1
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Ussia GP, Mangieri A, Cammalleri V, Sarkar K, Regazzoli D, Cozzi O, Gitto M, Francone M, Fumero A, Torracca L, Bragato RM, Civilini E, Reimers B, Colombo A. 6 Months' Follow-Up of the First-in-Man Implantation of a Novel Tricuspid Flow Optimizer. JACC Cardiovasc Interv 2024:S1936-8798(24)00526-0. [PMID: 38639687 DOI: 10.1016/j.jcin.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Gian Paolo Ussia
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Antonio Mangieri
- Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Valeria Cammalleri
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Kunal Sarkar
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | | | - Ottavia Cozzi
- Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mauro Gitto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Milan, Italy
| | - Marco Francone
- Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Milan, Italy
| | - Andrea Fumero
- Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lucia Torracca
- Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Renato M Bragato
- Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Efrem Civilini
- Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Milan, Italy
| | - Bernhard Reimers
- Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antonio Colombo
- Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Milan, Italy
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2
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Mangieri A, Cannata F, Cozzi O, Monti L, Regazzoli D, Guetta V, Fumero A, Bragato RM, Brizzi S, Reimers B, Colombo A. A Fully Percutaneous Transeptal Transcatheter Mitral Valve Replacement With a Novel Device. JACC Cardiovasc Interv 2023; 16:2050-2052. [PMID: 37191607 DOI: 10.1016/j.jcin.2023.04.040] [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: 03/28/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Francesco Cannata
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ottavia Cozzi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lorenzo Monti
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Victor Guetta
- Heart Center, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - Andrea Fumero
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Renato M Bragato
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Brizzi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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3
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Cannata F, Pinto G, Chiarito M, Maurina M, Condello F, Bombace S, Villaschi A, Novelli L, Stankowski K, Liccardo G, Gasparini G, Donia D, Celata A, My I, Kallikourdis M, Figliozzi S, Mantovani R, Fazzari F, Bragato RM, Condorelli G, Stefanini GG. Long-term prognostic impact of subclinical myocardial dysfunction in patients recovered from COVID-19. Echocardiography 2023. [PMID: 37100745 DOI: 10.1111/echo.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Cardiovascular sequelae may occur in patients recovered from coronavirus disease 2019 (COVID-19). Recent studies have detected a considerable incidence of subclinical myocardial dysfunction-assessed with speckle-tracking echocardiography-and of long-COVID symptoms in these patients. This study aimed to define the long-term prognostic role of subclinical myocardial dysfunction and long-COVID condition in patients recovered from COVID-19 pneumonia. METHODS We prospectively followed up 110 patients hospitalized at our institution due to COVID-19 pneumonia in April 2020 and then recovered from SARS-CoV-2 infection. A 7-month clinical and echocardiographic evaluation was performed, followed by a 21-month clinical follow-up. The primary outcome was major adverse cardiovascular events (MACE), a composite of myocardial infarction, stroke, heart failure hospitalization, and all-cause mortality. RESULTS A subclinical myocardial dysfunction-defined as an impairment of left ventricular global longitudinal strain (≥-18%)-was identified at a 7-month follow-up in 37 patients (34%), was associated with an increased risk of long-term MACE with a good discriminative power (area under the curve: .73) and resulted in a strong independent predictor of extended MACE in multivariate regression analyses. Long-COVID condition was not associated with a worse long-term prognosis, instead. CONCLUSIONS In patients recovered from COVID-19 pneumonia, a subclinical myocardial dysfunction is present in one-third of the whole population at 7-month follow-up and is associated with a higher risk of MACE at long-term follow-up. Speckle-tracking echocardiography is a promising tool to optimize the risk-stratification in patients recovered from COVID-19 pneumonia, while the definition of a long-COVID condition has no prognostic relevance.
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Affiliation(s)
- Francesco Cannata
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Pinto
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mauro Chiarito
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Matteo Maurina
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesco Condello
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Sara Bombace
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Alessandro Villaschi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Laura Novelli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Kamil Stankowski
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gaetano Liccardo
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gaia Gasparini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Dario Donia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Anastasia Celata
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ilaria My
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Cardiology, Universitäres Herzzentrum, Hamburg, Germany
| | - Marinos Kallikourdis
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | - Fabio Fazzari
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Peri Operative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Gianluigi Condorelli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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4
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Cannata F, Chiarito M, Pinto G, Villaschi A, Sanz-Sánchez J, Fazzari F, Regazzoli D, Mangieri A, Bragato RM, Colombo A, Reimers B, Condorelli G, Stefanini GG. Transcatheter aortic valve replacement in aortic stenosis and cardiac amyloidosis: a systematic review and meta-analysis. ESC Heart Fail 2022; 9:3188-3197. [PMID: 35770333 DOI: 10.1002/ehf2.13876] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/03/2021] [Accepted: 02/24/2022] [Indexed: 01/15/2023] Open
Abstract
AIMS Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical diseases of the elderly. Up to 16% of older adults with severe AS referred to transcatheter aortic valve replacement (TAVR) have a concomitant diagnosis of CA. CA-AS population suffers from reduced functional capacity and worse prognosis than AS patients. As the prognostic impact of TAVR in patients with CA-AS has been historically questioned and in light of recently published evidence, we aim to provide a comprehensive synthesis of the efficacy and safety of TAVR in CA-AS patients. METHODS AND RESULTS We performed a systematic review and meta-analysis of studies: (i) evaluating mortality with TAVR as compared with medical therapy in CA-AS patients and (ii) reporting complications and clinical outcomes of TAVR in CA-AS patients as compared with patients with AS alone. A total of seven observational studies were identified: four reported mortality with TAVR, and four reported complications and clinical outcomes after TAVR of patients with CA-AS compared with AS alone patients. In patients with CA-AS, the risk of mortality was lower with TAVR (n = 44) as compared with medical therapy (n = 36) [odds ratio (OR) 0.23, 95% confidence interval (CI) 0.07-0.73, I2 = 0%, P = 0.001, number needed to treat = 3]. The safety profile of TAVR seems to be similar in patients with CA-AS (n = 75) as compared with those with AS alone (n = 536), with comparable risks of stroke, vascular complications, life-threatening bleeding, acute kidney injury, and 30 day mortality, although CA-AS was associated with a trend towards an increased risk of permanent pacemaker implantation (OR 1.76, 95% CI 0.91-4.09, I2 = 0%, P = 0.085). CA is associated with a numerically higher rate of long-term mortality and rehospitalizations following TAVR in patients with CA-AS as compared with those with AS alone. CONCLUSIONS TAVR is an effective and safe procedure in CA-AS patients, with a substantial survival benefit as compared with medical therapy, and a safety profile comparable with patients with AS alone except for a trend towards higher risk of permanent pacemaker implantation.
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Affiliation(s)
- Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giuseppe Pinto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Alessandro Villaschi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Jorge Sanz-Sánchez
- Hospital Universitario y Politecnico La Fe, Valencia, Spain.,Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Fabio Fazzari
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | | | | | | | | | | | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele-Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
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5
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Cannata F, Chiarito M, Pinto G, Villaschi A, Sanz-sanchez J, Fazzari F, Regazzoli D, Mangieri A, Bragato RM, Colombo A, Reimers B, Condorelli G, Stefanini GG. 241 Transcatheter aortic valve replacement in aortic stenosis and cardiac amyloidosis: a systematic review and meta-analysis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical diseases of the elderly. Up to 16% of older adults with severe AS referred to transcatheter aortic valve replacement (TAVR) have a concomitant diagnosis of CA. CA-AS population suffers from reduced functional capacity and worse prognosis than AS patients. As the prognostic impact of TAVR in patients with CA-AS has been historically questioned and in light of recently published evidence, we aim to provide a comprehensive synthesis of the efficacy and safety of TAVR in CA-AS patients.
Methods
We performed a systematic review and meta-analysis of studies: 1) evaluating mortality with TAVR as compared to medical therapy in CA-AS patients, and 2) reporting complications and clinical outcomes of TAVR in CA-AS patients as compared to patients with AS alone.
Results
A total of 8 observational studies were identified, 4 of which reporting mortality with TAVR and 4 reporting complications and clinical outcomes after TAVR of patients with CA-AS compared with AS alone patients. In patients with CA-AS, the risk of mortality was lower with TAVR as compared to medical therapy (OR 0.23, 95% CI 0.07–0.73, I²=0%, P=0.001, number needed to treat=3). The safety profile of TAVR seems to be similar in patients with CA-AS as compared to those with AS alone, with comparable risks of stroke, vascular complications, life-threatening bleeding, acute kidney injury and 30-day mortality, although CA-AS was associated with a trend towards an increased risk of permanent pacemaker implantation (OR 1.93, 95% CI 0.91–4.09, I2=0%, P=0.085). CA is associated with a numerically higher rate of long-term mortality and rehospitalizations following TAVR in patients with CA-AS as compared to those with AS alone.
Conclusions
TAVR is an effective and safe procedure in CA-AS patients, with a substantial survival benefit as compared to medical therapy, and a safety profile comparable to patients with AS alone except for a trend towards higher risk of permanent pacemaker implantation.
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Affiliation(s)
- Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giuseppe Pinto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Alessandro Villaschi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Jorge Sanz-sanchez
- Hospital Universitario Y Politecnico La Fe, Valencia
- Centro De Investigacion Biomedica En Red (CIBERCV), Madrid
| | - Fabio Fazzari
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | | | | | | | | | | | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
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6
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Figliozzi S, Bombace S, Stankowski K, Olivieri M, Lofino L, Di Dedda E, Donghi V, Cannata F, Mantovani R, Fazzari F, Curzi M, Bragato RM, Stefanini GG, Francone M, Condorelli G, Monti L. 750 Mitral annulus disjunction in consecutive patients undergoing cardiovascular magnetic resonance: arrhythmogenic substrate or anatomical variant? Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab132.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Mitral annulus disjunction (MAD) has been associated with sudden cardiac death in selected patients with arrhythmic presentation, while its clinical significance in unselected cohorts remains unknown. Our purpose was to assess the prevalence and clinical significance of MAD in consecutive patients referred to cardiovascular-magnetic-resonance (CMR).
Methods and results
Our population included 103 consecutive patients undergoing CMR at our Institution, between August and September 2021. MAD was defined as a ≥ 1 mm atrial displacement of the mitral leaflet hinge point in standard long-axis cine images during end-systole. MAD analysis was performed in 97 patients (feasibility = 94%) and resulted positive in 49 (51%). MAD—patients were more often males (75% vs. 57%; P = 0.045) and affected by ischaemic (35% vs. 12%, P = 0.01) and non-ischaemic cardiomyopathy (38% vs. 16%, P = 0.026) compared to MAD+ patients. No significant differences were found in terms of age, history of ventricular arrhythmias, bi-ventricular and bi-atrial volumes, bi-ventricular ejection fraction, native T1 and T2 mapping values, extracellular volume, and prevalence of late gadolinium enhancement (P > 0.05 for all) between MAD + vs. MAD—patients. MAD extent was higher in patients with mitral valve prolapse (MVP; n = 7), (3.5 ± 1.5 mm in MVP+ vs. 2.0 ± 1.0 mm in MVP– patients; P = 0.004). No significant differences were conversely found in MAD extent between patients with and without ventricular arrhythmias (2.5 ± 1.1 mm vs. 2.3 ± 1.1 mm; P = 0.815).
Conclusions
Our findings suggest a high prevalence of MAD in unselected cohorts of patients, with no clinical significance. Prospective studies are needed to further elucidate the interplay between MAD and malignant ventricular arrhythmias in unselected cohorts of patients.
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Affiliation(s)
- Stefano Figliozzi
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Sara Bombace
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
| | - Kamil Stankowski
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
| | - Marzia Olivieri
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
| | - Ludovica Lofino
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
| | - Emanuele Di Dedda
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
| | - Valeria Donghi
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Francesco Cannata
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
| | - Riccardo Mantovani
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Fabio Fazzari
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Mirko Curzi
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Renato M Bragato
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Giulio G Stefanini
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
| | - Marco Francone
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
| | - Gianluigi Condorelli
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
| | - Lorenzo Monti
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
- Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy
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7
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Pinto G, Villaschi A, Sanz-Sanchez J, Fazzari F, Regazzoli D, Mangieri A, Pini D, Bragato RM, Colombo A, Reimers B, Condorelli G, Stefanini GG, Chiarito M, Cannata F. Transcatheter aortic valve replacement in severe aortic stenosis and cardiac amyloidosis: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical degenerative diseases of the elderly. According to recent studies, up to 16% of patients referred to transcatheter aortic valve replacement (TAVR) have a concomitant diagnosis of CA. Until recently, TAVR in patients with CA and AS has been considered futile, following the results of small observational studies. However, few studies recently suggested a beneficial impact of TAVR in patients with AS and CA as compared with medical therapy alone.
Purpose
To clarify the efficacy and safety profile of TAVR in CA-AS patients.
Methods
We performed a systematic review and meta-analysis of studies evaluating the risk of mortality after TAVR in CA-AS patients as compared with medical therapy. Moreover, we performed a systematic review and descriptive meta-analysis of studies reporting outcomes and complication rates of TAVR in CA-AS patients as compared with patients with AS alone.
Results
We identified 4 observational studies reporting data on mortality in CA-AS patients treated with either TAVR or medical therapy. Mortality was significantly lower in patients undergoing TAVR (OR 0.23, 95% CI 0.07–0.73, I2=0%, NNT=2.6) as compared with medical therapy. A sensitivity analysis with hazard ratio as effect estimate showed consistent results. Then, we identified 4 observational studies reporting data on mortality, re-hospitalizations and periprocedural complications of TAVR in CA-AS patients as compared with patients with AS alone. We found higher rates of mortality, cardiovascular hospitalization and need for permanent pacemaker implantation in CA-AS patients as compared to lone AS patients undergoing TAVR. Conversely, no differences were found in terms of stroke, acute kidney injury and vascular complications.
Conclusions
Our analysis rejects the idea of futility of TAVR in CA-AS patients showing a clear survival benefit of CA-AS patients undergoing TAVR as compared with medical therapy. Moreover, these patients may undergo TAVR with an acceptable procedural risk, that is substantially comparable to lone AS patients, except for a higher incidence of permanent pacemaker implantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Pinto
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - A Villaschi
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - J Sanz-Sanchez
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - F Fazzari
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - D Regazzoli
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - A Mangieri
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - D Pini
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - R M Bragato
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - A Colombo
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - B Reimers
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - G Condorelli
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - G G Stefanini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - M Chiarito
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - F Cannata
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
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8
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Manno G, Fazzari F, Lavanco V, Donghi V, Curzi M, Pappalardo A, Cozzi O, Novo G, Bragato RM. Multimodality imaging approach to paradoxical embolism. J Cardiovasc Med (Hagerstown) 2020; 21:75-77. [DOI: 10.2459/jcm.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Di Lisi D, Raspante D, Lavanco V, Curzi M, Macaione F, Cavallaro M, Tona R, Novo G, Novo S, Bragato RM. Three-dimensional transesophageal echocardiography in the guide of cardiac mass biopsy: future prospectives. J Cardiovasc Med (Hagerstown) 2017; 19:29-30. [PMID: 29028783 DOI: 10.2459/jcm.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | - Riccardo Tona
- Division of Cardiology, Policlinico 'P. Giaccone', Palermo, Italy
| | - Giuseppina Novo
- Division of Cardiology, Policlinico 'P. Giaccone', Palermo, Italy
| | - Salvatore Novo
- Division of Cardiology, Policlinico 'P. Giaccone', Palermo, Italy
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10
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Bragato RM, La Marchesina U, Grimaldi A, Faletra F. [Clinical usefulenss of a saggital ultrasonography study of the left atrium: report of a case]. Ital Heart J Suppl 2001; 2:1117-20. [PMID: 11723616] [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: 02/22/2023]
Abstract
Multiplane transesophageal echocardiography allows a more complete image of the complex anatomy of the left atrial appendage. In this study we describe a clinical case in which a "sagittal echocardiographic section" revealed a thrombus not imaged with the usual horizontal and longitudinal echocardiographic planes.
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Affiliation(s)
- R M Bragato
- Unità Operativa di Ecocardiografia, Istituto Clinico Humanitas, Rozzano, Via Manzoni, 56 20089 Rozzano
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La Marchesina U, Bragato RM, Grimaldi A, Melzi G, Armino F, Faletra F. [Posterior echocardiography windows: usefulness in clinical practice]. Ital Heart J Suppl 2001; 2:158-60. [PMID: 11255884] [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: 02/19/2023]
Abstract
Posterior cardiac structures cannot always be imaged by means of standard transthoracic echocardiography. Left pleural effusion leading to pulmonary atelectasis and/or to displacement of air-filled pulmonary tissue displacement, allows ultrasound transmission from a patient's back to his heart through a liquid interface. In this study we present the clinical usefulness of echocardiographic posterior windows for the diagnosis of constrictive pericarditis and aortic dissection in 2 patients in whom the standard transthoracic approach did not permit diagnostic imaging. We conclude that, in the case of left pleural effusion, the use of posterior windows should be encouraged.
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Affiliation(s)
- U La Marchesina
- Unità Operativa di Ecocardiografia, Istituto Clinico Humanitas, Via Manzoni, 56 20089 Rozzano, MI.
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