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Demola P, Beneduce A, Masiero G, Serino F, Baldi E, Polimeni A, Attisano T, Contarini M, Castiglioni B, De Marco F, Fineschi M, Menozzi A, Musto C, Tarantini G, Saia F, Esposito G. [Management of patients with myocardial ischemia/infarction with non-obstructive coronary artery disease in Italian catheterization laboratories: results of the SICI-GISE national survey promoted by the GISE Young Committee]. G Ital Cardiol (Rome) 2023; 24:42S-52S. [PMID: 37767847 DOI: 10.1714/4101.40994] [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: 09/29/2023]
Abstract
BACKGROUND Myocardial ischemia (INOCA) and acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) represent emerging entities in the landscape of interventional cardiology. These conditions have heterogeneous pathophysiological mechanisms and clinical presentations, complex diagnostics, and high prognostic significance. METHODS This survey was carried out jointly by the GISE Young Committee with the support of the SICI-GISE Society and the ICOT group with the aim of evaluating the implementation of diagnostic-therapeutic pathways in cases of suspected/confirmed INOCA and MINOCA diseases. A web-based questionnaire based on 22 questions was distributed to SICI-GISE and ICOT members. RESULTS The survey was distributed to 1550 physicians with 104 (7%) responses. The majority of participants included interventional cardiologists (70%), in two-thirds of cases working in centers with high volume of procedures (>1000 coronary angiographies/year), who estimated a <10% annual rate of INOCA and MINOCA cases in their case load. Approximately 25% of the participants stated that they do not have the option of performing any investigation for the evaluation of patients with suspected INOCA, and less than 50% make use of advanced invasive testing for the diagnosis of MINOCA, including physiology and intravascular imaging tests. It also turns out that about 50% of respondents reported the present and future absence of dedicated diagnostic-therapeutic pathways. Even with a high perception of the clinical relevance of these diseases, about 40% of the respondents rely on clinical experience or do not deal with their management, also reporting a low prevalence of dedicated follow-up care (20% of cases followed at dedicated outpatient clinics). Factors predominantly limiting the prevalence of appropriate diagnostic and treatment pathways included the cost of materials, lack of training and expertise of practitioners, and of solid data on the long-term clinical efficacy of treatments. CONCLUSIONS Currently, the proper management of INOCA and MINOCA disease is widely advocated but poorly implemented in clinical practice. To reverse the trend and solve the remaining controversies, it is necessary to enhance awareness, produce robust scientific data, and implement dedicated pathways for patients.
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Affiliation(s)
| | | | - Giulia Masiero
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Federica Serino
- Divisione di Cardiologia, A.O.R.N. Antonio Cardarelli, Napoli
| | - Enrico Baldi
- Divisione di Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Alberto Polimeni
- Dipartimento di Farmacia e Scienze della Salute e della Nutrizione, Università della Calabria, Rende (CS)
| | - Tiziana Attisano
- Divisione di Cardiologia Interventistica, Dipartimento Cardiotoracovascolare, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno
| | - Marco Contarini
- U.O. Cardiologia con UTIC ed Emodinamica, Presidio Ospedaliero Umberto I, Siracusa
| | | | - Federico De Marco
- U.O. Cardiologia Interventistica Valvolare e Strutturale, Centro Cardiologico Monzino, Milano
| | - Massimo Fineschi
- U.O.S.A. Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena
| | - Alberto Menozzi
- S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia
| | - Carmine Musto
- Divisione di Cardiologia, Azienda Ospedaliera San Camillo, Roma
| | - Giuseppe Tarantini
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Francesco Saia
- Alma Mater Studiorum, Università degli Studi di Bologna e IRCCS Policlinico Sant'Orsola, Bologna
| | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli "Federico II", Napoli
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Botti G, Barioli A, D'Agosta G, Ruggiero R, Demola P, Sánchez-Luna JP, Amat Santos I, Masiero G. [Drug-coated balloon-based percutaneous coronary intervention: results in multivessel coronary artery]. G Ital Cardiol (Rome) 2023; 24:64S-65S. [PMID: 37767849 DOI: 10.1714/4101.40996] [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: 09/29/2023]
Affiliation(s)
| | - Alberto Barioli
- Dipartimento Cardio-Neurovascolare, Azienda Ospedaliera Ca' Foncello e San Giacomo, Treviso
| | | | | | | | | | | | - Giulia Masiero
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
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Franchin L, Piroli F, Demola P, Mantovani F, Iannaccone M, Manfredi R, D’Ascenzo F, Fortuni F, Ugo F, Meucci F, Navazio A, Boccuzzi G. Efficacy and safety of left atrial appendage closure compared with oral anticoagulation in atrial fibrillation: a meta-analysis of randomized controlled trials and propensity-matched studies. Front Cardiovasc Med 2023; 10:1212161. [PMID: 37829693 PMCID: PMC10565038 DOI: 10.3389/fcvm.2023.1212161] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023] Open
Abstract
Backgrounds Two recent randomized controlled trials (RCTs), the PROTECT-AF and the PREVAIL, showed that in atrial fibrillation (AF) patients, left atrial appendage closure (LAAC) is comparable to oral anticoagulants (OAC) in the prevention of stroke and could also possibly reduce mortality. Nevertheless, this net clinical benefit was not confirmed in the most recent RCT comparing LAAC vs. OAC, the PRAGUE-17 trial. Aim aim of the present study was to evaluate the efficacy and safety of LAAC compared with OAC among available high-quality studies. Methods A systematic search of electronic databases (Medline, Scopus, Embase and the Cochrane Library) was performed to identify eligible RCTs and observational studies with propensity score matching (PSM) analysis. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Outcomes of interest were the occurrence of cardiovascular death (CVD), all-cause death, all-type stroke, and major bleedings. Results A total of 3 RCTs and 7 PMS studies involving 25,700 patients were identified. 12,961 patients received LAAC while 12,739 received OAC therapy. After a median follow-up of 2.6 years (IQR 2-4.4), patients who received LAAC had lower risk of CVD (RR = 0.62; 95%CI, 0.51-0.74, I2 = 0%), all-cause death (RR = 0.67; 95% CI, 0.57-0.78, I2 68%) and major bleedings (RR = 0.68; 95%CI, 0.48-0.95 I2 = 87%) compared with patients on OAC. No difference was found between the two groups regarding strokes incidence (RR = 0.94; 95% CI, 0.77-1.15, I2 = 0%). Conclusions According to this meta-analysis, LAAC has comparable efficacy in the prevention of stroke compared with OAC and a reduced risk of major bleedings, all-cause death and CVD that may be even larger with longer follow-up. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269768, identifier CRD42021269768.
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Affiliation(s)
- Luca Franchin
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
- Department of Cardiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Francesco Piroli
- Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pierluigi Demola
- Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
| | - Roberto Manfredi
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti”, Ancona, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medicine, A.O.U Città Della Salute e Della Scienza, Turin, Italy
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Fabrizio Ugo
- Division of Cardiology, Sant’Andrea Hospital, Vercelli, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Alessandro Navazio
- Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giacomo Boccuzzi
- Department of Cardiology, San Giovanni Bosco Hospital, Turin, Italy
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Bosi D, Canovi S, Pennacchioni A, Demola P, Corradini M, Guiducci V, Colla R, Navazio A. "Troponinosis", the Cardiologist's Curse-When Clinic-Laboratory Interaction Unveils the Mystery: A Case Report. J Cardiovasc Dev Dis 2023; 10:378. [PMID: 37754807 PMCID: PMC10531523 DOI: 10.3390/jcdd10090378] [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: 08/07/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Cardiac troponins are key diagnostic and prognostic biomarkers in acute myocardial infarction and, more generally, for the detection of myocardial injury. Since the introduction of the first immunochemistry methods, there has been a remarkable evolution in analytical performance, especially concerning a progressive improvement in sensitivity. However, the measurement of circulating troponins remains rarely susceptible to analytical interferences. We report a case of persistently elevated troponin I concentrations in a patient with known ischemic heart disease, which almost led to unnecessary diagnostic-therapeutic interventions. A prompt laboratory consultation by the cardiologist ultimately led to the identification of an analytical interference due to troponin macrocomplexes (macrotroponin) causing elevated troponin values in the absence of a clinical presentation compatible with myocardial damage.
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Affiliation(s)
- Davide Bosi
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
| | - Simone Canovi
- Clinical Laboratory Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (S.C.); (M.C.); (R.C.)
| | - Andrea Pennacchioni
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
| | - Pierluigi Demola
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
| | - Mattia Corradini
- Clinical Laboratory Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (S.C.); (M.C.); (R.C.)
| | - Vincenzo Guiducci
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
| | - Rossana Colla
- Clinical Laboratory Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (S.C.); (M.C.); (R.C.)
| | - Alessandro Navazio
- Cardiology Unit, AUSL—IRCCS di Reggio Emilia, 42100 Reggio Emilia, Italy; (A.P.); (P.D.); (V.G.); (A.N.)
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Demola P, Colaiori I, Bosi D, Musto D’Amore S, Vitolo M, Benatti G, Vignali L, Tadonio I, Gabbieri D, Losi L, Magnavacchi P, Sgura FA, Boriani G, Guiducci V. Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study. Front Cardiovasc Med 2023; 10:1188644. [PMID: 37711555 PMCID: PMC10499393 DOI: 10.3389/fcvm.2023.1188644] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background Coronary artery disease (CAD) is common in patients with aortic valve stenosis (AS) ranging from 60% to 80%. The clinical and prognostic role of coronary artery lesions in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) remains unclear. The aim of the present observational study was to estimate long-term clinical outcomes by Quantitative Flow Ratio (QFR) characterization of CAD in a well-represented cohort of patients affected by severe AS treated by TAVI. Methods A total of 439 invasive coronary angiographies of patients deemed eligible for TAVI by local Heart Teams with symptomatic severe AS were retrospectively screened for QFR analysis. The primary endpoint of the study was all-cause mortality. The secondary endpoint was a composite of cardiovascular mortality, stroke/transient ischemic attack (TIA), acute myocardial infarction (AMI), and any hospitalization after TAVI. Results After exclusion of patients with no follow-up data, coronary angiography not feasible for QFR analysis and previous surgical myocardial revascularization (CABG) 48/239 (20.1%) patients had a QFR value lower or equal to 0.80 (QFR + value), while the remaining 191/239 (79.9%) did not present any vessel with a QFR positive value. In the adjusted Cox regression analysis, patients with positive QFR were independently associated with an increased risk of all-casual mortality (Model 1, HR 3.47, 95% CI, 2.35-5.12; Model 2, HR 5.01, 95% CI, 3.17-7.90). In the adjusted covariate analysis, QFR+ involving LAD (37/48, 77,1%) was associated with the higher risk of the composite outcome compared to patients without any positive value of QFR or non-LAD QFR positive value (11/48, 22.9%). Conclusions Pre-TAVI QFR analysis can be used for a safe, simple, wireless functional assessment of CAD. QFR permits to identify patients at high risk of cardiovascular mortality or MACE, and it could be considered by local Heart Teams.
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Affiliation(s)
- Pierluigi Demola
- Cardiology Unit, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Iginio Colaiori
- Cardiology Unit, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Bosi
- Cardiology Unit, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio Benatti
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Luigi Vignali
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Iacopo Tadonio
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | | | - Luciano Losi
- U.O. Cardiologia, Ospedale “Guglielmo da Saliceto”, Piacenza, Italy
| | | | - Fabio Alfredo Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Vincenzo Guiducci
- Cardiology Unit, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Demola P, Conti M, Pignatelli G, Bosi D, Faragasso E, Mantovani F, Guiducci V, Navazio A. [Spontaneous coronary dissection complicated by Takotsubo syndrome or Takotsubo syndrome complicated by spontaneous coronary dissection: the complex integration of invasive and non-invasive imaging]. G Ital Cardiol (Rome) 2023; 24:547-550. [PMID: 37392120 DOI: 10.1714/4060.40434] [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
Spontaneous coronary artery dissection syndrome and Takotsubo syndrome are similar entities. They have peculiar features in common, such as a predilection for female sex, signs and symptoms compatible with acute coronary syndrome, high probability of restitutio ad integrum. The interdependence between these two diseases is of intriguing diagnostic and therapeutic implication.A 51-year-old woman presented to our attention with chest pain and evidence of ST-segment elevation. Coronary angiography showed the presence of type 2 dissection involving the diagonal branch. A conservative strategy was preferred. A severe emotional stress conditioned the following hours of hospitalization. A Takotsubo-like pattern was detected at focused echocardiogram. Cardiac magnetic resonance imaging confirmed the typical left ventricular motion abnormalities of a stress cardiomyopathy and T2-weighted sequences showed increased late gadolinium enhancement in the diagonal branch area, leading to the diagnosis of a concomitant coronary dissection and Takotsubo cardiomyopathy.
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Affiliation(s)
- Pierluigi Demola
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Massimo Conti
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Gianluca Pignatelli
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Davide Bosi
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | | | - Francesca Mantovani
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Vincenzo Guiducci
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
| | - Alessandro Navazio
- S.O.C. Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia
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Pompei G, Barioli A, D'Agosta G, Ruggiero R, Demola P, Bianchini F, Burzotta F, Masiero G. [The EBC MAIN study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies for the treatment of left main bifurcation lesions]. G Ital Cardiol (Rome) 2023; 24:39S-40S. [PMID: 37158032 DOI: 10.1714/4035.40106] [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: 05/10/2023]
Affiliation(s)
- Graziella Pompei
- U.O. Cardiologia, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE)
| | - Alberto Barioli
- Dipartimento Cardio-Neurovascolare, Azienda Ospedaliera Ca' Foncello e San Giacomo, Treviso
| | | | | | | | - Francesco Bianchini
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - Giulia Masiero
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
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Compagnone M, Demola P, Serino F, Masiero G, Giuliani L, Rossi S, Polimeni A, Attisano T, Contarini M, Castiglioni B, De Marco F, Fineschi M, Menozzi A, Musto C, Saia F, Tarantini G, Esposito G. [Right heart catheterization in Italian catheterization laboratories: results of the SICI-GISE national survey promoted by the GISE Young Committee]. G Ital Cardiol (Rome) 2023; 24:30-38. [PMID: 37158031 DOI: 10.1714/4035.40105] [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: 05/10/2023]
Abstract
BACKGROUND Over the past decades, the improvements in the diagnostic power and availability of non-invasive cardiac imaging techniques have led to a decline of right heart catheterization (RHC) performance. However, RHC remains the gold standard for diagnosing pulmonary hypertension and an essential tool for the evaluation of patient candidacy to heart transplantation. METHODS This survey was carried out jointly by the Young Committee of GISE, with the support of the SICI-GISE Society, and the ICOT group, with the aim of evaluating how the interventional cardiology community perform RHC. A web-based questionnaire based on 20 questions was distributed to SICI-GISE members. RESULTS The survey was distributed to 1550 physicians with 174 (11%) responses. Most centers perform few procedures per year (<10 RHC/year) and a dedicated cardiologist is usually lacking. Patients were frequently admitted as ordinary hospitalization regimen and the most frequent indication for RHC was the hemodynamic assessment of pulmonary hypertension, followed by diagnostics of valvular diseases and advanced heart failure/heart transplantation. Indeed, the majority of participants (86%) are involved in transcatheter procedures for structural heart disease. The average time taken to perform the RHC was approximately 30-60 min. The femoral access (60%) was the most frequently used, usually by an echo-guided approach. Two-thirds of participants discontinued oral anticoagulant therapy before RHC. Only 27% of centers assess wedge position from an integrated analysis. Furthermore, the edge pressure is detected in the end-diastolic cardiac phase in half cases and in the end-expiratory phase in only 31%. The most commonly used method for cardiac output calculation was the indirect Fick method (58%). CONCLUSIONS Guidance on the best practice for performing RHC is currently lacking. A more precise standardization of this demanding procedure is warranted.
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Affiliation(s)
| | | | - Federica Serino
- Divisione di Cardiologia, A.O.R.N. Antonio Cardarelli, Napoli
| | - Giulia Masiero
- Dipartimnto di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Livio Giuliani
- U.O. Cardiologia Interventistica, Ospedale "SS. Annunziata", Chieti
| | - Serena Rossi
- U.O. Cardiologia Interventistica, Ospedale "SS. Annunziata", Chieti
| | - Alberto Polimeni
- Divisione di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro
| | - Tiziana Attisano
- Divisione di Cardiologia Interventistica, Dipartimento Cardiotoracovascolare, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno
| | - Marco Contarini
- Dipartimento di Cardiologia, Presidio Ospedaliero Umberto I, Siracusa
| | | | - Federico De Marco
- Dipartimento di Cardiologia Clinica e Interventistica, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | - Massimo Fineschi
- U.O.S.A. Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena
| | - Alberto Menozzi
- S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia
| | - Carmine Musto
- Divisione di Cardiologia, Azienda Ospedaliera San Camillo, Roma
| | - Francesco Saia
- Alma Mater Studiorum, Università degli Studi di Bologna e IRCCS Policlinico Sant'Orsola, Bologna
| | - Giuseppe Tarantini
- Dipartimnto di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli "Federico II", Napoli
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Biscaglia S, Verardi FM, Tebaldi M, Guiducci V, Caglioni S, Campana R, Scala A, Marrone A, Pompei G, Marchini F, Scancarello D, Pignatelli G, D'Amore SM, Colaiori I, Demola P, Di Serafino L, Tumscitz C, Penzo C, Erriquez A, Manfrini M, Campo G. QFR-Based Virtual PCI or Conventional Angiography to Guide PCI: The AQVA Trial. JACC Cardiovasc Interv 2023; 16:783-794. [PMID: 36898939 DOI: 10.1016/j.jcin.2022.10.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 03/12/2023]
Abstract
BACKGROUND Post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) values ≥0.90 are associated with a low incidence of adverse events. OBJECTIVES The AQVA (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR) trial aims to test whether a QFR-based virtual percutaneous coronary intervention (PCI) is superior to a conventional angiography-based PCI at obtaining optimal post-PCI QFR results. METHODS The AQVA trial is an investigator-initiated, randomized, controlled, parallel-group clinical trial. Three hundred patients (356 study vessels) undergoing PCI were randomized 1:1 to receive either QFR-based virtual PCI or angiography-based PCI (standard of care). The primary outcome was the rate of study vessels with a suboptimal post-PCI QFR value, which was defined as <0.90. Secondary outcomes were procedure duration, stent length/lesion, and stent number/patient. RESULTS Overall, 38 (10.7%) study vessels missed the prespecified optimal post-PCI QFR target. The primary outcome occurred significantly more frequently in the angiography-based group (n = 26, 15.1%) compared with the QFR-based virtual PCI group (n = 12 [6.6%]; absolute difference = 8.5%; relative difference = 57%; P = 0.009). The main cause of a suboptimal result in the angiography-based group is the underestimation of a diseased segment outside the stented one. There were no significant differences among secondary endpoints, although stent length/lesion and stent number/patient were numerically lower in the virtual PCI group (P = 0.06 and P = 0.08, respectively), whereas procedure length was higher in the virtual PCI group (P = 0.06). CONCLUSIONS The AQVA trial demonstrated the superiority of QFR-based virtual PCI over angiography-based PCI with regard to post-PCI optimal physiological results. Future larger randomized clinical trials that demonstrate the superiority of this approach in terms of clinical outcomes are warranted. (Angio-based Quantitative Flow Ratio Virtual PCI Versus Conventional Angio-guided PCI in the Achievement of an Optimal Post-PCI QFR [AQVA]; NCT04664140).
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Affiliation(s)
- Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy.
| | | | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Vincenzo Guiducci
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Caglioni
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Roberta Campana
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Antonella Scala
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Andrea Marrone
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Graziella Pompei
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Federico Marchini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Davide Scancarello
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Gianluca Pignatelli
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Sergio Musto D'Amore
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Iginio Colaiori
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Pierluigi Demola
- Cardiology Unit, Azienda Unità Sanitaria Locale, Istituti di Ricovero e Cura a Carattere Scientifico, Istituto in Tecnologie Avanzate e Modelli Assistenziali di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Di Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Carlo Penzo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Marco Manfrini
- Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Cotignola, Ravenna, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
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Melania M, Rampini F, Bagnoli A, Demola P, Benatti G, Tadonio I, Boriani G, Navazio A, Vignali L, Guiducci V. 209 A COMMON CASE OF AORTIC STENOSIS IN A UNIQUE QUADRICUSPID ANATOMY: MANAGEMENT IN REAL LIFE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
A 85-year-old lady with severe dyspnea presented in emergency dept. of our institution in Reggio Emilia last July. Typical signs and symptoms of heart failure were associated with high voltage at ECG and echocardiographic findings show a reduced EF (40%) with trans-aortic mean gradient of 42 mmHg, aortic valvular area of 0.8 cm2 and moderate aortic regurgitation.
At CT scan analysis, a dismorphic quadricuspid aortic valve (QAV) was detected. This is a rare congenital heart disease generally unrelated to other cardiac abnormalities and usually diagnosed incidentally. Due to QAV stenosis rarity, many considerations in Trans Aortic Valve Implantation (TAVI) in QAV are unclear.
Some individuals with QAV develop aortic regurgitation and rarely other cardiovascular complications such as aortic aneurysm. Because of its infrequency, it is difficult to characterize these patients and standardize their management. Tailored therapy is more than ever necessary.
Our patient also had bicameral pacemaker for grade II Mobitz 2 atrioventricular blockage. At coronarography angiography mild atheromasia was detected;
AngioCT reconstructions in figure 1 panel A and B show the presence of QAV. Severe wall atheromasia along the entire course of the aorta was also detected.
A few days later the patient underwent the TAVI procedure. A coronary guidewire was positioned in right coronary artery in order to protect its ostium that was slightly lower and, as known from literature, QAV has a longer leaflet height and a shallower cusp depth. After implantation of a Balloon Expandable Valve, a chimney stenting was also performed.
An excellent final result was achieved with a safe deployment and a 90/10 final position (last aortography frame in Figure 2, where both coronary arteries are well visible).
Post-procedural echo follow-up showed a well functioning aortic prosthesis (with mean gradient of 9 mmHg).
The case presented is particularly interesting mainly for three reasons: Extreme rarity of this condition that can be challenging especially in the elderly people with calcific valve affected by stenosis and regurgitation;Paucity of procedural data in literature on QAV;It is a real life management example with subsequent successful implantation of the BEV and chimney stenting in QAV;
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11
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Minnocci M, Trapanese P, Menozzi M, Rampini F, Bagnoli A, Demola P, Guiducci V, Manca F, Navazio A, Boriani G. 1043 INTEGRATED DIAGNOSIS AND TREATMENT IN EOSINOPHILIC MYOCARDITIS, THE IMPORTANCE OF TEAM AGAINST RARE CONDITIONS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Eosinophilic myocarditis is an inflammatory disease of the heart, even if rare, it could be a life-threatening condition, characterized by eosinophils infiltration of the myocardial tissue. First report of this type of endocarditis was reported by Löffler in 1935 and was described as an eosinophilic filling of endocardial cells with consequent myocardial fibrosis.
Etiologically, viral infections are the prominent cause of myocarditis, especially the Coxsackie-B virus, drugs such as sumatriptan and canine Toxoplasma infections have been associated with eosinophilic myocarditis. Eosinophilia indeed (increase in eosinophils count in blood sample) has a similar etiology to eosinophilic myocarditis.
However, as known from the literature, the relationship between myocardial damage and eosinophilia can have multiple etiologies, from hypersensitivity to autoimmune diseases but also malignancies. Clinically, its signs and symptoms present a wide spectrum of manifestations such as chest pain, dyspnea, rhythm disturbances, until sudden cardiac death.
Diagnostic gold standard is endomyocardial biopsy, but cardiac magnetic resonance is a valid option in such scenarios following Lewis Lake criteria and suggestive laboratory results.
We present the case of a 78-year-old lady, affected by arterial hypertension and dyslipidemia. Among her main comorbidities she complained late-onset asthma and hypothyroidism. The patient went to the emergency department of our hospital for onset of dyspnea associated with chest pain. An echocardiogram showed a dilated and diffusely hypokinetic left ventricle, severely reduced systolic function (EF 30%) and atrial fibrillation with high ventricular response. The patient presented with acute pulmonary edema and oliguria, for which non-invasive ventilation, diuretics therapy and inotropic therapy were needed. Invasive coronary angiography was negative, excluding any kind of coronary syndrome. HS-troponin peak detected was very high (73.170 ng/L).
CMR was performed that showed images indicative of myocarditis (as shown in the picture A and B) with typical distribution of late gadolinium enhancement and reduced left ventricular function:
The finding of hypereosinophilia was highly suspicious, so the endomyocardial biopsy performed confirmed the histotype of eosinophilic myocarditis. Hypereosinophilic myeloproliferative syndrome was ruled out after genetic testing. Therefore, a final diagnosis of eosinophilic granulomatosis with ANCA-negative polyangiotis with predominantly hematologic (peripheral hypereosinophilia), cardiac (multifocal myocarditis with inflammatory infiltrate with predominantly eosinophilic component), pulmonary (late-onset asthma) and peripheral neurologic (sciatic mononeuropathy) involvement was made. The patient underwent corticosteroid therapy, to which mepolizumab and cyclophosphamide were added.
This case enlightens the rarity of this pathology, enhancing the appropriate indication of CMR in complex settings. We also remark the importance of close team collaboration with rheumatologists and CMR-expert radiologists for the resolution of the case and its proper therapeutic management.
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12
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Fumagalli C, Nardi G, Bonanni F, Credi G, Demola P, Carrabba N, Valenti R, Meucci F, Stefano P, Scheggi V, Di Mario C, Ungar A, Baldasseroni S, Marchionni N. 569 IMPACT OF FRAILTY ON VERY LONG-TERM OUTCOME IN PATIENTS UNDERGOING PERCUTANEOUS TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) IN A HIGH-FLOW REFERRAL CENTER: A PROSPECTIVE STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Transcatheter strategies for aortic stenosis (AS) are a therapeutic option in older patients not amenable for open heart surgery. Guidelines recommend surgical scores like the Society of Thoracic Surgeons (STS) for risk stratification. However, the long-term predictive power of these scores in older patients is limited.
Purpose
To assess the impact of frailty status on the very long-term mortality in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care center.
Methods
Consecutive patients >80 years referred to TAVI from January to December 2019 at our tertiary care institution were prospectively screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the Multidimensional Prognostic Index (MPI).
The MPI is a three-level score used to stratify frailty and risk of mortality (low, intermediate, or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility, and risk of pressure sores, multimorbidity, polypharmacy and co-habitation).
Frailty was defined by an intermediate-high MPI. Patients were also analyzed by STS score (<4%: low risk; 4-8%: intermediate risk; >8%: high risk). All patients prospectively called at 1, 2 and 3 years from TAVI.
Results
Overall, 134 patients were referred for TAVI (mean age: 84±4 years; >90 years: 12%, women 67%). Average STS score was 4.6 ± 3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3±3.7 (SPPB <6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group.
After 3 years, 17 (12.7%) patients died, and 40 (29.9%) were hospitalized: 21 (15.7%) for cardiovascular complications (N=11 for acute heart failure, N=6 for major bleeding, N=4 for stroke). Four patients (2.9%) implanted a pacemaker. One patient (0.7%) required a de-novo intervention.
At Cox multivariable analysis, only frailty (MPI intermediate-high) was associated with mortality (HR 5.42, 95% C.I. 1.88-12.11, p=0.002) while a high STS score showed a trend towards higher mortality risk (HR 1.63, 95% C.I. 0.91-2.91, p=0.101). Overall, at Kaplan Meier survival analysis, patients considered fit (non-frail) were characterized by a better prognosis irrespective of STS score (<8 vs >8).
Conclusions
In a prospectively enrolled cohort of old TAVI candidates, frailty status was able to identify patients at higher risk of mortality irrespective of STS risk. Frailty assessment could be a useful tool, coupled with other scores, for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure.
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13
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Barioli A, D'Agosta G, Ruggiero R, Demola P, Nai Fovino L, Tarantini G, Masiero G. [Left main percutaneous coronary intervention using zotarolimus-eluting stent: data from the ROLEX registry]. G Ital Cardiol (Rome) 2022; 23:36S-37S. [PMID: 36636874 DOI: 10.1714/3949.39291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Alberto Barioli
- Dipartimento Cardio-Neuro-Vascolare, Ospedale Ca' Foncello, Treviso
| | | | | | | | - Luca Nai Fovino
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Giuseppe Tarantini
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Giulia Masiero
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
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14
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Toscano E, Demola P, Serino F, Masiero G, Polimeni A, Attisano T, Contarini M, Castiglioni B, De Marco F, Fineschi M, Menozzi A, Musto C, Saia F, Tarantini G, Esposito G. [Percutaneous transcatheter treatment of hypertension and heart failure: results of the SICI-GISE national survey promoted by the GISE Young Committee]. G Ital Cardiol (Rome) 2022; 23:27S-35S. [PMID: 36636873 DOI: 10.1714/3949.39290] [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: 01/14/2023]
Abstract
BACKGROUND During the last decade, thanks to contemporary evidence and technological improvements, the role of interventional cardiology in the field of cardiac conditions that are mainly treated conservatively has grown a lot. In such scenario, drug-resistant arterial hypertension and heart failure (HF) have a significant role, considering the huge number of involved patients and their impact on mortality and quality of life. METHODS This survey was jointly performed by the GISE Young Committee with the support of the SICI-GISE Society and the ICOT group with the aim of evaluating the view of the cardiology community on interventional therapies for arterial hypertension and HF. A web-based questionnaire based on 22 questions was distributed online to SICI-GISE members. RESULTS The survey was distributed to 1550 physicians with 156 (10%) responses, 58% of whom was under 35 years of age. Renal denervation was available in 49% of Centers, its principal indication was the evidence of severe adverse reactions to anti-hypertensive drugs (80%). Most participants agreed that, compared to past years, there is more understanding of anatomical characteristics and improvement of devices, thus increasing procedural safety; however, main limitations were: appropriate patients' selection criteria (45%), lack of robust evidence (41%) and regulatory (36%) and economical (33%) factors. In the field of HF, this survey enlightened a wide availability of conventional therapies (i.e. mechanical circulatory support, defibrillators, resynchronization) in Italy; on the other side, there is limited availability of innovative devices (i.e. atrial decompression systems, transcatheter left ventricular reshaping). Many participants expressed enthusiastic attitude in this new field, with a look for the need of further evidence in terms of safety and efficacy. Finally, in the treatment of both acute and chronic HF, many participants expressed a problem of limited patient access to advanced therapies, mainly associated with suboptimal networking among institutions. CONCLUSIONS Device-based therapies for arterial hypertension and HF represent a promising option for selected patients; this survey highlights the importance of achieving good quality evidence in both fields, with the goal of proper identification of defined criteria for patients' selection and improvement of procedural and long-term safety and efficacy.
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Affiliation(s)
| | | | - Federica Serino
- Divisione di Cardiologia, A.O.R.N. Antonio Cardarelli, Napoli
| | - Giulia Masiero
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Alberto Polimeni
- Centro di Ricerche Cardiovascolari, Divisione di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro
| | - Tiziana Attisano
- Divisione di Cardiologia Interventistica, Dipartimento Cardiotoracovascolare, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno
| | - Marco Contarini
- U.O. Cardiologia con UTIC ed Emodinamica, Presidio Ospedaliero Umberto I, Siracusa
| | | | - Federico De Marco
- Dipartimento di Cardiologia Clinica e Interventistica, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | - Massimo Fineschi
- U.O.S.A. Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena
| | - Alberto Menozzi
- S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia
| | - Carmine Musto
- Divisione di Cardiologia, Azienda Ospedaliera San Camillo, Roma
| | - Francesco Saia
- Alma Mater Studiorum, Università degli Studi di Bologna e IRCCS Policlinico Sant'Orsola, Bologna
| | - Giuseppe Tarantini
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli "Federico II", Napoli
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15
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Di Muro FM, Demola P, Nardi G, Ciardetti N, Meucci F, Stolcova M, Ristalli F, Di Mario C, Mattesini A. Optical coherence tomography and artificial intelligence for calcium quantification in coronary disease of diabetic patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. Coronary artery disease in diabetic patients is characterized by a greater burden of lipidic plaques and calcifications. Little is known on the quantitative and qualitative characteristics of calcific plaques in diabetics vs non diabetics. The recent application of Artificial Intelligence (AI) to optical coherence tomography (OCT) enables unique evaluation of coronary calcification.
Purpose
To compare qualitative and quantitative characteristics of coronary calcified plaques in diabetic and non-diabetic patients using AI-OCT.
Methods and material
We recruited 78 patients admitted for chronic coronary syndrome (CCS) or acute coronary syndrome (ACS) undergone intracoronary imaging with OCT between January 2019 to October 2021. Differences in plaques characteristics assessed by Artificial Intelligence applied at OCT runs were compared in DM and non-DM population using generalized estimating equations. To estimate the burden of calcification we classified the calcific lesions according to the Fujino score, an OCT based calcium scoring system.
Results
A total of 78 patients were included (54 non-DM lesions, 29 DM lesions). The culprit lesion was examined by OCT in all patients without any peri- or postprocedural complications. The population was homogeneous for cardiovascular risk factors even if we observed a higher prevalence of peripheral arterial disease (PAD) in the DM cohort (22.2% vs 2% p value 0.003). There were no statistical differences in previous PCI or CABG but we observed more multivessel PCI in the history of DM patients if compared with non-diabetic ones (33.3% vs 11.8% p value 0.021). The clinical presentation in DM groups was more often unstable angina (22.2% vs 0% p value <0.001) while STEMI, NSTEMI or CCS had the same prevalence in the two cohorts. At baseline angiography, patients with diabetes had more often multivessel disease (29.6% vs 17.6% p=0.014) with all the vessels equally involved. There were no qualitative differences in plaque morphology but using the Fujino score to estimate the calcium burden in the two population we found hardest calcific plaques expressed by higher Fujino score more frequently in DM patients compared to non-DM ones (50% vs 26.9%, p=0.04 of Fujino score 4).
Conclusion
DM has an impact on atherosclerotic process and plaque remodeling. Applying AI methods at OCT plaque analysis, we can extract important and standardized information on calcium burden in diabetic. This might help the interventional cardiologist in image interpretation, therapeutic strategy decision, improving workflow and clinical outcomes.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of Florence
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Affiliation(s)
- F M Di Muro
- Careggi University Hospital (AOUC) , Florence , Italy
| | - P Demola
- Careggi University Hospital (AOUC) , Florence , Italy
| | - G Nardi
- Careggi University Hospital (AOUC) , Florence , Italy
| | - N Ciardetti
- Careggi University Hospital (AOUC) , Florence , Italy
| | - F Meucci
- Careggi University Hospital (AOUC) , Florence , Italy
| | - M Stolcova
- Careggi University Hospital (AOUC) , Florence , Italy
| | - F Ristalli
- Careggi University Hospital (AOUC) , Florence , Italy
| | - C Di Mario
- Careggi University Hospital (AOUC) , Florence , Italy
| | - A Mattesini
- Careggi University Hospital (AOUC) , Florence , Italy
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16
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Ciardetti N, Di Muro FM, Kucukseymen S, Nardi G, Demola P, Mattesini A, Ristalli F, Stolcova M, Meucci F, Di Mario C. The role of calcification in cardiovascular outcome after left main bifurcation revascularization: a single centre experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Left main bifurcation (LMB) disease represents a high-risk subset of advanced coronary artery disease, often associated with severe calcification. Different stenting techniques have been evaluated to overcome challenges of the LMB anatomy, but the role of the calcific burden on cardiovascular (CV) outcome after LMB revascularization is unclear.
Purpose
We sought to evaluate the CV hospitalization predictors during follow-up of patients who underwent LMB revascularization (LMBR) in a high-volume center in Italy.
Methods
We performed a retrospective analysis of LMBR patients between 2018 and 2021. Patients were treated with different techniques in the acute or chronic settings and followed-up by telephone or outpatient visit. Coronary calcification (CC) was visually judged as absent, mild, moderate or severe. Predictors of CV hospitalizations were assessed.
Results
The median follow-up was 511 days. Among 129 patients who underwent LMBR during the study period, 32 (24.8%) were female, with a mean age of 72 (±10.6) years. 105 (81.4%) patients were hypertensive and 49 (38%) diabetics. The mean eGFR value was 66.3 (± 21.8) ml/min/m2. The majority of patients had three vessel disease (79, 61.3%), while only a small minority had one vessel disease (5, 3.9%). The mean SYNTAX score I was 27.1 (± 8.6), with most patients at intermediate risk (65, 50.4%) followed by patients at low (37, 28.7%) and high (27, 20.9%) risk. A provisional technique was used in most cases (79, 61.2%), followed by double-kissing crush (37, 28.7%) and T-stent/T-and-protrusion (13, 10.1%). Intravascular imaging was used in 84 (65.1%) cases. Most patients had no angiographic demonstration of CC (73, 57.9%), while when present, they were mild in 14 (11.1%), moderate in 29 (23%) and severe in 10 (7.9%) patients. Preparation of the CC was performed only with non-compliant (NC) balloons in mild CC (10, 71.4%) and with NC balloons (14, 48.3%) or intravascular lithotripsy (IVL) (13, 44.8%) in case of moderate CC. In the presence of severe CC, lesion preparation was carried out with IVL (4, 40%) or NC balloons (6, 60%). CC were associated with a more unfavorable outcome and, when present in a severe grade, resulted in a statistically significant risk of CV hospitalizations (HR 1.652; 95% CI 1.723–15.793; p=0.003) (Figure 1). After univariate and multivariate Cox regression analysis (Figure 2), only the presence of severe CC was associated with an increased risk of CV hospitalizations (HR 1.9; 95% CI 1.76–19.63; p=0.002), whereas aspirin therapy was a protective factor (HR −1.34; CI 0.07–0.86; p=0.02).
Conclusions
The presence of severe calcification is associated with a higher risk of CV hospitalizations, despite preparation of calcific lesions was always performed and intravascular imaging use was extensive. There were no differences in outcomes regardless to clinical presentation at admission, different stenting techniques and SYNTAX score I.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Ciardetti
- Careggi University Hospital (AOUC) , Florence , Italy
| | - F M Di Muro
- Careggi University Hospital (AOUC) , Florence , Italy
| | - S Kucukseymen
- Careggi University Hospital (AOUC) , Florence , Italy
| | - G Nardi
- Careggi University Hospital (AOUC) , Florence , Italy
| | - P Demola
- Careggi University Hospital (AOUC) , Florence , Italy
| | - A Mattesini
- Careggi University Hospital (AOUC) , Florence , Italy
| | - F Ristalli
- Careggi University Hospital (AOUC) , Florence , Italy
| | - M Stolcova
- Careggi University Hospital (AOUC) , Florence , Italy
| | - F Meucci
- Careggi University Hospital (AOUC) , Florence , Italy
| | - C Di Mario
- Careggi University Hospital (AOUC) , Florence , Italy
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17
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Ruggiero R, Barioli A, Demola P, D'Agosta G, Pompei G, Occhipinti G, Capodanno D, Masiero G. [Dual antiplatelet therapy (DAPT) after acute coronary syndrome: short DAPT versus de-escalation]. G Ital Cardiol (Rome) 2022; 23:25S-26S. [PMID: 35848915 DOI: 10.1714/3838.38225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Alberto Barioli
- Dipartimento Cardioneurovascolare, Ca' Foncello e San Giacomo Hospital Azienda No. 2, Marca Trevigiana, Treviso
| | | | - Guido D'Agosta
- Divisione di Cardiologia, Azienda Ospedaliero Universitaria "Policlinico Vittorio Emanuele", Università di Catania, Catania
| | - Graziella Pompei
- U.O. Cardiologia, Azienda Ospedaliera Universitaria di Ferrara, Cona (FE)
| | - Giovanni Occhipinti
- Divisione di Cardiologia, Azienda Ospedaliero Universitaria "Policlinico Vittorio Emanuele", Università di Catania, Catania
| | - Davide Capodanno
- Divisione di Cardiologia, Azienda Ospedaliero Universitaria "Policlinico Vittorio Emanuele", Università di Catania, Catania
| | - Giulia Masiero
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
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18
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Beneduce A, Demola P, Masiero G, Serino F, Polimeni A, Saia F, Menozzi A, Contarini M, Fineschi M, Musto C, De Marco F, Castiglioni B, Attisano T, Tarantini G, Esposito G. [Percutaneous transcatheter treatment of pulmonary embolism: results of the SICI-GISE national survey promoted by the GISE-Young Committee]. G Ital Cardiol (Rome) 2022; 23:5S-12S. [PMID: 35848912 DOI: 10.1714/3838.38222] [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: 01/02/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) represents the third leading acute cardiovascular syndrome in the world and it is burdened with high mortality and morbidity rates. Percutaneous or catheter-based treatments of high- and intermediate-risk patients have garnered interest because of the limitations of both systemic thrombolysis and anticoagulation strategies. However, data on these techniques are heterogeneous and limited to small non-randomized evidences. METHODS This survey was jointly performed by the GISE Young Committee with the support of the SICI-GISE Society and ICOT group with the aim of evaluating the view of the cardiology community on interventional therapies for PE. A web-based questionnaire based on 19 questions was distributed to SICI-GISE and ICOT members. RESULTS The survey was distributed to 1550 physicians with 220 (14%) responses, 65% from North Italy. Multidisciplinary diagnostic and therapeutic pathways for patients with PE were not available in most centers (56%), and transcatheter treatment was available in 55% of centers, most of them at low volume (<5 percutaneous treatments/year). Among the devices used, mechanical thrombectomy was the predominant one (62%) in the absence of significant differences in the availability of devices within the three Italian geographic macro-areas. Respondents recognize the theoretical benefits of percutaneous treatment of PE, including: improving a prompt hemodynamic stabilization and respiratory exchange (89%) in high-risk patients, avoiding hemodynamic deterioration (39%) and right ventricular dysfunction (51%) in intermediate-risk patients, and reducing hemorrhagic complications related to systemic thrombolysis (36%). According to participants' judgement, the main factors limiting the use of percutaneous transcatheter treatment of PE in clinical practice are the lack of specific operator training (60%), lack of solid clinical data to support it (39%), difficult patient selection (34%), high costs (30%), and risk of procedural complications (26%). CONCLUSIONS Currently, transcatheter treatment of PE appears to be widely supported but poorly used in clinical practice. Solid evidences are needed regarding the safety and efficacy profile of the different available devices, the identification of patient selection criteria, alongside the enhancement of the availability of techniques and technologies.
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Affiliation(s)
| | | | - Giulia Masiero
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Federica Serino
- Divisione di Cardiologia, A.O.R.N. Antonio Cardarelli, Napoli
| | - Alberto Polimeni
- Centro di Ricerche delle Malattie Cardiovascolari, Divisione di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro
| | - Francesco Saia
- Alma Mater Studiorum, Università degli Studi di Bologna and IRCCS Policlinico Sant'Orsola, Bologna
| | - Alberto Menozzi
- S.C. Cardiologia, Ospedale Sant'Andrea, ASL5 Liguria, La Spezia
| | - Marco Contarini
- U.O. Cardiologia con UTIC ed Emodinamica, P.O. Umberto I, Siracusa
| | - Massimo Fineschi
- U.O.S.A. Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena
| | - Carmine Musto
- Divisione di Cardiologia, Azienda Ospedaliera San Camillo Forlanini, Roma
| | - Federico De Marco
- Cardiologia Interventistica, IRCCS Policlinico San Donato, San Donato Milanese (MI)
| | | | - Tiziana Attisano
- Dipartimento di Cardiologia Interventistica, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno
| | - Giuseppe Tarantini
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | - Giovanni Esposito
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli
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Mattesini A, Demola P, Shlofmitz R, Shlofmitz E, Waksman R, Jaffer FA, Di Mario C. Optical Coherence Tomography, Near‐Infrared Spectroscopy, and Near‐Infrared Fluorescence Molecular Imaging. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Demola P, Bosi D, Musto D‘Amore S, Tarantini L, De Francesco V, Romagnoli F, Colaioiri I, Pignatelli G, Navazio A, Guiducci V. C82 PROCEDURES AND DEVICES FOR CALCIUM TREATMENT IN AN INCREASINGLY COMMON SCENARIO: YOUNG ONCOLOGIC PATIENTS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Cardiovascular disease and cancer have a high prevalence in Western countries, sharing many risk factors: obesity, diabetes, cigarette smoking, advanced age, diet and sedentary lifestyle. There is growing evidence that patients with ischemic heart disease (CAD) have a higher risk of developing cancer and, conversely, patients with a history of cancer are exposed to a higher incidence of CAD. In particular, cancer and its related therapies may promote the process of atherosclerosis, often with high calcific burden.
Case Report
This is a case of a 58 years old gentleman with a past smoking habit. Unfortunately from 2019 he was diagnosed by a stage IV lung adenocarcinoma, actually in 3rd line therapy: Carboplatin–Alimta, Atezolizumab and Paclitaxel weekly; no metastatic localizations was found at follow up CT scan. Last July, the patient complained of breath fatigue during exertion. At a complete cardiologic examination EKG was normal, and severe aortic stenosis was detected with concentric left ventricular hypertrophy, preserved ejection fraction. At CT scan, the aortic valve was confirmed as bicuspid Sievers type 0 (Figure 1, panel A). Vmax was 5.49 cm/s, max gradient was up to 120 mmHg, and medium gradient was 67 mmHg, as shown in Figure 1, panel B. Coronary angiography showed a very severe, focal, concentric calcific lesion of the left anterior descendant branch (Figure 2, Panel A). The patient was then referred to our local Heart Team and due to his oncological condition with prognosis >12 months, we decided to treat him percoutaneously. Aortic stenosis was treated Transcatheter Aortic Valve Implantation (TAVI) a few days later: predilatation, implant of a with a balloon–expandable valve Edwards Sapien 3 n°23 and post–dilatation, by femoral access (Figure 2, four steps of TAVI). Coronary lesion was uncrossable with the lowest profile balloons, so rotatripsy was perfomed: rotational atherectomy followed by 40 pulses of lithotripsy with Shockwave (Figure 2, Panel B and C). Everolimus eluting stent 3.00 x 23 mm was implanted and optimized (Figure 2, Panel D). Conclusion Recent devices and techniques in Invasive Cardiology allow percutaneous therapies for patients with time–dependent diseases, such as patients with advanced lung adenocarcinoma. Lately, oncological therapies for this type of lung cancer are very promising, allowing the combination of interventional procedures capable of further increasing the prognosis of these patients.
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Affiliation(s)
- P Demola
- ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA
| | - D Bosi
- ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA
| | | | - L Tarantini
- ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA
| | | | - F Romagnoli
- ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA
| | - I Colaioiri
- ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA
| | | | - A Navazio
- ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA
| | - V Guiducci
- ARCISPEDALE SANTA MARIA NUOVA, REGGIO EMILIA
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21
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Mattesini A, Demola P, Parikh SA, Secco GG, Pighi M, Di Mario C. Material Selection. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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22
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Nardi G, De Backer O, Saia F, Sondergaard L, Ristalli F, Meucci F, Stolcova M, Mattesini A, Demola P, Wang X, Al Jabri A, Palmerini T, Bruno AG, Ielasi A, Van Belle E, Berti S, Di Mario C. Peripheral intravascular lithotripsy for transcatheter aortic valve implantation: a multicentre observational study. EUROINTERVENTION 2022; 17:e1397-e1406. [PMID: 34734559 PMCID: PMC9896402 DOI: 10.4244/eij-d-21-00581] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve implantation (TAVI) by the transfemoral (TF) approach. Intravascular lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium and increases vessel compliance allowing TF TAVI in selected patients with peripheral artery disease (PAD). AIMS The aim of this study was to report on the safety and efficacy of IVL-assisted TF TAVI in an all-comers population. METHODS Clinical, imaging and procedural data on all consecutive patients treated by IVL-assisted TF TAVI in six high-volume European centres (2018-2020) were collected in this prospective, real-world, multicentre registry. RESULTS IVL-assisted TF TAVI was performed in 108 patients, increasing from 2.4% to 6.5% of all TAVI from 2018 to 2020, respectively. The target lesion was most often localised at the common and/or external iliac artery (93.5% of cases; average TL-MLD 4.6±0.9 mm with 318 degrees of calcium arc). Transfemoral aortic valve delivery was successful in 100% of cases; final procedural success in 98.2% (two conversions to cardiac open surgery for annular rupture and valve migration). Complications of the IVL-treated segments consisted of 1 perforation and 3 major dissections requiring stent implantation (2 covered stents and 2 BMS). Access-site-related complications included 3 major bleedings. Three in-hospital deaths were recorded (2.8%, 1 failed surgical conversion after annular rupture, 1 cardiac arrest after initial valvuloplasty, 1 late hyperkalaemia in renal dysfunction). CONCLUSIONS IVL-assisted TF TAVI proved to be a safe and effective approach, which helps to expand the indications for TF TAVI in patients with severe calcific PAD. However, these patients continue to have a higher-than-average incidence of periprocedural complications.
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Affiliation(s)
- Giulia Nardi
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Francesco Saia
- Interventional Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Francesca Ristalli
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Pierluigi Demola
- Structural Interventional Cardiology, Department of Clinical & Experimental Medicine, University Hospital Careggi, Florence, Italy
| | - Xi Wang
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Tullio Palmerini
- Interventional Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Antonio Giulio Bruno
- Interventional Cardiology Unit, Cardio-Thoracic Vascular Department, University Hospital of Bologna, Policlinico Sant’Orsola-Malpighi, Bologna, Italy
| | - Alfonso Ielasi
- Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Cardiology, Institut Cœur Poumon, CHU de Lille, Université Lille, Lille, France
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23
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Fumagalli C, Nardi G, Demola P, Meucci F, Valenti R, Scheggi V, Carrabba N, Mario CD, Baldasseroni S, Ungar A, Marchionni N. 775 Impact of frailty on medium-term follow-up in patients undergoing transcatheter aortic valve implantation in a high flow referral centre with high volumes. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Transcatheter strategies to treat aortic stenosis (AS) are an established therapeutic option in older patients not candidate for open heart surgery. Guidelines recommend the adoption of surgical scores like the Society of Thoracic Surgeons (STS) as tools for risk stratification. However, these scores may have limited predictive value in older patients. To assess the impact of frailty status on a composite endpoint comprising all-cause death and cardiovascular (CV) events in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care centre.
Methods and results
Consecutive patients >80 years referred to TAVI from January to December 2019 at our institution were screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the multidimensional prognostic index (MPI). Physical function was evaluated by the short physical performance battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB <6 is an established strong predictor of mortality and disability. The MPI is a three-level score used to stratify risk of mortality (low, intermediate, or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility and risk of pressure sores, multimorbidity, polypharmacy, and co-habitation). Data on mortality and CV events at 6 and 12 months were retrieved via administrative records and/or telephone follow-up. Overall, 134 patients were referred for TAVI (mean age: 84 ± 4 years; >90 years: 12%, women 67%). The STS risk score was 4.6 ± 3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3 ± 3.7 (SPPB <6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group. SPPB and MPI scores were moderately correlated with STS (Spearman correlation coefficient: SPPB R = 0.31, P = 0.01, MPI R = 0.29, P = 0.03, Figure 1A and B). At 1 year, 3 (2.2%) patients died, and 11 (8.2%) were hospitalized for CV events: major bleeding, N = 6(4.5%); stroke: N = 4 (3.0%); re-do: N = 1 (0.7%). The probability of the composite endpoint was higher for patients at intermediate/high MPI risk (HR intermediate/high risk vs. low risk: HR: 2.9, 95% CI: 1.1–6.8, P = 0.031, Figure 1C), while no association with STS (P = 0.332) was found.
Conclusions
In a prospective cohort of TAVI candidates, frailty stratified short- and medium-term prognosis. The integrated frailty assessment could be a useful tool for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure. 120 Figure
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24
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Nardi G, Backer OD, Saia F, Sondergaard L, Ristalli F, Meucci F, Stolcova M, Mattesini A, Demola P, Wang CX, Jabri AA, Bruno AG, Palmierini T, Ielasi A, Belle EV, Berti S, Mario CD. 680 Peripheral intravascular lithotripsy of ILEO-femoral arteries to facilitate transfemoral TAVI: a multicentric prospective registry. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Aims
The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve implantation (TAVI) by transfemoral (TF) approach. Intravascular lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium and increases vessel compliance allowing TF-TAVI in selected patients with peripheral artery disease (PAD). To report on the safety and efficacy of IVL-assisted TF-TAVI in an all-comers population.
Methods and results
Clinical, imaging and procedural data on all consecutive patients treated by IVL-assisted TF-TAVI in six high-volume European centres (2018–2020) were collected in this prospective, real-world, multicentre registry. IVL-assisted TF-TAVI was performed in 108 patients, increasing from 2.4% to 6.5% of all TAVI in 2018 to 2020, respectively. The target lesion was most often localized at the common and/or external iliac artery (93.5% of cases; average TL-MLD 4.6 ± 0.9 mm with 318 degrees of calcium arc). Transfemoral aortic valve delivery was successful in 100% of cases; final procedural success in 98.2% (two conversion to cardiac open surgery for annular rupture and valve migration). Complications of the IVL-treated segments consisted of one perforation and three major dissections requiring stent implantation (two covered stents and two BMS). Access site related complication included three major bleedings. Three in-hospital deaths were recorded (2.8%, one failed surgical conversion after annular rupture, one cardiac arrest after initial valvuloplasty, one late hyperkalaemia in renal dysfunction).
Conclusions
IVL-assisted TF-TAVI proved to be a safe and effective approach, which helps expanding the indications for TF-TAVI in patients with severe calcific PAD. Still, these patients maintain a higher than average incidence of peri-procedural complication.
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Affiliation(s)
- Giulia Nardi
- AOUC Interventistica Cardiologica Strutturale, Careggi, Firenze, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Francesco Saia
- Interventional Cardiology Unit, Policlinico S.Orsola Malpighi, Bologna, Italy
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | | | - Francesco Meucci
- AOUC Interventistica Cardiologica Strutturale, Careggi, Firenze, Italy
| | | | - Alessio Mattesini
- AOUC Interventistica Cardiologica Strutturale, Careggi, Firenze, Italy
| | - Pierluigi Demola
- AOUC Interventistica Cardiologica Strutturale, Careggi, Firenze, Italy
| | - Christina Xi Wang
- Department of Cardiology West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Tullio Palmierini
- Interventional Cardiology Unit, Policlinico S.Orsola Malpighi, Bologna, Italy
| | - Alfonso Ielasi
- Istituto Clinico Sant’Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Eric Van Belle
- Institut Coeur Poumon, Chu de Lille, Universite’ Lille, France
| | | | - Carlo Di Mario
- AOUC Interventistica Cardiologica Strutturale, Careggi, Firenze, Italy
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Monello A, Moderato L, Lazzeroni D, Benatti G, Demola P, Binno S, Vermi AC, Valenti G, Losi L, Rusticali G, Piepoli MF. [Acute coronary syndrome after insect bites: a systematic review of available literature]. G Ital Cardiol (Rome) 2021; 22:944-949. [PMID: 34709235 DOI: 10.1714/3689.36754] [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: 06/13/2023]
Abstract
BACKGROUND Kounis syndrome is a hypersensitivity coronary disorder induced by exposure to several triggers; the most common are antibiotics, followed by insect bites. METHODS We reviewed the literature and identified 66 patients who experienced acute coronary syndrome after insect bites. RESULTS The median age was 51 years, and 19.0% were women and only 12% had a history of allergy. The most involved insects were bee and wasp (86%) and the most frequent clinical manifestations were chest pain and anaphylaxis (36% and 29%, respectively). ST-segment elevation was the most common electrocardiographic finding (>70%). There was a not negligible rate of complications (15%), with a possible increased arrhythmic burden in patients without significant coronary atherosclerosis. CONCLUSIONS Acute coronary syndrome after insect bites is not so rare and it could have serious complications, with a possible increased arrhythmic burden in patients without significant coronary atherosclerosis.
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Affiliation(s)
- Alberto Monello
- U.O. Cardiologia, Ospedale "Guglielmo da Saliceto", Piacenza
| | - Luca Moderato
- U.O. Cardiologia, Ospedale "Guglielmo da Saliceto", Piacenza
- U.O. Cardiologia, Azienda Ospedaliera Universitaria di Parma
| | | | - Giorgio Benatti
- U.O. Cardiologia, Azienda Ospedaliera Universitaria di Parma
| | - Pierluigi Demola
- Interventistica Cardiologica Strutturale, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Simone Binno
- U.O. Cardiologia, Ospedale "Guglielmo da Saliceto", Piacenza
| | - Anna Chiara Vermi
- U.O. Cardiologia e Riabilitazione Cardiologica, Ospedale Civile di Castel San Giovanni (PC)
| | | | - Luciano Losi
- U.O. Cardiologia, Ospedale "Guglielmo da Saliceto", Piacenza
| | - Guido Rusticali
- U.O. Cardiologia, Ospedale "Guglielmo da Saliceto", Piacenza
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26
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Fumagalli C, Blandina A, Nardi G, Campicelli S, Bandini G, Marchetti F, Demola P, Meucci F, Scheggi V, Baldasseroni S, Carrabba N, Di Mario C, Ungar A, Marchionni N. Impact of frailty status on medium-term follow up in patients undergoing percutaneous transcatheter aortic valve implantation in a high-flow referral center with high procedural volumes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcatheter strategies to treat aortic stenosis (AS) are an established therapeutic option in older patients not candidate for open heart surgery. Current guidelines recommend the adoption of surgical scores like the Society of Thoracic Surgeons (STS) as tools for risk stratification. However, these scores may have limited predictive value in older patients.
Purpose
To assess the impact of frailty status on a composite endpoint comprising mortality and cardiovascular (CV) events in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care center.
Methods
Consecutive patients >80 years referred to TAVI from January to December 2019 at our tertiary care institution were prospectively screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the Multidimensional Prognostic Index (MPI). Physical function was evaluated by the Short Physical Performance Battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB <6 is an established strong predictor of mortality and disability.
The MPI is a three-level score used to stratify risk of mortality (low, intermediate or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility and risk of pressure sores, multimorbidity, polypharmacy and co-habitation).
Data on mortality and CV events at 6 and 12 months were retrieved via administrative records and/or telephone follow-up.
Results
Overall, 134 patients were referred for TAVI (mean age: 84±4 years; >90 years: 12%, women 67%). The average STS risk score was 4.6±3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3±3.7 (SPPB <6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group. SPPB and MPI scores were moderately correlated with STS (Spearman correlation coefficient: SPPB R=0.31, p=0.01, MPI R=0.29, p=0.03, Figure Panel A and B).
At 12 months, 3 (2.2%) patients died, and 11 (8.2%) were hospitalized for CV events: major bleeding, N=6 (4.5%); stroke: N=4 (3.0%); re-do: N=1 (0.7%). The probability of the composite endpoint was higher for patients at intermediate/high MPI risk (HR intermediate/high risk vs low risk: HR 2.9, 95% CI 1.1–6.8, p=0.031, Figure 1 Panel C), while no association with STS (p=0.332) was found.
Conclusions
In a prospectively enrolled cohort of TAVI candidates, frailty indices stratified short- and medium-term prognosis. The integrated frailty assessment could be a useful tool for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- C Fumagalli
- Careggi University Hospital (AOUC), Cardiomyopathies Unit, Florence, Italy
| | - A Blandina
- Careggi University Hospital, Florence, Italy
| | - G Nardi
- Careggi University Hospital, Florence, Italy
| | | | - G Bandini
- Careggi University Hospital, Florence, Italy
| | - F Marchetti
- Careggi University Hospital, Florence, Italy
| | - P Demola
- Careggi University Hospital, Florence, Italy
| | - F Meucci
- Careggi University Hospital, Florence, Italy
| | - V Scheggi
- Careggi University Hospital, Florence, Italy
| | | | - N Carrabba
- Careggi University Hospital, Florence, Italy
| | - C Di Mario
- Careggi University Hospital, Florence, Italy
| | - A Ungar
- Careggi University Hospital, Florence, Italy
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27
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Ciatti F, Stolcova M, Romano CD, Mattesini A, Ristalli F, Demola P, Meucci F, Di Mario C. Predictive factors of Permanent Pacemaker Implantation following Transcatheter Aortic Valve Replacement: membranous septum length and implantation depth evaluated with preoperative computed tomography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
In the last decades, transcatheter aortic valve replacement (TAVR) revolutionized the treatment of symptomatic severe aortic stenosis. Cardiac conduction disturbances (CD) and the need for permanent pacemaker implantation (PPMI) remain the most frequent drawback of TAVR.The efficacy and safety of TAVR is proven not only in inoperable and high-risk patients, but TAVR use is increasing rapidly among intermediate- and low-risk populations, including progressively younger patients. In these prospective the risk of new-onset CD becomes increasingly important in clinical management. Several pre-procedural nonmodifiable factors (e.g., right bundle branch block [RBBB]) and modifiable factors (such as valve type and implantation depth) have been associated with conduction disturbances post-TAVR.
Purpose
The His bundle passes through the membranous septum (MS) and it is therefore not surprising that deeper valve implantation increases the likelihood of mechanical damage of the His bundle, leading to a transient or persistent CD. To date, it remains uncertain whether the association between valve type and CD relates primarily to a valve class effect or it is mainly secondary to differences in valve positioning accuracy and implantation depth between valve types. The aim of this study is to evaluate the length of the membranous septum (MS) and the implant depth (ID) in relation to the risk of permanent pacemaker (PPM) with both balloon-expandable (BE) and self-expanding (SE) transcatheter heart valves.
Methods
Of the 104 patients in the study, 79 patients underwent TAVIs with BE (44) and SE valves (35). Using preoperative computed tomography (CT) and angiography, MS length and implantation depth (ID) were retrospectively assessed. 14 patients were excluded for the presence of pre-TAVI PPM, 3 for the presence of congenital bicuspid aortic valve, 8 due to the presence of non-evaluable CT angiography.
Results
In the study population, out of the total of 79 patients, PPMs were implanted in 8 patients (10.12%), of which 7 in 35 (20%) patients undergoing TAVI with SE and 1 in 44 (2.27%) with BE valves. The measurements of MS was 4±2.1 mm for BE vs 3.3±2 mm for SE valves (p=0.141) and ID was 4.9±1.7 mm for BE vs 5.9±3.2 mm for SE valves (p=0.046). At multivariate logistic regression, two significant variables related to the post-TAVI PPMI were identified: MS (p=0.029) and ID (p=0.009), moreover the MS / ID ratio represents an additional predictor for PPMI regardless of the type of valve used (p=0.002).
Conclusion(s)
The study confirms the importance of the pre-TAVI MS length measurement for both types of valves. The only modifiable factor is the implantation technique which, knowing the PPMI's preoperative risk must be modified according to the patient's septum. Therefore it will be possible to modify the valve ID according to the patient's septum, looking for higher implants in higher-risk cases, particularly with self-expanding valves.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): No fundings
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Affiliation(s)
- F Ciatti
- Careggi University Hospital (AOUC), Florence, Italy
| | - M Stolcova
- Careggi University Hospital (AOUC), Florence, Italy
| | - C D Romano
- Careggi University Hospital (AOUC), Florence, Italy
| | - A Mattesini
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Ristalli
- Careggi University Hospital (AOUC), Florence, Italy
| | - P Demola
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Meucci
- Careggi University Hospital (AOUC), Florence, Italy
| | - C Di Mario
- Careggi University Hospital (AOUC), Florence, Italy
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Muraca I, Pennesi M, Mattesini A, Migliorini A, Carrabba N, Virgili G, Bruscoli F, Demola P, Colombi R, Pontecorboli G, Marchionni N, Di Mario C, Valenti R. Comparison of myocardial reperfusion between intracoronary versus intravenous cangrelor administration in patients undergoing primary percutaneous coronary intervention. Cardiol J 2021; 30:587-594. [PMID: 34581427 PMCID: PMC10508075 DOI: 10.5603/cj.a2021.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Myocardial reperfusion is the main target of treatment in patients with ST-segment elevation myocardial infarction (STEMI). The intracoronary administration of cangrelor bolus could favor a higher local drug concentration, favoring an earlier thrombotic resolution and a reduced distal micro-embolization. METHODS Seventy-one patients undergoing primary percutaneous coronary intervention (PCI) for STEMI: 37 treated with intracoronary and 34 with intravenous bolus administration of cangrelor. The primary endpoint was ST-segment elevation resolution (STR) ≥ 50% after 30 min from the end of the PCI. Other explorative reperfusion indices investigated were: STR ≥ 50% at 24 hours, STR ≥ 70% at 30 min, Thrombolysis In Myocardial Infarction frame count and the QT dispersion. Moreover, acute and subacute stent thrombosis, bleeding events and 30-day mortality have been evaluated. RESULTS More frequent STR ≥ 50% was observed in the intravenous cangrelor bolus group as compared to the intracoronary administration at 30 min (71.9% vs. 45.5%; p = 0.033), the difference was maintained 24 hours after PCI (87.1% vs. 63.6%; p = 0.030). STR ≥ 70% at 30 min was statistically more frequent in the intravenous bolus administration cohort (66.7% vs. 28.6% p = 0.02). At multivariable analysis, intravenous cangrelor administration was significantly related to STR ≥ 50% (odds ratio: 3.586; 95% confidence interval: 1.134-11.335; p = 0.030). The incidence of Bleeding Academic Research Consortium 3-5 bleedings was 15.5% and mortality was 4.2% without any significant difference between the two groups. CONCLUSIONS In conclusion the results of the study do not show any advantages in the administration of intracoronary bolus of cangrelor in patients affected by STEMI and treated with primary PCI.
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Affiliation(s)
- Iacopo Muraca
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Matteo Pennesi
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Alessio Mattesini
- Structural Intervention Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Angela Migliorini
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Nazario Carrabba
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Giacomo Virgili
- Department of Clinical and Experimental Medicine, Car eggi University Hospital, Florence, Italy
| | - Filippo Bruscoli
- Department of Clinical and Experimental Medicine, Car eggi University Hospital, Florence, Italy
| | - Pierluigi Demola
- Structural Intervention Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Riccardo Colombi
- Department of Clinical and Experimental Medicine, Car eggi University Hospital, Florence, Italy
| | - Giulia Pontecorboli
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- Department of Clinical and Experimental Medicine, Car eggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Intervention Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy
| | - Renato Valenti
- Interventional Cardiology Unit, Cardiovascular Department, Careggi University Hospital, Florence, Italy.
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Demola P, Di Mario C, Torguson R, Ten Cate T, Bambagioni G, Ali Z, Skinner W, Artis A, Zhang C, Garcia-Garcia HM, Doros G, Mintz GS, Waksman R. Greater plaque burden and cholesterol content may explain an increased incidence of non-culprit events in diabetic patients: a Lipid-Rich Plaque substudy. Eur Heart J Cardiovasc Imaging 2021; 23:1098-1107. [PMID: 34568945 DOI: 10.1093/ehjci/jeab161] [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: 04/12/2021] [Accepted: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. The multicentre, prospective Lipid-Rich Plaque trial (LRP) examined non-culprit (NC) non-obstructive coronary segments with a combined near-infrared spectroscopy (NIRS)-intravascular ultrasound (IVUS) catheter. This study assessed the differences in NC plaque characteristics and their influence on major adverse cardiac events (MACE) in diabetic and non-diabetic patients. METHODS AND RESULTS Patients with known DM status were divided into no diabetes, diabetes not treated with insulin (non-ITDM), and insulin-treated diabetes (ITDM). The association between presence and type of DM and NC-MACE was assessed at both the patient and coronary segment levels by Cox proportional regression modelling. Out of 1552 patients enrolled, 1266 who had their diabetes status recorded were followed through 24 months. Female sex, hypertension, chronic kidney disease, peripheral vascular disease, and high body mass index were significantly more frequent in diabetic patients. The ITDM group had more diseased vessels, at least one NC segment with a maxLCBI4 mm ≥400 in 46.2% of patients, and maxLCBI4 mm ≥400 in nearly one out of six Ware segments (15.2%, 125/824 segments). The average maxLCBI4 mm significantly increased from non-diabetic patients (NoDM) to non-insulin-treated diabetic patients (non-ITDM) to insulin-treated diabetic patients (ITDM; 137.7 ± 161.9, 154.8 ± 173.6, 182.9 ± 193.2, P < 0.001, respectively). In patients assigned to follow-up (692 ± 129 days), ITDM doubled the incidence of NC-MACE compared with the absence of diabetes (15.7% vs. 6.9%, P = 0.0008). The presence of maxLCBI4 mm>400 further increased the NC-MACE rate to 21.6% (Kaplan-Meier estimate). CONCLUSION Cholesterol-rich NC plaques detected by NIRS-IVUS were significantly more frequent in diabetic patients, especially those who were insulin-treated, and were associated with an increased NC-MACE during follow-up.
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Affiliation(s)
- Pierluigi Demola
- Department of Clinical and Experimental Medicine, Structural Interventional Cardiology, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy
| | - Carlo Di Mario
- Department of Clinical and Experimental Medicine, Structural Interventional Cardiology, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy
| | - Rebecca Torguson
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tim Ten Cate
- Cardiology Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gabriele Bambagioni
- Department of Clinical and Experimental Medicine, Structural Interventional Cardiology, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy
| | - Ziad Ali
- St. Francis Hospital-The Heart Center, Roslyn, NY, USA
| | - William Skinner
- Cardiovascular Department, Central Baptist Hospital, Lexington, KY, USA
| | - Andre Artis
- Cardiovascular Department, Methodist Hospital, Merrillville, IN, USA
| | - Cheng Zhang
- Cardiovascular Department, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Gary S Mintz
- Cardiovascular Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Cardiovascular Department, MedStar Washington Hospital Center, Washington, DC, USA
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Bambagioni G, Di Mario C, Torguson R, Demola P, Ali Z, Singh V, Skinner W, Artis A, Cate TT, Zhang C, Garcia-Garcia HM, Doros G, Mintz GS, Waksman R. Lipid-rich plaques detected by near-infrared spectroscopy predict coronary events irrespective of age: A Lipid Rich Plaque sub-study. Atherosclerosis 2021; 334:17-22. [PMID: 34455112 DOI: 10.1016/j.atherosclerosis.2021.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/27/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS In this Lipid Rich Plaque (LRP) sub-study, 1551 patients undergoing coronary angiography for acute coronary syndromes or stable angina were examined with near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS). We aimed to assess the correlation of patient age with the presence of high-risk plaques, defined as maximum 4-mm Lipid Core Burden Index (maxLCBI4mm) >400 and plaque burden >70%, and 2-year incidence of non-culprit major adverse cardiovascular events (NC-MACE). METHODS The study population was divided into four groups according to age: <50 years (122), 50-64 years (700), 65-74 years (502), and ≥75 years (227). The primary outcome was NC-MACE from index procedure to event or the end of the study. Cox regression and mixed-effects Cox regression models were used to assess the effect of age on the association between LCBI and NC-MACE at the patient and plaque levels. RESULTS Average maxLCBI4mm and percentage of patients with at least one segment with maxLCBI4mm > 400 were similar across the four age groups at both the patient and coronary segment levels. Having at least one segment with maxLCBI4mm > 400 was strongly associated with NC-MACE, and that association did not differ significantly across age subgroups. Although less common (prevalence of 0.8%-1.3%), a similar trend toward greater NC-MACE rates was seen in patients with plaque burden >70% at the maximum LCBI site across age subgroups. CONCLUSIONS Lipid-rich plaques were as frequent in older as in younger patients and predicted a higher incidence of NC-MACE over 2-year follow-up irrespective of age.
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Affiliation(s)
- Gabriele Bambagioni
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy.
| | - Rebecca Torguson
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierluigi Demola
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Ziad Ali
- St Francis Hospital & Heart Center, Roslyn, NY, USA; Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | - Tim Ten Cate
- Radboud University Medical Center, Nijmegen, Netherlands
| | - Cheng Zhang
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | - Gary S Mintz
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington, DC, USA
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31
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Di Mario C, Ciardetti N, Demola P. Second Generation: Better Also for Covered Stents? Cardiovasc Revasc Med 2021; 29:29-31. [PMID: 34420692 DOI: 10.1016/j.carrev.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy.
| | - Niccolò Ciardetti
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
| | - Pierluigi Demola
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
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32
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Demola P, Mattesini A. Optical coherence tomography guidance: when one size does not fit all. Eur Heart J Cardiovasc Imaging 2021; 22:760-764. [PMID: 33409532 DOI: 10.1093/ehjci/jeaa319] [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)
- Pierluigi Demola
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Careggi University Hospital, Largo Brambilla n. 3, Florence 50134, Italy
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33
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Ciardetti N, Ciatti F, Nardi G, Di Muro FM, Demola P, Sottili E, Stolcova M, Ristalli F, Mattesini A, Meucci F, Di Mario C. Advancements in Transcatheter Aortic Valve Implantation: A Focused Update. Medicina (Kaunas) 2021; 57:711. [PMID: 34356992 PMCID: PMC8306774 DOI: 10.3390/medicina57070711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 01/07/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65-75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Room 124, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy; (N.C.); (F.C.); (G.N.); (F.M.D.M.); (P.D.); (E.S.); (M.S.); (F.R.); (A.M.); (F.M.)
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34
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Demola P, Di Mario C, Turguson R, Bambagioni G, ten Cate T, Ali Z, Singh V, Artis A, Skinner W, Garcia-Garcia H, Mintz GS, Doros G, Waksman R. Greater Plaque Volume and Cholesterol Content Explain an Increased Incidence of Non-Culprit Events in Diabetic Patients: A Lipid Rich Plaque Substudy. Cardiovascular Revascularization Medicine 2021. [DOI: 10.1016/j.carrev.2021.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
A longtime aspiration of interventional cardiologists remains to improve the long-term impact of stent permanence in coronaries to restore original vessel patency and physiological endothelium response. Bioresorbable vascular scaffolds were considered revolutionary in coronary devices, but several trials were disappointing; thus, the challenge in this field remains. DESolve is a novolimus-eluting poly-L lactide-based polymer scaffold that dissolves through a bio-reabsorption mechanism, vanishing completely in 2 years. Its ability to supply the necessary radial strength to support the vessel for the critical early months after delivery is an important feature showing a unique self-correction property, which reduces incomplete stent apposition. Overexpansion has a good, safe margin with DESolve. This review aims to provide an overview of this controversial topic.
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Affiliation(s)
- Pierluigi Demola
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
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36
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Stolcova M, Ciatti F, Cardaioli F, Demola P, Nai Fovino L, Fabris T, Mattesini A, Matsuda Y, Ristalli F, Di Mario C, Tarantini G, Meucci F, Fraccaro C. [Prosthesis embolization during transcatheter aortic valve implantation]. G Ital Cardiol (Rome) 2020; 21:35S-44S. [PMID: 33295333 DOI: 10.1714/3487.34671] [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
Transcatheter aortic valve implantation (TAVI) has been a revolution in the treatment of severe aortic stenosis evolving to a high procedural success rate and low rate of complications. Embolization of the percutaneous device is a rare but potentially life-threatening complication. The spectrum of clinical manifestations ranges between incidental finding on cardiac imaging to cardiogenic shock or cardiac arrest. Data about predictors and management of transcatheter heart valve embolization are scarce and mostly anecdotical. Management strategies are related to the type, the size, the location of the embolized device, the timing of diagnosis, and the clinical presentation of the patient. According to recent data from TRAVEL registry, device embolization and migration occur in approximately 1% of the patients and is responsible for increased morbidity and mortality. However, in a considerable proportion of cases it could have been prevented, hence structural interventionalists should plan the procedures carefully and know thoroughly the risk factors for device embolization. Increased awareness of predisposing factors, preventive measures, and appropriate bail-out options and techniques are strongly advisable. This paper is a review of the incidence, and outcomes of percutaneous prosthesis embolization during TAVI. It also suggests an integrated algorithmic approach for the management of device embolization incorporating both percutaneous and surgical techniques.
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Affiliation(s)
- Miroslava Stolcova
- Interventistica Cardiologica Strutturale, Dipartimento Cardio-Toraco-Vascolare, AOU Careggi, Firenze
| | - Francesca Ciatti
- Interventistica Cardiologica Strutturale, Dipartimento Cardio-Toraco-Vascolare, AOU Careggi, Firenze
| | - Francesco Cardaioli
- Emodinamica e Cardiologia Interventistica, Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, AOU Padova, Padova
| | - Pierluigi Demola
- Dipartimento di Medicina e Chirurgia, Università degli Studi, Parma - Interventistica Cardiologica Strutturale, Dipartimento Cardio-Toraco-Vascolare, AOU Careggi, Firenze
| | - Luca Nai Fovino
- Emodinamica e Cardiologia Interventistica, Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, AOU Padova, Padova
| | - Tomaso Fabris
- Emodinamica e Cardiologia Interventistica, Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, AOU Padova, Padova
| | - Alessio Mattesini
- Interventistica Cardiologica Strutturale, Dipartimento Cardio-Toraco-Vascolare, AOU Careggi, Firenze
| | - Yuji Matsuda
- Emodinamica e Cardiologia Interventistica, Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, AOU Padova, Padova
| | - Francesca Ristalli
- Interventistica Cardiologica Strutturale, Dipartimento Cardio-Toraco-Vascolare, AOU Careggi, Firenze
| | - Carlo Di Mario
- Interventistica Cardiologica Strutturale, Dipartimento Cardio-Toraco-Vascolare, AOU Careggi, Firenze
| | - Giuseppe Tarantini
- Emodinamica e Cardiologia Interventistica, Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, AOU Padova, Padova
| | - Francesco Meucci
- Interventistica Cardiologica Strutturale, Dipartimento Cardio-Toraco-Vascolare, AOU Careggi, Firenze
| | - Chiara Fraccaro
- Emodinamica e Cardiologia Interventistica, Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, AOU Padova, Padova
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37
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Di Mario C, Demola P. Morphology and physiology together: Is optical coherence tomography the one-stop-shop of invasive cardiology? Cardiol J 2020; 27:345-346. [PMID: 32929703 DOI: 10.5603/cj.2020.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy.
| | - Pierluigi Demola
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
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Miragoli M, Goldoni M, Demola P, Paterlini A, Li Calzi M, Gioia MI, Visioli F, Rossi S, Pelà G. Left ventricular geometry correlates with early repolarization pattern in adolescent athletes. Scand J Med Sci Sports 2019; 29:1727-1735. [DOI: 10.1111/sms.13518] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Michele Miragoli
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Matteo Goldoni
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Pierluigi Demola
- Department of Medicine and Surgery University of Parma Parma Italy
- University Hospital of Parma Parma Italy
| | | | - Mauro Li Calzi
- Department of Medicine and Surgery University of Parma Parma Italy
| | | | - Francesco Visioli
- Department of Molecular Medicine University of Padova Parma Italy
- IMDEA‐Food Madrid Spain
| | - Stefano Rossi
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery University of Parma Parma Italy
- University Hospital of Parma Parma Italy
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Demola P, Crocamo A, Ceriello L, Botti A, Cremonini I, Pattoneri P, Corradi D, Visioli F, Goldoni M, Pelà G. Hemodynamic and ECG responses to stress test in early adolescent athletes explain ethnicity-related cardiac differences. Int J Cardiol 2019; 289:125-130. [PMID: 31072636 DOI: 10.1016/j.ijcard.2019.04.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/14/2019] [Revised: 04/10/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ethnicity is an important determinant of athletes' cardiovascular adaptation. Black adolescent and adult athletes exhibit a left ventricular (LV) hypertrophy with a concentric remodelling higher than their Caucasian counterparts. Scant data, however, are available on race-related differences in hemodynamic response of adolescent athletes to exercise and its relation with heart remodelling. We evaluated if race-specific, sport-related structural and electrical remodelling in adolescent athletes of Caucasian and African ethnicity exclusively depends on race itself rather than on different cardiovascular responses to physical exercise. METHODS We examined 90 adolescent athletes, 60 Caucasian (WA) and 30 Black (BA). All participants underwent thorough clinical, echocardiographic and stress test evaluations. RESULTS BA had greater indexed LV mass (LVM/BSA) with increased relative wall thickness (RWT) implying a concentric remodelling. BA showed higher systolic blood pressure (SBP) compared to WA during the whole exercise test. ECG data showed that BA vs WA had a significant shorter QRS duration in each step considered with a significant greater QT dispersion. BA reached a higher relative pressure peak as compared to WA. RWT was strongly influenced by ethnicity and less by SBP at peak of exercise (PE), although LVM/BSA was significantly related to SBP at PE and just marginally to age and not significantly to race. CONCLUSIONS Black adolescent athletes showed higher SBP during all steps of exercise associated to a different trend. Ethnicity was the main determinant of RWT, suggesting that LV geometry is principally race-related rather than influenced by a different hemodynamic profile to physical activity.
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Affiliation(s)
- Pierluigi Demola
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Antonio Crocamo
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Laura Ceriello
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Andrea Botti
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Isabella Cremonini
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | | | - Domenico Corradi
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Francesco Visioli
- Department of Molecular Medicine, University of Padova, Italy; IMDEA-Food, CEI UAM+CSIC, Madrid, Spain
| | - Matteo Goldoni
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy.
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Pelà G, De Rosa F, Demola P, Crocamo A, Missale G, Cecchini S, Marchesi F, Visioli F, Silini EM, Roncoroni L. Resolution of late-onset heart and liver failures after reversion of jejuno-ileal bypass: a case report. Scand J Gastroenterol 2018; 53:891-894. [PMID: 29790800 DOI: 10.1080/00365521.2018.1474944] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Jejuno-ileal bypass (JIB) was a kind of bariatric surgery performed from 1960s to 1980s, able to induce sustainable weight loss by creating a surgical short bowel syndrome. MATERIALS AND METHODS We report a case of an octogenarian woman who underwent in the early eighties this kind of surgery with consequent 40 kg weight loss. After 27 years, she first developed a reversible metabolic cardiomyopathy that began with signs and symptoms of heart failure. Thereafter, she was diagnosed with severe intractable liver insufficiency. RESULTS Despite her old age, the patient underwent reversal of JIB with consequent early improvement of hepatic function. CONCLUSIONS This case demonstrate that in case of long-term and life-threatening complications, it is possible to successfully reverse JIB surgery after upto 30 years. The hypothesis on pathophysiology of heart and liver insufficiency are discussed.
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Affiliation(s)
- Giovanna Pelà
- a Department of Medicine and Surgery , University Hospital of Parma , Parma , Italy
| | - Fabrizio De Rosa
- a Department of Medicine and Surgery , University Hospital of Parma , Parma , Italy
| | - Pierluigi Demola
- a Department of Medicine and Surgery , University Hospital of Parma , Parma , Italy
| | - Antonio Crocamo
- a Department of Medicine and Surgery , University Hospital of Parma , Parma , Italy
| | - Gabriele Missale
- b Unit of Hepatology , University Hospital of Parma , Parma , Italy
| | - Stefano Cecchini
- c Unit of Surgery , University Hospital of Parma , Parma , Italy
| | | | - Francesco Visioli
- d Department of Molecular Medicine , University of Padova , Padova , Italy.,e CEI UAM CSIC, IMDEA FOOD, Ctra Canto Blanco , Madrid , Spain
| | | | - Luigi Roncoroni
- c Unit of Surgery , University Hospital of Parma , Parma , Italy
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