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Russo G, Hahn RT, Alessandrini H, Andreas M, Badano LP, Braun D, Connelly KA, Denti P, Estevez-Loureiro R, Fam N, Gavazzoni M, Hausleiter J, Himbert D, Kalbacher D, Latib A, Lubos E, Ludwig S, Lurz P, Monivas V, Nickenig G, Pedicino D, Pedrazzini G, Pozzoli A, Praz F, Rodes-Cabau J, Rommel KP, Schofer J, Sievert H, Tang G, Thiele H, Unterhuber M, von Bardeleben RS, Webb J, Windecker S, Leon M, Maisano F, Taramasso M. Effects of tricuspid transcatheter edge-to-edge repair on tricuspid annulus diameter - Data from the TriValve registry. Int J Cardiol 2024; 405:131934. [PMID: 38437953 DOI: 10.1016/j.ijcard.2024.131934] [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: 11/17/2023] [Revised: 01/13/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
AIMS T-TEER is an effective therapy for the treatment of tricuspid regurgitation (TR). However, the effects of leaflets clipping on tricuspid valve annulus (TA) have not been investigated in detail. The aim of this study is to investigate the effects of tricuspid transcatheter edge-to-edge repair (T-TEER) on TA diameter. METHODS AND RESULTS The TriValve registry (Transcatheter Tricuspid Valve Therapies, NCT03416166) collected 556 patients from 22 European and North American centres undergoing transcatheter tricuspid valve interventions from 2016 to 2022. Patients undergoing T-TEER with available pre- and post-procedural data on TA diameter measured in the apical 4-chamber view on transthoracic echocardiography were selected for this study. Primary end-point was the reduction of TA diameter after T-TEER. A total of 186 patients were included in the study. In 115 patients (62%) TA diameter was reduced by at least 1 mm as compared to baseline. A significant reduction of TA dimension was observed following T-TEER (mean 2.3 mm [from pre-procedural diameter 46.7 mm to post-procedural diameter 44.4 mm], p < 0.001). In particular, the greatest reduction was observed in those with T-TEER in antero-septal commissure (mean 2.7 mm [from 47.1 mm to 44.4 mm], p < 0.001) as compared to those combining both antero-septal and postero-septal commissures (mean 1.4, from 46.0 mm to 44.6 mm, P = 0.06). A significant reduction of TA dimension was recorded in patients with 1 or 2 clips implanted but not in those patients with ≥3 clips implanted. CONCLUSIONS In almost two third of patients T-TEER reduces TA diameter in addition to leaflet approximation. CONDENSED ABSTRACT The effects of tricuspid transcatheter edge-to-edge repair (T-TEER) on tricuspid valve annulus (TA) have not been studied in details. This study investigates TA diameter as measured in apical 4-chamber view on transthoracic echocardiography before and after T-TEER. A total of 186 patients from the TriValve registry were included in the study. The study results show that 62% of patients have a TA reduction after T-TEER, especially in those receiving 1 or 2 clips in the antero-septal commissure. These suggest that T-TEER reduces tricuspid regurgitation not only by approximation of leaflets, but also by TA diameter reduction.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, University of Rome, Italy.
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, NY,USA
| | - Hannes Alessandrini
- MVZ Structural Heart Department, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Luigi P Badano
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Daniel Braun
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Kim A Connelly
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paolo Denti
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mara Gavazzoni
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Joerg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | | | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Philipp Lurz
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland + Biomedical Faculty, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Fabien Praz
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joseph Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Joachim Schofer
- MVZ Structural Heart Department, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany
| | - Gilbert Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - John Webb
- St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Leon
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, NY,USA
| | - Francesco Maisano
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
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Adamo M, Russo G, Pagnesi M, Pancaldi E, Alessandrini H, Andreas M, Badano LP, Braun D, Connelly KA, Denti P, Estevez-Loureiro R, Fam N, Gavazzoni M, Hahn RT, Harr C, Hausleiter J, Himbert D, Kalbacher D, Ho E, Latib A, Lubos E, Ludwig S, Lupi L, Lurz P, Monivas V, Nickenig G, Pedicino D, Pedrazzini G, Pozzoli A, Marafon DP, Pastorino R, Praz F, Rodes-Cabau J, Besler C, Schöber AR, Schofer J, Scotti A, Piayda K, Sievert H, Tang GHL, Sticchi A, Messika-Zeitoun D, Thiele H, Schlotter F, von Bardeleben RS, Webb J, Dreyfus J, Windecker S, Leon M, Maisano F, Metra M, Taramasso M. Prediction of Mortality and Heart Failure Hospitalization After Transcatheter Tricuspid Valve Interventions: Validation of TRISCORE. JACC Cardiovasc Interv 2024; 17:859-870. [PMID: 38599688 DOI: 10.1016/j.jcin.2024.02.013] [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: 08/07/2023] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Data on the prognostic role of the TRI-SCORE in patients undergoing transcatheter tricuspid valve intervention (TTVI) are limited. OBJECTIVES The aim of this study was to evaluate the performance of the TRI-SCORE in predicting outcomes of patients undergoing TTVI. METHODS TriValve (Transcatheter Tricuspid Valve Therapies) is a large multicenter multinational registry including patients undergoing TTVI. The TRI-SCORE is a risk model recently proposed to predict in-hospital mortality after tricuspid valve surgery. The TriValve population was stratified based on the TRI-SCORE tertiles. The outcomes of interest were all-cause death and all-cause death or heart failure hospitalization. Procedural complications and changes in NYHA functional class were also reported. RESULTS Among the 634 patients included, 223 patients (35.2%) had a TRI-SCORE between 0 and 5, 221 (34.8%) had 6 or 7, and 190 (30%) had ≥8 points. Postprocedural blood transfusion, acute kidney injury, new atrial fibrillation, and in-hospital mortality were more frequent in the highest TRI-SCORE tertile. Postprocedure length of stay increased with a TRI-SCORE increase. A TRI-SCORE ≥8 was associated with an increased risk of 30-day all-cause mortality and all-cause mortality and the composite endpoint assessed at a median follow-up of 186 days (OR: 3.00; 95% CI: 1.38-6.55; HR: 2.17; 95% CI: 1.78-4.13; HR: 2.08, 95% CI: 1.57-2.74, respectively) even after adjustment for procedural success and EuroSCORE II or Society of Thoracic Surgeons Predicted Risk of Mortality. The NYHA functional class improved across all TRI-SCORE values. CONCLUSIONS In the TriValve registry, the TRI-SCORE has a suboptimal performance in predicting clinical outcomes. However, a TRISCORE ≥8 is associated with an increased risk of clinical events and a lack of prognostic benefit after successful TTVI.
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Affiliation(s)
- Marianna Adamo
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Giulio Russo
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Pancaldi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Luigi P Badano
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Daniel Braun
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Kim A Connelly
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paolo Denti
- Division of Cardiology, San Raffaele University Hospital, Milan Italy; Department of Cardiac Surgery, San Raffaele University Hospital, Milan Italy
| | | | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mara Gavazzoni
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy; Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Claudia Harr
- Department of Cardiology, Asklepios Clinic Sankt Georg, Hamburg, Germany
| | - Joerg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | | | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Edwin Ho
- Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Laura Lupi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A Gemelli IRCSS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland; Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
| | - Denise Pires Marafon
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica Del Sacro Cuore, Rome, Italy; Department of Woman and Child Health and Public Health, Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabien Praz
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joseph Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Joachim Schofer
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | | | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Alessandro Sticchi
- Interventional Cardiology, Humanitas Research Hospital, Rozzano Milanese, Italy
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - John Webb
- St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Leon
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Francesco Maisano
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan Italy
| | - Marco Metra
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Landi A, Pedrazzini G, Wild L, Beele A, Nafi M, Joner M, Valgimigli M. Coronary embolisation of native aortic valve debris during transcatheter aortic valve replacement: mechanical embolectomy and histopathological analysis. Lancet 2024; 403:e5-e6. [PMID: 38218613 DOI: 10.1016/s0140-6736(23)02623-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/09/2023] [Accepted: 11/21/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Antonio Landi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Léa Wild
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Alicia Beele
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Matteo Nafi
- Department of Cardiac Anaesthesiology and Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Michael Joner
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; University of Bern, Bern, Switzerland.
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4
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Russo G, Badano LP, Adamo M, Alessandrini H, Andreas M, Braun D, Connelly KA, Denti P, Estevez-Loureiro R, Fam N, Gavazzoni M, Hahn RT, Harr C, Hausleiter J, Himbert D, Kalbacher D, Ho E, Latib A, Lubos E, Ludwig S, Lurz P, Monivas V, Nickenig G, Pedicino D, Pedrazzini G, Pozzoli A, Pires Marafon D, Pastorino R, Praz F, Rodes-Cabau J, Besler C, Schofer J, Scotti A, Piayda K, Sievert H, Tang GHL, Thiele H, Schlotter F, von Bardeleben RS, Webb J, Windecker S, Leon M, Maisano F, Metra M, Taramasso M. Characteristics and outcomes of patients with atrial versus ventricular secondary tricuspid regurgitation undergoing tricuspid transcatheter edge-to-edge repair - Results from the TriValve registry. Eur J Heart Fail 2023; 25:2243-2251. [PMID: 37905381 DOI: 10.1002/ejhf.3075] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/19/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
AIM Functional or secondary tricuspid regurgitation (STR) is the most common phenotype of tricuspid regurgitation (TR) with atrial STR (ASTR) and ventricular STR (VSTR) being recently identified as two distinct entities. Data on tricuspid transcatheter edge-to-edge repair (T-TEER) in patients with STR according to phenotype (i.e. ASTR vs. VSTR) are lacking. The aim of this study was to assess characteristics and outcomes of patients with ASTR versus VSTR undergoing T-TEER. METHODS AND RESULTS Patients with STR undergoing T-TEER were selected from the Transcatheter Tricuspid Valve Therapies (TriValve) registry. ASTR was defined by (i) left ventricular ejection fraction ≥50%, (ii) atrial fibrillation, and (iii) systolic pulmonary artery pressure <50 mmHg. Patients not matching these criteria were classified as VSTR. Patients with primary TR and cardiac implantable electronic device were excluded. Key endpoints included procedural success and survival at follow-up. A total of 298 patients were enrolled in the study: 65 (22%) with ASTR and 233 (78%) with VSTR. Procedural success was similar in the two groups (80% vs. 83% for ASTR vs. VSTR, p = 0.56) and TEER was effective in reducing TR in both groups (from 97% of patients with baseline TR ≥3+ to 23% in ASTR and to 15% in VSTR, all p = 0.001). At 12-month follow-up, survival was significantly higher in the ASTR versus VSTR cohort (91% vs. 72%, log-rank p = 0.02), with VSTR being an independent predictor of mortality at multivariable analysis (hazard ratio 4.75). CONCLUSIONS In a real-world, multicentre registry, T-TEER was effective in reducing TR grade in both ASTR and VSTR. At 12-month follow-up, ASTR showed better survival than VSTR.
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Affiliation(s)
- Giulio Russo
- Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - Luigi P Badano
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy
- Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Marianna Adamo
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Braun
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Kim A Connelly
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Paolo Denti
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Mara Gavazzoni
- Department of Medicine and Surgery, University Milano Bicocca, Milan, Italy
- Department of Cardiology, Auxologico IRCCS, Milan, Italy
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, NY, USA
| | - Claudia Harr
- Department of Cardiology, Asklepios clinic Sankt Georg, Hamburg, Germany
| | - Joerg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | | | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Edwin Ho
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Vanessa Monivas
- Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland
- Biomedical Faculty, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute EOC, Lugano, Switzerland
| | - Denise Pires Marafon
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabien Praz
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Joseph Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Joachim Schofer
- Department of Cardiology, Asklepios clinic Sankt Georg, Hamburg, Germany
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | | | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - John Webb
- St. Paul Hospital, Vancouver, BC, Canada
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Leon
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, NY, USA
| | - Francesco Maisano
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Mahendiran T, Hoepli A, Foster-Witassek F, Rickli H, Roffi M, Eberli F, Pedrazzini G, Jeger R, Radovanovic D, Fournier S. Twenty-year trends in the prevalence of modifiable cardiovascular risk factors in young acute coronary syndrome patients hospitalized in Switzerland. Eur J Prev Cardiol 2023; 30:1504-1512. [PMID: 36929213 DOI: 10.1093/eurjpc/zwad077] [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: 10/25/2022] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
AIMS Modifiable cardiovascular risk factors (RFs) play a key role in the development of coronary artery disease. We evaluated 20-year trends in RF prevalence among young adults hospitalized with acute coronary syndromes (ACS) in Switzerland. METHODS AND RESULTS Data were analysed from the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry from 2000 to 2019. Young patients were defined as those aged <50 years. Among 58 028 ACS admissions, 7073 (14.1%) were young (median 45.6 years, IQR 42.0-48.0), of which 91.6% had at least one modifiable RF and 59.0% had at least two RFs. Smoking was the most prevalent RF (71.4%), followed by dyslipidaemia (57.3%), hypertension (35.9%), obesity (21.7%), and diabetes (10.1%). Compared with older patients, young patients were more likely to be obese (21.7% vs. 17.4%, P < 0.001) and active smokers (71.4% vs. 33.9%, P < 0.001). Among young patients, between 2000 and 2019, there was a significant increase in the prevalence of hypertension from 29.0% to 51.3% and obesity from 21.2% to 27.1% (both Ptrend < 0.001) but a significant decrease in active smoking from 72.5% to 62.5% (Ptrend = 0.02). There were no significant changes in the prevalence of diabetes (Ptrend = 0.32) or dyslipidaemia (Ptrend = 0.067). CONCLUSION Young ACS patients in Switzerland exhibit a high prevalence of RFs and are more likely than older patients to be obese and smokers. Between 2000 and 2019, RF prevalence either increased or remained stable, except for smoking which decreased but still affected approximately two-thirds of young patients in 2019. Public health initiatives targeting RFs in young adults in Switzerland are warranted.
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Affiliation(s)
- Thabo Mahendiran
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland
| | - André Hoepli
- AMIS Plus Data Center Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Fabienne Foster-Witassek
- AMIS Plus Data Center Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Franz Eberli
- Department of Cardiology, Stadtspital Zurich, Zurich, Switzerland
| | | | - Raban Jeger
- Department of Cardiology, Stadtspital Zurich, Zurich, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland
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Biasco L, Klersy C, Benfari G, Biaggi P, Corti R, Curti M, Gaemperli O, Jeger R, Maisano F, Mueller O, Naegeli B, Noble S, Praz F, Tersalvi G, Toggweiler S, Valgimigli M, Enriquez-Sarano M, Pedrazzini G. Restoration of Life Expectancy After Transcatheter Edge-to-Edge Mitral Valve Repair. JACC Cardiovasc Interv 2023; 16:2231-2241. [PMID: 37632476 DOI: 10.1016/j.jcin.2023.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Survival data after mitral transcatheter edge-to-edge repair (TEER) are scarce, and its impact on predicted life expectancy is unknown. OBJECTIVES The aim of this study was to estimate the impact of TEER on postprocedural life expectancy among patients enrolled in the MitraSwiss registry through a relative survival (RS) analysis. METHODS Consecutive TEER patients 60 to 89 years of age enrolled between 2011 and 2018 (N = 1140) were evaluated. RS was defined as the ratio between post-TEER survival and expected survival in an age-, sex- and calendar period-matched group derived from the Swiss national 2011 to 2019 mortality tables. The primary aim was to assess 5-year survival and RS after TEER. The secondary aim was to assess RS according to the etiology of mitral regurgitation, age class and sustained procedural success over time. RESULTS Overall, 5-year survival after TEER was 59.3% (95% CI: 54.9%-63.4%), whereas RS reached 80.5% (95% CI: 74.6%-86.0%). RS was 91.1% (95% CI: 82.5%-98.6%) in primary mitral regurgitation (PMR) and 71.5% (95% CI: 63.0%-79.3%) in secondary mitral regurgitation (SMR). Patients 80 to 89 years of age (n = 579) showed high 5-year RS (93.0%; 95% CI: 83.3%-101.9%). In this group, restoration of predicted life expectancy was achieved in PMR with a 5-year RS of 100% (95% CI: 87.9%-110.7%), whereas sustained procedural success increased the RS rate to 90.6% (95% CI: 71.3%-107.3%) in SMR. CONCLUSIONS Mitral TEER in patients 80 to 89 years of age is able to restore predicted life expectancy in PMR, whereas in SMR with sustained procedural success, high RS estimates were observed. Our analysis suggests that successful, sustained mitral regurgitation reduction is key to survival improvement, particularly in patients 80 to 89 years of age.
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Affiliation(s)
- Luigi Biasco
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; Azienda Sanitaria Locale Torino 4, Ciriè, Turin, Italy.
| | - Catherine Klersy
- Service of Clinical Epidemiology and Biostatistics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Giovanni Benfari
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Patric Biaggi
- Heart Clinic Zurich, Hirslanden, Zurich, Switzerland
| | - Roberto Corti
- Heart Clinic Zurich, Hirslanden, Zurich, Switzerland
| | - Moreno Curti
- Service of Clinical Epidemiology and Biostatistics, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | | | - Raban Jeger
- Division of Cardiology, Triemli Hospital Zürich, Zurich, Switzerland; Division of Cardiology, University of Basel, Basel, Switzerland
| | - Francesco Maisano
- Division of Cardiovascular Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Olivier Mueller
- Division of Cardiology, University Hospital Lausanne, Switzerland
| | | | - Stephane Noble
- Division of Cardiology, University Hospital Geneve, Geneve, Switzerland
| | - Fabien Praz
- Division of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Gregorio Tersalvi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Marco Valgimigli
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Giovanni Pedrazzini
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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7
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Bass RD, García-García HM, Ueki Y, Holmvang L, Pedrazzini G, Roffi M, Koskinas KC, Shibutani H, Losdat S, Ziemer PGP, Blanco PJ, Levine MB, Bourantas CV, Räber L. Effect of High-Intensity Statin Therapy on Atherosclerosis (IBIS-4): Manual Versus Automated Methods of IVUS Analysis. Cardiovasc Revasc Med 2023; 54:33-38. [PMID: 37087308 DOI: 10.1016/j.carrev.2023.04.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
AIMS Standard manual analysis of IVUS to study the impact of anti-atherosclerotic therapies on the coronary vessel wall is done by a core laboratory (CL), the ground truth (GT). Automatic segmentation of IVUS with a machine learning (ML) algorithm has the potential to replace manual readings with an unbiased and reproducible method. The aim is to determine if results from a CL can be replicated with ML methods. METHODS This is a post-hoc, comparative analysis of the IBIS-4 (Integrated Biomarkers and Imaging Study-4) study (NCT00962416). The GT baseline and 13-month follow-up measurements of lumen and vessel area and percent atheroma volume (PAV) after statin induction were repeated by the ML algorithm. RESULTS The primary endpoint was change in PAV. PAV as measured by GT was 43.95 % at baseline and 43.02 % at follow-up with a change of -0.90 % (p = 0.007) while the ML algorithm measured 43.69 % and 42.41 % for baseline and follow-up, respectively, with a change of -1.28 % (p < 0.001). Along the most diseased 10 mm segments, GT-PAV was 52.31 % at baseline and 49.42 % at follow-up, with a change of -2.94 % (p < 0.001). The same segments measured by the ML algorithm resulted in PAV of 51.55 % at baseline and 47.81 % at follow-up with a change of -3.74 % (p < 0.001). CONCLUSIONS PAV, the most used endpoint in clinical trials, analyzed by the CL is closely replicated by the ML algorithm. ML automatic segmentation of lumen, vessel and plaque effectively reproduces GT and may be used in future clinical trials as the standard.
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Affiliation(s)
- Ronald D Bass
- School of Medicine, Georgetown University, Washington, DC, USA.
| | | | - Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Lene Holmvang
- Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen, Denmark.
| | | | - Marco Roffi
- Division of Cardiology, University Hospital, Geneva, Switzerland.
| | | | - Hiroki Shibutani
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | | | - Paulo G P Ziemer
- National Laboratory for Scientific Computing, Petrópolis, Brazil
| | - Pablo J Blanco
- National Laboratory for Scientific Computing, Petrópolis, Brazil
| | - Molly B Levine
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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8
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Foster-Witassek F, Rickli H, Roffi M, Pedrazzini G, Eberli F, Fassa A, Jeger R, Fournier S, Erne P, Radovanovic D. Reducing gap in pre-hospital delay between women and men presenting with ST-elevation myocardial infarction. Eur J Prev Cardiol 2023; 30:1056-1062. [PMID: 36511951 DOI: 10.1093/eurjpc/zwac294] [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: 08/12/2022] [Revised: 10/20/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
AIMS This study aimed to analyse changes in pre-hospital delay over time in women and men presenting with ST-elevation myocardial infarction (STEMI) in Switzerland. METHODS AND RESULTS AMIS Plus registry data of patients admitted for STEMI between 2002 and 2019 were analysed using multivariable quantile regression including the following covariates: interaction between sex and admission year, age, diabetes, pain at presentation, myocardial infarction (MI) history, heart failure history, hypertension, and renal disease. Among the 15,350 patients included (74.5% men), the median (interquartile range) delay between 2002 and 2019 was 150 (84; 345) min for men and 180 (100; 414) min for women. The unadjusted median pre-hospital delay significantly decreased over time for both sexes but the decreasing trend was stronger for women. Specifically, the unadjusted sex differences in delay decreased from 60 min in 2002 (P = 0.0042) to 40.5 min in 2019 (P = 0.165). The multivariable model revealed a significant interaction between sex and admission year (P = 0.038) indicating that the decrease in delay was stronger for women (-3.3 min per year) than for men (-1.6 min per year) even after adjustment. The adjusted difference between men and women decreased from 26.93 min in 2002 to -1.97 min for women in 2019. CONCLUSION Over two decades, delay between symptom onset and hospital admission in STEMI decreased significantly for men and women. The decline was more pronounced in women, leading to the sex gap disappearing in the adjusted analysis for 2019.
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Affiliation(s)
- Fabienne Foster-Witassek
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, Rorschacher Str. 95, 9000 St. Gallen, Switzerland
| | - Marco Roffi
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino, Via Tesserete 48, 6900 Lugano, Switzerland
| | - Franz Eberli
- Department of Cardiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
| | - Amir Fassa
- Department of Cardiology, Hôpital de La Tour, Av. J.-D.-Maillard 3, 1217 Meyrin, Switzerland
| | - Raban Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Cardiology, Triemli Hospital, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
| | - Stéphane Fournier
- Department of Cardiology, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Paul Erne
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
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9
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Bonanni M, Angelini G, Leo LA, Schlossbauer SA, Bergamaschi L, Landi A, Sangiorgi GM, Forleo C, Pasotti E, Pedrazzini G, Valgimigli M, Faletra FF, Guglielmo M, Pavon AG. Multimodality Imaging Evaluation to Detect Subtle Right Ventricular Involvement in Patients with Acute Myocarditis and Preserved Left Ventricular Ejection Fraction. J Clin Med 2023; 12:4308. [PMID: 37445342 DOI: 10.3390/jcm12134308] [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: 03/17/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Background: Evaluation of the right ventricle (RV) in patients with acute myocarditis (MY) remains challenging with both 2D transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR). We examined the incremental diagnostic value of CMR feature tracking (FT) to evaluate RV involvement in patients with myocarditis. Methods: We enrolled 54 patients with myocarditis and preserved left ventricle (LV) ejection fraction (EF). The CMR protocol included T2-weighted images for edema detection and late gadolinium enhancement (LGE) images. Global longitudinal strain (GLS) of the left ventricle (LV) and RV free wall strain (CMR-FWS) were obtained with CMR-FT. We identified 34 patients (62%) with inferior and lateral segment (IL-MY) involvement and 20 (38%) noIL-MY in case of any other myocardial segment involved. Here, 20 individuals who underwent CMR for suspected cardiac disease, which was not confirmed thereafter, were considered as the control population. Results: TTE and CMR showed normal RV function in all patients without visible RV involvement at the LGE or T2-weighted sequences. At CMR, LV-GLS values were significantly lower in patients with MY compared to the control group (median -19.0% vs. -21.0%, p = 0.029). Overall, CMR RV-FWS was no different between MY patients and controls (median -21.2% vs. -23.2 %, p = 0.201) while a significant difference was found between RV FWS in IL-MY and noIL-MY (median -18.17% vs. -24.2%, p = 0.004). Conclusions: CMR-FT has the potential to unravel subclinical RV involvement in patients with acute myocarditis, specifically in those with inferior and lateral injuries that exhibit lower RV-FWS values. In this setting, RV deformation analysis at CMR may be effectively implemented for a comprehensive functional assessment.
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Affiliation(s)
- Michela Bonanni
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Gianmarco Angelini
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
- Cardiology Unit, Department of Emergency and Organ Transplantation, Policlinico of Bari, University Hospital, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Laura Anna Leo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Susanne Anna Schlossbauer
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Luca Bergamaschi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
- Unit of Cardiology, IRCCS Policlinico St. Orsola-Malpighi, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, 40138 Bologna, Italy
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | | | - Cinzia Forleo
- Cardiology Unit, Department of Emergency and Organ Transplantation, Policlinico of Bari, University Hospital, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Elena Pasotti
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Francesco F Faletra
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
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10
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Guglielmo M, Arangalage D, Bonino MA, Angelini G, Bonanni M, Pontone G, Pascale P, Leo LA, Faletra F, Schwitter J, Pedrazzini G, Monney P, Pavon AG. Additional value of cardiac magnetic resonance feature tracking parameters for the evaluation of the arrhythmic risk in patients with mitral valve prolapse. J Cardiovasc Magn Reson 2023; 25:32. [PMID: 37316826 PMCID: PMC10268415 DOI: 10.1186/s12968-023-00944-x] [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: 11/05/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES The identification of patients with mitral valve prolapse (MVP) presenting high arrhythmic risk remains challenging. Cardiovascular Magnetic Resonance (CMR) feature tracking (FT) may improve risk stratification. We analyzed the role of CMR-FT parameters in relation to the incidence of complex ventricular arrhythmias (cVA) in patients with MVP and mitral annular disjunction (MAD). METHODS 42 patients with MVP and MAD who underwent 1.5 T CMR were classified as MAD-cVA (n = 23, 55%) in case of cVA diagnosed on a 24-h Holter monitoring and as MAD-noVA in the absence of cVA (n = 19, 45%). MAD length, late gadolinium enhancement (LGE), basal segments myocardial extracellular volume (ECV) and CMR-FT were assessed. RESULTS LGE was more frequent in the MAD-cVA group in comparison with the MAD-noVA group (78% vs 42%, p = 0.002) while no difference was observed in terms of basal ECV. Global longitudinal strain (GLS) was reduced in MAD-cVA compared to MAD-noVA (- 18.2% ± 4.6% vs - 25.1% ± 3.1%, p = 0.004) as well as global circumferential strain (GCS) at the mid-ventricular level (- 17.5% ± 4.7% vs - 21.6% ± 3.1%, p = 0.041). Univariate analysis identified as predictors of the incidence of cVA: GCS, circumferential strain (CS) in the basal and mid infero-lateral wall, GLS, regional longitudinal strain (LS) in the basal and mid-ventricular inferolateral wall. Reduced GLS [Odd ratio (OR):1.56 (confidence interval (CI) 95%: 1.45-2.47; p < 0.001)] and regional LS in the basal inferolateral wall [OR: 1.62 (CI 95%: 1.22-2.13; p < 0.001)] remained independent prognostic factors in multivariate analysis. CONCLUSION In patients with MVP and MAD, CMR-FT parameters are correlated with the incidence of cVA and may be of interest in arrhythmic risk stratification.
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Affiliation(s)
- Marco Guglielmo
- Division of Heart and Lungs, Department of Cardiology, Utrecht University, Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Dimitri Arangalage
- Cardiology Department, AP-HP, Bichat Hospital and Université de Paris, Paris, France
| | | | - Gianmarco Angelini
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Policlinico of Bari, University Hospital, Bari, Italy
| | - Michela Bonanni
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Patrizio Pascale
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Center for Cardiac Magnetic Resonance of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
| | - Laura Anna Leo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Francesco Faletra
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Jurg Schwitter
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Center for Cardiac Magnetic Resonance of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Center for Cardiac Magnetic Resonance of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne (UniL), Lausanne, Switzerland
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
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11
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Galea R, Aminian A, Meneveau N, De Marco F, Heg D, Anselme F, Gräni C, Huber AT, Teiger E, Iriart X, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Valgimigli M, Räber L. Impact of Preprocedural Computed Tomography on Left Atrial Appendage Closure Success: A Swiss-Apero Trial Subanalysis. JACC Cardiovasc Interv 2023; 16:1332-1343. [PMID: 37316145 DOI: 10.1016/j.jcin.2023.02.027] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The benefit related to the use of preprocedural computed tomography angiography (CCTA) on top of periprocedural echocardiography to plan percutaneous left atrial appendage closure (LAAC) procedures is still unclear. OBJECTIVES The authors sought to evaluate the impact of preprocedural CCTA on LAAC procedural success. METHODS In the investigator-initiated SWISS-APERO (Comparison of Amplatzer Amulet and Watchman Device in Patients Undergoing Left Atrial Appendage Closure) trial, patients undergoing echocardiography-guided LAAC were randomly assigned to receive the Amulet (Abbott) or Watchman 2.5/FLX (Boston Scientific) device across 8 European centers. According to the study protocol ongoing at the time of the procedure, the first operators had (CCTA unblinded group) or did not have (CCTA blinded group) access to preprocedural CCTA images. In this post hoc analysis, we compared blinded vs unblinded procedures in terms of procedural success defined as complete left atrial appendage occlusion as evaluated at the end of LAAC (short-term) or at the 45-day follow-up (long-term) without procedural-related complications. RESULTS Among 219 LAACs preceded by CCTA, 92 (42.1%) and 127 (57.9%) were assigned to the CCTA unblinded and blinded group, respectively. After adjusting for confounders, operator unblinding to preprocedural CCTA remained associated with a higher rate of short-term procedural success (93.5% vs 81.1%; P = 0.009; adjusted OR: 2.76; 95% CI: 1.05-7.29; P = 0.040) and long-term procedural success (83.7% vs 72.4%; P = 0.050; adjusted OR: 2.12; 95% CI: 1.03-4.35; P = 0.041). CONCLUSIONS In a prospective multicenter cohort of clinically indicated echocardiography-guided LAACs, unblinding of the first operators to preprocedural CCTA images was independently associated with a higher rate of both short- and long-term procedural success. Further studies are needed to better evaluate the impact of preprocedural CCTA on clinical outcomes.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. https://twitter.com/RobertoGalea7
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Nicolas Meneveau
- Besancon University Hospital, University of Burgundy Franche-Comté, Besancon, France
| | - Federico De Marco
- Department of Cardiology, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Frederic Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. https://twitter.com/chrisgraeni
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Teiger
- Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux-Pessac, France
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Neurology, University Hospital Basel, University of Basel, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute and Università della Svizzera Italiana, Lugano, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute and Università della Svizzera Italiana, Lugano, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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12
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Tersalvi G, Gaiero L, Capriolo M, Cristoforetti Y, Salizzoni S, Senatore G, Pedrazzini G, Biasco L. Sex Differences in Epidemiology, Morphology, Mechanisms, and Treatment of Mitral Valve Regurgitation. Medicina (Kaunas) 2023; 59:1017. [PMID: 37374220 DOI: 10.3390/medicina59061017] [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] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral regurgitation. Furthermore, access to treatments and outcomes for surgical and interventional therapies among women and men appears to be different. Despite this, current European and US guidelines have identified common diagnostic and therapeutic pathways that do not consider patient sex in decision-making. The aim of this review is to summarize the current evidence on sex-related differences in non-rheumatic mitral regurgitation, particularly regarding incidence, imaging modalities, surgical-derived evidence, and outcomes of transcatheter edge-to-edge repair, with the goal of informing clinicians about sex-specific challenges to consider when making treatment decisions for patients with mitral regurgitation.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Cardiology, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Lorenzo Gaiero
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
| | - Michele Capriolo
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
| | - Yvonne Cristoforetti
- Division of Cardiology, Ospedale Gradenigo, Humanitas Torino, 10153 Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Città della Salute e della Scienza, Università degli Studi di Torino, 10126 Turin, Italy
| | - Gaetano Senatore
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Luigi Biasco
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, 10073 Ciriè, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
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13
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Tersalvi G, Beltrani V, Grübler MR, Molteni A, Cristoforetti Y, Pedrazzini G, Treglia G, Biasco L. Positron Emission Tomography in Heart Failure: From Pathophysiology to Clinical Application. J Cardiovasc Dev Dis 2023; 10:220. [PMID: 37233187 PMCID: PMC10218989 DOI: 10.3390/jcdd10050220] [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: 03/31/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Imaging modalities are increasingly being used to evaluate the underlying pathophysiology of heart failure. Positron emission tomography (PET) is a non-invasive imaging technique that uses radioactive tracers to visualize and measure biological processes in vivo. PET imaging of the heart uses different radiopharmaceuticals to provide information on myocardial metabolism, perfusion, inflammation, fibrosis, and sympathetic nervous system activity, which are all important contributors to the development and progression of heart failure. This narrative review provides an overview of the use of PET imaging in heart failure, highlighting the different PET tracers and modalities, and discussing fields of present and future clinical application.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Vittorio Beltrani
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Martin R. Grübler
- Department of Cardiology, Regional Hospital Neustadt, 2700 Wiener Neustadt, Austria
- Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Alessandra Molteni
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Yvonne Cristoforetti
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Luigi Biasco
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, 10073 Ospedale di Ciriè, Italy
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14
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Pavon AG, Ceriani L, Raditchkova M, Leo LA, Pedrazzini G, Auricchio A, Caporali E. What is this image? 2023 image 5 result: Role of 18-Fluorodeoxyglucose positron emission tomography and computed tomography in cardiac implanted electronic device infection. J Nucl Cardiol 2023; 30:480-483. [PMID: 36972001 DOI: 10.1007/s12350-023-03228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Anna Giulia Pavon
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
| | - Luca Ceriani
- Clinic of Nuclear Medicine and PET-CT Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Mariana Raditchkova
- Clinic of Nuclear Medicine and PET-CT Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
| | - Laura Anna Leo
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
| | - Giovanni Pedrazzini
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Angelo Auricchio
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Elena Caporali
- Cardiovascular Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, 6900, Lugano, Switzerland.
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15
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Coisne A, Scotti A, Taramasso M, Granada JF, Ludwig S, Rodés-Cabau J, Lurz P, Hausleiter J, Fam N, Kodali SK, Pozzoli A, Alessandrini H, Biasco L, Brochet E, Denti P, Estevez-Loureiro R, Frerker C, Ho EC, Monivas V, Nickenig G, Praz F, Puri R, Sievert H, Tang GHL, Andreas M, Von Bardeleben RS, Rommel KP, Muntané-Carol G, Gavazzoni M, Braun D, Lubos E, Kalbacher D, Connelly KA, Juliard JM, Harr C, Pedrazzini G, Philippon F, Schofer J, Thiele H, Unterhuber M, Himbert D, Alcázar MU, Wild MG, Jorde U, Windecker S, Maisano F, Leon MB, Hahn RT, Latib A. Prognostic Value of Tricuspid Valve Gradient After Transcatheter Edge-to-Edge Repair: Insights From the TriValve Registry. JACC Cardiovasc Interv 2023:S1936-8798(23)00452-1. [PMID: 36948892 DOI: 10.1016/j.jcin.2023.01.375] [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: 10/24/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Data regarding the impact of the tricuspid valve gradient (TVG) after tricuspid transcatheter edge-to-edge repair (TEER) are scarce. OBJECTIVES This study sought to evaluate the association between the mean TVG and clinical outcomes among patients who underwent tricuspid TEER for significant tricuspid regurgitation. METHODS Patients with significant tricuspid regurgitation who underwent tricuspid TEER within the TriValve (International Multisite Transcatheter Tricuspid Valve Therapies) registry were divided into quartiles based on the mean TVG at discharge. The primary endpoint was the composite of all-cause mortality and heart failure hospitalization. Outcomes were assessed up to the 1-year follow-up. RESULTS A total of 308 patients were included from 24 centers. Patients were divided into quartiles of the mean TVG as follows: quartile 1 (n = 77), 0.9 ± 0.3 mm Hg; quartile 2 (n = 115), 1.8 ± 0.3 mm Hg; quartile 3 (n = 65), 2.8 ± 0.3 mm Hg; and quartile 4 (n = 51), 4.7 ± 2.0 mm Hg. The baseline TVG and the number of implanted clips were associated with a higher post-TEER TVG. There was no significant difference across TVG quartiles in the 1-year composite endpoint (quartiles 1-4: 35%, 30%, 40%, and 34%, respectively; P = 0.60) or the proportion of patients in New York Heart Association class III to IV at the last follow-up (P = 0.63). The results were similar after adjustment for clinical and echocardiographic characteristics (composite endpoint quartile 4 vs quartile 1-quartile 3 adjusted HR: 1.05; 95% CI: 0.52-2.12; P = 0.88) or exploring post-TEER TVG as a continuous variable. CONCLUSIONS In this retrospective analysis of the TriValve registry, an increased discharge TVG was not significantly associated with adverse outcomes after tricuspid TEER. These findings apply for the explored TVG range and up to the 1-year follow-up. Further investigations on higher gradients and longer follow-up are needed to better guide the intraprocedural decision-making process.
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Affiliation(s)
- Augustin Coisne
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Universitè Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | | | - Juan F Granada
- Cardiovascular Research Foundation, New York, New York, USA
| | - Sebastian Ludwig
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Jörg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Luigi Biasco
- Azienda Sanitaria Locale Torino 4, Ciriè, Italy; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Eric Brochet
- Division of Cardiology, Bichat Hospital, Paris, France
| | - Paolo Denti
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Christian Frerker
- University Heart Center, Schleswig-Holstein University, Lübeck, Germany
| | - Edwin C Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vanessa Monivas
- Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | - Georg Nickenig
- Division of Cardiology, Bonn University Hospital, Bonn, Germany
| | - Fabien Praz
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Horst Sievert
- Division of Cardiology, Cardiovascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Karl-Philipp Rommel
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Daniel Braun
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Edith Lubos
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Kim A Connelly
- Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | | | - Giovanni Pedrazzini
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland; Division of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Unterhuber
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Mirjam G Wild
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ulrich Jorde
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephan Windecker
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Francesco Maisano
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Rebecca T Hahn
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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16
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Scotti A, Coisne A, Taramasso M, Granada JF, Ludwig S, Rodés-Cabau J, Lurz P, Hausleiter J, Fam N, Kodali SK, Rosiene J, Feinberg A, Pozzoli A, Alessandrini H, Biasco L, Brochet E, Denti P, Estévez-Loureiro R, Frerker C, Ho EC, Monivas V, Nickenig G, Praz F, Puri R, Sievert H, Tang GHL, Andreas M, Von Bardeleben RS, Rommel KP, Muntané-Carol G, Gavazzoni M, Braun D, Koell B, Kalbacher D, Connelly KA, Juliard JM, Harr C, Pedrazzini G, Russo G, Philippon F, Schofer J, Thiele H, Unterhuber M, Himbert D, Alcázar MU, Wild MG, Windecker S, Jorde U, Maisano F, Leon MB, Hahn RT, Latib A. Sex-related characteristics and short-term outcomes of patients undergoing transcatheter tricuspid valve intervention for tricuspid regurgitation. Eur Heart J 2023; 44:822-832. [PMID: 36445158 DOI: 10.1093/eurheartj/ehac735] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 06/30/2022] [Revised: 11/04/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
AIMS The impact of sexuality in patients with significant tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI) is unknown. The aim of this study was to investigate sex-specific outcomes in patients with significant TR treated with TTVI vs. medical therapy alone. METHODS AND RESULTS The Transcatheter Tricuspid Valve Therapies (TriValve) registry collected data on patients with significant TR from 24 centres who underwent TTVI from 2016 to 2021. A control cohort was formed by medically managed patients with ≥severe isolated TR diagnosed in 2015-18. The primary endpoint was freedom from all-cause mortality. Secondary endpoints were heart failure (HF) hospitalization, New York Heart Association (NYHA) functional status, and TR severity. One-year outcomes were assessed for the TriValve cohort and compared with the control cohort with the inverse probability of treatment weighting (IPTW). A total of 556 and 2072 patients were included from the TriValve and control groups, respectively. After TTVI, there was no difference between women and men in 1-year freedom from all-cause mortality 80.9% vs. 77.9%, P = 0.56, nor in HF hospitalization (P = 0.36), NYHA Functional Classes III and IV (P = 0.17), and TR severity >2+ at last follow-up (P = 0.42). Multivariable Cox-regression weighted by IPTW showed improved 1-year survival after TTVI compared with medical therapy alone in both women (adjusted hazard ratio 0.45, 95% confidence interval 0.23-0.83, P = 0.01) and men (adjusted hazard ratio 0.42, 95% confidence interval 0.18-0.89, P = 0.03). CONCLUSION After TTVI in high-risk patients, there were no sex-related differences in terms of survival, HF hospitalization, functional status, and TR reduction up to 1 year. The IPTW analysis shows a survival benefit of TTVI over medical therapy alone in both women and men.
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Affiliation(s)
- Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Augustin Coisne
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA.,University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, F-59000 Lille, France
| | | | | | - Sebastian Ludwig
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA.,Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Jörg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Neil Fam
- Division of Cardiology, Toronto Heart Center, St Michael's Hospital, Toronto, Ontario, Canada
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Joel Rosiene
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ari Feinberg
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alberto Pozzoli
- Division of Cardiac Surgery, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Hannes Alessandrini
- Asklepios Clinic St Georg, Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany
| | - Luigi Biasco
- Azienda Sanitaria Locale Torino 4. Via Battitore 7, 10071 Ciriè, Italy.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Eric Brochet
- Division of Cardiology, Bichat Hospital, Paris, France
| | - Paolo Denti
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | | | - Christian Frerker
- University Heart Center, Schleswig-Holstein University, Lübeck, Germany
| | - Edwin C Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vanessa Monivas
- Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | - Georg Nickenig
- Division of Cardiology, Bonn University Hospital, Bonn, Germany
| | - Fabien Praz
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Horst Sievert
- Division of Cardiology, Cardiovascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Karl-Philipp Rommel
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Daniel Braun
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Benedikt Koell
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Kim A Connelly
- Division of Cardiology, Toronto Heart Center, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Claudia Harr
- Asklepios Clinic St Georg, Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany
| | - Giovanni Pedrazzini
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.,Division of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giulio Russo
- Cardiology Unit, Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Joachim Schofer
- Asklepios Clinic St Georg, Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Unterhuber
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Mirjam G Wild
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ulrich Jorde
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francesco Maisano
- Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, NY, USA.,Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Rebecca T Hahn
- Cardiovascular Research Foundation, New York, NY, USA.,Division of Cardiology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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17
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Biasco L, Foster-Witassek F, Radovanovic D, Dittli P, Tersalvi G, Rickli H, Roffi M, Eberli F, Jeger R, Erne P, Pedrazzini G. Prognostic value of low heart rates in patients admitted with acute myocardial infarction. Rev Esp Cardiol (Engl Ed) 2023:S1885-5857(23)00041-5. [PMID: 36746231 DOI: 10.1016/j.rec.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES The risk prediction scores adopted in acute coronary syndromes (ACS) use incremental models to estimate mortality for heart rate (HR) above 60 bpm. Nonetheless, previous studies reported a nonlinear relationship between HR and events, suggesting that low HR may have an unrecognized prognostic role. We aimed to assess the prognostic impact of low HR in ACS, defined as admission HR <50 bpm. METHODS This study analyzed data from the AMIS Plus registry, a cohort of hospitalized patients with ACS between 1999 and 2021. The primary endpoint was in-hospital all-cause mortality, while a composite of all-cause mortality, major cardiac/cerebrovascular events was set as the secondary endpoint. A multilevel statistical method was used to assess the prognostic role of low HR in ACS. RESULTS The study included 51 001 patients. Crude estimates showed a bimodal distribution of primary and secondary endpoints with peaks at low and high HR. A nonlinear relationship between HR and in-hospital mortality was observed on restricted cubic spline analysis. An HR of 50 to 75 bpm showed lower mortality than HR <50 bpm (OR, 0.67; 95%CI, 0.47-0.99) only after primary multivariable analysis, which was not confirmed after multiple sensitivity analyses. After propensity score matching, progressive fading of the prognostic role of HR <50 bpm was evident. CONCLUSIONS Low admission HR in ACS is associated with a higher crude rate of adverse events. Nonetheless, after correction for baseline differences, the prognostic role of low HR was not confirmed. Therefore, low HR probably represents a marker of underlying morbidity. These results may be clinically relevant in improving the accuracy of risk scores in ACS.
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Affiliation(s)
- Luigi Biasco
- Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland. https://twitter.com/@BiascoDr
| | - Fabienne Foster-Witassek
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Philip Dittli
- Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio Tersalvi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland; Division of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland. https://twitter.com/@GTersalvi
| | - Hans Rickli
- Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco Roffi
- Division of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Franz Eberli
- Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Raban Jeger
- Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Paul Erne
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Giovanni Pedrazzini
- Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
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18
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Biemmi V, Milano G, Ciullo A, Cervio E, Burrello J, Dei Cas M, Paroni R, Tallone T, Moccetti T, Pedrazzini G, Longnus S, Vassalli G, Barile L. Erratum: Inflammatory extracellular vesicles prompt heart dysfunction via TLR4-dependent NF-κB activation: Erratum. Theranostics 2023; 13:1286. [PMID: 36923528 PMCID: PMC10008747 DOI: 10.7150/thno.83071] [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: 02/17/2023] Open
Abstract
[This corrects the article DOI: 10.7150/thno.39072.].
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Affiliation(s)
- Vanessa Biemmi
- Laboratory for Cardiovascular Theranostics, Cardiocentro Ticino Institute, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Giuseppina Milano
- Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland.,Dept. Cœur-Vaisseaux, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Alessandra Ciullo
- Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Elisabetta Cervio
- Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Jacopo Burrello
- Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Michele Dei Cas
- Department of Health Sciences of the University of Milan, Milan, Italy
| | - Rita Paroni
- Department of Health Sciences of the University of Milan, Milan, Italy
| | - Tiziano Tallone
- Cell and Biomedical Technologies Unit Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Sarah Longnus
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Giuseppe Vassalli
- Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Lucio Barile
- Laboratory for Cardiovascular Theranostics, Cardiocentro Ticino Institute, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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Garzoli GEA, Biasco L, Radovanovic D, Moccetti M, Rickli H, Roffi M, Eberli F, Jeger R, Moccetti T, Witassek F, Erne P, Pedrazzini G. Cocaine consumption and acute coronary syndromes: a cross sectional study from the Swiss registry AMIS Plus. Cardiovasc Med 2022. [DOI: 10.4414/cvm.2021.02140] [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] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Luigi Biasco
- Azienda Sanitaria Locale TO4, Ospedale civile di Ciriè, Torino, Italy;
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Hans Rickli
- Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marco Roffi
- Division of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Franz Eberli
- Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Raban Jeger
- Division of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Tiziano Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Fabienne Witassek
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Paul Erne
- AMIS Plus Zurich and Department of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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20
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Pozzoli A, Torre T, Pedrazzini G, Demertzis S, Ferrari E. Transcatheter mitral valve replacement in native mitral valve with severe mitral annular calcification: Skirting the Sapien 3 to reduce the risk of paravalvular leaks. Front Cardiovasc Med 2022; 9:967473. [DOI: 10.3389/fcvm.2022.967473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMitral annular calcification (MAC) may represent a significant challenge for heart surgeons with an extremely high perioperative risk during mitral valve (MV) surgery. The risk is further increased when patients fail to be eligible for any percutaneous treatment, particularly because circumferential calcifications involving the anterior leaflet suggest a critical obstruction of the left ventricular outflow tract (LVOT).ObjectivesThe objective of this study was to evaluate residual mitral regurgitation (MR) after surgical mitral valve replacement using a Sapien 3 Ultra (Edwards Lifesciences, CA, USA) transcatheter aortic valve implantation (TAVI) prosthesis, reinforced with a pericardial skirt, in high-risk selected patients with severe MAC.MethodsSince 2020, five high-risk patients (mean age 70 years; 63–76; four women) with severe mitral disease in the context of severe MAC (computed tomography-based mean MAC Score 8.2 ± 1.1) were operated on after we adopted this novel technique. The operations were performed under general anesthesia, using a transapical TAVI delivery system to position the Sapien 3 in the mitral position under direct vision. To reinforce and avoid paravalvular leakages, a pericardial skirt was previously sewn around the prosthesis, securing it to the annulus and perivalvular atrial surface.ResultsSapien 3 Ultra implantation was successful without residual MR in all five patients (mild paravalvular leak in one case). Four patients had a 29-mm valve implanted, while one had a 26-mm valve implanted. Predilatation of the native annulus was never performed. Perfusion and clamping times were 134 ± 53 mins and 108 ± 43 mins, respectively. The presence of the pericardial skirt reduced the risk of leakage between the prosthesis and the rigid calcium surface, with final mean and maximal gradients of the TAVI prosthesis of 4.1 and 10.8 mmHg, respectively. There were no left ventricular outflow tract obstructions (mean LVOT gradient of 8 ± 1 mmHg). All patients were discharged, and neither mortality nor prosthetic dysfunction, nor residual mitral regurgitation was recorded. During follow-up, the last patient treated (MAC Score 10, severe calcification of the mitro-aortic junction) returned to our attention with a significant recurrent jet originating from the anterolateral commissure, currently medically treated, given the prohibitive redo risk.ConclusionDirect open surgical implantation of the Sapien 3 valve can be safely done in patients with severe MAC in dedicated centers. Reinforcing the TAVI prosthesis by sewing a pericardial skirt led to satisfactory perioperative and early postoperative results, reducing paravalvular leakages. Complex anatomies have a CERTAIN risk of recurrence.
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21
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Radovanovic D, Schoenenberger-Berzins R, Roffi M, Pedrazzini G, Eberli F, Erne P, Rickli H. Sex differences in acute coronary syndromes: a never ending same old story or sign for improvement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1373] [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
Introduction
We previously described sex differences in baseline characteristics, interventional therapy and mortality in patients admitted for acute coronary syndromes (ASC) in Swiss hospitals and enrolled in the AMIS Plus registry between 1997 and 2006 (1). This present analysis aimed to reassess whether anything changed over the last 15 years.
Method
All AMIS Plus patients enrolled between 2007 and 2021 were included. Baseline characteristics, therapy and outcome were analysed according to sex and age groups. Multivariate analyses were performed to assess independent predictors of in-hospital mortality.
Results
Among 42,471 patients, 10,825 (25.5%) were women. Women were still older (71.6±12.6y vs. 64.2±12.6y for men), had more comorbidities (Charlson Comorbidity Index>1: 26.5% vs. 21.7%), were less likely to receive drug therapy (e.g., P2Y12 inhibitors 83.3% vs. 89.2% or statins 73.0% vs. 78.5%) and underwent percutaneous coronary intervention (PCI) less frequently (OR 0.77; 95% CI 0.73–0.83). These findings paralleled our observations for the period 1997–2006. However, the increase in PCI use over the years, particularly in women, led to a marked decrease in differences between men and women with respect to revascularization, from 16.6% in 2006 down to 2.0% in 2020. Unadjusted in-hospital mortality was higher in women (OR 1.55; 95% CI 1.41–1.70), but this significance disappeared after adjustment for baseline differences (OR 1.07; (95% CI 0.96–1.20)). However, in women under the age of 50 years, crude mortality (3.1% versus 1.6%) was significantly higher than in same-aged men; adjusted OR 1.78 (95% CI 0.99–3.20).
Conclusions
Sex differences in the baseline characteristics of ACS patients and the use of evidence-based drugs persisted but the sex gap in PCI access slowly but surely diminished. Female sex per se was not an independent predictor of in-hospital mortality in the overall population but it showed a strong trend among patients younger than 50 years of age.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Radovanovic
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich , Zurich , Switzerland
| | | | - M Roffi
- Geneva University Hospitals, Cardiologie Interventionnelle , Geneva , Switzerland
| | - G Pedrazzini
- Cardiocentro Ticino, Division of Cardiology , Lugano , Switzerland
| | - F Eberli
- Triemli Hospital , Zurich , Switzerland
| | - P Erne
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich , Zurich , Switzerland
| | - H Rickli
- Cantonal Hospital St. Gallen, Klinik für Kardiologie , St. Gallen , Switzerland
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22
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Beckmann C, Foster-Witassek F, Brutsche M, Maeder MT, Eberli F, Roffi M, Pedrazzini G, Radovanovic D, Rickli H. Treatment and outcome of patients with acute myocardial infarction and chronic lung disease: insights from the nationwide AMIS Plus registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1374] [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
Introduction
Little is known about patients with acute myocardial infarction (AMI) and chronic lung disease (CLD). The aim of our study was to analyze risk factors, treatment, and outcome of AMI patients with CLD over the last 20 years using the nationwide AMIS Plus registry.
Methods
All AMI patients enrolled in the AMIS Plus registry with data on CLD between January 2002 and December 2021 were included. Chronic lung disease was determined according to the definition used in the Charlson Comorbidity Index. Data on baseline characteristics, regular medication, immediate therapy within 24 hours, in-hospital interventions and treatments, in-hospital outcome, complications and discharge medication were analyzed using descriptive statistics and logistic regression.
Results
Among 53,680 AMI patients, 5.8% had a CLD. The CLD group included 26.6% female and 73.4% male patients. Gender distribution was similar in patients with and without CLD. Patients with CLD were significantly older (71.2 vs. 65.8 y; p<0.001), more frequently diagnosed with NSTEMI, had more comorbidities and were less frequently never smokers (17.4% vs. 35.3%; p<0.001) compared to patients without CLD. In addition, CLD patients were less likely to receive aspirin, P2Y12 inhibitors, beta-blockers, ACE inhibitors and statins (all p<0.001), and were also less likely to undergo percutaneous coronary interventions (68.7% vs. 82.5%; p<0.001). Median length of stay was 2 days longer for CLD patients. Patients with CLD had more major adverse cardiac and cerebrovascular events in-hospital (10.3% vs. 5.9%; p<0.001) and higher crude in-hospital mortality (8.3% vs. 4.7%; p<0.001). However, multivariable regression analysis showed that CLD was not an independent predictor for in-hospital mortality (OR 1.19 (95% CI 0.98–1.45), p=0.081).
Conclusion
Patients with CLD were less likely to receive evidence-based medicine and had a worse in-hospital outcome compared to those without CLD. However, after adjustment, CLD was not an independent predictor of in-hospital mortality.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca AG, Biotronik (Schweiz) AG
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Affiliation(s)
- C Beckmann
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich , Zürich , Switzerland
| | - F Foster-Witassek
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich , Zürich , Switzerland
| | - M Brutsche
- Lung Center, Kantonsspital St. Gallen , St. Gallen , Switzerland
| | - M T Maeder
- Department of Cardiology, Kantonsspital St. Gallen , St. Gallen , Switzerland
| | - F Eberli
- Division of Cardiology, Triemli Hospital , Zurich , Switzerland
| | - M Roffi
- Division of Cardiology, Geneva University Hospitals , Geneva , Switzerland
| | - G Pedrazzini
- Department of Cardiology, Cardiocentro Ticino , Lugano , Switzerland
| | - D Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich , Zürich , Switzerland
| | - H Rickli
- Department of Cardiology, Kantonsspital St. Gallen , St. Gallen , Switzerland
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23
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Barresi F, Foster-Witassek F, Rickli H, Pedrazzini G, Roffi M, Puhan M, Dressel H, Radovanovic D. Acute myocardial infarction and work inability: insights from the AMIS Plus registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1156] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
The impact of acute myocardial infarction (AMI) on the ability to pursue professional life is not well defined. Using a nationwide database, we aimed to describe the ability to return to work after AMI in Switzerland and identify factors associated therewith.
Methods
AMI patients of working-age enrolled in the AMIS Plus registry between 01/2006 and 09/2020 with data on self-reported work status before and 12 months after AMI were included. Using the Kruskal-Wallis rank sum test or Fisher's exact test we compared patient characteristics between those who did not reduce work hours, those who reduced, and those no longer working 12 months after the AMI.
Results
Of 4315 AMI patients (median (IQR) age 54 (49, 59)), 3204 (74.3%) did not reduce work, 592 (13.7%) reduced and 519 (12.0%) stopped working. Patients not reducing were youngest (median age (IQR)): 54y (49y, 58y), those who reduced: 56y (51y, 60y), those who stopped: 56y (51y, 61y), p<0.001) and more often men (no reduction: 90%, reduced: 80%, stopped: 82%, p<0.001). Patients who reduced showed worst cardiac function at AMI reflected in the highest rates of Killip class>2 (no reduction: 1.8%, reduced: 5.2%, stopped: 3.3%, p<0.001) and resuscitation before admission (no reduction: 4.1%, reduced: 6.9%, stopped: 4.0%, p=0.008). Patients who stopped work had the most comorbidities such as past AMI (no reduction: 8.6%, reduced: 10%, stopped: 13%, p=0.003), hypertension (no reduction: 45%, reduced: 50%, stopped: 54%, p<0.001), diabetes (no reduction: 10%, reduced: 13%, stopped: 16%, p<0.001) and cerebrovascular disease (no reduction: 0.8%, reduced: 1.2%, stopped: 2.3%, p=0.007). There was no significant difference for rehabilitation participation during follow up (no reduction: 84%, reduced: 86%, stopped: 84%, n.s. for all group comparisons). Multivariable regression showed that the reduction group had a higher proportion of women (OR 2.30; 95% CI 1.80–2.93 p<0.001) and were more likely to have a Killip class >2 at admission (OR 2.58; 95% CI 1.54–4.31 p<0.001) as compared to the no reduction group whereas the comparison between no reduction and work stop identified comorbidities (past MI (OR 1.46; 95% CI 1.07–1.94 p=0.016), diabetes (OR 1.59; 95% CI 1.21–2.09 p=0.001), cerebrovascular disease (OR 2.53; 95% CI 1.22–5.25 p=0.013)) and being female (OR 1.98; 95% CI 1.51–2.58 p<0.001) as major predictors for work stop.
Conclusion
Our data showed that 1:7 had reduced and 1:8 stopped professional activity 1 year after AMI. Younger age, being male and lower rates of comorbidities such as a past AMI, hypertension, diabetes and cerebrovascular disease were important factors associated with returning to work after AMI. Work reduction was significantly related with worse cardiac function whereas work stop was more related with comorbidities.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Barresi
- University of Zurich, EBPI, Division of Occupational and Environmental Medicine , Zurich , Switzerland
| | - F Foster-Witassek
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute , Zurich , Switzerland
| | - H Rickli
- Cantonal Hospital St. Gallen, Department of Cardiology , St. Gallen , Switzerland
| | - G Pedrazzini
- Cardiocentro Ticino, Department of Cardiology , Lugano , Switzerland
| | - M Roffi
- Geneva University Hospitals, Division of Cardiology , Geneva , Switzerland
| | - M Puhan
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute , Zurich , Switzerland
| | - H Dressel
- University of Zurich, EBPI, Division of Occupational and Environmental Medicine , Zurich , Switzerland
| | - D Radovanovic
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute , Zurich , Switzerland
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24
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Stähli BE, Foster Witassek F, Roffi M, Eberli FR, Rickli H, Erne P, Maggiorini M, Pedrazzini G, Radovanovic D. Trends in treatment and outcomes of patients with diabetes and acute myocardial infarction: Insights from the nationwide AMIS plus registry. Int J Cardiol 2022; 368:10-16. [PMID: 35995301 DOI: 10.1016/j.ijcard.2022.08.032] [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] [Received: 03/15/2022] [Revised: 08/02/2022] [Accepted: 08/15/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
| | - Fabienne Foster Witassek
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Marco Roffi
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Franz R Eberli
- Division of Cardiology, Triemli Hospital, Zurich, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Paul Erne
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Marco Maggiorini
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | | | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
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25
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Landi A, Branca M, Vranckx P, Leonardi S, Frigoli E, Heg D, Calabro P, Esposito G, Sardella G, Tumscitz C, Garducci S, Ando G, Limbruno U, Sganzerla P, Santarelli A, Briguori C, de la Torre Hernandez JM, Pedrazzini G, Windecker S, Valgimigli M. Radial versus femoral access in ACS patients undergoing complex PCI is associated with consistent bleeding benefit and no excess of risks. Can J Cardiol 2022; 38:1488-1500. [PMID: 35753631 DOI: 10.1016/j.cjca.2022.06.014] [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] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The comparative effectiveness of transradial (TRA) compared with transfemoral access (TFA) in acute coronary syndrome (ACS) patients undergoing complex percutaneous coronary intervention (PCI) remains unclear. METHODS Among 8,404 ACS patients in the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX)-Access trial, 5,233 underwent noncomplex (TRA, n=2,590 and TFA, n=2,643) and 1,491 complex PCI (TRA, n=777 and TFA, n=714). Co-primary outcomes were major adverse cardiovascular events (MACE, the composite of all-cause mortality, myocardial infarction, or stroke) and the composite of MACE and BARC type 3-5 bleeding (net adverse cardiovascular events, NACE) at 30 days. RESULTS Rates of 30-day MACE (hazard ratio [HR]:0.94; 95% confidence interval [CI]:0.72-1.22) or NACE (HR:0.89; 95% CI:0.69-1.14) did not significantly differ between groups in the complex PCI group, whereas both primary endpoints were lower (HR:0.84; 95% CI:0.70-1.00, HR:0.83; 95% CI:0.70-0.98, respectively) with TRA among noncomplex PCI patients, with negative interaction testing (Pint 0.473 and 0.666, respectively). Access-site BARC type 3 or 5 bleeding was lower with TRA, consistently among complex (HR:0.18; 95% CI:0.05-0.63) and noncomplex (HR:0.41; 95% CI:0.20-0.85) PCI patients, whereas the former group had a greater absolute risk reduction of 1.7% (number needed to treat: 59) due to their higher absolute risk. CONCLUSIONS Among ACS patients, PCI complexity does not affect the comparative efficacy and safety of TRA versus TFA, whereas the absolute risk reduction of access-site major bleeding was greater with TRA compared with TFA in complex as opposed to noncomplex PCI.
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Affiliation(s)
- Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | | | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Dik Heg
- CTU Bern, University of Bern, Switzerland
| | - Paolo Calabro
- Division of Cardiology, "Sant'Anna e San Sebastiano" Hospital, Caserta, Italy; Department of Translational Medicine, University of Campania "Luigi Vanvitelli," Caserta, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Gennaro Sardella
- Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona (FE), Italy
| | - Stefano Garducci
- Unità Operativa Complessa di Cardiologia, ASST della Brianza (MB), Vimercate Hospital, Italy
| | - Giuseppe Ando
- Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", University of Messina, Messina, Italy
| | - Ugo Limbruno
- Cardiology Department, Misericordia Hospital, Grosseto, Italy
| | - Paolo Sganzerla
- IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milano
| | | | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | | | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | | | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland.
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26
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Valgimigli M, Smits PC, Frigoli E, Bongiovanni D, Tijssen J, Hovasse T, Mafragi A, Ruifrok WT, Karageorgiev D, Aminian A, Garducci S, Merkely B, Routledge H, Ando K, Fernandez JFD, Cuisset T, Malik FTN, Halabi M, Belle L, Din J, Beygui F, Abhyankar A, Reczuch K, Pedrazzini G, Heg D, Vranckx P. Duration of Antiplatelet Therapy After Complex Percutaneous Coronary Intervention In Patients at High Bleeding Risk: a MASTER DAPT trial sub-analysis. Eur Heart J 2022; 43:3100-3114. [PMID: 35580836 DOI: 10.1093/eurheartj/ehac284] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 03/07/2022] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess the effects of 1- or ≥3-month dual antiplatelet therapy (DAPT) in high bleeding risk (HBR) patients who received biodegradable-polymer sirolimus-eluting stents for complex percutaneous coronary intervention (PCI) and/or acute coronary syndrome (ACS). METHODS AND RESULTS In the MASTER DAPT trial, 3383 patients underwent noncomplex (abbreviated DAPT, n = 1707; standard DAPT, n = 1676) and 1196 complex (abbreviated DAPT, n = 588; standard DAPT, n = 608) PCI. Co-primary outcomes at 335 days were net adverse clinical events (NACE; composite of all-cause death, myocardial infarction, stroke, and Bleeding Academic Research Consortium [BARC] 3 or 5 bleeding events); major adverse cardiac or cerebral events (MACCE; all-cause death, myocardial infarction, and stroke); and type 2, 3, or 5 BARC bleeding.NACE and MACCE did not differ with abbreviated versus standard DAPT among patients with complex (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 0.69-1.52, and HR: 1.24, 95% CI: 0.79-1.92, respectively) and noncomplex PCI (HR: 0.90, 95% CI: 0.71-1.15, and HR: 0.91, 95% CI: 0.69-1.21; Pinteraction = 0.60 and 0.26, respectively). BARC 2, 3 or 5 was reduced with abbreviated DAPT in patients with and without complex PCI (HR: 0.64; 95% CI: 0.42-0.98, and HR: 0.70; 95% CI: 0.55-0.89; Pinteraction = 0.72). Among the 2,816 patients with complex PCI and/or ACS, NACE and MACCE did not differ and BARC 2, 3 or 5 was lower with abbreviated DAPT. CONCLUSION In HBR patients free from recurrent ischemic events at 1 month, DAPT discontinuation was associated with similar NACE and MACCE and lower bleeding rates compared with standard DAPT, regardless of PCI or patient complexity.
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Affiliation(s)
- Marco Valgimigli
- From the Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), CH- 6900 Lugano, Switzerland
| | - Pieter C Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Dario Bongiovanni
- From the Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), CH- 6900 Lugano, Switzerland
| | - Jan Tijssen
- Amsterdam University Medical Center, the Netherlands
| | - Thomas Hovasse
- Ramsay Générale de Santé, ICPS, Hôpital Jacques Cartier, Massy, France
| | - Al Mafragi
- Department of Cardiology, Zorgsaam Hospital, Terneuzen, the Netherlands
| | | | | | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Stefano Garducci
- Unita' Operativa Complessa di Cardiologia, ASST Di Vimercate (MB), Vimercate, Italy
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Kenji Ando
- Department of Cardiolog y, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Thomas Cuisset
- Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France
| | | | - Majdi Halabi
- Department of Cardiology, Ziv Medical Center, Safed, Israel
| | - Loic Belle
- Cardiology Department, Hospital of Annecy, Annecy, France
| | - Jehangir Din
- Royal Bournemouth Hospital, East Bournemouth, UK
| | - Farzin Beygui
- Service de Cardiologie, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen, France; Électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, Normandie Univ, UNICAEN, Caen, France
| | - Atul Abhyankar
- Department of Cardiology, Shree B. D. Mehta Mahavir Heart Institute, Surat, India
| | - Krzysztof Reczuch
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Giovanni Pedrazzini
- From the Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), CH- 6900 Lugano, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis Hasselt, faculty of medicine and life sciences University of Hasselt, Hasselt, Belgium
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Klingenberg R, Stähli BE, Heg D, Denegri A, Manka R, Kapos I, von Eckardstein A, Carballo D, Hamm CW, Vietheer J, Rolf A, Landmesser U, Mach F, Moccetti T, Jung C, Kelm M, Münzel T, Pedrazzini G, Räber L, Windecker S, Matter CM, Ruschitzka F, Lüscher TF. Controlled-Level EVERolimus in Acute Coronary Syndrome (CLEVER-ACS) - A phase II, randomized, double-blind, multi-center, placebo-controlled trial. Am Heart J 2022; 247:33-41. [PMID: 35092722 DOI: 10.1016/j.ahj.2022.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/19/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Activation of inflammatory pathways during acute myocardial infarction contributes to infarct size and left ventricular (LV) remodeling. The present prospective randomized clinical trial was designed to test the efficacy and safety of broad-spectrum anti-inflammatory therapy with a mammalian target of rapamycin (mTOR) inhibitor to reduce infarct size. DESIGN Controlled-Level EVERolimus in Acute Coronary Syndrome (CLEVER-ACS, clinicaltrials.gov NCT01529554) is a phase II randomized, double-blind, multi-center, placebo-controlled trial on the effects of a 5-day course of oral everolimus on infarct size, LV remodeling, and inflammation in patients with acute ST-elevation myocardial infarction (STEMI). Within 5 days of successful primary percutaneous coronary intervention (pPCI), patients are randomly assigned to everolimus (first 3 days: 7.5 mg every day; days 4 and 5: 5.0 mg every day) or placebo, respectively. The primary efficacy outcome is the change from baseline (defined as 12 hours to 5 days after pPCI) to 30-day follow-up in myocardial infarct size as measured by cardiac magnetic resonance imaging (CMRI). Secondary endpoints comprise corresponding changes in cardiac and inflammatory biomarkers as well as microvascular obstruction and LV volumes assessed by CMRI. Clinical events, laboratory parameters, and blood cell counts are reported as safety endpoints at 30 days. CONCLUSION The CLEVER-ACS trial tests the hypothesis whether mTOR inhibition using everolimus at the time of an acute STEMI affects LV infarct size following successful pPCI.
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Affiliation(s)
- Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Dik Heg
- Clinical Trial Unit, Social and Preventive Medicine, University of Bern, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ioannis Kapos
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | | | - David Carballo
- Department of Cardiology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Julia Vietheer
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Department of Cardiology, Charité - University Medicine, , Berlin, Germany
| | - François Mach
- Department of Cardiology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Christian Jung
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Thomas Münzel
- Department of Cardiology, University Hospital Mainz, Mainz, Germany
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland; Imperial College, National Heart and Lung Institute and Royal Brompton and Harefield Hospitals, Heart Division London, U.K..
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Angelini G, Bonanni M, Paiocchi VL, Leo LA, Schlossbauer S, Pasotti E, Pedrazzini G, Valgimigli M, Favale S, Forleo C, Pavon AG, Faletra F. Multimodality imaging in the evaluation of left ventricle myocardial deformation determined by edema and scar in acute myocarditis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.439] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
acute myocarditis (aMY) is characterized by the presence of edema and myocardial scar detected by cardiovascular magnetic resonance (CMR).
Aim of our study is to investigate the diagnostic value of two-dimensional (2D) speckle tracking echocardiography and Cardiovascular Magnetic Resonance (CMR) feature tracking (FT) in detecting edema and myocardial scar in aMY.
METHODS
all consecutive patients with clinically suspected aMY were enrolled in our study. Inclusion criteria were: 1) new ECG abnormalities 2) myocardial cytolysis markers and 3) absence of angiographically detectable coronary artery disease. Exclusion criteria included poor cine image quality caused by respiratory motion and arrhythmia. All patients underwent transthoracic echocardiography and cardiac function was evaluated by a comprehensive assessment of LV function, including 2D speckle-tracking echocardiography (2D STE). CMR was performed in all patients in a 3T scanner. Extension of edema and myocardial scar were respectively evaluated on T2 mapping and on Late Gadolinium Enhancement sequences considering numbers of segments involved according to 17-segment model (AHA). FT analysis of the left ventricle (LV) was performed using the Tissue Tracking Module to obtain LV strain data.
RESULTS
52 patients were included in the study, mean age was 36± 17 years, three patients were female (6%). Mean LVEF was 56,2 ± 7,2 % and mean end diastolic volume index (EDVi) was 62,52 ± 19,02 ml/m2. 10 patients (19,2%) had impaired EF with mean values of 44,6 ± 6,15%. aMY was confirmed in all patients with the presence of myocardial edema and subepicardial late gadolinium enhancement (LGE). Inferior segments were involved in 28 patients (53,8%), lateral segment in 19 patients (36,5%), septal segments in 7 patients (13,5%) and anterior segments in 15 patients (28,8%). 2D STE LV GLS was -16.41± 5,47% while CMR-FT LV GLS was -19,07 ± 4,65%, showing a good agreement between the two methods (r = 0,5; p < 0,001). The univariate analysis showed a significant correlation between 2D STE LV GLS and CMR-FT LV GLS with the extension of myocardial edema assessed by CMR (r= 0,43; p= 0,002 and r = 0.47; p = 0,002 respectively). The univariate analysis did not show a significant correlation between 2D STE LV and the extension of myocardial scar assessed by CMR (r= 0.2; p= 0.155) while a significant correlation was found between CMR-FT LV GLS and myocardial scar (r = 0.4; p = 0.01).
CONCLUSIONS
in patients with aMY, good correlation was found between CMR-FT and 2D STE in the evaluation of GLS. 2D STE LV GLS and CMR-FT LV GLS proved to have a good correlation with the extension of myocardial edema, while only CMR-FT LV GLS proved to be associated with myocardial scar extension.
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Affiliation(s)
- G Angelini
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - M Bonanni
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - VL Paiocchi
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - LA Leo
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | | | - E Pasotti
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - G Pedrazzini
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - M Valgimigli
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - S Favale
- Polyclinic Hospital of Bari, Bari, Italy
| | - C Forleo
- Polyclinic Hospital of Bari, Bari, Italy
| | - AG Pavon
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - F Faletra
- Cardiocentro Ticino Foundation, Lugano, Switzerland
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29
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Bonanni M, Angelini G, Paiocchi VL, Leo LA, Schlossbauer SA, Pasotti E, Pedrazzini G, Valgimigli M, Sangiorgi GM, Faletra FF, Pavon AG. Right-ventricular involvement in acute myocarditis assessed by cardiac magnetic resonance feature tracking. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.422] [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.
INTRODUCTION
the prevalence of right ventricular (RV) involvement in acute myocarditis (aMY) has been poorly investigated. Actually, RV evaluation may be difficult in echocardiography and scar detection as well as the presence of edema in cardiovascular magnetic resonance (CMR) may be challenging due to small RV wall thickness. We sought to examine the incremental diagnostic value of CMR feature tracking (FT) in RV strain-analysis for patients with aMY.
METHODS
all consecutive patients with clinically suspected aMY were enrolled in our study. Inclusion criteria were: 1) new ECG abnormalities 2) myocardial cytolysis markers and 3) absence of angiographically detectable coronary artery disease. Exclusion criteria included poor cine image quality caused by respiratory motion and arrhythmias. All patients underwent transthoracic echocardiography (TTE) and CMR within hospitalization on a 3T scan. CMR protocol included current standard Lake Louise criteria (LLC) for myocarditis and T2 weighted images. The definite diagnosis was made when 2 or more Lake Louise criteria were fulfilled. FT analysis of the left ventricle (LV) and RV was performed using the Tissue Tracking Module to obtain LV and RV global longitudinal (RV-GLS) strain data. 20 sex and aged matched individuals who underwent to CMR for suspected cardiac disease, which was not confirmed thereafter, were considered as control population.
RESULTS
52 patients were included in the study, mean age was 36 ± 17 years, three patients were female (6%). Mean LV ejection fraction (EF) was 56,2 ± 7,2 and mean end-diastolic volume indexed (EDVi) was 62,52 ± 19,02 ml/mq. 10 patients (19%) had impaired EF with mean values of 44,6 ± 6,1%. All patients have normal RV function evaluated in TTE considering tricuspid annular plane systolic excursion (TAPSE) (22,7 ± 2,4mm). No kinetic abnormalities were reported. All patients underwent CMR within 3 ± 1 days. Normal RV-EF, normal volumes and no RV kinetic abnormalities were reported in all cases also in CMR examination. aMY was confirmed in all patients with the presence of myocardial oedema and subepicardial late gadolinium enhancement (LGE). Inferior segments were involved in 28 patients (54%), lateral segments in 19 patients (37%), septal segments in 7 patients (13%) and anterior segments in 15 patients (29%). RV-GLS was -21,5 ± 5,6% which was not significantly different from control population (-23,01 ± 3,63; p value= 0,201). Globally, 34 patients (65%) had an aMY involving inferior and lateral segments. In this subgroup, RV-GLS was significantly lower compared to other aMY (-19,8 ± 5,7 vs -23,9 ± 4,6 p value = 0,047) and compared to control population (-19,8 ± 5,7 vs -23,01 ± 3,6 p value= 0,032).
CONCLUSIONS
Despite normal RV function detected in both TTE and CMR, patients with infero-lateral aMY have lower values of RV longitudinal strain. CMR-FT RV strain analysis has proven to be a useful tool in detecting subclinical RV involvement in patients with aMY. Abstract Figure. CMR Right Ventricle GLS
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Affiliation(s)
- M Bonanni
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - G Angelini
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - VL Paiocchi
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - LA Leo
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | | | - E Pasotti
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - G Pedrazzini
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - M Valgimigli
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - GM Sangiorgi
- Tor Vergata University Hospital Polyclinic, Rome, Italy
| | - FF Faletra
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - AG Pavon
- Cardiocentro Ticino Foundation, Lugano, Switzerland
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30
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Pavon A, Guglielmo M, Arangalage D, Bonanni M, Angelini G, Paiocchi V, Leo L, Valgimigli M, Pedrazzini G, Pontone G, Monney P, Faletra F. Additional value of CMR feature tracking parameters for the evaluation of the risk of complex ventricular arrhythmias and sudden cardiac death in patients with Mitral Valve Prolapse. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.372] [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
Mitral valve prolapse (MVP) with mitro-annular disjunction (MAD) has been associated with complex ventricular arrhythmias (c-VA) and sudden cardiac death (SCD) but risk stratification in this subset of patients remains insufficiently characterized. The aim of this study was to investigate the association between deformation parameters assessed by feature tracking (FT) cardiac magnetic resonance (CMR) in patients with MVP and MAD (MVP-MAD) and c-VA and/or SCD.
Methods
We included 23 patients (47 ± 13 years; 43 % males) with MVP-MAD, of whom 17 (74 %) presented with c-VA and 6 (26%) with SCD, as well as 20 age- and sex-matched controls (50 ± 18 years; 57% males). All patients underwent CMR with assessment of MAD length, late gadolinium enhancement (LGE), extracellular volume (ECV), global and regional longitudinal (LS), and circumferential strain (CS). RATIO-CS was defined as the ratio between regional CS in the basal inferolateral and mid-inferolateral walls (fig.1).
Results
In MVP-MAD patients, non-ischemic LGE of the LV inferior and inferolateral wall was observed in 21 patients (50%). As compared to controls, MVP-MAD patients showed lower global LS (-18.7 ±4.1 vs -24.7 ± 5.7 p < 0.001), higher native T1 relaxation time and ECV of the left ventricle (LV) inferolateral wall (1104 ± 63ms vs 1083 ± 66ms p < 0.029 and 0.31 ± 0.03 vs 0.27 ± 0.04 p 0.003), lower CS and LS of the LV mid and inferolateral segments (p < 0.005).
Logistic univariate regression analysis showed an increased risk of c-VA in case of LGE presence (OR: 9.52 [2.28-39.7] p = 0.002), a high number of LV segments with LGE (OR: 1.78 [1.21-2.63] p = 0.004), GLS (OR: 1.58 [1.21-2.07] p < 0.001), decreased inferolateral mid ventricular wall CS (OR: 1.41 [1.16-1.72] p < 0.001), decreased basal and mid-ventricular inferolateral wall LS (OR: 1.11 [1.00-1.23] p = 0.047 and OR: 1.62 [1.22-2.13] p < 0.001 respectively), increased native T1 times (OR: 1.01 [1.00-1.02] p = 0.039), increased ECV of the basal infero-lateral wall (OR: 4.93e + 07 [1.22-1.98e + 15] p = 0.047) and decreased RATIO-CS (OR: 7.48 [1.87-30.00] p = 0.005) (table 1). In multivariate analysis the presence of a lower LS in the basal inferolateral wall remained an independent predictor of c-VA (OR: 1.62 [1.22-2.13.00] p = 0.0007) and RATIO-CS remained an independent predictor of SCD (OR: 7.73 [1.78-33.60] p = 0.006).
Conclusion
Lower inferolateral LS and RATIO CS are respectively associated with c-VA and SCD in MVP-MAD patients. FT may provide additional value for risk stratification on top of standard CMR parameters in this subset of patients. Abstract Figure. fig.1 Abstract table 1
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Affiliation(s)
- A Pavon
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - M Guglielmo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - D Arangalage
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | - M Bonanni
- University of Rome Tor Vergata, tor, Rome, Italy
| | | | - V Paiocchi
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - L Leo
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - M Valgimigli
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - G Pedrazzini
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | - G Pontone
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Monney
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - F Faletra
- Cardiocentro Ticino Foundation, Lugano, Switzerland
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31
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Brener MI, Lurz P, Hausleiter J, Rodés-Cabau J, Fam N, Kodali SK, Rommel KP, Muntané-Carol G, Gavazzoni M, Nazif TM, Pozzoli A, Alessandrini H, Latib A, Biasco L, Braun D, Brochet E, Denti P, Lubos E, Ludwig S, Kalbacher D, Estevez-Loureiro R, Connelly KA, Frerker C, Ho EC, Juliard JM, Harr C, Monivas V, Nickenig G, Pedrazzini G, Philippon F, Praz F, Puri R, Schofer J, Sievert H, Tang GH, Andreas M, Thiele H, Unterhuber M, Himbert D, Alcázar MU, Von Bardeleben RS, Windecker S, Wild MG, Maisano F, Leon MB, Taramasso M, Hahn RT. Right Ventricular-Pulmonary Arterial Coupling and Afterload Reserve in Patients Undergoing Transcatheter Tricuspid Valve Repair. J Am Coll Cardiol 2022; 79:448-461. [DOI: 10.1016/j.jacc.2021.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
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Ghidini S, Gasperetti A, Winterton D, Vicenzi M, Busana M, Pedrazzini G, Biasco L, Tersalvi G. Echocardiographic assessment of the right ventricle in COVID-19: a systematic review. Int J Cardiovasc Imaging 2021; 37:3499-3512. [PMID: 34292433 PMCID: PMC8295549 DOI: 10.1007/s10554-021-02353-6] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
Cardiac involvement has been frequently reported in COVID-19 as responsible of increased morbidity and mortality. Given the importance of right heart function in acute and chronic respiratory diseases, its assessment in SARS-CoV-2 infected patients may add prognostic accuracy. Transthoracic echocardiography has been proposed to early predict myocardial injury and risk of death in hospitalized patients. This systematic review presents the up-to-date sum of literature regarding right ventricle ultrasound assessment. We evaluated commonly used echocardiographic parameters to assess RV function and discussed their relationship with pathophysiological mechanisms involved in COVID-19. We searched Medline and Embase for studies that used transthoracic echocardiography for right ventricle assessment in patients with COVID-19.
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Affiliation(s)
- Simone Ghidini
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dario Winterton
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Marco Vicenzi
- Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mattia Busana
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Giovanni Pedrazzini
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Luigi Biasco
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy
| | - Gregorio Tersalvi
- Division of Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland.
- Department of Internal Medicine, Hirslanden Klinik St. Anna, Sankt-Anna-Strasse 32, 6006, Lucerne, Switzerland.
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Galea R, De Marco F, Meneveau N, Aminian A, Anselme F, Gräni C, Huber AT, Teiger E, Iriart X, Babongo Bosombo F, Heg D, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Räber L, Valgimigli M. Amulet or Watchman Device for Percutaneous Left Atrial Appendage Closure: Primary Results of the SWISS-APERO Randomized Clinical Trial. Circulation 2021; 145:724-738. [PMID: 34747186 DOI: 10.1161/circulationaha.121.057859] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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: 12/29/2022]
Abstract
Background: No study has so far compared Amulet with the new Watchman FLX in terms of residual left atrial appendage (LAA) patency or clinical outcomes in patients undergoing percutaneous LAA closure (LAAC). Methods: In the investigator-initiated SWISS APERO trial, patients undergoing LAAC were randomized (1:1) open-label to receive Amulet or Watchman 2.5 or FLX (Watchman) across 8 European centres. The primary endpoint was the composite of justified crossover to a non-randomized device during LAAC procedure or residual LAA patency detected by cardiac computed tomography angiography (CCTA) at 45 days. The secondary endpoints included procedural complications, device related thrombus (DRT), peridevice leak (PDL) at transesophageal echocardiography (TEE) and clinical outcomes at 45 days. Results: Between June 2018, and May 2021, 221 patients were randomly assigned to Amulet (111 [50.2%]) or Watchman (110 [49.8%]), of whom 25 (22.7%) patients included before October 2019 received Watchman 2.5, and 85 (77.3%) patients received Watchman FLX. The primary endpoint was assessable in 205 (92.8%) patients and occurred in 71 (67.6%) Amulet and 70 (70.0%) Watchman patients respectively (risk ratio [RR] 0.97 [95% CI 0.80- 1.16]; P=0.713). A single justified cross-over occurred in an Amulet patient who fulfilled LAA patency criteria at 45-day CCTA. Major procedure related complications occurred more frequently in the Amulet group (9.0% vs. 2.7%; P=0.047), owing to more frequent bleeding (7.2% vs.1.8%). At 45 days, the PDL rate at TEE was higher with Watchman than Amulet (27.5% vs. 13.7%, p=0.020), albeit none was major (i.e. > 5 mm), whereas DRT was detected in 1 (0.9%) patient with Amulet and 3 (3.0%) patients with Watchman at CCTA and in 2 (2.1%) and 5 (5.5%) patients at TEE, respectively. Clinical outcomes at 45 days did not differ between the groups. Conclusions: Amulet was not associated with lower rate of the composite of crossover or residual LAA patency compared with Watchman at 45-day CCTA. Amulet, was however associated with lower PDL rates at TEE, higher procedural complications and similar clinical outcomes at 45 days compared with Watchman. The clinical relevance of CCTA-detected LAA patency requires further investigation. Clinical Trial Registration: URL https://clinicaltrials.gov Unique Identifier NCT03399851.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nicolas Meneveau
- Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Frédéric Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Teiger
- Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Flora Babongo Bosombo
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland and Department of Neurology, University Hospital Basel, University of Basel, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Cardiocentro Ticino Institute and Università della Svizzera Italiana (USI), Lugano, Switzerland
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Blumetti L, De Perna ML, Reinehr M, Pedrazzini G. Eosinophilic perimyocarditis associated with eosinophilic granulomatosis with polyangiitis: a case report. Eur Heart J Case Rep 2021; 5:ytab399. [PMID: 34738066 PMCID: PMC8564711 DOI: 10.1093/ehjcr/ytab399] [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] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/03/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022]
Abstract
Background Eosinophilic myocarditis (EM) is a rare and potentially life-threatening form of myocarditis, frequently (but not always) associated with eosinophilia, and presents with acute chest pain, or signs and symptoms of acute or chronic heart failure. Eosinophilic myocarditis has various aetiologies, including eosinophilic granulomatosis with polyangiitis (EGPA). Case summary A 52-year-old female with a long-standing history of asthma, acral paraesthesia, subcutaneous nodules, and recurrent chest pain treated with anti-inflammatory drugs was admitted to our hospital with chest pain, repolarization disturbances, eosinophilia, and increased troponin levels. After an initial evaluation by coronary angiography, echocardiography and cardiac magnetic resonance, a definitive diagnosis of EM was made with the help of an endomyocardial biopsy. The aetiological diagnosis of EM as a manifestation of tissue involvement in EGPA was concluded after ruling out other possible causes of eosinophilia and with the help of other diagnostic criteria for EGPA (asthma, eosinophilia, and neuropathy). Therefore, we started with a high dosage of glucocorticoids, and attained relief of symptoms and normalization of eosinophilic count after a few days. Discussion In cases of myocarditis (particularly if associated with eosinophilia), EM is a manifestation of EGPA and should be considered for a prompt differential diagnosis. Endomyocardial biopsy represents the gold standard for the diagnosis of EM. The mainstay of therapy for EM is immunosuppressive drugs to help prevent its evolution to a fulminant form and chronic progression towards restrictive cardiomyopathy.
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Affiliation(s)
- Ludovica Blumetti
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Maria Luisa De Perna
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Michael Reinehr
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland.,Institut für Pathologie und Molekularpathologie, Universitätsspital Zürich, Rämistrasse 100 8091 Zürich, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland
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Araco M, Quagliana A, Pedrazzini G, Valgimigli M. A new iteration for the single-access large-bore technique during Impella supported complex and high-risk coronary intervention: a case report. Eur Heart J Case Rep 2021; 5:ytab428. [PMID: 34917876 PMCID: PMC8669554 DOI: 10.1093/ehjcr/ytab428] [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: 03/29/2021] [Revised: 05/26/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Complex and high-risk coronary intervention (CHIP-PCI) and PCI in cardiogenic shock complicating acute coronary syndrome (ACS) are increasingly performed under mechanical circulatory support-so-called protected PCI. Among the available options, Impella Cardiac Power (CP) heart pump (Abiomed) is percutaneously inserted over the femoral artery and typically requires a second arterial access to perform PCI, which further enhances the risk of vascular and bleeding complications. The single-access technique allows Impella CP placement and PCI performance through the same vascular access. When a 7 Fr system is desirable, only a long and entirely hydrophilic coated sheath has been previously used, which is not available in Europe. CASE SUMMARY A 85-year-old patient admitted with non ST-elevation - acute coronary syndrome (NSTE-ACS), severely reduced left ventricular function and three-vessel coronary artery disease underwent single-access CHIP-PCI under Impella CP support. After a failed attempt to insert a standard 7 Fr long femoral sheath alongside the Impella catheter, we successfully introduced a 7.5 Fr sheathless guiding catheter and delivered the planned percutaneous treatment with the benefits conferred by a 7 Fr-rather than 6-lumen catheter, without the need for an additional arterial access. DISCUSSION This is, to the best of our knowledge, the first case of CHIP-PCI performed under Impella support utilizing the single-access technique with a 7.5 Fr sheathless guiding catheter. Beyond advantages of the single-access technique in sparing time and avoiding vascular complications associated with gaining a second arterial access, the lower outer diameter of the sheathless catheter compared with standard 7 Fr sheaths may allow improved limb perfusion and lower chance of interference with the Impella CP catheter.
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Affiliation(s)
- Marco Araco
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Interventional Cardiology Department, via Tesserete 48, 6900 Lugano, Switzerland
| | - Angelo Quagliana
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Interventional Cardiology Department, via Tesserete 48, 6900 Lugano, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Interventional Cardiology Department, via Tesserete 48, 6900 Lugano, Switzerland
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Interventional Cardiology Department, via Tesserete 48, 6900 Lugano, Switzerland
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Stahli B, Witassek F, Roffi M, Eberli F, Rickli H, Erne P, Maggiorini M, Pedrazzini G, Radovanovic D. Long-term trends in treatment and outcomes of patients with diabetes and acute coronary syndromes: insights from the nationwide AMIS plus registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1341] [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
Although impressive advances in the treatment of patients with acute coronary syndromes (ACS) have been achieved over the last decades, morbidity and mortality of patients with diabetes and ACS remain substantial. This study aimed at investigating long-term trends in treatment and outcomes of patients with diabetes and ACS, using data from a large, prospective, nation-wide database.
Methods
Patients with ST segment elevation myocardial infarction (STEMI) or non-ST segment elevation myocardial infarction (NSTEMI) enrolled in the prospective AMIS Plus registry between 01/2003 and 12/2018 and available data on diabetes diagnosis were included in the analysis. Major adverse cardiovascular events (MACE), a composite of all-cause death, non-fatal myocardial infarction, and cerebrovascular events were assessed for each 3-year period.
Results
Out of 49'413 ACS patients, 10'200 (20.6%) had diabetes (29.4% women). In diabetic patients, the percentage of women decreased from 32.3% in 2002–2004 to 25.9% in 2017–2019 (p<0.001). Diabetic patients were older (p<0.001), more frequently women (p<0.001), and had a higher body mass index (p<0.001). They less often underwent percutaneous coronary intervention (p<0.001) and were more frequently treated by coronary artery bypass grafting (p<0.001). Over the 18-year period, the percentage of diabetic patients undergoing PCI or CABG increased (p<0.001). While treatment with glycoprotein IIb/IIIa inhibitors, low-molecular weight heparin, and beta blockers decreased over time, administration of aspirin, P2Y12 inhibitors, lipid-lowering drugs, and unfractionated heparin increased. Rates of MACE were 9.5% and 5.2% in diabetic and non-diabetic patients (p<0.001). Rates of mortality (7.7% versus 4.1%, p<0.001), recurrent myocardial infarction (1.5% versus 0.9%, p<0.001), and cerebrovascular events (1.2% versus 0.6%, p<0.001) were higher in diabetic as compared with non-diabetic patients, with highest rates of MACE, mortality, and myocardial infarction observed in diabetic women. Rates of MACE decreased from 11.8% in 2002–2004 to 7.5% in 2017–2019 in diabetic patients (p for trend <0.001). While rates of mortality (9.4% to 5.9%, p for trend =0.001) and rates of recurrent myocardial infarction (3.4% to 0.9%, p for trend <0.001) decreased over time, rates of cerebrovascular events remained stable (p for trend =0.34). Trends were the same in diabetic women and men.
Conclusions
Rates of MACE significantly decreased over the 18-year period in both diabetic women and men, with highest rates observed in diabetic women. Despite the observed improvements, rates of MACE remained 50% higher in diabetic as compared with non-diabetic patients. These findings emphasize that advanced strategies particularly targeting the vulnerable high-risk diabetic patient population are warranted to further improve quality of care in ACS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Stahli
- Cardiology, Cardiovascular Center, University Hospital Zürich, Zurich, Switzerland
| | - F Witassek
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - M Roffi
- Geneva University Hospitals, Division of Cardiology, Geneva, Switzerland
| | - F Eberli
- Triemli Hospital, Division of Cardiology, Zurich, Switzerland
| | - H Rickli
- Kantonsspital, Department of Cardiology, St. Gallen, Switzerland
| | - P Erne
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - M Maggiorini
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | | | - D Radovanovic
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
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Hoepli A, Ahmed K, Rickli H, Eberli F, Kobza R, Pedrazzini G, Radovanovic D. Achievement of guideline recommended LDL-C goals in patients with acute myocardial infarction (AMI) in Switzerland. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1422] [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: 11/12/2022] Open
Abstract
Abstract
Background
In 2016 and subsequently again in 2019 the ESC/EAS Guidelines for the Management of Dyslipidaemia established a more intensive reduction of LDL cholesterol (LDL-C) treatment recommendations. We aim to characterize patients with acute myocardial infarction (AMI) with regards to achievement of recommended LDL-C goals and their current lipid lowering therapy.
Methods
We retrospectively analysed patients with AMI admitted to Swiss hospitals between 2016 and 2020. Patients were classified as “very high risk” due to prior atherosclerotic cardiovascular disease (ACSVD) events including at least one of the following: Myocardial infarction (MI), stroke, peripheral arterial disease (PAD) and type 2 diabetes mellitus with target organ damage. The remaining patients were classified as “other risk”. LDL-C treatment recommendation goals for the “very high risk” population were set to 1.8mmol/L (2016 ESC/EAS Guidelines) or 1.4mmol/L (2019 ESC/EAS Guidelines) and for the “other risk” population to 2.6mmol/L or 1.8mmol/L. To identify differences between the two groups the Mann-Whitney test was used and for differences within a group the Kruskal-Wallis test. In-hospital outcomes were summarised as major adverse cardiac and cerebrovascular events (MACCE).
Results
Among 7114 patients included, 18.4% were categorized as “very high risk” and 81.6% as “other risk” (p<0.001). In general, the “very high risk” patients were older (69.2y vs. 63.6y, p<0.001), more likely to be men (78.8% vs. 75.3%, p=0.007), had poorer in-hospital outcomes (6.0% vs. 3.4%, p<0.001) and were more often on lipid lowering treatment (statin/ezetimibe/combination) (LLT) prior to admission (64.8% vs 14.0%, p<0.001). The overall LDL-C median for the “very high risk” population was significantly lower than for the “other risk” population (2.4mmol/L vs. 3.5mmol/L, p<0.001). In addition, median (IQR) LDL-C increased in the “other risk” group over the years from 3.5mmol/L (2.7; 4.2) in 2016 to 3.7mmol/L (3.1; 4.4) in 2020. In contrast, no change in LDL-C was observed in the patients at higher risk (Fig. 1).
Patients in the “other risk” group were more likely to miss the recommended LDL-C goals (2016 Guidelines: 80.0% vs. 75.4%, 2019 Guidelines: 94.2% vs. 89.1%). Patients without LLT prior to admission had a higher chance of not reaching the recommendations compared to patients with LLT prior to admission (without LLT: 2016: 85.3% vs. 91.0%, 2019: 96.1% vs. 96.6%), (with LLT: 2016: 50.8% vs. 66.8%, 2019: 83.2% vs.85.2%) (Fig. 2).
Conclusion
Median LDL-C levels have tended to increase in recent years in patients with very high CV risk and AMI admitted to Swiss hospitals. Despite existing lipid lowering therapies only few patients met guideline recommended LDL-C goals. Our results indicate that clinical implementation of guidelines remains to be optimised with regards to achievement of LDL-C goals to reduce CV risk and improve outcomes.
Funding Acknowledgement
Type of funding sources: None. Figure 1. LDL-C developmentFigure 2. Recommended LDL-C goal achievement
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Affiliation(s)
- A Hoepli
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - K Ahmed
- Novartis Pharma Switzerland AG, Rotkreuz, Switzerland
| | - H Rickli
- Cantonal Hospital St. Gallen, Klinik für Kardiologie, St. Gallen, Switzerland
| | - F Eberli
- Triemli Hospital, Zurich, Switzerland
| | - R Kobza
- Kantonsspital Lucerne, Herzzentrum, Lucerne, Switzerland
| | - G Pedrazzini
- Cardiocentro Ticino, Department of Cardiology, Lugano, Switzerland
| | - D Radovanovic
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
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Fournier S, Mahendiran T, Radovanovic D, Pedrazzini G, Eberli F, Roffi M, Kobza R, Rickli H. The impact of the COVID-19 pandemic on the management and outcomes of STEMI patients in Switzerland. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1407] [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
Introduction
The COVID-19 pandemic has placed unprecedented strain on healthcare systems around the world, with potential repercussions on the quality of care of patients with other diseases. From a cardiological perspective, there have been concerns that the pandemic may have impacted the management of the most acute cardiovascular conditions.
Purpose
We evaluated the impact of the COVID-19 pandemic on the management of ST-elevation myocardial infarction (STEMI) in Switzerland by assessing a range of quality-of-care metrics during the first year of the pandemic, as compared with the preceding year.
Methods
Data on STEMI patients hospitalised in Switzerland from 1st January 2019 to 31st December 2020 were obtained from the Acute Myocardial Infarction in Switzerland (AMIS) registry. Symptom-to-first-medical-contact (symptom-to-FMC) time, symptom-to-door time, and door-to-balloon (DTB) time were compared between 2020 and 2019 in an analysis by year and by month. Additionally, rates of in-hospital all-cause mortality and in-hospital major adverse cardiovascular events (MACE: all-cause mortality, MI, stroke) were compared.
Results
Data on 2192 STEMI patients were available. Compared with the preceding 12 months, the first year of the pandemic was not associated with a significant change in median symptom-to-FMC time (2020: 90 minutes vs 2019: 95 minutes, p=0.32) or median symptom-to-door time (2020: 145 min vs 2019: 157 min, p=0.51). In 2020, February (start of the pandemic) and March (start of national lockdown) were associated with increased DTB times as compared with the same months of 2019 (+7 minutes, +10 minutes, respectively). However, overall median door-to-balloon times remained stable (2020: 40 min vs 2019: 39 min, p=0.06). Furthermore, there was no significant difference in the proportion of patients undergoing percutaneous coronary intervention (2020: 95.6% vs 2019: 95.1%, p=0.54). Finally, there were no significant differences in median length of stay (2020: 4 days vs 2019: 157 min, p=0.51), in-hospital all-cause mortality (2020: 4.9% vs. 2019: 4.2%, p=0.41) or MACE (2020: 6.2% vs. 2019: 5.6%, p=0.52).
Conclusions
Although there are some limitations associated with the present study inherent to its retrospective observational design (for instance, a potentially important number of late comers may not have been included in the registry), the data suggest that despite the impact of COVID-19 on the healthcare system in Switzerland in 2020, STEMI management as defined by a range of quality-of-care metrics remained effective and efficient.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Fournier
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - T Mahendiran
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - D Radovanovic
- University of Zurich, AMIS plus Data Center, Zurich, Switzerland
| | | | - F Eberli
- Triemli Hospital, Zurich, Switzerland
| | - M Roffi
- Geneva University Hospitals, Department of Cardiology, Geneva, Switzerland
| | - R Kobza
- Luzerner Kantonsspital, Lucerne, Switzerland
| | - H Rickli
- Kantonsspital St. Gallen, St Gallen, Switzerland
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Landi A, Branca M, Andò G, Russo F, Frigoli E, Gargiulo G, Briguori C, Vranckx P, Leonardi S, Gragnano F, Calabrò P, Campo G, Ambrosio G, Santucci A, Varbella F, Zaro T, Heg D, Windecker S, Jüni P, Pedrazzini G, Valgimigli M. Acute kidney injury in patients with acute coronary syndrome undergoing invasive management treated with bivalirudin vs. unfractionated heparin: insights from the MATRIX trial. Eur Heart J Acute Cardiovasc Care 2021; 10:1170-1179. [PMID: 34491323 DOI: 10.1093/ehjacc/zuab080] [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] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/03/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022]
Abstract
AIMS Acute kidney injury (AKI) is a critical complication among patients with acute coronary syndrome (ACS) undergoing invasive management. The value of adjunctive antithrombotic strategies, such as bivalirudin or unfractionated heparin (UFH) on the risk of AKI is unclear. METHODS AND RESULTS Among 7213 patients enrolled in the MATRIX-Antithrombin and Treatment Duration study, 128 subjects were excluded due to incomplete information on serum creatinine (sCr) or end-stage renal disease on dialysis treatment. The primary endpoint was AKI defined as an absolute (>0.5 mg/dL) or a relative (>25%) increase in sCr. AKI occurred in 601 patients (16.9%) treated with bivalirudin and 616 patients (17.4%) treated with UFH [odds ratio (OR): 0.97; 95% confidence interval (CI): 0.85-1.09; P = 0.58]. A >25% sCr increase was observed in 597 patients (16.8%) with bivalirudin and 616 patients (17.4%) with UFH (OR: 0.96; 95% CI: 0.85-1.08; P = 0.50), whereas a >0.5 mg/dL absolute sCr increase occurred in 176 patients (5.0%) with bivalirudin vs. 189 patients (5.4%) with UFH (OR: 0.92; 95% CI: 0.75-1.14; P = 0.46). By implementing the Kidney Disease Improving Global Outcomes (KDIGO) criteria, the risk of AKI was not significantly different between bivalirudin and UFH groups (OR: 0.88; 95% CI: 0.72-1.07; P = 0.21). Subgroup analyses of the primary endpoint suggested a benefit with bivalirudin in patients randomized to femoral access. CONCLUSION Among ACS patients undergoing invasive management, the risk of AKI was not significantly lower with bivalirudin compared with UFH. TRIAL REGISTRATION clinicaltrials.gov NCT01433627.
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Affiliation(s)
- Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 48, CH-6900 Lugano, Switzerland
| | | | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", University of Messina, Messina, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Giuseppe Gargiulo
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Sergio Leonardi
- Coronary Care Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Felice Gragnano
- Division of Cardiology, "Sant'Anna e San Sebastiano" Hospital, Caserta, Italy.,Department of Translational Medicine, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Paolo Calabrò
- Division of Cardiology, "Sant'Anna e San Sebastiano" Hospital, Caserta, Italy.,Department of Translational Medicine, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Gianluca Campo
- Cardiology Unit, Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Giuseppe Ambrosio
- Department of Cardiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
| | - Andrea Santucci
- Department of Cardiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
| | - Ferdinando Varbella
- Cardiology Unit, Ospedali Riuniti di Rivoli, ASL Torino 3, Turin, Italy.,Cardiology Unit, Azienda Ospedaliera Universitaria San Luigi Gonzaga Orbassano, Turin, Italy
| | - Tiziana Zaro
- Cardiology Division, A.O. Ospedale Civile di Vimercate (MB), Vimercate, Italy
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | | | - Peter Jüni
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 48, CH-6900 Lugano, Switzerland
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete, 48, CH-6900 Lugano, Switzerland.,Department of Cardiology, University of Bern, Bern, Switzerland
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Landi A, Faletra FF, Pavon AG, Pedrazzini G, Valgimigli M. From secondary to tertiary mitral regurgitation: the paradigm shifts, but uncertainties remain. Eur Heart J Cardiovasc Imaging 2021; 22:835-843. [PMID: 33982052 DOI: 10.1093/ehjci/jeab080] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/16/2021] [Indexed: 12/27/2022] Open
Abstract
Secondary mitral regurgitation (MR) is the most common and undertreated form of MR, whose contribution to poor prognosis and indications to correction remains under discussion. MR has been characterized into 'proportionate' or 'disproportionate', based on left ventricle (LV) and regurgitant volumes, whereas 'tertiary' MR identifies conditions, in which regurgitation is pathologic per se and actively contributes to LV dysfunction. Echocardiographic and anatomo-pathological studies revealed that secondary MR prompts subtle leaflet maladaptive changes, actively contributing to the dynamic progression of secondary MR. We critically discuss the paradigm shift from secondary to tertiary MR and question the notion that MV leaflets play a passive role in secondary MR. We also review the role of standard transthoracic echocardiography for appraising and quantifying maladaptive MV leaflet changes and LV volumes and call for a more sophisticated and comprehensive imaging framework for classifying MR in future interventional studies.
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Affiliation(s)
- Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Francesco Fulvio Faletra
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Anna Giulia Pavon
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland.,Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Baldi E, Auricchio A, Cresta R, Vanetta C, Anselmi L, Pedrazzini G, Benvenuti C. Patient voluntarily delays call to emergency medical system for ST-elevation myocardial infarction during COVID-19 pandemic. Int J Cardiol Heart Vasc 2021; 35:100824. [PMID: 34131581 PMCID: PMC8193031 DOI: 10.1016/j.ijcha.2021.100824] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/13/2021] [Accepted: 06/05/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND An increase in the time from the symptoms onset to first medical contact and to primary percutaneous coronary intervention (pPCI) has been observed in countries with high-incidence of COVID-19 cases. We aimed to verify if there was any change in the patient delay and in the EMS response times up to the pPCI for STEMI patients in Swiss Ticino Canton. METHODS We assessed STEMI management including time from symptoms onset to EMS call, time of EMS response, time to pPCI in Swiss Canton Ticino. Data were retrieved from the Acute-Coronary-Syndrome-Ticino-Registry. We considered the patients included in the registry from March to May 2020 (pandemic period) and then from June to August 2020 (post-pandemic period) in whom a pPCI was performed. We compared these patients to those undergoing a pPCI in the same months in the year 2016-2019. RESULTS During the pandemic period, the time from symptoms onset to pPCI significantly increased compared to non-pandemic periods. This was due to a significant prolongation of the time from symptoms onset to EMS call, that nearly tripled. In contrast, after the pandemic period, there was a significantly shorter time from symptom onset to EMS call compared to non-pandemic years, whereas all other times remained unchanged. CONCLUSION Patients delay the call to EMS despite symptoms of myocardial infarction during the COVID-19 pandemic also in a region with a relatively low incidence of COVID-19.
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Affiliation(s)
- Enrico Baldi
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angelo Auricchio
- Fondazione Ticino Cuore, Breganzona, Switzerland
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | | | - Luciano Anselmi
- Federazione Cantonale Ticinese Servizi Autoambulanze (FCTSA), Breganzona, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
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Landi A, Quagliana A, Leo LA, Faletra FF, Pedrazzini G, Valgimigli M. Intimal Flap Sealing and Healing of Spontaneous Coronary Artery Dissection With Drug-Eluting Balloons. JACC Cardiovasc Interv 2021; 14:1843-1845. [PMID: 34332937 DOI: 10.1016/j.jcin.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland. https://twitter.com/antoniolandii
| | - Angelo Quagliana
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Laura Anna Leo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Francesco Fulvio Faletra
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Department of Cardiology, University of Bern, Bern, Switzerland.
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Schlotter F, Miura M, Kresoja KP, Alushi B, Alessandrini H, Attinger-Toller A, Besler C, Biasco L, Braun D, Brochet E, Connelly K, de Bruijn S, Denti P, Estévez-Loureiro R, Fam NP, Gavazzoni M, Himbert D, Ho E, Juliard JM, Kalbacher D, Kaple R, Kreidel F, Latib A, Lubos E, Ludwig S, Mehr M, Monivas V, Nazif T, Nickenig G, Pedrazzini G, Pozzoli A, Praz F, Puri R, Rodés-Cabau J, Rommel KP, Schäfer U, Schofer J, Sievert H, Tang G, Thiele H, Unterhuber M, Vahanian A, von Bardeleben R, von Roeder M, Webb J, Weber M, Wild MG, Windecker S, Zuber M, Hausleiter J, Maisano F, Leon MB, Hahn RT, Lauten A, Taramasso M, Lurz P. Outcomes of transcatheter tricuspid valve intervention by right ventricular function: a multicentre propensity-matched analysis. EUROINTERVENTION 2021; 17:e343-e352. [PMID: 33956637 PMCID: PMC9724849 DOI: 10.4244/eij-d-21-00191] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 11/23/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) has a poor prognosis and limited treatment options and is frequently accompanied by right ventricular (RV) dysfunction. Transcatheter tricuspid valve interventions (TTVI) to reduce TR have been shown to be safe and feasible with encouraging early results. Patient selection for TTVI remains challenging, with the role of right ventricular (RV) function being unknown. AIMS The aims of this study were 1) to investigate survival in a TTVI-treated patient population and a conservatively treated TR population, and 2) to evaluate the outcome of TTVI as compared to conservative treatment stratified according to the degree of RV function. METHODS We studied 684 patients from the multicentre TriValve cohort (TTVI cohort) and compared them to 914 conservatively treated patients from two tertiary care centres. Propensity matching identified 213 pairs of patients with severe TR. As we observed a non-linear relationship of RV function and TTVI outcome, we stratified patients according to tricuspid annular plane systolic excursion (TAPSE) to preserved (TAPSE >17 mm), mid-range (TAPSE 13-17 mm) and reduced (TAPSE <13 mm) RV function. The primary outcome was one-year all-cause mortality. RESULTS TTVI was associated with a survival benefit in patients with severe TR when compared to matched controls (one-year mortality rate: 13.1% vs 25.8%; p=0.031). Of the three RV subgroups, only in patients with mid-range RV function was TTVI associated with an improved survival (p log-rank 0.004). In these patients, procedural success was associated with a reduced hazard ratio for all-cause mortality (HR 0.22; 95% CI: 0.09, 0.57). CONCLUSIONS TTVI is associated with reduced mortality compared to conservative therapy and might exert its highest treatment effect in patients with mid-range reduced RV function.
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Affiliation(s)
- Florian Schlotter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Mizuki Miura
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Brunilda Alushi
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | | | | | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Kim Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | | | - Neil P. Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Toronto, ON, Canada
| | - Mara Gavazzoni
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Dominique Himbert
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | | | | | - Ryan Kaple
- Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, NY, USA
| | - Edith Lubos
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | - Vanessa Monivas
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Tamim Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Georg Nickenig
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | | | - Alberto Pozzoli
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Ulrich Schäfer
- Cardiology, Angiology and Intensive Care Medicine, Catholic Marienhospital, Hamburg, Germany
| | - Joachim Schofer
- MVZ Department Structural Heart Disease, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - Gilbert Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, NY, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Alec Vahanian
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France
| | | | - Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - John Webb
- Cardiology Department, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marcel Weber
- Cardiology Department, Universitaetsklinikum Bonn, Bonn, Germany
| | - Mirjam G. Wild
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michel Zuber
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Munich, Germany
| | | | - Martin B. Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Rebecca T. Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Alexander Lauten
- HELIOS Klinikum Erfurt, Department of General and Interventional Cardiology & Rhythmology, Erfurt, Germany,Universitätsklinikum Charité, Campus Benjamin Franklin, Berlin, and German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Maurizio Taramasso
- Division of Cardiac Surgery, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Lurz
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Struempellstr. 39, 04289 Leipzig, Germany
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Ueki Y, Yamaji K, Losdat S, Karagiannis A, Taniwaki M, Roffi M, Otsuka T, Koskinas KC, Holmvang L, Maldonado R, Pedrazzini G, Radu MD, Dijkstra J, Windecker S, Garcia-Garcia HM, Räber L. Discordance in the diagnostic assessment of vulnerable plaques between radiofrequency intravascular ultrasound versus optical coherence tomography among patients with acute myocardial infarction: insights from the IBIS-4 study. Int J Cardiovasc Imaging 2021; 37:2839-2847. [PMID: 34236570 PMCID: PMC8494667 DOI: 10.1007/s10554-021-02272-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022]
Abstract
We aimed to evaluate the diagnostic agreement between radiofrequency (RF) intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for thin-cap fibroatheroma (TCFA) in non-infarct-related coronary arteries (non-IRA) in patients with ST-segment elevation myocardial infarction (STEMI). In the Integrated Biomarker Imaging Study (IBIS-4), 103 STEMI patients underwent OCT and RF-IVUS imaging of non-IRA after successful primary percutaneous coronary intervention and at 13-month follow-up. A coronary lesion was defined as a segment with ≥ 3 consecutive frames (≈1.2 mm) with plaque burden ≥ 40% as assessed by grayscale IVUS. RF-IVUS-derived TCFA was defined as a lesion with > 10% confluent necrotic core abutting to the lumen in > 10% of the circumference. OCT-TCFA was defined by a minimum cap thickness < 65 μm. The two modalities were matched based on anatomical landmarks using a dedicated matching software. Using grayscale IVUS, we identified 276 lesions at baseline (N = 146) and follow-up (N = 130). Using RF-IVUS, 208 lesions (75.4%) were classified as TCFA. Among them, OCT identified 14 (6.7%) TCFA, 60 (28.8%) thick-cap fibroatheroma (ThCFA), and 134 (64.4%) non-fibroatheroma. All OCT-TCFA (n = 14) were confirmed as RF-TCFA. The concordance rate between RF-IVUS and OCT for TCFA diagnosis was 29.7%. The reasons for discordance were: OCT-ThCFA (25.8%); OCT-fibrous plaque (34.0%); attenuation due to calcium (23.2%); attenuation due to macrophage (10.3%); no significant attenuation (6.7%). There was a notable discordance in the diagnostic assessment of TCFA between RF-IVUS and OCT. The majority of RF-derived TCFA were not categorized as fibroatheroma using OCT, while all OCT-TCFA were classified as TCFA by RF-IVUS. ClinicalTrials.gov Identifier NCT00962416.
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Kyohei Yamaji
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | | | - Masanori Taniwaki
- Department of Cardiology, Tokorozawa Heart Center, Tokorozawa, Japan
| | - Marco Roffi
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Konstantinos C Koskinas
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Lene Holmvang
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rafaela Maldonado
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | | | - Maria D Radu
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jouke Dijkstra
- Leiden University Medical Center, Leiden, the Netherlands
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Hector M Garcia-Garcia
- MedStar Cardiovacular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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Bär S, Kavaliauskaite R, Ueki Y, Otsuka T, Kelbæk H, Engstrøm T, Baumbach A, Roffi M, von Birgelen C, Ostojic M, Pedrazzini G, Kornowski R, Tüller D, Vukcevic V, Magro M, Losdat S, Windecker S, Räber L. Quantitative Flow Ratio to Predict Nontarget Vessel-Related Events at 5 Years in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Angiography-Guided Revascularization. J Am Heart Assoc 2021; 10:e019052. [PMID: 33899509 PMCID: PMC8200733 DOI: 10.1161/jaha.120.019052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background In ST-segment-elevation myocardial infarction, angiography-based complete revascularization is superior to culprit-lesion-only percutaneous coronary intervention. Quantitative flow ratio (QFR) is a novel, noninvasive, vasodilator-free method used to assess the hemodynamic significance of coronary stenoses. We aimed to investigate the incremental value of QFR over angiography in nonculprit lesions in patients with ST-segment-elevation myocardial infarction undergoing angiography-guided complete revascularization. Methods and Results This was a retrospective post hoc QFR analysis of untreated nontarget vessels (any degree of diameter stenosis [DS]) from the randomized multicenter COMFORTABLE AMI (Comparison of Biolimus Eluted From an Erodible Stent Coating With Bare Metal Stents in Acute ST-Elevation Myocardial Infarction) trial by assessors blinded for clinical outcomes. The primary end point was cardiac death, spontaneous nontarget vessel myocardial infarction, and clinically indicated nontarget vessel revascularization (ie, ≥70% DS by 2-dimensional quantitative coronary angiography or ≥50% DS and ischemia) at 5 years. Of 1161 patients with ST-segment-elevation myocardial infarction, 946 vessels in 617 patients were analyzable by QFR. At 5 years, the rate of the primary end point was significantly higher in patients with QFR ≤0.80 (n=35 patients, n=36 vessels) versus QFR >0.80 (n=582 patients, n=910 vessels) (62.9% versus 12.5%, respectively; hazard ratio [HR], 7.33 [95% CI, 4.54-11.83], P<0.001), driven by higher rates of nontarget vessel myocardial infarction (12.8% versus 3.1%, respectively; HR, 4.38 [95% CI, 1.47-13.02], P=0.008) and nontarget vessel revascularization (58.6% versus 7.7%, respectively; HR, 10.99 [95% CI, 6.39-18.91], P<0.001) with no significant differences for cardiac death. Multivariable analysis identified QFR ≤0.80 but not ≥50% DS by 3-dimensional quantitative coronary angiography as an independent predictor of the primary end point. Results were consistent, including only >30% DS by 3-dimensional quantitative coronary angiography. Conclusions Our study suggests incremental value of QFR over angiography-guided percutaneous coronary intervention for nonculprit lesions among patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
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Affiliation(s)
- Sarah Bär
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
| | | | - Yasushi Ueki
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
| | - Henning Kelbæk
- Department of Cardiology Zealand University Hospital Roskilde Denmark
| | - Thomas Engstrøm
- Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices William Harvey Research InstituteQueen Mary University of London and Barts Heart Centre London United Kingdom
| | - Marco Roffi
- Division of Cardiology University Hospital Geneva Geneva Switzerland
| | - Clemens von Birgelen
- Department of Cardiology Thoraxcentrum Medisch Spectrum Twente Enschede the Netherlands.,Department of Health Technology and Services Research Technical Medical Centre University of Twente Enschede the Netherlands
| | | | | | - Ran Kornowski
- Cardiology Department Rabin Medical Center Tel Aviv University Petah Tikwa Israel
| | - David Tüller
- Cardiology Department Triemlispital Zurich Switzerland
| | | | | | - Sylvain Losdat
- Clinical Trials Unit (CTU) Bern University of Bern Switzerland
| | - Stephan Windecker
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
| | - Lorenz Räber
- Department of Cardiology Bern University Hospital Inselspital Bern Switzerland
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Galea R, De Marco F, Aminian A, Meneveau N, Anselme F, Gräni C, Huber AT, Teiger E, Iriart X, Angelillis M, Brugger N, Spirito A, Corpataux N, Franzone A, Vranckx P, Fischer U, Pedrazzini G, Bedogni F, Windecker S, Räber L, Valgimigli M. Design and Rationale of the Swiss-Apero Randomized Clinical Trial: Comparison of Amplatzer Amulet vs Watchman Device in Patients Undergoing Left Atrial Appendage Closure. J Cardiovasc Transl Res 2021; 14:930-940. [PMID: 33884564 DOI: 10.1007/s12265-020-10095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022]
Abstract
Residual or newly acquired leaks are routinely appraised after left atrial appendage closure (LAAC). The Watchman and the Amulet are the two most frequently used devices for LAAC but no randomized study has so far assessed their comparative leak rates after intervention. The "Comparison of Amplatzer Amulet vs Watchman devices in patients undergoing left atrial appendage closure" (Swiss-Apero, clinicaltrial.gov NCT03399851) is an academic-sponsored multicenter, randomized clinical trial comparing Amulet versus Watchman/FLX devices among patients undergoing a clinically indicated LAAC. The study is designed to assess the superiority of Amulet vs. Watchman/FLX in terms of leaks detected by cardiac computed tomography angiography (CCTA) at 45 days (primary endpoint) and 13 months (secondary endpoint) after intervention by an imaging Core Laboratory. The Swiss-Apero study is the first randomized clinical trial comparing Amulet and Watchman/FLX with respect to the prevalence of post-procedural leak as assessed with CCTA.
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Nicolas Meneveau
- Besancon University Hospital, EA3920, University of Burgundy Franche-Comté, Besancon, France
| | - Frederic Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emmanuel Teiger
- Department of Cardiology, Henri-Mondor Hospital, Public Assistance Hospitals of Paris, Créteil, France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Hôpital Cardiologique du Haut- Lévêque, CHU de Bordeaux, Bordeaux-Pessac, France
| | - Marco Angelillis
- Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessandro Spirito
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University Federico II University, Naples, Italy
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Urs Fischer
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Giovanni Pedrazzini
- Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, 6900, Lugano, Switzerland
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. .,Cardiocentro Ticino, Via Tesserete 48, 6900, Lugano, Switzerland.
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47
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Muntané-Carol G, Taramasso M, Miura M, Gavazzoni M, Pozzoli A, Alessandrini H, Latib A, Attinger-Toller A, Biasco L, Braun D, Brochet E, Connelly KA, de Bruijn S, Denti P, Deuschl F, Lubos E, Ludwig S, Kalbacher D, Estevez-Loureiro R, Fam N, Frerker C, Ho E, Juliard JM, Kaple R, Kodali S, Kreidel F, Harr C, Lauten A, Lurz J, Monivas V, Mehr M, Nazif T, Nickening G, Pedrazzini G, Philippon F, Praz F, Puri R, Schäfer U, Schofer J, Sievert H, Tang GHL, Khattab AA, Andreas M, Russo M, Thiele H, Unterhuber M, Himbert D, Urena M, von Bardeleben RS, Webb JG, Weber M, Windecker S, Winkel M, Zuber M, Hausleiter J, Lurz P, Maisano F, Leon MB, Hahn RT, Rodés-Cabau J. Transcatheter Tricuspid Valve Intervention in Patients With Right Ventricular Dysfunction or Pulmonary Hypertension: Insights From the TriValve Registry. Circ Cardiovasc Interv 2021; 14:e009685. [PMID: 33541097 DOI: 10.1161/circinterventions.120.009685] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Scarce data exist on patients with right ventricular dysfunction (RVD) or pulmonary hypertension (PH) undergoing transcatheter tricuspid valve intervention. This study aimed to determine the early and midterm outcomes and the factors associated with mortality in this group of patients. METHODS This subanalysis of the multicenter TriValve (Transcatheter Tricuspid Valve Therapies) registry included 300 patients with severe tricuspid regurgitation with RVD (n=244), PH (n=127), or both (n=71) undergoing transcatheter tricuspid valve intervention. RVD was defined as a tricuspid annular plane systolic excursion <17 mm, and PH as an estimated pulmonary artery systolic pressure ≥50 mm Hg. RESULTS Mean age of the patients was 77±9 years (54% women). Procedural success was 80.7%, and 9 patients (3%) died during the hospitalization. At a median follow-up of 6 (interquartile range, 2-12) months, 54 patients (18%) died, and the independent associated factors were higher gamma-glutamyl transferase values at baseline (hazard ratio, 1.02 for each increase of 10 u/L [95% CI, 1.002-1.04]), poorer renal function defined as an estimated glomerular filtration rate <45 mL/min (hazard ratio, 2.3 [95% CI, 1.22-4.33]), and the lack of procedural success (hazard ratio, 2.11 [95% CI, 1.17-3.81]). The grade of RVD and the amount of PH at baseline were not found to be predictors of mortality. Most patients alive at follow-up improved their functional class (New York Heart Association I-II in 66% versus 7% at baseline, P<0.001). CONCLUSIONS In patients with severe tricuspid regurgitation and RVD/PH, transcatheter tricuspid valve intervention was associated with high procedural success and a relatively low in-hospital mortality, along with significant improvements in functional status. However, about 1 out of 5 patients died after a median follow-up of 6 months, with hepatic congestion, renal dysfunction, and the lack of procedural success determining an increased risk. These results may improve the clinical evaluation of transcatheter tricuspid valve intervention candidates and would suggest a closer follow-up in those at increased risk. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03416166.
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Affiliation(s)
- Guillem Muntané-Carol
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Maurizio Taramasso
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Mizuki Miura
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Mara Gavazzoni
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Alberto Pozzoli
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Hannes Alessandrini
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Azeem Latib
- Cardiology Department, Montefiore Medical Center, New York, NY (A. Latib, E.H.)
| | | | - Luigi Biasco
- Cardiology Department, Cardiocentro, Lugano, Switzerland (L.B., G.P.)
| | - Daniel Braun
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Eric Brochet
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Kim A Connelly
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Sabine de Bruijn
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany (S.d.B., H.S.)
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy (P.D.)
| | - Florian Deuschl
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Edith Lubos
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Sebastian Ludwig
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Daniel Kalbacher
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Rodrigo Estevez-Loureiro
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain (R.E.-L., V.M.)
| | - Neil Fam
- Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Christian Frerker
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Edwin Ho
- Cardiology Department, Montefiore Medical Center, New York, NY (A. Latib, E.H.).,Cardiology Department, Toronto Heart Center, St. Michael's Hospital, Canada (K.A.C., N.F., E.H.)
| | - Jean-Michel Juliard
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Ryan Kaple
- Cardiology Department, Westchester Medical Center, Valhalla, NY (R.K.)
| | - Susheel Kodali
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Felix Kreidel
- Cardiology Department, Department of Cardiology, University Medical Center Mainz, Germany (F.K., R.S.V.B.)
| | - Claudia Harr
- Cardiology Department, Asklepios Klinik St. Georg, Hamburg, Germany (H.A., C.F., C.H.)
| | - Alexander Lauten
- Cardiology Department, Charité University Hospital, Berlin, Germany (A. Lauten)
| | - Julia Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Vanessa Monivas
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain (R.E.-L., V.M.)
| | - Michael Mehr
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Tamin Nazif
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Georg Nickening
- Cardiology Department, Universitatsklinikum Bonn, Germany (G.N., M. Weber)
| | | | - François Philippon
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Fabien Praz
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Rishi Puri
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
| | - Ulrich Schäfer
- Cardiology Department, University Heart and Vascular Center Hamburg, Germany (F.D., E.L., S.L., D.K., U.S.)
| | - Joachim Schofer
- Cardiology Department, Albertinen Heart Center, Hamburg, Germany (J.S.)
| | - Horst Sievert
- Cardiology Department, CardioVascular Center Frankfurt, Frankfurt am Main, Germany (S.d.B., H.S.)
| | - Gilbert H L Tang
- Cardiac Surgery Department, Mount Sinai Hospital, New York, NY (G.H.L.T.)
| | - Ahmed A Khattab
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.).,Cardiology Department (A.A.K.), University of Bern, Switzerland.,Cardiology Department, Cardiance Clinic, Pfäffikon, Switzerland (A.A.K.)
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna (M.A., M.R.)
| | - Marco Russo
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna (M.A., M.R.)
| | - Holger Thiele
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Matthias Unterhuber
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Dominique Himbert
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | - Marina Urena
- Cardiology Department, Hôpital Bichat, Université Paris VI, Paris, France (E.B., J.-M.J., D.H., M.U.)
| | | | - John G Webb
- Cardiology Department, St. Paul Hospital, Vancouver, Canada (A.A.-T., J.G.W.)
| | - Marcel Weber
- Cardiology Department, Universitatsklinikum Bonn, Germany (G.N., M. Weber)
| | - Stephan Windecker
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Mirjam Winkel
- Cardiology Department, Inselspital, Bern University Hospital (F. Praz, S.W., M. Winkel), University of Bern, Switzerland
| | - Michel Zuber
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Jörg Hausleiter
- Cardiology Department, Klinikum der Universität München, Germany (D.B., M. Mehr, J.H.)
| | - Philipp Lurz
- Cardiology Department, Heart Center Leipzig, University Hospital Leipzig, Germany (J.L., H.T., M.U., P.L.)
| | - Francesco Maisano
- Cardiology Department, University Hospital of Zurich, University of Zurich, Switzerland (M.T., M. Miura, M.G., A.P., A.A.K., M.Z., F.M.)
| | - Martin B Leon
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Rebecca T Hahn
- Cardiology Department, New York-Presbyterian/Columbia University Medical Center, New York, NY (S.K., T.N., M.B.N., R.T.H.)
| | - Josep Rodés-Cabau
- Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (G.M.-C., F. Philippon, R.P., J.R.-C.)
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48
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Garzoli G, Biasco L, Radovanovic D, Moccetti M, Rickli H, Roffi M, Eberli F, Jeger R, Moccetti T, Witassek F, Erne P, Pedrazzini G. Cocaine consumption and acute coronary syndromes: a cross sectional study from the Swiss registry AMIS Plus. CVM 2021. [DOI: 10.4414/cvm.2021.w10044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION
Cocaine abuse is a relevant public health issue which causes medical, psychological and social drawbacks. Only limited data are currently available on outcomes of acute coronary syndromes (ACS) in cocaine-addicted patients. The aim of this study was to evaluate the cardiovascular impact of cocaine in a population of patients enrolled in the Swiss nationwide AMIS Plus registry, with a focus on in-hospital outcomes.
METHODS
We retrospectively analysed data of patients enrolled in the Swiss AMIS Plus registry from 1 January 2007 to 31 December 2018. Baseline and in-hospital data of ACS patients with self-reported regular cocaine abuse were compared with the remaining AMIS Plus population and a sex and age-matched group of non-cocaine user ACS patients (ratio 1:5, 540 patients). Primary endpoints were in-hospital death and major adverse cardiac and cardiovascular events (MACCEs).
RESULTS
A total of 20,036 patients were included in the AMIS Plus registry for ACS in the study period, of whom 110 (0.5%) reported regular cocaine abuse. As compared with the remaining AMIS population, cocaine users were significantly younger (46.4 ± 10.8 vs 66.4 ± 13.2 years, p <0.001), presented more frequently with out-of-hospital cardiac arrest (11.8% vs 4.7%, p <0.001) and ST-elevation myocardial infarction (68.2% vs 54.7%, p = 0.007). Of the traditional cardiovascular risk factors, there was a higher incidence of positive family history and active smoking, but a lower incidence of arterial hypertension, diabetes and obesity. In-hospital mortality (3.6% vs 4.4%, p = 1) and MACCEs (5.4% vs 5.5%, p = 0.83) were comparable. When compared with an age-matched non-cocaine user ACS population, cocaine users were more frequently smokers (87.6% vs 63.6%, p <0.001) but less frequently obese (10.4% vs 25.6%, p = 0.001). Clinical presentation was comparable between the two groups. However, cocaine abuse was associated with a higher incidence of in-hospital death (3.7% vs 0.7%, p <0.05) and MACCEs (5.6% vs 1.3%, p <0.05).
CONCLUSION
Cocaine abuse increases the risk of mortality by a factor of 5 and the risk of major adverse cardiac and cardiovascular events by a factor of 4 as compared with a sex and age-matched population hospitalised after an acute coronary syndrome.
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49
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Bocchino PP, Angelini F, Alushi B, Conrotto F, Cioffi GM, Tersalvi G, Senatore G, Pedrazzini G, De Ferrari GM, Biasco L. Transcatheter Aortic Valve Replacement in Young Low-Risk Patients With Severe Aortic Stenosis: A Review. Front Cardiovasc Med 2021; 7:608158. [PMID: 33381528 PMCID: PMC7767870 DOI: 10.3389/fcvm.2020.608158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/19/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
In the last decades, transcatheter aortic valve replacement (TAVR) revolutionized the treatment of symptomatic severe aortic stenosis. The efficacy and safety of TAVR were first proven in inoperable and high-risk patients. Then, subsequent randomized clinical trials showed non-inferiority of TAVR as compared to surgical aortic valve replacement also in intermediate- and low-risk populations. As TAVR was progressively studied and clinically used in lower-risk patients, issues were raised questioning its opportunity in a younger population with a longer life-expectancy. As long-term follow-up data mainly derive from old studies with early generation devices on high or intermediate surgical risk patients, results can hardly be extended to most of currently treated patients who often show a low surgical risk and are treated with newer generation prostheses. Thus, in this low-risk younger population, decision making is difficult due to the lack of supporting data. The aim of the present review is to revise current literature regarding TAVR in younger patients.
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Affiliation(s)
- Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Brunilda Alushi
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Erfurt, Germany.,Department of Cardiology, Campus Benjamin Franklin, Charite' Medical University Berlin, Berlin, Germany
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Giacomo Maria Cioffi
- Department of Cardiology, Kantonsspital Luzern, Lucerne, Switzerland.,Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Gregorio Tersalvi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Gaetano Senatore
- Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy
| | - Giovanni Pedrazzini
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Luigi Biasco
- Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
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50
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Tersalvi G, Winterton D, Cioffi GM, Ghidini S, Roberto M, Biasco L, Pedrazzini G, Dauw J, Ameri P, Vicenzi M. Telemedicine in Heart Failure During COVID-19: A Step Into the Future. Front Cardiovasc Med 2020; 7:612818. [PMID: 33363223 PMCID: PMC7755592 DOI: 10.3389/fcvm.2020.612818] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 09/30/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023] Open
Abstract
During the Coronavirus Disease 2019 worldwide pandemic, patients with heart failure are a high-risk group with potential higher mortality if infected. Although lockdown represents a solution to prevent viral spreading, it endangers regular follow-up visits and precludes direct medical assessment in order to detect heart failure progression and optimize treatment. Furthermore, lifestyle changes during quarantine may trigger heart failure decompensations. During the pandemic, a paradoxical reduction of heart failure hospitalization rates was observed, supposedly caused by patient reluctance to visit emergency departments and hospitals. This may result in an increased patient mortality and/or in more complicated heart failure admissions in the future. In this scenario, different telemedicine strategies can be implemented to ensure continuity of care to patients with heart failure. Patients at home can be monitored through dedicated apps, telephone calls, or devices. Virtual visits and forward triage screen the patients with signs or symptoms of decompensated heart failure. In-hospital care may benefit from remote communication platforms. After discharge, patients may undergo remote follow-up or telerehabilitation to prevent early readmissions. This review provides a comprehensive appraisal of the many possible applications of telemedicine for patients with heart failure during Coronavirus disease 2019 and elucidates practical limitations and challenges regarding specific telemedicine modalities.
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Affiliation(s)
- Gregorio Tersalvi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Internal Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Dario Winterton
- Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Giacomo Maria Cioffi
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Cardiology, Kantonsspital Luzern, Lucerne, Switzerland
| | - Simone Ghidini
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Roberto
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Luigi Biasco
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, Ospedale di Ciriè, Ciriè, Italy.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Giovanni Pedrazzini
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Pietro Ameri
- Cardiovascular Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Marco Vicenzi
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Cardiovascular Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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