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Paolisso P, Gallinoro E, Belmonte M, Bertolone DT, Bermpeis K, De Colle C, Shumkova M, Leone A, Caglioni S, Esposito G, Fabbricatore D, Moya A, Delrue L, Penicka M, De Bruyne B, Barbato E, Bartunek J, Vanderheyden M. Coronary Microvascular Dysfunction in Patients With Heart Failure: Characterization of Patterns in HFrEF Versus HFpEF. Circ Heart Fail 2024; 17:e010805. [PMID: 38108151 DOI: 10.1161/circheartfailure.123.010805] [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: 04/21/2023] [Accepted: 10/18/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is involved in heart failure (HF) onset and progression, independently of HF phenotype and obstructive coronary artery disease. Invasive assessment of CMD might provide insights into phenotyping and prognosis of patients with HF. We aimed to assess absolute coronary flow, absolute microvascular resistance, myocardial perfusion, coronary flow reserve, and microvascular resistance reserve in patients with HF with preserved ejection fraction and HF with reduced ejection fraction (HFrEF). METHODS Single-center, prospective study of 56 consecutive patients with de novo HF with nonobstructive coronary artery disease divided into HF with preserved ejection fraction (n=21) and HFrEF (n=35). CMD was invasively assessed by continuous intracoronary thermodilution and defined as coronary flow reserve <2.5. Left ventricular and left anterior descending artery-related myocardial mass was quantified by echocardiography and coronary computed tomography angiography. Myocardial perfusion (mL/min per g) was calculated as the ratio between absolute coronary flow and left anterior descending artery-related mass. RESULTS Patients with HFrEF showed a higher left ventricular and left anterior descending artery-related myocardial mass compared with HF with preserved ejection fraction (P<0.010). Overall, 52% of the study population had CMD, with a similar prevalence between the 2 groups. In HFrEF, CMD was characterized by lower absolute microvascular resistance and higher absolute coronary flow at rest (functional CMD; P=0.002). CMD was an independent predictor of a lower rate of left ventricular reverse remodeling at follow-up. In patients with HF with preserved ejection fraction, CMD was mainly due to higher absolute microvascular resistance and lower absolute coronary flow during hyperemia (structural CMD; P≤0.030). CONCLUSIONS Continuous intracoronary thermodilution allows the definition and characterization of patterns with distinct CMD in patients with HF and could identify patients with HFrEF with a higher rate of left ventricular reverse remodeling at follow-up.
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Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Cardiology Unit, Galeazzi-Sant'Ambrogio Hospital, Scientific Institute for Research, Hospitalization, and Health Care (IRCCS), Milan, Italy (E.G.)
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Konstantinos Bermpeis
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Monika Shumkova
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Serena Caglioni
- Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Italy (S.C.)
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.)
| | - Ana Moya
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Leen Delrue
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
- Department of Cardiology, Lausanne University Hospital, Switzerland (B.D.B.)
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy (E.B.)
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
| | - Marc Vanderheyden
- Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.)
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Herman R, Demolder A, Vavrik B, Martonak M, Boza V, Kresnakova V, Iring A, Palus T, Bahyl J, Nelis O, Beles M, Fabbricatore D, Perl L, Bartunek J, Hatala R. Validation of an automated artificial intelligence system for 12‑lead ECG interpretation. J Electrocardiol 2024; 82:147-154. [PMID: 38154405 DOI: 10.1016/j.jelectrocard.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The electrocardiogram (ECG) is one of the most accessible and comprehensive diagnostic tools used to assess cardiac patients at the first point of contact. Despite advances in computerized interpretation of the electrocardiogram (CIE), its accuracy remains inferior to physicians. This study evaluated the diagnostic performance of an artificial intelligence (AI)-powered ECG system and compared its performance to current state-of-the-art CIE. METHODS An AI-powered system consisting of 6 deep neural networks (DNN) was trained on standard 12‑lead ECGs to detect 20 essential diagnostic patterns (grouped into 6 categories: rhythm, acute coronary syndrome (ACS), conduction abnormalities, ectopy, chamber enlargement and axis). An independent test set of ECGs with diagnostic consensus of two expert cardiologists was used as a reference standard. AI system performance was compared to current state-of-the-art CIE. The key metrics used to compare performances were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score. RESULTS A total of 932,711 standard 12‑lead ECGs from 173,949 patients were used for AI system development. The independent test set pooled 11,932 annotated ECG labels. In all 6 diagnostic categories, the DNNs achieved high F1 scores: Rhythm 0.957, ACS 0.925, Conduction abnormalities 0.893, Ectopy 0.966, Chamber enlargement 0.972, and Axis 0.897. The diagnostic performance of DNNs surpassed state-of-the-art CIE for the 13 out of 20 essential diagnostic patterns and was non-inferior for the remaining individual diagnoses. CONCLUSIONS Our results demonstrate the AI-powered ECG model's ability to accurately identify electrocardiographic abnormalities from the 12‑lead ECG, highlighting its potential as a clinical tool for healthcare professionals.
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Affiliation(s)
- Robert Herman
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Cardiovascular Centre Aalst, Aalst, Belgium; Powerful Medical, Bratislava, Slovakia.
| | | | | | | | - Vladimir Boza
- Powerful Medical, Bratislava, Slovakia; Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Bratislava, Slovakia
| | - Viera Kresnakova
- Powerful Medical, Bratislava, Slovakia; Department of Cybernetics and Artificial Intelligence, Technical University of Kosice, Kosice, Slovakia
| | | | | | | | | | | | | | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petah Tikvah, Israel
| | | | - Robert Hatala
- Department of Arrhythmia and Pacing, National Institute of Cardiovascular Diseases, Bratislava, Slovakia.
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3
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Bertolone DT, Paolisso P, Gallinoro E, Belmonte M, Bermpeis K, De Colle C, Esposito G, Caglioni S, Fabbricatore D, Leone A, Valeriano C, Shumkova M, Storozhenko T, Viscusi MM, Botti G, Verstreken S, Morisco C, Barbato E, Bartunek J, Vanderheyden M. Innovative Device-Based Strategies for Managing Acute Decompensated Heart Failure. Curr Probl Cardiol 2023; 48:102023. [PMID: 37553060 DOI: 10.1016/j.cpcardiol.2023.102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
Acute decompensated heart failure (ADHF) is a major cause of hospitalizations in older adults, leading to high mortality, morbidity, and healthcare costs. To address the persistent poor outcomes in ADHF, novel device-based approaches targeting specific pathophysiological mechanisms are urgently needed. The recently introduced DRI2P2S classification categorizes these innovative therapies based on their mechanisms. Devices include dilators (increasing venous capacitance), removers (directly removing sodium and water), inotropes (enhancing left ventricular contractility), interstitials (accelerating lymph removal), pushers (increasing renal arterial pressure), pullers (decreasing renal venous pressure), and selective drippers (selective intrarenal drug infusion). Some are tailored for chronic HF, while others focus on the acute setting. Most devices are in early development, necessitating further research to understand mechanisms, assess clinical effectiveness, and ensure safety before routine use in ADHF management. Exploring these innovative device-based strategies may lead to improved outcomes and revolutionize HF treatment in the future.
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Affiliation(s)
- Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy; Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | | | - Cristina De Colle
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | | | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Chiara Valeriano
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | | | | | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Giulia Botti
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples, Naples, Italy
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
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De Colle C, Paolisso P, Gallinoro E, Bertolone DT, Mileva N, Fabbricatore D, Valeriano C, Herman R, Beles M, De Oliveira EK, Mancusi C, Heggermont W, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. Association of Mild-to-Moderate Aortic Regurgitation With Outcomes in Heart Failure With Preserved Ejection Fraction. Mayo Clin Proc 2023; 98:1469-1481. [PMID: 37793725 DOI: 10.1016/j.mayocp.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To assess aortic regurgitation (AR) prevalence, its hemodynamic effect, and long-term prognostic implications in patients admitted with de novo or worsened heart failure with preserved ejection fraction (HFpEF). METHODS Consecutive patients hospitalized with de novo or worsened HFpEF between 2014 and 2020 were enrolled. Patients with more than moderate aortic and/or mitral valve disease were excluded. Based on the presence and degree of AR, patients were divided into those without AR, those with mild, and those with moderate AR. Data on cardiovascular death, heart failure (HF) rehospitalization, and their composite (major adverse cardiovascular events) were collected. RESULTS The final study population consisted of 458 HFpEF patients: 156 (34.1%) with mild-AR, 153 (33.4%) with moderate-AR, and the remaining 149 (32.5%) with no AR. Mild-to-moderate AR patients were older, with larger left atrium-left ventricle (LV) volumes, greater LV mass index, higher filling pressure, and prevalence of diastolic dysfunction compared with the no-AR group (all P<.05). During 5-year follow-up, 113 patients died of cardiovascular causes, 124 patients were rehospitalized for HF, whereas 196 experienced the composite endpoint. Mild-to-moderate AR was identified as an independent predictor of all-cause death (HR, 1.62; 95% CI, 1.14 to 1.58; P=.04) and major adverse cardiovascular event occurrence (HR, 1.48; 95% CI, 1.05 to 2.09; P=.02). A total of 126 (35.5%) of 355 patients showed progression of AR at follow-up echocardiography. CONCLUSION Mild-to-moderate AR is common among patients hospitalized for HFpEF. It is associated with adverse LV remodeling and worse long-term outcomes. These findings warrant further prospective studies addressing the importance of AR in prognostic stratification and exploring therapeutic strategies to mitigate its hemodynamic effect on HF.
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Affiliation(s)
- Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Clinic, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Robert Herman
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Monika Beles
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
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Devgun J, De Potter T, Fabbricatore D, Wang DD. Pre-cath Laboratory Planning for Left Atrial Appendage Occlusion - Optional or Essential? Card Electrophysiol Clin 2023; 15:141-150. [PMID: 37076226 DOI: 10.1016/j.ccep.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
In the wake of rapid advancement in cardiovascular procedural technologies, physician-led preprocedural planning utilizing multi-modality imaging training is increasingly recognized as invaluable for procedural accuracy. Left atrial appendage occlusion (LAAO) is one such procedure in which complications such as device leak, cardiac injury, and device embolization can be decreased substantially with incorporation of physician driven imaging and digital tools. We discuss the benefits of cardiac CT and 3D printing in preprocedural planning for the Heart Team, as well as novel applications by physicians of intraprocedural 3D angiography and dynamic fusion imaging. Furthermore, incorporation of computational modeling and artificial intelligence (AI) may yield promise. For optimal patient-centric procedural success, we advocate for standardized preprocedural imaging planning by physicians within the Heart Team as an essential part of LAAO.
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Affiliation(s)
- Jasneet Devgun
- Division of Cardiology, Henry Ford Health System, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI 48202, USA
| | - Tom De Potter
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Davide Fabbricatore
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI 48202, USA.
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Mileva N, Paolisso P, Gallinoro E, Fabbricatore D, Munhoz D, Bergamaschi L, Belmonte M, Panayotov P, Pizzi C, Barbato E, Penicka M, Andreini D, Vassilev D. Diagnostic and Prognostic Role of Cardiac Magnetic Resonance in MINOCA: Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:376-389. [PMID: 36889851 DOI: 10.1016/j.jcmg.2022.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [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: 07/01/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND Myocardial infarction with nonobstructive coronary arteries (MINOCA) is common in current clinical practice. Cardiac magnetic resonance (CMR) plays an important role in its management and is increasingly recommended by all the current guidelines. However, the prognostic value of CMR in patients with MINOCA is still undetermined. OBJECTIVES The purpose of this study was to determine the diagnostic and prognostic value of CMR in the management of patients with MINOCA. METHODS A systematic review was performed to identify studies reporting the results of CMR findings in patients with MINOCA. Random effects models were used to determine the prevalence of different disease entities: myocarditis, myocardial infarction (MI), or takotsubo syndrome. Pooled odds ratios (ORs) and 95% CIs were calculated to evaluate the prognostic value of CMR diagnosis in the subgroup of studies that reported clinical outcomes. RESULTS A total of 26 studies comprising 3,624 patients were included. The mean age was 54.2 ± 5.3 years, and 56% were men. MINOCA was confirmed in only 22% (95% CI: 0.17-0.26) of the cases and 68% of patients with initial MINOCA were reclassified after the CMR assessment. The pooled prevalence of myocarditis was 31% (95% CI: 0.25-0.39), and takotsubo syndrome 10% (95% CI: 0.06-0.12). In a subgroup analysis of 5 studies (770 patients) that reported clinical outcomes, CMR diagnosis of confirmed MI was associated with an increased risk of major adverse cardiovascular events (pooled OR: 2.40; 95% CI: 1.60-3.59). CONCLUSIONS In patients with MINOCA, CMR has been demonstrated to add an important diagnostic and prognostic value, proving to be crucial for the diagnosis of this condition. Sixty-eight percent of patients with initial MINOCA were reclassified after the CMR evaluation. CMR-confirmed diagnosis of MINOCA was associated with an increased risk of major adverse cardiovascular events at follow-up.
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Affiliation(s)
- Niya Mileva
- Specialized Cardiovascular Hospital "Medica Cor," Ruse, Bulgaria; Medical University of Sofia, Sofia, Bulgaria.
| | - Pasquale Paolisso
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy; Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy
| | - Emanuele Gallinoro
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Davide Fabbricatore
- Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Daniel Munhoz
- Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Clinical Medicine, Discipline of Cardiology, University of Campinas UNICAMP, Campinas, Brazil
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marta Belmonte
- Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy
| | - Martin Penicka
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Daniele Andreini
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Dobrin Vassilev
- Specialized Cardiovascular Hospital "Medica Cor," Ruse, Bulgaria; University of Ruse "Angel Kanchev," Ruse, Bulgaria
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Pascale R, Toschi A, Aslan AT, Massaro G, Maccaro A, Fabbricatore D, Dell'Aquila A, Ripa M, Işık ME, Kızmaz YU, Iacopino S, Camici M, Perna F, Akinosoglou K, Karruli A, Papadimitriou-Olivgeris M, Kayaaslan B, Bilir YA, Evren Özcan E, Turan OE, Işık MC, Pérez-Rodríguez MT, Yagüe BL, Quirós AM, Yılmaz M, Petersdorf S, De Potter T, Durante-Mangoni E, Akova M, Curnis A, Gibertoni D, Diemberger I, Scudeller L, Viale P, Giannella M. Risk factors for Gram-negative bacterial infection of cardiovascular implantable electronic devices: multicentre observational study (CarDINe Study). Int J Antimicrob Agents 2023; 61:106734. [PMID: 36690123 DOI: 10.1016/j.ijantimicag.2023.106734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Infections of cardiovascular implantable electronic devices (CIED) are mainly due to Gram-positive bacteria (GPB). Data about Gram-negative bacteria CIED (GNB-CIED) infections are limited. This study aimed to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED. METHODS A multicentre, international, retrospective, case-control-control study was performed on patients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected. RESULTS A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infection and 118 without infection. No between-group differences were found regarding clinical presentation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infection were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implantation (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067). CONCLUSIONS Obesity, high number of comorbidities and right subclavian vein implantation site were associated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome observed in this group.
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Affiliation(s)
- Renato Pascale
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Alice Toschi
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Abdullah Tarik Aslan
- Golhisar State Hospital, Department of Internal Medicine, Burdur, Turkey; Hacettepe University School of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Giulia Massaro
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Maccaro
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Fabbricatore
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Andrea Dell'Aquila
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili Hospital of Brescia and University of Brescia, Brescia, Italy
| | - Marco Ripa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mehmet Emirhan Işık
- University of Health Sciences Kosuyolu Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Yeşim Uygun Kızmaz
- University of Health Sciences Kosuyolu Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | | | - Marta Camici
- Institute of infectious diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; HIV/AIDS Clinical Unit, National Institute for infectious Diseases L. Spallanzani IRCCS, Rome, Italy
| | - Francesco Perna
- Cardiac Arrhythmia Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Arta Karruli
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | | | - Bircan Kayaaslan
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Yeşim Aybar Bilir
- Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara City Hospital, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Emin Evren Özcan
- Dokuz Eylul University, Heart Rhythm Management Center, İzmir, Turkey
| | | | - Muhammed Cihan Işık
- Hacettepe University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain Instituto de Investigación Biomédica Galicia Sur, Spain
| | - Belén Loeches Yagüe
- Infectious Diseases Unit, Hospital Universitario La Paz - IDIPAZ, Madrid, Spain
| | | | - Mesut Yılmaz
- Istanbul Medipol University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Sabine Petersdorf
- Institute of Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal, Witten/Herdecke University, Witten, Germany
| | - Tom De Potter
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Murat Akova
- Hacettepe University School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Antonio Curnis
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili Hospital of Brescia and University of Brescia, Brescia, Italy
| | - Dino Gibertoni
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy; Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigia Scudeller
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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8
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Fabbricatore D, Buytaert D, Valeriano C, Mileva N, Paolisso P, Nagumo S, Munhoz D, Collet C, De Potter T. Ambulatory pulmonary vein isolation workflow using the Perclose ProglideTM suture-mediated vascular closure device: the PRO-PVI study. Europace 2023; 25:1361-1368. [PMID: 36793243 PMCID: PMC10105833 DOI: 10.1093/europace/euad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/11/2023] [Indexed: 02/17/2023] Open
Abstract
AIMS The leading reason for delayed discharge after pulmonary vein isolation (PVI) is vascular complications. This study aimed to evaluate feasibility, safety, and efficacy of the Perclose Proglide™ suture-mediated vascular closure in ambulatory PVI, report complications, patient satisfaction, and cost of this approach. METHODS AND RESULTS Patients scheduled for PVI were enrolled prospectively in an observational design. Feasibility was assessed as % discharged the day of procedure. Efficacy was analysed as acute access site closure rate, time to reach haemostasis, time to ambulate, and time to discharge. Safety analysis consisted of vascular complications at 30 days. Cost analysis was reported using direct and indirect cost analysis. A 1:1 propensity matched control cohort was used for comparing time to discharge to usual workflow. Of 50 enrolled patients, 96% were discharged on the same day. 100% of devices were successfully deployed. Immediate (<1 min) haemostasis was reached in 30 patients (62.5%). Mean time to discharge was 5:48 ± 1:03 h (vs. 10:16 ± 1:21 h in the matched cohort, P < 0.0001). Patients reported high level of satisfaction with the post-operative time. No major vascular complication occurred. Cost analysis showed a neutral impact compared to the standard of care. CONCLUSION The use of the closure device for femoral venous access after PVI led to safe discharge of patients within 6 h from the intervention in 96% of the population. This approach could minimize the overcrowding of healthcare facilities. The gain in post-operative recovery time improved patients' satisfaction and balanced the economic cost of the device.
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Affiliation(s)
- Davide Fabbricatore
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, corso Umberto I, 40, 80138 Napoli NA, Italy
| | - Dimitri Buytaert
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Chiara Valeriano
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, corso Umberto I, 40, 80138 Napoli NA, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, corso Umberto I, 40, 80138 Napoli NA, Italy
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Cardiology, Showa University Fujigaoka Hospital, 1 Chome-30 Fujigaoka, Aoba Ward, Yokohama, Kanagawa 227-0043, Japan
| | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, corso Umberto I, 40, 80138 Napoli NA, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Tom De Potter
- Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
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9
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Fabbricatore D, Valeriano C, Gallinoro E, Paolisso P, De Schouwer K, De Potter T. 1045 COMPARISON OF CEPHALIC VEIN VERSUS SUBCLAVIAN APPROACH FOR LEFT BUNDLE BRANCH PACING: A SINGLE CENTRE EXPERIENCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
left bundle branch area pacing (LBBAP) is a recently introduced pacing method and has been described suggesting the subclavian venous puncture as the preferred approach.
Aim
This is the first study comparing the cephalic access to the “classical” subclavian approach for the implantation of LBBAP.
Methods
Retrospective study evaluating all consecutive patients undergoing LBBAP at the cardiovascular research Centre of Aalst in Belgium from October 2020 to February 2022. LBBAP was performed either using cephalic or subclavian approach at the operator's discretion and for one of lead or both in case of multiple leads. In both cases, dedicated delivery sheaths were used for the implantation of the ventricular lead in the left bundle branch area. Implant success, complications, procedural and pacing characteristics were analyzed at implant.
Results
81 patients were enrolled (age 78.20±11.47), 44 (54%) of which in the cephalic groups. LBBAP was successful at first attempt in 97% of the population, without significant differences between groups (P=0.886); dislocation of leads after the slitting occurred in 5 (11,4%) and 3 (8,1%) patients (P=0,625). Procedural and X-ray times were not significantly different in the two groups. Pacing parameters were normal at the end of the procedure in both groups.
Conclusion
This is the first study comparing safety and feasibility of LBBAP of a cephalic versus the subclavian one. Procedural success and times were not affected from the choice of cephalic instead than subclavian access. Periprocedural dislocation rates did not differ between groups.
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Affiliation(s)
- Davide Fabbricatore
- Università Degli Studi Di Napoli Federico Ii
- Cardiovascular Research Centre Olv - Aalst (Belgio)
| | | | | | - Pasquale Paolisso
- Università Degli Studi Di Napoli Federico Ii
- Cardiovascular Research Centre Olv - Aalst (Belgio)
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10
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Valeriano C, Fabbricatore D, Buytaert D, De Potter T. 764 CARDIONEUROABLATION OF VAGALLY MEDIATED BRADYARRHYTHMIA: A SINGLE-CENTER EXPERIENCE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Cardioneuroablation (CNA) is a novel catheter-ablation technique for the treatment of vagally-mediated bradyarrhythmia including vaso-vagal syncope (VVS), functional atrioventricular block (AVB) and sinus node dysfunction (SND). CNA aims to blunt the cardioinhibitory reflex by eliminating postganglionic parasympathetic neurons in the atrial wall and ganglionated plexi (GPs). Early-phase studies have shown promising results, but clinical evidence remains limited.
Purpose
We present our single-center experience with CNA in the setting of VVS, symptomatic functional AVB, and SND.
Methods
Baseline and procedural characteristics, procedure-related complications, and clinical outcomes were collected in patients who underwent CNA from December 2018 to July 2022. The procedural workflow included an electroanatomic mapping-guided ablation strategy, which combines the bi-atrial 3D mapping with endocardial atrial bipolar electrograms (EGM), specifically targeting high-amplitude fractionated EGM.
Results
A total of 14 CNA procedures were performed in our center. Ablation indication was mainly VVS (57%), followed by AVB (29%) and SND (14%). Syncope was the most common symptom in our cohort (71%, burden of 7 per person-lifetime). Patients were young (43±16 years) and without structural heart disease (LVEF 58±4 ml, LAD 31±7 mm). Procedures were performed under general anesthesia, mean procedure time was 102±42 min, with minimal fluoroscopy dose (2.7±1.8 Gy/cm2). We observed 1 instance of post-ablation pericarditis and 2 sinus tachycardia which required medical treatment; no major adverse events occurred. Heart rate increased after ablation in all the patients, with a mean RR interval shortening of 28% and no further increase after atropine administration. Two patients had a recurrence at a median follow-up of 251 days (IQR: 118-536), both cases were syncopal events without documentation at loop-recorder of sinus bradycardia or atrial bradyarrhythmia.
Conclusions
CNA may be an alternative to pacemaker implantation in young, highly symptomatic patients, refractory to conventional therapies and without structural heart disease. Ablation is reasonably safe in experts’ hands, especially if compared with the long-life risk of device-related complications. Further large-scale randomized studies are needed to support these findings.
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Affiliation(s)
- Chiara Valeriano
- Cardiovascular Center, Olv Hospital , Aalst (Be)
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples (It)
| | - Davide Fabbricatore
- Cardiovascular Center, Olv Hospital , Aalst (Be)
- Department Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples (It)
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11
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Gallinoro E, Paolisso P, Bertolone DT, Bermpeis K, Fernandez-peregrina E, Esposito G, Belmonte M, Vanderheyden M, Fabbricatore D, Sonck J, Barbato E, Collet C, De Bruyne B. 851 REPEATABILITY OF BOLUS AND CONTINUOUS THERMODILUTION FOR ASSESSING CORONARY MICROVASCULAR FUNCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
The bolus thermodilution-derived index of microcirculatory resistance (IMR) has emerged over years as the standard of reference to invasively define coronary microvascular dysfunction (CMD). However, the technique still presents some limitations, mainly related to the fact that manual injection of saline bolus accounts for some variance in the measurements. Continuous intracoronary thermodilution has been recently introduced as a tool to directly quantify absolute coronary flow and microvascular resistance both at rest and during hyperemia and has shown to be safe and operator independent. Microvascular resistance reserve (MRR), derived from continuous thermodilution, has been validated as novel index specific for microcirculation and independent from myocardial mass.
Purpose
To compare head-to-head the intra-observer repeatability of bolus and continuous thermodilution for assessing microvascular function.
Methods
Patients undergoing coronary angiography in the absence of obstructive coronary artery disease were prospectively enrolled. Bolus and continuous intracoronary thermodilution measurements were performed in duplicates in the left anterior descending artery (LAD). Patients were randomly assigned in a 1:1 ratio to undergo first bolus thermodilution or first continuous thermodilution assessment.
Results
A total of 102 patients were enrolled. Average FFR was 0.86±0.06. Coronary Flow Reserve (CFR) calculated with continuous thermodilution (CFRthermo) was significantly lower than bolus thermodilution-derived CFR (CFRbolus) (2.63±0.65 and 3.29±1.17, respectively, p<0.001). CFRthermo showed a lower variability and a higher agreement than CFRbolus (variability 12.74 ± 10.41% vs 31.26±24.85%, respectively, p<0.001; ICC= 0.78 (0.70-0.85) and 0.48 (0.32-0.62), respectively, p<0.001, Figure 1). Both MRR and IMR showed a good agreement (ICC 0.81 (0.74-0.87) and 0.80 (0.71-0.86)) but the variability of the MRR was significantly lower (12.44 ± 10.06% vs 24.24±19.27, respectively, p<0.001, figure 1). Reproducibility data of all indices derived from duplicated measurements of bolus and continuous thermodilution are reported in Figure 2.
Conclusion
Continuous intracoronary thermodilution has a higher repeatability than bolus thermodilution in the assessment of CMD.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
- Irccs Galeazzi Sant’ambrogio - Università Degli Studi Di Milano
- Dipartimento Di Scienze Mediche Traslazionali, Università Degli Studi Della Campania ”L.Vanvitelli”
| | | | | | | | | | | | - Marta Belmonte
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | | | - Carlos Collet
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
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12
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Gallinoro E, Paolisso P, Vanderheyden M, Esposito G, Bertolone DT, Belmonte M, Bermpeis K, Fabbricatore D, De Colle C, Candreva A, Penicka M, Collet C, Sonck J, De Bruyne B, Barbato E. 840 ASSESSMENT OF ABSOLUTE CORONARY FLOW AND MICROVASCULAR RESISTANCE RESERVE IN PATIENTS WITH AORTIC STENOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction
The development of left ventricular hypertrophy in patients with severe aortic stenosis (AS) is accompanied by adaptive coronary flow regulation, both in epicardial and microvascular compartment, which ultimately lead to a chronic ischemic insult even in the absence of obstructive coronary artery disease. Intracoronary continuous thermodilution of saline through a dedicated infusion catheter (RayFlow ®) is a novel tool that allows to measure absolute coronary flow and microvascular resistance at rest and during hyperemia and to calculate both coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR)
Purpose
We aimed to assess absolute coronary flow, microvascular resistance, CFR and MRR in patients with AS, assessed by continuous intracoronary thermodilution, comparing these hemodynamic findings with a propensity-score matched contemporary cohort of patients without AS.
Methods
Absolute coronary blood flow and microvascular resistance were measured by continuous thermodilution in 29 patients with AS and compared to 15 controls matched for age, gender, diabetes mellitus and functional severity of epicardial coronary lesions. Myocardial work, total myocardial mass and LAD-specific mass were quantified by echocardiography and cardiac-CT.
Results
Patients with AS presented a significantly positive LV remodeling with lower global longitudinal strain and higher global work index compared to controls (p<0.02). Total LV myocardial mass and LAD-specific myocardial mass were significantly higher in patients with AS. Compared to matched controls, absolute resting flow in the LAD was significantly higher in the AS cohort (86 [66–107] ml/min vs 68 [52–75] ml/min, p=0.036), resulting, in lower CFR (2.30 ± 0.69 vs 2.89 ± 0.77, p=0.005) and MRR (2.73 ± 0.74 vs 3.53 ± 0.95, p=0.005) in the AS cohort compared to controls (Figure 1). No differences were found in hyperemic flow and resting and hyperemic resistances. Interestingly, hyperemic myocardial perfusion (calculated as the ratio between the absolute coronary flow subtended to the LAD and expressed in mL/min/g), but not resting, was significantly lower in the AS group (1.9 [1.5–2.5] ml/min/g vs 2.3 [2–3.1] ml/min/g p=0.036).
Conclusions
In patients with severe aortic stenosis and non-obstructive coronary artery disease, with the progression of LVH, the compensatory mechanism of increased resting flow maintains an adequate perfusion at rest, but not during hyperemia (Figure 2). As consequence, both CFR and MRR are significantly impaired.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
- Irccs Galeazzi Sant’ambrogio - Universita’ Degli Studi Di Milano
- Dipartimento Di Scienze Mediche Traslazionali, Università Della Campania ”L.Vanvitelli” , Napoli, IT
| | | | | | | | | | - Marta Belmonte
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | | | | | | | | | - Martin Penicka
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, Olv Clinic , Aalst , Belgium
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13
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De Colle C, Paolisso P, Gallinoro E, Bertolone D, Mileva N, Fabbricatore D, Valeriano C, Mancusi C, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. 268 IMPACT OF AORTIC REGURGITATION ON LONG TERM OUTCOME IN HEART FAILURE AND PRESERVED EJECTION FRACTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Aortic Regurgitation (AR) may aggravate the clinical course in patients with heart failure and preserved ejection fraction (HFpEF) by increasing filling pressures and triggering LV remodelling.
Objective
To assess AR's prevalence and long-term prognostic implications in patients with HFpEF.
Methods
The study population consisted of 458 consecutive patients (age 77.5 ± 9.2 y, 57.9% females) hospitalized with de novo or worsened HFpEF. Patients with more than moderate aortic and/or mitral valve disease were excluded. Data on cardiovascular death, HF re-hospitalization and their composite (MACE) were collected.
Results
Out of 309 (67.5%) patients with any AR, 156 (34.0%) and 153 (33.5%) had mild-AR and moderate-AR, respectively. The remaining 149 (32.5%) individuals had no-AR. Patients with versus without AR were significantly older with larger LV and LA volumes and a higher prevalence of diastolic dysfunction (all p < 0.05). During a median follow-up of 33 ± 25 months, a total of 114 patients (24.9%) died from cardiovascular causes, 126 patients (27.5%) were re-hospitalized for HF, while 272 (59.4%) had the composite endpoint (MACE). In multivariable Cox regression analysis, any AR emerged as an only independent predictor of MACE (HR=1.90, 95%CI 1.26–2.87, p=0.002). Mild-AR and Moderate AR increased the risk of MACE by 77% and 92%, respectively, compared to the No-AR.
Conclusions
In patients with HFpEF, mild-to-moderate AR is highly prevalent, and it seems to identify individuals with worse long-term outcomes. This suggests that even mild AR should be considered a high-risk prognostic marker in patients with HFpEF.
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Affiliation(s)
- Cristina De Colle
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Pasquale Paolisso
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | - Dario Bertolone
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Niya Mileva
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
| | - Davide Fabbricatore
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | - Costantino Mancusi
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | | | | | - Nicola De Luca
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
| | - Guy Van Camp
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
| | - Emanuele Barbato
- Cardiovascular Center, Olv Clinic , Aalst , Belgium
- Dept. Of Advanced Biomedical Sciences, University Of Naples Federico Ii , Naples , Italy
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14
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Fabbricatore D, Gallinoro E, Paolisso P, Valeriano C, Potter TD. 1049 PREVALENCE OF ATRIAL FIBRILLATION AND FEASIBILITY OF PULMONARY VEIN ISOLATION AFTER PATENT FORAMEN OVALE CLOSURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Data about prevalence and the risk of atrial fibrillation, stroke, and need for pulmonary vein isolation (PVI) after device closure of a patent foramen ovale (PFO) are still lacking.
We aim to investigate the prevalence and the risk of atrial fibrillation after PFO closure and the feasibility of PVI in a PFO closure cohort compared to contemporary PVI without PFO closure.
Methods
retrospective observational study of consecutive patients undergoing PFO closure enrolled from February 2013 to September 2020. Patients were divided into 3 groups: i) patients without AF before and after the procedure (n=132), ii) patients with paroxysmal AF prior to the procedure (n=21), iii) patients with documented AF after the procedure (n=13). All patients with AF occurrence were treated with adequate anticoagulation therapy according to the current ESC Guidelines. We compared the procedural data of these patients to a matched contemporary cohort without previous PFO closure undergoing PVI in our center. AF and stroke prevalence and PVI feasibility after PFO closure were assessed at follow up.
Results
one-hundred and sixty-six consecutive PFO closure patients were enrolled; the mean age was 54 ± 13 years. Median follow-up was 3.5 + 2.5 years. During the study period, 21 patients had AF before or after the PFO closure (group 2) and 13 (7.8%) new onset AF (group 3). Stroke after the PFO closure occurred in 8 patients (4.8%), of which 4 in the group with new onset AF (30% of the group 3).
Among the 34 patients with AF, 10 patients (6%) underwent a PVI. Compared to a contemporary matched PVI cohort, total procedural times and fluoroscopy times were significantly higher in the patients with previous PFO closure (108±15 vs 75±29, p=0.002 and 3±1.5 vs 8±7, p<0.001). Similar rate of AF relapses (p=0.198) was observed between the two groups, with a trend for higher rate of complication (pericardial effusion) for the cohort with previous PFO closure (p=0.06).
Conclusion
This study shows that a more accurate screening and treatment of AF is needed in patients with cryptogenic stroke despite the presence of a PFO, possibly a bystander. In our study, 30% of patients with new onset AF after PFO closure, experienced a further stroke after the procedure. In case of AF, the indication for PVI should be considered prior to the PFO closure since it turns out to be more difficult in terms of procedural and fluoroscopy times and risks of complications after PFO closure.
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Affiliation(s)
- Davide Fabbricatore
- Università Degli Studi Di Napoli Federico Ii
- Cardiovascular Research Centre Olv - Aalst ( Belgium )
| | | | - Pasquale Paolisso
- Università Degli Studi Di Napoli Federico Ii
- Cardiovascular Research Centre Olv - Aalst ( Belgium )
| | | | - Tom De Potter
- Cardiovascular Research Centre Olv - Aalst ( Belgium )
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15
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Paolisso P, Gallinoro E, Vanderheyden M, Esposito G, Bertolone DT, Belmonte M, Mileva N, Bermpeis K, De Colle C, Fabbricatore D, Candreva A, Munhoz D, Degrieck I, Casselman F, Penicka M, Collet C, Sonck J, Mangiacapra F, de Bruyne B, Barbato E. Absolute coronary flow and microvascular resistance reserve in patients with severe aortic stenosis. Heart 2022; 109:47-54. [PMID: 35977812 DOI: 10.1136/heartjnl-2022-321348] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Development of left ventricle (LV) hypertrophy in aortic stenosis (AS) is accompanied by adaptive coronary flow regulation. We aimed to assess absolute coronary flow, microvascular resistance, coronary flow reverse (CFR) and microvascular resistance reserve (MRR) in patients with and without AS. METHODS Absolute coronary flow and microvascular resistance were measured by continuous thermodilution in 29 patients with AS and 29 controls, without AS, matched for age, gender, diabetes and functional severity of epicardial coronary lesions. Myocardial work, total myocardial mass and left anterior descending artery (LAD)-specific mass were quantified by echocardiography and cardiac-CT. RESULTS Patients with AS presented a significantly positive LV remodelling with lower global longitudinal strain and global work efficacy compared with controls. Total LV myocardial mass and LAD-specific myocardial mass were significantly higher in patients with AS (p=0.001). Compared with matched controls, absolute resting flow in the LAD was significantly higher in the AS cohort (p=0.009), resulting into lower CFR and MRR in the AS cohort compared with controls (p<0.005 for both). No differences were found in hyperaemic flow and resting and hyperaemic resistances. Hyperaemic myocardial perfusion (calculated as the ratio between the absolute coronary flow subtended to the LAD, expressed in mL/min/g), but not resting, was significantly lower in the AS group (p=0.035). CONCLUSIONS In patients with severe AS and non-obstructive coronary artery disease, with the progression of LV hypertrophy, the compensatory mechanism of increased resting flow maintains adequate perfusion at rest, but not during hyperaemia. As a consequence, both CFR and MRR are significantly impaired.
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Affiliation(s)
- Pasquale Paolisso
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | | | - Giuseppe Esposito
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Dario Tino Bertolone
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Marta Belmonte
- Hartcentrum OLV Aalst, Aalst, Belgium.,Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Lombardia, Italy
| | | | | | - Cristina De Colle
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Davide Fabbricatore
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | | | - Daniel Munhoz
- Hartcentrum OLV Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
| | - Ivan Degrieck
- Cardiovascular and Thoracic Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Filip Casselman
- Cardiovascular and Thoracic Surgery, Hartcentrum OLV Aalst, Aalst, Belgium
| | - Martin Penicka
- Cardiology, Hartcentrum OLV Aalst, Aalst, Flanderen, Belgium
| | | | | | | | | | - Emanuele Barbato
- Hartcentrum OLV Aalst, Aalst, Belgium .,Department of Advanced Biomedical Sciences, Federico II University Hospital, Napoli, Campania, Italy
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16
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De Colle C, Paolisso P, Gallinoro E, Bertolone DT, Mileva N, Fabbricatore D, Valeriano C, Mancusi C, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. Impact of aortic regurgitation on long-term outcomes in heart failure with preserved ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic Regurgitation (AR) may aggravate the clinical course in patients with heart failure and preserved ejection fraction (HFpEF) by increasing filling pressures and triggering LV remodelling.
Objective
To assess AR's prevalence and long-term prognostic implications in patients with HFpEF.
Methods
The study population consisted of 458 consecutive patients (age 77.5±9.2 y, 57.9% females) hospitalized with de novo or worsened HFpEF. Patients with more than moderate aortic and/or mitral valve disease were excluded. Data on cardiovascular death, HF re-hospitalization and their composite (MACE) were collected.
Results
Out of 309 (67.5%) patients with any AR, 156 (34.0%) and 153 (33.5%) had mild-AR and moderate-AR, respectively. The remaining 149 (32.5%) individuals had no-AR. Patients with versus without AR were significantly older with larger LV and LA volumes and a higher prevalence of diastolic dysfunction (all p<0.05). During a median follow-up of 33±25 months, a total of 114 patients (24.9%) died from cardiovascular causes, 126 patients (27.5%) were re-hospitalized for HF, while 272 (59.4%) had the composite endpoint (MACE). In multivariable Cox regression analysis, any AR emerged as an only independent predictor of MACE (HR=1.90, 95% CI 1.26–2.87, p=0.002). Mild-AR and Moderate AR increased the risk of MACE by 77% and 92%, respectively, compared to the No-AR (Figure).
Conclusions
In patients with HFpEF, mild-to-moderate AR is highly prevalent, and it seems to identify individuals with worse long-term outcomes. This suggests that even mild AR should be considered a high-risk prognostic marker in patients with HFpEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C De Colle
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - P Paolisso
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Gallinoro
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - D T Bertolone
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - N Mileva
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - C Valeriano
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - C Mancusi
- Federico II University Hospital , Naples , Italy
| | - C Collet
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - N De Luca
- Federico II University Hospital , Naples , Italy
| | - G Van Camp
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Barbato
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - J Bartunek
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Penicka
- Cardiovascular Research Center Aalst , Aalst , Belgium
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17
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Fabbricatore D, Paolisso PP, Gallinoro EG, De Colle CDC, Valeriano CV, De Schouwer KDS, Geelen PG, Barbato EB, De Potter TDP. Prevalence of atrial fibrillation and feasibility of pulmonary vein isolation after patent foramen ovale closure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data about prevalence and the risk of atrial fibrillation, stroke, and need for pulmonary vein isolation (PVI) after device closure of a patent foramen ovale (PFO) are still lacking.
We aim to investigate the prevalence and the risk of atrial fibrillation after PFO closure and the feasibility of PVI in a PFO closure cohort compared to contemporary PVI without PFO closure.
Methods
Retrospective observational study of consecutive patients undergoing PFO closure enrolled from February 2013 to September 2020. Patients were divided into 3 groups: i) patients without AF before and after the procedure (n=132), ii) patients with paroxysmal AF prior to the procedure (n=21), iii) patients with documented AF after the procedure (n=13). All patients with AF occurrence were treated with adequate anticoagulation therapy according to the current ESC Guidelines. We compared the procedural data of these patients to a matched contemporary cohort without previous PFO closure undergoing PVI in our center. AF and stroke prevalence and PVI feasibility after PFO closure were assessed at follow up.
Results
One-hundred and sixty-six consecutive PFO closure patients were enrolled; the mean age was 54±13 years. Median follow-up was 3.5±2.5 years. During the study period, 21 patients had AF before or after the PFO closure (group 2) and 13 (7.8%) new onset AF (group 3). Stroke after the PFO closure occurred in 8 patients (4.8%), of which 4 in the group with new onset AF (30% of the group 3).
Among the 34 patients with AF, 10 patients (6%) underwent a PVI. Compared to a contemporary matched PVI cohort, total procedural times and fluoroscopy times were significantly higher in the patients with previous PFO closure (108±15 vs 75±29, p=0.002 and 3±1.5 vs 8±7, p<0.001). Similar rate of AF relapses (p=0.198) was observed between the two groups, with a trend for higher rate of complication (pericardial effusion) for the cohort with previous PFO closure (p=0.06).
Conclusion
This study shows that a more accurate screening and treatment of AF is needed in patients with cryptogenic stroke despite the presence of a PFO, possibly a bystander. In our study, 30% of patients with new onset AF after PFO closure, experienced a further stroke after the procedure. In case of AF, the indication for PVI should be considered prior to the PFO closure since it turns out to be more difficult in terms of procedural and fluoroscopy times and risks of complications after PFO closure.
Funding Acknowledgement
Type of funding sources: Public Institution(s).
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18
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Paolisso P, Gallinoro E, Belmonte M, Bertolone DT, Bermpeis K, Esposito G, Seki R, Fabbricatore D, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. Microvascular dysfunction in patients with diabetes mellitus: assessment of absolute coronary flow and microvascular resistance reserve. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (CMD) is an early feature of diabetic cardiomyopathy, which usually precedes the onset of systolic and diastolic dysfunction (DDF). Continuous intracoronary thermodilution allows an accurate and reproducible assessment of absolute coronary blood flow and microvascular resistance thus allowing the evaluation of coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR), a novel index specific for microvascular function, which is independent from the myocardial mass. In the present study we compared absolute coronary flow and resistance, CFR and MRR assessed by continuous intracoronary thermodilution in diabetic versus non-diabetic patients. Left atrial reservoir strain (LASr), an early marker of DDF was compared between the two groups.
Methods
In this observational retrospective study, 108 patients with suspected angina and non-obstructive coronary artery disease (NOCAD) consecutively undergoing elective coronary angiography (CAG) from September 2018 to June 2021 were enrolled. The invasive functional assessment of microvascular function was performed in the left anterior descending artery (LAD) with intracoronary continuous thermodilution. Patients were classified according to the presence of DM. Absolute resting and hyperemic coronary flow (in mL/min) and resistance (in WU) were compared between the two cohorts. FFR was measured to assess coronary epicardial lesions, while CFR and MRR were calculated to assess microvascular function. LAS, assessed by speckle tracking echocardiography, was used to detect early myocardial structural changes potentially associated with microvascular dysfunction.
Results
The median FFR value was 0.83 [0.79–0.87] without any significant difference between the two groups. Absolute resting and hyperemic flow in the left anterior descending coronary were similar between diabetic and non-diabetic patients. Similarly, resting and hyperemic resistances did not change significantly between the two groups. In the DM cohort the CFR and MRR were significantly lower compared to the control group (CFR=2.4±0.6 and 2.9±0.8; MRR=2.8±0.9 and 3.5±1 for diabetic and non-diabetic patients respectively, [p<0.05 for both], Figure 1 and 2). Likewise, diabetic patients had a significantly lower reservoir, contractile and conductive LAS (all p<0.05).
Conclusions
Compared with non-diabetic patients, CFR and MRR were lower in patients with DM and non-obstructive epicardial coronary arteries, while both resting and hyperemic coronary flow and resistance were similar. LASr was lower in diabetic patients, confirming the presence of a subclinical DDF associated to the microcirculatory impairment. Continuous intracoronary thermodilution-derived indexes provide a reliable and operator-independent assessment of coronary macro- and microvasculature and might potentially facilitate widespread clinical adoption of invasive physiologic assessment of suspected microvascular disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Paolisso
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Gallinoro
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - M Belmonte
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - D T Bertolone
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - K Bermpeis
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - G Esposito
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - R Seki
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - J Bartunek
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | | | - E Wyffels
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - J Sonck
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - C Collet
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - B De Bruyne
- Cardiovascular Research Center Aalst , Aalst , Belgium
| | - E Barbato
- Cardiovascular Research Center Aalst , Aalst , Belgium
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19
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Gallinoro E, Paolisso P, Di Gioia G, Bermpeis K, Fernandez-Peregrina E, Candreva A, Esposito G, Fabbricatore D, Bertolone DT, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. Deferral of Coronary Revascularization in Patients With Reduced Ejection Fraction Based on Physiological Assessment: Impact on Long-Term Survival. J Am Heart Assoc 2022; 11:e026656. [PMID: 36129045 DOI: 10.1161/jaha.122.026656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Deferring revascularization in patients with nonsignificant stenoses based on fractional flow reserve (FFR) is associated with favorable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction is unclear. We aimed to investigate whether FFR provides adjunctive clinical benefit compared with coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced left ventricular ejection fraction. Methods and Results Consecutive patients with reduced left ventricular ejection fraction (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We included patients with at least 1 intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR guided) or angiography alone (angiography guided). The primary end point was the cumulative incidence of all-cause death at 10 years. The secondary end point (incidence of major adverse cardiovascular and cerebrovascular events) was a composite of all-cause death, myocardial infarction, any revascularization, and stroke. A total of 840 patients were included (206 in the FFR-guided group and 634 in the angiography-guided group). Median follow-up was 7 years (interquartile range, 3.22-11.08 years). After 1:1 propensity-score matching, baseline characteristics between the 2 groups were similar. All-cause death was significantly lower in the FFR-guided group compared with the angiography-guided group (94 [45.6%] versus 119 [57.8%]; hazard ratio [HR], 0.65 [95% CI, 0.49-0.85]; P<0.01). The rate of major adverse cardiovascular and cerebrovascular events was lower in the FFR-guided group (123 [59.7%] versus 139 [67.5%]; HR, 0.75 [95% CI, 0.59-0.95]; P=0.02). Conclusions In patients with reduced left ventricular ejection fraction, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and major adverse cardiovascular and cerebrovascular events at 10 years.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Translational Medical Sciences University of Campania "Luigi Vanvitelli" Naples Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Giuseppe Di Gioia
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | | | | | - Alessandro Candreva
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Cardiology Zurich University Hospital Zurich Switzerland.,PoliToBIO Med Lab Department of Mechanical and Aerospace Engineering Politecnico di Torino Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Davide Fabbricatore
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Marc Vanderheyden
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Cardiology Lausanne University Hospital Lausanne Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst Onze Lieve Vrouwziekenhuis Hospital Aalst Belgium.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
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20
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Bermpeis K, Esposito G, Gallinoro E, Paolisso P, Bertolone DT, Fabbricatore D, Mileva N, Munhoz D, Wyfels E, Sonck J, Collet C, Barbato E, De Bruyne B, Bartunek J, Vanderheyden M. TCT-346 Safety of Right and Left Ventricular Endomyocardial Biopsy in Heart Transplant and Cardiomyopathy Patients. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.406] [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: 10/14/2022]
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21
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Pascale R, Abdullah TA, Fabbricatore D, De Potter T, Ripa M, Durante-Mangoni E, Leventopulos G, Domenichini G, Iacopino S, Akova M, Diemberger I, Viale P, Giannella M. Risk factors for gram-negative infection of cardiovascular implantable electronic devices: retrospective multicenter study - CarDINe study. Europace 2022. [DOI: 10.1093/europace/euac053.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Dr. Fabbricatore is supported by a research grant from the CardioPaTh PhD Program
Background
Gram-negative bacteria (GNB) are unfrequently isolated from patients with cardiac implantable electronic device (CIED) infection. However, data about risk factors for GNB-CIED-infection and associated clinical outcome are missing.
Methods
Multicenter, retrospective case-control-control study. Adult patients undergoing CIED implantation from Jan 2015 to Dec 2019 were included and classified as case (C) if diagnosed of GNB-CIED-infection; control 1 (C1) if diagnosed with Gram positive bacteria (GPB)-CIED infection; and control 2 (C2) if no CIED-infection was diagnosed during the study period. Patients were matched by center and risk period (from CIED implantation to infection diagnosis ±1 month), with a minimum follow-up period after infection diagnosis of 180 days.
Results
Study cohort consisted of 134 patients (33 C, 53 C1 and 42 C2) from 11 centers. Overall, 99 (73.9%) were male, median age 73 (IQR 66-81) years. Cardiac diseases leading to CIED implantation were bradi-arrythmia (48%), hearth failure (23.5), and primary prevention (20.6%). There were not differences for demographic variables and Charlson Index between C, C1 and C2. Time from implantation to infection diagnosis was similar between C and C1 [274 (39-621) vs 220 (58-866) days, p=0.581]. Shariff score was lower in C compared with C1 [1(1-2) vs 2 (1-3); p<0.001]. C reported more frequently than C1 a prior infection (not CIED related) (33% vs 16%, p=0.08). GN and GP causative agents of CIED-infection are depicted in Fig.1. No differences regarding CIED-infection type (pocket site, endocarditis) were observed between C and C1. Interestingly, PET-FDG was more frequently performed in C compared with C1 (41.2% vs 17%, p=0.013), with a trend toward higher yielding (83% vs. 50%, p=0.16). CIED extraction was performed in 79.4% and 92.5% (p=0.07) of C and C1, respectively. Length of stay was similar between groups [17 (7-39) vs23 (12-41) days, p=0.326]. 6-month survival was significantly lower in C compared with C1 and C2 at Kaplan Meier analysis (Fig.2).
Conclusions
GNB-CIED infection is associated with higher 6-month mortality than GPB- or no-CIED infections, prior GNB infection may favor subsequent GNB-CIED infection, the role of PET-FDG in diagnosing GNB-CIED infection seems to be key.
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Affiliation(s)
- R Pascale
- University of Bologna - Alma Mater Studiorum, Infectious disease, Bologna, Italy
| | - TA Abdullah
- Hacettepe University, Infectious disease, Ankara, Turkey
| | - D Fabbricatore
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - T De Potter
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - M Ripa
- University Vita-Salute San Raffaele, Milan, Italy
| | | | | | - G Domenichini
- University Hospital of Lausanne, Lausanne, Switzerland
| | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - M Akova
- Hacettepe University, Infectious disease, Ankara, Turkey
| | - I Diemberger
- Institute of Cardiology University of Bologna, Bologna, Italy
| | - P Viale
- University of Bologna - Alma Mater Studiorum, Infectious disease, Bologna, Italy
| | - M Giannella
- University of Bologna - Alma Mater Studiorum, Infectious disease, Bologna, Italy
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22
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Fabbricatore D, Mileva N, Valeriano C, Buytaert D, Paolisso P, Paolisso P, Geelen P, Geelen P, De Potter T. Ambulatory pulmonary vein isolation workflow using suture-mediated vascular closure devices: a prospective observational cohort study. Europace 2022. [DOI: 10.1093/europace/euac053.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Cardiovascular Abbott D. Fabbricatore is supported by a research grant from the CardioPaTh PhD Program
Background
Pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is an increasingly performed procedure worldwide, presenting an attractive opportunity for performing it in a day care setting.[1] The main reason for delayed discharge are the potential vascular complications that may occur.[2–5] There is still a lack of knowledge considering the usage of vascular closure devices in the electrophysiological field.
Purpose
The aim of the study was to evaluate feasibility, safety, and efficacy of a suture-mediated vascular closure device in ambulatory management after PVI.
Methods
Prospective single-centre cohort study on 50 patients admitted for PVI from January 2020 to May 2021. At the end of the procedure, a suture-mediated vascular closure system was used for each vascular access. The feasibility of an ambulatory PVI strategy was assessed as the percentage of patients being able to be discharged the same day of the procedure. Outcomes were defined as acute rate of vascular device closure performance, postprocedural time to haemostasis, time to ambulation and time to discharge. Vascular complications, analysed on the total number of patients enrolled, were assessed during the 30-days follow-up.
Results
A total of 48/50 (96%) patients were discharged at the same day of the procedure. Haemostasis was reached within 1 minute after the deployment of the device in 30 patients (60%). During the post-operative stay, two patients had minor bleeding without necessity of intervention and one patient was kept in supine position until an ultrasound evaluation resulted negative. Mean and median time to be deemed suitable for discharge in the 48 patients who reached the primary endpoint were 4:55 (±00:54) and 4:48 (2:50-7:30) hours respectively. Mean and median time to discharge were 5:48 (± 1:03) and 5:51 (3:38-7:57) hours respectively. Patient satisfaction was queried and resulted excellent. No major vascular complications were observed during 30-days follow up. Minor complications occurred in 4 patients and were three minor superficial haematomas (<6 cm) and one transient access site related nerve injury.
Conclusion
The use of a closure device for femoral venous accesses after PVI led to a safe discharge of patients within 6 hours from the intervention in 96% of the population. The ambulatory management described in the abstract could be useful for minimizing the overcrowding of healthcare facilities and reduce the post-operative recovery time and management. Additionally, patients were satisfied with the treatment received. Randomised trials are needed for further evaluate the efficacy of this approach.
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Affiliation(s)
- D Fabbricatore
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - N Mileva
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - C Valeriano
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - D Buytaert
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - P Paolisso
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - P Paolisso
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - P Geelen
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - P Geelen
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
| | - T De Potter
- Cardiovascular Research Center OLVZ - Aalst, Aalst, Belgium
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23
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Devgun J, De Potter T, Fabbricatore D, Wang DD. Pre-cath Laboratory Planning for Left Atrial Appendage Occlusion - Optional or Essential? Interv Cardiol Clin 2022; 11:143-152. [PMID: 35361459 DOI: 10.1016/j.iccl.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the wake of rapid advancement in cardiovascular procedural technologies, physician-led preprocedural planning utilizing multi-modality imaging training is increasingly recognized as invaluable for procedural accuracy. Left atrial appendage occlusion (LAAO) is one such procedure in which complications such as device leak, cardiac injury, and device embolization can be decreased substantially with incorporation of physician driven imaging and digital tools. We discuss the benefits of cardiac CT and 3D printing in preprocedural planning for the Heart Team, as well as novel applications by physicians of intraprocedural 3D angiography and dynamic fusion imaging. Furthermore, incorporation of computational modeling and artificial intelligence (AI) may yield promise. For optimal patient-centric procedural success, we advocate for standardized preprocedural imaging planning by physicians within the Heart Team as an essential part of LAAO.
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Affiliation(s)
- Jasneet Devgun
- Division of Cardiology, Henry Ford Health System, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI 48202, USA
| | - Tom De Potter
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Davide Fabbricatore
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, Aalst 9300, Belgium
| | - Dee Dee Wang
- Division of Cardiology, Henry Ford Health System, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI 48202, USA.
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24
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Fabbricatore D, Heggermont W, Buytaert D, Van Bockstal K, De Potter T. Arrhythmic Storm Due to ICD Atrial Lead Malfunction. JACC Case Rep 2022; 4:438-442. [PMID: 35693896 PMCID: PMC9175138 DOI: 10.1016/j.jaccas.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
Abstract
We describe the case of a young woman with a dual-chamber implantable cardioverter-defibrillator for long-QT syndrome who was referred to our emergency department (Cardiovascular Research Centre of Aalst, Belgium) because of an “arrhythmic storm” caused by atrial lead fracture. This case highlights the importance of the correct choice of both the device type and the pacing modality. (Level of Difficulty: Intermediate.)
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25
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Bertolone DT, Gallinoro E, Esposito G, Paolisso P, Bermpeis K, De Colle C, Fabbricatore D, Mileva N, Valeriano C, Munhoz D, Belmonte M, Vanderheyden M, Bartunek J, Sonck J, Wyffels E, Collet C, Mancusi C, Morisco C, De Luca N, De Bruyne B, Barbato E. Contemporary Management of Stable Coronary Artery Disease. High Blood Press Cardiovasc Prev 2022; 29:207-219. [PMID: 35147890 PMCID: PMC9050764 DOI: 10.1007/s40292-021-00497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/30/2021] [Indexed: 10/28/2022] Open
Abstract
Coronary artery disease (CAD) continues to be the leading cause of mortality and morbidity in developed countries. Assessment of pre-test probability (PTP) based on patient's characteristics, gender and symptoms, help to identify more accurate patient's clinical likelihood of coronary artery disease. Consequently, non-invasive imaging tests are performed more appropriately to rule in or rule out CAD rather than invasive coronary angiography (ICA). Coronary computed tomography angiography (CCTA) is the first-line non-invasive imaging technique in patients with suspected CAD and could be used to plan and guide coronary intervention. Invasive coronary angiography remains the gold-standard method for the identification and characterization of coronary artery stenosis. However, it is recommended in patients where the imaging tests are non-conclusive, and the clinical likelihood is very high, remembering that in clinical practice, approximately 30 to 70% of patients with symptoms and/or signs of ischemia, referred to coronary angiography, have non obstructive coronary artery disease (INOCA). In this contest, physiology and imaging-guided revascularization represent the cornerstone of contemporary management of chronic coronary syndromes (CCS) patients allowing us to focus specifically on ischemia-inducing stenoses. Finally, we also discuss contemporary medical therapeutic approach for secondary prevention. The aim of this review is to provide an updated diagnostic and therapeutic approach for the management of patients with stable coronary artery disease.
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Affiliation(s)
- Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium. .,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
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26
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Paolisso P, Gallinoro E, Mileva N, Moya A, Fabbricatore D, Esposito G, De Colle C, Spapen J, Heggermont W, Collet C, Van Camp G, Vanderheyden M, Barbato E, Bartunek J, Penicka M. Performance of non-invasive myocardial work to predict the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF). Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Dr. Paolisso, Dr. Esposito, Dr. Fabbricatore are supported by a research grant from the CardioPaTh PhD Program of University of Naples Federico II
Background
Non-invasive myocardial work (MW) is a validated index of left ventricular (LV) systolic performance, incorporating afterload and myocardial metabolism. The role of MW in predicting the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF) is still unknown.
Purpose
To investigate the diagnostic performance of MW to predict the first de novo HFpEF hospitalization in ambulatory individuals with preserved LVEF.
Methods
Twenty-nine patients with trans-thoracic echocardiography performed at least 6 months before the first HFpEF hospitalization were compared with 29 matched controls. MW was derived as the area of pressure-strain loop using speckle-tracking and brachial artery blood pressure. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were collected. First HFpEF hospitalization and its combination with cardiovascular death (MACE) and all-cause of death (MAE) were assessed.
Results
At baseline, future HFpEF patients showed lower GWI, GCW, GWE and higher GWW than controls (all p < 0.05). At admission versus baseline, GWE significantly decreased, and GWW increased in the HFpEF group (p < 0.05), whereas no significant difference was observed in the controls over time. GWW, with a cut-off of 170 mmHg%, showed the largest AUC to predict first HFpEF hospitalization (AUC = 0.80, 95% CI 0.69–0.91, p < 0.001), MACE (AUC = 0.80, 95% CI 0.66–0.90, p < 0.001) and MAE (AUC = 0.79, 95% CI 0.62–0.88, p = 0.001). GWW > 170 mmHg% was associated with a 4-fold increase of MACE (HR = 4.5, 95% CI 1.59–13.12, p = 0.005) and a 3-fold higher risk of MAE (HR = 2.9, 95% CI 1.24–6.6, p = 0.014).
Conclusions
In ambulatory patients with preserved LVEF and risk factors, GWW showed high accuracy to predict the first HFpEF hospitalization and its combination with mortality. The GWW routine assessment may be clinically helpful in patients with dyspnea. Abstract Figure 1: Serial changes of LARs, LV GLS Abstract Figure 2:Kaplan–Meier survival curves fo
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Affiliation(s)
- P Paolisso
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - E Gallinoro
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - N Mileva
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - A Moya
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | | | - G Esposito
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - C De Colle
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - J Spapen
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - W Heggermont
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - C Collet
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - G Van Camp
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | | | - E Barbato
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - J Bartunek
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - M Penicka
- Cardiovascular Research Center Aalst, Aalst, Belgium
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27
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Paolisso P, Gallinoro E, Candreva A, Bermpeis K, Fabbricatore D, Esposito G, Bertolone DT, Peregrina EF, Munhoz D, Mileva N, Penicka M, Bartunek J, Vanderheyden M, Wiffels E, Sonck J, Collet C, De Bruyne B, Barbato E. 389 Microvascular dysfunction in patients with Type II diabetes mellitus: invasive assessment of absolute coronary blood flow and microvascular resistance reserve. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab136.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Coronary microvascular dysfunction (CMD) is an early feature of diabetic cardiomyopathy, which usually precedes the onset of diastolic and systolic dysfunction. Continuous intracoronary thermodilution allows an accurate and reproducible assessment of absolute coronary blood flow and microvascular resistance thus allowing the evaluation of coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR), a novel index specific for microvascular function, which is independent from the myocardial mass. In the present study we compared absolute coronary flow and resistance, CFR and MRR assessed by continuous intracoronary thermodilution in diabetic vs. non-diabetic patients. Left atrial reservoir strain (LASr), an early marker of diastolic dysfunction was compared between the two groups.
Methods
In this observational retrospective study, 108 patients with suspected angina and non-obstructive coronary artery disease (NOCAD) consecutively undergoing elective coronary angiography (CAG) from September 2018 to June 2021 were enrolled. The invasive functional assessment of microvascular function was performed in the left anterior descending artery (LAD) with intracoronary continuous thermodilution. Patients were classified according to the presence of DM. Absolute resting and hyperaemic coronary blood flow (in mL/min) and resistance (in WU) were compared between the two cohorts. FFR was measured to assess coronary epicardial lesions, while CFR and MRR were calculated to assess microvascular function. LAS, assessed by speckle tracking echocardiography, was used to detect early myocardial structural changes potentially associated with microvascular dysfunction.
Results
The median FFR value was 0.83 (0.79–0.87) without any significant difference between the two groups. Absolute resting and hyperaemic flow in the left anterior descending coronary were similar between diabetic and non-diabetic patients. Similarly, resting and hyperaemic resistances did not change significantly between the two groups. In the DM cohort the CFR and MRR were significantly lower compared to the control group [CFR = 2.38 ± 0.61 and 2.88 ± 0.82; MRR = 2.79 ± 0.87 and 3.48 ± 1.02 for diabetic and non-diabetic patients respectively, (P < 0.05 for both)]. Likewise, diabetic patients had a significantly lower reservoir, contractile and conductive LAS (all P < 0.05).
Conclusions
Compared with non-diabetic patients, CFR and MRR were lower in patients with DM and non-obstructive epicardial coronary arteries, while both resting and hyperaemic coronary flow and resistance were similar. LASr was lower in diabetic patients, confirming the presence of a subclinical diastolic dysfunction associated to the microcirculatory impairment. Continuous intracoronary thermodilution-derived indexes provide a reliable and operator-independent assessment of coronary macro- and microvasculature and might potentially facilitate widespread clinical adoption of invasive physiologic assessment of suspected microvascular disease.
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Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, Olv-Clinic, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | | | | | | | - Davide Fabbricatore
- Cardiovascular Center Aalst, Olv-Clinic, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, Olv-Clinic, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, Olv-Clinic, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, Olv-Clinic, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, Olv-Clinic, Belgium
| | | | | | | | - Eric Wiffels
- Cardiovascular Center Aalst, Olv-Clinic, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, Olv-Clinic, Belgium
| | | | | | - Emanuele Barbato
- Cardiovascular Center Aalst, Olv-Clinic, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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28
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Gallinoro E, Paolisso P, Di Gioia G, Bermpeis K, Fernandez-peregrina E, Candreva A, Esposito G, Fabbricatore D, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. 451 Deferral of coronary revascularization in patients with reduced ejection fraction based on physiological assessment: impact on long-term survival. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Deferring percutaneous coronary intervention (PCI) in patients with non-significant stenoses based on fractional flow reserve (FFR) is associated with favourable clinical outcomes up to 15 years. Whether this holds true in patients with reduced left ventricular ejection fraction (LVEF) is unclear. To investigate whether FFR provides adjunctive clinical benefit compared to coronary angiography in deferring revascularization of patients with intermediate coronary stenoses and reduced LVEF.
Methods and results
Consecutive patients (n = 4577) with reduced LVEF (≤50%) undergoing coronary angiography between 2002 and 2010 were screened. We eventually included patients with at least one intermediate coronary stenosis (diameter stenosis ≥40%) in whom revascularization was deferred based either on angiography plus FFR (FFR-guided) or angiography alone (angiography-guided). The primary endpoint of the study was the cumulative incidence of all-cause death at 10 years. The secondary endpoint [the incidence of major adverse cardiovascular and cerebrovascular events (MACCE)], was a composite of all-cause death, myocardial infarction, any revascularization and stroke. A total of 840 patients were included (206 in the FFR-guided and 634 in the angiography-guided group). Median clinical follow-up was 7 years [IQR: (3.22–11.08)]. After 1:1 propensity score matching, baseline characteristics between the two groups were similar. All-cause death was significantly lower in the FFR-guided group compared with the angiography-guided group [94 (45.6%) vs. 119 (57.8%), HR: 0.65 (95% CI: 0.49–0.85), P < 0.01]. The rate of major adverse cardiovascular and cerebrovascular events [(MACCE), a composite of all-cause death, myocardial infarction, any revascularization, and stroke) was lower in the FFR-guided group [123 (59.7%) vs. 139 (67.5%), HR: 0.75 (95% CI: 0.59–0.95), P = 0.02].
Conclusions
In patients with reduced LVEF, deferring revascularization of intermediate coronary stenoses based on FFR is associated with a lower incidence of death and MACCE at 10 years.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Translational Medical Sciences, University of Campania ‘L. Vanvitelli’, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | - Giuseppe Di Gioia
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | | | | | | | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | | | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples ‘Federico II’, Naples, Italy
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29
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Paolisso P, Gallinoro E, Mileva N, Moya A, Fabbricatore D, Esposito G, De Colle C, Beles M, Spapen J, Heggermont W, Collet C, Van Camp G, Vanderheyden M, Barbato E, Bartunek J, Penicka M. Performance of non-invasive myocardial work to predict the first hospitalization for de novo heart failure with preserved ejection fraction. ESC Heart Fail 2021; 9:373-384. [PMID: 34821061 PMCID: PMC8788027 DOI: 10.1002/ehf2.13740] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Non-invasive myocardial work (MW) is a validated index of left ventricular (LV) systolic performance, incorporating afterload and myocardial metabolism. The role of MW in predicting the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF) is still unknown. We aim to investigate the diagnostic performance of MW to predict the first de novo HFpEF hospitalization in ambulatory individuals with preserved LV ejection fraction. METHODS AND RESULTS Twenty-nine patients with transthoracic echocardiography performed at least 6 months before the first HFpEF hospitalization were compared with 29 matched controls. MW was derived as the area of pressure-strain loop using speckle-tracking and brachial artery blood pressure. Global work index, global constructive work, global wasted work (GWW), and global work efficiency (GWE) were collected. First HFpEF hospitalization and its combination with cardiovascular death [major adverse cardiovascular events (MACE)] and all-cause of death [major adverse events (MAE)] were assessed. At baseline, future HFpEF patients showed lower global work index, global constructive work, GWE, and higher GWW than controls (all P < 0.05). At admission vs. baseline, GWE significantly decreased, and GWW increased in the HFpEF group (P < 0.05), whereas no significant difference was observed in the controls over time. GWW, with a cut-off of 170 mmHg%, showed the largest area under the curve (AUC) to predict first HFpEF hospitalization [AUC = 0.80, 95% confidence interval (CI) 0.69-0.91, P < 0.001], MACE (AUC = 0.80, 95% CI 0.66-0.90, P < 0.001), and MAE (AUC = 0.79, 95% CI 0.62-0.88, P = 0.001). GWW > 170 mmHg% was associated with a 4-fold increase of MACE (HR = 4.5, 95% CI 1.59-13.12, P = 0.005) and a 3-fold higher risk of MAE (HR = 2.9, 95% CI 1.24-6.6, P = 0.014). CONCLUSIONS In ambulatory patients with preserved LV ejection fraction and risk factors, GWW showed high accuracy to predict the first HFpEF hospitalization and its combination with mortality. The GWW routine assessment may be clinically helpful in patients with dyspnoea.
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Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Cardiology Clinic, 'Alexandrovska' University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ana Moya
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Monika Beles
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Jerrold Spapen
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Ward Heggermont
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
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Gallinoro E, Paolisso P, di Gioia G, Bermpeis K, Candreva A, Esposito G, Fabbricatore D, Bartunek J, Vanderheyden M, Sonck J, Collet C, de Bruyne B, Barbato E. TCT-170 Angiography- Versus FFR-Based Deferral of Revascularization in Patients With Reduced Ejection Fraction: 10-Year Follow-Up Study. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1023] [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: 10/20/2022]
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31
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Gallinoro E, Paolisso P, Candreva A, Bermpeis K, Fabbricatore D, Esposito G, Bertolone D, Fernandez Peregrina E, Munhoz D, Mileva N, Penicka M, Bartunek J, Vanderheyden M, Wyffels E, Sonck J, Collet C, De Bruyne B, Barbato E. Microvascular Dysfunction in Patients With Type II Diabetes Mellitus: Invasive Assessment of Absolute Coronary Blood Flow and Microvascular Resistance Reserve. Front Cardiovasc Med 2021; 8:765071. [PMID: 34738020 PMCID: PMC8562107 DOI: 10.3389/fcvm.2021.765071] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Coronary microvascular dysfunction (CMD) is an early feature of diabetic cardiomyopathy, which usually precedes the onset of diastolic and systolic dysfunction. Continuous intracoronary thermodilution allows an accurate and reproducible assessment of absolute coronary blood flow and microvascular resistance thus allowing the evaluation of coronary flow reserve (CFR) and Microvascular Resistance Reserve (MRR), a novel index specific for microvascular function, which is independent from the myocardial mass. In the present study we compared absolute coronary flow and resistance, CFR and MRR assessed by continuous intracoronary thermodilution in diabetic vs. non-diabetic patients. Left atrial reservoir strain (LASr), an early marker of diastolic dysfunction was compared between the two groups. Methods: In this observational retrospective study, 108 patients with suspected angina and non-obstructive coronary artery disease (NOCAD) consecutively undergoing elective coronary angiography (CAG) from September 2018 to June 2021 were enrolled. The invasive functional assessment of microvascular function was performed in the left anterior descending artery (LAD) with intracoronary continuous thermodilution. Patients were classified according to the presence of DM. Absolute resting and hyperemic coronary blood flow (in mL/min) and resistance (in WU) were compared between the two cohorts. FFR was measured to assess coronary epicardial lesions, while CFR and MRR were calculated to assess microvascular function. LAS, assessed by speckle tracking echocardiography, was used to detect early myocardial structural changes potentially associated with microvascular dysfunction. Results: The median FFR value was 0.83 [0.79-0.87] without any significant difference between the two groups. Absolute resting and hyperemic flow in the left anterior descending coronary were similar between diabetic and non-diabetic patients. Similarly, resting and hyperemic resistances did not change significantly between the two groups. In the DM cohort the CFR and MRR were significantly lower compared to the control group (CFR = 2.38 ± 0.61 and 2.88 ± 0.82; MRR = 2.79 ± 0.87 and 3.48 ± 1.02 for diabetic and non-diabetic patients respectively, [p < 0.05 for both]). Likewise, diabetic patients had a significantly lower reservoir, contractile and conductive LAS (all p < 0.05). Conclusions: Compared with non-diabetic patients, CFR and MRR were lower in patients with DM and non-obstructive epicardial coronary arteries, while both resting and hyperemic coronary flow and resistance were similar. LASr was lower in diabetic patients, confirming the presence of a subclinical diastolic dysfunction associated to the microcirculatory impairment. Continuous intracoronary thermodilution-derived indexes provide a reliable and operator-independent assessment of coronary macro- and microvasculature and might potentially facilitate widespread clinical adoption of invasive physiologic assessment of suspected microvascular disease.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli', Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Dario Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Daniel Munhoz
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Discipline of Cardiology, Department of Internal Clinical Medicine, University of Campinas, Campinas, Brazil
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | | | | | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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32
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Gallinoro E, Paolisso P, Bermpeis K, Peregrina EF, Candreva A, Esposito G, Fabbricatore D, Sonck J, Di Gioia G, Vanderheyden M, Bartunek J, Collet C, De Bruyne B, Barbato E. Angiography vs physiology-based deferral of revascularization in patients with reduced left ventricular ejection fraction: a 10-year clinical follow-up. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Deferring percutaneous coronary intervention (PCI) in patients with non-ischemic coronary stenoses based on fractional flow reserve (FFR) and preserved left ventricular ejection fraction (LVEF) is associated with favorable long-term clinical outcomes. In patients with reduced LVEF, the role of reversible/residual ischemia in deferring revascularization is still debated.
Purpose
To investigate whether FFR provides additive clinical benefit compared to coronary angiography in deferring revascularization in patients with intermediate coronary stenoses and reduced LVEF.
Methods
Among 4577 coronary angiographies performed between 2002 and 2010, consecutive patients with reduced LVEF (≤50%) and at least one intermediate coronary stenosis [diameter stenosis (DS)% 40–70%] in whom revascularization was deferred based either on FFR (FFR-guided) or angiography (Angiography-guided) were screened. The primary endpoint of the study was cumulative incidence of death at 10 years.
Results
A total of 843 patients were included (209 in the FFR-guided and 634 in the Angio-guided group). Median clinical follow-up was 7.1 years (IQR 3.2–11.2 years). After 1:1 propensity score matching, baseline characteristics between the two groups were similar. All-cause death at 10 years was significantly lower in the FFR-guided compared with the Angiography-guided group (94 [45%] vs 115 [55%], HR 0.72 [95% CI 0.55–0.95], p<0.05). Similarly, the incidence of major adverse cardiovascular and cerebrovascular events (MACCE, composite of all-cause death, myocardial infarction, any revascularization and stroke) was lower in the FFR guided group (125 [60%] vs 140 [67%], HR 0.77 [95% CI 0.61–0.98], p<0.05).
Conclusions
In patients with reduced LVEF and associated coronary artery disease, deferring revascularization of intermediate stenoses based on FFR is associated with lower incidence of death and MACCE at 10 years.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Gallinoro
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - P Paolisso
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - K Bermpeis
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - E F Peregrina
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - A Candreva
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - G Esposito
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | | | - J Sonck
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - G Di Gioia
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | | | - J Bartunek
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - C Collet
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - B De Bruyne
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - E Barbato
- Cardiovascular Research Center Aalst, Aalst, Belgium
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33
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Chinitz LA, Barbhaiya C, Fabbricatore D, Viville A, Groenendijk A, Haagen T, Schwartz Y, Oren E, Sulkin M, Buytaert D, De Potter T. B-PO01-072 DIELECTRIC-BASED TISSUE THICKNESS MEASURED WITH A RADIOFREQUENCY ABLATION CATHETER: INITIAL CLINICAL RESULTS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Klaver MN, De Potter TJR, Iliodromitis K, Babkin A, Cabrita D, Fabbricatore D, Boersma LVA. Ultralow temperature cryoablation using near-critical nitrogen for cavotricuspid isthmus-ablation, first-in-human results. J Cardiovasc Electrophysiol 2021; 32:2025-2032. [PMID: 34196991 PMCID: PMC8457224 DOI: 10.1111/jce.15142] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
Introduction Cryoablation has evolved as a safe alternative to radiofrequency ablation in the treatment of several supraventricular arrhythmias and has potential advantages, yet is limited by the properties of the cryogen used. We investigated a novel ultralow temperature cryoablation (ULTC) system using nitrogen near its liquid‐vapor critical point as a freezing source, achieving temperatures as low as ‐196 degrees Celsius in a long linear catheter with a continuous energy release. Initial safety, procedural and efficacy outcomes of ULTC are described in patients undergoing cavotricuspid isthmus (CTI) ablation. Methods and Results The Cryocure studies (NCT02355106, NCT02839304) are prospective, single‐arm, multi‐center, first‐in‐human clinical studies in 17 patients with atrial flutter (AFL) and 13 patients with atrial fibrillation (AF). A total of 30 patients, mean age 65 ± 8 years old and 67% male, were enrolled and underwent ablation of the CTI. Acute success, defined as the confirmation of stable bidirectional conduction block across the CTI, was achieved in all 30 patients. After 12 months of follow‐up, 14 out of 17 AFL patients remained free from any AFL. One (3.3%) procedure‐related but not device‐related serious adverse event was reported, involving transient inferolateral ST‐elevation associated with temporary AV conduction block. Conclusion In this first‐in‐human clinical study the safety and performance results demonstrate the capabilities of ultralow temperature near‐critical nitrogen as an effective energy source for CTI ablation. Ongoing, larger, studies should confirm our findings and evaluate the capabilities to create linear and focal transmural lesions in other arrhythmias.
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Affiliation(s)
- Martijn N Klaver
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiology, Amsterdam University Medical Centers, The Netherlands
| | - Tom J R De Potter
- Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium
| | | | | | | | | | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiology, Amsterdam University Medical Centers, The Netherlands
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35
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Pascariello G, Cimino G, Calvi E, Bernardi N, Grigolato M, Garyfallidis P, Fabbricatore D, Pezzola E, Lombardi CM, Metra M, Vizzardi E. Cardiogenic Shock due to COVID-19-Related Myocarditis in a 19-Year-Old Autistic Patient. J Med Cases 2021; 11:207-210. [PMID: 33984092 PMCID: PMC8040434 DOI: 10.14740/jmc3517] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is mainly responsible for respiratory involvement but cardiac complications are also reported. Nevertheless, potential life-threatening conditions in young people have not been described. A 19-year-old male autistic patient was admitted with fever and cough. The chest radiography showed viral pneumonia and the nasopharyngeal swab detected SARS-CoV-2. He rapidly developed hypotension, oliguria and increased myocardial injury markers and was treated with adrenaline, antiviral drugs and mechanical ventilation. Echocardiography revealed diffuse myocardial hypo-akinesia and decreased left ventricular ejection fraction (LVEF). After several days of treatment, the patient was weaned off mechanical ventilation, LVEF recovered to 50% and laboratory tests showed a decrease of markers of myocardial injury. Coronavirus disease 2019 (COVID-19) can therefore severely affect myocardium with life-threatening complications and even young people can be involved.
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Affiliation(s)
- Greta Pascariello
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Italy
| | - Giuliana Cimino
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Italy
| | - Emiliano Calvi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Italy
| | - Nicola Bernardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Italy
| | | | | | - Davide Fabbricatore
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Italy
| | - Elisa Pezzola
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Italy
| | - Carlo M Lombardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Italy
| | - Marco Metra
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Italy
| | - Enrico Vizzardi
- Department of Medical and Surgical Specialties, Institute of Cardiology, University of Brescia, Italy
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36
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Curnis A, Aboelhassan M, Cerini M, Salghetti F, Fabbricatore D, Maiolo V, Arabia G, Giacopelli D, Fouad DA, Bontempi L. Transvenous lead extraction in patients with persistent left superior vena cava. J Cardiovasc Electrophysiol 2021; 32:1407-1410. [PMID: 33783892 DOI: 10.1111/jce.15021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/11/2021] [Accepted: 03/21/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Predictors of difficulty and complications of transvenous lead extraction (TLE) have been investigated in several studies; however, little is known about the venous anatomical characteristics that can have an impact on procedural outcomes. Among them, the persistent left superior vena cava (PLSVC) is a common anomaly often discovered incidentally during cardiac device implantation and could raise concerns if TLE is indicated. We report technical considerations and outcomes of TLE for two patients with leads implanted via PLSVC. METHODS AND RESULTS Two cardiac implantable electronic device recipients with isolated PLSVC required TLE due to infective endocarditis in one case and lead failure in the other. In the first case, TLE procedure was performed in a hybrid operating room with minimally invasive video-assisted thoracoscopic monitoring due to the high procedural risk. Two active fixation 20-year-old pacing leads were removed with a relatively short fluoroscopy time. In the second case, we successfully extracted a single-coil active fixation lead without the need of a locking stylet or advanced extraction tools. There were no procedural complications or adverse events at 1-year follow-up. CONCLUSION TLE procedures for two patients with isolated PLSVC were successfully completed with less difficulty and tools than expected based on the characteristics of the targeted leads. If indicated, TLE in the presence of a PLSVC should be considered in experienced centers.
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Affiliation(s)
- Antonio Curnis
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
| | - Mohamed Aboelhassan
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy.,Assiut University Heart Hospital, Assiut, Egypt
| | - Manuel Cerini
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
| | | | | | - Vincenzo Maiolo
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
| | | | - Daniele Giacopelli
- Clinical Unit, Biotronik Italia, Vimodrone, Italy.,Department of Cardiac, Thoracic, Vascular Science and Public Health, Padova University, Padova, Italy
| | | | - Luca Bontempi
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
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37
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Bontempi L, Aboelhassan M, Cerini M, Salghetti F, Fabbricatore D, Maiolo V, Freda L, Giacopelli D, Curnis A. Could Home Monitoring parameters provide information about the impact of the pandemic period on CIED patients? A comparison between 2019 and 2020. J Cardiovasc Med (Hagerstown) 2021; 22:606-608. [PMID: 34076608 DOI: 10.2459/jcm.0000000000001193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Luca Bontempi
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | - Manuel Cerini
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | | | - Vincenzo Maiolo
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | | | - Daniele Giacopelli
- Clinical Research, Biotronik Italia, Milano.,Department of Cardiac, Thoracic, Vascular Sciences & Public Health, University of Padova, Padua, Italy
| | - Antonio Curnis
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
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38
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Bontempi L, Cerini M, Salghetti F, Fabbricatore D, Nozza C, Campari M, Valsecchi S, Curnis A. Use of a novel implantable cardioverter-defibrillator multisensor algorithm for heart failure monitoring in a COVID-19 patient: A case report. Clin Case Rep 2021; 9:1178-1182. [PMID: 33768806 PMCID: PMC7981691 DOI: 10.1002/ccr3.3721] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
We report the case of a patient implanted with an implantable defibrillator endowed with a multisensor algorithm for heart failure monitoring. Automatic measurement of multiple clinical variables allowed to detect impending heart failure decompensation and showed its ability to facilitate differential diagnosis in the context of the current COVID-19 pandemic.
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Affiliation(s)
- Luca Bontempi
- Chair and Unit of CardiologyUniversity of BresciaSpedali Civili HospitalBresciaItaly
| | - Manuel Cerini
- Chair and Unit of CardiologyUniversity of BresciaSpedali Civili HospitalBresciaItaly
| | - Francesca Salghetti
- Chair and Unit of CardiologyUniversity of BresciaSpedali Civili HospitalBresciaItaly
| | - Davide Fabbricatore
- Chair and Unit of CardiologyUniversity of BresciaSpedali Civili HospitalBresciaItaly
| | | | | | | | - Antonio Curnis
- Chair and Unit of CardiologyUniversity of BresciaSpedali Civili HospitalBresciaItaly
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39
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Gasperetti A, Biffi M, Duru F, Schiavone M, Ziacchi M, Mitacchione G, Lavalle C, Saguner A, Lanfranchi A, Casalini G, Tocci M, Fabbricatore D, Salghetti F, Mariani MV, Busana M, Bellia A, Cogliati CB, Viale P, Antinori S, Galli M, Galiè N, Tondo C, Forleo GB. Arrhythmic safety of hydroxychloroquine in COVID-19 patients from different clinical settings. Europace 2021; 22:1855-1863. [PMID: 32971536 PMCID: PMC7543547 DOI: 10.1093/europace/euaa216] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
Aims The aim of the study was to describe ECG modifications and arrhythmic events in COVID-19 patients undergoing hydroxychloroquine (HCQ) therapy in different clinical settings. Methods and results COVID-19 patients at seven institutions receiving HCQ therapy from whom a baseline and at least one ECG at 48+ h were available were enrolled in the study. QT/QTc prolongation, QT-associated and QT-independent arrhythmic events, arrhythmic mortality, and overall mortality during HCQ therapy were assessed. A total of 649 COVID-19 patients (61.9 ± 18.7 years, 46.1% males) were enrolled. HCQ therapy was administrated as a home therapy regimen in 126 (19.4%) patients, and as an in-hospital-treatment to 495 (76.3%) hospitalized and 28 (4.3%) intensive care unit (ICU) patients. At 36–72 and at 96+ h after the first HCQ dose, 358 and 404 ECGs were obtained, respectively. A significant QT/QTc interval prolongation was observed (P < 0.001), but the magnitude of the increase was modest [+13 (9–16) ms]. Baseline QT/QTc length and presence of fever (P = 0.001) at admission represented the most important determinants of QT/QTc prolongation. No arrhythmic-related deaths were reported. The overall major ventricular arrhythmia rate was low (1.1%), with all events found not to be related to QT or HCQ therapy at a centralized event evaluation. No differences in QT/QTc prolongation and QT-related arrhythmias were observed across different clinical settings, with non-QT-related arrhythmias being more common in the intensive care setting. Conclusion HCQ administration is safe for a short-term treatment for patients with COVID-19 infection regardless of the clinical setting of delivery, causing only modest QTc prolongation and no directly attributable arrhythmic deaths.
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Affiliation(s)
- Alessio Gasperetti
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy.,University Heart Center, University Hospital Zürich, Zürich, Switzerland
| | - Mauro Biffi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Firat Duru
- University Heart Center, University Hospital Zürich, Zürich, Switzerland
| | - Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Matteo Ziacchi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Gianfranco Mitacchione
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Carlo Lavalle
- Department of Cardiovascular Disease, Policlinico Umberto I Hospital, Rome, Italy
| | - Ardan Saguner
- University Heart Center, University Hospital Zürich, Zürich, Switzerland
| | - Antonio Lanfranchi
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giacomo Casalini
- III Division of Infectious Diseases, ASST-Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Marco Tocci
- Department of Cardiovascular Disease, Policlinico Umberto I Hospital, Rome, Italy
| | | | | | | | - Mattia Busana
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | | | - Pierluigi Viale
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Spinello Antinori
- III Division of Infectious Diseases, ASST-Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Massimo Galli
- III Division of Infectious Diseases, ASST-Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Italy
| | - Nazzareno Galiè
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanni Battista Forleo
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
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40
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Curnis A, Salghetti F, Cerini M, Fabbricatore D, Ghizzoni G, Arrigoni L, Generati G, Arabia G, Maiolo V, Aboelhassan M, Bontempi L. Leadless pacemaker: State of the art and incoming developments to broaden indications. Pacing Clin Electrophysiol 2020; 43:1428-1437. [DOI: 10.1111/pace.14097] [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] [Received: 05/25/2020] [Revised: 09/30/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Curnis
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Francesca Salghetti
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Manuel Cerini
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Davide Fabbricatore
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Giulia Ghizzoni
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Luca Arrigoni
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Greta Generati
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Gianmarco Arabia
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | - Vincenzo Maiolo
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
| | | | - Luca Bontempi
- Division of Cardiology Spedali Civili Hospital, University of Brescia Brescia Italy
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Bontempi L, Aboelhassan M, Cerini M, Salghetti F, Arabia G, Fabbricatore D, Maiolo V, Giacopelli D, Curnis A. Abandoned and fractured ICD lead with complete superior veins occlusion: Is transvenous lead extraction still possible? J Cardiovasc Electrophysiol 2020; 31:3042-3044. [PMID: 32955129 DOI: 10.1111/jce.14752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/12/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022]
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Sciatti E, Bernardi N, Dallapellegrina L, Valentini F, Fabbricatore D, Scodro M, Cotugno A, Alonge M, Munari F, Zanini B, Ricci C, Vizzardi E. Evaluation of systo-diastolic cardiac function and arterial stiffness in subjects with new diagnosis of coeliac disease without cardiovascular risk factors. Intern Emerg Med 2020; 15:981-988. [PMID: 31898206 DOI: 10.1007/s11739-019-02261-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/23/2019] [Accepted: 12/11/2019] [Indexed: 01/05/2023]
Abstract
In literature, there are conflicting opinions on the development of cardiovascular disease risk in patients with coeliac disease (CD). The aim of the research was to identify in young subjects without cardiovascular risk factor and newly diagnosed CD, alterations in different instrumental parameters that are associated with an augmented cardiovascular risk. Twenty-one consecutive young adults with a new diagnosis of CD and without cardiovascular risk factors were prospectively enrolled and underwent transthoracic echocardiography to analyse ascending aorta elastic properties [including tissue Doppler imaging strain (TDI-ε)] and left ventricular 2D strains (global longitudinal, radial and circumferential), and applanation tonometry by SphygmoCor. Cases were compared with 21 age- and sex-matched healthy controls. Mean age of the cases was 38 ± 9 years and 15 of them (71%) were female. Brachial and central blood pressure was higher in the CD group. Elastic properties of the ascending aorta were all impaired in the CD group: TDI-ε was altered in 57% of cases (0% of controls, p < 0.001). Concentric remodelling and grade I diastolic dysfunction were present in 38% and 24% of cases, respectively (0% of controls, p < 0.001). Global longitudinal strain was normal in all subjects, while radial and circumferential strain were altered in 67% and 35%, respectively (0% of controls, p < 0.001). In young subjects without cardiovascular risk factor, a newly diagnosed CD is associated with altered aortic elastic properties, left ventricular concentric remodelling and diastolic dysfunction and altered radial and circumferential strain.
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Affiliation(s)
- Edoardo Sciatti
- Cardiology Unit, ASST Spedali Civili and University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Nicola Bernardi
- Cardiology Unit, ASST Spedali Civili and University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Lucia Dallapellegrina
- Cardiology Unit, ASST Spedali Civili and University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Francesca Valentini
- Cardiology Unit, ASST Spedali Civili and University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Davide Fabbricatore
- Cardiology Unit, ASST Spedali Civili and University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Marta Scodro
- Cardiology Unit, ASST Spedali Civili and University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Annunziata Cotugno
- Cardiology Unit, ASST Spedali Civili and University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Marco Alonge
- Gastroenterology Unit, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Francesca Munari
- Gastroenterology Unit, ASST Spedali Civili and University of Milan, Brescia, Italy
- Gastroenterology Unit, ASST Spedali Civili and University of Milan, Milan, Italy
| | - Barbara Zanini
- Gastroenterology Unit, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Chiara Ricci
- Gastroenterology Unit, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, ASST Spedali Civili and University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Inciardi RM, Adamo M, Lupi L, Cani DS, Di Pasquale M, Tomasoni D, Italia L, Zaccone G, Tedino C, Fabbricatore D, Curnis A, Faggiano P, Gorga E, Lombardi CM, Milesi G, Vizzardi E, Volpini M, Nodari S, Specchia C, Maroldi R, Bezzi M, Metra M. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J 2020; 41:1821-1829. [PMID: 32383763 PMCID: PMC7239204 DOI: 10.1093/eurheartj/ehaa388] [Citation(s) in RCA: 355] [Impact Index Per Article: 88.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
Aims To compare demographic characteristics, clinical presentation, and outcomes of patients with and without concomitant cardiac disease, hospitalized for COVID-19 in Brescia, Lombardy, Italy. Methods and results The study population includes 99 consecutive patients with COVID-19 pneumonia admitted to our hospital between 4 March and 25 March 2020. Fifty-three patients with a history of cardiac disease were compared with 46 without cardiac disease. Among cardiac patients, 40% had a history of heart failure, 36% had atrial fibrillation, and 30% had coronary artery disease. Mean age was 67 ± 12 years, and 80 (81%) patients were males. No differences were found between cardiac and non-cardiac patients except for higher values of serum creatinine, N-terminal probrain natriuretic peptide, and high sensitivity troponin T in cardiac patients. During hospitalization, 26% patients died, 15% developed thrombo-embolic events, 19% had acute respiratory distress syndrome, and 6% had septic shock. Mortality was higher in patients with cardiac disease compared with the others (36% vs. 15%, log-rank P = 0.019; relative risk 2.35; 95% confidence interval 1.08–5.09). The rate of thrombo-embolic events and septic shock during the hospitalization was also higher in cardiac patients (23% vs. 6% and 11% vs. 0%, respectively). Conclusions Hospitalized patients with concomitant cardiac disease and COVID-19 have an extremely poor prognosis compared with subjects without a history of cardiac disease, with higher mortality, thrombo-embolic events, and septic shock rates. ![]()
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Affiliation(s)
- Riccardo M Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Laura Lupi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Dario S Cani
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Mattia Di Pasquale
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Leonardo Italia
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gregorio Zaccone
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Chiara Tedino
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Fabbricatore
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Curnis
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Pompilio Faggiano
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Elio Gorga
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo M Lombardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giuseppe Milesi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Enrico Vizzardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Volpini
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Savina Nodari
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia Italy
| | - Roberto Maroldi
- Institute of Radiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Michela Bezzi
- Respiratory Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Ghizzoni G, Sciatti E, Vizzardi E, Bonadei I, Fabbricatore D, Metra M. Wellens' syndrome: a case report with atypical features. Monaldi Arch Chest Dis 2019; 89. [PMID: 31564087 DOI: 10.4081/monaldi.2019.1093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
Abstract
Wellens' syndrome is a pattern of electrocardiographic T-wave changes seen in the precordial leads in patients with unstable angina. Two different patterns have been described. Type A presents with biphasic T-waves in V2-V3 and type B presents with symmetrical deep T-wave inversions in V2-V3. The etiology is related to a critical stenosis in the proximal left anterior descending artery (LAD). We describe a patient who presented at our emergency department with intermittent chest pain and showing Wellens' pattern T-wave inversions in the precordial leads of the electrocardiogram. She was found to have 95% stenosis in mid LAD.
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Affiliation(s)
- Giulia Ghizzoni
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia; Cardio-Thoracic Department, ASST Spedali Civili, Brescia.
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Pascale AV, Finelli R, Giannotti R, Visco V, Fabbricatore D, Matula I, Mazzeo P, Ragosa N, Massari A, Izzo R, Coscioni E, Illario M, Ciccarelli M, Trimarco B, Iaccarino G. Vitamin D, parathyroid hormone and cardiovascular risk: the good, the bad and the ugly. J Cardiovasc Med (Hagerstown) 2018; 19:62-66. [PMID: 29252600 PMCID: PMC5757656 DOI: 10.2459/jcm.0000000000000614] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
25-Hydroxyvitamin D insufficiency and increased cardiovascular risk (CVR) association is still debated. The vitamin D (VitD)-dependent parathyroid hormone (PTH) is considered as the possible actuator of VitD effects on CVR. To investigate the association of CVR, PTH and VitD, we carried out blood pressure measurements and blood samples and collected information on dietary habits, anamnestic, clinical and metabolic data of 451 participants in the Salerno area (Southern Italy) during the World Hypertension Day (17 May). CVR was calculated according to the Framingham CVR charts. The overall population mean age was 51.6 ± 0.7 years, and female sex was slightly prevalent (55%). VitD deficiency (<20 ng/ml) was most frequent (59.7%). In this population, VitD and CVR did not correlate. VitD and PTH inversely correlated (r = −0.265, P < 0.001) as expected. PTH was in direct correlation (r = 0.225, P < 0.001) with CVR. Elevated PTH (75 percentile; ≥49.5 pg/ml) levels identify a population with higher CVR (11.8 ± 0.5 vs. 8.5 ± 0.3, P < 0.001). In a multivariate analysis, both age and PTH correlate to CVR, but not VitD. In conclusion, VitD does not directly affect CVR in the overall population. Rather, increased PTH might be a better predictor of CVR.
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Affiliation(s)
| | - Rosa Finelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Rocco Giannotti
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Davide Fabbricatore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Ida Matula
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Pietro Mazzeo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Nicola Ragosa
- Department of Cardiology, San Luca Hospital, Vallo della Lucania
| | - Angelo Massari
- San Giovanni di Dio e Rugi d'Aragona University Hospital, Salerno, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University
| | - Enrico Coscioni
- San Giovanni di Dio e Rugi d'Aragona University Hospital, Salerno, Italy
| | - Maddalena Illario
- Division of Health Innovation, Directorate General for Health Protection and Coordination of the Regional Health System.,Depatment of Medical and Translational Sciences, Federico II University and Hospital, Napoli, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University
| | - Guido Iaccarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi
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Sciatti E, Vizzardi E, Bonadei I, Fabbricatore D, Prati F, Pagnoni M, Metra M. Prognostic evaluation of the elastic properties of the ascending aorta in dilated cardiomyopathy. Eur J Clin Invest 2018; 48:e12950. [PMID: 29754460 DOI: 10.1111/eci.12950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 05/05/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Nowadays there is an increased interest in the role of aortic stiffness in the pathophysiology of heart failure (HF), as it is a major determinant of left ventricular (LV) performance. We aimed at assessing the predictive value of the aortic stiffness parameters, measured by echocardiography, in patients affected by nonischaemic dilated cardiomyopathy (DCM) regarding three end-points: death, HF rehospitalization, combined death or HF rehospitalization in a long-term follow-up. MATERIALS AND METHODS A total of 202 patients affected by nonischaemic DCM underwent an outpatient examination by echocardiography and blood pressure check at the brachial artery, in order to calculate aortic elastic properties (ie, compliance, distensibility, stiffness index, Peterson's elastic modulus, M-mode strain). ROC curves, Kaplan-Meier curves and multivariable Cox regressions (correcting for age, LV ejection fraction (LVEF), atrial fibrillation, cardiac resynchronization therapy (CRT)) were run to assess the predictive ability of aortic elastic properties against the 3 end-points. RESULTS Mean follow-up was 9.83 ± 2.80 years. 24.8% of patients died, while 34.7% were rehospitalized for HF cause and 44.6% experienced the combined end-point. LVEF did not correlate with aortic elastic properties. ROC curves and Kaplan-Meier curves were elaborated. Aortic stiffness did not predict death in our cohort. Otherwise, all aortic elastic properties predicted HF rehospitalization and combined death or HF rehospitalization, after correcting for age, LVEF, atrial fibrillation, CRT. CONCLUSIONS Elastic properties of the ascending aorta measured by echocardiography in patients with nonischaemic DCM predict long-term HF rehospitalization and combined death or HF rehospitalization, also after correcting for the confounding factors.
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Affiliation(s)
- Edoardo Sciatti
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Ivano Bonadei
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Francesco Prati
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Mattia Pagnoni
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
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Bonadei I, Sciatti E, Vizzardi E, Fabbricatore D, Pagnoni M, Rossi L, Carubelli V, Lombardi CM, Metra M. Effects of ivabradine on endothelial function, aortic properties and ventricular-arterial coupling in chronic systolic heart failure patients. Cardiovasc Ther 2018; 36:e12323. [PMID: 29460403 DOI: 10.1111/1755-5922.12323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/30/2017] [Accepted: 02/15/2018] [Indexed: 12/28/2022] Open
Abstract
AIM Heart rate (HR) is an important prognostic factor in patients affected by chronic heart failure (CHF); ivabradine has been demonstrated to significantly reduce nonfatal myocardial infarction and hospitalization rate for acute heart failure and to improve left ventricular (LV) reverse remodeling, quality of life, exercise capacity, and arterial elastance (Ea) in these patients. We aimed at evaluating the short-term effects of ivabradine on ventricular-arterial coupling (VAC), aortic stiffness, and endothelial function in stable patients with CHF. METHODS We evaluated 30 consecutive CHF patients (LVEF≤ 35%, NYHA class II) with sinus rhythm and HR ≥ 70 bpm on optimized pharmacological therapy. All of them underwent both transthoracic echocardiogram to assess aortic elastic properties (aortic distensibility, AD; aortic stiffness index, ASI; systolic aortic strain, SAS) and VAC, and peripheral arterial tonometry to measure endothelial function. Therapy with ivabradine 5 mg bid was added and each patient was evaluated with the same examinations after 4 months. RESULTS At the baseline, 73% of patients had impaired VAC and 63% endothelial dysfunction. After 4 months, there was a significant improvement in the VAC value (ΔVAC -0.10 ± 0.18, P = .021), mainly linked to Ea (ΔEa -0.40 ± 0.23 mm Hg/mL; P = .003). All the parameters of aortic elasticity underwent significant improvement (ΔAD 1.82 ± 1.43 cm² × dyn- ¹, P = .004; ΔASI -4.73 ± 6.07, P = .033; ΔSAS -7.98 ± 4.37%, P = .003). Lastly, we also noted a significant improvement of endothelial function (Δ RHI 0.35 ± 0.35; P < .001). At follow-up 40% of patients had impaired VAC (P = .018) and 33% endothelial dysfunction (P = .038). CONCLUSION In patients with CHF adding ivabradine on top to the standard optimized medical therapy, when indicated, seems to improve endothelial function, aortic properties, and VAC.
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Affiliation(s)
- Ivano Bonadei
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Edoardo Sciatti
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Mattia Pagnoni
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Laura Rossi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Carlo M Lombardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
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48
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Visco V, Finelli R, Pascale AV, Giannotti R, Fabbricatore D, Ragosa N, Ciccarelli M, Iaccarino G. Larger Blood Pressure Reduction by Fixed-Dose Compared to Free Dose Combination Therapy of ACE Inhibitor and Calcium Antagonist in Hypertensive Patients. Transl Med UniSa 2017; 16:17-23. [PMID: 28775965 PMCID: PMC5536158] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The introduction of fixed combination of ACEi+CCB (Fixed) has significantly increased patients compliance and adherence to therapy. At the moment, however, there are no data suggesting the better control of once-daily fixed (Fixed) over free doses in separate administrations combination therapy in hypertensives. In a population of 39 consecutive outpatient patients referred to the departmental Hypertension clinic of the University Hospital of Salerno Medical School with the first diagnosis of arterial hypertension, we tested the hypothesis that the Fixed achieve a better control of blood pressure than the Free combination. Patients were randomized to either strategy and after 3 months patients underwent a clinical assessment to evaluate the antihypertensive effect. The two groups, matched for anthropometric and clinical parameters, received Amlodipine (5-10 mg/daily) and Perindopril (5-10 mg/daily). Perindopril and Amlodipine doses did not significantly differ between the two groups. After 3 months BP control was improved in both groups and BP targets were similarly reached in both groups (SBP; Fixed: 61.54%; Free 69.23%; n.s. DPB; Fixed: 80.77%; Free 84.62%; n.s.). The reduction in systolic blood pressure was similar in both groups (Fixed:7.64±2.49%; Free: 7.81±4.00%, n.s.), while the reduction of diastolic blood pressure was greater in the Fixed group (Fixed: 14.22±2.03%; Free: 4.92±5.00%, p<0.05). Although both strategies are effective in reducing BP, the use of Fixed dose has an advantage in the reduction of BP. The present study does not allow to identify the mechanisms of this difference, which can be assumed to be due to the pharmacokinetics of the drugs administered in once-daily fixed combination.
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Affiliation(s)
- Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Rosa Finelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | | | - Rocco Giannotti
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | | | - Nicola Ragosa
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy
| | - Guido Iaccarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Italy,Address Correspondence to Guido Iaccarino MD, PhD, FESC, ()
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