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Pica S, Di Odoardo L, Testa L, Bollati M, Crimi G, Camporeale A, Tondi L, Pontone G, Guglielmo M, Andreini D, Squeri A, Monti L, Roccasalva F, Grancini L, Gasparini GL, Secco GG, Bellini B, Azzalini L, Maestroni A, Bedogni F, Lombardi M. Collateral presence and extent do not predict myocardial viability and ischemia in chronic total occlusions: A stress-CMR study. Int J Cardiol 2023; 371:10-15. [PMID: 36181950 DOI: 10.1016/j.ijcard.2022.09.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/05/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Well-developed collaterals are assumed as a marker of viability and ischemia in chronic total occlusions (CTO). We aim to correlate viability and ischemia with collateral presence and extent in CTO patients by cardiac magnetic resonance (CMR). METHODS Multicentre study of 150 CTO patients undergoing stress-CMR, including adenosine if normal systolic function, high-dose-dobutamine for patients with akinetic/>2 hypokinetic segments and EF ≥35%, otherwise low-dose-dobutamine (LDD); all patients underwent late gadolinium enhancement (LGE) imaging. Viability was defined as mean LGE transmurality ≤50% for adenosine, as functional improvement for dobutamine-stress-test, ischemia as ≥1.5 segments with perfusion defects outside the scar zone. RESULTS Rentrop 3/CC 2 defined well-developed (WD, n = 74) vs poorly-developed collaterals (PD, n = 76). Viability was equally prevalent in WD vs PD: normo-functional myocardium with ≤50% LGE in 52% vs 58% segments, p = 0.76, functional improvement by LDD in 48% vs 52%, p = 0.12. Segments with none, 1-25%,26-50%,51-75% LGE showed viability by LDD in 90%,84%,81%,61% of cases, whilst in 12% if 76-100% LGE (p < 0.01). There was no difference in WD vs PD for ischemia presence (74% vs 75%, p = 0.99) and extent (2.7 vs 2.8 segments, p = 0.77). CONCLUSIONS In a large cohort of CTO patients, presence and extent of collaterals did not predict viability and ischemia by stress-CMR. Scar extent up to 75% LGE was still associated with viability, whereas ischemia was undetectable in 25% of patients, suggesting that the assessment of CTO patients with CMR would lead to a more comprehensive evaluation of viability and ischemia to guide revascularization.
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Affiliation(s)
- S Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - L Di Odoardo
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - L Testa
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Bollati
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - G Crimi
- Interventional Cardiology, Cardio Thoraco-Vascular-Department, IRCCS Policlinico San Martino, Genoa, Italy
| | - A Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - L Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - G Pontone
- Cardiology Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Guglielmo
- Cardiology Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - D Andreini
- Cardiology Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - A Squeri
- Cardiology Department, Villa Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - L Monti
- Cardiology Department, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy
| | - F Roccasalva
- Cardiology Department, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy
| | - L Grancini
- Cardiology Department, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G L Gasparini
- Cardiology Department, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy
| | - G G Secco
- Interventional Cardiology Department, A.O.Ss. Antonio e Biagio, Alessandria, Italy
| | - B Bellini
- Interventional Cardiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - L Azzalini
- Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | - A Maestroni
- Cardiology Department, ASST Valle Olona, Busto Arsizio, Varese, Italy
| | - F Bedogni
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Pica S, Di Giovine G, Bollati M, Testa L, Bedogni F, Camporeale A, Pontone G, Andreini D, Monti L, Gasparini G, Grancini L, Secco GG, Maestroni A, Ambrogi F, Milani V, Lombardi M. Cardiac magnetic resonance for ischaemia and viability detection. Guiding patient selection to revascularization in coronary chronic total occlusions: The CARISMA_CTO study design. Int J Cardiol 2018; 272:356-362. [PMID: 30173921 DOI: 10.1016/j.ijcard.2018.08.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/21/2018] [Accepted: 08/20/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND It is debated whether percutaneous revascularization (PCI) of total coronary chronic occlusion (CTO) is superior to optimal medical therapy (OMT) in improving symptoms, left ventricular (LV) function and major adverse cardiac/cerebrovascular events (MACCE). Furthermore, CTO-PCI is a challenging technique, with lower success rate than in other settings. A systematic analysis of baseline LV function, infarction extent and ischaemic burden to predict response to revascularization has never been performed. PURPOSES To establish a CMR protocol to identify patients (pts) who can benefit most from CTO-PCI. Myocardial viability/ischaemia retains high biological plausibility as predictors of response to revascularization. Therefore, baseline viability (necrotic tissue extent, response to inotropic stimulation) and ischaemia (perfusion defect, wall motion abnormality during stress) will be studied as potential predictors of mechanical LV segmental improvement and ischaemic burden reduction in CTO territory (primary endpoint), LV remodelling and global function, Seattle Angina Questionnaire, and MACCE improvement (secondary endpoints) in the follow-up. METHODS Pts with CTO suitable for PCI undergo stress-CMR for viability/ischaemia assessment. Pts with normal LV function undergo adenosine, those with moderately-reduced ejection fraction (EF) and wall motion abnormalities high-dose dobutamine, pts with EF <35% low-dose dobutamine. All pts undergo late gadolinium enhancement and repeat the same scan at 12 ± 3 months, regardless of PCI success or decision for OMT. CONCLUSIONS A multi-parameter CMR protocol tailored on pts characteristics to study viability/ischaemia could help in identifying responders in terms of LV function, ischaemic burden and clinical outcome among pts suitable for CTO-PCI, improving selection of best candidates to percutaneous revascularization.
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Affiliation(s)
- S Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| | - G Di Giovine
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Bollati
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - L Testa
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - F Bedogni
- Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - A Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - G Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - D Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - L Monti
- Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - G Gasparini
- Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - L Grancini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G G Secco
- A.O.Ss. Antonio e Biagio, Alessandria, Italy
| | - A Maestroni
- ASTT Valle Olona, Busto Arsizio, Varese, Italy
| | - F Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - V Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - M Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Gili S, Montefusco A, Smolka G, Baumbach A, Escaned J, Sganzerla P, Tomassini F, Secco GG, Nicolino AM, Mancone M, Poli A, Cirillo P, Colombo A, Cortese B, D'Ascenzo F. P5581Self-expandable sirolimus-eluting stents for the treatment of the unprotected left main: propensity score-matched comparison with second generation drug-eluting stents. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Gili
- University Hospital Zurich, University Heart Centre, Department of Cardiology, Zurich, Switzerland
| | - A Montefusco
- University of Turin, Division of Cardiology, Department of Medical Sciences, Turin, Italy
| | - G Smolka
- Medical University of Silesia, Department of Cardiology, Katowice, Poland
| | - A Baumbach
- Queen Mary University of London, London, United Kingdom
| | - J Escaned
- Hospital Clinic San Carlos, Madrid, Spain
| | - P Sganzerla
- AO Ospedale Treviglio, Department of Cardiology, Treviglio, Italy
| | - F Tomassini
- Degli Infermi Hospital, Interventional Cardiology Unit, Rivoli, Italy
| | - G G Secco
- Ospedale SS. Antonio e Biagio e Cesare Arrigo, Interventional Cardiology Unit, Alessandria, Italy
| | - A M Nicolino
- Ospedale Santa Corona, Department of Cardiology, Pietra Ligure, Italy
| | - M Mancone
- Umberto I Polyclinic of Rome, Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiological and Geriatric Sciences, Rome, Italy
| | - A Poli
- Civil Hospital of Legnano, Department of Cardiology, Legnano, Italy
| | - P Cirillo
- Federico II University of Naples, Division of Cardiology, Department of Advanced Biomedical Sciences, Naples, Italy
| | - A Colombo
- San Raffaele Hospital of Milan (IRCCS), Interventional Cardiology Unit, Milan, Italy
| | - B Cortese
- Fatebenefratelli Hospital, Interventional Cardiology Unit, Milan, Italy
| | - F D'Ascenzo
- University of Turin, Division of Cardiology, Department of Medical Sciences, Turin, Italy
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Parisi R, Goffi L, Ritelli M, Marinucci L, Secco GG, Uguccioni L, Cocco G, Colombi M, Fattori R. Aortic rupture after thoracic endovascular repair in a patient with Familial Thoracic Aortic Aneurysm and Dissections type 6 (FTAAD6). J Cardiovasc Surg (Torino) 2015:R37Y9999N00A150061. [PMID: 26220220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- R Parisi
- Department of Cardiology and Interventional Cardiology,Ospedali Riuniti Marche Nord, Pesaro, Italy -
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Mattesini A, Pighi M, Konstantinidis N, Ghione M, Kilic D, Foin N, Dall'ara G, Secco GG, Valente S, Di Mario C. Optical coherence tomography in bioabsorbable stents: mechanism of vascular response and guidance of stent implantation. Minerva Cardioangiol 2014; 62:71-82. [PMID: 24500218] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Fully biodegradable L-polylactic acid stents (biodegradable vascular scaffold, BVS), the latest breakthrough in the area of coronary implants, entered clinical trials in 2005 and became commercially available in 2011. Optical coherence tomography (OCT) was used from the first implants to study the vessel wall response and the timing of the resorption process in man. Analysis of BVS with OCT has several advantages over that of metallic stents. BVS polymeric struts are transparent to the light so that scaffold integrity, apposition to the underlying wall, presence of thrombus and hyperplasia, and changes in the strut characteristics over time can be easily studied. We present a comprehensive review of the findings OCT provided when used as a research tool in serial examination up to five years for investigation of the mechanism of resorption, neointimal coverage, shrinkage and late lumen enlargement. We also report our experience with OCT in 47 lesions of various complexity as a practical means of percutaneous coronary intervention guidance during BVS implantation.
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Affiliation(s)
- A Mattesini
- NIHR Biomedical Research Unit Royal Brompton & Harefield NHS Foundation Trust, London, UK2 Interventional Cardiology Unit Department of Heart and Vessels Florence University AOU Careggi, Florence, Italy3 National Heart Centre Singapore, Singapore4 University of Eastern Piedmont "Maggiore della Carità" Hospital, Novara, Italy -
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Lupi A, Porto I, Rognoni A, Secco GG, Lazzero M, Rossi L, Rosso R, Cristallini J, Nardi F, Bongo AS. Clinical and biomechanical behavior of a platinum-cromium stent platform in a large all-comers single centre PCI population: insights from the Novara-PROMETEUS registry. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3017] [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: 11/12/2022] Open
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Lupi A, Secco GG, Rognoni A, Porto I, Rossi L, Cristallini J, Sheiban I, Stella PR, Agostoni PF, Bongo AS. Drug eluting balloon vs drug eluting stent in PCI: insights from a meta-analysis of 1462 patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3015] [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: 11/12/2022] Open
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De Luca G, Secco GG, Santagostino M, Venegoni L, Iorio S, Cassetti E, Verdoia M, Coppo L, Di Mario C, Bellomo G, Marino P. Uric acid does not affect the prevalence and extent of coronary artery disease. Results from a prospective study. Nutr Metab Cardiovasc Dis 2012; 22:426-433. [PMID: 21186110 DOI: 10.1016/j.numecd.2010.08.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [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: 04/12/2010] [Revised: 07/27/2010] [Accepted: 08/09/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hyperuricemia may be involved in the atherosclerotic process due to endothelial dysfunction and facilitation of smooth muscle cell proliferation. However, debates still exist on the independent role of hyperuricemia, due to its association with several cardiovascular risk factors, such as hypertension, hyperlipidemia, obesity and insulin resistance. Thus, the aim of the current study was to investigate in a consecutive cohort of patients undergoing coronary angiography whether hyperuricemia is associated with the extent of coronary artery disease. METHODS AND RESULTS Our population is represented by a total of 1901 consecutive patients undergoing coronary angiography between May 2007 and January 2010 at the Azienda Ospedaliera "Maggiore della Carità", Novara, Italy. We additionally evaluated platelet aggregation by PFA-100 (Collagen/Epinefrine) and Multiplate. Quantitative coronary angiography and analysis of IMT were performed by experienced cardiologists who had no knowledge of the patients' clinical information. Higher uric acid was associated with advanced age, larger prevalence of male gender, diabetes, renal insufficiency, hypertension, previous CABG and MI, but with a lower prevalence of family history of CAD. Patients with high uric acid were more often on calcium antagonists, ace-inhibitors, angiotensin receptor antagonists, and, as expected, on diuretics. A significant relationship was observed between uric acid and the prevalence (OR [95% CI] = 1.18 [1.04-1.32], p = 0.01) and severity of CAD (OR [95% CI] = 1.17 [1.03-1.33], p = 0.014). However, the relationship disappeared after correction for baseline confounding factors for both prevalence (OR [95% CI] = 1.06 [0.93-1.21], p = 0.35) and extent of CAD (OR [95% CI] = 1.0 [0.87-1.15], p = 0.96). No relationship was observed between acid uric and IMT (p = 0.73) analyzed in 359 consecutive patients. Finally, there was no relationship between uric acid and platelet aggregation in patients with or without aspirin therapy, as measured by PFA-100 and Multiplate. CONCLUSIONS Our study showed that uric acid is not associated with platelet aggregation, the extent of coronary artery disease and IMT. Thus, waiting for the results of additional large studies, uric acid may not be considered as a risk factor for coronary artery disease, and its reduction by specific therapies may not be recommended to prevent coronary artery disease and atherosclerosis.
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Affiliation(s)
- G De Luca
- 1st Division of Cardiology, Division of Neurology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
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