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Di Fusco SA, Abrignani MG, Amico AF, Lucà F, Mureddu GF, Ceravolo R, Temporelli PL, Acerbo V, Altamura V, Baccino D, Binaghi G, Bugani G, Cesaro A, Ciccirillo F, Cocozza S, D'Errigo P, Di Martino M, Di Nora C, Fileti L, Lopriore V, Maloberti A, Monitillo F, Gulizia MM, Grimaldi M, Gabrielli D, Oliva F, Colivicchi F. [Multidistrict atherosclerotic disease: epidemiological and clinical framework]. G Ital Cardiol (Rome) 2024; 25:239-251. [PMID: 38526360 DOI: 10.1714/4244.42205] [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: 03/26/2024]
Abstract
Atherosclerosis is a systemic disease that can involve different arterial districts. Traditionally, the focus of cardiologists has been on the diagnosis and treatment of atherosclerotic coronary artery disease (CAD). However, atherosclerosis localization in other districts is increasingly common and is associated with an increased risk of CAD and, more generally, of adverse cardiovascular events. Although the term peripheral arterial disease (PAD) commonly refers to the localization of atherosclerotic disease in the arterial districts of the lower limbs, in this document, in accordance with the European Society of Cardiology guidelines, the term PAD will be used for all the locations of atherosclerotic disease excluding coronary and aortic ones. The aim of this review is to report updated data on PAD epidemiology, with particular attention to the prevalence and its prognostic impact on patients with CAD. Furthermore, the key points for an appropriate diagnostic framework and a correct pharmacological therapeutic approach are summarized, while surgical/interventional treatment goes beyond the scope of this review.
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Affiliation(s)
- Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | | | | | - Fabiana Lucà
- UTIC, Cardiologia Interventistica, Grande Ospedale Metropolitano "GOM", Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria
| | | | - Roberto Ceravolo
- U.O. Cardiologia e UTIC, Ospedale Giovanni Paolo II, Lamezia Terme (CZ)
| | | | | | - Vito Altamura
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Danilo Baccino
- Cardiologia, Ospedale S. Spirito, Casale Monferrato (AL)
| | | | | | - Arturo Cesaro
- Università della Campania "L. Vanvitelli", Napoli - Divisione di Cardiologia, AORN Sant'Anna e San Sebastiano, Caserta
| | | | | | | | | | - Concetta Di Nora
- S.O.C. Cardiochirurgia, A.O.U. Santa Maria della Misericordia, Udine
| | | | | | - Alessandro Maloberti
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti (BA)
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
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Zuin M, Rigatelli G, Cavedon S, Temporelli PL, Bilato C. Trends in sudden cardiac death mortality in Italy, 2013-2019. Intern Emerg Med 2024; 19:423-428. [PMID: 38112986 DOI: 10.1007/s11739-023-03492-5] [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: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
We sought to analyse the incidence of sudden cardiac deaths (SCDs) amongst subjects aged less than 39 years in Italy and its time trend between 2013 and 2019. Data regarding cause-specific mortality and population size by sex in 5-year age groups were extracted from the World Health Organization (WHO) mortality database. Decedents reporting the codes I46.1, I45.6, I47.2, I41.9, R09.2 and R96.0 of the International Classification of Disease-10 (ICD-10) coding system, were extracted. The age-adjusted mortality rates (AAMRs), with relative 95% confidence intervals (CIs) stratified by sex, were determined using the direct method. Joinpoint regression analyses were used to identify periods with statistically distinct log linear trends in SCD-related death rates. To calculate nationwide annual trends in SCD-related mortality, we assessed the annual and average annual per cent change (AAPC) and relative 95% CIs. Over the study period, 314 deaths [220 males (70.0%) and 94 females] were due to SCD corresponding to a 0.06 per 100,000 per year (0.10 per 100,000 in males and 0.04 per 100,000 in females, respectively). Proportional mortality slightly increased, without reaching the statistical significance (p = 0.82) from 3.06 to 3.56 per 100 deaths, with a similar trend in both sexes. Joinpoint regression analysis revealed a plateau in age-standardised SCD-related mortality over the period [AAPC: -4.2 (95% CI: -24.0 to 20.8, p = 0.71], which was consistent between males and females. In Italy, SCD remains a public health issue of concern in the last decade after adjusting for age.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
- Department of Cardiology, West Vicenza Hospital, Arzignagno, Italy.
| | | | - Stefano Cavedon
- Department of Cardiology, West Vicenza Hospital, Arzignagno, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignagno, Italy
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Lucà F, Oliva F, Abrignani MG, Di Fusco SA, Gori M, Giubilato S, Ceravolo R, Temporelli PL, Cornara S, Rao CM, Caretta G, Pozzi A, Binaghi G, Maloberti A, Di Nora C, Di Matteo I, Pilleri A, Gelsomino S, Riccio C, Grimaldi M, Colivicchi F, Gulizia MM. Heart Failure with Preserved Ejection Fraction: How to Deal with This Chameleon. J Clin Med 2024; 13:1375. [PMID: 38592244 PMCID: PMC10933980 DOI: 10.3390/jcm13051375] [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: 12/13/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 04/10/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is characterized by a notable heterogeneity in both phenotypic and pathophysiological features, with a growing incidence due to the increase in median age and comorbidities such as obesity, arterial hypertension, and cardiometabolic disease. In recent decades, the development of new pharmacological and non-pharmacological options has significantly impacted outcomes, improving clinical status and reducing mortality. Moreover, a more personalized and accurate therapeutic management has been demonstrated to enhance the quality of life, diminish hospitalizations, and improve overall survival. Therefore, assessing the peculiarities of patients with HFpEF is crucial in order to obtain a better understanding of this disorder. Importantly, comorbidities have been shown to influence symptoms and prognosis, and, consequently, they should be carefully addressed. In this sense, it is mandatory to join forces with a multidisciplinary team in order to achieve high-quality care. However, HFpEF remains largely under-recognized and under-treated in clinical practice, and the diagnostic and therapeutic management of these patients remains challenging. The aim of this paper is to articulate a pragmatic approach for patients with HFpEF focusing on the etiology, diagnosis, and treatment of HFpEF.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, 89129 Reggio Calabria, Italy
| | - Fabrizio Oliva
- Cardiology Department De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (A.M.)
| | | | | | - Mauro Gori
- Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Simona Giubilato
- Cardiology Department, Ospedale Lamezia Terme, 88046 Catanzaro, Italy
| | - Roberto Ceravolo
- Cardiac Rehabilitation Unitof Maugeri, IRCCS, 28010 Gattico-Veruno, Italy
| | | | - Stefano Cornara
- Arrhytmia Unit, Division of Cardiology, Ospedale San Paolo, Azienda Sanitaria Locale 2, 17100 Savona, Italy;
| | | | - Giorgio Caretta
- Levante Ligure Sant’Andrea Hospital, ASL 5 Liguria, 19121 La Spezia, Italy
| | - Andrea Pozzi
- Cardiology Division, Valduce Hospital, 22100 Como, Italy
| | - Giulio Binaghi
- Department of Cardiology, Azienda Ospedaliera Brotzu, 09134 Cagliari, Italy
| | - Alessandro Maloberti
- Cardiology Department De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (A.M.)
| | - Concetta Di Nora
- Department of Cardiothoracic Science, Azienda Sanitaria UniversitariaIntegrata di Udine, 33100 Udine, Italy
| | - Irene Di Matteo
- Cardiology Department De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (A.M.)
| | - Anna Pilleri
- Department of Cardiology, Azienda Ospedaliera Brotzu, 09134 Cagliari, Italy
| | - Sandro Gelsomino
- Cardiovascular Research Institute, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Carmine Riccio
- Cardiovascular Department, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy
| | - Furio Colivicchi
- Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Rome, Italy
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4
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Tikhonoff V, Casiglia E, Virdis A, Grassi G, Angeli F, Arca M, Barbagallo CM, Bombelli M, Cappelli F, Cianci R, Cicero AFG, Cirillo M, Cirillo P, Dell'oro R, D'elia L, Desideri G, Ferri C, Galletti F, Gesualdo L, Giannattasio C, Iaccarino G, Mallamaci F, Maloberti A, Masi S, Masulli M, Mazza A, Mengozzi A, Muiesan ML, Nazzaro P, Palatini P, Parati G, Pontremoli R, Quarti‐Trevano F, Rattazzi M, Reboldi G, Rivasi G, Russo E, Salvetti M, Temporelli PL, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Borghi C. Prognostic Value and Relative Cutoffs of Triglycerides Predicting Cardiovascular Outcome in a Large Regional-Based Italian Database. J Am Heart Assoc 2024; 13:e030319. [PMID: 38293920 PMCID: PMC11056112 DOI: 10.1161/jaha.123.030319] [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: 04/02/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Despite longstanding epidemiologic data on the association between increased serum triglycerides and cardiovascular events, the exact level at which risk begins to rise is unclear. The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension has conceived a protocol aimed at searching for the prognostic cutoff value of triglycerides in predicting cardiovascular events in a large regional-based Italian cohort. METHODS AND RESULTS Among 14 189 subjects aged 18 to 95 years followed-up for 11.2 (5.3-13.2) years, the prognostic cutoff value of triglycerides, able to discriminate combined cardiovascular events, was identified by means of receiver operating characteristic curve. The conventional (150 mg/dL) and the prognostic cutoff values of triglycerides were used as independent predictors in separate multivariable Cox regression models adjusted for age, sex, body mass index, total and high-density lipoprotein cholesterol, serum uric acid, arterial hypertension, diabetes, chronic renal disease, smoking habit, and use of antihypertensive and lipid-lowering drugs. During 139 375 person-years of follow-up, 1601 participants experienced cardiovascular events. Receiver operating characteristic curve showed that 89 mg/dL (95% CI, 75.8-103.3, sensitivity 76.6, specificity 34.1, P<0.0001) was the prognostic cutoff value for cardiovascular events. Both cutoff values of triglycerides, the conventional and the newly identified, were accepted as multivariate predictors in separate Cox analyses, the hazard ratios being 1.211 (95% CI, 1.063-1.378, P=0.004) and 1.150 (95% CI, 1.021-1.295, P=0.02), respectively. CONCLUSIONS Lower (89 mg/dL) than conventional (150 mg/dL) prognostic cutoff value of triglycerides for cardiovascular events does exist and is associated with increased cardiovascular risk in an Italian cohort.
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Affiliation(s)
- Valérie Tikhonoff
- Department of MedicineUniversità degli Studi di PadovaVia Giustiniani 8Padua35128Italy
| | - Edoardo Casiglia
- Studium Patavinum, Department of MedicineUniversità degli Studi di PadovaPaduaItaly
| | - Agostino Virdis
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Guido Grassi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | - Fabio Angeli
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - Marcello Arca
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Carlo M. Barbagallo
- Biomedical Department of Internal Medicine and SpecialisticsUniversity of PalermoItaly
| | - Michele Bombelli
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
- Internal Medicine, Pio XI Hospital of Desio, ASST BrianzaDesioItaly
| | - Federica Cappelli
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Rosario Cianci
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Arrigo F. G. Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences DepartmentAlma Mater Studiorum University of BolognaBolognaItaly
- IRCCS AOU S.Orsola di BolognaBolognaItaly
| | - Massimo Cirillo
- Department of Medicine “Scuola Medica Salernitana”University of SalernoBaronissi (SA)Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation“Aldo Moro” University of BariBariItaly
| | - Raffaella Dell'oro
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | - Lanfranco D'elia
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | | | - Claudio Ferri
- Department of Life, Health and Environmental SciencesUniversity of L’AquilaItaly
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation“Aldo Moro” University of BariBariItaly
| | - Cristina Giannattasio
- Cardiology IV, “A.De Gasperi’s” DepartmentNiguarda Ca’ Granda HospitalMilanItaly
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences“Federico II” University of NaplesNaplesItaly
| | - Francesca Mallamaci
- CNR‐IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal UnitReggio CalabriaItaly
| | - Alessandro Maloberti
- Cardiology IV, “A.De Gasperi’s” DepartmentNiguarda Ca’ Granda HospitalMilanItaly
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Stefano Masi
- Department of Clinical and Experimental MedicineUniversity of PisaItaly
| | - Maria Masulli
- Department of Clinical Medicine and Surgery“Federico II” University of Naples Medical SchoolNaplesItaly
| | - Alberto Mazza
- Department of Internal MedicineSanta Maria della Misericordia General Hospital, AULSS 5 PolesanaRovigoItaly
| | | | | | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense OrgansUniversity of Bari Medical SchoolBariItaly
| | - Paolo Palatini
- Studium Patavinum, Department of MedicineUniversità degli Studi di PadovaPaduaItaly
| | - Gianfranco Parati
- S. Luca HospitalIstituto Auxologico Italiano and University of Milan‐BicoccaMilanItaly
| | - Roberto Pontremoli
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | | | - Marcello Rattazzi
- Department of MedicineUniversità degli Studi di PadovaVia Giustiniani 8Padua35128Italy
- Medicina Interna ICa’ Foncello University HospitalTrevisoItaly
| | - Gianpaolo Reboldi
- Department of Medical and Surgical ScienceUniversity of PerugiaItaly
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care MedicineCareggi Hospital and University of FlorenceItaly
| | - Elisa Russo
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | - Massimo Salvetti
- Department of Clinical and Experimental SciencesUniversity of BresciaItaly
| | - Pier Luigi Temporelli
- Division of Cardiac RehabilitationIstituti Clinici Scientifici Maugeri, IRCCS, Gattico‐VerunoItaly
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and PsychologyUniversity of Rome Sapienza, Sant’Andrea HospitalRomeItaly
| | - Andrea Ungar
- Department of Geriatric and Intensive Care MedicineCareggi Hospital and University of FlorenceItaly
| | | | - Francesca Viazzi
- Department of Internal MedicineUniversity of Genoa, and Policlinico San MartinoGenoaItaly
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and PsychologyUniversity of Rome Sapienza, Sant’Andrea HospitalRomeItaly
- IRCCS San Raffaele RomeRomeItaly
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences DepartmentAlma Mater Studiorum University of BolognaBolognaItaly
- IRCCS AOU S.Orsola di BolognaBolognaItaly
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5
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Abrignani MG, Maloberti A, Di Fusco SA, Lucà F, Cesaro A, Acerbo V, Fabbri S, Di Matteo I, Amico AF, Temporelli PL, Riccio C, Colivicchi F, Grimaldi M, Gabrielli D, Oliva F. [Lipoprotein(a): relationships with atherosclerosis and valvular heart disease, and emerging therapies]. G Ital Cardiol (Rome) 2024; 25:76-87. [PMID: 38270363 DOI: 10.1714/4187.41756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Lipoprotein(a) [Lp(a)] is a well-established cardiovascular risk factor, whose relationship with atherosclerotic disease has been confirmed by epidemiological, genome-wide association, Mendelian randomization, and meta-analysis studies. This association is determined by its pro-atherogenic, pro-thrombotic and pro-inflammatory properties. Lp(a) is the most common monogenic risk factor for atherosclerosis, with a prevalence of about 1 in 5 people. Recently, its etiopathogenetic relationship with calcific and degenerative valvular heart diseases, particularly with aortic and mitral stenosis, has been suspected. It has not yet been demonstrated whether its reduction translates into a lower risk of cardiovascular events. Up to now, Lp(a) has been considered a non-modifiable risk factor, as current lipid-lowering drugs have limited effects on its levels. New specific lipid-lowering therapies with high efficacy in reducing circulating Lp(a) levels are being investigated in randomized trials; however, the effects of this reduction on cardiovascular outcomes are still being studied.
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Affiliation(s)
| | - Alessandro Maloberti
- Riabilitazione Cardiologica, Cardiologia 4, ASST Grande Ospedale Metropolitano Niguarda, Milano - Dipartimento di Medicina e Chirurgia, Università degli Studi Milano-Bicocca, Milano
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Fabiana Lucà
- UTIC, Cardiologia Interventistica, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria
| | - Arturo Cesaro
- Università della Campania "L. Vanvitelli", Napoli - Divisione Cardiologia, AORN S. Anna e Sebastiano, Caserta
| | | | - Saverio Fabbri
- Dipartimento di Medicina e Chirurgia, Università degli Studi Milano-Bicocca, Milano
| | - Irene Di Matteo
- U.O.C. Cardiologia 1 - Emodinamica, Grande Ospedale Metropolitano Niguarda, Milano
| | - Antonio F Amico
- U.O.C. Cardiologia, Ospedale San Giuseppe da Copertino, Copertino (LE)
| | | | - Carmine Riccio
- U.O.S.D. Follow-Up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, A.O.R.N. Sant'Anna e San Sebastiano, Caserta
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | | | - Domenico Gabrielli
- U.O.C. Cardiologia-UTIC, Azienda Ospedaliera San Camillo Forlanini, Roma - Presidente, Fondazione per il Tuo cuore-Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- U.O.C. Cardiologia 1 - Emodinamica, Grande Ospedale Metropolitano Niguarda, Milano - Presidente Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Firenze
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6
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De Luca L, Temporelli PL, Gulizia MM, Gonzini L, Ammaturo TA, Tedesco L, Pede S, Oliva F, Gabrielli D, Colivicchi F, Averna MR. Prevalence and predictive role of hypertriglyceridemia in statin-treated patients at very high risk: Insights from the START study. Nutr Metab Cardiovasc Dis 2023; 33:2398-2405. [PMID: 37788956 DOI: 10.1016/j.numecd.2023.07.036] [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: 01/31/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND AIM Elevated triglyceride (TG) levels seem to identify subjects at increased cardiovascular risk, independent of LDL-C levels. We sought to evaluate the predictive role of hypertriglyceridemia, defined as TG levels ≥150 mg/dl, in very high risk (VHR) patients with chronic coronary syndromes (CCS) treated with statins. METHODS AND RESULTS Using the data from the STable Coronary Artery Diseases RegisTry (START) study, an Italian nationwide registry, we assessed the association between the TG levels and baseline clinical characteristics, pharmacological treatment and major adverse cardio-cerebrovascular events (MACCE) at 1 year in a large cohort of statin-treated patients at VHR. Of the 4751 consecutive patients with CCS enrolled in the registry and classified as VHR, 2652 (55.8%) had TG values available (mean 120.6 ± 54.9) and were treated with at least a statin at baseline: 2019 (76.1%) with TG < 150 and 633 (23.9%) with TG ≥ 150 mg/dl. At 1 year from enrolment, MACCE occurred in 168 (6.3%) patients, without differences between the two groups of TG (5.9 vs 7.6%; p = 0.14). At multivariable analysis, hypertriglyceridemia did not result as independent predictor of the MACCE (hazard ratio: 1.16; 95% confidence intervals: 0.82-1.64; p = 0.42). CONCLUSIONS In the present large, nationwide cohort of consecutive CCS patients at VHR with statin-controlled LDL-C levels, hypertriglyceridemia was present in around 24% of cases and did not result as predictor of MACCE at 1 year. Further studies with a longer follow-up and larger sample size are needed to better define the prognostic role of TG levels when intensive LDL lowering therapies are used.
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Affiliation(s)
- Leonardo De Luca
- Department of of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, S. Camillo-Forlanini, Roma, Italy.
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Novara, Italy
| | | | - Lucio Gonzini
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | | | - Luigi Tedesco
- Division of Cardiology, Ospedale Santa Maria della Speranza, Battipaglia SA, Italy
| | - Silvia Pede
- Division of Cardiology, Casa di Cura Petrucciani, Lecce, Italy
| | - Fabrizio Oliva
- Cardiovascular Department, Division of Cardiology, "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Domenico Gabrielli
- Department of of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, S. Camillo-Forlanini, Roma, Italy; ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | | | - Maurizio R Averna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Università degli Studi di Palermo, Palermo, Italy; Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Palermo, Italy
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7
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Maffeis C, Rossi A, Bonapace S, Cannata L, Tafciu E, Cicoira M, Temporelli PL. Aortic stiffness plays a role in the discrepancy between mitral valve lesion severity and hemodynamic burden of secondary mitral regurgitation. Eur J Intern Med 2023; 117:85-90. [PMID: 37393182 DOI: 10.1016/j.ejim.2023.06.024] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND By the framework of proportionate/disproportionate secondary mitral regurgitation (sMR), disproportionate sMR is characterized by a low left ventricular stroke volume (SV) and an out of proportion regurgitant fraction (RF) for the same effective regurgitant orifice area (EROA). The degree of aortic stiffness is a determinant of the ventricular forward SV. We aim to analyze the importance of aortic stiffness in influencing the discrepancy between measures of mitral valve lesion severity (EROA) and sMR hemodynamic burden (regurgitant volume [RV] and RF). METHODS We enrolled stable patients with heart failure with reduced ejection fraction (HFrEF) and at least mild sMR. Mitral EROA, RV, RF and aortic pulse wave velocity (PWV) were measured by echocardiography. We defined three groups based on the degree of actual RF deviation from RF estimated by the linear regression equation of RF on EROA (concordant, low-discordant [residuals lower-than -5%] and high-discordant RF [residuals higher-than 5%]). RESULTS 117 patients were analyzed (68±13 years; female 30%; LVEF 33±8%; EROA 16±12mm2; RV 24±15 ml; RF 27±13%; PWV 6.6 ± 3.2 m/s). LVEF, end-diastolic-volume and EROA didn't differ among groups. PWV and RV were higher in patients with high-discordant RF (p ≤ 0.01), whereas total left ventricular-SV and left ventricular outflow tract-SV (LVOT-SV) were lower (p ≤ 0.0004). PWV was associated with LVOT-SV (r=-0.3;p = 0.0008) and RV (r = 0.3;p = 0.0009). High-discordant RF was predicted by PWV (p = 0.001) independently of LVOT-SV and RV. CONCLUSION In this HFrEF cohort with sMR, higher PWV was associated with higher-than-expected RF for a given EROA. Aortic stiffness might play a role in the discrepancy between mitral valve lesion severity and sMR hemodynamic burden.
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Affiliation(s)
- Caterina Maffeis
- Division of Cardiology, Department of Medicine, University of Verona, P.le Stefani 1, Verona 37126, Italy.
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, P.le Stefani 1, Verona 37126, Italy
| | - Stefano Bonapace
- Division of Cardiology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Italy
| | - Lorenzo Cannata
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
| | - Elvin Tafciu
- Division of Cardiology, Department of Medicine, University of Verona, P.le Stefani 1, Verona 37126, Italy
| | | | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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8
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Giubilato S, Lucà F, Abrignani MG, Gatto L, Rao CM, Ingianni N, Amico F, Rossini R, Caretta G, Cornara S, Di Matteo I, Di Nora C, Favilli S, Pilleri A, Pozzi A, Temporelli PL, Zuin M, Amico AF, Riccio C, Grimaldi M, Colivicchi F, Oliva F, Gulizia MM. Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention. J Clin Med 2023; 12:5989. [PMID: 37762932 PMCID: PMC10531720 DOI: 10.3390/jcm12185989] [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: 07/24/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Chronic coronary syndrome (CCS), which encompasses a broad spectrum of clinical presentations of coronary artery disease (CAD), is the leading cause of morbidity and mortality worldwide. Recent guidelines for the management of CCS emphasize the dynamic nature of the CAD process, replacing the term "stable" with "chronic", as this disease is never truly "stable". Despite significant advances in the treatment of CAD, patients with CCS remain at an elevated risk of major cardiovascular events (MACE) due to the so-called residual cardiovascular risk. Several pathogenetic pathways (thrombotic, inflammatory, metabolic, and procedural) may distinctly contribute to the residual risk in individual patients and represent a potential target for newer preventive treatments. Identifying the level and type of residual cardiovascular risk is essential for selecting the most appropriate diagnostic tests and follow-up procedures. In addition, new management strategies and healthcare models could further support available treatments and lead to important prognostic benefits. This review aims to provide an overview of the diagnostic and therapeutic challenges in the management of patients with CCS and to promote more effective multidisciplinary care.
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Affiliation(s)
- Simona Giubilato
- Cardiology Department, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy; (F.L.); (C.M.R.)
| | | | - Laura Gatto
- Cardiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Carmelo Massimiliano Rao
- Cardiology Department, Grande Ospedale Metropolitano, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy; (F.L.); (C.M.R.)
| | - Nadia Ingianni
- ASP Trapani Cardiologist Marsala Castelvetrano Districts, 91022 Castelvetrano, Italy;
| | - Francesco Amico
- Cardiology Department, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Roberta Rossini
- Cardiology Unit, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy;
| | - Giorgio Caretta
- Sant’Andrea Hospital, ASL 5 Regione Liguria, 19124 La Spezia, Italy;
| | - Stefano Cornara
- Arrhytmia Unit, Division of Cardiology, Ospedale San Paolo, Azienda Sanitaria Locale 2, 17100 Savona, Italy;
| | - Irene Di Matteo
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy; (I.D.M.); (F.O.)
| | - Concetta Di Nora
- Department of Cardiothoracic Science, Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy;
| | - Silvia Favilli
- Department of Pediatric Cardiology, Meyer Hospital, 50139 Florence, Italy;
| | - Anna Pilleri
- Cardiology Unit, Brotzu Hospital, 09121 Cagliari, Italy;
| | - Andrea Pozzi
- Cardiology Department, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
| | - Pier Luigi Temporelli
- Division of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 28013 Gattico-Veruno, Italy;
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy;
- Department of Cardiology, West Vicenza Hospital, 136071 Arzignano, Italy
| | - Antonio Francesco Amico
- CCU-Cardiology Unit, Ospedale San Giuseppe da Copertino Hospital, Copertino, 73043 Lecce, Italy
| | - Carmine Riccio
- Cardiovascular Department, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy;
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy;
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, 00135 Rome, Italy;
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy; (I.D.M.); (F.O.)
| | - Michele Massimo Gulizia
- Cardiology Department, Garibaldi Nesima Hospital, 95122 Catania, Italy;
- Heart Care Foundation, 50121 Florence, Italy
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9
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Lucà F, Oliva F, Abrignani MG, Di Fusco SA, Parrini I, Canale ML, Giubilato S, Cornara S, Nesti M, Rao CM, Pozzi A, Binaghi G, Maloberti A, Ceravolo R, Bisceglia I, Rossini R, Temporelli PL, Amico AF, Calvanese R, Gelsomino S, Riccio C, Grimaldi M, Colivicchi F, Gulizia MM. Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios. J Clin Med 2023; 12:5955. [PMID: 37762897 PMCID: PMC10531873 DOI: 10.3390/jcm12185955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug-drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Fabrizio Oliva
- Cardiology Department De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | | | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Roma, Italy
| | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano, 10128 Turin, Italy
| | - Maria Laura Canale
- Cardiology Department, Nuovo Ospedale Versilia Lido di Camaiore Lucca, 55049 Camaiore, Italy
| | - Simona Giubilato
- Cardiology Department, Cannizzaro Hospital, 95126 Catania, Italy
| | - Stefano Cornara
- Arrhytmia Unit, Division of Cardiology, Ospedale San Paolo, Azienda Sanitaria Locale 2, 17100 Savona, Italy
| | | | - Carmelo Massimiliano Rao
- Cardiology Department, Grande Ospedale Metropolitano, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Andrea Pozzi
- Cardiology Division Valduce Hospital, 22100 Como, Italy
| | - Giulio Binaghi
- Department of Cardiology, Azienda Ospedaliera Brotzu, 09047 Cagliari, Italy
| | - Alessandro Maloberti
- Cardiology Department De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | - Irma Bisceglia
- Integrated Cardiology Services, Department of Cardio-Thoracic-Vascular, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy
| | - Roberta Rossini
- Cardiology Unit, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy;
| | - Pier Luigi Temporelli
- Division of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 28010 Gattico-Veruno, Italy
| | | | | | - Sandro Gelsomino
- Cardiovascular Research Institute, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Carmine Riccio
- Cardiovascular Department, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Roma, Italy
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10
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Riccio C, Mureddu GF, Di Fusco SA, Abrignani MG, Orso F, Temporelli PL, De Luca L, Fattirolli F, Faggiano P, Ambrosetti M, Nardi F, Caldarola P, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. [ANMCO Position paper in collaboration with ITACARE-P: Anti-ischemic treatment in patients with chronic coronary syndrome]. G Ital Cardiol (Rome) 2023; 24:571-580. [PMID: 37392122 DOI: 10.1714/4060.40436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Over the last decade, pharmacological therapies for primary and secondary prevention of chronic coronary syndromes enriched with new agents have been demonstrated to be effective in reducing cardiovascular adverse events. However, currently available evidence on treatment for anginal symptom control is weaker. This position paper of the Italian Association of Hospital Cardiologists (ANMCO) aims to briefly report evidence that supports the use of anti-ischemic drugs for chronic coronary syndromes. Furthermore, we propose a therapeutic algorithm for the choice of the most appropriate drug on the basis of the clinical characteristics of the individual patient.
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Affiliation(s)
- Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | | | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma
| | | | - Francesco Orso
- SODc Geriatria-UTIG e Cardiologia Geriatrica, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | | | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Francesco Fattirolli
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi, Firenze
| | | | - Marco Ambrosetti
- Unità di Riabilitazione Cardiovascolare, ASST Crema, Ospedale Santa Marta, Rivolta d'Adda (CR)
| | - Federico Nardi
- S.C. Cardiologia, Dipartimento Medico ASL AL, Ospedale Santo Spirito, Casale Monferrato (AL)
| | | | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania
| | - Domenico Gabrielli
- U.O.C. Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Roma - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
| | - Fabrizio Oliva
- Unità di Cure Intensive Cardiologiche, Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma
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11
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Abrignani MG, Ciccirillo F, Temporelli PL, Cesaro A, Binaghi G, Maloberti A, Cappelletto C, Oliva F, Riccio C, Caldarola P, Gabrielli D, Colivicchi F. [Substances of abuse and cardiovascular risk: cannabinoids]. G Ital Cardiol (Rome) 2023; 24:455-465. [PMID: 37227205 DOI: 10.1714/4041.40205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Progressive legalization for medical conditions or recreational use has led to an increased use of cannabis and synthetic cannabinoids over the past years. Most consumers are young and healthy, without cardiovascular risk factors; however, this population is expected to include older individuals. Thus, concerns have arisen about safety and short- and long-term potential adverse effects, with special emphasis on vulnerable groups. Studies show that cannabis might be linked with thrombosis, inflammation, and atherosclerosis, and many reports have associated cannabis and synthetic cannabinoids use with serious adverse cardiovascular complications, including myocardial infarction, cardiomyopathy, arrhythmias, stroke, and cardiac arrest. A clearly defined causal role cannot be demonstrated, because of confounding variables. Physicians need to become aware of the possible spectrum of clinical presentations, not only for timely diagnosis and treatment, but also for effective counseling and prevention.In this review, we aim to provide a basic understanding of the physiological effects of cannabis, the role of the endocannabinoid system in cardiovascular disease, and the cardiovascular consequences of cannabis and synthetic cannabinoid use, including a comprehensive review of the studies and case reports that provide supportive evidence for cannabis as a trigger of adverse cardiovascular events according to the current literature.
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Affiliation(s)
| | | | | | - Arturo Cesaro
- Università della Campania "L. Vanvitelli", Napoli - Divisione Cardiologia, AORN Sant'Anna e San Sebastiano, Caserta
| | | | - Alessandro Maloberti
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Chiara Cappelletto
- S.C. Patologie Cardiovascolari, Dipartimento Specialistico Territoriale, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste
| | - Fabrizio Oliva
- Cardiologia 4, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Carmine Riccio
- U.O.S.D. Follow-Up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | | | - Domenico Gabrielli
- U.O.C. Cardiologia-UTIC, Azienda Ospedaliera San Camillo Forlanini, Roma - Presidente, Fondazione per il Tuo cuore-Heart Care Foundation, Firenze
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, P.O. San Filippo Neri - ASL Roma 1, Roma - Presidente Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Firenze
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12
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Pontremoli R, Desideri G, Arca M, Temporelli PL, Perrone V, Dovizio M, Borghi C, Esposti LD. Hypertriglyceridemia is associated with decline of estimated glomerular filtration rate and risk of end-stage kidney disease in a real-word Italian cohort: Evidence from the TG-RENAL Study. Eur J Intern Med 2023; 111:90-96. [PMID: 36906475 DOI: 10.1016/j.ejim.2023.02.019] [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: 12/06/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND This analysis investigated the role of hypertriglyceridemia on renal function decline and development of end-stage kidney disease (ESKD) in a real-world clinical setting. METHODS A retrospective analysis using administrative databases of 3 Italian Local Health Units was performed searching patients with at least one plasma triglyceride (TG) measurement between 2013 and June 2020, followed-up until June 2021. Outcome measures included reduction in estimated glomerular filtration rate (eGFR) ≥30% from baseline and ESKD onset. Subjects with normal (normal-TG), high (HTG) and very high TG levels (vHTG) (respectively <150 mg/dL, 150-500 mg/dL and >500 mg/dL) were comparatively evaluated. RESULTS Overall 45,000 subjects (39,935 normal-TGs, 5,029 HTG and 36 vHTG) with baseline eGFR of 96.0 ± 66.4 mL/min were considered. The incidence of eGFR reduction was 27.1 and 31.1 and 35.1 per 1000 person-years, in normal-TG, HTG and vHTG subjects, respectively (P<0.01). The incidence of ESKD was 0.7 and 0.9 per 1000 person-years, in normal-TG and HTG/vHTG subjects, respectively (P<0.01). Univariate and multivariate analyses revealed that HTG subjects had a risk of eGFR reduction or ESKD occurrence (composite endpoint) increased by 48% compared to normal-TG subjects (adjusted OR:1.485, 95%CI 1.300-1.696; P<0.001). Moreover, each 50 mg/dL increase in TG levels resulted in significantly greater risk of eGFR reduction (OR:1.062, 95%CI 1.039-1.086 P<0.001) and ESKD (OR:1.174, 95%CI 1.070-1.289, P = 0.001). CONCLUSIONS This real-word analysis in a large cohort of individuals with low-to-moderate cardiovascular risk suggests that moderate-to-severe elevation of plasma TG levels is associated with a significantly increased risk of long-term kidney function deterioration.
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Affiliation(s)
- Roberto Pontremoli
- Department of Internal Medicine and Medical Specialties, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Giovambattista Desideri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Novara, , Italy
| | - Valentina Perrone
- CliCon s.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Melania Dovizio
- CliCon s.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Degli Esposti
- CliCon s.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
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Ciccirillo F, Abrignani MG, Temporelli PL, Binaghi G, Cappelletto C, Lopriore V, Cesaro A, Maloberti A, Cozzoli D, Riccio C, Caldarola P, Oliva F, Gabrielli D, Colivicchi F. The Key Role of a Psychoactive Substance Use History in Comprehensive Cardiovascular Risk Assessment, Diagnosis, Treatment, and Prevention. Cardiology 2023; 148:257-268. [PMID: 37040728 DOI: 10.1159/000530246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/11/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Psychoactive substances have toxic effects resulting different cardiovascular and non-cardiovascular organ damage. Through a variety of mechanisms, they can trigger the onset of various forms of cardiovascular disease: acute or chronic, transient or permanent, subclinical or symptomatic. Hence, a thorough knowledge of the patient's drug habits is essential for a more complete clinical-etiopathogenetic diagnosis and consequent therapeutic, preventive, and rehabilitative management. SUMMARY The prime reason for taking a psychoactive substance use history in the cardiovascular context is to identify those people who use substances (whether habitual or occasional users, symptomatic or not) and adequately assess their overall cardiovascular risk profile in terms of "user status" and type of substance(s) used. A psychoactive substance history could also alert the physician to suspect, and eventually diagnose, cardiovascular disease related to the intake of psychoactive substances, so optimizing the medical management of users. This anamnesis could finally assess the likelihood of patients persisting in the habit as a user or relapse, while maintaining high their cardiovascular risk profile. Taking such a history should be mandatory when a causal connection is suspected between intake of psychoactive substances and the observed symptoms or pathology, regardless of whether the individual is a declared user or not. KEY MESSAGES The purpose of this article was to provide practical information on when, how, and why to perform a psychoactive substance use history.
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Affiliation(s)
| | | | - Pier Luigi Temporelli
- Division of Cardiac Rehabilitation, ICS Maugeri, IRCCS Gattico-Veruno, Gattico-Veruno, Italy
| | | | | | | | - Arturo Cesaro
- Cardiology Division, AORN Sant'Anna and San Sebastiano, Caserta, Italy
- Campania University "L. Vanvitelli,", Napoli, Italy
| | | | | | - Carmine Riccio
- Post-Acute Patient Follow-Up UOSD, Cardiovascular Department, AORN, Sant'Anna and San Sebastiano, Caserta, Italy
| | | | - Fabrizio Oliva
- Cardiology- Heart Failure and Transplants, Cardiotoracovascular Department "A. De Gasperis,", Milan, Italy
| | - Domenico Gabrielli
- Cardiology-UTIC Unit, AO San Camillo Forlanini, Rome, Italy
- Heart Care Foundation, Florence, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitative Cardiology, San Filippo Neri Hospital, ASL Rome 1, Rome, Italy
- ANMCO, Florence, Italy
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14
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Temporelli PL. Cardiovascular prevention: Mediterranean or low-fat diet? Eur Heart J Suppl 2023; 25:B166-B170. [PMID: 37091669 PMCID: PMC10120950 DOI: 10.1093/eurheartjsupp/suad097] [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] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The international scientific community has long agreed on the fact that a low-fat diet is actually able to bring benefits to cardiovascular health and beyond. By low-fat diet, experts mean a diet where the average calories assimilated daily are made up of no more than 30% fat. The Mediterranean Diet, on the other hand, identifies a nutritional model inspired by the traditional eating habits of the countries bordering the Mediterranean Sea. It began to be studied scientifically in the 1950s and it is still today one of the diets that have a positive impact on our health when associated with correct lifestyles. Although epidemiological and mechanistic studies show similar results, there is no evidence from large-scale, long-term clinical trials on the efficacy of the Mediterranean Diet compared with another active group, particularly in secondary prevention. A convincing response has been obtained from the recent CORDIOPREV study (CORonary Diet Intervention with Olive oil and cardiovascular PREVention) which randomized ∼1000 patients with documented coronary artery disease to a Mediterranean Diet or a low-fat dietary intervention. In a 7-year follow-up, the Mediterranean Diet was superior to the low-fat diet in the prevention of major cardiovascular events.
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15
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Temporelli PL, Boccanelli A, Rossini R, De Luca L, Sciatti E, Terrosu P, Ceconi C, Urbinati S, Senni M. [Gaps in evidence in recent cardiovascular guidelines: uncertainties in chronic coronary syndrome]. G Ital Cardiol (Rome) 2023; 24:172-177. [PMID: 36853153 DOI: 10.1714/3980.39619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The clinical guidelines, while representing an objective reference to perform correct therapeutic choices, contain grey zones, where the recommendations are not supported by solid evidence. In the fifth National Congress Grey Zones held in Bergamo in June 2022, an attempt was made to highlight some of the main grey zones in Cardiology and, through a comparison between experts, to draw shared conclusions that can illuminate our clinical practice. This manuscript contains the statements of the symposium concerning the controversies regarding ischemic cardiomyopathy. The manuscript represents the organization of the meeting, with an initial review of the current guidelines on this topic, followed by an expert presentation of pros (White) and cons (Black) related to the identified "gaps of evidence". For every issue is then reported the "response" derived from the votes of the experts and the public, the discussion and, finally, the highlights, which are intended as practical take home messages to be used in the everyday clinical practice. The first gap in evidence discussed regards the validity of the indication to search for ischemia in light of the data from the ISCHEMIA trial. The second examines the possibility of modifying the algorithm proposed by the European guidelines on anti-ischemic therapy in chronic coronary syndromes. The last gap in evidence evaluates the comparability of long-term antithrombotic strategies in chronic coronary syndromes.
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Affiliation(s)
| | | | | | | | - Edoardo Sciatti
- U.O.C. Cardiologia, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | | | - Claudio Ceconi
- Dipartimento di Medicina Traslazionale, Università degli Studi, Ferrara
| | | | - Michele Senni
- U.O.C. Cardiologia, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
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Temporelli PL. Polygenic risk score and age: an extra help in the cardiovascular prevention of the young? Eur Heart J Suppl 2022; 24:I181-I185. [PMID: 36380786 PMCID: PMC9662707 DOI: 10.1093/eurheartjsupp/suac091] [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]
Abstract
All major guidelines recommend assessing the risk of atherosclerotic cardiovascular disease (ASCVD) using risk scores. In fact, it has been shown that their use at the population level increases the accuracy of event prediction and facilitates the choice of strategies to be adopted in primary prevention. In fact, their use in clinical practice is far from optimal and their predictive ability on an individual level is not excellent. Our genetic heritage is substantially stable from birth and determines a ‘baseline risk’ on which external influences act. Genetic information therefore has the potential to be an early predictor of risk. Common diseases such as diabetes mellitus, ASCVD and neurodegenerative diseases are conditioned by different genetic variants with small individual effects, so that a reliable risk prediction requires careful examination of the aggregate impact of these multiple variants. The polygenic risk score (PRS) is a tool that potentially enables this complex assessment and provides a new opportunity to explore our risk of developing common diseases, including coronary artery disease (CAD). In the future, it is possible that a specific PRS could be used as an independent CAD screening tool, but this requires a detailed assessment of the practical implications, including the population to be investigated, and the consequent interventions that would then be offered.
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Affiliation(s)
- Pier Luigi Temporelli
- Division of Cardiac Rehabilitation, Maugeri Scientific Clinical Institutes, IRCCS , Gattico-Veruno , Italy
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Abrignani MG, Maloberti A, Temporelli PL, Binaghi G, Cesaro A, Ciccirillo F, Oliva F, Gabrielli D, Riccio C, Gulizia MM, Colivicchi F. [Long COVID: nosographic aspects and clinical epidemiology]. G Ital Cardiol (Rome) 2022; 23:651-662. [PMID: 36039714 DOI: 10.1714/3860.38447] [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: 06/15/2023]
Abstract
Recent evidence shows that a range of persistent or new symptoms can manifest after 4-12 weeks in a subset of patients who have recovered from acute SARS-CoV-2 infection, and this condition has been coined long COVID by COVID-19 survivors among social support groups. Long COVID can affect the whole spectrum of people with COVID-19, from those with very mild acute disease to the most severe forms. Like the acute form, long COVID has multisystemic aspects. Patients can manifest with a very heterogeneous multitude of symptoms, including fatigue, post-exertional malaise, dyspnea, cognitive impairment, sleep disturbances, anxiety and depression, muscle pain, brain fog, anosmia/dysgeusia, headache, and limitation of functional capacity, which impact their quality of life. Because of the extreme clinical heterogeneity, and also due to the lack of a shared, specific definition, it is very difficult to know the real prevalence and incidence of this condition. Risk factors for developing long COVID would be female sex, initial severity, and comorbidities. Globally, with the re-emergence of new waves, the population of people infected with SARS-CoV-2 continues to expand rapidly, necessitating a more thorough understanding of potential sequelae of COVID-19. This review summarizes up to date definitions and epidemiological aspects of long COVID.
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Affiliation(s)
| | | | | | | | - Arturo Cesaro
- Università della Campania "L. Vanvitelli", Napoli - Divisione Cardiologia, AORN Sant'Anna e San Sebastiano, Caserta
| | | | - Fabrizio Oliva
- Cardiologia 2-Insufficienza Cardiaca e Trapianti, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Domenico Gabrielli
- U.O.C. Cardiologia-UTIC, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Carmine Riccio
- U.O.S.D. Follow-Up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, ARNAS "Garibaldi", Catania - Fondazione per il Tuo cuore-Heart Care Foundation, Firenze
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, P.O. San Filippo Neri, ASL Roma 1, Roma
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De Luca L, Cappadona F, Temporelli PL, Gonzini L, Ledda A, Raisaro A, Viazzi F, Gabrielli D, Colivicchi F, Gulizia MM, Pontremoli R. Impact of eGFR rate on 1-year all-cause mortality in patients with stable coronary artery disease. Eur J Intern Med 2022; 101:98-105. [PMID: 35513990 DOI: 10.1016/j.ejim.2022.04.021] [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: 03/19/2022] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of mortality and is often complicated by chronic kidney disease. We sought to investigate the prevalence of different degree of estimated glomerular filtration rate (eGFR) reduction, the clinical and bio-humoral correlates, its relationship with therapeutic management, and its predictive role on 1-year all-cause mortality, in patients with stable CAD. METHODS We studied 4,130 patients with stable CAD recruited in a prospective, observational, nationwide study (START, STable coronary Artery diseases RegisTry) in Italy. Baseline clinical characteristics, pharmacological treatment, and all-cause 1-year mortality were evaluated according to groups of eGFR (<30; 30-59; 60-89; ≥90 ml/min/1.73 m2) at baseline. RESULTS The presence and the degree of chronic kidney disease entailed an unfavorable risk profile, since it was gradually associated with more comorbidities. Furthermore, progressively lower eGFR values were associated to lower diastolic blood pressure and hemoglobin values. As eGFR lowers, optimal medical treatment and its persistence overtime is reduced. Multivariate analysis showed that progressively lower eGFR significantly correlated with all-cause 1-year mortality [hazard ratio (HR): 1.02; 95% confidence intervals (CI): 1.01-1-03; p = 0.0001]. CONCLUSIONS Low eGFR is associated with an increasing risk of all-cause mortality in patients with stable CAD. Chronic kidney disease may hamper the optimization of treatment limiting the use of drugs which may favorably impact cardiovascular and renal outcomes.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, Division of Cardiology, A.O. San Camillo-Forlanini, Circonvallazione Gianicolense, 87, Roma 00152, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
| | - Francesca Cappadona
- Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Novara, Gattico-Veruno, Italy
| | - Lucio Gonzini
- Heart Care Foundation ANMCO Research Center, Florence, Italy
| | | | - Arturo Raisaro
- Division of Cardiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Domenico Gabrielli
- Department of Cardiosciences, Division of Cardiology, A.O. San Camillo-Forlanini, Circonvallazione Gianicolense, 87, Roma 00152, Italy
| | | | - Michele Massimo Gulizia
- Heart Care Foundation ANMCO Research Center, Florence, Italy; Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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De Luca L, Temporelli PL, Colivicchi F, Gonzini L, Fasano ML, Pantaleoni M, Greco G, Oliva F, Gabrielli D, Gulizia MM. Clinical Impact and Prognostic Role of Triglyceride to High-Density Lipoprotein Cholesterol Ratio in Patients With Chronic Coronary Syndromes at Very High Risk: Insights From the START Study. Front Cardiovasc Med 2022; 9:874087. [PMID: 35498014 PMCID: PMC9043517 DOI: 10.3389/fcvm.2022.874087] [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: 02/11/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSeveral studies have reported that the combination of high TG and low HDL-C, as simplified by the TG/HDL-C ratio, was a predictor of cardiovascular disease independent of LDL-C level. Nevertheless, poor data are available on the predictive role of TG/HDL-C ratio in very high risk (VHR) patients with chronic coronary syndromes (CCS).MethodsUsing the data from the STable Coronary Artery Diseases RegisTry (START) study, an Italian nationwide registry, we assessed the association between the TG/HDL-C ratio and baseline clinical characteristics, pharmacological treatment, and major adverse cardio-cerebrovascular events (MACCE) at 1 year in a large cohort of CCS patients at VHR.ResultsVHR patients with both TG and HDL-C levels available were grouped in tertiles of TG/HDL-C ratio: low (TG/HDL-C ratio <2, n = 967), middle (TG/HDL-C ratio 2–3.3, n = 1,071) and high (TG/HDL-C ratio >3.3, n = 1,028). At 1 year from enrolment, 232 (7.6%) patients presented a MACCE, with a higher incidence in the higher tertile, even though not statistically significant (6.0, 8.2, and 8.4% in the low, middle and high tertile, respectively; p = 0.08). At multivariable analysis, the TG/HDL-C ratio in tertiles did not result an independent predictor of the MACCE (p = 0.29) at 1-year follow-up (HR: 1.30; 95% CI: 0.93–1.82; p = 0.12 middle vs. lower tertile, and HR: 1.22; 95% CI: 0.87–1.72; p = 0.25 higher vs. lower).ConclusionsIn the present large, nationwide cohort of CCS patients at VHR a high TG/HD ratio did not emerge as independent predictor of MACCE at 1 year. Further studies with a longer follow-up are needed to better define the prognostic role of TG/HDL ratio in CCS.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, Division of Cardiology, S. Camillo-Forlanini, Roma, Italy
- *Correspondence: Leonardo De Luca ;
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Gattico-Veruno, Italy
| | | | | | - Maria Luisa Fasano
- Division of Cardiology, Cardiac Rehabilitation Unit, S. Carlo Hospital, Potenza, Italy
| | - Massimo Pantaleoni
- Division of Cardiology, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | | | - Fabrizio Oliva
- Cardiovascular Department, Division of Cardiology, “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Domenico Gabrielli
- Department of Cardiosciences, Division of Cardiology, S. Camillo-Forlanini, Roma, Italy
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20
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Maffeis C, Rossi A, Cannata L, Zocco C, Belyavskiy E, Radhakrishnan AK, Feuerstein A, Morris DA, Pieske-Kraigher E, Pieske B, Edelmann F, Temporelli PL. Left atrial strain predicts exercise capacity in heart failure independently of left ventricular ejection fraction. ESC Heart Fail 2022; 9:842-852. [PMID: 34989138 PMCID: PMC8934969 DOI: 10.1002/ehf2.13788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/06/2021] [Accepted: 12/13/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS We hypothesized that left atrial (LA) remodelling and function are associated with poor exercise capacity as prognostic marker in chronic heart failure (CHF) across a broad range of left ventricular ejection fraction (LVEF). METHODS AND RESULTS One hundred seventy-one patients with CHF were analysed [age 65 ± 11 years, 136 males (80%); 86 heart failure with reduced ejection fraction (HFrEF), 27 heart failure with mid-range ejection fraction (HFmrEF), 58 heart failure with preserved ejection fraction (HFpEF)]. All patients underwent echocardiography and maximal cardiopulmonary exercise testing and were classified according to a prognostic cut-off of peak VO2 (pVO2 ; 14 mL/kg/min). Seventy-seven (45%) patients reached pVO2 < 14 and 94 (55%) pVO2 ≥ 14 mL/kg/min. Between the two groups, there was a considerable difference in both left atrial volume (LAVi, 53 ± 24 vs. 44 ± 18 mL/m2 , P = 0.005) and function (LA reservoir strain 12 ± 5 vs. 20 ± 10%, P < 0.0001). Receiver-operating characteristic curves identified LA reservoir strain (area under the curve: 0.73 [0.65-0.80], P < 0.0001) as strong predictor for impaired pVO2 among all echocardiographic variables; LA reservoir strain < 23% had 37% specificity but a very high sensitivity (96%) in identifying a severely reduced pVO2 . In logistic regression analysis, LA reservoir strain < 23% was associated with a highly increased risk of pVO2 < 14 mL/kg/min (odds ratio 16.0 [4.7-54.6]; P < 0.0001). The multivariate analysis showed that a reduced LA reservoir strain was associated with pVO2 < 14 mL/kg/min after adjustment for age, body mass index (BMI), and clinical variables, that is, New York Heart Association class, atrial fibrillation, haemoglobin, and creatinine (b 0.22 [95% confidence interval, CI, 0.12-0.31]; P < 0.0001), and after adjustment for echocardiographic variables, that is, LVEF or left ventricular global longitudinal strain (LVGLS) and tricuspid annular plane systolic excursion (TAPSE) (b 0.16 [95% CI 0.08-0.24]; P < 0.0001). Patients with HFrEF, HFmrEF, and HFpEF were separately analysed. Among LA reservoir strain, LAVi, LVEF, LVGLS, and TAPSE, LA reservoir strain was the only one significantly associated with pVO2 in all subgroups (after adjustment for sex and BMI, P = 0.003, 0.04, and 0.01, respectively). CONCLUSIONS In patients with CHF, an impaired LA reservoir function is independently associated with a severely reduced pVO2 . LA dysfunction represents a marker of poor prognosis across LVEF borders in the CHF population.
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Affiliation(s)
- Caterina Maffeis
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Lorenzo Cannata
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
| | - Camilla Zocco
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
| | - Evgeny Belyavskiy
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Aravind Kumar Radhakrishnan
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Anna Feuerstein
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Daniel Armando Morris
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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Temporelli PL. Risk scores, atherosclerotic cardiovascular disease and the crystal ball. Eur J Prev Cardiol 2021; 28:e14-e15. [PMID: 33611441 DOI: 10.1177/2047487320903157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Regular physical activity is a known protective factor for the prevention of non-communicable diseases such as cardiovascular disease, type 2 diabetes, breast, and colon cancer. Physical activity also has benefits for mental health, delays the onset of dementia, contributes to the maintenance of an adequate body weight and to general well-being. Research on physical activity has mainly focused on leisure and total time, and less on the activity in the workplace. The current guidelines actually recommend physical activity in any form and do not distinguish between the different areas, e.g. physical activity carried out during leisure time, at home or at work. However, new evidence suggests a contrast between the health effects of physical activity in leisure time vs. that in the workplace. In particular, while physical activity, even of high intensity in leisure time, has been associated with positive health outcomes, adverse consequences have been documented for physical activity in the workplace, both in terms of cardiovascular diseases, work absences due to illness and mortality from all causes. These contrasting effects of physical activity in leisure time compared to that in the workplace constitute the so-called 'physical activity paradox'.
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Affiliation(s)
- Pier Luigi Temporelli
- Divisione di Cardiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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De Luca L, Gabrielli D, Gonzini L, Riccio C, Arena G, Miserrafiti B, Mortara A, Colivicchi F, Gulizia MM, Temporelli PL. Comparing the Prognostic Impact of Prediabetes with Diabetes in a Nationwide Cohort of Patients with Chronic Coronary Syndromes: An Analysis of the START Registry. Cardiology 2021; 146:547-555. [PMID: 34233326 DOI: 10.1159/000517122] [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: 03/27/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
AIMS Using data from the nationwide prospective START registry that enrolled a large cohort of patients with chronic coronary syndromes (CCS), we aimed to investigate whether the presence of diabetes mellitus (DM) and pre-DM independently affected the risk of cardiovascular events at 1-year follow-up. METHODS We assessed the impact of DM and pre-DM on all-cause mortality and a composite of all-cause mortality and hospitalization for cardiovascular causes at 1-year follow-up. RESULTS Among the 3,778 patients with available fasting plasma glucose data at study entry, 37% were classified as DM, 25% as pre-DM, and 38% as no DM. At 1 year, patients with DM had higher rates of all-cause death (p = 0.004) and death/cardiovascular hospitalization (p = 0.003) than those with pre-DM or without DM. Conversely, no significant differences in the adverse event rate were found between patients with pre-DM and those without DM. At unadjusted Cox analysis, DM resulted as a predictor of both death for any cause (hazard ratio [HR]: 2.41; 95% confidence intervals [CI]: 1.34-4.34; p = 0.003) and all-cause death/hospitalization for cardiovascular causes (HR: 1.29; 95% CI: 1.02-1.62; p = 0.03). However, DM did not result as an independent predictor of either endpoint at multivariate analysis. CONCLUSIONS The risk of 1-year major events among patients with CCS and pre-DM is comparable to that of patients with CCS and normoglycemic status and is lower than that of patients with DM.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Domenico Gabrielli
- Department of Cardiosciences, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | | | - Carmine Riccio
- Division of Cardiology, Azienda Ospedaliera Sant'Anna e San Sebastiano, Caserta, Italy
| | | | - Bruna Miserrafiti
- Division of Cardiology, Ospedale Tiberio Evoli, Melito Porto Salvo, Italy
| | - Andrea Mortara
- Division of Cardiology, Policlinico di Monza (MI), Monza, Italy
| | | | | | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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De Servi S, Sciatti E, Temporelli PL, De Caterina R, Prati F, Zito GB, Carugo S, De Biase L, Senni M, Rossini R. [Grey zones on dual antiplatelet therapy. Expert opinion]. G Ital Cardiol (Rome) 2021; 21:530-536. [PMID: 32555572 DOI: 10.1714/3386.33642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Clinical guidelines, while representing an objective reference to perform appropriate treatment choices, contain grey zones, where recommendations are not supported by solid evidence. In a conference held in Bergamo in October 2018, an attempt was made to highlight some of the main gray zones in Cardiology and, through a comparison between experts, to draw shared conclusions that can illuminate our clinical practice. This manuscript contains the statements of the symposium concerning the controversies regarding dual antiplatelet therapy (DAPT). The manuscript represents the organization of the meeting, with an initial review of current guidelines on this topic, followed by an expert presentation of pros (white) and cons (black) related to the identified "gaps of evidence". For every issue is then reported the response derived from the votes of the experts and the public, the discussion and, finally, the highlights, which are intended as practical "take home messages" to be used in everyday clinical practice. The first topic concerns the utility of scores to shorten the duration of DAPT in patients at high bleeding risk. The second issue examines the appropriateness of the level of evidence to prolong DAPT beyond 1 year in patients at high ischemic risk. The last "gap in evidence" concerns the possibility of adopting the single antiplatelet therapy plus an anticoagulant vs the triple therapy in patients with atrial fibrillation and acute coronary syndrome. The work has also been implemented with evidences deriving from important randomized studies published after the date of the Conference.
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Affiliation(s)
| | - Edoardo Sciatti
- U.O.C. Cardiologia, ASST Spedali Civili e Università degli Studi, Brescia
| | - Pier Luigi Temporelli
- U.O. Riabilitazione Cardiologica, IRCCS Istituti Clinici Scientifici Maugeri, Veruno (NO)
| | | | - Francesco Prati
- U.O.C. Cardiologia d'Urgenza, A.O. San Giovanni-Addolorata, Roma - Centro per la Lotta Contro l'Infarto - Fondazione CLI, Roma
| | | | - Stefano Carugo
- U.O.C. Cardiologia, ASST Santi Paolo e Carlo, Ospedale San Paolo e Università degli Studi, Milano
| | - Luciano De Biase
- U.O.C. Cardiologia, A.O. Sant'Andrea e Sapienza Università di Roma, Roma
| | - Michele Senni
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
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Rossi A, Barbieri A, Benfari G, Gaibazzi N, Erlicher A, Mureddu G, Frattini S, Faden G, Manicardi M, Beraldi M, Agostini F, Lazzarini V, Moreo A, Luigi Temporelli P, Magni G, Pressman G, Faggiano P. Heart valve calcification and cardiac hemodynamics. Echocardiography 2021; 38:525-530. [PMID: 33705585 DOI: 10.1111/echo.14994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/25/2020] [Revised: 01/05/2021] [Accepted: 01/25/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Heart valve calcification (VC) is associated with increased cardiovascular risk, but the hemodynamic and functional profile of patients affected by VC has not been fully explored. METHODS The study population was formed by consecutive unselected patients included in seven echocardiographic laboratories in a 2-week period. A comprehensive echocardiographic examination was performed. VC was defined by the presence of calcification on at least one valve. RESULTS Population was formed of 1098 patients (mean age 65 ± 15 years; 47% female). VC was present in 31% of the overall population. Compared with subjects without VC, VC patients were older (60 ± 14 vs 75 ± 9; P < .0001), had more hypertension (40% vs 57%; P = .0005), diabetes (11% vs 18%; P = .002), coronary artery disease (22% vs 38%; P = .04), and chronic kidney disease (4% vs 8%; P = .007). Furthermore, VC patients had lower ejection fraction (55 ± 14 vs 53 ± 25; P < .0001), worse diastolic function (E/e' 8.5 ± 4.6 vs 13.0 ± 7.1; P < .0001) and higher pulmonary artery pressure (29 ± 9 vs 37 ± 12; P < .0001). The association between VC and EF was not independent of etiology (p for VC 0.13), whereas the association with E/e' and PASP was independent in a full multivariate model (P < .0001 and P = .0002, respectively). CONCLUSION Heart valve calcification patients were characterized by a worse functional and hemodynamic profile compared to patients with normal valve. The association between VC and diastolic function and PASP were independent in comprehensive multivariate models.
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Affiliation(s)
- Andrea Rossi
- Section of Cardiology, Department of Medicine, School of Medicine, Verona, Italy
| | - Andrea Barbieri
- Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, School of Medicine, Verona, Italy
| | | | | | | | | | - Giacomo Faden
- Cardiology Division, Pieve di Coriano, Brescia, Italy
| | - Marcella Manicardi
- Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
| | | | | | | | | | | | | | | | - Pompilio Faggiano
- Cardiology Division, Spedali Civili and University of Brescia, Brescia, Italy
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De Luca L, Uguccioni M, Temporelli PL, Arca M. [Does the STRENGTH trial confirm or deny previous evidence on the role of n-3 polyunsaturated fatty acids for the prevention of cardiovascular events?]. G Ital Cardiol (Rome) 2021; 22:197-201. [PMID: 33687371 DOI: 10.1714/3557.35338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento di Cardioscienze, A.O. San Camillo-Forlanini, Roma
| | - Massimo Uguccioni
- U.O.C. Cardiologia, Dipartimento di Cardioscienze, A.O. San Camillo-Forlanini, Roma
| | - Pier Luigi Temporelli
- Divisione di Cardiologia, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno (NO)
| | - Marcello Arca
- Dipartmento di Medicina Traslazionale e di Precisione, Sapienza Università di Roma, Roma
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Temporelli PL, Arca M, D’Erasmo L, De Caterina R. Lipid-Lowering Therapy in Patients with Coronary Heart Disease and Prior Stroke: Mission Impossible? J Clin Med 2021; 10:jcm10040886. [PMID: 33671688 PMCID: PMC7926692 DOI: 10.3390/jcm10040886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 12/18/2022] Open
Abstract
Hyperlipidemia is a powerful risk factor for coronary heart disease (CHD). It has been known for a long time that lipid-lowering drugs significantly reduce morbidity from CHD, thus proving a causal role for cholesterol in coronary events. Conversely, the relationship between low-density lipoprotein cholesterol (LDL-C) levels and stroke has been less clear and debated for many years. Recent data conclusively demonstrate not only the inverse epidemiological relationship of blood LDL-C with stroke, but also the efficacy of different strategies to attain cholesterol-lowering on stroke. They also dissipate lingering doubts about the possibility that lipid-lowering is linked to an increase in hemorrhagic stroke. However, despite current international lipid guidelines now strongly recommend aggressive lipid-lowering therapy in patients with atherosclerotic cardiovascular disease, including CHD and cerebrovascular disease (CeVD), secondary prevention patients are often undertreated with lipid-lowering therapies in routine clinical practice. This review highlights that patients with CHD and concomitant CeVD do not receive aggressive lipid-lowering therapy despite being at very high risk and with clear evidence of benefit from lowering LDL-C levels below current targets.
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Affiliation(s)
- Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Via Revislate 13, 28013 Gattico-Veruno, Italy
- Correspondence: ; Tel.: +39-0322-884711
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell’Università 37, 00161 Roma, Italy; (M.A.); (L.D.)
| | - Laura D’Erasmo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell’Università 37, 00161 Roma, Italy; (M.A.); (L.D.)
| | - Raffaele De Caterina
- Chair of Cardiology, Cardiovascular Division, Pisa University Hospital, University of Pisa, Via Paradisa 2, 56126 Pisa, Italy;
- Fondazione Villa Serena per la Ricerca, 65013 Città Sant’Angelo, Italy
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Ghio S, Crimi G, Houston B, Montalto C, Garascia A, Boffini M, Temporelli PL, La Rovere MT, Pacileo G, Panneerselvam K, Santolamazza C, D'angelo L, Moschella M, Scelsi L, Marro M, Masarone D, Ameri P, Rinaldi M, Guazzi M, D'alto M, Tedford RJ. Nonresponse to Acute Vasodilator Challenge and Prognosis in Heart Failure With Pulmonary Hypertension. J Card Fail 2021; 27:869-876. [PMID: 33556547 DOI: 10.1016/j.cardfail.2021.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND An acute vasodilator challenge is recommended in patients with heart failure and pulmonary hypertension during heart transplant evaluation. The aim of the study was to assess which hemodynamic parameters are associated with nonresponsiveness to the challenge. METHODS AND RESULTS This study is a retrospective analysis of 402 patients with heart failure with pulmonary hypertension who underwent right heart catheterization and a pulmonary vasodilator challenge. Among the 140 who fulfilled the transplant guidelines eligibility criteria for the vasodilator challenge, 38 were responders and 102 nonresponders. At multivariable analysis, a diastolic blood pressure of <70 mm Hg, pulmonary vascular resistance of >5 Woods units, and pulmonary artery compliance of <1.2 mL/mm Hg were independently associated with poor response to vasodilator challenge (all P < .001). The presence of any 2 of these 3 conditions was associated with a 90% probability of being a nonresponder. The covariate-adjusted hemodynamic predictors of death in the entire population were a low baseline systolic blood pressure (P = .0017) and a low baseline right ventricular stroke work index (P = .0395). CONCLUSIONS In patients with heart failure and pulmonary hypertension, low pulmonary arterial compliance, high pulmonary vascular resistance, and low diastolic blood pressure predict the nonresponsiveness to acute vasodilator challenge whilst a poor right ventricular function predicts a dismal prognosis.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Gabriele Crimi
- Cardio Thoraco Vascular Department (DICATOV), IRCCS Policlinico San Martino di Genova, Genova, Italy
| | - Brian Houston
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Garascia
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Boffini
- Division of Cardiac Surgery, Surgical Sciences Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
| | | | - Giuseppe Pacileo
- Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Kavin Panneerselvam
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Caterina Santolamazza
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luciana D'angelo
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Moschella
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Marro
- Division of Cardiac Surgery, Surgical Sciences Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Daniele Masarone
- Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Pietro Ameri
- Cardio Thoraco Vascular Department (DICATOV), IRCCS Policlinico San Martino di Genova, Genova, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Surgical Sciences Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Marco Guazzi
- Cardiology Department, Policlinico San Donato and University of Milano, Milano, Italy
| | - Michele D'alto
- Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
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De Luca L, Uguccioni M, Meessen J, Temporelli PL, Tomai F, De Rosa FM, Passamonti E, Formigli D, Riccio C, Gabrielli D, Colivicchi F, Gulizia MM, Perna GP. External applicability of the ISCHEMIA trial: an analysis of a prospective, nationwide registry of patients with stable coronary artery disease. EUROINTERVENTION 2020; 16:e966-e973. [PMID: 32830646 DOI: 10.4244/eij-d-20-00610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS We sought to assess the proportion of patients eligible for the ISCHEMIA trial and to compare the characteristics and outcomes of these patients with those without ISCHEMIA inclusion or with ISCHEMIA exclusion criteria in a contemporary, nationwide cohort of patients with stable coronary artery disease (CAD). METHODS AND RESULTS Among the 5,070 consecutive patients enrolled in the START registry, 4,295 (84.7%) did not fulfil the inclusion criteria (ISCHEMIA-Not Included or ISCHEMIA-Unclassifiable), 582 (11.5%) had exclusion criteria (ISCHEMIA-Excluded), and the remaining 193 (3.8%) were classified as ISCHEMIA-Like. At one year, the incidence of the primary outcome, a composite of death from cardiovascular (CV) causes, myocardial infarction (MI), or hospitalisation for unstable angina and heart failure, was 0.5% in the ISCHEMIA-Like versus 3.3% in other patients (p=0.03). The composite secondary outcome of CV mortality and MI occurred in 0.5% of the ISCHEMIA-Like patients and in 1.4% of the remaining patients (p=0.1). CONCLUSIONS In a contemporary real-world cohort of stable CAD patients, only 4% resulted in being eligible for the ISCHEMIA trial. These patients presented an extremely low annual risk of adverse events, especially when compared with other groups of stable CAD patients.
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, A. O. San Camillo-Forlanini, Roma, Italy
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Targher G, Lunardi G, Mantovani A, Meessen J, Bonapace S, Temporelli PL, Nicolis E, Novelli D, Conti A, Tavazzi L, Maggioni AP, Latini R. Relation between plasma ceramides and cardiovascular death in chronic heart failure: A subset analysis of the GISSI-HF trial. ESC Heart Fail 2020; 7:3288-3297. [PMID: 32627354 PMCID: PMC7754905 DOI: 10.1002/ehf2.12885] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS Ceramides exert several biological activities that may contribute to the pathophysiology of cardiovascular disease and heart failure (HF). The association between plasma levels of distinct ceramides (that have been previously associated with increased cardiovascular risk) and cardiovascular mortality in patients with chronic HF has received little attention. METHODS AND RESULTS In a post hoc ancillary analysis of the Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure (GISSI-HF; NCT00336336) trial, we randomly selected a sample of 200 ambulatory patients with chronic HF who died due to cardiovascular causes and 200 patients who were alive at the end of the trial (after a median follow-up period of 3.9 years). We measured baseline plasma concentrations of six previously identified high-risk ceramide species [Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/22:0), Cer(d18:1/24:0), and Cer(d18:1/24:1) and their individual plasma ratios with Cer(d18:1/24:0)]. Patients who died due to cardiovascular causes had significantly (P < 0.05 or less) higher levels of plasma Cer(d18:1/16:0) and Cer(d18:1/24:1), but lower levels of plasma Cer(d18:1/22:0) and Cer(d18:1/24:0) than had those who did not. All plasma ratios of each ceramide with Cer(d18:1/24:0) were significantly higher in patients who died due to cardiovascular causes. In Cox regression analyses, all five plasma ratios of each ceramide with Cer(d18:1/24:0) were significantly associated with a greater risk of cardiovascular mortality (with unadjusted hazard ratios ranging from 1.23 to 1.59; P < 0.001 or less). These significant associations were attenuated after adjustment for multiple established risk factors, New York Heart Association functional class, left ventricular ejection fraction, use of medications, plasma pentraxin-3 levels, and, especially, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. When we applied a Bonferroni correction for multiple comparisons (using a P-threshold 0.05/5 ceramide ratios = 0.01), none of the five plasma ratios of each ceramide with Cer(d18:1/24:0) remained statistically associated with the risk of cardiovascular mortality (with adjusted hazard ratios ranging from 1.10 to 1.23). CONCLUSIONS Higher levels of specific plasma ceramides [especially when used in ratios with Cer(d18:1/24:0)] are associated with increased cardiovascular mortality in ambulatory patients with chronic HF. However, these associations are weakened after adjustment for established cardiovascular risk factors, medication use, and plasma NT-proBNP concentrations.
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Affiliation(s)
- Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaPiazzale Stefani, 1Verona37126Italy
| | - Gianluigi Lunardi
- Medical Analysis Laboratory‘IRCCS Sacro Cuore—Don Calabria’ HospitalNegrarItaly
| | - Alessandro Mantovani
- Division of Endocrinology, Diabetes and Metabolism, Department of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaPiazzale Stefani, 1Verona37126Italy
| | - Jennifer Meessen
- Department of Cardiovascular MedicineIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Stefano Bonapace
- Division of Cardiology‘IRCCS Sacro Cuore—Don Calabria’ HospitalNegrarItaly
| | | | - Enrico Nicolis
- Department of Cardiovascular MedicineIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Deborah Novelli
- Department of Cardiovascular MedicineIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Antonio Conti
- Medical Analysis Laboratory‘IRCCS Sacro Cuore—Don Calabria’ HospitalNegrarItaly
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & ResearchCotignolaItaly
| | | | - Roberto Latini
- Department of Cardiovascular MedicineIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
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Ghio S, Carluccio E, Scardovi AB, Dini FL, Rossi A, Falletta C, Scelsi L, Greco A, Temporelli PL. Prognostic relevance of Doppler echocardiographic re-assessment in HFrEF patients. Int J Cardiol 2020; 327:111-116. [PMID: 33220364 DOI: 10.1016/j.ijcard.2020.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current guidelines do not recommend periodically repeating echocardiograms in the follow-up of stable heart failure patients with reduced ejection fraction (HFrEF). The objective of the study was to verify the additional prognostic information provided by a comprehensive re-assessment of their cardiac function and hemodynamic profile at Doppler echocardiography in HFrEF patients. METHODS Retrospective analysis of 769 stable HFrEF outpatients who underwent two complete echocardiograms, at baseline and at re-assessment. Main candidate predictors of prognosis were: left ventricular (LV) filling pattern, pulmonary artery systolic pressure (PASP) and right ventricular function (TAPSE). Age, LV ejection fraction, mitral regurgitation severity, NYHA class, brain natriuretic peptide plasma levels at baseline, and their changes at 12 months, were used as covariates. Median follow-up was 30 months. All-cause death was the study end-point. RESULTS At baseline, restrictive filling pattern and low TAPSE were significant predictors of poor prognosis. At re-evaluation, persistently restrictive/worsened filling pattern, persistently-low/worsened TAPSE and worsened PASP, were associated with poorer survival. A significant interaction between changes in TAPSE, PASP and LV filling pattern was observed: in the restrictive pattern subgroup, survival was poorer in worsened/persistently low TAPSE (p < 0.01); in non-restrictive pattern subgroup, survival was poorer in worsened/persistently elevated PASP (p = 0.01). The re-assessment model improved the C-index from 0.69 to 0.74 (P < 0.01) compared to baseline model. CONCLUSIONS Doppler echocardiographic re-assessment of LV filling pattern, PASP and TAPSE allows a better prognostic stratification of HFrEF outpatients than baseline evaluation and is additional to changes in BNP and NYHA class.
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Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S.Maria della Misericordia", Perugia, Italy
| | | | - Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Italy
| | - Andrea Rossi
- Department of Biomedical and Surgical Sciences, Cardiology Section, University of Verona, Verona, Italy
| | - Calogero Falletta
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, I.R.C.C.S. - ISMETT, Palermo, Italy
| | - Laura Scelsi
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Alessandra Greco
- Division of Cardiology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy
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Arca M, Veronesi C, D'Erasmo L, Borghi C, Colivicchi F, De Ferrari GM, Desideri G, Pontremoli R, Temporelli PL, Perrone V, Degli Esposti L. Association of Hypertriglyceridemia with All-Cause Mortality and Atherosclerotic Cardiovascular Events in a Low-Risk Italian Population: The TG-REAL Retrospective Cohort Analysis. J Am Heart Assoc 2020; 9:e015801. [PMID: 32954906 PMCID: PMC7792416 DOI: 10.1161/jaha.119.015801] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Evidence regarding the relationships among high plasma triglycerides (TG), all‐cause mortality, and atherosclerotic cardiovascular disease (ASCVD) events in low‐to‐moderate risk individuals is limited. The aim of this study was to determine whether the presence of high TG levels influences the risk of all‐cause mortality and ASCVD events in a population cohort followed in the real‐world clinical setting. Methods and Results A retrospective longitudinal cohort analysis using administrative databases of 3 Italian Local Health Units was performed. All individuals with at least one TG measurement between January 1, 2010 and December 31, 2015 were followed through December 2016. Outcome measures included incident ASCVD events and all‐cause mortality. Individuals with normal TG levels (<150 mg/dL) were compared with those with high (150–500 mg/dL) and very high TG (>500 mg/dL). 158 042 individuals (142 289 with normal, 15 558 with high, and 195 with very high TG) were considered. In the whole cohort, the overall incidence rates of ASCVD and all‐cause mortality were 7.2 and 17.1 per 1000 person‐years, respectively. After multivariate adjustment for potential confounders, individuals with high and very high TG showed a significantly increased risk of all‐cause mortality (hazard ratio [HR]=1.49 [95% confidence interval (CI) 1.36–1.63], P<0.001, and HR=3.08 [95% CI 1.46–6.50], P<0.01, respectively) and incident ASCVD events (HR=1.61 [95% CI 1.43–1.82], P<0.001, and HR=2.30 [95% CI 1.02–5.18], P<0.05, respectively) as compared to those with normal TG. Conclusions Moderate‐to‐severe elevation of TG is associated with a significantly increased risk of all‐cause mortality and ASCVD events in a large cohort of low‐to‐moderate cardiovascular risk individuals in a real‐world clinical setting.
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Affiliation(s)
- Marcello Arca
- Department of Translational and Precision Medicine Sapienza University of Rome Italy
| | - Chiara Veronesi
- CliCon Srl, Health Economics and Outcomes Research Ravenna Italy
| | - Laura D'Erasmo
- Department of Translational and Precision Medicine Sapienza University of Rome Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences University of Bologna Italy
| | - Furio Colivicchi
- Cardiology Division Emergency Department San Filippo Neri Hospital ASL Roma 1 Rome Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology Department of Medical Sciences "Città della Salute e della Scienza di Torino" Hospital University of Turin Italy
| | | | - Roberto Pontremoli
- Department of Internal Medicine University of Genoa and IRCCS Policlinico San Martino Genoa Italy
| | - Pier Luigi Temporelli
- Division of Cardiac Rehabilitation Istituti Clinici Scientifici Maugeri IRCCS Gattico-Veruno Italy
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De Luca L, Temporelli PL, Riccio C, Gonzini L, Marinacci L, Tartaglione SN, Costa P, Scherillo M, Senni M, Colivicchi F, Gulizia MM. Clinical outcomes, pharmacological treatment, and quality of life of patients with stable coronary artery diseases managed by cardiologists: 1-year results of the START study. Eur Heart J Qual Care Clin Outcomes 2020; 5:334-342. [PMID: 30649303 DOI: 10.1093/ehjqcco/qcz002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/17/2018] [Accepted: 01/07/2019] [Indexed: 01/26/2023]
Abstract
AIMS We evaluated the 1-year clinical events, pharmacological management, and quality of life in a contemporary cohort of stable coronary artery disease (CAD) patients managed by cardiologists. METHODS AND RESULTS START (STable Coronary Artery Diseases RegisTry) was a prospective, observational, nationwide study that enrolled 5070 stable CAD patients over 3 months in 183 cardiology centres in Italy. At 1 year, 4790 (94.5%) patients had data on vital status. Death occurred in 107 (2.2%) patients and the cause of death was cardiovascular in 41 (38.3%) of cases. Among the 4775 patients with follow-up data on clinical events available, a hospitalization due to cardiovascular and non-cardiovascular causes occurred in 523 (11.0%) and in 231 (4.8%) of cases, respectively. Over 60% of patients reported as 'no problems' in all domains (61.4-84.5%) of the EuroQoL quality of life 5D-5L questionnaire. Among the 3239 patients with clinical visit/telephone interview at follow-up, in whom optimal medical therapy (OMT; aspirin or thienopyridine, β-blocker, and statin) was prescribed at enrolment, 2971 (91.7%) were still receiving OMT at follow-up. At multivariable analysis, only increasing age (odds ratio 0.98; 95% confidence interval 0.97-0.99; P = 0.04) resulted as independent negative predictor of OMT persistence at 1 year from enrolment. CONCLUSION In this large, contemporary registry, stable CAD patients managed by cardiologists presented a high rate of clinical events at 1 year. Nevertheless, the persistence to OMT and quality of life appeared reasonable.
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, Interventional Cardiology Unit, S. Giovanni Evangelista Hospital, Via Parrozzani, 3 Tivoli, Rome, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Via Revislate, 13, Novara, Italy
| | - Carmine Riccio
- Division of Cardiology, Azienda Ospedaliera Sant'Anna e San Sebastiano, Via F. Palasciano, Caserta, Italy
| | - Lucio Gonzini
- ANMCO Research Center, Via A. la Marmora, 36, Firenze, Italy
| | - Lina Marinacci
- Division of Cardiology, Presidio Ospedaliero Città di Castello, Via L. Angelini, 10, Perugia, Italy
| | - Sara Norma Tartaglione
- Division of Cardiology, Presidio Ospedaliero of Sanremo, Via Giovanni Borea, 56, Imperia, Italy
| | - Paolo Costa
- Division of Cardiology, G Di Maria Hospital, Avola, Vi G Mazzini, Siracusa, Italy
| | - Marino Scherillo
- Division of Cardiology, Azienda Ospedaliera G. Rummo, Via Pacevecchia, 53, Benevento, Italy
| | - Michele Senni
- Division of Cardiology, ASST Papa Giovanni XXIII, Piazza OMS, 1, Bergamo, Italy
| | - Furio Colivicchi
- Division of Cardiology, S. Filippo Neri Hospital, Via Giovanni Martinotti, 20, Rome, Italy
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Temporelli PL. Prevention after acute coronary syndrome the ‘less is more’ philosophy. Eur Heart J Suppl 2020; 22:E153-E156. [PMID: 32523461 PMCID: PMC7270904 DOI: 10.1093/eurheartj/suaa082] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
In the cardiology field, in recent years, we have witnessed an exponential increase in the use of both invasive and non-invasive instrument diagnostics. Particularly after an acute coronary syndrome, instrumental examinations, especially non-invasive ones, are often prescribed inappropriately until they almost completely replace the clinical evaluation. Their correct use, on the contrary, would require the choice of a test to be prescribed according to the epidemiological and clinical context of the individual patient. The strategy of early diagnosis, obtainable through instrumental screening and borrowed from oncological pathologies, was transferred ‘tout court’ in the cardiovascular field without any scientific basis, replacing the pharmacological or non-pharmacological intervention, such as the appropriate lifestyle, aimed at reducing cardiovascular risk factors. The guidelines of the main scientific societies define the most appropriate paths in the management of the coronary heart disease patients, both in the immediate post-acute phase and in the chronic phase. Although the guidelines sometimes show an excessive simplification of clinical problems, in an age in which the control of health expenditure has become a priority the correctness of the indications is an indispensable objective, being incontrovertible that a test is indicated only when an instrumental examination is able to modify the diagnostic-therapeutic path and the outcome of the patient.
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Affiliation(s)
- Pier Luigi Temporelli
- Divisione di Cardiologia, Istituti Clinici Scientifici Maugeri, IRCCS, Via Revislate 13, Veruno 28010, Italy
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Faggiano P, Patti G, Cercone S, Canullo L, Rossini R, Perna GP, Pirillo A, Fattirolli F, Terrosu G, Temporelli PL, Catapano A. Lipid Lowering Treatment and Follow Up in Recent Post Acute Coronary Syndrome Patients: Real-World Evidence from the Multicenter Observational Prospective - Post Acute Coronary Syndrome Italian Study (PACSI). ICFJ 2020. [DOI: 10.17987/icfj.v19i0.639] [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: 11/20/2022] Open
Abstract
PURPOSE: Patients suffering from an acute coronary syndrome are at very high risk for recurrent events. Early targeted pharmacological intervention primarily aimed at controlling plasma LDL-cholesterol (LDL-C) levels can result in the reduction of recurrent cardiovascular events. This study aimed to evaluate real-life evidence from the Italian setting to document current practice of secondary prevention in patients after acute coronary syndrome (ACS), specifically assessing: (i) the rate of LDL-C target (<70 mg/dl) achievement after 6-10 weeks from index event and at later follow-up, (ii) the distance from LDL-C target during follow up, (iii) adherence rate and visit attendance. METHODS Multicenter observational prospective clinical study ACS patients, evaluating target attainment rate at 6 weeks (V0) and 18 months (V2). RESULTS Approximately 97.4% patients enrolled (N=524) received statin-based therapy, and 3.6% received ezetimibe at discharge; mean LDL-C values decreased from 113.0±44.7 mg/dL at discharge to 71.3±26.5 mg/dl at V0. Among patients with known LDL-C for main time-points, 51.7% achieved target LDL-C at V0, 45.8% at V2. Among patients not reaching the target, the mean distance from target was 23.5±20.7 mg/dL. Attainment of target LDL-C was similar in patients receiving intensive or low-moderate statin-based treatment (approximately 50%). LDL-C target attainment was associated with lower LDL-C value at discharge and smoking status. Adherence to statin treatment was high (96.2%) throughout, similarly to medical appointment attendance at V2 (84.7%). CONCLUSION Despite most ACS patients receiving intensive statin-based regimens, only approximately half achieved LDL-C target, suggesting the need for further optimizing drug selection, combination and dosage.
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Bonapace S, Rossi A, Laroche C, Crespo-Leiro MG, Piepoli MF, Coats AJS, Dahlström U, Malek F, Macarie C, Temporelli PL, Maggioni AP, Tavazzi L. Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry. ESC Heart Fail 2019; 6:1167-1177. [PMID: 31814303 PMCID: PMC6989281 DOI: 10.1002/ehf2.12537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/14/2019] [Revised: 08/23/2019] [Accepted: 09/17/2019] [Indexed: 11/14/2022] Open
Abstract
Aims To investigate the still uncertain independent prognostic impact of pulse pressure (PP) in acute heart failure (HF), in particular across the left ventricular ejection fraction (EF) phenotypes, and the potential contribution of PP in outlining the individual phenotypes. Methods and results We prospectively evaluated 1‐year death and rehospitalization in 4314 patients admitted for acute HF grouped by EF and stratified by their PP level on admission. In HF with reduced (< 40%) EF (HFrEF), the highest quartiles of PP had the lowest unadjusted [hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.61–0.98] and adjusted (HR 0.64 0.50–0.82) risk of 1 year all cause death compared to the lowest quartile. Its prognostic impact was partially mediated by systolic blood pressure (SBP). In HF with preserved (≥ 50%) EF (HFpEF), the intermediate quartile of PP showed the lowest 1 year all cause mortality in unadjusted (HR 0.598, CI 0.416–0.858) and adjusted (HR 0.55, 95% CI 0.388‐0.801) models with no relationship with SBP. In a receiver operating characteristic analysis, a combination of PP > 60 mmHg and SBP > 140 mmHg was associated to a preserved EF with a high performance value. No prognostic significance of PP was found in the HF with mid‐range EF subgroup. Conclusions In acute HFrEF, there is an almost linear inverse relation between mortality and PP, partly mediated by SBP. In HFpEF, a J‐shaped relationship between mortality and PP was present with a better prognosis at the nadir. A combination of PP > 60 mmHg with SBP > 140 mmHg may be clinically helpful as marker of a preserved left ventricular EF.
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Affiliation(s)
- Stefano Bonapace
- Unità Complessa di Cardiologia, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Sacro Cuore don Calabria, Negrar, Italy
| | - Andrea Rossi
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Cécile Laroche
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France
| | - Maria G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, A Coruña, Spain.,Instituto de Investigación Biomédica, A Coruña, Spain.,Universidade da Coruña, A Coruña, Spain.,Centro de Investigación en Red en Enfermedades Cardiovasculares, A Coruña, Spain
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, AUSL Piacenza, Italy
| | | | - Ulf Dahlström
- Division of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Filip Malek
- Heart Failure and Hypertension Clinic, Na Homolce Hospital Cardiovascular Center, Prague, Czech Republic
| | - Cezar Macarie
- Institutul de Urgenta pentru Boli Cardiovasculare C.C. Iliescu, Bucharest, Romania
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Veruno, Italy
| | - Aldo P Maggioni
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.,ANMCO Research Center, Florence, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy
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Tilz RR, Dagres N, Arbelo E, Blomström-Lundqvist C, Crijns HJ, Kirchhof P, Kautzner J, Temporelli PL, Laroche C, Roberts PR, Pehrson S, Lip GYH, Brugada J, Tavazzi L. Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EORP Atrial Fibrillation Ablation Long-Term and Atrial Fibrillation General Pilot Registries. Europace 2019; 22:250-258. [DOI: 10.1093/europace/euz291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/23/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Rhythm control management in patients with atrial fibrillation (AF) may be unequal across Europe. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection.
Methods and results
Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC EORP AFA-LT) registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC EORP AF-Gen) pilot registry. Data collection was performed using a web-based system. In the AFA and in the Atrial Fibrillation General (AFG) pilot registries, 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger, more commonly male, and had significantly less comorbidities. Atrial Fibrillation Ablation patients often presented without comorbidities, resulting in a lower risk of stroke (CHA2DS2-VASc ≥5: 2.9% vs. 24.5%, all P < 0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P < 0.001) but with European Heart Rhythm Association (EHRA) scores >1 and more prevalent AF-related symptoms such as palpitations, fatigue, and weakness (all P < 0.001) as compared to the general AF patients. Atrial Fibrillation Ablation patients were significantly more often male, had higher left ventricular ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P < 0.001 each).
Conclusion
The comparison of the patient cohorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and relatively healthy patients.
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Affiliation(s)
- Roland Richard Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center, Medical Clinic II, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Luebeck, Germany
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Harry J Crijns
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trusts, Birmingham, Great Britain
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Cécile Laroche
- EURObservational Research Programme (EORP), ESC, Sophia-Antipolis, France
| | - Paul R Roberts
- University Hospital Southampton NHS Trust, Southampton, Great Britain
| | - Steen Pehrson
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, Great Britain
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu University of Barcelona, Barcelona, Spain
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy
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Tilz R, Dagres N, Arbelo E, Blomstroem Lundqvist CH, Pokushalov E, Crijns HJ, Kirchhof P, Kautzner J, Temporelli PL, Laroche CH, Pisapia A, Pehrson S, Lip GYH, Brugada J, Tavazzi L. P341Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EURObservational Research Programme. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0175] [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
Aims
Great heterogeneity in rhythm control management of patients with atrial fibrillation (AF) has been described. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection.
Methods
Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC-EORP EHRA AFA-LT) Registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC-EORP EHRA AF-Gen) PilotRegistry. Data collection was performed using a web-based system.
Results
In the AFA and in the AFG pilot registries 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger,more commonly male, and had significantly less co-morbidities. Lone AF was predominant in AFA patients who were at lower risk of stroke (CHA2DS2-VASc >5: 2.9% vs. 24.5%, all P<0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P<0.001) but with EHRA scores >1 and more prevalentAF-related symptoms such as palpitations, fatigue and weakness (all p<0.001)as compared to the general AF patients. AFA patients were significantly more often male, had higher LV ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P<0.001 each).
Conclusions
The comparison of the patient chorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and otherwise relatively healthy patients.
Acknowledgement/Funding
Abbott Vascular Int.; Amgen Cardiovascular, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb and Pfizer Alliance
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Affiliation(s)
- R Tilz
- University Heart Center, Luebeck, Germany
| | - N Dagres
- Heart Center of Leipzig, Electrophysiology, Leipzig, Germany
| | - E Arbelo
- University of Barcelona, Arrhythmia Section, Cardiology Department, Barcelona, Spain
| | | | - E Pokushalov
- Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - H J Crijns
- Maastricht University, Maastricht, Netherlands (The)
| | - P Kirchhof
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - J Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - P L Temporelli
- Istituto Scientifico di Veruno, Division of Cardiology, Veruno, Italy
| | - C H Laroche
- EURObservational Research Programme (EORP), Scientific Division, European Society of Cardiology, Sophia-Antipolis, France
| | - A Pisapia
- St. Joseph Hospital of Marseille, Marseille, France
| | - S Pehrson
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G Y H Lip
- Aalborg University, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg, Denmark
| | - J Brugada
- Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu Uni, Barcelona, Spain
| | - L Tavazzi
- Maria Cecilia Hospital, 18GVM Care and Research, E.S. Health Science Fnd, Cotignola, Italy
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Affiliation(s)
- Savina Nodari
- Cardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson
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Pedretti RFE, Fattirolli F, Griffo R, Ambrosetti M, Angelino E, Brazzo S, Corrà U, Dasseni N, Faggiano P, Favretto G, Febo O, Ferrari M, Giallauria F, Greco C, Iannucci M, La Rovere MT, Mallardo M, Mazza A, Piepoli M, Riccio C, Scalvini S, Tavazzi L, Temporelli PL, Mureddu GF. [Cardiac rehabilitation "3.0": from the acute to the chronic stage. A position paper from the Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR)]. G Ital Cardiol (Rome) 2019; 19:3S-40S. [PMID: 30353206 DOI: 10.1714/3001.30010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac rehabilitation (CR) represents a cardiology subspecialty that is devoted to the care of cardiac patients, early and long term after an acute event. CR aims at improving both quality of life and prognosis through risk and prognostic stratification, clinical stabilization and optimization of therapy, management of comorbidities, treatment of disability, and the provision of sustained long-term preventive and rehabilitative services.The mission of CR has changed over time. From being centred on the acute phase, health care of cardiac patients is increasingly involving the long-term chronic phase. The aim of the present position paper is to provide the state of the art of CR in Italy, discussing strengths and weaknesses as well as future perspectives.
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Affiliation(s)
- Roberto F E Pedretti
- U.O. Cardiologia Riabilitativa, Dipartimento di Cardioangiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS di Pavia
| | - Francesco Fattirolli
- S.O.D. Riabilitazione Cardiologica, Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, AOU Careggi, Firenze
| | - Raffaele Griffo
- Centro Studi per la Ricerca Clinica e la Formazione GICR-IACPR, Genova
| | - Marco Ambrosetti
- U.O. Cardiologia Riabilitativa, Dipartimento di Cardioangiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS di Pavia
| | - Elisabetta Angelino
- U.O. Psicologia, Istituti Clinici Scientifici Maugeri, Presidio Sanitario di Torino, Torino
| | - Silvia Brazzo
- Ambulatorio di Dietetica e Nutrizione Clinica, Istituti Clinici Scientifici Maugeri, IRCCS di Pavia
| | - Ugo Corrà
- U.O. Cardiologia Riabilitativa, Dipartimento di Cardioangiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS di Veruno (NO)
| | | | | | - Giuseppe Favretto
- U.O. Cardiologia Riabilitativa e Preventiva, Ospedale Riabilitativo di Alta Specializzazione, Motta di Livenza (TV)
| | - Oreste Febo
- U.O. Cardiologia Riabilitativa, Ospedale Maggiore ASST-Crema, Presidio di Rivolta d'Adda (CR)
| | - Marina Ferrari
- U.O. Cardiologia Riabilitativa, Dipartimento di Cardioangiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS di Montescano (PV)
| | - Francesco Giallauria
- U.O.C. Medicina Interna ad Indirizzo Metabolico e Riabilitativo, AOU "Federico II", Napoli
| | - Cesare Greco
- U.O.C. Cardiologia e Riabilitazione Cardiologica, A.O. San Giovanni-Addolorata, Roma
| | | | - Maria Teresa La Rovere
- U.O. Cardiologia Riabilitativa, Dipartimento di Cardioangiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS di Montescano (PV)
| | - Mario Mallardo
- U.O.C Cardiologia e Riabilitazione Cardiologica, Ospedale San Gennaro, Napoli
| | - Antonio Mazza
- U.O. Cardiologia Riabilitativa, Dipartimento di Cardioangiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS di Pavia
| | - Massimo Piepoli
- Unità per lo Scompenso Cardiaco, Ospedale Polichirurgico, Ospedale Guglielmo da Saliceto, Piacenza
| | - Carmine Riccio
- U.O. Cardiologia e Riabilitazione Cardiologica, A.O. S. Anna e S. Sebastiano, Caserta
| | - Simonetta Scalvini
- U.O. Cardiologia Riabilitativa, Dipartimento di Cardioangiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS di Lumezzane (BS)
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA)
| | - Pier Luigi Temporelli
- U.O. Cardiologia Riabilitativa, Dipartimento di Cardioangiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS di Veruno (NO)
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Ambrosetti M, Faggiano P, Greco C, Mureddu GF, Temporelli PL, Pedretti RF. Referral from vascular surgery to cardiovascular rehabilitation and related outcomes in patients with peripheral arterial disease: the THINKPAD-RELOADED survey. Monaldi Arch Chest Dis 2019; 89. [DOI: 10.4081/monaldi.2019.1101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022] Open
Abstract
The utilization of cardiovascular rehabilitation (CR) programmes in patients with Lower Extremity Peripheral Artery Disease (LEPAD) is generally poor, with limited evidence of current policies for referral. The aim of the study was to evaluate, within a cohesive network of CR and vascular surgery facilities with facilitated referral process, the clinical characteristic of LEPAD patients referred to CR and related outcomes, as compared to patients not referred. The present is an observational prospective study of consecutive patients recruited at vascular surgery facilities. Out of 329 patients observed, the average referral rate to CR was 34% (28% and 39% in patients with and without recent peripheral revascularization, p<0.05). LEPAD patients entering the CR programme were similar to those who did not according to sex, age, the vascular surgery setting of evaluation, and localization of arterial lesions. Patients with moderate intermittent claudication and patients with acute limb ischemia as index event were more represented among those who attended CR (41% vs 21% and 9% vs 2% respectively, p<0.05). Patients referred to CR had five times more episodes of acute coronary syndrome and heart failure as complication of the index event. The cardiovascular risk profile (obesity 29.5% vs 11%, p<0.05; hypercholesterolemia 80% vs 61%, p<0.05) was much worse in LEPAD patients referred to CR, but conversely, they better achieved secondary prevention targets, particularly for blood pressure control (97% vs 57%, p<0.05). All-cause 2-year mortality in the whole patients’ population was 6%. Patients entering the CR programme displayed less events (13.5% vs 37.7%, p<0.05), mainly death (3.1% vs 11.3%, p<0.05) and limb-related events (4.2% vs 15.2%, p<0.05). The results of our study suggest that when a cohesive network of vascular surgery and CR facilities becomes available, the referral rate to rehabilitation may increase up to one third of eligible patients. Patients with higher comorbidity and cardiovascular risk seem to have priority in the referral process, nevertheless those with peripheral revascularization are still underestimated. Entering CR may ensure better cardiovascular risk profile and cardiovascular prognosis in LEPAD patients, and consequently the systematic adoption of this care model needs to be strongly recommended and facilitated.
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Scardovi AB, De Maria R, Galeotti GG, Faggiano P, Arcari L, Ghio S, Temporelli PL, Rossi A, Magni G, Simioniuc A, Ricci R, Dini FL. Similar predictive value of six-minute walking distance and B-type natriuretic peptide in heart failure with reduced to mid-range ejection fraction. Monaldi Arch Chest Dis 2019; 89. [DOI: 10.4081/monaldi.2019.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/19/2019] [Indexed: 11/23/2022] Open
Abstract
The prognostic insights of heart failure (HF) with mid-range (40-49%) ejection fraction (HFmrEF) are not fully elucidated. We investigated whether the six-minutes walking test (6MWT) and brain natriuretic peptide (BNP) are predictive of outcome across the spectrum of LV systolic dysfunction and whether the HFmrEF cut-off impacts the risk stratification abilities of these tests. We studied 538 outpatients, aged 70±12 years, 28% females, with stable chronic HF and EF<50%, 349 with HFmrEF and 189 with HFrEF. End-points were all-cause and cardiac death. HFrEF patients were more often male, with ischemic etiology, severe symptoms, higher BNP levels, and cardiac mortality than HFmrEF subjects. During 32 (15-46) months follow-up, 123 (23%) patients died, 95 (18%) for cardiac causes. Cut-offs of 125 pg/ml for BNP and 360 meters for 6MWT distance were associated with lower all-cause (10% vs 38%, p<0.001 and 10% vs 26%, p<0.001, respectively) and cardiac mortality (6% vs 36%, p<0.001 and 8% vs 23%, p<0.001, respectively). BNP (HR 2.144, 95%CI, 1.403-3.276) and 6MWT walked distance (HR 1.923, 95%CI, 1.195-3.096) independently predicted outcome, after adjustment for age, gender, obesity, kidney dysfunction, ischemic etiology, NYHA class, unlike the 40% LVEF threshold. Model discrimination and survival differences were significant across LVEF strata. Higher BNP levels and shorter walked distance combined identified patients (26% overall) at particularly poor prognosis in both phenotype groups. Despite differences between HFmrEF and HFrEF patients in clinical and biomarker profile, BNP levels and 6MWT walked distance retain prognostic value over the entire spectrum of LV systolic dysfunction.
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Temporelli PL, Tilz RR, Arbelo E, Dagres N, Laroche C, Crijns HJ, Blomstrom-Lundqvist C, Kirchhof P, Lip GYH, Boriani G, Pokushalov E, Nakou E, Brugada J, Tavazzi L. Clinical characteristics of heart failure patients undergoing atrial fibrillation ablation today in Europe. Data from the atrial fibrillation registries of the European Society of Cardiology and the European Heart Rhythm Association. Eur J Heart Fail 2019; 21:690-693. [PMID: 30896056 DOI: 10.1002/ejhf.1458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/16/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno (NO), Italy
| | - Roland R Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | - Cécile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, Sophia Antipolis, France
| | - Harry J Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Departments of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Evengy Pokushalov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Eleni Nakou
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Josep Brugada
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
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Temporelli PL. Four golden rules to halve the risk of cardiovascular events. Eur Heart J Suppl 2019; 21:B103-B104. [PMID: 30948964 PMCID: PMC6439921 DOI: 10.1093/eurheartj/suz022] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Pier Luigi Temporelli
- Division of Cardiology and Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, NO, Italy
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Ghio S, Crimi G, Pica S, Temporelli PL, Boffini M, Rinaldi M, Raineri C, Scelsi L, Pistono M, Totaro R, Guida S, Visconti LO. Correction: Persistent abnormalities in pulmonary arterial compliance after heart transplantation in patients with combined post-capillary and pre-capillary pulmonary hypertension. PLoS One 2018; 13:e0208863. [PMID: 30513121 PMCID: PMC6279026 DOI: 10.1371/journal.pone.0208863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pedretti RFE, Fattirolli F, Griffo R, Ambrosetti M, Angelino E, Brazzo S, Corrà U, Dasseni N, Faggiano P, Favretto G, Febo O, Ferrari M, Giallauria F, Greco C, Iannucci M, La Rovere MT, Mallardo M, Mazza A, Piepoli M, Riccio C, Scalvini S, Tavazzi L, Temporelli PL, Mureddu GF. Cardiac Prevention and Rehabilitation "3.0": From acute to chronic phase. Position Paper of the ltalian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR). Monaldi Arch Chest Dis 2018; 88:1004. [PMID: 30375810 DOI: 10.4081/monaldi.2018.1004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 11/23/2022] Open
Abstract
Cardiac rehabilitation (CR) is the subspecialty of clinical cardiology dedicated to the treatment of cardiac patients, early and in the long term after an acute event. The aim of CR is to improve both quality of life and prognosis through prognostic stratification, clinical stabilization and optimization of therapy (pharmacological and non), management of comorbidities, treatment of disability, as well as through the provision and reinforcement of secondary prevention interventions and maintenaince of adherence to treatment. The mission of CR has changed over time. Once centered on the acute phase, aimed primarily at short-term survival, the healthcare of cardiac patients now increasingly involves the chronic phase where the challenge is to guarantee continuity and quality of care in the medium and long-term. The aim of the present position paper is to provide the state-of-the-art of CR in Italy, discussing its trengths and weaknesses as well as future perspectives.
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Affiliation(s)
- Roberto F E Pedretti
- U.O. Cardiologia Riabilitativa, Dipartimento di Cardioangiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS di Pavia.
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Rigolli M, Rossi A, Temporelli PL, Benfari G, Cioffi G, Nistri S, Gaibazzi N, Guidetti F, Tavazzi L, Myerson S, Bafadhel M, Faggiano P. P6298COPD in symptomatic aortic stenosis: the importance of correct assessment for defining prognosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Rigolli
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A Rossi
- University of Verona, Cardiology Department, Verona, Italy
| | - P L Temporelli
- Fondazione Maugeri, Cardiology Division, IRCCS, Veruno, Italy
| | - G Benfari
- University of Verona, Cardiology Department, Verona, Italy
| | - G Cioffi
- Villa Bianca Hospital, Cardiology Department, Trento, Italy
| | - S Nistri
- CMSR Veneto Medica, Cardiology Service, Altavilla Vicentina, Italy
| | - N Gaibazzi
- University of Parma, Division of Cardiology, Parma, Italy
| | - F Guidetti
- University of Brescia, Department of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - S Myerson
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M Bafadhel
- University of Oxford, Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - P Faggiano
- University of Brescia, Department of Cardiology, Spedali Civili Hospital, Brescia, Italy
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Mantovani A, Targher G, Temporelli PL, Lucci D, Gonzini L, Nicolosi GL, Marchioli R, Tognoni G, Latini R, Cosmi F, Tavazzi L, Maggioni AP. Prognostic impact of elevated serum uric acid levels on long-term outcomes in patients with chronic heart failure: A post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. Metabolism 2018; 83:205-215. [PMID: 29477817 DOI: 10.1016/j.metabol.2018.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 10/16/2017] [Revised: 02/07/2018] [Accepted: 02/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prognostic impact of hyperuricemia on long-term clinical outcomes in patients with chronic heart failure (HF) has been investigated in observational registries and clinical trials, but the results have been often inconclusive. We examined the prognostic impact of elevated serum uric acid levels on long-term clinical outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. CLINICAL TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER NCT00336336. METHODS We assessed the rates of all-cause death, cardiovascular death, cardiovascular hospitalization and the composite of all-cause death or cardiovascular hospitalization over a median follow-up of 3.9 years among 6683 ambulatory patients with chronic HF. RESULTS Patients in the 3rd serum uric acid tertile (>7.2 mg/dl) had a nearly 1.8-fold increased risk of both all-cause death and cardiovascular death, and a nearly 1.5-fold increased risk of cardiovascular hospitalization and of the composite endpoint compared to those in the 1st uric acid tertile (<5.7 mg/dl). Beyond serum uric acid ≥ 7 mg/dl the risk of outcomes increased sharply and linearly. The significant association between elevated serum uric acid levels and adverse outcomes persisted after adjustment for multiple established cardiovascular risk factors, HF etiology, left ventricular ejection fraction, medication use and other potential confounders, with an adjusted hazard ratio of 1.37 (95% CI 1.22-1.55) for all-cause death, 1.48 (1.29-1.69) for cardiovascular death, 1.19 (1.09-1.30) for cardiovascular hospitalization and 1.21 (1.11-1.31) for the composite endpoint, respectively. CONCLUSIONS Elevated serum uric acid levels are independently associated with poor long-term survival and increased risk of cardiovascular hospitalization in patients with chronic HF.
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Affiliation(s)
- Alessandro Mantovani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | | | | | | | - Gian Luigi Nicolosi
- Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Gianni Tognoni
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy
| | - Roberto Latini
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy
| | - Franco Cosmi
- Division of Cardiology, Ospedale Valdichiana Santa Margherita, Cortona, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy
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Barbieri A, Rossi A, Gaibazzi N, Erlicher A, Mureddu GF, Frattini S, Faden G, Manicardi M, Beraldi M, Agostini F, Lazzarini V, Moreo A, Temporelli PL, Faggiano P. Refined 4-group classification of left ventricular hypertrophy based on ventricular concentricity and volume dilatation outlines distinct noninvasive hemodynamic profiles in a large contemporary echocardiographic population. Echocardiography 2018; 35:1258-1265. [PMID: 29797430 DOI: 10.1111/echo.14031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/19/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) may reflect a wide variety of physiologic and pathologic conditions. Thus, it can be misleading to consider all LVH to be homogenous or similar. Refined 4-group classification of LVH based on ventricular concentricity and dilatation may be identified. To determine whether the 4-group classification of LVH identified distinct phenotypes, we compared their association with various noninvasive markers of cardiac stress. METHODS Cohort of unselected adult outpatients referred to a seven tertiary care echocardiographic laboratory for any indication in a 2-week period. We evaluated the LV geometric patterns using validated echocardiographic indexation methods and partition values. RESULTS Standard echocardiography was performed in 1137 consecutive subjects, and LVH was found in 42%. The newly proposed 4-group classification of LVH was applicable in 88% of patients. The most common pattern resulted in concentric LVH (19%). The worst functional and hemodynamic profile was associated with eccentric LVH and those with mixed LVH had a higher prevalence of reduced EF than those with concentric LVH (P < .001 for all). CONCLUSIONS The new 4-group classification of LVH system showed distinct differences in cardiac function and noninvasive hemodynamics allowing clinicians to distinguish different LV hemodynamic stress adaptations in patients with LVH.
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Affiliation(s)
- Andrea Barbieri
- Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Andrea Rossi
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Nicola Gaibazzi
- Cardiology Division, Parma University Hospital, Parma, Italy
| | | | | | | | - Giacomo Faden
- Cardiology Division, Spedali Civili and University of Brescia, Brescia, Italy
| | - Marcella Manicardi
- Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Monica Beraldi
- Cardiological Department, "Carlo Poma" Hospital Mantova, Mantova, Italy
| | | | | | | | | | - Pompilio Faggiano
- Cardiology Division, Spedali Civili and University of Brescia, Brescia, Italy
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50
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Arca M, Borghi C, Pontremoli R, De Ferrari GM, Colivicchi F, Desideri G, Temporelli PL. Hypertriglyceridemia and omega-3 fatty acids: Their often overlooked role in cardiovascular disease prevention. Nutr Metab Cardiovasc Dis 2018; 28:197-205. [PMID: 29397253 DOI: 10.1016/j.numecd.2017.11.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/12/2017] [Accepted: 11/06/2017] [Indexed: 01/12/2023]
Abstract
AIMS This review aims to describe the pathogenic role of triglycerides in cardiometabolic risk, and the potential role of omega-3 fatty acids in the management of hypertriglyceridemia and cardiovascular disease. DATA SYNTHESIS In epidemiological studies, hypertriglyceridemia correlates with an increased risk of cardiovascular disease, even after adjustment for low density lipoprotein cholesterol (LDL-C) levels. This has been further supported by Mendelian randomization studies where triglyceride-raising common single nucleotide polymorphisms confer an increased risk of developing cardiovascular disease. Although guidelines vary in their definition of hypertriglyceridemia, they consistently define a normal triglyceride level as <150 mg/dL (or <1.7 mmol/L). For patients with moderately elevated triglyceride levels, LDL-C remains the primary target for treatment in both European and US guidelines. However, since any triglyceride level in excess of normal increases the risk of cardiovascular disease, even in patients with optimally managed LDL-C levels, triglycerides are an important secondary target in both assessment and treatment. Dietary changes are a key element of first-line lifestyle intervention, but pharmacological treatment including omega-3 fatty acids may be indicated in people with persistently high triglyceride levels. Moreover, in patients with pre-existing cardiovascular disease, omega-3 supplements significantly reduce the risk of sudden death, cardiac death and myocardial infarction and are generally well tolerated. CONCLUSIONS Targeting resistant hypertriglyceridemia should be considered as a part of clinical management of cardiovascular risk. Omega-3 fatty acids may represent a valuable resource to this aim.
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Affiliation(s)
- M Arca
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Roma, Italy.
| | - C Borghi
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Ospedale Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - R Pontremoli
- Dipartimento di Medicina Interna, Università di Genova, Ospedale Policlinico San Martino, Genova, Italy
| | - G M De Ferrari
- Unità Coronarica e Laboratori Sperimentazione e Ricerca, Centro Clinico di Ricerca Cardiovascolare, IRCCS Fondazione Policlinico San Matteo, Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia, Italy
| | - F Colivicchi
- UOC Cardiologia, Ospedale S. Filippo Neri, ASL ROMA 1, Roma, Italy
| | - G Desideri
- Facoltà di Medicina e Chirurgia, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - P L Temporelli
- Divisione di Cardiologia Riabilitativa, ICS Maugeri, IRCCS, Veruno-NO, Italy
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