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Masè M, Rossi M, Setti M, Barbati G, Teso MV, Ribichini FL, Koni M, Stolfo D, Merlo M, Sinagra G. Applicability and performance of heart failure prognostic scores in dilated cardiomyopathy: the real-world experience of an Italian referral center for cardiomyopathies. Int J Cardiol 2024; 396:131562. [PMID: 37907097 DOI: 10.1016/j.ijcard.2023.131562] [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: 07/18/2023] [Revised: 09/26/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND The performance of heart failure (HF) risk models is validated in the general population with HF but in specific aetiological settings, and specifically in dilated cardiomyopathy (DCM), has scarcely been explored. We tested eight of the main prognostic scores used in HF in a large real-world population of patients with DCM. METHODS We included 784 consecutive DCM patients enrolled, both inpatients and outpatients, enrolled between January 2000 and December 2017. The risk of 1 and/or 3-year all-cause mortality/heart transplantation/durable left ventricular assist device (LVAD) implantation (D/HTx/LVAD) was estimated in our cohort according to the following risk scores SHFM, 3-CHF, CHARM, MAGGIC, GISSI-HF, MECKI, Barcelona Bio-HF, Krakow score and their accuracy calculated through the receiver operator characteristic (ROC) curve analysis. RESULTS During a median follow-up of 5.8 years (Interquartile Range 3.2-7.6 years), 191 patients (20%) died or underwent HTx/LVAD (158 deaths, 30 heart transplantations, and 3 LVAD implantations). The high missing rate allowed to calculated only four prognostic models (MAGGIC, CHARM, 3-CHF and SHFM). All the scores overestimated the rate of D/HTx/LVAD. The prognostic accuracy was suboptimal for MAGGIC (AUC 0.754) and CHARM (AUC 0.720) scores and only modest for 3-CHF (AUC 0.677) and SHFM (AUC 0.667). CONCLUSIONS Main prognostic scores for the risk stratification of HF are only partially applicable to real-world patients with DCM. MAGGIC and CHARM scores showed the best accuracy, despite the overestimation of risk. Our findings corroborate the need of specific risk scores for the prognostic stratification of DCM. CLINICAL PERSPECTIVE What is new? The present study is the largest analysis in literature which investigate how the main existing heart failure prognostic risk scores performed in a real-world of dilated cardiomyopathy population, both in- and outpatients. What are the clinical implications? DCM is a stand-alone model of heart failure, where the performance of multiple heart failure prognostic scores for the risk stratification is quite limited. The need for contemporary, dedicated prognostic scores in this disease is increasingly evident.
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Affiliation(s)
- M Masè
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - M Rossi
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - M Setti
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy; Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - G Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | | | - F L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - M Koni
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - D Stolfo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - M Merlo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy.
| | - G Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
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Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Porcari A, Pagura L, Canepa M, Biagini E, Cappelli F, Tini G, Dore F, Longhi S, Sciagra' R, Fontana M, Gillmore J, Rapezzi C, Merlo M, Sinagra G. Prognostic implications of biventricular uptake of bone tracers at planar scintigraphy in transthyretin cardiac amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1770] [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
The prognostic role of bone tracer uptake in transthyretin cardiac amyloidosis (ATTR-CA) is controversial. A further characterization of cardiac retention measured by Perugini scale with differentiation between biventricular (BiV) and isolated left ventricle (LV) uptake has never been attempted previously.
Purpose
The study investigated the potential prognostic significance of BiV uptake in ATTR-CA.
Methods
In this multicentre, observational study, we analysed data of ATTR-CA patients who underwent bone tracer scintigraphy with acquisition of both planar and single photon emission computed tomography (SPECT) imaging. Cardiac uptake was defined according to the Perugini visual scale. Planar BiV uptake was defined according to right ventricle (RV) uptake: 0= absent, 1= < bone, 2= equal to bone, and 3= > bone and confirmed by SPECT imaging. The primary outcome was a composite of cardiac death or hospitalization for heart failure. The secondary outcome was all-cause mortality.
Results
All 124 ATTR-CA patients enrolled had LV and RV free wall uptake on SPECT images. Of them, 93 (75%) had BiV uptake visible on planar scintigraphy. BiV uptake was found in 14%, 70%, and 92% of Perugini grade 1, 2 and 3 respectively. Compared to those with isolated LV uptake, patients with BiV uptake were older (81 vs 77 years, p=0.006) and more frequently in NYHA≥3 (32% vs 10%, p=0.018). During a median follow-up of 21 months, BiV uptake was associated with a greater occurrence of the primary outcome compared to isolated LV uptake (40% vs 19%, p=0.021), whereas the Perugini scale was not (p=0.2) (Figure 1). At multivariable analysis, NYHA class ≥3 (hazard ratio [HR] 8.1, p=0.007), eGFR <60 ml/min (HR 2.1, p=0.025) and higher degree of RV uptake (HR 1.69, p=0.007) emerged as independent prognostic parameters. In an external cohort of 463 ATTR-CA patients with a median follow-up of 30 months, planar BiV uptake was independently associated with all-cause mortality, with an incremental risk in higher grades of RV uptake (p<0.001) (Figure 1).
Conclusions
The presence of BiV uptake at planar scintigraphy identified ATTR-CA patients with worse cardiovascular and global outcomes (Figure 2), potentially serving as a novel prognostic marker.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - L Pagura
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - M Canepa
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - E Biagini
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit , Bologna , Italy
| | - F Cappelli
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - G Tini
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - F Dore
- Giuliano Isontina University Health Authority, Department of Nuclear Medicine , Trieste , Italy
| | - S Longhi
- University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit , Bologna , Italy
| | - R Sciagra'
- Careggi University Hospital, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio” , Florence , Italy
| | - M Fontana
- Royal Free London NHS Foundation Trust, National Amyloidosis Centre, Division of Medicine , London , United Kingdom
| | - J Gillmore
- Royal Free London NHS Foundation Trust, National Amyloidosis Centre, Division of Medicine , London , United Kingdom
| | - C Rapezzi
- University Hospital of Ferrara, Cardiothoracic Department , Ferrara , Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
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4
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Paldino A, Dal Ferro M, Stolfo D, Gandin I, Graw S, Gigli M, Medo K, Gagno G, Zaffalon D, Castrichini M, Mase' M, Merlo M, Taylor M, Mestroni L, Sinagra G. Prognostic prediction of genotype versus phenotype in genetic cardiomyopathies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In cardiomyopathies (CMPs), the diverse genetic background often leads to phenotypic heterogeneity. Currently, genotype-phenotype studies are founded on clinical phenotype-based classification of CMPs, contributing possible biases due to the exclusion of specific and unascertained phenotypic expressions of CMP genes.
Purpose
We sought to define differences in outcome when stratifying patients based on phenotype at presentation compared with genotype in a large cohort of CMP patients with positive genetic testing.
Methods
In this study, we included the whole spectrum of non-hypertrophic CMP phenotypes, genetically determined: dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), left ventricular arrhythmogenic cardiomyopathy (ALVC) and biventricular ARVC (BiV). The primary and secondary outcomes were: 1) all-cause mortality/heart transplant (D/HT); 2) heart failure-related death/heart transplant/left ventricular assist device implantation (DHF/HT/VAD); and 3) sudden cardiac death/life-threatening ventricular arrhythmias (SCD/MVA).
Results
Two hundred and eighty-one patients (80% DCM) carrying pathogenic or likely pathogenic variants were included in this study. The phenotype was classified as DCM, ARVC, ALVC and BiV according to current consensus criteria. The median follow-up was 188 months. Variants in titin (TTN; 34%) and sarcomeric genes (SARC; 22%) were the most frequent genotypes and almost invariably associated with a DCM phenotype. DSP, LMNA and FLNC displayed more heterogeneous phenotypic presentations, including DCM, ARVC, ALVC, BiV. At survival analysis, the arrhythmic outcome occurred more frequently in patients without a DCM phenotype and in carriers of DSP, PKP2, LMNA and FLNC variants. However, after adjustment for age and sex, the genotype-based classification but not the phenotype-based classification was predictive of the arrhythmic outcome. LMNA showed the worst trend in term of D/HT and DHF/HT/LVAD.
Conclusions
In genetic cardiomyopathies, genotype is associated with significant phenotypic heterogeneity. Nevertheless, in our study, the genotypic-based classification showed higher precision in predicting CMP patients' outcome in respect to the phenotype-based classification. These findings add to the current understanding of inherited CMPs and may implement the risk stratification of patients with positive genetic testing.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Paldino
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Dal Ferro
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - D Stolfo
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - I Gandin
- University of Trieste, Biostatistics Unit , Trieste , Italy
| | - S Graw
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - M Gigli
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - K Medo
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - G Gagno
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - D Zaffalon
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Castrichini
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Mase'
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Merlo
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Taylor
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - L Mestroni
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - G Sinagra
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
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5
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Lalario A, Del Mestre E, Lo Casto M, Nuzzi V, Manca P, Bromage D, Barbati G, Merlo M, Sinagra G, Cannata A. Natural history and clinical parameters of chemotherapy-induced dilated cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1742] [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
Chemotherapy-induced dilated cardiomyopathy (CI-DCM) is a well-recognized phenotype of non-ischemic dilated cardiomyopathy (DCM), characterized by poor outcomes. However, a detailed comparison between idiopathic DCM (iDCM) and CI-DCM is still lacking.
Methods
All consecutive DCM patients enrolled in the Trieste Muscle Heart Disease Registry were analyzed. CI-DCM and iDCM were defined according to current recommendations. The primary study outcome measure was all-mortality death and secondary outcomes were a) a composite of cardiovascular death/heart-transplantation/ventricular-assist-device implantation, and b) major ventricular arrhythmias.
Results
The study included 551 patients (499 iDCM and 52 CI-DCM). At enrolment, compared to iDCM, CI-DCM patients were older (51±14 years vs 58±3 years respectively, p<0.001) and had a higher left ventricular ejection fraction (35%±10 vs 32%±9, p=0.03). Over a median follow-up of 90 months (IQR 54–140 months), CI-DCM patients had a higher incidence of all-cause mortality compared to iDCM (36.5% vs 8.4% in CI-DCM and iDCM respectively, p<0.001), while the incidence of major ventricular arrhythmias was higher in the iDCM group compared to CI-DCM (4% vs 0%, in CI-DCM and iDCM respectively, p=0.03). The risk of the composite outcome was comparable between the two groups (p=0.91). At Cox multivariable analysis, the diagnosis of CI-DCM emerged as independently associated to primary outcome (HR 6.42, 95% CI 2.52–16.31, p<0.001).
Conclusions
In a well-selected DCM cohort, patients with a chemotherapy-induced aetiology had a higher incidence of all-cause mortality compared to iDCM. Conversely, the incidence of life-threatening ventricular arrhythmic events was higher among patients with iDCM.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Lalario
- University of Trieste , Trieste , Italy
| | | | | | - V Nuzzi
- University of Trieste , Trieste , Italy
| | - P Manca
- University of Trieste , Trieste , Italy
| | - D Bromage
- University of Trieste , Trieste , Italy
| | - G Barbati
- University of Trieste , Trieste , Italy
| | - M Merlo
- University of Trieste , Trieste , Italy
| | - G Sinagra
- University of Trieste , Trieste , Italy
| | - A Cannata
- King's College London , London , United Kingdom
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6
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Bessi R, Dal Ferro M, Gregorio C, Paldino A, De Angelis G, De Bellis A, Mase M, Zaffalon D, Gigli M, Stolfo D, Merlo M, Zecchin M, Sinagra G. Cardiac resynchronization therapy: association between genetically determinated dilated cardiomyopathy and dissinchronopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.828] [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
Patients with non-ischemic dilated cardiomyopathy (DCM) and left bundle branch block (LBBB) often undergoes cardiac resynchronization therapy (CRT). Despite CRT only a small group of patients restore normal left ventricular geometry and function. Many predictors of response to CRT have been described, but there are still insufficient data on the role of genetic mutations in sarcomere, cytoskeletal or desmosomal genes.
Purpose
To asses the role of genetic background as predictor of response after CRT in patient DCM and LBBB.
Methods
We retrospectively analyzed DCM patients with successful CRT implantation and available genetic testing consecutively included in the CRT-Registry of our Institution. DCM was defined by the presence of left ventricular or biventricular dilatation and systolic dysfunction in the absence of abnormal loading conditions or coronary artery disease sufficient to cause global systolic impairment. Changes in main echocardiographic parameters: left ventricular ejection fraction (LVEF), LV End Systolic and End Diastolic Volume (LVESV and LVEDV), where compared between basal and 24–48 months of follow up. LV remodeling was defined by relative changes (Δ) in LV End Systolic Volume (LVESV) [(follow-up LVESV − PRE LVESV) / PRE LVESV × 100)]. Patients were considered super-responders (SR) if LVEF at 24–48 months was>50%.
Genetic testing was done by Next Generation DNA and all variants were validated with bidirectional Sanger sequencing. Variants of uncertain significance (VUS) were excluded from the analysis. Patients being carrier of pathogenic (P) or likely pathogenic (LP) variants were considered affected by genetic DCM (GEN+ DCM). Patients non carrier of P/LP variants and with no evidence of familial disease were considered affected by non-genetically determined DCM (GEN− DCM).
Results
73 patients met the inclusion criteria, 23 patients were GEN+ DCM, the remaining 50 patients had negative genetic test and no family history of DCM. Baseline characteristics were similar between groups. GEN− group was characterized by a greater improvement in LVEF (39±12 vs 29±12, p=0,006) and a greater relative reduction in LVESV (ΔLVESV 43% vs 18%, p=0,007). GEN− patients had a 33 ml higher mean LVESV reduction at 24–48 months after CRT, indipendently of their respective baseline values. 20 patients (27% of the total population) suffered of heart failure related death, heart transplantation or left ventricular assistance device implantation during follow up and the prevalence was significantly higher in GEN+ group (43% vs 20%, p=0,037). Coherently, patients in the GEN+ group showed a lower prevalence of super responders (4%, vs 24%, p=0,02) after CRT.
Conclusions
Non-genetically determined DCM DCM is associated with a better clinical and instrumental response to CRT and a higher probability of being super responders. Furthermore, our data support the hypothesis about dyssyncronopathy as a specific clinical entity inside DCM diseases.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Bessi
- Cattinara Hospital , Trieste , Italy
| | | | | | - A Paldino
- Cattinara Hospital , Trieste , Italy
| | | | | | - M Mase
- Cattinara Hospital , Trieste , Italy
| | | | - M Gigli
- Cattinara Hospital , Trieste , Italy
| | - D Stolfo
- Cattinara Hospital , Trieste , Italy
| | - M Merlo
- Cattinara Hospital , Trieste , Italy
| | - M Zecchin
- Cattinara Hospital , Trieste , Italy
| | - G Sinagra
- Cattinara Hospital , Trieste , Italy
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7
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Tomasoni D, Aimo A, Merlo M, Nardi M, Adamo M, Cani D, Lombardi CM, Pancaldi E, Panichella G, Porcari A, Vergaro G, Sinagra G, Rapezzi C, Emdin M, Metra M. Value of the HFA-PEFF and H2FPEF scores in patients with heart failure and preserved ejection fraction caused by cardiac amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The HFA-PEFF and H2FPEF scores have been developed to diagnose heart failure with preserved ejection fraction (HFpEF), and hold prognostic value. Their use in patients with HFpEF caused by cardiac amyloidosis (CA) has never been investigated.
Methods and results
We evaluated the diagnostic and prognostic value of the HFA-PEFF and H2FPEF scores in 304 patients from 3 cohorts with HFpEF caused by transthyretin (ATTR)-CA (n=160, 53%) or immunoglobulin light-chain (AL)-CA (n=144, 47%). A diagnosis of HFpEF was more likely using the HFA-PEFF score with 2 (1%), 71 (23%), and 231 (76%) patients ranked as having a low (0–1), intermediate (2–4) or high (5–6) probability of HFpEF, respectively. Conversely, 36 (12%), 179 (59%) and 89 (29%) of patients ranked as having a low (0–1), intermediate (2–5) or high (6–9) probability of HFpEF using the H2FPEF score. During a median follow-up of 19 months (interquartile range 8–40), 132 (43%) patients died. The HFA-PEFF score, but not the H2FPEF, predicted a high risk of all-cause death which remained significant after adjustment for age, AL-CA diagnosis, high-sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, and echocardiographic parameters, including left ventricular (LV) global longitudinal strain, LV diastolic function and right ventricular function (hazard ratio 1.51, 95% confidence interval 1.16–1.95, p=0.002 for every 1-point increase in HFA-PEFF).
Conclusions
The HFA-PEFF score has a high sensitivity to diagnose HFpEF caused by CA and holds independent prognostic value for all-cause mortality, while the H2FPEF score does not.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - A Aimo
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - M Merlo
- Giuliano Isontina University Health Authority , Trieste , Italy
| | - M Nardi
- University of Brescia , Brescia , Italy
| | - M Adamo
- University of Brescia , Brescia , Italy
| | - D Cani
- University of Brescia , Brescia , Italy
| | | | | | - G Panichella
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - A Porcari
- Giuliano Isontina University Health Authority , Trieste , Italy
| | - G Vergaro
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority , Trieste , Italy
| | - C Rapezzi
- Ferrara University Hospital , Ferrara , Italy
| | - M Emdin
- Sant'Anna School of Advanced Studies , Pisa , Italy
| | - M Metra
- University of Brescia , Brescia , Italy
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8
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Sadler M, Cannata A, Baggio CHIARA, Monzo L, Scott P, Piper S, Sinagra G, McDonagh T, Merlo M, Bromage D. Prognostic implication of neutrophil-lymphocyte ratio (NLR) in myocarditis: results from a multicentre, multinational study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1700] [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
Neutrophil–lymphocyte ratio (NLR) is an accessible inflammatory biomarker. Recently, baseline NLR has been shown to be independently associated with incident cardiovascular (CV) events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated. The aim of the present study was to investigate the prognostic value of NLR in patients with AM.
Methods
All consecutive patients with a diagnosis of AM admitted to three tertiary referral cardiac centres in two countries between October 2006 and June 2020 were included in the study. Diagnosis was confirmed by either cardiac magnetic resonance or endomyocardial biopsy. The outcome measure was all-cause mortality. Patients were divided into two groups according to NLR value defined in previous studies (i.e., 2.5).
Results
A total of 287 patients with AM were included in the study. Baseline characteristics were comparable in both groups. Approximately two thirds of patients were males (n=194, 68%) with a mean age of 39±16 years. The main clinical presentation was predominantly infarct-like (n=215, 75%), followed by heart failure (HF) (n=46, 16%) and arrhythmic (n=26, 9%). Patients admitted with a HF presentation were more prevalent in the group with elevated NLR, while no difference was found in the other clinical presentations. For all patients, ECG features were comparable between groups. However, patients with elevated NLR presented with slightly higher LVEF (55±11% vs 50±13% respectively, p=0.003). Over a median follow-up of 54 months, higher NLR was associated with worse prognosis (Figure 1, p=0.02). Patients with high NLR have a 7-fold higher risk of adverse events during follow-up (Hazard Ratio 7.83, 95% confidence interval 1.02–59.89, p=0.047).
Conclusions
NLR is a promising and accessible inflammatory biomarker. In patients with AM, elevated NLR is associated with worse prognosis. Further research is advocated to confirm these data in larger populations.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Sadler
- King's College London , London , United Kingdom
| | - A Cannata
- King's College London , London , United Kingdom
| | | | - L Monzo
- Polyclinic Casilino , Rome , Italy
| | - P Scott
- King's College London , London , United Kingdom
| | - S Piper
- King's College London , London , United Kingdom
| | - G Sinagra
- Integrated University Health Authority of Trieste , Trieste , Italy
| | - T McDonagh
- King's College London , London , United Kingdom
| | - M Merlo
- Integrated University Health Authority of Trieste , Trieste , Italy
| | - D Bromage
- King's College London , London , United Kingdom
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9
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Porcari A, Rossi M, Cappelli F, Canepa M, Musumeci B, Cipriani A, Tini G, Varra' GG, Argiro' A, Sessarego E, Sinigiani G, Di Bella G, Rapezzi C, Sinagra G, Merlo M. Incidence and risk factors for pacemaker implantation in light chain and transthyretin cardiac amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The incidence and risk factors of pacemaker (PM) implantation in patients with cardiac amyloidosis (CA) are largely unexplored.
Purpose
We sought to characterise the trends in the incidence of permanent PM and to identify baseline predictors of future PM implantation in light chain (AL) and transthyretin (ATTR) CA.
Methods
Multicentre, retrospective, observational study. Consecutive patients with AL and ATTR-CA diagnosed or referred at participating Centres between 2017 and 2020 were included. Clinical data recorded within ± 1 month from baseline evaluation were collected from electronic medical records. The primary outcome of the study was the need for clinically-indicated PM implantation. Reversible causes of conduction system disease were systematically ruled out before PM implantation. Patients with PM (n=41) and/or permanent defibrillator in situ (n=13) at the time of CA diagnosis were excluded.
Results
The study population consisted of 405 patients: 29.4% AL, 14.6% variant ATTR and 56% wild-type ATTR; 82.5% were males, with median age 76 years. During a median follow-up of 33 months (interquartile range 21–46), 36 (8.9%) patients experienced the primary outcome: 10 patients with AL-CA, 2 with variant ATTR-CA and 24 with wild-type ATTR-CA (p=0.08). At multivariable analysis, history of atrial fibrillation (hazard ratio [HR] 3.80, p=0.002), PR interval (HR 1.013, p=0.002) and QRS >120 ms (HR 4.7, p=0.001) on baseline ECG were independently associated with PM implantation (Figure 1). In the individual patient, the contemporary presence of these 3 factors yielded the highest risk of PM implantation (HR 6.26, p=0.003).
Conclusion
In a large cohort of AL and ATTR-CA, the incidence of PM implantation was high accounting for ≈9% of patients in the 3 years following the diagnosis. History of atrial fibrillation, longer PR interval and QRS >120 ms identified CA patients at high-risk of future PM implantation (Figure 2).
CA patients with these features might need close monitoring during follow-up for the development of conduction system disease requiring PM implantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - M Rossi
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - F Cappelli
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - M Canepa
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - B Musumeci
- Sapienza University of Rome, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology , Rome , Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health , Padua , Italy
| | - G Tini
- Sapienza University of Rome, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology , Rome , Italy
| | - G G Varra'
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - A Argiro'
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - E Sessarego
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - G Sinigiani
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health , Padua , Italy
| | - G Di Bella
- University of Messina, Department of Cardiology , Messina , Italy
| | - C Rapezzi
- University of Ferrara, Cardiothoracic Department , Ferrara , Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
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10
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Wang M, Liu D, Nguyen T, McNamara D, Barlera S, Pileggi S, Mestroni L, Merlo M, Sinagra G, Pinet F, Krejci J, Kilianova A, De Groote P, Weishilboum R, Pereira N. NAV3 is a genetic determinant of myocardial recovery in dilated cardiomyopathy and attenuates cardiac fibrosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A genome-wide association study (GWAS) assessing change in left ventricular ejection fraction (LVEF) in dilated cardiomyopathy (DCM), a surrogate marker of morbidity and mortality in heart failure (HF), had not been performed previously and could provide insight into novel biological pathways that could lead to the development of new drugs that might target myocardial recovery. The presence and extent of cardiac fibrosis in DCM is independently associated with myocardial recovery and cardiovascular mortality.
Purpose
To identify the biological relevance of genetic targets that are associated with change in LVEF in patients with DCM.
Methods
A GWAS was performed using DNA from 686 patients with recent onset DCM who were on standard HF therapy using change in LVEF at a median of 6 months after initial diagnosis. Cultured human cardiac fibroblasts (HCFs) were used as an in vitro model to study the functional and biological relevance of the gene target identified in the GWAS. Specifically, HCFs were transfected with siRNA by using the Lipofectamine™ RNAiMAX Transfection Reagent for gene knockdown (KD). RNA-seq was performed using the Illumina TruSeq protocol with expression analysis conducted with the EdgeR package. Ingenuity Pathway Analysis was used.
Results
A single-nucleotide polymorphism, rs11105445(G>A), mapping to the neuron navigator 3 (NAV3) gene (rs11105445, p=2.37E-07; beta 2.74±0.53) was associated with improvement in LVEF. We performed a phenome-wide association study using data from the UK Biobank and demonstrated that genetic variation in NAV3 was significantly associated with HF mortality (p=3.2E-28), highlighting the potential importance of this gene in HF. Using GTEx data we demonstrated that in LV tissue the minor allele A was associated with ↓NAV3 expression (p=0.03) suggesting that ↓NAV3 expression might be associated with improvement in LVEF. We demonstrated that NAV3 KD significantly ↓TGF-β1 mediated HCF transdifferentiation into myofibroblasts, ↓α-smooth muscle actin (ACTA2) and ↓collagen I (COL1A1), therefore NAV3 KD was anti-fibrotic (see Figure 1), 1a. HCFs treated by vehicle/TGF-β1 after KD of NAV3/ctrl, and ACTA2 and COL1A1 were analyzed by qPCR; 1b. Representative immunofluorescence staining for α-SMA (in green), RNA-seq after NAV3 KD followed by pathway analysis suggested that NAV3 exerted its effect by regulating cell cycle related proteins (Figure 2), 2a. Volcano plot shows significant differentially expressed genes identified by RNA-seq analysis (down-regulated in blue, up-regulated in red); 2b. NAV3 KD significantly increased expression of cell cycle related proteins, which was validated by Western blot.
Conclusions
Decreased expression of NAV3 is associated with myocardial recovery in DCM, most likely due to its anti-fibrotic effect via direct regulation of cell cycle proteins. The role of NAV3 as a novel therapeutic target in DCM needs to be explored.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Mayo Clinic Center for Individualized MedicineMayo Clinic Department of Cardiovascular Medicine
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Affiliation(s)
- M Wang
- Mayo Clinic , Rochester , United States of America
| | - D Liu
- Mayo Clinic , Rochester , United States of America
| | - T Nguyen
- Mayo Clinic , Rochester , United States of America
| | - D McNamara
- University of Pittsburgh Medical Centre , Pittsburgh , United States of America
| | - S Barlera
- The Mario Negri Institute for Pharmacological Research , Milan , Italy
| | - S Pileggi
- The Mario Negri Institute for Pharmacological Research , Milan , Italy
| | - L Mestroni
- University of Colorado , Denver , United States of America
| | - M Merlo
- Milan Polytechnic , Milan , Italy
| | - G Sinagra
- University of Trieste , Trieste , Italy
| | - F Pinet
- Institut Pasteur , Paris , France
| | - J Krejci
- Institut Pasteur , Paris , France
| | | | | | | | - N Pereira
- Mayo Clinic , Rochester , United States of America
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11
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Cannie D, Protonotarios A, Syrris P, Sengupta A, Bilinska Z, Arana Achaga X, Barriales-Villa R, Garcia-Pavia P, Gimeno J, Merlo M, Wahbi K, Fatkin D, Mogensen J, Rasmussen TB, Elliott P. Influence of sex on cardiovascular outcomes in RBM20 variant carriers. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Variants in the RBM20 gene cause dilated cardiomyopathy and may be associated with a poor prognosis.
Objectives
To determine disease penetrance, the risk of adverse events and the influence of sex on outcomes in RBM20 variant carriers.
Methods
Consecutive probands and relatives carrying pathogenic or likely pathogenic RBM20 variants were retrospectively recruited from 12 cardiomyopathy units. The primary endpoint was a composite of malignant ventricular arrhythmia (MVA) and end-stage heart failure (ESHF). MVA and ESHF endpoints were also analysed separately and males and females compared.
Results
Longitudinal follow-up data were available for 163 RBM20 variant carriers (82 male, median age 36.5 years, median follow-up 77.6 months). 10/163 had an MVA event at baseline. 30/153 without baseline MVA (19.6%) reached the primary endpoint with a trend towards worse outcomes in males (p=0.08). 16/153 (10.5%) had new MVA with no difference between males and females (p=0.92). 20/163 (12.2%) developed ESHF (17 males and 3 females; p<0.001).
By the end of follow-up, 114 patients (70%) had either left ventricular systolic dysfunction (LVSD) or had experienced MVA. 22 patients received a first diagnosis of LVSD during follow-up. Disease penetrance in individuals over 40 years of age was 78.5% by last evaluation.
Eleven patients that reached the MVA endpoint had a left ventricular ejection fraction (LVEF) available within 6 months of the event. Median [IQR] contemporary LVEF was 30% [23.75, 40%]. 5/11 patients had a contemporary LVEF >35%. 1/11 had a contemporary LVEF >45% (a female, 1st degree relative presenting with sustained ventricular tachycardia and an LVEF of 65%).
Conclusions
RBM20 variants are highly penetrant. The risk of MVA in male and female RBM20 variant carriers is similar but male sex is strongly associated with ESHF. MVA events occur in patients with LVEF >35%.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
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Affiliation(s)
- D Cannie
- University College London & Barts Heart Centre , London , United Kingdom
| | - A Protonotarios
- University College London & Barts Heart Centre , London , United Kingdom
| | - P Syrris
- University College London , London , United Kingdom
| | - A Sengupta
- Yorkshire Heart Centre , Leeds , United Kingdom
| | - Z Bilinska
- Institute of Cardiology, Unit for Screening Studies in Inherited Cardiovascular Disease , Warsaw , Poland
| | - X Arana Achaga
- University Hospital Donostia, Heart Failure and Inherited Cardiac Diseases , Donostia , Spain
| | - R Barriales-Villa
- Universidade da Coruna, Instituto de Investigaciόn Biomédica de A Coruña (INIBIC/ CIBERCV) , A Coruna , Spain
| | - P Garcia-Pavia
- Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Heart Failure and Inherited Cardiac Diseases Unit , Madrid , Spain
| | - J Gimeno
- Virgin of the Arrixaca University Clinical Hospital, Inherited Cardiac Disease Unit , Murcia , Spain
| | - M Merlo
- University of Trieste, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina , Trieste , Italy
| | - K Wahbi
- Université de Paris, Institut Imagine, AP-HP, Cochin Hospital, Cardiology Department , Paris , France
| | - D Fatkin
- Victor Chang Cardiac Research Institute , Sydney , Australia
| | - J Mogensen
- Aalborg University Hospital , Aalborg , Denmark
| | | | - P Elliott
- University College London & Barts Heart Centre , London , United Kingdom
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12
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Peretto G, Casella M, Merlo M, Benedetti S, Cappelletto C, Rizzo S, Dello Russo A, Casari G, Basso C, Sala S, Sinagra G, Cooper LT, Della Bella P. Prognostic role of myocardial inflammation in patients with undefined left ventricular arrhythmogenic cardiomyopathy. Europace 2022. [DOI: 10.1093/europace/euac053.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Etiology identification and risk stratification represent major issues for patients presenting with undefined left ventricular arrhythmogenic cardiomyopathy (ULVACM).
Purpose
To investigate the role of genetics and histology for ULVACM classification, management, and risk assessment.
Methods
We retrospectively analyzed a multicenter cohort of patients (screened n=1037) with ULVACM defined by ventricular arrhythmia (VA) onset, nonischemic late gadolinium enhancement (LGE) limited to the LV, and no severe dilated cardiomyopathy (LVEF≥40%). We selected patients undergoing both next generation sequencing (NGS) screening and endomyocardial biopsy (EMB) for etiology definition. When feasible, immunosuppressive therapy (IST) was used to target active myocardial inflammation (AMI). The study endpoint was a composite of cardiac death, heart transplantation and malignant VAs (VT, VF, appropriate ICD treatment).
Results
The study cohort is composed by 135 ULVACM patients (age 43±14 years, 63% males, LVEF 55±7 %). NGS identified pathogenic or likely-pathogenic variants (PVs/LPVs) consistent with ACM in 21 cases (16%), whereas EMB showed AMI in 78 patients (58%), including 13/21 PVs/LPVs+ (62%). After reclassification of 86 patients (64%), only 49 (36%) remained ULVACM. IST was started in 41/78 AMI patients (53%), including 9/13 PVs/LPVs+ (69%). Twenty patients (15%) met the study endpoint by 12 months, and 36 (27%) by the end of the study (60±27 months). Beyond malignant VT onset, AMI was the only predictor of events by 12 months (HR 5.0, 95%CI 1.4-18.1, p=0.007). No prognostic role was found for PVs/LPVs, except for the subgroup (n=77) with nonsustained VT onset. Among AMI patients, those treated by IST had a significantly lower occurrence of events, both by 12-months (1/41 vs. 16/37, p<0.001) and later (HR 0.05, 95%CI 0.01-0.21, p<0.001). Results were independently confirmed in PVs/LPVs+ and PVs/LPVs- cases. Excluding the IST population, the association of multiple factors among VT onset, PVs/LPVs, and AMI, resulted in an improved discrimination of arrhythmic risk profiles.
Conclusion
The combined genetic and histological workup allowed reclassification of up to 64% ULVACM patients, and substantially contributed into prognostic assessment. Furthermore, EMB identified suitable candidates for IST, who showed better outcomes irrespectively of their genotype.
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Affiliation(s)
| | - M Casella
- Riuniti Hospital of Ancona, Ancona, Italy
| | - M Merlo
- Cardiovascular Center A.S.S. 1 of Trieste, Trieste, Italy
| | | | - C Cappelletto
- Cardiovascular Center A.S.S. 1 of Trieste, Trieste, Italy
| | - S Rizzo
- University Hospital of Padova, Padua, Italy
| | | | - G Casari
- San Raffaele Hospital, Milan, Italy
| | - C Basso
- University Hospital of Padova, Padua, Italy
| | - S Sala
- San Raffaele Hospital, Milan, Italy
| | - G Sinagra
- Cardiovascular Center A.S.S. 1 of Trieste, Trieste, Italy
| | - LT Cooper
- Mayo Clinic, Jacksonville, United States of America
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13
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Mapelli M, Romani S, Magrì D, Merlo M, Cittar M, Masè M, Muratori M, Gallo G, Sclafani M, Carriere C, Zaffalon D, Salvioni E, Mattavelli I, Vignati C, De Martino F, Rovai S, Autore C, Sinagra G, Agostoni P. P295 EXERCISE OXYGEN KINETIC IN HYPERTROPHIC CARDIOMYOPATHY: RESULTS FROM A MULTICENTER CARDIOPULMONARY EXERCISE TESTING STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Reduced cardiac output (CO) has been considered crucial in symptoms’ genesis in hypertrophic cardiomyopathy (HCM). We evaluated the cardiopulmonary exercise testing (CPET) response in HCM focusing on parameters strongly associated with stroke volume (SV) and cardiac output (CO), such as oxygen uptake (VO2) and O2–pulse, considering both their absolute values and temporal behavior during physical exercise.
Methods and Results
We enrolled 312 non–end stage HCM patients, divided according to left ventricle outflow tract obstruction (LVOTO) at rest or during Valsalva maneuver (72% with LVOTO<30; 10% between 30 and 49 and 18% ≥ 50mmHg). Peak VO2 (percent of predicted), O2–pulse and ventilation to carbon dioxide production (VE/VCO2) slope did not change across LVOTO groups. Ninety–six (31%) HCM patients presented an abnormal O2–pulse temporal behavior, irrespective of LVOTO values. These patients showed lower peak systolic pressure, workload (106±45 vs. 130±49W), VO2 (74±17 vs. 80±20%) and O2–pulse (12 [9–14] vs. 14 [11–17]ml/beat), with higher VE/VCO2 slope (28 [25–31] vs. 27 [24–31]) (p < 0.005 for all). Only 2 patients had an abnormal VO2/work slope.
Conclusion
None of CPET parameters, either as absolute values or dynamic relationships, were associated with LVOTO. Differently, an abnormal O2–pulse exercise behavior, which is strongly related to inadequate SV during exercise, correlates with reduced functional capacity (peak and anaerobic threshold VO2 and workload) and increased VE/VCO2 slope, helping identifying more advanced disease irrespectively of LVOTO. Adding O2–pulse kinetics evaluation to standard CPET could lead to a potential incremental benefit in terms of HCM prognostic stratification and, then, therapeutic management.
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Affiliation(s)
- M Mapelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - S Romani
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - D Magrì
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Merlo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Cittar
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Masè
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Muratori
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - G Gallo
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - M Sclafani
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - C Carriere
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - D Zaffalon
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - E Salvioni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - I Mattavelli
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - C Vignati
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - F De Martino
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - S Rovai
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - C Autore
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - G Sinagra
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
| | - P Agostoni
- CENTRO CARDIOLOGICO MONZINO, IRCCS, MILANO; DIPARTIMENTO DI MEDICINA CLINICA E MOLECOLARE, SAPIENZA, UNIVERSITÀ DEGLI STUDI DI ROMA, ROMA; CARDIOTHORACOVASCULAR DEPARTMENT, CENTER FOR THE DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, AZIENDA SANITARIA UNIVERSITARIA GIULIANO ISONTINA, UNIVERSITY OF TRIESTE, TRIESTE
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14
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Aimo A, Merlo M, Porcari A, Pagura L, Sinagra G, Vergaro G, Emdin M, Rapezzi C. P292 REDEFINING THE EPIDEMIOLOGY OF CARDIAC AMYLOIDOSIS. A SYSTEMATIC REVIEW OF SCREENING STUDIES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Over the last years, an algorithm for non–invasive diagnosis of amyloid transthyretin cardiac amyloidosis (ATTR–CA) and novel disease–modifying therapies have prompted an active search of CA in different clinical settings.
Methods
We performed a systematic search of screening studies investigating CA.
Results
The average prevalence of CA in different settings were as follows: total body scintigraphy with “bone tracers” for non–cardiac reasons (n = 5 studies), 1%; heart failure (HF) with preserved ejection fraction (n = 6), 12%; HF with reduced or mildly reduced ejection fraction (n = 2), 10%, conduction disorders warranting pacemaker implantation (n = 1), 2%; surgery for carpal tunnel syndrome (CTS; n = 3), 7%; hypertrophic cardiomyopathy phenotype (n = 2), 9%; aortic stenosis (AS) undergoing surgical or transaortic valve replacement (n = 7), 10%; autopsy series of “unselected” elderly individuals (n = 4), 15%. Many of these patients had ATTR–CA, but the percentage of cases with amyloid light–chain CA was far from negligible.
Conclusions
Screening for CA in specific settings allows to identify a relatively high number of cases, in agreement with the notion that CA is not a rare disease. Many patients have ATTR–CA. Most studies focused on elderly subjects, given the clear relationship between age and the likelihood of CA. Men accounted for a high proportion of patients with CA, but women were quite represented.
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Affiliation(s)
- A Aimo
- FTGM, PISA; OSPEDALI RIUNITI, TRIESTE; UNIVERSITÀ DI FERRARA, FERRARA
| | - M Merlo
- FTGM, PISA; OSPEDALI RIUNITI, TRIESTE; UNIVERSITÀ DI FERRARA, FERRARA
| | - A Porcari
- FTGM, PISA; OSPEDALI RIUNITI, TRIESTE; UNIVERSITÀ DI FERRARA, FERRARA
| | - L Pagura
- FTGM, PISA; OSPEDALI RIUNITI, TRIESTE; UNIVERSITÀ DI FERRARA, FERRARA
| | - G Sinagra
- FTGM, PISA; OSPEDALI RIUNITI, TRIESTE; UNIVERSITÀ DI FERRARA, FERRARA
| | - G Vergaro
- FTGM, PISA; OSPEDALI RIUNITI, TRIESTE; UNIVERSITÀ DI FERRARA, FERRARA
| | - M Emdin
- FTGM, PISA; OSPEDALI RIUNITI, TRIESTE; UNIVERSITÀ DI FERRARA, FERRARA
| | - C Rapezzi
- FTGM, PISA; OSPEDALI RIUNITI, TRIESTE; UNIVERSITÀ DI FERRARA, FERRARA
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15
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Merlo M, Pagura L, Porcari A, Cameli M, Vergaro G, Musumeci B, Biagini E, Canepa M, Crotti L, Imazio M, Forleo C, Cappelli F, Favale S, Di Bella G, Dore F, Girardi F, Tomasoni D, Pavasini R, Rella V, Palmiero G, Caiazza M, Albanese M, Igoren Guarrucci A, Branzi G, Caponetti A, Saturi G, La Malfa G, Merlo A, Andreis A, Bruno F, Longo F, Rossi M, Varra‘ G, Saro R, Di Ienno L, De Carli G, Giacomin E, Spini V, Limongelli G, Autore C, Olivotto I, Badano L, Parati G, Perlini S, Metra M, Emdin M, Rapezzi C, Sinagra G. C64 UNMASKING THE PREVALENCE OF AMYLOID CARDIOMYOPATHY IN THE REAL WORLD: RESULTS FROM PHASE 2 OF AC–TIVE STUDY, AN ITALIAN NATIONWIDE SURVEY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Clinicians need to identify patients with amyloid cardiomyopathy (AC) at an early stage, due to the availability of disease–modifying therapies. Some echocardiographic findings may rise the suspicion of AC, also in patients with mild or no symptoms, addressing second level diagnostic tests.
Aim
To investigate the prevalence of AC in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram in Italy and presenting echocardiographic signs suggestive of AC.
Methods
This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) a recording phase consisting in a national survey on prevalence of possible echocardiographic red flags of AC in consecutive unselected patients ≥55 years undergoing routine echocardiogram (previously published) and 2) an AC diagnostic phase involving a diagnostic work–up for AC to investigate AC prevalence among patients with at least one echocardiographic red flag (herein presented). Patients that in Phase 1 presented an “AC suggestive” echocardiogram (i.e., at least one red flag of AC in hypertrophic, non–dilated left ventricles with preserved ejection fraction) underwent clinical evaluation, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related–AC (ATTR–AC) was made in presence of grade 2–3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov (#NCT04738266).
Results
Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as “AC suggestive” and proceeded to Phase 2. 217 patients completed Phase 2 investigations. Main reasons for the 164 non–entering patients into Phase 2 were death (n = 49) and refusal to participate (n = 66). A final diagnosis of AC was made in 62 patients with an estimated prevalence of 28,6% (95% CI: 22,5%–34,7%). ATTR–AC was diagnosed in 51 and AL–AC in 11 patients, ascertaining a prevalence of 23,5% (95% CI: 17,8%–29,2%) and 5,1% (95% CI: 2,2%–8,0%), respectively.
Conclusion
Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of AC, the prevalence of AC ranged from 23% up to 35%. Although ATTR–AC was predominant, AL–AC was diagnosed in a significant number of cases. Echocardiography has a fundamental role in screening patients, raising the suspicion of disease and orienting diagnostic work–up for AC.
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Affiliation(s)
- M Merlo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Pagura
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Porcari
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Cameli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Vergaro
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - B Musumeci
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - E Biagini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Canepa
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Crotti
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Imazio
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Forleo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Cappelli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - S Favale
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Di Bella
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Dore
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Girardi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - D Tomasoni
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - R Pavasini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - V Rella
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Palmiero
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Caiazza
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Albanese
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Igoren Guarrucci
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Branzi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Caponetti
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Saturi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G La Malfa
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Merlo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - A Andreis
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Bruno
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - F Longo
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Rossi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Varra‘
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - R Saro
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Di Ienno
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G De Carli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - E Giacomin
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - V Spini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Limongelli
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Autore
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - I Olivotto
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - L Badano
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Parati
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - S Perlini
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Metra
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - M Emdin
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - C Rapezzi
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
| | - G Sinagra
- CENTER FOR DIAGNOSIS AND TREATMENT OF CARDIOMYOPATHIES, CARDIOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA GIULIANO–ISONTINA (ASUGI) AND UNIVERSITY OF TRIESTE, TRIESTE; DEPARTMENT OF MEDICAL BIOTECHNOLOGIES, DIVISION OF CARDIOLOGY, UNIVERSITY OF SIENA, SIENA; ISTITUTO DI SCIENZE DELLA VITA, SCUOLA SUPERIORE SANT’ANNA, PISA; DEPARTMENT OF CLINICAL AND MOLECULAR MEDICINE, FACULTY OF MEDICIN
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Gentile P, Merlo M, Peretto G, Ammirati E, Sala S, Della Bella P, Aquaro G, Imazio M, Potena L, Campodonico J, Foà A, Raafs A, Hazebroek M, Brambatti M, Cercek A, Nucifora G, Shrivastava S, Huang F, Schmidt M, Muser D, Van De Heyning C, Van Craenenbroeck E, Aoki T, Sugimura K, Shimokawa H, Cannatà A, Artico J, Porcari A, Colopi M, Bussani R, Barbati G, Garascia A, Cipriani M, Agostoni P, Pereira N, Heymans S, Adler E, Camici P, Frigerio M, Sinagra G. C65 POST–DISCHARGE ARRHYTHMIC RISK STRATIFICATION OF PATIENTS WITH ACUTE MYOCARDITIS AND LIFE–THREATENING VENTRICULAR TACHYARRHYTHMIAS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
The outcomes of patients presenting with acute myocarditis and life–threatening ventricular arrhythmias (LT–VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population.
Methods and Results
We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT–VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter–defibrillator therapy or synchronized external cardioversion. Median follow–up was 23months [first to third quartile (Q1–Q3) 7–60]. Fifty–eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1–Q3 2.5–24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38–6.11]; late gadolinium enhancement involving ≥2 myocardial segments (HR 4.51, 95% CI 2.39–8.53), and absence of positive short–tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40–4.79) at first CMR.
Conclusions
In this international multicentre study, patients discharged free from HTx or LVAD after an acute myocarditis complicated by LT–VA had a recurrence of MAEs during follow–up of 37.2%, after a median time of 8 months. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
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Affiliation(s)
- P Gentile
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Merlo
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Peretto
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - E Ammirati
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - S Sala
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - P Della Bella
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Aquaro
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Imazio
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - L Potena
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - J Campodonico
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Foà
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Raafs
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Hazebroek
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Brambatti
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Cercek
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Nucifora
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - S Shrivastava
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - F Huang
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Schmidt
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - D Muser
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - C Van De Heyning
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - E Van Craenenbroeck
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - T Aoki
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - K Sugimura
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - H Shimokawa
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Cannatà
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - J Artico
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Porcari
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Colopi
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - R Bussani
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Barbati
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - A Garascia
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Cipriani
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - P Agostoni
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - N Pereira
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - S Heymans
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - E Adler
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - P Camici
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - M Frigerio
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
| | - G Sinagra
- DE GASPERIS CARDIO CENTER, AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; CARDIOTHORACOVASCULAR DEPARTMENT, AZIENDA SANITARIA UNIVERSITARIA INTEGRATA DI TRIESTE AND UNIVERSITY OF TRIESTE, TRIESTE; VITA SALUTE UNIVERSITY AND SAN RAFFAELE HOSPITAL, MILANO; DE GASPERIS CARDIO CENTER AND TRANSPLANT CENTER, NIGUARDA HOSPITAL, MILANO; FONDAZIONE TOSCANA G. MONASTERIO, MILANO; CARDIOTHORACIC DEPARTME
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De Angelis E, Ravera A, Ammirati E, Tedeschi A, Polito M, Pieroni M, Gentile P, Merlo M, Van De Heyning C, Bekelaarh T, Cipriani A, Camilli M, Sanna T, Sinagra G, Bonnefoy–cudraz E, Bochaton T, Hayek A, Aloia A. C75 PHEOCHROMOCYTOMA–INDUCED CARDIOGENIC SHOCK: A MULTICENTER ANALYSIS OF CLINICAL PROFILES, MANAGEMENT AND OUTCOMES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Pheochromocytoma is a rare neuroendocrine tumor that arises from the adrenal gland and overproduces catecholamines; it is an infrequent cause of cardiogenic shock (CS). Several case reports have investigated pheochromocytoma–induced CS, but larger studies have not yet been carried out.
Objectives
Our work aims to describe a multicenter experience in the diagnosis and management of patients with pheochromocytoma–induced CS, and to raise awareness around this rare condition. Methods: We enrolled all patients with a diagnosis of pheochromocytoma–induced CS admitted to the intensive care units of 8 European referral Hospitals.
Results
Among the 17 patients (47% males, mean age 49,5 years), we found that pulmonary congestion was the mostly represented clinical feature (82%). The most represented echocardiographic left ventricle (LV) pattern was the reverse Takotsubo (TTS) pattern with apical hyperkinesis associated with basal– to mid–ventricular hypokinesis (47%). Elevated systemic vascular resistances (SVR) were observed. Endomyocardial biopsy of the LV was performed in one patient showing contraction band necrosis, oedema and inflammatory reaction. 76% of patients were treated with dobutamine, 70% needed noradrenaline, 29% adrenaline, 23.5% were treated with levosimendan and 17% with milrinone. Mechanical circulatory support devices (MCS) were necessary for 65% of patients. All patients benefited from pheochromocytoma’s surgical excision, with 4 patients operated on while under ECLS. All patients recovered, excepted one (presenting a severe left ventricular dilatation at admission) who required cardiac transplantation.
Conclusion
Pheochromocytoma is an infrequent cause of CS, with most often a TTS–like presentation. It should be suspected in case of a CS with high initial SVR and rapid deterioration. MCS must be considered in the most severe cases. The main challenge is to stabilize the patient, mostly with MCS, since it remains a reversible cause of CS with a low mortality rate. Adrenalectomy can safely be performed even when the patient is under MCS.
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Affiliation(s)
- E De Angelis
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Ravera
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - E Ammirati
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Tedeschi
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - M Polito
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - M Pieroni
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - P Gentile
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - M Merlo
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - C Van De Heyning
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - T Bekelaarh
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Cipriani
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - M Camilli
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - T Sanna
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - G Sinagra
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - E Bonnefoy–cudraz
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - T Bochaton
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Hayek
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Aloia
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
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Porcari A, Merlo M, Pagura L, Rapezzi C, Sinagra G. Unmasking the prevalence of cardiac amyloidosis in the real world: first insights from the phase 2 of the AC-TIVE study, an italian nationwide survey. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.112] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer
Introduction
Clinicians need to identify patients with cardiac amyloidosis (CA) at an early stage, due to the availability of disease modifying therapies. Some echocardiographic findings may rise the suspicion of CA, also in patients with mild or no symptoms, orienting second level diagnostic tests.
Purpose
To investigate the prevalence of CA in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram (TTE) in Italy with echocardiographic signs suggestive of CA.
Methods
This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) an observational phase consisting in a national survey on prevalence of possible echocardiographic red flags of CA in consecutive patients ≥55 years undergoing routine TTE (1), and 2) a CA diagnostic phase. Preliminary results of phase 2 are herein presented. Patients who presented a CA-suggestive TTE (i.e. at least one red flag of CA in hypertrophic, non-dilated left ventricles) in the phase 1 were further evaluated (1). Those who consented to proceed in the study, underwent clinical evaluation, electrocardiography, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related-CA (ATTR-CA) was made in presence of grade 2 -3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov.
Results
Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as CA-suggestive (1). Two-hundred-twelve of the 381 patients with a CA-suggestive TTE proceeded to the phase 2 of the study. The main reasons for the 169 non-entering patients into the phase 2 were death [n=53] and refusal to participate [n=85]. Sixty-five of these 212 patients (31%; 17% considering also the 169 non-entering patients into the phase 2 and assuming they did not have CA) had a circumstantiated diagnosis of CA. In detail, ATTR-CA was diagnosed in 53 (25%) and AL-CA in 12 (5.7%) patients.
Conclusion
Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of CA, the real prevalence of disease ranged from 17% up to 31%. Although ATTR-CA was predominant, AL-CA was diagnosed in a significant amount of cases. TTE has a fundamental role in screening patients, raising the suspicion of disease and orienting diagnostic work-up for CA.
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - L Pagura
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - C Rapezzi
- Maria Cecilia Hospital, GVM Care & Research, Ravenna, Cotignola, Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
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19
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Porcari A, Merlo M, Baggio C, Gagno G, Andreis A, Rosmini S, Raafs A, Bromage D, Cannata' A, Di Bella G, Nucifora G, Perazzolo Marra M, Heymans S, Imazio M, Sinagra G. Global longitudinal strain by CMR improves prognostic stratification in acute myocarditis presenting with normal LVEF. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Prognostic stratification of acute myocarditis (AM) presenting with normal left ventricular ejection fraction (LVEF) relies mostly on late gadolinium enhancement (LGE) characterization (1).
Purpose
Left ventricular peak global longitudinal strain (LV-GLS) measured by feature tracking analysis might improve prognostication of AM presenting with normal LVEF (2,3).
Methods
Data of patients undergoing cardiac magnetic resonance (CMR) for clinically suspected AM in seven European Centres (2013-2020) were retrospectively analysed. Patients with AM confirmed by CMR and LVEF ≥50% were included. LGE was visually characterized: localized vs. diffuse, subepicardial vs midwall. LV-GLS was measured by dedicated software. The primary outcome was the first occurrence of an adverse cardiovascular event (ACE) including cardiac death, life-threatening arrhythmias, development of heart failure or of LVEF <50%.
Results
Of 389 screened patients, 256 (66%) fulfilled inclusion criteria: median age 36 years, 71% males, median LVEF 60%, median LV-GLS -17.3%. CMR was performed at 4 [2-12] days from hospitalization. At 27 months, 24 (9%) patients experienced ≥1 ACE (71% developed LVEF <50%). Compared to the others, patients experiencing ACEs had lower median LV-GLS values (-13.9% vs -17.5%, p=0.001). At Kaplan-Meier analysis, impaired LV-GLS (both considered as >-20% or quartiles), diffuse and midwall LGE were associated with ACEs (Figure 1). Patients with LV-GLS ≤-20% did not experience ACEs. LV-GLS remained associated with ACEs after adjustment for diffuse and midwall LGE.
Conclusions
In AM presenting with LVEF ≥50%, LV-GLS provides independent prognostic value over LGE characterization, improving risk stratification and representing a rationale for further studies of therapy in this cohort (Figure 2).
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - C Baggio
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - G Gagno
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
| | - A Andreis
- Hospital Citta Della Salute e della Scienza di Torino, University Cardiology A.O.U., Turin, Italy
| | - S Rosmini
- King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Raafs
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - D Bromage
- King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - A Cannata'
- King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom of Great Britain & Northern Ireland
| | - G Di Bella
- University of Messina, Department of Cardiology, Messina, Italy
| | - G Nucifora
- Manchester University NHS Foundation Trust, NorthWest Cardiac Imaging Centre, Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padua, Italy
| | - S Heymans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - M Imazio
- Hospital Santa Maria della Misericordia, Cardiology, Cardiothoracic Department, Udine, Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Trieste, Italy
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20
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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Ludot M, Merlo M, Ibrahim N, Piot MA, Lefèvre H, Carles ME, Harf A, Moro MR. ["Somatic symptom disorders" in adolescence. A systematic review of the recent literature]. Encephale 2021; 47:596-604. [PMID: 34538623 DOI: 10.1016/j.encep.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 04/02/2021] [Accepted: 04/18/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Body expression of mental disorders is common in adolescence. Only two literature reviews over the last five years have been identified about somatoform disorders in children., The present article provides a systematic review of articles in English, which concern "Somatic Symptom and Related Disorders" according to the DSM-5 (Diagnostic and Statistical Manual - 5th Edition) among adolescents. METHODS The article search was made on Medline, Psychinfo, Google Scholar, BiomedCentral, Central and tripdatabase (for grey literature) according to PRISMA criteria and with the items "somatoform disorders" or "somatic symptom disorders". An age filter was applied for "adolescents", and a selection was done from the last five years. All articles concerning adolescents (often associated with children) were initially included, except for articles concerning eating disorders, dysmorphic disorders or adult population. Comments, editorials, opinion or descriptive articles were also excluded. The authors then carried out an analysis of the main topics, themes and questions covered in the selected publications and presented a descriptive synthesis. RESULTS A total of seventy-seven publications were included in the analysis, from three hundred and seventy-two publications. First, the terms used to refer to these "somatic symptom disorders" were varied, such as "somatization", "somatic complaints/symptoms", "functional disorder", "unexplained symptoms" and "somatoform disorders". Then, studies related just to adolescents were limited: most of studies included children and adolescents in their methodologies; and some of them questioned somatic symptoms from a developmental perspective. Case reports were the most represented articles among all medical specialties, with clinical descriptions about "functional neurological symptom disorder", "factitious disorder" and "somatic symptom disorder" with a medical disease, among children and adolescents. We sometimes observed a controversial borderline between psychological and somatic disorders. Various explanatory models appeared, especially the trauma path; familial and social environment was also pointed out, with a possible peer group effect; neurocognitive theories were finally described. The literature highlights the effectiveness of psychosocial therapies (especially the cognitive-behavioral therapy) and the importance of multidisciplinary management. Finally, a few studies with a qualitative methodology are represented. CONCLUSIONS Only nine articles included "somatic symptom disorder" in their titles, despite a terminology valued by many authors (compared to "somatoform disorders" from the DSM-IV). The heterogeneity of terminologies, case reports and explanatory models witness a lack of connexions between medical specialties. This could explain in part the wandering of adolescents and their families in the health care system. It could also contribute to the delay before diagnosis, especially when neurological symptoms exist, and a late referral for psychiatric consultation. Further studies are needed to understand difficulties to use a clinical pathway among medical specialties, when the benefit of amultidisciplinary approach seems to be unanimous.
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Affiliation(s)
- M Ludot
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France.
| | - M Merlo
- Maison de Solenn, hôpital Cochin, 75014 Paris, France
| | - N Ibrahim
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France; Groupe français de recherche en médecine et santé de l'adolescent, maison de Solenn, hôpital Cochin, 75014 Paris, France
| | - M-A Piot
- Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France; Faculté de santé, UFR de médecine, université de Paris, 75006 Paris, France; Service de psychiatrie de l'enfant, de l'adolescent et du jeune adulte, institut mutualiste Montsouris, 75014 Paris, France
| | - H Lefèvre
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France; Groupe français de recherche en médecine et santé de l'adolescent, maison de Solenn, hôpital Cochin, 75014 Paris, France
| | - M-E Carles
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France
| | - A Harf
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France
| | - M R Moro
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France
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Longo L, Jannini T, Merlo M, Bombacci C, Biancolino M, Rossi R, Carlo ED, Niolu C, Siracusano A, Lorenzo GD. Suicidality and relation with dissociation and alexithymia in PNES and conversion disorder. Eur Psychiatry 2021. [PMCID: PMC9479824 DOI: 10.1192/j.eurpsy.2021.1576] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Amongst different subtypes of Conversion Disorder (CD), DSM-V lists the Psychogenic Non-epileptic seizures (PNES). PNES are defined as episodes that visually resemble epileptic seizures but, etiologically, they are not due to electrical discharges in the brain. Objectives Our study aims to explore the differences between PNES and other CDs. In particular, we studied the suicidality and its correlations with dissociation and alexithymia. Methods Patients, recruited from the Psychiatry and Clinical Psychology Unit of the Fondazione Policlinico Tor Vergata, Rome, Italy, were diagnosed with PNES (n=22) and CD (n=16) using the DSM-5 criteria. Patients underwent the following clinical assessments: HAM-D, BDI, DES, BHS, TAS, CTQ. Results PNES showed significantly higher scores than CD in all assessments, except for BDI-somatic (p=0.39), BHS-feeling (p=0.86), and the presence of childhood trauma. PNES also showed significantly higher suicidality (p = 0.003). By controlling for the confounding factor “depression”, in PNES suicidality (and in particular the BHS-loss of motivation) appears to be correlated with DES-total score (p = 0.008), DES-amnesia (p = 0.002) and DES -derealization-depersonalization (p = 0.003). On the other hand, in CDs, the BHS-total score shows a correlation with the TAS-total score (p = 0.03) and BHS-Feelings with TAS-Externally-Oriented Thinking (p = 0.035), while only the BHS-Loss of motivation appears correlated with DES-Absorption (p = 0.011). Conclusions Our study shows significant differences between PNES and CD, in several symptomatologic dimensions, including suicidality. Indeed, in PNES suicidality appears to be related to dissociation, while in CDs it appears mainly to be correlated with alexithymia.
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Longo L, Jannini T, Merlo M, Cecora V, Gagliano M, D’Imperia B, Daverio A, Monaco L, Rossi R, Niolu C, Siracusano A, Lorenzo GD. Suicidality in post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). Eur Psychiatry 2021. [PMCID: PMC9471773 DOI: 10.1192/j.eurpsy.2021.390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionInternational Classification of Diseases 11th Revision (ICD-11) has inserted complex post-traumatic stress disorder (cPTSD) as a clinically distinct disorder, different from PTSD. The diagnosis of cPTSD has the same requirements for the one of PTSD, in addition to disturbances of self-organization (DSO – e.g., disturbances in relationships, affect dysregulation, and negative self-concept).ObjectivesThis study aimed to explore suicidality in PTSD and cPTSD. We examined also the association between clinical dimensions of hopelessness (feelings, loss of motivation, future expectations) and other symptomatologic variables.MethodsThe sample, recruited at the Fondazione Policlinico Tor Vergata, Rome, Italy, consisted of 189 subjects, 132 diagnosed with PTSD, and 57 with cPTSD, according to the ICD-11 criteria. Participants underwent the following clinical assessments: Clinician-Administered PTSD Scale (CAPS), Impact of Event Scale-Revised (IES), Beck Depression Inventory (BDI), Symptom Checklist-90-Revised (SCL-90), Dissociative Experience Scale (DES), Beck Hopelessness Scale (BHS).ResultscPTSD showed significantly higher BHS-total (p = 0.01) and BHS-loss of motivation subscale (p <0.001) scores than PTSD. Besides, cPTSD showed significantly higher scores in all clinical variables except for the IES-intrusive subscale. By controlling for the confounding factor “depression”, suicidality in cPTSD (and in particular the BHS-total) appears to be correlated with IES-total score (p = 0.042) and with DES-Absorption (p = 0.02). Differently, no such correlations are found in PTSD.ConclusionsOur study shows significant symptomatologic differences between PTSD and cPTSD, including suicidality. Indeed, suicidality in cPTSD appears to be correlated with the “loss of motivation” dimension, which fits well within the ICD-11 criteria of DSO.DisclosureNo significant relationships.
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Caiffa T, Castrichini M, Biagini E, De Luca A, Compagnone M, Berardini A, Merlo M, Fabris E, Vitrella G, Pinamonti B, Korcova R, Barbati G, Saia F, Stolfo D, Sinagra G. Impact on clinical outcomes of right ventricular response to percutaneous correction of secondary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Right ventricular function (RVF) is a strong determinant of prognosis in patients with reduced ejection fraction heart failure (HFrEF) and secondary mitral regurgitation (SMR). Percutaneous mitral valve repair (pMVR) can promote the recovery of RVF.
Purpose. We sought to characterize the RV response to pMVR in HFrEF with SMR and to assess the influence of improved RVF after pMVR in this specific setting of patients.
Methods. We included all the patients with HFrEF and SMR≥3+ successfully treated with pMVR between April 2012 and January 2020 in two tertiary care centers for HF. Improved RVF was defined as DRVFAC≥5% at early follow-up (median time 4 months). The primary endpoint was a composite of death/heart transplant (D/HT).
Results. In total, 110 patients were included. Mean age was 67 ± 12 years, mean LVEF was 31 ± 8% and mean RVFAC was 31 ± 10%. DRVFAC≥5% occurred in 54 (49%) patients and was independent from the measures of left ventricle recovery. During a median follow-up of 36 months (IQR 19-52), 40 patients (36%) died or were transplanted. After adjustment for other significant covariates, DRVFAC≥5% was significantly associated with lower risk of D/HT (HR 0.49, 95% CI 0.24 – 0.98 p < 0.042) along with M2+ at follow-up (HR 0.36; 95% CI 0.17-0.74 p 0.005).
Conclusions. In patients with HFrEF and SMR, the improvement of RVF is frequent after pMVR and is associated with better long-term survival free from HT.
Abstract Figure.
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Affiliation(s)
- T Caiffa
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - M Castrichini
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - E Biagini
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A De Luca
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - M Compagnone
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - A Berardini
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - M Merlo
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - E Fabris
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - G Vitrella
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - B Pinamonti
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - R Korcova
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - G Barbati
- University of Trieste, Trieste, Italy
| | - F Saia
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - D Stolfo
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
| | - G Sinagra
- UNITED HOSPITALS OF TRIESTE University hospital, Trieste, Italy
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De Angelis G, Merlo M, Bertolo S, De Luca A, Paldino A, Ramani F, Barbati G, Sinagra G. Late improvement of left ventricular ejection fraction in patients with persistent severe systolic dysfunction under guideline-directed medical therapy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. A consistent proportion of patients with dilated cardiomyopathy (DCM) experience left ventricular reverse remodelling (LVRR) during the first 24 months of guideline-directed medical therapy (GDMT). However, important decisions, such as the need for ICD, are requested after 3 months of GDMT. The evolution of left ventricular ejection fraction (LVEF) during the first years after GDMT in DCM is unknown.
Purpose. Our study aims to investigate the proportion and characterise DCM patients experiencing late LVEF improvement.
Methods. We analysed DCM patients consecutively enrolled with short disease duration, recent initiation of GDMT (≤ 3 months) and a LVEF ≤ 35% at 6-month follow-up evaluation. LVEF > 35% at 24-month was the primary end-point of the study.
Results. Among 131 patients (mean age 53 ± 14, male sex 74%), 88 (67%) improved their LVEF at 24 months above 35%. A > 10% reduction of the indexed left ventricular end-diastolic diameter (LVEDDi) between enrolment and 6-month evaluation emerged as the only independent predictor of late LVEF improvement. During the subsequent follow-up, the late LVEF improvement was associated with a lower cumulative incidence of major arrhythmic events, compared to patients with persistent LVEF ≤ 35% (p = 0.010).
Conclusions. A high proportion of DCM patients improve their LVEF after more than 3-6 months of GDMT, which is associated with lower long-term arrhythmic risk. The early evaluation of dynamic parameters, such as the reduction of LVEDDi could help to identify those patients.
Baseline population characteristics Total (131) LVEF > 35% at 24 months (88) LVEF ≤ 35% at 24 months (43) p Age (years) 53 ± 14 52 ± 14 54 ± 14 0.52 LVEF (%) 28.4 ± 5.6 29.2 ± 5.3 26.7 ± 5.8 0.02 LVEDDi (mm/m2) 34.9 ± 4.6 34.1 ± 4.7 36.5 ± 4.1 0.01 LVEDVi (ml/m2) 89.4 ± 34.2 83.7 ± 28.5 101.0 ± 41.5 0.01 RV dysfunction normalisation or persistence of normal RV function* 92 (84.4) 59 (84.3) 33 (84.6) 0.96 RFP disappearance* 115 (93.5) 80 (95.2) 35 (89.7) 0.25 MR improvement or persistence of mild/absent MR* 91 (72.2) 66 (78.6) 25 (59.5) 0.02 LVEF improvement* 30 (22.9) 21 (23.9) 9 (20.9) 0.7 LVEDDi reduction* 28 (23.7) 25 (32.1) 3 (7.5) 0.003 Values are presented as n (%) or mean ± SD. *Dynamic parameters are evaluated as change from enrollment to the 6-months evaluation. LVEDDi left ventricular end-diastolic diameter indexed; LVEDVi: left ventricular end diastolic volume indexed; LVEF: left ventricular ejection fraction; MR: mitral regurgitation; RFP: restrictive filling pattern; RV: right ventricular. Abstract Figure. Major outcome
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Affiliation(s)
- G De Angelis
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - M Merlo
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - S Bertolo
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - A De Luca
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - A Paldino
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - F Ramani
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - G Barbati
- University of Trieste, Biostatistics Unit, Department of Medical Sciences, Trieste, Italy
| | - G Sinagra
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
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Cannata A, Merlo M, Manca P, Dal Ferro M, Paldino A, Artico J, Gentile P, Jirikowic J, Todd E, Salcedo E, Graw S, McDonagh T, Taylor M, Mestroni L, Sinagra G. The late-onset dilated cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2096] [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: 11/15/2022] Open
Abstract
Abstract
Background
Dilated Cardiomyopathy (DCM) represents a specific subgroup of non-ischemic cardiomyopathies. Little is known about the genotypic characterization of dilated cardiomyopathy (DCM) patients diagnosed over 60 years of age.
Aim
To investigate prevalence, characterization and prognostic impact of the genetic background of late-onset DCM patients.
Methods
We analyzed a study population of 566 DCM patients from two international referral centers. Genetic background was analyzed and patients were grouped into typical-onset DCM (<60 years of age at diagnosis) or late-onset DCM (>60 years of age at diagnosis).
Results
Approximately 12% of patients (n=70) had late-onset DCM and female sex was significantly more frequent in the late-onset DCM cohort (p<0.001). Diagnostic yield of genetic testing was comparable between typical- and late-onset DCM (53% vs 50%, respectively p=0.438) whereas the prevalence of Titin gene truncation variants (TTNtv) was higher in the late-onset DCM group compared to the younger cohort (23% vs 13% respectively; p<0.05). Notably, patients with late-onset genetic DCM had comparable long-term outcomes to those with typical-onset DCM.
Conclusions
Late-onset DCM patients have nearly double the rate of TTNtv mutations and are more likely to be female compared to younger DCM patients. These observed differences in mutational makeup and sex may reveal insights into age and sex dependent mechanisms for TTNtv and should prompt further study. Notably, the increased prevalence of TTNtv and female sex did not translate into noticeable differences in rates of measurable cardiac events.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Cannata
- King's College London, London, United Kingdom
| | - M Merlo
- University of Trieste, Trieste, Italy
| | - P Manca
- University of Trieste, Trieste, Italy
| | | | - A Paldino
- University of Trieste, Trieste, Italy
| | - J Artico
- University of Trieste, Trieste, Italy
| | - P Gentile
- University of Trieste, Trieste, Italy
| | - J Jirikowic
- University of Colorado Health, Denver, United States of America
| | - E Todd
- University of Colorado Health, Denver, United States of America
| | - E Salcedo
- University of Colorado Health, Denver, United States of America
| | - S Graw
- University of Colorado Health, Denver, United States of America
| | - T McDonagh
- King's College London, London, United Kingdom
| | - M Taylor
- University of Colorado Health, Denver, United States of America
| | - L Mestroni
- University of Colorado Health, Denver, United States of America
| | - G Sinagra
- University of Trieste, Trieste, Italy
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Artico J, Merlo M, Delcaro G, Cannata A, Gentile P, De Angelis G, Paldino A, Bussani R, Dal Ferro M, Sinagra G. Lymphocytic myocarditis: a genetically predisposed disease? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical presentation of myocarditis is extremely heterogeneous from asymptomatic to overt severe heart failure (HF). A complex interaction between pre-existing genetic background and inflammation might be responsible for this heterogeneity.
Purpose
The aim of the present study was to investigate whether positive genetic background for pathogenic cardiomyopathy-related variants might underlie a higher susceptibility to left ventricular dysfunction in patients with active lymphocytic myocarditis.
Methods
We prospectively performed genetic tests in 36 patients (46±15 years; 61% males; no relatives included) with biopsy-proven active lymphocytic myocarditis according to Dallas criteria and immunohistochemistry. Only pathogenic (P) or likely pathogenic (LP) variants were considered.
Results
After genetic test, 31% of patients (n=11) were carriers of P/LP truncating variants in structural Cardiomyopathy related genes: Titin (TTN, n=8, 73%), Desmoplakin (DSP, n=1), Filamin C (FLNC, n=1) and RNA binding protein 20 (RBM20, n=1). Among the 27 patients presenting with HF and LV dysfunction, the positive genetic yield was similar to the total cohort (n=9, 34%; 90% with TTN). Two out of six arrhythmic patients (30%) were carriers in arrhythmogenic genes (i.e. DSP and FLNC), whereas no patients with infarct-like presentation were carriers. During follow-up, 44% of patients (n=16) presented normal Left Ventricular Ejection Fraction (LVEF). Carriers had a lower rate of LVEF normalization compared to non-carriers (18% vs 56%, respectively; p=0.035).
Conclusion
Positive genetic testing for cardiomyopathy-related-genes might be found in a non-negligible percentage of patients with biopsy-proven myocarditis, especially if presenting with heart failure and LV dysfunction. Compared to non-carriers, carriers of P/LP variants show lower likelihood of LVEF normalization during follow-up.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Artico
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - M Merlo
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - G Delcaro
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - A Cannata
- King's College London, Cardiovascular, London, United Kingdom
| | - P Gentile
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - G De Angelis
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - A Paldino
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - R Bussani
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - M Dal Ferro
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - G Sinagra
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
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Paldino A, De Angelis G, Dal Ferro M, Faganello G, Porcari A, Barbati G, Korcova R, Gentile P, Artico J, Pinamonti B, Merlo M, Sinagra G. 1040 Unexpected prevalence of subtle systolic and diastolic dysfunction in genotype-positive phenotype-negative relatives of dilated cardiomyopathy patients. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Background
Left ventricular global longitudinal strain (LV-GLS) and peak left atrial longitudinal strain (PALS) are promising techniques for the detection of a subtle systolic and diastolic dysfunction for an early diagnosis of genetically determined dilated cardiomyopathy (DCM). Purpose. We sought to evaluate the prevalence of subtle systolic and diastolic dysfunction by LV-GLS and PALS in a cohort of genotype-positive phenotype-negative (GPFN) DCM relatives. Methods. We analysed echocardiograms (including LV-GLS and PALS) of 41 GPFN relatives of DCM patients (GPFN group - 37 ± 14 years, 48.8% male). They were compared with a matched group of 52 healthy individuals (control group). Reduced LV-GLS and PALS were defined as >-18% and <23.1%, respectively, according to literature data. Results. GPFN and control groups were grossly similar according to standard echocardiographic measurements. Conversely, mean LV-GLS was -18.8 ± 2.7% in the GPFN group vs. -24.0 ± 1.8% in the control group (p < 0.001). 20 subjects (48.8%) in the GPFN group and no subjects in the control group had a reduced LV-GLS. The mean PALS was 29.2 ± 6.7% in the GPFN group vs. 40.8 ± 8.5% in the control group (p < 0.001). 7 subjects (18.4%) in the GPFN group and one (2%) in the control group had a reduced PALS. During a median follow-up of 27 months, 6 (14.6%) GPFN relatives developed a LV ejection fraction <50%. Among them, 4 (66%) had a reduced LV-GLS at initial evaluation. Conclusions. LV-GLS and PALS are impaired in GPFN relatives of DCM patients compared to healthy individuals, when standard echocardiographic parameters are normal. Further studies are warranted to add prognostic significance to this result, which may lead in the future to an early therapy initiation.
Abstract 1040 Figure. Mean LV-GLS and PALS in GPFN and control
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Affiliation(s)
- A Paldino
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
| | - G De Angelis
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
| | - M Dal Ferro
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
| | - G Faganello
- Cardiovascular Center A.S.S. 1 of Trieste, Trieste, Italy
| | - A Porcari
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
| | - G Barbati
- University of Trieste, Biostatistics Unit, Department of Medical Sciences, Trieste, Italy
| | - R Korcova
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
| | - P Gentile
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
| | - J Artico
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
| | - B Pinamonti
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
| | - M Merlo
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
| | - G Sinagra
- Ospedale Cattinara, Cardiovascular department, Trieste, Italy
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Sinagra G, Porcari A, Merlo M. Precision medicine in heart failure no longer a visual theory but a realistic opportunity. Eur J Intern Med 2020; 71:20-22. [PMID: 31727453 DOI: 10.1016/j.ejim.2019.10.034] [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: 10/20/2019] [Accepted: 10/28/2019] [Indexed: 11/20/2022]
Affiliation(s)
- G Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Via P. Valdoni 7, 34100, Trieste, Italy.
| | - A Porcari
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Via P. Valdoni 7, 34100, Trieste, Italy
| | - M Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata (ASUITS) and University of Trieste, Via P. Valdoni 7, 34100, Trieste, Italy
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Ammirati E, Veronese G, Brambatti M, Merlo M, Potena L, Okumura T, Pinney S, Braun O, Van De Heyning CM, Montero S, Shimokawa H, Sinagra G, Adler E, Frigerio M, Camici PG. 2422Outcome of histologically-proven fulminant versus acute non-fulminant myocarditis with left ventricular systolic dysfunction. Evidence from the International Registry on Acute Myocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Fulminant myocarditis (FM) is a form of acute myocarditis characterized by severe left ventricular (LV) dysfunction requiring inotropes and/or mechanical circulatory support. Based on a retrospective single-center study published in 2000, patients with FM were considered to have better outcomes than those affected by acute non-fulminant myocarditis (NFM) presenting with LV systolic dysfunction (LVSD). Recently, this tenet was challenged, though substantial disagreement still exists.
Purpose
Aim of the present study is to provide additional evidence on the outcome of FM and to ascertain if patient stratification based on the main histologic subtypes can provide additional prognostic information.
Methods
Two hundred and twenty patients (median age 42 years, 46.3% female) with histologically proven acute myocarditis (onset of symptoms <30 days) presenting with LVSD were included in a retrospective, international registry comprising 16 tertiary hospitals in the United States, Europe, and Japan. The primary endpoint was the occurrence of cardiac death or heart transplant (HTx) within 60 days from admission and at long-term follow-up.
Results
Patients with FM (N=165) had significantly higher rates of cardiac death and HTx compared with those with NFM (N=55), both at 60 days (28.0% vs. 1.8%, p=0.0001) and at 7-year follow up (47.7% vs. 10.4%, p<0.0001; Figure). At Cox-multivariate analysis, the histologic subtype emerged as a further variable affecting outcome in FM patients, with giant cell myocarditis having a significantly worse prognosis compared with eosinophilic and lymphocytic myocarditis both at 60 days (62.5% vs. 26.3% vs. 21.0%) and at 3 years (81.3% vs. 39.9% vs. 37.3%, overall p<0.0001). In a sub-analysis including only adults with lymphocytic myocarditis, the main endpoints occurred more frequently in FM compared with NFM both at 60 days (19.5% vs. 0%, p=0.005) and up to 7 years (41.4% vs. 3.1%, p=0.0004).
Outcome of FM vs NFM
Conclusions
The results of this international registry confirm that patients with FM have higher rates of cardiac death and HTx both in the short and long-term compared with patients with NFM. Furthermore, we provide evidence that the histologic subtype of FM carries independent prognostic value, highlighting the need for timely endomyocardial biopsy in this condition.
Acknowledgement/Funding
None
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Affiliation(s)
- E Ammirati
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Veronese
- University of Milano-Bicocca, Department of Health Sciences, Monza, Italy
| | - M Brambatti
- University of California San Diego, San Diego, United States of America
| | - M Merlo
- University Hospital Riuniti, Trieste, Italy
| | - L Potena
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - T Okumura
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - S Pinney
- Mount Sinai School of Medicine, New York, United States of America
| | - O Braun
- Skane University Hospital, Lund, Sweden
| | | | - S Montero
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - H Shimokawa
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - G Sinagra
- University Hospital Riuniti, Trieste, Italy
| | - E Adler
- University of California San Diego, San Diego, United States of America
| | - M Frigerio
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - P G Camici
- University Vita-Salute San Raffaele, Milan, Italy
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Gigli M, Merlo M, Graw S, Barbati G, Rowland T, Stolfo D, Slavov D, Dal Ferro M, Sweet M, Altinier A, Brun F, Mc Kenna W, Taylor M, Sinagra G, Mestroni L. P6589Genetic risks for arrhythmia phenotypes in dilated cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1177] [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: 11/15/2022] Open
Abstract
Abstract
Background
Genotype-phenotype correlations in dilated cardiomyopathy (DCM) and in particular the effects of gene variants on clinical outcomes remain poorly understood.
Purpose
To investigate the prognostic role of genetic variant carrier status in a large cohort of DCM patients.
Methods
We analyzed 487 DCM patients by next-generation sequencing and categorized the disease genes into functional gene groups. The following composite outcome measures were assessed: 1) all-cause mortality, heart transplantation or left ventricular assist device (D/HTx/VAD); 2) sudden cardiac death or malignant ventricular arrhythmias (SCD/MVAs); 3) heart failure related death, heart transplantation or left ventricular assist device implantation (DHF/HTx/VAD).
Results
A total of 187 pathogenic/likely pathogenic variants were found in 180 patients (37%): 55 (11%) TTN; 19 (4%) LMNA; 24 (5%) structural cytoskeleton-Z disk genes; 16 (3%) desmosomal genes; 47 (10%) sarcomeric genes; 8 (2%) ion channels genes; 11 (2%) other genes. The occurrence of D/HTx/VAD was no different between variant carriers and non-carriers (p=0.17). However, carriers of desmosomal and LMNA variants experienced the highest rate of SCD/MVA, which was independent of the left ventricular ejection fraction.
Conclusions
Desmosomal and LMNA gene variants identify the subset of DCM patients at greatest risk for SCD and life-threatening ventricular arrhythmias, regardless the left ventricular ejection fraction.
Acknowledgement/Funding
National Institutes of Health grants R01 HL69071, HL116906, and AHA17GRNT33670495
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Affiliation(s)
- M Gigli
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - M Merlo
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - S Graw
- University of Colorado Health, Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical, Denver, United States of America
| | - G Barbati
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - T Rowland
- University of Colorado Health, Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical, Denver, United States of America
| | - D Stolfo
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - D Slavov
- University of Colorado Health, Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical, Denver, United States of America
| | - M Dal Ferro
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - M Sweet
- University of Colorado Health, Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical, Denver, United States of America
| | - A Altinier
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - F Brun
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - W Mc Kenna
- Hamad Medical Corporation Heart Hospital, Institute of Cardiovascular Science, Doha, Qatar
| | - M Taylor
- University of Colorado Health, Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical, Denver, United States of America
| | - G Sinagra
- Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - L Mestroni
- University of Colorado Health, Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical, Denver, United States of America
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Porcari A, Merlo M, Crosera L, Stolfo D, Cittar M, Della Paolera M, Barbati G, Pagnan L, Belgrano M, Cova MA, Gentile P, Aleksova A, Vitrella G, Sinagra G. 229Strain analysis reveals subtle systolic dysfunction in "confirmed" and "suspected" myocarditis with normal LVEF: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez113.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Porcari
- University Hospital Riuniti, Trieste, Italy
| | - M Merlo
- University Hospital Riuniti, Trieste, Italy
| | - L Crosera
- University Hospital Riuniti, Trieste, Italy
| | - D Stolfo
- University Hospital Riuniti, Trieste, Italy
| | - M Cittar
- University Hospital Riuniti, Trieste, Italy
| | | | - G Barbati
- University Hospital Riuniti, Biostatistics Unit, Department of Medical Sciences, Trieste, Italy
| | - L Pagnan
- University Hospital Riuniti, Department of Radiology, Trieste, Italy
| | - M Belgrano
- University Hospital Riuniti, Department of Radiology, Trieste, Italy
| | - M A Cova
- University Hospital Riuniti, Department of Radiology, Trieste, Italy
| | - P Gentile
- University Hospital Riuniti, Trieste, Italy
| | - A Aleksova
- University Hospital Riuniti, Trieste, Italy
| | - G Vitrella
- University Hospital Riuniti, Trieste, Italy
| | - G Sinagra
- University Hospital Riuniti, Trieste, Italy
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Stolfo D, Della Paolera M, Mazzanti A, Kukavica D, Vitrella G, Merlo M, Muser D, Pagnan L, Eshja E, De Luca A, Altinier A, Barbati G, Proclemer A, Priori S, Sinagra G. 338Myocardial deformation imaging for the assessment of left ventricular function in arrhythmogenic right ventricular cardiomyopathy: a feature tracking cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez122.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Stolfo
- Azienda Sanitaria Universitaria Integrata of Trieste, Cardiovascular Department, Division of Cardiology, Trieste, Italy
| | - M Della Paolera
- Azienda Sanitaria Universitaria Integrata of Trieste, Cardiovascular Department, Division of Cardiology, Trieste, Italy
| | - A Mazzanti
- Salvatore Maugeri Foundation IRCCS, Molecular Cardiology, Pavia, Italy
| | - D Kukavica
- Salvatore Maugeri Foundation IRCCS, Molecular Cardiology, Pavia, Italy
| | - G Vitrella
- Azienda Sanitaria Universitaria Integrata of Trieste, Cardiovascular Department, Division of Cardiology, Trieste, Italy
| | - M Merlo
- Azienda Sanitaria Universitaria Integrata of Trieste, Cardiovascular Department, Division of Cardiology, Trieste, Italy
| | - D Muser
- Azienda Sanitaria Universitaria Integrata of Udine, Cardiothoracic Department, Division of Cardiology, Udine, Italy
| | - L Pagnan
- Azienda Sanitaria Universitaria Integrata of Trieste, Department of Radiology, Trieste, Italy
| | - E Eshja
- Salvatore Maugeri Foundation IRCCS, Molecular Cardiology, Pavia, Italy
| | - A De Luca
- Azienda Sanitaria Universitaria Integrata of Trieste, Cardiovascular Department, Division of Cardiology, Trieste, Italy
| | - A Altinier
- Azienda Sanitaria Universitaria Integrata of Trieste, Cardiovascular Department, Division of Cardiology, Trieste, Italy
| | - G Barbati
- University of Trieste, Department of Medical Sciences, Biostatistics Unit, Trieste, Italy
| | - A Proclemer
- Azienda Sanitaria Universitaria Integrata of Udine, Cardiothoracic Department, Division of Cardiology, Udine, Italy
| | - S Priori
- Salvatore Maugeri Foundation IRCCS, Molecular Cardiology, Pavia, Italy
| | - G Sinagra
- Azienda Sanitaria Universitaria Integrata of Trieste, Cardiovascular Department, Division of Cardiology, Trieste, Italy
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Paldino A, De Angelis G, Merlo M, Gigli M, Dal Ferro M, Severini GM, Mestroni L, Sinagra G. Genetics of Dilated Cardiomyopathy: Clinical Implications. Curr Cardiol Rep 2018; 20:83. [DOI: 10.1007/s11886-018-1030-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Merlo M, Caiffa T, Gobbo M, Adamo L, Sinagra G. Reverse remodeling in Dilated Cardiomyopathy: Insights and future perspectives. Int J Cardiol Heart Vasc 2018; 18:52-57. [PMID: 29876504 PMCID: PMC5988485 DOI: 10.1016/j.ijcha.2018.02.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/06/2018] [Accepted: 02/16/2018] [Indexed: 01/09/2023]
Abstract
Dilated Cardiomyopathy (DCM) has been classically considered a progressive disease of the heart muscle that inexorably progresses towards refractory heart failure, ventricular arrhythmias and heart transplant. However, the prognosis of DCM has significantly improved in the past few years, mostly as the result of successful therapy-induced reverse remodeling. Reverse remodeling is a complex process that involves not only the left ventricle, but also many other cardiac structures and it is now recognized both as a measure of therapeutic effectiveness and as an important prognostic tool. Nevertheless, several aspects of reverse remodeling remain unclear, including the best timing for its quantification, its predictors and its interaction with individual genetic backgrounds. In this review, we summarize our current understanding of reverse remodeling in patients with DCM and provide practical recommendations for the clinical management of this challenging patient population.
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Affiliation(s)
- M. Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
| | - T. Caiffa
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
| | - M. Gobbo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
| | - L. Adamo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine St. Louis, MO, USA
| | - G. Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
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Gentile P, Merlo M, Gobbo M, Pinamonti B, Ramani F, Barbati G, Gigli M, Stolfo D, Sinagra G. P711Dilated cardiomyopathy with Mid-range ejection fraction at diagnosis: characterization and natural history. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Finocchiaro G, Dhutia H, Zaidi A, Malhotra A, De Luca A, Merlo M, Cappelletto C, Fabi E, Brook J, Behr E, Tome M, Carr-White G, Papadakis M, Sinagra G, Sharma S. P1602Electrocardiographic diifferentiation between benign T wave inversion and arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Boileve V, Schueler R, Hinojar R, Bando M, Lo Iudice F, Andersen OS, Nielsen KM, Merlo M, Dreyfus J, Attias D, Codogno I, Brochet E, Vahanian A, Messika-Zeitoun D, Kaplan S, Oeztuerk C, Weber M, Sinning JM, Welt A, Werner N, Nickenig G, Hammerstingl C, Fernandez-Golfin C, Gonzalez-Gomez A, Garcia Martin A, Casas E, Del Val D, Pardo A, Mejias A, Moya JL, Barrios V, Jimenez Nacher JJ, Zamorano JL, Yamada H, Amano R, Tamai R, Torii Y, Nishio S, Seno Y, Kusunose K, Sata M, Santoro C, Buonauro A, Ferrone M, Esposito R, Trimarco B, Petitto M, Galderisi M, Gude E, Andreassen AK, Broch K, Skulstad H, Smiseth OA, Remme EW, Damgaard DW, Jensen JM, Kraglund KL, Kim WY, Stolfo D, Gobbo M, Gabassi G, Barbati G, De Luca A, Korcova R, Secoli G, Pinamonti B, Sinagra G. Moderated Posters: A little bit of everythingP1190What causes mitral annulus dilatation-A three dimensional studyP1191Impact of interventional edge-to-edge repair with the MitraClip system on mitral valve geometry: Long-term results from a prospective single centre studyP1192Real live applications of three-dimensional echocardiographic quantification of the left atrial volumes using an automated adaptive analytics algorithmP1193Quantitative ultrasound evaluation of the changes on tissue characteristics of carotid plaques by lipid lowering therapyP1194Effort heart rate increase is an independent predictor of longitudinal function reserve in the trained heart: a stress echocardiography studyP1195Incremental value of strain imaging in classification of heart failure with normal ejection fractionP1196Multimodality work-up of young stroke patients is beneficialP1197Prognostic significance of the hemodynamic non-invasive assessment in patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Targher G, Dauriz M, Laroche C, Temporelli PL, Hassanein M, Seferovic PM, Drozdz J, Ferrari R, Anker S, Coats A, Filippatos G, Crespo‐Leiro MG, Mebazaa A, Piepoli MF, Maggioni AP, Tavazzi L, Crespo‐Leiro M, Anker S, Coats A, Ferrari R, Filippatos G, Maggioni A, Mebazaa A, Piepoli M, Amir O, Chioncel O, Dahlström U, Jimenez JD, Drozdz J, Erglis A, Fazlibegovic E, Fonseca C, Fruhwald F, Gatzov P, Goncalvesova E, Hassanein M, Hradec J, Kavoliuniene A, Lainscak M, Logeart D, Merkely B, Metra M, Otljanska M, Seferovic P, Kostovska ES, Temizhan A, Tousoulis D, Andarala M, Ferreira T, Fiorucci E, Gracia G, Laroche C, Pommier C, Taylor C, Cuculici A, Gaulhofer C, Casado EP, Szymczyk E, Ramani F, Mulak G, Schou IL, Semenka J, Stojkovic J, Mehanna R, Mizarienne V, Auer J, Ablasser K, Fruhwald F, Dolze T, Brandner K, Gstrein S, Poelzl G, Moertl D, Reiter S, Podczeck‐Schweighofer A, Muslibegovic A, Vasilj M, Fazlibegovic E, Cesko M, Zelenika D, Palic B, Pravdic D, Cuk D, Vitlianova K, Katova T, Velikov T, Kurteva T, Gatzov P, Kamenova D, Antova M, Sirakova V, Krejci J, Mikolaskova M, Spinar J, Krupicka J, Malek F, Hegarova M, Lazarova M, Monhart Z, Hassanein M, Sobhy M, El Messiry F, El Shazly A, Elrakshy Y, Youssef A, Moneim A, Noamany M, Reda A, Dayem TA, Farag N, Halawa SI, Hamid MA, Said K, Saleh A, Ebeid H, Hanna R, Aziz R, Louis O, Enen M, Ibrahim B, Nasr G, Elbahry A, Sobhy H, Ashmawy M, Gouda M, Aboleineen W, Bernard Y, Luporsi P, Meneveau N, Pillot M, Morel M, Seronde M, Schiele F, Briand F, Delahaye F, Damy T, Eicher J, Groote P, Fertin M, Lamblin N, Isnard R, Lefol C, Thevenin S, Hagege A, Jondeau G, Logeart D, Le Marcis V, Ly J, Coisne D, Lequeux B, Le Moal V, Mascle S, Lotton P, Behar N, Donal E, Thebault C, Ridard C, Reynaud A, Basquin A, Bauer F, Codjia R, Galinier M, Tourikis P, Stavroula M, Tousoulis D, Stefanadis C, Chrysohoou C, Kotrogiannis I, Matzaraki V, Dimitroula T, Karavidas A, Tsitsinakis G, Kapelios C, Nanas J, Kampouri H, Nana E, Kaldara E, Eugenidou A, Vardas P, Saloustros I, Patrianakos A, Tsaknakis T, Evangelou S, Nikoloulis N, Tziourganou H, Tsaroucha A, Papadopoulou A, Douras A, Polgar L, Merkely B, Kosztin A, Nyolczas N, Nagy AC, Halmosi R, Elber J, Alony I, Shotan A, Fuhrmann AV, Amir O, Romano S, Marcon S, Penco M, Di Mauro M, Lemme E, Carubelli V, Rovetta R, Metra M, Bulgari M, Quinzani F, Lombardi C, Bosi S, Schiavina G, Squeri A, Barbieri A, Di Tano G, Pirelli S, Ferrari R, Fucili A, Passero T, Musio S, Di Biase M, Correale M, Salvemini G, Brognoli S, Zanelli E, Giordano A, Agostoni P, Italiano G, Salvioni E, Copelli S, Modena M, Reggianini L, Valenti C, Olaru A, Bandino S, Deidda M, Mercuro G, Dessalvi CC, Marino P, Di Ruocco M, Sartori C, Piccinino C, Parrinello G, Licata G, Torres D, Giambanco S, Busalacchi S, Arrotti S, Novo S, Inciardi R, Pieri P, Chirco P, Galifi MA, Teresi G, Buccheri D, Minacapelli A, Veniani M, Frisinghelli A, Priori S, Cattaneo S, Opasich C, Gualco A, Pagliaro M, Mancone M, Fedele F, 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Dodic S, Adic NC, Cankovic M, Stojiljkovic J, Mihajlovic B, Radin A, Radovanovic S, Krotin M, Klabnik A, Goncalvesova E, Pernicky M, Murin J, Kovar F, Kmec J, Semjanova H, Strasek M, Iskra MS, Ravnikar T, Suligoj NC, Komel J, Fras Z, Jug B, Glavic T, Losic R, Bombek M, Krajnc I, Krunic B, Horvat S, Kovac D, Rajtman D, Cencic V, Letonja M, Winkler R, Valentincic M, Melihen‐Bartolic C, Bartolic A, Vrckovnik MP, Kladnik M, Pusnik CS, Marolt A, Klen J, Drnovsek B, Leskovar B, Anguita MF, Page JG, Martinez FS, Andres J, Genis A, Mirabet S, Mendez A, Garcia‐Cosio L, Roig E, Leon V, Gonzalez‐Costello J, Muntane G, Garay A, Alcade‐Martinez V, Fernandez SL, Rivera‐Lopez R, Puga‐Martinez M, Fernandez‐Alvarez M, Serrano‐Martinez J, Crespo‐Leiro M, Grille‐Cancela Z, Marzoa‐Rivas R, Blanco‐Canosa P, Paniagua‐Martin M, Barge‐Caballero E, Cerdena IL, Baldomero IFH, Padron AL, Rosillo SO, Gonzalez‐Gallarza RD, Montanes OS, Manjavacas AI, Conde AC, Araujo A, Soria T, Garcia‐Pavia P, Gomez‐Bueno M, Cobo‐Marcos M, Alonso‐Pulpon L, Cubero JS, Sayago I, Gonzalez‐Segovia A, Briceno A, Subias PE, Hernandez MV, Cano MR, Sanchez MG, Jimenez JD, Garrido‐Lestache EB, Pinilla JG, Villa BG, Sahuquillo A, Marques RB, Calvo FT, Perez‐Martinez M, Gracia‐Rodenas M, Garrido‐Bravo IP, Pastor‐Perez F, Pascual‐Figal D, Molina BD, Orus J, Gonzalo FE, Bertomeu V, Valero R, Martinez‐Abellan R, Quiles J, Rodrigez‐Ortega J, Mateo I, ElAmrani A, Fernandez‐Vivancos C, Valero DB, Almenar‐Bonet L, Sanchez‐Lazaro I, Marques‐Sule E, Facila‐Rubio L, Perez‐Silvestre J, Garcia‐Gonzalez P, Ridocci‐Soriano F, Garcia‐Escriva D, Pellicer‐Cabo A, Fuente Galan L, Diaz JL, Platero AR, Arias J, Blasco‐Peiro T, Julve MS, Sanchez‐Insa E, Aured‐Guallar C, Portoles‐Ocampo A, Melin M, Hägglund E, Stenberg A, Lindahl I, Asserlund B, Olsson L, Dahlström U, Afzelius M, Karlström P, Tengvall L, Wiklund P, Olsson B, Kalayci S, Temizhan A, Cavusoglu Y, Gencer E, Yilmaz M, Gunes H. In‐hospital and 1‐year mortality associated with diabetes in patients with acute heart failure: results from the
ESC‐HFA
Heart Failure Long‐Term Registry. Eur J Heart Fail 2016; 19:54-65. [DOI: 10.1002/ejhf.679] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [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: 05/10/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Cécile Laroche
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
| | | | | | | | | | - Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research E.S: Health Science Foundation Cotignola Italy
| | - Stephan Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Andrew Coats
- Monash University Australia and University of Warwick Coventry UK
| | | | - Maria G. Crespo‐Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna CHUAC La Coruna Spain
| | - Alexandre Mebazaa
- Inserm 942, Hôpital Lariboisière Université Paris Diderot Paris France
| | - Massimo F. Piepoli
- Department of Cardiology Polichirurgico Hospital G. da Saliceto Piacenza Italy
| | - Aldo Pietro Maggioni
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
- ANMCO Research Center Florence Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research E.S. Health Science Foundation Cotignola Italy
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Sandrucci S, Merlo M, Grignani G, Lista P, Verri A, Pau R. 756. Resection of primary leiomyosarcoma of the inferior vena cava (IVC) with reconstruction: A case series. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Marinescu C, Onciul S, Zamfir D, Tautu O, Dorobantu M, Carbonell San Roman A, Rincon Diez LM, Gonzalez Gomez A, Fernandez Santos S, Lazaro Rivera C, Moreno Vinues C, Sanmartin Fernandez M, Fernandez-Golfin C, Zamorano Gomez JL, Alirezaei T, Karimi AS, Kakiouzi V, Felekos I, Panagopoulou V, Latsios G, Karabela M, Petras D, Tousoulis D, Abid L, Abid D, Kammoun S, Ben Kahla S, Lee JW, Martin Fernandez M, Costilla Garcia SM, Diaz Pelaez E, Moris De La Tassa C. Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Losito M, Incampo E, Maccherini M, Mondillo S, Werther Evaldsson A, Radegran G, Stagmo M, Waktare J, Roijer A, Meurling CJ, Hui W, Meijboom FJ, Bijnens B, Dragulescu A, Mertens L, Friedberg MK, Sensoy B, Suleymanoglu M, Akin Y, Sahan E, Sasmaz H, Pasca L, Buzdugan E, Chis B, Stoicescu L, Lynce FC, Smith KL, Mete M, Isaacs C, Viapiana O, Di Nora C, Ognibeni F, Fracassi E, Giollo A, Mazzone C, Faganello G, Di Lenarda A, Rossini M, Galrinho A, Branco L, Timoteo AT, Rodrigues I, Daniel P, Rosa S, Ferreira L, Ferreira R, Polak L, Krauza G, Stokfisz K, Zielinska M, Branco LM, Galrinho A, Mota Carmo M, Teresa Timoteo A, Aguiar Rosa S, Abreu J, Pinto Teixeira P, Viveiros Monteiro A, Cruz Ferreira R, Peeraphatdit T, Chaiteerakij R, Klarich KW, Masia S, Necas J, Nistri S, Negri F, Barbati G, Cioffi G, Russo G, Mazzone C, Faganello G, Pandullo C, Di Lenarda A, Durante A, Rovelli E, Genchi V, Trabattoni L, Zerboni SC, Cattaneo L, Butti E, Ferrari G, Luneva E, Mitrofanova L, Uspensky V, Zemtsovsky E, Kasprzak JD, Rosner S, Karl M, Ott I, Sonne C, Ali Lahmar HM, Hammou L, Forsey J, Gowing L, Miller F, Ramanujam P, Stuart AG, Williams CA, Bandera F, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Patel NR, Raju P, Beale L, Brickley G, Lloyd GW, Fernandez-Golfin C, Gonzalez A, Rincon LM, Hinojar R, Garcia A, Megias A, Jimenez-Nacher JJ, Moya JL, Zamorano JL, Molon G, Canali G, Bonapace S, Chiampan A, Albrigi L, Barbieri E, Noris Mora M, Rodriguez Fernandez A, Exposito Pineda C, Grande C, Gonzalez Colino R, Macaya Ten F, Fernandez Vazquez X, Fortuny Frau E, Bethencourt Gonzalez A, Karvandi M, Blaszczyk R, Zarczuk R, Brzozowski W, Janowski M, Wysokinski A, Stanczyk B, Myftiu S, Teferici D, Quka A, Dado E, Djamandi J, Kresto L, Duka A, Kristo A, Balla I, Issa Z, Moiduddin N, Siblini G, Bulbul Z, Abid L, Abid D, Kammoun S, Rush E, Craft M, Goodwin J, Kreikemeier R, Cantinotti M, Kutty S, Zolaly MA, Khoshhal SQ, El-Harbi K, Tarawah A, Al-Hawsawi Z, Al-Mozainy I, Bakhoum SWG, Nabil MN, Elebrashy IN, Chinali M, Albanese S, Carotti A, Iacobelli R, Esposito C, Secinaro A, Moscogiuri G, Pasquini L, Malvezzi Caracciolo M, Bianchi RM, Caso P, Arenga F, Riegler L, Scarafile R, D'andrea A, Russo MG, Calabro' P, Simic DS, Peric VP, Mujovic NM, Marinkovic MM, Jankovic NJ, Shim A, Wejner-Mik P, Kasprzak JD, Lipiec P, Jain N, Kharwar R, Saran RK, Narain VS, Dwivedi SK, Sethi R, Chandra S, Pradhan A, Safal S, Marchetti MF, Cacace C, Congia M, Nissardi V, Ruscazio M, Meloni L, Montisci R, Gallego Sanchez G, Calero S, Portero JJ, Tercero A, Garcia JC, Barambio M, Martinez Lazaro R, Meretta AH, Perea GO, Belcastro F, Aguirre E, De Luca I, Henquin R, Masoli O. Poster session 2THE IMAGING EXAMINATIONP536Appropriate use criteria of transthoracic echocardiography and its clinical impact: a continuous challengeP537Implementation of proprietary plug-ins in the DICOM-based computerized echo reporting system fuels the use of 3D echo and deformation imaging in the clinical routine of a multivendor laboratoryP538Exercise stress echocardiography appropriate use criteria: real-life cases classification ease and agreement among cardiologistsANATOMY AND PHYSIOLOGY OF THE HEART AND GREAT VESSELSP539Functional capacity in older people with normal ejection fraction correlates with left ventricular functional reserve and carotid-femoral pulse wave velocity but not with E/e and augmentation indexP540Survey of competency of practitioners for diagnosis of acute cardiopulmonary diseases manifest on chest x-rayASSESSMENT OF DIAMETERS, VOLUMES AND MASSP541Left atrium remodeling in dialysis patients with normal ejection fractionP542The prediction of postinfarction left ventricular remodeling and the role of of leptin and MCP-1 in regard to the presence of metabolic syndromeP543Ascending aorta and common carotid artery: diameters and stiffness in a group of 584 healthy subjectsAssessments of haemodynamicsP544Alternate echo parameters in patients without estimable RVSPAssessment of systolic functionP545Reduced contractile performance in heart failure with preserved ejection fraction: determination using novel preload-adjusted maximal left ventricular ejection forceP546Left ventricular dimensions and prognosis in acute coronary syndromesP547Time course of myocardial alterations in a murine model of high fat diet: A strain rate imaging studyP548Subclinical left ventricular systolic dysfunction in patients with premature ventricular contractionsP549Global myocardial strain by CMR-based feature tracking (FT) and tagging to predict development of severe left ventricular systolic dysfunction after acute st-elevation myocardial infarctionP550Echocardiographic analysis of left and right ventricular function in patients after mitral valve reconstructionP551The role of regional longitudinal strain assessment in predicting response to cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and left bundle branch blockP552Speckle tracking automatic border detection improves echocardiographic evaluation of right ventricular systolic function in repaired tetralogy of fallot patients: comparison with MRI findingsP553Echocardiography: a reproducible and relevant tool in pah? intermediate results of the multicentric efort echogardiographic substudy (evaluation of prognostic factors and therapeutic targets in pah)Assessment of diastolic functionP554Relationship between left ventricular filling pressures and myocardial fibrosis in patients with uncomplicated arterial hypertensionP555Cardiac rehabilitation improves echocardiographic parameters of diastolic function in patients with ischemic heart diseaseP556Diastolic parameters in the calcified mitral annulusP557Biomarkers and echocardiography - combined weapon to diagnose and prognose heart failure with and without preserved ejection fractionP558Diastolic function changes of the maternal heart in twin and singleton pregnancyIschemic heart diseaseP559Syntax score as predictor for the correlation between epicardial adipose tissue and the severity of coronary lesions in patients with significant coronary diseaseP560Impact of strain analysis in ergonovine stress echocardiography for diagnosis vasospastic anginaP561Cardiac magnetic resonance tissue tracking: a novel method to predict infarct transmurality in acute myocardial infarctionP562Infarct size is correlated to global longitudinal strain but not left ventricular ejection fraction in the early stage of acute myocardial infarctionP563Magnetic resonance myocardial deformation assessment with tissue tracking and risk stratification in acute myocardial infarction patientsP564Increase in regional end-diastolic wall thickness by transthoracic echocardiography as a biomarker of successful reperfusion in anterior ST elevation acute myocardial infarctionP565Mitral regurgitation is associated with worse long-term prognosis in ST-segment elevation myocardial infarction treated with primary percutaneous coronary interventionP566Statistical significance of 3D motion and deformation indexes for the analysis of LAD infarctionHeart valve DiseasesP567Paradoxical low gradient aortic stenosis: echocardiographic progression from moderate to severe diseaseP568The beneficial effects of TAVI in mitral insufficiencyP569Impact of thoracic aortic calcification on the left ventricular hypertrophy and its regression after aortic valve replacement in patients with severe aortic stenosisP570Additional value of exercise-stress echocardiography in asymptomatic patients with aortic valve stenosisP571Valvulo-arterial impedance in severe aortic stenosis: a dual imaging modalities studyP572Left ventricular mechanics: novel tools to evaluate left ventricular performance in patients with aortic stenosisP573Comparison of long-term outcome after percutaneous mitral valvuloplasty versus mitral valve replacement in moderate to severe mitral stenosis with left ventricular dysfunctionP574Incidence of de novo left ventricular dysfunction in patient treated with aortic valve replacement for severe aortic regurgitationP575Transforming growth factor-beta dependant progression of the mitral valve prolapseP576Quantification of mitral regurgitation with multiple jets: in vitro validation of three-dimensional PISA techniqueP577Impaired pre-systolic contraction and saddle-shape deepening of mitral annulus contributes to atrial functional regurgitation: a three-dimensional echocardiographic studyP578Incidence and determinants of left ventricular (lv) reverse remodeling after MitraClip implantation in patients with moderate-to severe or severe mitral regurgitation and reduced lv ejection fractionP579Severe functional tricuspid regurgitation in rheumatic heart valve disease. New insights from 3D transthoracic echocardiographyP58015 years of evolution of the etiologic profile for prosthetic heart valve replacement through an echocardiography laboratoryP581The role of echocardiography in the differential diagnosis of prolonged fever of unknown originP582Predictive value for paravalvular regurgitation of 3-dimensional anatomic aortic annulus shape assessed by multidetector computed tomography post-transcatheter aortic valve replacementP583The significance and advantages of echo and CT imaging & measurement at transcatherter aortic valve implantation through the left common carotid accessP584Comparison of the self-expandable Medtronic CoreValve versus the balloon-expandable Edwards SAPIEN bioprostheses in high-risk patients undergoing transfemoral aortic valve implantationP585The impact of transcatheter aortic valve implantation on mitral regurgitation severityP586Echocardiographic follow up of children with valvular lesions secondary to rheumatic heart disease: Data from a prospective registryP587Valvular heart disease and different circadian blood pressure profilesCardiomyopathiesP588Comparison of transthoracic echocardiography versus cardiac magnetic for implantable cardioverter defibrillator therapy in primary prevention strategy dilated cardiomyopathy patientsP589Incidence and prognostic significance of left ventricle reverse remodeling in a cohort of patients with idiopathic dilated cardiomyopathyP590Early evaluation of diastolic function in fabry diseaseP591Echocardiographic predictors of atrial fibrillation development in hypertrophic cardiomyopathyP592Altered Torsion mechanics in patients with hypertrophic cardiomyopathy: LVOT-obstruction is the topdog?P593Prevention of sudden cardiac death in hypertrophic cardiomyopathy: what has changed in the guidelines?P594Coronary microcirculatory function as determinator of longitudinal systolic left ventricular function in hypertrophic cardiomyopathyP595Detection of subclinical myocardial dysfunction by tissue Doppler ehocardiography in patients with muscular dystrophiesP596Speckle tracking myocardial deformation analysis and three dimensional echocardiography for early detection of chemotherapy induced cardiac dysfunction in bone marrow transplantation patientsP597Left ventricular non compaction or hypertrabeculation: distinguishing between physiology and pathology in top-level athletesP598Role of multi modality imaging in familiar screening of Danon diseaseP599Early impairment of global longitudinal left ventricular systolic function independently predicts incident atrial fibrillation in type 2 diabetes mellitusP600Fetal cardiovascular programming in maternal diabetes mellitus and obesity: insights from deformation imagingP601Longitudinal strain stress echo evaluation of aged marginal donor hearts: feasibility in the Adonhers project.P602Echocardiographic evaluation of left ventricular size and function following heart transplantation - Gender mattersSystemic diseases and other conditionsP603The impact of septal kinetics on adverse ventricular-ventricular interactions in pulmonary stenosis and pulmonary arterial hypertensionP604Improvement in right ventricular mechanics after inhalation of iloprost in pulmonary hypertensionP605Does the treatment of patients with metabolic syndrome correct the right ventricular diastolic dysfunction?P606Predictors of altered cardiac function in breast cancer survivors who were treated with anthracycline-based therapyP607Prevalence and factors related to left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis: a prospective tissue-doppler echocardiography studyP608Diastolic and systolic left ventricle dysfunction presenting different prognostic implications in cardiac amyloidosisP609Diagnostic accuracy of Bedside Lung Ultrasonography in Emergency (BLUE) protocol for the diagnosis of pulmonary embolismP610Right ventricular systolic dysfunction and its incidence in breast cancer patients submitted to anthracycline therapyP611Right ventricular dysfunction is an independent predictor of survival among cirrhotic patients undergoing liver transplantCongenital heart diseaseP612Hypoplasia or absence of posterior leaflet: a rare congenital anomaly of the mitral valveP613ECHO screening for Barlow disease in proband's relativesDiseases of the aortaP614Aortic size distribution and prognosis in an unselected population of patients referred for standard transthoracic echocardiographyP615Abdominal aorta aneurysm ultrasonographic screening in a large cohort of asympromatic volounteers in an Italian urban settingP616Thoracic aortic aneurysm and left ventricular systolic functionStress echocardiographyP617Wall motion score index, systolic mitral annulus velocity and left ventricular mass predicted global longitudinal systolic strain in 238 patients examined by stress echocardiographyP618Prognostic parameters of exercise-induced severe mitral valve regurgitation and exercise-induced systolic pulmonary hypertensionP619Risk stratification after myocardial infarction: prognostic value of dobutamine stress echocardiographyP620relationship between LV and RV myocardial contractile reserve and metabolic parameters during incremental exercise and recovery in healthy children using 2-D strain analysisP621Increased peripheral extraction as a mechanism compensatory to reduced cardiac output in high risk heart failure patients with group 2 pulmonary hypertension and exercise oscillatory ventilationP622Can exercise induced changes in cardiac synchrony predict response to CRT?Transesophageal echocardiographyP623Fully-automated software for mitral valve assessment in chronic mitral regurgitation by three-dimensional transesophageal echocardiographyP624Real-time 3D transesophageal echocardiography provides more accurate orifice measurement in percutaneous transcatheter left atrial appendage closureP625Percutaneous closure of left atrial appendage: experience of 36 casesReal-time three-dimensional TEEP626Real-time three-dimensional transesophageal echocardiography during pulmonary vein cryoballoon ablation for atrial fibrilationP627Three dimensional ultrasound anatomy of intact mitral valve and in the case of type 2 disfunctionTissue Doppler and speckle trackingP629Left ventricle wall motion tracking from echocardiographic images by a non-rigid image registrationP630The first experience with the new prototype of a robotic system for remote echocardiographyP631Non-invasive PCWP influence on a loop diuretics regimen monitoring model in ADHF patients.P632Normal range of left ventricular strain, dimensions and ejection fraction using three-dimensional speckle-tracking echocardiography in neonatesP633Circumferential ascending aortic strain: new parameter in the assessment of arterial stiffness in systemic hypertensionP634Aortic vascular properties in pediatric osteogenesis imperfecta: a two-dimensional echocardiography derived aortic strain studyP635Assessment of cardiac functions in children with sickle cell anemia: doppler tissue imaging studyP636Assessment of left ventricular function in type 1 diabetes mellitus patients by two-dimensional speckle tracking echocardiography: relation to duration and control of diabetesP637A study of left ventricular torsion in l-loop ventricles using speckle-tracking echocardiographyP638Despite No-Reflow, global and regional longitudinal strains assessed by two-dimensional speckle tracking echocardiography are predictive indexes of left ventricular remodeling in patients with STEMIP639The function of reservoir of the left atrium in patients with medicaly treated arterial hypertensionP640The usefulness of speckle tracking analysis for predicting the recovery of regional systolic function after myocardial infarctionP641Two dimensional speckle tracking echocardiography in assessment of left ventricular systolic function in patients with rheumatic severe mitral regurgitation and normal ejection fractionP642The prediction of left-main and tripple vessel coronary artery disease by tissue doppler based longitudinal strain and strain rate imagingP643Role of speckle tracking in predicting arrhythmic risk and occurrence of appropriate implantable defibrillator Intervention in patients with ischemic and non-ischemic cardiomyopathyComputed Tomography & Nuclear CardiologyP644Cardiac adrenergic activity in patients with nonischemic dilated cardiomyopathy. Correlation with echocardiographyP645Different vascular territories and myocardial ischemia, there is a gradient of association? Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tong L, Huang C, Ramalli A, Tortoli P, Luo J, D'hooge J, Tzemos N, Mordi I, Bishay T, Bishay T, Negishi T, Hristova K, Kurosawa K, Bansal M, Thavendiranathan P, Yuda S, Popescu B, Vinereanu D, Penicka M, Marwick T, Hamed W, Kamel M, Yaseen R, El-Barbary H, Nemes A, Kis O, Gavaller H, Kanyo E, Forster T, Angelis A, Vlachopoulos C, Ioakimidis N, Felekos I, Chrysohoou C, Aznaouridis K, Abdelrasoul M, Terentes D, Ageli K, Stefanadis C, Kurnicka K, Domienik-Karlowicz J, Lichodziejewska B, Goliszek S, Grudzka K, Krupa M, Dzikowska-Diduch O, Ciurzynski M, Pruszczyk P, Gual Capllonch F, Lopez Ayerbe J, Teis A, Ferrer E, Vallejo N, Junca G, Pla R, Bayes-Genis A, Schwaiger J, Knight D, Gallimore A, Schreiber B, Handler C, Coghlan J, Bruno RM, Giardini G, Malacrida S, Catuzzo B, Armenia S, Brustia R, Ghiadoni L, Cauchy E, Pratali L, Kim K, Lee K, Cho J, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Cho S, Nastase O, Enache R, Mateescu A, Botezatu D, Popescu B, Ginghina C, Gu H, Sinha M, Simpson J, Chowienczyk P, Fazlinezhad A, Tashakori Behesthi A, Homaei F, Mostafavi H, Hosseini G, Bakaeiyan M, Boutsikou M, Petrou E, Dimopoulos A, Dritsas A, Leontiadis E, Karatasakis G, Sahin ST, Yurdakul S, Yilmaz N, Cengiz B, Cagatay Y, Aytekin S, Yavuz S, Karlsen S, Dahlslett T, Grenne B, Sjoli B, Smiseth O, Edvardsen T, Brunvand H, Nasr G, Nasr A, Eleraki A, Elrefai S, Mordi I, Sonecki P, Tzemos N, Gustafsson U, Naar J, Stahlberg M, Cerne A, Capotosto L, Rosato E, D'angeli I, Azzano A, Truscelli G, De Maio M, Salsano F, Terzano C, Mangieri E, Vitarelli A, Renard S, Najih H, Mancini J, Jacquier A, Haentjens J, Gaubert J, Habib G, Caminiti G, D'antoni V, D'antoni V, Cardaci V, Cardaci V, Conti V, Conti V, Volterrani M, Volterrani M, Ahn J, Kim D, Lee H, Iliuta L, Lo Iudice F, Esposito R, Lembo M, Santoro C, Ballo P, Mondillo S, De Simone G, Galderisi M, Hwang Y, Kim J, Kim J, Moon K, Yoo K, Kim C, Tagliamonte E, Rigo F, Cirillo T, Caruso A, Astarita C, Cice G, Quaranta G, Romano C, Capuano N, Calabro' R, Zagatina A, Zhuravskaya N, Guseva O, Huttin O, Benichou M, Voilliot D, Venner C, Micard E, Girerd N, Sadoul N, Moulin F, Juilliere Y, Selton-Suty C, Baron T, Christersson C, Johansson K, Flachskampf F, Lee S, Lee J, Hur S, Park J, Yun J, Song S, Kim W, Ko J, Nyktari E, Bilal S, Ali S, Izgi C, Prasad S, Aly M, Kleijn S, Kandil H, Kamp O, Beladan C, Calin A, Rosca M, Craciun A, Gurzun M, Calin C, Enache R, Mateescu A, Ginghina C, Popescu B, Mornos C, Mornos A, Ionac A, Cozma D, Crisan S, Popescu I, Ionescu G, Petrescu L, Camacho S, Gamaza Chulian S, Carmona R, Diaz E, Giraldez A, Gutierrez A, Toro R, Benezet J, Antonini-Canterin F, Vriz O, La Carrubba S, Poli S, Leiballi E, Zito C, Careri S, Caruso R, Pellegrinet M, Nicolosi G, Kong W, Kyu K, Wong R, Tay E, Yip J, Yeo T, Poh K, Correia M, Delgado A, Marmelo B, Correia E, Abreu L, Cabral C, Gama P, Santos O, Rahman M, Borges IP, Peixoto E, Peixoto R, Peixoto R, Marcolla V, Okura H, Kanai M, Murata E, Kataoka T, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Carigi S, Baldazzi F, Bologna F, Amati S, Venturi P, Grosseto D, Biagetti C, Fabbri E, Arlotti M, Piovaccari G, Rahbi H, Bin Abdulhaq A, Tleyjeh I, Santoro C, Galderisi M, Costantino M, Tarsia G, Innelli P, Dores E, Esposito G, Matera A, De Simone G, Trimarco B, Capotosto L, Azzano A, Mukred K, Ashurov R, Tanzilli G, Mangieri E, Vitarelli A, Merlo M, Gigli M, Stolfo D, Pinamonti B, Antonini Canterin F, Muca M, D'angelo G, Scapol S, Di Nucci M, Sinagra G, Behaghel A, Feneon D, Fournet M, Thebault C, Martins R, Mabo P, Leclercq C, Daubert C, Donal E, Davinder Pal S, Prakash Chand N, Sanjeev A, Rajeev M, Ankur D, Ram Gopal S, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Ben Chaabene A, Kamoun S, Mrabet K, Fennira S, Zargouni A, Kraiem S, Demkina A, Hashieva F, Krylova N, Kovalevskaya E, Potehkina N, Zaroui A, Ben Said R, Smaali S, Rekik B, Ben Hlima M, Mizouni H, Mechmeche R, Mourali M, Malhotra A, Sheikh N, Dhutia H, Siva A, Narain R, Merghani A, Millar L, Walker M, Sharma S, Papadakis M, Siam-Tsieu V, Mansencal N, Arslan M, Deblaise J, Dubourg O, Zaroui A, Rekik B, Ben Said R, Boudiche S, Larbi N, Tababi N, Hannachi S, Mechmeche R, Mourali M, Mechmeche R, Zaroui A, Chalbia T, Ben Halima M, Rekik B, Boussada R, Mourali M, Lipari P, Bonapace S, Valbusa F, Rossi A, Zenari L, Lanzoni L, Targher G, Canali G, Molon G, Barbieri E, Novo G, Giambanco S, Sutera M, Bonomo V, Giambanco F, Rotolo A, Evola S, Assennato P, Novo S, Budnik M, Piatkowski R, Kochanowski J, Opolski G, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Marketou M, Parthenakis F, Kalyva N, Pontikoglou C, Maragkoudakis S, Zacharis E, Patrianakos A, Maragoudakis F, Papadaki H, Vardas P, Rodrigues A, Perandini L, Souza T, Sa-Pinto A, Borba E, Arruda A, Furtado M, Carvalho F, Bonfa E, Andrade J, Hlubocka Z, Malinova V, Palecek T, Danzig V, Kuchynka P, Dostalova G, Zeman J, Linhart A, Chatzistamatiou E, Konstantinidis D, Memo G, Mpampatzeva Vagena I, Moustakas G, Manakos K, Trachanas K, Vergi N, Feretou A, Kallikazaros I, Corut H, Sade L, Ozin B, Atar I, Turgay O, Muderrisoglu H, Ledakowicz-Polak A, Polak L, Krauza G, Zielinska M, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Nogueira M, Branco L, Agapito A, Galrinho A, Borba A, Teixeira P, Monteiro A, Ramos R, Cacela D, Cruz Ferreira R, Guala A, Camporeale C, Tosello F, Canuto C, Ridolfi L, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Hristova K, Marinov R, Stamenov G, Mihova M, Persenska S, Racheva A, Plaskota K, Trojnarska O, Bartczak A, Grajek S, Ramush Bejiqi R, Retkoceri R, Bejiqi H, Beha A, Surdulli S, Dreyfus J, Durand-Viel G, Cimadevilla C, Brochet E, Vahanian A, Messika-Zeitoun D, Jin C, Fang F, Meng F, Kam K, Sun J, Tsui G, Wong K, Wan S, Yu C, Lee A, Cho IJ, Chung H, Heo R, Ha S, Hong G, Shim C, Chang H, Ha J, Chung N, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Alexopoulos A, Dawson D, Nihoyannopoulos P, Zainal Abidin HA, Ismail J, Arshad K, Ibrahim Z, Lim C, Abd Rahman E, Kasim S, Peteiro J, Barrio A, Escudero A, Bouzas-Mosquera A, Yanez J, Martinez D, Castro-Beiras A, Scali M, Simioniuc A, Mandoli G, Lombardo A, Massaro F, Di Bello V, Marzilli M, Dini F, Adachi H, Tomono J, Oshima S, Merchan Ortega G, Bravo Bustos D, Lazaro Garcia R, Sanchez Espino A, Macancela Quinones J, Ikuta I, Ruiz Lopez M, Valencia Serrano F, Bonaque Gonzalez J, Gomez Recio M, Romano G, D'ancona G, Pilato G, Di Gesaro G, Clemenza F, Raffa G, Scardulla C, Sciacca S, Lancellotti P, Pilato M, Addetia K, Takeuchi M, Maffessanti F, Weinert L, Hamilton J, Mor-Avi V, Lang R, Sugano A, Seo Y, Watabe H, Kakefuda Y, Aihara H, Nishina H, Ishizu T, Fumikura Y, Noguchi Y, Aonuma K, Luo X, Fang F, Lee A, Shang Q, Yu C, Sammut EC, Chabinok R, Jackson T, Siarkos M, Lee L, Carr-White G, Rajani R, Kapetanakis S, Byrne D, Walsh J, Ellis L, Mckiernan S, Norris S, King G, Murphy R, Hristova K, Katova T, Simova I, Kostova V, Shuie I, Ferferieva V, Bogdanova V, Castelon X, Nemes A, Sasi V, Domsik P, Kalapos A, Lengyel C, Orosz A, Forster T, Grapsa J, Demir O, Dawson D, Sharma R, Senior R, Nihoyannopoulos P, Pilichowska E, Zaborska B, Baran J, Stec S, Kulakowski P, Budaj A, Kosmala W, Kaye G, Saito M, Negishi K, Marwick T, Maceira Gonzalez AM, Ripoll C, Cosin-Sales J, Igual B, Salazar J, Belloch V, Dulai RS, Taylor A, Gupta S. Poster session 1: Wednesday 3 December 2014, 09:00-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014; 15:ii25-ii51. [DOI: 10.1093/ehjci/jeu248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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Furtado ARR, Parrinello L, Merlo M, Di Bella A. Primary penile adenocarcinoma with concurrent hypercalcaemia of malignancy in a dog. J Small Anim Pract 2014; 56:289-92. [PMID: 25370307 DOI: 10.1111/jsap.12285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 07/22/2014] [Accepted: 08/07/2014] [Indexed: 11/28/2022]
Abstract
A 13-year-old male neutered Siberian husky crossbreed dog was presented with a 3-week history of haematuria and penile swelling. Clinical examination and computed tomography demonstrated a soft-tissue mass located at the base of the penis without signs of other primary tumours or metastasis. Clinicopathological findings revealed paraneoplastic hypercalcaemia. Fine-needle aspiration cytology of the mass suggested an epithelial tumour with several criteria of malignancy present. Following surgical excision of the mass, the hypercalcaemia resolved. Histopathology and immunohistochemistry revealed features consistent with an adenocarcinoma. Despite thorough examination, no perineal or anal sac tumour was found. To the authors' knowledge, this is the first reported case of a penile adenocarcinoma with hypercalcaemia of malignancy.
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Affiliation(s)
- A R R Furtado
- Animal Health Trust, Lanwades Park, Kentford, Newmarket CB8 7UU
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Pau R, Merlo M, Piana R, Sandrucci S. 469. Oncovascular surgery: A new perspective facing advanced retroperitoneal and pelvic malignancies. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Yamada A, Bemrah N, Veyrand B, Pollono C, Merlo M, Desvignes V, Sirot V, Marchand P, Berrebi A, Cariou R, Antignac JP, Le Bizec B, Leblanc JC. Dietary exposure to perfluoroalkyl acids of specific French adult sub-populations: high seafood consumers, high freshwater fish consumers and pregnant women. Sci Total Environ 2014; 491-492:170-175. [PMID: 24530183 DOI: 10.1016/j.scitotenv.2014.01.089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 06/03/2023]
Abstract
Perfluoroalkyl acids (PFAAs) are globally found in various media, including food and especially fishery products. In the present study, the dietary exposure to 15 perfluoroalkyl acids was assessed for 3 French adult populations, namely high seafood consumers, high freshwater fish consumers, and pregnant women. Purified food extracts were analysed by LC-MS/MS and PFBA, PFPA, PFHxA, PFHpA, PFOA, PFNA, PFDA, PFUnA, PFTrDA, PFTeDA, PFBS, PFHxS, PFHpS, PFOS and PFDS were monitored and quantified according to the isotope dilution principle. Under lower bound (LB) hypothesis (i.e. contamination values<LOD considered as 0), high freshwater fish consumers appear as the most exposed to PFOS (7.5 ng.kg(-1) bw.d(-1)), PFUnA (1.3 ng.kg(-1) bw.d(-1)), PFDA (0.4 ng.kg(-1) bw.d(-1)) and PFHpS (0.03 ng.kg(-1) bw.d(-1)) while high seafood consumers appear as the most exposed to PFOA (1.2 ng.kg(-1) bw.d(-1)), PFNA (0.2 ng.kg(-1) bw.d(-1)) and PFHxS (0.06 ng.kg(-1) bw.d(-1)). For all considered populations, the major exposure contributors are fish, seafood and water under LB hypothesis, while dairy products, bread and crispbread are the main contributors under upper bound (UB) hypothesis. Besides this food exposure assessment, further studies are needed to assess the more global PFAA exposure, taking into account indoor and outdoor air, dust and cutaneous contact, which could be other important contributors for this particular class of chemicals.
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Affiliation(s)
- A Yamada
- Risk Assessment Directorate, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), 27-31 avenue du Général Leclerc, Maisons-Alfort 94701, France.
| | - N Bemrah
- Risk Assessment Directorate, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), 27-31 avenue du Général Leclerc, Maisons-Alfort 94701, France.
| | - B Veyrand
- LUNAM Université, Oniris, Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, Nantes 44307, France.
| | - C Pollono
- LUNAM Université, Oniris, Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, Nantes 44307, France.
| | - M Merlo
- Risk Assessment Directorate, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), 27-31 avenue du Général Leclerc, Maisons-Alfort 94701, France.
| | - V Desvignes
- Risk Assessment Directorate, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), 27-31 avenue du Général Leclerc, Maisons-Alfort 94701, France.
| | - V Sirot
- Risk Assessment Directorate, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), 27-31 avenue du Général Leclerc, Maisons-Alfort 94701, France.
| | - P Marchand
- LUNAM Université, Oniris, Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, Nantes 44307, France.
| | - A Berrebi
- Service de Gynécologie-Obstétrique, Hôpital Paule de Viguier, CHU de Toulouse, Hôtel-Dieu, 2 rue Viguerie, Toulouse cedex 9 31052, France.
| | - R Cariou
- LUNAM Université, Oniris, Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, Nantes 44307, France.
| | - J P Antignac
- LUNAM Université, Oniris, Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, Nantes 44307, France.
| | - B Le Bizec
- LUNAM Université, Oniris, Laboratoire d'Etude des Résidus et Contaminants dans les Aliments (LABERCA), USC INRA 1329, Nantes 44307, France.
| | - J C Leblanc
- Risk Assessment Directorate, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), 27-31 avenue du Général Leclerc, Maisons-Alfort 94701, France.
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Orioles M, Di Bella A, Merlo M, Ter Haar G. Ascites resulting from a ruptured perinephric pseudocyst associated with a renal cyst in a dog. Vet rec case rep 2014. [DOI: 10.1136/vetreccr-2013-000012] [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: 11/04/2022]
Affiliation(s)
- M. Orioles
- Animal Health TrustLanwades Park, Kentford, NewmarketSuffolkCB87UUUK
| | - A. Di Bella
- Department of Diagnostic ImagingVetsNow Referrals Kent, 36 Warren Road, Blue Bell HillChathamKentME5 9RDUK
| | - M. Merlo
- Department of Diagnostic ImagingVetsNow Referrals Kent, 36 Warren Road, Blue Bell HillChathamKentME5 9RDUK
| | - G. Ter Haar
- Small Animal Medicine and Surgery GroupRoyal Veterinary CollegeHawkshead Lane, North MymmsHatfieldHertfordshireAL9 7TAUK
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Tsang W, Salgo I, Gajjar M, Abduch M, Freed B, Weinert L, Lang R, Mordi I, Al-Attar N, Tzemos N, Cacicedo A, Velasco Del Castillo S, Anton Ladislao A, Aguirre Larracoechea U, Arana Achaga X, Zugazabeitia Irazabal G, Romero Pereiro A, Sadaba Sagredo M, Laraudogoitia Zaldumbide E, Lekuona Goya I, Zilberszac R, Gabriel H, Wisser W, Maurer G, Rosenhek R, Fabris E, Morosin M, Moretti M, Pinamonti B, Merlo M, Barbati G, Pappalardo A, Sinagra G. Moderated Posters session * New insights into risk stratification in valvular heart disease - Part A: 11/12/2013, 09:30-16:00 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bertrand P, Grieten L, Smeets C, Verbrugge F, Mullens W, Vrolix M, Rivero-Ayerza M, Verhaert D, Vandervoort P, Tong L, Ramalli A, Tortoli P, D'hoge J, Bajraktari G, Lindqvist P, Henein M, Obremska M, Boratynska M, Kurcz J, Zysko D, Baran T, Klinger M, Darahim K, Mueller H, Carballo D, Popova N, Vallee JP, Floria M, Chistol R, Tinica G, Grecu M, Rodriguez Serrano M, Osa-Saez A, Rueda-Soriano J, Buendia-Fuentes F, Domingo-Valero D, Igual-Munoz B, Alonso-Fernandez P, Quesada-Carmona A, Miro-Palau V, Palencia-Perez M, Bech-Hanssen O, Polte C, Lagerstrand K, Janulewicz M, Gao S, Erdogan E, Akkaya M, Bacaksiz A, Tasal A, Sonmez O, Turfan M, Kul S, Vatankulu M, Uyarel H, Goktekin O, Mincu R, Magda L, Mihaila S, Florescu M, Mihalcea D, Enescu O, Chiru A, Popescu B, Tiu C, Vinereanu D, Broch K, Kunszt G, Massey R, De Marchi S, Aakhus S, Gullestad L, Urheim S, Yuan L, Feng J, Jin X, Bombardini T, Casartelli M, Simon D, Gaspari M, Procaccio F, Hasselberg N, Haugaa K, Brunet A, Kongsgaard E, Donal E, Edvardsen T, Sahin T, Yurdakul S, Cengiz B, Bozkurt A, Aytekin S, Cesana F, Spano' F, Santambrogio G, Alloni M, Vallerio P, Salvetti M, Carerj S, Gaibazzi N, Rigo F, Moreo A, Wdowiak-Okrojek K, Michalski B, Kasprzak J, Shim A, Lipiec P, Generati G, Pellegrino M, Bandera F, Donghi V, Alfonzetti E, Guazzi M, Marcun R, Stankovic I, Farkas J, Vlahovic-Stipac A, Putnikovic B, Kadivec S, Kosnik M, Neskovic A, Lainscak M, Iliuta L, Szymanski P, Lipczynska M, Klisiewicz A, Sobieszczanska-Malek M, Zielinski T, Hoffman P, Gjerdalen GF, Hisdal J, Solberg E, Andersen T, Radunovic Z, Steine K, Svanadze A, Poteshkina N, Krylova N, Mogutova P, Shim A, Kasprzak J, Szymczyk E, Wdowiak-Okrojek K, Michalski B, Stefanczyk L, Lipiec P, Benedek T, Matei C, Jako B, Suciu Z, Benedek I, Yaroshchuk NA, Kochmasheva VV, Dityatev VP, Kerbikov OB, Przewlocka-Kosmala M, Orda A, Karolko B, Mysiak A, Kosmala W, Rechcinski T, Wierzbowska-Drabik K, Lipiec P, Chmiela M, Kasprzak J, Aziz A, Hooper J, Rayasamudra S, Uppal H, Asghar O, Potluri R, Zaroui A, Mourali M, Rezine Z, Mbarki S, Jemaa M, Aloui H, Mechmeche R, Farhati A, Gripari P, Maffessanti F, Tamborini G, Muratori M, Fusini L, Vignati C, Bartorelli A, Alamanni F, Agostoni P, Pepi M, Ruiz Ortiz M, Mesa D, Delgado M, Seoane T, Carrasco F, Martin M, Mazuelos F, Suarez De Lezo Herreros De Tejada J, Romero M, Suarez De Lezo J, Brili S, Stamatopoulos I, Misailidou M, Chrisochoou C, Christoforatou E, Stefanadis C, Ruiz Ortiz M, Mesa D, Delgado M, Martin M, Seoane T, Carrasco F, Ojeda S, Segura J, Pan M, Suarez De Lezo J, Cammalleri V, Ussia G, Muscoli S, Marchei M, Sergi D, Mazzotta E, Romeo F, Igual Munoz B, Bel Minguez A, Perez Guillen M, Maceira Gonzalez A, Monmeneu Menadas J, Hernandez Acuna C, Estornell Erill J, Lopez Lereu P, Francisco Jose Valera Martinez F, Montero Argudo A, Sunbul M, Akhundova A, Sari I, Erdogan O, Mutlu B, Cacicedo A, Velasco Del Castillo S, Anton Ladislao A, Aguirre Larracoechea U, Rodriguez Sanchez I, Subinas Elorriaga A, Oria Gonzalez G, Onaindia Gandarias J, Laraudogoitia Zaldumbide E, Lekuona Goya I, Ding W, Zhao Y, Lindqvist P, Nilson J, Winter R, Holmgren A, Ruck A, Henein M, Attenhofer Jost CH, Soyka R, Oxenius A, Kretschmar O, Valsangiacomo Buechel E, Greutmann M, Weber R, Keramida K, Kouris N, Kostopoulos V, Karidas V, Damaskos D, Makavos G, Paraskevopoulos K, Olympios C, Eskesen K, Olsen N, Fritz-Hansen T, Sogaard P, Cameli M, Lisi M, Righini F, Curci V, Massoni A, Natali B, Maccherini M, Chiavarelli M, Massetti M, Mondillo S, Mabrouk Salem Omar A, Ahmed Abdel-Rahman M, Khorshid H, Rifaie O, Santoro C, Santoro A, Ippolito R, De Palma D, De Stefano F, Muscariiello R, Galderisi M, Squeri A, Censi S, Baldelli M, Grattoni C, Cremonesi A, Bosi S, Saura Espin D, Gonzalez Canovas C, Gonzalez Carrillo J, Oliva Sandoval M, Caballero Jimenez L, Espinosa Garcia M, Garcia Navarro M, Valdes Chavarri M, De La Morena Valenzuela G, Ryu S, Shin D, Son J, Choi J, Goh C, Choi J, Park J, Hong G, Sklyanna O, Yuan L, Yuan L, Planinc I, Bagadur G, Ljubas J, Baricevic Z, Skoric B, Velagic V, Bijnens B, Milicic D, Cikes M, Gospodinova M, Chamova T, Guergueltcheva V, Ivanova R, Tournev I, Denchev S, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Calabro R, Neametalla H, Boitard S, Hamdi H, Planat-Benard V, Casteilla L, Li Z, Hagege A, Mericskay M, Menasche P, Agbulut O, Merlo M, Stolfo D, Anzini M, Negri F, Pinamonti B, Barbati G, Di Lenarda A, Sinagra G, Stolfo D, Merlo M, Pinamonti B, Gigli M, Poli S, Porto A, Di Nora C, Barbati G, Di Lenarda A, Sinagra G, Coppola C, Piscopo G, Cipresso C, Rea D, Maurea C, Esposito E, Arra C, Maurea N, Nemes A, Kalapos A, Domsik P, Forster T, Voilliot D, Huttin O, Vaugrenard T, Schwartz J, Sellal JM, Aliot E, Juilliere Y, Selton-Suty C, Sanchez Millan PJ, Cabeza Lainez P, Castillo Ortiz J, Chueca Gonzalez E, Gheorghe L, Fernandez Garcia P, Herruzo Rojas M, Del Pozo Contreras R, Fernandez Garcia M, Vazquez Garcia R, Rosca M, Popescu B, Botezatu D, Calin A, Beladan C, Gurzun M, Enache R, Ginghina C, Farouk H, Al-Maimoony T, Alhadad A, El Serafi M, Abdel Ghany M, Poorzand H, Mirfeizi S, Javanbakht A, Tellatin S, Famoso G, Dassie F, Martini C, Osto E, Maffei P, Iliceto S, Tona F, Radunovic Z, Steine K, Jedrzejewska I, Braksator W, Krol W, Swiatowiec A, Sawicki J, Kostarska-Srokosz E, Dluzniewski M, Maceira Gonzalez AM, Cosin-Sales J, Diago J, Aguilar J, Ruvira J, Monmeneu J, Igual B, Lopez-Lereu M, Estornell J, Olszanecka A, Dragan A, Kawecka-Jaszcz K, Czarnecka D, Scholz F, Gaudron P, Hu K, Liu D, Florescu C, Herrmann S, Bijnens B, Ertl G, Stoerk S, Weidemann F, Krestjyaninov M, Razin V, Gimaev R, Bogdanovic Z, Burazor I, Deljanin Ilic M, Peluso D, Muraru D, Cucchini U, Mihaila S, Casablanca S, Pigatto E, Cozzi F, Punzi L, Badano L, Iliceto S, Zhdanova E, Rameev V, Safarova A, Moisseyev S, Kobalava Z, Magnino C, Omede' P, Avenatti E, Presutti D, Losano I, Moretti C, Bucca C, Gaita F, Veglio F, Milan A, Bellsham-Revell H, Bell A, Miller O, Simpson J, Hwang Y, Kim G, Jung M, Woo G, Driessen M, Leiner T, Schoof P, Breur J, Sieswerda G, Meijboom F, Bellsham-Revell H, Hayes N, Anderson D, Austin B, Razavi R, Greil G, Simpson J, Bell A, Zhao X, Xu X, Qin Y, Szmigielski CA, Styczynski G, Sobczynska M, Placha G, Kuch-Wocial A, Ikonomidis I, Voumbourakis A, Triantafyllidi H, Pavlidis G, Varoudi M, Papadakis I, Trivilou P, Paraskevaidis I, Anastasiou-Nana M, Lekakis I, Kong W, Yip J, Ling L, Milan A, Tosello F, Leone D, Bruno G, Losano I, Avenatti E, Sabia L, Veglio F, Zaborska B, Baran J, Pilichowska-Paszkiet E, Sikora-Frac M, Michalowska I, Kulakowski P, Budaj A, Mega S, Bono M, De Francesco V, Castiglione I, Ranocchi F, Casacalenda A, Goffredo C, Patti G, Di Sciascio G, Musumeci F, Kennedy M, Waterhouse D, Sheahan R, Foley D, Mcadam B, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Calabro R, Remme EW, Smedsrud MK, Hasselberg NE, Smiseth OA, Edvardsen T, Halmai L, Nemes A, Kardos A, Neubauer S, Degiovanni A, Baduena L, Dell'era G, Occhetta E, Marino P, Hotchi J, Yamada H, Nishio S, Bando M, Hayashi S, Hirata Y, Amano R, Soeki T, Wakatsuki T, Sata M, Lamia B, Molano L, Viacroze C, Cuvelier A, Muir J, Lipczynska M, Piotr Szymanski P, Anna Klisiewicz A, Lukasz Mazurkiewicz L, Piotr Hoffman P, Van 'T Sant J, Wijers S, Ter Horst I, Leenders G, Cramer M, Doevendans P, Meine M, Hatam N, Goetzenich A, Aljalloud A, Mischke K, Hoffmann R, Autschbach R, Sikora-Frac M, Zaborska B, Maciejewski P, Bednarz B, Budaj A, Evangelista A, Torromeo C, Pandian N, Nardinocchi P, Varano V, Schiariti M, Teresi L, Puddu P, Storve S, Dalen H, Snare S, Haugen B, Torp H, Fehri W, Mahfoudhi H, Mezni F, Annabi M, Taamallah K, Dahmani R, Haggui A, Hajlaoui N, Lahidheb D, Haouala H, Colombo A, Carminati M, Maffessanti F, Gripari P, Pepi M, Lang R, Caiani E, Walker J, Abadi S, Agmon Y, Carasso S, Aronson D, Mutlak D, Lessick J, Saxena A, Ramakrishnan S, Juneja R, Ljubas J, Reskovic Luksic V, Matasic R, Pezo Nikolic B, Lovric D, Separovic Hanzevacki J, Quattrone A, Zito C, Alongi G, Vizzari G, Bitto A, De Caridi G, Greco M, Tripodi R, Pizzino G, Carerj S, Ibrahimi P, Jashari F, Johansson E, Gronlund C, Bajraktari G, Wester P, Henein M, Kosmala W, Marwick T, Souza JRM, Zacharias LGT, Geloneze B, Pareja JC, Chaim A, Nadruz WJ, Coelho OR, Apostolovic S, Stanojevic D, Jankovic-Tomasevic R, Salinger-Martinovic S, Djordjevic-Radojkovic D, Pavlovic M, Tahirovic E, Musial-Bright L, Lainscak M, Duengen H, Filipiak D, Kasprzak J, Lipiec P. Poster session Wednesday 11 December all day display: 11/12/2013, 09:30-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stolfo D, Merlo M, Pinamonti B, Barbati G, Di Lenarda A, Sinagra G. Evolution of left ventricular sphericity index in idiopathic dilated cardiomyopathy: clinical and prognostic implications. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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