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Oliva A, Mangieri A, Cozzi O, Bragato R, Sticchi A, Bertoldi L, De Marco F, Monti L, Tosi P, Vitrella G, Torracca L, Reimers B, Colombo A, Regazzoli D. Transseptal Balloon-Assisted Translocation of the Mitral Anterior Leaflet (BATMAN) in Mitral Valve-in-Ring Implantation. JACC Cardiovasc Interv 2024; 17:568-570. [PMID: 38127027 DOI: 10.1016/j.jcin.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Angelo Oliva
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Mangieri
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Ottavia Cozzi
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Renato Bragato
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Alessandro Sticchi
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Letizia Bertoldi
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | | | - Lorenzo Monti
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Paolo Tosi
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | | | - Lucia Torracca
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Antonio Colombo
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy.
| | - Damiano Regazzoli
- Cardio Center, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
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2
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Rosario Pagliaro B, Mincione G, Taormina A, Ceriotti C, Poggio L, Cannata F, Del Monaco G, Gitto M, Battaglia V, Pinna G, Galimberti P, Loiacono F, Pellegrino M, Panico C, Bragato R, Stefanini G, Condorelli G, Pini D, Frontera A. Atrial arrhythmias and heart failure: a "modern view" of an old paradox. Pacing Clin Electrophysiol 2023; 46:395-408. [PMID: 36949598 DOI: 10.1111/pace.14697] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/09/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Heart failure (HF) and atrial arrhythmias (AAs) are two clinical conditions that characterize the daily clinical practice of cardiologists. In this perspective review, we analyze the shared etiopathogenetic pathways of atrial arrhythmias, which are the most common cause of atrial arrhythmias-induced cardiomyopathy (AACM) and HF. HYPOTHESIS The aim is to explore the pathophysiology of these two conditions considering them as a "unicum", allowing the definition of a cardiovascular continuum where it is possible to predict the factors and to identify the patient phenotype most at risk to develop HF due to atrial arrhythmias. METHODS Potentially eligible articles, identified from the Electronic database (PubMed), and related references were used for a literature search that was conducted between January 2022 and January 2023. Search strategies were designed to identify articles that reported atrial arrhythmias in association with heart failure and vice versa. For the search we used the following keywords: atrial arrhythmias, atrial fibrillation, heart failure, arrhythmia-induced cardiomyopathy, tachycardiomyopathy. We identified 620 articles through the electronic database search. Out of the 620 total articles we removed 320 duplicates, thus selecting 300 eligible articles. About 150 titles/abstracts were excluded for the following reasons: no original available data, no mention of atrial arrhythmias and heart failure crosstalk, very low quality analysis or evidence. We excluded also non-English articles. When multiple articles were published on the same topic, the articles with the most complete set of data were considered. We preferentially included all papers that could provide the best evidence in the field. As a result, the present review article is based on a final number of 104 references. RESULTS While the pathophysiology of AACM and Heart Failure with reduced ejection fraction (HFrEF) has been studied in detail over the years, the causal link between atrial arrhythmias and heart failure with Preserved Ejection Fraction (HFpEF) has been often subject of interest. HFpEF is strictly related to AAs, which has always been considered significant risk factor. In this review we described the pathophysiological links between atrial fibrillation and heart failure (Fig. 1). Furthermore, we illustrated and discussed the preclinical and clinical predicting factors of AF and HFpEF, and the corresponding targets of the available therapeutic agents. Finally, we outlined the patient phenotype at risk of developing AF and HFpEF. CONCLUSIONS In this review, we underline how these two clinical conditions (AF and HFpEF) represent a "unicum" and, therefore, should be considered as a single disease that can manifest itself in the same phenotype of patients but at different times. Furthermore, considering that today we have few therapeutic strategies to treat these patients, it would be good to make an early diagnosis in the initial stages of the disease or intervene even before the development of signs and symptoms of HF. This is possible only by paying greater attention to patients with predisposing factors and carrying out a targeted screening with the correct diagnostic methods. A systemic approach aimed at improving the immuno-metabolic profile of these patients by lowering the body mass index, threatening the predisposing factors, lowering the mean heart rate and reducing the sympathetic nervous system activation is the key strategy to reduce the clinical impact of this disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Beniamino Rosario Pagliaro
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gianluca Mincione
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carlo Ceriotti
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Poggio
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Cannata
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Guido Del Monaco
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mauro Gitto
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Vincenzo Battaglia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gabriele Pinna
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | | | - Renato Bragato
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gianluigi Condorelli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Daniela Pini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Gallone G, Islas F, Gorla R, Melillo F, Leone PP, Cimaglia P, Pastore MC, Franzone A, Landra F, Bruno F, Scudeler L, Jimenez-Quevedo P, Viva T, Piroli F, Bragato R, Trichilo M, Degiovanni A, Ilardi F, Andreis A, Nombela-Franco L, Maurizio T, Toselli M, Conrotto F, Montorfano M, Manzo R, Cameli M, Patti G, Stefanini G, Testa L, Giannini F, Agricola E, Escaned J, D'Ascenzo F, De Ferrari GM. Stroke volume index and transvalvular flow rate trajectories in severe aortic stenosis treated with TAVR. Eur Heart J Cardiovasc Imaging 2023:7031091. [PMID: 36752044 DOI: 10.1093/ehjci/jead018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/29/2022] [Accepted: 01/12/2023] [Indexed: 02/09/2023] Open
Abstract
AIMS The prognostic impact of flow trajectories according to stroke volume index (SVi) and transvalvular flow rate (FR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains poorly assessed. We evaluated and compared SVi and FR prior and after TAVR for severe AS. METHODS AND RESULTS Patients were categorized according to SVi (<35 mL/m2) and FR (<200 mL/s). The association of pre- and post-TAVR SVi and FR with all-cause mortality up to 3 years was assessed with multivariable Cox regression models. Among 980 patients with pre-TAVR flow assessment, SVi was reduced in 41.3% and FR in 48.1%. Baseline flow status was not an independent mortality predictor [SVi: hazard ratio (HR) 1.22, 95% confidence interval (CI) 0.85-1.82, FR: HR 0.78, 95% CI 0.48-1.27]. Among 731 patients undergoing early (5 days, interquartile range 2-29) post-TAVR flow assessment, SVi recovered in 40.1% and FR in 49.0% patients with baseline low flow. Reduced FR following TAVR was an independent predictor of mortality (HR 1.67, 95% CI 1.02-2.74), whereas SVi was not (HR 0.97, 95% CI 0.53-1.78). Three-year estimated mortality in patients with recovered FR was lower than that in patients with reduced FR (13.3 vs. 37.7% vs, P = 0.003) and similar to that in patients with normal baseline FR (P = 0.317). CONCLUSION Baseline flow status was not an independent predictor of mid-term mortality among all-comers with severe AS undergoing TAVR. Flow recovery early after TAVR was frequent. Post-TAVR FR, but not SVi, was independently associated with mid-term all-cause mortality. By impacting flow status, AV replacement modifies the association of flow status with outcomes.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Fabian Islas
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Melillo
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy.,Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Paolo Cimaglia
- GVM Care and Research Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita";, L.go Bellini, 28100 Novara, Italy.,Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Federico Landra
- Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 22, 53100 Siena, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Luca Scudeler
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Pilar Jimenez-Quevedo
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Tommaso Viva
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Piroli
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Renato Bragato
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy.,Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Michele Trichilo
- Division of Cardiology, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Italy
| | - Anna Degiovanni
- Division of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita", L.go Bellini, 28100 Novara, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Luis Nombela-Franco
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Tusa Maurizio
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Marco Toselli
- GVM Care and Research Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Matteo Montorfano
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 22, 53100 Siena, Italy
| | - Giuseppe Patti
- Division of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita", L.go Bellini, 28100 Novara, Italy.,Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy.,Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Giannini
- GVM Care and Research Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
| | - Eustachio Agricola
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
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Gallone G, Gorla R, Melillo F, Leone PP, Cimaglia P, Pastore MC, Franzone A, Landra F, Bruno F, Scudeler L, Bragato R, Ilardi F, Toselli M, Conrotto F, Montorfano M, Manzo R, Cameli M, Patti G, Stefanini G, Testa L, Giannini F, Agricola E, D´ascenzo F, De Ferrari GM. 1005 STROKE VOLUME INDEX AND TRANSVALVULAR FLOW RATE TRAJECTORIES IN SEVERE AORTIC STENOSIS TREATED WITH TAVR. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.333] [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
Aims
The prognostic impact of flow trajectories according to stroke volume index (SVi) and transvalvular flow rate (FR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains poorly assessed. We evaluated and compared SVi and FR prior and after TAVR for severe AS.
Methods and results
Patients were categorized according to SVi (<35 ml/m2) and FR (<200 ml/sec). The association of pre- and post-TAVR SVi and FR with all-cause mortality up to 3 years was assessed with multivariable Cox regression models. Among 980 patients with pre-TAVR flow assessment, SVi was reduced in 41.3% and FR in 48.1%. Baseline flow status was not an independent mortality predictor (SVi: HR 1.39, 95%CI 0.81-2.40, FR: HR 0.86, 95%CI 0.51-1.46). Among 731 patients undergoing early (5 days, IQR 2-29) post-TAVR flow assessment, SVi recovered in 40.1% and FR in 49.0% patients with baseline low-flow. Reduced FR following TAVR was an independent predictor of mortality (HR 2.08, 95%CI 1.07-4.04) while SVi was not (HR 0.68, 95%CI 0.34-1.36). Three-year estimated mortality in patients with recovered FR was lower as compared to patients with reduced FR (13.3% vs 37.7% vs, p=0.003) and similar to patients with normal baseline FR (p=0.317).
Conclusions
Baseline flow status was not an independent predictor of mid-term mortality among all-comers with severe AS undergoing TAVR. Flow recovery early after TAVR was frequent. Post-TAVR FR, but not SVi, was independently associated with mid-term all-cause mortality. By impacting flow status, AV replacement modifies the association of flow status with outcomes.
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Affiliation(s)
- Guglielmo Gallone
- Città Della Salute E Della Scienza, University Of Turin , Turin , Italy
| | | | | | | | - Paolo Cimaglia
- Gvm Care And Research, Maria Cecilia Hospital , Ravenna , Italy
| | | | | | | | - Francesco Bruno
- Città Della Salute E Della Scienza, University Of Turin , Turin , Italy
| | - Luca Scudeler
- Città Della Salute E Della Scienza, University Of Turin , Turin , Italy
| | - Renato Bragato
- Humanitas University , Pieve Emanuele, Milan , Italy
- Irccs Humanitas Research Hospital , Rozzano, Milan , Italy
| | | | - Marco Toselli
- Azienda Ospedaliero Universitaria Di Ferrara , Cona, Ferrara , Italy
| | - Federico Conrotto
- Città Della Salute E Della Scienza, University Of Turin , Turin , Italy
| | | | | | - Matteo Cameli
- University Of Siena, Policlinico Le Scotte , Siena , Italy
| | | | - Giulio Stefanini
- Humanitas University , Pieve Emanuele, Milan , Italy
- Irccs Humanitas Research Hospital , Rozzano, Milan , Italy
| | - Luca Testa
- Irccs Policlinico San Donato , Milan , Italy
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Scudeler L, Gallone G, Bruno F, Signorini A, Gorla R, Melillo F, Tusa M, Montorfano M, Leone P, Cimaglia P, Pastore MC, Benfari G, Landra F, Franzone A, Bragato R, Spiringhetti P, Andreis A, Trichilo M, Patti G, Cameli M, D´ascenzo F, De Ferrari GM. 891 EARLY EVOLUTION OF CARDIAC DAMAGE STAGING FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT: PREVALENCE, CLINICAL PATTERNS AND PROGNOSTIC SIGNIFICANCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.749] [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
The early evolution of extravalvular cardiac damage following transcatheter aortic valve replacement (TAVR) as assessed by a previous validated score system remains unstudied. We sought to assess the patterns of early cardiac damage change among patients with severe aortic stenosis (AS) undergoing TAVR and its prognostic implications.
Methods
The RECOVERY-TAVR is a multi-center, international retrospective registry including all consecutive patients undergoing TAVR in thirteen high-volume centers. All the enrolled patients with available paired echocardiography assessment pre- and post TAVR were included in this sub-analysis. Patients were categorized according to the extension of cardiac damage based on a previous published and validated classification (stage 0, no damage; stage 1, left ventricular damage; stage 2, left atrial or mitral valve damage; stage 3, pulmonary vasculature or tricuspid valve damage; and stage 4, right ventricular damage). The primary endpoint was a composite of all-cause mortality or first heart failure hospitalization at 1 year. The association of cardiac damage stage evaluated prior and following TAVR along with the staging evolution was assessed with multivariate Cox regression model (that include hemoglobin, NYHA class and max aortic valve gradient) for the primary outcome.
Results
Of 1331 Patients included in the RECOVERY-TAVR registry with a full echocardiographic pre-TAVR assessment, 892 patients with available paired echocardiography exams were finally included in this analysis (pre-TAVR assessment: median 8 days prior to TAVR; post-TAVR assessment: median 7 days post-TAVR). 63 (7.1%) had stage 0/1, 433 (48.2%) had stage 2, 235 (26.3%) had stage 3 and 161 (18%) had stage 4 myocardial damage. Pre-TAVR myocardial damage staging was associated with the primary outcome (Adj-HR for myocardial stage increase: HR 1.40, 95% CI 1.01–1.93). Following TAVR 274 (30.7%) patients experienced myocardial damage improvement and 161 (18.1%) myocardial damage worsening. Post-TAVR myocardial damage staging was more strongly associated with the primary outcome (HR 1.55, 95%CI 1.14–2.10) as compared to pre-TAVR assessment. Male Sex (p = 0.044) and post-procedural permanent pacemaker implantation (p = 0.044) was associated with myocardial damage worsening, while the use of a balloon-expandable valve (p = 0.011) was associated with myocardial damage improvement. Early myocardial damage worsening (HR 1.89, 95%CI 1.12–3.21), but not early myocardial damage improvement (HR 0.86, 95%CI 0.54–1.37) was associated with the primary outcome.
Conclusion
In patients undergoing TAVR, the extent of extravalvular cardiac damage prior to and early after TAVR has an independent prognostic value while early myocardial damage worsening following TAVR portends a poor prognosis. Whether strategies to improve procedural success and treatments addressing extravalvular myocardial damage early following TAVR may improve outcomes has to be prospectively assessed.
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Affiliation(s)
- Luca Scudeler
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Città Della Salute E Della Scienza” Hospital , Turin , Italy
- Department Of Medical Sciences, University Of Turin , Italy
| | - Guglielmo Gallone
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Città Della Salute E Della Scienza” Hospital , Turin , Italy
- Department Of Medical Sciences, University Of Turin , Italy
| | - Francesco Bruno
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Città Della Salute E Della Scienza” Hospital , Turin , Italy
- Department Of Medical Sciences, University Of Turin , Italy
| | | | - Riccardo Gorla
- Department Of Clinical And Interventional Cardiology, Irccs Policlinico San Donato , Milan , Italy
| | | | - Maurizio Tusa
- Department Of Clinical And Interventional Cardiology, Irccs Policlinico San Donato , Milan , Italy
| | | | - Pasquale Leone
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele-Milan , Italy
| | - Paolo Cimaglia
- Gvm Care And Research, Maria Cecilia Hospital , Ravenna , Italy
| | | | - Giovanni Benfari
- Department Of Cardiovascular Medicine, University Of Verona , Verona , Italy
| | - Federico Landra
- Department Of Cardiovascular Diseases, University Of Siena, Policlinico ”Le Scotte” , Siena , Italy
| | - Anna Franzone
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Renato Bragato
- Department Of Biomedical Sciences, Humanitas University , Pieve Emanuele-Milan , Italy
| | - Paolo Spiringhetti
- Department Of Cardiovascular Medicine, University Of Verona , Verona , Italy
| | - Alessandro Andreis
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Città Della Salute E Della Scienza” Hospital , Turin , Italy
| | - Michele Trichilo
- Azienda Ospedaliera Universitaria Di Ferrara , Via Aldo Moro 8, 44124 Coana,Fe
| | - Giuseppe Patti
- Azienda Ospedaliera Universitaria Maggiore Della Carità , Novara , Italy
| | - Matteo Cameli
- Department Of Cardiovascular Diseases, University Of Siena, Policlinico ”Le Scotte” , Siena , Italy
| | - Fabrizio D´ascenzo
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Città Della Salute E Della Scienza” Hospital , Turin , Italy
- Department Of Medical Sciences, University Of Turin , Italy
| | - Gaetano Maria De Ferrari
- Division Of Cardiology, Cardiovascular And Thoracic Department, ”Città Della Salute E Della Scienza” Hospital , Turin , Italy
- Department Of Medical Sciences, University Of Turin , Italy
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Fazzari F, Cannata F, Chiarito M, Gitto M, Terzi R, Didedda E, Lisi C, Condorelli G, Stefanini G, Chiti A, Bragato R, Francone M. 1129 IMAGING STRESS TEST OR CORONARY COMPUTED TOMOGRAPHY PRIOR TO NON-CARDIAC SURGERY? A SEVEN YEARS SINGLE CENTRE EXPERIENCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
Recent published ESC guidelines on non-cardiac surgery suggest the use of imaging stress test in patients with poor functional capacity and high likelihood of coronary artery disease or high clinical risk (class I, level B), while the use of coronary computed tomography has lower evidence (class IIa, level B). Witch test has the best performance in the clinical contest of pre-operative risk assessment is a matter of debate.
Aim
The aim of our single centre, retrospective study was to compare the prognostic role of the three main cardiac imaging modalities (CCT: Cardiac computed tomography, sCMR: stress cardiac magnetic resonance, SPECT MPI:single photon emission computed tomography myocardial perfusion imaging) in relation to 30 days post-surgery cardiac events (composite endpoint of myocardial infarction, unstable angina, cardiac death, cardiogenic shock, pulmonary oedema, life threatening cardiac arrythmias).
Method
Clinical data of patients from January 2015 to December 2021 were retrospectively collected from review of electronical medical records. Recorded data included demographic characteristics, clinical risk factors, results from laboratory tests, results from cardiac imaging tests, pharmacological therapy, type of intervention, cardiac complication within 30 days after surgery.
Results
Eight-hundred eighty-three patients were included (287 sCMR, 382 SPECT-MPI, 214 CCT). Rate of 30-days myocardial infarction was not significantly different between different modalities (CMR 1.1%, SPECT 1.3%; CT 0.5%; CMR vs SPECT p 0.998; sCMR vs CT p 0.639; SPECT vs CT 0.427); while planned invasive coronary angiography (ICA) was more common in CT group (CT 34%, CMR 16%, SPECT 10%, p<0,001). Absence of ischemia on stress test and absence of relevant coronary artery disease on CT are associate to lower cardiac events at follow-up (0.67%).
Conclusions
The use of imaging stress test and coronary CT are both associated to low incidence of cardiac events and should be recommended in risk assessment before non-cardiac surgery, in the appropriate clinical context.
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Affiliation(s)
- Fabio Fazzari
- Humanitas Research Hospital , Rozzano, Milano, Italia
| | | | | | - Mauro Gitto
- Humanitas Research Hospital , Rozzano, Milano, Italia
| | | | | | - Costanza Lisi
- Humanitas Research Hospital , Rozzano, Milano, Italia
| | | | | | - Arturo Chiti
- Humanitas Research Hospital , Rozzano, Milano, Italia
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7
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Gallone G, Bruno F, Trenkwalder T, D'Ascenzo F, Islas F, Leone PP, Nicol P, Pellegrini C, Incaminato E, Jimenez-Quevedo P, Alvarez-Covarrubias HA, Bragato R, Andreis A, Salizzoni S, Rinaldi M, Kastrati A, Conrotto F, Joner M, Stefanini G, Nombela-Franco L, Xhepa E, Escaned J, De Ferrari GM. Prognostic implications of impaired longitudinal left ventricular systolic function assessed by tissue Doppler imaging prior to transcatheter aortic valve implantation for severe aortic stenosis. Int J Cardiovasc Imaging 2022; 38:10.1007/s10554-021-02519-2. [PMID: 35006473 DOI: 10.1007/s10554-021-02519-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
Abstract
Change in longitudinal left ventricular (LV) systolic function serves as an early marker of the deleterious effect of aortic stenosis (AS) and other cardiac comorbidities on cardiac function. We explored the prognostic value of tissue Doppler imaging (TDI)-derived longitudinal LV systolic function, defined by the peak systolic average of lateral and septal mitral annular velocities (average S') among symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI). 297 consecutive patients with severe AS undergoing TAVI at three european centers with available average S' at preprocedural echocardiography were retrospectively included. The primary endpoint was the Kaplan Meier estimate of all-cause mortality. After a median 18 months (IQR 12-18) follow-up, 36 (12.1%) patients had died. Average S' was associated with all-cause mortality (per 1 cm/sec decrease: HR 1.29, 95%CI 1.03-1.60, p = 0.025), the cut-off of 6.5 cm/sec being the most accurate. Patients with average S' < 6.5 cm/sec (55.2%) presented characteristics of more advanced LV remodeling and functional impairment along with higher burden of cardiac comorbidities, and experienced higher all-cause mortality (17.6% vs. 7.5%, p = 0.007), also when adjusted for in-study outcome predictors (adj-HR: 2.69, 95%CI 1.22-5.93, p = 0.014). Results were consistent among patients with preserved ejection fraction, normal-flow AS, high-gradient AS and in those without LV hypertrophy. Longitudinal LV systolic function assessed by average S' is independently associated with long-term all-cause mortality among TAVI patients. An average S' below 6.5 cm/sec best defines clinically meaningful reduced longitudinal systolic function and may aid clinical risk stratification in these patients.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy.
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Fabian Islas
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Enrico Incaminato
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Pilar Jimenez-Quevedo
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | | | - Renato Bragato
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | | | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | | | - Giulio Stefanini
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Luis Nombela-Franco
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Erion Xhepa
- Deutsches Herzzentrum München, Munich, Germany
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
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8
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Leone PP, Fazzari F, Cannata F, Sanz-Sanchez J, Mangieri A, Monti L, Cozzi O, Stefanini GG, Bragato R, Colombo A, Reimers B, Regazzoli D. Clinical and Technical Challenges of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2021; 8:670457. [PMID: 34150868 PMCID: PMC8211887 DOI: 10.3389/fcvm.2021.670457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Prosthesis-patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.
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Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Jorge Sanz-Sanchez
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | | | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
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9
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Ferrante G, Fazzari F, Cozzi O, Maurina M, Bragato R, D’Orazio F, Torrisi C, Lanza E, Indolfi E, Donghi V, Mantovani R, Liccardo G, Voza A, Azzolini E, Balzarini L, Reimers B, Stefanini GG, Condorelli G, Monti L. Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography. Cardiovasc Res 2020; 116:2239-2246. [PMID: 32637999 PMCID: PMC7454387 DOI: 10.1093/cvr/cvaa193] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19. METHODS AND RESULTS This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I >20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th-75th percentile, 27-32) mm vs. 27.7 (25-30) mm, P < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02-1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02-1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27-3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death. CONCLUSIONS An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.
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Affiliation(s)
- Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Fabio Fazzari
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Ottavia Cozzi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Matteo Maurina
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Renato Bragato
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Federico D’Orazio
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Chiara Torrisi
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Ezio Lanza
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Eleonora Indolfi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Valeria Donghi
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Riccardo Mantovani
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Gaetano Liccardo
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Antonio Voza
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Department of Emergency, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Elena Azzolini
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Luca Balzarini
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Bernhard Reimers
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Gianluigi Condorelli
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Lorenzo Monti
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano (Milan), Italy
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10
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Giustino G, Croft LB, Stefanini GG, Bragato R, Silbiger JJ, Vicenzi M, Danilov T, Kukar N, Shaban N, Kini A, Camaj A, Bienstock SW, Rashed ER, Rahman K, Oates CP, Buckley S, Elbaum LS, Arkonac D, Fiter R, Singh R, Li E, Razuk V, Robinson SE, Miller M, Bier B, Donghi V, Pisaniello M, Mantovani R, Pinto G, Rota I, Baggio S, Chiarito M, Fazzari F, Cusmano I, Curzi M, Ro R, Malick W, Kamran M, Kohli-Seth R, Bassily-Marcus AM, Neibart E, Serrao G, Perk G, Mancini D, Reddy VY, Pinney SP, Dangas G, Blasi F, Sharma SK, Mehran R, Condorelli G, Stone GW, Fuster V, Lerakis S, Goldman ME. Characterization of Myocardial Injury in Patients With COVID-19. J Am Coll Cardiol 2020; 76:2043-2055. [PMID: 33121710 PMCID: PMC7588179 DOI: 10.1016/j.jacc.2020.08.069] [Citation(s) in RCA: 249] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. OBJECTIVES This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. METHODS We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. RESULTS A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. CONCLUSIONS Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.
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Affiliation(s)
- Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York.
| | - Lori B Croft
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | | | - Renato Bragato
- Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Jeffrey J Silbiger
- Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Marco Vicenzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tatyana Danilov
- Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Nina Kukar
- Mount Sinai West Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Nada Shaban
- Mount Sinai Queens Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Solomon W Bienstock
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Eman R Rashed
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York; Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Karishma Rahman
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Connor P Oates
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Samantha Buckley
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Lindsay S Elbaum
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York; Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Derya Arkonac
- Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Ryan Fiter
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Ranbir Singh
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Emily Li
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Victor Razuk
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Sam E Robinson
- Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Michael Miller
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Benjamin Bier
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Valeria Donghi
- Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Marco Pisaniello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Giuseppe Pinto
- Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Irene Rota
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Sara Baggio
- Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Mauro Chiarito
- Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Fabio Fazzari
- Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Ignazio Cusmano
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mirko Curzi
- Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Richard Ro
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Waqas Malick
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Mazullah Kamran
- Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Roopa Kohli-Seth
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Adel M Bassily-Marcus
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Eric Neibart
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Gregory Serrao
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Gila Perk
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Donna Mancini
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Vivek Y Reddy
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Sean P Pinney
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Francesco Blasi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Martin E Goldman
- The Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York. https://twitter.com/g_giustinoMD
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11
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Stefanini GG, Chiarito M, Ferrante G, Cannata F, Azzolini E, Viggiani G, De Marco A, Briani M, Bocciolone M, Bragato R, Corrada E, Gasparini GL, Marconi M, Monti L, Pagnotta PA, Panico C, Pini D, Regazzoli D, My I, Kallikourdis M, Ciccarelli M, Badalamenti S, Aghemo A, Reimers B, Condorelli G. Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19. Heart 2020; 106:1512-1518. [PMID: 32817312 DOI: 10.1136/heartjnl-2020-317322] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [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: 05/10/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Risk stratification is crucial to optimise treatment strategies in patients with COVID-19. We aimed to evaluate the impact on mortality of an early assessment of cardiac biomarkers in patients with COVID-19. METHODS Humanitas Clinical and Research Hospital (Rozzano-Milan, Lombardy, Italy) is a tertiary centre that has been converted to the management of COVID-19. Patients with confirmed COVID-19 were entered in a dedicated database for cohort observational analyses. Outcomes were stratified according to elevated levels (ie, above the upper level of normal) of high-sensitivity cardiac troponin I (hs-TnI), B-type natriuretic peptide (BNP) or both measured within 24 hours after hospital admission. The primary outcome was all-cause mortality. RESULTS A total of 397 consecutive patients with COVID-19 were included up to 1 April 2020. At the time of hospital admission, 208 patients (52.4%) had normal values for cardiac biomarkers, 90 (22.7%) had elevated both hs-TnI and BNP, 59 (14.9%) had elevated only BNP and 40 (10.1%) had elevated only hs-TnI. The rate of mortality was higher in patients with elevated hs-TnI (22.5%, OR 4.35, 95% CI 1.72 to 11.04), BNP (33.9%, OR 7.37, 95% CI 3.53 to 16.75) or both (55.6%, OR 18.75, 95% CI 9.32 to 37.71) as compared with those without elevated cardiac biomarkers (6.25%). A multivariate analysis identified concomitant elevation of both hs-TnI and BNP as a strong independent predictor of all-cause mortality (OR 3.24, 95% CI 1.06 to 9.93). CONCLUSIONS An early detection of elevated hs-TnI and BNP predicts mortality in patients with COVID-19. Cardiac biomarkers should be systematically assessed in patients with COVID-19 at the time of hospital admission in order to optimise risk stratification.
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Affiliation(s)
- Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy .,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Giuseppe Ferrante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Elena Azzolini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Giacomo Viggiani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Andrea De Marco
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Martina Briani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Monica Bocciolone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Renato Bragato
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Elena Corrada
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Gabriele L Gasparini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Manuel Marconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Lorenzo Monti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Paolo A Pagnotta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Cristina Panico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Daniela Pini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Ilaria My
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Marinos Kallikourdis
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Michele Ciccarelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Salvatore Badalamenti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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12
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Cozzi O, Regazzoli D, Citterio E, Rossi A, Chiarito M, Stefanini GG, Bragato R, Torracca L, Condorelli G, Pagnotta P, Reimers B. Coral Reef Aorta: A Rare Occlusive Disease of the Aorta Complicating Decision Making for Severe Aortic Stenosis Treatment. Can J Cardiol 2019; 35:940.e13-940.e16. [DOI: 10.1016/j.cjca.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
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13
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Bertuzzi A, Marrari A, Quagliuolo V, Cananzi F, Cariboni U, Specchia C, Bragato R, Balzarini L, Scorsetti M, Navarria P, Siracusano L, Mencaglia E, Vicenzi E, Spinelli A, Santoro A. Developing an adolescent and young adult (AYA) cancer program in an Italian adult high-volume cancer center. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18034] [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: 11/20/2022] Open
Abstract
e18034 Background: Given the lack of survival improvement and the several unmet clinical/psychosocial issues, programs for AYA (15 to 39 yo) are underway, involving local resources and organizations. Conventionally the healthcare system address inadequately the needs of AYAs. Humanitas Research Hospital is a high volume Cancer Center for adult patients with long lasting expertise in rare cancers based on a multidisciplinary approach. Methods: We conducted a retrospective evaluation of the number of patients followed in our Institute from 2010 to 2017 to assess our potential as an AYA referral center. In February 2017 we started a dedicated program, focused on medical and psychosocial issues of AYA and supported by an interdisciplinary team including medical oncologists, psychologists, surgeons, radiation oncologists, fertility experts, cardiologists, genetic consultants, endocrinologist, palliative care providers, social workers, and liason nurses . Results: From 2010 to 2017 more than 6600 AYA pts were seen in Humanitas. The epidemiology reflects the published data. Since the beginning of the program (February 2017), more than 2000 new AYA pts were referred to our dedicated clinic. Based on a patient-focused model of care, the aims of the first access are the comprehension of the complex pathways to diagnosis often delayed, the access to optimal care including clinical trial, the recognition of the unique psychosocial context, the counselling on key issues for AYA (fertility, cardiology, nutrition, smoking, financial). We created a dedicated physical space where pts, families and caregivers can spend time together, reducing the feeling of isolation. They meet also specialists trained to deal with their needs, to reduce the adverse impact of the diagnosis and to improve the adherence to treatment. Daily activities, such as cooking and photography class, professional writing and acting, are also offered. Conclusions: Humanitas AYA project modified the hospital environment making it more comfortable for our pts and improved the awareness of the healthcare providers to AYA unmet needs. Outcome and research program improvement are long-term endpoints to bridge the clinical gap of AYA pts.
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Affiliation(s)
- Alexia Bertuzzi
- Department of Oncology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Armando Santoro
- Medical Oncology and Hematology Unit. Humanitas Cancer Center. Humanitas Clinical and Research Center - IRCCS. Department of Biomedical Sciences. Humanitas University, Rozzano, Milan, Italy
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14
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Cannata F, Regazzoli D, Barberis G, Chiarito M, Leone PP, Lavanco V, Stefanini GG, Ferrante G, Pagnotta P, Bragato R, Corrada E, Torracca L, Condorelli G, Reimers B. Mitral Valve Stenosis after Transcatheter Aortic Valve Replacement: Case Report and Review of the Literature. Cardiovasc Revasc Med 2019; 20:1196-1202. [PMID: 30905659 DOI: 10.1016/j.carrev.2019.02.023] [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: 01/02/2019] [Revised: 02/05/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Abstract
Mitral stenosis is a rare and potentially severe complication of transcatheter aortic valve replacement (TAVR). Given the anatomic coupling and interdependence of the aortic and mitral valves, it comes by itself that procedures (either surgical or percutaneous) involving the aortic valve imply the risk of altering mitral valve function. Indeed, transcatheter aortic prostheses may impair adequate anterior mitral leaflet (AML) opening, especially when implanted in a "low" position, thus resulting in high transvalvular gradients. Hereby, we report the case of a 71-year-old male with symptomatic severe aortic stenosis and a history of previous surgical mitral valve repair who underwent TAVR with a self-expandable prosthesis. Notwithstanding an acceptable angiographic position, the prosthetic frame was shown to interfere with the AML, as evidenced by augmented transmitral gradients; nonetheless, pulmonary artery pressures remained unchanged, and the patient experienced symptomatic improvement. Therefore, a conservative approach was chosen and the patient was discharged home after medical therapy optimization. Moreover, we provide a review of the available literature regarding the incidence, predictors and possible management of this infrequent complication.
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Affiliation(s)
- Francesco Cannata
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy.
| | - Giancarlo Barberis
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Mauro Chiarito
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Pier Pasquale Leone
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Vincenzo Lavanco
- Non-invasive Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Giulio G Stefanini
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Giuseppe Ferrante
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Paolo Pagnotta
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Renato Bragato
- Non-invasive Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Elena Corrada
- Non-invasive Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Lucia Torracca
- Cardiac Surgery, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Gianluigi Condorelli
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Bernhard Reimers
- Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano-Milano, Italy
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15
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Gasparini M, Galimberti P, Bragato R, Ghio S, Raineri C, Landolina M, Chieffo E, Lunati M, Mulargia E, Proclemer A, Facchin D, Rordorf R, Vicentini A, Marcantoni L, Zanon F, Klersy C. Multipoint Pacing versus conventional ICD in Patients with a Narrow QRS complex (MPP Narrow QRS trial): study protocol for a pilot randomized controlled trial. Trials 2016; 17:572. [PMID: 27927248 PMCID: PMC5143452 DOI: 10.1186/s13063-016-1698-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/11/2016] [Indexed: 11/23/2022] Open
Abstract
Background Despite an intensive search for predictors of the response to cardiac resynchronization therapy (CRT), the QRS duration remains the simplest and most robust predictor of a positive response. QRS duration of ≥ 130 ms is considered to be a prerequisite for CRT; however, some studies have shown that CRT may also be effective in heart failure (HF) patients with a narrow QRS (<130 ms). Since CRT can now be performed by pacing the left ventricle from multiple vectors via a single quadripolar lead, it is possible that multipoint pacing (MPP) might be effective in HF patients with a narrow QRS. This article reports the design of the MPP Narrow QRS trial, a prospective, randomized, multicenter, controlled feasibility study to investigate the efficacy of MPP using two LV pacing vectors in patients with a narrow QRS complex (100–130 ms). Methods Fifty patients with a standard ICD indication will be enrolled and randomized (1:1) to either an MPP group or a Standard ICD group. All patients will undergo a low-dose dobutamine stress echo test and only those with contractile reserve will be included in the study and randomized. The primary endpoint will be the percentage of patients in each group that have reverse remodeling at 12 months, defined as a reduction in left ventricular end-systolic volume (LVESV) of >15% from the baseline. Discussion This feasibility study will determine whether MPP improves reverse remodeling, as compared with standard ICD, in HF patients who have a narrow QRS complex (100–130 ms). Trial registration ClinicalTrials.gov, NCT02402816. Registered on 25 March 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1698-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Renato Bragato
- Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | - Stefano Ghio
- Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Catherine Klersy
- Servizio di Biometria e Statistica, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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16
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Gronda E, Genovese S, Padeletti L, Cacciatore F, Vitale DF, Bragato R, Innocenti L, Schiano C, Sommese L, De Pascale MR, Genovese L, Abete P, Donatelli F, Napoli C. Renal function impairment predicts mortality in patients with chronic heart failure treated with resynchronization therapy. Cardiol J 2016; 22:459-66. [PMID: 26325259 DOI: 10.5603/cj.a2015.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/06/2015] [Accepted: 03/02/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The use of cardiac resynchronization therapy (CRT) and implantable cardioverter- defibrillator (ICD) for advanced heart failure (HF) is increasing. Renal dysfunction is a common condition in HF which is associated with a worse survival. The study aims at identifying in patients with advanced HF treated with CRT the effect of baseline glomerular filtration rate (GFR), GFR improvement and left ventricular ejection fraction (LVEF) change, after 6-months of CRT implant, on survival. METHODS The study population consisted of 375 advanced HF patients who received a CRT between 1999 and 2009, of these 277 received also an ICD implant. Clinical characteristics (New York Heart Association [NYHA] functional class, ischemic vs. non-ischemic etiology, atrial fibrillation, diabetes, hypertension, LVEF, QRS duration and GFR were recorded. The use of common used drugs was evaluated. Cox proportional hazards analysis was calculated in order to evaluate variables associated to mortality. RESULTS During a median follow-up of 43.0 months, 93 (24.8%) patients died. Patients deceased during the study had at baseline higher NYHA class and lower LVEF and GFR. In Cox regression analysis, GFR predicts long-term mortality (hazard ratio [HR] 0.983; 95% confidence interval [CI] 0.969-0.998; p = 0.023) independently from the effect of others covariates. In addition, a positive GFR improvement 6 months after CRT implant is significantly associated with a lower hazard of mortality (for each 10 mL/min of GFR improvement HR 0.86; 95% CI 0.75-0.99; p = 0.038). CONCLUSIONS GFR is a significant predictor of mortality in advanced HF patients who received CRT. A GFR improvement 6 months after CRT implant is significantly associated with a lower hazard of mortality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Claudio Napoli
- Fondazione Studio Diagnostica Nucleare, IRCCS, Naples, Italy Department of Internal Medicine and Specialist Units, U.O.C. Immunohematology, and Excellence Research Center on Cardiovascular Disease, 1st School of Medicine, Second University of Naples, Naples, Italy.
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17
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Pagnotta P, Mennuni MG, Ferrante G, Ornaghi D, Bragato R, Cappai A, Presbitero P. A Hybrid Double Access for Transcatheter Mitral Valve-In-Valve Implantation. Ann Thorac Surg 2015; 99:e149-50. [PMID: 26046908 DOI: 10.1016/j.athoracsur.2015.02.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 02/12/2015] [Accepted: 02/17/2015] [Indexed: 11/25/2022]
Abstract
We present a case of hybrid mitral valve-in valve implantation. The planned transapical approach failed due to the inability to cross the degenerated stenotic mitral bioprosthesis. An alternative strategy was performed: first, an anterograde crossing of mitral stenosis, and then, a guidewire externalization through the apex by using a snare. To our knowledge, this is the first described case of double approach mitral valve-in valve implantation.
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Affiliation(s)
- Paolo Pagnotta
- Department of Interventional Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco G Mennuni
- Department of Interventional Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Giuseppe Ferrante
- Department of Interventional Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Diego Ornaghi
- Department of Cardiothoracic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Renato Bragato
- Echocardiography Laboratory, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antioco Cappai
- Department of Cardiothoracic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Patrizia Presbitero
- Department of Interventional Cardiology, Humanitas Research Hospital, Rozzano, Milan, Italy
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18
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Barbone A, Pini D, Ornaghi D, Visigalli MM, Ardino L, Bragato R, Curzi M, Cioccarelli SA, Di Diodoro L, Basciu A, Cappai A, Settepani F, Citterio E, Cappelleri A, Calcagnino M, Mangiavacchi M, Tarelli G, Lettino M, Vitali E. [CircuLite Synergy ventricular assist device: a new approach to end-stage congestive heart failure]. G Ital Cardiol (Rome) 2014; 15:116-22. [PMID: 24625851 DOI: 10.1714/1424.15781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Synergy system, a miniature partial circulatory support device, is implanted by an off-pump, minimally invasive surgical approach. The system has been optimized to improve performance in an EU clinical trial for chronic ambulatory heart failure. This therefore offers the possibility of treating elderly chronic heart failure patients who might not usually be considered for long-term circulatory support. METHODS From June 2007 to December 2012, 63 patients were implanted with the Synergy system (12 patients ≥70 years) using four different releases of the device. Briefly, the system draws blood through the inflow cannula from the left atrium into the micro-pump (placed in a right subclavicular pocket) and pumps it through an outflow graft to the right subclavian artery. In this paper, we present an intermediate analysis of the clinical trial as performed on April 30, 2013, leading to the placing of the CE mark. RESULTS Mean duration of support is ongoing at 230 days (range 23-1387). Follow-up showed improved hemodynamic response, with additional improvements in 6-min walk distance (299 ± 144 to 420 ± 119 m) and Minnesota Living with Heart Failure Questionnaire (69.5 ± 20.4 to 49.2 ± 24.3). Older patients had longer mean durations of support (337 vs 188 days). On average, elderly and younger patients showed similar improvements in hemodynamics and 6-min walk distance (107 ± 120 vs 130 ± 121 m). Major adverse cardiac events included bleeding (n=4) with one bleeding related to renal failure resulting in death. CONCLUSIONS Clinical use of the Synergy device was associated with a significant functional improvement. Very low adverse event rates were reported with the latest device release. Older patients had smaller body sizes and worse renal function than younger patients. Both groups experienced similar hemodynamic benefits and functional improvements. The risk of bleeding and renal dysfunction appears to be increased in the elderly, though still within acceptable ranges compared to other full support devices. Minimally invasive long-term circulatory support devices, like Synergy, offer a new treatment option that might be available even for the elderly chronic heart failure population.
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19
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Gasparini M, Muto C, Iacopino S, Zanon F, Dicandia C, Distefano G, Favale S, Peraldo Neja C, Bragato R, Davinelli M, Mangoni L, Denaro A. Low-dose dobutamine test associated with interventricular dyssynchrony: a useful tool to identify cardiac resynchronization therapy responders: data from the LOw dose DObutamine stress-echo test in Cardiac Resynchronization Therapy (LODO-CRT) phase 2 study. Am Heart J 2012; 163:422-9. [PMID: 22424013 DOI: 10.1016/j.ahj.2011.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 11/17/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is effective in patients with heart failure, but 30% to 50% of subjects are classified as nonresponders. Identifying responders remains a challenging task. AIMS The LODO-CRT trial investigated the association between left ventricular contractile reserve (LVCR) and clinical and echocardiographic long-term CRT response. METHODS This is a multicenter, prospective, observational study. Left ventricular contractile reserve was detected using a dobutamine stress echocardiography test, defined as an ejection fraction increase of >5 points. Clinical CRT response was defined as the absence of major cardiovascular events (ie, cardiovascular death or heart failure hospitalization). Echocardiographic response was defined as a left ventricle end-systolic volume reduction of >10%. RESULTS A total of 221 CRT-indicated patients were studied (80% presented LVCR). During a mean follow-up of 15 ± 5 months, 17 patients died and 16 were hospitalized due to heart failure. The proportion of clinical responders was 155 (88%) of 177 and 33 (75%) of 44 (P = .036) in the groups with and without LVCR, respectively. Kaplan-Meier analysis showed a significant difference in cardiac survival/hospitalization between patients with and without LVCR. The proportion of echocardiographic responders was 144 (87%) of 166 and 16 (42%) of 38 in the groups with and without LVCR (P < .001), respectively; LVCR showed 90% sensitivity and 87% positive predictive value to prefigure echocardiographic CRT responders. Multivariable analysis identified LVCR and interventricular dyssynchrony as independent predictors of CRT response. The concomitant presence of both factors showed 99% specificity and 83% sensitivity in detecting responders. CONCLUSION The presence of LVCR helps in predicting a clinical and echocardiographic CRT response. Concomitant assessment of LVCR and interventricular dyssynchrony accurately stratifies responder and nonresponder patients.
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20
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Affiliation(s)
- Maurizio Gasparini
- IRCCS Istituto Clinico Humanitas, Via Manzoni, 56, IT-2089 Rozzano-Milano, Italy.
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21
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Mangiavacchi M, Gasparini M, Genovese S, Pini D, Klersy C, Bragato R, Andreuzzi B, Municinò A, Regoli F, Galimberti P, Ceriotti C, Gronda E. Insulin-treated type 2 diabetes is associated with a decreased survival in heart failure patients after cardiac resynchronization therapy. Pacing Clin Electrophysiol 2009; 31:1425-32. [PMID: 18950300 DOI: 10.1111/j.1540-8159.2008.01206.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves cardiac performance and survival in patients with congestive heart failure. Recent observations suggest that diabetes is associated with a worse outcome in these patients. The aim of the study was to investigate the effect of diabetes and insulin treatment on outcome after CRT. METHODS Diabetic status and insulin treatment were assessed in 447 patients who underwent CRT (males 80.8%, mean age 65.7 +/- 9.7 years, ejection fraction 29.9 +/- 6.11%). Patients were stratified in three groups according to the presence or absence of diabetes and insulin treatment. RESULTS Nondiabetic patients were 366 (79.6%), noninsulin-treated diabetic patients 62 (13.9%), insulin-treated diabetic patients 29 (6.5%). The estimated death rate was 5.15 per 100 patients-year in the nondiabetic group, 8.63 in noninsulin-treated diabetics (HR 1.59, P = 0.240), and 15.84 in insulin-treated diabetics (HR 3.05, P = 0.004). Cardiac mortality accounted for 81% of deaths in nondiabetic patients and for 56% of deaths in diabetic patients. Diabetic patients tended to have a worse recovery of left ventricular ejection fraction over time (P = 0.057) and of the distance at 6-minute walking test (6MWT) (P = 0.018). CONCLUSIONS Insulin-treated diabetes is associated with a worse functional recovery and a higher mortality in patients with advanced heart failure after CRT. While cardiac death accounts for the majority of deaths in nondiabetic patients, a relevant proportion of the mortality in diabetic patients seem to result from noncardiac causes.
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Mantero A, Gentile F, Alberti A, Bencini C, Bongarzoni A, Bragato R, Branzi G, Casazza F, Cialfi A, Dihel L, Giagnoni E, Heyman J, Lombardi L, Mattioli R, Mazzola AA, Montericcio V, Pepi M, Tusa M, Morabito A. [The "Appropriatezza ECO Milano" project. Assessment of appropriateness of indications, prescriptions and clinical utility of two-dimensional Doppler echocardiography among inpatients and outpatients of Milan, Italy]. G Ital Cardiol (Rome) 2008; 9:844-852. [PMID: 19119694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The value of echocardiography in the diagnosis and follow-up of most cardiovascular diseases is well established, even though the ever-increasing demand for the use of this technique is not always justifiable. The "Appropriatezza ECO Milano" project was developed among hospitals in Milan (Italy) to foster a rational use of echocardiography. The aim of this study was to evaluate and improve appropriateness of requests for two-dimensional color Doppler echocardiography, considering indications, prescription behaviors and clinical utility in both the outpatient and inpatient settings. METHODS Following several meetings, a consensus was reached whereby a multicenter, observational study would be undertaken. We assessed the value of each request in agreement with the 2003 American College of Cardiology/American Heart Association/American Society of Echocardiography guidelines. An ad hoc Microsoft Access database was developed to collect study data, which refer to May 2007. Eleven hospitals participated in the study. RESULTS 4130 echocardiographic examinations were considered (2300 performed in men and 1830 performed in women; mean age 64 +/- 16 years); 1701 examinations were performed in hospitalized patients and 2429 in outpatients. The incidence of pathological findings was higher in hospitalized patients (73%) than in outpatients (53%) (Pearson chi2 = 29, p<0.001). A higher additional clinical value was found in hospitalized vs non-hospitalized patients (48 vs. 35%, Pearson chi2 = 99; p <0.001). In both settings, the majority of echocardiographic examinations were requested by cardiologists (inpatients 36%, outpatients 54%). The most appropriate examinations were performed more frequently in class I or class IIA hospitalized patients (73%) than in outpatients (52%) (Pearson chi2 = 277, p<0.001). Furthermore, the least accurate the indication, the less the clinical utility found in examinations requested from hospitals and outpatient clinics (64 vs 61% in class I patients, Pearson chi2 = 413, p<0.001; 5 vs 11% in class III patients, Pearson chi2 = 584, p<0.001). Conclusions. Our data confirm an inadequate level of appropriateness of requests for two-dimensional color Doppler examinations in either inpatients or outpatients. After over 10 years of passively observing and recording this trend, a timely resolution of these issues is topical in order to improve the implementation of criteria and to guarantee cost-effective and high-quality cardiovascular care.
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Affiliation(s)
- Antonio Mantero
- U.O. di Cardiologia, Dipartimento Specialità Mediche, Azienda Ospedaliera-Polo Universitario San Paolo, Milano.
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Gasparini M, Regoli F, Ceriotti C, Galimberti P, Bragato R, De Vita S, Pini D, Andreuzzi B, Mangiavacchi M, Klersy C. Remission of left ventricular systolic dysfunction and of heart failure symptoms after cardiac resynchronization therapy: temporal pattern and clinical predictors. Am Heart J 2008; 155:507-14. [PMID: 18294488 DOI: 10.1016/j.ahj.2007.10.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of the study was to determine whether cardiac resynchronization therapy (CRT) may induce a heart failure (HF) remission phase (recovery to New York Heart Association functional class I-II and regression of left ventricular [LV] dysfunction: LV ejection fraction [EF] > or = 50%) and to define the incidence and predictors of such a process. METHODS Cardiac resynchronization therapy devices were successfully implanted in 520 consecutive HF patients from 1999 to 2006 (mean age 66 years, 82% male sex, New York Heart Association class > or = II, LVEF 28%, QRS 164 milliseconds, 6-minute hall walk distance 302 m) at our institution. Follow-up data were prospectively collected every 3 to 6 months. Continuous variables were stratified in tertiles. RESULTS Over a median follow-up of 28 months, 26% of patients achieved LV remission (rate: 16 per 100 person-years). At univariate analysis, female sex (P = .032), non-coronary artery disease (CAD) etiology (P < .001), mitral regurgitation < 2/4 (P = .022), higher EF tertile (P < .001), lower diameter and volume tertiles (both P < .001), previous conventional right ventricle pacing (P = .029), and post-CRT-paced QRS (P = .008) predicted remission. At multivariate analysis, non-CAD etiology, LVEF 30% to 35%, and LV end-diastolic volume < 180 mL were strongly associated with HF remission phase (all P < .001). Concomitance of these 3 factors yielded a significantly higher remission rate compared with either no or only 1 factor (respectively, 60 vs 7 and 11 per 100 person-years, P < .001). CONCLUSIONS Cardiac resynchronization therapy induces HF remission phase in 26% of patients, even after 3 years. Non-CAD etiology and moderately compromised LV function at baseline may easily predict this process.
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Gasparini M, Regoli F, Galimberti P, Ceriotti C, Bonadies M, Mangiavacchi M, Andreuzzi B, Bragato R, Pini D, Klersy C, Gronda E. Three Years of Cardiac Resynchronization Therapy: Could Superior Benefits be Obtained in Patients with Heart Failure and Narrow QRS? Pacing Clin Electro 2007; 30 Suppl 1:S34-9. [PMID: 17302713 DOI: 10.1111/j.1540-8159.2007.00600.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY To examine the long-term effects of cardiac resynchronization therapy (CRT) in patients presenting with heart failure (HF) and QRS </= 120 ms. METHODS This was a prospective, longitudinal study of 376 patients [mean age = 65 years, mean left ventricular (LV) ejection fraction (EF) = 29%, mean QRS duration = 165 ms, mean distance covered during a 6-minute hall walk (6-MHW) = 325 m], who underwent successful implantation of CRT systems. The QRS duration at baseline was </= 120 ms in 45 patients (12%) who were not pre-selected by echocardiographic criteria of dyssynchrony, and > 120 ms in the remaining 331 patients. The baseline characteristics of the 2 groups were similar. We evaluated indices of cardiac function, percentage of responders, and survival rates over a mean 28-month follow-up. RESULTS Both groups experienced similar long-term increases in 6-MHW, and decreases in New York Heart Association functional class and LV end-systolic volume (all comparisons P < 0.0001 in both groups). Time interaction of changes in LVEF and percentage of responders were significantly different (P = 0.03 and P = 0.004, respectively), in favor of the narrow QRS group, where the changes were sustained and persisted at 2 and 3 years. The long-term death rate from HF was lower in the group with narrow than in the group with wide QRS complex (P = 0.04; log-rank test). CONCLUSIONS CRT confers considerable long-term clinical, functional, and survival benefits in patients presenting with HF and narrow QRS, not preselected by echocardiographic criteria of dyssynchrony. Caution is advised before denying CRT to these patients on the basis of QRS width only.
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Facchini M, Sala L, Malfatto G, Bragato R, Redaelli G, Invitti C. Low-K+ dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiol 2006; 106:170-6. [PMID: 16321688 DOI: 10.1016/j.ijcard.2005.01.041] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Revised: 12/13/2004] [Accepted: 01/19/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND QT prolongation and ventricular arrhythmia have been proposed as the mechanism for sudden death in anorexia nervosa. The prevalence and the cause of QT prolongation remain controversial. OBJECTIVES 1) to evaluate ventricular repolarization in patients with anorexia; 2) to evaluate factors that may influence repolarization, with focus on electrolyte plasma levels and heart rate. METHODS 29 patients with anorexia, age 22 +/- 5 years, BMI 13.8 +/- 1.5 were compared to 14 control female subjects, age 23 +/- 2 years, BMI 20.7 +/- 1.1. QT interval and QT dispersion were measured. Whenever a low potassium (<3.5 mEq/l) was found, ECG was repeated after normalization of serum levels. Heart rate and its variability in the frequency domain (LF/HF ratio) were evaluated. RESULTS Three patients (10.3%) showed severe hypokalemia (K(+) levels <2.0 mEq/l). In 2 patients, QT was severely prolonged (QT(c) 600 and 670 msec) and in one case associated with ventricular arrhythmia. QT(c) after K(+) plasma levels normalization was 392 +/- 25 in anorexia vs. 407 +/- 19 msec in controls, p = 0.08. Heart rate was 55 +/- 11 in anorexia vs. 66 +/- 8 beats per minute (BPM) in controls, p = 0.002. The LF/HF ratio was 1.79 +/- 1.35 in anorexia and 3.66 +/- 2.64 in controls, p = 0.006. CONCLUSIONS QT interval is usually normal in patients with anorexia. QT prolongation and ventricular arrhythmia may develop in the setting of severe hypokalemia, exposing patients to high risk of sudden cardiac event. Resting heart rate is lower in anorexia than in controls with the spectral indices of sympatho-vagal balance indicating a prevalence of vagal activity.
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Affiliation(s)
- Mario Facchini
- Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano, Milano.
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Mangiavacchi M, Gasparini M, Faletra F, Klersy C, Morenghi E, Galimberti P, Genovese L, Regoli F, De Chiara F, Bragato R, Andreuzzi B, Pini D, Gronda E. Clinical predictors of marked improvement in left ventricular performance after cardiac resynchronization therapy in patients with chronic heart failure. Am Heart J 2006; 151:477.e1-477.e6. [PMID: 16442917 DOI: 10.1016/j.ahj.2005.08.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Accepted: 08/14/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have shown that cardiac resynchronization therapy (CRT) improves cardiac performance and decreases mortality and hospital admission rates. However, it is not yet clear which patients will benefit from the procedure the most. The purpose of the study was to identify the pre-implant characteristics that better predict which patients will have the best outcome after CRT. METHODS In this observational study, 156 patients were studied with echocardiography and a 6-minute walking test at baseline and 12 months after CRT. RESULTS After CRT, we observed an increase in left ventricular ejection fraction (+29.6%, P < .0001), a decrease in left ventricular end systolic volume (-26.4%, P < .0001), in the proportion of patients with grade 2-4 mitral regurgitation (from 47.1% to 34.0%, P = .002), and with NYHA functional class III-IV (from 83.2% to 11.6%, P < .0001), an increase in exercise tolerance (+31.1%, P < .0001). Sixty-two patients had a marked increase in left ventricular ejection fraction (> 10 units); the only independent predictor of a marked effect of CRT was the nonischemic etiology of heart failure. In patients with ischemic cardiomyopathy, the benefit on ejection fraction correlates inversely with the extension of the ischemic damage. CONCLUSIONS CRT improves left ventricular function and exercise tolerance in the long term. The nonischemic etiology of the cardiomyopathy is the only independent predictor of a marked effect of CRT; this is probably due to the absence of ischemic, nonviable scar tissue in these patients.
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Malfatto G, Sala L, Branzi G, Bragato R, Perego G, Leonetti G, Facchini M. Baseline sympatho-vagal balance and autonomic reactivity differ in heart failure of ischemic and idiopathic origin. Eur J Heart Fail 2004. [DOI: 10.1016/s1388-9842(00)80172-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- G. Malfatto
- Divisione di Cardiologia, Ospedale San Luca; Milano Italy
| | - L. Sala
- Divisione di Cardiologia, Ospedale San Luca; Milano Italy
| | - G. Branzi
- Divisione di Cardiologia, Ospedale San Luca; Milano Italy
| | - R. Bragato
- Divisione di Cardiologia, Ospedale San Luca; Milano Italy
| | - G.B. Perego
- Divisione di Cardiologia, Ospedale San Luca; Milano Italy
| | - G. Leonetti
- Divisione di Cardiologia, Ospedale San Luca; Milano Italy
| | - M. Facchini
- Divisione di Cardiologia, Ospedale San Luca; Milano Italy
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Affiliation(s)
- G. Malfatto
- Divisione di Cardiologia; Ospedale San Luca; Milano Italy
| | - S. Gritti
- Divisione di Cardiologia; Ospedale San Luca; Milano Italy
| | - G. Branzi
- Divisione di Cardiologia; Ospedale San Luca; Milano Italy
| | - R. Bragato
- Divisione di Cardiologia; Ospedale San Luca; Milano Italy
| | - G.B. Perego
- Divisione di Cardiologia; Ospedale San Luca; Milano Italy
| | - G. Leonetti
- Divisione di Cardiologia; Ospedale San Luca; Milano Italy
| | - M. Facchini
- Divisione di Cardiologia; Ospedale San Luca; Milano Italy
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Pincelli AI, Bragato R, Scacchi M, Branzi G, Osculati G, Viarengo R, Leonetti G, Cavagnini F. Three weekly injections (TWI) of low-dose growth hormone (GH) restore low normal circulating IGF-I concentrations and reverse cardiac abnormalities associated with adult onset GH deficiency (GHD). J Endocrinol Invest 2003; 26:420-8. [PMID: 12906369 DOI: 10.1007/bf03345197] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GH replacement therapy given 3 times weekly (TWI) and adjusted to allow serum IGF-I concentrations in the mid-normal range for sex and age has been shown to be as effective as the daily regimen in improving lipid profile, body composition, bone mass and turnover in adult GH deficient (GHD) patients. Only one study has investigated so far the short-term (6 months) effect of a fixed weight-based TWI dosing schedule on heart structure and function in childhood onset (CO) GHD patients, whereas such a schedule in adult onset (AO) GHD patients has not been studied as yet. Aim of this study was to investigate whether a 1-yr low-dose titrated TWI GH-replacement regimen aimed at achieving and maintaining IGF-I levels within the low normal limits for age and sex is able to affect cardiovascular and heart parameters in a group of AO GHD patients. Eight adult patients (4 women and 4 men, age 35.8 +/- 3.37 yr, body mass index, BMI, 28.7 +/- 2.62 kg/m2) with AO GHD were included in the study, along with 10 healthy subjects, matched for age, sex, BMI and physical activity (6 women and 4 men, age 35.2 +/- 4.05 yr, BMI 28.4 +/- 2.34 kg/m2). M- and B- mode ecocardiography and pulsed doppler examination of transmitral flow were performed in GHD patients at baseline and after 3 and 12 months of GH therapy (mean GH dose 6.7 +/- 0.8 microg/kg/day given thrice a week), while normal subjects were studied once. Treatment with GH for 1 yr induced a significant increase in left ventricular (LV) diastolic and systolic volumes (+11.1 and +16.5%, respectively). Systolic LV posterior wall thickness and LV mass were increased (+10.2 and +7.7%, respectively) by GH administration. Systemic vascular resistance was significantly decreased by 1-yr GH therapy (-13.8% after 1 yr), while stroke volume, cardiac output and cardiac index were increased (+9.4, +11.6 and + 11.9%, respectively). LV end-systolic stress was decreased at the end of GH therapy (-11.2%). E and A wave, significantly reduced at baseline, were increased by 1 yr of GH therapy (+23.3% and +28.1%, respectively); likewise, the abnormally high E peak deceleration time was partially reversed by GH administration (-10.7%). Our study, though conducted in a small sample size, demonstrates that a TWI GH treatment schedule is able to reverse the cardiovascular abnormalities in AO GHD patients and to improve body composition and lipid profile. The maintenance of circulating IGF-I concentrations within the low normal range allows to avoid most of the side-effects reported with higher GH doses while being cost-effective and improving the patient's compliance.
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Affiliation(s)
- A I Pincelli
- University of Milan, IRCCS San Luca Hospital, Italian Auxologic Institute, Milan, Italy
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Faletra F, La Marchesina U, Bragato R, Grimaldi A. [Mitral insufficiency]. Ital Heart J Suppl 2002; 3:486-94. [PMID: 12064187] [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: 02/25/2023]
Abstract
Over the past 15 years, outcome of patients with severe mitral insufficiency is significantly improved. This may be due to concomitant advances in many fields of medicine such as a more effective diagnosis and left ventricular function monitoring by means of echocardiography, development of useful guidelines and advances in valve reconstruction techniques. We will discuss some aspects of mitral anatomy, pathophysiology, echocardiographic diagnosis and the proper timing for surgical intervention.
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Affiliation(s)
- Francesco Faletra
- U.O. di Ecocardiografia, Istituto Clinico Humanitas, Via Manzoni, 56, 20089 Rozzano, MI.
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Malfatto G, Branzi G, Gritti S, Sala L, Bragato R, Perego GB, Leonetti G, Facchini M. Different baseline sympathovagal balance and cardiac autonomic responsiveness in ischemic and non-ischemic congestive heart failure. Eur J Heart Fail 2001; 3:197-202. [PMID: 11246057 DOI: 10.1016/s1388-9842(00)00139-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A profound autonomic unbalance is present in heart failure: its correlation with the etiology of the disease has never been investigated. AIMS We characterized the sympatho-vagal balance and autonomic responsiveness of 42 patients (21 with ischemic heart failure, 21 with idiopathic dilated cardiomyopathy). Patients had comparable NYHA class, ejection fraction, exercise pVO(2), exercise ventilatory response, incidence of beta-blocking treatment. None showed periodic breathing or nocturnal arterial desaturation. METHODS Heart rate variability was assessed in the time and frequency domain during: (1) 10 min of quiet supine resting and free breathing; (2) 10 min of regular breathing at a frequency of 20 acts/min (=parasympathetic stimulus); and (3) 10 min of active standing (=sympathetic stimulus). The ratio of the low- to high-frequency components of each autospectrum obtained in the frequency domain (LF/HF) was used as an index of sympathovagal balance. RESULTS Patients with ischemic heart failure had a greater baseline sympathetic activation (higher LF/HF) than those with idiopathic dilated cardiomyopathy, maintaining some parasympathetic responsiveness as well (reduced LF/HF with regular breathing). CONCLUSIONS There is a distinct autonomic control according to the etiology of heart failure, a finding that may help understanding its pathophysiology, and could be useful in the clinical management of patients.
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Affiliation(s)
- G Malfatto
- Divisione di Cardiologia, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Università di Milano, Milan, Italy.
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Malfatto G, Facchini M, Sala L, Bragato R, Branzi G, Leonetti G. Long-term lifestyle changes maintain the autonomic modulation induced by rehabilitation after myocardial infarction. Int J Cardiol 2000; 74:171-6. [PMID: 10962118 DOI: 10.1016/s0167-5273(00)00262-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The altered autonomic balance observed after myocardial infarction is shifted toward a higher parasympathetic tone by rehabilitation. This effect persists after 1 year, however we observed a discrete variability in the long-term sympathovagal balance among patients. We postulated that such variability derives from the disparate adherence of patients to lifestyle prescriptions regarding exercise continuance and smoking avoidance. To test this hypothesis, we reviewed the data of 40 patients, who completed with a favourable autonomic modulation the initial rehabilitation phase after myocardial infarction and underwent the annual follow-up. One year after infarction, 23 patients complied to the advice about regular exercise and smoking avoidance (adherent, Group 1); 17 did not (non-adherent, Group 2). Groups were similar for age, site of infarction, left ventricular function, stress test duration and therapy. The ratio LF/HF, derived from the power spectral density of RR intervals variability, was used as an index of the sympathovagal balance. It was obtained from 15 min of ECG at rest, assessed 1 month after MI (baseline), and repeated 3 months (rehabilitation) and 1 year (follow-up) afterwards. Rehabilitation increased parasympathetic tone in all patients, reducing LF/HF by 33%. At follow-up, this potentially favourable autonomic profile persisted only in Group 1 patients. In conclusion, after a first myocardial infarction, the persistence of the potentially beneficial effect of rehabilitation on the sympathovagal balance depends on the compliance to the lifestyle changes proposed during the initial phase.
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Affiliation(s)
- G Malfatto
- Divisione di Riabilitazione Cardiologica, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano IRCCS, via Spagnoletto, 3-20147, Milan, Italy.
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Facchini M, Malfatto G, Ciambellotti F, Riva B, Bragato R, Branzi G, Leonetti G. Markers of electrical instability in hypertensive patients with and without ventricular arrhythmias. Are they useful in identifying patients with different risk profiles? J Hypertens 2000; 18:763-8. [PMID: 10872562 DOI: 10.1097/00004872-200018060-00015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Markers of electrical instability of the ventricular myocardium, namely abnormal repolarization and late potentials, are frequently observed in patients with hypertension when both ventricular arrhythmias and left ventricular hypertrophy are present. This information cannot be extrapolated to the population of hypertensive patients with ventricular arrhythmias but without left ventricular hypertrophy. OBJECTIVE To evaluate QT duration, QT dispersion and the incidence of ventricular late potentials in patients with essential hypertension, already on anti-hypertensive therapy, both with and without non-sustained ventricular arrhythmia. DESIGN The study population consisted of 49 patients with essential hypertension who were compared to 89 control normotensive subjects both with and without frequent (> 30 per h) ventricular ectopic beats (VPBs). Patients were divided into four groups: (1) hypertensive patients without VPBs (H, n = 19), (2) hypertensive patients with VPBs (HA, n = 30), (3) normotensive subjects without VPBs (C, n = 28), and (4) normotensive subjects with VPBs (CA, n=61). METHODS Echocardiographic parameters, QT interval, QT dispersion and signal-averaged ECG were evaluated without withdrawing anti-hypertensive drugs. RESULTS In no case was left ventricular hypertrophy documented. The number of VPBs during 24 h Holter recording (median 11 343 versus 7617) and the incidence of repetitive VPBs (37 versus 46% of patients) were similar in the two groups of patients (HA versus CA). Signal-averaged ECG parameters were normal and not different between the four groups. QT interval was longer in hypertensive patients compared to controls irrespective of the presence of VPBs. QT dispersion was slightly greater in subjects with VPBs, both hypertensive and normotensive, compared to subjects without arrhythmias. CONCLUSIONS In patients with hypertension well-controlled by drug therapy and without left ventricular hypertrophy, frequent VPBs are not associated with markers indicating an electrophysiological substrate for re-entrant arrhythmias. However, QT prolongation suggests the persistence of a higher risk of cardiovascular mortality that is independent of the presence of VPBs.
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Affiliation(s)
- M Facchini
- Department of Cardiology, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano (IRCCS), Milan, Italy.
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Malfatto G, Ciambellotti F, Chianca R, Bragato R, Branzi G, Leonetti G, Facchini M. Dispersion of the QT Interval in Subjects with Frequent Nonsustained Ventricular Arrhythmias and No Underlying Heart Disease: Arrhythmogenic Substrate or Mechanoelectrical Feedback of Arrhythmias? Ann Noninvasive Electrocardiol 2000. [DOI: 10.1111/j.1542-474x.2000.tb00376.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Malfatto G, Facchini M, Sala L, Branzi G, Bragato R, Leonetti G. Relationship between baseline sympatho-vagal balance and the autonomic response to cardiac rehabilitation after a first uncomplicated myocardial infarction. Ital Heart J 2000; 1:226-32. [PMID: 10806991] [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: 02/16/2023]
Abstract
BACKGROUND After a first uncomplicated myocardial infarction, cardiac rehabilitation increases the parasympathetic tone, in a direction linked to a reduced risk of sudden cardiac death. This change in sympatho-vagal balance may be related to other clinical variables. The aim of this study was to define the factors implicated in determining the autonomic response to cardiovascular rehabilitation after myocardial infarction. METHODS In 55 patients (39-80 years) we evaluated the modulation of the autonomic profile induced by 8 weeks of rehabilitation: we analyzed the changes in pNN50 derived from time-domain analysis (deltapNN50) and in the low frequency/high frequency (LF/HF) ratio derived from autoregressive power spectral analysis (deltaLF/HF). A control group of 15 patients not undergoing rehabilitation was also studied. Variables considered at 4 weeks postinfarction and related to deltapNN50 and deltaLF/HF ratio were: age, site of myocardial infarction, previous thrombolysis, ejection fraction, stress test duration, baseline LF/HF ratio. RESULTS Patients not undergoing rehabilitation did not change their autonomic profile. On the contrary, rehabilitation induced a higher vagal tone (pNN50 from 6.5 +/- 1.5 to 16.2 +/- 3.1; LF/HF ratio from 8.3 +/- 5.2 to 5.1 +/- 2.9, p < 0.05). Eleven patients (20%) had baseline LF/HF ratio exceeding the mean value by 1.5 SD (19.4 +/- 1.4): in this subgroup, pNN50 was very low. In these patients, rehabilitation increased pNN50 and decreased LF/HF ratio. Indeed, both deltapNN50 and deltaLF/HF ratio were significantly related to their baseline values (p < 0.001), even considering thrombolysis, site of myocardial infarction, age, and beta-blocker therapy. CONCLUSIONS After a first uncomplicated myocardial infarction, sympatho-vagal balance may be very disturbed in some patients, despite a preserved ventricular function, good exercise capability and beta-blockers. These patients should be encouraged to undergo rehabilitation, since the significant improvement in the parasympathetic tone may protect them against subsequent arrhythmic events.
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Affiliation(s)
- G Malfatto
- Division of Cardiology, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano, IRRCS, University of Milan.
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Facchini M, Malfatto G, Ciambellotti F, Chianca R, Bragato R, Branzi G, Leonetti G. Increased left ventricular dimensions in patients with frequent nonsustained ventricular arrhythmia and no evidence of underlying heart disease. J Cardiovasc Electrophysiol 1999; 10:1433-8. [PMID: 10571363 DOI: 10.1111/j.1540-8167.1999.tb00202.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To test the hypothesis that frequent nonsustained ventricular premature beats (VPBs) in patients without underlying heart disease are the first marker of mild systolic dysfunction of the left ventricle, we evaluated whether a subclinical abnormality of left ventricular function and/or an intraventricular conduction defect was present at the first clinical documentation of the arrhythmia. METHODS AND RESULTS We compared 57 patients (mean age 46 +/- 14 years) with > 30 VPBs/hour and no heart disease (A) to 32 healthy volunteers (mean age 42 +/- 12 years) without arrhythmia (B). Left ventricular echocardiographic parameters and signal-averaged ECG were evaluated. Filtered QRS duration (98 +/- 10 msec in A vs 98 +/- 7 msec in B) was similar in the two groups. End-diastolic left ventricular diameter (EDLVD) was 50 +/- 6 mm in A versus 47 +/- 3 mm in B (P < 0.005); 15 patients (26%) and none of the controls had EDLVD > or = 55 mm (P < 0.005). Filtered QRS interval was longer in the subgroup of patients (n = 15) with increased EDLVD (> or = 55 mm) compared with the subgroup (n = 42) with EDLVD < 55 mm (106 +/- 9 msec vs 95 +/- 9 msec; P < 0.001) and was related to greater left ventricular mass. CONCLUSION We documented a subclinical but significant increase of left ventricular dimensions that suggests that frequent VPBs may be an initial marker of mild systolic dysfunction of the left ventricle. However, an effect of VPBs per se in modifying left ventricular dimensions cannot be excluded.
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Affiliation(s)
- M Facchini
- Department of Cardiology, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano (IRCCS), Italy.
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Malfatto G, Facchini M, Sala L, Branzi G, Bragato R, Leonetti G. Effects of cardiac rehabilitation and beta-blocker therapy on heart rate variability after first acute myocardial infarction. Am J Cardiol 1998; 81:834-40. [PMID: 9555771 DOI: 10.1016/s0002-9149(98)00021-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
After acute myocardial infarction (AMI), rehabilitation with physical training increases parasympathetic tone. It is unknown whether such a favorable effect of exercise on the sympathovagal balance interacts with effects of other widespread therapies, such as beta blockers. In 53 patients after a first, uncomplicated AMI, we studied the combined short- and long-term influence on heart rate variability (HRV) of rehabilitation and beta blockade. Patients were divided into 3 groups: group 1 (n = 19) underwent rehabilitation with physical training; group 2 (n = 20) was taking beta blockers and underwent rehabilitation; group 3 (n = 14) was taking beta blockers and did not enter the rehabilitation program for logistic reasons. Patients were similar as to age, site of infarction, ejection fraction, left ventricular diameter, and baseline stress test duration. Measures of HRV (obtained from a 15-minute resting electrocardiogram) were the standard deviation of the mean RR interval (RRSD), the mean squared successive differences (MSSD), the percent of RR intervals differing >50 ms from the preceding one (pNN50), the low-(LF) and high-(HF) frequency components of the autoregressive power spectrum of the RR intervals and their ratio (LF/HF). Four weeks after AMI, there was less sympathetic predominance in groups 2 and 3 (i.e., patients taking beta blockers [p <0.05]). Rehabilitation modified HRV in groups 1 and 2 (p <0.05), with signs of increased parasympathetic tone (group 1: MSSD +25%, pNN50 +69%, LF/HF -40%; group 2: MSSD +41%, pNN50 +48%, LF/HF -39%). These changes persisted in the long term. In group 3, HRV was unchanged over time. Hence, after AMI, the effects of rehabilitation and beta blockers on HRV are not redundant: their association induces a more favorable sympathovagal balance, accelerating the recovery of a normal autonomic profile.
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Affiliation(s)
- G Malfatto
- Divisione di Riabilitazione Cardiologica, Istituto Scientifico Ospedale San Luca, Universita' degli Studi di Milano, Milan, Italy
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Sartorio A, Ferrero S, Conti A, Bragato R, Malfatto G, Leonetti G, Faglia G. Adults with childhood-onset growth hormone deficiency: effects of growth hormone treatment on cardiac structure. J Intern Med 1997; 241:515-20. [PMID: 10497628 DOI: 10.1111/j.1365-2796.1997.tb00010.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effects of growth hormone deficiency (GHD) and of growth hormone (GH) therapy on cardiac structure in adults with childhood-onset GHD. SETTING Out-patient clinic in the Italian Institute for Auxology, Milan. SUBJECTS Eight adults with childhood-onset GHD and eight healthy controls, matched for sex, age, exercise and body mass index. INTERVENTIONS Recombinant GH (Saizen Serono, Italy), administered in a conventional dose of 0.5 IU kg-1 week-1 for 6 months. MAIN OUTCOME MEASURES Cardiac structure parameters, evaluated by two-dimensional, M-mode and Doppler echocardiograms, and stress test, by means of a modified Bruce protocol with a bicycle ergometer, were determined before and after 6 months GH therapy. RESULTS Before treatment, mean (+/- SE) intraventricular septal thickness (IVST: 7.1 +/- 0.2 mm), LV posterior wall thickness (LVPT: 5.2 +/- 0.1 mm), LV mass (LVM: 94.6 +/- 5.0 g), LV mass index (LVM/body surface area, LVMI: 65.1 +/- 3.0 g m-2) and left ventricular end-diastolic diameter (LVED: 41.4 +/- 0.6 mm) of patients were significantly lower (P < 0.01) than in controls, whilst LV end-systolic diameter (LVES) of patients (25.5 +/- 0.7 mm) was similar to controls (27.5 +/- 0.7). GH treatment significantly (P < 0.01) increased LVPT (6.8 +/- 0.2 mm), LVM (111.6 +/- 4.6 g) and LVMI (80.5 +/- 3.5 g m-2); no significant changes were observed in LVED, LVES and IVST values. The stress test showed a significant improvement of cardiac performance, as demonstrated by the reduction of blood pressure x heart rate product at the same workload (basal: 32,722.5 +/- 897.4 vs. after: 25,574.6 +/- 439.7). CONCLUSIONS GH plays a role in the maintenance of a normal cardiac structure in adulthood. The present study suggests that GH treatment might be able to improve the cardiac structure of patients with childhood-onset GHD.
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Affiliation(s)
- A Sartorio
- Laboratorio Sperimentale di Ricerche Endocrinologiche, Istituto Auxologico Italiano, IRCCS, Milano, Italy
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Malfatto G, Facchini M, Bragato R, Branzi G, Sala L, Leonetti G. Short and long term effects of exercise training on the tonic autonomic modulation of heart rate variability after myocardial infarction. Eur Heart J 1996; 17:532-8. [PMID: 8733085 DOI: 10.1093/oxfordjournals.eurheartj.a014905] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We studied the effects of cardiac rehabilitation on the sympathovagal control of heart rate variability in 30 patients after a first, uncomplicated myocardial infarction. Twenty-two patients completed 8 weeks of endurance training (trained), while eight decided not to engage in the rehabilitation programme for logistical reasons, and were taken as untrained controls. Age, site of infarction, ejection fraction, ventricular diameter and stress test duration were similar in the two groups at baseline. Heart rate variability was evaluated 4 weeks after infarction before starting rehabilitation, and repeated 8 weeks and one year later in both trained and untrained patients. Measures of heart rate variability, obtained from both time- and frequency-domain analysis of a 15 min ECG recording in resting conditions, were as follows: mean RR interval and its standard deviation (RRSD), the mean square successive differences (MSSD), the percent of RR intervals differing > 50 ms from the preceding RR (pNN50), the low and high frequency components of the autoregressive power spectrum of the RR intervals and their ratio (LF/HF). At baseline, heart rate variability was similar in trained and untrained patients. In the short term (8 weeks after infarction), training increased RRSD by 25% (P < 0.01), MSSD by 69% (P < 0.01), pNN50 by 120% (P < 0.01), and reduced LF/HF ratio by 30% (P < 0.01). The effects persisted after one year in trained patients. In untrained patients, the autonomic control of heart rate variability did not change 8 weeks after myocardial infarction and was only slightly modified by time. Thus, exercise training, performed for 8 weeks after a myocardial infarction, modifies the sympathovagal control of heart rate variability toward a persistent increase in parasympathetic tone, known to be associated with a better prognosis. This may partly account for the favourable outcome of patients who undergo rehabilitation.
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Affiliation(s)
- G Malfatto
- Divisione di Riabilitazione Cardiologica, Istituto Scientifico Ospedale San Luca, Centro Auxologico Italiano IRCCS, Italy
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Cuspidi C, Boselli L, Bragato R, Sampieri L, Lonati L, Bocciolone M, Leonetti G. [Cardiac and vascular hypertrophy in juvenile borderline hypertension: echocardiographic and ultrasonographic study]. G Ital Cardiol 1993; 23:575-81. [PMID: 8405819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND High resolution ultrasonography is a noninvasive technique that allows us to investigate the cardiovascular system, in particular the wall thickness and the lumen diameter of the arteries, with accuracy and reproducibility. METHODS We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 20 borderline hypertensive (age 24 +/- 4 years) and in 20 normotensive subjects (age 24 +/- 4 years), as a control group. Both carotid axes were scanned from different views (anterior, lateral, posterior) on a transversal and longitudinal section using a high resolution steerable linear array of 5 MHz. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. RESULTS In borderline patients blood pressure (147.8 +/- 10.5/90.7 +/- 6.6 mmHg) and left ventricular mass index (102.5 +/- 15.3 g/m2) were significantly higher than in normotensive subjects (blood pressure 120.5 +/- 11.5/78.0 +/- 5.4 mm Hg; left ventricular mass 90.5 +/- 14.3 g/m2). The intima-media thickness of both the CCA and BIF was significantly higher in borderlines than in normotensives (CCA 0.6 +/- 0.08 vs 0.4 +/- 0.05 mm, p < 0.001; BIF 0.7 +/- 0.08 vs 0.5 +/- 0.08, p < 0.001). In the whole population there was a statistically significant correlation between the carotid wall thickness and the left ventricular mass. CONCLUSIONS Our data show that ultrasonography provides direct evidence that in young borderline hypertensives the increased left ventricular mass is associated with vascular hypertrophy.
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Affiliation(s)
- C Cuspidi
- Istituto di Clinica Medica e Terapia Medica, Università di Milano
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Leonetti G, Sampieri L, Bragato R, Comerio G. Effect of verapamil on atherosclerosis. Drugs 1993; 46 Suppl 2:75-81. [PMID: 7512486 DOI: 10.2165/00003495-199300462-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Whether antihypertensive agents exert an antiatherosclerotic effect by blood pressure reduction or independently of their antihypertensive effect is clinically relevant. Animal studies have generally shown that the calcium antagonist verapamil has a preventive rather than a therapeutic antiatherosclerotic effect, which is independent of its antihypertensive effect. However, doses used in animal studies were much higher than those administered to humans and, in animals, the time of administration of verapamil coincided with the application of atherogenic stimulus. Human studies have given controversial results. Verapamil appears to effectively reduce the restenosis rate after coronary angioplasty. However, in patients with coronary stenosis who were undergoing bypass surgery, results were conflicting: a retrospective study provided positive results, while a prospective study gave negative results. An ongoing study investigating the effect of verapamil on the carotid arteries of hypertensive patients could help clarify the relationship between blood pressure reduction and the progression, regression or development of carotid lesions.
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Affiliation(s)
- G Leonetti
- Ospedale S. Luca, Centro Auxologico Italiano, Milan
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Cuspidi C, Bragato R, Boselli L, Lonati L, Bocciolone M, Sampieri L, Leonetti G. [Ultrasonographic evaluation of cardiac and vascular hypertrophy in patients with essential hypertension]. G Ital Cardiol 1992; 22:405-11. [PMID: 1426782] [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: 12/27/2022]
Abstract
High resolution ultrasonography allows the accurate and reproducible measurement of thickness and lumen diameter of carotid arteries. We investigated Common carotid (CCA) and bifurcation intima-media thickness in 40 hypertensive patients, 20 without left ventricular hypertrophy (LVH) (age 42 +/- 10 years) and 20 with LVH (age 44 +/- 12 years), all free from other important cardiovascular risk factors. Both carotid axes were scanned from different views (anterior, lateral, posterior) on traversal and longitudinal section, using a high resolution steerable (HRS) 5.0 MHz linear array. Carotid diameter and thickness from longitudinal section were measured. CCA parameters were taken 20 mm caudally to flow divider. Using the B-mode as a guide we assessed LVH presence with M-mode technique when left ventricular mass index (LVMI) > or = 135 g/m2 for men and > or = 110 g/m2 for women. In hypertensive patients with LVH, left ventricular mass was significantly higher than in those without LVH (156 +/- 38 vs 98 +/- 10 g/m2, p < 0.01). Even blood pressure was significantly higher in hypertrophic group (172 +/- 21/108 +/- 9 vs 158 +/- 11/99 +/- 12 mmHg, p < 0.01), while there was no difference in serum glycemia, triglycerides, total and fractioned cholesterol levels. The intima-media thickness scanned in both CCA and bifurcation resulted significantly higher in hypertensives with LVH (CCA: 0.85 +/- 0.02 mm vs 0.65 +/- 0.02 mm; BIF: 0.93 +/- 0.04 mm vs 0.70 +/- 0.03 mm, p < 0.01). We also noticed a statistically significant correlation between carotid wall thickness and left ventricular mass index.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Cuspidi
- Istituto di Clinica Medica Generale e Centro di Fisiologia Clinica e Ipertensione, Università e Ospedale Maggiore, Milano
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Cuspidi C, Boselli L, Bragato R, Lonati L, Sampieri L, Bocciolone M, Leonetti G, Zanchetti A. Echocardiographic and ultrasonographic evaluation of cardiac and vascular hypertrophy in patients with essential hypertension. Cardiology 1992; 80:305-11. [PMID: 1451117 DOI: 10.1159/000175019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
High-resolution ultrasonography is a noninvasive technique that allows to investigate the cardiovascular system, in particular the wall thickness and the lumen diameter of the arteries with accuracy and reproducibility. We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 40 patients with essential hypertension, 20 of them with left ventricular hypertrophy (LVH; age 42 +/- 10 years) and 20 without LVH (age 44 +/- 12 years); no other major cardiovascular risk factor was present in all the patients. Both carotid axes have been scanned from different views (anterior, lateral, posterior) on a transversal and longitudinal section using a high-resolution steerable linear array of 5.0 MHz. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. In patients with LVH, blood pressure (172 +/- 21/108 +/- 9 mm Hg) and left ventricular mass index (156 +/- 38 g/m2) were significantly (p < 0.01) higher than in patients without LVH (blood pressure: 158 +/- 11/99 +/- 12 mm Hg; left ventricular mass index: 98 +/- 10 g/m2), while there was no difference in serum glycemia, triglycerides, total and fractioned cholesterol levels. The intima-media thickness of both the CCA and BIF was significantly higher in the hypertensives with LVH (CCA: 0.85 +/- 0.02 vs. 0.65 +/- 0.02 mm; BIF: 0.93 +/- 0.04 vs. 0.70 +/- 0.03 mm, p < 0.01). There was a statistically significant correlation between the carotid wall thickness and the left ventricular mass index.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Cuspidi
- Istituto di Clinica Medica, Università e Ospedale Maggiore, Milano, Italia
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45
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Cuspidi C, Sampieri L, Boselli L, Bragato R, Lonati L, Bocciolone M, Leonetti G, Zanchetti A. Effect of acute and chronic administration of verapamil on cardiac structure and function in essential hypertension without left ventricular hypertrophy. J Hypertens Suppl 1991; 9:S402-3. [PMID: 1819005] [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: 12/28/2022]
Affiliation(s)
- C Cuspidi
- Istituto di Clinica Medica Generale e Terapia Medica, University of Milan, Italy
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46
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Cuspidi C, Sampieri L, Boselli L, Bragato R, Bocciolone M, Lonati L, Leonetti G. [Effects of acute and chronic administration of verapamil on the anatomy and function of the left ventricle in essential hypertensive patients ]. G Ital Cardiol 1991; 21:493-500. [PMID: 1936753] [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: 12/29/2022]
Abstract
The aim of this study was to analyze the acute and chronic effects of oral verapamil on diastolic function indices, derived from Doppler echocardiography and left ventricular (LV) dimensions and mass, assessed by M-mode echocardiography, in hypertensive patients (pts). Twelve essential hypertensive pts without LV hypertrophy were studied in basal conditions and 1) after a single oral administration of verapamil 160 mg and placebo, in double blind protocol and 2) over chronic treatment (six months) of verapamil 240 mg/day. At baseline the ratio between early and atrial-induced transmitral velocities (E/A ratio) was lower in pts than in 12 age-matched normal subjects (1.0 +/- 0.3 vs 1.5 +/- 0.3, p less than 0.01). Acute verapamil administration significantly decreased arterial blood pressure (162 +/- 26/101 +/- 15 to 142 +/- 12/88 +/- 7 mmHg, p less than 0.01) after two hours and increased the E/A ratio to 1.26 +/- 0.3 (p less than 0.05) after three hours. No change in ventricular dimensions or heart rate was observed. After chronic therapy we found a further increase in the E/A ratio (1.49 +/- 0.3, p less than 0.01) in 10 responder pts. The LV mass index, which was higher than in normal subjects before the treatment (118 +/- 16 vs 91 +/- 11 g/m2, p less than 0.01), was significantly reduced (100 +/- 17 g/m2, p less than 0.05 vs basal, ns vs normal subjects). Our results demonstrate that acute administration of verapamil only partially improves the abnormal indices of diastolic function in hypertensive pts, whereas chronic treatment, by reducing left ventricular mass indices and blood pressure to normal values, can completely normalize the indices of LV diastolic filling.
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Affiliation(s)
- C Cuspidi
- Istituto di Clinica Medica Generale e Terapia Medica Università di Milano
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47
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Cuspidi C, Sampieri L, Angioni L, Boselli L, Bragato R, Leonetti G, Zanchetti A. Effects of long-term blood pressure control on left and right ventricular structure and function in hypertensive patients. J Cardiovasc Pharmacol 1991; 17 Suppl 2:S157-8. [PMID: 1715470 DOI: 10.1097/00005344-199117002-00039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The functional and anatomical abnormalities of the right ventricle may occur in hypertensive patients with left ventricular hypertrophy (LVH). The present study was designed to assess the functional and structural changes in both left and right ventricles induced by chronic antihypertensive therapy. Doppler and standard echocardiography were performed in 10 hypertensive patients with LVH before and after 1 year of treatment with captopril alone (5 patients) or captopril plus nifedipine (5 patients). We found that the left ventricular mass index and right ventricular thickness were significantly reduced in all patients when compared with pretreatment values. Furthermore, the Doppler-derived diastolic filling indexes show a significant improvement of both ventricular chambers. Our data suggest that anatomical and functional changes induced by therapy in hypertensive patients are not limited to the left ventricle but also involve the right ventricle.
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Affiliation(s)
- C Cuspidi
- Istituto di Clinica Medica Generale e Terapia Medica, Università di Milano, Italy
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48
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Cuspidi C, Sampieri L, Boselli L, Angioni L, Bragato R, Leonetti G, Zanchetti A. Left ventricular diastolic function in athletes and borderline hypertensives with mild cardiac hypertrophy. Cardiology 1991; 78:278-81. [PMID: 1831068 DOI: 10.1159/000174794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of this study was to evaluate the diastolic function in athletes and in young borderline hypertensives with mild left ventricular hypertrophy. Left ventricular filling was assessed by echo Doppler measurement of transmitral flow velocity in 18 soccer players (age 22 +/- 4 years, left ventricular mass index, LVMI 136 +/- 12 g/m2), in 15 borderline hypertensives (age 21 +/- 3 years, LVMI 137 +/- 9 g/m2), and 20 normotensive subjects (age 22 +/- 4 years, LVMI 93 +/- 10 g/m2) as reference group. We found that left ventricular filling profile was similar in borderline hypertensives, in athletes and in normotensive subjects. These findings suggest that, at least in the early stage, mild cardiac hypertrophy secondary to borderline blood pressure elevation is characterized by indexes of diastolic function not different from those found in athletes with physiological hypertrophy.
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Affiliation(s)
- C Cuspidi
- Istituto di Clinica Medica Generale e Terapia Medica, Università di Milano, Italia
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49
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Cuspidi C, Sampieri L, Boselli L, Bragato R, Lonati L, Bocciolone M, Leonetti G, Zanchetti A. Cardiac structure and function before and after acute and chronic verapamil administration in hypertensive patients. Cardiology 1991; 79:180-7. [PMID: 1837496 DOI: 10.1159/000174878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of this study has been to analyze the acute and chronic effects of oral verapamil on diastolic function indices, derived from Doppler echocardiography, and left-ventricular (LV) dimensions and mass, assessed by M-mode echocardiography, in hypertensive patients without LV hypertrophy. 12 patients with essential hypertension were studied in basal conditions and (1) after a single oral administration of verapamil 160 mg and placebo in a double-blind protocol and (2) over chronic treatment (12 months) with verapamil 240 mg/day. At baseline, the ratio between early and atrial-induced transmitral velocities (E/A ratio) was lower in patients than in 12 age-matched normal subjects (1.08 +/- 0.2 vs. 1.51 +/- 0.3, p less than 0.01). Acute verapamil administration significantly decreased arterial blood pressure (162 +/- 26/101 +/- 8 to 142 +/- 12/88 +/- 7 mm Hg, p less than 0.01 after 2 h) and increased the E/A ratio to 1.26 +/- 0.3 (p less than 0.05) after 3 h. No change in ventricular dimensions and heart rate was observed. After chronic therapy, we found a further increase in the E/A ratio in 10 responder patients (1.49 +/- 0.3, p less than 0.01). The LV mass index, that was higher than in normal subjects before the treatment (118 +/- 16 vs. 91 +/- 11 g/m2, p less than 0.01), was significantly reduced (100 +/- 17 g/m2, p less than 0.05 vs. basal, nonsignificant vs. normal subjects). Our results demonstrate that acute administration of verapamil only partially improves the abnormal indices of diastolic function in hypertensive patients, whereas chronic treatment, by reducing LV mass indices and blood pressure to normal values, can completely normalize the indices of LV diastolic filling.
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Affiliation(s)
- C Cuspidi
- Istituto di Clinica Medica Generale e Terapia Medica, Università di Milano, Italia
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Cuspidi C, Sampieri L, Boselli L, Angioni L, Bragato R, Leonetti G. [Morphofunctional characteristics of the left ventricle in arterial hypertension: echocardiographic and Doppler study]. G Ital Cardiol 1990; 20:300-8. [PMID: 2142660] [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: 12/30/2022]
Abstract
The role of arterial hypertension in the development of left ventricular hypertrophy is well documented; in contrast, the characteristics of the right ventricle in this condition are poorly defined. To investigate whether structural and functional changes of the right ventricle are associated with systemic hypertension, we studied a total of 105 patients using M-mode, 2D and pulsed-Doppler echocardiography. Of these, 31 were hypertensive patients with left ventricular hypertrophy (III), 42 were hypertensives without left ventricular hypertrophy (II) and 32 were normotensive controls (I). Right ventricular anterior wall thickness was measured from the parasternal window, in long axis. The following left and right ventricular filling parameters were evaluated using Doppler mitral and tricuspid flow analysis: the early (E) and late (A) peak velocity, the ratio E/A. Our results show that: right ventricular anterior thickness was 5.7 +/- 0.9 mm in III, 4.3 +/- 0.8 in II and 3.7 +/- 0.8 in I (p less than 0.05 II vs I, p less than 0.01 III vs II and I). There is a significant correlation between right and left ventricular wall thickness in the hypertensive population (r = 0.75, p less than 0.01). Left ventricular filling shows a progressive reduction in E and an increase in A with a progressive reduction in the E/A ratio from 1.47 in I to 1.31 in II and 0.78 in III. Similarly E/A ratio for right ventricular filling decreases from 1.70 in I, 1.32 in II and 0.92 in III.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C Cuspidi
- Istituto di Clinica Medica Generale e Terapia Medica, Università di Milano
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