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Fumagalli C, Smorti M, Ponti L, Pozza F, Argirò A, Credi G, Di Mario C, Marfella R, Marchionni N, Olivotto I, Perfetto F, Ungar A, Cappelli F. Frailty and caregiver relationship quality in older patients diagnosed with transthyretin cardiac amyloidosis. Aging Clin Exp Res 2023; 35:1363-1367. [PMID: 37129709 DOI: 10.1007/s40520-023-02419-6] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
Aim of the study was to explore frailty and quality of the relationship with the caregiver in a cohort of older patients with transthyretin cardiac amyloidosis (ATTR-CA). Sixty-eight consecutive ATTR-CA patients were recruited and assessed for frailty, depressive symptoms, quality of the relationship in terms of social support, or conflict toward caregivers, New York Heart Association Class (NYHA), and National Amyloid Center score (NAC Score) for grading disease severity. Results showed that 10% of patients were frail. Depressive symptoms were present in 46% of patients. Regression analyses showed that both mFI and depression were associated with worse perception of social support, and that mFI and NAC score were associated with higher levels of conflict perceived in the caregivers' relationship. Overall, the mFI score was associated with worse perceived social support and caregiver relationship quality. Tertiary care heart failure clinics should actively support the patient-caregiver relationship to improve quality of life.
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Affiliation(s)
- Carlo Fumagalli
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Martina Smorti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lucia Ponti
- Department of Humanities, University of Urbino, 61029, Urbino, Italy.
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
| | - Francesca Pozza
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Alessia Argirò
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Giacomo Credi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Meyer Children Hospital, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
- IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - Andrea Ungar
- Geriatric Intensive Care Unit, University of Florence, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
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Fumagalli C, Nardi G, Bonanni F, Credi G, Demola P, Carrabba N, Valenti R, Meucci F, Stefano P, Scheggi V, Di Mario C, Ungar A, Baldasseroni S, Marchionni N. 569 IMPACT OF FRAILTY ON VERY LONG-TERM OUTCOME IN PATIENTS UNDERGOING PERCUTANEOUS TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) IN A HIGH-FLOW REFERRAL CENTER: A PROSPECTIVE STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Transcatheter strategies for aortic stenosis (AS) are a therapeutic option in older patients not amenable for open heart surgery. Guidelines recommend surgical scores like the Society of Thoracic Surgeons (STS) for risk stratification. However, the long-term predictive power of these scores in older patients is limited.
Purpose
To assess the impact of frailty status on the very long-term mortality in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care center.
Methods
Consecutive patients >80 years referred to TAVI from January to December 2019 at our tertiary care institution were prospectively screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the Multidimensional Prognostic Index (MPI).
The MPI is a three-level score used to stratify frailty and risk of mortality (low, intermediate, or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility, and risk of pressure sores, multimorbidity, polypharmacy and co-habitation).
Frailty was defined by an intermediate-high MPI. Patients were also analyzed by STS score (<4%: low risk; 4-8%: intermediate risk; >8%: high risk). All patients prospectively called at 1, 2 and 3 years from TAVI.
Results
Overall, 134 patients were referred for TAVI (mean age: 84±4 years; >90 years: 12%, women 67%). Average STS score was 4.6 ± 3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3±3.7 (SPPB <6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group.
After 3 years, 17 (12.7%) patients died, and 40 (29.9%) were hospitalized: 21 (15.7%) for cardiovascular complications (N=11 for acute heart failure, N=6 for major bleeding, N=4 for stroke). Four patients (2.9%) implanted a pacemaker. One patient (0.7%) required a de-novo intervention.
At Cox multivariable analysis, only frailty (MPI intermediate-high) was associated with mortality (HR 5.42, 95% C.I. 1.88-12.11, p=0.002) while a high STS score showed a trend towards higher mortality risk (HR 1.63, 95% C.I. 0.91-2.91, p=0.101). Overall, at Kaplan Meier survival analysis, patients considered fit (non-frail) were characterized by a better prognosis irrespective of STS score (<8 vs >8).
Conclusions
In a prospectively enrolled cohort of old TAVI candidates, frailty status was able to identify patients at higher risk of mortality irrespective of STS risk. Frailty assessment could be a useful tool, coupled with other scores, for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure.
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Simonelli P, Petacchi D, Scardigli V, Brugnoli R, Giordano G, Credi G, Barbanti E, Lombardi R, Pratesi C. Studio della biforcazione carotidea con Angio-TC: Correlazione tra reperti densitometrici e chirurgici sulla morfologia e composizione della placca ateromasica. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/19714009010140s323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | - G. Credi
- U.O. di Chirurgia Vascolare, Università di Firenze
| | - E. Barbanti
- U.O. di Chirurgia Vascolare, Università di Firenze
| | - R. Lombardi
- U.O. di Chirurgia Vascolare, Università di Firenze
| | - C. Pratesi
- U.O. di Chirurgia Vascolare, Università di Firenze
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Dorigo W, Pulli R, Turini F, Pratesi G, Credi G, Innocenti AA, Pratesi C. Acute leg ischaemia from thrombosed popliteal artery aneurysms: role of preoperative thrombolysis. Eur J Vasc Endovasc Surg 2002; 23:251-4. [PMID: 11914013 DOI: 10.1053/ejvs.2001.1595] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to evaluate early and long term results of thrombolysis and surgery in acutely thrombosed popliteal artery aneurysms. SETTING retrospective study; teaching hospital. MATERIALS between 1990 and 2000, 109 popliteal artery aneurysms were operated on. In 24 patients acute leg ischaemia due to thrombosis of aneurysm was present. METHODS ten patients underwent urgent surgical intervention (group 1); and 14 thrombolysis with urokinase, until patency of popliteal and tibial vessels was achieved or for a maximum of 3 days (group 2). Ultrasonographic follow-up was performed at 1, 3, 6 and 12 months and then annually. Early results and follow-up data were analysed by chi-square test and life-table analysis (Kaplan-Meier curve) and late results were compared by mean of log rank test. RESULTS in group 1 early limb salvage was 70%; in group 2 it was 86% (p=n.s.). When thrombolysis was successful, patency and limb salvage were 100%. There was no local or systemic complications during thrombolysis nor worsening of ischaemia. Follow-up was completed in 91 cases, with a mean duration of 26 months. Forty-eight months primary patency rate was better, even if not statistically significant, in group 2 than in group 1. CONCLUSIONS in patients with acute leg ischaemia due to thrombosis of popliteal artery aneurysms, preoperative thrombolysis can be considered a safe and effective alternative to urgent surgery.
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Affiliation(s)
- W Dorigo
- Department of Vascular Surgery, University of Florence, Florence, Italy
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Pulli R, Chiti E, Ercolini L, Azas L, Barbanti E, Semerano L, Terreni A, Credi G, Alessi Innocenti A, Pratesi C. [Does the presence of obliterative arteriopathy of the legs change the long term mortality and survival of patients surgically treated for abdominal aortic aneurysm?]. Minerva Cardioangiol 1999; 47:559-60. [PMID: 10670202] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- R Pulli
- Cattedra e Scuola di Specializzazione in Chirurgia Vascolare, Università degli Studi, Firenze
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Pulli R, Gatti M, Credi G, Narcetti S, Capaccioli L, Pratesi C. Extracranial carotid artery aneurysms. J Cardiovasc Surg (Torino) 1997; 38:339-46. [PMID: 9267341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Extracranial carotid aneurysms are quite rare diseases. Their importance is linked both to critical localization and natural history which can lead to neurological events such as TIA and stroke. The importance of an accurate diagnosis is related to the necessity to carry out an early repair of these lesions and so to achieve the prevention of serious complications with minimal surgical risk. MATERIALS AND METHODS At the Department of Vascular Surgery of the University of Florence from January 1982 to December 1995, 2138 surgical procedures on extracranial carotid arteries carried out. Twenty-one (0.98%) were performed for aneurysms. On the basis of clinical history and instrumental findings we divided the patients into three groups: atherosclerotic aneurysms (AA, 10 cases), dysplasic aneurysms (DA, 6 cases) and pseudoaneurysms (PA, 5 cases). RESULTS Global mortality and major morbility rate was 4.7% (one patient suffered perioperative stroke). Eighteen (85.7%) were followed by echo color Doppler. No one stenosis and/or dilatation of operated vessel was observed during the mean follow-up period of 24 months. In one case (5.5%) of pseudoaneurysms group an asymptomatic internal carotid artery occlusion was discovered 3 months after surgery. CONCLUSIONS In our experience, surgical treatment of extracranial carotid aneurysms is associated with satisfactory results and low incidence of perioperative complications that justified an extensive and early surgical therapy.
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Affiliation(s)
- R Pulli
- Chair of Vascular Surgery, University of Florence, Italy
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Matticari S, Credi G, Pratesi C, Bertini D. Diagnosis and surgical treatment of the carotid body tumors. J Cardiovasc Surg (Torino) 1995; 36:233-9. [PMID: 7629206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Resection of carotid body tumors can be difficult to perform because of its site, vascularity, arterial adherence and local cranial nerve involvement. Advances in vascular surgical technique have reduced the risks of perioperative complications such as carotid injury, stroke and death. From January 1980 to May 1994 20 patients (22 carotid body tumors) were examined. All patients except one were evaluated with a preoperative angiography. No preoperative embolization was performed. Thirteen patients underwent ultrasonography, nine a CT scan of the neck, 5 magnetic resonance scanning and two magnetic resonance angiography. One old patient refused operation. The authors report their experience on 21 carotid body tumor resections (14 Shamblin group I and 7 group II paragangliomas). Surgical technique is based on subadventitial resection (18 excisions) and 3 resections were performed from the medial surface of the carotid bifurcation which had been partially absorbed into the mass. In the last 15 operations intraoperative Somatosensorial Evoked Potential (SEP) monitoring has been used. Only two patient required arterial repair because intimal dissection and another patient needed vagus nerve section. The ligation of external carotid artery and internal carotid resection with graft replacement were never necessary in these patients. No early or late deaths occurred and no recurrences were detected at follow-up.
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Affiliation(s)
- S Matticari
- Department of Vascular Surgery, University of Florence, Italy
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Abstract
PURPOSE To report the immediate and long-term outcome of intraoperative balloon angioplasty for the treatment of recurrent disease in the internal carotid arteries (ICAs). METHODS Three patients (2 males, 1 female; ages 53 to 70 years) presented with > 80% restenotic lesions (bilateral in one patient) at the distal aspect of a previous carotid endarterectomy. Two patients exhibited hemianopia, while the third was asymptomatic but had a contralateral ICA occlusion. All four lesions appeared smooth and fibrous on ultrasonography and were located high in the ICA. The location and morphology of the lesions made balloon angioplasty a more potentially successful treatment option. RESULTS Through open access to the common carotid artery, the lesions were approached and dilated under fluoroscopic guidance with monitoring of evoked potentials. The lesions were successfully dilated as determined by control arteriography, and no complications were encountered. Over a follow-up period extending to 18 months in one patient and 24 months in the other two, ultrasound imaging and arteriography have shown no restenosis at any treatment site. CONCLUSIONS Although caution is prudent when dealing with lesions in the cervical arteries, balloon angioplasty may have a role in treating surgically inaccessible restenotic carotid lesions that demonstrate a low potential for embolic complications. More experience with this technique will be required before widespread application of balloon angioplasty in the cervical vessels can occur.
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Affiliation(s)
- C Pratesi
- Department of Vascular Surgery, University of Florence, Italy
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Mannelli M, Pupilli C, Lanzillotti R, Ianni L, Amorosi A, Credi G, Pratesi C. A nonsecreting pheochromocytoma presenting as an incidental adrenal mass. Report on a case. J Endocrinol Invest 1993; 16:817-22. [PMID: 8144856 DOI: 10.1007/bf03348933] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [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] [Indexed: 01/29/2023]
Abstract
A 25 year old women presented an incidental adrenal mass which was diagnosed to be a pheochromocytoma before surgery by means of a positive 131-I-MIBG scintigraphy. Urinary vanilmandelic acid resulted repeatedly normal as well as basal plasma norepinephrine (NE), epinephrine (E) and dopamine (DA). Urinary homovannilic acid resulted in the normal range. Stimulation tests with iv glucagone, tyramine and metoclopramide evoked normal NE and E responses while a slight increase in plasma DA was observed after metoclopramide. Oral clonidine suppressed plasma catecholamines (CA) normally. Histologic and immunohistochemical studies confirmed that the tumor was a pheochromocytoma showing positivity for tyrosine hydroxylase but not for dopamine-beta-hydroxylase activity. This case is the first report on a completely asymptomatic pheochromocytoma presenting as an incidental adrenal mass which was investigated with repeated biochemical tests before surgery and demonstrates that, among the extremely variable functional attitudes of pheochromocytomas, a defect in CA synthesis and secretion is also to be included.
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Affiliation(s)
- M Mannelli
- Dipartimento di Fisiopathologia Clinica, University of Florence, Italy
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Credi G, Pratesi C, Innocenti AA, Matticari S, Pulli R, Bertini D. [The choice of approach in the surgical therapy of the superior thoracic outlet syndrome]. Minerva Cardioangiol 1992; 40:417-24. [PMID: 1291921] [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: 12/26/2022]
Abstract
The symptoms of thoracic outlet syndrome (TOS) may be improved or cured either by physiotherapy or by a surgical operation. The choice of patients to be submitted to surgery must be performed on the basis of clinical picture and of non invasive and invasive assessment. Moreover the surgeon must choose the best procedure to relieve symptoms. The Authors on the basis of their experience and of a literature review refer to the various surgical approaches used in the treatment of TOS.
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Affiliation(s)
- G Credi
- Cattedra di Chirurgia Vascolare, Università degli Studi di Firenze
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Pernice LM, Andreoli F, Taruffi F, Ingenito A, Credi G. [Intestinal motility in the rat: manometric study]. Chir Patol Sper 1979; 27:242-55. [PMID: 261940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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