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D'Alto M, Badagliacca R, Airò E, Ameri P, Argiento P, Garascia A, Lombardi CM, Mulè M, Raineri C, Scelsi L, Vizza CD, Ghio S. Gaps in evidence in the management of patients with intermediate-risk pulmonary arterial hypertension: Considerations following the ESC/ERS 2022 guidelines. Vascul Pharmacol 2024; 155:107374. [PMID: 38642596 DOI: 10.1016/j.vph.2024.107374] [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: 12/19/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
A comprehensive evaluation of risk, using multiple indices, is necessary to provide reliable prognostic information and guide therapy in pulmonary arterial hypertension (PAH). The current ESC/ERS guidelines suggest using a three-strata model for incident (newly diagnosed) patients and a four-strata model for prevalent patients with PAH. The four-strata model serves as a fundamental risk-stratification tool and relies on a minimal dataset of indicators that must be considered during follow-up. Nevertheless, there are still areas of vagueness and ambiguity when classifying and managing patients in the intermediate-risk category. For these patients, considerations should include right heart imaging, hemodynamics, as well as individual factors such as age, sex, genetic profile, disease type, comorbidities, and kidney function. The aim of this report is to present case studies, with a specific focus on patients ultimately classified as intermediate risk. We aim to emphasize the challenges and complexities encountered in the realms of diagnosis, classification, and treatment for these particular patients.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Roberto Badagliacca
- Department of Scienze Cliniche Internistiche, Anestesiologiche e Cardiologiche, Università "La Sapienza", Roma, Italy
| | - Edoardo Airò
- UO Pneumologia - Fondazione Toscana "G.Monasterio" - CNR/Regione Toscana, Pisa, Italy
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy; Cardiac, Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paola Argiento
- U.O.C. Cardiologia pediatrica e UTIC, A.O.R.N. dei colli - Ospedale Monaldi, Napoli, Italy
| | - Andrea Garascia
- Cardiologia 2 Insufficienza Cardiaca e Trapianti, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Carlo Mario Lombardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Massimiliano Mulè
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Claudia Raineri
- Department of Cardiology, Città della salute- Molinette Hospital, Turin, Italy
| | - Laura Scelsi
- Fondazione I.R.C.C.S. Policlinico San Matteo Pavia, Pavia, Italy
| | - Carmine Dario Vizza
- Department of Scienze Cliniche Internistiche, Anestesiologiche e Cardiologiche, Università "La Sapienza", Roma, Italy
| | - Stefano Ghio
- UOC Cardiologia 1, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
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Papa S, Badagliacca R, D´alto M, Ghio S, Argiento P, Brunetti N, Casu G, Cedrone N, Confalonieri M, Corda M, Correale M, D´agostino C, Galgano G, Manzi G, Mercurio V, Mulè M, Paciocco G, Romeo E, Scelsi L, Stolfo D, Vitulo P, Vizza CD. 121 RELEVANCE OF COMORBIDITIES ON INITIAL COMBINATION THERAPY IN PULMONARY ARTERIAL HYPERTENSION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.271] [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
Rationale
Demographic characteristics of pulmonary arterial hypertension (PAH) patients have changed over time, but the effects of cardiovascular risk factors on risk status and pulmonary vascular resistance (PVR) reduction with initial oral combination therapy are not known. Therefore, we tested the relevance of cardiovascular comorbidities in this setting.
Methods
The study enrolled 181 treatment-naive PAH patients with a 6- months (IQR 144-363 days) right heart catheterization and risk assessment after initial oral combination therapy.
Results
Group-A, 96 (53.0%) patients without cardiac comorbidities; Group-B, 54 (29.8%) patients with one cardiac comorbidity; Group-C, 31 (17.1%) patients with ≥2 cardiac comorbidities. Group-C patients were older with a balanced gender distribution. There was a significant difference in PVR reduction moving from the absence to one or ≥2 cardiac comorbidities, respectively, median -45.0%, -30.3%, -24.3%. A ERS/ESC low-risk status was present at first follow-up in 50 (52.0%) patients in Group-A, 19 (35.1%) in Group-B, and 9 (29.0%) in Group-C; a REVEAL 2.0 low-risk status was present at first follow-up in 41 (42.0%) patients in Group-A, 15 (27.7%) in Group-B, and 7 (22.6%) in Group-C. Group-A patients were 2.3 times more likely to achieve/maintain a low risk status compared with Group-B and -C (OR 2.27, 95% C.I. 1.15-4.54, p=0.02). No significant difference was observed between patients with non-cardiac comorbidities and those without comorbidities.
Conclusion
Initial oral combination therapy seems associated with a less effective response for patients with cardiovascular comorbidities compared with the others, related to the magnitude of treatment- induced decrease in PVR.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Marco Confalonieri
- University Of Trieste Clinical Department Of Medical Surgical And Health Sciences
| | | | | | | | | | | | | | | | | | | | | | | | - Patrizio Vitulo
- Istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione
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Badagliacca R, D'Alto M, Ghio S, Argiento P, Brunetti ND, Casu G, Cedrone N, Confalonieri M, Corda M, Correale M, D'Agostino C, De Michele L, Di Marino S, Filomena D, Galgano G, Greco A, Lombardi C, Manzi G, Mercurio V, Mulè M, Paciocco G, Papa S, Romeo E, Scelsi L, Stolfo D, Vitulo P, Vizza CD. Relevance of comorbidities on initial combination therapy in pulmonary arterial hypertension. ERJ Open Res 2022; 8:00298-2022. [DOI: 10.1183/23120541.00298-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
Abstract
RationaleDemographic characteristics of pulmonary arterial hypertension (PAH) patients have changed over time, but the effects of cardiovascular risk factors on risk status and pulmonary vascular resistance (PVR) reduction with initial oral combination therapy are not known. Therefore, we tested the relevance of cardiovascular comorbidities in this setting.MethodsThe study enrolled 181 treatment-naive PAH patients with a 6-months (IQR 144–363 days) right heart catheterization and risk assessment after initial oral combination therapy.ResultsGroup-A, 96 (53.0%) patients without cardiac comorbidities; Group-B, 54 (29.8%) patients with one cardiac comorbidity; Group-C, 31 (17.1%) patients with ≥2 cardiac comorbidities. Group-C patients were older with a balanced gender distribution. There was a significant difference in PVR reduction moving from the absence to one or ≥2 cardiac comorbidities, respectively, median −45.0%, −30.3%, −24.3%. A ERS/ESC low-risk status was present at first follow-up in 50 (52.0%) patients in Group-A, 19 (35.1%) in Group-B, and 9 (29.0%) in Group-C; a REVEAL 2.0 low-risk status was present at first follow-up in 41 (42.0%) patients in Group-A, 15 (27.7%) in Group-B, and 7 (22.6%) in Group-C. Group-A patients were 2.3 times more likely to achieve/maintain a low risk status compared with Group-B and -C (OR 2.27, 95% C.I. 1.15–4.54, p=0.02). No significant difference was observed between patients with non-cardiac comorbidities and those without comorbidities.ConclusionInitial oral combination therapy seems associated with a less effective response for patients with cardiovascular comorbidities compared with the others, related to the magnitude of treatment-induced decrease in PVR.
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Badagliacca R, Papa S, D'Alto M, Ghio S, Agostoni P, Ameri P, Argiento P, Brunetti ND, Casamassima V, Casu G, Cedrone N, Confalonieri M, Corda M, Correale M, D'Agostino C, De Michele L, Famoso G, Galgano G, Greco A, Lombardi CM, Manzi G, Madonna R, Mercurio V, Mulè M, Paciocco G, Romaniello A, Romeo E, Scelsi L, Serra W, Stolfo D, Toma M, Vatrano M, Vitulo P, Vizza CD. The paradox of pulmonary arterial hypertension in Italy in the COVID-19 era: is risk of disease progression around the corner? Eur Respir J 2022; 60:13993003.02276-2021. [PMID: 35301247 PMCID: PMC9535117 DOI: 10.1183/13993003.02276-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/09/2022] [Indexed: 01/01/2023]
Abstract
Objective The coronavirus disease 2019 (COVID-19) outbreak has led to significant restrictions on routine medical care. We conducted a multicentre nationwide survey of patients with pulmonary arterial hypertension (PAH) to determine the consequences of governance measures on PAH management and risk of poor outcome in patients with COVID-19. Materials and methods The present study, which included 25 Italian centres, considered demographic data, the number of in-person visits, 6-min walk and echocardiographic test results, brain natriuretic peptide/N-terminal pro-brain natriuretic peptide test results, World Health Organization functional class assessment, presence of elective and non-elective hospitalisation, need for treatment escalation/initiation, newly diagnosed PAH, incidence of COVID-19 and mortality rates. Data were collected, double-checked and tracked by institutional records between March 1 and May 1, 2020, to coincide with the first peak of COVID-19 and compared with the same time period in 2019. Results Among 1922 PAH patients, the incidences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 were 1.0% and 0.46%, respectively, with the latter comparable to that in the overall Italian population (0.34%) but associated with 100% mortality. Less systematic activities were converted into more effective remote interfacing between clinicians and PAH patients, resulting in lower rates of hospitalisation (1.2% versus 1.9%) and related death (0.3% versus 0.5%) compared with 2019 (p<0.001). A high level of attention is needed to avoid the potential risk of disease progression related to less aggressive escalation of treatment and the reduction in new PAH diagnoses compared with 2019. Conclusion A cohesive partnership between healthcare providers and regional public health officials is needed to prioritise PAH patients for remote monitoring by dedicated tools. COVID-19 showed low incidence among PAH patients, but high mortality rates. A high level of attention is needed to avoid the potential risk of disease progression in the near future.https://bit.ly/3s1lEYM
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Affiliation(s)
- Roberto Badagliacca
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Papa
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli", Naples, Italy
| | - Stefano Ghio
- Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
| | - Piergiuseppe Agostoni
- Departement of Clinical and Community Sciences, University of Milan, Milan, Italy.,Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Pietro Ameri
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Paola Argiento
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli", Naples, Italy
| | | | - Vito Casamassima
- Department of Cardiology, "F.Miulli" Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Gavino Casu
- ATS Sardegna-ASSL Nuoro, San Francesco Hospital Nuoro, Nuoro, Italy.,University of Sassari, Sassari, Italy
| | - Nadia Cedrone
- Unità di Medicina Interna, Ospedale S. Pertini, Rome, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Heart-Thorax-Vessels Department, University Hospital of Cattinara, Trieste, Italy
| | - Marco Corda
- Cardiology Unit, Azienda Ospedaliera "G. Brotzu" San Michele, Cagliari, Italy
| | - Michele Correale
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Carlo D'Agostino
- Cardiology Department, University Hospital Policlinico Consorziale Bari, Bari, Italy
| | - Lucrezia De Michele
- Cardiology Department, University Hospital Policlinico Consorziale Bari, Bari, Italy
| | - Giulia Famoso
- Department of Cardiac Thoracic Vascular Sciences and Public Health Padua, Padua, Italy
| | | | | | | | - Giovanna Manzi
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Rosalinda Madonna
- Cardiology Unit, Department of Surgical, Medical and Molecular Pathology and of Critical Sciences, University of Pisa - UNIPI, Pisa, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Giuseppe Paciocco
- Dipartimento Cardio-Toraco-Vascolare, Clinica Pneumologica, Azienda Ospedaliera San Gerardo, Monza, Italy
| | | | - Emanuele Romeo
- Department of Cardiology, Monaldi Hospital - University "L. Vanvitelli", Naples, Italy
| | - Laura Scelsi
- Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
| | - Walter Serra
- Cardiology Unit, University Hospital of Parma, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Matteo Toma
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, Univeristy of Genova, Genova, Italy
| | - Marco Vatrano
- Azienda Ospedaliera Pugliese - Ciaccio di Catanzaro, Catanzaro, Italy
| | - Patrizio Vitulo
- Pulmonology Unit, IRCCS - Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
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Badagliacca R, D'Alto M, Ghio S, Argiento P, Bellomo V, Brunetti ND, Casu G, Confalonieri M, Corda M, Correale M, D'Agostino C, De Michele L, Galgano G, Greco A, Lombardi C, Manzi G, Mercurio V, Mulè M, Paciocco G, Papa S, Romeo E, Scelsi L, Stolfo D, Vitulo P, Naeije R, Vizza CD. Risk Reduction and Hemodynamics with Initial Combination Therapy in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2021; 203:484-492. [PMID: 32857597 DOI: 10.1164/rccm.202004-1006oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Rationale: An initial oral combination of drugs is being recommended in pulmonary arterial hypertension (PAH), but the effects of this approach on risk reduction and pulmonary vascular resistance (PVR) are not known.Objectives: To test the hypothesis that a low-risk status would be determined by the reduction of PVR in patients with PAH treated upfront with a combination of oral drugs.Methods: The study enrolled 181 treatment-naive patients with PAH (81% idiopathic) with a follow-up right heart catheterization at 6 months (interquartile range, 144-363 d) after the initial combination of endothelin receptor antagonist + phosphodiesterase-5 inhibitor drugs and clinical evaluation and risk assessments by European guidelines and Registry to Evaluate Early and Long-Term PAH Disease Management scores.Measurements and Main Results: Initial combination therapy improved functional class and 6-minute-walk distance and decreased PVR by an average of 35% (median, 40%). One-third of the patients had a decrease in PVR <25%. This poor hemodynamic response was independently predicted by age, male sex, pulmonary artery pressure and cardiac index, and at echocardiography, a right/left ventricular surface area ratio of greater than 1 associated with low tricuspid annular plane systolic excursion of less than 18 mm. A low-risk status at 6 months was achieved or maintained in only 34.8% (Registry to Evaluate Early and Long-Term PAH Disease Management score) to 43.1% (European score) of the patients. Adding criteria of poor hemodynamic response improved prediction of a low-risk status.Conclusions: A majority of patients with PAH still insufficiently improved after 6 months of initial combinations of oral drugs is identifiable at initial evaluation by hemodynamic response criteria added to risk scores.
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Affiliation(s)
- Roberto Badagliacca
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital, University L. Vanvitelli, Naples, Italy
| | - Stefano Ghio
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S Matteo, Pavia, Italy
| | - Paola Argiento
- Department of Cardiology, Monaldi Hospital, University L. Vanvitelli, Naples, Italy
| | - Vincenzo Bellomo
- Department of Cardiology, F.Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | | | - Gavino Casu
- Azienda per la Tutela della Salute Sardegna-Area Socio Sanitaria Locale Nuoro, San Francesco Hospital, Nuoro, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Heart-Thorax-Vessels Department, University Hospital of Cattinara, Trieste, Italy
| | - Marco Corda
- Azienda Ospedaliera G. Brotzu San Michele, Cagliari, Italy
| | - Michele Correale
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Carlo D'Agostino
- Cardiology Department, University Hospital Policlinico Consorziale Bari, Italy
| | - Lucrezia De Michele
- Cardiology Department, University Hospital Policlinico Consorziale Bari, Italy
| | - Giuseppe Galgano
- Department of Cardiology, F.Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Alessandra Greco
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S Matteo, Pavia, Italy
| | - Carlo Lombardi
- Cardiologia, Università degli studi di Brescia, Brescia, Italy
| | - Giovanna Manzi
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Giuseppe Paciocco
- Dipartimento Cardio-Toraco-Vascolare, Clinica Pneumologica, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Silvia Papa
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
| | - Emanuele Romeo
- Department of Cardiology, Monaldi Hospital, University L. Vanvitelli, Naples, Italy
| | - Laura Scelsi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S Matteo, Pavia, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Patrizio Vitulo
- Pulmonology Unit, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy; and
| | - Robert Naeije
- Department of Pathophysiology, Free University of Brussels, Brussels, Belgium
| | - Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome, Rome, Italy
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Badagliacca R, Raina A, Ghio S, D’Alto M, Confalonieri M, Correale M, Corda M, Paciocco G, Lombardi C, Mulè M, Poscia R, Scelsi L, Argiento P, Sciomer S, Benza RL, Vizza CD. Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension. J Heart Lung Transplant 2018; 37:365-375. [DOI: 10.1016/j.healun.2017.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 08/03/2017] [Accepted: 08/24/2017] [Indexed: 01/22/2023] Open
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Barbieri M, Ghio S, D’Alto M, Albera C, Carignola R, Mulè M, Vitulo P, Vighini M, Silvestri R, Zamboni W, Vizza CD. Initial combination therapy for patients with pulmonary arterial hypertension (PAH): a budget impact analysis from the perspective of the Italian national healthcare system. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2018.1411259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marco Barbieri
- Centre for Health Economics, University of York, York, UK
| | - Stefano Ghio
- Department of Cardiology, S. Matteo Hospital, Pavia, Italy
| | - Michele D’Alto
- Department of Cardiology, Second University of Naples, S. Matteo Hospital, Monaldi Hospital, Naples, Italy
| | - Carlo Albera
- Department of Clinical and Biological Sciences, Interstitial and Rare Lung Disease Unit, University of Turin, Orbassano, Turin, Italy
| | - Renato Carignola
- Department of Clinical and Biological Science, University of Turin, Hospital Internal Medicine I, Orbassano, Turin, Italy
| | - Massimiliano Mulè
- Cardiothoracic-Vascular and Transplant Department, A.O.U. Policlinico, Vittorio Emanuele, Catania, Italy
| | - Patrizio Vitulo
- Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS – ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | | | | | | | - Carmine Dario Vizza
- Pulmonary Hypertension Unit, Department of Cardiovascular and Respiratory Disease, Sapienza University of Rome, Rome, Italy
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Foti R, Visalli E, Amato G, Benenati A, Converso G, Bellofiore S, Mulè M, Di Gangi M. SAT0243 Reduction of Pulmonary Artery Pressure in Scleroderma Patients: The Role of Long-Term, Intensive IV Iloprost Treatment. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Puglisi S, Torrisi SE, Vindigni V, Giuliano R, Palmucci S, Mulè M, Vancheri C. New perspectives on management of idiopathic pulmonary fibrosis. Ther Adv Chronic Dis 2016; 7:108-20. [PMID: 26977280 DOI: 10.1177/2040622315624276] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive parenchymal lung disease characterized by a median survival of 3-5 years following diagnosis. The diagnosis is based on clinical, radiological and histopathological evaluation. Therefore, a multidisciplinary team is needed to reach the correct diagnosis. For a long time, supportive care and lung transplantation in selected cases, have been considered the only possible treatments for IPF. In the last decade many studies have investigated IPF pathogenesis, leading to an improved knowledge of the mechanisms underlying the disease and to the approval of two new drugs for IPF treatment (pirfenidone and nintedanib). The therapeutic approach of IPF cannot be limited to the administration of antifibrotic drugs, but it is necessary for improving the quality of life of patients and for facilitating, as far as possible, the performance of normal daily activities and relationships. IPF patients are also afflicted by disease-related complications such as gastroesophageal reflux, pulmonary hypertension, acute exacerbations and an increased risk of developing lung cancer. The clinician who treats IPF patients, should also treat these possible complications to slow disease progression, thus maintaining the possibility of a pulmonary transplantation.
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Affiliation(s)
- Silvia Puglisi
- Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78 Catania, 95123, Italy
| | - Sebastiano Emanuele Torrisi
- Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78 Catania, 95123, Italy
| | - Virginia Vindigni
- Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78 Catania, 95123, Italy
| | - Riccardo Giuliano
- Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78 Catania, 95123, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit-University Hospital "Policlinico-Vittorio Emanuele" Via Santa Sofia 78, Catania 95123-Italy
| | - Massimiliano Mulè
- University of Catania - Division of Cardiology Ferrarotto Hospital, Catania, Italy
| | - Carlo Vancheri
- Regional Centre for Interstitial and Rare Lung Diseases, Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78 Catania, 95123, Italy
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Martinot JB, Mulè M, de Bisschop C, Overbeek MJ, Le-Dong NN, Naeije R, Guénard H. Lung membrane conductance and capillary volume derived from the NO and CO transfer in high-altitude newcomers. J Appl Physiol (1985) 2013; 115:157-66. [DOI: 10.1152/japplphysiol.01455.2012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute exposure to high altitude may induce changes in carbon monoxide (CO) membrane conductance (DmCO) and capillary lung volume (Vc). Measurements were performed in 25 lowlanders at Brussels (D0), at 4,300 m after a 2- or 3-day exposure (D2,3) without preceding climbing, and 5 days later (D7,8), before and after an exercise test, under a trial with two arterial pulmonary vasodilators or a placebo. The nitric oxide (NO)/CO transfer method was used, assuming both infinite and finite values to the NO blood conductance (θNO). Doppler echocardiography provided hemodynamic data. Compared with sea level, lung diffusing capacity for CO increased by 24% at D2,3 and is returned to control at D7,8. The acute increase in lung diffusing capacity for CO resulted from increases in DmCO and Vc with finite and infinite θNO assumptions. The alveolar volume increased by 16% at D2,3 and normalized at D7,8. The mean increase in systolic arterial pulmonary pressure at rest at D2,3 was minimal. In conclusion, the acute increase in Vc may be related to the increase in alveolar volume and to the increase in capillary pressure. Compared with the infinite θNO value, the use of a finite θNO value led to about a twofold increase in DmCO value and to a persistent increase in DmCO at D7,8 compared with D0. After exercise, DmCO decreased slightly less in subjects treated by the vasodilators, suggesting a beneficial effect on interstitial edema.
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Affiliation(s)
| | | | - Claire de Bisschop
- Laboratory Mobilité Vieillissement Exercice (MOVE), Poitiers University, Poitiers, France
| | - Maria J. Overbeek
- Department of Pulmonology, Medical Center Haaglanden, the Hague, the Netherlands
| | - Nhat-Nam Le-Dong
- Service de Physiologie, Explorations Fonctionnelles, Hôpital Cochin, Paris, France
| | - Robert Naeije
- Laboratory of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium; and
| | - Hervé Guénard
- Department of Physiology, University Hospital Bordeaux 2, Bordeaux, France
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11
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Argiento P, Vanderpool RR, Mulè M, Russo MG, D'Alto M, Bossone E, Chesler NC, Naeije R. Exercise stress echocardiography of the pulmonary circulation: limits of normal and sex differences. Chest 2013; 142:1158-1165. [PMID: 22539647 DOI: 10.1378/chest.12-0071] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Exercise stress echocardiography has not been recommended in the diagnostic workup of pulmonary hypertension because of insufficient certainty about feasibility and limits of normal. METHODS Doppler echocardiography pulmonary hemodynamic measurements were performed at a progressively increased workload in 56 healthy male and 57 healthy female volunteers aged 19 to 63 years. Mean pulmonary artery pressure (mPAP) was estimated from the maximal tricuspid regurgitation jet velocity. Cardiac index was calculated from the left ventricular outflow velocity-time integral. Pulmonary vascular distensibility a index, the percentage change of vessel diameter permm Hg of mPAP, was calculated from multipoint mPAP-cardiac output (CO) plots. RESULTS Peak exercise at 175 ±50 W was associated with an mPAP of 33±7 mm Hg and a CO of 18 ±5 L/min. The slope of mPAP-CO relationships was 1.5 ± 0.5 mm Hg/L/min, and the distensibility coefficient ( α ) was 1.3%± 1.0%/mm Hg. Maximal workload and cardiac index were higher in men than in women ( P , .05), but mPAP-cardiac index relationships were not different. However,women had a higher a (1.6%± 1.3%/mm Hg vs 1.1%± 0.6%/mm Hg, P < .05). The average mPAP-cardiac index slope was higher and a lower in subjects ≥50 years old. Upper limits of normal of mPAP at exercise were 34 mm Hg at a CO , 10 L/min, 45 mm Hg at a CO <20 L/min, and 52 mm Hg at a CO<30 L/min. These values are in keeping with previously reported invasive measurements. CONCLUSIONS Exercise stress echocardiography of the pulmonary circulation is feasible and allows for fl ow-corrected definition of upper limits of normal. Women have a more distensible pulmonary circulation.
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Affiliation(s)
- Paola Argiento
- Department of Cardiology, Second University of Naples, Naples, Italy
| | - Rebecca R Vanderpool
- Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - Massimiliano Mulè
- Clinical Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Michele D'Alto
- Department of Cardiology, Second University of Naples, Naples, Italy
| | - Eduardo Bossone
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Naomi C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI
| | - Robert Naeije
- Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium.
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12
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Groepenhoff H, Overbeek MJ, Mulè M, van der Plas M, Argiento P, Villafuerte FC, Beloka S, Faoro V, Macarlupu JL, Guenard H, de Bisschop C, Martinot JB, Vanderpool R, Penaloza D, Naeije R. Exercise Pathophysiology in Patients With Chronic Mountain Sickness. Chest 2012; 142:877-884. [DOI: 10.1378/chest.11-2845] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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13
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Tamburino C, Barbanti M, Capodanno D, Mignosa C, Gentile M, Aruta P, Pistritto AM, Bonanno C, Bonura S, Cadoni A, Gulino S, Di Pasqua MC, Cammalleri V, Scarabelli M, Mulè M, Immè S, Del Campo G, Ussia GP. Comparison of complications and outcomes to one year of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis. Am J Cardiol 2012; 109:1487-93. [PMID: 22356793 DOI: 10.1016/j.amjcard.2012.01.364] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 01/10/2012] [Accepted: 01/10/2012] [Indexed: 12/26/2022]
Abstract
Comparisons of transcatheter aortic valve implantation (TAVI) to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis remain sparse or limited by a short follow-up. We sought to evaluate early and midterm outcomes of consecutive patients (n = 618) undergoing successful TAVI (n = 218) or isolated SAVR (n = 400) at 2 centers. The primary end point was incidence of Valvular Academic Research Consortium-defined major adverse cerebrovascular and cardiac events (MACCEs) up to 1 year. Control of potential confounders was attempted with extensive statistical adjustment by covariates and/or propensity score. In-hospital MACCEs occurred in 73 patients (11.8%) and was more frequent in patients treated with SAVR compared to those treated with TAVI (7.8% vs 14.0%, p = 0.022). After addressing potential confounders using 3 methods of statistical adjustment, SAVR was consistently associated with a higher risk of MACCEs than TAVI, with estimates of relative risk ranging from 2.2 to 2.6 at 30 days, 2.3 to 2.5 at 6 months, and 2.0 to 2.2 at 12 months. This difference was driven by an adjusted increased risk of life-threatening bleeding at 6 and 12 months and stroke at 12 months with SAVR. Conversely, no differences in adjusted risk of death, stroke and myocardial infarction were noted between TAVI and SAVR at each time point. In conclusion, in a large observational registry with admitted potential for selection bias and residual confounding, TAVI was not associated with a higher risk of 1-year MACCEs compared to SAVR.
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14
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Timineri S, Mulè M, Puzzangara E, Santangelo G, Dugo D, Schillaci V, Di Grazia A, Liotta C, Scandura S, Tempio D, Tamburino C, Calvi V. Selection of patient for cardiac resynchronization therapy: role of QT corrected dispersion. Pacing Clin Electrophysiol 2012; 35:850-5. [PMID: 22548384 DOI: 10.1111/j.1540-8159.2012.03402.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS About 30 to 50% of patients undergoing cardiac resynchronization therapy (CRT) may not show clinical or echocardiographic improvement, despite fulfilling guidelines recommendations for CRT. For this reason, we need a more accurate method to assess CRT eligibility. The aims of this study were to verify, on a 12-month follow-up, the usefulness of QT corrected dispersion (QTcD) in a patient's selection for CRT. METHODS We stratified 53 patients who underwent CRT, into two groups based on the estimation of QTcD, that is, QTcD > 60 ms and QTcD ≤ 60 ms. In all patients were performed New York Heart Association (NYHA) class determination, six-minute walking test, QtcD, and QRS measurements, and complete echocardiographic assessment at 1, 3, 6, and 12 months after implantation. RESULTS At baseline, there were no significant differences in clinical, echocardiographic, and electrocardiographic parameters duration between two groups. At 12-month follow-up between the two groups, there were significant differences in NYHA (1.2 ± 0.4 vs 2 ± 0.6; P < 0.01), six-minute walking distance (422 ± 68 vs 364 ± 68; P < 0.01), left ventricular (LV) ejection fraction (34 ± 7% vs 28 ± 6%; P < 0.01), LV end-diastolic diameter (57 ± 7 vs 63 ± 8; P < 0.01), and LV intraventricular dyssynchrony (24 ± 14 vs 39 ± 23; P < 0.01). CONCLUSION This study suggests that QTc dispersion in addition to QRS duration could improve the sensitivity of electrocardiogram in a patient's selection for CRT.
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Affiliation(s)
- Salvatore Timineri
- Electrophysiology Unit, Cardiology Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
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15
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Tamburino C, Barbanti M, Capodanno D, Sarkar K, Cammalleri V, Scarabelli M, Mulè M, Immè S, Aruta P, Ussia GP. Early- and mid-term outcomes of transcatheter aortic valve implantation in patients with logistic EuroSCORE less than 20%: A comparative analysis between different risk strata. Catheter Cardiovasc Interv 2012; 79:132-40. [DOI: 10.1002/ccd.23100] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 02/28/2011] [Indexed: 11/06/2022]
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16
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Ussia GP, Barbanti M, Sarkar K, Aruta P, Scarabelli M, Cammalleri V, Immè S, Pistritto AM, Gulino S, Mulè M, Deste W, Cannata S, Tamburino C. Transcatheter aortic bioprosthesis dislocation: technical aspects and midterm follow-up. EUROINTERVENTION 2012; 7:1285-92. [DOI: 10.4244/eijv7i11a203] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Mulè M, Scarabelli M, Capodanno D, Ussia GP, Tamburino C. Clinical pharmacotherapy and drug development for pulmonary arterial hypertension. ACTA ACUST UNITED AC 2012; 6:180-8. [PMID: 21834768 DOI: 10.2174/157489011797377059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 05/09/2011] [Indexed: 11/22/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a rare, but serious condition which, if untreated, is associated with a poor survival. Currently, even if several trials have led to the approval of many drugs for PAH, there is no established cure for this disease. However, approved drugs for PAH have contributed to significantly improve symptoms, exercise capacity, quality of life and survival of these patients. The aim of this review is to overview the standard treatment of PAH and to give some insights about new treatments that are currently under investigation along with the discussion of recent patents.
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Ussia GP, Scarabelli M, Mulè M, Barbanti M, Sarkar K, Cammalleri V, Immè S, Aruta P, Pistritto AM, Gulino S, Deste W, Capodanno D, Tamburino C. Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation. Am J Cardiol 2011; 108:1772-6. [PMID: 21907949 DOI: 10.1016/j.amjcard.2011.07.049] [Citation(s) in RCA: 188] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 07/15/2011] [Accepted: 07/15/2011] [Indexed: 11/15/2022]
Abstract
Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve implantation (TAVI), but this approach is not evidence based. The goal of the present study was to determine whether DAPT in patients undergoing TAVI is associated with improved outcomes compared to aspirin alone. From May 2009 to August 2010, consecutive patients were randomized to receive a 300-mg loading dose of clopidogrel on the day before TAVI followed by a 3-month maintenance daily dose of 75 mg plus aspirin 100 mg lifelong (DAPT group) or aspirin 100 mg alone (ASA group). The primary end point was the composite of major adverse cardiac and cerebrovascular events, defined as death from any cause, myocardial infarction, major stroke, urgent or emergency conversion to surgery, or life-threatening bleeding. The cumulative incidence of major adverse cardiac and cerebrovascular events at 30 days and 6 months was 14% and 16%, respectively. No significant differences between the DAPT and ASA groups were noted at both 30 days (13% vs 15%, p = 0.71) and 6 months (18% vs 15%; p = 0.85). In conclusion, the strategy of adding clopidogrel to aspirin for 3 months after TAVI was not found to be superior to aspirin alone. These results must be confirmed in a larger randomized trial.
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Affiliation(s)
- Gian Paolo Ussia
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
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Ussia G, Barbanti M, Cammalleri V, Scarabelli M, Mulè M, Aruta P, Pistritto AM, Immè S, Capodanno D, Sarkar K, Gulino S, Tamburino C. Quality-of-life in elderly patients one year after transcatheter aortic valve implantation for severe aortic stenosis. EUROINTERVENTION 2011; 7:573-9. [DOI: 10.4244/eijv7i5a93] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Santangelo G, Dugo D, Mulè M, Puzzangara E, Schillaci V, Timineri S, Capranzano P, Di Grazia A, Liotta C, Scandura S, Ragusa A, Tamburino C, Calvi V. Functional and clinical implications of cardiac resynchronization therapy on outcomes of diabetic patients with heart failure. J Cardiovasc Med (Hagerstown) 2011; 12:396-400. [DOI: 10.2459/jcm.0b013e328341da34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Tamburino C, Immè S, Barbanti M, Mulè M, Pistritto AM, Aruta P, Cammalleri V, Scarabelli M, Mangiafico S, Scandura S, Ussia GP. Reduction of mitral valve regurgitation with Mitraclip® percutaneous system. Minerva Cardioangiol 2010; 58:589-598. [PMID: 20948505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Mitral regurgitation (MR) is the second most common heart valve disease worldwide and the current gold-standard treatment is surgical repair or replacement. Nevertheless, many patients do not undergo surgical intervention due to several comorbidities. Percutaneous "edge-to-edge" mitral valve repair using the MitraClip System is an emerging and effective option to this subset of patients. This device has been used to treat both functional and degenerative mitral valve regurgitation and has been compared to surgery in the Endovascular Valve Edge-to-Edge Repair Study II (EVEREST II) randomized trial. Although the field of percutaneous management of MR is at an early stage, it has been demonstrated that percutaneous approaches can reduce MR, suggesting there is a great deal of potential for clinical benefit to patients with MR.
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Affiliation(s)
- C Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
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Abstract
Exercise stress tests have been used for the diagnosis of pulmonary hypertension, but with variable protocols and uncertain limits of normal. The pulmonary haemodynamic response to progressively increased workload and recovery was investigated by Doppler echocardiography in 25 healthy volunteers aged 19-62 yrs (mean 36 yrs). Mean pulmonary artery pressure ((Ppa)) was estimated from the maximum velocity of tricuspid regurgitation. Cardiac output (Q) was calculated from the aortic velocity-time integral. Slopes and extrapolated pressure intercepts of (Ppa)-Q plots were calculated after using the adjustment of Poon for individual variability. A pulmonary vascular distensibility alpha was calculated from each (Ppa)-Q plot to estimate compliance. (Ppa) increased from 14+/-3 mmHg to 30+/-7 mmHg, and decreased to 19+/-4 mmHg after 5 min recovery. The slope of (Ppa)-Q was 1.37+/-0.65 mmHg x min(-1) x L(-1) with an extrapolated pressure intercept of 8.2+/-3.6 mmHg and an alpha of 0.017+/-0.018 mmHg(-1). These results agree with those of previous invasive studies. Multipoint (pa)-Q plots were well described by a linear approximation, from which resistance can be calulated. We conclude that exercise echocardiography of the pulmonary circulation is feasible and provides realistic resistance and compliance estimations. Measurements during recovery are unreliable because of rapid return to baseline.
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Ussia GP, Scarabelli M, Mulè M, Barbanti M, Cammalleri V, Immè S, Aruta P, Pistritto AM, Carbonaro A, Deste W, Sciuto P, Licciardello G, Calvi V, Tamburino C. Postprocedural management of patients after transcatheter aortic valve implantation procedure with self-expanding bioprosthesis. Catheter Cardiovasc Interv 2010; 76:757-66. [DOI: 10.1002/ccd.22602] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ussia GP, Barbanti M, Immè S, Scarabelli M, Mulè M, Cammalleri V, Aruta P, Pistritto AM, Capodanno D, Deste W, Di Pasqua MC, Tamburino C. Management of implant failure during transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2010; 76:440-9. [DOI: 10.1002/ccd.22595] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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25
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Ussia GP, Barbanti M, Cammalleri V, Scarabelli M, Mulè M, Tamburino C. Percutaneous Heart Valve Therapy – Options, Risks and Benefits. Eur Cardiol 2010. [DOI: 10.15420/ecr.2010.6.1.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transcatheter valve therapy is emerging as an effective option for aortic valve stenosis and mitral regurgitation. In 1992, Anderson demonstrated the feasibility of percutaneous implantation of catheter-based valve prosthesis. Since then, many technical and device advances have been made, and transcatheter aortic valve implantation and mitral valve repair have became a concrete alternative to surgical replacement.
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26
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Ussia GP, Mulè M, Cammalleri V, Scarabelli M, Barbanti M, Immè S, Mangiafico S, Marchese A, Galassi AR, Tamburino C. Percutaneous closure of left atrial appendage to prevent embolic events in high-risk patients with chronic atrial fibrillation. Catheter Cardiovasc Interv 2009; 74:217-22. [PMID: 19472361 DOI: 10.1002/ccd.22099] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Percutaneous closure of the left atrial appendage (LAA) is a novel alternative for the treatment of patients with atrial fibrillation (AF) and with a high risk of stroke who are not eligible for long-term anticoagulation therapy. The aim of this study was to asses the safety, feasibility, and long-term efficacy of this procedure. METHODS From July 2004 to June 2007, 20 patients (13 male, mean age 69 +/- 8 years) with non-valvular AF (NV-AF) underwent LAA percutaneous closure using the PLAATO system, implanted through a transeptal access. All patients had contraindications to anticoagulant therapy and were at high risk for cardioembolic stroke (mean CHADS(2) score 3 +/- 1.2). A trans-thoracic echocardiogram was performed at 1, 3, and every 6 months after the procedure, whereas a trans-oesophageal echocardiogram (TOE) was scheduled at 6 months. After 24 months, a phone interview was obtained. RESULTS All procedures were successfully performed in 18 patients. In two patients, LAA closure was not feasible for the presence of a multilobed LAA. Two patients underwent percutaneous closure of patent foramen ovale in the same session. In one patient, the procedure was complicated by cardiac perforation with pericardial effusion, treated with pericardiocentesis. At a mean follow up of 40 +/- 10 months, no embolic events occurred. One patient died, after 36 months, for gastric cancer. TOE examination showed the complete exclusion of the LAA in all patients. CONCLUSIONS Percutaneous closure of LAA is safe and efficacious to prevent stroke in patients with NV-AF at high risk for cardioembolic events, with contraindications to anticoagulant therapy.
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Affiliation(s)
- Gian Paolo Ussia
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
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Ussia GP, Cammalleri V, Mulè M, Scarabelli M, Barbanti M, Scardaci F, Mangiafico S, Immè S, Capodanno D, Tamburino C. Percutaneous closure of patent foramen ovale with a bioabsorbable occluder device. Catheter Cardiovasc Interv 2009; 74:607-14. [DOI: 10.1002/ccd.22033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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28
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Ussia GP, Mulè M, Tamburino C. The valve-in-valve technique: Transcatheter treatment of aortic bioprothesis malposition. Catheter Cardiovasc Interv 2009; 73:713-6. [DOI: 10.1002/ccd.21896] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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29
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Tamburino C, Capodanno D, Mulè M, Scarabelli M, Cammalleri V, Barbanti M, Calafiore A, Ussia G. Procedural success and 30-day clinical outcomes after percutaneous aortic valve replacement using current third-generation self-expanding CoreValve prosthesis. J Invasive Cardiol 2009; 21:93-98. [PMID: 19258637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Percutaneous aortic valve replacement (PAVR) is an emerging alternative for high-risk patients with severe aortic stenosis. The aim of this study was to report acute and short-term outcomes of PAVR with the 18 Fr CoreValve Revalving System. METHODS From January 2007 to July 2008, 69 high-risk symptomatic patients with severe aortic stenosis were screened to assess their eligibility criteria for PAVR. All candidates were evaluated by a cardiac surgeon and a cardiologist. Thirty patients (13 men, 17 women, ages 82 +/- 5 years, range 73-88 years) met all the eligibility criteria and were enrolled in the study. RESULTS Twenty-nine patients (97%) underwent successful valve implantation by a retrograde approach, with improvement in valve area (0.61 +/- 0.18 cm(2) to 1.49 +/- 0.39 cm(2); p < 0.001) and transvalvular gradient (58.1 +/- 17.6 mmHg to 9.2 +/- 4.0; p < 0.001). Paravalvular leakages were 1+ (n = 12) and 2+ (n = 2). Procedural success was achieved in 93% of patients, with 1 case of pericardial tamponade occurred during the first 48 hours after implantation. At 30-day mortality was 7%. The mean NYHA Functional Class declined from 2.72 +/- 0.59 to 1.31 +/- 0.47 (p < 0.001). No other major adverse events occurred at a mean follow up of 4.9 +/- 4.0 months (range 1-13 months). CONCLUSIONS Our initial experience of PAVR in a cohort of older and high-risk surgical patients has been positive, with excellent acute and encouraging short-term results in terms of safety and efficacy.
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Ussia GP, Tina LG, Scarabelli M, Nigro F, Li Volti G, Cavallaro D, Salvo V, Mulè M, Caruso E, Tamburino C, Gazzolo D. Nitric oxide test during cardiac catheterization decreases the serum concentrations of S100B protein in adult patients with idiopathic pulmonary hypertension. Scand J Clin Lab Invest 2007; 67:668-72. [PMID: 17891653 DOI: 10.1080/00365510701286202] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Cardiac catheterization (CC) is a life-threatening procedure in adult patients. Complicated by idiopathic arterial pulmonary hypertension (IPAH), there is a potential risk of central nervous system (CNS) damage. We measured serum levels of a well-established brain damage marker, namely S100B, collected before, during and after CC in adult patients in whom the nitric oxide (NO) test had been performed. MATERIAL AND METHODS In 12 adult patients who had undergone CC for IPAH diagnosis, we recorded clinical and standard monitoring procedures (laboratory variables and echocardiographic patterns) and serum concentrations of S100B before (time 0), during (time 1) and after the NO test (time 2) and at 24 h after (time 3) the procedure in samples obtained from the systemic and pulmonary circulation. Patients were subdivided into NO test responders (n=6) and non-responders (n=6). Neurological evaluation was performed at admission and at discharge from hospital. RESULTS Adult patients subjected to CC showed no overt neurological injury at discharge from hospital. No significant differences (p > 0.05 for all) in S100B serum levels between groups at times 0, 1 and 3 have been shown independently from the sampling site. It was noteworthy that the concentration of protein in the responders group at time 2 was significantly decreased (p < 0.05, for all) compared to the responder group and to baseline values. A significant correlation was found between arterial oxygen partial pressure and individual S100B concentration in the pulmonary and systemic bloodstream in the entire study group (R = -0.66 and R = 0.71, respectively; p < 0.05, for both). CONCLUSIONS The data suggest that S100B protein assessment, as well as the NO test, may be useful when monitoring possible CNS damage during CC in patients with IPAH, and may also be valuable in relation to brain functions, especially when performed as an emergency procedure in severely hypoxic patients.
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Affiliation(s)
- G P Ussia
- Department of Heart, Ferrarotto Hospital, University of Catania, Catania, Italy
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Ussia GP, Caruso E, Mulè M, Tamburino C, Tina LG, Nigro F, Cavallaro D, Salvo V, Gazzolo D, Li Volti G. S100B protein blood concentrations in pulmonary and systemic circulation: Correlations with oxygenation status and sampling modalities. Clin Chim Acta 2007; 380:243-4. [PMID: 17328881 DOI: 10.1016/j.cca.2007.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2006] [Revised: 01/09/2007] [Accepted: 01/09/2007] [Indexed: 11/30/2022]
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Ussia GP, Mulè M, Caruso E, Aiello R, Tamburino C. Combined endothelin receptor antagonist and transcatheter interventional therapy of patent ductus arteriosus with severe pulmonary artery hypertension. Int J Cardiol 2007; 116:427-9. [PMID: 16875749 DOI: 10.1016/j.ijcard.2006.03.080] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Accepted: 03/25/2006] [Indexed: 11/21/2022]
Abstract
The natural history of congenital heart disease (CHD) with left to right shunt and high pulmonary blood flow, is characterized by development of severe Pulmonary Artery Hypertension (PAH); this condition usually contraindicates any type of surgical or interventional cardiac correction because of bad results. We here report the case of an adult patient with a patent ductus arteriosus and severe PAH, treated uneventfully with a staged combined therapy: Bosentan for 3 months and then percutaneous closure with amplatzer duct occluder (AGA Med. Co. Golden Valley, MN). The patient showed a dramatic improvement both of pulmonary hemodynamics and functional capacity at 8 months follow up confirming the efficacy of pulmonary vasodilator therapy in PAH associated to congenital heart disease.
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Ussia GP, Mangiafico S, Privitera A, Mulè M, Caruso E, Galassi AR, Famoso G, Tamburino C. Percutaneous left atrial appendage transcatheter occlusion in patients with chronic nonvalvular atrial fibrillation: early institutional experience. J Cardiovasc Med (Hagerstown) 2006; 7:569-72. [PMID: 16858233 DOI: 10.2459/01.jcm.0000237902.57764.4c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The percutaneous left atrial appendage transcatheter occlusion system (PLAATO, ev3 Inc., Plymouth, Minnesota, USA) is a novel technique of interventional cardiology, which has recently been proposed for the nonpharmacological prophylaxis of thromboembolic events in patients with chronic nonvalvular atrial fibrillation ineligible for oral anticoagulation therapy with vitamin K antagonists. The aim of this study was to assess the safety, feasibility and mid-term efficacy of this procedure. METHODS We conducted a preliminary institutional experience on a selected population of seven patients (two male, five female, mean age 64 +/- 7 years) with chronic nonvalvular atrial fibrillation at high risk for thromboembolic events with contraindications for oral anticoagulation therapy with vitamin K antagonists. RESULTS All procedures were successfully performed without any complications at a mean follow-up of 7 +/- 4 months and no thromboembolic or adverse cardiac events occurred. CONCLUSIONS Percutaneous left atrial appendage transcatheter occlusion is safe and feasible, without any complications at mid-term follow-up.
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Affiliation(s)
- Gian Paolo Ussia
- Cardiology Division, University of Catania, Ferrarotto Hospital, Italy.
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Abstract
BACKGROUND AND PURPOSE The present study evaluated the concurrent validity of the NK hand dexterity test (NKHDT) by use of three separate analyses: (1) the correlation between the NKHDT and a criterion comparator (Jebson's Hand Function Test (JHFT)); (2) the correlation between both dexterity tests and a patient-rated function questionnaire; and (3) the ability of subscales to differentiate between subjects with and without upper extremity pathology. METHOD The study population included 40 individuals with a variety of musculoskeletal problems affecting the upper extremity and 10 individuals without any history of upper extremity problems. Both dexterity tests were administered on a single occasion according to a standard protocol. Subjects also completed a rating scale which evaluated self-care, household work, work and recreation on an 0-10-point scale. RESULTS The validity of the NKHDT was supported in all three analyses because: (1) the correlation between the NKHDT and JHFT subtests was moderate to strong (Pearson's r = 0.47-0.87) and stronger when the objects were more similar in size; (2) both scales correlated to a similar extent with patient-rated function (Pearson's r = 0.34-0.67); and (3) all subscales were statistically different between subjects with and without upper extremity pathology (p < 0.01). CONCLUSIONS The present study supports the use of the NKHDT as a measure of hand dexterity.
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Affiliation(s)
- J C MacDermid
- Clinical Research Laboratory, Hand and Upper Limb Centre, St Joseph's Health Centre, PO Box 5777, London, Ontario N6A 4L6, Canada.
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Cataldo F, Di Stefano P, Violante M, Traverso G, Mulè M. [Pseudohyperaldosteronism secondary to licorice poisoning associated with hemorrhagic gastritis]. Pediatr Med Chir 1997; 19:219-21. [PMID: 9340615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The case is described of a 6 1/2-year-old child with pseudohyperaldosteronism due to excessive and prolonged liquorice ingestion. The authors debate its differential diagnosis, its physiopathological mechanism (glycyrrhetinic acid, the active metabolite of liquorice, inhibits the conversion of cortisol in cortisone) and its unusual association with haemorrhagic gastritis never observed in the course of liquorice intoxication.
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Affiliation(s)
- F Cataldo
- Divisione di Pediatria, Clinica Pediatrica R, P.O. Aiuto Materno di Palermo, Italia
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Tàmmaro AE, Noto M, Mulè M, Bonaccorso O. [Senile mental deterioration: therapeutic aspects]. Clin Ter 1975; 72:55-65. [PMID: 776497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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