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Paldino A, Dal Ferro M, Stolfo D, Gandin I, Graw S, Gigli M, Medo K, Gagno G, Zaffalon D, Castrichini M, Mase' M, Merlo M, Taylor M, Mestroni L, Sinagra G. Prognostic prediction of genotype versus phenotype in genetic cardiomyopathies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In cardiomyopathies (CMPs), the diverse genetic background often leads to phenotypic heterogeneity. Currently, genotype-phenotype studies are founded on clinical phenotype-based classification of CMPs, contributing possible biases due to the exclusion of specific and unascertained phenotypic expressions of CMP genes.
Purpose
We sought to define differences in outcome when stratifying patients based on phenotype at presentation compared with genotype in a large cohort of CMP patients with positive genetic testing.
Methods
In this study, we included the whole spectrum of non-hypertrophic CMP phenotypes, genetically determined: dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), left ventricular arrhythmogenic cardiomyopathy (ALVC) and biventricular ARVC (BiV). The primary and secondary outcomes were: 1) all-cause mortality/heart transplant (D/HT); 2) heart failure-related death/heart transplant/left ventricular assist device implantation (DHF/HT/VAD); and 3) sudden cardiac death/life-threatening ventricular arrhythmias (SCD/MVA).
Results
Two hundred and eighty-one patients (80% DCM) carrying pathogenic or likely pathogenic variants were included in this study. The phenotype was classified as DCM, ARVC, ALVC and BiV according to current consensus criteria. The median follow-up was 188 months. Variants in titin (TTN; 34%) and sarcomeric genes (SARC; 22%) were the most frequent genotypes and almost invariably associated with a DCM phenotype. DSP, LMNA and FLNC displayed more heterogeneous phenotypic presentations, including DCM, ARVC, ALVC, BiV. At survival analysis, the arrhythmic outcome occurred more frequently in patients without a DCM phenotype and in carriers of DSP, PKP2, LMNA and FLNC variants. However, after adjustment for age and sex, the genotype-based classification but not the phenotype-based classification was predictive of the arrhythmic outcome. LMNA showed the worst trend in term of D/HT and DHF/HT/LVAD.
Conclusions
In genetic cardiomyopathies, genotype is associated with significant phenotypic heterogeneity. Nevertheless, in our study, the genotypic-based classification showed higher precision in predicting CMP patients' outcome in respect to the phenotype-based classification. These findings add to the current understanding of inherited CMPs and may implement the risk stratification of patients with positive genetic testing.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Paldino
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Dal Ferro
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - D Stolfo
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - I Gandin
- University of Trieste, Biostatistics Unit , Trieste , Italy
| | - S Graw
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - M Gigli
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - K Medo
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - G Gagno
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - D Zaffalon
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Castrichini
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Mase'
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Merlo
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Taylor
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - L Mestroni
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - G Sinagra
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
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Janjusevic M, Gagno G, Fluca A, Beltrami A, Sinagra G, Aleksova A. P205 PROGNOSTIC VALUE OF AMYLOID–Β (1–40) IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Survivors of acute myocardial infarction (AMI) have an increased risk of various cardiovascular complications during follow–up; therefore, adequate risk stratification remains the main challenge in the clinical setting. Amyloid β 1–40 (Aβ (1–40)) has already emerged as a negative prognostic marker for cardiovascular mortality, both in patients with stable chronic coronary artery disease and in patients with NSTEMI–type infarction. This is probably due to the pro–inflammatory and pro–atherosclerotic role of this peptide.
Methods
Plasma Aβ (1–40) values were tested acutely in a large prospective cohort of patients hospitalized for AMI (both NSTEMI and STEMI). The primary end–point was defined as all–cause mortality during the period of follow–up.
Results
894 individuals were enrolled in the study (607 with STEMI and 287 with NSTEMI). The median plasma concentration of Aβ (1–40) at the time of admission was 96.59 (60.94–134.5) pg/ml. During a median follow–up of 43 months, 123 patients died (primary endpoint). Higher Aβ (1–40) concentrations were associated with an increased risk of mortality, both on univariate analysis and after correction for other confounding variables. Furthermore, we found a strong positive correlation between plasma Aβ (1–40) values and age. The prognostic value of Aβ (1–40) was maintained only in the subgroup of patients with greater than the median age of 67 years.
Conclusions
This is currently the largest single–centre study evaluating the role of plasma Aβ (1–40) concentrations in predicting outcome in a population of patients admitted for AMI, both STEMI and NSTEMI. Our data represent a strong correlation between plasma (1–40) values and the increased risk of all–cause mortality during follow–up.
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Affiliation(s)
- M Janjusevic
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - G Gagno
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - A Fluca
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - A Beltrami
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - G Sinagra
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
| | - A Aleksova
- CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA (ASUGI) AND DEPARTMENT OF MEDICAL SURGICAL AND HEALTH SCIENCE, UNIVERSITY OF TRIESTE, TRIESTE; CLINICAL PATHOLOGY DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE (ASUFC) AND DEPARTMENT OF MEDICINE (DAME), UNIVERSITY OF UDINE, UDINE
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Porcari A, Merlo M, Baggio C, Gagno G, Andreis A, Rosmini S, Raafs A, Bromage D, Cannata' A, Di Bella G, Nucifora G, Perazzolo Marra M, Heymans S, Imazio M, Sinagra G. Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.066] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular ejection fraction (LVEF) relies mostly on late gadolinium enhancement (LGE) characterization (1).
Purpose
Left ventricular peak global longitudinal strain (LV-GLS) measured by feature tracking analysis might improve prognostication of AM presenting with normal LVEF (2,3).
Methods
Data of patients undergoing cardiac magnetic resonance (CMR) for clinically suspected AM in seven European Centres (2013-2020) were retrospectively analysed. Patients with AM confirmed by CMR and LVEF ≥50% were included. LGE was visually characterized: localized vs. diffuse, subepicardial vs midwall. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including cardiac death, life-threatening arrhythmias, development of heart failure or of LVEF <50%.
Results
Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV-GLS -17.3%. CMR was performed at 4 [2-12] days from hospitalization. At 27 months, 24 (9%) patients experienced ≥1 ACE (71% developed LVEF <50%). Compared to the others, patients experiencing ACEs had lower median LV-GLS values (-13.9% vs -17.5%, p=0.001). At Kaplan-Meier analysis, impaired LV-GLS (both considered as >-20% or quartiles), diffuse and midwall LGE were associated with ACEs (Figure 1). Patients with LV-GLS ≤-20% did not experience ACEs. LV-GLS remained associated with ACEs after adjustment for diffuse and midwall LGE.
Conclusions
In AM presenting with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE characterization, improving risk stratification and representing a rationale for further studies of therapy in this cohort (Figure 2).
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - C Baggio
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - G Gagno
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, University Cardiology A.O.U., Turin, Italy
| | - S Rosmini
- King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Raafs
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - D Bromage
- King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Cannata'
- King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - G Di Bella
- University of Messina, Department of Cardiology, Messina, Italy
| | - G Nucifora
- Manchester University NHS Foundation Trust, NorthWest Cardiac Imaging Centre, Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua, Italy
| | - S Heymans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - M Imazio
- Hospital Santa Maria della Misericordia, Cardiology, Cardiothoracic Department, Udine, Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
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4
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Aleksova A, Santon D, Stenner E, Gagno G, Francescut C, Padoan L, Saro R, Beltrami A, Sinagra G. Prognostic implications of previously known or newly diagnosed diabetes and hypovitaminosis D in patients with myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vitamin D deficiency and diabetes mellitus are frequent among patients with acute myocardial infarction. Independently, both were associated with a worse prognosis after myocardial infarction (MI). However, it is unclear whether the risk of worse outcome, associated with diabetes mellitus, may be accentuated in presence of hypovitaminosis D.
Purpose
We assessed if previously known or newly diagnosed diabetes is associated with worse outcome (major cardiovascular events) in combination with hypovitaminosis D in patients with acute MI.
Methods and results
Were enrolled 1004 patients with acute MI; 64.7% of them, had hypovitaminosis D and 37% were diabetic.
We grouped our population by diabetic status: previously known diabetes (diagnosis of diabetes before MI, n=330; 32.9%); newly diagnosed diabetes (during hospitalization for MI, but no known diabetes at presentation, n=47; 4.7%); or no diabetes (n=627; 62.5%).
Hypovitaminosis D was more frequent among patients with previously known (70.2%) and newly diagnosed diabetes (73.3%), when compared to non diabetic patients (61.2%).
During median follow-up of 15.6 months, patients with previously known and newly diagnosed diabetes had increased risks of major cardiovascular events (HR 1.72; 95% CI, 1.26 to 2.36. The risk of major events during the follow-up among diabetic patients, was further increased in presence of hypovitaminosis D (Figure 1).
Conclusions
The presence of both, previously known or newly diagnosed diabetes and hypovitaminosis D, in patients with MI is synergistically associated with a worse outcome.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Aleksova
- Azienda Sanitaria Universitaria Giuliano Isontina, trieste, Italy
| | - D Santon
- Azienda Sanitaria Universitaria Giuliano Isontina, trieste, Italy
| | - E Stenner
- Azienda Sanitaria Universitaria Giuliano Isontina, trieste, Italy
| | - G Gagno
- University of Trieste, Trieste, Italy
| | | | - L Padoan
- University of Perugia, Perugia, Italy
| | - R Saro
- University of Trieste, Trieste, Italy
| | | | - G Sinagra
- Azienda Sanitaria Universitaria Giuliano Isontina, trieste, Italy
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5
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Aleksova A, Ferro F, Gagno G, Cappelletto C, Santon D, Rossi M, Ippolito G, Zumla A, Beltrami AP, Sinagra G. COVID-19 and renin-angiotensin system inhibition: role of angiotensin converting enzyme 2 (ACE2) - Is there any scientific evidence for controversy? J Intern Med 2020; 288:410-421. [PMID: 32459372 PMCID: PMC7283873 DOI: 10.1111/joim.13101] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/15/2022]
Abstract
Renin-angiotensin system (RAS) blockers are extensively used worldwide to treat many cardiovascular disorders, where they are effective in reducing both mortality and morbidity. These drugs are known to induce an increased expression of angiotensin-converting enzyme 2 (ACE2). ACE2 acts as receptor for the novel SARS coronavirus-2 (SARS-CoV-2) which raising the important issue of possible detrimental effects that RAS blockers could exert on the natural history and pathogenesis of the coronavirus disease-19 (COVID-19) and associated excessive inflammation, myocarditis and cardiac arrhythmias. We review the current knowledge on the interaction between SARS-CoV-2 infection and RAS blockers and suggest a scientific rationale for continuing RAS blockers therapy in patients with COVID-19 infection.
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Affiliation(s)
- A Aleksova
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - F Ferro
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - G Gagno
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - C Cappelletto
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - D Santon
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - M Rossi
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - G Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani - IRCCS, Rome, Italy
| | - A Zumla
- Division of Infection and Immunity, University College London, London, UK.,National Institute of Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - G Sinagra
- From the, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
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