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Banovic M, Iung B, Putnik S, Mahendiran T, Vanderheyden M, Barbato E, Bartunek J. Asymptomatic Aortic Stenosis: From Risk Stratification to Treatment. Am J Cardiol 2024; 218:51-62. [PMID: 38432341 DOI: 10.1016/j.amjcard.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Our understanding of the natural history of aortic stenosis has significantly increased over the last decade. There have been considerable advances in the diagnosis and risk stratification of patients with aortic stenosis and in surgical and anesthetic techniques. In addition, transcatheter aortic valve replacement has established itself as a viable alternative to surgical management. Inevitably, these developments have raised questions regarding the merits of waiting for symptom onset in asymptomatic patients with severe aortic stenosis before offering treatment. Recent observational and randomized trial data suggest that early intervention in asymptomatic patients with severe aortic stenosis and normal left ventricular function may confer a prognostic advantage to a watchful waiting strategy. In this review, we highlight advances in the management and risk stratification of patients with asymptomatic severe aortic stenosis with particular consideration of recent findings supporting early valvular intervention.
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Affiliation(s)
- Marko Banovic
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia; Belgrade Medical Faculty, University of Belgrade, Serbia.
| | - Bernard Iung
- Cardiology Department, Bichat Hospital APHP and Université Paris Cité, France
| | - Svetozar Putnik
- Belgrade Medical Faculty, University of Belgrade, Serbia; Cardiac-Surgery Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Thabo Mahendiran
- Cardiovascular Center, OLV Hospital, Aalst, Belgium; Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Emanuele Barbato
- Cardiovascular Center, OLV Hospital, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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Patel RB, Silvestry FE, Komtebedde J, Solomon SD, Hasenfuß G, Litwin SE, Borlaug BA, Price MJ, Kawash R, Hummel SL, Cutlip DE, Leon MB, van Veldhuisen DJ, Rieth AJ, McKenzie S, Bugger H, Mazurek JA, Kapadia SR, Vanderheyden M, Ky B, Shah SJ. Atrial Shunt Device Effects on Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction: The REDUCE LAP-HF II Randomized Clinical Trial. JAMA Cardiol 2024:2817472. [PMID: 38630494 PMCID: PMC11024798 DOI: 10.1001/jamacardio.2024.0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/10/2024] [Indexed: 04/19/2024]
Abstract
Importance Although the results of A Study to Evaluate the Corvia Medical Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure (REDUCE LAP-HF II) trial were neutral overall, atrial shunt therapy demonstrated potential efficacy in responders (no latent pulmonary vascular disease and no cardiac rhythm management device). Post hoc analyses were conducted to evaluate the effect of shunt vs sham stratified by responder status. Objective To evaluate the effect of atrial shunt vs sham control on cardiac structure/function in the overall study and stratified by responder status. Design, Setting, and Participants This was a sham-controlled randomized clinical trial of an atrial shunt device in heart failure with preserved ejection fraction (HFpEF)/HF with mildly reduced EF (HFmrEF). Trial participants with evaluable echocardiography scans were recruited from 89 international medical centers. Data were analyzed from April 2023 to January 2024. Interventions Atrial shunt device or sham control. Main Outcome Measures Changes in echocardiographic measures from baseline to 1, 6, 12, and 24 months after index procedure. Results The modified intention-to-treat analysis of the REDUCE LAP-HF II trial included 621 randomized patients (median [IQR] age, 72.0 [66.0-77.0] years; 382 female [61.5%]; shunt arm, 309 [49.8%]; sham control arm, 312 [50.2%]). Through 24 months, 212 of 217 patients (98%) in the shunt arm with evaluable echocardiograms had patent shunts. In the overall trial population, the shunt reduced left ventricular (LV) end-diastolic volume (mean difference, -5.65 mL; P <.001), left atrial (LA) minimal volume (mean difference, -2.8 mL; P =.01), and improved LV systolic tissue Doppler velocity (mean difference, 0.69 cm/s; P <.001) and LA emptying fraction (mean difference, 1.88 percentage units; P =.02) compared with sham. Shunt treatment also increased right ventricular (RV; mean difference, 9.58 mL; P <.001) and right atrial (RA; mean difference, 9.71 mL; P <.001) volumes but had no effect on RV systolic function, pulmonary artery pressure, or RA pressure compared with sham. In the shunt arm, responders had smaller increases in RV end-diastolic volume (mean difference, 5.71 mL vs 15.18 mL; interaction P =.01), RV end-systolic volume (mean difference, 1.58 mL vs 7.89 mL; interaction P =.002), and RV/LV ratio (mean difference, 0.07 vs 0.20; interaction P <.001) and larger increases in transmitral A wave velocity (mean difference, 5.08 cm/s vs -1.97 cm/s; interaction P =.02) compared with nonresponders randomized to the shunt, suggesting greater ability to accommodate shunted blood through the pulmonary circulation enabling LA unloading. Conclusions and Relevance In this post hoc analysis of the REDUCE LAP-HF II trial, over 2 years of follow-up, atrial shunting led to reverse remodeling of left-sided chambers and increases in volume of right-sided chambers consistent with the shunt flow but no change in RV systolic function compared with sham. Changes in cardiac structure/function were more favorable in responders compared with nonresponders treated with the shunt, supporting the previously identified responder group hypothesis and mechanism, although further evaluation with longer follow-up is needed. Trial Registration ClinicalTrials.gov Identifier: NCT03088033.
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Affiliation(s)
- Ravi B. Patel
- Bluhm Cardiovascular Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frank E. Silvestry
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia
| | | | - Scott D. Solomon
- Division of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Gerd Hasenfuß
- Heart Centre, Georg-August Universitat, Gottigen, Germany
| | - Sheldon E. Litwin
- Medical University of South Carolina and Ralph H. Johnson Veterans Affairs Medical Center, Charleston
| | - Barry A. Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Rami Kawash
- Division of Cardiology, Ohio State Wexner Medical Center, Columbus
| | - Scott L. Hummel
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor
- VA Ann Arbor, Ann Arbor, Michigan
| | - Donald E. Cutlip
- Division of Cardiology, Beth Israel Medical Center, Boston, Massachusetts
| | | | - Dirk J. van Veldhuisen
- Department of Cardiology, University Medical Center, University of Groningen, Groningen, the Netherlands
| | - Andreas J. Rieth
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Scott McKenzie
- The Prince Charles Hospital, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Heiko Bugger
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Jeremy A. Mazurek
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | | | | | - Bonnie Ky
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia
| | - Sanjiv J. Shah
- Bluhm Cardiovascular Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Belmonte M, Paolisso P, Bertolone DT, Viscusi MM, Gallinoro E, de Oliveira EK, Shumkova M, Beles M, Esposito G, Addeo L, Botti G, Moya A, Leone A, Wyffels E, De Bruyne B, van Camp G, Bartunek J, Barbato E, Penicka M, Vanderheyden M. Combined Cardiac Damage Staging by Echocardiography and Cardiac Catheterization in Patients With Clinically Significant Aortic Stenosis. Can J Cardiol 2024; 40:643-654. [PMID: 37979721 DOI: 10.1016/j.cjca.2023.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Cardiac damage (CD) staging enhances risk stratification in patients with clinically significant aortic stenosis (AS). We aimed to assess the prognostic value and reclassification rate of right heart catheterization (RHC) compared with transthoracic echocardiography (TTE) in characterising CD staging at 3-year follow-up in patients with clinically significant AS, to identify patients that would benefit from RHC for prognostic stratification, and to test the prognostic value of combined CD staging. METHODS An observational cohort study of 432 AS patients undergoing TTE and RHC were divided into moderate or asymptomatic severe (m/asAS) and symptomatic severe (ssAS) AS. Kaplan-Meier curves were used to compare survival. The accuracy in prognostic stratification was tested by area under the receiver operating characteristic curve analysis and Delong test. RESULTS In both cohorts, TTE- and RHC-derived staging systems had prognostic value, although the agreement between them appeared moderate. A higher proportion of patients were assigned to stage 2 by TTE than by RHC. Patients in TTE-derived stage 2 had a high reclassification rate, with 40%-50% presenting with right chamber involvement (stages 3-4) according to RHC. Discordant cases were significantly older, with higher prevalence of atrial fibrillation, markedly elevated N-terminal pro-B-type natriuretic peptide, and higher indexed left atrial volume, E/e', and systolic pulmonary artery pressure vs concordant cases (P < 0.05). The combined CD staging, integrating TTE and RHC, was more accurate in predicting mortality than the TTE-derived system (P < 0.05). CONCLUSIONS In patients with m/asAS and ssAS, the combined CD staging, derived from TTE and RHC, was more accurate in predicting mortality than TTE alone. In a subset of AS patients, the integration of RHC may significantly improve prognostic stratification.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Elayne Kelen de Oliveira
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Monika Beles
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Lucio Addeo
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Giulia Botti
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ana Moya
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Guy van Camp
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Scarsini R, Gallinoro E, Ancona MB, Portolan L, Paolisso P, Springhetti P, Della Mora F, Mainardi A, Belmonte M, Moroni F, Ferri LA, Bellini B, Russo F, Vella C, Bertolone DT, Pesarini G, Benfari G, Vanderheyden M, Montorfano M, De Bruyne B, Barbato E, Ribichini F. Characterisation of coronary microvascular dysfunction in patients with severe aortic stenosis undergoing TAVI. EUROINTERVENTION 2024; 20:e289-e300. [PMID: 37982178 PMCID: PMC10905195 DOI: 10.4244/eij-d-23-00735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/27/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Microvascular resistance reserve (MRR) is a validated measure of coronary microvascular function independent of epicardial resistances. AIMS We sought to assess whether MRR is associated with adverse cardiac remodelling, a low-flow phenotype and extravalvular cardiac damage (EVCD) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). METHODS Invasive thermodilution-based assessment of the coronary microvascular function of the left anterior descending artery was performed in a prospective, multicentre cohort of patients undergoing TAVI. Coronary microvascular dysfunction (CMD) was defined as the lowest MRR tertile of the study cohort. Haemodynamic measurements were performed at baseline and then repeated immediately after TAVI. EVCD and markers of a low-flow phenotype were assessed with echocardiography. RESULTS A total of 134 patients were included in this study. Patients with low MRR were more frequently females, had a lower estimated glomerular filtration rate and a higher rate of atrial fibrillation. MRR was significantly lower in patients with advanced EVCD (median 1.80 [1.26-3.30] vs 2.50 [1.87-3.41]; p=0.038) and in low-flow, low-gradient AS (LF LG-AS) (median 1.85 [1.20-3.04] vs 2.50 [1.87-3.40]; p=0.008). Overall, coronary microvascular function tended to improve after TAVI and, in particular, MRR increased significantly after TAVI in the subgroup with low MRR at baseline. However, MRR was significantly impaired in 38 (28.4%) patients immediately after TAVI. Advanced EVCD (adjusted odds ratio 3.08 [1.22-7.76]; p=0.017) and a low-flow phenotype (adjusted odds ratio 3.36 [1.08-10.47]; p=0.036) were significant predictors of CMD. CONCLUSIONS In this observational, hypothesis-generating study, CMD was associated with extravalvular cardiac damage and a low-flow phenotype in patients with severe AS undergoing TAVI.
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Affiliation(s)
- Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Division of University Cardiology, IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Portolan
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Paolo Springhetti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Della Mora
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca A Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Vella
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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5
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Belmonte M, Paolisso P, Gallinoro E, Bertolone DT, Caglioni S, Leone A, De Colle C, Viscusi MM, Bermpeis K, Storozhenko T, Mileva N, Sonck J, Wyffels E, Vanderheyden M, Collet C, De Bruyne B, Andreini D, Penicka M, Barbato E. Predictors of percutaneous coronary intervention derived from CCTA in patients with chronic coronary syndrome. J Cardiovasc Comput Tomogr 2024; 18:154-161. [PMID: 38238196 DOI: 10.1016/j.jcct.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/23/2023] [Accepted: 01/06/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND To identify anatomical and morphological plaque features predictors of PCI and create a multiparametric score to increase the predictive yield. Moreover, we assessed the incremental predictive value of FFRCT (Fractional Flow Reserve derived from CCTA) trans-lesion gradient (ΔFFRCT) when integrated into the score. METHODS Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with FFRCT available, referred to invasive coronary angiogram and assessment of fractional flow reserve. Plaque analysis was performed using validated semi-automated software. Logistic regression was performed to identify anatomical and morphological plaque features predictive of PCI. Optimal thresholds were defined by area under the receiver-operating characteristics curve (AUC) analysis. A scoring system was developed in a derivation cohort (70 % of the study population) and tested in a validation cohort (30 % of patients). RESULTS The overall study population included 340 patients (455 vessels), among which 238 patients (320 vessels) were included in the derivation cohort. At multivariate logistic regression analysis, absence of left main disease, diameter stenosis (DS), non-calcified plaque (NCP) volume, and percent atheroma volume (PAV) were independent predictors of PCI. Optimal thresholds were: DS ≥ 50 %, volume of NCP>113 mm3 and PAV>17 %. A weighted score (CT-PCI Score) ranging from 0 to 11 was obtained. The AUC of the score was 0.80 (95%CI 0.74-0.86). The integration of ΔFFRCT in the CT-PCI score led to a mild albeit not significant increase in the AUC (0.82, 95%CI 0.77-0.87, p = 0.328). CONCLUSIONS Plaque anatomy and morphology derived from CCTA could aid in identifying patients amenable to PCI.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Serena Caglioni
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Cona, Ferrara, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Niya Mileva
- Specialized Cardiovascular Hospital "Medica Cor", Ruse, Bulgaria; Medical University of Sofia, Sofia, Bulgaria
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniele Andreini
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
| | - Emanuele Barbato
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy.
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6
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Herman R, Meyers HP, Smith SW, Bertolone DT, Leone A, Bermpeis K, Viscusi MM, Belmonte M, Demolder A, Boza V, Vavrik B, Kresnakova V, Iring A, Martonak M, Bahyl J, Kisova T, Schelfaut D, Vanderheyden M, Perl L, Aslanger EK, Hatala R, Wojakowski W, Bartunek J, Barbato E. International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardial infarction. Eur Heart J Digit Health 2024; 5:123-133. [PMID: 38505483 PMCID: PMC10944682 DOI: 10.1093/ehjdh/ztad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/13/2023] [Accepted: 11/02/2023] [Indexed: 03/21/2024]
Abstract
Aims A majority of acute coronary syndromes (ACS) present without typical ST elevation. One-third of non-ST-elevation myocardial infarction (NSTEMI) patients have an acutely occluded culprit coronary artery [occlusion myocardial infarction (OMI)], leading to poor outcomes due to delayed identification and invasive management. In this study, we sought to develop a versatile artificial intelligence (AI) model detecting acute OMI on single-standard 12-lead electrocardiograms (ECGs) and compare its performance with existing state-of-the-art diagnostic criteria. Methods and results An AI model was developed using 18 616 ECGs from 10 543 patients with suspected ACS from an international database with clinically validated outcomes. The model was evaluated in an international cohort and compared with STEMI criteria and ECG experts in detecting OMI. The primary outcome of OMI was an acutely occluded or flow-limiting culprit artery requiring emergent revascularization. In the overall test set of 3254 ECGs from 2222 patients (age 62 ± 14 years, 67% males, 21.6% OMI), the AI model achieved an area under the curve of 0.938 [95% confidence interval (CI): 0.924-0.951] in identifying the primary OMI outcome, with superior performance [accuracy 90.9% (95% CI: 89.7-92.0), sensitivity 80.6% (95% CI: 76.8-84.0), and specificity 93.7 (95% CI: 92.6-94.8)] compared with STEMI criteria [accuracy 83.6% (95% CI: 82.1-85.1), sensitivity 32.5% (95% CI: 28.4-36.6), and specificity 97.7% (95% CI: 97.0-98.3)] and with similar performance compared with ECG experts [accuracy 90.8% (95% CI: 89.5-91.9), sensitivity 73.0% (95% CI: 68.7-77.0), and specificity 95.7% (95% CI: 94.7-96.6)]. Conclusion The present novel ECG AI model demonstrates superior accuracy to detect acute OMI when compared with STEMI criteria. This suggests its potential to improve ACS triage, ensuring appropriate and timely referral for immediate revascularization.
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Affiliation(s)
- Robert Herman
- Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy
- Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium
- Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia
| | | | - Stephen W Smith
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Dario T Bertolone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy
- Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy
- Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Konstantinos Bermpeis
- Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy
- Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Michele M Viscusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy
- Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Marta Belmonte
- Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy
- Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | | | - Vladimir Boza
- Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia
- Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Bratislava, Slovakia
| | - Boris Vavrik
- Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia
| | - Viera Kresnakova
- Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia
- Department of Cybernetics and Artificial Intelligence, Technical University of Kosice, Kosice, Slovakia
| | - Andrej Iring
- Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia
| | - Michal Martonak
- Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia
| | - Jakub Bahyl
- Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia
| | - Timea Kisova
- Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia
- Faculty of Medicine and Dentistry, Barts and The London School of Medicine and Dentistry, London, UK
| | - Dan Schelfaut
- Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Marc Vanderheyden
- Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petah Tikvah, Israel
| | - Emre K Aslanger
- Department of Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Robert Hatala
- Department of Arrhythmia and Pacing, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Jozef Bartunek
- Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Yamada S, Bartunek J, Povsic TJ, Cotter G, Davison BA, Edwards C, Behfar A, Metra M, Filippatos GS, Vanderheyden M, Wijns W, Terzic A. Cell Therapy Improves Quality-of-Life in Heart Failure: Outcomes From a Phase III Clinical Trial. Stem Cells Transl Med 2024; 13:116-124. [PMID: 38006196 PMCID: PMC10872684 DOI: 10.1093/stcltm/szad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/13/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with heart failure experience limitations in daily activity and poor quality-of-life. Prospective surveillance of health-related quality-of-life supplemented traditional death and hospitalization outcomes in the multinational, randomized, double-blinded CHART-1 clinical trial that assessed cardiopoiesis-guided cell therapy in ischemic heart failure patients with reduced left ventricular ejection fraction. The Minnesota Living with Heart Failure Questionnaire (MLHFQ), a Food and Drug Administration qualified instrument for evaluating therapeutic effectiveness, was applied through the 1-year follow-up. Cell treated (n = 109) and sham procedure (n = 140) cohorts reported improved MLHFQ scores comparable between the 2 study arms (mean treatment difference with baseline adjustment -3.2 points, P = .107). Superiority of cell treatment over sham in betterment of the MLHFQ score was demonstrated in patients with pre-existing advanced left ventricular enlargement (baseline-adjusted mean treatment difference -6.4 points, P = .009). In this highly responsive subpopulation, benefit on the MLHFQ score paralleled reduction in death and hospitalization post-cell therapy (adjusted Mann-Whitney odds 1.43, 95% CI, 1.01-2.01; P = .039). The potential of cell therapy in addressing the quality-of-life dimension of heart failure requires further evaluation for disease relief.
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Affiliation(s)
- Satsuki Yamada
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas J Povsic
- Program for Advanced Coronary Disease, Duke Clinical Research Institute and Duke University Medical Center, Durham, NC, USA
| | - Gad Cotter
- Momentum Research, Inc., Durham, NC, USA
- Université Paris Cité; Inserm UMR-S 942, MASCOT, Paris, France
| | - Beth A Davison
- Momentum Research, Inc., Durham, NC, USA
- Université Paris Cité; Inserm UMR-S 942, MASCOT, Paris, France
| | | | - Atta Behfar
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Spedali Civili, Brescia, Italy
| | - Gerasimos S Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | | | - William Wijns
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Andre Terzic
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
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Claeys MJ, Aminian A, Bartunek J, Bennett J, Buysschaert I, Claeys M, De Bock D, Delodder L, Debonnaire P, Dewilde W, Ferdinande B, Geerinck S, Goetschalckx K, Lambrechts O, Lochy S, Paelinck BP, Rosseel L, Stroobants D, Vanderheyden M, Van der Heyden J, Verbrugghe P, Verheye S, Dubois C. Bleeding and thrombotic risk of different antiplatelet regimens posttranscatheter edge-to-edge mitral valve repair in patients with an indication for oral anticoagulation: Results from an all-comers national registry. Catheter Cardiovasc Interv 2024; 103:382-388. [PMID: 38078877 DOI: 10.1002/ccd.30931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/01/2023] [Accepted: 11/23/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Evidence-based recommendations for antithrombotic treatment in patients who have an indication for oral anticoagulation (OAC) after transcatheter edge-to-edge mitral valve repair (TEER) are lacking. AIMS To compare bleeding and thrombotic risk for different antithrombotic regimens post-TEER with MitraClip in an unselected population with the need for OACs. METHODS Bleeding and thrombotic complications (stroke and myocardial infarction) up to 3 months after TEER with mitraclip were evaluated in 322 consecutive pts with an indication for OACs. These endpoints were defined by the Mitral Valve Academic Research Consortium criteria and were compared between two antithrombotic regimens: single antithrombotic therapy with OAC (single ATT) and double/triple ATT with a combination of OAC and aspirin and/or clopidogrel (combined ATT). RESULTS Collectively, 108 (34%) patients received single ATT, 203 (63%) received double ATT and 11 (3%) received triple ATT. Bleeding events occurred in 67 patients (20.9%), with access site related events being the most frequent cause (37%). Bleeding complications were observed more frequently in the combined ATT group than in the single ATT group: 24% versus 14% [p = 0.03, adjusted RR: 0.55 (0.3-0.98)]. Within the combined group, the bleeding risk was 23% in the double ATT and 45% in the triple ATT group. Thrombotic complications occurred in only three patients (0.9%), and all belonged to the combined ATT group. CONCLUSIONS In patients with an indication for OACs, withholding of antiplatelet therapy post-TEER with Mitraclip was associated with a 45% reduction in bleeding and without a signal of increased thrombotic risk.
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Affiliation(s)
- Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier, Universitaire de Charleroi, Charleroi, Belgium
| | - Jozef Bartunek
- Department of Cardiology, OLV Hospital Aalst, Aalst, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ian Buysschaert
- Department of Cardiology, Hospital Sint-Jan Brugge, Bruges, Belgium
| | - Mathias Claeys
- Department of Cardiology, Hospital Sint-Jan Brugge, Bruges, Belgium
| | - Dina De Bock
- Deptartment of Cardiovascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Lies Delodder
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | | | - Willem Dewilde
- Department of Cardiology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | | | - Kaatje Goetschalckx
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Stijn Lochy
- Department of Cardiology, Brussels University Hospital, Brussels, Belgium
| | | | | | | | | | | | - Peter Verbrugghe
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Stefan Verheye
- Department of Cardiology, ZAS Hospital, Antwerp, Belgium
| | - Christophe Dubois
- Department of Cardiovascular Medicine, UZ Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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9
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Scisciola L, Paolisso P, Belmonte M, Gallinoro E, Delrue L, Taktaz F, Fontanella RA, Degrieck I, Pesapane A, Casselman F, Puocci A, Franzese M, Van Praet F, Torella M, Marfella R, De Feo M, Bartunek J, Paolisso G, Barbato E, Barbieri M, Vanderheyden M. Myocardial sodium-glucose cotransporter 2 expression and cardiac remodelling in patients with severe aortic stenosis: The BIO-AS study. Eur J Heart Fail 2024; 26:471-482. [PMID: 38247224 DOI: 10.1002/ejhf.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
AIM Cardiac remodelling plays a major role in the prognosis of patients with aortic stenosis (AS) and could impact the benefits of aortic valve replacement. Our study aimed to evaluate the expression of sodium-glucose cotransporter 2 (SGLT2) gene and protein in patients with severe AS stratified in high gradient (HG) and low flow-low gradient (LF-LG) AS and its association with cardiac functional impairments. METHODS AND RESULTS Gene expression and protein levels of main biomarkers of cardiac fibrosis (galectin-3, sST2, serpin-4, procollagen type I amino-terminal peptide, procollagen type I carboxy-terminal propeptide, collagen, transforming growth factor [TGF]-β), inflammation (growth differentiation factor-15, interleukin-6, nuclear factor-κB [NF-κB]), oxidative stress (superoxide dismutase 1 [SOD1] and 2 [SOD2]), and cardiac metabolism (sodium-hydrogen exchanger, peroxisome proliferator-activated receptor [PPAR]-α, PPAR-γ, glucose transporter 1 [GLUT1] and 4 [GLUT4]) were evaluated in blood samples and heart biopsies of 45 patients with AS. Our study showed SGLT2 gene and protein hyper-expression in patients with LF-LG AS, compared to controls and HG AS (p < 0.05). These differences remained significant even after adjusting for age, gender, body mass index, history of diabetes mellitus, arterial hypertension, and coronary artery disease. SGLT2 gene expression was positively correlated with: (i) TGF-β (r = 0.72, p < 0.001) and collagen (r = 0.73, p < 0.001) as markers of fibrosis; (ii) NF-κB (r = 0.36, p < 0.01) and myocardial interleukin-6 (r = 0.68, p < 0.001) as markers of inflammation: (iii) SOD2 (r = -0.38, p < 0.006) as a marker of oxidative stress; (iv) GLUT4 (r = 0.33, p < 0.02) and PPAR-α (r = 0.36, p < 0.01) as markers of cardiac metabolism. CONCLUSION In patients with LF-LG AS, SGLT2 gene and protein were hyper-expressed in cardiomyocytes and associated with myocardial fibrosis, inflammation, and oxidative stress.
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Affiliation(s)
- Lucia Scisciola
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Emanuele Gallinoro
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Leen Delrue
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Fatemeh Taktaz
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Rosaria Anna Fontanella
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Ivan Degrieck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Ada Pesapane
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Armando Puocci
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Martina Franzese
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Michele Torella
- Department of Translation Medical Science, University of Campania 'Luigi Vanvitelli' and Monaldi Hospital, Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marisa De Feo
- Department of Translation Medical Science, University of Campania 'Luigi Vanvitelli' and Monaldi Hospital, Naples, Italy
| | | | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
- UniCamillus, International Medical University, Rome, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Paolisso P, Gallinoro E, Belmonte M, Bertolone DT, Bermpeis K, De Colle C, Shumkova M, Leone A, Caglioni S, Esposito G, Fabbricatore D, Moya A, Delrue L, Penicka M, De Bruyne B, Barbato E, Bartunek J, Vanderheyden M. Coronary Microvascular Dysfunction in Patients With Heart Failure: Characterization of Patterns in HFrEF Versus HFpEF. Circ Heart Fail 2024; 17:e010805. [PMID: 38108151 DOI: 10.1161/circheartfailure.123.010805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/18/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is involved in heart failure (HF) onset and progression, independently of HF phenotype and obstructive coronary artery disease. Invasive assessment of CMD might provide insights into phenotyping and prognosis of patients with HF. We aimed to assess absolute coronary flow, absolute microvascular resistance, myocardial perfusion, coronary flow reserve, and microvascular resistance reserve in patients with HF with preserved ejection fraction and HF with reduced ejection fraction (HFrEF). METHODS Single-center, prospective study of 56 consecutive patients with de novo HF with nonobstructive coronary artery disease divided into HF with preserved ejection fraction (n=21) and HFrEF (n=35). CMD was invasively assessed by continuous intracoronary thermodilution and defined as coronary flow reserve <2.5. Left ventricular and left anterior descending artery-related myocardial mass was quantified by echocardiography and coronary computed tomography angiography. Myocardial perfusion (mL/min per g) was calculated as the ratio between absolute coronary flow and left anterior descending artery-related mass. RESULTS Patients with HFrEF showed a higher left ventricular and left anterior descending artery-related myocardial mass compared with HF with preserved ejection fraction (P<0.010). Overall, 52% of the study population had CMD, with a similar prevalence between the 2 groups. In HFrEF, CMD was characterized by lower absolute microvascular resistance and higher absolute coronary flow at rest (functional CMD; P=0.002). CMD was an independent predictor of a lower rate of left ventricular reverse remodeling at follow-up. In patients with HF with preserved ejection fraction, CMD was mainly due to higher absolute microvascular resistance and lower absolute coronary flow during hyperemia (structural CMD; P≤0.030). CONCLUSIONS Continuous intracoronary thermodilution allows the definition and characterization of patterns with distinct CMD in patients with HF and could identify patients with HFrEF with a higher rate of left ventricular reverse remodeling at follow-up.
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Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Cardiology Unit, Galeazzi-Sant'Ambrogio Hospital, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS), Milan, Italy (E.G.)
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Konstantinos Bermpeis
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Monika Shumkova
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Serena Caglioni
- Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Italy (S.C.)
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Ana Moya
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Leen Delrue
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Cardiology, Lausanne University Hospital, Switzerland (B.D.B.)
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy (E.B.)
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Marc Vanderheyden
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
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De Roo E, Van Ryckeghem F, Kympers C, Vanderheyden M, Heyse A. Metastatic tumour of the heart as an unusual cause of ST elevation. Hellenic J Cardiol 2024; 75:103-104. [PMID: 37597769 DOI: 10.1016/j.hjc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Affiliation(s)
- Evelien De Roo
- Department of Internal Medicine, AZ Glorieux, Ronse, Belgium
| | | | - Celine Kympers
- Department of Geriatric Medicine, AZ Glorieux, Ronse, Belgium
| | | | - Alex Heyse
- Department of Cardiology, AZ Glorieux, Ronse, Belgium.
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12
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Bertolone DT, Paolisso P, Gallinoro E, Belmonte M, Bermpeis K, De Colle C, Esposito G, Caglioni S, Fabbricatore D, Leone A, Valeriano C, Shumkova M, Storozhenko T, Viscusi MM, Botti G, Verstreken S, Morisco C, Barbato E, Bartunek J, Vanderheyden M. Innovative Device-Based Strategies for Managing Acute Decompensated Heart Failure. Curr Probl Cardiol 2023; 48:102023. [PMID: 37553060 DOI: 10.1016/j.cpcardiol.2023.102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
Acute decompensated heart failure (ADHF) is a major cause of hospitalizations in older adults, leading to high mortality, morbidity, and healthcare costs. To address the persistent poor outcomes in ADHF, novel device-based approaches targeting specific pathophysiological mechanisms are urgently needed. The recently introduced DRI2P2S classification categorizes these innovative therapies based on their mechanisms. Devices include dilators (increasing venous capacitance), removers (directly removing sodium and water), inotropes (enhancing left ventricular contractility), interstitials (accelerating lymph removal), pushers (increasing renal arterial pressure), pullers (decreasing renal venous pressure), and selective drippers (selective intrarenal drug infusion). Some are tailored for chronic HF, while others focus on the acute setting. Most devices are in early development, necessitating further research to understand mechanisms, assess clinical effectiveness, and ensure safety before routine use in ADHF management. Exploring these innovative device-based strategies may lead to improved outcomes and revolutionize HF treatment in the future.
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Affiliation(s)
- Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy; Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | | | - Cristina De Colle
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | | | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Chiara Valeriano
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | | | | | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Giulia Botti
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
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Moya A, Oeste CL, Beles M, Verstreken S, Dierckx R, Heggermont W, Bartunek J, Bogaerts E, Masuy I, Hens D, Bertolone D, Vanderheyden M. Detection of transthyretin amyloid cardiomyopathy by automated data extraction from electronic health records. ESC Heart Fail 2023; 10:3483-3492. [PMID: 37726928 PMCID: PMC10682883 DOI: 10.1002/ehf2.14517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS Transthyretin amyloid cardiomyopathy (ATTR-CM), a progressive and fatal cardiomyopathy, is frequently misdiagnosed or entails diagnostic delays, hindering patients from timely treatment. This study aimed to generate a systematic framework based on data from electronic health records (EHRs) to assess patients with ATTR-CM in a real-world population of heart failure (HF) patients. Predictive factors or combinations of predictive factors related to ATTR-CM in a European population were also assessed. METHODS AND RESULTS Retrospective unstructured and semi-structured data from EHRs of patients from OLV Hospital Aalst, Belgium (2012-20), were processed using natural language processing (NLP) to generate an Observational Medical Outcomes Partnership Common Data Model database. NLP model performance was assessed on a random subset of EHRs by comparing algorithm outputs to a physician-generated standard (using precision, recall, and their harmonic mean, or F1-score). Of the 3127 HF patients, 103 potentially had ATTR-CM (age 78 ± 9 years; male 55%; ejection fraction of 48% ± 16). The mean diagnostic delay between HF and ATTR-CM diagnosis was 1.8 years. Besides HF and cardiomyopathy-related phenotypes, the strongest cardiac predictor was atrial fibrillation (AF; 72% in ATTR-CM vs. 60% in non-ATTR-CM, P = 0.02), whereas the strongest non-cardiac predictor was carpal tunnel syndrome (21% in ATTR-CM vs. 3% in non-ATTR-CM, P < 0.001). The strongest combination predictor was AF, joint disorders, and HF with preserved ejection fraction (29% in ATTR-CM vs. 18% in non-ATTR-CM: odds ratio = 2.03, 95% confidence interval = 1.28-3.22). CONCLUSIONS Not only well-known variables associated with ATTR-CM but also unique combinations of cardiac and non-cardiac phenotypes are able to predict ATTR-CM in a real-world HF population, aiding in early identification of ATTR-CM patients.
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Affiliation(s)
- Ana Moya
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
- CardioPath PhD Program, Department of Advanced Biomedical Sciences, Cardiovascular Pathophysiology and TherapeuticsUniversity of Naples Federico IINaplesItaly
| | | | - Monika Beles
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Sofie Verstreken
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Riet Dierckx
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Ward Heggermont
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Eline Bogaerts
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | | | | | - Dario Bertolone
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
- CardioPath PhD Program, Department of Advanced Biomedical Sciences, Cardiovascular Pathophysiology and TherapeuticsUniversity of Naples Federico IINaplesItaly
| | - Marc Vanderheyden
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
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14
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Ratti A, Belmonte M, Paolisso P, Shumkova M, Botti G, Viscusi MM, Bertolone DT, Gallinoro E, Barbato E, Andreini D, Vanderheyden M. Dual left anterior descending coronary artery and anomalous origin of left circumflex artery: a novel coronary anomaly revealed by CCTA. Int J Cardiovasc Imaging 2023; 39:2527-2529. [PMID: 37759093 DOI: 10.1007/s10554-023-02958-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
In the rare coronary anomaly of Dual LAD, two segments of the vessel reside within the anterior interventricular sulcus. In our case, the short LAD originated from the Left Coronary Sinus (LCS), while the long LAD emerged from the Right Coronary Sinus (RCS). The LCx arose from the RCS, and the RCA displayed typical features. This anomaly was deemed incidental, prompting routine follow-up. It underscores the significance of integrating CCTA for a thorough assessment, offering crucial insights for patient management.
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Affiliation(s)
- Angelo Ratti
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
- University of Milan, Milan, Italy
| | - Marta Belmonte
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
- University Federico II, Naples, Italy
| | - Pasquale Paolisso
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
- University Federico II, Naples, Italy
| | - Monika Shumkova
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Giulia Botti
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Michele Mattia Viscusi
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Dario Tino Bertolone
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | | | | | - Daniele Andreini
- University of Milan, Milan, Italy
- Galeazzi-Sant'Ambrogio Hospital, Milan, Italy
| | - Marc Vanderheyden
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium.
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15
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Gallinoro E, Bertolone DT, Mizukami T, Paolisso P, Bermpeis K, Munhoz D, Sakai K, Seki R, Ohashi H, Esposito G, Caglioni S, Mileva N, Leone A, Candreva A, Belmonte M, Storozhenko T, Viscusi MM, Vanderheyden M, Wyffels E, Bartunek J, Sonck J, Barbato E, Collet C, De Bruyne B. Continuous vs Bolus Thermodilution to Assess Microvascular Resistance Reserve. JACC Cardiovasc Interv 2023; 16:2767-2777. [PMID: 38030361 DOI: 10.1016/j.jcin.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Coronary flow reserve (CFR) and microvascular resistance reserve (MRR) can, in principle, be derived by any method assessing coronary flow. OBJECTIVES The aim of this study was to compare CFR and MRR as derived by continuous (CFRcont and MRRcont) and bolus thermodilution (CFRbolus and MRRbolus). METHODS A total of 175 patients with chest pain and nonobstructive coronary artery disease were studied. Bolus and continuous thermodilution measurements were performed in the left anterior descending coronary artery. MRR was calculated as the ratio of CFR to fractional flow reserve and corrected for changes in systemic pressure. In 102 patients, bolus and continuous thermodilution measurements were performed in duplicate to assess test-retest reliability. RESULTS Mean CFRbolus was higher than CFRcont (3.47 ± 1.42 and 2.67 ± 0.81 [P < 0.001], mean difference 0.80, upper limit of agreement 3.92, lower limit of agreement -2.32). Mean MRRbolus was also higher than MRRcont (4.40 ± 1.99 and 3.22 ± 1.02 [P < 0.001], mean difference 1.2, upper limit of agreement 5.08, lower limit of agreement -2.71). The correlation between CFR and MRR values obtained using both methods was significant but weak (CFR, r = 0.28 [95% CI: 0.14-0.41]; MRR, r = 0.26 [95% CI: 0.16-0.39]; P < 0.001 for both). The precision of both CFR and MRR was higher when assessed using continuous thermodilution compared with bolus thermodilution (repeatability coefficients of 0.89 and 2.79 for CFRcont and CFRbolus, respectively, and 1.01 and 3.05 for MRRcont and MRRbolus, respectively). CONCLUSIONS Compared with bolus thermodilution, continuous thermodilution yields lower values of CFR and MRR accompanied by an almost 3-fold reduction of the variability in the measured results.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Division of University Cardiology, IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Koshiro Sakai
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Ruiko Seki
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Alessandro Candreva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Zurich University Hospital, Zurich, Switzerland; PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | | | | | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
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Belmonte M, De Colle C, Paolisso P, Danino A, Pichersky Y, Lereya C, Kislev E, Planer D, Viscusi MM, Botti G, Bertolone DT, Gallinoro E, Shumkova M, Ratti A, Barbato E, Penicka M, Vanderheyden M, Bartunek J. Implantation of a Stent Graft System for Torrential Tricuspid Regurgitation: A First-in-Human Experience. JACC Cardiovasc Interv 2023; 16:2678-2681. [PMID: 37804288 DOI: 10.1016/j.jcin.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | | | | | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giulia Botti
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Angelo Ratti
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; University of Milan, Milan, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.
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Belmonte M, Gallinoro E, Bermpeis K, Bertolone DT, Paolisso P, Viscusi MM, Botti G, Bartunek J, Barbato E, Vanderheyden M. Comprehensive invasive evaluation of coronary microcirculation in patients with Takotsubo syndrome. Atherosclerosis 2023; 385:117332. [PMID: 37866008 DOI: 10.1016/j.atherosclerosis.2023.117332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND AIMS The etiology and pathophysiology of Takotsubo syndrome (TTS) remain a matter of debate. In murine models of coronary microvascular dysfunction (CMD), abnormalities in myocardial perfusion led to the development of TTS. Importantly, TTS was reversible when normal perfusion was restored. However, in clinical practice, the assessment of coronary microcirculation in patients with TTS has primarily relied on non-invasive or indirect, angiography-derived methods. METHODS AND RESULTS For the first time, we performed invasive microcirculatory assessment, by both validated techniques currently available in the catheterization laboratory, namely intracoronary bolus and continuous thermodilution, in patients with TTS, upon hospital admission and at short term follow-up. Our findings demonstrate that CMD was consistently present in all patients upon hospital admission, as assessed by both techniques. At a median follow-up of 3 months, after the recovery of left ventricular ejection fraction, two third of patients no longer exhibited CMD. CONCLUSIONS These findings support the hypothesis that an acute and transient worsening in coronary microvascular function plays a pivotal role in the pathophysiology of TTS.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giulia Botti
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy
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18
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Patel RB, Reddy VY, Komtebedde J, Wegerich SW, Sekaric J, Swarup V, Walton A, Laurent G, Chetcuti S, Rademann M, Bergmann M, McKenzie S, Bugger H, Bruno RR, Herrmann HC, Nair A, Gupta DK, Lim S, Kapadia S, Gordon R, Vanderheyden M, Noel T, Bailey S, Gertz ZM, Trochu JN, Cutlip DE, Leon MB, Solomon SD, van Veldhuisen DJ, Auricchio A, Shah SJ. Atrial Fibrillation Burden and Atrial Shunt Therapy in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 2023; 11:1351-1362. [PMID: 37480877 DOI: 10.1016/j.jchf.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and in heart failure with mildly reduced ejection fraction (HFmrEF). OBJECTIVES This study sought to describe AF burden and its clinical impact among individuals with HFpEF and HFmrEF who participated in a randomized clinical trial of atrial shunt therapy (REDUCE LAP-HF II [A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure]) and to evaluate the effect of atrial shunt therapy on AF burden. METHODS Study investigators characterized AF burden among patients in the REDUCE LAP-HF II trial by using ambulatory cardiac patch monitoring at baseline (median patch wear time, 6 days) and over a 12-month follow-up (median patch wear time, 125 days). The investigators determined the association of baseline AF burden with long-term clinical events and examined the effect of atrial shunt therapy on AF burden over time. RESULTS Among 367 patients with cardiac monitoring data at baseline and follow-up, 194 (53%) had a history of AF or atrial flutter (AFL), and median baseline AF burden was 0.012% (IQR: 0%-1.3%). After multivariable adjustment, baseline AF burden ≥0.012% was significantly associated with heart failure (HF) events (HR: 2.00; 95% CI: 1.17-3.44; P = 0.01) both with and without a history of AF or AFL (P for interaction = 0.68). Adjustment for left atrial reservoir strain attenuated the baseline AF burden-HF event association (HR: 1.71; 95% CI: 0.93-3.14; P = 0.08). Of the 367 patients, 141 (38%) had patch-detected AF during follow-up without a history of AF or AFL. Atrial shunt therapy did not change AF incidence or burden during follow-up. CONCLUSIONS In HFpEF and HFmrEF, nearly 40% of patients have subclinical AF by 1 year. Baseline AF burden, even at low levels, is associated with HF events. Atrial shunt therapy does not affect AF incidence or burden. (A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients with Heart Failure [REDUCE LAP-HF II]; NCT03088033).
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Affiliation(s)
- Ravi B Patel
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Illinois, USA
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | - Gabriel Laurent
- Department of Cardiology, Dijon University Hospital, Dijon, France
| | - Stanley Chetcuti
- Division of Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Matthias Rademann
- Department of Cardiology, University of Giessen, Bad Nauheim, Germany
| | - Martin Bergmann
- Department of Interventional Cardiology, Cardiologicum, Hamburg, Germany
| | - Scott McKenzie
- School of Medicine, University of Queensland, The Prince Charles Hospital, Brisbane, Australia
| | - Heiko Bugger
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine, Faculty of Medicine, University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Howard C Herrmann
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ajith Nair
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Deepak K Gupta
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott Lim
- Division of Cardiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Samir Kapadia
- Division of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Gordon
- Division of Cardiology, NorthShore University Health System, Evanston, Illinois, USA
| | | | - Thomas Noel
- Southern Medical Group, P.A., Tallahassee, Florida, USA
| | - Steven Bailey
- Division of Cardiology, Louisiana State University School of Medicine, Baton Rouge, Louisiana, USA
| | - Zachary M Gertz
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jean-Noël Trochu
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Donald E Cutlip
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Martin B Leon
- Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Scott D Solomon
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Angelo Auricchio
- Division of Cardiology, Ticino Cardiocentro Institute, Lugano, Switzerland
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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De Colle C, Paolisso P, Gallinoro E, Bertolone DT, Mileva N, Fabbricatore D, Valeriano C, Herman R, Beles M, De Oliveira EK, Mancusi C, Heggermont W, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. Association of Mild-to-Moderate Aortic Regurgitation With Outcomes in Heart Failure With Preserved Ejection Fraction. Mayo Clin Proc 2023; 98:1469-1481. [PMID: 37793725 DOI: 10.1016/j.mayocp.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To assess aortic regurgitation (AR) prevalence, its hemodynamic effect, and long-term prognostic implications in patients admitted with de novo or worsened heart failure with preserved ejection fraction (HFpEF). METHODS Consecutive patients hospitalized with de novo or worsened HFpEF between 2014 and 2020 were enrolled. Patients with more than moderate aortic and/or mitral valve disease were excluded. Based on the presence and degree of AR, patients were divided into those without AR, those with mild, and those with moderate AR. Data on cardiovascular death, heart failure (HF) rehospitalization, and their composite (major adverse cardiovascular events) were collected. RESULTS The final study population consisted of 458 HFpEF patients: 156 (34.1%) with mild-AR, 153 (33.4%) with moderate-AR, and the remaining 149 (32.5%) with no AR. Mild-to-moderate AR patients were older, with larger left atrium-left ventricle (LV) volumes, greater LV mass index, higher filling pressure, and prevalence of diastolic dysfunction compared with the no-AR group (all P<.05). During 5-year follow-up, 113 patients died of cardiovascular causes, 124 patients were rehospitalized for HF, whereas 196 experienced the composite endpoint. Mild-to-moderate AR was identified as an independent predictor of all-cause death (HR, 1.62; 95% CI, 1.14 to 1.58; P=.04) and major adverse cardiovascular event occurrence (HR, 1.48; 95% CI, 1.05 to 2.09; P=.02). A total of 126 (35.5%) of 355 patients showed progression of AR at follow-up echocardiography. CONCLUSION Mild-to-moderate AR is common among patients hospitalized for HFpEF. It is associated with adverse LV remodeling and worse long-term outcomes. These findings warrant further prospective studies addressing the importance of AR in prognostic stratification and exploring therapeutic strategies to mitigate its hemodynamic effect on HF.
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Affiliation(s)
- Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Clinic, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Robert Herman
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Monika Beles
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
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Moya A, Buytaert D, Penicka M, Bartunek J, Vanderheyden M. State-of-the-Art: Noninvasive Assessment of Left Ventricular Function Through Myocardial Work. J Am Soc Echocardiogr 2023; 36:1027-1042. [PMID: 37437670 DOI: 10.1016/j.echo.2023.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
The assessment of myocardial work (MW) using noninvasive pressure-strain loop analysis is a novel echocardiographic method that provides a more precise assessment of cardiac performance by considering the left ventricular loading condition. By integrating various MW components such as index, efficiency, and constructive and wasted work, an extensive analysis of left ventricular mechanics and energetics can be achieved. This approach offers a more comprehensive assessment of global cardiac function and performance, surpassing conventional surrogate indices. In this review, we aim to summarize the existing knowledge on MW and its distinctive characteristics in various cardiac pathologies.
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Affiliation(s)
- Ana Moya
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; CardioPath PhD Program, Department of Advanced Biomedical Sciences, Cardiovascular Pathophysiology and Therapeutics, University of Naples Federico II, Naples, Italy.
| | - Dimitri Buytaert
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
| | - Martin Penicka
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center and Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
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21
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Wyffels E, Beles M, Baeyens A, Croeckaert K, De Potter T, Van Camp G, Collet C, Sonck J, Vanderheyden M, Bartunek J, Barbato E, Bermpeis K, Bertolone DT, Gallinoro E, Esposito G, Schoonjans G, Staelens F, Van Laer E, De Bruyne B. Corrigendum to ' Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory. Value Based Healthcare-Change in Practice.' [Health Policy, Volume 132, June 2023, 104826, ISSN 0168-8510]. Health Policy 2023:104829. [PMID: 37149401 DOI: 10.1016/j.healthpol.2023.104829] [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: 05/08/2023]
Affiliation(s)
- Eric Wyffels
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.
| | - Monika Beles
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Ann Baeyens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | | | - Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Van Camp
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Schoonjans
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Frank Staelens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Els Van Laer
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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22
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Beles M, Masuy I, Verstreken S, Bartunek J, Dierckx R, Heggermont W, Oeste C, De Boeck M, Fovel I, Maris M, Vermeulen Z, Vanderheyden M. Cardio-renal-metabolic syndrome: clinical features and dapagliflozin eligibility in a real-world heart failure cohort. ESC Heart Fail 2023. [PMID: 37095712 PMCID: PMC10375172 DOI: 10.1002/ehf2.14381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 03/22/2023] [Accepted: 04/02/2023] [Indexed: 04/26/2023] Open
Abstract
AIMS The Cardiovascular Outcomes Retrospective Data analysIS in Heart Failure (CORDIS-HF) is a single-centre retrospective study aimed to (i) clinically characterize a real-world population with heart failure (HF) with reduced (HFrEF) and mildly reduced ejection fraction (HFmrEF), (ii) evaluate impact of renal-metabolic comorbidities on all-cause mortality and HF readmissions, and (iii) determine patients' eligibility for sodium-glucose cotransporter 2 inhibitors (SGLT2is). METHODS AND RESULTS Using a natural language processing algorithm, clinical data of patients diagnosed with HFrEF or HFmrEF were retrospectively collected from 2014 to 2018. Mortality and HF readmission events were collected during subsequent 1 and 2 year follow-up periods. The predictive role of patients' baseline characteristics for outcomes of interest was assessed using univariate and multivariate Cox proportional hazard models. Kaplan-Meier analysis was used to determine if type 2 diabetes (T2D) and chronic kidney disease (CKD) impacted mortality and HF readmission rates. The European SGLT2i label criteria were used to assess patients' eligibility. The CORDIS-HF included 1333 HF patients with left ventricular ejection fraction (LVEF) < 50% (413 HFmrEF and 920 HFrEF), who were predominantly male (69%) with a mean [standard deviation (SD)] age of 74.7 (12.3) years. About one-half (57%) of patients presented CKD and 37% T2D. The use of guideline-directed medical therapy (GDMT) was high (76-90%). HFrEF patients presented lower age [mean (SD): 73.8 (12.4) vs. 76.7 (11.6) years, P < 0.05], higher incidence of coronary artery disease (67% vs. 59%, P < 0.05), lower systolic blood pressure [mean (SD): 123 (22.6) vs. 133 (24.0) mmHg, P < 0.05], higher N-terminal pro-hormone brain natriuretic peptide (2720 vs. 1920 pg/mL, P < 0.05), and lower estimated glomerular filtration rate [mean (SD): 51.4 (23.3) vs. 54.1 (22.3) mL/min/1.73 m2 , P < 0.05] than those with HFmrEF. No differences in T2D and CKD were detected. Despite optimal treatment, event rates for the composite endpoint of HF readmission and mortality were 13.7 and 8.4/100 patient years. The presence of T2D and CKD negatively impacted all-cause mortality [T2D: hazard ratio (HR) = 1.49, P < 0.01; CKD: HR = 2.05, P < 0.001] and hospital readmission events in all patients with HF. Eligibility for SGLT2is dapagliflozin and empagliflozin was 86.5% (n = 1153) and 97.9% (n = 1305) of the study population, respectively. CONCLUSIONS This study identified high residual risk for all-cause mortality and hospital readmission in real-world HF patients with LVEF < 50% despite GDMT. T2D and CKD aggravated the risk for these endpoints, indicating the intertwinement of HF with CKD and T2D. SGLT2i treatment that clinically benefits these different disease conditions can be an important driver to lower mortality and hospitalizations in this HF population.
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Affiliation(s)
- Monika Beles
- Cardiovascular Research Centre, OLV Hospital, Moorselbaan 164, 9300, Aalst, Belgium
| | - Imke Masuy
- LynxCare Inc., LynxCare Clinical Informatics N.V., Leuven, Belgium
| | - Sofie Verstreken
- Cardiovascular Research Centre, OLV Hospital, Moorselbaan 164, 9300, Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Research Centre, OLV Hospital, Moorselbaan 164, 9300, Aalst, Belgium
| | - Riet Dierckx
- Cardiovascular Research Centre, OLV Hospital, Moorselbaan 164, 9300, Aalst, Belgium
| | - Ward Heggermont
- Cardiovascular Research Centre, OLV Hospital, Moorselbaan 164, 9300, Aalst, Belgium
| | - Clara Oeste
- LynxCare Inc., LynxCare Clinical Informatics N.V., Leuven, Belgium
| | | | - Isabelle Fovel
- AstraZeneca Belgium and Luxemburg, Groot-Bijgaarden, Belgium
| | - Michael Maris
- AstraZeneca Belgium and Luxemburg, Groot-Bijgaarden, Belgium
| | - Zarha Vermeulen
- AstraZeneca Belgium and Luxemburg, Groot-Bijgaarden, Belgium
| | - Marc Vanderheyden
- Cardiovascular Research Centre, OLV Hospital, Moorselbaan 164, 9300, Aalst, Belgium
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23
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Wyffels E, Beles M, Baeyens A, Croeckaert K, De Potter T, Van Camp G, Collet C, Sonck J, Vanderheyden M, Bartunek J, Barbato E, Bermpeis K, Bertolone DT, Gallinoro E, Esposito G, Schoonjans G, Staelens F, Van Laer E, De Bruyne B. Same Day Discharge Strategy by Default in a Tertiary Catheterization Laboratory. Value Based Healthcare-Change in Practice. Health Policy 2023; 132:104826. [PMID: 37087953 DOI: 10.1016/j.healthpol.2023.104826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/29/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
AIMS To assess the effects on outcomes and hospital revenues (societal cost) of a by default strategy of same day discharge (SDD) in patients undergoing a cardiac catheterization procedure in a Belgian Hospital. METHODS AND RESULTS Outcome and complete financial data were obtained in all consecutive patients with a cardiac catheterization performed in 2019 (n=5237) and in 2021 (n=5377). Patient-reported experience, patient satisfaction and Net promotor score were obtained prospectively for the SDD cohort in 2021. The proportion of patients receiving catheterization procedure in SDD increased from 28 to 44 % (p<0.001). This translates to the saving of 889 conventional hospitalizations in 2021. All-cause death and readmission rate remained unchanged (0,17% vs 0,15% (p=0,004); and 0,7% vs 1,8% (p>0,05)) in 2019 and 2021, respectively. Patients satisfaction top box score was 91% and the Net Promotor Score was 89,5. The by default SDD strategy was associated with reduction in in-hospital health care spending, on average 3206€ per procedure is saved. This means a 57% decrease in hospital revenues and translates into an important decrease in physician income. CONCLUSION Implementing a by default SDD cardiac catheterization strategy results in a reduction of societal cost, excellent patient satisfaction and unchanged clinical outcome. Yet, in the given context this approach negatively impacts hospital and physician revenues precluding the sustainability of such protocol.
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Affiliation(s)
- Eric Wyffels
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.
| | - Monika Beles
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Ann Baeyens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | | | - Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Van Camp
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | | | - Dario Tino Bertolone
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S Pansini 5, 80131 Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Guy Schoonjans
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Frank Staelens
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Els Van Laer
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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24
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Bermpeis K, Esposito G, Bertolone D, Gallinoro E, Verstreken S, Bogaerts E, Munhoz D, Heggermont W, Dierckx R, Bartunek J, Vanderheyden M. Safety of Ventricular Endomyocardial Biopsy in Heart Transplant Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.587] [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: 04/05/2023] Open
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25
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Tibrewala A, Hu M, Petito L, Rich J, Pham D, De By T, Gustafsson F, Veen K, Vanderheyden M, Lloyd-Jones D, Shah S. Derivation and Validation of a Risk Prediction Model for Waitlist Mortality in Left Ventricular Assist Device Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.536] [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: 04/05/2023] Open
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26
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Zymliński R, Biegus J, Vanderheyden M, Gajewski P, Dierckx R, Bartunek J, Ponikowski P. Safety, Feasibility of Controllable Decrease of Vena Cava Pressure by Doraya Catheter in Heart Failure. JACC Basic Transl Sci 2023; 8:394-402. [PMID: 37138800 PMCID: PMC10149648 DOI: 10.1016/j.jacbts.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 05/05/2023]
Abstract
Lowering elevated central venous pressure may reduce renal dysfunction in acute heart failure (AHF) patients. The Doraya catheter lowers renal venous pressure by creating a gradient in the inferior vena cava below the renal veins. Here, we present a first-in-human feasibility study of the Doraya catheter performed on 9 AHF patients. We assessed the safety, feasibility, and acute clinical (hemodynamic and renal) effects of transient Doraya catheter deployment when added to the standard diuretic-based regimen in AHF patients with a poor diuretic response. The procedures decreased central venous pressure from 18.4 ± 3.8 mm Hg to 12.4 ± 4.7 mm Hg (P < 0.001) and improved mean diuresis and clinical signs of congestion. No device-related serious adverse events were observed. Thus, Doraya catheter deployment was safe and feasible in AHF patients. (First In Human Study of the Doraya Catheter for the Treatment of AHF Patients; NCT03234647).
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Affiliation(s)
- Robert Zymliński
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Address for correspondence: Dr Jan Biegus, Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | | | - Piotr Gajewski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Riet Dierckx
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | | | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
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27
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Paolisso P, Beles M, Belmonte M, Gallinoro E, De Colle C, Mileva N, Bertolone DT, Deschepper C, Spapen J, Brouwers S, Degrieck I, Casselman F, Stockman B, Van Praet F, Penicka M, Collet C, Wyffels E, Vanderheyden M, Barbato E, Bartunek J, Van Camp G. Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics. Heart 2023; 109:634-642. [PMID: 36598073 DOI: 10.1136/heartjnl-2022-321874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Heart valve clinics (HVC) have been introduced to manage patients with valvular heart disease within a multidisciplinary team. OBJECTIVE To determine the outcome benefit of HVC approach compared with standard of care (SOC) for patients with moderate and asymptomatic severe aortic stenosis (mAS and asAS). METHODS Single-centre, observational registry of patients with mAS and asAS with at least one cardiac ambulatory consultation at our Cardiovascular Centre. Based on the outpatient strategy, patients were divided into HVC group, if receiving at least one visit at HVC, and SOC group, if followed by routine cardiac consultations. RESULTS 2129 patients with mAS and asAS were divided into those followed in HVC (n=251) versus SOC group (n=1878). The mean age was 76.5±12.4 years; 919 (43.2%) had asAS. During a follow-up of 4.8±1.8 years, 822 patients (38.6%) died, 307 (14.4%) were hospitalised for heart failure and 596 (28%) underwent aortic valve replacement (AVR). After propensity score matching, the number of consultations per year, exercise stress tests, brain natriuretic peptide (BNP) determinations and CTs were higher in the HVC cohort (p<0.05 for all). A shorter time between indication of AVR and less advanced New York Heart Association class was reported in the HVC cohort (p<0.001 and p=0.032). Compared with SOC, the HVC approach was associated with reduced all-cause mortality (HR=0.63, 95% CI 0.40 to 0.98, p=0.038) and cardiovascular death (p=0.030). At multivariable analysis, the HVC remained an independent predictor of all-cause mortality (HR=0.54, 95% CI 0.34 to 0.85, p=0.007). CONCLUSIONS In patients with mAS and asAS, the HVC approach was associated with more efficient management and outcome benefit compared with SOC.
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Affiliation(s)
- Pasquale Paolisso
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Monika Beles
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Marta Belmonte
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | - Cristina De Colle
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Niya Mileva
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Dario Tino Bertolone
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | - Jerrold Spapen
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Sofie Brouwers
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Vrije Universiteit Brussel, Brussel, Belgium
| | - Ivan Degrieck
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Filip Casselman
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Bernard Stockman
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Frank Van Praet
- Department of Cardiovascular Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Martin Penicka
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Carlos Collet
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Eric Wyffels
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | | | - Emanuele Barbato
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Jozef Bartunek
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Guy Van Camp
- Cardiology Department, Hartcentrum OLV Aalst, Aalst, Belgium
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28
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Norhammar A, Bodegard J, Vanderheyden M, Tangri N, Karasik A, Maggioni AP, Sveen KA, Taveira-Gomes T, Botana M, Hunziker L, Thuresson M, Banerjee A, Sundström J, Bollmann A. Prevalence, outcomes and costs of a contemporary, multinational population with heart failure. Heart 2023; 109:548-556. [PMID: 36781285 PMCID: PMC10086499 DOI: 10.1136/heartjnl-2022-321702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/20/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE Digital healthcare systems could provide insights into the global prevalence of heart failure (HF). We designed the CardioRenal and Metabolic disease (CaReMe) HF study to estimate the prevalence, key clinical adverse outcomes and costs of HF across 11 countries. METHODS Individual level data from a contemporary cohort of 6 29 624 patients with diagnosed HF was obtained from digital healthcare systems in participating countries using a prespecified, common study plan, and summarised using a random effects meta-analysis. A broad definition of HF (any registered HF diagnosis) and a strict definition (history of hospitalisation for HF) were used. Event rates were reported per 100 patient years. Cumulative hospital care costs per patient were calculated for a period of up to 5 years. RESULTS The prevalence of HF was 2.01% (95% CI 1.65 to 2.36) and 1.05% (0.85 to 1.25) according to the broad and strict definitions, respectively. In patients with HF (broad definition), mean age was 75.2 years (95% CI 74.0 to 76.4), 48.8% (40.9-56.8%) had ischaemic heart disease and 34.5% (29.4-39.6%) had diabetes. In 51 442 patients with a recorded ejection fraction (EF), 39.1% (30.3-47.8%) had a reduced, 18.8% (13.5-24.0%) had a mildly reduced and 42.1% (31.5-52.8%) had a preserved left ventricular EF. In 1 69 518 patients with recorded estimated glomerular filtration rate, 49% had chronic kidney disease (CKD) stages III-V. Event rates were highest for cardiorenal disease (HF or CKD) and all cause mortality (19.3 (95% CI 11.3 to 27.1) and 13.1 (11.1 to 15.1), respectively), and lower for myocardial infarction, stroke and peripheral artery disease. Hospital care costs were highest for cardiorenal diseases. CONCLUSIONS We estimate that 1-2% of the contemporary adult population has HF. These individuals are at significant risk of adverse outcomes and associated costs, predominantly driven by hospitalisations for HF or CKD. There is considerable public health potential in understanding the contemporary burden of HF and the importance of optimising its management.
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Affiliation(s)
- Anna Norhammar
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bodegard
- CVRM Evidence, BioPharmaceuticals Medical, AstraZeneca, Oslo, Norway
| | | | - Navdeep Tangri
- Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Avraham Karasik
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Aldo Pietro Maggioni
- Fondazione ReS Ricerca e Salute, Bologna, Italy.,ANMCO Research Center, Florence, Italy
| | - Kari Anne Sveen
- Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Tiago Taveira-Gomes
- Department of Community Medicine, Information and Decision in Health, University of Porto, Porto, Portugal
| | | | - Lukas Hunziker
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | | | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK.,Department of Cardiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,The George Institute for Global Health, Newtown, New South Wales, Australia
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29
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Robinson EL, Ameri P, Delrue L, Vanderheyden M, Bartunek J, Altieri P, Heymans S, Heggermont WA. Differential expression of epigenetic modifiers in early and late cardiotoxic heart failure reveals DNA methylation as a key regulator of cardiotoxicity. Front Cardiovasc Med 2023; 10:884174. [PMID: 36970338 PMCID: PMC10034031 DOI: 10.3389/fcvm.2023.884174] [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] [Received: 02/25/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundAnthracycline-induced cardiotoxicity is a well-known serious clinical entity. However, detailed mechanistic insights on how short-term administration leads to late and long-lasting cardiotoxicity, are still largely undiscovered. We hypothesize that chemotherapy provokes a memory effect at the level of epigenomic DNA modifications which subsequently lead to cardiotoxicity even years after cessation of chemotherapy.MethodsWe explored the temporal evolution of epigenetic modifiers in early and late cardiotoxicity due to anthracyclines by means of RNA-sequencing of human endomyocardial left ventricular biopsies and mass spectrometry of genomic DNA. Based on these findings, validation of differentially regulated genes was obtained by performing RT-qPCR. Finally, a proof-of-concept in vitro mechanistic study was performed to dissect some of the mechanistic aspects of epigenetic memory in anthracycline-induced cardiotoxicity.ResultsCorrelation of gene expression between late and early onset cardiotoxicity revealed an R2 value of 0.98, demonstrating a total of 369 differentially expressed genes (DEGs, FDR < 0.05). of which 72% (n = 266) were upregulated, and 28% of genes, (n = 103) downregulated in later as compared to earlier onset cardiotoxicity. Gene ontology analysis showed significant enrichment of genes involved in methyl-CpG DNA binding, chromatin remodeling and regulation of transcription and positive regulation of apoptosis. Differential mRNA expression of genes involved in DNA methylation metabolism were confirmed by RT-qPCR in endomyocardial biopsies. In a larger biopsy cohort, it was shown that Tet2 was more abundantly expressed in cardiotoxicity biopsies vs. control biopsies and vs. non-ischemic cardiomyopathy patients. Moreover, an in vitro study was performed: following short-term doxorubicin treatment, H9c2 cells were cultured and passaged once they reached a confluency of 70%–80%. When compared to vehicle-only treated cells, in doxorubicin-treated cells, three weeks after short term treatment, Nppa, Nppb, Tet1/2 and other genes involved in active DNA demethylation were markedly upregulated. These alterations coincided with a loss of DNA methylation and a gain in hydroxymethylation, reflecting the epigenetic changes seen in the endomyocardial biopsies.ConclusionsShort-term administration of anthracyclines provokes long-lasting epigenetic modifications in cardiomyocytes both in vivo and in vitro, which explain in part the time lapse between the use of chemotherapy and the development of cardiotoxicity and, eventually, heart failure.
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Affiliation(s)
- Emma L. Robinson
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy
- Cardiothoracic and Vascular Department, Ospedale Policlinico San Martino – IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Leen Delrue
- Cardiovascular Research Center Aalst, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Research Center Aalst, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Jozef Bartunek
- Cardiovascular Research Center Aalst, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
| | - Paola Altieri
- Department of Internal Medicine, University of Genova, Genova, Italy
- Cardiothoracic and Vascular Department, Ospedale Policlinico San Martino – IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Stephane Heymans
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Ward A. Heggermont
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
- Cardiovascular Research Center Aalst, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium
- Correspondence: Ward A. Heggermont
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SAKAI KOSHIRO, Collet CA, Mizukami T, Caglioni S, Bouisset F, Munhoz D, Vanderheyden M, Wyffels E, Bartunek J, Sonck J, Barbato E, De Bruyne B. VASCULAR REMODELING IN CORONARY MICROVASCULAR DYSFUNCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01699-6] [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: 03/06/2023]
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Gallinoro E, Bertolone DT, Fernandez-Peregrina E, Paolisso P, Bermpeis K, Esposito G, Gomez-Lopez A, Candreva A, Mileva N, Belmonte M, Mizukami T, Fournier S, Vanderheyden M, Wyffels E, Bartunek J, Sonck J, Barbato E, Collet C, De Bruyne B. Reproducibility of bolus versus continuous thermodilution for assessment of coronary microvascular function in patients with ANOCA. EUROINTERVENTION 2023:EIJ-D-22-00772. [PMID: 36809253 DOI: 10.4244/eij-d-22-00772] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND A bolus thermodilution-derived index of microcirculatory resistance (IMR) has emerged as the standard for assessing coronary microvascular dysfunction (CMD). Continuous thermodilution has recently been introduced as a tool to quantify absolute coronary flow and microvascular resistance directly. Microvascular resistance reserve (MRR) derived from continuous thermodilution has been proposed as a novel metric of microvascular function, which is independent of epicardial stenoses and myocardial mass. AIMS We aimed to assess the reproducibility of bolus and continuous thermodilution in assessing coronary microvascular function. METHODS Patients with angina and non-obstructive coronary artery disease (ANOCA) at angiography were prospectively enrolled. Bolus and continuous intracoronary thermodilution measurements were obtained in duplicate in the left anterior descending artery (LAD). Patients were randomly assigned in a 1:1 ratio to undergo either bolus thermodilution first or continuous thermodilution first. RESULTS A total of 102 patients were enrolled. The mean fractional flow reserve (FFR) was 0.86±0.06. Coronary flow reserve (CFR) calculated with continuous thermodilution (CFRcont) was significantly lower than bolus thermodilution-derived CFR (CFRbolus; 2.63±0.65 vs 3.29±1.17; p<0.001). CFRcont showed a higher reproducibility than CFRbolus (variability: 12.7±10.4% continuous vs 31.26±24.85% bolus; p<0.001). MRR showed a higher reproducibility than IMR (variability 12.4±10.1% continuous vs 24.2±19.3% bolus; p<0.001). No correlation was found between MRR and IMR (r=0.1, 95% confidence interval: -0.09 to 0.29; p=0.305). CONCLUSIONS In the assessment of coronary microvascular function, continuous thermodilution demonstrated significantly less variability on repeated measurements than bolus thermodilution.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | - Alessandro Candreva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, Zurich University Hospital, Zurich, Switzerland.,Department of Mechanical and Aerospace Engineering, PolitoBIO Med Lab, Politecnico di Torino, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | | | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
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Scisciola L, Taktaz F, Fontanella RA, Pesapane A, Surina, Cataldo V, Ghosh P, Franzese M, Puocci A, Paolisso P, Rafaniello C, Marfella R, Rizzo MR, Barbato E, Vanderheyden M, Barbieri M. Targeting high glucose-induced epigenetic modifications at cardiac level: the role of SGLT2 and SGLT2 inhibitors. Cardiovasc Diabetol 2023; 22:24. [PMID: 36732760 PMCID: PMC9896756 DOI: 10.1186/s12933-023-01754-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Sodium-glucose co-transporters (SGLT) inhibitors (SGLT2i) showed many beneficial effects at the cardiovascular level. Several mechanisms of action have been identified. However, no data on their capability to act via epigenetic mechanisms were reported. Therefore, this study aimed to investigate the ability of SGLT2 inhibitors (SGLT2i) to induce protective effects at the cardiovascular level by acting on DNA methylation. METHODS To better clarify this issue, the effects of empagliflozin (EMPA) on hyperglycemia-induced epigenetic modifications were evaluated in human ventricular cardiac myoblasts AC16 exposed to hyperglycemia for 7 days. Therefore, the effects of EMPA on DNA methylation of NF-κB, SOD2, and IL-6 genes in AC16 exposed to high glucose were analyzed by pyrosequencing-based methylation analysis. Modifications of gene expression and DNA methylation of NF-κB and SOD2 were confirmed in response to a transient SGLT2 gene silencing in the same cellular model. Moreover, chromatin immunoprecipitation followed by quantitative PCR was performed to evaluate the occupancy of TET2 across the investigated regions of NF-κB and SOD2 promoters. RESULTS Seven days of high glucose treatment induced significant demethylation in the promoter regions of NF-kB and SOD2 with a consequent high level in mRNA expression of both genes. The observed DNA demethylation was mediated by increased TET2 expression and binding to the CpGs island in the promoter regions of analyzed genes. Indeed, EMPA prevented the HG-induced demethylation changes by reducing TET2 binding to the investigated promoter region and counteracted the altered gene expression. The transient SGLT2 gene silencing prevented the DNA demethylation observed in promoter regions, thus suggesting a role of SGLT2 as a potential target of the anti-inflammatory and antioxidant effect of EMPA in cardiomyocytes. CONCLUSIONS In conclusion, our results demonstrated that EMPA, mainly acting on SGLT2, prevented DNA methylation changes induced by high glucose and provided evidence of a new mechanism by which SGLT2i can exert cardio-beneficial effects.
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Affiliation(s)
- Lucia Scisciola
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fatemeh Taktaz
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Rosaria Anna Fontanella
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ada Pesapane
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Surina
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vittoria Cataldo
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Puja Ghosh
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Martina Franzese
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Armando Puocci
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pasquale Paolisso
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ,grid.416672.00000 0004 0644 9757Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Concetta Rafaniello
- grid.9841.40000 0001 2200 8888Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Raffaele Marfella
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy ,grid.477084.80000 0004 1787 3414Mediterranea Cardiocentro, Naples, Italy
| | - Maria Rosaria Rizzo
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Emanuele Barbato
- grid.7841.aDepartment of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Marc Vanderheyden
- grid.416672.00000 0004 0644 9757Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Tino Bertolone D, Gallinoro E, Caglioni S, Paolisso P, Bermpeis K, De Colle C, Esposito G, Leone A, Belmonte M, Storozhenko T, Sonck J, Wyffels E, Collet C, Vanderheyden M, Bartunek J, De Bruyne B, Barbato E. 742 PROGNOSTIC IMPACT OF HIGH BLEEDING RISK IN PATIENTS WITH CALCIFIED CORONARY ARTERY DISEASE UNDERGOING ROTATIONAL ATHERECTOMY PCI. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Percutaneous coronary interventions (PCI) in calcified coronary artery lesions is associated with higher rate of cardiovascular adverse events and mortality.
The aim of our study was to evaluate the prognostic impact of High Bleeding Risk (HBR) condition, as defined by the Academic Research Consortium (ARC) HBR criteria, on clinical outcomes in patients with complex calcified coronary artery disease undergoing PCI after lesion preparation using Rotational Atherectomy (RA).
Methods
In this observational retrospective study, all patients with calcified coronary artery disease undergoing RA-assisted PCI between 2011 and 2021 were included. According to ARC-HBR criteria, patients were considered at HBR if at least one major criterion or two minor criteria were met. The primary endpoint was the occurrence of major adverse cardiac and cerebrovascular events (MACCE) at 4 years defined as the composite of cardiovascular death, myocardial infarction, stroke and target vessel revascularization (TVR). Secondary endpoints were cardiovascular death, bleeding events and TVR.
Results
The final population consisted of 343 patients. Median follow-up was 39 months. Among patients, 198 (57,7%) met the HBR criteria while 145 (42,7%) did not. Patients with HBR criteria were older [78.21 vs 71.68; p < 0.001], with lower GFR (ml/min/1.73m2) [53.67 vs 77.51; p < 0.001] and lower hemoglobin levels [Hb: g/dl; 11.93 vs 13.74; p < 0.001] compare with patients without HBR. The rate of MACCE was significantly higher in patients at HBR compare with patients not at HBR (HR 1.86 [1.08-3.26]; p = 0.026) mainly driven by an increased risk of cardiovascular death. No significant differences were found concerning the rates of TVR (HR 0.48 [0.21-1.04]; p = 0.057), stroke (HR=7.7 [0.98-61.09], p=0.05) and MI (HR 2.2[0.58-8.35], p=0.241) between the two groups. Bleedings were more frequent in patients at HBR (HR 12.31 [2.93-51.64]; p < 0.001) compared to patients without HBR.
Conclusion
In patients with calcified coronary artery disease PCI, despite the use of dedicated tools for optimal lesion preparation such as RA, those at HBR still present higher risk of MACCE and cardiovascular death. Conversely, rates of TVR and MI were comparable, suggesting frailty and comorbidities as primary causes of worse outcomes in patients at HBR.
Figure Legend:
Panel A: the rate of MACCE was significantly higher in patients at HBR compare with patients not at HBR (HR 1.86 [1.08-3.26]; p = 0.026),) mainly driven by an increased risk of cardiovascular death (Panel B).
Panel C: the rates of TVR were not significant different between the two groups (HR 0.48 [0.21-1.04]; p = 0.057).
Panel D: Bleedings were more frequent in patients at HBR (HR 12.31 [2.93-51.64]; p < 0.001) compared to patients without HBR.
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Affiliation(s)
- Dario Tino Bertolone
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
- Department Of Translational Medical Sciences, University Of Campania ”Luigi Vanvitelli” , Naples , Italy
| | | | - Pasquale Paolisso
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | | | - Cristina De Colle
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Giuseppe Esposito
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Attilio Leone
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Marta Belmonte
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | | | - Jozef Bartunek
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
- Department Of Cardiology, Lausanne University Hospital , Lausanne , Switzerland
| | - Emanuele Barbato
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
- Cardiovascular Center Aalst, Olv-Clinic , Aalst , Belgium
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Gallinoro E, Paolisso P, Bertolone DT, Bermpeis K, Fernandez-peregrina E, Esposito G, Belmonte M, Vanderheyden M, Fabbricatore D, Sonck J, Barbato E, Collet C, De Bruyne B. 851 REPEATABILITY OF BOLUS AND CONTINUOUS THERMODILUTION FOR ASSESSING CORONARY MICROVASCULAR FUNCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
The bolus thermodilution-derived index of microcirculatory resistance (IMR) has emerged over years as the standard of reference to invasively define coronary microvascular dysfunction (CMD). However, the technique still presents some limitations, mainly related to the fact that manual injection of saline bolus accounts for some variance in the measurements. Continuous intracoronary thermodilution has been recently introduced as a tool to directly quantify absolute coronary flow and microvascular resistance both at rest and during hyperemia and has shown to be safe and operator independent. Microvascular resistance reserve (MRR), derived from continuous thermodilution, has been validated as novel index specific for microcirculation and independent from myocardial mass.
Purpose
To compare head-to-head the intra-observer repeatability of bolus and continuous thermodilution for assessing microvascular function.
Methods
Patients undergoing coronary angiography in the absence of obstructive coronary artery disease were prospectively enrolled. Bolus and continuous intracoronary thermodilution measurements were performed in duplicates in the left anterior descending artery (LAD). Patients were randomly assigned in a 1:1 ratio to undergo first bolus thermodilution or first continuous thermodilution assessment.
Results
A total of 102 patients were enrolled. Average FFR was 0.86±0.06. Coronary Flow Reserve (CFR) calculated with continuous thermodilution (CFRthermo) was significantly lower than bolus thermodilution-derived CFR (CFRbolus) (2.63±0.65 and 3.29±1.17, respectively, p<0.001). CFRthermo showed a lower variability and a higher agreement than CFRbolus (variability 12.74 ± 10.41% vs 31.26±24.85%, respectively, p<0.001; ICC= 0.78 (0.70-0.85) and 0.48 (0.32-0.62), respectively, p<0.001, Figure 1). Both MRR and IMR showed a good agreement (ICC 0.81 (0.74-0.87) and 0.80 (0.71-0.86)) but the variability of the MRR was significantly lower (12.44 ± 10.06% vs 24.24±19.27, respectively, p<0.001, figure 1). Reproducibility data of all indices derived from duplicated measurements of bolus and continuous thermodilution are reported in Figure 2.
Conclusion
Continuous intracoronary thermodilution has a higher repeatability than bolus thermodilution in the assessment of CMD.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
- Irccs Galeazzi Sant’ambrogio - Università Degli Studi Di Milano
- Dipartimento Di Scienze Mediche Traslazionali, Università Degli Studi Della Campania ”L.Vanvitelli”
| | | | | | | | | | | | - Marta Belmonte
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | | | - Carlos Collet
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
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Gallinoro E, Paolisso P, Vanderheyden M, Esposito G, Bertolone DT, Belmonte M, Bermpeis K, Fabbricatore D, De Colle C, Candreva A, Penicka M, Collet C, Sonck J, De Bruyne B, Barbato E. 840 ASSESSMENT OF ABSOLUTE CORONARY FLOW AND MICROVASCULAR RESISTANCE RESERVE IN PATIENTS WITH AORTIC STENOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
The development of left ventricular hypertrophy in patients with severe aortic stenosis (AS) is accompanied by adaptive coronary flow regulation, both in epicardial and microvascular compartment, which ultimately lead to a chronic ischemic insult even in the absence of obstructive coronary artery disease. Intracoronary continuous thermodilution of saline through a dedicated infusion catheter (RayFlow ®) is a novel tool that allows to measure absolute coronary flow and microvascular resistance at rest and during hyperemia and to calculate both coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR)
Purpose
We aimed to assess absolute coronary flow, microvascular resistance, CFR and MRR in patients with AS, assessed by continuous intracoronary thermodilution, comparing these hemodynamic findings with a propensity-score matched contemporary cohort of patients without AS.
Methods
Absolute coronary blood flow and microvascular resistance were measured by continuous thermodilution in 29 patients with AS and compared to 15 controls matched for age, gender, diabetes mellitus and functional severity of epicardial coronary lesions. Myocardial work, total myocardial mass and LAD-specific mass were quantified by echocardiography and cardiac-CT.
Results
Patients with AS presented a significantly positive LV remodeling with lower global longitudinal strain and higher global work index compared to controls (p<0.02). Total LV myocardial mass and LAD-specific myocardial mass were significantly higher in patients with AS. Compared to matched controls, absolute resting flow in the LAD was significantly higher in the AS cohort (86 [66–107] ml/min vs 68 [52–75] ml/min, p=0.036), resulting, in lower CFR (2.30 ± 0.69 vs 2.89 ± 0.77, p=0.005) and MRR (2.73 ± 0.74 vs 3.53 ± 0.95, p=0.005) in the AS cohort compared to controls (Figure 1). No differences were found in hyperemic flow and resting and hyperemic resistances. Interestingly, hyperemic myocardial perfusion (calculated as the ratio between the absolute coronary flow subtended to the LAD and expressed in mL/min/g), but not resting, was significantly lower in the AS group (1.9 [1.5–2.5] ml/min/g vs 2.3 [2–3.1] ml/min/g p=0.036).
Conclusions
In patients with severe aortic stenosis and non-obstructive coronary artery disease, with the progression of LVH, the compensatory mechanism of increased resting flow maintains an adequate perfusion at rest, but not during hyperemia (Figure 2). As consequence, both CFR and MRR are significantly impaired.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
- Irccs Galeazzi Sant’ambrogio - Universita’ Degli Studi Di Milano
- Dipartimento Di Scienze Mediche Traslazionali, Università Della Campania ”L.Vanvitelli” , Napoli, IT
| | | | | | | | | | - Marta Belmonte
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | | | | | | | | | - Martin Penicka
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
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De Colle C, Paolisso P, Gallinoro E, Bertolone D, Mileva N, Fabbricatore D, Valeriano C, Mancusi C, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. 268 IMPACT OF AORTIC REGURGITATION ON LONG TERM OUTCOME IN HEART FAILURE AND PRESERVED EJECTION FRACTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Aortic Regurgitation (AR) may aggravate the clinical course in patients with heart failure and preserved ejection fraction (HFpEF) by increasing filling pressures and triggering LV remodelling.
Objective
To assess AR's prevalence and long-term prognostic implications in patients with HFpEF.
Methods
The study population consisted of 458 consecutive patients (age 77.5 ± 9.2 y, 57.9% females) hospitalized with de novo or worsened HFpEF. Patients with more than moderate aortic and/or mitral valve disease were excluded. Data on cardiovascular death, HF re-hospitalization and their composite (MACE) were collected.
Results
Out of 309 (67.5%) patients with any AR, 156 (34.0%) and 153 (33.5%) had mild-AR and moderate-AR, respectively. The remaining 149 (32.5%) individuals had no-AR. Patients with versus without AR were significantly older with larger LV and LA volumes and a higher prevalence of diastolic dysfunction (all p < 0.05). During a median follow-up of 33 ± 25 months, a total of 114 patients (24.9%) died from cardiovascular causes, 126 patients (27.5%) were re-hospitalized for HF, while 272 (59.4%) had the composite endpoint (MACE). In multivariable Cox regression analysis, any AR emerged as an only independent predictor of MACE (HR=1.90, 95%CI 1.26–2.87, p=0.002). Mild-AR and Moderate AR increased the risk of MACE by 77% and 92%, respectively, compared to the No-AR.
Conclusions
In patients with HFpEF, mild-to-moderate AR is highly prevalent, and it seems to identify individuals with worse long-term outcomes. This suggests that even mild AR should be considered a high-risk prognostic marker in patients with HFpEF.
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Affiliation(s)
- Cristina De Colle
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Pasquale Paolisso
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | - Dario Bertolone
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Niya Mileva
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
| | - Davide Fabbricatore
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | - Costantino Mancusi
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | | | - Nicola De Luca
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Guy Van Camp
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
| | - Emanuele Barbato
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
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37
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Paolisso P, Gallinoro E, Vanderheyden M, Esposito G, Bertolone DT, Belmonte M, Mileva N, Bermpeis K, De Colle C, Fabbricatore D, Candreva A, Munhoz D, Degrieck I, Casselman F, Penicka M, Collet C, Sonck J, Mangiacapra F, de Bruyne B, Barbato E. Absolute coronary flow and microvascular resistance reserve in patients with severe aortic stenosis. Heart 2022; 109:47-54. [PMID: 35977812 DOI: 10.1136/heartjnl-2022-321348] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Development of left ventricle (LV) hypertrophy in aortic stenosis (AS) is accompanied by adaptive coronary flow regulation. We aimed to assess absolute coronary flow, microvascular resistance, coronary flow reverse (CFR) and microvascular resistance reserve (MRR) in patients with and without AS. METHODS Absolute coronary flow and microvascular resistance were measured by continuous thermodilution in 29 patients with AS and 29 controls, without AS, matched for age, gender, diabetes and functional severity of epicardial coronary lesions. Myocardial work, total myocardial mass and left anterior descending artery (LAD)-specific mass were quantified by echocardiography and cardiac-CT. RESULTS Patients with AS presented a significantly positive LV remodelling with lower global longitudinal strain and global work efficacy compared with controls. Total LV myocardial mass and LAD-specific myocardial mass were significantly higher in patients with AS (p=0.001). Compared with matched controls, absolute resting flow in the LAD was significantly higher in the AS cohort (p=0.009), resulting into lower CFR and MRR in the AS cohort compared with controls (p<0.005 for both). No differences were found in hyperaemic flow and resting and hyperaemic resistances. Hyperaemic myocardial perfusion (calculated as the ratio between the absolute coronary flow subtended to the LAD, expressed in mL/min/g), but not resting, was significantly lower in the AS group (p=0.035). CONCLUSIONS In patients with severe AS and non-obstructive coronary artery disease, with the progression of LV hypertrophy, the compensatory mechanism of increased resting flow maintains adequate perfusion at rest, but not during hyperaemia. As a consequence, both CFR and MRR are significantly impaired.
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Affiliation(s)
- Pasquale Paolisso
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | | | - Giuseppe Esposito
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Dario Tino Bertolone
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Marta Belmonte
- Hartcentrum OLV Aalst, Aalst, Belgium.,Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Lombardia, Italy
| | | | | | - Cristina De Colle
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Davide Fabbricatore
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | - Daniel Munhoz
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Ivan Degrieck
- Cardiovascular and Thoracic Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Filip Casselman
- Cardiovascular and Thoracic Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Martin Penicka
- Cardiology, Hartcentrum OLV Aalst, Aalst, Flanderen, Belgium
| | | | | | | | | | - Emanuele Barbato
- Hartcentrum OLV Aalst, Aalst, Belgium .,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
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38
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Paolisso P, Belmonte M, Bermpeis K, Gallinoro E, Bertolone DT, Leone A, Caglioni S, Bassas AI, De Colle C, Vanderheyden M, Casselman F, Degrieck I, Barbato E, Wyffels E, Penicka M. Successful Transcatheter Aortic Valve Replacement in Patient With Aortic Annulus Pseudoaneurysm After Balloon Aortic Valvuloplasty. JACC Cardiovasc Interv 2022; 15:2448-2451. [PMID: 36480989 DOI: 10.1016/j.jcin.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Serena Caglioni
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Cona, Ferrara, Italy
| | | | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Ivan Degrieck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
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39
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Gallinoro E, Paolisso P, Vanderheyden M, Esposito G, Bertolone DT, Mileva N, Bermpeis K, Belmonte M, De Colle C, Candreva A, Penicka M, Collet C, Sonck J, De Bruyne B, Barbato E. Assessment of absolute coronary flow and microvascular resistance reserve in patients with severe aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2023] [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
Introduction
The development of left ventricular hypertrophy in patients with severe aortic stenosis (AS) is accompanied by adaptive coronary flow regulation, both in epicardial and microvascular compartment, which ultimately lead to a chronic ischemic insult even in the absence of obstructive coronary artery disease. Intracoronary continuous thermodilution of saline through a dedicated infusion catheter is a novel tool that allows to measure absolute coronary flow and microvascular resistance at rest and during hyperemia and to calculate both coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR)
Purpose
We aimed to assess absolute coronary flow, microvascular resistance, CFR and MRR in patients with AS, by continuous intracoronary thermodilution, comparing these hemodynamic findings with a propensity-score matched contemporary cohort of patients without AS.
Methods
Absolute coronary blood flow and microvascular resistance were measured by continuous thermodilution in 29 patients with AS and compared to 15 controls matched for age, gender, diabetes mellitus and functional severity of epicardial coronary lesions. Myocardial work, total myocardial mass and LAD-specific mass were quantified by echocardiography and cardiac-CT.
Results
Patients with AS presented a significantly positive LV remodeling with lower global longitudinal strain and higher global work index compared to controls (p<0.02). Total LV myocardial mass and LAD-specific myocardial mass were significantly higher in patients with AS. Compared to matched controls, absolute resting flow in the LAD was significantly higher in the AS cohort (86 [66–107] ml/min vs 68 [52–75] ml/min, p=0.036), resulting, in lower CFR (2.30±0.69 vs 2.89±0.77, p=0.005) and MRR (2.73±0.74 vs 3.53±0.95, p=0.005) in the AS cohort compared to controls (Figure 1). No differences were found in hyperemic flow and resting and hyperemic resistances. Interestingly, hyperemic myocardial perfusion (calculated as the ratio between the absolute coronary flow in the LAD and the mass subtended by the vessel, expressed in mL/min/g), but not resting, was significantly lower in the AS group (1.9 [1.5–2.5] ml/min/g vs 2.3 [2–3.1] ml/min/g p=0.036).
Conclusions
In patients with severe aortic stenosis and non-obstructive coronary artery disease, with the progression of LVH, the compensatory mechanism of increased resting flow maintains an adequate perfusion at rest, but not during hyperemia (Figure 2). As consequence, both CFR and MRR are significantly impaired.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Gallinoro
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - P Paolisso
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - G Esposito
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - D T Bertolone
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - N Mileva
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - K Bermpeis
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Belmonte
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - C De Colle
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - A Candreva
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Penicka
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - C Collet
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - J Sonck
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - B De Bruyne
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Barbato
- Cardiovascular Research Center Aalst , Aalst , Belgium
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40
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Moya A, Buytaert D, Paolisso P, Verstreken S, Goethals M, Dierckx R, Beles M, Penicka M, Vanderheyden M, Heggermont W. Myocardial work analysis for early detection of type 1 CTRCD and patient risk stratification. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.803] [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
Aim
This prospective longitudinal study analyses the potential role of Myocardial Work in early detection of cardiotoxicity during chemotherapy and its added value for prognosis and patients' risk stratification.
Methods
We enrolled 47 consecutive female patients with HER2-positive breast cancer referred for anti-cancer therapy based on anthracycline and taxane. Patients with depressed LV function at baseline were excluded. Medical therapy, clinical parameters and echocardiographic data were recorded at baseline and at 3, 6, 12 months follow-up. Additionally, cuff blood pressure was measured at the time of 2D-TTE examination and adequate echocardiographic images were stored for off-line analysis.
Results
CTRCD was detected in 17 patients (36%) while 30 patients remained free of CTRCD (64%). There were no intergroup differences for age, body mass index, resting heart rate and brachial arterial pressure. Both groups presented unaltered LV systolic function after 3 months follow-up yet overt cardiac dysfunction showed up in the CTRCD group at 6 months with significant decline in LVEF, GLS, MWI, MWE and CW from baseline values (LVEF, %: 56.0±4.1 vs 52.2±6.5; GLS, %: −20.9±1.9 vs −17.6±3.2; MWI, mmHg%: 2125±348 vs 1704±620; MWE, %: 95±2.6 vs 93±3.9 and CW, mmHg%: 2562±3567 vs 2212±455, p<0.05). Additionally, GLS, MWI and MWE at 6 months were significantly worse in the CTRCD group vs non-CTRCD group (GLS, %: −17.6±3.2 vs −20.6±1.8; MWI, mmHg%: 1704±620 vs 2087±347; MWE, %: 93±3.9 vs 96±1.5, p<0.05). Depressed LV systolic function persisted after 1 year follow-up (Figure 1). After 3 months, only de relative change in GLS and WW from baseline were significantly worse in CTRCD vs non-CTRCD (ΔGLS: +3.7±11 vs −3.9±10, ΔWW: +46.1±83 vs +2.2±45). Whereas no correlation was found, the combination of both ΔGLS and ΔWW at 3 months showed stronger prognostic value for CTRCD than each parameter alone, AUC of 0.72 (Figure 2).
Conclusion
These findings point the superiority of Myocardial Work for early type 1 CTRCD detection in comparison to the current diagnostic tools. Additionally, we suggest the add-on value of ΔWW on top of ΔGLS quantification for better patient risk stratification. These are promising results for better clinical surveillance of cardiac function during cancer treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Moya
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - D Buytaert
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - P Paolisso
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - S Verstreken
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Goethals
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - R Dierckx
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Beles
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Penicka
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - W Heggermont
- Cardiovascular Research Center Aalst , Aalst , Belgium
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41
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De Colle C, Paolisso P, Gallinoro E, Bertolone DT, Mileva N, Fabbricatore D, Valeriano C, Mancusi C, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. Impact of aortic regurgitation on long-term outcomes in heart failure with preserved ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.774] [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
Aortic Regurgitation (AR) may aggravate the clinical course in patients with heart failure and preserved ejection fraction (HFpEF) by increasing filling pressures and triggering LV remodelling.
Objective
To assess AR's prevalence and long-term prognostic implications in patients with HFpEF.
Methods
The study population consisted of 458 consecutive patients (age 77.5±9.2 y, 57.9% females) hospitalized with de novo or worsened HFpEF. Patients with more than moderate aortic and/or mitral valve disease were excluded. Data on cardiovascular death, HF re-hospitalization and their composite (MACE) were collected.
Results
Out of 309 (67.5%) patients with any AR, 156 (34.0%) and 153 (33.5%) had mild-AR and moderate-AR, respectively. The remaining 149 (32.5%) individuals had no-AR. Patients with versus without AR were significantly older with larger LV and LA volumes and a higher prevalence of diastolic dysfunction (all p<0.05). During a median follow-up of 33±25 months, a total of 114 patients (24.9%) died from cardiovascular causes, 126 patients (27.5%) were re-hospitalized for HF, while 272 (59.4%) had the composite endpoint (MACE). In multivariable Cox regression analysis, any AR emerged as an only independent predictor of MACE (HR=1.90, 95% CI 1.26–2.87, p=0.002). Mild-AR and Moderate AR increased the risk of MACE by 77% and 92%, respectively, compared to the No-AR (Figure).
Conclusions
In patients with HFpEF, mild-to-moderate AR is highly prevalent, and it seems to identify individuals with worse long-term outcomes. This suggests that even mild AR should be considered a high-risk prognostic marker in patients with HFpEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C De Colle
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - P Paolisso
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Gallinoro
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - D T Bertolone
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - N Mileva
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - C Valeriano
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - C Mancusi
- Federico II University Hospital , Naples , Italy
| | - C Collet
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - N De Luca
- Federico II University Hospital , Naples , Italy
| | - G Van Camp
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Barbato
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - J Bartunek
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Penicka
- Cardiovascular Research Center Aalst , Aalst , Belgium
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42
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Moya A, Delrue L, Beles M, Heggermont W, Verstreken S, Goethals M, Dierckx R, Bartunek J, Vanderheyden M. Global longitudinal strain and NT-proBNP as predictors for LV function recovery after TAVR. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Abnormal GLS values as well as high plasma levels of NT-proBNP previous to TAVR are independent predictors for higher peri-procedural mortality. Moreover, in a subgroup of TAVR patients LV function does not recover following the procedure. Until today, it is still unclear how to predict impaired post-procedural LV function for optimal clinical patient's management.
Purpose
This study was set up to assess the predictive value of baseline GLS and NT-proBNP levels on LV function recovery (LVfr) in a cohort of patients with severe AS referred for TAVR.
Methods
A total of 25 patients (9 male, 84±5 yo, EF 50±11%) with severe AS (AVA 0.6±0.3 cm2, MPG 49±16 mmHg) referred for TAVR were included. Blood analysis and TTE were performed before intervention (baseline, bl) and at follow-up (fu). Myocardial work was analysed offline integrating the longitudinal strain and afterload pressure (SBP + AVPmean). LVfr was defined as GLS <−19% at fu. The median values at bl of NT-proBNP (1781 ng/L) and GLS (−15%) were taken as cut-off to categorize patients in 4 groups: NT-proBNPhighGLShigh, NT-proBNPlowGLShigh, NT-proBNPhighGLSlow and NT-proBNPlowGLSlow. The ROC curve analysis for prediction of LVfr after TAVR were performed.
Results
LV function recovered in 13 patients (52%). Despite similar EF and global MWI after TAVR, the LV contraction became more efficient as evidenced by a significant improvement (bl vs fu, p<0.05) in GLS (−14±4.5 vs −18±4.2%), MWW (400±510 vs 157±107 mmHg%) MWE (88±6 vs 92±6%) together with a reduction in afterload pressure (203±38 vs 156±22 mmHg, p<0.05). In the NT-proBNPlow groups, GLS (−15±4 vs −20±3%, p<0.05) and MCW (2166±874 vs 2978±634 mmHg%, p<0.05) at fu were significantly better when compared to the NT-proBNPhigh groups. Likewise, the GLSlow groups showed higher EF (47±10 vs 54±6%, p<0.05) and MCW (2181±832 vs 2961±715 mmHg%, p<0.05) than the GLShigh groups at fu. Interestingly, the GLSlow groups had lower LVESV (57±38 vs 29±10 ml, p<0.05) and LVEDV (113±49 vs 80±20 ml, p<0.05) post-TAVR than the GLShigh groups which suggests a positive remodelling following afterload reduction. At the ROC curve analysis, combined GLS and NT-proBNP at bl were better predictors for LVfr than each parameter alone, AUC 0.86 (Fig. 1). Additionally, only 20% LVfr was seen in the NT-proBNPhighGLShigh group in contrast to 67–75% in the other groups.
Conclusion
Elevated afterload in severe AS leads to a physiological reduction of GLS. Although the decrease in afterload after TAVR beneficially affects GLS and may lead to LVfr, this was not observed in a subgroup of patients with high NT-proBNP levels in whom GLS remained impaired at follow-up. We speculate that myocardial tissue damage and fibrosis due to long lasting high pressure exposure may partly be responsible for this observation. The combination of pre-procedural NT-proBNP levels and GLS shows strong predictive potential for LVfr after TAVR and larger studies are warranted for further evaluation and cut-off values determination.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Cardiovascular Research Center Aalst (npo)
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Affiliation(s)
- A Moya
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - L Delrue
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Beles
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - W Heggermont
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - S Verstreken
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Goethals
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - R Dierckx
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - J Bartunek
- Cardiovascular Research Center Aalst , Aalst , Belgium
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Paolisso P, Gallinoro E, Belmonte M, Bertolone DT, Bermpeis K, Esposito G, Seki R, Fabbricatore D, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. Microvascular dysfunction in patients with diabetes mellitus: assessment of absolute coronary flow and microvascular resistance reserve. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2015] [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
Coronary microvascular dysfunction (CMD) is an early feature of diabetic cardiomyopathy, which usually precedes the onset of systolic and diastolic dysfunction (DDF). Continuous intracoronary thermodilution allows an accurate and reproducible assessment of absolute coronary blood flow and microvascular resistance thus allowing the evaluation of coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR), a novel index specific for microvascular function, which is independent from the myocardial mass. In the present study we compared absolute coronary flow and resistance, CFR and MRR assessed by continuous intracoronary thermodilution in diabetic versus non-diabetic patients. Left atrial reservoir strain (LASr), an early marker of DDF was compared between the two groups.
Methods
In this observational retrospective study, 108 patients with suspected angina and non-obstructive coronary artery disease (NOCAD) consecutively undergoing elective coronary angiography (CAG) from September 2018 to June 2021 were enrolled. The invasive functional assessment of microvascular function was performed in the left anterior descending artery (LAD) with intracoronary continuous thermodilution. Patients were classified according to the presence of DM. Absolute resting and hyperemic coronary flow (in mL/min) and resistance (in WU) were compared between the two cohorts. FFR was measured to assess coronary epicardial lesions, while CFR and MRR were calculated to assess microvascular function. LAS, assessed by speckle tracking echocardiography, was used to detect early myocardial structural changes potentially associated with microvascular dysfunction.
Results
The median FFR value was 0.83 [0.79–0.87] without any significant difference between the two groups. Absolute resting and hyperemic flow in the left anterior descending coronary were similar between diabetic and non-diabetic patients. Similarly, resting and hyperemic resistances did not change significantly between the two groups. In the DM cohort the CFR and MRR were significantly lower compared to the control group (CFR=2.4±0.6 and 2.9±0.8; MRR=2.8±0.9 and 3.5±1 for diabetic and non-diabetic patients respectively, [p<0.05 for both], Figure 1 and 2). Likewise, diabetic patients had a significantly lower reservoir, contractile and conductive LAS (all p<0.05).
Conclusions
Compared with non-diabetic patients, CFR and MRR were lower in patients with DM and non-obstructive epicardial coronary arteries, while both resting and hyperemic coronary flow and resistance were similar. LASr was lower in diabetic patients, confirming the presence of a subclinical DDF associated to the microcirculatory impairment. Continuous intracoronary thermodilution-derived indexes provide a reliable and operator-independent assessment of coronary macro- and microvasculature and might potentially facilitate widespread clinical adoption of invasive physiologic assessment of suspected microvascular disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Paolisso
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Gallinoro
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Belmonte
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - D T Bertolone
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - K Bermpeis
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - G Esposito
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - R Seki
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - J Bartunek
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - E Wyffels
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - J Sonck
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - C Collet
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - B De Bruyne
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Barbato
- Cardiovascular Research Center Aalst , Aalst , Belgium
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44
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Paolisso P, Dagan A, Gallinoro E, De Colle C, Bertolone DT, Moya A, Penicka M, Degrieck I, Vanderheyden M, Bartunek J. Aortic thoracic neuromodulation in heart failure with preserved ejection fraction. ESC Heart Fail 2022; 10:699-704. [PMID: 36151858 PMCID: PMC9871658 DOI: 10.1002/ehf2.14136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/07/2022] [Accepted: 08/24/2022] [Indexed: 01/27/2023] Open
Abstract
The inadequacy of medical therapies for heart failure with preserved ejection fraction (HFpEF) is driving the development of device-based solutions targeting underlying pathophysiologic abnormalities. The maladaptive autonomic imbalance with a reduction in vagal parasympathetic activity and increased sympathetic signalling contributes to the deterioration of cardiac performance, patient fitness, and the increased overall morbidity and mortality. Thoracic aortic vagal afferents mediate parasympathetic signalling, and their stimulation has been postulated to restore autonomic balance. In this first-in-man experience with chronic stimulation of aortic vagal afferents (Harmony™ System, Enopace, Israel), we demonstrate improved left atrial remodelling and function parallel with improved left ventricular performance. The observed favourable structural and functional cardiac changes remained stable throughout the 1 year follow-up and were associated with improved symptoms and physical fitness. The current experience warrants further validation of the endovascular stimulation of aortic thoracic afferents as a new interventional approach for device-based treatment in HFpEF.
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Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium,Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | | | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium,Department of Translational Medical SciencesUniversity of Campania' Luigi Vanvitelli'NaplesItaly
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium,Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium,Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Ana Moya
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium
| | | | - Ivan Degrieck
- Cardiovascular and Thoracic Surgery, OLV‐ClinicAalstBelgium
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45
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Gallinoro E, Paolisso P, Di Gioia G, Bermpeis K, Fernandez-Peregrina E, Candreva A, Esposito G, Fabbricatore D, Bertolone DT, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long-Term Survival. J Am Heart Assoc 2022; 11:e026656. [PMID: 36129045 DOI: 10.1161/jaha.122.026656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Deferring revascularization in patients with nonsignificant stenoses based on fractional flow reserve (FFR) is associated with favorable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction is unclear. We aimed to investigate whether FFR provides adjunctive clinical benefit compared with coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced left ventricular ejection fraction. Methods and Results Consecutive patients with reduced left ventricular ejection fraction (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We included patients with at least 1 intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR guided) or angiography alone (angiography guided). The primary end point was the cumulative incidence of all-cause death at 10 years. The secondary end point (incidence of major adverse cardiovascular and cerebrovascular events) was a composite of all-cause death, myocardial infarction, any revascularization, and stroke. A total of 840 patients were included (206 in the FFR-guided group and 634 in the angiography-guided group). Median follow-up was 7 years (interquartile range, 3.22-11.08 years). After 1:1 propensity-score matching, baseline characteristics between the 2 groups were similar. All-cause death was significantly lower in the FFR-guided group compared with the angiography-guided group (94 [45.6%] versus 119 [57.8%]; hazard ratio [HR], 0.65 [95% CI, 0.49-0.85]; P<0.01). The rate of major adverse cardiovascular and cerebrovascular events was lower in the FFR-guided group (123 [59.7%] versus 139 [67.5%]; HR, 0.75 [95% CI, 0.59-0.95]; P=0.02). Conclusions In patients with reduced left ventricular ejection fraction, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and major adverse cardiovascular and cerebrovascular events at 10 years.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Translational Medical Sciences University of Campania "Luigi Vanvitelli" Naples Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Giuseppe Di Gioia
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | | | | | - Alessandro Candreva
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Cardiology Zurich University Hospital Zurich Switzerland.,PoliToBIO Med Lab Department of Mechanical and Aerospace Engineering Politecnico di Torino Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Davide Fabbricatore
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Marc Vanderheyden
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Cardiology Lausanne University Hospital Lausanne Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
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Delrue L, Muylaert A, Beernaert A, De Pelsmaeker I, Boel E, Moya A, Verstreken S, Dierckx R, Heggermont W, Bartunek J, Vanderheyden M. T Cell and Antibody Response Following Double Dose of BNT162b2 mRNA Vaccine in SARS-CoV-2 Naïve Heart Transplant Recipients. Diagnostics (Basel) 2022; 12:diagnostics12092148. [PMID: 36140549 PMCID: PMC9497465 DOI: 10.3390/diagnostics12092148] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Preliminary studies have suggested a low post-vaccination antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in heart transplant(HTx)recipients. Although many studies have focused on the role of antibodies in vaccine-induced protection against SARS-CoV-2, the role of T cell immunity is less well characterized. To date, data regarding seroconversion and T cell response after mRNA SARS-CoV-2 vaccination in patients undergoing HTx are scarce. Therefore, the present study aimed to assess the specific memory humoral and cellular responses after two doses of the BNT162b2 vaccine in HTx recipients. Methods: Blood was drawn from heart transplant (HTx) recipients at two pre-specified time points after the first and second vaccine doses to measure both the anti-SARS-CoV-2 antibody response against the spike protein and the SARS-CoV-2-reactive T cell response. Results: Our study included 34 SARS-CoV-2 naïve HTx recipients (mean age, 61 ± 11 years). The mean time from transplantation to the first vaccine dose is 10 ± 10 years. Subgroup analysis (n = 21) demonstrated that after the first vaccine dose, only 14% had antibodies and 19% had a SARS-CoV-2-reactive T-cell response, which increased to 41% and 53%, respectively, after the second dose. Interestingly, 20% of patients with no antibodies after the second dose still had a positive SARS-CoV-2-reactive T cell response. The percentage of patients with positive S-IgG antibody titers was significantly higher 5 years after transplantation (18% 0–5 years post-TX vs. 65% 5 years post-TX, p = 0.013). Similarly, 5 years after heart transplantation, the percentage of patients with a T cell response was significantly higher (35% 0–5 years post-TX vs. 71% 5 years post-TX, p = 0.030). Conclusions: In SARS-CoV-2 naïve HTx recipients, post-vaccination antibody titers but also SARS-CoV-2 specific T cell response are low. Therefore, the protection from SARS-CoV-2 that is generally attributed to vaccination should be regarded with caution in HTx recipients.
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47
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Bermpeis K, Esposito G, Gallinoro E, Paolisso P, Bertolone DT, Fabbricatore D, Mileva N, Munhoz D, Wyfels E, Sonck J, Collet C, Barbato E, De Bruyne B, Bartunek J, Vanderheyden M. TCT-346 Safety of Right and Left Ventricular Endomyocardial Biopsy in Heart Transplant and Cardiomyopathy Patients. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.406] [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: 10/14/2022]
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Marfella R, D'Onofrio N, Mansueto G, Grimaldi V, Trotta MC, Sardu C, Sasso FC, Scisciola L, Amarelli C, Esposito S, D'Amico M, Golino P, De Feo M, Signoriello G, Paolisso P, Gallinoro E, Vanderheyden M, Maiello C, Balestrieri ML, Barbato E, Napoli C, Paolisso G. Glycated ACE2 reduces anti-remodeling effects of renin-angiotensin system inhibition in human diabetic hearts. Cardiovasc Diabetol 2022; 21:146. [PMID: 35932065 PMCID: PMC9356400 DOI: 10.1186/s12933-022-01573-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High glycated-hemoglobin (HbA1c) levels correlated with an elevated risk of adverse cardiovascular outcomes despite renin-angiotensin system (RAS) inhibition in type-2 diabetic (T2DM) patients with reduced ejection fraction. Using the routine biopsies of non-T2DM heart transplanted (HTX) in T2DM recipients, we evaluated whether the diabetic milieu modulates glycosylated ACE2 (GlycACE2) levels in cardiomyocytes, known to be affected by non-enzymatic glycosylation, and the relationship with glycemic control. OBJECTIVES We investigated the possible effects of GlycACE2 on the anti-remodeling pathways of the RAS inhibitors by evaluating the levels of Angiotensin (Ang) 1-9, Ang 1-7, and Mas receptor (MasR), Nuclear-factor of activated T-cells (NFAT), and fibrosis in human hearts. METHODS We evaluated 197 first HTX recipients (107 non-T2DM, 90 T2DM). All patients were treated with angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) at hospital discharge. Patients underwent clinical evaluation (metabolic status, echocardiography, coronary CT-angiography, and endomyocardial biopsies). Biopsies were used to evaluate ACE2, GlycACE2, Ang 1-9, Ang 1-7, MasR, NAFT, and fibrosis. RESULTS GlycACE2 was higher in T2DM compared tonon-T2DM cardiomyocytes. Moreover, reduced expressions of Ang 1-9, Ang 1-7, and MasR were observed, suggesting impaired effects of RAS-inhibition in diabetic hearts. Accordingly, biopsies from T2DM recipients showed higher fibrosis than those from non-T2DM recipients. Notably, the expression of GlycACE2 in heart biopsies was strongly dependent on glycemic control, as reflected by the correlation between mean plasma HbA1c, evaluated quarterly during the 12-month follow-up, and GlycACE2 expression. CONCLUSION Poor glycemic control, favoring GlycACE2, may attenuate the cardioprotective effects of RAS-inhibition. However, the achievement of tight glycemic control normalizes the anti-remodeling effects of RAS-inhibition. TRIAL REGISTRATION https://clinicaltrials.gov/ NCT03546062.
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Affiliation(s)
- Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Nunzia D'Onofrio
- Department of Precision Medicine, The University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Gelsomina Mansueto
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Vincenzo Grimaldi
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maria Consiglia Trotta
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy.
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Lucia Scisciola
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Cristiano Amarelli
- Unit of Cardiac Surgery and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, 80131, Naples, Italy
| | | | - Michele D'Amico
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Paolo Golino
- Cardiology Division, University "L. Vanvitelli" - Monaldi Hospital, 80131, Naples, Italy
| | - Marisa De Feo
- Department of Cardio-Thoracic Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Signoriello
- Statistical Unit-Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiology Division, University "L. Vanvitelli" - Monaldi Hospital, 80131, Naples, Italy.,Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Ciro Maiello
- Unit of Cardiac Surgery and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, 80131, Naples, Italy
| | - Maria Luisa Balestrieri
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Claudio Napoli
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
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Iturriagagoitia A, Vanderheyden M, Budts W, Vercauter P. Right Heart Failure in a Patient with Critical Pulmonary Stenosis, Absent Right Pulmonary Artery, and Lung Cancer. Am J Case Rep 2022; 23:e937305. [PMID: 35974681 PMCID: PMC9394545 DOI: 10.12659/ajcr.937305] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patient: Female, 67-year-old
Final Diagnosis: Absence of right pulmonary artery • lung cancer • pulmonary stenosis
Symptoms: Abdomen distension • dyspnea • fatigue • right heart failure
Medication: —
Clinical Procedure: Percutaneous pulmonary valve implantation • radiation therapy • right heart catherization
Specialty: Cardiology • Pulmonology
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Affiliation(s)
| | | | - Werner Budts
- Department of Congenital and Structural Cardiology, UZ Leuven, Leuven, Belgium
| | - Piet Vercauter
- Department of Pneumology, OLV Hospital Aalst, Aalst, Belgium
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50
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Herman R, Vanderheyden M, Vavrik B, Beles M, Palus T, Nelis O, Goethals M, Verstreken S, Dierckx R, Penicka M, Heggermont W, Bartunek J. Utilizing longitudinal data in assessing all-cause mortality in patients hospitalized with heart failure. ESC Heart Fail 2022; 9:3575-3584. [PMID: 35695324 DOI: 10.1002/ehf2.14011] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/14/2022] [Accepted: 05/31/2022] [Indexed: 12/20/2022] Open
Abstract
AIMS Risk stratification in patients with a new onset or worsened heart failure (HF) is essential for clinical decision making. We have utilized a novel approach to enrich patient level prognostication using longitudinally gathered data to develop ML-based algorithms predicting all-cause 30, 90, 180, 360, and 720 day mortality. METHODS AND RESULTS In a cohort of 2449 HF patients hospitalized between 1 January 2011 and 31 December 2017, we utilized 422 parameters derived from 151 451 patient exams. They included clinical phenotyping, ECG, laboratory, echocardiography, catheterization data or percutaneous and surgical interventions reflecting the standard of care as captured in individual electronic records. The development of predictive models consisted of 101 iterations of repeated random subsampling splits into balanced training and validation sets. ML models yielded area under the receiver operating characteristic curve (AUC-ROC) performance ranging from 0.83 to 0.89 on the outcome-balanced validation set in predicting all-cause mortality at aforementioned time-limits. The 1 year mortality prediction model recorded an AUC of 0.85. We observed stable model performance across all HF phenotypes: HFpEF 0.83 AUC, HFmrEF 0.85 AUC, and HFrEF 0.86 AUC, respectively. Model performance improved when utilizing data from more hospital contacts compared with only data collected at baseline. CONCLUSIONS Our findings present a novel, patient-level, comprehensive ML-based algorithm for predicting all-cause mortality in new or worsened heart failure. Its robust performance across phenotypes throughout the longitudinal patient follow-up suggests its potential in point-of-care clinical risk stratification.
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Affiliation(s)
- Robert Herman
- Powerful Medical, Bratislava, Slovak Republic
- Sigmund Freud University, Vienna, Austria
- Department of Advanced Biomedical Sciences, University of Naples Frederico II, Naples, Italy
| | | | | | - Monika Beles
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | | | | | | | | | - Riet Dierckx
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
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