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Aurigemma C, Ding D, Tu S, Li C, Yu W, Li Y, Leone AM, Romagnoli E, Vergallo R, Maino A, Trani C, Wijns W, Burzotta F. Three-year Clinical Impact of Murray Law-Based Quantitative Flow Ratio and OCT- or FFR-Guidance in Angiographically Intermediate Coronary Lesions. Circ Cardiovasc Interv 2024:e013191. [PMID: 38660794 DOI: 10.1161/circinterventions.123.013191] [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: 05/06/2023] [Accepted: 02/14/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The FORZA trial (FFR or OCT Guidance to Revascularize Intermediate Coronary Stenosis Using Angioplasty) prospectively compared the use of fractional flow reserve (FFR) or optical coherence tomography (OCT) for treatment decisions and percutaneous coronary intervention (PCI) optimization in patients with angiographically intermediate coronary lesions. Murray law-based quantitative-flow-ratio (μQFR) is a novel noninvasive method for the computation of FFR. In the present study, we evaluated the clinical impact of μQFR, FFR, or OCT guidance in FORZA trial lesions at 3-year follow-up. METHODS μQFR was assessed at baseline and, in the case of a decision to intervene, after (FFR- or OCT-guided) PCI. The baseline μQFR was considered the final μQFR for deferred lesions, and post-PCI μQFR value was taken as final for stented lesions. The primary end point was target vessel failure ([TVF]; cardiac death, target-vessel-related myocardial infarction, and target-vessel-revascularization) at a 3-year follow-up. RESULTS A total of 419 vessels (199 OCT-guided and 220 FFR-guided) were included in the FORZA trial. μQFR was evaluated in 256 deferred lesions and 159 treated lesions (98 OCT-guided PCI and 61 FFR-guided PCI). In treated lesions, post-PCI μQFR was higher in OCT-group compared with FFR-group (median, 0.93 versus 0.91; P=0.023), and the post-PCI μQFR improvement was greater in FFR-group (0.14 versus 0.08; P<0.0001). At 3-year follow-up, OCT- and FFR-guided treatment decisions resulted in comparable TVF rate (6.7% versus 7.9%; P=0.617). Final μQFR was the only predictor of TVF. μQFR ≤0.89 was associated with 3× increase in TVF (11.6% versus 3.7%; P=0.004). PCI was a predictor of higher final μQFR (odds ratio, 0.22 [95% CI, 0.14-0.34]; P<0.001). CONCLUSIONS In vessels with angiographically intermediate coronary lesions, OCT-guided PCI resulted in comparable clinical outcomes as FFR-guided PCI. μQFR estimated at the end of diagnostic or interventional procedure predicted 3-year TVF. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01824030.
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Affiliation(s)
- Cristina Aurigemma
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
| | - Daixin Ding
- Lambe Institute for Translational Research, Smart Sensors Laboratory and Curam, University of Galway, Ireland (D.D., W.W.)
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China (D.D., S.T.)
| | - Shengxian Tu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China (D.D., S.T.)
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., C.L., W.Y., Y.L.)
| | - Chunming Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., C.L., W.Y., Y.L.)
| | - Wei Yu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., C.L., W.Y., Y.L.)
| | - Yingguang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., C.L., W.Y., Y.L.)
| | - Antonio Maria Leone
- Ospedale Fatebenefratelli Isola Tiberina Gemelli Isola Roma, Italia (A.M.L.)
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
| | - Rocco Vergallo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
| | - Alessandro Maino
- Università Cattolica del Sacro Cuore, Rome, Italy (A.M., C.T., F.B.)
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
- Università Cattolica del Sacro Cuore, Rome, Italy (A.M., C.T., F.B.)
| | - William Wijns
- Lambe Institute for Translational Research, Smart Sensors Laboratory and Curam, University of Galway, Ireland (D.D., W.W.)
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., R.V., C.T., F.B.)
- Università Cattolica del Sacro Cuore, Rome, Italy (A.M., C.T., F.B.)
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Nesta M, Bruno P, d'Acierno EM, Cutrone G, Rovere G, Burzotta F, Trani C, Romagnoli E, Aurigemma C, Infusino F, Locorotondo G, Chiariello GA, Cammertoni F, Grandinetti M, Pavone N, Massetti M. Unrecognized Hole in the Aortic Stenosis Heart: Acquired Gerbode Defect Detected During Pretransfemoral Aortic Valve Implantation Evaluation. Circ Cardiovasc Imaging 2024:e016151. [PMID: 38602112 DOI: 10.1161/circimaging.123.016151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Marialisa Nesta
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Piergiorgio Bruno
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Edoardo Maria d'Acierno
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Gessica Cutrone
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Giuseppe Rovere
- Division of Radiology, Department of Diagnostical Imaging, Catholic University of the Sacred Heart, Rome, Italy. (G.R.)
| | - Francesco Burzotta
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Carlo Trani
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Enrico Romagnoli
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Cristina Aurigemma
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Fabio Infusino
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Gabriella Locorotondo
- Division of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (F.B., C.T., E.R., C.A., F.I., G.L.)
| | - Giovanni A Chiariello
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Federico Cammertoni
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Maria Grandinetti
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Natalia Pavone
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
| | - Massimo Massetti
- Division of Cardiac Surgery, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. (M.N., P.B., E.d.M.A., G.C., G.A.C., F.C., M.G., N.P., M.M.)
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3
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Russo G, Zambrano A, Burzotta F, Pedicino D, Graziani F, Cangemi S, Bianchini F, Bruno P, Locorotondo G, Calabrese M, Aurigemma C, Romagnoli E, Trani C. Temporal trends of frame expansion and paravalvular leak reduction after transcatheter aortic valve replacement with self-expandable prostheses. Minerva Cardiol Angiol 2024; 72:172-181. [PMID: 38088090 DOI: 10.23736/s2724-5683.23.06368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Paravalvular leakage (PVL) is a common finding after transcatheter aortic valve replacement (TAVR) and affects late clinical outcome. It is more frequent with self-expandable (SE) transcatheter-heart-valve (THV). Few is known about SE-THV expansion after implantation. The purpose is to assess SE-THV frame expansion and its possible influence on PVL. METHODS We designed a prospective pilot study to assess the time-course of SE-THV frame dimensions and PVL after TAVR. Consecutive patients undergoing TAVR with SE-THV were enrolled. Prosthesis fluoroscopy and echocardiography were prospectively performed immediately after TAVR (T0) and before discharge (T1) to grade PVL. Prosthesis diameters were assessed in 2 fluoroscopic orthogonal views. PVL reduction ≥1+ from T0 to T1 at echocardiography was the primary study endpoint. RESULTS Twenty-five patients were enrolled. Mean interval between T0 and T1 evaluations was 5 days. Grade 1 or 2 was present in 76% of patients at T0 and in 68% at T1 (P=0.034). A total of 7 patients (28%) improved PVL ≥1 grade from T0 to T1. Differences between T0 and T1 fluoroscopic diameters were not statistically significant. When comparing the diameter changes according to PVL evolution, patients with PVL improvement (as compared with those without) had significantly larger minimum diameter increase at both annulus/inflow (P=0.016) and outflow/distal edge (P=0.027). CONCLUSIONS PVL may improve in the early days after SE-THV and those patients with PVL improvement may have THV frame expansion. Further studies are needed to confirm such preliminary observations and to establish the clinical relevance of this phenomenon.
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Affiliation(s)
- Giulio Russo
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Aniello Zambrano
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
- Sacred Heart Catholic University, Rome, Italy
| | - Daniela Pedicino
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Francesca Graziani
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Stefano Cangemi
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Francesco Bianchini
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Piergiorgio Bruno
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Gabriella Locorotondo
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Michele Calabrese
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Cristina Aurigemma
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Enrico Romagnoli
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
| | - Carlo Trani
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Sacred Heart Catholic University, Rome, Italy
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4
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Galante D, Leone AM, Migliaro S, DI Giusto F, Anastasia G, Petrolati E, Viceré A, Zimbardo G, Cialdella P, Basile E, D'Amario D, Vergallo R, Montone RA, Buffon A, Romagnoli E, Aurigemma C, Burzotta F, Trani C, Crea F. Prognostic value of combined fractional flow reserve and pressure-bounded coronary flow reserve: outcomes in FFR and Pb-CFR assessment. Minerva Cardiol Angiol 2024; 72:152-162. [PMID: 37930018 DOI: 10.23736/s2724-5683.23.06399-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND Coronary flow reserve (CFR) has an emerging role to predict outcome in patients with and without flow-limiting stenoses. However, the role of its surrogate pressure bounded-CFR (Pb-CFR) is controversial. We investigated the usefulness of combined use of fractional flow reserve (FFR) and Pb-CFR to predict outcomes. METHODS This is a sub-study of the PROPHET-FFR Trial, including patients with chronic coronary syndrome and functionally tested coronary lesions. Patients were divided into four groups based on positive or negative FFR (cut-off 0.80) and preserved (lower boundary ≥2) or reduced (upper boundary <2) Pb-CFR: Group1 FFR≤0.80/ Pb-CFR <2; Group 2 FFR≤0.80/Pb-CFR≥2; Group 3 FFR >0.80/Pb-CFR<2; Group 4 FFR>0.80/Pb-CFR≥2. Lesions with positive FFR were treated with PCI. Primary endpoint was the rate of major adverse cardiac events (MACEs), defined as a composite of death from any cause, myocardial infarction, target vessel revascularization, unplanned cardiac hospitalization at 36-months. RESULTS A total of 609 patients and 816 lesions were available for the analysis. At Kaplan-Meier analysis MACEs rate was significantly different between groups (36.7% Group 1, 27.4% Group 2, 19.2% Group 3, 22.6% Group 4, P=0.019) and more prevalent in groups with FFR≤0.80 irrespective of Pb-CFR. In case of discrepancy, no difference in MACEs were observed between groups stratified by Pb-CFR. FFR≤0.80 was associated with an increased MACEs rate (30.2% vs. 21.5%, P<0.01) while Pb-CFR<2 was not (24.5% vs. 24.2% Pb-CFR≥2 P=0.67). CONCLUSIONS FFR confirms its ability to predict outcomes in patients with intermediate coronary stenoses. Pb-CFR does not add any relevant prognostic information.
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Affiliation(s)
- Domenico Galante
- Sacred Heart Catholic University, Rome, Italy
- Operative Unit of Diagnostic and Interventional Cardiology, Fatebenefratelli Gemelli Isola Tiberina Hospital, Rome, Italy
| | - Antonio M Leone
- Sacred Heart Catholic University, Rome, Italy -
- Operative Unit of Diagnostic and Interventional Cardiology, Fatebenefratelli Gemelli Isola Tiberina Hospital, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | | | | | | | | | | | | | | | | | - Domenico D'Amario
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonino Buffon
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Francesco Burzotta
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Carlo Trani
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Filippo Crea
- Sacred Heart Catholic University, Rome, Italy
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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5
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Cambise N, Gnan E, Tremamunno S, Telesca A, Belmusto A, Tinti L, Di Renzo A, Aurigemma C, Burzotta F, Trani C, Crea F, Lanza GA. Impact on clinical outcome of ventricular arrhythmias in patients undergoing transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown) 2024; 25:327-333. [PMID: 38358902 DOI: 10.2459/jcm.0000000000001596] [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: 02/17/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become a largely used treatment for severe aortic stenosis. There are limited data, however, about predictors of long-term prognosis in this population. In this study, we assessed whether ventricular arrhythmias may predict clinical outcomes in patients undergoing TAVI. METHODS AND RESULTS We performed a 24 h ECG Holter monitoring in 267 patients who underwent TAVI for severe aortic stenosis within 30 days from a successful procedure. The occurrence of frequent premature ventricular complexes (PVCs; ≥30/h), polymorphic PVCs and nonsustained ventricular tachycardia (NSVT) was obtained for each patient. Clinical outcome was obtained for 228 patients (85%), for an average follow-up of 3.5 years (range 1.0-8.6). Cardiovascular events (CVEs; cardiovascular death or resuscitated cardiac arrest) occurred in 26 patients (11.4%) and 63 patients died (27.6%). Frequent PVCs but not polymorphic PVCs and NSVT were found to be associated with CVEs at univariate analysis. Frequent PVCs were indeed found in 12 patients with (46.2%) and 35 without (17.3%) CVEs [hazard ratio 2.30; 95% confidence interval (CI) 1.03-5.09; P = 0.04], whereas polymorphic PVCs were found in 11 (42.3%) and 54 (26.7%) patients of the two groups, respectively (hazard ratio 1.44; 95% CI 0.64-3.25; P = 0.38), and NSVT in 9 (34.6%) and 43 patients of the two groups, respectively (hazard ratio 1.18; 95% CI 0.48-2.87; P = 0.72). Frequent PVCs, however, were not significantly associated with CVEs at multivariate Cox regression analysis (hazard ratio 1.53; 95% CI 0.37-6.30; P = 0.56). Both frequent PVCs, polymorphic PVCs and NSVT showed no significant association with mortality. CONCLUSION In our study, the detection of frequent PVCs at Holter monitoring after TAVI was a predictor of CVEs (cardiovascular death/cardiac arrest), but this association was lost in multivariable analysis.
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Affiliation(s)
| | | | | | | | | | | | | | - Cristina Aurigemma
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Department of Cardiovascular Sciences, Rome, Italy
| | - Francesco Burzotta
- Università Catto1ica del Sacro Cuore
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Department of Cardiovascular Sciences, Rome, Italy
| | - Carlo Trani
- Università Catto1ica del Sacro Cuore
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Department of Cardiovascular Sciences, Rome, Italy
| | - Filippo Crea
- Università Catto1ica del Sacro Cuore
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Department of Cardiovascular Sciences, Rome, Italy
| | - Gaetano Antonio Lanza
- Università Catto1ica del Sacro Cuore
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Department of Cardiovascular Sciences, Rome, Italy
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Anastasia G, Galante D, Biscaglia S, Vergallo R, Di Giusto F, Migliaro S, Petrolati E, Viceré A, Scancarello D, Marrone A, Verardi FM, Campaniello G, Giuliana C, Pollio Benvenuto C, Viccaro V, Todisco S, Burzotta F, Aurigemma C, Romagnoli E, Trani C, Crea F, Porto I, Campo G, Leone AM. Efficacy of "Physiology-Guided PCI" Using Pressure Catheter in Comparison to Conventional Pressure Wires: A Multicenter Analysis. Am J Cardiol 2024; 215:28-31. [PMID: 38301752 DOI: 10.1016/j.amjcard.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Affiliation(s)
- G Anastasia
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy; Department of Internal Medicine, University of Genoa, Genova, Italy
| | - D Galante
- Diagnostic and Interventional Cardiology Unit, Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola Roma, Italia; Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia
| | - S Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - R Vergallo
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy; Department of Internal Medicine, University of Genoa, Genova, Italy
| | - F Di Giusto
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia
| | - S Migliaro
- Clinical, Interventional and Hemodynamic Cardiology Unit, Aurelia Hospital, Roma, Italia
| | - E Petrolati
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia
| | - A Viceré
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia
| | - D Scancarello
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - A Marrone
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - F M Verardi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - G Campaniello
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia
| | - C Giuliana
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia
| | - C Pollio Benvenuto
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia
| | - V Viccaro
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia
| | - S Todisco
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia
| | - F Burzotta
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia; Department of Cardiovascular Sciences, Fondazione Policlinico Agostino Gemelli IRCCS, Roma, Italy
| | - C Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Agostino Gemelli IRCCS, Roma, Italy
| | - E Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Agostino Gemelli IRCCS, Roma, Italy
| | - C Trani
- Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia; Department of Cardiovascular Sciences, Fondazione Policlinico Agostino Gemelli IRCCS, Roma, Italy
| | - F Crea
- Diagnostic and Interventional Cardiology Unit, Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola Roma, Italia
| | - I Porto
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy; Department of Internal Medicine, University of Genoa, Genova, Italy
| | - G Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - A M Leone
- Diagnostic and Interventional Cardiology Unit, Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola Roma, Italia; Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, Roma, Italia; Department of Cardiovascular Sciences, Fondazione Policlinico Agostino Gemelli IRCCS, Roma, Italy.
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7
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Locorotondo G, Leone AM, Aurigemma C, Romagnoli E, Graziani F, Lombardo A, Burzotta F, Trani C. Atypical Thrombosis Following Mitral Transcatheter Edge-to-Edge Repair: Face to Face Between Scar and Clip. JACC Cardiovasc Interv 2024; 17:566-567. [PMID: 38127028 DOI: 10.1016/j.jcin.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Gabriella Locorotondo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Antonio Maria Leone
- Diagnostic and Interventional Unit, Ospedale Fatebenefratelli Gemelli Isola Tiberina, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Graziani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
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8
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Bianchini E, Lombardi M, Buonpane A, Ricchiuto A, Maino A, Laborante R, Anastasia G, D'Amario D, Aurigemma C, Romagnoli E, Leone AM, D'Ascenzo F, Trani C, Crea F, Porto I, Burzotta F, Vergallo R. Impact of thrombus aspiration on left ventricular remodeling and function in patients with ST-segment elevation myocardial infarction: A meta-analysis of randomized controlled trials. Int J Cardiol 2024; 397:131590. [PMID: 37979785 DOI: 10.1016/j.ijcard.2023.131590] [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: 08/02/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Routine thrombus aspiration (TA) does not improve clinical outcomes in patients with ST-segment-elevation myocardial infarction (STEMI), although data from meta-analyses suggest that patients with high thrombus burden may benefit from it. The impact of TA on left ventricular (LV) functional recovery and remodeling after STEMI remains controversial. We aimed to pool data from randomized controlled trials (RCTs) on the impact of TA on LV function and remodeling after primary percutaneous coronary intervention (pPCI). METHODS PubMed and CENTRAL databases were scanned for eligible studies. Primary outcome measures were: LV ejection fraction (LVEF), LV end diastolic volume (LVEDV), LV end systolic volume (LVESV) and wall motion score index (WMSI). A primary pre-specified subgroup analysis was performed comparing manual TA with mechanical TA. RESULTS A total of 28 studies enrolling 4990 patients were included. WMSI was lower in TA group than in control (mean difference [MD] -0.11, 95% confidence interval [CI] -0.19 to -0.03). A greater LVEF (MD 1.91, 95% CI 0.76 to 3) and a smaller LVESV (MD -6.19, 95% CI -8.7 to -3.6) were observed in manual TA group compared to control. Meta regressions including patients with left anterior descending artery (LAD) involvement showed an association between TA use and the reduction of both LVEDV and LVESV (z = -2.13, p = 0.03; z = -3.7, p < 0.01) and the improvement in myocardial salvage index (z = 2.04, p = 0.04). CONCLUSION TA is associated with improved LV function. TA technique, total ischemic time and LAD involvement appears to influence TA benefit on post-infarction LV remodeling.
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Affiliation(s)
- Emiliano Bianchini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Angela Buonpane
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alessandro Maino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Gianluca Anastasia
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genoa, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Domenico D'Amario
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Italo Porto
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genoa, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.
| | - Rocco Vergallo
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genoa, Italy; Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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9
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Bianchini F, Lombardi M, Ricchiuto A, Paraggio L, Aurigemma C, Romagnoli E, Trani C, Burzotta F. Combined ultrasound and angiographic guidance to facilitate transradial access procedures. Catheter Cardiovasc Interv 2024; 103:443-454. [PMID: 38173287 DOI: 10.1002/ccd.30947] [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: 09/27/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
The introduction of transradial access for percutaneous coronary diagnostic and interventional procedures has led to a decrease in access site complications. The aim of this paper is to propose a combined stepwise technical approach where real time ultrasound ("echo-first" approach) can be used to select the best vascular access and, together with angiography, to manage the potential obstacles that may occur during transradial procedures. In each section, we summarize some tips and tricks based on both our experience and current literature that can be easily implemented in daily practice to increase the success of transradial procedures.
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Affiliation(s)
- Francesco Bianchini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Lombardi
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lazzaro Paraggio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Burzotta F, Bianchini F, Di Giusto F, Bianchini E, Aurigemma C, Romagnoli E, Marano R, Trani C. Long-Term Outcome of Percutaneously Managed Coronary Pseudoaneurysm Caused by Stent Fracture. JACC Cardiovasc Interv 2024; 17:315-316. [PMID: 37943199 DOI: 10.1016/j.jcin.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | - Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Riccardo Marano
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Bianchini E, Morello A, Bellamoli M, Romagnoli E, Aurigemma C, Tagliaferri M, Montonati C, Dumonteil N, Cimmino M, Villa E, Corcione N, Bettari L, Messina A, Stanzione A, Troise G, Mor D, Maggi A, Bellosta R, Pegorer MA, Zoccai GB, Ielasi A, Burzotta F, Trani C, Maffeo D, Tchétché D, Buono A, Giordano A. Comparison of ultrasound- versus fluoroscopy-guidEd femorAl access In tranS-catheter aortic valve replacement In the Era of contempoRary devices: The EASIER registry. Cardiovasc Revasc Med 2023:S1553-8389(23)00938-7. [PMID: 38135568 DOI: 10.1016/j.carrev.2023.12.007] [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: 11/15/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Vascular complications (VCs) still represent one of the principal concerns of trans-femoral trans-catheter aortic valve replacement (TF-TAVR). New-generation devices can minimize such complications but the arterial access management is left to the operator's choice. This study aims to describe the rate of VCs in a contemporary cohort of patients undergoing TAVR with new-generation devices and to determine whether an ultrasound-guided (USG) vs. a fluoroscopy-guided (FG) femoral access management has an impact on their prevention. METHODS This is a prospective, observational, multicenter study. Consecutive patients undergoing TAVR with new-generation devices were analyzed from January 2022 to October 2022 in five tertiary care centers. Femoral accesses were managed according to the operator's preferences. All the patients underwent a pre-discharge peripheral ultrasound control. VCs and bleedings were the main endpoints of interest. RESULTS A total of 458 consecutive patients were enrolled (274 in the USG group and 184 in the FG group). VCs occurred in 6.5 % of the patients (5.2 % minor and 1.3 % major). There was no difference between the USG and the FG groups in terms of any VCs (7.3 % vs. 5.4 %; p = 0.4), or any VARC-3 bleedings (6.9 % vs 6 %, p = 0.9). At logistic regression analysis, the two guidance strategies did not result as predictors of VCs (odds Ratio 0.8, 95 % Confidence Interval 0.46-1.4; P = 0.4). CONCLUSIONS In a contemporary cohort of patients undergoing TAVR with new-generation devices, the occurrence of VCs is low and mostly represented by minor VCs. USG and FG modalities did not affect the rate of VCs.
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Affiliation(s)
- Emiliano Bianchini
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy; Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Morello
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Bellamoli
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy; Clinique Pasteur, Toulouse, France
| | - Enrico Romagnoli
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Carolina Montonati
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
| | | | - Michele Cimmino
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Emmanuel Villa
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Nicola Corcione
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Luca Bettari
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Antonio Messina
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | | | - Giovanni Troise
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Donata Mor
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Antonio Maggi
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Department Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Matteo Alberto Pegorer
- Vascular Surgery, Department Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Alfonso Ielasi
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Diego Maffeo
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy
| | | | - Andrea Buono
- Valve Center, Fondazione Poliambulanza Institute, Brescia, Italy.
| | - Arturo Giordano
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
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12
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D'Amario D, Galli M, Restivo A, Canonico F, Vergallo R, Migliaro S, Trani C, Burzotta F, Aurigemma C, Laborante R, Romagnoli E, Francese F, Ceccarelli I, Borovac JA, Angiolillo DJ, Tavazzi B, Leone AM, Crea F, Patti G, Porto I. Ticagrelor Enhances the Cardioprotective Effects of Ischemic Preconditioning in Stable Patients Undergoing Percutaneous Coronary Intervention: the TAPER-S Randomized Study. Eur Heart J Cardiovasc Pharmacother 2023:pvad092. [PMID: 38006237 DOI: 10.1093/ehjcvp/pvad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
BACKGROUND Ticagrelor improves clinical outcomes in patients with acute coronary syndrome compared with clopidogrel. Ticagrelor also inhibits cell uptake of adenosine and has been associated with cardioprotective effects in animal models. We sought to investigate the potential cardioprotective effects of ticagrelor, as compared with clopidogrel, in stable patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS This was a Prospective Randomized Open Blinded End-points (PROBE) trial enrolling stable patients with coronary artery disease (CAD) requiring fractional flow reserve (FFR)-guided PCI of intermediate epicardial coronary lesions. ST-segment elevation at intracoronary (IC)-ECG during a two-step sequential coronary balloon inflations in the reference vessel during PCI was used as an indirect marker of cardioprotection induced by ischemic preconditioning. The primary endpoint of the study was the comparison of the delta (Δ) (difference) ST-segment elevation measured by intracoronary-ECG during two-step sequential coronary balloon inflations. RESULTS Fifty-three patients were randomized to either clopidogrel or ticagrelor. The study was stopped earlier because the primary endpoint was met at a pre-specified interim analysis. ΔST-segment elevation was significantly higher in ticagrelor as compared to clopidogrel arms (p<0.0001). Ticagrelor was associated with lower angina score during coronary balloon inflations. There was no difference in coronary microvascular resistance between groups. Adenosine serum concentrations were increased in patients treated with ticagrelor as compared to those treated with clopidogrel. CONCLUSIONS Ticagrelor enhances the cardioprotective effects of ischemic preconditioning compared with clopidogrel in stable patients with CAD undergoing PCI. Further studies are warranted to fully elucidate the mechanisms through which ticagrelor may exert cardioprotective effects in humans. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique Identifier: NCT02701140.
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Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Attilio Restivo
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Canonico
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Migliaro
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesca Francese
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ilaria Ceccarelli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Josip A Borovac
- Department of Pathophysiology, University of Split School of Medicine (USSM) and Cardiovascular Diseases Department, University Hospital of Split (KBC Split), Split, Croatia
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Barbara Tavazzi
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular Science, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Patti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino, Genova, Italy - Italian IRCCS Cardiovascular Network
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italy
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13
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Aurigemma C, Massussi M, Fraccaro C, Adamo M, D'Errigo P, Rosato S, Seccareccia F, Santoro G, Baiocchi M, Barbanti M, Biancari F, Baglio G, Marcellusi A, Trani C, Tarantini G. Impact of Chronic Coronary Artery Disease and Revascularization Strategy in Patients with Severe Aortic Stenosis Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 206:14-22. [PMID: 37677878 DOI: 10.1016/j.amjcard.2023.08.045] [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: 03/27/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/09/2023]
Abstract
The prognostic impact of coronary artery disease (CAD) after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study is to investigate the impact of CAD and different revascularization strategies on clinical outcomes in patients who underwent TAVI with third generation devices. Patients enrolled in the national observational Observational Study of Effectiveness of SAVR-TAVI Procedures for Severe Aortic Stenosis Treatment II study were stratified according to the presence of CAD (CAD+, n = 1,130) versus no CAD (CAD-, n = 1,505), and compared using a propensity matched analysis. CAD+ group was further stratified according to the revascularization strategy: no revascularization (n = 331), revascularization performed >90 days before index-TAVI (n = 417) and coronary revascularization performed <90 days before index-TAVI or during TAVI (n = 382). In-hospital, 30-day and 1-year clinical outcomes were estimated. The mean age of the overall population was 81.8 years; 54.9% of patients were female. Propensity score matching yielded 813 pairs and their 30-day all-cause mortality was comparable (p = 0.480). Major periprocedural adverse events were also similar between the groups. At 1-year follow-up, the rate of major adverse cardiac and cerebrovascular events (MACCEs) and all-cause mortality were similar between the groups (p = 0.732 and p = 0.633, respectively). Conversely, patients with CAD experienced more often myocardial infarction and need for percutaneous coronary intervention at 1 year (p = 0.007 and p = 0.001, respectively). Neither CAD nor revascularization strategy were independent predictors of 1-year MACCE. About 40% of patients presenting with severe AS and who underwent TAVI had concomitant CAD. The presence of CAD had no impact on all-cause mortality and MACCE 1-year after TAVR. However, CAD carries a higher risk for acute myocardial infarction and need of percutaneous coronary intervention during follow-up.
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Affiliation(s)
- Cristina Aurigemma
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Mauro Massussi
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Chiara Fraccaro
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Gennaro Santoro
- Fondazione "G. Monasterio" CNR/Regione Toscana per la Ricerca Medica e la Sanità Pubblica, Massa, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Fausto Biancari
- Department of Internal Medicine, South Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA-CEIS), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Giuseppe Tarantini
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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14
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Ravenna E, Locorotondo G, Manfredonia L, Diana G, Filice M, Graziani F, Leone AM, Aurigemma C, Romagnoli E, Burzotta F, Trani C, Massetti M, Lombardo A, Lanza GA. Global longitudinal strain for prediction of mortality in ST-segment elevation myocardial infarction and aortic stenosis patients: two sides of the same coin. Eur Rev Med Pharmacol Sci 2023; 27:10736-10748. [PMID: 37975399 DOI: 10.26355/eurrev_202311_34354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Global longitudinal strain (GLS) predicts major adverse events in ST-segment elevation myocardial infarction (STEMI) and aortic stenosis (AS). Different cut-off values and different end-points have been proposed for prognostic stratification. We aimed to verify whether a single GLS cut-off value can be used to identify increased risk of all-cause death in STEMI and AS. PATIENTS AND METHODS One-hundred- seventeen successfully treated first STEMI (age 63.8±12.5 yrs, 70% men) and 64 AS (age 80.3±6.9 yrs, 44% men) patients, undergoing echocardiography before discharge and before AS treatment, respectively, were retrospectively analyzed. GLS was analyzed, together with pulmonary artery systolic pressure (PASP), Killip class and Genereux stage. End-point was all-cause death at 6-month follow-up. RESULTS All-cause death occurred in 4 (3.4%) STEMI and 5 (7.8%) AS patients (p=ns). AS patients who died had GLS similar to died STEMI patients (9.7±2.1 vs. 11.3±1.7, p=ns). GLS cut-off ≤12% predicted death with 89% sensitivity and 70% specificity (AUC 0.84, p=0.001): STEMI and AS patients with GLS ≤12% had worse survival than STEMI and AS patients with GLS >12% (log-rank p=0.001). At multivariate Cox regression analysis, lower GLS values independently predicted death (HR 0.667, 95% CI 0.451-0.986, p=0.042), and the prediction model was improved when GLS was added to old age, significant comorbidities, PASP and Killip/Genereux stage (χ2 6.691 vs. 1.364, p=0.010). CONCLUSIONS Died patients with STEMI and AS show similar values of GLS. A unique cut-off value of GLS can reliably be used to stratify the risk of all-cause death at 6-month follow-up in both two clinical settings.
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Affiliation(s)
- E Ravenna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Restivo A, Maggio L, Locorotondo G, Costa F, Savino G, Lombardo A, Aurigemma C, Romagnoli E, Trani C, Graziani F, Burzotta F. Unexpected Left Ventricle Pseudoaneurysm With Unusual Origin: History of a Diseased Annulus Broken Into a Diseased Myocardium. Circ Cardiovasc Imaging 2023; 16:e015222. [PMID: 37283043 DOI: 10.1161/circimaging.123.015222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Attilio Restivo
- Department of Cardiovascular Medicine (A.R., L.M., G.L., A.L., C.A., E.R., C.T., F.G., F.B.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.R., L.M., G.S., A.L., C.T., F.B.)
| | - Luca Maggio
- Department of Cardiovascular Medicine (A.R., L.M., G.L., A.L., C.A., E.R., C.T., F.G., F.B.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.R., L.M., G.S., A.L., C.T., F.B.)
| | - Gabriella Locorotondo
- Department of Cardiovascular Medicine (A.R., L.M., G.L., A.L., C.A., E.R., C.T., F.G., F.B.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federico Costa
- Department of Radiological and Hematological Sciences (F.C., G.S.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological and Hematological Sciences (F.C., G.S.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.R., L.M., G.S., A.L., C.T., F.B.)
| | - Antonella Lombardo
- Department of Cardiovascular Medicine (A.R., L.M., G.L., A.L., C.A., E.R., C.T., F.G., F.B.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.R., L.M., G.S., A.L., C.T., F.B.)
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine (A.R., L.M., G.L., A.L., C.A., E.R., C.T., F.G., F.B.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine (A.R., L.M., G.L., A.L., C.A., E.R., C.T., F.G., F.B.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine (A.R., L.M., G.L., A.L., C.A., E.R., C.T., F.G., F.B.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.R., L.M., G.S., A.L., C.T., F.B.)
| | - Francesca Graziani
- Department of Cardiovascular Medicine (A.R., L.M., G.L., A.L., C.A., E.R., C.T., F.G., F.B.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Medicine (A.R., L.M., G.L., A.L., C.A., E.R., C.T., F.G., F.B.), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.R., L.M., G.S., A.L., C.T., F.B.)
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16
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Lombardi M, Chiabrando JG, Romagnoli E, D'Amario D, Leone AM, Aurigemma C, Montone RA, Ricchiuto A, Biondi-Zoccai G, Burzotta F, Jang IK, Escaned J, Trani C, Porto I, Crea F, Vergallo R. Impact of acute and persistent stent malapposition after percutaneous coronary intervention on adverse cardiovascular outcomes. Minerva Cardiol Angiol 2023; 71:525-534. [PMID: 36912166 DOI: 10.23736/s2724-5683.22.06185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION The association of coronary stent malapposition (SM) and adverse clinical outcomes after percutaneous coronary intervention (PCI) remains unclear. We aimed to perform a systematic review and meta-analysis of randomized and observational studies to assess the association between acute and persistent SM detected using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) and adverse cardiovascular outcomes. EVIDENCE ACQUISITION Available studies were identified through a systematic search of PubMed, reference lists of relevant articles, and Medline. Main efficacy outcomes of interest were: device-oriented composite endpoint (DoCE, including cardiac death, myocardial infarction [MI], target lesion revascularization [TLR], and stent thrombosis [ST]), major safety events (MSE, including cardiac death, MI and ST), TLR, and ST. A sensitivity analysis regarding the impact of major malapposition was also performed. EVIDENCE SYNTHESIS A total of 9 studies enrolling 6497 patients were included in the meta-analysis. After a mean follow-up of 24±14 months, overall acute and/or persistent malapposition was not significantly associated with the occurrence of all the outcomes of interest, including DoCE (risk ratio [RR] 1.00, 95% confidence interval [CI, 0.79-1.26], P=0.99), MSE (RR 1.42, 95%CI [0.81-2.50], P=0.22), TLR (RR 0.84, 95%CI [0.59-1.19], P=0.33), and ST (RR 1.16, 95%CI [0.48-2.85], P=0.74). In the sensitivity analysis, we found a significant increase of MSE in patients with major malapposition (RR 2.97, 95%CI [1.51-5.87], P=0.001). CONCLUSIONS Acute and persistent SM were not overall associated with adverse cardiovascular clinical outcomes at follow-up. However, major malapposition was associated with an increased risk of major safety events, including cardiac death, MI and ST. These findings should be taken into account during stent implantation and PCI optimization.
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Affiliation(s)
- Marco Lombardi
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Juan G Chiabrando
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Enrico Romagnoli
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ik-Kyung Jang
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Italo Porto
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy -
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
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Petrolati E, Montone RA, Leone AM, Ricchiuto A, La Vecchia G, Rinaldi R, Fracassi F, Romagnoli E, Paraggio L, Burzotta F, Crea F, Trani C, Aurigemma C. [Myocardial infarction with non-obstructive coronary artery disease: diagnostic work-up in the catheterization laboratory]. G Ital Cardiol (Rome) 2023; 24:21S-28S. [PMID: 37767844 DOI: 10.1714/4101.40991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a heterogeneous clinical condition affecting 5% to 8% of patients presenting with acute myocardial infarction. Initially it was considered a favorable clinical diagnosis, nowadays it is known that MINOCA can significantly affect patient quality of life and portends a guarded prognosis. Therefore, it is of utmost importance to identify the specific pathophysiological mechanism underlying this clinical condition in order to set up a targeted pharmacological and non-pharmacological therapy. Coronary angiography is still a mandatory diagnostic test to rule out obstructive coronary artery disease but has limited capability to identify other potential functional and structural etiologies of MINOCA. The purpose of this review is to provide an overview of the invasive diagnostic work-up of patients with MINOCA, highlighting the diagnostic tools warranted beyond coronary angiography inside the cath lab (intracoronary provocation tests, intracoronary imaging and indexes for the assessment of coronary microvascular dysfunction), and the remaining essential knowledge gaps in this field.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Francesco Burzotta
- Università Cattolica del Sacro Cuore, Roma - Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Filippo Crea
- Università Cattolica del Sacro Cuore, Roma - Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Carlo Trani
- Università Cattolica del Sacro Cuore, Roma - Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
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18
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Romagnoli E, Burzotta F, Cerracchio E, Russo G, Aurigemma C, Pedicino D, Locorotondo G, Graziani F, Leone AM, D'Amario D, Lombardo A, Malara S, Fulco L, Bianchini F, Sanna T, Trani C. Impact of Impella protected-percutaneous coronary intervention on left ventricle function recovery of patients with extensive coronary disease and poor left ventricular function. Int J Cardiol 2023; 387:131098. [PMID: 37290663 DOI: 10.1016/j.ijcard.2023.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/15/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The use of Impella support is increasingly adopted to "protect" patients with severe coronary artery disease (CAD) and left ventricle (LV) dysfunction undergoing percutaneous coronary intervention (PCI). AIMS To evaluate the impact of Impella-protected (Abiomed, Danvers, Massachusetts, USA) PCIs on myocardial function recovery. METHODS Patients with significant LV dysfunction undergoing multi-vessel PCIs with pre-intervention Impella implantation were evaluated by echocardiography before PCI and at median follow up of 6 months: global and segmental LV contractile function were assessed by LV ejection fraction (LVEF) and wall motion score index (WMSI), respectively. Extent of revascularization was graded using the British Cardiovascular Intervention Society Jeopardy score (BCIS-JS). Study endpoints were LVEF and WMSI improvement, and its correlation with revascularization. RESULTS A total of 48 high surgical risk (mean EuroSCORE II 8) patients with median LVEF value of 30%, extensive wall motion abnormalities (median WMSI 2.16), and severe multi-vessel CAD (mean SYNTAX score 35) were included. PCIs brought a significant reduction of ischemic myocardium burden with BCIS-JS decrease from mean value of 12 to 4 (p < 0.001). At follow-up, WMSI reduced from 2.2 to 2.0 (p = 0.004) and LVEF increased from 30% to 35% (p = 0.016). WMSI improvement was proportional to the baseline impairment (R - 0.50, p < 0.001), and confined to revascularized segments (from 2.1 to 1.9, p < 0.001). CONCLUSIONS In patients with extensive CAD and severe LV dysfunction, multi-vessel Impella-protected PCI was associated to an appreciable contractile recovery, mainly determined by regional wall motion improvement in revascularized segments.
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Affiliation(s)
- Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Emma Cerracchio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giulio Russo
- Division of Cardiology, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | | | | | - Antonella Lombardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Silvia Malara
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Linda Fulco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Tommaso Sanna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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Lombardi M, Bianchini F, Romagnoli E, Paraggio L, Aurigemma C, Burzotta F, Trani C. Postcatheterization Forearm Artery Pseudoaneurysm Resolution in the Context of Subsequent PCI. JACC Cardiovasc Interv 2023; 16:2178-2180. [PMID: 37409993 DOI: 10.1016/j.jcin.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Marco Lombardi
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lazzaro Paraggio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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20
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Meucci MC, Malara S, Butcher SC, Hirasawa K, van der Kley F, Lombardo A, Aurigemma C, Romagnoli E, Trani C, Massetti M, Burzotta F, Bax JJ, Crea F, Ajmone Marsan N, Graziani F. Evolution and Prognostic Impact of Right Ventricular-Pulmonary Artery Coupling After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2023; 16:1612-1621. [PMID: 37438027 DOI: 10.1016/j.jcin.2023.05.003] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND There is limited evidence regarding the association between right ventricular-to-pulmonary artery (RV-PA) coupling and outcomes after transcatheter aortic valve replacement (TAVR). OBJECTIVES This study aimed to explore the evolution of RV-PA coupling in patients with severe aortic stenosis undergoing TAVR and its prognostic impact. METHODS A total of 900 patients who underwent TAVR in 2 tertiary centers and with echocardiographic analysis performed within 3 months before and after the procedure were included. RV-PA coupling was measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). RV-PA uncoupling was defined by TAPSE/PASP <0.55, whereas a TAPSE/PASP <0.32 identified a severe uncoupling. The primary endpoint was all-cause mortality. RESULTS A total of 520 patients (58%) showed RV-PA uncoupling before TAVR, whereas post-TAVR RV-PA uncoupling was observed in 407 patients (45%). During a median follow-up of 40 months, 250 deaths (28%) occurred. Post-TAVR RV-PA uncoupling was independently associated with an increased risk of mortality (adjusted HR: 1.474; 95% CI: 1.115-1.948; P = 0.006), whereas pre-TAVR uncoupling did not. Among patients with post-TAVR RV-PA uncoupling, the presence of severe uncoupling identified a subgroup with the worst survival (P = 0.008). Patients with RV-PA coupling recovery after TAVR showed similar outcomes as compared with patients with normal coupling. Conversely, the presence of either persistent or new-onset RV-PA uncoupling following TAVR was associated with an increased mortality risk. CONCLUSIONS Post-TAVR RV-PA uncoupling is an independent predictor of long-term mortality, irrespective of coupling before intervention. Assessment of TAPSE/PASP response after TAVR may be helpful to improve risk stratification.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Silvia Malara
- Catholic University of the Sacred Heart, Rome, Italy
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Antonella Lombardo
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Filippo Crea
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Francesca Graziani
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Zito A, Galli M, Biondi-Zoccai G, Abbate A, Douglas PS, Princi G, D'Amario D, Aurigemma C, Romagnoli E, Trani C, Burzotta F. Diagnostic Strategies for the Assessment of Suspected Stable Coronary Artery Disease : A Systematic Review and Meta-analysis. Ann Intern Med 2023. [PMID: 37276592 DOI: 10.7326/m23-0231] [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: 06/07/2023] Open
Abstract
BACKGROUND There is uncertainty about which diagnostic strategy for detecting coronary artery disease (CAD) provides better outcomes. PURPOSE To compare the effect on clinical management and subsequent health effects of alternative diagnostic strategies for the initial assessment of suspected stable CAD. DATA SOURCES PubMed, Embase, and Cochrane Central Register of Controlled Trials. STUDY SELECTION Randomized clinical trials comparing diagnostic strategies for CAD detection among patients with symptoms suggestive of stable CAD. DATA EXTRACTION Three investigators independently extracted study data. DATA SYNTHESIS The strongest available evidence was for 3 of the 6 comparisons: coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) (4 trials), CCTA versus exercise electrocardiography (ECG) (2 trials), and CCTA versus stress single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) (5 trials). Compared with direct ICA referral, CCTA was associated with no difference in cardiovascular death and myocardial infarction (relative risk [RR], 0.84 [95% CI, 0.52 to 1.35]; low certainty) but less index ICA (RR, 0.23 [CI, 0.22 to 0.25]; high certainty) and index revascularization (RR, 0.71 [CI, 0.63 to 0.80]; moderate certainty). Moreover, CCTA was associated with a reduction in cardiovascular death and myocardial infarction compared with exercise ECG (RR, 0.66 [CI, 0.44 to 0.99]; moderate certainty) and SPECT-MPI (RR, 0.64 [CI, 0.45 to 0.90]; high certainty). However, CCTA was associated with more index revascularization (RR, 1.78 [CI, 1.33 to 2.38]; moderate certainty) but less downstream testing (RR, 0.56 [CI, 0.45 to 0.71]; very low certainty) than exercise ECG. Low-certainty evidence compared SPECT-MPI versus exercise ECG (2 trials), SPECT-MPI versus stress cardiovascular magnetic resonance imaging (1 trial), and stress echocardiography versus exercise ECG (1 trial). LIMITATION Most comparisons primarily rely on a single study, many studies were underpowered to detect potential differences in direct health outcomes, and individual patient data were lacking. CONCLUSION For the initial assessment of patients with suspected stable CAD, CCTA was associated with similar health effects to direct ICA referral, and with a health benefit compared with exercise ECG and SPECT-MPI. Further research is needed to better assess the relative performance of each diagnostic strategy. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42022329635).
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.Z., G.P.)
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (M.G.)
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy (G.B.)
- Mediterranea Cardiocentro, Napoli, Italy (G.B.)
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, Virginia (A.A.)
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (P.S.D.)
| | - Giuseppe Princi
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy (A.Z., G.P.)
| | - Domenico D'Amario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy (D.D.)
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R.)
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R.)
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.T., F.B.)
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, and Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.T., F.B.)
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22
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Aurigemma C, Trani C, D'Errigo P, Barbanti M, Biancari F, Tarantini G, Santoro G, Baiocchi M, Baglio G, Seccareccia F, Rosato S. Impact of vascular complications after transcatheter aortic valve implantation. VASC-OBSERVANT II sub-study. Catheter Cardiovasc Interv 2023. [PMID: 37265025 DOI: 10.1002/ccd.30695] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/21/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Trans-femoral (TF) access is the commonest approach for transcatheter aortic valve implantation (TAVI). However this vascular approach is associated with vascular complications (VC) which in turn have prognostic implications. The aim of this study is to evaluate the clinical impact of access site VC in patients undergoing TAVI with newer generation transcatheter prostheses enrolled in the national observational prospective multicenter study OBSERVANT II. METHODS Vascular events were defined according to the Valve Academic Research Consortium (VARC)-2 criteria. The population enrolled in OBSERVANT II was divided into 3 groups: patients without VC (No-VC), patients with minor VC or percutaneous closure device failure (Minor-VC) and patients with major VC (Major-VC). The primary endpoint was 1-year major adverse cardiac and cerebrovascular event (MACCE), a composite endpoint of all-cause mortality, stroke, myocardial infarction and coronary revascularization. A multivariate Cox regression model was used for risk estimation of MACCE between the three analyzed groups. RESULTS 2.504 patients were included in this analysis: 2.167 patients in No-VC group; 249 patients in the Minor-VC and 88 patients in the Major-VC. At 1-year Minor-VC group had a freedom from MACCE comparable to the No-VC group, while Major-VC patients had significantly worse outcome (Log-rank test: p = 0.003). These results were driven by higher 1-year mortality in the Major-VC (p < 0.0001). Major-VC was an independent predictor of MACCE in adjusted analysis (hazard ratio 1.89, 95% confidence interval 1.18-3.03, p = 0.008). CONCLUSIONS Despite a low incidence of major VC with current TF-TAVI devices, our data confirm that major VC is still associated with a significantly worse clinical outcome.
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Affiliation(s)
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore Roma, Roma, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, Division of Cardiology, University of Padova, Padova, Italy
| | - Gennaro Santoro
- Fondazione " G. Monasterio" CNR/Regione Toscana per la Ricerca Medica e la Sanità Pubblica, Massa, Italy
| | | | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
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23
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Aurigemma C, Romagnoli E, Burzotta F, Trani C. Transcatheter aortic valve implantation: does the age matter? Minerva Cardiol Angiol 2023; 71:321-323. [PMID: 36719672 DOI: 10.23736/s2724-5683.22.06133-6] [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] [Indexed: 02/01/2023]
Affiliation(s)
- Cristina Aurigemma
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy -
| | | | - Carlo Trani
- Università Cattolica del Sacro Cuore, Rome, Italy
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24
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Ding D, Tu S, Li Y, Li C, Yu W, Liu X, Leone AM, Aurigemma C, Romagnoli E, Vergallo R, Trani C, Wijns W, Burzotta F. Quantitative flow ratio modulated by intracoronary optical coherence tomography for predicting physiological efficacy of percutaneous coronary intervention. Catheter Cardiovasc Interv 2023. [PMID: 37172214 DOI: 10.1002/ccd.30681] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/07/2023] [Accepted: 04/30/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND The combination of coronary imaging assessment and blood flow perturbation estimation has the potential to improve percutaneous coronary intervention (PCI) guidance. OBJECTIVES We aimed to evaluate a novel method for fast computation of Murray law-based quantitative flow ratio (μQFR) from coregistered optical coherence tomography (OCT) and angiography (OCT-modulated μQFR, OCT-μQFR) in predicting physiological efficacy of PCI. METHODS Patients treated by OCT-guided PCI in the OCT-arm of the Fractional Flow Reserve versus Optical Coherence Tomography to Guide RevasculariZAtion of Intermediate Coronary Stenoses trial (FORZA, NCT01824030) were included. Based on angiography and OCT before PCI, simulated residual OCT-μQFR was computed by assuming full stent expansion to the intended-to-treat segment. Plaque composition was automatically characterized using a validated artificial intelligence algorithm. Actual post-PCI OCT-μQFR pullback was computed based on coregistration of angiography and OCT acquired immediately after PCI. Suboptimal functional stenting result was defined as OCT-μQFR ≤ 0.90. RESULTS Paired simulated residual OCT-μQFR and actual post-PCI OCT-μQFR were obtained in 76 vessels from 74 patients. Simulated residual OCT-μQFR showed good correlation (r = 0.80, p < 0.001), agreement (mean difference = -0.02 ± 0.02, p < 0.001), and diagnostic concordance (79%, 95% confidence interval: 70%-88%) with actual post-PCI OCT-μQFR. Actual post-PCI in-stent OCT-μQFR had a median value of 0.02 and was associated with left anterior descending artery lesion location (β = 0.38, p < 0.001), higher baseline total plaque burden (β = 0.25, p = 0.031), and fibrous plaque volume (β = 0.24, p = 0.026). CONCLUSIONS This study based on patients enrolled in a prospective OCT-guidance PCI trial shows that simulated residual OCT-μQFR had good correlation, agreement, and diagnostic concordance with actual post-PCI OCT-μQFR. In OCT-guided procedures, OCT-μQFR in-stent pressure drop was low and was significantly predicted by pre-PCI vessel/plaque characteristics.
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Affiliation(s)
- Daixin Ding
- Smart Sensors Laboratory and CÚRAM, Lambe Institute for Translational Research, University of Galway, Galway, Ireland
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yingguang Li
- International Smart Medical Devices Innovation Center, Kunshan Industrial Technology Research Institute, Suzhou, China
| | - Chunming Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Yu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xun Liu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Antonio Maria Leone
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - William Wijns
- Smart Sensors Laboratory and CÚRAM, Lambe Institute for Translational Research, University of Galway, Galway, Ireland
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy
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25
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Cangemi S, Burzotta F, Bianchini F, DeVos A, Valenzuela T, Trani C, Aurigemma C, Romagnoli E, Lassen JF, Stankovic G, Iaizzo PA. Configuration of two-stent coronary bifurcation techniques in explanted beating hearts: the MOBBEM study. EUROINTERVENTION 2023:EIJ-D-23-00063. [PMID: 37171514 PMCID: PMC10397672 DOI: 10.4244/eij-d-23-00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND In patients with complex coronary bifurcation lesions undergoing percutaneous coronary intervention (PCI), various 2-stent techniques might be utilised. The Visible Heart Laboratories (VHL) offer an experimental environment where PCI results can be assessed by multimodality imaging. AIMS We aimed to assess the post-PCI stent configuration achieved by 2-stent techniques in the VHL and to evaluate the procedural factors associated with suboptimal results. METHODS Bifurcation PCI with 2-stent techniques, performed by expert operators in the VHL on explanted beating swine hearts, was studied. The adopted bifurcation PCI strategy and the specific procedural steps applied in each procedure were classified according to Main, Across, Distal, Side (MADS)-2 and to their adherence to the European Bifurcation Club (EBC) recommendations. Microcomputed tomography (micro-CT) was used to assess the post-PCI stent configuration. The primary endpoint was "suboptimal stent implantation", defined as a composite of stent underexpansion (<90%), side branch ostial area stenosis >50% and the gap between stents. RESULTS A total of 82 PCI with bifurcation stenting were assessed, comprised of 29 crush, 25 culotte, 28 T/T and small protrusion (TAP) techniques. Suboptimal stent implantation was observed in as many as 53.7% of the cases, regardless of baseline anatomy or the stenting strategy. However, less frequent use of the proximal optimisation technique (POT; p=0.015) and kissing balloon inflations (KBI; p=0.027) and no adherence to EBC recommendations (p=0.004, p multivariate=0.006) were significantly associated with the primary endpoint. CONCLUSIONS Commonly practised bifurcation 2-stent techniques may result in imperfect stent configurations. More frequent use of POT/KBI and adherence to expert recommendations might reduce the occurrence of post-PCI suboptimal stent configurations.
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Affiliation(s)
- Stefano Cangemi
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amanda DeVos
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Thomas Valenzuela
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jens Flested Lassen
- Department of Cardiology B, Odense University Hospital & University of Southern Denmark, Odense C, Denmark
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Paul Anthony Iaizzo
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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26
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Aurigemma C, Giannico MB, Burzotta F, Romagnoli E, Cangemi S, Bianchini F, Bruno P, Leone AM, Gaspardone A, Crea F, Trani C. Clinical impact of the extent of jeopardized myocardium in patients undergoing transcatheter aortic valve intervention. Rev Esp Cardiol (Engl Ed) 2023; 76:157-164. [PMID: 35691553 DOI: 10.1016/j.rec.2022.05.020] [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: 11/07/2021] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Coronary artery disease (CAD) is found in 30%-50% of patients with severe aortic stenosis (AS) undergoing treatment. The best management of CAD in AS patients undergoing transcatheter aortic valve implantation (TAVI) is still unclear. We investigated the clinical impact of the extent of jeopardized myocardium in patients with concomitant CAD and severe AS treated by TAVI. METHODS Consecutive patients who underwent TAVI procedures at our hospital were identified. In the presence of CAD, the myocardium jeopardized before TAVI was graded using the British Cardiovascular Intervention Society (BCIS) jeopardy score (JS). The study population was divided in 3 groups: patients without concomitant CAD (no-CAD), patients with CAD and BCIS-JS ≤ 4 (CAD BCIS-JS ≤ 4) and patients with concomitant CAD and BCIS-JS> 4 (CAD BCIS-JS> 4). The primary study endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS A total of 403 patients entered the study: 223 no-CAD, 94 CAD BCIS-JS ≤ 4 and 86 CAD BCIS-JS> 4. At> 3 months of follow-up [range 104-3296 days], patients without CAD and CAD patients with BCIS-JS ≤ 4 had better survival free from MACCE compared with those with less extensive revascularization (BCIS-JS> 4) (P=.049). This result was driven by a significant reduction in death (P=.031). On multivariate analysis, residual BCIS-JS ≤ 4 and NYHA class III-IV independently predicted MACCE. CONCLUSIONS In patients with concomitant CAD and severe AS, the extent of jeopardized myocardium before TAVI impacts on clinical outcomes.
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Affiliation(s)
- Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Benedetta Giannico
- Unità Operativa Complessa Cardiologia (UOC), Ospedale Sant'Eugenio di Roma, ASL Roma 2, Rome, Italy
| | - Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Enrico Romagnoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Cangemi
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bianchini
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Maria Leone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Achille Gaspardone
- Unità Operativa Complessa Cardiologia (UOC), Ospedale Sant'Eugenio di Roma, ASL Roma 2, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
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27
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Bianchini F, Cangemi S, DeVos A, Bielecki M, Aurigemma C, Romagnoli E, Trani C, Iaizzo PA, Burzotta F. Multimodal Comparisons of Results Achieved by Different Side Branch Ballooning Techniques for Bifurcation Provisional Stenting. Circ Cardiovasc Interv 2023; 16:e012908. [PMID: 36943931 DOI: 10.1161/circinterventions.123.012908] [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: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Stepwise provisional stenting is the gold standard for percutaneous coronary intervention (PCI) on bifurcation lesions, but the optimal ballooning technique for eventual side branch treatment is not established. The objective of the present study was to compare the stent configuration obtained by 2 different side branch optimization techniques performed after main vessel (MV) stent implantation: proximal optimization technique+kissing balloon inflation+final proximal optimization technique (POT/KBI/POT [PKP]) versus proximal optimization technique+isolated side branch dilation+final proximal optimization technique (POT-side-POT [PSP]). METHODS We realized a 1:1 prospective randomized trial comparing bifurcation PCI conducted (under angiographic and angioscopic visualization) with either PKP or PSP in reanimated swine hearts using commercially available drug-eluting stents. After PCI, the obtained stent configuration (expansion, eccentricity, apposition) was assessed by optical coherence tomography and micro-computed tomography dividing the stent in 4 segments. Primary study end point was minimum stent expansion at the distal MV segment. RESULTS A total of 30 PCIs were successfully performed according to randomization obtaining overall good results (average minimum stent expansion >90% at optical coherence tomography and micro-computed tomography) with PSP or PKP. Minimum stent expansion at the distal MV segment was significantly higher with PKP as compared with PSP at optical coherence tomography (97.9±4.2% versus 91.0±7.7%; P=0.002) and micro-computed tomography (98.1±4.1% versus 91.3±7.9%; P=0.006). Other significant findings included higher stent eccentricity index at proximal MV with PSP, higher side branch scaffolding length and lower malapposition (at bifurcation core and distal MV) with PKP. CONCLUSIONS This first prospective randomized trial in a unique non-atherosclerotic preclinical environment showed that bifurcation PCI conducted with PSP and PKP achieves different stent configurations. These findings might be useful in bifurcation PCI practice and call for further evaluations in clinical ground.
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Affiliation(s)
- Francesco Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy (F.B., S.C., C.T., F.B.)
| | - Stefano Cangemi
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy (F.B., S.C., C.T., F.B.)
| | - Amanda DeVos
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis (A.D., M.B., P.A.I.)
| | - Michael Bielecki
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis (A.D., M.B., P.A.I.)
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., C.T., F.B.)
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., C.T., F.B.)
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy (F.B., S.C., C.T., F.B.)
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., C.T., F.B.)
| | - Paul Anthony Iaizzo
- Visible Heart Laboratories, Department of Surgery, University of Minnesota, Minneapolis (A.D., M.B., P.A.I.)
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy (F.B., S.C., C.T., F.B.)
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (C.A., E.R., C.T., F.B.)
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28
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Vergallo R, Lombardi M, Besis G, Migliaro S, Ricchiuto A, Maino A, Buonpane A, Bianchini E, Annibali G, Galli M, D'Amario D, Montone RA, Leone AM, Aurigemma C, Romagnoli E, Buffon A, Hamilton-Craig C, Burzotta F, Porto I, Trani C, Crea F. Pre-stenting residual thrombotic volume assessed by dual quantitative coronary angiography predicts microvascular obstruction in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Minerva Cardiol Angiol 2023:S2724-5683.22.06156-7. [PMID: 36847435 DOI: 10.23736/s2724-5683.22.06156-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Microvascular obstruction (MVO) is a frequent occurrence after primary percutaneous coronary intervention (pPCI), and is associated with adverse left ventricular remodeling and worse clinical outcome. Distal embolization of thrombotic material is one of the most important underlying mechanisms. The aim of this study was to investigate the relation between the thrombotic volume evaluated by dual quantitative coronary angiography (QCA) prior to stenting and the occurrence of MVO as assessed by cardiac magnetic resonance (CMR). METHODS Forty-eight patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI and receiving CMR within 7 days from admission were included. Pre-stenting residual thrombus volume at the site of the culprit lesion was measured by applying automated edge detection and video-assisted densitometry techniques (i.e., dual-QCA), and patients were categorized into tertiles of thrombus volume. The presence of delayed-enhancement MVO, as well as its extent (MVO mass), were assessed by CMR. RESULTS Pre-stenting dual-QCA thrombus volume was significantly greater in patients with MVO than in those without (5.85 mm3 [2.05-16.71] vs. 1.88 mm3 [1.03-6.92], P=0.009). Patients in the highest tertile showed greater MVO mass compared to those in the mid and lowest tertiles (113.3 gr [0.0-203.8] vs. 58.5 g [0.00-144.4] vs. 0.0 g [0.0-60.225], respectively; P=0.031). The best cut-off value of dual-QCA thrombus volume for prediction of MVO was 2.07 mm3 (AUC: 0.720). The addition of dual-QCA thrombus volume to the traditional angiographic indices of no-reflow enhanced the prediction of MVO by CMR (R=0.752). CONCLUSIONS Pre-stenting dual-QCA thrombus volume is associated with the presence and extent of MVO detected by CMR in patients with STEMI. This methodology may aid the identification of patients at higher risk of MVO and guide adoption of preventive strategies.
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Affiliation(s)
- Rocco Vergallo
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy - .,Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy -
| | - Marco Lombardi
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Giorgos Besis
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Migliaro
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alfredo Ricchiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Alessandro Maino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ferrara, Italy
| | - Angela Buonpane
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Gianmarco Annibali
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ferrara, Italy
| | - Domenico D'Amario
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Antonino Buffon
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Italo Porto
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Hospital, Genoa, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
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Aurigemma C, Burzotta F, Trani C. Heart valve disease gender difference in the era of transcatether treatment. HVT 2023. [DOI: 10.24969/hvt.2023.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Available data have demonstrated important sex-related differences in patients with valvular heart disease, regarding clinical presentation, treatment, and outcomes. Although the calcific aortic stenosis (AS) is more frequent in men compared to women, the majority of AS patients over 80 years old are women, in whom fibrotic remodeling of aortic valve is typically found. Mitral valve disease is more common in women. However females are under-referred or delayed referrals to treatment, probably due to the absence of sex-based LV dimension values guiding surgical timing. The development of transcatheter devices have revolutionized the treatment of valvular heart disease and increased the interest in this topic.
In this context, the consideration of gender differences in presentation, diagnosis, treatment success, and prognosis is of great importance.
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30
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Laborante R, Bianchini E, Restivo A, Ciliberti G, Galli M, Vergallo R, Rodolico D, Zito A, Princi G, Leone AM, Aurigemma C, Romagnoli E, Montone RA, Burzotta F, Trani C, Crea F, D'Amario D. Adenosine as adjunctive therapy in acute coronary syndrome: a meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother 2023; 9:173-182. [PMID: 36496163 DOI: 10.1093/ehjcvp/pvac069] [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: 10/19/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
AIMS Adenosine has been tested in several randomized controlled trials (RCTs) to minimize the incidence of coronary microvascular obstruction (CMVO). The aim of this study was to pool all the RCTs comparing intracoronary or intravenous adenosine versus placebo in patients with acute coronary syndrome (ACS) undergoing myocardial revascularization. METHODS AND RESULTS PubMed and Scopus electronic databases were scanned for eligible studies up to 5th June 2022. A total of 26 RCTs with 5843 patients were included. Efficacy endpoints were major adverse cardiac events (MACE), all-cause death, non-fatal myocardial infarction, and heart failure. Atrioventricular blocks and ventricular fibrillation/sustained ventricular tachycardia (VF/SVT) were the safety endpoints. Myocardial blush grade, thrombolysis in myocardial infarction (TIMI) flow grade, left ventricular ejection fraction (LVEF), infarct size, and ST-segment resolution were also assessed. Adenosine administration was not associated with any clinical benefit in terms of MACE, all-cause death, non-fatal myocardial infarction, and heart failure. However, adenosine was associated with an increased rate of advanced atrioventricular blocks and of VF/SVT in studies with total mean ischaemic time >3 h, compared to placebo. Remarkably, among patients undergoing percutaneous coronary intervention, adenosine was associated with reduced myocardial blush grade 0-1 and TIMI flow grade 0-2, compared to placebo. Furthermore, adenosine did not show favourable effects on LVEF and infarct size. CONCLUSION Adenosine infusion, as adjunctive therapy in ACS, was associated with an increased risk of advanced atrioventricular blocks and increased rates of adenosine-triggered ventricular arrhythmias in patients with long ischaemic time, without providing any clinical benefit compared to placebo.
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Affiliation(s)
- Renzo Laborante
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Mattia Galli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy.,Department of Cardiology, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Cotignola 48033, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Andrea Zito
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome 00168, Italy.,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Domenico D'Amario
- Department of Translational Medicine, Università del Piemonte Orientale, Padiglione G, L.go Bellini, Novara, NO, 28100, Italy
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Burzotta F, Aurigemma C, Paraggio L, Romagnoli E, Leone AM, Vergallo R, Cangemi S, Bianchini F, Trani C. Under-deployment of extra-large drug-eluting stent: an adapted provisional technique for selected patients with distal lesions in large left main. Minerva Cardiol Angiol 2023; 71:20-26. [PMID: 33703859 DOI: 10.23736/s2724-5683.21.05545-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In provisional technique, main vessel (MV) drug-eluting stent (DES) diameter is usually selected according to distal MV to reduce carina shift. Proximal optimization technique (POT) is used to expand the DES in the proximal MV. Occasionally, the size discrepancy between left main (LM) and left anterior descending artery (LAD) may be huge and this may cause stent malapposition and poor vessel wall coverage in large-sized LM. Recently, some manufactures designed extra-large DES to treat large vessels. METHODS We developed an "adapted" provisional strategy based on under-deployment of extra-large DES in case of major size mismatch between LM and proximal LAD. Bench tests were realized in appropriately designed LM bifurcation model using an extra-large DES (Onyx XL, Medtronic, Santa Rosa, CA, USA). This technique was adopted when such "rare" anatomy was found in our clinical practice. RESULTS At bench test, Onyx XL 4.5 mm stent reaches 3.8 mm at 5-6 atmospheres, with favorable stent deformation achieved after POT, kissing balloon and re-POT. This technique was performed in 10 patients undergoing unprotected LM stenting with large LM and major mismatch toward LAD. Angiographic success was achieved in all cases and optical coherence tomography assessment was performed in 5 patients revealing optimal stent result. After a follow-up of 557 days (range: 90-1369 days), clinical course was uneventful in all treated patients. CONCLUSIONS Under-deployment of extra-large DES is a technical option that can be considered to optimize the provisional stenting technique in selected patients with major diameter mismatch between large-sized LM and LAD.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy - .,Sacred Heart Catholic University, Rome, Italy -
| | - Cristina Aurigemma
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Lazzaro Paraggio
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Enrico Romagnoli
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonio M Leone
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Rocco Vergallo
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Stefano Cangemi
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Francesco Bianchini
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
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Russo G, Pedicino D, Chiastra C, Vinci R, Lodi Rizzini M, Genuardi L, Sarraf M, d'Aiello A, Bologna M, Aurigemma C, Bonanni A, Bellantoni A, D'Ascenzo F, Ciampi P, Zambrano A, Mainardi L, Ponzo M, Severino A, Trani C, Massetti M, Gallo D, Migliavacca F, Maisano F, Lerman A, Morbiducci U, Burzotta F, Crea F, Liuzzo G. Coronary artery plaque rupture and erosion: Role of wall shear stress profiling and biological patterns in acute coronary syndromes. Int J Cardiol 2023; 370:356-365. [PMID: 36343795 DOI: 10.1016/j.ijcard.2022.10.139] [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: 05/31/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
AIMS Wall shear stress (WSS) is involved in coronary artery plaque pathological mechanisms and modulation of gene expression. This study aims to provide a comprehensive haemodynamic and biological description of unstable (intact-fibrous-cap, IFC, and ruptured-fibrous-cap, RFC) and stable (chronic coronary syndrome, CCS) plaques and investigate any correlation between WSS and molecular pathways. METHODS AND RESULTS We enrolled 24 CCS and 25 Non-ST Elevation Myocardial Infarction-ACS patients with IFC (n = 11) and RFC (n = 14) culprit lesions according to optical coherence tomography analysis. A real-time PCR primer array was performed on peripheral blood mononuclear cells for 17 different molecules whose expression is linked to WSS. Computational fluid dynamics simulations were performed in high-fidelity 3D-coronary artery anatomical models for three patients per group. A total of nine genes were significantly overexpressed in the unstable patients as compared to CCS patients, with no differences between IFC and RFC groups (GPX1, MMP1, MMP9, NOS3, PLA2G7, PI16, SOD1, TIMP1, and TFRC) while four displayed different levels between IFC and RFC groups (TNFα, ADAMTS13, EDN1, and LGALS8). A significantly higher WSS was observed in the RFC group (p < 0.001) compared to the two other groups. A significant correlation was observed between TNFα (p < 0.001), EDN1 (p = 0.036), and MMP9 (p = 0.005) and WSS values in the RFC group. CONCLUSIONS Our data demonstrate that IFC and RFC plaques are subject to different WSS conditions and gene expressions, suggesting that WSS profiling may play an essential role in the plaque instability characterization with relevant diagnostic and therapeutic implications in the era of precision medicine.
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Affiliation(s)
- Giulio Russo
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy; University of Zurich, Zurich, Switzerland
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Claudio Chiastra
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Ramona Vinci
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maurizio Lodi Rizzini
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Lorenzo Genuardi
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Mohammad Sarraf
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Alessia d'Aiello
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco Bologna
- Biosignals, Bioimaging and Bioinformatics Laboratory (B3-Lab), Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Cristina Aurigemma
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alice Bonanni
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Bellantoni
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Fabrizio D'Ascenzo
- Hemodynamic Laboratory, Dept. of Medical Sciences, University of Turin, Turin, Italy
| | - Pellegrino Ciampi
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Luca Mainardi
- Biosignals, Bioimaging and Bioinformatics Laboratory (B3-Lab), Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Myriana Ponzo
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Carlo Trani
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Massimo Massetti
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Francesco Maisano
- University of Zurich, Zurich, Switzerland; University Hospital San Raffaele, Milan, Italy
| | - Amir Lerman
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanna Liuzzo
- Fondazione Policlinico Universitario A Gemelli IRCSS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
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Laborante R, Bianchini E, Ciliberti G, Restivo A, Galli M, Zito A, Princi G, Antonio Montone R, Vergallo R, Romagnoli E, Aurigemma C, Maria Leone A, Burzotta F, Trani C, Crea F, D´amario D. 515 ADENOSINE AS ADJUNCTIVE THERAPY IN PATIENTS WITH ACUTE CORONARY SYNDROME: WHEN LESS IS MORE. AN UPDATED META-ANALYSIS OF 26 RANDOMIZED CONTROLLED TRIALS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.316] [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
Percutaneous coronary intervention (PCI) is the milestone of treatment for patients with acute coronary syndrome (ACS). However, a considerable number of patients do not achieve a complete myocardial reperfusion since coronary microvascular obstruction (CMVO) might occur. Adenosine is one of the pharmacological strategies tested in several randomized controlled trials (RCTs) to minimize the incidence of CMVO. However, conflicting results have been reported so far. The aim of the present study was to evaluate all the RCTs comparing intracoronary or intravenous adenosine versus placebo as adjunctive therapy in patients with ACS undergoing PCI or thrombolysis.
Methods
PubMed and Scopus electronic databases were scanned for eligible studies up to June 5th, 2022. Our meta-analysis included 26 randomized RCTs with a total of 5843 patients involved. Primary endpoints were the rate of clinical events, defined as major adverse cardiovascular events (MACE), heart failure (HF), all-cause-death and non-fatal myocardial infarction (MI). The rate of advanced atrioventricular (AV) blocks and ventricular fibrillation/sustained ventricular tachycardia (VF/SVT) were considered as safety endpoints. Further subgroup analyses and meta regressions were conducted to evaluate the role of different procedural and non-procedural factors influencing the results. Finally, a secondary analysis was conducted only including RCTs enrolling patients with ST-segment elevation myocardial infarction (STEMI).
Results
Adenosine administration did not confer any significant clinical benefit in terms of reduction of MACE (RR 0.91 CI 0.79-1.05, p 0.16), all-cause-death (RR 0.90 CI0.74-1.09, p 0.28), non-fatal MI (RR 1 CI 0.74 - 1.35, p 0.44) and HF (RR 0.94 CI 0.77-1.16, p 0.59). Remarkably, adenosine was associated with a significant reduction of post-procedural CMVO parameters such as Myocardial Blush Grade (MBG) 0-1 (RR 0.69 CI 0.53-0.90, p 0.01) and Thrombolysis In Myocardial Infarction (TIMI) flow grade 0-2 (RR 0.67 CI 0.53-0.85, p <0.01), when compared to placebo. Secondary analyses of STEMI patients showed similar results. As regards safety, adenosine therapy was associated with a higher rate of advanced AV blocks (RR 2.72 CI 1.57-4.74, p <0.01). A higher rate of VF/SVT was observed with adenosine in studies with total mean ischemic time >3 hours (RR 1.67 CI 1.14-2.42)
Conclusions
This is the most up-to-date meta-analysis summarizing the available evidence on adenosine safety and efficacy in the prevention or treatment of CMVO in ACS patients. Although adenosine improves surrogate parameters of myocardial perfusion, its use does not provide any clinical benefits. Additionally, adenosine infusion increases the risk of advanced AV blocks. Moreover, a longer ischemic time seems to be associated with a higher rate of adenosine-triggered ventricular arrhythmias, suggesting that higher myocardial ischemic damage may represent a substrate for adenosine arrhythmogenic effects.
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Affiliation(s)
- Renzo Laborante
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Emiliano Bianchini
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Giuseppe Ciliberti
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Attilio Restivo
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Mattia Galli
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Maria Cecilia Hospital, Gvm Care E Research , Cotignola , Italy
| | - Andrea Zito
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Giuseppe Princi
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Rocco Antonio Montone
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Rocco Vergallo
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Enrico Romagnoli
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Cristina Aurigemma
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Antonio Maria Leone
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Francesco Burzotta
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Carlo Trani
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Filippo Crea
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Domenico D´amario
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
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Zito A, Galli M, Biondi-zoccai G, Abbate A, Princi G, D´amario D, Aurigemma C, Romagnoli E, Trani C, Burzotta F. 901 DIAGNOSTIC STRATEGIES FOR THE ASSESSMENT OF SUSPECTED STABLE CORONARY ARTERY DISEASE: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.250] [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
It is unclear which diagnostic strategy for detecting coronary artery disease (CAD) yields better outcomes. We aimed to compare the clinical accuracy and efficacy of non-invasive and invasive diagnostic strategies for the initial assessment of patients with suspected stable CAD.
Methods
On March 16, 2022, we searched PubMed, Embase, and CENTRAL databases for randomised controlled trials comparing diagnostic strategies for CAD detection among patients with symptoms suggestive of stable CAD. Diagnostic modalities included coronary computed tomographic angiography (CCTA), cardiovascular magnetic resonance (CMR), exercise electrocardiography, invasive coronary angiography (ICA), single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI), and stress echocardiography. Functional tests were grouped into a single node for the primary analyses, while being analysed as separate nodes for the secondary analyses. Frequentist random-effect network meta-analyses were conducted to summarise the evidence. GRADE frameworks were applied to rate the certainty of findings. The primary efficacy outcome was trial-defined major adverse cardiovascular events (MACE) and the primary accuracy outcome was the rate of unnecessary angiography. The study was registered with PROSPERO (CRD42022329635).
Results
Twenty trials (n=27753 participants) were included. Compared with direct-ICA referral, CCTA and functional testing provided no significant difference in the risk of MACE (incidence rate ratios [IRRs] 0·87 [95% CI 0·65-1·17] and 1·19 [95% CI 0·87-1·62], respectively; moderate certainty) and a large reduction in the rate of unnecessary angiography (odds ratios 0·04 [95% CI 0·02-0·09] and 0·08 [95% CI 0·03-0·18], respectively; high certainty). Among non-invasive diagnostic strategies, CCTA significantly reduced the risk of MACE compared with functional testing (IRR 0·73, 95% CI 0·57-0·95; high certainty). The worse prognostic performance of functional testing was mainly driven by the poor efficacy of exercise electrocardiography (high certainty) and stress echocardiography (moderate to low certainty), whose risk of MACE was significantly reduced by CCTA (IRRs 0·56 [95% CI 0·42-0·75] and 0·59 [95% CI 0·42-0·81], respectively), SPECT-MPI (IRRs 0·56 [95% CI 0·41-0·77] and 0·59 [95% CI 0·43-0·81], respectively), and direct-ICA referral (IRRs 0·64 [95% CI 0·45-0·91] and 0·67 [95% CI 0·48-0·92], respectively), while non-significantly reduced by CMR (IRRs 0·71 [95% CI 0·47-1·06] and 0·74 [95% CI 0·53-1·04], respectively).
Conclusion
In patients with suspected stable CAD, an initial assessment with non-invasive diagnostic strategies is safe and addresses the low diagnostic yield of direct-ICA referral. CCTA is among the most effective strategies in terms of both clinical accuracy and efficacy. Among functional non-invasive tests, exercise electrocardiography and stress echocardiography may not be deemed effective diagnostic alternatives, while SPECT-MPI and CMR are valuable and feasible options, respectively.
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Affiliation(s)
- Andrea Zito
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Mattia Galli
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Maria Cecilia Hospital, Gvm Care & Research , Cotignola , Italy
| | - Giuseppe Biondi-zoccai
- Department Of Medical-Surgical Sciences And Biotechnologies, Sapienza University Of Rome , Rome , Italy
- Mediterranea Cardiocentro , Napoli , Italy
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Division Of Cardiovascular Medicine, University Of Virginia - School Of Medicine , Charlottesville, Va , Usa
| | - Giuseppe Princi
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
| | - Domenico D´amario
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Cristina Aurigemma
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Enrico Romagnoli
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Carlo Trani
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
| | - Francesco Burzotta
- Department Of Cardiovascular And Thoracic Sciences, Catholic University Of The Sacred Heart , Rome , Italy
- Department Of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli Irccs , Rome , Italy
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35
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Malara S, Burzotta F, Aurigemma C, Romagnoli E, Graziani F, Trani C. 326 STAGED ENDOVASCULAR TREATMENT FOR MULTIVALVULAR HEART DISEASE: A CASE REPORT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.343] [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: Multiple valvular heart disease is a very prevalent condition and represents a challenge in terms of diagnosis and treatment. In patients undergoing cardiac surgery, multiple valvular lesions are often treated during the same procedure. In older high-risk patients, the treatment of choice for VHD is usually percutaneous: transcatheter aortic valve replacement (TAVR) has been widely developed in the past years and percutaneous interventions on other valvular lesions are rapidly evolving. In patients undergoing TAVR, concomitant severe tricuspid regurgitation (TR) is frequent and it's a marker of advanced disease. After TAVR, secondary TR can regress to a lower grade; persistent TR is associated with higher incidence of heart failure and mortality, so an additional intervention for TR is reasonable. The aim of this case report is to highlight the role of staged percutaneous treatment of multiple VHD as a new paradigm, with reassessment of other valvular lesion severity after the first endovascular valvular treatment
Case description: We describe a case of successful staged percutaneous treatment for severe low flow – low gradient aortic stenosis in a 71 years old patient, with previous mitral valve replacement with mechanical valve and tricuspid annuloplasty, atrial fibrillation and COPD (STS score 9.5%). Four years after cardiac surgery she experienced worsening dyspnea and two hospitalizations for pulmonary edema; the echocardiography showed significant biventricular dysfunction, severe aortic stenosis (low-flow low-gradient, with contractile reserve at dobutamine stress echocardiography) and normal function of mitral prosthesis. The case was evaluated by a multidisciplinary ‘’Heart Team’’ and a decision was made to undergo TAVR and then reassess TR severity and patient symptoms. She underwent TAVR (Evolut Pro 26 mm direct implantation) using a ‘’less-invasive totally-endovascular’’ technique, without complications. Two month later the echocardiogram showed a little improvement in left ventricular systolic function and persistent severe tricuspid regurgitations; the patient was still symptomatic for leg swelling and fatigue. After a second evaluation from the ‘’Heart Team’’, she underwent successful transcatheter tricuspid valve-in-ring implantation (Edwards Sapien3 29) via right transgiugular approach, with no complications. 19 months after she was alive, with no more hospitalization, NYHA class II, on heart failure therapy; at an echocardiogram tricuspid regurgitation was mild-to-moderate.
Discussion: Multivalular heart disease patients more often have several comorbidities, greater cardiac damage, that leads to higher incidence of heart failure and death than single VHD. In particular right ventricular dysfunction and tricuspid regurgitation, mostly secondary to pressure overload, are associated with adverse outcomes in severe aortic stenosis, especially in the ‘’low flow- low gradient’’ group. After treatment of a severe valvular disease, hemodynamic changes in pression and volume loads may improve the function of other valves, so previous valvulopaties can regress to a lower stage of severity, with a better prognosis and the possibility to avoid a second valvular treatment and all the procedural risks.
Conclusion
There is lack of data in the literature concerning the management of multiple VDH, which does not allow for evidence-based recommendations in current guidelines. Transcatherer interventions offer the option of a staged approach and a tailored treatment, after accurate evaluation by the Heart Team.
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Conte C, D´aiello A, Cribari F, Buono MD, Saponara G, Pinnacchio G, Antonio Montone R, Aurigemma C, Pedicino D, Liuzzo G, Sanna T. 752 CARDIOGENIC SHOCK AS THE FIRST PRESENTATION OF ACUTE ANTRACYCLINE CARDIOTOXICITY: A CLINICAL CASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.118] [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
Several therapeutic strategies are available for cancer patients, leading to a longer life expectancy; however, each drug might have different side effects, which increase morbidity and mortality. Cardiovascular diseases are one of the most frequent and dramatic of these side effects, leading to interruption of a potentially lifesaving treatment or hesitating into heart failure.
Clinical Case
A 50 year-old female with recent diagnosis of breast cancer presented to our Emergency Department (ED) for asthenia, vomiting and dyspnea. A first dose of epirubicin and cyclophosphamide as neoadjuvant chemotherapy (CT) was administered three days before the onset of symptoms. Screening echocardiogram performed before starting the CT showed normal systolic ejection fraction, normal diastolic function and no valvular disease. At ED admission, the patient presented hypotension, tachycardia, sweating and mental confusion. The ECG showed sinus tachycardia with diffuse ST segment elevation and diffuse low QRS voltages. Echocardiogram proved severe left dysfunction (LVEF 15%) with low cardiac output (LVOT VTI 6 mm) and elevated ventricular filling pressure (E/e’ 26). EAB showed severe hyperlactacidemia. The diagnosis of cardiogenic shock was done and high doses of dobutamine and noradrenaline were started. Laboratory values confirmed multiorgan involvement, in absence of any signs of inflammation and infection. The coronary angiography performed revealed normal coronary arteries and elevated left ventricular end-diastolic pressure (LVEDP 29 mmHg). Despite pharmacological therapy, the patient's condition worsened so we proceeded to IMPELLA CP implantation and started methylprednisolone 10 mg/kg for three days with subsequent tapering doses. After 24 hours, we obtained hemodynamic stability and hyperlactacidemia clearance. Unfortunately, myelotoxicity and marked piastrinopenia (until 16 000*10 9/L) complicated the clinical course; for this reason, we stopped unfractionated Heparin (UHF) and no anticoagulant therapy, other the one in purge solution, was performed. CMR revealed diffuse signal enhancement during the T2w sequences associated with a global enhancement of T2 Mapping values due to general edema, a global intramyocardial strengthening, a significant enhancement of the T1 mapping values and extracellular volume were described at the delayed enhancement sequences. The hemodynamic conditions progressively improved during the hospitalization and the IMPELLA pump was removed. Serial echocardiograms documented an improvement of the ejection fraction and further mild reduction of ventricular filling pressure (E/e’ 8) normal right ejection fraction and initial inferior vena cava collapsibility. All the inotropic supports were suspended; we introduced beta-blocker, ACE-inhibitors, subsequently replaced with sacubitril/valsartan, well tolerated.
Conclusion
Acute cardiotoxicity with possible life-threatening conditions regardless of the basal cardiovascular risk class is a rare clinical condition, but needs further investigation. Future researches are warranted to determine the molecular mechanisms underlying cardiotoxicity to contain the side effects, maximize the benefit of the oncological therapy and, when necessary, select the best therapeutic option.
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Affiliation(s)
- Cristina Conte
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Alessia D´aiello
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Francesco Cribari
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Marco Del Buono
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Gianluigi Saponara
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Gaetano Pinnacchio
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Rocco Antonio Montone
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Cristina Aurigemma
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Daniela Pedicino
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Giovanna Liuzzo
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
| | - Tommaso Sanna
- Department Of Cardiovascular Medicine - Universita’ Cattolica Del Sacro Cuore - Fondazione Policlinico Universitario ”Agostino Gemelli” Ircss
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Buonpane A, Ricchiuto A, Lombardi M, Maino A, Bianchini E, Busco M, D´amario D, Leone AM, Aurigemma C, Romagnoli E, Burzotta F, Trani C, Crea F, Vergallo R. 1150 SEX-BASED DIFFERENCES IN CORONARY PLAQUE PHENOTYPE AND HEALING AT OPTICAL COHERENCE TOMOGRAPHY (OCT) ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.302] [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
Introduction
Atherosclerotic plaque healing is a dynamic process that promotes plaque repair after destabilization. Previous studies showed that healed plaques are more common in patients with chronic coronary syndrome than in those with acute coronary syndrome, suggesting that they might be a marker of clinical stability. The mechanisms underlying plaque healing are not completely understood. The aim of the present study was to evaluate sex-based differences in plaque phenotype and healing of non-culprit coronary lesions by optical coherence tomography.
Methods
In this observational, single-center cohort study, we enrolled patients from the OCT Registry of the Fondazione Policlinico A Gemelli IRCCS. A total of 205 patients with both acute coronary syndromes or chronic coronary syndromes undergoing coronary angiography and intravascular OCT imaging of non-culprit vessels were included in the analysis and divided into two groups according to gender.
Results
Of 205 patients, 153 were male (75%) and 52 (25%) female. Compared with male patients, female patients had lower prevalence of lipid-rich plaque (40.4% vs. 57.7%; p=0.030), plaque rupture (7.7% vs. 21.2%; p=0.028) and cholesterol crystal (13.5% vs. 29.5%; p=0.022). Mean lipid arc and calcium depht were significantly lower in female patients than in male ones (118.0° ± 79.9° vs. 135.5° ± 77.9°; p=0.011; and 52.7 µm ± 79.2 µm vs. 72.3 µm ± 93.5 µm; p=0.007) while fibrous cap tended to be thicker (108.2 µm ± 70.4 µm vs. 96.2 µm ± 72.9 µm; p=0.055). Healed plaques were significantly more frequent in female patients than in male patients (51.9% vs 34.6%; p = 0.027). The prevalence of fibrous plaque, thrombi, neovascularization, diffuse calcifications and spotty calcification was not different between the two groups.
Conclusion
Females have a distinct atherosclerotic phenotype and healing capacity compared with male patients, including lower prevalence of lipid-rich plaque, cholesterol crystals and plaque ruptures and higher prevalence of healed plaques in non-culprit coronary lesions.
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Affiliation(s)
| | | | - Marco Lombardi
- Fondazione Policlinico Universitario Agostino Gemelli Irccs
| | | | | | - Marco Busco
- Fondazione Policlinico Universitario Agostino Gemelli Irccs
| | | | | | | | | | | | - Carlo Trani
- Fondazione Policlinico Universitario Agostino Gemelli Irccs
| | - Filippo Crea
- Fondazione Policlinico Universitario Agostino Gemelli Irccs
| | - Rocco Vergallo
- Fondazione Policlinico Universitario Agostino Gemelli Irccs
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Sinning JM, Al-Rashid F, Ibrahim K, Aurigemma C, Chieffo A. Defining the optimal revascularization strategy during protected high-risk procedures with Impella. Eur Heart J Suppl 2022; 24:J25-J29. [PMCID: PMC9730788 DOI: 10.1093/eurheartjsupp/suac062] [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: 12/13/2022]
Abstract
Abstract
Complete revascularization (CR) in patients with multi-vessel disease improves outcomes. The use of percutaneous left-ventricular assist devices, such as the Impella heart pump, is useful to minimize the risk of haemodynamic compromise in complex higher risk and clinically indicated patients. The recently published data from the PROTECT III trial suggest more CR during Impella-protected percutaneous coronary intervention with more extensive lesion preparation and treatment, resulting in the reduced need for repeat revascularization. To achieve CR and improve survival, procedural guidance by intravascular imaging, extensive lesion preparation, debulking with atherectomy devices, advanced chronic total occlusion revascularization techniques, and post-interventional treatment with modern anti-platelet medication are essential.
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Affiliation(s)
- Jan-Malte Sinning
- Department of Cardiology, St Vinzenz Hospital Cologne , 50733 Cologne , Germany
| | - Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen , Essen , Germany
| | - Karim Ibrahim
- Department of Cardiology, Technische Universität Dresden (Campus Chemnitz), Klinikum Chemnitz , Chemnitz , Germany
| | - Cristina Aurigemma
- UOC Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore , Rome , Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Hospital , Milan , Italy
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Leick J, Werner N, Mangner N, Panoulas V, Aurigemma C. Optimized patient selection in high-risk protected percutaneous coronary intervention. Eur Heart J Suppl 2022; 24:J4-J10. [PMCID: PMC9730792 DOI: 10.1093/eurheartjsupp/suac060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Percutaneous mechanical circulatory support (pMCS) is increasingly used in patients with poor left-ventricular (LV) function undergoing elective high-risk percutaneous coronary interventions (HR-PCIs). These patients are often in critical condition and not suitable candidates for coronary artery bypass graft surgery. For the definition of HR-PCI, there is a growing consensus that multiple factors must be considered to define the complexity of PCI. These include haemodynamic status, left-ventricular ejection fraction, clinical characteristics, and concomitant diseases, as well as the complexity of the coronary anatomy/lesions. Although haemodynamic support by percutaneous LV assist devices is commonly adopted in HR-PCI (protected PCI), there are no clear guideline recommendations for indication due to limited published data. Therefore, decisions to use a nonsurgical, minimally invasive procedure in HR-PCI patients should be based on a risk–benefit assessment by a multidisciplinary team. Here, the current evidence and indications for protected PCI will be discussed.
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Affiliation(s)
- Jürgen Leick
- Department of Cardiology, Heart Centre Trier, Barmherzige Brüder Hospital , Nordallee 1, 54296 Trier , Germany
| | - Nikos Werner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brüder Hospital , Nordallee 1, 54296 Trier , Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitaet Dresden , Dresden , Germany
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Harefield Hospital , London, Harefield, UB9 6BJ , UK
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London , UK
| | - Cristina Aurigemma
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS , 00168 Rome , Italy
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40
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Galli M, Migliaro S, Rodolico D, DI Stefano G, Piccinni C, Restivo A, Andreotti F, Vergallo R, Montone RA, Besis G, Buffon A, Romagnoli E, Aurigemma C, Leone AM, Burzotta F, Niccoli G, Trani C, Crea F, D'Amario D. Intracoronary bolus of glycoprotein IIb/IIIa inhibitor as bridging or adjunctive strategy to oral P2Y12 inhibitor load in the modern setting of ST-elevation myocardial infarction. Minerva Cardiol Angiol 2022; 70:697-705. [PMID: 33823577 DOI: 10.23736/s2724-5683.21.05669-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the acute management of ST-elevation myocardial infarction (STEMI), glycoprotein IIb/IIIa inhibitors (GPIs) bolus not followed by intravenous infusion is potentially advantageous given their fast onset and offset of action, but clinical evidence in a contemporary setting is limited. METHODS We collected data from consecutive STEMI patients admitted to the cardiac catheterization laboratory of the IRCCS A. Gemelli University Polyclinic Foundation from October 2017 to September 2019. RESULTS Out of 423 consecutive STEMI patients, 297 met the inclusion and exclusion criteria and were included in the study. Of them, 107/297 (36%) received an intracoronary GPI bolus-only during primary percutaneous coronary intervention (PPCI) not followed by intravenous infusion and 190/297 (64%) received standard antithrombotic therapy. Of the 107 GPI-treated, 22/107 (21%) had P2Y<inf>12</inf> inhibitor pretreatment (adjunctive strategy) and 85/107 (79%) did not (bridging strategy). During hospital staying, there was no difference in the primary safety endpoint of TIMI major+minor bleeding (P=0.283), TIMI major (P=0.267) or TIMI minor (P=0.685) bleeding between groups. No stroke event occurred in the GPI group. Despite patients receiving GPI having a significantly higher intraprocedural ischemic burden, no significant differences were found in the efficacy outcomes between groups. Consistent findings were observed for patients receiving GPIs bolus before (bridging strategy) or after (adjunctive strategy) P2Y<inf>12</inf> inhibitors, compared to those receiving standard therapy. Multivariate logistic regression analyses did not find any independent predictors significantly associated to the primary and secondary composite endpoints. CONCLUSIONS In a contemporary real-world population of STEMI patients undergoing PPCI, the use of intracoronary GPIs bolus-only in selected patients at high ischemic risk is safe and could represent a useful antithrombotic strategy both in those pretreated and in those naïve to P2Y<inf>12</inf> inhibitors.
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Affiliation(s)
- Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy - .,Sacred Heart Catholic University, Rome, Italy -
| | - Stefano Migliaro
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Gaetano DI Stefano
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Carlo Piccinni
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Felicita Andreotti
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - George Besis
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonino Buffon
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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Cappannoli L, Galli M, Zito A, Restivo A, Princi G, Laborante R, Vergallo R, Romagnoli E, Leone AM, Aurigemma C, Massetti M, Sanna T, Trani C, Burzotta F, Savarese G, Crea F, D'Amario D. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) with vs without left ventricular unloading by Impella: a systematic review and meta-analysis. European Heart Journal - Quality of Care and Clinical Outcomes 2022:6825448. [DOI: 10.1093/ehjqcco/qcac076] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background and aims
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for the treatment of cardiogenic shock (CS) may result in left ventricle overload and distension. Percutaneous microaxial flow pump Impella in addition to VA-ECMO (ECPELLA) is an emerging option to overcome these collateral effects. Aim of this study is to assess whether the addition of Impella to VA-ECMO is an effective and safe unloading strategy.
Methods
We performed a systematic literature review of studies comparing ECPELLA versus ECMO alone in patients with CS. The primary endpoint was early mortality (in-hospital or 30-day mortality). The secondary endpoints were bleeding, need for kidney replacement therapy, hemolysis, infections, and limb ischemia.
Results
A total of 3469 potentially relevant articles were screened and 8 retrospective studies including 11.137 patients were selected. There was no significant difference in early mortality (Risk Ratio, RR 0.90, 95% CI 0.78–1.03) between ECPELLA and ECMO. Nevertheless, there was a borderline significant reduction in early mortality with ECPELLA (RR 0.74, 95% CI 0.55–1.00) at sensitivity analysis selectively including studies reporting propensity matched analysis. ECPELLA was associated with increased bleeding (RR 1.45, 95% CI 1.20–1.75), need for kidney replacement therapy (RR 1.54, 95% CI 1.19–1.99), hemolysis (RR 1.71, 95% CI 1.41–2.07) and limb ischemia (RR 1.43, 95% CI 1.17–1.75) and with a non-significant increase in severe infections (RR 1.26, 95% CI 0.84–1.89), compared with ECMO alone.
Conclusions
Among patients with cardiogenic shock, ECPELLA is associated with increased complications compared with ECMO. Whether reducing ventricular overload with Impella among patients treated with ECMO reduces early mortality needs to be confirmed by further investigations.
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Affiliation(s)
| | - Mattia Galli
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Maria Cecilia Hospital, GVM Care & Research , Cotignola , Italy
| | - Andrea Zito
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
| | | | | | | | - Rocco Vergallo
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Enrico Romagnoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Antonio Maria Leone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Massimo Massetti
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Tommaso Sanna
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Carlo Trani
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Francesco Burzotta
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet , Stockholm , Sweden
| | - Filippo Crea
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Domenico D'Amario
- Università Cattolica del Sacro Cuore (UCSC) , Rome , Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
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Montone RA, Niccoli G, Russo M, Giaccari M, Del Buono MG, Meucci MC, Gurgoglione F, Vergallo R, D’Amario D, Buffon A, Leone AM, Burzotta F, Aurigemma C, Trani C, Liuzzo G, Lanza GA, Crea F. Correction: Clinical, angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries. Clin Res Cardiol 2022; 112:570. [PMID: 36326842 DOI: 10.1007/s00392-022-02110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Laborante R, Borovac JA, Galli M, Rodolico D, Ciliberti G, Restivo A, Cappannoli L, Arcudi A, Vergallo R, Zito A, Princi G, Leone AM, Aurigemma C, Romagnoli E, Montone RA, Burzotta F, Trani C, D’Amario D. Gender-differences in antithrombotic therapy across the spectrum of ischemic heart disease: Time to tackle the Yentl syndrome? Front Cardiovasc Med 2022; 9:1009475. [PMID: 36386309 PMCID: PMC9659635 DOI: 10.3389/fcvm.2022.1009475] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/14/2022] [Indexed: 08/11/2023] Open
Abstract
The incidence and clinical presentation of ischemic heart disease (IHD), as well as thrombotic and bleeding risks, appear to differ between genders. Compared with men, women feature an increased thrombotic risk, probably related to an increased platelet reactivity, higher level of coagulation factors, and sex-associated unique cardiovascular risk factors, such as pregnancy-related (i.e., pre-eclampsia and gestational diabetes), gynecological disorders (i.e., polycystic ovary syndrome, early menopause) and autoimmune or systemic inflammatory diseases. At the same time, women are also at increased risk of bleeding, due to inappropriate dosing of antithrombotic agents, smaller blood vessels, lower body weight and comorbidities, such as diabetes and chronic kidney disease. Pharmacological strategies focused on the personalization of antithrombotic treatment may, therefore, be particularly appealing in women in light of their higher bleeding and ischemic risks. Paradoxically, although women represent a large proportion of cardiovascular patients in our practice, adequate high-quality clinical trial data on women remain scarce and inadequate to guide decision-making processes. As a result, IHD in women tends to be understudied, underdiagnosed and undertreated, a phenomenon known as a "Yentl syndrome." It is, therefore, compelling for the scientific community to embark on dedicated clinical trials to address underrepresentation of women and to acquire evidence-based knowledge in the personalization of antithrombotic therapy in women.
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Affiliation(s)
- Renzo Laborante
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Josip Andjelo Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
| | - Mattia Galli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Cappannoli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandra Arcudi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrea Zito
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Maria Leone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D’Amario
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Leone AM, Burzotta F, Aurigemma C, Zambrano A, Zimbardo G, Galante D, Di Giusto F, Bianchini F, Vergallo R, Trani C, Crea F. PCI Deferral Based on Fractional Flow Reserve or Optical Coherence Tomography: Two-Year Results of the Forza Trial. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2311361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Cappannoli L, Galli M, Zito A, Restivo A, Princi G, Leone AM, Vergallo R, Aurigemma C, Romagnoli E, Aspromonte N, Burzotta F, Trani C, Sanna T, Crea F, D'Amario D. Clinical outcomes of left ventricular unloading with microaxial flow pump Impella during venoarterial extracorporeal membrane oxygenation (VA-ECMO): a systematic review and updated meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1100] [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
Whether the addition of percutaneous microaxial flow pump Impella to venoarterial extracorporeal membrane oxygenation (VA-ECMO) as left ventricle unloading strategy is effective in improving outcomes compared to VA-ECMO alone is still to be proved.
Purpose
Aim of this systematic review and meta-analysis was to assess whether patients with refractory cardiogenic shock treated with IMPELLA in addition to VA-ECMO (ECMELLA) versus ECMO alone may benefit a reduction in early mortality and to assess whether this strategy may result in an increased rate of complications.
Methods
For this systematic review and meta-analysis, from Dec 2021 to Jan 2022, we searched Scopus, MEDLINE (with PubMed interface) and the Cochrane Central Register of Controlled Trials for randomised controlled trials and observational studies published in any language comparing the use of ECMELLA versus ECMO alone in patients with acute refractory CS (with or without cardiac arrest). Two independent investigators screened titles and abstracts for eligibility, extracted the data, and assessed risk of bias. Risk ratios (RRs) and 95% CIs were calculated with random-effects or fixed-effect models according to the estimated heterogeneity among studies assessed by the I2 index. Primary efficacy endpoint was trial-defined early mortality (in hospital or 30-day mortality). Safety endpoints were major bleeding, the need for renal replacement therapy, hemolysis, severe infections/sepsis and limb ischemia. This study is registered with PROSPERO (CRD42022292517).
Results
2061 potentially relevant articles were screened. Our analysis included six retrospective studies with data for 1457 patients. Compared with ECMO alone, ECMELLA was associated with a non-significant reduction in early mortality (RR 0.87, 95% CI 0.72–1.06, p=0.17; Figure 1) and in a significant increase of major bleeding (RR 1.45, 95% CI 1.10–1.91, p=0.009), need for renal replacement therapy (RR 1.70, 95% CI 1.16–2.48, p=0.0008), hemolysis (RR 2.22, 95% CI 1.39–3.56, p=0.005) and limb ischemia (RR 1.61, 95% CI 1.20–2.16, p=0.001). No significant differences were observed in the incidence of severe infections/sepsis between the two groups (RR 1.23, 95% CI 0.97–1.58, p=0.09). (Figure 2)
Conclusions
The results of this meta-analysis showed that ECMELLA compared to ECMO alone did not significantly reduce early mortality and that, conversely, it resulted in a significantly increased risk of several complication (major bleeding, hemolysis, limb ischemia and renal replacement therapy). This study highlights that, if the benefit of left ventricle unloading with Impella during ECMO in CS shock is uncertain and probably limited to only selected patients, it surely increases the risk of some complications, therefore caution is needed in choosing such a strategy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Cappannoli
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - M Galli
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - A Zito
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - A Restivo
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - G Princi
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - A M Leone
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - R Vergallo
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - C Aurigemma
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - E Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - N Aspromonte
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - F Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - C Trani
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - T Sanna
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - F Crea
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
| | - D D'Amario
- Fondazione Policlinico Universitario A. Gemelli IRCSS , Rome , Italy
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Pinnacchio G, Ruscio E, Rocco E, Trani C, Burzotta F, Aurigemma C, Romagnoli E, Scacciavillani R, Narducci ML, Bencardino G, Perna F, Spera FR, Comerci G, Bisignani A, Pelargonio G. Short-Term Atrioventricular Dysfunction Recovery after Post-TAVI Pacemaker Implantation. J Cardiovasc Dev Dis 2022; 9:jcdd9100324. [PMID: 36286276 PMCID: PMC9604573 DOI: 10.3390/jcdd9100324] [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: 08/25/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
Permanent pacemaker implantation (PPI) represents a frequent complication after transcatheter aortic valve implantation (TAVI) due to atrio-ventricular (AV) node injury. Predictors of early AV function recovery were investigated. We analyzed 50 consecutive patients (82 ± 6 years, 58% males, EuroSCORE: 7.8 ± 3.3%, STS mortality score: 5 ± 2.8%). Pacemaker interrogations within 4−6 weeks from PPI were performed to collect data on AV conduction. The most common indication of PPI was persistent third-degree (44%)/high-degree (20%) AV block/atrial fibrillation (AF) with slow ventricular conduction (16%) after TAVI. At follow-up, 13 patients (26%) recovered AV conduction (i.e., sinus rhythm with stable 1:1 AV conduction/AF with a mean ventricular response >50 bpm, associated with a long-term ventricular pacing percentage < 5%). At multivariate analysis, complete atrio-ventricular block independently predicted pacemaker dependency at follow-up (p = 0.019). Patients with persistent AV dysfunction showed a significant AV conduction time prolongation after TAVI (PR interval from 207 ± 50 to 230 ± 51, p = 0.02; QRS interval from 124 ± 23 to 147 ± 16, p < 0.01) compared to patients with recovery, in whom AV conduction parameters remained unchanged. Several patients receiving PPI after TAVI have recovery of AV conduction within a few weeks. Longer observation periods prior to PPI might be justified, and algorithms to minimize ventricular pacing should be utilized whenever possible.
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Affiliation(s)
- Gaetano Pinnacchio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Correspondence:
| | - Eleonora Ruscio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Erica Rocco
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Roberto Scacciavillani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Francesco Raffaele Spera
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gianluca Comerci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Antonio Bisignani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Cardiology Institute, Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
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Marin F, Pighi M, Zucchelli F, Ruzzarin A, Russo G, Aurigemma C, Romagnoli E, Ferrero V, Piccoli A, Scarsini R, Pesarini G, Trani C, Burzotta F, Ribichini FL. Predictors and Prognostic Impact of Left Ventricular Ejection Fraction Recovery after Impella-Supported Percutaneous Coronary Interventions in Acute Myocardial Infarction. J Pers Med 2022; 12:jpm12101576. [PMID: 36294715 PMCID: PMC9604820 DOI: 10.3390/jpm12101576] [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: 08/30/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Aim: The aim of our study is to assess the predictors and the prognostic role of left ventricle ejection fraction (LVEF) recovery after Impella-supported percutaneous coronary intervention (PCI) in patients presenting with acute myocardial infarction (AMI). Methods: This retrospective, observational study included patients admitted for AMI who underwent Impella-supported PCI in two Italian high-volume cardiac catheterization laboratories. Only patients who underwent an echocardiographic assessment of left ventricle ejection fraction (LVEF) before the procedure (acute LVEF) and during follow-up (follow-up LVEF) were included in the present analysis. Patients with a baseline LVEF ≥40% were excluded from the present analysis. LVEF recovery was calculated as the difference between follow-up LVEF and acute LVEF. A delta ≥5% was considered significant and was used to define the responder group. Results: From April 2007 to December 2020, 64 consecutive patients were included in our study. A total of 55 patients (86%) received hemodynamic support with Impella 2.5, and 9 patients (14%) with Impella CP. Median LVEF at follow-up was significantly higher compared to baseline (36% (30−42) vs. 30% (24−33), p < 0.001). Based on LVEF recovery, 37 patients (57.8%) were deemed responders. According to multivariate analysis, complete functional revascularization was an independent predictor of a significant EF recovery (OR: 0.159; 95% CI: 0.038−0.668; p = 0.012). At three-year follow-up, lack of LVEF recovery was the only predictor of mortality (HR: 5.315; 95% CI: 1.100−25.676; p = 0.038). Conclusions: Functional complete revascularization is an independent predictor of the recovery of LVEF in patients presenting with AMI who underwent Impella-supported PCI. The recovery of LV function is associated with improved prognosis and could be used to stratify the risk of future events at long-term follow-up.
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Affiliation(s)
- Federico Marin
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
- Correspondence:
| | - Federico Zucchelli
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Alessandro Ruzzarin
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Giulio Russo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Anna Piccoli
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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48
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Ding D, Tu S, Li Y, Li C, Yu W, Leone AM, Aurigemma C, Romagnoli E, Vergallo R, Trani C, Wijns W, Burzotta F. TCT-238 Optical Flow Ratio From Co-Registration of Coronary Angiography and Optical Coherence Tomography for Predicting Stenting Result and Physiological Significance of Residual Disease. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Camilli M, Russo M, Rinaldi R, Caffè A, La Vecchia G, Bonanni A, Iannaccone G, Basile M, Vergallo R, Aurigemma C, Trani C, Niccoli G, Crea F, Montone RA. Air Pollution and Coronary Vasomotor Disorders in Patients with Myocardial Ischemia and Non-Obstructive Coronary Arteries. J Am Coll Cardiol 2022; 80:1818-1828. [PMID: 36049556 DOI: 10.1016/j.jacc.2022.08.744] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary vasomotor abnormalities are important causes of myocardial ischemia in patients with non-obstructive coronary artery disease (NOCAD). However, the role of air pollution in determining coronary vasomotor disorders has never been investigated. OBJECTIVES We aimed to evaluate the association between long-term exposure to particulate matter 2.5 (PM2.5) and 10 (PM10), and coronary vasomotor disorders in NOCAD patients. METHODS Patients with myocardial ischemia and NOCAD undergoing coronary angiography and intracoronary provocation test with acetylcholine (ACh) were prospectively studied. Both patients with chronic myocardial ischemia (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA) were enrolled. Based on each case's home address, exposure to PM2.5 and PM10 was assessed. RESULTS We included 287 patients (median age 62.0 years [52.0-70.0], 149 [51.9%] males): 161 (56.1%) INOCA and 126 (43.9%) MINOCA. One hundred seventy-six patients (61.3%) had positive provocation test. Exposure to PM2.5 and PM10 was higher in patients with a positive provocation test (p<0.001). At multivariate logistic regression analysis, PM2.5 and PM10 were independent predictors of a positive provocation test (p=0.001 and p=0.029, respectively). Interestingly, among these patients, PM2.5 and PM10 were both independent predictors of MINOCA (p<0.001 and p=0.001, respectively) as clinical presentation, while PM2.5 was independently associated with the occurrence of epicardial spasm as opposed to microvascular spasm (p=0.001). CONCLUSIONS Higher exposure to PM2.5 and PM10 in patients with myocardial ischemia and NOCAD is associated with coronary vasomotor abnormalities. In particular, PM2.5 is an independent risk factor for the occurrence of epicardial spasm and MINOCA as clinical presentation.
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Affiliation(s)
- Massimiliano Camilli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Russo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Caffè
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Alice Bonanni
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Mattia Basile
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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50
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Leone AM, Migliaro S, Zimbardo G, Cialdella P, Basile E, Galante D, Di Giusto F, Anastasia G, Vicere A, Petrolati E, Di Stefano A, Campaniello G, D’Amario D, Vergallo R, Montone RA, Buffon A, Romagnoli E, Aurigemma C, Burzotta F, Trani C, Crea F. Safety and effectiveness of post percutaneous coronary intervention physiological assessment: Retrospective data from the post-revascularization optimization and physiological evaluation of intermediate lesions using fractional flow reserve registry. Front Cardiovasc Med 2022; 9:983003. [PMID: 36061555 PMCID: PMC9433711 DOI: 10.3389/fcvm.2022.983003] [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: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background While the importance of invasive physiological assessment (IPA) to choose coronary lesions to be treated is ascertained, its role after PCI is less established. We evaluated feasibility and efficacy of Physiology-guided PCI in the everyday practice in a retrospective registry performed in a single high-volume and “physiology-believer” center. Materials and methods The PROPHET-FFR study (NCT05056662) patients undergoing an IPA in 2015–2020 were retrospectively enrolled in three groups: Control group comprising patients for whom PCI was deferred based on a IPA; Angiography-Guided PCI group comprising patients undergoing PCI based on an IPA but without a post-PCI IPA; Physiology-guided PCI group comprising patients undergoing PCI based on an IPA and an IPA after PCI, followed by a physiology-guided optimization, if indicated. Optimal result was defined by an FFR value ≥ 0.90. Results A total of 1,322 patients with 1,591 lesions were available for the analysis. 893 patients (67.5%) in Control Group, 249 patients (18.8%) in Angiography-guided PCI Group and 180 patients (13.6%) in Physiology-guided PCI group. In 89 patients a suboptimal functional result was achieved that was optimized in 22 cases leading to a “Final FFR” value of 0.90 ± 0.04 in Angiography-Guided PCI group. Procedural time, costs, and rate of complications were similar. At follow up the rate of MACEs for the Physiology-guided PCI group was similar to the Control Group (7.2% vs. 8.2%, p = 0.765) and significantly lower than the Angiography-guided PCI Group (14.9%, p < 0.001), mainly driven by a reduction in TVRs. Conclusion “Physiology-guided PCI” is a feasible strategy with a favorable impact on mid-term prognosis. Prospective studies using a standardized IPA are warrant to confirm these data.
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Affiliation(s)
- Antonio Maria Leone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
- *Correspondence: Antonio Maria Leone, ,
| | - Stefano Migliaro
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Eloisa Basile
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Galante
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federico Di Giusto
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Anastasia
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Vicere
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Petrolati
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Di Stefano
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgia Campaniello
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico D’Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Rocco Vergallo
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Rocco Antonio Montone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Antonino Buffon
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Romagnoli
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Cristina Aurigemma
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
| | - Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli (IRCCS), Rome, Italy
- Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy
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