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Ribichini F, Pesarini G, Fabris T, Lunardi M, Barbierato M, D'Amico G, Zanchettin C, Gregori D, Piva T, Nicolini E, Gandolfo C, Fineschi M, Petronio AS, Berti S, Caprioglio F, Saia F, Sclafani R, Esposito G, D'Ascenzo F, Tarantini G. A randomised multicentre study of angiography- versus physiologyguided percutaneous coronary intervention in patients with coronary artery disease undergoing TAVI: design and rationale of the FAITAVI trial. EUROINTERVENTION 2024; 20:e504-e510. [PMID: 38629420 DOI: 10.4244/eij-d-23-00679] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The treatment of coronary artery disease (CAD) in patients with severe aortic valve stenosis (AVS) eligible for transcatheter aortic valve implantation (TAVI) is not supported by clinical evidence, and the role of physiology over anatomy as well as the timing of coronary intervention are not defined. FAITAVI (ClinicalTrials.gov: NCT03360591) is a nationwide prospective, open-label, multicentre, randomised controlled study comparing the angiography-guided versus the physiology-guided coronary revascularisation strategy in patients with combined significant CAD and severe AVS undergoing TAVI. Significant CAD will be defined as coronary stenosis ≥50%, as assessed by visual estimation in vessels ≥2.5 mm. Physiology will be tested by fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). The study will be conducted at 15 sites in Italy. In the angiography arm, percutaneous coronary intervention (PCI) will be performed either before TAVI, during the TAVI procedure - before or after the valve implantation - or within 1 month±5 days of the valve implantation, left to the operator's decision. In the physiology arm, FFR and iFR will be performed before TAVI, and PCI will be indicated for FFR ≤0.80, otherwise the intervention will be deferred. In case of borderline values (0.81-0.85), FFR and iFR will be repeated after TAVI, with PCI performed when needed. With a sample size of 320 patients, the study is powered to evaluate the primary endpoint (a composite of death, myocardial infarction, stroke, major bleeding, or ischaemia-driven target vessel revascularisation). TAVI indication, strategy and medical treatment will be the same in both groups. After discharge, patients will be contacted at 1, 6, 12 and 24 months after the procedure to assess their general clinical status, and at 12 months for the occurrence of events included in the primary and secondary endpoints. FAITAVI is the first randomised clinical trial to investigate "optimal" percutaneous coronary intervention associated with TAVI in patients with severe AVS and CAD.
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Affiliation(s)
- Flavio Ribichini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Mattia Lunardi
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Marco Barbierato
- Division of Cardiology, Ospedale dell'Angelo di Mestre, Chirignago-Zelarino, Italy
| | - Gianpiero D'Amico
- Division of Cardiology, Ospedale dell'Angelo di Mestre, Chirignago-Zelarino, Italy
| | - Chiara Zanchettin
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
- Division of Cardiology, Ospedale dell'Angelo di Mestre, Chirignago-Zelarino, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Tommaso Piva
- Division of Cardiology, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Elisa Nicolini
- Division of Cardiology, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | | | - Massimo Fineschi
- Division of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Anna Sonia Petronio
- Division of Cardiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Sergio Berti
- Division of Cardiology, Ospedale del Cuore - Fondazione Monasterio, Massa, Italy
| | | | - Francesco Saia
- Division of Cardiology, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Rocco Sclafani
- Division of Cardiology, Azienda Ospedaliera di Perugia - Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Giovanni Esposito
- Division of Cardiology, Policlinico Universitario Federico II di Napoli, Napoli, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Hospital University of Turin, Torino, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
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Belfioretti L, Francioni M, Battistoni I, Angelini L, Matassini MV, Pongetti G, Shkoza M, Piangerelli L, Piva T, Nicolini E, Maolo A, Muçaj A, Compagnucci P, Munch C, Dello Russo A, Di Eusanio M, Marini M. Evolution of Cardiogenic Shock Management and Development of a Multidisciplinary Team-Based Approach: Ten Years Experience of a Single Center. J Clin Med 2024; 13:2101. [PMID: 38610866 PMCID: PMC11012883 DOI: 10.3390/jcm13072101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The management of cardiogenic shock (CS) after ACS has evolved over time, and the development of a multidisciplinary team-based approach has been shown to improve outcomes, although mortality remains high. Methods: All consecutive patients with ACS-CS admitted at our CICU from March 2012 to July 2021 were included in this single-center retrospective study. In 2019, we established a "shock team" consisting of a cardiac intensivist, an interventional cardiologist, an anesthetist, and a cardiac surgeon. The primary outcome was in-hospital mortality. Results: We included 167 patients [males 67%; age 71 (61-80) years] with ischemic CS. The proportion of SCAI shock stages from A to E were 3.6%, 6.6%, 69.4%, 9.6%, and 10.8%, respectively, with a mean baseline serum lactate of 5.2 (3.1-8.8) mmol/L. Sixty-six percent of patients had severe LV dysfunction, and 76.1% needed ≥ 1 inotropic drug. Mechanical cardiac support (MCS) was pursued in 91.1% [65% IABP, 23% Impella CP, 4% VA-ECMO]. From March 2012 to July 2021, we observed a significative temporal trend in mortality reduction from 57% to 29% (OR = 0.90, p = 0.0015). Over time, CS management has changed, with a significant increase in Impella catheter use (p = 0.0005) and a greater use of dobutamine and levosimendan (p = 0.015 and p = 0.0001) as inotropic support. In-hospital mortality varied across SCAI shock stages, and the SCAI E profile was associated with a poor prognosis regardless of patient age (OR 28.50, p = 0.039). Conclusions: The temporal trend mortality reduction in CS patients is multifactorial, and it could be explained by the multidisciplinary care developed over the years.
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Affiliation(s)
- Leonardo Belfioretti
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Matteo Francioni
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Ilaria Battistoni
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Luca Angelini
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Maria Vittoria Matassini
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Giulia Pongetti
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Matilda Shkoza
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Luca Piangerelli
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
| | - Tommaso Piva
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Elisa Nicolini
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Alessandro Maolo
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Andi Muçaj
- Intervention Cardiology, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (T.P.); (E.N.)
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (P.C.); (A.D.R.)
| | - Christopher Munch
- Cardiac Anaesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy;
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (P.C.); (A.D.R.)
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy;
| | - Marco Marini
- Intensive Care Unit, Cardiology Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (M.F.); (I.B.); (M.V.M.); (M.M.)
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Raisi A, Bernardi E, Myers J, Piva T, Zerbini V, Masotti S, Menegatti E, Caruso L, Mazzoni G, Grazzi G, Mandini S. Change in Peak Oxygen Uptake Predicted by the Moderate 1-km Treadmill Walking Test After Walking Training in Outpatients With Cardiovascular Disease. J Cardiopulm Rehabil Prev 2024; 44:131-136. [PMID: 37616588 DOI: 10.1097/hcr.0000000000000812] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE The purpose of this study was to determine the ability of the moderate 1-km treadmill walking test (1km-TWT) to predict changes in peak oxygen uptake (V˙O 2peak ) in patients with stable cardiovascular disease (CVD) during an exercise-based secondary prevention program. METHODS Sixty-four male outpatients with stable CVD (age 64 [41-85] yr) performed the 1km-TWT before and after an 8-wk walking training program. Patient V˙O 2peak was estimated using a sex-specific equation including age, body mass index, 1km-TWT performance time, and heart rate (V˙O 2peakEST ). Forty-one patients completed a maximal cardiopulmonary treadmill test (CPX) for direct V˙O 2peak determination (V˙O 2peakMEAS ). The training prescription consisted of moderate-to-high intensity supervised walking for 30-40 min/session, and an additional 2-4 times/wk of unsupervised home moderate walking sessions between 20-60 min at the end of the program. The walking intensity was based on the results of the 1km-TWT. RESULTS Patients participated in an average of 14 of the 16 supervised sessions. An overall significant improvement in V˙O 2peakMEAS and weekly recreational physical activity levels were observed. No differences were observed between V˙O 2peakMEAS and V˙O 2peakEST . Compared with CPX results, the 1km-TWT underestimated the V˙O 2peak increase after the exercise intervention (mean difference -0.3 mL/kg/min, P > .05). CONCLUSIONS The 1km-TWT provides a reasonably accurate and simple tool to predict changes in V˙O 2peak due to moderate walking training in male outpatients with CVD. These findings contribute to the growing body of evidence supporting the use of the 1km-TWT for exercise testing and training purposes in the context of cardiac rehabilitation/secondary prevention programs.
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Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Messrs Raisi and Piva, Drs Bernardi, Masotti, Mazzoni, Grazzi, and Mandini and Ms Zerbini), Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois, the United States (Drs Myers and Grazzi); Division of Cardiology, VA Palo Alto, California, the United States, and Stanford University School of Medicine, Stanford, California, the United States (Dr Myers); Department of Environmental Sciences and Prevention, University of Ferrara, Ferrara, Italy (Drs Menegatti and Caruso); and Public Health Department, AUSL Ferrara, Ferrara, Italy (Drs Mazzoni and Grazzi)
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Piva T, Raisi A, Myers J, Zerbini V, Menegatti E, Mazzoni G, Grazzi G, Mandini S. Attenuation of the increase of heart rate and oxygen consumption during progressive exercise in professional rugby players. J Sports Med Phys Fitness 2024; 64:272-278. [PMID: 38015477 DOI: 10.23736/s0022-4707.23.15151-6] [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: 11/29/2023]
Abstract
BACKGROUND The response of oxygen uptake (VO2) and heart rate (HR) to continuous progressive large muscle mass exercise is not always linear. This study aimed to compare the patterns of the Speed/VO2 (S/VO2) and speed/HR (S/HR) relationships during an incremental treadmill-running test in professional rugby players. METHODS Fourteen professional rugby athletes performed a maximal incremental treadmill-running test, following the Conconi test protocol. Speed, heart rate, and gas exchange parameters were recorded. The slope of the S/VO2 and S/HR relationships were mathematically determined. RESULTS The S/VO2 and S/HR relationships were linear up to a submaximal speed and curvilinear thereafter. The speed of locomotion at which the slope of the S/VO2 and S/HR relationships start to attenuate (VO2att and HRatt) were coincident (12.3±1.0 and 12.4±0.9 km/h), strongly correlated and in good agreement. VO2 values at VO2att (44.9±8.7 mL/kg/min) were significantly correlated with VO2 values at the ventilatory threshold (43.3±6.0 mL/kg/min) (R2=0.83, P=0.001) and in good agreement. The running speed/VO2 ratio (ΔS/ΔVO2) up to VO2att was significantly lower than that beyond VO2att (2.98±1.1 vs. 5.16±2.31); P<0,001). CONCLUSIONS The speed/oxygen uptake and S/HR relationships during progressive exercise start to attenuate at a coincident exercise intensity, and at oxygen uptake values strongly correlated with the ventilatory threshold. These findings further support the usefulness of the attenuation of the S/HR relationship as a practical tool for exercise testing and training purposes in professional rugby players.
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Affiliation(s)
- Tommaso Piva
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, Ferrara, Italy
| | - Andrea Raisi
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, Ferrara, Italy
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Valentina Zerbini
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, Ferrara, Italy -
| | - Erica Menegatti
- Department of Environmental Sciences and Prevention, University of Ferrara, Ferrara, Italy
| | - Gianni Mazzoni
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, Ferrara, Italy
- Department of Public Health, AUSL Ferrara, Ferrara, Italy
| | - Giovanni Grazzi
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, Ferrara, Italy
- Department of Public Health, AUSL Ferrara, Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Simona Mandini
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, Ferrara, Italy
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Benenati S, Gallo F, Kim WK, Khokhar AA, Zeus T, Toggweiler S, Galea R, De Marco F, Mangieri A, Regazzoli D, Reimers B, Nombela-Franco L, Barbanti M, Regueiro A, Piva T, Rodes-Cabau J, Porto I, Colombo A, Giannini F, Sticchi A. Comparison of Mid-Term Prognosis in Intermediate-to-Low-Risk Contemporary Population with Guidelines-Oriented Age Cutoff. J Cardiovasc Dev Dis 2024; 11:33. [PMID: 38276659 PMCID: PMC10816002 DOI: 10.3390/jcdd11010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Current European guidelines support transcatheter aortic valve implantation (TAVI) in intermediate-to-low-risk patients ≥75 years-old, but its prognostic relevance is unknown. METHODS Intermediate-to-low-risk (The Society of Thoracic Surgeons score <8%) patients enrolled in the HORSE registry were included. We compared the populations aged under 75 with those over 75. The primary endpoint was all-cause mortality. RESULTS A total of 2685 patients were included: 280 (8.6%) < 75 and 2405 ≥ 75 years. Through a mean follow-up of 437 ± 381 days, 198 (8.2%) and 23 (8.2%) patients died in the two arms without statistically significant differences (log-rank p = 0.925). At Cox regression analysis, age did not predict the occurrence of all-cause death, neither as a continuous variable (HR 1.01, 95% CI 0.99-1.04, p = 0.294) nor dichotomizing according to the prespecified cutoff of 75 years (HR 0.97, 95% CI 0.63-1.51, p = 0.924). Time-to-event ROC curves showed low accuracy of age to predict all-cause mortality (area under the curve of 0.54 for both 1-year and 2-year outcomes). CONCLUSIONS TAVI has comparable benefits across age strata for intermediate-to-low-risk patients. The age cutoff suggested by the current guidelines is not predictive of the risk of adverse events during hospital stays or of all-cause mortality through a mid-term follow-up.
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Affiliation(s)
- Stefano Benenati
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16126 Genoa, Italy (I.P.)
| | - Francesco Gallo
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell’Angelo, AULSS3 Serenissima, Mestre, 30174 Venezia, Italy
| | - Won-keun Kim
- Department of Cardiology, Kerckhoff Heart Center, 61231 Bad Nauheim, Germany;
| | - Arif A. Khokhar
- Cardiology Service, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, 40225 Duesseldorf, Germany
| | - Stefan Toggweiler
- Department of Cardiology, Cantonal Hospital Lucern, 6000 Luzern, Switzerland
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | | | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luis Nombela-Franco
- Interventional Cardiology Unit, Hospital Àlvaro Cunqueiro, 36312 Vigo, Spain
| | - Marco Barbanti
- Faculty of Medicine and Surgery, Università degli Studi di Enna “Kore”, 94100 Enna, Italy
| | - Ander Regueiro
- Cardiovascular Institute, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti Di Ancona, 60126 Ancona, Italy;
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC G1V 4G5, Canada
| | - Italo Porto
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16126 Genoa, Italy (I.P.)
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy
| | - Alessandro Sticchi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy (D.R.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy
- Dipartimento di Patologia Chirurgica, University of Pisa, Medica, Molecolare e dell’Area Critica, 56126 Pisa, Italy
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Ciliberti G, Guerra F, Pizzi C, Merlo M, Zilio F, Bianco F, Mancone M, Zaffalon D, Gioscia R, Bergamaschi L, Compagnucci P, Armillotta M, Casella M, Sansonetti A, Marini M, Paolisso P, Stronati G, Gallina S, Dello Russo A, Perna GP, Fedele F, Bonmassari R, De Luca G, Tritto I, Piva T, Sinagra G, Ambrosio G, Kaski JC, Verdoia M. Characteristics of patients with recurrent acute myocardial infarction after MINOCA. Prog Cardiovasc Dis 2023; 81:42-47. [PMID: 37852517 DOI: 10.1016/j.pcad.2023.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Myocardial infarction (MI) with non-obstructed coronary arteries (MINOCA) is an increasingly recognized condition with challenging management. Some MINOCA patients ultimately experience recurrent acute MI (re-AMI) during follow-up; however, clinical and angiographic factors predisposing to re-AMI are still poorly defined. METHODS In this retrospective multicenter cohort study we enrolled consecutive patients fulfilling diagnostic criteria of MINOCA according to the IV universal definition of myocardial infarction; characteristics of patients experiencing re-AMI during the follow-up were compared to a group of MINOCA patients without re-AMI. RESULTS 54 patients (mean age 66 ± 13) experienced a subsequent re-AMI after MINOCA and follow-up was available in 44 (81%). Compared to MINOCA patients without re-AMI (n = 695), on first invasive coronary angiography (ICA) MINOCA patients with re-AMI showed less frequent angiographically normal coronaries (37 versus 53%, p = 0.032) and had a higher prevalence of atherosclerosis involving 3 vessels or left main stem (17% versus 8%, p = 0.049). Twenty-four patients (44%) with re-AMI underwent a new ICA: 25% had normal coronary arteries, 12.5% had mild luminal irregularities (<30%), 20.8% had moderate coronary atherosclerosis (30-49%), and 41.7% showed obstructive coronary atherosclerosis (≥50% stenosis). Among patients undergoing new ICA, atherosclerosis progression was observed in 11 (45.8%), 37.5% received revascularization, only 4.5% had low-density lipoprotein cholesterol (LDL_C) under 55 mg/dL and 33% experienced a new cardiovascular disease (CVD) event (death, AMI, heart failure, stroke) at subsequent follow-up. CONCLUSIONS In the present study, only a minority of MINOCA patients with re-AMI underwent a repeated ICA, nearly one out of two showed atherosclerosis progression, often requiring revascularization. Recommended LDL-C levels were achieved only in a minority of the cases, indicating a possible underestimation of CVD risk in this population.
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Affiliation(s)
- Giuseppe Ciliberti
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Italy
| | - Filippo Zilio
- Department of Cardiology, S. Chiara Hospital, Trento, Italy
| | - Francesco Bianco
- Department of Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Denise Zaffalon
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Italy
| | | | - Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marco Marini
- Cardiology and Coronary Care Unit, Marche University Hospital, Ancona, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and clinical Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Gian Piero Perna
- Cardiology and Coronary Care Unit, Marche University Hospital, Ancona, Italy
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Giuseppe De Luca
- Division of Cardiology, Policlinico AOU G. Martino, and Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Isabella Tritto
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - Tommaso Piva
- Cardiology and Coronary Care Unit, Marche University Hospital, Ancona, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences, St George's, University of London, London, UK
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Raisi A, Piva T, Myers J, Lordi R, Zerbini V, Masotti S, Chiaranda G, Grazzi G, Mazzoni G, Mandini S. A Moderate Walking Test Predicts Survival in Women With Cardiovascular Disease. Am J Prev Med 2023; 65:497-504. [PMID: 36871638 DOI: 10.1016/j.amepre.2023.02.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the principal cause of death in U.S. women. Peak oxygen uptake is strongly related to mortality and CVD. This study aimed to investigate the association between estimated peak oxygen uptake, determined using a moderate 1-km walking test, and all-cause mortality in female patients with stable CVD. METHODS Of the 482 women in our registry between 1997 and 2020, we included 430 participants in the analysis (aged 67 [34-88] years). A Cox proportional hazard model was used to determine the variables significantly associated with mortality. On the basis of the peak oxygen uptake estimated using the 1-km walking test, the sample was subdivided into tertiles, and mortality risk was calculated. The discriminatory accuracy of peak oxygen uptake in estimating survival was assessed by receiver operating characteristic curves. All results were adjusted for demographic and clinical covariates. RESULTS A total of 135 deaths from any cause occurred over a median of 10.4 years (IQR=4.4-16.4), with an average annual mortality of 4.2%. Estimated peak oxygen uptake was a stronger predictor of all-cause mortality than demographic and clinical variables (c-statistic-0.767; 95% CI=0.72, 0.81; p<0.0001). The survival rate decreased from the highest tertile of fitness to the lowest. Compared with the lowest group, hazard ratios (95% CIs) for the second and third tertiles were 0.55 (0.37, 0.83) and 0.29 (0.16, 0.51), respectively (p for trend <0.0001). CONCLUSIONS Higher peak oxygen uptake levels were associated with a lower risk of all-cause mortality. The indirect estimation of peak oxygen uptake using the 1-km walking test is feasible and can be applied for risk stratification among female patients undergoing secondary prevention programs.
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Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Jonathan Myers
- Division of Cardiology, Palo Alto VA Medical Center, Palo Alto, California; Stanford University School of Medicine, Stanford, California; Healthy Living for Pandemic Event Protection Network, Chicago, Ilinois
| | - Rosario Lordi
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Public Health Department, Azienda Unità Sanitaria Locale di Piacenza, Piacenza, Italy
| | - Valentina Zerbini
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
| | - Sabrina Masotti
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giorgio Chiaranda
- Public Health Department, Azienda Unità Sanitaria Locale di Piacenza, Piacenza, Italy; General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Healthy Living for Pandemic Event Protection Network, Chicago, Ilinois; Public Health Department, Azienda Unità Sanitaria Locale di Piacenza, Piacenza, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Public Health Department, Azienda Unità Sanitaria Locale di Piacenza, Piacenza, Italy
| | - Simona Mandini
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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8
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Raisi A, Zerbini V, Piva T, Belvederi Murri M, Menegatti E, Caruso L, Masotti S, Grazzi G, Mazzoni G, Mandini S. Treating Binge Eating Disorder With Physical Exercise: A Systematic Review and Meta-analysis. J Nutr Educ Behav 2023; 55:523-530. [PMID: 37245147 DOI: 10.1016/j.jneb.2023.03.010] [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] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This review aimed to collect evidence about the effectiveness of exercise programs for managing binge eating disorder (BED) (recurrent binge eating episodes). METHODS Meta-analysis was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Articles were searched in PubMed, Scopus, Web of Science, and Cochrane Library. Randomized controlled trials were eligible for inclusion if they reported the effect of an exercise-based program on BED symptoms in adults. Outcomes were changes in binge eating symptom severity, measured through validated assessment instruments, after an exercise-based intervention. Study results were pooled using the Bayesian model averaging for random and fixed effects meta-analysis. RESULTS Of 2,757 studies, 5 trials were included, with 264 participants. The mean age was 44.7 ± 8.1 years for the intervention group and 46.6 ± 8.5 years for the control group. All participants were female. A significant improvement was observed between groups (standardized mean difference, 0.94; 95% credibility interval, -1.46 to -0.31). Patients obtained significant improvements either following supervised exercise programs or home-based exercise prescriptions. IMPLICATIONS FOR RESEARCH AND PRACTICE These findings suggest that physical exercise, within a multidisciplinary clinical and psychotherapeutic approach, may be an effective intervention for managing BED symptoms. Further comparative studies are needed to clarify which exercise modality is associated with greater clinical benefits.
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Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Valentina Zerbini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
| | - Martino Belvederi Murri
- Institute of Psychiatry Department of Neuroscience and Rehabilitation University of Ferrara, Ferrara, Italy
| | - Erica Menegatti
- Departement of Environmental Sciences and Prevention, University of Ferrara, Ferrara, Italy
| | - Lorenzo Caruso
- Departement of Environmental Sciences and Prevention, University of Ferrara, Ferrara, Italy
| | - Sabrina Masotti
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Public Health Department, AUSL Ferrara, Ferrara, Italy; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Matassini MV, Marini M, Angelozzi A, Angelini L, Shkoza M, Compagnucci P, Falanga U, Battistoni I, Pongetti G, Francioni M, Piva T, Mucaj A, Nicolini E, Maolo A, Di Eusanio M, Munch C, Dello Russo A, Perna G. Clinical outcomes and predictors of success with Impella weaning in cardiogenic shock: a single-center experience. Front Cardiovasc Med 2023; 10:1171956. [PMID: 37416919 PMCID: PMC10321515 DOI: 10.3389/fcvm.2023.1171956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Cardiogenic shock (CS) is a severe syndrome with poor prognosis. Short-term mechanical circulatory support with Impella devices has emerged as an increasingly therapeutic option, unloading the failing left ventricle (LV) and improving hemodynamic status of affected patients. Impella devices should be used for the shortest time necessary to allow LV recovery because of time-dependent device-related adverse events. The weaning from Impella, however, is mostly performed in the absence of established guidelines, mainly based on the experience of the individual centres. Methods The aim of this single center study was to retrospectively evaluate whether a multiparametrical assessment before and during Impella weaning could predict successful weaning. The primary study outcome was death occurring during Impella weaning and secondary endpoints included assessment of in-hospital outcomes. Results Of a total of 45 patients (median age, 60 [51-66] years, 73% male) treated with an Impella device, 37 patients underwent impella weaning/removal and 9 patients (20%) died after the weaning. Non-survivors patients after impella weaning more commonly had a previous history of known heart failure (p = 0.054) and an implanted ICD-CRT (p = 0.01), and were more frequently treated with continuous renal replacement therapy (p = 0.02). In univariable logistic regression analysis, lactates variation (%) during the first 12-24 h of weaning, lactate value after 24 h of weaning, left ventricular ejection fraction (LVEF) at the beginning of weaning, and inotropic score after 24 h from weaning beginning were associated with death. Stepwise multivariable logistic regression identified LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning beginning as the most accurate predictors of death after weaning. The ROC analysis indicated 80% accuracy (95% confidence interval = 64%-96%) using the two variables in combination to predict death after weaning from Impella. Conclusions This single-center experience on Impella weaning in CS showed that two easily accessible parameters as LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning begin were the most accurate predictors of death after weaning.
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Affiliation(s)
- M. V. Matassini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Marini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Angelozzi
- Unit of Cardiology and Cardiac Intensive Therapy, Cardiovascular Department, G. Mazzini Hospital, Teramo, Italy
| | - L. Angelini
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Shkoza
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - P. Compagnucci
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - U. Falanga
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - I. Battistoni
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - G. Pongetti
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Francioni
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - T. Piva
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Mucaj
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - E. Nicolini
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Maolo
- Interventional Cardiology-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Di Eusanio
- Cardiac Surgery Unit, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
| | - C. Munch
- Anaesthesia and Cardiac Surgery Intensive Care, Ospedali Riuniti di Ancona, Ancona, Italy
| | - A. Dello Russo
- Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health, University Hospital Ospedali Riuniti di Ancona and Marche Polytechnic University, Ancona, Italy
| | - G. Perna
- Cardiac Intensive Care Unit-Cardiology Division, Cardiovascular Department, Ospedali Riuniti di Ancona, Ancona, Italy
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Fogante M, Esposto Pirani P, Cela F, Balardi L, Piva T, Argalia G, Schicchi N. Ultra-low radiation dose and contrast volume CT protocol and TAVI-CT score for TAVI planning and outcome. Br J Radiol 2023:20221026. [PMID: 37183830 PMCID: PMC10392642 DOI: 10.1259/bjr.20221026] [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: 05/16/2023] Open
Abstract
OBJECTIVE To investigate the feasibility of an ultra-low radiation dose and contrast volume protocol using third-generation dual-source (DS) CT for transcatheter aortic valve implantation (TAVI) planning with coronary artery disease (CAD) assessment, coronary artery calcium score (CACS) and aortic valve calcium score (AVCS) quantification and to evaluate their relationship with TAVI outcome. METHODS In this retrospective study were selected 203 patients (131 males, 79.4 ± 5.4 years) underwent to TAVI and at 30- and 90-day follow-up. All patients had performed a third-generation 2 × 192-slices DSCT. The CT protocol included a non-contrast and a contrast high-pitch aortic acquisition for TAVI planning and CAD assessment. Semi-qualitative and quantitative image analysis were performed; the performance in CAD assessment was compared with ICA; the relationship between AVCS and CACS and paravalvular aortic regurgitation (PAR) and major cardiovascular events (MACEs) were evaluated. Mean radiation dose were calculated. Non-parametric tests were used. RESULTS Semi-qualitative image analysis was good. Contrast enhancement >500 Hounsfield unit (HU) and contrast-to-noise ratio <20 were obtained in all segments. The diagnostic accuracy in CAD was 89.0%. AVCS was significantly higher in patients with 30-day severe PAR. AVCS and CACS were higher in patients with 90-day MACE complications, respectively, 1904.5 ± 621.3 HU (p < 0.0001) and 769.2 ± 365.5 HU (p < 0.0230). Mean radiation dose was 2.8 ± 0.3 mSv. CONCLUSION A TAVI planning ultra-low radiation dose and contrast volume protocol using third-generation DSCT provides highly diagnostic images with CAD assessment, AVCS and CACS quantification and these latter were related with TAVI outcomes. ADVANCES IN KNOWLEDGE The proposed protocol using third-generation 2 × 192-slices DSCT allows with an ultra-low radiation dose and contrast volume the TAVI planning and the coronary artery assessment.
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Affiliation(s)
- Marco Fogante
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Paolo Esposto Pirani
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Fatjon Cela
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Liliana Balardi
- Direzione Aziendale, University Hospital of Marche, Ancona, Italy
| | - Tommaso Piva
- SOD Cardiologia Ospedaliera e UTIC, University Hospital of Marche, Ancona, Italy
| | - Giulio Argalia
- SOD di Radiologia Materno-Infantile, Senologica, Cardiologica ed Ecografia Ambulatoriale, University Hospital of Marche, Ancona, Italy
| | - Nicolò Schicchi
- SOS Diagnostica Radiologica Cardiovascolare - University Hospital of Marche, Ancona, Italy
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Iannaccone M, Franchin L, Burzotta F, Botti G, Pazzanese V, Briguori C, Trani C, Piva T, De Marco F, Masiero G, Di Biasi M, Pagnotta P, Casu G, Scandroglio AM, Tarantini G, Chieffo A. Impact of in-Hospital Left Ventricular Ejection Fraction Recovery on Long-Term Outcomes in Patients Who Underwent Impella Support for HR PCI or Cardiogenic Shock: A Sub-Analysis from the IMP-IT Registry. J Pers Med 2023; 13:826. [PMID: 37240996 PMCID: PMC10222801 DOI: 10.3390/jpm13050826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Percutaneous left ventricle assist devices (pLVADs) demonstrated an improvement in mid-term clinical outcomes in selected patients with severely depressed left ventricular ejection fraction (LVEF) undergoing percutaneous coronary interventions. However, the prognostic impact of in-hospital LVEF recovery is unclear. Accordingly, the present sub-analysis aims to evaluate the impact of LVEF recovery in both cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR PCI) supported with pLVADs in the IMP-IT registry. (2) Methods: A total of 279 patients (116 patients in CS and 163 patients in HR PCI) treated with Impella 2.5 or CP in the IMP-IT registry were included in this analysis, after excluding those who died while in the hospital or with missing data on LVEF recovery. The primary study objective was a composite of all-cause death, rehospitalisation for heart failure, left ventricle assist device (LVAD) implantation, or heart transplantation (HT), overall referred to as the major adverse cardiac events (MACE) at 1 year. The study aimed to evaluate the impact of in-hospital LVEF recovery on the primary study objective in patients treated with Impella for HR PCI and CS, respectively. (3) Results: The mean in-hospital change in LVEF was 10 ± 1% (p < 0.001) in the CS cohort and 3 ± 7% (p < 0.001) in the HR PCI group, achieved by 44% and 40% of patients, respectively. In the CS group, patients with less than 10% in-hospital LVEF recovery experienced higher rates of MACE at 1 year of follow-up (FU) (51% vs. 21%, HR 3.8, CI 1.7-8.4, p < 0.01). After multivariate analysis, LVEF recovery was the main independent protective factor for MACE at FU (HR 0.23, CI 0.08-0.64, p = 0.02). In the HR PCI group, LVEF recovery (>3%) was not associated with lower MACE at multivariable analysis (HR 0.73, CI 0.31-1.72, p = 0.17). Conversely, the completeness of revascularisation was found to be a protective factor for MACE (HR 0.11, CI 0.02-0.62, p = 0.02) (4) Conclusions: Significant LVEF recovery was associated with improved outcomes in CS patients treated with PCI during mechanical circulatory support with Impella, whereas complete revascularisation showed a significant clinical relevance in HR PCI.
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Affiliation(s)
- Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, 10100 Turin, Italy
| | - Luca Franchin
- Department of Cardiology, San Giovanni Bosco Hospital, 10100 Turin, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Giulia Botti
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy
| | - Vittorio Pazzanese
- Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, 80100 Naples, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Federico De Marco
- Valvular and Structural Heart Cardiology, Centro Cardiologico Monzino, 20100 Milan, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, 35100 Padua, Italy
| | - Maurizio Di Biasi
- Interventional Cardiology Unit, Ospedale Luigi Sacco, 20100 Milan, Italy
| | - Paolo Pagnotta
- Cardiovascular Department, Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Gavino Casu
- Clinical and Interventional Cardiology, Sassari University Hospital, 07100 Sassari, Italy
| | - Anna Mara Scandroglio
- Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, 20100 Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, University of Padua, 35100 Padua, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20100 Milan, Italy
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Marzullo R, Capestro A, Muçaj A, Piva T. Percutaneous rheolytic thrombectomy and cerebral embolic protection in a massive thrombosis of a fenestrated Fontan conduit: a case report. Eur Heart J Case Rep 2023; 7:ytad238. [PMID: 37215519 PMCID: PMC10199720 DOI: 10.1093/ehjcr/ytad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/05/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
Background Clinical thromboembolism in Fontan patients is often a catastrophic event resulting in death and adverse long-term outcomes. The treatment of acute thromboembolic complications in these patients is very controversial. Case summary We describe the use of rheolytic thrombectomy in a Fontan patient with life-threatening pulmonary embolism, employing a cerebral protection system to reduce the risk of stroke through the fenestration. Discussion Rheolytic thrombectomy may be a successful alternative to systemic thrombolytic therapy and open surgical resection for the treatment of acute high-risk pulmonary embolism in the Fontan population. Embolic protection device to capture and remove thrombus/debris may be an innovative tool to reduce the risk of stroke through the fenestration while performing a percutaneous procedure in fenestrated Fontan patient.
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Affiliation(s)
| | - Alessandro Capestro
- Department of Pediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria—Ospedali Riuniti Ancona ‘Umberto I—G.M.Lancisi—G.Salesi’, Ancona, Italy
| | - Andi Muçaj
- Department of Cardiology, Azienda Ospedaliero-Universitaria—Ospedali Riuniti Ancona ‘Umberto I—G.M.Lancisi—G.Salesi’, Ancona, Italy
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Raisi A, Zerbini V, Myers J, Piva T, Campo G, Mazzoni G, Grazzi G, Mandini S. A Novel Motivational Approach in the Management of Older Patients With Cardiovascular Disease. J Cardiopulm Rehabil Prev 2023:01273116-990000000-00084. [PMID: 37014940 DOI: 10.1097/hcr.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sports, University of Ferrara, Ferrara, Italy (Messrs Raisi and Piva, Ms Zerbini, and Drs Mazzoni, Grazzi, and Mandini); Division of Cardiology, VA, Palo Alto, California (Dr Myers); Stanford University School of Medicine, Stanford, California (Dr Myers); Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois (Drs Myers and Grazzi); Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy (Dr Campo); and Public Health Department, AUSL Ferrara, Ferrara, Italy (Drs Mazzoni and Grazzi)
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14
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Tonet E, Raisi A, Zagnoni S, Chiaranda G, Pavasini R, Vitali F, Gibiino F, Campana R, Boccadoro A, Scala A, Canovi L, Amantea V, Matese C, Berloni ML, Piva T, Zerbini V, Cardelli LS, Pasanisi G, Mazzoni G, Casella G, Grazzi G, Campo G. Multi-domain lifestyle intervention in older adults after myocardial infarction: rationale and design of the PIpELINe randomized clinical trial. Aging Clin Exp Res 2023; 35:1107-1115. [PMID: 36964866 PMCID: PMC10039445 DOI: 10.1007/s40520-023-02389-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Traditional cardiac rehabilitation (CR) is effective in improving physical performance and prognosis after myocardial infarction (MI). Anyway, it is not consistently recommended to older adults, and its attendance rate is low. Previous studies suggested that alternative, early and tailored exercise interventions are feasible and effective in improving physical performance in older MI patients. Anyway, the demonstration that they are associated also with a significant reduction of hard endpoints is lacking. AIM To describe rationale and design of the "Physical activity Intervention in Elderly patients with myocardial Infarction" (PIpELINe) trial. METHODS The PIpELINe trial is a prospective, randomized, multicentre study with a blinded adjudicated evaluation of the outcomes. Patients aged ≥ 65 years, admitted to hospital for MI and with a low physical performance one month after discharge, as defined as short physical performance battery (SPPB) value between 4 and 9, will be randomized to a multi-domain lifestyle intervention (including dietary counselling, strict management of cardiovascular and metabolic risk factors, and exercise training) or health education. The primary endpoint is the one-year occurrence of the composite of cardiovascular death or re-hospitalization for cardiovascular causes. RESULTS The recruitment started in March 2020. The estimated sample size is 456 patients. The conclusion of the enrolment is planned for mid-2023. The primary endpoint analysis will be available for the end of 2024. CONCLUSIONS The PIpELINe trial will show if a multi-domain lifestyle intervention is able to reduce adverse events in older patients with reduced physical performance after hospitalization for MI. TRIAL REGISTRATION ClinicalTrials.gov NCT04183465.
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Affiliation(s)
- Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Andrea Raisi
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Silvia Zagnoni
- Cardiology Unit, Ospedale Maggiore, Azienda USL Bologna, Bologna, Italy
| | - Giorgio Chiaranda
- Sports Medicine and Health Promotion Unit, Azienda Unità Sanitaria locale di Piacenza, Piacenza, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Francesco Vitali
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Federico Gibiino
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Roberta Campana
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Alberto Boccadoro
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Antonella Scala
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Luca Canovi
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Veronica Amantea
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Camilla Matese
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Maria Letizia Berloni
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy
| | - Tommaso Piva
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Valentina Zerbini
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | | | - Giovanni Pasanisi
- Rehabilitation Cardiology, Azienda USL di Ferrara, Lagosanto, FE, Italy
| | - Gianni Mazzoni
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Gianni Casella
- Cardiology Unit, Ospedale Maggiore, Azienda USL Bologna, Bologna, Italy
| | - Giovanni Grazzi
- Center for Sports and Exercise Science, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliera Universitaria di Ferrara, Cona, FE, Italy.
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15
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Piva T, Masotti S, Raisi A, Zerbini V, Grazzi G, Mazzoni G, Belvederi Murri M, Mandini S. Exercise program for the management of anxiety and depression in adults and elderly subjects: Is it applicable to patients with post-covid-19 condition? A systematic review and meta-analysis. J Affect Disord 2023; 325:273-281. [PMID: 36634854 PMCID: PMC9829440 DOI: 10.1016/j.jad.2022.12.155] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 08/06/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
The Coronavirus Disease 2019 (Covid-19) pandemic had dramatic effect on mental health, causing long-term psychiatricmorbidity. At present, there are no randomized trials reporting the effect of physical exercise on individuals with post- Covid-19 condition are available. The aim of this review was to summarize the evidence regarding the evidence on exercise as a treatment for anxiety and depression symptoms secondary to chronic diseases, which may be generalized to individuals suffering from the post- Covid-19 condition. Trials were included if they reported the effects of physical exercise programs on anxiety or depression symptoms in adults, either healthy or affected by chronic diseases. Outcomes were changes of anxiety or depression severity after an exercise-based intervention. Of the 2161 RCTs identified, eight out of 15 studies were included. Exercise was associated with greater improvements of depressive (SMD = -0.169; 95 % CI -0.302 at -0.003; p = 0.013) and anxiety symptoms (SMD = -0.263, 95 % CI -0.418 at -0.109; p = 0.001), compared with control interventions. Supervised exercise programs were effective against symptoms of anxiety or depression among individuals with chronich illnesses. Pending specific clinical trials, exercise may be considered for adoption among patients with the post Covid-19 condition.
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Affiliation(s)
- Tommaso Piva
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Sabrina Masotti
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Andrea Raisi
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy.
| | - Valentina Zerbini
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy,Public Health Department, AUSL Ferrara, Ferrara, Italy,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Gianni Mazzoni
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy,Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sports, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
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16
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Cannata S, Gandolfo C, Ribichini FL, van Mieghem N, Buccheri S, Barbanti M, Berti S, Teles RC, Bartorelli AL, Musumeci G, Piva T, Nombela-Franco L, La Spina K, Palmerini T, Adrichem R, Esposito A, Lopes P, Olivares P, Annibali G, Nicolini E, Marroquin L, Tamburino C, Tarantini G, Saia F. One-year outcomes after transcatheter aortic valve implantation with the latest-generation SAPIEN balloon-expandable valve: the S3U registry. EUROINTERVENTION 2023; 18:1418-1427. [PMID: 36880333 PMCID: PMC10111124 DOI: 10.4244/eij-d-22-01022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Initial data about the performance of the new-generation SAPIEN 3 Ultra (S3U) valve are highly promising. However, evidence about the longer-term performance and safety of the S3U is scarce. AIMS We aimed to investigate the 1-year clinical and echocardiographic outcomes of transcatheter aortic valve implantation (TAVI) using the S3U compared with its predecessor, the SAPIEN 3 valve (S3). METHODS The SAPIEN 3 Ultra registry included consecutive patients who underwent transfemoral TAVI at 12 European centres with the S3U or S3 between October 2016 and December 2020. One-to-one propensity score (PS) matching was performed to account for differences in baseline characteristics. The primary outcomes of interest were all-cause death and the composite of all-cause death, disabling stroke and hospitalisation for heart failure at 1 year. RESULTS The overall study cohort encompassed 1,692 patients treated with either the S3U (n=519) or S3 (n=1,173). The PS-matched population had a total of 992 patients (496 per group). At 1 year, the rate of death from any cause was 4.9% in the S3U group and 6.3% in the S3 group (p=0.743). Similarly, there were no significant differences in the rates of the primary composite outcome (9.5% in the S3 group and 6.6% in the S3U group; p=0.162). The S3U was associated with lower rates of mild paravalvular leak (PVL) compared with the S3 (odds ratio 0.63, 95% confidence interval: 0.44 to 0.88; p<0.01). No significant differences in transprosthetic gradients were observed between the two groups. CONCLUSIONS Compared with the S3, the S3U transcatheter heart valve was associated with similar 1-year clinical outcomes but reduced rates of mild PVL.
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Affiliation(s)
- Stefano Cannata
- Unit of Interventional Cardiology, Department of Cardiothoracic Surgery, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), UPMC, Palermo, Italy
| | - Caterina Gandolfo
- Unit of Interventional Cardiology, Department of Cardiothoracic Surgery, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), UPMC, Palermo, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Nicolas van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Thorax Center, Rotterdam, the Netherlands
| | - Sergio Buccheri
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
| | - Marco Barbanti
- Division of Cardiology, AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Sergio Berti
- UOC Cardiologia Diagnostica e Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Massa, Italy
| | - Rui Campante Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | | | | | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Ketty La Spina
- Unit of Interventional Cardiology, Department of Cardiothoracic Surgery, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), UPMC, Palermo, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Rik Adrichem
- Department of Cardiology, Erasmus University Medical Center, Thorax Center, Rotterdam, the Netherlands
| | - Augusto Esposito
- UOC Cardiologia Diagnostica e Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Massa, Italy
| | - Pedro Lopes
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Paolo Olivares
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | | | - Elisa Nicolini
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Corrado Tamburino
- UOC Cardiologia Diagnostica e Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Massa, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
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17
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Palmerini T, Saia F, Kim WK, Renker M, Iadanza A, Fineschi M, Bruno AG, Ghetti G, Vanhaverbeke M, Søndergaard L, De Backer O, Romagnoli E, Burzotta F, Trani C, Adrichem R, Van Mieghem NM, Nardi E, Chietera F, Orzalkiewicz M, Tomii D, Pilgrim T, Aranzulla TC, Musumeci G, Adam M, Meertens MM, Taglieri N, Marrozzini C, Alvarez Covarrubias HA, Joner M, Nardi G, Di Muro FM, Di Mario C, Loretz L, Toggweiler S, Gallitto E, Gargiulo M, Testa L, Bedogni F, Berti S, Ancona MB, Montorfano M, Leone A, Savini C, Pacini D, Gmeiner J, Braun D, Nerla R, Castriota F, De Carlo M, Petronio AS, Barbanti M, Costa G, Tamburino C, Leone PP, Reimers B, Stefanini G, Sudo M, Nickenig G, Piva T, Scotti A, Latib A, Vercellino M, Porto I, Codner P, Kornowski R, Bartorelli AL, Tarantini G, Fraccaro C, Abdel-Wahab M, Grube E, Galié N, Stone GW. Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR: The Hostile Registry. JACC Cardiovasc Interv 2023; 16:396-411. [PMID: 36858659 DOI: 10.1016/j.jcin.2022.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined. OBJECTIVES This study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD. METHODS Patients with PAD and hostile femoral access (TFA impossible, or possible only after percutaneous treatment) undergoing TAVR at 28 international centers were included in this registry. The primary endpoint was the propensity-adjusted risk of 30-day major adverse events (MAE) defined as the composite of all-cause mortality, stroke/transient ischemic attack (TIA), or main access site-related Valve Academic Research Consortium 3 major vascular complications. Outcomes were also stratified according to the severity of PAD using a novel risk score (Hostile score). RESULTS Among the 1,707 patients included in the registry, 518 (30.3%) underwent TAVR with TFA after percutaneous treatment, 642 (37.6%) with TTA, and 547 (32.0%) with TAA (mostly transaxillary). Compared with TTA, both TFA (adjusted HR: 0.58; 95% CI: 0.45-0.75) and TAA (adjusted HR: 0.60; 95% CI: 0.47-0.78) were associated with lower 30-day rates of MAE, driven by fewer access site-related complications. Composite risks at 1 year were also lower with TFA and TAA compared with TTA. TFA compared with TAA was associated with lower 1-year risk of stroke/TIA (adjusted HR: 0.49; 95% CI: 0.24-0.98), a finding confined to patients with low Hostile scores (Pinteraction = 0.049). CONCLUSIONS Among patients with PAD undergoing TAVR, both TFA and TAA were associated with lower 30-day and 1-year rates of MAE compared with TTA, but 1-year stroke/TIA rates were higher with TAA compared with TFA.
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Affiliation(s)
- Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy.
| | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | | | | | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimo Fineschi
- UOSA Cardiologia Interventistica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonio Giulio Bruno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Gabriele Ghetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Maarten Vanhaverbeke
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Enrico Romagnoli
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rik Adrichem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Elena Nardi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Chietera
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Matti Adam
- Klinik III für Innere Medizin - Kardiologie, Pneumologie und Internistische Intensivmedizin, University Hospital Cologne - Heart Center, Cologne, Germany
| | - Max M Meertens
- Klinik III für Innere Medizin - Kardiologie, Pneumologie und Internistische Intensivmedizin, University Hospital Cologne - Heart Center, Cologne, Germany
| | - Nevio Taglieri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Cinzia Marrozzini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Hector Alfonso Alvarez Covarrubias
- German Heart Centre Munich, Munich, Germany; Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Institutio Mexicano de Seguro Social, Mexico City, Mexico
| | | | | | | | | | - Lucca Loretz
- Cardiology, Heart Center Lucerne, Lucerne, Switzerland
| | | | - Enrico Gallitto
- Vascular Surgery, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy
| | - Sergio Berti
- Unit of Diagnostic and Interventional Cardiology, C.N.R. Reg. Toscana G. Monasterio Foundation, Ospedale del Cuore, Massa, Italy
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Leone
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Savini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jonas Gmeiner
- Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany
| | - Daniel Braun
- Department of Medicine I, University Hospital Munich, Medical Faculty, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | - Marco De Carlo
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | | | - Bernhard Reimers
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Stefanini
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Mitsumasa Sudo
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Tommaso Piva
- Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I - GM Lancisi, Torette, Italy
| | - Andrea Scotti
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Matteo Vercellino
- Cardiology Unit, Cardio-Thoraco Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Cardiology Unit, Cardio-Thoraco Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Eberhard Grube
- Medizinische Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Nazzareno Galié
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Cardiac, Thoracic and Vascular Department, Università di Bologna, Bologna, Italy
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Raisi A, Piva T, Myers J, Zerbini V, Mandini S, Zappaterra T, Mazzoni G, Tonet E, Pavasini R, Campo G, Grazzi G, Visintin EP. Experience and Perceptions among Older Outpatients after Myocardial Infarction following an Exercise Intervention: A Qualitative Analysis from the PIpELINe Trial. Int J Environ Res Public Health 2023; 20:2196. [PMID: 36767563 PMCID: PMC9915135 DOI: 10.3390/ijerph20032196] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Traditional cardiac rehabilitation (CR) programs effectively improve physical performance and outcomes after myocardial infarction (MI). However, older patients are less likely to participate in such programs. The aim of this qualitative analysis was to investigate experiences and perceptions of cardiac outpatients enrolled in an innovative and exercise-based CR program and to identify possible barriers to improving adherence and quality of life. Semi-structured interviews were conducted on a sample of 31 patients (84% male; age 76 ± 6 years) from the Physical Activity Intervention in Elderly after Myocardial Infarction (PIpELINe) trial, after about six months of the event. Three main themes were identified: Personal feelings after the event; lifestyle change and perception of barriers; and relationships with familiars. Participants perceived sensations of fear at the time of their diagnosis and showed awareness of the importance of following specific health suggestions. They reported a significative change in previous habits and highlighted the need for periodic controls. Few of them felt insecure in carrying out daily activities or practicing exercise and reported an unnecessary protection from the family members. These findings will provide valuable insights for the development of a more feasible patient-centered CR model of intervention.
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Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Valentina Zerbini
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
| | - Tamara Zappaterra
- Department of Humanities, University of Ferrara, 44121 Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
- Public Health Department, AUSL Ferrara, 44121 Ferrara, Italy
| | - Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, University of Ferrara, 44123 Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, University of Illinois at Chicago, Chicago, IL 60612, USA
- Public Health Department, AUSL Ferrara, 44121 Ferrara, Italy
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Raisi A, Zerbini V, Myers J, Masotti S, Piva T, Lordi R, Chiaranda G, Grazzi G, Mazzoni G, Mandini S. Moderate walking speed and survival association across 23-years follow-up in female patients with cardiovascular disease. Int J Cardiol 2023; 371:371-376. [PMID: 36089160 DOI: 10.1016/j.ijcard.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
AIMS To estimate the association between average walking speed (WS), determined using a moderate 1-km treadmill-walking test (1 k-TWT), and all-cause mortality in female patients with stable cardiovascular disease (CVD). METHODS A sample of 431 patients (age 67 [34-88] years), performed a 1 k-TWT and were followed for all-cause mortality for up to 23 years. Variables significantly associated with mortality were determined by Cox proportional hazard models. Based on average WS during the 1k_TWT the sample was subdivided into tertiles, and mortality risk was calculated. Receiver-operating-characteristic curves were constructed to assess the discriminatory accuracy of WS for estimating survival. RESULTS During a median follow-up of 10.4 years, a total of 135 deaths from any cause occurred, with an average mortality rate of 4.2%. The strongest predictor of mortality was WS (c-statistic for all-cause mortality 0.801, 95% confidence intervals: 0.51-1.11, p < 0.0001). Survival rate decreased from the fastest to the lowest tertile. Compared to the group with the lowest WS, the hazard ratios (95% confidence intervals) for the second and third tertiles were 0.73 (0.48-1.12) and 0.47 (0.25-0.91), respectively (p for trend <0.0001). CONCLUSION Average WS maintained during a moderate treadmill-walk is inversely related to survival in female patients with CVD. The 1 k-TWT is a simple and useful tool for assessing progress and stratifying risk in women undergoing secondary prevention programs.
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Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Valentina Zerbini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy.
| | - Jonathan Myers
- Division of Cardiology, VA, Palo Alto, CA, USA; Stanford University School of Medicine, Stanford, CA, USA; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Sabrina Masotti
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Rosario Lordi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy; Public Health Department, AUSL Ferrara, Italy
| | - Giorgio Chiaranda
- Public Health Department, AUSL Piacenza, Italy; General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA; Public Health Department, AUSL Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy; Public Health Department, AUSL Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
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20
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Mainardi A, Nicolini E, Andreaggi S, Fabroni M, Maolo A, Mariottini M, Pesarini G, Scarsini R, Mammone C, Ribichini F, Piva T, Pighi M. 735 CLINICAL EFFICACY OF CEREBRAL EMBOLIC PROTECTION IN TRANSFEMORAL TAVI PROCEDURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.327] [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
Although in the context of Transcatheter Aortic Valve Implantation (TAVI) technological improvements, refinements in technique and increased operator experience have led to progressive reduction in most complications, periprocedural neurological ischemic event (stroke and TIA) continues to occur in up to 2% of patients undergoing TAVI. Many of these are attributed to embolic events during the procedure and can lead to potentially devastating consequences. Cerebral Embolic Protection (CEP) devices have been developed to mitigate this risk. Data regarding the clinical efficacy of these devices in preventing neurological events in TAVI are conflicting. The aim of the present study is to investigate the impact of CEP on clinical neurological events in TAVI.
Methods
We performed a multicentric retrospective observational case-control study to evaluate the rate of periprocedural clinical neurological ischemic event in patients undergoing transfemoral TAVI with or without using CEP (Sentinel, Boston Scientific) during the procedure. Patients were consecutively enrolled between January 2018 and December 2021 by two tertiary centers (Verona and Ancona). A total population of 1042 patients were enrolled. The primary endpoint was the rate of a periprocedural clinical neurological ischemic event. The secondary was a composite endpoint: in-hospital death, periprocedural major vascular complication and periprocedural major bleeding. Clinical events at 30-day follow-up were evaluated (death, clinical neurological ischemic event, vascular complications, major bleeding). In consideration of the retrospective study design, we performed a propensity match analysis to account for differences in the baseline characteristics of patients in the two enrolling centers.
Results
The overall population comprised patients who underwent TAVI without using CEP (No-CEP group, n=581) and with CEP (CEP group, n=461). The propensity match analysis yielded a final population of 922 patients: 461 patients in the No-CEP group and 461 patients in the CEP group. There were no differences in baseline characteristics between the groups. Primary endpoint occurred in 8 (0,9%) patients overall, 3 (0,7%) patients in the No-CEP group and in 5 (1,1%) patients in CEP group (p=0,725). There were no differences in secondary endpoint: 25 (5,4) patients in No-CEP group and 20 (4,3%) in CEP group (p=0,541). In particular: in-hospital death (0,7% vs 1,3%, p=0,506), periprocedural major vascular complications (2,0% vs 0,7%, p=0,143), periprocedural major bleeding (5,0% vs 3,0%, p=0,179). No differences were observed in 30-days outcomes: death (0,0% vs 0,9%, p=0,131), clinical neurological ischemic events (0,8% vs 0,7%, p=1), vascular complications (0,3% vs 0,0%, p=0,450), major bleeding (0,8% vs 0,7%, p=1). The multiple logistic regression performed to estimate the effect of CEP on the primary endpoint showed Euroscore II (OR, 1.10; 95% CI, 1.00–1.19; P=0.028) and predilatation (OR, 4.84; 95% CI, 1.21–21.64; P=0.028) was associated with an increase in primary endpoint after TAVI, while CEP and valve type did not contribute significantly.
Conclusions
This study suggests that using CEP devices during transfemoral TAVI is safe and does not increase vascular complications, although it does not impact the rate of periprocedural clinical neurological ischemic events.
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Affiliation(s)
- Andrea Mainardi
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Elisa Nicolini
- Division Of Cardiology , Azienda Ospedaliero Universitaria Delle Marche
| | - Stefano Andreaggi
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | | | - Alessandro Maolo
- Division Of Cardiology , Azienda Ospedaliero Universitaria Delle Marche
| | | | - Gabriele Pesarini
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Roberto Scarsini
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Concetta Mammone
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Flavio Ribichini
- Division Of Cardiology, Department Of Medicine, University Of Verona
| | - Tommaso Piva
- Division Of Cardiology , Azienda Ospedaliero Universitaria Delle Marche
| | - Michele Pighi
- Division Of Cardiology, Department Of Medicine, University Of Verona
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21
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Menegatti E, Mandini S, Pagani A, Mandini B, Zerbini V, Piva T, Raisi A, Fabbri M, Fogli M, Mazzoni G, Zamboni P, Gianesini S. The Effect of Active Stretching Training in Patients with Chronic Venous Insufficiency Monitored by Raster-Stereography. Sensors (Basel) 2022; 22:8509. [PMID: 36366206 PMCID: PMC9657419 DOI: 10.3390/s22218509] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Musculoskeletal disorders can be associated with advanced clinical stages of chronic venous insufficiency (CVI). The aim of the study is to investigate the effect of active stretching (AS) training on lower limb venous function and quality of life in patients affected by CVI. (2) Methods: A prospective two-armed pilot randomized controlled was conducted. Twenty (20) CVI patients were randomly assigned to an AS training or to a control group (C) who did not receive any exercise indication. At baseline and after three months all the participants were tested for leg volumetry (LV), air plethysmography (APG), and quality of life (QoL) measured by a disease specific validated questionnaire (VVSymQ), ankle range of motion (ROM), and postural deformities using an optoelectronic body posture machine. (3) Results: At the end of the training in the AS group a significant leg volume reduction was detected (from 2340 ± 239 mL to 2239 ± 237 mL (4.3%); p < 0.0001), whereas in the C group no significant volume changes were found. The ejection fraction rate (EF%) increased significantly from 49.3 ± 9.3 to 61.1 ± 14.5, p < 0.005. A moderate-strong linear correlation with EF% and ankle ROM variation was found (R2 = 0.6790; p < 0.0034). Several postural outcomes such as pelvic tilt, pelvic torsion, and lordotic angle significantly improved in the AS group (p < 0.01, p < 0.04, p < 0.01 respectively). (4) Conclusion: The AS training impacts on the APG parameters related to the musculoskeletal pump efficiency, opening a further possibility in the management of CVI patients by means of an appropriate adapted physical exercise program.
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Affiliation(s)
- Erica Menegatti
- Department of Environmental and Prevention Sciences, University of Ferrara, 44123 Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Anselmo Pagani
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Beatrice Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Valentina Zerbini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Marinella Fabbri
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Marco Fogli
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Sergio Gianesini
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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22
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Menegatti E, Proto A, Paternò G, Gadda G, Gianesini S, Raisi A, Pagani A, Piva T, Zerbini V, Mazzoni G, Grazzi G, Taibi A, Zamboni P, Mandini S. The Effect of Submaximal Exercise on Jugular Venous Pulse Assessed by a Wearable Cervical Plethysmography System. Diagnostics (Basel) 2022; 12:diagnostics12102407. [PMID: 36292096 PMCID: PMC9600745 DOI: 10.3390/diagnostics12102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
The jugular venous pulse (JVP) is a one of the crucial parameters of efficient cardiovascular function. Nowadays, limited data are available regarding the response of JVP to exercise because of its complex and/or invasive assessment procedure. The aim of the present work is to test the feasibility of a non-invasive JVP plethysmography system to monitor different submaximal exercise condition. Twenty (20) healthy subjects (13M/7F mean age 25 ± 3, BMI 21 ± 2) underwent cervical strain-gauge plethysmography, acquired synchronously with the electrocardiogram, while they were carrying out different activities: stand supine, upright, and during the execution of aerobic exercise (2 km walking test) and leg-press machine exercise (submaximal 6 RM test). Peaks a and x of the JVP waveform were investigated since they reflect the volume of cardiac filling. To this aim, the Δax parameter was introduced, representing the amplitude differences between a and x peaks. Significant differences in the values of a, x, and Δax were found between static and exercise conditions (p < 0.0001, p < 0.0001, p < 0.0001), respectively. Particularly, the Δax value for the leg press was approximately three times higher than the supine, and during walking was even nine times higher. The exercise monitoring by means of the novel JVP plethysmography system is feasible during submaximal exercise, and it provides additional parameters on cardiac filling and cerebral venous drainage to the widely used heartbeat rate value.
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Affiliation(s)
- Erica Menegatti
- Department of Environmental Science and Prevention, University of Ferrara, 44123 Ferrara, Italy
| | - Antonino Proto
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
- Correspondence: ; Tel.: +39-0532-974375
| | - Gianfranco Paternò
- Department of Physics and Earth Sciences, University of Ferrara, 44122 Ferrara, Italy
| | - Giacomo Gadda
- Department of Physics and Earth Sciences, University of Ferrara, 44122 Ferrara, Italy
| | - Sergio Gianesini
- Department of Translational Medicine, University of Ferrara, 44123 Ferrara, Italy
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Andrea Raisi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Anselmo Pagani
- Department of Translational Medicine, University of Ferrara, 44123 Ferrara, Italy
| | - Tommaso Piva
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Valentina Zerbini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Gianni Mazzoni
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Giovanni Grazzi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL 60612, USA
| | - Angelo Taibi
- Department of Physics and Earth Sciences, University of Ferrara, 44122 Ferrara, Italy
| | - Paolo Zamboni
- Department of Translational Medicine, University of Ferrara, 44123 Ferrara, Italy
| | - Simona Mandini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
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23
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Belfioretti L, Marini M, Francioni M, Battistoni I, Angelini L, Matassini MV, Angelozzi A, Pongetti G, Shkoza M, Piva T, Compagnucci P, Munch C, Dello Russo A, Di Eusanio M, Perna GP. Temporal trend mortality and in-hospital mortality predictors in an ischemic cardiogenic shock population: a 10 years single-centre retrospective study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiogenic shock (CS) after acute myocardial infarction (AMI) is a life-threatening condition with an high rate of in-hospital mortality.
Purpose
This study aims to 1) describe predictors of in-hospital mortality; 2) evaluate ten years mortality temporal trend in our Cardiac Intensive Care Unit (CICU); 3) assess the feasibility of CARDSHOCK risk score in our population; 4) elaborate a simpler version of CARDSHOCK risk score.
Methods
All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single-centre retrospective study.
Results
We included 167 patients [males 67%; age 71 (61–80) years] with ischemic CS. Patients had severe LV dysfunction in 66%. Baseline serum lactate was 5.2 (3.1–8.8) mmol/L. All patients required inotropes: 71% required dopamine [mean dose 5.6 (2.4–11,3) mcg/kg/min], 65% required noradrenaline [mean dose 0.10 (0.05–0.18) mcg/kg/min], 32% required dobutamine [mean dose 4.5 (2.2–15.9) mcg/kg/min]; 17.4% received levosimendan alone [mean dose 0.1 mcg/kg/min]. Mechanical cardiac support (MCS) was pursued in 91.1% [65% IABP, 23% Impella CP, 4% VA-ECMO]. From March 2012 to July 2021 we observed a significative temporal trend mortality reduction (OR=0.90, 95% CI: 0.84–0.96, p=0.0015), in particular in-hospital mortality has reduced from 57% of first time-quartile to 29% of the fourth quartile (Figure 1). In addition we also noted a significant increase in Impella catheter use (p=0.0005) with a consequent reduction of IABP (p=0.01), a reduction in dopamine administration (p=0.0007) and a greater use of dobutamine and levosimendan (p=0.015 and p=0.0001). In our population of AMI-CS patients CARDSHOCK risk score was a reliable in-hospital mortality predictor tool (OR 1.11; 95% CI, 1.06–1.17; p=0.00011). After the multivariate analysis only ejection fraction (EF) at baseline (OR=0.99, 95% CI: 0.98–0.99, p=0.009), lactate level at presentation (OR=1.03, 95% CI: 1.01–1.06, p=0.015) and presence of three-vessels coronary artery disease (OR=0.73, 95% CI: 0.59–0.90, p=0.0038) resulted to be in-hospital mortality predictors. For this reason, a prediction model composed by those three variables was created which exhibited better predictive performance for in-hospital mortality than Cardshock risk score (AUC of 0.94 vs AUC of 0.72 respectively, p=0.015) (Figure 2).
Conclusions
In our retrospective single-centre study a significant reduction of mortality through the years is observed, probably due to more extensive use of micro axial pumps and better manipulation of inotropic drug therapies. The use of Cardshock risk score has been proven to be a feasible tool in prediction on in-hospital mortality also in our sample composed only of AMI-CS patients. In addition, a more simplified risk score made up of only three clinical variables demonstrates at least the same predictive performance. Future validation in a larger population could be advisable to validate the simplified score.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Belfioretti
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - M Marini
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - M Francioni
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - I Battistoni
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - L Angelini
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - M V Matassini
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - A Angelozzi
- G. Mazzini Hospital, Cardiology , Teramo , Italy
| | - G Pongetti
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - M Shkoza
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
| | - T Piva
- Riuniti Hospital of Ancona, Interventional Cardiology , Ancona , Italy
| | - P Compagnucci
- University Hospital Riuniti of Ancona, Cardiology and Arrhythmology Clinic , Ancona , Italy
| | - C Munch
- Riuniti Hospital of Ancona, Cardiac Anaesthesia and Intensive Care Unit , Ancona , Italy
| | - A Dello Russo
- University Hospital Riuniti of Ancona, Cardiology and Arrhythmology Clinic , Ancona , Italy
| | - M Di Eusanio
- Riuniti Hospital of Ancona, Cardiac Surgery Unit , Ancona , Italy
| | - G P Perna
- Riuniti Hospital of Ancona, Cardiology Department Intensive Care Unit , Ancona , Italy
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24
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Lordi R, Veronese S, Piccinini A, Ferro A, Zerbini V, Piva T, Raisi A, Mandini S, Grazzi G, Sassone B, Pasanisi G. P370 INNOVATIVE TELEMONITORED MODEL OF PHYSICAL EXERCISE PRESCRIPTION IN SECONDARY PREVENTION DURING THE QUARANTINE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.356] [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
Introduction
COVID–19 pandemic induced the emanation of extraordinary measures like quarantine, that can be considered a risk factor for both physical and mental health in the population. In particular, gym’s closure and the need to stay home didn’t allow people to perform physical activity easily, with a consequent worsening of cardiovascular risk factors. During quarantine some general recommendations have been disseminated, but little is known about specific guidelines for home–based exercise prescription in patients with cardiovascular disease. Therefore, the purpose of this study is to develop home–based physical exercise programs for cardiac patients referred to the Center for Exercise Science and Sports of University of Ferrara.
Methods
On the basis of exercise capacity obtained from the last functional evaluation, performed in presence before the closure, three structured workouts were realized following the guidelines. They are composed as follows: warm–up, strenght and balance exercises alternate to indoor walking, cool–down. Patients received an explicative iconographic via e–mail or smartphone. Some domiciliary sessions were supervised by an operator through video connection.
Results
All patients showed excellent compliance with the proposed program. Adherence has been verified through biweekly recalls. No adverse events occurred.
Conclusions
Telemonitored exercise prescription in cardiac outpatients was effective and safe, helping to prevent negative consequences of the abrupt cessation of physical activity due to COVID–19 pandemic. These evidence could be useful even after the end of pandemic, for all those patients that are less likely to participate in traditional cardiovascular rehabilitation programs because of difficulties in reaching facilities or leaving home.
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Affiliation(s)
- R Lordi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - S Veronese
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - A Piccinini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - A Ferro
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - V Zerbini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - T Piva
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - A Raisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - S Mandini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - G Grazzi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - B Sassone
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
| | - G Pasanisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, FERRARA; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND
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Lordi R, Veronese S, Ferro A, Piccinini A, Piva T, Zerbini V, Raisi A, Mandini S, Grazzi G, Sassone B, Pasanisi G. P401 REMOTE COUNSELING ROLE DURING COVID–19 PANDEMIC IN SECONDARY PREVENTION AFTER ACUTE CORONARY SYNDROME. Eur Heart J Suppl 2022. [PMCID: PMC9384009 DOI: 10.1093/eurheartj/suac012.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Patients affected by acute coronary syndrome are usually referred to center–based secondary prevention programs where they are enrolled in physical activity programs and received indications about cardiovascular risk factors control. COVID–19 pandemic induced the emanation of restrictions in people’s mobility, ban on gathering and the obligation of social distancing. This made it difficult to maintain such group meetings in presence. Methods After hospitalization for acute coronary syndrome in Cardiology Unit of the AUSL of Ferrara, patients equipped with electronic devices were allowed to participate to remote counseling meetings on the digital platform LifesizeC. To improve participation, meetings were organized monthly (in order to gradually include new discharged patients) and involving caregivers (if patients weren’t able to access the web app). Information on regular physical activity benefits were provided. In particular, the F.I.T.T. principle (Frequency, Intensity, Type, Time) has been explained and Borg’s exertion scale was illustrated to be used in autonomy. Furthermore, there were provided recommendations about the need of a proper warm– up/cool–down, the possibility to wear a heart rate monitor and the early recognition of symptoms and warning signs. To complete health education, there were given information about correct nutrition, risk factors control and correct assumption of pharmacological therapy. Results All patients showed interest in the topics analyzed, asking various questions during the meetings. They also stated that they were strongly motivated to undertake regular physical activity having received convincing explanations on its usefulness and safety. Conclusions Remote counseling meetings obtained a high approval rating and the moments of discussion with the speakers were particularly well attended. The prescription of physical exercise in secondary prevention can follow innovative telemonitored approaches, which could be maintained even after COVID–19.
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Affiliation(s)
- R Lordi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Veronese
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Ferro
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Piccinini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - T Piva
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - V Zerbini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Raisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Mandini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - G Grazzi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - B Sassone
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - G Pasanisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
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Lordi R, Veronese S, Mandini S, Raisi A, Piccinini A, Ferro A, Zerbini V, Piva T, Grazzi G, Biagio S, Pasanisi G. P422 EARLY EXERCISE PRESCRIPTION AFTER ACUTE CORONARY SINDROME. A NEW MODEL FROM BEDSIDE TO THE COMMUNITY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.406] [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: 11/15/2022]
Abstract
Abstract
Purpose
Physical inactivity is a major risk factor and negative prognostic index of cardiovascular disease. It is necessary to define effective strategies to direct patients after an acute coronary syndrome (ACS) to physically active lifestyle. The aim of this study was to examin efficacy, feasibility and long term adherence of a new physical activity prescription, adapted to patients (pts) early after ACS.
Methods
34 pts, mean age 67years, hospitalized for ACS, were enrolled consecutively and randomized 2:1 in treatment (TR) group (n = 23) or in control (CT) group. All pts were evaluated before discharge from hospital (T0) through Quality of Life (QoL) SF12 questionnaire, determination of physical activity during free time, six–minute walking test (6MWT). All pts were orally advised about the importance of changing life–style as recommended by current international guidelines. At T0, pts in the TR group performed a 500m moderate and perceptually–regulated (11–13 on the 6–20 Borg scale) treadmill walking test (500–m TWT) to estimate peak oxygen uptake (VO2peak). A home–based physical activity based on walking, was provided to pts in the TR group: it was recommended to maintain the level of perceived intensity of effort as indicated during 500m–TWT. These pts also received a reinforce phone–call at 2 and 4 weeks (T1 and T2), that allowed monitoring the adherence to the programme. All pts were finally evaluated 8 weeks after enrollment (T3) through the same tests performed at T0.
Results
Pts of the TR group at T3 reported significative improvement, compared to T0, in 6MWT (+79 m, p < 0.001), QoL (expressed in the items of SF12), usual physical activity during free time (+13MET/h/week, p < 0.001), VO2peak (+4 mL/kg/min, p < 0.001). Compliance to the programme resulted optimal since all TR group pts continued the planned physical activity for all the follow–up.
Conclusions
Results of this study on efficacy, feasibility and compliance of a new model of secondary prevention programme, suggest the importance of implementing programmes of tailored physical activity schedules, based on walking, that can be safetly started soon after clinical stabilization of ACS.
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Affiliation(s)
- R Lordi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Veronese
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Mandini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Raisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Piccinini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - A Ferro
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - V Zerbini
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - T Piva
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - G Grazzi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - S Biagio
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
| | - G Pasanisi
- CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA; DEPARTMENT OF EMERGENCY, DIVISION OF CARDIAC REHABILITATION, AUSL FERRARA, LAGOSANTO; CENTRE FOR EXERCISE SCIENCE AND SPORT, UNIVERSITY OF FERRARA, FERRARA, PUBLIC HEALTH DEPARTMENT, AUSL FERRARA, FERRARA; DEPARTMENT OF MORPHOLOGY, SURGERY AND EXPERIMENTAL MEDICINE, UNIVERSITY OF FERRARA, FERRARA, DEPARTMENT OF EMERGENCY, DIVI
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Gallo F, Gallone G, Kim WK, Reifart J, Veulemans V, Zeus T, Toggweiler S, De Backer O, Søndergaard L, De Marco F, Regazzoli D, Reimers B, Muntané-Carol G, Estevez-Loureiro R, Hernandez U, Moscarelli M, Airale L, D'Ascenzo F, Armario X, Mylotte D, Bhadra OD, Conradi L, Donday LAM, Nombela-Franco L, Barbanti M, Reddavid C, Criscione E, Brugaletta S, Nicolini E, Piva T, Tzanis G, Ronco F, Barbierato M, Rodes-Cabau J, Mangieri A, Colombo A, Giannini F. Procedural outcomes of the 34 mm EvolutR Transcatheter valve in a real-world population insights from the HORSE multicenter collaborative registry. Int J Cardiol 2022; 361:55-60. [PMID: 35500820 DOI: 10.1016/j.ijcard.2022.04.079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate outcomes of real-world patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) with the 34 mm Evolut R (Medtronic, Minneapolis, Minnesota). BACKGROUND Larger aortic annulus has been associated with increased incidence of paravalvular leaks (PVLs) after TAVR. However, little is known, so far, about the performance of the 34 mm Evolut R in this setting. METHODS From the multicenter, international, retrospective Horizontal Aorta in Transcatheter Self-expanding Valves (HORSE) registry, including patients who underwent TAVR for native severe AS, we selected patients treated with the 34 mm Evolut R evaluating procedural characteristics and VARC-2 defined device success. We also compared 34 mm Evolut R with other Evolut R sizes. RESULTS Among the 4434 patients included in the registry, 572 (13%) received the 34 mm Evolut R valve. Mean age was 80.8 ± 6.5 years and the median STS PROM score was 4 [interquartile range 2-6]. Device success was achieved in 87.4% with 7.7% of PVLs; moreover, the rate of permanent pacemaker implantation (PPMI) was 22.4%. Patients who underwent 34 mm Evolut R implantation experienced more in-hospital permanent pacemaker implantation (22.4% vs. 15%; p < 0.001). At multivariate analysis, 34 mm Evolut R did not affect device success (OR: 0.81 [0.60-1.09]; p = 0.151). Device success was consistent with other THVs sizes (87.4% vs. 89.6%; p = 0.157). CONCLUSIONS THV replacement in patients requiring 34 mm Evolut R has an acceptable performance. Compared to other Medtronic sizes it demonstrated to be comparable in terms of device success, despite an increased rate of pacemaker implantation.
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Affiliation(s)
- Francesco Gallo
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Guglielmo Gallone
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Jörg Reifart
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany
| | | | - Ole De Backer
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | | | - Ubaldo Hernandez
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Bari, Italy
| | - Lorenzo Airale
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Xavier Armario
- Department of Cardiology, National University of Ireland, Galway, (NUIG), Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway, (NUIG), Galway, Ireland
| | - Oliver Daniel Bhadra
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Claudia Reddavid
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Enrico Criscione
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elisa Nicolini
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giorgos Tzanis
- Department of Interventional Cardiology, Henry Dunant Hospital Center, Athens, Greece
| | - Federico Ronco
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Marco Barbierato
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research.
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Mandini S, Morelli M, Belvederi Murri M, Grassi L, Masotti S, Simani L, Zerbini V, Raisi A, Piva T, Grazzi G, Mazzoni G. Adherence to a guided walking program with amelioration of cognitive functions in subjects with schizophrenia even during COVID-19 pandemic. BMC Sports Sci Med Rehabil 2022; 14:48. [PMID: 35337370 PMCID: PMC8951652 DOI: 10.1186/s13102-022-00440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022]
Abstract
Background Aim of the study was to enrol a group of individuals with schizophrenia in a long-term moderate-intensity physical activity program and to evaluate its effects on their cognitive functions and cardiovascular risk factors. An additional aim of the study was the comparison of the adherence to the physical activity program before and during the COVID-19 pandemic. Methods Forty sedentary patients diagnosed with schizophrenia (mean age 46.4 ± 9.6) followed by the Public Mental Health Department of Ferrara were included in the study. 28 of them followed a 1-year walking program consisting of two guided walking sessions/week, while 12 maintained their sedentary lifestyle and followed the usual Cognitive Rehabilitation program. To the participants following the walking program VO2 peak and walking speed were assessed at baseline and at the end of the program. All participants were evaluated on blood pressure and anthropometric variable. Cognitive functions were assessed with the Screen for Cognitive Impairment in Psychiatry (SCIP) and with the Frontal Assessment Battery (FAB) questionnaires. Results The 20 participants completing the walking program displayed significant improvements in cognitive functions (dppc2 0.35 for SCIP and 0.26 for FAB), with a positive correlation between SCIP score and the number of sessions attended (R = 0.86, p < 0.001), evident in the patients attending to at least 75 of the 100 walking sessions. Walking speed and VO2peak increased significantly and a decrease of body weight, BMI, systolic and diastolic blood pressure was also observed. The adherence to the walking program registered during Covid-19 period did not differ from that observed before the pandemic. The 12 CG (Control Group) patients maintaining the sedentary lifestyle did not display improvements of cognitive functions. Conclusions The main finding of this study is the improvement of cognitive functions which is significantly related to the number of walking sessions attended by participants with schizophrenia. The walking program, guided by exercise specialists, proved to be an enjoyable activity for people with mental disorder feasible even during the COVID-19 pandemic. Trial registration Retrospectively registered on ISRCTN as non-randomized trial (n. ISRCTN14763786).
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Affiliation(s)
- S Mandini
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
| | - M Morelli
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
| | - M Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - L Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - S Masotti
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
| | - L Simani
- Public Mental Health Department, AUSL Ferrara, Ferrara, Italy
| | - V Zerbini
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy.
| | - A Raisi
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
| | - T Piva
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
| | - G Grazzi
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy.,Public Health Department, AUSL Ferrara, Ferrara, Italy.,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - G Mazzoni
- Department of Neuroscience and Rehabilitation, Center for Exercise Science and Sports, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy.,Public Health Department, AUSL Ferrara, Ferrara, Italy
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Sticchi A, Gallo F, Benenati S, Won-keun K, Khokhar AA, Zeus T, Toggweiler S, De Marco F, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 595 Impact of age on outcomes in a large multicentre low-to-intermediate risk TAVI population: in and out the age cut-off from ESC 2021 valvular heart disease guidelines. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
The ESC 2021 valvular heart disease [VHD] guidelines introduced an important and debated age cut-off (75 years) to lead the choice between surgical and transcatheter aortic valve implantation (TAVI) in non-high-risk patients. The aim of this study was to evaluate what impact an age cut-off has on clinical outcomes following TAVI in low-to-Intermediate Risk patients from a real word registry.
Methods
We performed the investigation in a large, contemporary, real-world, multicentre, international, retrospective registry of 3862 consecutive patients, comparing the rates of patient risk factors, procedural characteristics, complications, and outcomes in the populations with < or ≥ 75 years old.
Results
In our real-world cohort of 2977 patients with mean STS score of 3.6% (5.0–2.5), we found 301 (10.1%) patients with age <75 years and 2676 (89.9%) with ≥75 years. In the younger group compared with the older, we have a higher prevalence of male (44% vs. 35%, P=0.003), higher BMI (mean of 28.5 kg/m² vs. 26.7 kg/m², P = <0.001), diabetes (32% vs. 26%, P=0.027), insulin-dependent diabetes (12% vs. 7%, P=0.001), smoking (18% vs. 7%, P<0.001), COPD (26% vs. 16%, P<0.001). Moreover, younger patients presented less previous PM/ICD (6% vs. 11%, P=0.023), less atrial fibrillation (24% vs. 33%, P=0.033), less renal impairment (30% vs. 66%, P<0.001) and a lower mean STS score (2.6% vs. 3.7%, P<0.001). There was no difference in annular sizing, valvular and LVOT calcifications between the two groups. Older patients had a higher prevalence of porcelain aorta (2% for age<75 vs. 9%, P=0.001). Between the two groups no significant differences in procedural characteristics were observed, including rates of pre-dilatation (P=0.369), post-dilatation (P=0.159) and contrast volume (P=0.259). Procedural complications, in-hospital outcomes and 2-year Kaplan-Meier (KM) survival was equivalent between both groups (P=0.930). Finally, we assessed the best age cut-off related to 1-year mortality in our population, resulting in 86 years. Still, also in this scenario, the KM survival analysis did not show significant differences (P=0.120).
Conclusions
In our large real-world contemporary low-to-intermediate risk TAVI population, an age cut-off of 75 years was not associated with any difference in clinical outcomes and survival at 2-years follow-up. This data reinforces the concept that age alone is not a sufficient variable to be considered when choosing between TAVI or SAVR. The recent ESC 2021 VHD guidelines cut-off is justified only by the lack of evidence and valve durability strategy but not of a proper advantage age-related.
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Affiliation(s)
- Alessandro Sticchi
- Centro Per La Lotta Contro L’infarto (CLI) Foundation, Rome, Italy; Unicamillus, Saint Camillus International University Of Health Sicences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Stefano Benenati
- Cattedra Di Malattie Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS Genova
| | - Kim Won-keun
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Tobias Zeus
- Division of Cardiology, Pulmonolgy and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti Di Ancona, Italy
| | - Josep Rodes-cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Italo Porto
- Cattedra Di Malattie Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS Genova
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital Irccs, Rozzano, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
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30
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Sticchi A, Gallo F, Benenati S, Won-keun K, Khokhar AA, Zeus T, Toggweiler S, De Marco F, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 597 Comparison between low versus intermediate-high risk patients in a contemporary real-world multicentre TAVI registry using self-expanding supra-annular valves: a propensity score matched analysis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Recent ESC VHD guidelines from 2021 recommend TAVI for intermediate-risk and in certain cases low-risk populations. There is relatively little data regarding the impact of transcatheter heart valve design in these populations. The aim of this study was to investigate the clinical outcomes of low-risk versus intermediate-high risk patients following TAVI in a large real-world contemporary registry.
Methods
In a large TAVI registry using self-expanding supra-annular bioprosthesis, we performed a comparison between low vs. intermediate-high risk population. Primary outcome was 1-year mortality and secondary outcomes, defined according to Valve Academic Research Consortium 2 criteria, included major and minor vascular complications, annular rupture, myocardial infarction, cardiac tamponade, new permanent pacemaker, stroke, and major and minor bleeding. Finally, we assessed the same investigation applying a propensity score matched (PSM) analysis.
Results
In the unmatched comparison, the low-risk (LR) group included 1698 patients compared to the 1690 patients of the Intermediate-to-high risk group (IHR). The IHR population showed a mean age of 84 years old vs. 81 of the LR (P<0.001), a higher prevalence of male sex (41% vs. 30%, P<0.001) and increased prevalence of co-morbidities as evidenced by the higher mean STS score 5.80% vs. 2.63% (P<0.001). About the echocardiographic characteristics, the LR presented a higher mean gradient (45.9±15 mmHg vs. 43.7±16.8 mmHg, P<0.001) but similar area compared to the IHR group (0.7 [0.8–0.6] for LR and 0.7 (0.8–0.55) for IHR, P=0.096). In the first unmatched comparison, we found a higher rate of major vascular complications (5.4% vs. 7.3%, P=0.026), new permanent pacemaker (10.5% vs. 13.7%, P=0.006) and major bleeding (2.9% vs. 5.0%, P=0.002) for the IHR group. After the PSM, we obtained 1015 matched patients observing similar outcomes except for minor vascular complications (7.4% vs. 11%, P=0.014) for the IHR group. At a median follow-up of 368 days, the mortality rate was 12.2% (104/1559) vs. 6.8% (104/1520) for the un-matched populations (P<0.001), and 10.4% (98/940) vs. 7.9% (71/898) for the matched patients (P=0.100), respectively for the IHR and the LR group.
Conclusions
In this large, contemporary real-world registry of TAVI patients, there was no difference in mortality observed between LR and IHR populations at a 1-year follow-up. This data suggests that additional factors beyond surgical risk scores should be considered during heart team evaluation of patients with severe aortic stenosis towards a single-patient tailored approach.
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Affiliation(s)
- Alessandro Sticchi
- Centro Per La Lotta Contro L’infarto (CLI) Foudnation, Rome, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Stefano Benenati
- Cattedra Di Malattia Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova
| | - Kim Won-keun
- Department of Cardiology, Kerckoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institue, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti Di Ancona, Italy
| | - Joseph Rodes-cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Italo Porto
- Cattedra Di Malattia Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova
| | - Antonio Colombo
- Department of Biomedical Sicences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital Irccs, Rozzano, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
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31
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Sticchi A, Gallo F, Marzo VD, Won-keun K, Khokhar AA, Zeus T, Toggweiler S, Marco FD, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 607 Comparison of incidence and predictors of new left bundle branch block and permanent pacemaker implantation in a large multicentre contemporary TAVI registry using the Evolut R/pro system vs. the accurate neo valve. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.044] [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
Conduction disorders and permanent pacemaker implantation (PPI) continue to be an important issue in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to investigate the incidence and clinical outcomes of new left bundle branch block (LBBB) and PPI after TAVI in a comparison between two self-expandable supra-annular transcatheter valves.
Methods and results
We report the data from an international, retrospective registry including 3862 consecutive patients who underwent TAVI with two self-expanding transcatheter heart valves (Medtronic Evolut R/PRO and Boston ACURATE neo). Patients with pre-existing left or right bundle branch block, any atrioventricular blocks or previous pacemaker implantation were excluded. Finally, we performed a propensity score matched analysis (PSM) to match the patients and overcome pre-procedural differences reaching 427 couples. New-onset Left Bundle Branch Block (LBBB) occurred with a rate of 13.1% (56/427) in the ACURATE group and 18.7% (80/427) in the Evolut group (P = 0.031). The incidence of new permanent pacemaker implantation was 16.4% (70/427) in the Evolut group and 6.8% (29/427) in the ACURATE group, respectively (P < 0.001). In the multivariate regression analysis, we found the valve recapture [odds ratio (OR): 4.66, 95% confidence interval (CI): 1.08–23.75, P = 0.042] as significant predictors for LBBB, and male sex (OR: 1.59, CI: 1.03–2.46, P = 0.036), ACURATE valve (OR: 0.34, CI: 0.20–0.57, P < 0.001) and post-procedure LBBB (OR: 4.38, CI: 2.78–6.85, P < 0.001) for PPI.
Conclusions
In our large multi-centre contemporary cohort of patients, new LBBB and PPI occurred more frequently in patients following TAVI with Evolut R/PRO vs. ACURATE valve. However, the choice of the valve seemed to influence only the rate of pacemaker implantation and not the incidence of new LBBB. Further data is required to clarify the impact of valve design on conduction abnormalities.
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Affiliation(s)
- Alessandro Sticchi
- Centro per la Lotta Contro L’Infarto (CLI) Foundation, Unicamillus—Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Vincenzo De Marzo
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Kim Won-keun
- Department of Cardiology Kerckoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center—IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut D’Investigacions Biomèdiques August Pi i Sunyer (Idibaps), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Italy
| | - Josep Rodes-cabau
- Quebec Heart and Lung Insitute, Laval University, Quebec City, Quebec, Canada
| | - Italo Porto
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Cardio Center, Humanitas Research Hospital IRCCS, Humanitas University, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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Sticchi A, Gallo F, Marzo VD, Won-keun K, Zeus T, Toggweiler S, Marco FD, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 612 Comparison of two self-expandable supra-annular bioprosthesis: a propensity score-matched analysis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab134.045] [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
Limited data reported the comparison of bioprostheses for transcatheter aortic valve implantation (TAVI) among devices of supra-annular design. The aim of this study is to compare the clinical outcomes of the ACURATE neo and Evolut R/PRO valves for TAVI in a propensity score-matched analysis (PSM).
Methods and results
We performed a propensity score-matched analysis equalizing almost all the patient’s risk factors, anatomical and procedural characteristics, and assessing the predictive value of the remaining features. Our data were derived from a large, real-world, contemporary, multicentre, international, retrospective registry of 3862 consecutive patients undergoing TAVI using two different self-expandable supra-annular valves (Medtronic Evolut R/PRO and Boston ACURATE neo). We reached a matched population of 713 couples for each device group with a medium follow-up of 456.5 days. In the comparison of the clinical outcomes between the Evolut and the ACURATE patients, no difference occurred in mortality (9.8% vs. 9.0%, P = 0.650), heart failure hospitalization (9.6% vs. 6.0%, P = 0.076), myocardial infarction (0.7% vs. 0.4%, P = 0.718), stroke (2.4% vs. 1.4%, P = 0.239), major bleeding (3.3% vs. 3.4%, P = 1.000), vascular complications (13.7% vs. 10.9%, P = 0.126), endocarditis (1.1% vs. 0.6%, P = 0.568), sepsis (0.9% vs. 0.5%, P = 0.605), acute kidney injury (0.9% vs. 0.5%, P = 0.605), and new left bundle branch block (17% vs. 13.5%, P = 0.187). The only outcome with a significant difference between the groups was the need of pacemaker implantation in favour of the ACURATE valve (5.3% vs. 12.9% for the Evolut, P < 0.001).
Conclusions
In our PSM cohort, the comparison between the Evolut and the ACURATE valve showed no significant differences in the multiple outcomes evaluated, except for the rate of new pacemaker implantation. This data confirmed the recent literature, but it needs further dedicated investigation using the following devices generations.
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Affiliation(s)
- Alessandro Sticchi
- Centro per la Lotta Contro L’Infarto (CLI) Foundation, Unicamillus—Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Vincenzo De Marzo
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Kim Won-keun
- Department of Cardiology Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center—IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut D’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Italy
| | - Josep Rodes-cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Italo Porto
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova—U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Cardio Center, Humanitas Research Hospital IRCCS, Humanitas University, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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33
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Sticchi A, Gallo F, De Marzo V, Won-keun K, Zeus T, Ruggiero R, Toggweiler S, De Marco F, Reimers B, Nombela-franco L, Barbanti M, Brugaletta S, Piva T, Rodes-cabau J, Porto I, Colombo A, Giannini F. 599 Gender-based differences in TAVI outcomes: report from a large contemporary real-world population of self-expandable valves. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Small sub-study data derived from randomized clinical trials suggest a gender-based disparity in TAVI outcomes. However, large real-world contemporary data is missing. The aim of this study is to compare the risk factors, procedural characteristics and clinical outcomes of male and female patients who underwent transcatheter aortic valve implantation (TAVI) using two next-generation self-expandable bioprostheses (ACURATE neo and Evolut R/Pro valves).
Methods
We performed a first unmatched comparison and a propensity score-matched analysis (PSM) to assess the outcomes derived by the sex difference beyond the impact of pre-procedural risk factors in a large, contemporary, real-world, multicentre, international, retrospective registry of 3862 consecutive patients. The primary endpoint was a composite of all-cause death or any stroke (disabling and non-disabling) at 1 year.
Results
Sixty-four per cent (2162/3353 patients) of the study cohort was female and was older (mean age 82.3 years vs. 81.1 years for men (P<0.001)) had a higher BMI (27.7±5.7 for women vs. 27.2±4.5 for men), and lower prevalence of dyslipidaemia (50.2% vs. 54.7, P=0.037), diabetes (26.8% vs. 33.7, P<0.001), smoking (10.0% vs. 24.3%, P<0.001), COPD (17.4% vs. 21.9%, P=0.002), pacemaker/ICD (9.6% vs. 14.0%, P<0.001), previous cardiac surgery (8.6% vs. 18.8%, P<0.001), previous PCI (23.0% vs. 36.8%, P<0.001). Mean STS score for women was higher 5.2±3.9% vs. 4.5±3.4% (P<0.001). Women had higher mean valve gradients (45.4±17.1 vs. 42.7±14.7 mmHg; P<0.001), smaller valve areas (mean 0.7 cm2 vs. 0.9 cm2, P=0.037) and smaller annular perimeters (56.8±23.0 vs. 62.0±23.8, P<0.001). The primary endpoint was resulted in a rate of 7.9% vs. 6.9% (P=0.337) in the unmatched population and 9.4% vs. 6.0% (P=0.014) after the PSM, respectively for women and for men. Independently, there was no difference in mortality (5.9% vs. 5.6%; P=0.786) and stroke (2.5% vs. 1.8%; P=0.243) rates between women and men in the un-matched groups. Rates of cardiac tamponade (1.5% vs. 0.4%, P=0.008), major vascular complications (7.7% vs. 4.1%, P<0.001), life-threatening bleeding (2.8% vs. 1.4%, P=0.016), major bleeding (5.1% vs. 2.9%, P=0.004), need of transfusion (8.9% vs. 4.6%, P<0.001) and acute kidney injury (8.5% vs. 5.7%, P=0.009), were all significantly higher in women. After PSM, mortality was similar between the two groups (11.3% for women vs. 9.5% for men, P=0.264) but strokes were more prevalent in women (2.8% vs. 1.2%, P<0.024). Furthermore, in the matched population, major vascular complications (6.8% vs. 4.1%, P=0.024), need of transfusion (9.1% vs. 4.6%, P<0.001) and acute kidney injury (8.7% vs. 5.6%, P=0.009) remained significantly different between women and men, respectively.
Conclusions
In this large real-world contemporary TAVI registry, female gender was associated with higher rates of stroke, vascular complications, major bleeding, and acute kidney injury. Further studies are required to explore the underlying pathophysiological mechanisms for these observations.
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Affiliation(s)
- Alessandro Sticchi
- Centro Per La Lotta Contro L’infarto (CLI) Foundation, Rome, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Francesco Gallo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | - Vincenzo De Marzo
- Cattedra Di Malattie Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino Irccs, Genova
| | - Kim Won-keun
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Duesseldorf, Germany
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
| | | | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut D’investigacions Biomèdiques August Pi I Sunyer (Idibaps), Barcelona, Spain
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti Di Ancona, Italy
| | - Josep Rodes-cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Italo Porto
- Cattedra Di Malattie Cardiovascolari, Dipartimento Di Medicina Interna (DIMI), Università Degli Studi Di Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino Irccs, Genova
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna
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Ancona MB, Montorfano M, Masiero G, Burzotta F, Briguori C, Pagnesi M, Pazzanese V, Trani C, Piva T, De Marco F, Di Biasi M, Pagnotta P, Casu G, Garbo R, Preti G, Nicolini E, Sclafani R, Colonna G, Mojoli M, Siviglia M, Denurra C, Caprioglio F, Scandroglio AM, Tarantini G, Chieffo A. Device-related complications after Impella mechanical circulatory support implantation: an IMP-IT observational multicentre registry substudy. Eur Heart J Acute Cardiovasc Care 2021; 10:999-1006. [PMID: 34389852 DOI: 10.1093/ehjacc/zuab051] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/05/2021] [Accepted: 06/23/2021] [Indexed: 12/31/2022]
Abstract
AIMS To report the incidence, the predictors and clinical impact of device-related complications (DRCs) in the IMP-IT (IMPella Mechanical Circulatory Support Device in Italy) registry. Impella is percutaneous left ventricular assist devices, which provides mechanical circulatory support both in cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). The IMP-IT registry is a multicentre registry evaluating the trends in use and clinical outcomes of Impella in Italy. METHODS AND RESULTS A total of 406 patients have been included in this registry: 56.4% in the setting of CS, while 43.6% patients in the setting of HR-PCI. DRCs were defined as a composite endpoint of access-site bleeding, limb ischaemia, vascular complication requiring treatment, haemolysis, aortic injury, and left ventricular perforation. DRC incidence in the overall population was 25.6%, with significantly higher rate in the CS (37.1%) than in the HR-PCI (10.7%) group. The most frequent complication was haemolysis (11.8%), which occurred almost exclusively in CS population. Access-site bleeding was observed in 9.6% of the overall population, with no significant difference between the two groups. Limb ischaemia was observed in 8.3% of the overall population, with significantly higher rate in the CS group. CS and right ventricular dysfunction appear as the strongest independent predictors of DRC. One-year mortality in patients with DRC appears higher than in patients with no DRC. However, DRC was not confirmed as an independent predictor of 1-year mortality at multivariate analysis. CONCLUSION In the IMP-IT registry, the rate of DRC was 25.6%, with CS being the strongest independent predictor. DRC was not found as an independent predictor of 1-year mortality.
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Affiliation(s)
- Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy
| | - Giulia Masiero
- Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2 - 35128, Padua, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Gemelli, 1 - 00168, Rome, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Via Orazio 2 - 80121, Naples, Italy
| | - Matteo Pagnesi
- Department of Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60 - 20132, Milan, Italy
| | - Vittorio Pazzanese
- Department of Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60 - 20132, Milan, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Gemelli, 1 - 00168, Rome, Italy
| | - Tommaso Piva
- Interventional Cardiology Unit, Ospedali Riuniti di Ancona, via Conca 71, 60126 - Ancona, Ancona, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2 - 20097 - San Donato Milanese, Milan, Italy
| | - Maurizio Di Biasi
- Interventional Cardiology Unit, Ospedale Luigi Sacco, via G.B.Grassi 74 - 20157, Milan, Italy
| | - Paolo Pagnotta
- Cardiovascular Department, Humanitas Research Hospital, Via Alessandro Manzoni, 56 - 20089, Rozzano (MI), Italy
| | - Gavino Casu
- Clinical cardiology and Interventional cardiology Unit, Azienda Ospedaliera Universitaria Sassari, Via E. De Nicola - 07100 - Sassari, Italy
| | - Roberto Garbo
- Interventional Cardiology Unit, Maria Pia Hospital, GVM Care & Research, Strada Comunale di Mongreno 180 - 10132 - Torino, Italy
| | - Gerlando Preti
- Interventional Cardiology Unit, Ospedale di Conegliano, Via Brigata Bisagno 6 - 31015, Conegliano, Italy
| | - Elisa Nicolini
- Interventional Cardiology Unit, Ospedali Riuniti di Ancona, via Conca 71, 60126 - Ancona, Ancona, Italy
| | - Rocco Sclafani
- Cardiology Unit, Azienda Ospedaliera Santa Maria della Misericordia, Piazzale Gambuli 8-9 Sant'Andrea delle Fratte - 06129 - Perugia, Italy
| | - Giuseppe Colonna
- Interventional Cardiology Unit, Vito Fazzi Hospital, P.za F. Muratore 1, 73100, Lecce, Italy
| | - Marco Mojoli
- Department of Cardiology, Azienda Ospedaliera Friuli Occidentale - Ospedale Santa Maria degli Angeli Via della Vecchia Ceramica 1, 33170, Pordenone, Italy
| | - Massimo Siviglia
- Cardiology Unit, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, via Melacrino - 89100 - Reggio Calabria, Italy
| | - Cristiana Denurra
- Clinical cardiology and Interventional cardiology Unit, Azienda Ospedaliera Universitaria Sassari, Via E. De Nicola - 07100 - Sassari, Italy
| | - Francesco Caprioglio
- Cardiology Unit, Ospedale San Bortolo, Viale Rodolfi 37 - 36100 - Vicenza, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60 - 20132, Milan, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2 - 35128, Padua, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 60, Via Olgettina, 20132 Milan, Italy
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Raisi A, Zerbini V, Myers J, Lordi R, Piva T, Mazzoni G, Grazzi G, Mandini S. Relationship between exercise capacity and grip strength in a cohort of older cardiac outpatients. J Sports Med Phys Fitness 2021; 62:1404-1409. [PMID: 34664910 DOI: 10.23736/s0022-4707.21.13106-8] [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: 11/08/2022]
Abstract
BACKGROUND Progressive ageing of the population has highlighted the importance of the relationship between physical function and frailty in patients with chronic disease. The aim of this study was to assess the association between exercise capacity and grip strength (GS) in a cohort of older patients involved in an exercise-based secondary prevention program. METHODS 65 outpatients (aged 75±6 years) were included. Exercise capacity was assessed through the estimation of maximal oxygen consumption (VO2peak) and the measurement of walking speed (WS). GS was evaluated in the dominant arm using a hand-held dynamometer. RESULTS Patients with higher VO2peak and WS values exhibited significantly higher GS (p<0.01). GS was significantly related to WS (p<0.01) and VO2peak (p<0.01), and inversely associated with age (p<0.01). Results from linear multiple regression analysis (p<0.01) demonstrate that GS was strongly associated with WS (p<0.01) and age (p=0.01), while BMI, weekly LTPA, cardiovascular diagnosis, VO2peak and education were not. CONCLUSIONS The evaluation of WS, VO2peak and GS was feasible and well tolerated. These preliminary results suggest that prescribing regular walking activity, educating subjects to perform it at higher average WS, can help to maintain physical function in older patients with cardiovascular disease.
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Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Valentina Zerbini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy -
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto, Palo Alto, CA, USA.,Stanford University School of Medicine, Stanford, CA, USA.,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Rosario Lordi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA.,Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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36
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Rapetto C, Leoncini M, Cerrato E, Regazzoli D, Cortese B, Rossi A, Fetiveau R, Geraci S, De Angelis MC, Tespili M, Iannaccone M, Centola A, Durante A, De Carlo M, De Caterina A, Ribichini F, Favaretto E, Testa L, Pirisi R, Varbella F, Nicolini E, di Palma G, Loi B, Poli A, Caramanno G, Varricchio A, Garbo R, Cuculo A, Petronio AS, Berti S, Bollati M, Spedicato L, De Candia G, Piva T, Quadri G, Colombo A, Ielasi A. ImpaCt of an Optimal Implantation Strategy on Absorb Long-Term Outcomes: The CIAO Registry. Cardiovascular Revascularization Medicine 2021; 30:1-8. [DOI: 10.1016/j.carrev.2020.09.036] [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] [Received: 02/23/2020] [Revised: 05/16/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
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Gallo F, Gallone G, Kim WK, Reifart J, Veulemans V, Zeus T, Toggweiler S, De Backer O, Søndergaard L, Mangieri A, Khokhar A, De Marco F, Regazzoli D, Reimers B, Muntané-Carol G, Estévez-Loureiro R, Espino A, Moscarelli M, Armario X, Mylotte D, Gorla R, Bhadra OD, Conradi L, Marroquin Donday LA, Nombela-Franco L, Barbanti M, Reddavid C, Criscione E, Brugaletta S, Regueiro A, Pérez-Fuentes P, Nicolini E, Piva T, Tzanis G, Rodes-Cabau J, Colombo A, Giannini F. Horizontal Aorta in Transcatheter Self-Expanding Valves: Insights From the HORSE International Multicentre Registry. Circ Cardiovasc Interv 2021; 14:e010641. [PMID: 34455799 DOI: 10.1161/circinterventions.121.010641] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Francesco Gallo
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital (F.G., A.M., A.K., A.C.)
| | - Guglielmo Gallone
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (G.G.)
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (W.-K.K., J.R.)
| | - Jörg Reifart
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (W.-K.K., J.R.)
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany (V.V., T.Z.)
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany (V.V., T.Z.)
| | | | - Ole De Backer
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (O.D.B., L.S.)
| | - Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (O.D.B., L.S.)
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital (F.G., A.M., A.K., A.C.)
| | - Arif Khokhar
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital (F.G., A.M., A.K., A.C.)
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (F.D.M., R.G.)
| | - Damiano Regazzoli
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy (D.R., B.R.)
| | - Bernhard Reimers
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy (D.R., B.R.)
| | - Guillem Muntané-Carol
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (G.M.-C., J.R.-C.)
| | | | - Antonio Espino
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Vigo, Spain (R.E.-L., A.E.)
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Bari, Italy (M.M.)
| | - Xavier Armario
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (X.A., D.M.)
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (X.A., D.M.)
| | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (F.D.M., R.G.)
| | - Oliver Daniel Bhadra
- Department for Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany (O.D.B., L.C.)
| | - Lenard Conradi
- Department for Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany (O.D.B., L.C.)
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain (L.A.M.D., L.N.-F.)
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy (M.B., C.R., E.C.)
| | - Claudia Reddavid
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy (M.B., C.R., E.C.)
| | - Enrico Criscione
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy (M.B., C.R., E.C.)
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., A.R., P.P.-F.)
| | - Ander Regueiro
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., A.R., P.P.-F.)
| | - Pedro Pérez-Fuentes
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., A.R., P.P.-F.)
| | - Elisa Nicolini
- Interventional Cardiology, Ospedali Riuniti di Ancona, Italy (E.N., T.P.)
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Italy (E.N., T.P.)
| | - Giorgos Tzanis
- Department of Interventional Cardiology, Henry Dunant Hospital Center, Athens, Greece (G.T.)
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (G.M.-C., J.R.-C.)
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital (F.G., A.M., A.K., A.C.)
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Bianco F, Bucciarelli V, Surace FC, Iezzi FV, Berton E, Baldinelli A, Piva T, Maolo A, Schicchi N, Colaneri M, Pozzi M, Gallina S. Echocardiographic changes and quality of life after surgical unroofing of myocardial bridges. J Int Med Res 2021; 49:3000605211014847. [PMID: 34013761 PMCID: PMC8150422 DOI: 10.1177/03000605211014847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the echocardiographic changes and quality of life (QoL) after surgical unroofing of myocardial bridges (MBs) involving the left anterior descending (LAD) coronary artery compared with optimal medical therapy (OMT). METHODS Twenty-two patients (median age, 24 years; interquartile range, 16-40 years) with MBs of the LAD artery and exertional angina from 2018 to 2019 were retrospectively analyzed. Twelve patients underwent OMT and 10 underwent surgery. Both groups underwent clinical and echocardiographic examinations during hospitalization and follow-up (mean, 1.0 ± 0.8 years). QoL was assessed with the Seattle Angina Questionnaire, short version (SAQ-7). RESULTS Surgery resulted in significantly better QoL than OMT, with a significant improvement in left ventricular global longitudinal strain (GLS) [mean (standard error): 19% (0.19) to 22% (0.34) and 19% (0.15) to 20% (0.24), respectively; delta-change (delta-GLS) of 0.15 vs. 0.067]. In the univariate and multivariable analyses, delta-GLS was positively correlated with the SAQ-7 score and MB length (rho = 0.64 and 0.71, respectively), with a significant interaction between MB length and surgical treatment (beta coefficient, 1.95; 95% confidence interval, 0.14-3.77). CONCLUSIONS MB unroofing surgery provided benefits in terms of QoL and left ventricular GLS improvement compared with 1 year of OMT.
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Affiliation(s)
- Francesco Bianco
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio," University of Chieti, Italy
| | - Valentina Bucciarelli
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio," University of Chieti, Italy.,Department of Pharmacy, "G. d'Annunzio," University of Chieti, Italy
| | - Francesca Chiara Surace
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Federica Valentina Iezzi
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Emanuela Berton
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Alessandra Baldinelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Tommaso Piva
- Interventional Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Alessandro Maolo
- Interventional Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Nicolo' Schicchi
- Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Massimo Colaneri
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Marco Pozzi
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio," University of Chieti, Italy
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39
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Tarantini G, Masiero G, Burzotta F, Pazzanese V, Briguori C, Trani C, Piva T, De Marco F, Di Biasi M, Pagnotta P, Mojoli M, Casu G, Giustino G, Lorenzoni G, Montorfano M, Ancona MB, Pappalardo F, Chieffo A. Timing of Impella implantation and outcomes in cardiogenic shock or high-risk percutaneous coronary revascularization. Catheter Cardiovasc Interv 2021; 98:E222-E234. [PMID: 33793051 PMCID: PMC8451815 DOI: 10.1002/ccd.29674] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/19/2022]
Abstract
Objective To evaluate the role of the microaxial percutaneous mechanical circulatory support device (Impella® pump) implantation pre‐percutaneous coronary intervention (PCI) versus during/after PCI in cardiogenic shock (CS) and high‐risk PCI populations. Background A better understanding of the safety and effectiveness of the Impella and the role of timing of this support initiation in specific clinical settings is of utmost clinical relevance. Methods A total of 365 patients treated with Impella 2.5/CP in the 17 centers of the IMP‐IT Registry were included. Through propensity‐score weighting (PSW) analysis, 1‐year clinical outcomes were assessed separately in CS and HR‐PCI patients, stratified by timing of Impella support. Results Pre‐procedural insertion was associated with an improvement in 1‐year survival in patients with CS due to acute myocardial infarction (AMI) treated with PCI (p = .04 before PSW, p = .009 after PSW) and HR‐PCI (p < .01 both before and after PSW). Among patients undergoing HR‐PCI, early Impella support was also associated with a lower rate of the composite of mortality, re‐hospitalization for heart failure, and need for left‐ventricular assist device/heart transplantation at 1‐year (p = .04 before PSW, p = .01 after PSW). Furthermore, Impella use during/after PCI was associated with an increased in‐hospital life‐threatening and severe bleeding among patients with AMI‐CS receiving PCI (7 vs. 16%, p = .1) and HR‐PCI (1 vs. 9%, p = .02). Conclusions Our findings suggested a survival benefit and reduced rates of major bleeding when a pre‐PCI Impella implantation instead of during‐after procedure was used in the setting of HR‐PCI and AMI‐CS.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Science and Public Health, University of Padova, Padua, Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Science and Public Health, University of Padova, Padua, Italy
| | - Francesco Burzotta
- Division of cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vittorio Pazzanese
- Division of cardiology, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, Milan, Italy
| | - Carlo Briguori
- Division of cardiology, Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Carlo Trani
- Division of cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Piva
- Division of cardiology, Interventional Cardiology Unit, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Maurizio Di Biasi
- Division of cardiology, Interventional Cardiology Unit, Ospedale Luigi Sacco, Milan, Italy
| | - Paolo Pagnotta
- Division of cardiology, Cardiovascular Department, Humanitas Research Hospital, Milan, Italy
| | - Marco Mojoli
- Division of cardiology, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - Gavino Casu
- Interventional Cardiology Unit, Ospedale San Francesco, Nuoro, Italy
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Matteo Montorfano
- Division of cardiology, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco B Ancona
- Division of cardiology, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Pappalardo
- Division of cardiology, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Vita Salute University, Milan, Italy
| | - Alaide Chieffo
- Division of cardiology, Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Tumscitz C, Di Cesare A, Balducelli M, Piva T, Santarelli A, Saia F, Tarantino F, Preti G, Picchi A, Rolfo C, Attisano T, Colonna G, De Iaco G, Parodi G, Di Marco M, Cerrato E, Pierini S, Fileti L, Cavazza C, Dall'Ara G, Govoni B, Mantovani G, Serenelli M, Penzo C, Tebaldi M, Campo G, Biscaglia S. Safety, efficacy and impact on frailty of mini-invasive radial balloon aortic valvuloplasty. Heart 2021; 107:874-880. [PMID: 33627400 DOI: 10.1136/heartjnl-2020-318548] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The study was designed to: (1) confirm safety and feasibility of mini-invasive radial balloon aortic valvuloplasty (BAV); (2) assess its impact in terms of quality of life and frailty; and (3) evaluate whether changes in frailty after BAV are associated with death in patients undergoing transcatheter aortic valve implantation (TAVI). METHODS 330 patients undergoing BAV in 16 Italian centres were prospectively included. The primary endpoint was the occurrence of major and minor Valve Academic Research Consortium (VARC)-2 bleeding. Secondary endpoints were scales of quality of life, frailty, evaluated at baseline and 30 days, and their relationship with the occurrence of all-cause death. RESULTS BAV was performed by radial access in 314 (95%) patients. No VARC-2 major and six (1.8%) VARC-2 minor bleedings occurred in the study population. Quality of life, as well as frailty status, significantly improved 30 days after BAV. At 1 year, patients undergoing TAVI with baseline essential frailty toolset (EFT) <3 or achieving an EFT <3 after BAV had a comparable occurrence of all-cause death (15% vs 19%, p=0.58). On the contrary, patients with EFT ≥3 at 30 days despite BAV showed the worst prognosis (all-cause death: 40% vs 15% and 19%, p=0.006 and p=0.05, respectively). CONCLUSIONS Mini-invasive radial BAV is safe, feasible and associated with a low rate of vascular complications. Patients improving EFT 30 days after BAV showed a favourable outcome after TAVI. TRIAL REGISTRATION NUMBER NCT03087552.
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Affiliation(s)
- Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Annamaria Di Cesare
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Marco Balducelli
- Cardiovascular Department, Azienda Unità Sanitaria Locale della Romagna, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Tommaso Piva
- Cardiology Unit, Ospedali Riuniti Umberto I - GM Lancisi, Ancona, Italy
| | | | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | - Gerlando Preti
- Cardiac Unit, Aulss 2 Marca Trevigiana, Ospedale civile, Conegliano Veneto (TV), Italy
| | - Andrea Picchi
- Cardiovascular Department, Azienda USL Toscana SudEst, Misericordia Hospital, Grosseto, Italy
| | - Cristina Rolfo
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli (TO), Italy
| | - Tiziana Attisano
- Interventional Cardiology Unit, Heart Department, AOU S.Giovanni di Dio e Ruggi D'Aragona (SA), Salerno, Italy
| | | | - Giuseppe De Iaco
- Interventional Cardiology, AO Cardinal G Panico, Tricase (LE), Italy
| | - Guido Parodi
- Clinica Cardiologica, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli (TO), Italy
| | - Simona Pierini
- Cardiovascular Department, ASST Nord Milano - Bassini Hospital, Cinisello Balsamo (MI), Italy, Cinisello Balsamo, Italy
| | - Luca Fileti
- Cardiovascular Department, Azienda Unità Sanitaria Locale della Romagna, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | | | | | - Benedetta Govoni
- Department of Medical Sciences, Ferrara University, Ferrara, Italy
| | | | - Matteo Serenelli
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Carlo Penzo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Gianluca Campo
- Department of Medical Sciences, Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona (FE), Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
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Piva T, Nicolini E, Muçaj A, Maolo A, Terracciano F, Beltrame M, Schicchi N, Boscarato P, Aprile A, Serenelli M, Dello Russo A, Perna G, Gabrielli G. [Management of access site vascular complications in transcatheter aortic valve implantation]. G Ital Cardiol (Rome) 2020; 21:4S-12S. [PMID: 33295329 DOI: 10.1714/3487.34667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since its advent, transcatheter aortic valve implantation (TAVI) has experienced a continuous expansion, thanks to extraordinary clinical results and to the dramatic increase of safety, enabled by improvements of prosthesis and delivery systems, refinement of implantation techniques, increasing operator experience, and use of computed tomography scan for procedural planning. However, complications rates are still not negligible. As vascular complications, and, particularly, access-related complications are among the most frequent adverse events, all TAVI operators should know how to prevent and how to manage those potentially catastrophic situations. Here we provide an overview of the most frequent access site vascular complications and the respective treatment options.
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Affiliation(s)
- Tommaso Piva
- SOSD Emodinamica Interventistica Strutturale e Pediatrica
| | - Elisa Nicolini
- SOSD Emodinamica Interventistica Strutturale e Pediatrica
| | - Andi Muçaj
- SOSD Emodinamica Interventistica Strutturale e Pediatrica
| | | | | | - Mirko Beltrame
- SOSD Emodinamica Interventistica Strutturale e Pediatrica
| | | | | | | | | | | | - Gianpiero Perna
- SOD Cardiologia Ospedaliera e UTIC, AOU Ospedali Riuniti di Ancona
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Zimarino M, Barbanti M, Dangas GD, Testa L, Capodanno D, Stefanini GG, Radico F, Marchioni M, Amat-Santos I, Piva T, Saia F, Reimers B, De Innocentiis C, Picchi A, Toro A, Rodriguez-Gabella T, Nicolini E, Moretti C, Gallina S, Maddestra N, Bedogni F, Tamburino C. Early Adverse Impact of Transfusion After Transcatheter Aortic Valve Replacement: A Propensity-Matched Comparison From the TRITAVI Registry. Circ Cardiovasc Interv 2020; 13:e009026. [PMID: 33272037 DOI: 10.1161/circinterventions.120.009026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is no consensus on the benefit of red blood cell (RBC) transfusion after transcatheter aortic valve replacement. METHODS The multicenter Transfusion Requirements in Transcatheter Aortic Valve Implantation (TRITAVI) registry retrospectively included patients after transfemoral transcatheter aortic valve replacement; propensity score-matching identified pairs of patients with and without RBC transfusion. The primary end point was 30-day mortality; nonfatal myocardial infarction, cerebrovascular accident, and stage 2 to 3 acute kidney injury at 30 days were secondary end points. We repeated propensity score-matching according to the hemoglobin nadir, hemoglobin drop, and in the subgroup of uncomplicated patients, without major vascular complications or major bleeding. RESULTS Among 2587 patients, RBC transfusion was administered in 421 cases (16%). The primary end point occurred in 104 (4.0%) patients, myocardial infarction in 9 (0.4%), cerebrovascular accident in 38 (1.5%), and acute kidney injury in 125 (4.8%) cases. In the 842 propensity-matched patients, RBC transfusion was associated with increased mortality (hazard ratio, 2.07 [95% CI, 1.06-4.05]; P=0.034) and acute kidney injury (hazard ratio, 4.35 [95% CI, 2.21-8.55]; P<0.001). Interaction testing between RBC transfusion and mortality was not statistically significant in the above-mentioned subgroups, and such association was not documented in the corresponding propensity score-matched cohorts. In the multivariable Cox proportional hazards regression model, major vascular complications (P=0.044), major bleeding (P=0.041), and RBC transfusion (P=0.048) were independent correlates of 30-day mortality. CONCLUSIONS RBC transfusion correlates with increased mortality and acute kidney injury early after transcatheter aortic valve replacement and is an independent predictor of 30-day mortality, irrespective of periprocedural major bleeding and vascular complications. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03740425.
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Affiliation(s)
- Marco Zimarino
- Institute of Cardiology (M.Z., F.R., A.T., S.G.), "G. d'Annunzio" University Chieti-Pescara, Italy.,Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy (M.Z., N.M.)
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., D.C., A.P., C.T.)
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.D.D.)
| | - Luca Testa
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese Milan, Italy (L.T., F.B.)
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., D.C., A.P., C.T.)
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (G.G.S., B.R.).,Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy (G.G.S., B.R.)
| | - Francesco Radico
- Institute of Cardiology (M.Z., F.R., A.T., S.G.), "G. d'Annunzio" University Chieti-Pescara, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics (M.M.), "G. d'Annunzio" University Chieti-Pescara, Italy
| | - Ignacio Amat-Santos
- CIBERCV, Hospital Clínico Universitario de Valladolid, Spain (I.A.-S., T.R.-G.)
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy (T.P., E.N.)
| | - Francesco Saia
- Division of Cardiology, Cardiothoracic and Vascular Department, S. Orsola Hospital, Bologna University, Bologna, Italy (F.S., C.M.)
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (G.G.S., B.R.).,Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy (G.G.S., B.R.)
| | | | - Andrea Picchi
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., D.C., A.P., C.T.)
| | - Alessandro Toro
- Institute of Cardiology (M.Z., F.R., A.T., S.G.), "G. d'Annunzio" University Chieti-Pescara, Italy
| | | | - Elisa Nicolini
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy (T.P., E.N.)
| | - Carolina Moretti
- Division of Cardiology, Cardiothoracic and Vascular Department, S. Orsola Hospital, Bologna University, Bologna, Italy (F.S., C.M.)
| | - Sabina Gallina
- Institute of Cardiology (M.Z., F.R., A.T., S.G.), "G. d'Annunzio" University Chieti-Pescara, Italy
| | - Nicola Maddestra
- Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy (M.Z., N.M.)
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese Milan, Italy (L.T., F.B.)
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy (M.B., D.C., A.P., C.T.)
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Ziviello F, Burzotta F, Briguori C, Trani C, Nicolini E, Masiero G, Pagnotta P, Pazzanese V, Scandroglio M, Piva T, De Marco F, Di Biasi M, Montorfano M, Tarantini G, Chieffo A. Sex sub analysis from observational multicenter registry of patients treated with Impella mechanical circulatory support device in Italy: the IMP-IT women. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Women-specific data on safety, effectiveness, and outcomes for mechanical support in the setting of cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI) are still unsettled. The IMP-IT study was a multicenter observational national registry that enrolled all patients treated with Impella 2.5, Impella CP, Impella 5.0 and Impella RP, both for CS and HR-PCI indications, across 17 Italian centers from 2004 to June 2018
Purpose
To analyze the characteristics of female population enrolled in IMP-IT registry and to assess differences in presentation, timing to interventions and outcomes between men and women.
Methods
The Women-IMP-IT study is a multicenter observational national registry focusing on female population enrolled in IMP-IT study. Baseline, procedural and hemodynamics characteristics, such as outcome were collected. Differences between men and women were examined.
Results
Mean age of female population was 66.9±16.1 years, Body mass index was 26.3±5.5 kg/m2. There was a higher rate of cardiogenic shock (66.7% vs. 49.1%; p=0.06), NSTEMI (18% vs 9%, p=0.03) and acute myocarditis (9.6% vs 1.4%, p=0.01) in women vs men, associated with a lower rate of protected PCI (33.3% vs 50.9%, p=0.06). We did not observed a statistically difference in device related complications (27.4% vs 23.3%; p=0.50), respectively in women compared to men. In particular, no differences were observed in access site bleedings (10.8% vs 9%; p=0.70) and life threatening or severe bleeding (15.3% vs 11.4%; p=0.40). At one year, all-cause death rate was 45.1% in women vs 30.1% in men (p=0.016), and cardiac death rate was 42.5% in women and 27.5% in men (p=0.013). At 1-year no significant difference was observed in the rate of myocardial infarction (3.7% vs 2.3%; p=0.44), stroke (3.7% vs 2.6%; p=0.70), heat-failure hospitalization (7.7% vs 7.5%; p=1.0), need for left ventricular assist device or heart transplantation (1.3% vs 5.5%; p=0.21).
Conclusions
In our series, use of Impella is CS and HR-PCI is increasing in female population. Sex-differences in mortality are mostly explained by clinical differences at presentation.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): EAPCI Education and Training Grants
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Affiliation(s)
- F Ziviello
- IRCCS San Raffaele Hospital, Milan, Italy
| | - F Burzotta
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Cardiology, Rome, Italy
| | | | - C Trani
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Cardiology, Rome, Italy
| | - E Nicolini
- University Hospital Riuniti of Ancona, Ancona, Italy
| | | | - P Pagnotta
- Istituto Clinico Humanitas, Milan, Italy
| | | | | | - T Piva
- University Hospital Riuniti of Ancona, Ancona, Italy
| | - F De Marco
- IRCCS Polyclinic San Donato, Milan, Italy
| | | | | | | | - A Chieffo
- IRCCS San Raffaele Hospital, Milan, Italy
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Navarese EP, Frediani L, Kandzari DE, Caiazzo G, Cenname AM, Cortese B, Piva T, Muçaj A, Tumscitz C, Paparoni F, Larosa C, Bisceglia T, Menozzi M, Gurbel PA, Kubica J. Efficacy and safety of intracoronary epinephrine versus conventional treatments alone in STEMI patients with refractory coronary no‐reflow during primary PCI: The RESTORE observational study. Catheter Cardiovasc Interv 2020; 97:602-611. [DOI: 10.1002/ccd.29113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Eliano P. Navarese
- Department of Cardiology, Collegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
- SIRIO MEDICINE Network Bydgoszcz Poland
- Faculty of Medicine University of Alberta Edmonton Canada
| | - Lara Frediani
- Department of Cardiology Livorno Hospital, Azienda Usl Toscana Nord‐Ovest, Ospedali Riuniti di Livorno Livorno Italy
| | | | | | | | | | - Tommaso Piva
- Department of Cardiologic Azienda Ospedaliero Universitaria "Ospedali Riuniti" Ancona Italy
| | - Andi Muçaj
- Department of Cardiologic Azienda Ospedaliero Universitaria "Ospedali Riuniti" Ancona Italy
| | | | | | - Claudio Larosa
- Department of Cardiology Azienda Ospedaliera Bonomo Andria Italy
| | - Teodoro Bisceglia
- Department of Cardiology Santa Maria della Misericordia Hospital Udine Italy
| | | | - Paul A. Gurbel
- Sinai Center form Thrombosis Research Sinai Hospital of Baltimore Baltimore Maryland USA
| | - Jacek Kubica
- Department of Cardiology, Collegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
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Chieffo A, Ancona MB, Burzotta F, Pazzanese V, Briguori C, Trani C, Piva T, De Marco F, Di Biasi M, Pagnotta P, Casu G, Giustino G, Montorfano M, Pappalardo F, Tarantini G. Observational multicentre registry of patients treated with IMPella mechanical circulatory support device in ITaly: the IMP-IT registry. EUROINTERVENTION 2020; 15:e1343-e1350. [PMID: 31422925 DOI: 10.4244/eij-d-19-00428] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate nationwide trends and clinical outcomes of the Impella device for cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI). METHODS AND RESULTS The IMP-IT study was a multicentre observational national registry which enrolled all patients treated with Impella 2.5, Impella CP, Impella 5.0 and Impella RP, both for CS and HR-PCI indications, across 17 Italian centres from 2004 to June 2018. A total of 406 patients were included: 229 had CS (56.4%) and 177 underwent HR-PCI (43.6%). The use of Impella increased significantly during the study period (average annual percent change 39.8%, 95% confidence interval: 30.4 to 49.9; p<0.0001) for both indications. The Impella 2.5 was the most commonly used device (N=242; 59.6%). Rates of in-hospital and one-year all-cause death in patients with CS were 46.9% and 57.0%, respectively; 18.5% underwent left ventricular assist device implantation or heart transplant at one year. Rates of in-hospital and one-year all-cause death in patients who underwent HR-PCI were 5.7% and 15.6%, respectively. Rates of device-related complications were 37.1% and 10.7% in the setting of CS and HR-PCI, respectively. CONCLUSIONS Use of the Impella for CS and HR-PCI is increasing substantially in Italy, despite relatively high rates of device-related complications.
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Affiliation(s)
- Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Saia F, Gandolfo C, Palmerini T, Berti S, Doshi SN, Laine M, Marcelli C, Piva T, Ribichini F, De Benedictis M, Cardaioli F, Cannata S, Tarantini G. In-hospital and thirty-day outcomes of the SAPIEN 3 Ultra balloon-expandable transcatheter aortic valve: the S3U registry. EUROINTERVENTION 2020; 15:1240-1247. [DOI: 10.4244/eij-d-19-00541] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rescigno G, Piva T, Mazzanti I, Aratari C, Pupita G, Matteucci S, D'Alfonso A, Capucci A, Perna GP, Torracca L. Conventional surgery results in patients originally referred for transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown) 2014; 16:267-70. [PMID: 25010501 DOI: 10.2459/jcm.0000000000000135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Transcatheter aortic valve implantation (TAVI) is increasingly considered as a viable alternative to conventional aortic valve replacement (AVR) in high-risk patients. Long-term results, however, are still scarce and medical community hesitates in enlarging indications to lower-risk patients. Moreover, available devices are expensive and a strict potential candidate selection is necessary. METHODS From April 2008 to August 2012, a total of 212 patients, originally referred for percutaneous treatment, were thoroughly evaluated by the aortic team of our department in order to choose the optimal procedure. Of them, 55 patients (35 women; 20 men) were considered as still acceptable candidates for conventional AVR. RESULTS Mean age was 80.7 ± 4.7 years; mean additive and logistic Euroscore I were 9.7 ± 1.8 and 17.8 ± 9.5%, respectively. Mean Euroscore II was 7.9 ± 5.5%. Mean New York Heart Association class was 2.9 ± 0.5. The majority of patients (87.2%) presented a geriatric frailty score of 0-1. Four patients showed a heavily calcified ascending aorta, and five patients (9%) underwent reoperations. Hospital mortality was 10.9% (six patients). Mean follow-up was 535.9 ± 407.4 days (range: 6-1365 days). Six other patients died during this period for a mean survival of 74.4 ± 6.9% at 2 years. Mean New York Heart Association class at 1 year was 1.25 ± 0.5 (P < 0.01 vs. preoperative value). CONCLUSION AVR should be indicated with caution in high-risk patients originally referred for TAVI. Despite medium-term results being good, with excellent functional status, hospital mortality is not negligible.
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Affiliation(s)
- Giuseppe Rescigno
- aDepartments of Cardiac Surgery bInterventional Cardiology cAcademic Cardiology dCardiology, Ospedali Riuniti di Ancona, Ancona, Italy
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Rescigno G, Piva T, Mazzanti I, Aratari C, Pupita G, D’Alfonso A, Capucci A, Perna GP, Torracca L. Conventional surgery results in patients originally referred for transcatheter aortic valve implantation. J Cardiothorac Surg 2013. [PMCID: PMC3845865 DOI: 10.1186/1749-8090-8-s1-o47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gabrielli G, Serenelli M, Piva T, Muai A, Nicolini E, Angelini L, Boscarato P, Paci MV, Pangrazi A. Use of Excimer Laser in Undilable Coronary Lesions. Am J Cardiol 2013. [DOI: 10.1016/j.amjcard.2013.01.227] [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]
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Valgimigli M, Campo G, Gambetti S, Bolognese L, Ribichini F, Colangelo S, de Cesare N, Rodriguez AE, Russo F, Moreno R, Piva T, Sheiban I, Penzo C, Prati F, Nazzaro MS, Díaz Fernández JF, Vassanelli C, Parrinello G, Ferrari R. Three-year follow-up of the MULTIcentre evaluation of Single high-dose Bolus TiRofiban versus Abciximab with Sirolimus-eluting STEnt or Bare-Metal Stent in Acute Myocardial Infarction StudY (MULTISTRATEGY). Int J Cardiol 2013; 165:134-41. [DOI: 10.1016/j.ijcard.2011.07.106] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/29/2011] [Accepted: 07/31/2011] [Indexed: 11/26/2022]
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