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Masarone D, Falco L, d'Onofrio A, Nigro G, Ammendola E, Pacileo G. Response to levosimendan predicts response to cardiac contractility modulation therapy: a pilot study. Rev Esp Cardiol (Engl Ed) 2024:S1885-5857(24)00077-X. [PMID: 38460883 DOI: 10.1016/j.rec.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy.
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Antonio d'Onofrio
- Electrophysiology Unit, Department of Cardiology, AORN dei Colli Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania "Luigi Van-Vitelli" Naples, Italy
| | - Ernesto Ammendola
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
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Masarone D, Lombardi C, Falco L, Coscioni E, Metra M. Recent Advances across the Spectrum of Heart Failure and Heart Transplant. J Clin Med 2024; 13:1427. [PMID: 38592320 PMCID: PMC10932249 DOI: 10.3390/jcm13051427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
In recent years, remarkable progress has been accomplished in the heart failure (HF) landscape, with novel drugs and groundbreaking device approaches [...].
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, AOS dei Colli-Monaldi Hospital, 80121 Naples, Italy;
| | - Carlo Lombardi
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (C.L.); (M.M.)
| | - Luigi Falco
- Heart Failure Unit, AOS dei Colli-Monaldi Hospital, 80121 Naples, Italy;
| | - Enrico Coscioni
- Cardiac Surgery Division, AOU San Leonardo, 84100 Salerno, Italy;
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (C.L.); (M.M.)
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Amdani S, Auerbach SR, Bansal N, Chen S, Conway J, Silva JPDA, Deshpande SR, Hoover J, Lin KY, Miyamoto SD, Puri K, Price J, Spinner J, White R, Rossano JW, Bearl DW, Cousino MK, Catlin P, Hidalgo NC, Godown J, Kantor P, Masarone D, Peng DM, Rea KE, Schumacher K, Shaddy R, Shea E, Tapia HV, Valikodath N, Zafar F, Hsu D. Research Gaps in Pediatric Heart Failure: Defining the Gaps and Then Closing Them Over the Next Decade. J Card Fail 2024; 30:64-77. [PMID: 38065308 DOI: 10.1016/j.cardfail.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 01/13/2024]
Abstract
Given the numerous opportunities and the wide knowledge gaps in pediatric heart failure, an international group of pediatric heart failure experts with diverse backgrounds were invited and tasked with identifying research gaps in each pediatric heart failure domain that scientists and funding agencies need to focus on over the next decade.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio.
| | - Scott R Auerbach
- Division of Pediatric Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Neha Bansal
- Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine, New York, New York
| | - Sharon Chen
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer Conway
- Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Julie Pires DA Silva
- Division of Pediatric Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Jessica Hoover
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Kimberly Y Lin
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Shelley D Miyamoto
- Division of Pediatric Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kriti Puri
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Jack Price
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Joseph Spinner
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Rachel White
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph W Rossano
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David W Bearl
- Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
| | - Melissa K Cousino
- Department of Pediatrics, University of Michigan, C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Perry Catlin
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Nicolas Corral Hidalgo
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Justin Godown
- Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
| | - Paul Kantor
- Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Naples, Italy
| | - David M Peng
- Department of Pediatrics, University of Michigan, C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Kelly E Rea
- Department of Pediatrics, University of Michigan, C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Kurt Schumacher
- Department of Pediatrics, University of Michigan, C. S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Robert Shaddy
- Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Erin Shea
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Naples, Italy
| | - Henry Valora Tapia
- Division of Pediatric Cardiology, University of Utah. Salt Lake City, Utah
| | - Nishma Valikodath
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Daphne Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Masarone D, Kittleson MM, D'Onofrio A, Falco L, Fumarulo I, Massetti M, Crea F, Aspromonte N, Pacileo G. Basic science of cardiac contractility modulation therapy: Molecular and electrophysiological mechanisms. Heart Rhythm 2024; 21:82-88. [PMID: 37769793 DOI: 10.1016/j.hrthm.2023.09.021] [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: 08/31/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
In heart failure with reduced ejection fraction and heart failure with preserved ejection fraction, profound cellular and molecular changes have recently been documented in the failing myocardium. These changes include altered calcium handling and metabolic efficiency of the cardiac myocyte, reactivation of the fetal gene program, changes in the electrophysiological properties of the heart, and accumulation of collagen (fibrosis) at the interstitial level. Cardiac contractility modulation therapy is an innovative device-based therapy currently approved for heart failure with reduced ejection fraction in patients with narrow QRS complex and under investigation for the treatment of heart failure with preserved ejection fraction. This therapy is based on the delivery of high-voltage biphasic electrical signals to the septal wall of the right ventricle during the absolute refractory period of the myocardium. At the cellular level, in patients with heart failure with reduced ejection fraction, cardiac contractility modulation therapy has been shown to restore calcium handling and improve the metabolic status of cardiac myocytes, reverse the heart failure-associated fetal gene program, and reduce the extent of interstitial fibrosis. This review summarizes the preclinical literature on the use of cardiac contractility modulation therapy in heart failure with reduced and preserved ejection fraction, correlating the molecular and electrophysiological effects with the clinical benefits demonstrated by this therapy.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli/Monaldi Hospital, Naples, Italy.
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Antonio D'Onofrio
- Electrophysiology Unit, Department of Cardiology, AORN dei Colli/Monaldi Hospital, Naples, Italy
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli/Monaldi Hospital, Naples, Italy
| | | | - Massimo Massetti
- Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nadia Aspromonte
- Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli/Monaldi Hospital, Naples, Italy
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Contaldi C, Montesarchio V, Catapano D, Falco L, Caputo F, D’Aniello C, Masarone D, Pacileo G. Multimodality Cardiovascular Imaging of Cardiotoxicity Due to Cancer Therapy. Life (Basel) 2023; 13:2103. [PMID: 37895484 PMCID: PMC10608651 DOI: 10.3390/life13102103] [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: 09/11/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023] Open
Abstract
Cancer therapies have revolutionized patient survival rates, yet they come with the risk of cardiotoxicity, necessitating effective monitoring and management. The existing guidelines offer a limited empirical basis for practical approaches in various clinical scenarios. This article explores the intricate relationship between cancer therapy and the cardiovascular system, highlighting the role of advanced multimodality imaging in monitoring patients before, during, and after cancer treatment. This review outlines the cardiovascular effects of different cancer therapy classes, offering a comprehensive understanding of their dose- and time-dependent impacts. This paper delves into diverse imaging modalities such as echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, and nuclear imaging, detailing their strengths and limitations in various conditions due to cancer treatment, such as cardiac dysfunction, myocarditis, coronary artery disease, Takotsubo cardiomyopathy, pulmonary hypertension, arterial hypertension, valvular heart diseases, and heart failure with preserved ejection fraction. Moreover, it underscores the significance of long-term follow-up for cancer survivors and discusses future directions.
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Affiliation(s)
- Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (D.C.); (L.F.); (D.M.); (G.P.)
| | - Vincenzo Montesarchio
- Division of Medical Oncology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (V.M.); (F.C.); (C.D.)
| | - Dario Catapano
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (D.C.); (L.F.); (D.M.); (G.P.)
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (D.C.); (L.F.); (D.M.); (G.P.)
| | - Francesca Caputo
- Division of Medical Oncology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (V.M.); (F.C.); (C.D.)
| | - Carmine D’Aniello
- Division of Medical Oncology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (V.M.); (F.C.); (C.D.)
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (D.C.); (L.F.); (D.M.); (G.P.)
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (D.C.); (L.F.); (D.M.); (G.P.)
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Carluccio E, Dini FL, Correale M, Dattilo G, Ciccarelli M, Vannuccini F, Sforna S, Pacileo G, Masarone D, Scelsi L, Ghio S, Tocchetti CG, Mercurio V, Brunetti ND, Nodari S, Ambrosio G, Palazzuoli A. Effect of sacubitril/valsartan on cardiac remodeling compared with other renin-angiotensin system inhibitors: a difference-in-difference analysis of propensity-score matched samples. Clin Res Cardiol 2023:10.1007/s00392-023-02306-0. [PMID: 37733084 DOI: 10.1007/s00392-023-02306-0] [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: 06/10/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND In patients with heart failure with reduced ejection fraction (HFrEF), treatment with sacubitril-valsartan (S/V) may reverse left ventricular remodeling (rLVR). Whether this effect is superior to that induced by other renin-angiotensin system (RAS) inhibitors is not well known. METHODS HFrEF patients treated with S/V (n = 795) were compared, by propensity score matching, with a historical cohort of 831 HFrEF patients (non-S/V group) treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RAS inhibitors). All patients were also treated with beta-blockers and shared the same protocol with repeat echocardiogram 8-12 months after starting therapy. The difference-in-difference (DiD) analysis was used to evaluate the impact of S/V on CR indices between the two groups. RESULTS After propensity score matching, compared to non-S/V group (n = 354), S/V group (n = 354) showed a relative greater reduction in end-diastolic and end-systolic volume index (ESVI), and greater increase in ejection fraction (DiD estimator = + 5.42 mL/m2, P = 0.0005; + 4.68 mL/m2, P = 0.0009, and + 1.76%, P = 0.002, respectively). Reverse LVR (reduction in ESVI ≥ 15% from baseline) was more prevalent in S/V than in non-S/V group (34% vs 26%, P = 0.017), while adverse LVR (aLVR, increase in ESVI at follow-up ≥ 15%) was more frequent in non-S/V than in S/V (16% vs 7%, P < 0.001). The beneficial effect of S/V on CR over other RAS inhibitors was appreciable across a wide range of patient's age and baseline end-diastolic volume index, but it tended to attenuate in more dilated left ventricles (P for interaction = NS for both). CONCLUSION In HFrEF patients treated with beta-blockers, sacubitril/valsartan is associated with a relative greater benefit in LV reverse remodeling indices than other RAS inhibitors.
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Affiliation(s)
- Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, S. Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy.
| | - Frank L Dini
- Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Michele Correale
- Department of Cardiology, University Hospital Foggia, Foggia, Italy
| | - Giuseppe Dattilo
- Department of Biomedical, Dental Sciences, and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Michele Ciccarelli
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Francesca Vannuccini
- Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, Siena, Italy
| | - Stefano Sforna
- Cardiology and Cardiovascular Pathophysiology, S. Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN Dei Colli, Monaldi Hospital, Naples, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN Dei Colli, Monaldi Hospital, Naples, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Savina Nodari
- Department of Cardiology, University of Brescia and ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, S. Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
- CERICLET-Centro Ricerca Clinica E Traslazionale, University of Perugia, Perugia, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-Thoracic and Vascular Department, Le Scotte Hospital, University of Siena, Siena, Italy
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Falco L, Brescia B, Catapano D, Martucci ML, Valente F, Gravino R, Contaldi C, Pacileo G, Masarone D. Vericiguat: The Fifth Harmony of Heart Failure with Reduced Ejection Fraction. J Cardiovasc Dev Dis 2023; 10:388. [PMID: 37754817 PMCID: PMC10531735 DOI: 10.3390/jcdd10090388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
Heart failure with reduced ejection fraction is a chronic and progressive syndrome that continues to be a substantial financial burden for health systems in Western countries. Despite remarkable advances in pharmacologic and device-based therapy over the last few years, patients with heart failure with reduced ejection fraction have a high residual risk of adverse outcomes, even when treated with optimal guideline-directed medical therapy and in a clinically stable state. Worsening heart failure episodes represent a critical event in the heart failure trajectory, carrying high residual risk at discharge and dismal short- or long-term prognosis. Recently, vericiguat, a soluble guanylate cyclase stimulator, has been proposed as a novel drug whose use is already associated with a reduction in heart failure-related hospitalizations in patients in guideline-directed medical therapy. In this review, we summarized the pathophysiology of the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate cascade in patients with heart failure with reduced ejection fraction, the pharmacology of vericiguat as well as the evidence regarding their use in patients with HFrEF. Finally, tips and tricks for its use in standard clinical practice are provided.
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Affiliation(s)
- Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Benedetta Brescia
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Dario Catapano
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Maria Luigia Martucci
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (L.F.); (D.C.); (M.L.M.); (F.V.); (R.G.); (C.C.); (G.P.)
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Masarone D, Kittleson MM, Falco L, Martucci ML, Catapano D, Brescia B, Petraio A, De Feo M, Pacileo G. The ABC of Heart Transplantation-Part 1: Indication, Eligibility, Donor Selection, and Surgical Technique. J Clin Med 2023; 12:5217. [PMID: 37629260 PMCID: PMC10455167 DOI: 10.3390/jcm12165217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiac transplantation represents the gold standard of treatment for selected patients with advanced heart failure who have poor functional capacity and prognosis despite guideline-directed medical therapy and device-based therapy. Proper patient selection and appropriate referral of patients to centers for the treatment of advanced heart failure are the first but decisive steps for screening patients eligible for cardiac transplantation. The eligibility and the decision to list for cardiac transplantation, even for patients with relative contraindications, are based on a multidisciplinary evaluation of a transplant team. This review will discuss the practical indications, the process of patient eligibility for cardiac transplantation, the principle of donor selection, as well as the surgical technique.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Michelle M. Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA 90048, USA
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Maria L. Martucci
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Dario Catapano
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Benedetta Brescia
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplants, AORN dei Colli Monaldi Hospital, 80131 Naples, Italy
| | - Marisa De Feo
- Cardiac Surgery Unit, Department of Cardiac Surgery and Transplants, AORN dei Colli Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
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Masarone D, Houston B, Falco L, Martucci ML, Catapano D, Valente F, Gravino R, Contaldi C, Petraio A, De Feo M, Tedford RJ, Pacileo G. How to Select Patients for Left Ventricular Assist Devices? A Guide for Clinical Practice. J Clin Med 2023; 12:5216. [PMID: 37629257 PMCID: PMC10455625 DOI: 10.3390/jcm12165216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, a significant improvement in left ventricular assist device (LVAD) technology has occurred, and the continuous-flow devices currently used can last more than 10 years in a patient. Current studies report that the 5-year survival rate after LVAD implantation approaches that after a heart transplant. However, the outcome is influenced by the correct selection of the patients, as well as the choice of the optimal time for implantation. This review summarizes the indications, the red flags for prompt initiation of LVAD evaluation, and the principles for appropriate patient screening.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Brian Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC 158155, USA (R.J.T.)
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Maria L. Martucci
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Dario Catapano
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplant, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Marisa De Feo
- Cardiac Surgery Unit, Department of Cardiac Surgery and Transplant, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
| | - Ryan J. Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC 158155, USA (R.J.T.)
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, 84121 Naples, Italy
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10
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Ziacchi M, Spadotto A, Ghio S, Pellegrino M, Potena L, Masarone D, Merlo M, Stolfo D, Caracciolo MM, Inserra C, Ammirati F, Ciccarelli M, Colivicchi F, Bianchi S, Patti G, Oliva F, Arcidiacono G, Rordorf R, Pini D, Pacileo G, D'Onofrio A, Forleo GB, Mariani M, Adamo F, Alonzo A, Ruzzolini M, Ghiglieno C, Cipriani M, Firetto G, Aspromonte N, Clemenza F, Maria De Ferrari G, Senni M, Grazia Bongiorni M, Tondo C, Grimaldi M, Giallauria F, Rametta F, Marchese P, Biffi M, Sinagra G. Bridging the gap in the symptomatic heart failure patient journey: insights from the Italian scenario. Expert Rev Med Devices 2023; 20:951-961. [PMID: 37712650 DOI: 10.1080/17434440.2023.2258786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prognosis for heart failure (HF) patients remains poor, with a high mortality rate, and a marked reduction in quality of life (QOL) and functional status. This study aims to explore the ongoing needs of HF management and the epidemiology of patients followed by Italian HF clinics, with a specific focus on cardiac contractility modulation (CCM). RESEARCH DESIGN AND METHODS Data from patients admitted to 14 HF outpatients clinics over 4 weeks were collected and compared to the results of a survey open to physicians involved in HF management operating in Italian centers. RESULTS One hundred and five physicians took part in the survey. Despite 94% of patients receive a regular follow-up every 3-6 months, available therapies are considered insufficient in 30% of cases. Physicians reported a lack of treatment options for 23% of symptomatic patients with reduced ejection fraction (EF) and for 66% of those without reduced EF. Approximately 3% of HF population (two patients per month per HF clinic) meets the criteria for immediate CCM treatment, which is considered a useful option by 15% of survey respondents. CONCLUSIONS Despite this relatively small percentage, considering total HF population, CCM could potentially benefit numerous HF patients, particularly the elderly, by reducing hospitalizations, improving functional capacity and QOL.
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Affiliation(s)
- Matteo Ziacchi
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alberto Spadotto
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Stefano Ghio
- Division of Cardiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Pellegrino
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Luciano Potena
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | | | - Corinna Inserra
- Department of Cardiovascular Disease, Unit of Cardiology, Ospedale Civile di Legnano, Legnano, Italy
| | - Fabrizio Ammirati
- Cardiology Division, Presidio Ospedaliero GB Grassi Ostia Lido, Rome, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Stefano Bianchi
- UOC Cardiologia, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Giuseppe Patti
- Università del Piemonte Orientale, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Giuseppe Arcidiacono
- Dipartimento di Medicina clinica e Sperimemtale, University of Messina, Messina, Italy
| | - Roberto Rordorf
- Division of Cardiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Pini
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | | | | | - Matteo Mariani
- Department of Cardiovascular Disease, Unit of Cardiology, Ospedale Civile di Legnano, Legnano, Italy
| | - Francesco Adamo
- Cardiology Division, Presidio Ospedaliero GB Grassi Ostia Lido, Rome, Italy
| | | | - Matteo Ruzzolini
- UOC Cardiologia, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Chiara Ghiglieno
- Università del Piemonte Orientale, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | | | - Giorgio Firetto
- Dipartimento di Medicina clinica e Sperimemtale, University of Messina, Messina, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Gaetano Maria De Ferrari
- AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University Cardiology, Torino, Italy
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dentist Sciences, University of Milan, Milan, Italy
| | - Massimo Grimaldi
- Department of Cardiology, Ospedale Generale Regionale F. Muilli, Acquaviva delle Fonti, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Procolo Marchese
- Department of Cardiology, Mazzoni Civil Hospital, Ascoli Piceno, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
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11
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Masarone D, Rao I, Pacileo G. HOPE for a better selection of patients for cardiac contractility modulation. Expert Rev Med Devices 2023; 20:525-528. [PMID: 37209105 DOI: 10.1080/17434440.2023.2217329] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/26/2023] [Accepted: 05/19/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli Monaldi Hospital, Naples, Italy
| | - Ishu Rao
- Impulse Dynamics, Inc, Marlton, NJ, USA
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli Monaldi Hospital, Naples, Italy
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12
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Ciccarelli M, Giallauria F, Carrizzo A, Visco V, Silverio A, Cesaro A, Calabrò P, De Luca N, Mancusi C, Masarone D, Pacileo G, Tourkmani N, Vigorito C, Vecchione C. Artificial intelligence in cardiovascular prevention: new ways will open new doors. J Cardiovasc Med (Hagerstown) 2023; 24:e106-e115. [PMID: 37186561 DOI: 10.2459/jcm.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Prevention and effective treatment of cardiovascular disease are progressive issues that grow in tandem with the average age of the world population. Over recent decades, the potential role of artificial intelligence in cardiovascular medicine has been increasingly recognized because of the incredible amount of real-world data (RWD) regarding patient health status and healthcare delivery that can be collated from a variety of sources wherein patient information is routinely collected, including patient registries, clinical case reports, reimbursement claims and billing reports, medical devices, and electronic health records. Like any other (health) data, RWD can be analysed in accordance with high-quality research methods, and its analysis can deliver valuable patient-centric insights complementing the information obtained from conventional clinical trials. Artificial intelligence application on RWD has the potential to detect a patient's health trajectory leading to personalized medicine and tailored treatment. This article reviews the benefits of artificial intelligence in cardiovascular prevention and management, focusing on diagnostic and therapeutic improvements without neglecting the limitations of this new scientific approach.
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Affiliation(s)
- Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Naples, Italy
| | - Nidal Tourkmani
- Cardiology and Cardiac Rehabilitation Unit, 'Mons. Giosuè Calaciura Clinic', Catania, Italy
- ABL, Guangzhou, China
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli
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13
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Masarone D, Kittleson M, Pollesello P, Tedford RJ, Pacileo G. Use of Levosimendan in Patients with Pulmonary Hypertension: What is the Current Evidence? Drugs 2023; 83:195-201. [PMID: 36652192 DOI: 10.1007/s40265-022-01833-w] [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] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Abstract
Pulmonary hypertension, defined as an increase in mean arterial pressure > 20 mmHg, is a chronic and progressive condition with high mortality and morbidity. Drug therapy of patients with pulmonary hypertension is based on the distinctive pathophysiologic aspect that characterizes the different groups. However, recently, levosimendan, a calcium-sensitizing agent with inotropic, pulmonary vasodilator, and cardioprotective properties, has been shown to be an effective and safe therapeutic strategy for patients with pulmonary arterial hypertension (in addition to specific drugs) and pulmonary hypertension associated with left heart disease (as possible treatment). This review provides a comprehensive overview of the current evidence on the use of levosimendan in patients with pulmonary hypertension.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Via Leonardo Bianchi 1, 80100, Naples, Italy.
| | - Michelle Kittleson
- Department of Cardiology, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Piero Pollesello
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, Via Leonardo Bianchi 1, 80100, Naples, Italy
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14
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Masarone D, Falco L. Restrictive cardiomyopathies: The need for better characterization of a deadly disease. Kardiol Pol 2023; 81:1189-1190. [PMID: 38189501 DOI: 10.33963/v.kp.98518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy.
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
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15
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Masarone D, Kittleson MM, Pollesello P, Marini M, Iacoviello M, Oliva F, Caiazzo A, Petraio A, Pacileo G. Use of Levosimendan in Patients with Advanced Heart Failure: An Update. J Clin Med 2022; 11:jcm11216408. [PMID: 36362634 PMCID: PMC9659135 DOI: 10.3390/jcm11216408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/04/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
Levosimendan is an inodilator drug that, given its unique pharmacological actions and safety profile, represents a viable therapeutic option in patients with heart failure with reduced ejection fraction in the advanced stage of the disease (advHFrEF). Pulsed levosimendan infusion in patients with advHFrEF improves symptoms and clinical and hemodynamic status, prevents recurrent hospitalizations, and enables optimization of guidelines-directed medical therapy. Furthermore, considering its proprieties on right ventricular function and pulmonary circulation, levosimendan could be helpful for the prevention and treatment of the right ventricular dysfunction post-implanting a left ventricular assist device. However, to date, evidence on this issue is scarce and has yielded mixed results. Finally, preliminary experiences indicate that treatment with levosimendan at scheduled intervals may serve as a “bridge to transplant” strategy in patients with advHFrEF. In this review, we summarized the clinical pharmacology of levosimendan, the available evidence in the treatment of patients with advHFrEF, as well as a hypothesis for its use in patients with advanced heart failure with preserved ejection fraction.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-0817065163; Fax: +39-0817062674
| | - Michelle M. Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA 90048, USA
| | | | - Marco Marini
- Cardiology Division, Cardiovascular Department, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I-GM Lancisi-G Salesi, 60126 Ancona, Italy
| | - Massimo Iacoviello
- Intensive Cardiac Care Unit, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Fabrizio Oliva
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Angelo Caiazzo
- Heart Transplant Unit, Department of Cardiac Surgery and Transplant, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplant, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy
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16
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Marra AM, D'Assante R, Salzano A, Iacoviello M, Triggiani V, Rengo G, Limongelli G, Masarone D, Perticone M, Cimellaro A, Perrone Filardi P, Paolillo S, Gargiulo P, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Arcopinto M, D'Agostino A, Raparelli V, Isidori AM, Valente V, Giardino F, Crisci G, Sciacqua A, Savoia M, Suzuki T, Bossone E, Cittadini A. Testosterone deficiency independently predicts mortality in women with HFrEF: insights from the T.O.S.CA. registry. ESC Heart Fail 2022; 10:159-166. [PMID: 36134448 PMCID: PMC9871710 DOI: 10.1002/ehf2.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/12/2022] [Accepted: 08/04/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS Testosterone deficiency (TD) is associated with increased morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). However, data in women are scanty. The aim of this study was to investigate the prognostic impact of TD on women with HFrEF. METHODS Among 480 patients prospectively enrolled in the T.O.S.CA. (Terapia Ormonale Scompenso CArdiaco) registry, a prospective, multicentre, nationwide, observational study, 94 women were included in the current analysis. The TD was defined as serum testosterone levels lower than 25 ng/dl. Data regarding clinical status, echocardiography, exercise performance, cardiovascular hospitalization, and survival after an average follow-up of 36 months were analysed. RESULTS Thirty patients (31.9%) displayed TD. TD was associated with lower tricuspid annular plane excursion (TAPSE) to pulmonary arterial systolic pressure PASP ratio (TAPSE/PASP) (P = 0.008), peak oxygen consumption (VO2 peak) (P = 0.03) and estimated glomerular filtration rate (P < 0.001). TD was an independent predictor of the combined endpoint of all-cause mortality/cardiovascular hospitalization (HR: 10.45; 95% CI: 3.54-17.01; P = 0.001), all-cause mortality (HR: 8.33; 95%: 5.36-15.11; P = 0.039), and cardiovascular hospitalization (HR: 2.41; 95% CI: 1.13-4.50; P = 0.02). CONCLUSIONS One-third of women with HFrEF displays TD that impacts remarkably on their morbidity and mortality. TD is associated with a worse clinical profile including exercise capacity, right ventricular-pulmonary arterial coupling, and renal function. These findings lend support to an accurate profiling of women with HF, a problem often overlooked in clinical trials.
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Affiliation(s)
- Alberto M. Marra
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly,Italian Clinical Outcome Research and Reporting Program (I‐CORRP)NaplesItaly,Center for Pulmonary HypertensionThoraxclinic at Heidelberg University HospitalHeidelbergGermany
| | - Roberta D'Assante
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | | | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare DiseasesUniversity of Bari 'A Moro'BariItaly
| | - Giuseppe Rengo
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), IRCCSScientific Institute of Telese TermeTeleseItaly
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei ColliUniversity of Campania Luigi VanvitelliCasertaItaly
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei ColliUniversity of Campania Luigi VanvitelliCasertaItaly
| | - Maria Perticone
- Department of Experimental and Clinical MedicineUniversity Magna Græcia of CatanzaroCatanzaroItaly
| | - Antonio Cimellaro
- Department of Medical and Surgical SciencesUniversity Magna Græcia of CatanzaroCatanzaroItaly
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical SciencesFederico II UniversityNaplesItaly,Mediterranea CardiocentroNaplesItaly
| | - Stefania Paolillo
- Department of Advanced Biomedical SciencesFederico II UniversityNaplesItaly,Mediterranea CardiocentroNaplesItaly
| | - Paola Gargiulo
- Department of Advanced Biomedical SciencesFederico II UniversityNaplesItaly
| | - Antonio Mancini
- Department of Medical SciencesIRCCS San Raffaele PisanaRomeItaly
| | | | - Olga Vriz
- Heart Center DepartmentKing Faisal Hospital & Research CenterRiyadhSaudi Arabia
| | - Roberto Castello
- Division of General MedicineAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | | | - Michela Campo
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Metabolic DiseasesUniversity of FoggiaFoggiaItaly
| | - Pietro A. Modesti
- Dipartimento di Medicina Sperimentale e ClinicaUniversità degli Studi di FirenzeFlorenceItaly
| | - Alfredo De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and PreventionUniversity of FerraraFerraraItaly
| | - Michele Arcopinto
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly,Italian Clinical Outcome Research and Reporting Program (I‐CORRP)NaplesItaly
| | | | - Valeria Raparelli
- Department of Translational MedicineUniversity of FerraraFerraraItaly,University Center for Studies on Gender MedicineUniversity of FerraraFerraraItaly,Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
| | - Andrea M. Isidori
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Valeria Valente
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | - Federica Giardino
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | - Giulia Crisci
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | - Angela Sciacqua
- Department of Medical and Surgical SciencesUniversity Magna Græcia of CatanzaroCatanzaroItaly
| | - Marcella Savoia
- Department of Molecular Medicine and Medical BiotechnologiesUniversity of Naples Federico IINaplesItaly
| | - Toru Suzuki
- Department of Cardiovascular SciencesUniversity of Leicester, NIHR Biomedical Research Centre, Glenfield HospitalLeicesterUK
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program (I‐CORRP)NaplesItaly,Cardiology DivisionA Cardarelli HospitalNaplesItaly
| | - Antonio Cittadini
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly,Italian Clinical Outcome Research and Reporting Program (I‐CORRP)NaplesItaly
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17
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De Giorgi A, Marra AM, Iacoviello M, Triggiani V, Rengo G, Cacciatore F, Maiello C, Limongelli G, Masarone D, Perticone F, Filardi PP, Paolillo S, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, Salzano A, D’Assante R, Arcopinto M, Raparelli V, Fabbian F, Sciacqua A, Colao A, Suzuki T, Bossone E, Cittadini A. Insulin-like growth factor-1 (IGF-1) as predictor of cardiovascular mortality in heart failure patients: data from the T.O.S.CA. registry. Intern Emerg Med 2022; 17:1651-1660. [PMID: 35445917 PMCID: PMC9463276 DOI: 10.1007/s11739-022-02980-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/23/2022] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Data from the "Trattamento Ormonale nello Scompenso CArdiaco" (T.O.S.CA) registry showed that heart failure (HF) represents a complex clinical syndrome with different hormonal alterations. Renal failure represents a frequent complication in HF. We evaluated the relationship between renal function and insuline-like growth factor-1 (IGF-1) deficiency and its impact on cardiovascular mortality (CVM) in patients enrolled in the T.O.S.CA. registry. METHODS At the enrolment, all subjects underwent chemistry examinations, including circulating hormones and cardiovascular functional tests. COX regression analysis was used to evaluate factors related to CVM during the follow-up period in all populations, in high-risk patients and in the young-adult population. Also, we evaluate the effects of renal function on the CVM. RESULTS 337 patients (41 deceased) were analyzed. CVM was related to severe renal dysfunction (HR stages IV-V = 4.86), high-risk conditions (HR 2.25), serum IGF-1 (HR 0.42), and HF etiology (HR 5.85 and HR 1.63 for valvular and ischemic etiology, respectively). In high-risk patients, CVM was related to IGF-1 levels, severe renal dysfunction and valvular etiology, whereas in young patients CMV was related to the high-risk pattern and serum IGF-1 levels. CONCLUSIONS Our study showed the clinical and prognostic utility of the IGF-1 assay in patients with HF.
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Affiliation(s)
- Alfredo De Giorgi
- grid.416315.4Clinica Medica Unit, Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy
| | - Alberto Maria Marra
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
- grid.5253.10000 0001 0328 4908Italian Clinical Outcome Research and Reporting Program (I-CORRP)-Center for Pulmonary Hypertension, Thorax Clinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Massimo Iacoviello
- grid.10796.390000000121049995Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Vincenzo Triggiani
- grid.7644.10000 0001 0120 3326Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari ‘A Moro’, Bari, Italy
| | - Giuseppe Rengo
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
- grid.511455.1Istituti Clinici Scientifici Maugeri SpA Società Benefit-IRCCS-Scientific Institute of Telese Terme, Telese Terme, Italy
| | - Francesco Cacciatore
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ciro Maiello
- grid.416052.40000 0004 1755 4122Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- grid.416052.40000 0004 1755 4122Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania L. Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- grid.416052.40000 0004 1755 4122Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania L. Vanvitelli, Caserta, Italy
| | - Francesco Perticone
- grid.411489.10000 0001 2168 2547Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- grid.477084.80000 0004 1787 3414Mediterranea Cardiocentro, Naples, Italy
| | - Stefania Paolillo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- grid.477084.80000 0004 1787 3414Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Mancini
- grid.8142.f0000 0001 0941 3192Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Volterrani
- grid.18887.3e0000000417581884Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Olga Vriz
- grid.415310.20000 0001 2191 4301Heart Center Department, King Faisal Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Roberto Castello
- grid.411475.20000 0004 1756 948XDivision of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Passantino
- grid.414603.4Scientific Clinical Institutes Maugeri, IRCCS, Pavia, Italy
| | - Michela Campo
- grid.10796.390000000121049995Unit of Endocrinology and Metabolic Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro Amedeo Modesti
- grid.8404.80000 0004 1757 2304Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - Andrea Salzano
- grid.482882.c0000 0004 1763 1319Italian Clinical Outcome Research and Reporting Program (I-CORRP)-IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Roberta D’Assante
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Michele Arcopinto
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Valeria Raparelli
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Fabio Fabbian
- grid.416315.4Clinica Medica Unit, Azienda Ospedaliero-Universitaria S.Anna, Ferrara, Italy
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Angela Sciacqua
- grid.411489.10000 0001 2168 2547Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Annamaria Colao
- grid.4691.a0000 0001 0790 385XClinical Medicine and Surgery Department, Federico II University, Naples, Italy
| | - Toru Suzuki
- grid.412925.90000 0004 0400 6581Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Eduardo Bossone
- grid.413172.2Italian Clinical Outcome Research and Reporting Program (I-CORRP)-Cardiology Division, A. Cardarelli Hospital, Naples, Italy
| | - Antonio Cittadini
- grid.4691.a0000 0001 0790 385XDepartment of Translational Medical Sciences, Federico II University, Naples, Italy
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Masarone D, Kittleson MM, Martucci ML, Valente F, Gravino R, Verrengia M, Ammendola E, Contaldi C, Di Palma V, Caiazzo A, Petraio A, Pollesello P, Pacileo G. Levosimendan as a "Bridge to Optimization" in Patients with Advanced Heart Failure with Reduced Ejection-A Single-Center Study. J Clin Med 2022; 11:jcm11144227. [PMID: 35887992 PMCID: PMC9317236 DOI: 10.3390/jcm11144227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/02/2022] [Accepted: 07/19/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Patients with advanced heart failure with reduced ejection fraction often cannot tolerate target doses of guideline-directed medical therapy due to symptomatic hypotension, renal dysfunction, and associated electrolyte abnormalities. While levosimendan can facilitate the titration of β-blockers in patients with advanced HFrEF, it is unclear whether ambulatory levosimendan infusions would offer the same benefit. In this prospective study, we investigate the effects of intermittent ambulatory levosimendan infusions on the uptitration of disease-modifying drugs. Methods: We enrolled 37 patients with advanced HFrEF who received repeated ambulatory infusions of levosimendan between January 2018 and January 2021. The demographic, clinical, and laboratory data were acquired 24 h before the first and the last ambulatory levosimendan infusion. Results: At the 1 year follow-up, the enrolled patients were on significantly higher doses of guideline-directed medical therapy, including bisoprolol (3.2 ± 2.8 mg vs. 5.9 ± 4.1 mg; p = 0.02), sacubitril/valsartan (41.67 ± 32.48 mg vs. 68.5 ± 35.72 mg; p = 0.01), and eplerenone (12.7 ± 8.5 mg vs. 22.8 ± 13.6 mg; p = 0.03). Furthermore, a substantial decrease in the furosemide dose was observed (123.2 ± 32.48 mg vs. 81.6 ± 19.47 mg; p < 0.0001). Conclusions: Levosimendan facilitates the optimization of disease-modifying heart failure medications in previously intolerant advanced HFrEF patients.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
- Correspondence: ; Tel.: +39-081-7065163; Fax: +39-081-7062674
| | - Michelle M. Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA 90048, USA;
| | - Maria L. Martucci
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Marina Verrengia
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Ernesto Ammendola
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Vito Di Palma
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Angelo Caiazzo
- Heart Transplant Unit, Department of Cardiac Surgery and Transplant, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (A.C.); (A.P.)
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplant, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (A.C.); (A.P.)
| | | | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
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19
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Salzano A, D'Assante R, Iacoviello M, Triggiani V, Rengo G, Cacciatore F, Maiello C, Limongelli G, Masarone D, Sciacqua A, Filardi PP, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Arcopinto M, Gargiulo P, Perticone M, Colao A, Milano S, Garavaglia A, Napoli R, Suzuki T, Bossone E, Marra AM, Cittadini A. Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry. Cardiovasc Diabetol 2022; 21:108. [PMID: 35710369 PMCID: PMC9204878 DOI: 10.1186/s12933-022-01543-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023] Open
Abstract
Background Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov identifier: NCT023358017
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Affiliation(s)
- Andrea Salzano
- IRCCS SYNLAB SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122, Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari 'A Moro', Bari, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB) - IRCCS - Scientific Institute of Telese Terme, Telese Terme, BN, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ciro Maiello
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera Dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera Dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Olga Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Roberto Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michela Campo
- Unit of Endocrinology and Metabolic Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro A Modesti
- Dipartimento Di Medicina Sperimentale E Clinica, Università Degli Studi Di Firenze, Florence, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Annamaria Colao
- Clinical Medicine and Surgery Department, Federico II University, Naples, Italy
| | - Salvatore Milano
- Department of Laboratory Medicine, AOUP P. Giaccone, Palermo, Italy
| | | | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Cardiology Division, A Cardarelli Hospital, Naples, Italy
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Center for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy. .,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy. .,Department of Translational Medical Sciences, Division of Internal Medicine and Metabolism and Rehabilitation, Federico II University of Naples, Via S. Pansini 5, Bld.18, 1stfloor, 80131, Naples, Italy.
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20
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Visco V, Radano I, Campanile A, Ravera A, Silverio A, Masarone D, Pacileo G, Correale M, Mazzeo P, Dattilo G, Giallauria F, Cuomo A, Mercurio V, Tocchetti CG, Di Pietro P, Carrizzo A, Citro R, Galasso G, Vecchione C, Ciccarelli M. Predictors of sacubitril/valsartan high dose tolerability in a real world population with HFrEF. ESC Heart Fail 2022; 9:2909-2917. [PMID: 35702942 DOI: 10.1002/ehf2.13982] [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: 12/27/2021] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan (Sac/Val) demonstrated to be superior to enalapril in reducing hospitalizations, cardiovascular and all-cause mortality in patients with ambulatory heart failure and reduced ejection fraction (HFrEF), in particular when it is maximally up-titrated. Unfortunately, the target dose is achieved in less than 50% of HFrEF patients, thus undermining the beneficial effects on the outcomes. In this study, we aimed to evaluate the role of Sac/Val and its titration dose on reverse cardiac remodelling and determine which echocardiographic index best predicts the up-titration success. METHODS AND RESULTS From January 2020 to June 2021, we retrospectively identified 95 patients (65.6 [59.1-72.8] years; 15.8% females) with chronic HFrEF who were prescribed Sac/Val from the HF Clinics of 5 Italian University Hospitals and evaluated the tolerability of Sac/Val high dose (the ability of the patient to achieve and stably tolerate the maximum dose) as the primary endpoint in the cohort. We used a multivariable logistic regression analysis, with a stepwise backward selection method, to determine the independent predictors of Sac/Val maximum dose tolerability, using, as candidate predictors, only variables with a P-value < 0.1 in the univariate analyses. Candidate predictors identified for the multivariable backward logistic regression analysis were age, sex, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dyslipidaemia, atrial fibrillation, systolic blood pressure (SBP), baseline tolerability of ACEi/ARBs maximum dose, left ventricle global longitudinal strain (LVgLS), LV ejection fraction (EF), tricuspid annulus plane systolic excursion (TAPSE), right ventricle (RV) fractional area change (FAC), RV global and free wall longitudinal strain (RVgLS and RV-FW-LS). After the multivariable analysis, only one categorical (ACEi/ARBs maximum dose at baseline) and three continuous (younger age, higher SBP, and higher TAPSE), resulted significantly associated with the study outcome variable with a strong discriminatory capacity (area under the curve 0.874, 95% confidence interval (CI) (0.794-0.954) to predict maximum Sac/Val dose tolerability. CONCLUSIONS Our study is the first to analyse the potential role of echocardiography and, in particular, of RV dysfunction, measured by TAPSE, in predicting Sac/Val maximum dose tolerability. Therefore, patients with RV dysfunction (baseline TAPSE <16 mm, in our cohort) might benefit from a different strategy to titrate Sac/Val, such as starting from the lowest dose and/or waiting for a more extended period of observation before attempting with the higher doses.
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Affiliation(s)
- Valeria Visco
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Ilaria Radano
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Alfonso Campanile
- Department of Cardiology, "San Giovanni di Dio e Ruggi D'Aragona" Hopital-University, Salerno, Italy
| | - Amelia Ravera
- Department of Cardiology, "San Giovanni di Dio e Ruggi D'Aragona" Hopital-University, Salerno, Italy
| | - Angelo Silverio
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | | | | | - Michele Correale
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Pietro Mazzeo
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, Operative Unit of Cardiology, University of Messina, Messina, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Alessandra Cuomo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.,Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy.,Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Paola Di Pietro
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Albino Carrizzo
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy.,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Italy
| | - Rodolfo Citro
- Department of Cardiology, "San Giovanni di Dio e Ruggi D'Aragona" Hopital-University, Salerno, Italy
| | - Gennaro Galasso
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Carmine Vecchione
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy.,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Italy
| | - Michele Ciccarelli
- Chair of Cardiology, Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, Salerno, Italy
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21
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Badagliacca R, Mercurio V, Romeo E, Correale M, Masarone D, Papa S, Tocchetti C, Agostoni P. Beta-blockers in pulmonary arterial hypertension: Time for a second thought? Vascul Pharmacol 2022; 144:106974. [DOI: 10.1016/j.vph.2022.106974] [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] [Received: 12/06/2021] [Revised: 02/19/2022] [Accepted: 02/26/2022] [Indexed: 11/29/2022]
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22
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Masarone D, Tedford RJ, Melillo E, Petraio A, Pacileo G. Angiotensin-converting enzyme inhibitor therapy after heart transplant: from molecular basis to clinical effects. Clin Transplant 2022; 36:e14696. [PMID: 35523577 DOI: 10.1111/ctr.14696] [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: 12/05/2021] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
The use of angiotensin-converting enzyme inhibitors is an important therapy for various cardiovascular diseases, such as hypertension, ischemic heart disease and heart failure. In heart transplant recipients, angiotensin-converting enzyme inhibitors have been demonstrated to be a keystone for the treatment of hypertension with a wide spectrum of pleiotropic molecular effects ranging from improvement of the peripheral vascular system to regulation of the fluid and sodium balance. In addition, angiotensin-converting enzyme inhibitors may be also useful in the prevention of graft failure, cardiac allograft vasculopathy and chronic kidney disease progression. Further tailored multi-center and randomized studies are warranted to confirm the pleiotropic clinical effects of ACEi therapy in HTRs and to support more extended use in daily clinical practice. Finally in the near future, the use of novel pharmacological agents that inhibit the renin-angiotensin-aldosterone system such as the neprylisin inhibitor sacubitril should be investigated in heart transplant recipients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Enrico Melillo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Heart Transplant, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
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23
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Dini FL, Carluccio E, Bitto R, Ciccarelli M, Correale M, D'Agostino A, Dattilo G, Ferretti M, Grelli A, Guida S, Jacoangeli F, Lupi L, Luschi L, Masarone D, Mercurio V, Pacileo G, Pugliese NR, Rispoli A, Scelsi L, Tocchetti CG, Brunetti ND, Palazzuoli A, Piepoli M, Nodari S, Ambrosio G. Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan. ESC Heart Fail 2022; 9:1107-1117. [PMID: 35122477 PMCID: PMC8934975 DOI: 10.1002/ehf2.13779] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/06/2021] [Accepted: 12/05/2021] [Indexed: 12/11/2022] Open
Abstract
AIM Echo-derived haemodynamic classification, based on forward-flow and left ventricular (LV) filling pressure (LVFP) correlates, has been proposed to phenotype patients with heart failure and reduced ejection fraction (HFrEF). To assess the prognostic relevance of baseline echocardiographically defined haemodynamic profile in ambulatory HFrEF patients before starting sacubitril/valsartan. METHODS AND RESULTS In our multicentre, open-label study, HFrEF outpatients were classified into 4 groups according to the combination of forward flow (cardiac index; CI:< or ≥2.0 L/min/m2 ) and early transmitral Doppler velocity/early diastolic annular velocity ratio (E/e': ≥ or <15): Profile-A: normal-flow, normal-pressure; Profile-B: low-flow, normal-pressure; Profile-C: normal-flow, high-pressure; Profile-D: low-flow, high-pressure. Patients were started on sacubitril/valsartan and followed-up for 12.3 months (median). Rates of the composite of death/HF-hospitalization were assessed by multivariable Cox proportional-hazards models. Twelve sites enrolled 727 patients (64 ± 12 year old; LVEF: 29.8 ± 6.2%). Profile-D had more comorbidities and worse renal and LV function. Target dose of sacubitril/valsartan (97/103 mg BID) was more likely reached in Profile-A (34%) than other profiles (B: 32%, C: 24%, D: 28%, P < 0.001). Event-rate (per 100 patients per year) progressively increased from Profile-A to Profile-D (12.0%, 16.4%, 22.9%, and 35.2%, respectively, P < 0.0001). By covariate-adjusted Cox model, profiles with low forward-flow (B and D) remained associated with poor outcome (P < 0.01). Adding this categorization to MAGGIC-score and natriuretic peptides, provided significant continuous net reclassification improvement (0.329; P < 0.001). Intermediate and high-dose sacubitril/valsartan reduced the event's risk independently of haemodynamic profile. CONCLUSIONS Echocardiographically-derived haemodynamic classification identifies ambulatory HFrEF patients with different risk profiles. In real-world HFrEF outpatients, sacubitril/valsartan is effective in improving outcome across different haemodynamic profiles.
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Affiliation(s)
- Frank L. Dini
- Cardiac, Thoracic and Vascular DepartmentUniversity of PisaPisaItaly
| | - Erberto Carluccio
- Cardiology and Cardiovascular PathophysiologyUniversity of PerugiaPerugiaItaly
| | - Roberto Bitto
- Department of Clinical and Experimental Medicine Section of CardiologyUniversity of MessinaMessinaItaly
| | - Michele Ciccarelli
- Chair of Cardiology, Department of Medicine, Surgery and DentistryUniversity of SalernoSalernoItaly
| | | | | | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine Section of CardiologyUniversity of MessinaMessinaItaly
| | - Marco Ferretti
- Department of CardiologyUniversity Hospital of ParmaParmaItaly
| | - Arianna Grelli
- Division of CardiologyFondazione I.R.C.C.S. Policlinico San MatteoPaviaItaly
| | - Stefania Guida
- Division of CardiologyFondazione I.R.C.C.S. Policlinico San MatteoPaviaItaly
| | | | - Laura Lupi
- Department of CardiologyUniversity of Brescia and ASST Spedali Civili di BresciaBresciaItaly
| | - Lorenzo Luschi
- Cardiovascular Diseases Unit, Department of Internal MedicineUniversity of SienaSienaItaly
| | | | - Valentina Mercurio
- Department of Translational Medical SciencesFederico II UniversityNaplesItaly
| | | | | | - Antonella Rispoli
- Chair of Cardiology, Department of Medicine, Surgery and DentistryUniversity of SalernoSalernoItaly
| | - Laura Scelsi
- Division of CardiologyFondazione I.R.C.C.S. Policlinico San MatteoPaviaItaly
| | | | | | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal MedicineUniversity of SienaSienaItaly
| | - Massimo Piepoli
- Heart Failure Unit, Cardiology DepartmentGuglielmo da Saliceto Hospital, AUSLPiacenzaItaly
| | - Savina Nodari
- Department of CardiologyUniversity of Brescia and ASST Spedali Civili di BresciaBresciaItaly
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular PathophysiologyUniversity of PerugiaPerugiaItaly
- CERICLET‐Centro Ricerca Clinica e TraslazionaleUniversity of PerugiaPerugiaItaly
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Russo V, Ammendola E, Gasperetti A, Bottino R, Schiavone M, Masarone D, Pacileo G, Nigro G, Golino P, Lip GYH, D'Andrea A, Boriani G, Proietti R. Add-on Therapy With Sacubitril/Valsartan and Clinical Outcomes in CRT-D Nonresponder Patients. J Cardiovasc Pharmacol 2022; 79:472-478. [PMID: 34935699 PMCID: PMC9012526 DOI: 10.1097/fjc.0000000000001202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT No data on the add-on sacubitril/valsartan (S/V) therapy among cardiac resynchronization therapy with a defibrillator (CRT-D) nonresponder patients are currently available in literature. We conducted a prospective observational study including 190 CRT-D nonresponder patients with symptomatic heart failure with reduced ejection fraction despite the optimal medical therapy from at least 1 year. The primary endpoint was the rate of additional responders (left ventricular end-systolic volume reduction >15%) at 12 months from the introduction of S/V therapy. At the end of the 12 months follow-up, 37 patients (19.5%) were deemed as "additional responders" to the combination use of CRT + S/V therapy. The only clinical predictor of additional response was a lower left ventricular ejection fraction [OR 0.881 (0.815-0.953), P = 0.002] at baseline. At 12 months follow-up, there were significant improvements in heart failure (HF) symptoms and functional status [New York Heart Association 2 (2-3) vs. 1 (1-2), P < 0.001; physical activity duration/day: 10 (8-12) vs. 13 (10-18) hours, P < 0.001]. Compared with the 12 months preceding S/V introduction, there were significant reductions in the rate of HF rehospitalization (35.5% vs. 19.5%, P < 0.001), in atrial tachycardia/atrial fibrillation burden [6.0 (5.0-8.0) % vs. 0 (0-2.0) %, P < 0.001] and in the proportions of patients experiencing ventricular arrhythmias (21.6% vs. 6.3%; P < 0.001). Our results indicate that S/V add-on therapy in CRT-D nonresponder patients is associated with 19.5% of additional responders, a reduction in HF symptoms and rehospitalizations, AF burden, and ventricular arrhythmias.
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Affiliation(s)
- Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Ernesto Ammendola
- Department of Cardiology, Heart Failure Unit, Monaldi Hospital, Naples, Italy
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Roberta Bottino
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Daniele Masarone
- Department of Cardiology, Heart Failure Unit, Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Department of Cardiology, Heart Failure Unit, Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Paolo Golino
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Antonello D'Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, Salerno, Italy; and
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Proietti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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25
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Masarone D. Last before-death alert remote monitoring transmission in patients with heart failure with reduced ejection fraction. Kardiol Pol 2022; 80:254-255. [PMID: 35195272 DOI: 10.33963/kp.a2022.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy.
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26
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Masarone D, Petraio A, Fiorentino A, Dellegrottaglie S, Valente F, Ammendola E, Nigro G, Pacileo G. Use of Cardiac Contractility Modulation as Bridge to Transplant in an Obese Patient With Advanced Heart Failure: A Case Report. Front Cardiovasc Med 2022; 9:833143. [PMID: 35252403 PMCID: PMC8889036 DOI: 10.3389/fcvm.2022.833143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac contractility modulation (CCM) is a novel device-based therapy in patients with heart failure with reduced ejection fraction (HFrEF). In randomized clinical trials and real-life studies, CCM has been shown to improve exercise tolerance and quality of life, reverse left ventricular remodeling and reduce hospitalization in patients with HFrEF. In this case report, we describe for the first time the use of CCM as a “bridge to transplant” in a young obese patient with advanced heart failure due to non-ischemic dilated cardiomyopathy. The patient had a poor quality of life and frequent heart failure-related hospitalizations despite the optimal medical therapy and, due to obesity, a suitable heart donor was unlikely to be identified in the short term and due to severe obesity risk of complications after implantation of a left ventricular assist device (LVAD) was very high.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
- *Correspondence: Daniele Masarone
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplants, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | | | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Accreditato Villa dei Fiori, Naples, Italy
- Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Ernesto Ammendola
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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Masarone D, Kittleson M, Petraio A, Pacileo G. Advanced heart failure: state of the art and future directions. Rev Cardiovasc Med 2022; 23:48. [DOI: 10.31083/j.rcm2302048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/06/2022] Open
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Carluccio E, Dini FL, Bitto R, Ciccarelli M, Correale M, D'Agostino A, Dattilo G, Ferretti M, Grelli A, Guida S, Jacoangeli F, Lupi L, Luschi L, Masarone D, Mercurio V, Pacileo G, Pugliese NR, Rispoli A, Scelsi L, Tocchetti CG, Brunetti ND, Palazzuoli A, Piepoli M, Nodari S, Ambrosio G. Benefit from sacubitril/valsartan is associated with hemodynamic improvement in heart failure with reduced ejection fraction: An echocardiographic study. Int J Cardiol 2022; 350:62-68. [PMID: 34998946 DOI: 10.1016/j.ijcard.2022.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/15/2021] [Accepted: 01/02/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sacubitril/valsartan improves outcome in patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (EF, HFrEF). However, little is known about possible mechanisms underlying this favourable effect. PURPOSE To assess changes in echocardiographically-derived hemodynamic profiles induced by sacubitril/valsartan and their impact on outcome. METHODS In this multicenter, open-label study, 727 HFrEF outpatients underwent comprehensive echocardiography at baseline (before starting sacubitril/valsartan) and after 12 months. Estimated LV filling pressure (E/e') and cardiac index (CI, l/min/m2) were combined to determine 4 hemodynamic profiles: profile-A (normal-flow/normal-pressure); profile-B (low-flow/normal-pressure); profile-C: (normal-flow/high-pressure); profile-D: (low-flow/high-pressure). Changes among categories were recorded, and their associations with rates of the composite of death/HF-hospitalization were assessed by multivariable Cox analysis. RESULTS At baseline, 29% had profile-A, 15% had profile-B, 32% profile-C, and 24% profile-D. After 12 months, the hemodynamic profile improved in 53% of patients (all profile-A achievers, or profile-D patients achieving either C or B profile), while it remained unchanged in 39% patients and worsened in 9%. Prevalence of improved profile progressively increased with increasing dose of sacubitril/valsartan (P < 0.0001). After the second echocardiography, patients were followed up 12.6 ± 7.6 months: event-rate was lower in patients with improved profile (12.3%, 95%CI: 9.4-16.1) compared to patients in whom hemodynamic profile remained unchanged (29.9%, 24.0-37.3) or worsened (31.2%, 20.7-46.9, P < 0.0001). Improved hemodynamic profile was associated with favourable outcome independent of LVEF and other covariates (HR 0.65, 95%CI: 0.45-0.95, P < 0.05). CONCLUSION In HFrEF patients, the beneficial prognostic effects of sacubitril/valsartan are associated with improvement in hemodynamic conditions.
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Affiliation(s)
- Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, University of Perugia, Italy.
| | - Frank L Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Italy
| | - Roberto Bitto
- Dpt. of Clinical and Experimental Medicine Section of Cardiology, University of Messina, Italy
| | - Michele Ciccarelli
- Chair of Cardiology, Dept. of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | | | | | - Giuseppe Dattilo
- Dpt. of Clinical and Experimental Medicine Section of Cardiology, University of Messina, Italy
| | - Marco Ferretti
- Department of Cardiology, University Hospital of Parma, Parma, Italy
| | - Arianna Grelli
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Stefania Guida
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | - Laura Lupi
- Department of Cardiology, University of Brescia and ASST Spedali Civili di Brescia, Italy
| | - Lorenzo Luschi
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Siena, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | | | - Antonella Rispoli
- Chair of Cardiology, Dept. of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | | | | | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Siena, Italy
| | - Massimo Piepoli
- Heart Failure Unit, Cardiology Department, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Savina Nodari
- Department of Cardiology, University of Brescia and ASST Spedali Civili di Brescia, Italy
| | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, University of Perugia, Italy; CERICLET-Centro Ricerca Clinica e Traslazionale, University of Perugia, Italy
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Masarone D, Kittleson M, Gravino R, Valente F, Petraio A, Pacileo G. The Role of Echocardiography in the Management of Heart Transplant Recipients. Diagnostics (Basel) 2021; 11:diagnostics11122338. [PMID: 34943575 PMCID: PMC8699946 DOI: 10.3390/diagnostics11122338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 01/30/2023] Open
Abstract
Transthoracic echocardiography is the primary non-invasive modality for the investigation of heart transplant recipients. It is a versatile tool that provides comprehensive information on cardiac structure and function. Echocardiography is also helpful in diagnosing primary graft dysfunction and evaluating the effectiveness of therapeutic approaches for this condition. In acute rejection, echocardiography is useful with suspected cellular or antibody-mediated rejection, with findings confirmed and quantified by endomyocardial biopsy. For identifying chronic rejection, ultrasound has a more significant role and, in some specific patients (e.g., patients with renal failure), it may offer a role comparable to coronary angiography to identify cardiac allograft vasculopathy. This review highlights the usefulness of echocardiography in evaluating normal graft function and its role in the management of heart transplant recipients.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
- Correspondence:
| | - Michelle Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA 90048, USA;
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplantology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy;
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (R.G.); (F.V.); (G.P.)
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Masarone D, Vivo SD, Errigo V, Onofrio AD, D’Alterio G, Ammedola E, Nigro G, Pacileo G. 164 Effect of cardiac contractility modulation therapy on myocardial work in patients with heart failure with reduced ejection fraction. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab139.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Cardiac contractility modulation therapy (CCMT) has been shown to reduce hospitalizations and to improve quality of life in heart failure patients with reduced ejection fraction (HFrEF) who remain symptomatic despite disease-modifying therapies. Strain imaging derived myocardial work (MW) is an emerging tool for evaluating left ventricular mechanics by incorporating systolic deformation and afterload burden in the analysis. To evaluate prospectively the impact of CCMT in HFrEF patients on MW derived parameters in relation to standard echocardiographic indices.
Methods and results
We recruited 12 HFrEF patients with indications to CCMT according to current clinical practice. A comprehensive echo-Doppler evaluation, including speckle tracking derived assessment of global longitudinal strain (GLS), was performed before and after three months from the CCM device implantation. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW), and global work efficiency (GWE) were calculated according to standardized procedures. Median values (interquartile range) were compared for all those parameters from baseline and 3-month follow-up with Wilcoxon Rank Sum test for continuous variables. At three months from CCM implant an improvement of LVEF [from 32% (27–34) to 36% (29–39), P < 0.05], GLS [from 7.4% (6.2–11.2) to 9.9% (7.5–9.4), P < 0.05], GWI [from 461 mmHg (372–613) to 589 mmHg (413–696), P < 0.05], GCW [from 800 mmHg (620–930) to 970 mmHg (644–1009), P = 0.236], and GWE [from 73% (65–78) to 85% (78–87), P < 0.05] was observed, with a consistent reduction of GWW [from 161 mmHg (148–227) to 125 mmHg (101–188), P < 0.05]. We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.727, P = 0.011).
Conclusions
At 3 months, CCMT significantly improves standard and advanced left ventricular systolic function indices. This improvement is due to the increase of constructive work and a reduction of wasted work. In addition, the increase of left ventricular ejection fraction can be predicted by the global constructive work levels at baseline.
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Affiliation(s)
- Daniele Masarone
- UOSD Cardiologia Riabilitativa Intensiva e Scompenso, AORN dei Colli Ospedale Monaldi, Italy
| | - Stefano De Vivo
- UOSD Elettrofisiologia Studio e Terapoia delle Aritmie, AORN dei Colli Ospedale Monaldi, Italy
| | - Vittoria Errigo
- UOSD Cardiologia Riabilitativa Intensiva e Scompenso, AORN dei Colli Ospedale Monaldi, Italy
| | - Antonio D’ Onofrio
- UOSD Elettrofisiologia Studio e Terapoia delle Aritmie, AORN dei Colli Ospedale Monaldi, Italy
| | - Giuliano D’Alterio
- UOSD Elettrofisiologia Studio e Terapoia delle Aritmie, AORN dei Colli Ospedale Monaldi, Italy
| | - Ernesto Ammedola
- UOSD Cardiologia Riabilitativa Intensiva e Scompenso, AORN dei Colli Ospedale Monaldi, Italy
| | - Gerardo Nigro
- Dipartimento di Scienze Mediche e Translazionali, Università della Campania ‘Luigi Vanvitelli’, Italy
| | - Giuseppe Pacileo
- UOSD Cardiologia Riabilitativa Intensiva e Scompenso, AORN dei Colli Ospedale Monaldi, Italy
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Masarone D, Pacileo R, Pacileo G. Use of disease-modifying drugs in diabetic patients with heart failure with reduced ejection fraction. Heart Fail Rev 2021; 28:657-665. [PMID: 34734359 DOI: 10.1007/s10741-021-10189-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes mellitus and heart failure are closely related, patients with type 2 diabetes mellitus have a higher risk of developing heart failure, and those with heart failure are at increased risk of developing type 2 diabetes. Although no specific randomized clinical trials have been conducted to test the effect of cardiovascular therapies (drugs and/or devices) in diabetic patients with heart failure, a lot of evidence shows that all interventions effective in improving prognosis in patients with heart failure reduced ejection fraction are equally beneficial in patients with and without diabetes. However, the use of disease-modifying drugs in patients with diabetes and heart failure reduced ejection fraction is a clinical challenge due to the increased risk of adverse effects. For example, β-blockers are underutilized in diabetic patients due to the theoretical unfavorable effects on glucose metabolism as well as the use of drugs that interact with the renin-angiotensin system can be challenged in patients with diabetic nephropathy because of the risk of hyperkalemia. This review outlines the current use of disease-modifying drugs in diabetic patients with heart failure reduced ejection fraction. In addition, the role of novel pharmacologic agents as type 2 sodium-glucose co-transporter inhibitors (SGLT2ii) is discussed.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, Via Leonardo Bianchi 1, 80100, Naples, Italy.
| | - Roberta Pacileo
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, Via Leonardo Bianchi 1, 80100, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN Dei Colli-Monaldi Hospital, Via Leonardo Bianchi 1, 80100, Naples, Italy
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Pacileo G, Grigioni F, Masarone D, Potena L. Advanced Heart Failure: From Pathophysiology to Clinical Management. Heart Fail Clin 2021. [DOI: 10.1016/s1551-7136(21)00084-2] [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: 11/25/2022]
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Melillo E, Masarone D, Oh JK, Verrengia M, Valente F, Vastarella R, Ammendola E, Pacileo R, Pacileo G. Echocardiography in Advanced Heart Failure for Diagnosis, Management, and Prognosis. Heart Fail Clin 2021; 17:547-560. [PMID: 34511204 DOI: 10.1016/j.hfc.2021.05.001] [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] [Indexed: 10/20/2022]
Abstract
Advanced heart failure, an end-stage disease characterized by high mortality and morbidity despite standard medical therapy, requires various therapeutic strategies like heart transplant and long-term mechanical circulatory support. Echocardiography is the main imaging technique to identify transitions to advanced stages of disease and guide risk stratification and therapeutic decision-making processes. Progressive development of advanced echocardiographic techniques allows more comprehensive assessment of the hemodynamic and structural profiles of patients with advanced heart failure, and its use in clinical practice continues to expand. This article provides an overview of basic and emerging echocardiographic tools to assess patients with advanced heart failure.
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Affiliation(s)
- Enrico Melillo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy.
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marina Verrengia
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Fabio Valente
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | | | | | - Roberta Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
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Pacileo G, Grigioni F, Masarone D, Potena L, Bossone E. Management of Advanced Heart Failure: The Science of Uncertainty and the Art of Probability. Heart Fail Clin 2021; 17:xv-xvi. [PMID: 34511217 DOI: 10.1016/j.hfc.2021.06.003] [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] [Indexed: 11/17/2022]
Affiliation(s)
- Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Via Leonardo Bianchi 1, Naples, 80131 Italy.
| | - Francesco Grigioni
- University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, Rome, 00128 Italy.
| | - Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Via Leonardo Bianchi 1, Naples, 80131 Italy.
| | - Luciano Potena
- UO Cardiologia, Dipartimento Cardio-Toraco-Vascolare, IRCCS Policlinico di Sant'Orsola Padiglione, 25 Via Massarenti 9, Bologna, 40138 Italy.
| | - Eduardo Bossone
- Division of Cardiology, Cardarelli Hospital, Via A. Cardarelli, 9, 80131 Naples, Italy.
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Masarone D, Melillo E, Gravino R, Vastarella R, Caiazzo A, Ursomando F, Pacileo G, Petraio A. Left Ventricular Assist Device Implantation in a Thrombosed Apical Aneurysm. Clin Pract 2021; 11:430-434. [PMID: 34287286 PMCID: PMC8293107 DOI: 10.3390/clinpract11030057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/29/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022] Open
Abstract
Left ventricular assist device implantation is a challenging procedure in the presence of a giant thrombosed aneurysm, and no standard surgical techniques are currently recommended in this setting. In this case, we report the successful implantation of a left ventricular assist device (HeartMate III) in a patient with a massive thrombosed apical aneurysm. The patient presented with extended antero-apical necrosis as a result of a delay in hospital admission for acute coronary syndrome due to the patient’s concerns about the COVID-19 pandemic outbreak.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Cardiology Unit, Department of Cardiology, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (R.G.); (R.V.); (G.P.)
- Correspondence: or ; Tel.: +39-081-7065-163; Fax: +39-081-7062-674
| | - Enrico Melillo
- Heart Failure Cardiology Unit, Department of Cardiology, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (R.G.); (R.V.); (G.P.)
| | - Rita Gravino
- Heart Failure Cardiology Unit, Department of Cardiology, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (R.G.); (R.V.); (G.P.)
| | - Rossella Vastarella
- Heart Failure Cardiology Unit, Department of Cardiology, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (R.G.); (R.V.); (G.P.)
| | - Angelo Caiazzo
- Heart Transplant Unit, Department of Cardiovascular Surgery and Transplants, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy; (A.C.); (F.U.); (A.P.)
| | - Fabio Ursomando
- Heart Transplant Unit, Department of Cardiovascular Surgery and Transplants, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy; (A.C.); (F.U.); (A.P.)
| | - Giuseppe Pacileo
- Heart Failure Cardiology Unit, Department of Cardiology, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (R.G.); (R.V.); (G.P.)
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiovascular Surgery and Transplants, AO dei Colli, Monaldi Hospital, 80131 Naples, Italy; (A.C.); (F.U.); (A.P.)
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Cittadini A, Salzano A, Iacoviello M, Triggiani V, Rengo G, Cacciatore F, Maiello C, Limongelli G, Masarone D, Perticone F, Cimellaro A, Perrone Filardi P, Paolillo S, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Monte IP, Puzzo A, Ballotta A, D'Assante R, Arcopinto M, Gargiulo P, Sciacqua A, Bruzzese D, Colao A, Napoli R, Suzuki T, Eagle KA, Ventura HO, Marra AM, Bossone E. Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. Registry. Eur J Prev Cardiol 2021; 28:1691-1700. [PMID: 33693736 DOI: 10.1093/eurjpc/zwab020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 10/16/2020] [Revised: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
AIMS Recent evidence supports the occurrence of multiple hormonal and metabolic deficiency syndrome (MHDS) in chronic heart failure (CHF). However, no large observational study has unequivocally demonstrated its impact on CHF progression and outcome. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Treatment in Heart Failure) Registry has been specifically designed to test the hypothesis that MHDS affects morbidity and mortality in CHF patients. METHODS AND RESULTS The T.O.S.CA. Registry is a prospective, multicentre, observational study involving 19 Italian centres. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydropianoandrosterone sulfate, insulin resistance, and the presence of diabetes were evaluated. A MHDS was defined as the presence of ≥2 hormone deficiencies (HDs). Primary endpoint was a composite of all-cause mortality and cardiovascular hospitalizations. Four hundred and eighty heart failure patients with ejection fraction ≤45% were enrolled. MHDS or diabetes was diagnosed in 372 patients (77.5%). A total of 271 events (97 deaths and 174 cardiovascular hospitalizations) were recorded, 41% in NO-MHDS and 62% in MHDS (P < 0.001). Median follow-up was of 36 months. MHDS was independently associated with the occurrence of the primary endpoint [hazard ratio 95% (confidence interval), 1.93 (1.37-2.73), P < 0.001] and identified a group of patients with a higher mortality [2.2 (1.28-3.83), P = 0.01], with a graded relation between HDs and cumulative events (P < 0.01). CONCLUSION MHDS is common in CHF and independently associated with increased all-cause mortality and cardiovascular hospitalization, representing a promising therapeutic target. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT023358017.
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Affiliation(s)
- Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari 'A Moro', Bari, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), IRCCS, Scientific Institute of Telese Terme, Telese BN, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Ciro Maiello
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Antonio Cimellaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Olga Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Roberto Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michela Campo
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Metabolic Diseases, University of Foggia, Foggia, Italy
| | - Pietro A Modesti
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Ines P Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | | | - Andrea Ballotta
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Dario Bruzzese
- Department of Public Health, Federico II University, Naples, Italy
| | - Annamaria Colao
- Clinical Medicine and Surgery Department, Federico II University, Naples, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Kim A Eagle
- Michigan Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Center for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Cardiology Division, A Cardarelli Hospital, Naples, Italy
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Melillo E, Masarone D, Valente F, Vastarella R, Gravino R, Ammendola E, Verrengia M, Caiazzo A, Petraio A, Pacileo G. Intermittent outpatient administration of levosimendan improves right ventricular-pulmonary arterial coupling in ambulatory patients with advanced heart failure. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Intermittent infusions of levosimendan in an outpatient setting have been associated with improved symptoms and reduced hospitalizations in patients with advanced heart failure (HF). Little is known on the potential effect of intermittent levosimendan infusions on right ventricle (RV)-pulmonary arterial (PA) coupling in ambulatory patients with advanced HF.
Purpose Aim of the present study was to explore the effects of intermittent levosimendan infusions on the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PAPs), an echocardiographic measure of RV/PA coupling, in ambulatory patients with advanced HF, and on left ventricular arterial coupling (VAC), expressed as the relationship between arterial elastance (Ea) and ventricular elastance (Ees).
Methods 17 ambulatory patients with advanced HF treated with intermittent levosimendan (6-hour intravenous infusion, 0.2 ug/kg/min without bolus) received baseline clinical, biochemical and echocardiographic evaluation and changes in TAPSE/PAPs ratio were assessed from baseline to 48 hours after the infusion, based on the pharmacokinetic profile of levosimendan. VAC, expressed as Ea/Ees ratio, was obtained by a calculator (iElastance) designed for non-invasive single beat measure of end-systolic Ees and Ea according to Chen"s method.
Results After 48 hours from levosimendan infusion, there was a significant improvement of TAPSE/PAPs ratio (p = 0.04), stroke voume (SV) (p = 0.05) and cardiac output (CO)(p = 0.04). We observed a significant reduction of Ea (p = 0.007) and of Ees (p = 0.01) and a non significant improvement of VAC (p = 0.4)(Tab.1).
Conclusion. Our results show that an intermittent 6-hour levosimendan infusion at 0.2 ug/kg/min improves after 48 hours RV-PA coupling, SV, CO, Ea and Ees in ambulatory patients with advanced HF. Further studies including more patients are necessary to confirm these preliminary findings.
Tab.1 Baseline 48h afterlevosimendan infusion p value NT-proBNP (pg/mL) 5607 ± 4300 3868 ± 3856 <0.001 LVEF (%) 24.1 ± 7.7 25.7 ± 7.3 0.5 SV (mL) 36.8 ± 12.4 46.1 ± 14.8 0.05 CO (L/min)36.8 ± 12.4 2.6 ± 0.7 3.2 ± 0.9 0.05 TAPSE/PAPs (mm/mmHg) 0.38 ± 0.13 0.49 ± 0.16 0.04 Ea (mmHg/mL/m2) 2.9 ± 0.9 2.1 ± 0.6 0.007 Ees (mmHg/mL/m2) 1.3 ± 0.4 1.0 ± 0.2 0.01 VAC 2.2 ± 0.6 2.0 ± 0.4 0.4
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Affiliation(s)
- E Melillo
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - D Masarone
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - F Valente
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | | | - R Gravino
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - E Ammendola
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - M Verrengia
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - A Caiazzo
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - A Petraio
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - G Pacileo
- AO dei Colli-Monaldi Hospital, Naples, Italy
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Ghio S, Crimi G, Houston B, Montalto C, Garascia A, Boffini M, Temporelli PL, La Rovere MT, Pacileo G, Panneerselvam K, Santolamazza C, D'angelo L, Moschella M, Scelsi L, Marro M, Masarone D, Ameri P, Rinaldi M, Guazzi M, D'alto M, Tedford RJ. Nonresponse to Acute Vasodilator Challenge and Prognosis in Heart Failure With Pulmonary Hypertension. J Card Fail 2021; 27:869-876. [PMID: 33556547 DOI: 10.1016/j.cardfail.2021.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND An acute vasodilator challenge is recommended in patients with heart failure and pulmonary hypertension during heart transplant evaluation. The aim of the study was to assess which hemodynamic parameters are associated with nonresponsiveness to the challenge. METHODS AND RESULTS This study is a retrospective analysis of 402 patients with heart failure with pulmonary hypertension who underwent right heart catheterization and a pulmonary vasodilator challenge. Among the 140 who fulfilled the transplant guidelines eligibility criteria for the vasodilator challenge, 38 were responders and 102 nonresponders. At multivariable analysis, a diastolic blood pressure of <70 mm Hg, pulmonary vascular resistance of >5 Woods units, and pulmonary artery compliance of <1.2 mL/mm Hg were independently associated with poor response to vasodilator challenge (all P < .001). The presence of any 2 of these 3 conditions was associated with a 90% probability of being a nonresponder. The covariate-adjusted hemodynamic predictors of death in the entire population were a low baseline systolic blood pressure (P = .0017) and a low baseline right ventricular stroke work index (P = .0395). CONCLUSIONS In patients with heart failure and pulmonary hypertension, low pulmonary arterial compliance, high pulmonary vascular resistance, and low diastolic blood pressure predict the nonresponsiveness to acute vasodilator challenge whilst a poor right ventricular function predicts a dismal prognosis.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Gabriele Crimi
- Cardio Thoraco Vascular Department (DICATOV), IRCCS Policlinico San Martino di Genova, Genova, Italy
| | - Brian Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Garascia
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Boffini
- Division of Cardiac Surgery, Surgical Sciences Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
| | | | - Giuseppe Pacileo
- Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Kavin Panneerselvam
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Caterina Santolamazza
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luciana D'angelo
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Moschella
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Marro
- Division of Cardiac Surgery, Surgical Sciences Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Daniele Masarone
- Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Pietro Ameri
- Cardio Thoraco Vascular Department (DICATOV), IRCCS Policlinico San Martino di Genova, Genova, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Surgical Sciences Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Marco Guazzi
- Cardiology Department, Policlinico San Donato and University of Milano, Milano, Italy
| | - Michele D'alto
- Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
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Masarone D, Pacileo G. Repeated infusion of levosimendan in outpatients with advanced heart failure: to cure sometimes, to relieve often, and to comfort always. J Cardiovasc Med (Hagerstown) 2021; 22:150. [PMID: 32858644 DOI: 10.2459/jcm.0000000000001100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Daniele Masarone
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology. AORN dei Colli-Monaldi Hospital, Naples, Italy
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Abstract
BACKGROUND The worsening of renal function after the start of valsartan therapy is relatively common in clinical practice. However, few data are available on the incidence of worsening renal function after the beginning of therapy with sacubitril/valsartan. METHODS We retrospectively enrolled 202 outpatients with HFrEF that started therapy with sacubitril/valsartan to evaluate the prevalence of worsening renal function and its clinical significance. RESULTS At 1 month, a worsening renal function (defined as a > 20% decrease in eGFR occurring after 1 month of ARNi therapy) was found in 68 patients (33%), however after a mean follow-up of 650 ± 80 days, Kaplan-Meier analysis showed no significant in terms of HF-related deaths, HF-related hospitalizations, and the need for renal replacement therapy (25.2 vs. 23.6%; p = .812). In addition, the renal function recovered in patients with early WRF at 3 months (62 + 9.3 ml/min/1.73 m2 vs. 63 ± 13.8 ml/min/1.73 m2; p < .05), with an improvement in estimated glomerular filtration rate at 1 year compared with baseline value (62 ± 9.3 ml/min/1.73 m2 vs. 69 ± 8.6 ml/min/1.73 m2; p < .01). CONCLUSIONS WRF occurs in nearly 30% of HFrEF patients without impacting clinical outcomes; HF specialists should be aware of these changes to avoid unnecessary discontinuation of sacubitril/valsartan therapy.
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Affiliation(s)
- Daniele Masarone
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Enrico Melillo
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Vittoria Errigo
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Fabio Valente
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Department of Cardiology, Heart failure Unit, AORN dei Colli-Monaldi Hospital, Naples, Italy
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Masarone D, Melillo E, Petraio A, Valente F, Gravino R, Verrengia M, Pacileo G. Exercise-based rehabilitation strategies in heart transplant recipients: Focus on high-intensity interval training. Clin Transplant 2020; 35:e14143. [PMID: 33150597 DOI: 10.1111/ctr.14143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
Despite progressive improvement in medical therapy and standard care, the exercise capacity of heart transplant recipients is reduced compared with age-matched healthy individuals. Exercise-based rehabilitation programs have been shown to improve the exercise capacity of transplant patients through a multifactorial effect. In this context, high-intensity interval exercise is a growing field of research, with current evidence suggesting a major benefit in heart transplant recipients compared with a conventional training protocol. Therefore, this study aimed to provide an overview of the mechanisms involved in the reduced exercise capacity of heart transplant patients and a review of current rehabilitation strategies with a special focus on the mechanisms and clinical effects of high-intensity interval training exercise.
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Affiliation(s)
- Daniele Masarone
- Heart Failure and Rehabilitative Cardiology Unit, AO dei Colli, Monaldi Hospital, Naples, Italy
| | - Enrico Melillo
- Heart Failure and Rehabilitative Cardiology Unit, AO dei Colli, Monaldi Hospital, Naples, Italy
| | - Andrea Petraio
- Department of Cardiovascular Surgery and Transplants, AO dei Colli, Monaldi Hospital, Naples, Italy
| | - Fabio Valente
- Heart Failure and Rehabilitative Cardiology Unit, AO dei Colli, Monaldi Hospital, Naples, Italy
| | - Rita Gravino
- Heart Failure and Rehabilitative Cardiology Unit, AO dei Colli, Monaldi Hospital, Naples, Italy
| | - Marina Verrengia
- Heart Failure and Rehabilitative Cardiology Unit, AO dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure and Rehabilitative Cardiology Unit, AO dei Colli, Monaldi Hospital, Naples, Italy
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Esposito A, Monda E, Gragnano F, Simone FD, Cesaro A, Natale F, Concilio C, Moscarella E, Caiazza M, Pazzanese V, Verrengia M, Valente F, Masarone D, Pelliccia F, Bossone E, Calabro' P, Pacileo G, Limongelli G. Prevalence and clinical implications of hyperhomocysteinaemia in patients with hypertrophic cardiomyopathy and MTHFR C6777T polymorphism. Eur J Prev Cardiol 2020; 27:1906-1908. [DOI: 10.1177/2047487319888596] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Augusto Esposito
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Division of Cardiology, A.O.R.N. Sant'Anna e San Sebastiano, Italy
| | - Fabiana De Simone
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Francesco Natale
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Claudia Concilio
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Vittorio Pazzanese
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Marina Verrengia
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Fabio Valente
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Daniele Masarone
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | | | | | - Paolo Calabro'
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Division of Cardiology, A.O.R.N. Sant'Anna e San Sebastiano, Italy
| | - Giuseppe Pacileo
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Italy
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, University of Campania ‘Luigi Vanvitelli’, Italy
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Masarone D, Valente F, Verrengia M, Ammendola E, Gravino R, D'Alterio G, Petraio A, Pacileo G. Efficacy and safety of repeated infusion of levosimendan in outpatients with advanced heart failure: a real-world experience. J Cardiovasc Med (Hagerstown) 2020; 21:919-921. [PMID: 33017124 DOI: 10.2459/jcm.0000000000000983] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Daniele Masarone
- Heart Failure and Cardiac Rehabilitation Unit, Departement of Cardiology, AORN dei Colli, Monaldi Hospital
| | - Fabio Valente
- Heart Failure and Cardiac Rehabilitation Unit, Departement of Cardiology, AORN dei Colli, Monaldi Hospital
| | - Marina Verrengia
- Heart Failure and Cardiac Rehabilitation Unit, Departement of Cardiology, AORN dei Colli, Monaldi Hospital
| | - Ernesto Ammendola
- Heart Failure and Cardiac Rehabilitation Unit, Departement of Cardiology, AORN dei Colli, Monaldi Hospital
| | - Rita Gravino
- Heart Failure and Cardiac Rehabilitation Unit, Departement of Cardiology, AORN dei Colli, Monaldi Hospital
| | - Giuliano D'Alterio
- Heart Failure and Cardiac Rehabilitation Unit, Departement of Cardiology, AORN dei Colli, Monaldi Hospital
| | - Andrea Petraio
- Heart Transplant Unit, Departement of Cardiac Surgery and Heart Transplatation, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure and Cardiac Rehabilitation Unit, Departement of Cardiology, AORN dei Colli, Monaldi Hospital
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Masarone D, Vastarella R, Melillo E, Petraio A, Pacileo G. Beta-blocker therapy in heart transplant recipients: A review. Clin Transplant 2020; 34:e14081. [PMID: 32941656 DOI: 10.1111/ctr.14081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Abstract
Beta-blockers are essential drugs for the treatment of many cardiovascular diseases, such as heart failure, acute and chronic ischemic heart disease, tachyarrhythmias, and hypertension. However, these drugs have not been used in cardiac transplant patients for many years owing to the fear that they could reduce cardiac output and functional capacity. In recent years, however, some evidence has shown that even in cardiac transplanted patients, β-blockers are useful and effective in the treatment of sinus tachycardia, supraventricular and ventricular tachyarrhythmias, left ventricular systolic dysfunction, and arterial hypertension. Furthermore, some data have shown that the use of β-blockers is associated with reduced mortality in heart transplant recipients. In this review, we summarize this evidence with particular emphasis on the practical aspects of the use of β-blockers in post-transplantation patients to promote the use of this important class of drugs in clinical practice.
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Affiliation(s)
- Daniele Masarone
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Rossella Vastarella
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Enrico Melillo
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Heart Transplant, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
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Masarone D, Errigo V, Melillo E, Valente F, Gravino R, Verrengia M, Ammendola E, Vastarella R, Pacileo G. Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction. J Clin Med 2020; 9:jcm9103159. [PMID: 33003523 PMCID: PMC7600827 DOI: 10.3390/jcm9103159] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND right ventricle-pulmonary artery (RV-PA) coupling assessed by measuring the tricuspid anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been recently proposed as an early marker of right ventricular dysfunction in patients with heart failure with a reduced ejection fraction (HFrEF). METHODS As the effects of sacubitril/valsartan therapy on RV-PA coupling remain unknown, this study aimed to analyse the effect of this drug on TAPSE/PASP in patients with HFrEF. We retrospectively analysed all outpatients with HFrEF referred to our unit between October 2016 and July 2018. RESULTS At the 1-year follow-up, sacubitril/valsartan therapy was associated with a significant improvement in TAPSE (18.26 ± 3.7 vs. 19.6 ± 4.2 mm, p < 0.01), PASP (38.3 ± 15.7 vs. 33.7 ± 13.6, p < 0.05), and RV-PA coupling (0.57 ± 0.25 vs. 0.68 ± 0.30 p < 0.01). These improvements persisted at the 2-year follow-up. In the multivariable analysis, the improvement in the RV-PA coupling was independent of the left ventricular remodelling. CONCLUSIONS in patients with HFrEF, sacubitril/valsartan improved the RV-PA coupling; however, further trials are necessary to evaluate the role of sacubitril/valsartan in the treatment of right ventricle (RV) dysfunction either associated or not associated with left ventricular dysfunction.
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Masarone D, Melillo E, Valente F, Petraio A, Limongelli G, Verrengia M, Gravino R, Ammendola E, D'Alterio G, Vastarella R, Pacileo G. Use of sacubitril/valsartan as 'bridge to transplant' in patients with end-stage hypertrophic cardiomyopathy. Future Cardiol 2020; 17:89-94. [PMID: 32723181 DOI: 10.2217/fca-2020-0048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The end stage or burned-out phase is an uncommon but challenging clinical evolution of hypertrophic cardiomyopathy (HCM). The management of end-stage HCM is empirically based on the use of drugs approved for heart failure with reduced ejection fraction; however, cardiac transplantation often represents the best option to improve survival. In our case, we describe the use of sacubitril/valsartan as a 'bridge to transplant' in a patient with end-stage HCM. After introducing the drug, enhancements in functional capacity, a reduction in natriuretic peptides and an increase in left ventricular ejection fraction occurred. Given their improved volume of oxygen consumption (VO2) peak and hemodynamic parameters, our patient was left off the waiting list for cardiac transplant and continues to be regularly followed-up with every 3 months.
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Affiliation(s)
- Daniele Masarone
- Heart Failure & Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
| | - Enrico Melillo
- Heart Failure & Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
| | - Fabio Valente
- Heart Failure & Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplantation. AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
| | - Giuseppe Limongelli
- Rare Disease Unit, Department of Cardiology. AORN dei Colli, Monaldi Hospital, Naples 80100, Italy.,Department of Translational Medical Sciences, Luigi Vanvitelli University, Naples 80100, Italy.,Institute of Cardiovascular Sciences, University College of London, London, WC1E 6B, UK
| | - Marina Verrengia
- Heart Failure & Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
| | - Rita Gravino
- Heart Failure & Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
| | - Ernesto Ammendola
- Heart Failure & Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
| | - Giuliano D'Alterio
- Heart Failure & Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
| | - Rossella Vastarella
- Heart Failure & Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
| | - Giuseppe Pacileo
- Heart Failure & Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples 80100, Italy
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Correale M, Paolillo S, Mercurio V, Limongelli G, Barillà F, Ruocco G, Palazzuoli A, Scrutinio D, Lagioia R, Lombardi C, Lupi L, Magrì D, Masarone D, Pacileo G, Scicchitano P, Matteo Ciccone M, Parati G, Tocchetti CG, Nodari S. Comorbidities in chronic heart failure: An update from Italian Society of Cardiology (SIC) Working Group on Heart Failure. Eur J Intern Med 2020; 71:23-31. [PMID: 31708358 DOI: 10.1016/j.ejim.2019.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/27/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Abstract
The increasing number of patients with heart failure HF and comorbidities is due to aging population and increase of life expectancy of patients with cardiovascular disease. Encouraging results derived by recent trials may suggest some comorbidities as new targets for new drugs, highlighting the need for a better understanding of the comorbidities' effects in HF patients and the need of a multidisciplinary approach for the management of chronic HF with comorbidities. We report a brief review about main cardiovascular and non-cardiovascular comorbidities in HF patients in order to update physicians and researchers engaged in the HF research or in "fight against heart failure."
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Affiliation(s)
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giuseppe Limongelli
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy; Department of Translational Medical Sciences, Luigi Vanvitelli University, Naples, Italy; Institute of Cardiovascular Sciences, University College of London, London, United Kingdom
| | - Francesco Barillà
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza" University of Rome, Italy
| | - Gaetano Ruocco
- Cardiovascular Diseases Unit Department of Internal Medicine, University of Siena, Siena, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit Department of Internal Medicine, University of Siena, Siena, Italy
| | | | - Rocco Lagioia
- Cardiology Department, IRCCS "S. Maugeri" Cassano (BA), Bari, Italy
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences. San Luca Hospital, Milan, Italy
| | - Laura Lupi
- Section of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, University "La Sapienza", Rome, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Pietro Scicchitano
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari "A. Moro", Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari "A. Moro", Bari, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences. San Luca Hospital, Milan, Italy
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Savina Nodari
- Section of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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Gravino R, Limongelli G, Petraio A, Masarone D, Russo MG, Maiello C, Verrengia M, De Paulis D, Pacileo G. Berlin Heart EXCOR® pediatric ventricular assist device in a patient with Sotos syndrome: a case report. J Med Case Rep 2019; 13:286. [PMID: 31470900 PMCID: PMC6717362 DOI: 10.1186/s13256-019-2190-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 07/04/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Berlin Heart EXCOR® pediatric ventricular assist device is a mechanical circulatory support device currently used in pediatric patients. Sotos syndrome is a well-described multiple anomaly syndrome characterized by overgrowth, distinctive craniofacial appearance, cardiac abnormalities, and variable learning disabilities. Case presentation We describe a 7-year-old female Caucasian child with classic Sotos syndrome features subjected to implantation of Berlin Heart EXCOR® pediatric biventricular assist device mechanical support. A heart transplant was carried out after a support time of 459 days. After 5 years of follow-up, our patient is clinically stable and the performance of the transplanted heart is excellent. Conclusion This case confirms that Berlin Heart EXCOR® pediatric ventricular assist device can provide satisfactory and safe circulatory support for children with end-stage heart diseases, even in those with Sotos syndrome. The syndrome is not a contraindication to implantation, since the complications are the same as those observed in patients without the syndrome and the prognosis is not affected by the disease.
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Affiliation(s)
- Rita Gravino
- Department of Heart Failure Unit, Monaldi Hospital, via Leonardo Bianchi, 80131, Naples, Italy.
| | - Giuseppe Limongelli
- Department of Pediatric Cardiology Unit, Second University of Naples, Monaldi Hospital, Naples, Italy
| | - Andrea Petraio
- Department of Cardiac Transplant Unit, Monaldi Hospital, Naples, Italy
| | - Daniele Masarone
- Department of Heart Failure Unit, Monaldi Hospital, via Leonardo Bianchi, 80131, Naples, Italy
| | - Maria Giovanna Russo
- Department of Pediatric Cardiology Unit, Second University of Naples, Monaldi Hospital, Naples, Italy
| | - Ciro Maiello
- Department of Cardiac Transplant Unit, Monaldi Hospital, Naples, Italy
| | - Marina Verrengia
- Department of Heart Failure Unit, Monaldi Hospital, via Leonardo Bianchi, 80131, Naples, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, San Anna & San Sebastiano City Hospital Caserta, Caserta, Italy
| | - Giuseppe Pacileo
- Department of Heart Failure Unit, Monaldi Hospital, via Leonardo Bianchi, 80131, Naples, Italy
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Limongelli G, Monda E, Tramonte S, Gragnano F, Masarone D, Frisso G, Esposito A, Gravino R, Ammendola E, Salerno G, Rubino M, Caiazza M, Russo M, Calabrò P, Elliott PM, Pacileo G. Prevalence and clinical significance of red flags in patients with hypertrophic cardiomyopathy. Int J Cardiol 2019; 299:186-191. [PMID: 31303393 DOI: 10.1016/j.ijcard.2019.06.073] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We sought to determine prevalence and predictive accuracy of clinical markers (red flags, RF), known to be associated with specific systemic disease in a consecutive cohort of patients with hypertrophic cardiomyopathy (HCM). METHODS We studied 129 consecutive patients (23.7 ± 20.9 years, range 0-74 years; male/female 68%/32%). Pre-specified RF were categorized into five domains: family history; signs/symptoms; electrocardiography; imaging; and laboratory. Sensitivity (Se), specificity (Sp), negative predictive value (NPV), positive predictive value (PPV), and predictive accuracy of RF were analyzed in the genotyped population. RESULTS In the overall cohort of 129 patients, 169 RF were identified in 62 patients (48%). Prevalence of RF was higher in infants (78%) and in adults >55 years old (58%). Following targeted genetic and clinical evaluation, 94 patients (74%) had a definite diagnosis (sarcomeric HCM or specific causes of HCM). We observed 14 RF in 13 patients (21%) with sarcomeric gene disease, 129 RF in 34 patients (97%) with other specific causes of HCM, and 26 RF in 15 patients (45%) with idiopathic HCM (p < 0.0001). Non-sarcomeric causes of HCM were the most prevalent in ages <1yo and > 55yo. Se, Sp, PPV, NPV and PA of RF were 97%, 70%, 55%, 98% and 77%, respectively. Single and clinical combination of RF (clusters) had an high specificity, NPV and predictive accuracy for the specific etiologies (syndromes/metabolic/infiltrative disorders associated with HCM). CONCLUSIONS An extensive diagnostic work up, focused on analysis of specific diagnostic RF in patients with unexplained LVH facilitates a clinical diagnosis in 74% of patients with HCM.
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Affiliation(s)
- Giuseppe Limongelli
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania Luigi Vanvitelli, Napoli, Italy; Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy; European Reference Network - GUARD HEART, UK; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, UK.
| | - Emanuele Monda
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania Luigi Vanvitelli, Napoli, Italy; Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Stefania Tramonte
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Felice Gragnano
- UOC Cardiologia Vanvitelli - Osp. Snat'Anna e San Sebastiano - Caserta, Italy
| | - Daniele Masarone
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Giulia Frisso
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli 'Federico II', Italy; CEINGE-Biotecnologie Avanzate s.c.a r.l, Italy
| | - Augusto Esposito
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Rita Gravino
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Ernesto Ammendola
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Gemma Salerno
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Marta Rubino
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Martina Caiazza
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
| | - Mariagiovanna Russo
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Paolo Calabrò
- UOC Cardiologia Vanvitelli - Osp. Snat'Anna e San Sebastiano - Caserta, Italy
| | - Perry Mark Elliott
- Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, UK
| | - Giuseppe Pacileo
- Unità di Cardiomiopatie e Scompenso Cardiaco - Ospedale Monaldi, AORN Colli, Napoli, Italy
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