Lisa Seekircher
- Institute of Health Economics Medical University of Innsbruck Innsbruck Austria
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Maria V Manzi
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Damiano Baldassarre
- Department of Medical Biotechnology and Translational Medicine University of Milan Milan Italy
- Centro Cardiologico Monzino Stituto di Ricovero e Cura a Carattere Scientifico Milan Italy
| | - Mauro Amato
- Centro Cardiologico Monzino Stituto di Ricovero e Cura a Carattere Scientifico Milan Italy
| | | | | | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio Finland
| | - Bernhard Iglseder
- Department of Geriatric Medicine Gemeinnützige Salzburger Landeskliniken Betriebsgesellschaft GmbH Christian-Doppler-Klinik Salzburg Austria
- Department of Geriatric Medicine Paracelsus Medical University Salzburg Austria
| | - Lars Lind
- Department of Medicine Uppsala University Uppsala Sweden
| | - Tatjana Rundek
- Department of Neurology University of Miami Miller School of Medicine Miami FL
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health Columbia University New York NY
- METHODS Core, Centre de Recherche Epidémiologie et Statistique Paris Sorbonne Cité Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1153 Paris France
| | - Akihiko Kato
- Blood Purification Unit Hamamatsu University Hospital Hamamatsu Japan
| | - Eric de Groot
- Imagelabonline and Cardiovascular Erichem the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center-Academic Medical Centre Amsterdam the Netherlands
| | - Gülay Aşçi
- Nephrology Department Ege University School of Medicine Bornova-Izmir Turkey
| | - Ercan Ok
- Nephrology Department Ege University School of Medicine Bornova-Izmir Turkey
| | - Stefan Agewall
- Department of Clinical Sciences, Danderyd Hospital Division of Cardiology Karolinska Institutet Stockholm Sweden
- Institute of Clinical Sciences University of Oslo Oslo Norway
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam University Medical Center-Location Vrije Universiteit Medical Center Amsterdam the Netherlands
| | - Christopher D Byrne
- School of Human Development and Health, Faculty of Medicine University of Southampton Southampton UK
- Southampton National Institute for Health and Care Research, Biomedical Research Centre University Hospital Southampton Southampton UK
| | - Philip C Calder
- School of Human Development and Health, Faculty of Medicine University of Southampton Southampton UK
- Southampton National Institute for Health and Care Research, Biomedical Research Centre University Hospital Southampton Southampton UK
| | - Hertzel C Gerstein
- Department of Medicine and Population Health Research Institute McMaster University Hamilton Ontario Canada
- Hamilton General Hospital Hamilton Ontario Canada
| | - Paolo Gresele
- Division of Internal and Cardiovascular Medicine, Department of Medicine and Surgery University of Perugia Perugia Italy
| | | | - Michiaki Nagai
- Department of Internal Medicine General Medicine and Cardiology, Hiroshima City Asa Hospital Hiroshima Japan
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital University of Southern Denmark Odense Denmark
| | - Grace Parraga
- Department of Medical Biophysics, Robarts Research Institute Western University London ON Canada
| | - Maya S Safarova
- Department of Cardiovascular Medicine University of Kansas Medical Center Kansas City KS
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre University of Glasgow Glasgow UK
| | - Michael Skilton
- Charles Perkins Centre, Faculty of Medicine and Health University of Sydney Sydney NSW Australia
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht Maastricht University Medical Centre Maastricht the Netherlands
| | - Heiko Uthoff
- Department of Angiology University Hospital Basel Basel Switzerland
| | - Michiel A van Agtmael
- Department of Internal Medicine Amsterdam University Medical Center, Vrije Universiteit Amsterdam the Netherlands
| | - Amber A van der Heijden
- Department of General Practice, Amsterdam University Medical Center-Location Vrije Universiteit Medical Center Amsterdam the Netherlands
| | | | - Hyun-Woong Park
- Division of Cardiology, Department of Internal Medicine Chungnam National University Sejong Hospital Sejong-si South Korea
| | - Moo-Sik Lee
- Department of Preventive Medicine, College of Medicine Konyang University Daejeon South Korea
- Department of Occupational and Environmental Medicine Konyang University Hospital Daejeon South Korea
| | - Jang-Ho Bae
- Heart Center, Konyang University Hospital Daejeon South Korea
- Department of Cardiology Konyang University College of Medicine Daejeon South Korea
| | - Oscar Beloqui
- Department of Internal Medicine University Clinic of Navarra Navarra Spain
| | - Manuel F Landecho
- Department of Internal Medicine University Clinic of Navarra Navarra Spain
| | - Matthieu Plichart
- Paris Cardiovascular Research Centre University Paris Descartes Paris France
- Fondation Santé Service, Hospital at Home Levallois-Perret France
| | | | | | - Lena Bokemark
- Wallenberg Laboratory for Cardiovascular Research University of Gothenburg Gothenburg Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Clinical Physiology Sahlgrenska University Hospital, Region Västragötaland Gothenburg Sweden
| | - Caroline Schmidt
- Wallenberg Laboratory for Cardiovascular Research University of Gothenburg Gothenburg Sweden
| | - Samuela Castelnuovo
- Centro Dislipidemie, Aziende Socio Sanitarie Territoriali Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Laura Calabresi
- Department of Pharmacological and Biomolecular Sciences University of Milan Milan Italy
| | - Giuseppe D Norata
- Department of Pharmacological and Biomolecular Sciences University of Milan Milan Italy
- Società Italiana per lo Studio dell'Aterosclerosi Center for the Study of Atherosclerosis, Bassini Hospital Cinisello Balsamo Italy
| | - Liliana Grigore
- Stituto di Ricovero e Cura a Carattere Scientifico Multimedica Milan Italy
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences University of Milan Milan Italy
- Stituto di Ricovero e Cura a Carattere Scientifico Multimedica Milan Italy
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Miao Wang
- Department of Epidemiology, Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital Capital Medical University Beijing China
| | - M Arfan Ikram
- Department of Epidemiology Erasmus University Medical Center Rotterdam the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology Erasmus University Medical Center Rotterdam the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands
| | - Michael J Sweeting
- Department of Health Sciences University of Leicester Leicester UK
- Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - Matthias W Lorenz
- Klinik für Neurologie Krankenhaus Nordwest Frankfurt am Main Germany
- Department of Neurology Goethe University Frankfurt am Main Germany
| | - Peter Willeit
- Institute of Health Economics Medical University of Innsbruck Innsbruck Austria
- Department of Public Health and Primary Care University of Cambridge Cambridge UK
| |
Collapse
|
23
|
Lembo M, Acampa W, Elena Rao MA, Manzi MV, Morisco C, Esposito G, Assante R, Zampella E, Nappi C, Gaudieri V, Mannarino T, Mancusi C, de Simone G, Izzo R, Cuocolo A, Trimarco B. Left Ventricular Mechano-Energetic Efficiency Identifies an Early Impairment of Myocardial Blood Flow in Arterial Hypertension. Hypertension 2023. [PMID: 37170833 DOI: 10.1161/hypertensionaha.123.21071] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Arterial hypertension causes cardiac functional and structural alterations. In hypertensive patients without flow-limiting epicardial coronary artery disease, we investigated possible relationships between positron emission tomography/computed tomography-derived myocardial blood flow (MBF) and echocardiographic parameters of left ventricular (LV) performance, including mechano-energetic efficiency indexed for myocardial mass (MEEi). METHODS Seventy-eight patients with hypertensive without flow-limiting epicardial coronary artery disease underwent echocardiography, including MEEi computation, and cardiac positron emission tomography/computed tomography with assessment of MBF/mass ratio at rest and after stress and myocardial flow reserve. The lowest MEEi tertile (MEEi<0.031 mL/s/g) was compared to the merged second and third tertiles (MEEi≥0.031). RESULTS Patients in the lowest MEEi tertile were older, had higher systolic blood pressure and body mass index. They also had higher prevalence of LV hypertrophy, whereas lower resting and stress MBF/mass ratio. MEEi was significantly correlated with both resting (r=0.51; P<0.0001) and hyperemic (r=0.54; P<0.0001) MBF/mass ratios, whereas it was not related to myocardial flow reserve. Delta of MBF/mass ratio was lower in the lowest MEEi tertile than in the highest (P<0.0001). In separate multiple linear regression models, after adjusting for sex, systolic blood pressure, prevalence of LV hypertrophy, left atrial volume index, and diuretic therapy, the association between LV MEEi and both hyperemic (beta coefficient=0.44; P=0.003) and resting (beta coefficient=0.35; P=0.008) MBF/mass ratio remained significant. CONCLUSIONS In patients with hypertensive without flow-limiting epicardial coronary artery disease, low values of MEEi could detect an early LV dysfunction involving an impairment of both resting and hyperemic MBF/mass ratios. MEEi has the advantage of simpler detection, cheaper costs than positron emission tomography/computed tomography, and a lack of radiation exposure. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02211365.
Collapse
Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | | | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
- International Translational Research and Medical Education (ITME) Consortium, Naples, Italy. (B.T.)
| |
Collapse
|
24
|
Campanile A, Visco V, De Carlo S, Ferruzzi GJ, Mancusi C, Izzo C, Mongiello F, Di Pietro P, Virtuoso N, Ravera A, Bonadies D, Vecchione C, Ciccarelli M. Sacubitril/Valsartan vs. Standard Medical Therapy on Exercise Capacity in HFrEF Patients. Life (Basel) 2023; 13:1174. [PMID: 37240819 PMCID: PMC10220971 DOI: 10.3390/life13051174] [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: 03/02/2023] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Sacubitril/valsartan (Sac/Val) reduces mortality in patients with heart failure with reduced ejection fraction (HFrEF) compared to enalapril. However, its effects on functional capacity remain uncertain; consequently, we sought to compare Sac/Val vs. standard medical therapy, in terms of effects on prognostically significant CPET parameters, in HFrEF patients during a long follow-up period. We conducted a single-center, observational study in an HF clinic; specifically, we retrospectively identified that 12 patients switched to Sac/Val and 13 patients that managed with standard, optimal medical therapy (control group). At each visit, baseline, and follow-up (median time: 16 months; IQ range: 11.5-22), we collected demographic information, medical history, vital signs, cardiopulmonary exercise testing, standard laboratory data, pharmacological treatment information, and echocardiographic parameters. The study's primary end-point was the change from baseline in peak VO2 (adjusted to body weight). We did not observe significant differences between the two study groups at baseline. Similarly, we did not observe any significant differences during the follow-up in mean values of peak VO2 corrected for body weight: Sac/Val baseline: 12.2 ± 4.6 and FU: 12.7 ± 3.3 vs. control group: 13.1 ± 4.2 and 13.0 ± 4.2 mL/kg/min; p = 0.49. No significant treatment differences were observed for changes in VE/VCO2 slope: Sac/Val baseline: 35.4 ± 7.4 and FU: 37.2 ± 13.1 vs. control group: 34.6 ± 9.1 and 34.0 ± 7.3; p = 0.49. In conclusion, after a median follow-up period of 16 months, there was no significant benefit of Sac/Val on peak VO2 and other measures of CPET compared with standard optimal therapy in patients with HFrEF.
Collapse
Affiliation(s)
- Alfonso Campanile
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Stefania De Carlo
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Germano Junior Ferruzzi
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Felice Mongiello
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Nicola Virtuoso
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Amelia Ravera
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Domenico Bonadies
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| |
Collapse
|
25
|
Ciccarelli M, Giallauria F, Carrizzo A, Visco V, Silverio A, Cesaro A, Calabrò P, De Luca N, Mancusi C, Masarone D, Pacileo G, Tourkmani N, Vigorito C, Vecchione C. Artificial intelligence in cardiovascular prevention: new ways will open new doors. J Cardiovasc Med (Hagerstown) 2023; 24:e106-e115. [PMID: 37186561 DOI: 10.2459/jcm.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Prevention and effective treatment of cardiovascular disease are progressive issues that grow in tandem with the average age of the world population. Over recent decades, the potential role of artificial intelligence in cardiovascular medicine has been increasingly recognized because of the incredible amount of real-world data (RWD) regarding patient health status and healthcare delivery that can be collated from a variety of sources wherein patient information is routinely collected, including patient registries, clinical case reports, reimbursement claims and billing reports, medical devices, and electronic health records. Like any other (health) data, RWD can be analysed in accordance with high-quality research methods, and its analysis can deliver valuable patient-centric insights complementing the information obtained from conventional clinical trials. Artificial intelligence application on RWD has the potential to detect a patient's health trajectory leading to personalized medicine and tailored treatment. This article reviews the benefits of artificial intelligence in cardiovascular prevention and management, focusing on diagnostic and therapeutic improvements without neglecting the limitations of this new scientific approach.
Collapse
Affiliation(s)
- Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Naples, Italy
| | - Nidal Tourkmani
- Cardiology and Cardiac Rehabilitation Unit, 'Mons. Giosuè Calaciura Clinic', Catania, Italy
- ABL, Guangzhou, China
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli
| |
Collapse
|
26
|
Mancusi C, Serra C, Muiesan ML, Cogliati C. Lung ultrasound national report (LUNARE PROJECT) by the Italian Society of Internal Medicine (SIMI). Intern Emerg Med 2023; 18:685-688. [PMID: 36329375 PMCID: PMC9633021 DOI: 10.1007/s11739-022-03149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Costantino Mancusi
- School of Emergency Medicine and Department of Advanced Biomedical Science, Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Carla Serra
- Surgical and Medical Department of Digestive, Hepatic and Endocrine-Metabolic Diseases, Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- 2ª Medicina ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences, University of Milano and Medicina Generale, Ospedale L.Sacco, ASST-Fatebenefratelli-Sacco, Milan, Italy
| |
Collapse
|
27
|
Franco D, Goslar T, Radsel P, De Luca N, Mancusi C, Barbato E, Noc M. Coronary disease in refractory cardiac arrest undergoing resuscitation with extracorporeal membrane oxygenation (E-CPR). Eur Heart J Acute Cardiovasc Care 2023; 12:260-266. [PMID: 36809350 DOI: 10.1093/ehjacc/zuad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Because reestablishment of spontaneous circulation (ROSC) in patients with cardiac arrest is frequently not achieved by conventional cardiopulmonary resuscitation (C-CPR), selected patients may undergo resuscitation with extracorporeal membrane oxygenation (E-CPR). We compared angiographic features and percutaneous coronary intervention (PCI) between patients undergoing E-CPR and those with ROSC after C-CPR. METHODS Forty-nine consecutive E-CPR patients undergoing immediate coronary angiography admitted between August 2013 and August 2022 were matched to 49 patients with ROSC after C-CPR. RESULTS Multivessel disease (69.4% vs 34.7%; p = 0.001), ≥ 50% unprotected left main (ULM) stenosis (18.4% vs 4.1%; p = 0.025) and ≥1 chronic total occlusion (CTO) (28.6% vs 10.2%; p = 0.021) were more often documented in E-CPR group. There was no significant differences in the incidence, features and distribution of acute culprit lesion which was present in >90%. SYNTAX (27.6 vs 13.4; p = 0.002) and GENSINI (86.2 vs 46.0; p = 0.001) scores were increased in E-CPR group. Optimal cut-off predicting E-CPR was 19.75 for SYNTAX (sensitivity 74%, specificity 87%) and 60.50 (sensitivity 69%, specificity 75%) for GENSINI score. More lesions were treated (1.3 vs 1.1 lesions/patient; p = 0.002) and stents implanted (2.0 vs 1.3/patient; p < 0.001) in E-CPR group. Final TIMI 3 flow was comparable (88.6% vs 95.7%; p = 0.196) but residual SYNTAX (13.6 vs 3.1; p < 0.001) and GENSINI (36.7 vs 10.9; p < 0.001) scores remained increased in E-CPR group. CONCLUSION E-CPR patients have more multivessel disease, ULM stenosis and CTO but similar incidence, features and distribution of acute culprit lesion. Despite more complex PCI, revascularization is less complete.
Collapse
Affiliation(s)
- Danilo Franco
- Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.,Department of Advance Biomedical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy
| | - Tomaz Goslar
- Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Peter Radsel
- Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Nicola De Luca
- Department of Advance Biomedical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy
| | - Costantino Mancusi
- Department of Advance Biomedical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Marko Noc
- Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| |
Collapse
|
28
|
Visco V, Izzo C, Mancusi C, Rispoli A, Tedeschi M, Virtuoso N, Giano A, Gioia R, Melfi A, Serio B, Rusciano MR, Di Pietro P, Bramanti A, Galasso G, D’Angelo G, Carrizzo A, Vecchione C, Ciccarelli M. Artificial Intelligence in Hypertension Management: An Ace up Your Sleeve. J Cardiovasc Dev Dis 2023; 10:jcdd10020074. [PMID: 36826570 PMCID: PMC9963880 DOI: 10.3390/jcdd10020074] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Arterial hypertension (AH) is a progressive issue that grows in importance with the increased average age of the world population. The potential role of artificial intelligence (AI) in its prevention and treatment is firmly recognized. Indeed, AI application allows personalized medicine and tailored treatment for each patient. Specifically, this article reviews the benefits of AI in AH management, pointing out diagnostic and therapeutic improvements without ignoring the limitations of this innovative scientific approach. Consequently, we conducted a detailed search on AI applications in AH: the articles (quantitative and qualitative) reviewed in this paper were obtained by searching journal databases such as PubMed and subject-specific professional websites, including Google Scholar. The search terms included artificial intelligence, artificial neural network, deep learning, machine learning, big data, arterial hypertension, blood pressure, blood pressure measurement, cardiovascular disease, and personalized medicine. Specifically, AI-based systems could help continuously monitor BP using wearable technologies; in particular, BP can be estimated from a photoplethysmograph (PPG) signal obtained from a smartphone or a smartwatch using DL. Furthermore, thanks to ML algorithms, it is possible to identify new hypertension genes for the early diagnosis of AH and the prevention of complications. Moreover, integrating AI with omics-based technologies will lead to the definition of the trajectory of the hypertensive patient and the use of the most appropriate drug. However, AI is not free from technical issues and biases, such as over/underfitting, the "black-box" nature of many ML algorithms, and patient data privacy. In conclusion, AI-based systems will change clinical practice for AH by identifying patient trajectories for new, personalized care plans and predicting patients' risks and necessary therapy adjustments due to changes in disease progression and/or therapy response.
Collapse
Affiliation(s)
- Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy
| | - Antonella Rispoli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Michele Tedeschi
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Nicola Virtuoso
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Angelo Giano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Renato Gioia
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Americo Melfi
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Bianca Serio
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Maria Rosaria Rusciano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Gianni D’Angelo
- Department of Computer Science, University of Salerno, 84084 Fisciano, Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Correspondence:
| |
Collapse
|
29
|
Delli Carpini G, Giannella L, Carboni M, Fichera M, Pizzagalli D, Segnalini N, Conti C, Tafuri E, Giuliani L, Ragno F, Mancusi C, Giannubilo SR, Ciavattini A. Cervical pessary for preterm birth prevention after an episode of arrested preterm labor: a retrospective cohort study with targeted maximum likelihood estimation of the average treatment effect. Eur Rev Med Pharmacol Sci 2023; 27:1058-1068. [PMID: 36808353 DOI: 10.26355/eurrev_202302_31202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To evaluate whether cervical pessary effectively reduces the preterm birth < 37 weeks rate in patients who have not delivered after an episode of arrested preterm labor. PATIENTS AND METHODS Retrospective cohort study was conducted on singleton pregnant patients admitted to our institution between January 2016 and June 2021 for threatened preterm labor and who had a cervical length < 25 mm. Women in whom a cervical pessary was placed were considered as exposed, while women in whom expectant management was preferred were considered as unexposed. The primary outcome was the rate of preterm birth before 37 weeks. A targeted maximum likelihood estimation was used to estimate the average treatment effect of cervical pessary by adjusting for a-priori-defined confounders. RESULTS A cervical pessary was placed in 152 (36.6%) patients (exposed), while the remaining 263 (63.4%) were managed expectantly (unexposed). The adjusted average treatment effect was -14% (-18 to -11%), -17% (-20 to -13%), and -16% (-20 to -12%) for preterm birth < 37 weeks, < 34 weeks, and < 32 weeks, respectively. The average treatment effect for adverse neonatal outcomes was -7% (-8 to -5%). No difference in gestational weeks at delivery between exposed and unexposed emerged when gestational age at first admission was > 30.1 gestational weeks. CONCLUSIONS The positioning of a cervical pessary placement may be evaluated to reduce the risk of a subsequent preterm birth after an episode of arrested preterm labor in pregnant patients with onset of symptoms before 30 gestational weeks.
Collapse
Affiliation(s)
- G Delli Carpini
- Department of Odontostomatologic and Specialized Clinical Sciences, Obstetrics and Gynecology Section, Università Politecnica delle Marche, Ancona, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Ros SD, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Giudice CD, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi R, Inserra CA, Iori E, Izzo A, Rosa GL, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Di Bella G, Carerj S. Organization and Activity of Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:1-9. [PMID: 37426716 PMCID: PMC10328129 DOI: 10.4103/jcecho.jcecho_16_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 07/11/2023] Open
Abstract
Background The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue Doppler imaging in 53% of the centers, and using fractional area change in 33% of the centers. When we divided into cardiology (179, 78%) and noncardiology (49, 22%) centers, we found significant differences in the SE (93% vs. 26%, P < 0.001), TEE (85% vs. 18%), UCA (67% vs. 43%, P < 0001), and STE (87% vs. 20%, P < 0.001). The incidence of LUS evaluation was similar between the cardiology and noncardiology centers (69% vs. 61%, P = NS). Conclusions This nationwide survey demonstrated that digital infrastructures and advanced echocardiography modalities, such as 3D and STE, are widely available in Italy with a notable diffuse uptake of LUS in the core TTE examination, a suboptimal diffusion of PACS recording, and conservative use of UCA, 3D, and strain. There are significant differences between northern and central-southern regions and echocardiographic laboratories that pertain to the cardiac unit. This inhomogeneous distribution of technology represents one of the main issues that must be solved to standardize the practice of echocardiography.
Collapse
Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | - Andrea Barbieri
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Semi-Intensive Care Unit, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Integrated Cardiovascular Diagnostic Division, Auxologico San Luca IRCCS Hospital, Milano, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Department, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, MI, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Science, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Sassari, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo Nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Maria Di Fulvio
- Cardiology-ICCU Division, Ss. Annunziata Hospital, Chieti, Italy
| | | | | | - Angelo Di Gioia
- Cardiology Division, St Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, CN, Italy
| | | | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, NA, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Palermo, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Ferrara, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, MO, Italy
| | - Annibale Izzo
- Cardiology Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiological and Cardio Oncological Rehabilitation Department, Sacile (PN) CRO (PN) Hospital, Sacile (PN), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, PG, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, MI, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città della Salute e della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Department, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, St Anna University Hospital, Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, RM, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St Giovanni Evangelista Hospital, Tivoli, RM, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, VE, Italy
| | - Carlo Ratti
- Cardiology Division, St Maria Bianca Hospital, Mirandola, MO, Italy
| | - Sara Rettegno
- Cardiology Division, Hospital, Moncalieri, TO, Italy
| | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Cardiology Division, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Antonello Zugaro
- Department of Cardiology, Intensive Care Unit, St Salvatore Hospital, L’Aquila, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| |
Collapse
|
31
|
Minoia L, Consales G, Mazzariol S, Mancusi C, Terracciano G, Ceciarini I, Capanni F, Neri A, D'Agostino A, Marsili L. Preliminary assessment of persistent organic pollutants (POPs) in tissues of Risso's dolphin (Grampus griseus) specimens stranded along the Italian coasts. Mar Pollut Bull 2023; 186:114470. [PMID: 36528010 DOI: 10.1016/j.marpolbul.2022.114470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/18/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Ecotoxicological and pathological research on Grampus griseus (Cuvier, 1812) (Risso's dolphins) is scarce both globally and in the Mediterranean Sea. This species has been classified as "Vulnerable" by the International Union for Conservation of Nature (IUCN) in the Mediterranean Sea. To evaluate the presence of "persistent organic pollutants" (POPs), especially organochlorine compounds (OCs), in the animals, chemical analyses were performed on tissues and organs of Risso's dolphin stranded along the Italian coasts between 1998 and 2021. Toxic contaminants such as hexachlorobenzene (HCB), polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane and its metabolites (DDTs) were examined in the blubber, liver, muscle, and brain of 20 animals, and data was correlated with sex, age, and stranding locations.
Collapse
Affiliation(s)
- L Minoia
- Department of Physical Sciences Earth and Environment, University of Siena, Via Mattioli 4, 53100 Siena, Italy; Department of Integrative Marine Ecology, Stazione Zoologica Anton Dohrn, National Institute of Marine Biology, Ecology and Biotechnology, Genoa Marine Centre, Villa del Principe, Via San Benedetto 2, 16126 Genoa, Italy
| | - G Consales
- Department of Physical Sciences Earth and Environment, University of Siena, Via Mattioli 4, 53100 Siena, Italy; Department of Integrative Marine Ecology, Stazione Zoologica Anton Dohrn, National Institute of Marine Biology, Ecology and Biotechnology, Genoa Marine Centre, Villa del Principe, Via San Benedetto 2, 16126 Genoa, Italy.
| | - S Mazzariol
- Department of Comparative Biomedicine and Food Science - BCA, University of Padua, Agripolis, Viale dell'Università 16, 35020 Legnaro, PD, Italy
| | - C Mancusi
- Department of Physical Sciences Earth and Environment, University of Siena, Via Mattioli 4, 53100 Siena, Italy; Environmental Protection Agency Tuscany Region (ARPAT), Via Giovanni Marradi 114, 57126 Livorno, Italy
| | - G Terracciano
- Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana - Sezione di Pisa, Via SS Abetone Brennero 4, 56123 Pisa, Italy
| | - I Ceciarini
- Department of Physical Sciences Earth and Environment, University of Siena, Via Mattioli 4, 53100 Siena, Italy
| | - F Capanni
- Department of Physical Sciences Earth and Environment, University of Siena, Via Mattioli 4, 53100 Siena, Italy
| | - A Neri
- Department of Physical Sciences Earth and Environment, University of Siena, Via Mattioli 4, 53100 Siena, Italy; CIBM - Consortium for the Interuniversity Center of Marine Biology and Applied Ecology "G. Bacci", viale N. Sauro 4, 57128 Livorno, Italy
| | - A D'Agostino
- Department of Management Studies and Quantitative Methods (DISAQ), University of Naples Parthenope, Via Generale Parisi 13, 80132 Napoli, Italy
| | - L Marsili
- Department of Physical Sciences Earth and Environment, University of Siena, Via Mattioli 4, 53100 Siena, Italy; Centro Interuniversitario per la Ricerca sui CEtacei (CIRCE), Department of Physical Sciences Earth and Environment, University of Siena, Strada Laterina 8, 53100 Siena, Italy
| |
Collapse
|
32
|
Mancusi C, Bisogni V, Maloberti A, Manzi MV, Visco V, Biolcati M, Giani V, Spannella F, Monticone S, Saladini F, Rivasi G, Turrin G, Pucci G, Pengo M, Bertacchini F, Ferri C, Grassi G, Muiesan ML, Fucile I, Sorvillo G, Grieco F, Jacobitti G, Di Costanzo A, Vittoria Govetosa M, D’Avino G, D’Agosto D, Schiavi P, Biondini S, Ristori L. Accuracy of home blood pressure measurement: the ACCURAPRESS study – a proposal of Young Investigator Group of the Italian Hypertension Society (Società Italiana dell’Ipertensione Arteriosa). Blood Press 2022; 31:297-304. [DOI: 10.1080/08037051.2022.2137461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Valeria Bisogni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- ASST GOM Niguarda Hospital, Milan, Italy
| | - Maria Virginia Manzi
- Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Marco Biolcati
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Valentina Giani
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Silvia Monticone
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | | | - Giulia Rivasi
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giada Turrin
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Martino Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Fabio Bertacchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy and 2a Medicina ASST Spedali Civili di Brescia, Brescia, Italy
| | - Claudio Ferri
- MeSVA Department and San Salvatore Hospital, UOC Internal Medicine and Nephrology, University of L’Aquila, L’Aquila, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy and 2a Medicina ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ilaria Fucile
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Gianmarco Sorvillo
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Fabrizia Grieco
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Giulia Jacobitti
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Anita Di Costanzo
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Maria Vittoria Govetosa
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Giuseppina D’Avino
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Domenico D’Agosto
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | | | | | | | | |
Collapse
|
33
|
Basile C, Mancusi C, Franzone A, Avvedimento M, Angellotti D, Castiello DS, Mariani A, Manzo R, Cirillo P, De Simone G, Esposito G. 689 IMPACT OF RENIN-ANGIOTENSIN SYSTEM INHIBITORS ON CLINICAL OUTCOME IN HYPERTENSIVE PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION: INSIGHT FROM THE EFFECTAVI REGISTRY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.722] [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
Aims
Left ventricular pressure overload is connected with cardiac renin–angiotensin system activation, which may lead to myocardial fibrosis and poorer clinical outcomes. Hypertensive patients with symptomatic, severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) in the EffecTAVI registry were evaluated for the association between baseline treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and clinical outcomes.
Methods and results
The research comprised 373 patients with moderate, high, or prohibitive risk who had TAVI in the EffecTAVI registry (NCT05235555). Using Kaplan–Meier event rates and study-stratified multivariable Cox proportional hazards regression models, we evaluated clinical outcomes at 2 years according to ACEi/ARB therapy status at baseline. Among the 327 patients with hypertension included in the present study, 222 (67.9%) were treated with ACEI/ARB at baseline, whereas 105 (32.1%) were not. Treatment with ACEI/ARB was related with decreased all-cause mortality (HR=0.46, 95% CI 0.25-0.90, p=0.011), although this association was not statistically significant after multivariable adjustment for important covariates. Analyzing pre-procedural ACEi and ARBs separately, ARBs administration was related with a 58% decrease in all-cause mortality (HR=0.42, 95% CI 0.18-0.98, p=0.04), which was confirmed in multivariate analysis.
Conclusion
In a small cohort of hypertensive patients with severe symptomatic AS from the EffecTAVI registry, ARBs treatment at baseline was independently associated with a lower risk of 2-year all-cause mortality.
Collapse
Affiliation(s)
- Christian Basile
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Costantino Mancusi
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Anna Franzone
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Marisa Avvedimento
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Domenico Angellotti
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | | | - Andrea Mariani
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Rachele Manzo
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Plinio Cirillo
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Giovanni De Simone
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| | - Giovanni Esposito
- Department Of Advanced Biomedical Sciences, University Of Naples ”Federico Ii”
| |
Collapse
|
34
|
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.
Collapse
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”
| |
Collapse
|
35
|
Lembo M, Acampa W, Elena Rao MA, Virginia Manzi M, Morisco C, Mancusi C, Esposito G, Cuocolo A, Izzo R, Trimarco B. 150 ECHO-DERIVED LEFT VENTRICULAR MECHANO-ENERGETIC EFFICACY CHARACTERIZES HYPERTENSIVE PATIENTS WITH IMPAIRED PET-DERIVED MYOCARDIAL BLOOD FLOW. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.204] [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
Chronic left ventricular (LV) pressure overload determines both morphological and functional alterations in the heart and in the vascular system with occurrence of LV hypertrophy, coronary rarefaction and metabolic impairment, predisposing to heart failure. We aim at investigating early cardiac involvement in hypertensive disease by both Positron emission tomography (PET) and echo assessment and possible associations between alterations of PET-derived myocardial blood flow (MBF) and echocardiographic parameters of LV performance including mechano-energetic efficiency indexed for myocardial mass (MEEi), in a population of symptomatic hypertensive patients without flow-limiting epicardial coronary artery disease (CAD).
Methods
The study population included 78 symptomatic hypertensive patients without flow-limiting epicardial CAD. All patients underwent standard echocardiographic assessment, including evaluation of LV MEEi, and PET assessment with evaluation of MBF and MBF/mass ratio at rest and after stress and myocardial flow reserve (MFR).
Results
The study population included 67% males, 55% with dyslipidaemia, 42% with smoking habits and 21% obese. Prevalence of LV hypertrophy was of 43%. Among parameters of LV systolic performance, hyperaemic MBF/mass ratio resulted significantly correlated with LV MEEi (r=0.54, p<0.0001), midwall fractional shortening (r=0.38, p=0.001) but not with LVEF (r=0.10, p=0.47). Similarly, resting MBF/mass ratio resulted to have statistically significant correlations with LV MEEi (r=0.51, p<0.0001), midwall fractional shortening (r=0.29, p=0.01) but not with LVEF (r=0.11, p=0.39). LV MEEi reached the highest correlation coefficient with both resting and stress MBF/mass ratio. On the other hand, the correlation between MEEi and MFR did not reach statistical significance (r=0.11, p=0.33).
In a multiple linear regression analysis, after adjusting for sex, systolic blood pressure, prevalence of LV hypertrophy and therapy with diuretics, the association between LV MEEi and hyperaemic MBF/mass ratio remained significant (beta coefficient =0.40, p=0.007). In a subsequent multivariate model, adjusting for the same confounders, by replacing hyperaemic MBF/mass ratio with resting MBF/mass ratio, LV MEEi and resting MBF/mass ratio continued to be significantly associated (beta coefficient =0.32, p=0.015).
Conclusions
In a population of hypertensive patients without flow-limiting epicardial CAD, an early myocardial impairment possibly related to coronary rarefaction and inadequate angiogenesis contributing to the altered myocardial metabolic demand and efficacy is detectable by both PET and echo-derived LV MEEi. Indeed, an independent association between LV MEEi and both MBF/mass ratio at rest and after stress exists, LV MEEi having the advantage over PET of being easily derived from standard echocardiography and not needing radiation exposure.
Collapse
|
36
|
De Colle C, Paolisso P, Gallinoro E, Bertolone D, Mileva N, Fabbricatore D, Valeriano C, Mancusi C, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. 268 IMPACT OF AORTIC REGURGITATION ON LONG TERM OUTCOME IN HEART FAILURE AND PRESERVED EJECTION FRACTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.448] [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
Aortic Regurgitation (AR) may aggravate the clinical course in patients with heart failure and preserved ejection fraction (HFpEF) by increasing filling pressures and triggering LV remodelling.
Objective
To assess AR's prevalence and long-term prognostic implications in patients with HFpEF.
Methods
The study population consisted of 458 consecutive patients (age 77.5 ± 9.2 y, 57.9% females) hospitalized with de novo or worsened HFpEF. Patients with more than moderate aortic and/or mitral valve disease were excluded. Data on cardiovascular death, HF re-hospitalization and their composite (MACE) were collected.
Results
Out of 309 (67.5%) patients with any AR, 156 (34.0%) and 153 (33.5%) had mild-AR and moderate-AR, respectively. The remaining 149 (32.5%) individuals had no-AR. Patients with versus without AR were significantly older with larger LV and LA volumes and a higher prevalence of diastolic dysfunction (all p < 0.05). During a median follow-up of 33 ± 25 months, a total of 114 patients (24.9%) died from cardiovascular causes, 126 patients (27.5%) were re-hospitalized for HF, while 272 (59.4%) had the composite endpoint (MACE). In multivariable Cox regression analysis, any AR emerged as an only independent predictor of MACE (HR=1.90, 95%CI 1.26–2.87, p=0.002). Mild-AR and Moderate AR increased the risk of MACE by 77% and 92%, respectively, compared to the No-AR.
Conclusions
In patients with HFpEF, mild-to-moderate AR is highly prevalent, and it seems to identify individuals with worse long-term outcomes. This suggests that even mild AR should be considered a high-risk prognostic marker in patients with HFpEF.
Collapse
Affiliation(s)
- Cristina De Colle
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Pasquale Paolisso
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | - Dario Bertolone
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Niya Mileva
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
| | - Davide Fabbricatore
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | - Costantino Mancusi
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | | | - Nicola De Luca
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Guy Van Camp
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
| | - Emanuele Barbato
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | | |
Collapse
|
37
|
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.
Collapse
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.
| | | | | |
Collapse
|
38
|
De Colle C, Paolisso P, Gallinoro E, Bertolone DT, Mileva N, Fabbricatore D, Valeriano C, Mancusi C, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. Impact of aortic regurgitation on long-term outcomes in heart failure with preserved ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic Regurgitation (AR) may aggravate the clinical course in patients with heart failure and preserved ejection fraction (HFpEF) by increasing filling pressures and triggering LV remodelling.
Objective
To assess AR's prevalence and long-term prognostic implications in patients with HFpEF.
Methods
The study population consisted of 458 consecutive patients (age 77.5±9.2 y, 57.9% females) hospitalized with de novo or worsened HFpEF. Patients with more than moderate aortic and/or mitral valve disease were excluded. Data on cardiovascular death, HF re-hospitalization and their composite (MACE) were collected.
Results
Out of 309 (67.5%) patients with any AR, 156 (34.0%) and 153 (33.5%) had mild-AR and moderate-AR, respectively. The remaining 149 (32.5%) individuals had no-AR. Patients with versus without AR were significantly older with larger LV and LA volumes and a higher prevalence of diastolic dysfunction (all p<0.05). During a median follow-up of 33±25 months, a total of 114 patients (24.9%) died from cardiovascular causes, 126 patients (27.5%) were re-hospitalized for HF, while 272 (59.4%) had the composite endpoint (MACE). In multivariable Cox regression analysis, any AR emerged as an only independent predictor of MACE (HR=1.90, 95% CI 1.26–2.87, p=0.002). Mild-AR and Moderate AR increased the risk of MACE by 77% and 92%, respectively, compared to the No-AR (Figure).
Conclusions
In patients with HFpEF, mild-to-moderate AR is highly prevalent, and it seems to identify individuals with worse long-term outcomes. This suggests that even mild AR should be considered a high-risk prognostic marker in patients with HFpEF.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- C De Colle
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - P Paolisso
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Gallinoro
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - D T Bertolone
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - N Mileva
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - C Valeriano
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - C Mancusi
- Federico II University Hospital , Naples , Italy
| | - C Collet
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - N De Luca
- Federico II University Hospital , Naples , Italy
| | - G Van Camp
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Barbato
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - J Bartunek
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Penicka
- Cardiovascular Research Center Aalst , Aalst , Belgium
| |
Collapse
|
39
|
de Simone G, Mancusi C, Hanssen H, Genovesi S, Lurbe E, Parati G, Sendzikaite S, Valerio G, Di Bonito P, Di Salvo G, Ferrini M, Leeson P, Moons P, Weismann CG, Williams B. Hypertension in children and adolescents. Eur Heart J 2022; 43:3290-3301. [PMID: 35896123 DOI: 10.1093/eurheartj/ehac328] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 11/11/2021] [Revised: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 12/12/2022] Open
Abstract
Definition and management of arterial hypertension in children and adolescents are uncertain, due to different positions of current guidelines. The European Society of Cardiology task-force, constituted by Associations and Councils with interest in arterial hypertension, has reviewed current literature and evidence, to produce a Consensus Document focused on aspects of hypertension in the age range of 6-16 years, including definition, methods of measurement of blood pressure, clinical evaluation, assessment of hypertension-mediated target organ damage, evaluation of possible vascular, renal and hormonal causes, assessment and management of concomitant risk factors with specific attention for obesity, and anti-hypertensive strategies, especially focused on life-style modifications. The Consensus Panel also suggests aspects that should be studied with high priority, including generation of multi-ethnic sex, age and height specific European normative tables, implementation of randomized clinical trials on different diagnostic and therapeutic aspects, and long-term cohort studies to link with adult cardiovascular risk. Finally, suggestions for the successful implementation of the contents of the present Consensus document are also given.
Collapse
Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center & Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center & Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Simonetta Genovesi
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital & School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Empar Lurbe
- Paediatric Department, Consorcio Hospital General, University of Valencia; CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital & School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Skaiste Sendzikaite
- Clinic of Paediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, 'S.Maria delle Grazie' Hospital, Pozzuoli, Italy
| | - Giovanni Di Salvo
- Paediatric Cardiology Unit, Department of Woman's and Child's Health, University-Hospital of Padova, University of Padua, Padua, Italy
| | - Marc Ferrini
- St Joseph and St Luc Hospital Department of Cardiology and Vascular Pathology, Lyon, France
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium & Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Constance G Weismann
- Paediatric Heart Center, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, and NIHR University College London Hospitals Biomedical Research Centre, London, UK
| |
Collapse
|
40
|
Lembo M, Trimarco V, Manzi MV, Mancusi C, Esposito G, Esposito S, Morisco C, Izzo R, Trimarco B. Determinants of improvement of left ventricular mechano-energetic efficiency in hypertensive patients. Front Cardiovasc Med 2022; 9:977657. [PMID: 35966525 PMCID: PMC9365966 DOI: 10.3389/fcvm.2022.977657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Arterial hypertension, especially when coexisting with other cardiovascular risk factors, could determine an imbalance between myocardial energetic demand and altered efficiency, leading to an early left ventricular (LV) systolic dysfunction, even in terms of echo-derived mechano-energetic efficiency indexed for myocardial mass (MEEi). We aim to analyse an improvement in LV MEEi, if any, in a population of hypertensive patients with a long-term follow-up and to identify clinical, metabolic and therapeutic determinants of LV MEEi amelioration. Materials and methods In total, 7,052 hypertensive patients, followed-up for 5.3 ± 4.5 years, enrolled in the Campania Salute Network, underwent echocardiographic and clinical evaluation. LV MEEi was obtained as the ratio between stroke volume and heart rate and normalized per grams of LV mass and ΔMEEi was calculated as difference between follow-up and baseline MEEi. Patients in the highest ΔMEEi quartile (≥0.0454 mL/s/g) (group 1) were compared to the merged first, second and third quartiles (<0.0454 mL/s/g) (group 2). METS-IR (Metabolic Score for Insulin Resistance), an established index of insulin sensitivity, was also derived. Results Patients with MEEi improvement experienced a lower rate of major cardiovascular events (p = 0.02). After excluding patients experiencing cardiovascular events, patients in group 1 were younger (p < 0.0001), less often diabetic (p = 0.001) and obese (p = 0.035). Group 1 experienced more frequently LV mass index reduction, lower occurrence of LV ejection fraction reduction, and had a better metabolic control in terms of mean METS-IR during the follow-up (all p < 0.0001). Beta-blockers were more often used in group 1 (p < 0.0001) than group 2. A logistic regression analysis showed that younger age, lower mean METS-IR values, more frequent LV mass index reduction and therapy with beta-blockers were significantly associated with LV MEEi improvement, independently of presence of diabetes and obesity. Conclusion Metabolic control and therapy with beta-blockers could act in a synergic way, determining an improvement in LV MEEi in hypertensive patients over time, possibly confining cardiac damage and hampering progression toward heart failure.
Collapse
Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Valentina Trimarco
- Department of Neurosciences, Federico II University of Naples, Naples, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Salvatore Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
- *Correspondence: Raffaele Izzo,
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| |
Collapse
|
41
|
Manzi MV, Mancusi C, Lembo M, Esposito G, Rao MAE, de Simone G, Morisco C, Trimarco V, Izzo R, Trimarco B. Low mechano-energetic efficiency is associated with future left ventricular systolic dysfunction in hypertensives. ESC Heart Fail 2022; 9:2291-2300. [PMID: 35481670 PMCID: PMC9288798 DOI: 10.1002/ehf2.13908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 01/19/2023] Open
Abstract
Aims In a hypertensive population with optimal blood pressure control with a long‐term follow‐up, we aimed at analysing possible predictors of left ventricular (LV) ejection fraction (LVEF) reduction, including indexed mechano‐energetic efficiency (MEEi), a well‐recognized echo‐derived parameter of LV performance. Methods and results The study population included 5673 hypertensive patients from the Campania Salute Network with a long‐term follow‐up, normal baseline LVEF (≥50%), and no prevalent cardiovascular (CV) disease. Patients developing LVEF impairment (LVEF < 50% or a reduction of at least 10 percentage points compared with baseline) were compared with patients with persistently normal LVEF. Optimal blood pressure control was achieved in about 80% of patients. Patients who experienced LVEF reduction were 2.41% during a long‐term follow‐up (mean duration 5.6 ± 3.9 years). At baseline, they were older (59.46 ± 11.58 vs. 53.40 ± 11.41, P < 0.0001) and showed higher LV mass index (53.3 ± 12.83 vs. 47.56 ± 9.58, P < 0.0001), left atrial (LA) volume index (14.4 ± 4.2 vs. 13.1 ± 2.8, P < 0.0001) and carotid intima–media thickness (1.99 ± 0.86 vs. 1.61 ± 0.73, P < 0.0001), lower MEEi (0.32 ± 0.08 vs. 0.34 ± 0.07, P = 0.037), and higher prevalence of CV events during follow‐up (13.9% vs. 3%, P < 0.0001) compared with patients with persistently normal LVEF. A logistic regression analysis, performed after running univariate analyses and selecting parameters significantly associated with LVEF reduction, showed that having a CV event [odds ratio (OR) 7.57, P < 0.0001], being in the lowest MEEi quartile (OR 2.43, P = 0.003), and having a larger LA volume index (OR 1.08, P = 0.028) were all parameters independently associated with the development of LV systolic dysfunction. A further logistic regression model, performed by excluding patients experiencing CV events, demonstrated that the lowest MEEi quartile was independently associated with the evolution towards LVEF reduction (OR 2.35, P = 0.004), despite significant impact of LA volume index (OR 1.08, P = 0.023) and antiplatelet therapy (OR 1.89, P < 0.01). Receiver operating characteristic curves showed that the model including MEEi had higher accuracy than the model without MEEi in predicting LVEF reduction (areas under the curve 0.68 vs. 0.63, P = 0.046). Conclusions Lower values of MEEi at baseline identify hypertensive patients more liable to develop LVEF reduction. In hypertensive setting, MEEi evaluation improves risk stratification for development of LV systolic dysfunction during long‐term follow‐up.
Collapse
Affiliation(s)
- Maria V Manzi
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Maria Lembo
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Giovanni Esposito
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | | | - Giovanni de Simone
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Carmine Morisco
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Valentina Trimarco
- Department of Neurosciences, Federico II University of Naples, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| |
Collapse
|
42
|
Iaccarino G, Grassi G, Borghi C, Carugo S, Fallo F, Ferri C, Giannattasio C, Grassi D, Letizia C, Mancusi C, Minuz P, Perlini S, Pucci G, Rizzoni D, Salvetti M, Sarzani R, Sechi L, Veglio F, Volpe M, Muiesan ML. Correction: Gender differences in predictors of intensive care units admission among COVID-19 patients: The results of the SARS-RAS study of the Italian Society of Hypertension. PLoS One 2022; 17:e0267622. [PMID: 35443017 PMCID: PMC9020704 DOI: 10.1371/journal.pone.0267622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
43
|
Trimarco V, Manzi MV, Mancusi C, Strisciuglio T, Fucile I, Fiordelisi A, Pilato E, Izzo R, Barbato E, Lembo M, Morisco C. Insulin Resistance and Vitamin D Deficiency: A Link Beyond the Appearances. Front Cardiovasc Med 2022; 9:859793. [PMID: 35369303 PMCID: PMC8968037 DOI: 10.3389/fcvm.2022.859793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/17/2022] [Indexed: 12/23/2022] Open
Abstract
Vitamin D is a steroid hormone that plays a key role in the regulation of body homeostasis, including cardiovascular function. Although the chronic deficiency of vitamin D is associated with cardiovascular risk factors, as well as with an adverse prognosis, randomized controlled trials have failed in demonstrating that dietary vitamin D supplementation could ameliorate the prognosis of patients with cardiovascular diseases, and suggested that vitamin D deficiency is the expression of the effects of other determinants of cardiovascular risk. Thus, the supplementation of vitamin D is not sufficient to improve the cardiovascular risk profile and prognosis. Insulin resistance is a complex phenomenon that plays a key role in the pathogenesis of conventional cardiovascular risk factors. Interestingly, defects of vitamin D and insulin resistance have a superimposable epidemiological distribution. According to the common view, Insulin resistance is considered the direct or indirect consequence of vitamin D deficiency. However, it is also reasonable to speculate that the deficit or the impaired action of vitamin D, in some circumstances, could be the result of the same pathogenic mechanisms responsible of insulin resistance development. In this case, vitamin D deficiency could be considered an epiphenomenon of insulin resistance. Insulin resistance is a reversible condition, being possibly ameliorated by physical activity and hypocaloric diets. Notably, both physical exercise and energy-restricted dietary regimens are associated with an increase of vitamin D levels. These findings indicate that improving insulin resistance condition is a necessary step to ameliorate vitamin D supplementation-based strategies in cardiovascular prevention.
Collapse
Affiliation(s)
- Valentina Trimarco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Teresa Strisciuglio
- 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
| | - Antonella Fiordelisi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Pilato
- Department of Cardiac Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- *Correspondence: Maria Lembo
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| |
Collapse
|
44
|
Bertolone DT, Gallinoro E, Esposito G, Paolisso P, Bermpeis K, De Colle C, Fabbricatore D, Mileva N, Valeriano C, Munhoz D, Belmonte M, Vanderheyden M, Bartunek J, Sonck J, Wyffels E, Collet C, Mancusi C, Morisco C, De Luca N, De Bruyne B, Barbato E. Contemporary Management of Stable Coronary Artery Disease. High Blood Press Cardiovasc Prev 2022; 29:207-219. [PMID: 35147890 PMCID: PMC9050764 DOI: 10.1007/s40292-021-00497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/30/2021] [Indexed: 10/28/2022] Open
Abstract
Coronary artery disease (CAD) continues to be the leading cause of mortality and morbidity in developed countries. Assessment of pre-test probability (PTP) based on patient's characteristics, gender and symptoms, help to identify more accurate patient's clinical likelihood of coronary artery disease. Consequently, non-invasive imaging tests are performed more appropriately to rule in or rule out CAD rather than invasive coronary angiography (ICA). Coronary computed tomography angiography (CCTA) is the first-line non-invasive imaging technique in patients with suspected CAD and could be used to plan and guide coronary intervention. Invasive coronary angiography remains the gold-standard method for the identification and characterization of coronary artery stenosis. However, it is recommended in patients where the imaging tests are non-conclusive, and the clinical likelihood is very high, remembering that in clinical practice, approximately 30 to 70% of patients with symptoms and/or signs of ischemia, referred to coronary angiography, have non obstructive coronary artery disease (INOCA). In this contest, physiology and imaging-guided revascularization represent the cornerstone of contemporary management of chronic coronary syndromes (CCS) patients allowing us to focus specifically on ischemia-inducing stenoses. Finally, we also discuss contemporary medical therapeutic approach for secondary prevention. The aim of this review is to provide an updated diagnostic and therapeutic approach for the management of patients with stable coronary artery disease.
Collapse
Affiliation(s)
- Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium. .,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| |
Collapse
|
45
|
Mancusi C, Manzi MV, de Simone G, Morisco C, Lembo M, Pilato E, Izzo R, Trimarco V, Trimarco B, De Luca N. Carotid Atherosclerosis Predicts Blood Pressure Control in Patients With Hypertension: The Campania Salute Network Registry. J Am Heart Assoc 2022; 11:e022345. [PMID: 35043688 PMCID: PMC9075070 DOI: 10.1161/jaha.121.022345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The 2018 European Society of Cardiology/European Society of Hypertension arterial hypertension guidelines do not recommend routine carotid ultrasound as a tool to identify hypertension‐mediated organ damage, unless clinically indicated. However, carotid plaque (CP) is a strong correlate of increased arterial stiffness, which influences blood pressure (BP) control over time. Thus, we assessed whether evidence of CP at first visit could predict BP control during follow‐up. Methods and Results From the CSN (Campania Salute Network) Registry, 6684 patients with hypertension had complete carotid ultrasound examination and were categorized by the presence of CP at baseline. Optimal BP control was defined as average BP <140/90 mm Hg and <135/85 during follow‐up for office and home BP, respectively. At baseline, participants with CP (n=3061) were more likely to be men, to be older, to have diabetes, and to exhibit higher systolic BP, lower diastolic BP, worse lipid profile, and higher prevalence of left ventricular hypertrophy (all P<0.0001) than patients without CP. Optimal office BP control was adjudicated in 54% with and 62% without CP (P<0.0001), and optimal home BP in 51% with and 58% without CP (P<0.01). Presence of CP was significantly associated with the reduced probability of controlled office BP during follow‐up (both P<0.0001), independently of significant effect of older age, male sex, higher baseline BP values, classes of medication, and presence of left ventricular hypertrophy, and only attenuated by duration of hypertension. Conclusions Presence of CP in treated patients with hypertension is associated with suboptimal BP control during follow‐up, independently of worse metabolic profile and presence of left ventricular hypertrophy.
Collapse
Affiliation(s)
- Costantino Mancusi
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | | | - Giovanni de Simone
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Emanuele Pilato
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | | | - Bruno Trimarco
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| |
Collapse
|
46
|
Lembo M, Manzi MV, Mancusi C, Morisco C, Rao MAE, Cuocolo A, Izzo R, Trimarco B. Advanced imaging tools for evaluating cardiac morphological and functional impairment in hypertensive disease. J Hypertens 2022; 40:4-14. [PMID: 34582136 PMCID: PMC10871661 DOI: 10.1097/hjh.0000000000002967] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 06/15/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/19/2023]
Abstract
Arterial hypertension represents a systemic burden, and it is responsible of various morphological, functional and tissue modifications affecting the heart and the cardiovascular system. Advanced imaging techniques, such as speckle tracking and three-dimensional echocardiography, cardiac magnetic resonance, computed tomography and PET-computed tomography, are able to identify cardiovascular injury at different stages of arterial hypertension, from subclinical alterations and overt organ damage to possible complications related to pressure overload, thus giving a precious contribution for guiding timely and appropriate management and therapy, in order to improve diagnostic accuracy and prevent disease progression. The present review focuses on the peculiarity of different advanced imaging tools to provide information about different and multiple morphological and functional aspects involved in hypertensive cardiovascular injury. This evaluation emphasizes the usefulness of the emerging multiimaging approach for a comprehensive overview of arterial hypertension induced cardiovascular damage.
Collapse
Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Gionti L, Imparato L, Viggiano A, Losi MA, Gargiulo G, Mancusi C, Dellegrottaglie S, Scatteia A, Esposito G. 430 Diagnosis and management of a case of biventricular arrhythmogenic cardiomyopathy: a case report. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetically determined heart muscle disorder characterized by fibro-fatty replacement of myocardium which may affect the right ventricle (‘dominant right’ variant), the left ventricle (‘dominant left’ variant) or both (‘biventricular disease’ variant). Despite of ACM is one of the main causes of sudden cardiac death (SCD) in young people and athletes as well, the diagnosis of this complex clinical entity still remains a challenge. We report on a case of a 29 years old non-athletic woman with family history of SCD and a long-standing personal history of palpitations leading to frequent accesses to the Accident & Emergency Department. Her echocardiogram was normal while twelve leads ECG revealed negative T waves in the right precordial leads (V1–V3) and post-excitation epsilon waves. ECG Holter monitoring recorded frequent (up to 17 000 in 24 h) polymorphic premature ventricular contractions (PVCs) seldom organized in couplets or triplets. She was followed-up in our clinic and started on Propanolol 40 mg bid with slight relief of symptoms and reduction of PVCs. Cardiac magnetic resonance (CMR) showed regional dyskinesia of both ventricles and RV dilatation. Moreover, tissue characterization findings revealed the presence of diffuse subepicardial late gadolinium enhancement (LGE) of the LV. Genetic analysis was performed and a variant of uncertain significance (VUS) in Desmoplakin was identified. Non sustained monomorphic ventricular tachycardia was induced during electrophysiologic study by programmed ventricular stimulation. In light of these results, we diagnosed biventricular ACM and, after carefully discussion with the patient, a subcutaneous implantable cardioverter defibrillator (ICD) was implanted. The present case should be a persisting reminder that must be considered more than just a single diagnostic tool when dealing with arrhythmic presentations especially in young patients and the importance of contrast CMR along with genetic testing in order to aid clinicians in the demanding selection of the best candidates for ICD implantation.
Collapse
Affiliation(s)
- Luigia Gionti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini N. 5, Naples 80131, Italy
| | - Livio Imparato
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini N. 5, Naples 80131, Italy
| | - Aniello Viggiano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini N. 5, Naples 80131, Italy
| | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini N. 5, Naples 80131, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini N. 5, Naples 80131, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini N. 5, Naples 80131, Italy
| | | | - Alessandra Scatteia
- Division of Cardiology, Ospedale Accreditato Villa dei Fiori, Acerra, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini N. 5, Naples 80131, Italy
| |
Collapse
|
48
|
Basile C, Fucile I, Manzi MV, Ilardi F, Franzone A, Mancusi C. 443 Arterial hypertension in aortic valve stenosis: a critical update. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147] [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
Aortic stenosis (AS) is a very common valve disease and is associated with high mortality once it becomes symptomatic. Arterial hypertension (HT) has a high prevalence among patients with AS leading to worst left ventricle remodelling and faster degeneration of the valve. HT also seems to interfere with the assessment of the severity of AS leading to an underestimation of the real degree of stenosis. Treatment of HT in AS has historically been associated with reluctance due to both the lack of clear guidelines and the fear of adverse effects, but the most recent evidence shows as several drugs that can be used.
Methods
The pathophysiology of the combination of AS and HT is the association of a first fixed mechanical obstruction of the aortic root and a second obstruction due to systemic vascular resistance. Consequently, a decrease in systemic vascular resistance through, for example, the administration of vasodilators could theoretically cause a drop in systemic pressure due to the fixed mechanical obstruction given by the stenosis which prevents an increase in cardiac output. This theory was the basis for avoiding vasodilators in patients with AS.
Results
There is a unanimous opinion on maintaining blood pressure values of 130–139 mmHg of systolic and 70–90 mmHg of diastolic, but there is not the same agreement on which drugs to adopt to achieve the aforementioned values. Renin-Angiotensin-Aldosterone system inhibitors are certainly the first-line treatment thanks to their cardioprotective, plaque stabilizing, and antiarrhythmic effect since they are also associated with increased survival rates and greater left ventricular mass reduction in patients after surgical or transcatheter aortic valve replacement for severe AS. If blood pressure is not yet controlled, the addition of a beta-blocker should be considered: metoprolol has the greatest literature, showing not only an improvement in haemodynamic and metabolic performance but also a reduction in mortality in patients who already presented with coronary artery disease. Mineralocorticoid receptor antagonist can be used, among them eplerenone has been studied and can be useful to relieve symptoms of patients with a flare-up of heart failure by reducing the preload, provided that a close fluid and echocardiographic monitoring is implemented.
Conclusions
The use of phosphodiesterase 5 inhibitors can improve the haemodynamic status of patients with aortic stenosis and reduce the level of left ventricular hypertrophy, as well as improve pulmonary circulation and exercise tolerability of patients with AS, however it should be considered that in other studies sildenafil was associated with a worse clinical outcome. Calcium channel blocker are one the most used medications in patients with HT, but their use was associated with a 7-fold relative risk of all-cause mortality independent of known confounders and was also associated with an adverse effect on treadmill exercise and higher risk of all-cause mortality in patients with AS.
Collapse
|
49
|
Basile C, Mancusi C, Gargiulo P, Perrone Filardi P, Perrino C, Canciello G, Losi MA, Esposito G. Aortic thrombosis: the forgotten source of ischemic stroke. A case report and systematic review of the literature. Monaldi Arch Chest Dis 2021; 92. [PMID: 34865461 DOI: 10.4081/monaldi.2021.2090] [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: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
Ischemic stroke represents one of the most important health problems in industrialized countries, both for epidemiological and socio-economic impact. The presence of thrombi in the aorta is rare and its treatment has not been uniquely defined. Here we report the case of an 82-years-old man with aortic thrombosis and acute ischemic stroke.
Collapse
Affiliation(s)
- Christian Basile
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Costantino Mancusi
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Paola Gargiulo
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | | | - Cinzia Perrino
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Grazia Canciello
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Maria Angela Losi
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital, Naples.
| |
Collapse
|
50
|
Canciello G, Mancusi C, Izzo R, Morisco C, Strisciuglio T, Barbato E, Trimarco B, Luca ND, de Simone G, Losi MA. Determinants of aortic root dilatation over time in patients with essential hypertension: The Campania Salute Network. Eur J Prev Cardiol 2021; 28:1508-1514. [PMID: 32529944 DOI: 10.1177/2047487320931630] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/13/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Determinants of changes of aortic root dimension over time are not well defined. DESIGN We investigated whether specific phenotype and treatment exist predicting changes in aortic root dimension in hypertensive patients from the Campania Salute Network. METHODS N = 4856 participants (age 53 ± 11 years, 44% women) were included. At first and last available echocardiograms, we measured aortic root and a z-score of aortic root (AOz) was generated as the difference between measured and predicted aortic root, derived from a healthy reference population. Aortic root dilatation (ARD) was defined as AOz >75th percentile of distribution. RESULTS At baseline, 3642 patients (75%) exhibited normal aortic root, and 1214 (25%) ARD. After a follow-up of 6.1 years (interquartile range 3.0-8.8 years), 366 (11%) patients with initial normal aortic root exhibited ARD, whereas 457(38%) with initial ARD exhibited normal aortic root. At multivariate analysis patients with incident ARD were most likely to be women, obese, with left ventricular hypertrophy, lower systolic but higher diastolic blood pressure and stroke volume index at baseline, and higher average value of diastolic blood pressure during follow-up (p < 0.05); whereas patients normalizing their ARD were non-obese women with lower baseline systolic blood pressure, stroke volume index, average diastolic blood pressure during follow-up and longer follow-up time (p < 0.05). Anti-renin-angiotensin system (anti-RAS) was associated with 45% greater probability to normalize aortic root dimension. CONCLUSIONS Volume (stroke volume index) and pressure loads (diastolic blood pressure) influence aortic root dimension over time. Aortic root normalization, reflecting a more favourable haemodynamic load, is predictable in non-obese women with lower diastolic blood pressure, taking more anti-RAS therapy. This suggest that sex elicits a different response in aortic walls to pathological stimuli.
Collapse
Affiliation(s)
- Grazia Canciello
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Carmine Morisco
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Teresa Strisciuglio
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Emanuele Barbato
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center and Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| |
Collapse
|