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Ali N, Aktaa S, Younsi T, Beska B, Batra G, Blackman DJ, James S, Ludman P, Mamas MA, Abdel-Wahab M, Borregaard B, Iung B, Joner M, Kunadian V, Modine T, Neylon A, Petronio AS, Pibarot P, Popescu BA, Sabaté M, Stortecky S, Teles RC, Treede H, Gale CP. European Society of Cardiology Quality indicators for the care and outcomes of adults undergoing transcatheter aortic valve implantation. Eur Heart J Qual Care Clin Outcomes 2024:qcae006. [PMID: 38262740 DOI: 10.1093/ehjqcco/qcae006] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND AND AIMS To develop a suite of quality indicators (QIs) for the evaluation of the care and outcomes for adults undergoing transcatheter aortic valve intervention (TAVI). METHODS We followed the European Society of Cardiology (ESC) methodology for the development of QIs. Key domains were identified by constructing a conceptual framework for the delivery of TAVI care. A list of candidate QIs were developed by conducting a systematic review of the literature. A modified Delphi method was then used to select the final set of QIs. Finally, we mapped the QIs to the EuroHeart Data Standards for TAVI to ascertain the extent to which the EuroHeart TAVI registry captures information to calculate the QIs. RESULTS We formed an international group of experts in quality improvement and TAVI, including representatives from the European Association of Percutaneous Cardiovascular Interventions, the European Association of Cardiovascular Imaging and the Association of Cardiovascular Nursing & Allied Professions. In total, 27 QIs were selected across eight domains of TAVI care, comprising 22 main (81%) and five secondary (19%) QIs. Of these, 19/27 (70%) are now being utilised in the EuroHeart TAVI registry. CONCLUSION We present the 2023 ESC QIs for TAVI, developed using a standard methodology and in collaboration with ESC Associations. The EuroHeart TAVI registry allows calculation of the majority of the QIs, which may be used for benchmarking care and quality improvement initiatives.
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Affiliation(s)
- Noman Ali
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suleman Aktaa
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Tanina Younsi
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ben Beska
- Translational and Clinical Research Institute, Newcastle University Newcastle, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle, UK
| | - Gorav Batra
- Department of medical sciences and Uppsala Clinical research center Uppsala University, Uppsala Sweden
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stefan James
- Department of medical sciences and Uppsala Clinical research center Uppsala University, Uppsala Sweden
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | | | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Denmark. Department of Clinical Research, University of Southern Denmark, Denmark
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, and Université Paris-Cité, INSERM 1148, Paris, France
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Vijay Kunadian
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle, UK
| | - Thomas Modine
- Hopital Cardiologique de Haut Leveque, Bordeaux, France
| | - Antoinette Neylon
- Galway University Hospital, SAOLTA Health Care Group, and National University of Ireland, Galway, Ireland
| | - Anna S Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa 2-56100, Italy
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Bogdan A Popescu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Manel Sabaté
- Interventional Cardiology Department; Cardiovascular Institute; Hospital Clínic; IDIBAPS; Barcelona; Spain
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rui C Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Hendrik Treede
- Department of Cardiovascular Surgery, University Medical Center Mainz, Mainz, Germany
| | - Chris P Gale
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Angelillis M, Costa G, Primerano C, Giannini C, Adamo M, Chizzola G, Iadanza A, Fineschi M, Barletta M, Bedogni F, Ferrara E, Poli A, De Felice F, Bruschi G, De Carlo M, Petronio AS. Outcomes of Patients With Very Severe Aortic Stenosis Treated With Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 205:241-248. [PMID: 37611417 DOI: 10.1016/j.amjcard.2023.07.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023]
Abstract
Symptoms of aortic stenosis (AS) are not proportional to its severity and patients with very severe AS (VSAS) remain asymptomatic for a long time. The appropriate time for intervention in patients with VSAS and the effects of transcatheter aortic valve implantation (TAVI) on left ventricular hypertrophy (LVH) remain debated. Our aim was to compare the procedural and 30-day outcomes of TAVI between patients with VSAS and patients with severe AS (SAS) and the changes in LVH. We selected patients with an aortic peak velocity ≥5 m/s (VSAS) and those with aortic peak velocity 4 to 5 m/s (SAS) treated with TAVI. Patients with reduced left ventricular ejection fraction (<45%) were excluded. The primary end point was the incidence of all-cause death at 30 days. The secondary end points included the 30-day incidence of cardiac death, cardiac rehospitalization, and stroke/transient ischemic attack and the changes in LVH from baseline to 30 days. A total of 102 patients in the VSAS group and 535 in the SAS group were included. Patients in the VSAS group had a thicker septal wall (p <0.001) and a higher Agaston score (p <0.001) and calcium volume (p = 0.007). No differences were observed regarding the primary and secondary clinical end points. However, patients with VSAS showed a significantly greater improvement in concentric LVH, although the prevalence of concentric LVH remained higher than in patients with SAS. TAVI in patients with VSAS showed similar procedural and clinical outcomes to patients with SAS and experienced a more pronounced improvement in the prevalence of concentric LVH.
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Affiliation(s)
- Marco Angelillis
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Giulia Costa
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Chiara Primerano
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Giannini
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | | | - Alessandro Iadanza
- Department of Internal, Cardiovascular and Geriatric Medicine, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimo Fineschi
- Department of Internal, Cardiovascular and Geriatric Medicine, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Marta Barletta
- Department of Cardiology, Policlinico San Donato, Milan, Italy
| | | | - Erica Ferrara
- Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Italy
| | - Arnaldo Poli
- Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Italy
| | | | - Giuseppe Bruschi
- Department of Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco De Carlo
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Anna S Petronio
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Adamo M, Tomasoni D, Stolz L, Stocker TJ, Pancaldi E, Koell B, Karam N, Besler C, Giannini C, Sampaio F, Praz F, Ruf T, Pechmajou L, Neuss M, Iliadis C, Baldus S, Butter C, Kalbacher D, Lurz P, Melica B, Petronio AS, von Bardeleben RS, Windecker S, Butler J, Fonarow GC, Hausleiter J, Metra M. Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration. JACC Cardiovasc Interv 2023; 16:896-905. [PMID: 37100553 DOI: 10.1016/j.jcin.2023.01.362] [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: 10/11/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Guideline-directed medical therapy (GDMT) optimization is mandatory before transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with secondary mitral regurgitation (SMR) and heart failure (HF) with reduced ejection fraction (HFrEF). However, the effect of M-TEER on GDMT is unknown. OBJECTIVES The authors sought to evaluate frequency, prognostic implications and predictors of GDMT uptitration after M-TEER in patients with SMR and HFrEF. METHODS This is a retrospective analysis of prospectively collected data from the EuroSMR Registry. The primary events were all-cause death and the composite of all-cause death or HF hospitalization. RESULTS Among the 1,641 EuroSMR patients, 810 had full datasets regarding GDMT and were included in this study. GDMT uptitration occurred in 307 patients (38%) after M-TEER. Proportion of patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was 78%, 89%, and 62% before M-TEER and 84%, 91%, and 66% 6 months after M-TEER (all P < 0.001). Patients with GDMT uptitration had a lower risk of all-cause death (adjusted HR: 0.62; 95% CI: 0.41-0.93; P = 0.020) and of all-cause death or HF hospitalization (adjusted HR: 0.54; 95% CI: 0.38-0.76; P < 0.001) compared with those without. Degree of MR reduction between baseline and 6-month follow-up was an independent predictor of GDMT uptitration after M-TEER (adjusted OR: 1.71; 95% CI: 1.08-2.71; P = 0.022). CONCLUSIONS GDMT uptitration after M-TEER occurred in a considerable proportion of patients with SMR and HFrEF and is independently associated with lower rates for mortality and HF hospitalizations. A greater decrease in MR was associated with increased likelihood for GDMT uptitration.
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Affiliation(s)
- Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Edoardo Pancaldi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Benedikt Koell
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, and Paris Cardiovascular Research Center, INSERM U970, Paris, France
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany
| | - Louis Pechmajou
- Department of Cardiology, European Hospital Georges Pompidou, and Paris Cardiovascular Research Center, INSERM U970, Paris, France
| | - Michael Neuss
- Immanuel Heart Center Bernau, Brandenburg Medical School Theodor Fontane, Cardiology, Bernau, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Christian Butter
- Immanuel Heart Center Bernau, Brandenburg Medical School Theodor Fontane, Cardiology, Bernau, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Anna S Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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4
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De Luca G, Verdoia M, Morici N, Ferri LA, Piatti L, Grosseto D, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Cesana BM, De Luca L, Ottani F, Moffa N, Savonitto S, De Servi S. Corrigendum to "Impact of hemoglobin levels at admission on outcomes among elderly patients with acute coronary syndrome treated with low-dose Prasugrel or clopidogrel: A sub-study of the ELDERLY ACS 2 trial" [Int J Cardiol. 2022 Dec 15;369:5-11]. Int J Cardiol 2023; 377:133. [PMID: 36774304 DOI: 10.1016/j.ijcard.2023.01.021] [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: 02/12/2023]
Affiliation(s)
- G De Luca
- Clinical and Experimental Cardiology Unit, Azienda Ospedaliera-Universitaria "Sassari", University of Sassari, Sassari, Italy.
| | - M Verdoia
- Division of Cardiology, Ospedale degli Infermi, Biella, Italy
| | - N Morici
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - L A Ferri
- IRCCS Ospedale San Raffaele, Milan, Italy
| | - L Piatti
- IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - I Bossi
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - M Ferrario
- IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - E Murena
- Ospedale S. Maria delle Grazie, Pozzuoli, Italy
| | - S Tondi
- Ospedale Baggiovara, Modena, Italy
| | - A Toso
- Ospedale S. Stefano, Prato, Italy
| | | | - A Ravera
- Ospedale Ruggi D'Aragona, Salerno, Italy
| | - E Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - L Di Ascenzo
- Ospedale di San Donà di Piave-Portogruaro, Portogruaro, Italy
| | - A S Petronio
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - C Cavallini
- Ospedale S. Maria della Misericordia, Perugia, Italy
| | - G Vitrella
- Ospedali Riuniti di Trieste, Trieste, Italy
| | - R Antonicelli
- Istituto Nazionale di Ricerca e Cura per l' Anziano, Ancona, Italy
| | - B M Cesana
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Brescia, Italy
| | - L De Luca
- Department of Cardiosciences, AO San Camillo-Forlanini, Roma, Italy
| | - F Ottani
- Ospedale Treviglio-Caravaggio, Treviglio, Italy
| | - N Moffa
- IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - S De Servi
- Department of Molecular Medicine, University of Pavia Medical School, Pavia, Italy
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van Bergeijk KH, Wykrzykowska JJ, Sartori S, Snyder C, Vogel B, Tchetche D, Petronio AS, Mehilli J, Lefèvre T, Presbitero P, Capranzano P, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer-Gracia MC, Naber C, Kievit P, Sharma SK, Morice MC, Dangas GD, Chieffo A, Voors AA, Mehran R. Pre-procedural oral anticoagulant use is associated with cardiovascular events in women after transcatheter aortic valve replacement: An analysis from the WIN-TAVI cohort. Int J Cardiol 2023; 372:40-45. [PMID: 36455701 DOI: 10.1016/j.ijcard.2022.11.056] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/01/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become an accepted treatment for patients with severe aortic stenosis (AS). Predicting which patients are at risk for adverse clinical outcomes after TAVI remains difficult, especially in women. AIM To identify predictors of adverse events in the WIN-TAVI cohort. METHODS The WIN-TAVI study is an observational registry of 1019 women undergoing TAVI for severe symptomatic AS. Follow-up was 1 year. The primary outcome was defined according to VARC-2: a composite of mortality, stroke, myocardial infarction or hospitalization for valve-related symptoms or heart failure. The secondary outcome was a composite of cardiovascular mortality or hospitalization for valve-related symptoms or heart failure. RESULTS We included 1019 women with severe AS (mean age of 82.5 ± 6.3 years). At 1 year, 16.4% of the patients experienced the primary endpoint and 12.6% the secondary endpoint. The use of oral anticoagulants (OAC) was the strongest independent predictor of the primary outcome (adjusted hazard ratio [aHR] 1.51, 95% confidence interval [CI] 1.079-2.106, p = 0.016). Independent predictors of the secondary endpoint were age (aHR 1.04 per year, 95% CI 1.01-1.074, p = 0.016) and use of OAC (aHR: 1.79, 95% CI 1.24-2.60, p = 0.002). OAC use was not associated with higher bleeding risk. CONCLUSION Pre-procedural use of OAC was the strongest predictor of adverse outcomes during 1-year follow-up, likely reflecting a combination of high-risk factors and comorbidities, but was not related to increased bleeding risk.
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Affiliation(s)
- Kees H van Bergeijk
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joanna J Wykrzykowska
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Clayton Snyder
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | | | - Julinda Mehilli
- University Hospital Munich, Ludwig-Maximilians University and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | | | | | | | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Gennaro Sardella
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | - Christoph Naber
- Department of Internal Medicine I, Cardiology and Intensive Care, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | - Peter Kievit
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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6
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Angelillis M, Stazzoni L, Costa G, Giannini C, Primerano C, Spontoni P, Pieroni A, Guarracino F, Bertini P, Baldassarri R, De Carlo M, Petronio AS. Transcatheter aortic valve replacement with or without anesthesiologist: results from a high-volume single center. J Cardiovasc Med (Hagerstown) 2022; 23:801-806. [PMID: 36219144 DOI: 10.2459/jcm.0000000000001391] [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: 11/05/2022]
Abstract
AIMS Local instead of general anesthesia has become the standard approach in many centers for transfemoral transcatheter aortic valve replacement (TAVR). New generation devices and an increase in operator skills had led to a drastic reduction in periprocedural complications, bringing in the adoption of a minimalist approach. In our study, we aimed to compare patients treated with TAVR under local anesthesia with or without the presence of an anesthesiologist on site (AOS). METHODS We compare procedural aspects and results of patients treated with TAVR with an AOS against patients treated with TAVR with an anesthesiologist on call (AOC). From January 2019 to December 2020, all consecutive patients undergoing transfemoral TAVR with either the self-expandable Evolut (Medtronic, MN, USA) or balloon-expandable SAPIEN 3 (Edwards Lifesciences, CA, USA) were collected. RESULTS Of 332 patients collected, 96 (29%) were treated with TAVR with AOS, while 236 (71%) were treated with TAVR with AOC. No differences in procedural time, fluoroscopy time and amount of contrast medium were observed. No procedural death and conversion to open-chest surgery was reported. The rate of stroke/transient ischemic attacks and major vascular complications was similar in the two groups. No patients in both groups required conversion to general anesthesia. Two patients (0.8%) in the AOC group required urgent intervention of the anesthesiologist. In the AOC group, there was a greater use of morphine (55.9% vs. 33.3%, P = 0.008), but with a lower dose for each patient (2.0 vs. 2.8 mg, P = 0.006). On the other hand, there was a lower use of other painkiller drugs (3.4% vs. 20.8%, P = 0.001). No difference in inotropic drugs use was observed. CONCLUSION In patients at low or intermediate risk undergoing transfemoral TAVR, a safe procedure can be performed under local anesthesia without the presence of an anesthesiologist in the catheterization laboratory.
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Affiliation(s)
- Marco Angelillis
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Laura Stazzoni
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Giulia Costa
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | | | - Chiara Primerano
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Paolo Spontoni
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Andrea Pieroni
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Fabio Guarracino
- Cardiothoracic and vascular Anaesthesiology and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Pietro Bertini
- Cardiothoracic and vascular Anaesthesiology and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Rubia Baldassarri
- Cardiothoracic and vascular Anaesthesiology and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco De Carlo
- Catheterization laboratory, Cardiothoracic and Vascular Department
| | - Anna S Petronio
- Catheterization laboratory, Cardiothoracic and Vascular Department
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7
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De Lucia R, Giannini C, Parollo M, Costa G, Barletta V, Giannotti Santoro M, Primerano C, De Carlo M, Angelillis M, Zucchelli G, Petronio AS. Cardiac arrhythmias and conduction disorders monitoring after transcatheter aortic valve replacement procedure, using a mobile electrocardiogram 6 lead device. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the early post transcatheter aortic valve replacement (TAVR) discharge era, rate of readmission for permanent pacemaker implantation (PPM-I) due to delayed conduction disturbances (CDs) has significantly increased. This issue has powered post procedural ambulatory electrocardiogram (AECG) monitoring by using implantable cardiac monitors or mobile cardiac telemetry devices, despite several disadvantages as frequent electrode changes and costs.
Purpose
In this scenario we aimed to evaluate the incidence of post-TAVR new onset arrhythmias and delayed CDs, performing an AECG monitoring through a 30s spot digital ECG (AeECG), by using a mobile electrocardiogram 6 lead (ME6L) device in a 30 days period after a TAVR procedure.
Methods
Between March 2021 and February 2022 we consecutively enrolled all patients undergoing a TAVR at the University Hospital of Pisa, excepting who already had a PM. At discharge, all patients received ME6L device and were asked to record a spot eECG for 1 month: 1 eECG per day during the first week and then 1 eECG per week. Clinical and follow-up data were collected and analyzed, and eECG scheduling compliance and quality recordings were explored.
Results
Among 185 consecutive TAVR patients, 12 were excluded due to pre-existing pacing device and 33 due to PPM-I <2 days post TAVR; 3 died before enrollment and 10 refused the enrollment; 18 were excluded because failed the ME6L training phase, 6 for severe postprocedural complications and the last 3 because affected by isolated aortic regurgitation.The remaining ones (100) had 30-day AeECG data. Delayed CDs with a Class I/IIa indications for PPM-Ioccurred in 8 patients with a median of 6 days (range 4–8 days) post-TAVR. New onset documented arrhythmias were AT/AF in 3 patients, isolated PVCs in 10 patients, and competitive transitory junctional rhythm in 2 patients. Delayed PPM-I versus non-delayed PPM-Ipatients were more likely to have a non-self-expandable valve (3 vs 69; p=0.02) and longer PR and QRS intervals at discharge (250.00±53,29 ms vs 179.17±39.17 ms; p=0,003; 125±33.38 ms vs 102.55±30.48 ms; p=0,04). The overall eECG schedule level compliance was 96.5%. Out of a total of 965 sent eECGs, 950 (98,4%) have been correctly recorded and transmitted.
Conclusion
Delayed CDs requiring PPM-I are the most important drawback of TAVR procedure. In our study, AeECG was seen to be safe and helpful in the identification and treatment of delayed CDs requiring PPM-I, with a very high eECG schedule level of compliance and quality. Further prospective studies are needed to better identify patient selection for outpatient monitoring, making safer and safer the early post TAVR discharge approach.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R De Lucia
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - C Giannini
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M Parollo
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - G Costa
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - V Barletta
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - M Giannotti Santoro
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - C Primerano
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M De Carlo
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - M Angelillis
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
| | - G Zucchelli
- Azienda Ospedaliero Universitaria Pisana, Second Division of Cardiology, CardiacThoracic and Vascular Department , Pisa , Italy
| | - A S Petronio
- Azienda Ospedaliero Universitaria Pisana, Cardiac Catheterization Division, Cardiothoracic and Vascular Department , Pisa , Italy
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8
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Angelillis M, Costa G, Giannini C, Fiorina C, Branca L, Tamburino C, Barbanti M, Gorla R, Casenghi M, Bruschi G, Merlanti B, Montorfano M, Ferri LA, Poli A, Regazzoli D, De Felice F, Maffeo D, Trani C, Iadanza A, Petronio AS. Predictors of early discharge after transcatheter aortic valve implantation: insight from the CoreValve ClinicalService. J Cardiovasc Med (Hagerstown) 2022; 23:454-462. [PMID: 35763766 DOI: 10.2459/jcm.0000000000001318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS The aim of this study was to minimize the procedure, and reduce the length of hospital stay (LoS) is the future objective for transcatheter aortic valve replacement (TAVI).Aims of the study are to identify procedural and electrocardiographical predictors of fast-track discharge in patients who underwent TAVI. METHODS Patients treated with TAVI included in the One Hospital ClinicalService project were categorized according to the LoS. 'Fast-Track' population, with a postprocedural LoS less than or equal to 3 days, was compared with the 'Slow-Track' population with a postprocedural LoS greater than 3 days. RESULTS One thousand five hundred and one patients were collected. Despite single baseline characteristics being almost similar between the two groups, Slow-Track group showed a higher surgical risk (P < 0.001). Patients in the Slow-Track group were more frequently treated with general anaesthesia (P = 0.002) and less frequently predilated (P < 0.001) and received a lower amount of contrast media. No difference between Slow-Track and Fast-Track patients was observed at 30 days in death and in cardiovascular rehospitalization.In the multivariable analysis, STS score of at least 4% [odds ratio (OR): 1.64; P = 0.01], general anaesthesia (OR: 2.80; P = 0.03), predilation (OR: 0.45; P < 001), NYHA 3-4 at baseline (OR: 1.65; P = 0.01), AVB I/LBBB/RBBB onset (OR: 2.41; P < 0.001) and in-hospital new PM (OR: 2.63; P < 0.001) were independently associated with a higher probability of Slow-Track. CONCLUSION Fast-Track patients were safely discharged home showing no difference in clinical outcomes after discharge up to 30 days compared with the Slow-Track group. The STS score, general anaesthesia, NYHA 3--4 at baseline, in-hospital onset of conduction disturbances and new PM implantation after TAVI turned out to be predictors of Slow-Track.
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Affiliation(s)
- Marco Angelillis
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - Giulia Costa
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - Cristina Giannini
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | | | - Luca Branca
- Cardiothoracic Department, Spedali Civili Brescia, Brescia
| | - Corrado Tamburino
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital University of Catania, Catania
| | - Marco Barbanti
- Division of Cardiology, Policlinico-Vittorio Emanuele Hospital University of Catania, Catania
| | | | | | - Giuseppe Bruschi
- Department of Cardiology, ASST Grande Ospedale Metropolitano Niguarda
| | - Bruno Merlanti
- Department of Cardiology, ASST Grande Ospedale Metropolitano Niguarda
| | - Matteo Montorfano
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute
| | - Luca A Ferri
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute
| | - Arnaldo Poli
- Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Milan
| | | | | | - Diego Maffeo
- Cardiac Surgery, Poliambulanza Foundation, Brescia
| | - Carlo Trani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Alessandro Iadanza
- Department of Internal, Cardiovascular and Geriatric Medicine, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Anna S Petronio
- Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa
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Pivato CA, Cao D, Spirito A, Sartori S, Nicolas J, Chiarito M, Snyder C, Mehilli J, Lefèvre T, Stefanini GG, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Vogel B, Sardella G, Van Mieghem NM, Nardin M, Tavenier AH, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Sharma S, Ferrer MC, Naber C, Kievit P, Baber U, Petronio AS, Morice MC, Chieffo A, Dangas G, Mehran R. Impact of Small Valve Size on 1-Year Outcomes After Transcatheter Aortic Valve Implantation in Women (from the WIN-TAVI Registry). Am J Cardiol 2022; 172:73-80. [PMID: 35461697 DOI: 10.1016/j.amjcard.2022.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022]
Abstract
Although most patients with small aortic annulus are women, there is paucity of data on the prognostic impact of small aortic prosthesis in women who underwent transcatheter aortic valve implantation (TAVI). Therefore, we aimed to evaluate the impact of small valve size on 1-year clinical outcomes after TAVI in women. The Women's INternational Transcatheter Aortic Valve Implantation is an all-women registry evaluating patients with severe aortic stenosis who underwent TAVI. Based on the size of the aortic bioprosthesis implanted, women were stratified into small (≤23 mm) and nonsmall (>23 mm) valve. The primary efficacy endpoint was the Valve Academic Research Consortium-2 composite of all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction at 1-year follow-up. Of 934 women who underwent TAVI, 388 (41.5%) received a small valve. Women with a small valve size had a lower body mass index, lower surgical risk scores, were less likely to suffer from atrial fibrillation, less often required postdilation and had a lower rate of residual aortic regurgitation grade ≥2. The occurrence of the Valve Academic Research Consortium-2 efficacy endpoint was similar between women treated with small and nonsmall valve (16.0% vs 16.3%, p = 0.881; adjusted hazard ratio 1.34, 95% confidence interval 0.90 to 2.00). Likewise, there were no significant differences in the occurrence of other secondary endpoints after multivariable adjustment. In conclusion, women with severe aortic stenosis who underwent TAVI with the implantation of a small valve bioprosthesis had similar 1-year outcomes as those receiving a nonsmall bioprosthesis.
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Affiliation(s)
- Carlo A Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Clayton Snyder
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julinda Mehilli
- Department of Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Thierry Lefèvre
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | | | | | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Alessandro Iadanza
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Sardella
- Department of Cardiology, Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Matteo Nardin
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anne H Tavenier
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Nicholas Dumonteil
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Chiara Fraccaro
- Department of Cardiology, University of Padova, Padova, Italy
| | - Daniela Trabattoni
- Department of Invasive Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Ghada Mikhail
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Samin Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maria Cruz Ferrer
- Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular Centre, Elisabeth Krankenhaus, Essen, Germany
| | - Peter Kievit
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Usman Baber
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anna S Petronio
- Department of Cardiology, AOUP Cisanello, University Hospital, Pisa, Italy
| | - Marie C Morice
- Department of Cardiology, Institut Hospitalier Jacques Cartier, Ramsay Générale de Santé, Massy, France
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Pugliese NR, Del Punta L, Falcetta G, Besola L, De Biase N, Mazzola M, Giannini C, Petronio AS, Taddei S, Masi S, Colli A. Evaluation of energy loss in patients with severe primary valvular heart disease before cardiac valve intervention. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.356] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Valvular heart disease (VHD) determines non-physiological, inefficient blood flow within the left ventricle, resulting in abnormal vortex formation and energy loss (EL). EL evaluation could provide valuable insights in addition to more common parameters of left ventricle systolic and diastolic dysfunction. Vector flow mapping (VFM) is a novel, non-invasive echocardiographic technique that measures EL through the study of intraventricular flow.
Purpose. To assess EL throughout the whole cardiac cycle in patients with severe primary left-sided VHD before cardiac valve intervention.
Methods. VFM is based on the continuity equation applied to colour Doppler and speckle tracking echocardiography, acquired from the apical long-axis view. VFM estimates blood flow velocity and vortex characteristics to quantify energy dissipation (i.e., EL) due to blood viscosity in a turbulent flow. EL was calculated frame by frame and averaged over three beats.
Results. We enrolled 20 healthy controls (55 ± 19 years old, 65% male) and 73 patients (70 ± 17 years old, 59% male) with severe VHD before cardiac surgery: 30 with primary mitral regurgitation (MR), 8 with mitral stenosis (MS), 15 with aortic regurgitation (AR), 20 with aortic stenosis (AS). All patients had a left ventricle (LV) ejection fraction ≥50% and no wall motion abnormalities. We observed an increased number of vortexes in patients with VHD when compared to controls, especially in mid-diastole (p = 0.003). This is reflected in a significantly higher EL during the whole cardiac cycle in VHD patients than controls (p < 0.0001), with the highest values observed in MS and AR (post-hoc test: all p < 0.0.1; Figure 1 and Figure 2). The differences were driven by the diastolic EL (p < 0.0001), while the systolic EL values were similar between patients with VHD and controls (p = ns).
Conclusions. In addition to standard baseline echocardiography, VFM can quantitatively evaluate the energy dissipation in different subsets of VHD. EL is not uniform during the cardiac cycle, as diastole seems significantly more affected than systole. The assessment of EL after valve intervention is ongoing. VFM could provide further insights into the pathophysiology of heart valve disease and help to evaluate the efficacy of the procedure (repair/replacement) performed. Abstract Figure 1 Abstract Figure 2
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Affiliation(s)
- NR Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Del Punta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Falcetta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Besola
- St Paul"s Hospital, Division of Cardiac Surgery, Vancouver, Canada
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - C Giannini
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - AS Petronio
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Colli
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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11
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Berti S, Bartorelli AL, Koni E, Giordano A, Petronio AS, Iadanza A, Bedogni F, Reimers B, Spaccarotella C, Trani C, Attisano T, Sardella G, Bonmassari R, Medda M, Sherwood MW, Tomai F, Navarese EP. Impact of High Body Mass Index on Vascular and Bleeding Complications After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 155:86-95. [PMID: 34284861 DOI: 10.1016/j.amjcard.2021.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 12/20/2022]
Abstract
Increased body mass index (BMI) is an established cardiovascular risk factor. The impact of high BMI on vascular and bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI) is not clarified. RISPEVA, a multicenter prospective database of patients undergoing TAVI stratified by BMI was used for this analysis. Patients were classified as normal or high BMI (obese and overweight) according to the World Health Organization criteria. A comparison of 30-day vascular and bleeding outcomes between groups was performed using propensity scores methods. A total of 3776 matched subjects for their baseline characteristics were included. Compared with normal BMI, high BMI patients had significantly 30-day greater risk of the composite of vascular or bleeding complications (11.1% vs 8.8%, OR: 1.28, 95% CI [1.02 to 1.61]; p = 0.03). Complications rates were higher in both obese (11.3%) and overweight (10.5%), as compared with normal weight patients (8.8%). By a landmark event analysis, the effect of high versus normal BMI on these complications appeared more pronounced within 7 days after the TAVI procedure. A significant linear association between increased BMI and vascular complications was observed at this time frame (p = 0.03). In conclusion, compared with normal BMI, both obese and overweight patients undergoing TAVI, experience increased rates of 30-day vascular and bleeding complications. These findings indicate that high BMI is an independent risk predictor of vascular and bleeding complications after TAVI.
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Affiliation(s)
- Sergio Berti
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Antonio L Bartorelli
- Centro Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Endrin Koni
- Department of Diagnostic and Interventional Cardiology, Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital, Massa, Italy; Department of Interventional Cardiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
| | - Anna S Petronio
- Department of Cardiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Bernard Reimers
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Carmen Spaccarotella
- Division of Cardiology, CCU and Interventional, Cardiology, Cardiovascular Research Center, University Magna Graecia, Catanzaro, Italy
| | - Carlo Trani
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Attisano
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Gennaro Sardella
- Department of Cardiology, Policlinico "Umberto I," Sapienza University of Rome, Rome, Italy
| | | | - Massimo Medda
- Istituto Clinico Sant'Ambrogio, Gruppo San Donato, Milano, Italy
| | | | | | - Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland; Faculty of Medicine, University of Alberta, Edmonton, Canada.
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12
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Giordano A, Ferraro P, Finizio F, Biondi-Zoccai G, Denti P, Bedogni F, Rubbio AP, Petronio AS, Bartorelli AL, Mongiardo A, Giordano S, DE Felice F, Adamo M, Montorfano M, Baldi C, Tarantini G, Giannini F, Ronco F, Monteforte I, Villa E, Ferrario M, Fiocca L, Castriota F, Tamburino C. Implantation of one, two or multiple MitraClips for transcatheter mitral valve repair: insights from a 1824-patient multicenter study. Panminerva Med 2021; 64:1-8. [PMID: 34309332 DOI: 10.23736/s0031-0808.21.04497-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) with the MitraClip device is an established treatment for mitral regurgitation (MR). More than one MitraClip may be implanted if a single one does not reduce MR adequately. We aimed at appraising the outlook of patients undergoing implantation of one, two or multiple MitraClips for TMVR. METHODS Exploiting the ongoing prospective GIse registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) Study dataset, we compared patients, procedural details and outcomes distinguishing those receiving one, two or multiple MitraClips. The primary endpoint was the composite of 1-year cardiac death or rehospitalization for heart failure. Additional endpoints included all cause death, surgical mitral repair, and functional class. Multivariable adjusted Cox proportional hazard analysis was used for confirmatory purposes. RESULTS As many as 1824 patients were included: 718 (39.4%) treated with a single MitraClip, and 940 (51.5%) receiving two MitraClips, and 166 (9.1%) receiving three or more. Significant differences were found for baseline features, including age, female gender, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, atrial fibrillation, permanent pacemaker, cardiac resynchronization therapy, implantable cardioverter defibrillator, and prior mitral valve repair (all p<0.05). Several imaging features were also different, including left ventricular dimensions, MR severity and proportionality, mitral valve area, flail leaflet, and pulmonary vein flow (all p<0.05). Among procedural features, significant differences were found for anesthesia type, MitraClip type, fluoroscopy, device, and operating room times, postprocedural mitral gradient, residual MR, smoke-like effect, device success partial detachment and surgical conversion (all p<0.05). In-hospital death occurred more frequently in patients receiving multiple MitraClips, and the same applied severe residual MR (all p<0.05). Mid-term follow-up (15±13 months) showed significant difference in the risk of death, cardiac death, rehospitalization for heart failure, and their composites, mainly, but not solely, associated with multiple MitraClips (all p<0.05). Adjusted analysis confirmed the significantly increased risk of composite adverse events when comparing the multiple vs single MitraClip groups (p=0.014 for death and rehospitalization, p=0.013 for cardiac death or rehospitalization). CONCLUSIONS Implantation of one or two MitraClips is associated with favorable clinical outcomes. Conversely, bail-out implantation of three or more MitraClips may portend a worse long-term prognosis.
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Affiliation(s)
- Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Paolo Ferraro
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Napoli, Italy
| | - Filippo Finizio
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio P Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anna S Petronio
- Cardiothoracic and Vascular Department, University Hospital Pisa, Pisa, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Annalisa Mongiardo
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco DE Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy
| | - Matteo Montorfano
- Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy
| | - Cesare Baldi
- Heart Department, University Hospital Scuola Medica Salernitana, Salerno, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Federico Ronco
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Ida Monteforte
- Divisione di Cardiologia, A.O. dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Emmanuel Villa
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Maurizio Ferrario
- Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Luigi Fiocca
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Castriota
- Cardiovascular Department of Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
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Angelillis M, Costa G, De Backer O, Mochi V, Christou A, Giannini C, Spontoni P, De Carlo M, Søndergaard L, Miccoli M, Petronio AS. Threshold for calcium volume evaluation in patients with aortic valve stenosis: correlation with Agatston score. J Cardiovasc Med (Hagerstown) 2021; 22:496-502. [PMID: 33278208 DOI: 10.2459/jcm.0000000000001145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The evaluation of aortic valve calcium burden is important when planning for transcatheter aortic valve implantation (TAVI). Although a robust golden standard methodology is available for calcium evaluation on noncontrast-enhanced (NCE) computed tomographic (CT) series, a standard reference for calcium assessment on contrast-enhanced CT series is currently lacking. METHODS Two hundred and forty-four preprocedural CT scans from patients who had received TAVI were analysed. We correlated the aortic calcium volumes obtained on CE series at three thresholds [450, 850, and 'probe + 100' Hounsfield Units (HU)] with the Agatston score obtained on NCE scans. A subgroup analysis was performed taking into account the contrast enhancement of the left ventricular outflow tract (LVOT), with a prespecified cut-off of 300 HU. RESULTS The overall population analysis showed higher correlation with the Agatston score using the 850 HU threshold (r = 0.45, P < 0.0001); no correlation was found with the 450 HU threshold, whilst the 'probe + 100' HU threshold showed a weaker correlation (r = 0.30, P < 0.0001). In patients with LVOT enhancement less than 300 HU, 450 HU showed the highest accuracy in calcium identification (r = 0.70, P < 0.0001), whereas in patients with LVOT enhancement of at least 300 HU, the most accurate threshold was 850 HU (r = 0.46, P < 0.0001). CONCLUSION The thresholds for correct calcium identification using the automatic 3Mensio software depend on the contrast enhancement of aortic and cardiac structures, which can be estimated by measuring the HU in the LVOT. In patients with LVOT HU of less than 300, the correct threshold to be set in the software is 450 HU, whereas in patients with LVOT HU of at least 300 the correct threshold is 850 HU.
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Affiliation(s)
- Marco Angelillis
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Giulia Costa
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Veronica Mochi
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Andrea Christou
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Cristina Giannini
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Paolo Spontoni
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Marco De Carlo
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
| | - Lars Søndergaard
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Anna S Petronio
- Cardiothoracic and Vascular Department, University Hospital Pisa, Italy
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Giannini C, Angelillis M, Fiorina C, Tamburino C, Bedogni F, Bruschi G, Montorfano M, Poli A, De Felice F, Reimers B, Branca L, Barbanti M, Testa L, Merlanti B, Petronio AS. Clinical impact and evolution of mitral regurgitation after TAVI using the new generation self-expandable valves. Int J Cardiol 2021; 335:85-92. [PMID: 33811960 DOI: 10.1016/j.ijcard.2021.03.071] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/31/2020] [Accepted: 03/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Concomitant mitral regurgitation (MR) impaired prognosis in patients undergoing transcatheter aortic valve implantation (TAVI). It has been suggested that the use of first generation self-expandable valve in patients with significant MR is associated with worse outcome as compared with balloon expandable valve. However, the impact of newer generation transcatheter devices on MR has not been investigated so far. We aim to assess the prognostic impact of MR in patients undergoing TAVI with the first-generation vs. the latest generation of self-expandable valves. METHODS We analyzed 2964 consecutive patients who underwent TAVI. Patients were classified into 4 groups according to the degree of baseline MR and the generation of self expandable valve implanted. RESULTS Of 1234 patients with moderate or severe MR, 817 were treated with first generation and 417 patients with second generation valves. Whereas, of 1730 patients with no or mild MR, 1130 were treated with first generation and 600 patients with second generation valves. Although, concomitant moderate-severe MR was found to be an independent predictor of mortality after TAVI, the use of newer generation self expandable valves was associated with higher survival rate at 1 year irrespective of the degree of preprocedural MR. At multivariable analysis the use of newer generation valve was associated with MR improvement throughout 1 year follow-up. CONCLUSION Baseline moderate-severe MR is associated with an increase in mortality after TAVI. However, the degree of preprocedural MR doesn't impact survival when a second generation self expandable valve is used.
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Affiliation(s)
- C Giannini
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - M Angelillis
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | - C Tamburino
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | - F Bedogni
- Policlinico San Donato, San Donato, Italy
| | - G Bruschi
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | | | - A Poli
- Ospedale Civile, Legnano, Italy
| | | | - B Reimers
- Clinical Institute Humanitas, Rozzano, Milan, Italy
| | | | - M Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | - L Testa
- Policlinico San Donato, San Donato, Italy
| | - B Merlanti
- "De Gasperis" Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - A S Petronio
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Costa G, Valvo R, Fiorina C, Adamo M, Giannini C, Testa L, Bruschi G, Poli A, De Felice F, Montorfano M, Maffeo D, Iadanza A, Reimers B, Bedogni F, Petronio AS, Tamburino C, Barbanti M. Long-term outcomes after transcatheter aortic valve replacement in nonagenarians: a multicenter age-based analysis. J Cardiovasc Med (Hagerstown) 2021; 22:204-211. [PMID: 33136808 DOI: 10.2459/jcm.0000000000001119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To assess the outcome of nonagenarians patients receiving transcatheter aortic valve replacement (TAVR). METHODS We aimed to stratify the overall population from an Italian, multicenter, observational project including a total of 3792 consecutive patients who underwent TAVR with CoreValve and Evolut R/PRO devices between April 2009 and October 2018, into four groups according to their age class (≥90 vs. 80-89 years vs. 70-79 vs. <70 years) and to compare outcomes up to 4 years after TAVR. RESULTS At 4 years, survival estimates showed no difference in terms of overall survival [Kaplan-Meier estimates (KM est.) 49.9 vs. 58.1% vs. 57.0 vs. 69.3%; Plogrank = 0.28] among the four groups. After 2 years from the procedure, landmark analysis showed an age-based difference in overall survival (KM est. 63.8 vs. 75.0% vs. 75.1 vs. 88.7%; Plogrank = 0.025) but no difference in terms of survival from cardiovascular death (KM est. 87.8 vs. 87.4% vs. 86.1 vs. 96.1%; Plogrank = 0.43). Finally, age itself was not correlated with overall mortality at 4 years (hazard ratio 1.06, 95% confidence interval 0.86-1.30, P = 0.591). CONCLUSION TAVR with self-expanding CoreValve and Evolut prostheses was demonstrated to have good long-term outcomes, regardless of the patient's age. At 4 years, no difference in overall mortality was reported among age-based groups, while a higher overall mortality was reported in nonagenarians after 2 years from the procedure. TAVR showed good long-term outcomes even in nonagenarian patients, and it could be the therapy of choice for selected elderly patients.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, C.A.S.T., University of Catania, Catania
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, C.A.S.T., University of Catania, Catania
| | | | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Brescia
| | - Cristina Giannini
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa
| | - Luca Testa
- Cardiology Department, IRCCS Policlinico S. Donato
| | | | - Arnaldo Poli
- Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Milan
| | | | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan
| | - Diego Maffeo
- Cardiovascular Department, Fondazione Poliambulanza, Brescia
| | - Alessandro Iadanza
- Interventional Cardiology Unit, Azienda Ospedaliera Universitaria Senese, Siena
| | - Bernhard Reimers
- Department of Cardiology, Istituto Clinico Humanitas, Milan, Italy
| | | | - Anna S Petronio
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, C.A.S.T., University of Catania, Catania
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, C.A.S.T., University of Catania, Catania
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Angelillis M, De Carlo M, Christou A, Marconi M, Mocellin DM, Caravelli P, De Caterina R, Petronio AS. A case report of multisite arterial thrombosis in a patient with coronavirus disease 2019 (COVID-19). Eur Heart J Case Rep 2020; 5:ytaa339. [PMID: 33644636 PMCID: PMC7898566 DOI: 10.1093/ehjcr/ytaa339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/06/2020] [Accepted: 09/02/2020] [Indexed: 01/17/2023]
Abstract
Background A systemic coagulation dysfunction has been associated with COVID-19. In this case report, we describe a COVID-19-positive patient with multisite arterial thrombosis, presenting with acute limb ischaemia and concomitant ST-elevation myocardial infarction and oligo-symptomatic lung disease. Case summary An 83-year-old lady with history of hypertension and chronic kidney disease presented to the Emergency Department with acute-onset left leg pain, pulselessness, and partial loss of motor function. Acute limb ischaemia was diagnosed. At the same time, a routine ECG showed ST-segment elevation, diagnostic for inferior myocardial infarction. On admission, a nasopharyngeal swab was performed to assess the presence of SARS-CoV-2, as per hospital protocol during the current COVID-19 pandemic. A total-body CT angiography was performed to investigate the cause of acute limb ischaemia and to rule out aortic dissection; the examination showed a total occlusion of the left common iliac artery and a non-obstructive thrombosis of a subsegmental pulmonary artery branch in the right basal lobe. Lung CT scan confirmed a typical pattern of interstitial COVID-19 pneumonia. Coronary angiography showed a thrombotic occlusion of the proximal segment of the right coronary artery. Percutaneous coronary intervention was performed, with manual thrombectomy, followed by deployment of two stents. The patient was subsequently transferred to the operating room, where a Fogarty thrombectomy was performed. The patient was then admitted to the COVID area of our hospital. Seven hours later, the swab returned positive for COVID-19. Discussion COVID-19 can have an atypical presentation with thrombosis at multiple sites.
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Affiliation(s)
- Marco Angelillis
- Catheterization Laboratory, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Marco De Carlo
- Catheterization Laboratory, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Andrea Christou
- Catheterization Laboratory, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Michele Marconi
- Vascular Surgery Unit, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Davide M Mocellin
- Vascular Surgery Unit, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Paolo Caravelli
- Cardiology Unit, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Raffaele De Caterina
- Cardiology Unit, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Anna S Petronio
- Catheterization Laboratory, Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
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Armario X, Rosseel L, Kharbanda R, Khogali S, Abdel-Wahab M, Van Mieghem NM, Tchétché D, Dumonteil N, De Backer O, Cotton J, McGrath B, Balakrishnan D, Ali N, Farhan S, Joseph J, Charbonnier G, Okuno T, McHugh F, Hildick-Smith D, Gilgen N, Hokken T, Spence MS, Frerker C, Angelillis M, Grygier M, Cockburn J, Bjursten H, Jeger RV, Teles R, Petronio AS, Pilgrim T, Sinning JM, Nickenig G, Søndergaard L, Blackman DJ, Mylotte D. Transcatheter Aortic Valve Replacement With the LOTUS Edge System: Early European Experience. JACC Cardiovasc Interv 2020; 14:172-181. [PMID: 33478633 DOI: 10.1016/j.jcin.2020.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/10/2020] [Accepted: 09/29/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the short-term safety and efficacy of transcatheter aortic valve replacement (TAVR) with the LOTUS Edge system. BACKGROUND The LOTUS Edge system was commercially re-released in April 2019. The authors report the first European experience with this device. METHODS A multicenter, single-arm, retrospective registry was initiated to evaluate short-term clinical outcomes. Included cases are the first experience with this device and new implantation technique in Europe. Clinical, echocardiographic, and computed tomographic data were analyzed. Endpoints were defined according to Valve Academic Research Consortium-2 and were site reported. RESULTS Between April and November 2019, 286 consecutive patients undergoing TAVR with the LOTUS Edge system at 18 European centers were included. The mean age and Society of Thoracic Surgeons score were 81.2 ± 6.9 years and 5.2 ± 5.4%, respectively. Nearly one-half of all patients (47.9%) were considered to have complex anatomy. Thirty-day major adverse events included death (2.4% [n = 7]) and stroke (3.5% [n = 10]). After TAVR, the mean aortic valve area was 1.9 ± 0.9 cm2, and the mean transvalvular gradient was 11.9 ± 5.7 mm Hg. None or trace paravalvular leak (PVL) occurred in 84.4% and moderate PVL in 2.0%. There were no cases of severe PVL. New permanent pacemaker (PPM) implantation was required in 25.9% among all patients and 30.8% among PPM-naive patients. CONCLUSIONS Early experience with the LOTUS Edge system demonstrated satisfactory short-term safety and efficacy, favorable hemodynamic data, and very low rates of PVL in an anatomically complex cohort. New PPM implantation remained high. Further study will evaluate if increasing operator experience with the device and new implantation technique can reduce the incidence of PPM implantation.
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Affiliation(s)
- Xavier Armario
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Liesbeth Rosseel
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Rajesh Kharbanda
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Saib Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | | | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | | | - Ole De Backer
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - James Cotton
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Brian McGrath
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Deepu Balakrishnan
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Noman Ali
- Department of Cardiology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Serdar Farhan
- Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Jubin Joseph
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Taishi Okuno
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Fiachra McHugh
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - David Hildick-Smith
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Nicole Gilgen
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thijmen Hokken
- Department of Interventional Cardiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Mark S Spence
- Department of Cardiology, Belfast City Hospital Trust, Belfast, United Kingdom
| | - Christian Frerker
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Marco Angelillis
- Cardiothoracic Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - James Cockburn
- Department of Cardiology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Raban V Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rui Teles
- Department of Interventional Cardiology, UNICARV, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Anna S Petronio
- Cardiothoracic Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Bern, Switzerland
| | | | - Georg Nickenig
- Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Daniel J Blackman
- Department of Cardiology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, Galway, Ireland; National University of Ireland Galway, Galway, Ireland.
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Berti S, Bedogni F, Giordano A, Petronio AS, Iadanza A, Bartorelli AL, Reimers B, Spaccarotella C, Trani C, Attisano T, Marella Cenname A, Sardella G, Bonmassari R, Medda M, Tomai F, Tarantini G, Navarese EP. Efficacy and Safety of ProGlide Versus Prostar XL Vascular Closure Devices in Transcatheter Aortic Valve Replacement: The RISPEVA Registry. J Am Heart Assoc 2020; 9:e018042. [PMID: 33103545 PMCID: PMC7763424 DOI: 10.1161/jaha.120.018042] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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] [Indexed: 12/14/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) requires large‐bore access, which is associated with bleeding and vascular complications. ProGlide and Prostar XL are vascular closure devices widely used in clinical practice, but their comparative efficacy and safety in TAVR is a subject of debate, owing to conflicting results among published studies. We aimed to compare outcomes with Proglide versus Prostar XL vascular closure devices after TAVR. Methods and Results This large‐scale analysis was conducted using RISPEVA, a multicenter national prospective database of patients undergoing transfemoral TAVR treated with ProGlide versus Prostar XL vascular closure devices. Both multivariate and propensity score adjustments were performed. A total of 2583 patients were selected. Among them, 1361 received ProGlide and 1222 Prostar XL. The predefined primary end point was a composite of cardiovascular mortality, bleeding, and vascular complications assessed at 30 days and 1‐year follow‐up. At 30 days, there was a significantly greater reduction of the primary end point with ProGlide versus Prostar XL (13.8% versus 20.5%, respectively; multivariate adjusted odds ratio, 0.80 [95% CI, 0.65–0.99]; P=0.043), driven by a reduction of bleeding complications (9.1% versus 11.7%, respectively; multivariate adjusted odds ratio, 0.76 [95% CI, 0.58–0.98]; P=0.046). Propensity score analysis confirmed the significant reduction of major adverse cardiovascular events and bleeding risk with ProGlide. No significant differences in the primary end point were found between the 2 vascular closure devices at 1 year of follow‐up (multivariate adjusted hazard ratio, 0.88 [95% CI, 0.72–1.10]; P=0.902). Comparable results were obtained by propensity score analysis. During the procedure, compared with Prostar XL, ProGlide yielded significant higher device success (99.2% versus 97.5%, respectively; P=0.001). Conclusions ProGlide has superior efficacy as compared with Prostar XL in TAVR procedures and is associated with a greater reduction of composite adverse events at short‐term, driven by lower bleeding complications. Registration Information URL: clinicaltrials.gov; Unique identifier: NCT02713932.
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Affiliation(s)
- Sergio Berti
- Department of Diagnostic and Interventional Cardiology Gabriele Monasterio Tuscany Foundation, G. Pasquinucci Heart Hospital Massa Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology IRCCS Policlinico San Donato Milan Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare Pineta Grande Hospital Castel Volturno Italy
| | - Anna S Petronio
- Department of Cardiology Azienda Ospedaliero-Universitaria Pisana Pisa Italy
| | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte Siena Italy
| | - Antonio L Bartorelli
- Centro Monzino IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco" University of Milan Italy
| | - Bernard Reimers
- Cardio Center Humanitas Research Hospital IRCCS Rozzano-Milan Italy
| | - Carmen Spaccarotella
- Division of Cardiology CCU and Interventional Cardiology Cardiovascular Research Center University Magna Graecia Catanzaro Italy
| | - Carlo Trani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Tiziana Attisano
- Cardiologia Interventistica Dipartimento Cardio Toraco Vascolare AOU S. Giovanni di Dio e Ruggi D'Aragona Salerno Italt
| | - Angela Marella Cenname
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Gennaro Sardella
- Department of Cardiology Policlinico "Umberto I" Sapienza University of Rome Italy
| | | | - Massimo Medda
- Istituto Clinico Sant'Ambrogio, Gruppo San Donato Milano Italy
| | | | | | - Eliano P Navarese
- Department of Cardiology and Internal Medicine Interventional Cardiology and Cardiovascular Medicine Research Nicolaus Copernicus University Bydgoszcz Poland.,Faculty of Medicine University of Alberta Edmonton Canada.,SIRIO MEDICINE Research Network Bydgoszcz Poland
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Petronio AS, Angelillis M, De Backer O, Giannini C, Costa G, Fiorina C, Castriota F, Bedogni F, Laborde JC, Søndergaard L. Bicuspid aortic valve sizing for transcatheter aortic valve implantation: Development and validation of an algorithm based on multi-slice computed tomography. J Cardiovasc Comput Tomogr 2020; 14:452-461. [DOI: 10.1016/j.jcct.2020.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/01/2020] [Accepted: 01/23/2020] [Indexed: 01/10/2023]
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De Luca G, Verdoia M, Savonitto S, Piatti L, Grosseto D, Morici N, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Murena E, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Rogacka R, De Servi S. Impact of diabetes on clinical outcome among elderly patients with acute coronary syndrome treated with percutaneous coronary intervention: insights from the ELDERLY ACS 2 trial. J Cardiovasc Med (Hagerstown) 2020; 21:453-459. [PMID: 32355067 DOI: 10.2459/jcm.0000000000000978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/22/2022]
Abstract
BACKGROUND Despite recent improvements in percutaneous coronary revascularization and antithrombotic therapies for the treatment of acute coronary syndromes, the outcome is still unsatisfactory in high-risk patients, such as the elderly and patients with diabetes. The aim of the current study was to investigate the prognostic impact of diabetes on clinical outcome among patients included in the Elderly-ACS 2 trial, a randomized, open-label, blinded endpoint study carried out at 32 centers in Italy. METHODS Our population is represented by 1443 patients included in the Elderly-ACS 2 trial. Diabetes was defined as known history of diabetes at admission. The primary endpoint of this analysis was cardiovascular mortality, while secondary endpoints were all-cause death, recurrent myocardial infarction, Bleeding Academic Research Consortium type 2 or 3 bleeding, and rehospitalization for cardiovascular event or stent thrombosis within 12 months after index admission. RESULTS Diabetes was present in 419 (29%) out of 1443 patients. Diabetic status was significantly associated with major cardiovascular risk factors and history of previous coronary disease, presentation with non-ST segment elevation myocardial infarction (P = 0.01) more extensive coronary disease (P = 0.02), more advanced Killip class at presentation (P = 0.003), use at admission of statins (P = 0.004) and diuretics at discharge (P < 0.001). Median follow-up was 367 days (interquartile range: 337-378 days). Diabetic status was associated with an absolute increase in the rate of cardiovascular mortality as compared with patients without diabetes [5.5 vs. 3.3%, hazard ratio (HR) 1.7 (0.99-2.8), P = 0.054], particularly among those treated with clopidogrel [HR (95% confidence interval (CI)) = 1.89 (0.93-3.87), P = 0.08]. However, this difference disappeared after correction for baseline differences [Adjusted HR (95% CI) 1.1(0.4-2.9), P = 0.86]. Similar findings were observed for other secondary endpoints, except for bleeding complications, significantly more frequent in diabetic patients [HR (95% CI) 2.02 (1.14-3.6), P = 0.02; adjusted HR (95% CI) = 2.1 (1.01-4.3), P = 0.05]. No significant interaction was observed between type of dual antiplatelet therapy, diabetic status and outcome. CONCLUSION Among elderly patients with acute coronary syndromes, diabetic status was associated with higher rates of comorbidities, more severe cardiovascular risk profile and major bleeding complications fully accounting for the absolute increase in mortality. In fact, diabetes mellitus did not emerge as an independent predictor of survival in advanced age.
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Affiliation(s)
- Giuseppe De Luca
- Azienda Ospedaliera-Universitaria 'Maggiore della Carità', Eastern Piedmont University, Novara
| | - Monica Verdoia
- Azienda Ospedaliera-Universitaria 'Maggiore della Carità', Eastern Piedmont University, Novara
| | | | | | | | | | - Irene Bossi
- ASST Grande Ospedale Metropolitano Niguarda, Milano
| | | | | | | | | | | | | | | | - Elena Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | | | | | | | | | - Renata Rogacka
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Brescia
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Giordano A, Corcione N, Ferraro P, Morello A, Conte S, Testa L, Iadanza A, Sardella G, Mancone M, Berti S, Petronio AS, Romagnoli E, Pepe M, Frati G, Biondi-Zoccai G. Comparison of ProGlide vs. Prostar in patients undergoing transcatheter aortic valve implantation. Minerva Cardioangiol 2019; 67:443-449. [PMID: 31670491 DOI: 10.23736/s0026-4725.19.05071-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Arturo Giordano
- Unit of Cardiovascular Interventional Medicine, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Nicola Corcione
- Unit of Cardiovascular Interventional Medicine, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Paolo Ferraro
- Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Alberto Morello
- Unit of Cardiovascular Interventional Medicine, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Sirio Conte
- Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Luca Testa
- Department of Cardiology, San Donato Polyclinic IRCCS, San Donato Milanese, Milan, Italy
| | - Alessandro Iadanza
- Unit of Hemodynamics, Department of Cardiac, Thoracic and Vascular Sciences, Santa Maria alle Scotte Polyclinic, Siena, Italy
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Sergio Berti
- G. Monasterio C.N.R. Foundation, Ospedale del Cuore, Massa, Italy
| | - Anna S Petronio
- Department of Cardiology, AOUP Cisanello, University Hospital of Pisa, Pisa, Italy
| | - Enrico Romagnoli
- Institute of Cardiology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
- IRCCS NEUROMED, Pozzili, Isernia, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy -
- Mediterranea Cardiocentro, Naples, Italy
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Mehilli J, Chandrasekhar J, Sartori S, Chieffo A, Petronio AS, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Jochheim D, Zadrozny M, Mikhail GW, Sharma S, Ferrer MC, Naber C, Kievit P, Moalem K, Baber U, Snyder C, Sharma M, Morice MC, Mehran R. Impact of Discharge Location After Transcatheter Aortic Valve Replacement on 1-Year Outcomes in Women: Results From the WIN-TAVI Registry. Can J Cardiol 2019; 35:199-207. [DOI: 10.1016/j.cjca.2018.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/14/2018] [Accepted: 11/22/2018] [Indexed: 01/09/2023] Open
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Costa G, De Carlo M, Faggioni L, Angelillis M, Giannini C, Spontoni P, Caramella D, Petronio AS. P3597Multislice computed tomography SYNTAX score for coronary artery disease evaluation prior to transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Costa
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - M De Carlo
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - L Faggioni
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - M Angelillis
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - C Giannini
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - P Spontoni
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - D Caramella
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - A S Petronio
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Baldo A, Martina P, Lettieri C, Reimers B, Musto C, Fiorina C, Adamo M, Bruschi G, Petronio AS, Giannini C, Barbanti M, Tamburino C, Testa L, Bedogni F, Poli A. P1676Safety and efficacy of trans-subclavian aortic valve implantation in obese patients: a propensity-matched cohort of trans-subclavian versus trans-femoral approach. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Baldo
- University of Pavia, Cardiology, Pavia, Italy
| | - P Martina
- Civil Hospital of Legnano, Cardiology, Legnano, Italy
| | - C Lettieri
- Hospital Carlo Poma, Cardiology, Mantova, Italy
| | - B Reimers
- Istituto Clinico Humanitas, Milan, Italy
| | - C Musto
- San Camillo Forlanini Hospital, Rome, Italy
| | - C Fiorina
- Civil Hospital of Brescia, Brescia, Italy
| | - M Adamo
- Civil Hospital of Brescia, Brescia, Italy
| | - G Bruschi
- Niguarda Ca' Granda Hospital, Milan, Italy
| | | | | | | | | | - L Testa
- IRCCS, Policlinico San Donato, San Donato Milanese, Italy
| | - F Bedogni
- IRCCS, Policlinico San Donato, San Donato Milanese, Italy
| | - A Poli
- Civil Hospital of Legnano, Cardiology, Legnano, Italy
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De Carlo M, Limbruno U, Pistolesi S, Fontanini G, Petronio AS, Balbarini A, De Caterina R. Distal embolization during angioplasty for acute myocardial infarction: is pharmacological protection enough? Thromb Haemost 2017; 94:680-1. [PMID: 16268491 DOI: 10.1160/th05-03-0680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Giannini C, Petronio AS, Fiorelli F, Liga R, Spontoni P, De Carlo M, Marraccini E, Pieroni A, Guarracino F. Effects of levosimendan in patients with severe functional mitral regurgitation undergoing MitraClip implantation. J Cardiovasc Med (Hagerstown) 2017; 18:679-686. [DOI: 10.2459/jcm.0000000000000537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, Lancellotti P, Sondergaard L, Ludman PF, Tamburino C, Piazza N, Hancock J, Mehilli J, Byrne RA, Baumbach A, Kappetein AP, Windecker S, Bax J, Haude M. Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2017; 38:3382-3390. [DOI: 10.1093/eurheartj/ehx303] [Citation(s) in RCA: 251] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/19/2017] [Indexed: 01/18/2023] Open
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Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, Lancellotti P, Sondergaard L, Ludman PF, Tamburino C, Piazza N, Hancock J, Mehilli J, Byrne RA, Baumbach A, Kappetein AP, Windecker S, Bax J, Haude M. Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2017; 52:408-417. [DOI: 10.1093/ejcts/ezx244] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/19/2017] [Indexed: 01/04/2023] Open
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Calicchio F, Guarracino F, Giannini C, De Caro F, Baldassarri R, De Carlo M, Petronio AS. Balloon aortic valvuloplasty before noncardiac surgery in severe aortic stenosis. J Cardiovasc Med (Hagerstown) 2017; 18:109-113. [DOI: 10.2459/jcm.0000000000000331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Petronio AS, Sinning JM, Van Mieghem N, Zucchelli G, Nickenig G, Bekeredjian R, Bosmans J, Bedogni F, Branny M, Stangl K, Kovac J, Schiltgen M, Kraus S, de Jaegere P. Optimal Implantation Depth and Adherence to Guidelines on Permanent Pacing to Improve the Results of Transcatheter Aortic Valve Replacement With the Medtronic CoreValve System. JACC Cardiovasc Interv 2015; 8:837-846. [DOI: 10.1016/j.jcin.2015.02.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
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De Caro F, De Carlo M, Petronio AS. Optical coherence tomography-guided treatment of very late stent thrombosis caused by inaccurate stent deployment in a bifurcation. J Cardiovasc Med (Hagerstown) 2014; 17 Suppl 2:e185-e188. [PMID: 25004004 DOI: 10.2459/jcm.0000000000000126] [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: 11/05/2022]
Abstract
: A 65-year-old man presented at our institution with anterior wall reinfarction, due to very late stent thrombosis, 4 years after primary angioplasty on the first bifurcation of the left anterior descending artery. Using intravascular optical coherence tomography, we identified stent malapposition in the proximal left anterior descending artery, occurring during the first primary angioplasty, as the probable cause of the very late stent thrombosis. Imaging with optical coherence tomography guided our treatment strategy of mechanical and pharmacological thrombectomy, followed by staged stent postdilatation.
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Affiliation(s)
- Francesco De Caro
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
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Giannini C, De Carlo M, Guarracino F, Donne MG, Benedetti G, Verunelli F, Petronio AS. Dysfunction of a 21-mm aortic bioprosthesis treated with percutaneous implantation of a CoreValve prosthesis. J Cardiovasc Med (Hagerstown) 2013; 14:541-4. [DOI: 10.2459/jcm.0b013e328335fa67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Guarracino F, Ferro B, Baldassarri R, Bertini P, Forfori F, Giannini C, Di Bello V, Petronio AS. Non invasive evaluation of cardiomechanics in patients undergoing MitrClip procedure. Cardiovasc Ultrasound 2013; 11:13. [PMID: 23642140 PMCID: PMC3651274 DOI: 10.1186/1476-7120-11-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/26/2013] [Indexed: 11/28/2022] Open
Abstract
Background In the last recent years a new percutaneous procedure, the MitraClip, has been validated for the treatment of mitral regurgitation. MitraClip procedure is a promising alternative for patients unsuitable for surgery as it reduces the risk of death related to surgery ensuring a similar result. Few data are present in literature about the variation of hemodynamic parameters and ventricular coupling after Mitraclip implantation. Methods Hemodynamic data of 18 patients enrolled for MitraClip procedure were retrospectively reviewed and analyzed. Echocardiographic measurements were obtained the day before the procedure (T0) and 21 ± 3 days after the procedure (T1), including evaluation of Ejection Fraction, mitral valve regurgitation severity and mechanism, forward Stroke Volume, left atrial volume, estimated systolic pulmonary pressure, non invasive echocardiographic estimation of single beat ventricular elastance (Es(sb)), arterial elastance (Ea) measured as systolic pressure • 0.9/ Stroke Volume, ventricular arterial coupling (Ea/Es(sb) ratio). Data were expressed as median and interquartile range. Measures obtained before and after the procedure were compared using Wilcoxon non parametric test for paired samples. Results Mitraclip procedure was effective in reducing regurgitation. We observed an amelioration of echocardiographic parameters with a reduction of estimated systolic pulmonary pressure (45 to 37,5 p = 0,0002) and left atrial volume (110 to 93 p = 0,0001). Despite a few cases decreasing in ejection fraction (37 to 35 p = 0,035), the maintained ventricular arterial coupling after the procedure (P = 0,67) was associated with an increasing in forward stroke volume (60,3 to 78 p = 0,05). Conclusion MitraClip is effective in reducing mitral valve regurgitation and determines an amelioration of hemodynamic parameters with preservation of ventricular arterial coupling.
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Affiliation(s)
- Fabio Guarracino
- Department of Cardiothoracic Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56123, Italy.
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Conte L, Fabiani I, Barletta V, Giannini C, Leo LA, Delle Donne MG, Palagi C, Nardi C, Dini FL, Petronio AS, Marzilli M, Di Bello V. The role of cardiovascular imaging to understand the different patterns of post-ischemic remodeling. J Cardiovasc Echogr 2012. [DOI: 10.1016/j.jcecho.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Misuraca L, De Caro F, De Carlo M, Barzaghi C, Scioti G, Minzioni G, Petronio AS. Left main compression by an aortic root abscess. J Cardiovasc Med (Hagerstown) 2012; 13:207-8. [PMID: 22306781 DOI: 10.2459/jcm.0b013e3283511ec8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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
A 79-year-old man with severe aortic stenosis, history of coronary artery disease and a recent hospitalization for sepsis presented at our institution following a syncope and angina at rest. Coronary angiography and aortography showed an aortic root abscess, causing left main coronary artery compression. This life-threatening complication of aortic valve endocarditis is rare and requires immediate surgical correction.
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Affiliation(s)
- Leonardo Misuraca
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
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Sangiorgi GM, Morice MC, Bramucci E, Ferlini M, Grinfeld L, Petronio AS, Pierli C, Iadanza A, Biondi-Zoccai G, Colombo A. Evaluating the safety of very short-term (10 days) dual antiplatelet therapy after Genous™ bio-engineered R stent™ implantation: the multicentre pilot Genous trial. EUROINTERVENTION 2012; 7:813-9. [PMID: 22082577 DOI: 10.4244/eijv7i7a128] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Percutaneous coronary stenting is synonymous with dual antiplatelet therapy, ranging from four weeks to lifelong. However, even short-term (four weeks) therapy with aspirin and thienopyridines is occasionally contraindicated. No study has ever appraised very short-term dual antiplatelet therapy after stenting. We thus aimed to exploit the pro-healing features of the Genous™ Bio-engineered R stent™ (Genous) (OrbusNeich Medical Technologies, Hong Kong, People's Republic of China) and evaluate the safety of a 10-day dual antiplatelet regimen after its implantation in up to 50 patients. METHODS AND RESULTS Forty-nine consecutive patients with de novo lesions located in vessels able to receive a 2.5 mm Genous stent were included. After stenting, they received lifelong aspirin plus clopidogrel for 10 days. The primary endpoint of the study was sudden cardiac death, myocardial infarction or angiographic evidence of stent thrombosis ascribable to the study stent. Almost 70% of patients effectively discontinued clopidogrel nine to 11 days after stenting. At three-month clinical follow-up, no patient had died or reached the primary endpoint (95%; confidence interval 0-7.3%). Repeat revascularisation occurred instead in three (6.1%[2.1-16.5%]), with target lesion revascularisation in two (4.1%[1.1-13.7%]). CONCLUSIONS Even very short-term dual antiplatelet therapy seems safe after coronary stenting with Genous in de novo coronary artery lesions located in secondary branch vessels. This preliminary exploratory study gives some support to planning a large trial to test the hypothesis of short dual antiplatelet therapy following Genous stent implantation.
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DE Luca G, Bellandi F, Huber K, Noc M, Petronio AS, Arntz HR, Maioli M, Gabriel HM, Zorman S, DE Carlo M, Rakowski T, Gyongyosi M, Dudek D. Early glycoprotein IIb-IIIa inhibitors in primary angioplasty-abciximab long-term results (EGYPT-ALT) cooperation: individual patient's data meta-analysis. J Thromb Haemost 2011; 9:2361-70. [PMID: 21929513 DOI: 10.1111/j.1538-7836.2011.04513.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [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: 12/21/2022]
Abstract
BACKGROUND Even although time to treatment has been shown to be a determinant of mortality in primary angioplasty, the potential benefits are still unclear from early pharmacological reperfusion by glycoprotein (Gp) IIb-IIIa inhibitors. Therefore, the aim of this meta-analysis was to combine individual data from all randomized trials conducted on upstream as compared with late peri-procedural abciximab administration in primary angioplasty. METHODS The literature was scanned using formal searches of electronic databases (MEDLINE and EMBASE) from January 1990 to December 2010. All randomized trials on upstream abciximab administration in primary angioplasty were examined. No language restrictions were enforced. RESULTS We included a total of seven randomized trials enrolling 722 patients, who were randomized to early (n = 357, 49.4%) or late (n = 365, 50.6%) peri-procedural abciximab administration. No difference in baseline characteristics was observed between the two groups. Follow-up data were collected at a median (25th-75th percentiles) of 1095 days (720-1967). Early abciximab was associated with a significant reduction in mortality (primary endpoint) [20% vs. 24.6%; hazard ratio (HR) 95% confidence interval (CI) = 0.65 (0.42-0.98) P = 0.02, P(het) = 0.6]. Furthermore, early abciximab administration was associated with a significant improvement in pre-procedural thrombolysis in myocardial infarction (TIMI) 3 flow (21.6% vs. 10.1%, P < 0.0001), post-procedural TIMI 3 flow (90% vs. 84.8%, P = 0.04), an improvement in myocardial perfusion as evaluated by post-procedural myocardial blush grade (MBG) 3 (52.0% vs. 43.2%, P = 0.03) and ST-segment resolution (58.4% vs. 43.5%, P < 0.0001) and significantly less distal embolization (10.1% vs. 16.2%, P = 0.02). No difference was observed in terms of major bleeding complications between early and late abciximab administration (3.3% vs. 2.3%, P = 0.4). CONCLUSIONS This meta-analysis shows that early upstream administration of abciximab in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction (STEMI) is associated with significant benefits in terms of pre-procedural epicardial re-canalization and ST-segment resolution, which translates in to significant mortality benefits at long-term follow-up.
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Affiliation(s)
- G DE Luca
- Division of Cardiology, Maggiore della Carità Hospital, Eastern Piedmont University, Novara, Italy
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Navarese EP, De Servi S, Gibson CM, Buffon A, Castriota F, Kubica J, Petronio AS, Andreotti F, De Luca G. Early vs. delayed invasive strategy in patients with acute coronary syndromes without ST-segment elevation: a meta-analysis of randomized studies. QJM 2011; 104:193-200. [PMID: 21262739 DOI: 10.1093/qjmed/hcq258] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Although early percutaneous coronary intervention has been demonstrated to reduce the risk of mortality in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), there are emerging conflicting data as to whether the catheterization needs to be done very early or whether it could be delayed while the patient receives medical therapy. The aim of the current study was to perform a meta-analysis of randomized controlled trials (RCTs) comparing early vs. delayed invasive strategies for NSTE-ACS patients. Medline/CENTRAL and the Web were searched for RCTs comparing early vs. delayed invasive strategies for NSTE-ACS patients. The primary endpoint was all cause mortality, whereas myocardial infarction (MI), coronary revascularizations and 30-day major bleeding complications were secondary end points. Fixed or random effects models were used based on statistical heterogeneity. As a sensitivity analysis, Bayesian random effects meta-analysis was performed in addition to the classical random effects meta-analysis. A total of 5 RCTs were finally included, enrolling 4155 patients. As compared with a delayed strategy, an early invasive approach did not significantly reduce the rates of death [odds ratio (OR) 95% confidence interval (95% CI) = 0.81 (95% CI 0.60-1.09), P = 0.17], MI [OR = 1.18 (95% CI 0.68-2.05), P = 0.55] or revascularizations [OR = 0.97 (0.77-1.24), P = 0.82]. There was a not significant trend toward fewer major bleeding complications for the early invasive approach [OR (95% CI) = 0.76 (0.55-1.04), P = 0.08]. The present meta-analysis shows that for NSTE-ACS patients a routine early invasive strategy does not significantly improve survival nor reduce MI and revascularization rates as compared with a delayed approach.
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Affiliation(s)
- E P Navarese
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome.
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De Carlo M, De Viti D, Bellini F, Gistri R, Petronio AS. Usefulness of intravascular ultrasound in a case of angiographically unapparent myocardial bridging. J Cardiovasc Med (Hagerstown) 2009; 10:406-8. [PMID: 19436177 DOI: 10.2459/jcm.0b013e3283212ef3] [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
A patient with an acute coronary syndrome underwent coronary angiography, which showed only a moderate stenosis in the mid portion of the left anterior descending artery. Intravascular ultrasound was performed for a better assessment of the lesion, and surprisingly, it showed a myocardial bridge over the narrowed segment, which was unapparent at angiography. In fact, the systolic compression of the artery was very limited, and no 'step down-step up' course was recognized. Given the absence of significant atherosclerosis in the intramyocardial and adjacent segments, and considering the poor results reported for stenting of tunnelled coronary arteries, we decided to treat the patient medically. At 6-month follow-up, the patient is asymptomatic and has no inducible ischemia.In conclusion, this case shows how intravascular ultrasound can be useful in patients with an unclear angiographic diagnosis for a better patient management.
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Affiliation(s)
- Marco De Carlo
- Cardiac Catheterization Laboratory, Cardiothoracic Department, University of Pisa, Pisa, Italy
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De Carlo M, Wood DA, Webb JG, Gerckens U, Cortese B, Grube E, Mancini GJ, Krucoff MW, Rn CM, Goff T, Petronio AS, Hamburger JN. Adjunctive use of the Rinspiration system for fluidic thrombectomy during primary angioplasty: The Rinspiration international registry. Catheter Cardiovasc Interv 2008; 72:196-203. [DOI: 10.1002/ccd.21596] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Canale ML, Stroppa S, Caravelli P, Petronio AS, Mariotti R, Mariani M, Balbarini A, Barsotti A. Admission C-reactive protein serum levels and survival in patients with acute myocardial infarction with persistent ST elevation. Coron Artery Dis 2006; 17:693-8. [PMID: 17119378 DOI: 10.1097/01.mca.0000236286.48812.8c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the prognostic value of a single and early determination of high sensitivity C-reactive protein levels at admittance in patients with acute myocardial infarction with persistent ST elevation. PATIENTS AND METHODS We evaluated high-sensitivity C-reactive protein levels in 247 consecutive acute myocardial infarction with persistent ST elevation patients at admittance. Patients were monitored for the occurrence of major adverse cardiovascular events. RESULTS Mean follow-up was 26 months. High C-reactive protein levels were principally associated with age > or = 65 years (P=0.01), diabetes (P=0.03) and reduced left ventricle ejection fraction (P=0.048). We observed a significant C-reactive protein level difference between the major adverse cardiovascular event-free group and the major adverse cardiovascular event group (28.2+/-21.9 vs. 47.7+/-31.9 mg/l, P=0.03), between deceased patients group (vs. 81.5+/-51.8 mg/l, P<0.001) and early deaths (vs. 129.5+/-71.9 mg/l, P<0.001). Kaplan-Meier plots for survival and major adverse cardiovascular event occurrence showed a significant separation (P=0.01 and 0.002 by log-rank test, respectively) between high and low C-reactive protein level groups. C-reactive protein levels were independent risk predictors of major adverse cardiovascular events (odds ratio 2.931, 95% confidence interval 1.512-5.893; P=0.046) and death (odds ratio 5.068, 95% confidence interval 2.056-20.195; P=0.04). Patients with high C-reactive protein levels and age > or = 65 years were at highest risk for major adverse cardiovascular event occurrence (odds ratio 5.658, 95% confidence interval 2.898-6.249; P=0.022) and death (odds ratio 8.120, 95% confidence interval 5.656-22.729; P=0.03). CONCLUSIONS High C-reactive protein levels identify patients with a worse prognosis after acute myocardial infarction with persistent ST elevation. The evaluation of C-reactive protein and age may provide a tool to select high-risk patients.
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Affiliation(s)
- Maria L Canale
- Division of Cardiology, Cardio-Thoracic Department, Cisanello Hospital, University of Pisa, Pisa, Italy.
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Petronio AS, De Carlo M, Ciabatti N, Amoroso G, Limbruno U, Palagi C, Di Bello V, Romano MF, Mariani M. Left ventricular remodeling after primary coronary angioplasty in patients treated with abciximab or intracoronary adenosine. Am Heart J 2005; 150:1015. [PMID: 16290987 DOI: 10.1016/j.ahj.2005.07.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [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: 10/18/2004] [Accepted: 07/12/2005] [Indexed: 12/22/2022]
Abstract
BACKGROUND Primary angioplasty is the best treatment of acute myocardial infarction but fails to achieve adequate myocardial reperfusion in 25% to 30% of patients, despite TIMI grade 3 flow. Drug treatment aimed at reducing the no-reflow phenomenon may improve myocardial salvage, thus preventing left ventricular remodeling. Our aim was to evaluate the impact of abciximab and adenosine on immediate angiographic results and on 6-month left ventricular remodeling. METHODS Ninety consecutive patients undergoing primary angioplasty with coronary stenting were randomized in a sequential alternating fashion to standard abciximab treatment (ABCX) group, intracoronary adenosine distal to the occlusion (ADO) group, or neither (CTRL) group. All patients underwent a clinical and echocardiographic follow-up at 1 and 6 months. The primary end point was the prevalence of 6-month left ventricular remodeling. RESULTS Baseline clinical, echocardiographic, and angiographic characteristics were similar. Mean final corrected TIMI frame count was 17 +/- 9, 16 +/- 12, and 23 +/- 11 frames in ABCX, ADO, and CTRL patients, respectively (P = .002). Angiographic no-reflow was observed in 7%, 13%, and 17% of ABCX, ADO, and CTRL patients, respectively (P > .20). At 6 months, left ventricular remodeling occurred in 7%, 30%, and 30% of ABCX, ADO, and CTRL patients, respectively (P = .045), with a percent increase in end-diastolic volume of 5% +/- 13%, 15% +/- 15%, and 12% +/- 18% (P = .04). CONCLUSIONS During primary angioplasty, abciximab enhances myocardial reperfusion, translating into a reduced incidence of 6-month left ventricular remodeling. In contrast, adenosine administration improves angiographic results but does not prevent left ventricular remodeling.
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Hoffmann R, Guagliumi G, Musumeci G, Reimers B, Petronio AS, Disco C, Amoroso G, Moses JW, Fitzgerald PJ, Schofer J, Leon MB, Breithardt G. Vascular response to sirolimus-eluting stents delivered with a nonaggressive implantation technique: Comparison of intravascular ultrasound results from the multicenter, randomized E-SIRIUS, and SIRIUS trials. Catheter Cardiovasc Interv 2005; 66:499-506. [PMID: 16273564 DOI: 10.1002/ccd.20542] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The effectiveness of SES to reduce the risk of restenosis was initially demonstrated in short lesions using stent implantation with routine pre-dilatation and post-dilatation. This intravascular ultrasound (IVUS) substudy of the E-SIRIUS trial sought to evaluate local arterial responses to sirolimus-eluting stents (SES) delivered with a stent implantation technique allowing direct stenting and only selectively applying high-pressure post-dilatation. METHODS AND RESULTS IVUS was performed immediately after intervention and at 8-month follow-up in 51 patients randomised to either bare-metal stents (BMS; Bx-Velocitytrade mark; N=20) or SES (Cyphertrade mark N=31). Direct stenting was allowed (24%) and post-dilation was performed only selectively (32%). Lumen dimensions, intimal hyperplasia and vessel remodeling were compared between SES and BMS. Subsequently, results of SES in the E-SIRIUS IVUS substudy (N=31) were compared to those of SES in the IVUS substudy of the SIRIUS trial (N=137). SES in SIRIUS IVUS substudy were delivered with 100% pre-dilatation and 77% post-dilatation. Baseline stent and reference segment measurements were similar between BMS and SES in E-SIRIUS IVUS patients. Using SES there was a 96% reduction in intimal hyperplasia volume within the stented segment (1.8+/-4.9 vs 50.6+/-39.7 mm3, P<0.001) and a significantly larger minimal lumen cross sectional area at 8-month follow-up (4.5+/-1.1 vs 2.3+/-0.9 mm2, P<0.001). No vessel remodeling was observed with the use of SES. The applied stent implantation technique resulted in a minimal stent/reference vessel area ratio of 0.75+/-0.17 in E-SIRIUS SES as compared to 0.84+/-0.23 in SIRIUS SES (P=0.046). Mean intimal hyperplasia cross-sectional area at follow-up was 0.1+/-0.2 mm2 in the SES group of E-SIRIUS and 0.5+/-0.8 mm2 in the SES group of SIRIUS (P=0.003). CONCLUSIONS An implantation technique of SES which includes direct stenting and minimizes the use of high-pressure post-dilatation results in less optimal stent expansion. However, follow-up results compare very favourable to those of BMS and are characterised by even less intimal hyperplasia than after a more forceful implantation of SES.
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Affiliation(s)
- Rainer Hoffmann
- Medical Clinic I, University Hospital Aachen, Aachen, Germany.
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Fossati N, Meacci L, Amorese G, Bellissima G, Pieri M, Nardi S, Esposito Vangone M, Rondinini L, Mariotti R, Petronio AS, Boggi U, Rizzo G, Marchetti P, Sansevero A, Mosca F. Cardiac evaluation for simultaneous pancreas-kidney transplantation and incidence of cardiac perioperative complications: preliminary study. Transplant Proc 2004; 36:582-5. [PMID: 15110601 DOI: 10.1016/j.transproceed.2004.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/30/2022]
Abstract
Type I diabetes mellitus (IDDM) is associated with an increased cardiovascular risk, and eligibility protocols for simultaneous pancreas-kidney transplantation (SPKT) are consequently accurate for preoperative cardiovascular assessment. According to our algorithm, coronary angiography in SPKT candidates is indicated for patients not only experiencing previous cardiac events or symptoms, but also those with long-standing diabetes (more than 25 years) and/or age over 45 years. Furthermore, a basal transthoracic echocardiographic exam (TTE) is performed to assess cardiac volumes, left ventricular mass, systolic function, and kinesis. The aims of this study were to evaluate perioperative cardiac morbidity and mortality in 18 SPKT-eligible patients, divided into two groups on the basis of the presence/absence of angiographically evident coronary artery disease (CAD), as well as to assess the impact of left ventricular hypertrophy (LVH) on cardiac complications. Cardiac intraoperative morbidity and mortality and postoperative mortality and major morbidity were absent; minor cardiac morbidity consisted only of silent ischemic ECG alterations, without significant differences between groups, although the incidence seemed to be higher in the CAD-positive population. LVH detected preoperatively by TTE exam also failed to correlate with the incidence of such complications. Selection of SPKT candidates by coronary angiography may have positive effects on perioperative cardiac morbidity and mortality. A larger sample size is needed to give the study statistical power. Medium- and long-term follow-up studies are warranted to evaluate the effects of preoperative selection on survival rates.
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Affiliation(s)
- N Fossati
- I U.O. Anestesia e Rianimazione, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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Petronio AS, Rovai D, Musumeci G, Baglini R, Nardi C, Limbruno U, Palagi C, Volterrani D, Mariani M. Effects of abciximab on microvascular integrity and left ventricular functional recovery in patients with acute infarction treated by primary coronary angioplasty. Eur Heart J 2003; 24:67-76. [PMID: 12559938 DOI: 10.1016/s0195-668x(02)00324-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIM To investigate the effect of abciximab on microvascular integrity and left ventricular (LV) functional recovery in patients with acute myocardial infarction (MI) treated by primary coronary angioplasty (PTCA). METHODS AND RESULTS Thirty-one patients (27 males; age 39-76 years) with first, acute MI (<6 h after onset) were randomized to receive either abciximab+primary PTCA (n=17) or primary PTCA alone (n=14). Baseline characteristics of the two groups were similar. Myocardial reperfusion was studied shortly after PTCA by corrected TIMI frame count (cTFC) and intracoronary myocardial contrast echocardiography (MCE), after 48 h by intravenous MCE using intermittent, harmonic power Doppler, and after 1 month by intravenous MCE and 99 mTc-tetrofosmin SPECT. The patients treated with abciximab showed a shorter cTFC (23+/-4 vs 30+/-9 frames; P<0.05), a more preserved microvascular integrity shortly after PTCA (77% vs 55%; P<0.01), after 48 h (86% vs 50%; P<0.005) and at 1-month follow-up (86% vs 54% by MCE, P<0.001, and 68% vs 60% by SPECT, P<0.005) than patients treated with PTCA alone. Abciximab patients also showed a better recovery of LV function, as demonstrated by greater reduction in wall motion score index (1.4+/-0.3 vs 1.5+/-0.2; P<0.05) and increase in LV ejection fraction (53+/-7% vs 48+/-5%; P<0.001). CONCLUSIONS Abciximab improves microvascular perfusion and LV functional recovery in primary PTCA.
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Affiliation(s)
- A S Petronio
- CardioThoracic Department, University of Pisa, Ospedale Cisanello, Pisa, Italy
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Mengozzi G, Rossini R, Palagi C, Musumeci G, Garritano L, Molfesa M, Petronio AS, Volterrani D, Di Bello V, Mariani M. Incremental value of intravenous myocardial contrast echocardiography in the prediction of contractile recovery and left ventricular remodeling early after acute myocardial infarction. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)81746-6] [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: 10/27/2022]
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Petronio AS, Musumeci G, Nardi C, Limbruno U, Amoroso G, Baglini R, Palagi C, Marlani M. Microcirculation recovery after primary coronary angioplasty in patients with acute myocardial infarction treated with abciximab or intracoronary adenosina. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)81747-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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Mariani M, Petronio AS, Manes MT, Morelli M, Squecco D, Nardini V, Bevilacqua G, Ceccherini-Nelli L. Detection of enteroviral infection in myocardial tissues by polymerase chain reaction (PCR). Clin Microbiol Infect 2002; 2:109-114. [PMID: 11866827 DOI: 10.1111/j.1469-0691.1996.tb00215.x] [Citation(s) in RCA: 2] [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: 11/26/2022]
Abstract
OBJECTIVE: To determine if enteroviral infection is linked to myocarditis and dilated cardiomyopathy. Enteroviruses, especially coxsackieviruses, appear to be the most common agents of viral myocarditis. METHODS: We collected 53 endomyocardial biopsies and two autopsy specimens from 41 patients affected by myocarditis or dilated cardiomyopathy. The patients were diagnosed clinically, hemodynamically, virologically and histologically (Dallas classification). We tested for the presence of enteroviral sequences by PCR, using 5prime prime or minute non-coding (coxsackievirus B3, CB3, map position 450--474, 584--603) derived primers. Specificity was confirmed using the Southern blot. We used a fraction of CB3 acutely infected mouse myocardial tissue as a control. RESULTS: We detected enteroviral sequences in four patients with active myocarditis, borderline myocarditis or cardiomyopathy. The patient with active myocarditis had shown neutralizing antibodies in serologic analysis for coxsackievirus B3 and B5. CONCLUSIONS: The data support a weak link of enteroviral infection to human myocarditis and dilated cardiomyopathy, at least when using a PCR assay on biopsies.
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Affiliation(s)
- Mario Mariani
- Institute of Cardiology, Cisanello Hospital, University of Pisa, Italy
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Amoroso G, van Boven AJ, van Veldhuisen DJ, Tio RA, Baljé-Volkers CP, Petronio AS, van Oeveren W. Eptifibatide and abciximab exhibit equivalent antiplatelet efficacy in an experimental model of stenting in both healthy volunteers and patients with coronary artery disease. J Cardiovasc Pharmacol 2001; 38:633-41. [PMID: 11588534 DOI: 10.1097/00005344-200110000-00016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Platelet deposition and aggregation are the major determinants of acute thrombosis in coronary stents. We aimed to compare the antiplatelet efficacy of different treatments--glycoprotein (Gp) IIb/IIIa inhibitors and conventional antiaggregants--in an experimental model for stenting. Blood samples were obtained from patients with coronary artery disease (n = 15) and healthy volunteers (n = 8) and incubated either with eptifibatide (2.0 microg/ml), abciximab (3.0 microg/ml), indomethacin (15 microg/ml), or saline. Platelet adenosine diphosphate-induced aggregation in whole blood was assessed for all groups. Blood was also tested in an experimental circulation model containing metallic probes, on which platelet deposition in shear flow conditions was assessed by means of fluorescent-labeled platelet-specific (anti-GpIIIa and Ib) antibodies. Eptifibatide and abciximab, in comparison with indomethacin and no treatment, significantly reduced platelet aggregation (0, 0, 4, and 3 arbitrary units [AU], respectively; p < 0.001), anti-GpIIIa (2.25, 1.83, 11.24, and 13.42 counts per second [cps]/mg, respectively; p < 0.001), and anti-GpIb binding (0.61, 0.61, 1.00, and 1.83 cps/mg, respectively; p < 0.001). Anti-GpIIIa and anti-GpIb binding were significantly correlated (R = 0.36; p < 0.01). Patients showed a higher anti-GpIIIa, but not anti-GpIb binding, than controls (8.43 versus 3.33 cps/mg; p < 0.01), irrespective of treatment. In conclusion, eptifibatide and abciximab show equivalent in vitro antiplatelet efficacy, superior to that of indomethacin. Given the occurrence of GpIIb/IIIa platelet overexpression in the course of coronary artery disease, an extended use of GpIIb/IIIa inhibitors may be proposed to prevent acute thrombosis during routine coronary stenting.
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Affiliation(s)
- G Amoroso
- Department of Cardiology, Thoraxcenter, University Hospital of Groningen, The Netherlands.
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Balbarini A, Buttitta F, Limbruno U, Petronio AS, Baglini R, Strata G, Mariotti R, Ciccone M, Mariani M. Usefulness of carotid intima-media thickness measurement and peripheral B-mode ultrasound scan in the clinical screening of patients with coronary artery disease. Angiology 2000; 51:269-79. [PMID: 10778996 DOI: 10.1177/000331970005100401] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Abstract
Previous observational studies have shown a relationship between carotid intima-media thickness (IMT) and coronary artery disease (CAD). In this study the authors evaluated the accuracy of the common carotid IMT measurement in predicting the presence and severity of CAD and the additional information offered by the detection of carotid, iliac, and lower limb plaques. One hundred and fifty consecutive patients were subjected to coronary angiography and carotid, iliac, and lower limb ultrasound scan. The mean value of six IMT measurements of the far wall of the common carotid artery was calculated in each patient. The mean IMT was significantly correlated to the number of stenosed coronary vessels (r = 0.43, p<0.001), although the positive and negative predictive value of mean IMT in identifying patients with CAD was low (81% and 46%, respectively). The combined information offered by IMT measurements and peripheral (carotid, iliac, and lower limb) plaque detection was then used to obtain the best multivariate regression model able to predict CAD status. The multivariate model showed a highly significant multiple correlation coefficient (r = 0.60, p<0.0001) and a sharp improvement in the negative predictive value (92%) with respect to the univariable model. B-mode ultrasound scan including common carotid IMT measurement and peripheral plaque detection may be of clinical value in the screening of patients with CAD.
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Affiliation(s)
- A Balbarini
- Cardiac and Thoracic Department, University of Pisa, Italy.
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