1
|
Armario X, Carron J, Simpkin AJ, Elhadi M, Kennedy C, Abdel-Wahab M, Bleiziffer S, Lefèvre T, Wolf A, Pilgrim T, Villablanca PA, Blackman DJ, Van Mieghem NM, Hengstenberg C, Swaans MJ, Prendergast BD, Patterson T, Barbanti M, Webb JG, Behan M, Resar J, Chen M, Hildick-Smith D, Spence MS, Zweiker D, Bagur R, Teles R, Ribichini FL, Jagielak D, Park DW, Kornowski R, Wykrzykowska JJ, Bunc M, Estévez-Loureiro R, Poon K, Götberg M, Jeger RV, Ince H, Packer EJS, Angelillis M, Nombela-Franco L, Guo Y, Savontaus M, Al-Moghairi AM, Parasca CA, Kliger C, Roy D, Molnár L, Silva M, White J, Yamamoto M, Carrilho-Ferreira P, Toggweiler S, Voudris V, Ohno Y, Rodrigues I, Parma R, Ojeda S, Toutouzas K, Regueiro A, Grygier M, AlMerri K, Cruz-González I, Fridrich V, de la Torre Hernández JM, Noble S, Kala P, Asmarats L, Kurt IH, Bosmans J, Erglis M, Casserly I, Iskandarani D, Bhindi R, Kefer J, Yin WH, Rosseel L, Kim HS, O'Connor S, Hellig F, Sztejfman M, Mendiz O, Pineda AM, Seth A, Pllaha E, de Brito FS, Bajoras V, Balghith MA, Lee M, Eid-Lidt G, Vandeloo B, Vaz VD, Alasnag M, Ussia GP, Tay E, Mayol J, Gunasekaran S, Sardella G, Buddhari W, Kao HL, Dager A, Tzikas A, Gudmundsdottir IJ, Edris A, Gutiérrez Jaikel LA, Arias EA, Al-Hijji M, Ertürk M, Conde-Vela C, Boljević D, Ferrero Guadagnoli A, Hermlin T, ElGuindy AM, Lima-Filho MDO, de Moura Santos L, Perez L, Maluenda G, Akyüz AR, Alhaddad IA, Amin H, So CY, Al Nooryani AA, Vaca C, Albistur J, Nguyen QN, Arzamendi D, Grube E, Modine T, Tchétché D, Hayashida K, Latib A, Makkar RR, Piazza N, Søndergaard L, McEvoy JW, Mylotte D. Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study. JACC Cardiovasc Interv 2024; 17:374-387. [PMID: 38180419 DOI: 10.1016/j.jcin.2023.10.041] [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: 08/09/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected health care systems. Patients in need of transcatheter aortic valve replacement (TAVR) are especially susceptible to treatment delays. OBJECTIVES This study sought to evaluate the impact of the COVID-19 pandemic on global TAVR activity. METHODS This international registry reported monthly TAVR case volume in participating institutions prior to and during the COVID-19 pandemic (January 2018 to December 2021). Hospital-level information on public vs private, urban vs rural, and TAVR volume was collected, as was country-level information on socioeconomic status, COVID-19 incidence, and governmental public health responses. RESULTS We included 130 centers from 61 countries, including 65,980 TAVR procedures. The first and second pandemic waves were associated with a significant reduction of 15% (P < 0.001) and 7% (P < 0.001) in monthly TAVR case volume, respectively, compared with the prepandemic period. The third pandemic wave was not associated with reduced TAVR activity. A greater reduction in TAVR activity was observed in Africa (-52%; P = 0.001), Central-South America (-33%; P < 0.001), and Asia (-29%; P < 0.001). Private hospitals (P = 0.005), urban areas (P = 0.011), low-volume centers (P = 0.002), countries with lower development (P < 0.001) and economic status (P < 0.001), higher COVID-19 incidence (P < 0.001), and more stringent public health restrictions (P < 0.001) experienced a greater reduction in TAVR activity. CONCLUSIONS TAVR procedural volume declined substantially during the first and second waves of the COVID-19 pandemic, especially in Africa, Central-South America, and Asia. National socioeconomic status, COVID-19 incidence, and public health responses were associated with treatment delays. This information should inform public health policy in case of future global health crises.
Collapse
Affiliation(s)
- Xavier Armario
- Department of Cardiology, Galway University Hospital, Galway, Ireland; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jennifer Carron
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Andrew J Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - Mohamed Elhadi
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Ciara Kennedy
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | | | - Sabine Bleiziffer
- Heart and Diabetes Center Northrhine-Westfalia, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Miles Behan
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jon Resar
- John Hopkins Hospital, Baltimore, Maryland, USA
| | - Mao Chen
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | - Rodrigo Bagur
- University Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Rui Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | | | | | | | | | | | - Matjaz Bunc
- Ljubljana University Medical Center, Ljubljana, Slovenia
| | | | - Karl Poon
- The Prince Charles Hospital, Brisbane, Australia
| | - Matthias Götberg
- Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | | | | | | | | | | | - Yingqiang Guo
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | - Chad Kliger
- Lenox Hill/Northwell Health, New York, New York, USA
| | - David Roy
- St. Vincent's Hospital, Sydney, Australia
| | - Levente Molnár
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mariana Silva
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Masanori Yamamoto
- Toyohashi Heart Center, Toyohashi, Japan; Nagoya Heart Center, Nagoya, Japan; Gifu Heart Center, Gifu, Japan
| | | | | | | | - Yohei Ohno
- Tokai University School of Medicine, Isehara, Japan
| | | | | | - Soledad Ojeda
- Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | | | | | - Marek Grygier
- Poznan University School of Medical Sciences, Poznan, Poland
| | | | | | - Viliam Fridrich
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | | | | | - Petr Kala
- Centrum Kardiovaskulární a Transplantační Chirurgie, Brno, Czechia
| | | | | | | | | | - Ivan Casserly
- Mater Misericordiae University Hospital, Dublin, Ireland; Mater Private Hospital, Dublin, Ireland
| | | | | | - Joelle Kefer
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | | | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | | | | | | | - Andres M Pineda
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida, USA
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | - Vilhelmas Bajoras
- Division of Cardiology and Vascular Diseases, Vilnius University Hospital Santaros Clinics, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Michael Lee
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Guering Eid-Lidt
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | | | | | - Gian Paolo Ussia
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Edgar Tay
- National University Heart Center, Singapore, Singapore
| | | | | | | | | | - Hsien-Li Kao
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | - Ahmad Edris
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | | | | | - Mehmet Ertürk
- Istanbul Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | | | | | | | | | | | - Moysés de Oliveira Lima-Filho
- Hospital das Clínicas de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | - Luis Perez
- Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
| | - Gabriel Maluenda
- Hospital San Borja Arriaran, Santiago, Chile; Clínica Alemana, Santiago, Chile
| | - Ali Rıza Akyüz
- Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Trabzon, Turkey
| | | | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain
| | - Chak-Yu So
- Prince of Wales Hospital, Hong Kong, Hong Kong
| | | | - Carlos Vaca
- Instituto de Cardiología Intervencionista Cardiovida SRL, Santa Cruz, Bolivia
| | - Juan Albistur
- Hospital de Clínicas Dr Manuel Quintela, Montevideo, Uruguay
| | | | | | | | | | | | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nicolo Piazza
- McGill University Health Center, Montréal, Quebec, Canada
| | | | - John William McEvoy
- Department of Cardiology, Galway University Hospital, Galway, Ireland; School of Medicine, University of Galway, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, Galway, Ireland; School of Medicine, University of Galway, Galway, Ireland.
| |
Collapse
|
2
|
Masè M, Rossi M, Setti M, Barbati G, Teso MV, Ribichini FL, Koni M, Stolfo D, Merlo M, Sinagra G. Applicability and performance of heart failure prognostic scores in dilated cardiomyopathy: the real-world experience of an Italian referral center for cardiomyopathies. Int J Cardiol 2024; 396:131562. [PMID: 37907097 DOI: 10.1016/j.ijcard.2023.131562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/26/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND The performance of heart failure (HF) risk models is validated in the general population with HF but in specific aetiological settings, and specifically in dilated cardiomyopathy (DCM), has scarcely been explored. We tested eight of the main prognostic scores used in HF in a large real-world population of patients with DCM. METHODS We included 784 consecutive DCM patients enrolled, both inpatients and outpatients, enrolled between January 2000 and December 2017. The risk of 1 and/or 3-year all-cause mortality/heart transplantation/durable left ventricular assist device (LVAD) implantation (D/HTx/LVAD) was estimated in our cohort according to the following risk scores SHFM, 3-CHF, CHARM, MAGGIC, GISSI-HF, MECKI, Barcelona Bio-HF, Krakow score and their accuracy calculated through the receiver operator characteristic (ROC) curve analysis. RESULTS During a median follow-up of 5.8 years (Interquartile Range 3.2-7.6 years), 191 patients (20%) died or underwent HTx/LVAD (158 deaths, 30 heart transplantations, and 3 LVAD implantations). The high missing rate allowed to calculated only four prognostic models (MAGGIC, CHARM, 3-CHF and SHFM). All the scores overestimated the rate of D/HTx/LVAD. The prognostic accuracy was suboptimal for MAGGIC (AUC 0.754) and CHARM (AUC 0.720) scores and only modest for 3-CHF (AUC 0.677) and SHFM (AUC 0.667). CONCLUSIONS Main prognostic scores for the risk stratification of HF are only partially applicable to real-world patients with DCM. MAGGIC and CHARM scores showed the best accuracy, despite the overestimation of risk. Our findings corroborate the need of specific risk scores for the prognostic stratification of DCM. CLINICAL PERSPECTIVE What is new? The present study is the largest analysis in literature which investigate how the main existing heart failure prognostic risk scores performed in a real-world of dilated cardiomyopathy population, both in- and outpatients. What are the clinical implications? DCM is a stand-alone model of heart failure, where the performance of multiple heart failure prognostic scores for the risk stratification is quite limited. The need for contemporary, dedicated prognostic scores in this disease is increasingly evident.
Collapse
Affiliation(s)
- M Masè
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - M Rossi
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - M Setti
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy; Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - G Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | | | - F L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Italy
| | - M Koni
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - D Stolfo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| | - M Merlo
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy.
| | - G Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy
| |
Collapse
|
3
|
Lunardi M, Mamas MA, Mauri J, Molina CM, Rodriguez-Leor O, Eggington S, Pietzsch JB, Papo NL, Walleser-Autiero S, Baumbach A, Maisano F, Ribichini FL, Mylotte D, Barbato E, Piek JJ, Wijns W, Naber CK. Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries. Eur Heart J Qual Care Clin Outcomes 2024; 10:25-35. [PMID: 37286294 DOI: 10.1093/ehjqcco/qcad025] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/13/2023] [Accepted: 05/11/2023] [Indexed: 06/09/2023]
Abstract
AIMS As a consequence of untimely or missed revascularization of ST-elevation myocardial infarction (STEMI) patients during the COVID-19 pandemic, many patients died at home or survived with serious sequelae, resulting in potential long-term worse prognosis and related health-economic implications.This analysis sought to predict long-term health outcomes [survival and quality-adjusted life-years (QALYs)] and cost of reduced treatment of STEMIs occurring during the first COVID-19 lockdown. METHODS AND RESULTS Using a Markov decision-analytic model, we incorporated probability of hospitalization, timeliness of PCI, and projected long-term survival and cost (including societal costs) of mortality and morbidity, for STEMI occurring during the first UK and Spanish lockdowns, comparing them with expected pre-lockdown outcomes for an equivalent patient group.STEMI patients during the first UK lockdown were predicted to lose an average of 1.55 life-years and 1.17 QALYs compared with patients presenting with a STEMI pre-pandemic. Based on an annual STEMI incidence of 49 332 cases, the total additional lifetime costs calculated at the population level were £36.6 million (€41.3 million), mainly driven by costs of work absenteeism. Similarly in Spain, STEMI patients during the lockdown were expected to survive 2.03 years less than pre-pandemic patients, with a corresponding reduction in projected QALYs (-1.63). At the population level, reduced PCI access would lead to additional costs of €88.6 million. CONCLUSION The effect of a 1-month lockdown on STEMI treatment led to a reduction in survival and QALYs compared to the pre-pandemic era. Moreover, in working-age patients, untimely revascularization led to adverse prognosis, affecting societal productivity and therefore considerably increasing societal costs.
Collapse
Affiliation(s)
- Mattia Lunardi
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
- Division of Cardiology, University Hospital of Verona, Verona, Italy
| | - Mamas A Mamas
- Keele Cardiovascular Research, Keele University, Stoke on Trent, UK
| | - Josepa Mauri
- Gerència de Processos Integrats de Salut. Àrea Assistencial. Servei Català de la Salut. Generalitat de Catalunya, Barcelona, Spain
- Institut del Cor, Hospital Universiari Germans Trias i Pujol, Badalona, Spain
| | - Carmen Medina Molina
- Registry of Myocardial Infarction, Catalan Health Service, Catalunyia, Barcelona, Spain
| | | | - Simon Eggington
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Natalie L Papo
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Silke Walleser-Autiero
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Francesco Maisano
- Valve Center OSR, Cardiac Surgery IRCCS San Raffaele Hospital, Vita Salute University UniSR, Milano, Italy
| | | | - Darren Mylotte
- Galway University Hospital, SAOLTA Healthcare Group and University of Galway, Galway, Ireland
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, Roma, Italy
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
| | - Christoph K Naber
- Department of Internal Medicine I, Cardiology and Intensive Care, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| |
Collapse
|
4
|
Benfari G, Essayagh B, Michelena HI, Ye Z, Inojosa JM, Ribichini FL, Crestanello J, Messika-Zeitoun D, Prendergast B, Wong BF, Thapa P, Enriquez-Sarano M. Severe aortic stenosis: secular trends of incidence and outcomes. Eur Heart J 2024:ehad887. [PMID: 38190428 DOI: 10.1093/eurheartj/ehad887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND AND AIMS Severe aortic stenosis (AS) is the guideline-based indication for aortic valve replacement (AVR), which has markedly increased with transcatheter approaches, suggesting possible increasing AS incidence. However, reported secular trends of AS incidence remain contradictory and lack quantitative Doppler echocardiographic ascertainment. METHODS All adults residents in Olmsted County (MN, USA) diagnosed over 20 years (1997-2016) with incident severe AS (first diagnosis) based on quantitatively defined measures (aortic valve area ≤ 1 cm2, aortic valve area index ≤ 0.6 cm2/m2, mean gradient ≥ 40 mmHg, peak velocity ≥ 4 m/s, Doppler velocity index ≤ 0.25) were counted to define trends in incidence, presentation, treatment, and outcome. RESULTS Incident severe AS was diagnosed in 1069 community residents. The incidence rate was 52.5 [49.4-55.8] per 100 000 patient-year, slightly higher in males vs. females and was almost unchanged after age and sex adjustment for the US population 53.8 [50.6-57.0] per 100 000 residents/year. Over 20 years, severe AS incidence remained stable (P = .2) but absolute burden of incident cases markedly increased (P = .0004) due to population growth. Incidence trend differed by sex, stable in men (incidence rate ratio 0.99, P = .7) but declining in women (incidence rate ratio 0.93, P = .02). Over the study, AS clinical characteristics remained remarkably stable and AVR performance grew and was more prompt (from 1.3 [0.1-3.3] years in 1997-2000 to 0.5 [0.2-2.1] years in 2013-16, P = .001) but undertreatment remained prominent (>40%). Early AVR was associated with survival benefit (adjusted hazard ratio 0.55 [0.42-0.71], P < .0001). Despite these improvements, overall mortality (3-month 8% and 3-year 36%), was swift, considerable and unabated (all P ≥ .4) throughout the study. CONCLUSIONS Over 20 years, the population incidence of severe AS remained stable with increased absolute case burden related to population growth. Despite stable severe AS presentation, AVR performance grew notably, but while declining, undertreatment remained substantial and disease lethality did not yet decline. These population-based findings have important implications for improving AS management pathways.
Collapse
Affiliation(s)
- Giovanni Benfari
- Department ofCardiovascular Disease, Mayo Clinic, Rochester, MN, USA
- Section of Cardiology, University of Verona, Verona, Italy
| | - Benjamin Essayagh
- Department ofCardiovascular Disease, Mayo Clinic, Rochester, MN, USA
- Department of Echocardiography, Cardio X Clinic, Cannes, France
| | | | - Zi Ye
- Department ofCardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | | | | | - Juan Crestanello
- Department ofCardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - David Messika-Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Bernard Prendergast
- Department of Cardiology, Cleveland Clinic and Saint Thomas' Hospitals, London, UK
| | | | - Prabin Thapa
- Department ofCardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
5
|
Barbato E, Gallinoro E, Abdel-Wahab M, Andreini D, Carrié D, Di Mario C, Dudek D, Escaned J, Fajadet J, Guagliumi G, Hill J, McEntegart M, Mashayekhi K, Mezilis N, Onuma Y, Reczuch K, Shlofmitz R, Stefanini G, Tarantini G, Toth GG, Vaquerizo B, Wijns W, Ribichini FL. Management strategies for heavily calcified coronary stenoses: an EAPCI clinical consensus statement in collaboration with the EURO4C-PCR group. Eur Heart J 2023; 44:4340-4356. [PMID: 37208199 DOI: 10.1093/eurheartj/ehad342] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 05/28/2022] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
Since the publication of the 2015 EAPCI consensus on rotational atherectomy, the number of percutaneous coronary interventions (PCI) performed in patients with severely calcified coronary artery disease has grown substantially. This has been prompted on one side by the clinical demand for the continuous increase in life expectancy, the sustained expansion of the primary PCI networks worldwide, and the routine performance of revascularization procedures in elderly patients; on the other side, the availability of new and dedicated technologies such as orbital atherectomy and intravascular lithotripsy, as well as the optimization of the rotational atherectomy system, has increased operators' confidence in attempting more challenging PCI. This current EAPCI clinical consensus statement prepared in collaboration with the EURO4C-PCR group describes the comprehensive management of patients with heavily calcified coronary stenoses, starting with how to use non-invasive and invasive imaging to assess calcium burden and inform procedural planning. Objective and practical guidance is provided on the selection of the optimal interventional tool and technique based on the specific calcium morphology and anatomic location. Finally, the specific clinical implications of treating these patients are considered, including the prevention and management of complications and the importance of adequate training and education.
Collapse
Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa n. 1035, Rome, 00189, Italy
| | - Emanuele Gallinoro
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Division of University Cardiology, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Didier Carrié
- Service de Cardiologie B, CHU Rangueil, Université Paul Sabatier, Toulouse, France
| | - Carlo Di Mario
- Interventional Structural Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Javier Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Madrid, Spain
| | | | | | - Jonathan Hill
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Margaret McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, MediClin Heart Institute Lahr/Baden, Lahr & Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - Yoshinobu Onuma
- Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Toyoake, Japan
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | - Krzyszstof Reczuch
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Giulio Stefanini
- Humanitas Clinical and Research Hospital IRCCS & Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gabor G Toth
- University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Beatriz Vaquerizo
- Unidad de Cardiología Intervencionista, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory, Corrib Core Laboratory and Curam, National University of Ireland, Galway, Ireland
| | - Flavio L Ribichini
- Cardiovascular Section of the Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
6
|
Tafciu E, Niro L, Iseppi M, Fanti D, Maffeis C, Bergamini C, Benfari G, Rossi A, Ribichini FL. Right Atrial Function Role in Tricuspid Regurgitation-Related Systemic Venous Congestion. Am J Cardiol 2023; 204:320-324. [PMID: 37567024 DOI: 10.1016/j.amjcard.2023.07.107] [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: 04/08/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
Tricuspid regurgitation (TR) is a frequent valvular pathology and when significant, may cause systemic venous congestion (SC). The right atrium (RA) is an intermediate structure between the tricuspid valve and the venous system and its role in SC is not yet defined. A total of 116 patients with a measurable TR effective regurgitant orifice area (EROA) and regurgitant volume (RVol) were selected from 2020 to 2022. SC was estimated by echocardiography using inferior vena cava diameter and estimated right atrial pressure (eRAP) and by clinical congestive features. TR grade was mild in 23 patients (20%), moderate in 53 patients (46%), and severe in 40 patients (34%). There was a significant decrease in RA function measured by strain with increasing TR severity (p <0.001). There was a marked difference in RA strain between the groups with eRAP >10 and ≤10 mm Hg (25 ± 11% vs 11 ± 7%, p <0.0001). Variables independently associated with inferior vena cava diameter were RA strain (β -0.532, p <0.001), RA volume indexed (β 0.249, p = 0.002), RVol (β 0.229, p = 0.005) and EROA (β 0.185, p = 0.016), and independently associated with eRAP >10 mm Hg were EROA (odds ratio [OR] 1.024, 95% confidence interval [CI] 1.002 to 1.046), RVol (OR 1.039, 95% CI 1.007 to 1.072) and RA strain (OR 0.863, 95% CI 0.794 to 0.940). The addition of RA strain to models containing EROA or RVol significantly improved the power of the model. RA strain was independently associated with the presence of 3 or more congestive features. In conclusion, echocardiographic and clinical signs of SC are frequent in higher degrees of TR, and RA function seems to play a key role in modulating the downstream effect of TR.
Collapse
Affiliation(s)
- Elvin Tafciu
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
| | - Lorenzo Niro
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Manuela Iseppi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Diego Fanti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Caterina Maffeis
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
7
|
Pacchioni A, Pesarini G, Sanz-Sanchez J, Sgueglia GA, Bellamoli M, Ferro J, Mugnolo A, Morandin R, Penzo C, Turri R, Guiducci V, Benfari G, Giovannini D, Saccà S, Ribichini FL, Versaci F, Biondi-Zoccai G, Reimers B. Radial artery occlusion after transradial procedures: impact on 1-year adverse events. Minerva Cardiol Angiol 2023; 71:414-420. [PMID: 36468762 DOI: 10.23736/s2724-5683.22.06112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Radial artery occlusion after transradial procedures is a frequent iatrogenic thrombotic process. The impact on prognosis has not been investigated. This study sought to investigate whether radial artery occlusion is related to increased risk of major adverse cardiac and cerebrovascular events, defined as death, myocardial infarction, stroke and coronary revascularization. METHODS Eight hundred thirty-seven consecutive patients who underwent a transradial coronary procedure had patency of radial artery checked at 24 hours. Radial artery occlusion occurred in 41 over 837 patients (4.8%); 764 (91.2%) were available for planned follow-up at 1 year and were included in the analysis. Event-free survival rate between patients with and without radial artery occlusion was calculated using Kaplan-Meier estimates, and Cox proportional-hazards models were used to identify independent risk factors. RESULTS At a median 370-day follow-up (IQR: 366-375 days), adverse events occurred in 37 patients (4.8%), 2 in patients with radial artery occlusion and 35 in patients without. One-year survival rate was 94.9% vs. 95% (unadjusted HR=1.026, 95% CI: 0.24 to 4.6, P=0.9). After multivariable modeling, age and coronary artery disease extension was associated with increased risk of adverse events. CONCLUSIONS Age and coronary artery disease extension were independent predictors of adverse events at follow-up. RAO had no prognostic impact.
Collapse
Affiliation(s)
- Andrea Pacchioni
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy -
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jorge Sanz-Sanchez
- Division of Cardiology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Division of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain
- Centro de Investigation Biomedica en Red (CIBERCV), Madrid, Spain
| | | | - Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jayme Ferro
- Arcispedale Santa Maria, Reggio Emilia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Riccardo Morandin
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Penzo
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Riccardo Turri
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | | | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Davide Giovannini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Salvatore Saccà
- Division of Cardiology, Ospedale Civile, Mirano, Venice, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Versaci
- UOC of Hemodynamics and Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Bernhard Reimers
- Division of Cardiology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| |
Collapse
|
8
|
Abdel-Wahab M, Richter I, Taramasso M, Unbehaun A, Rudolph T, Ribichini FL, Binder R, Schofer J, Mangner N, Dambrink JH, Trejo-Velasco B, Thiele H, Kitamura M, Lanz J. Procedural and one-year outcomes of the BASILICA technique in Europe: the multicentre EURO-BASILICA registry. EUROINTERVENTION 2023:EIJ-D-22-00960. [PMID: 37103779 PMCID: PMC10397663 DOI: 10.4244/eij-d-22-00960] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The real-world outcomes of the use of the BASILICA (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction) transcatheter technique in Europe have not been described. AIMS We sought to evaluate the procedural and one-year outcomes of BASILICA in patients at high risk for coronary artery obstruction (CAO) undergoing transcatheter aortic valve implantation (TAVI) in a multicentre European registry (EURO-BASILICA). METHODS Seventy-six patients undergoing BASILICA and TAVI at ten European centres were included. Eighty-five leaflets were identified as targets for BASILICA due to high risk for CAO. The updated Valve Academic Research Consortium 3 (VARC-3) definitions were used to determine prespecified endpoints of technical and procedural success and adverse events up to one year. RESULTS Treated aortic valves included native (5.3%), surgical bioprosthetic (92.1%) and transcatheter valves (2.6%). Double BASILICA (for both left and right coronary cusps) was performed in 11.8% of patients. Technical success with BASILICA was achieved in 97.7% and resulted in freedom from any target leaflet-related CAO in 90.6% with a low rate of complete CAO (2.4%). Target leaflet-related CAO occurred significantly more often in older and stentless bioprosthetic valves and with higher implantation levels of transcatheter heart valves. Procedural success was 88.2%, and freedom from VARC-3-defined early safety endpoints was 79.0%. One-year survival was 84.2%; 90.5% of patients were in New York Heart Association Functional Class I/II. CONCLUSIONS EURO-BASILICA is the first multicentre study evaluating the BASILICA technique in Europe. The technique appeared feasible and effective in preventing TAVI-induced CAO, and one-year clinical outcomes were favourable. The residual risk for CAO requires further study.
Collapse
Affiliation(s)
- Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Ines Richter
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Maurizio Taramasso
- Department of Cardiac Surgery, HerzZentrum Hirslanden, Zürich, Switzerland and University of Zürich, Zürich, Switzerland
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Tanja Rudolph
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | | | - Ronald Binder
- Department of Cardiology and Intensive Care, University Teaching Hospital Klinikum Wels-Grieskrichen, Wels, Austria
| | - Joachim Schofer
- Medical Care Center and Department for Percutaneous Treatment of Valvular Heart Disease, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Norman Mangner
- Department of Cardiology, Heart Center Dresden, Dresden, Germany
| | - Jan-Henk Dambrink
- Department of Cardiology, Isala Klinieken, De Weezenlanden Hospital, Zwolle, the Netherlands
| | - Blanca Trejo-Velasco
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jonas Lanz
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
9
|
Cannata S, Gandolfo C, Ribichini FL, van Mieghem N, Buccheri S, Barbanti M, Berti S, Teles RC, Bartorelli AL, Musumeci G, Piva T, Nombela-Franco L, La Spina K, Palmerini T, Adrichem R, Esposito A, Lopes P, Olivares P, Annibali G, Nicolini E, Marroquin L, Tamburino C, Tarantini G, Saia F. One-year outcomes after transcatheter aortic valve implantation with the latest-generation SAPIEN balloon-expandable valve: the S3U registry. EUROINTERVENTION 2023; 18:1418-1427. [PMID: 36880333 PMCID: PMC10111124 DOI: 10.4244/eij-d-22-01022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/09/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Initial data about the performance of the new-generation SAPIEN 3 Ultra (S3U) valve are highly promising. However, evidence about the longer-term performance and safety of the S3U is scarce. AIMS We aimed to investigate the 1-year clinical and echocardiographic outcomes of transcatheter aortic valve implantation (TAVI) using the S3U compared with its predecessor, the SAPIEN 3 valve (S3). METHODS The SAPIEN 3 Ultra registry included consecutive patients who underwent transfemoral TAVI at 12 European centres with the S3U or S3 between October 2016 and December 2020. One-to-one propensity score (PS) matching was performed to account for differences in baseline characteristics. The primary outcomes of interest were all-cause death and the composite of all-cause death, disabling stroke and hospitalisation for heart failure at 1 year. RESULTS The overall study cohort encompassed 1,692 patients treated with either the S3U (n=519) or S3 (n=1,173). The PS-matched population had a total of 992 patients (496 per group). At 1 year, the rate of death from any cause was 4.9% in the S3U group and 6.3% in the S3 group (p=0.743). Similarly, there were no significant differences in the rates of the primary composite outcome (9.5% in the S3 group and 6.6% in the S3U group; p=0.162). The S3U was associated with lower rates of mild paravalvular leak (PVL) compared with the S3 (odds ratio 0.63, 95% confidence interval: 0.44 to 0.88; p<0.01). No significant differences in transprosthetic gradients were observed between the two groups. CONCLUSIONS Compared with the S3, the S3U transcatheter heart valve was associated with similar 1-year clinical outcomes but reduced rates of mild PVL.
Collapse
Affiliation(s)
- Stefano Cannata
- Unit of Interventional Cardiology, Department of Cardiothoracic Surgery, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), UPMC, Palermo, Italy
| | - Caterina Gandolfo
- Unit of Interventional Cardiology, Department of Cardiothoracic Surgery, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), UPMC, Palermo, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Nicolas van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Thorax Center, Rotterdam, the Netherlands
| | - Sergio Buccheri
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
| | - Marco Barbanti
- Division of Cardiology, AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Sergio Berti
- UOC Cardiologia Diagnostica e Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Massa, Italy
| | - Rui Campante Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | | | | | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Ketty La Spina
- Unit of Interventional Cardiology, Department of Cardiothoracic Surgery, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), UPMC, Palermo, Italy
| | - Tullio Palmerini
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| | - Rik Adrichem
- Department of Cardiology, Erasmus University Medical Center, Thorax Center, Rotterdam, the Netherlands
| | - Augusto Esposito
- UOC Cardiologia Diagnostica e Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Massa, Italy
| | - Pedro Lopes
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Paolo Olivares
- Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy
| | | | - Elisa Nicolini
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Corrado Tamburino
- UOC Cardiologia Diagnostica e Interventistica, Fondazione C.N.R. Reg. Toscana G. Monasterio, Massa, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Policlinico S. Orsola, Bologna, Italy
| |
Collapse
|
10
|
A Prado GF, Blanco PJ, Bulant CA, Ares GD, Mariani J, Caixeta A, Almeida BO, Garzon S, Pinton FA, Barbato E, Ribichini FL, Toth GG, Mahfoud F, Wijns W, Garcia-Garcia HM, Lemos PA. Quantitative coronary three-dimensional geometry and its association with atherosclerotic disease burden and composition. Catheter Cardiovasc Interv 2023; 101:1036-1044. [PMID: 37017418 DOI: 10.1002/ccd.30639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/09/2023] [Accepted: 03/06/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Isolate features of the coronary anatomy have been associated with the pathophysiology of atherosclerotic disease. Computational methods have been described to allow precise quantification of the complex three-dimensional (3D) coronary geometry. The present study tested whether quantitative parameters that describe the spatial 3D coronary geometry is associated with the extension and composition of the underlying coronary artery disease (CAD). METHODS Patients with CAD scheduled for percutaneous intervention were investigated with coronary computed tomography angiography (CCTA), and invasive coronary angiography, and virtual histology intravascular ultrasound (IVUS-VH). For all target vessels, 3D centerlines were extracted from CCTA images and processed to quantify 23 geometric indexes, grouped into 3 main categories as follows: (i) length-based; (ii) curvature-based, torsion-based, and curvature/torsion-combined; (iii) vessel path-based. The geometric variables were compared with IVUS-VH parameters assessing the extent and composition of coronary atherosclerosis. RESULTS A total of 36 coronary patients (99 vessels) comprised the study population. From the 23 geometric indexes, 18 parameters were significantly (p < 0.05) associated with at least 1 IVUS-VH parameter at a univariate analysis. All three main geometric categories provided parameters significantly related with atherosclerosis variables. The 3D geometric indexes were associated with the degree of atherosclerotic extension, as well as with plaque composition. Geometric features remained significantly associated with all IVUS-VH parameters even after multivariate adjustment for clinical characteristics. CONCLUSIONS Quantitative 3D vessel morphology emerges as a relevant factor associated with atherosclerosis in patients with established CAD.
Collapse
Affiliation(s)
- Guy F A Prado
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Pablo J Blanco
- Department of Mathematical and Computational Methods, National Laboratory for Scientific Computing LNCC/MCTI, Petrópolis, Brazil
| | - Carlos A Bulant
- Pladema Institute, National University of the Center and National Scientific and Technical Research Council, CONICET, Tandil, Buenos Aires, Argentina
| | - Gonzalo D Ares
- National University of Mar del Plata, Mar del Plata, Buenos Aires, Argentina
| | - Jose Mariani
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Adriano Caixeta
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Breno O Almeida
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Stefano Garzon
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Fábio A Pinton
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Gabor G Toth
- Graz University Heart Center, Medical University Graz, Graz, Austria
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | - Hector M Garcia-Garcia
- Department of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Pedro A Lemos
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Department of Interventional Cardiology, InCor-FMUSP, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
11
|
Leone PP, Regazzoli D, Pagnesi M, Cannata F, Mangieri A, Hokken TW, Costa G, Barbanti M, Teles RC, Adamo M, Taramasso M, Reifart J, De Marco F, Giannini F, Kargoli F, Ohno Y, Saia F, Buono A, Ielasi A, Pighi M, Chiarito M, Bongiovanni D, Cozzi O, Stefanini G, Ribichini FL, Maffeo D, Chizzola G, Bedogni F, Kim WK, Maisano F, Tamburino C, Van Mieghem NM, Colombo A, Reimers B, Latib A. Implantation of contemporary transcatheter aortic valves in small aortic annuli: the international multicentre TAVI-SMALL 2 registry. EUROINTERVENTION 2023:EIJ-D-22-00843. [PMID: 36950893 DOI: 10.4244/eij-d-22-00843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Treatment of aortic stenosis in patients with small annuli is challenging and can result in prosthesis-patient mismatch (PPM). AIMS We aimed to compare the forward flow haemodynamics and clinical outcomes of contemporary transcatheter valves in patients with small annuli. METHODS The TAVI-SMALL 2 international retrospective registry included 1,378 patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm2) treated with transfemoral self-expanding (SEV; n=1,092) and balloon-expandable valves (BEV; n=286) in 16 high-volume centres between 2011 and 2020. Analyses comparing SEV versus BEV and supra-annular (SAV; n=920) versus intra-annular valves (IAV; n=458) included inverse probability of treatment weighting (IPTW). The primary endpoints were the predischarge mean aortic gradient and incidence of severe PPM. The secondary endpoint was the incidence of more than mild paravalvular leak (PVL). RESULTS The predischarge mean aortic gradient was lower after SAV versus IAV (7.8±3.9 vs 12.0±5.1; p<0.001) and SEV versus BEV implantation (8.0±4.1 vs 13.6±4.7; p<0.001). Severe PPM was more common with IAV and BEV when compared to SAV and SEV implantation, respectively, (8.8% vs 3.6%; p=0.007 and 8.7% vs 4.6%; p=0.041). At multivariable logistic regression weighted by IPTW, SAV protected from severe PPM regardless of its definition. More than mild PVL occurred more often with SEV versus BEV (11.6% vs 2.6%; p<0.001). CONCLUSIONS In small aortic annuli, implantation of SAV and SEV was associated with a more favourable forward haemodynamic profile than after IAV and BEV implantation, respectively. More than mild PVL was more common after SEV than BEV implantation.
Collapse
Affiliation(s)
- Pier Pasquale Leone
- Montefiore Medical Center, New York, NY, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Thijmen W Hokken
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Giuliano Costa
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Marco Barbanti
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich, Zurich, Switzerland and University of Zurich, Zurich, Switzerland
| | - Jorg Reifart
- DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | - Yohei Ohno
- Department of Cardiology, Tokai University Hospital, Kanagawa, Japan
| | - Francesco Saia
- Cardiology Unit, Sant'Orsola Polyclinic, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Dario Bongiovanni
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Ottavia Cozzi
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giuliano Chizzola
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy.Misc
| | - Corrado Tamburino
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| |
Collapse
|
12
|
Barbato E, Azizi M, Schmieder RE, Lauder L, Böhm M, Brouwers S, Bruno RM, Dudek D, Kahan T, Kandzari DE, Lüscher TF, Parati G, Pathak A, Ribichini FL, Schlaich MP, Sharp ASP, Sudano I, Volpe M, Tsioufis C, Wijns W, Mahfoud F. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EUROINTERVENTION 2023; 18:1227-1243. [PMID: 36789560 PMCID: PMC10020821 DOI: 10.4244/eij-d-22-00723] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/19/2022] [Indexed: 02/16/2023]
Abstract
Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.
Collapse
Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michel Azizi
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France
- Hypertension Department, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France and FCRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany and Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Hospital Aalst, Aalst, Belgium and Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rosa Maria Bruno
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France
- Pharmacology Unit, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland and GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Thomas Kahan
- Department of Clinical Sciences, Karolinska Institute, Solna, Sweden and Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden and Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | | | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals, London, UK, and National Heart and Lung Institute, Imperial College, London, UK, and School of Cardiovascular Medicine and Sciences, Kings College London, London, UK, and Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy and Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Atul Pathak
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, Perth, WA, Australia, and Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia and Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia
| | - Andrew S P Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Isabella Sudano
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Massimo Volpe
- Department of Cardiology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Costas Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece and Hippocratio Hospital, Athens, Greece
| | - William Wijns
- The Lambe Institute for Translational Medicine, Galway, Ireland and University of Galway, Galway, Ireland
- The Smart Sensors Lab, London, UK and CURAM, London, UK
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| |
Collapse
|
13
|
Mugnai G, Donazzan L, Tomasi L, Piccoli A, Cavedon S, Pescoller F, Bolzan B, Perrone C, Rauhe WG, Oberhollenzer R, Bilato C, Ribichini FL. The usefulness of QRS Index for prediction of echocardiographic response in cardiac resynchronization therapy: a multicenter study. Minerva Cardiol Angiol 2023:S2724-5683.23.06245-2. [PMID: 36912167 DOI: 10.23736/s2724-5683.23.06245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND The association between QRS narrowing and response to cardiac resynchronization therapy (CRT) has been investigated by several studies, but their findings remain inconclusive. Aim of our study was to explore the relationship between QRS Index and echocardiographic response to CRT. METHODS This multicenter, retrospective analysis included 326 consecutive patients (mean age was 70.0±10.1 years old; males 76.7%) who underwent CRT-D implantation in primary and secondary prevention between 2018 and 2020. The estimation of QRS shortening after CRT-D implantation was precisely assessed through the QRS Index, calculated as follows: [(QRS duration before implantation - paced QRS duration)/QRS duration before implantation]*100. RESULTS After a mean follow-up of 12.7±4.5 months, 55.2% (180/326) of the patients showed an echocardiographic response to CRT. The median [25-75th] QRS Index was 3.85% [-14.1% - +13.9%]. The best predictive cut-off value of QRS Index was 1.40% (sensitivity 70.4%, specificity 64.5%, AUC 0.70). In patients with left bundle branch block, the median [25-75th] QRS Index was 9.85% [+3.87% - +16.7%]. In this subgroup, the AUC was 0.737 and the best predictive cut-off of QRS Index was 2.20% (sensitivity 78.3%, specificity 67%). The multivariable model showed that only left ventricular ejection fraction and QRS Index were independently associated with CRT response (respectively OR 0.92, CI 95% 0.86-0.98, P=0.01 and OR 1.057, CI 95% 1.026-1.089, P<0.001). CONCLUSIONS the QRS Index tightly correlated with CRT response. Only LVEF and QRS Index were independently associated with echocardiographic response to CRT.
Collapse
Affiliation(s)
- Giacomo Mugnai
- Unit of Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy -
| | - Luca Donazzan
- Unit of Electrophysiology and Cardiac Pacing, San Maurizio Regional Hospital, Bolzano, Italy
| | - Luca Tomasi
- Unit of Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Anna Piccoli
- Unit of Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Stefano Cavedon
- Unit of Electrophysiology and Cardiac Pacing, Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | - Felix Pescoller
- Unit of Electrophysiology and Cardiac Pacing, San Maurizio Regional Hospital, Bolzano, Italy
| | - Bruna Bolzan
- Unit of Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Cosimo Perrone
- Unit of Electrophysiology and Cardiac Pacing, Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | - Werner G Rauhe
- Unit of Electrophysiology and Cardiac Pacing, San Maurizio Regional Hospital, Bolzano, Italy
| | - Rainer Oberhollenzer
- Unit of Electrophysiology and Cardiac Pacing, San Maurizio Regional Hospital, Bolzano, Italy
| | - Claudio Bilato
- Unit of Electrophysiology and Cardiac Pacing, Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | - Flavio L Ribichini
- Unit of Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| |
Collapse
|
14
|
Barbato E, Azizi M, Schmieder RE, Lauder L, Böhm M, Brouwers S, Bruno RM, Dudek D, Kahan T, Kandzari DE, Lüscher TF, Parati G, Pathak A, Ribichini FL, Schlaich MP, Sharp ASP, Sudano I, Volpe M, Tsioufis C, Wijns W, Mahfoud F. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2023; 44:1313-1330. [PMID: 36790101 DOI: 10.1093/eurheartj/ehad054] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [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: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.
Collapse
Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michel Azizi
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France.,Hypertension Department, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France.,FCRIN INI-CRCT, Universitéde Lorraine, Nancy, France
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.,Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Hospital Aalst, Aalst, Belgium.,Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rosa Maria Bruno
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France.,Pharmacology Unit, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,GVM Care &Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Thomas Kahan
- Department of Clinical Sciences, Karolinska Institute, Solna, Sweden.,Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | | | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals, London, UK.,National Heart and Lung Institute, Imperial College, London, UK.,School of Cardiovascular Medicine and Sciences, Kings College London, London, UK.,Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Atul Pathak
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, Perth, WA, Australia.,Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia
| | - Andrew S P Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Isabella Sudano
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Massimo Volpe
- Department of Cardiology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Costas Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece.,Hippocratio Hospital, Athens, Greece
| | - William Wijns
- The Lambe Institute for Translational Medicine, Galway, Ireland.,University of Galway, Galway, Ireland.,The Smart Sensors Lab, London, UK.,CURAM, London, UK
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| |
Collapse
|
15
|
Tarantini G, Fovino LN, Varbella F, Trabattoni D, Caramanno G, Trani C, De Cesare N, Esposito G, Montorfano M, Musto C, Picchi A, Sheiban I, Gasparetto V, Ribichini FL, Cardaioli F, Saccà S, Cerrato E, Napodano M, Martinato M, Azzolina D, Andò G, Mugnolo A, Caruso M, Rossini R, Passamonti E, Teles RC, Rigattieri S, Gregori D, Tamburino C, Burzotta F. A large, prospective, multicentre study of left main PCI using a latest-generation zotarolimus-eluting stent: the ROLEX study. EUROINTERVENTION 2023; 18:e1108-e1119. [PMID: 36043326 PMCID: PMC9909455 DOI: 10.4244/eij-d-22-00454] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 05/18/2022] [Accepted: 07/11/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Data on left main (LM) percutaneous coronary interventions (PCI) have mostly been obtained in studies using drug-eluting stent (DES) platforms without dedicated large-vessel devices and with limited expansion capability. AIMS Our study aimed to investigate the safety and efficacy of LM PCI with the latest-generation Resolute Onyx DES. METHODS ROLEX (Revascularization Of LEft main with resolute onyX) is a prospective, multicentre study (ClinicalTrials.gov: NCT03316833) enrolling patients with unprotected LM coronary artery disease and a SYNTAX score <33 undergoing PCI with the Resolute Onyx zotarolimus-eluting coronary stent, that includes dedicated extra-large vessel platforms. The primary endpoint (EP) was target lesion failure (TLF): a composite of cardiac death, target vessel myocardial infarction (TVMI) and ischaemia-driven target lesion revascularisation (ID-TLR), at 1 year. All events were adjudicated by an independent clinical event committee. An independent core lab analysed all procedural angiograms. RESULTS A total of 450 patients (mean age 71.8 years, SYNTAX score 24.5±7.2, acute coronary syndrome in 53%) were enrolled in 26 centres. Of these, 77% of subjects underwent PCI with a single-stent and 23% with a 2-stent technique (8% double kissing [DK] crush, 6% culotte, 9% T/T and small protrusion [TAP] stenting). Intravascular imaging guidance was used in 45% (42% intravascular ultrasound [IVUS], 3% optical coherence tomography [OCT]). At 1 year, the primary EP incidence was 5.1% (cardiac death 2.7%, TVMI 2.7%, ID-TLR 2.0%). The definite/probable stent thrombosis rate was 1.1%. In a prespecified adjusted subanalysis, the primary EP incidence was significantly lower in patients undergoing IVUS/OCT-guided versus angio-guided PCI (2.0 vs 7.6%; hazard ratio [HR] 0.28, 95% confidence interval [CI]: 0.13-0.58; p<0.001). CONCLUSIONS In this large, multicentre, prospective registry, LM PCI with the Resolute Onyx DES showed good safety and efficacy at 1 year, particularly when guided by intracoronary imaging.
Collapse
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | | | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli ICCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carmine Musto
- Department of Cardiosciences, A.O. San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Picchi
- Cardiovascular Department, Azienda USL Toscana SudEst, Misericordia Hospital, Grosseto, Italy
| | - Imad Sheiban
- Division of Cardiology, Peschiera del Garda Hospital, Verona, Italy
| | | | - Flavio L Ribichini
- Division of Cardiovascular Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Martinato
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Andò
- Division of Cardiology, University of Messina, Messina, Italy
| | | | - Marco Caruso
- Division of Cardiology, University of Palermo, Palermo, Italy
| | - Roberta Rossini
- Division of Cardiology, ASST Papa Giovanni XXIII Hospital, Cuneo, Italy
| | - Enrico Passamonti
- Division of Cardiology, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Rui Campante Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | | | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Corrado Tamburino
- Cardiology, CAST-Policlinico Hospital, Cardio-Thorax-Vascular and Transplant Department, University of Catania, Catania, Italy
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli ICCS, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
16
|
Amat-Santos IJ, Blasco-Turrión S, Ferrero V, Ribichini FL. PCI of bystander coronary artery lesions should be performed before TAVI: pros and cons. EUROINTERVENTION 2022; 18:783-785. [PMID: 36412138 PMCID: PMC9725088 DOI: 10.4244/eij-e-22-00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ignacio J Amat-Santos
- Department of Interventional Cardiology, University Clinic Hospital, Valladolid, Spain
| | - Sara Blasco-Turrión
- Department of Interventional Cardiology, University Clinic Hospital, Valladolid, Spain
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
17
|
Fezzi S, Huang J, Lunardi M, Ding D, Ribichini FL, Tu S, Wijns W. Coronary physiology in the catheterisation laboratory: an A to Z practical guide. AsiaIntervention 2022; 8:86-109. [PMID: 36798834 PMCID: PMC9890586 DOI: 10.4244/aij-d-22-00022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022]
Abstract
Coronary revascularisation, either percutaneous or surgical, aims to improve coronary flow and relieve myocardial ischaemia. The decision-making process in patients with coronary artery disease (CAD) remains largely based on invasive coronary angiography (ICA), even though until recently ICA could not assess the functional significance of coronary artery stenoses. Invasive wire-based approaches for physiological evaluations were developed to properly assess the ischaemic relevance of epicardial CAD. Fractional flow reserve (FFR) and later, instantaneous wave-free ratio (iFR), were shown to improve clinical outcomes in several patient subsets when used for coronary revascularisation guidance or deferral and for procedural optimisation of percutaneous coronary intervention (PCI) results. Despite accumulating evidence and positive guideline recommendations, the adoption of invasive physiology has remained quite low, mainly due to technical and economic issues as well as to operator-resistance to change. Coronary image-based computational physiology has been recently developed, with promising results in terms of accuracy and a reduction in computational time, costs, radiation exposure and risks for the patient. Lastly, the integration of intracoronary imaging and physiology allows for individualised PCI treatment, aiming at complete relief of ischaemia through optimised morpho-functional immediate procedural results. Instead of a conventional state-of-the-art review, this A to Z dictionary attempts to provide a practical guide for the application of coronary physiology in the catheterisation laboratory, exploring several methods, their pitfalls, and useful tips and tricks.
Collapse
Affiliation(s)
- Simone Fezzi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jiayue Huang
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland,Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Mattia Lunardi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland,Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Flavio L. Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Department of Cardiology, Fujian Medical University Union Hospital, Fujian, China
| | - William Wijns
- The Lambe Institute for Translational Research, Galway National University of Ireland Galway (NUIG), Costello Road, Shantalla, Galway, H91 V4AY, Ireland
| |
Collapse
|
18
|
Urbani G, Springhetti P, Quer L, Dotto A, Ciceri L, Fanti D, Maffeis C, Tafciu E, Bergamini C, Nistri S, Inciardi RM, Ribichini FL, Benfari G. Left atrial function may mitigate the effect of mitral regurgitation on right chambers in patients with severe aortic valve stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1545] [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
Introduction
Left atrial (LA) function has been associated to right chambers hemodynamics in the context of mitral valve regurgitation (MR). However, this physiological interplay between left atrial function, mitral regurgitation and right ventricular (RV) parameters has not yet been clarified in patients with aortic valve stenosis (AS).
Aim of the study
To assess the combination of LA function and different MR grades with right chambers performance and pulmonary non-invasive hemodynamics status in patients with severe AS using an advanced automated echocardiographic approach.
Methods
Consecutive patients with severe AS referred to our institution were analyzed. Mitral regurgitation was classified according to integrative guideline-based criteria. 2D advanced speckle tracking echocardiography analysis was conducted to measure the LA peak atrial longitudinal strain (PALS) and right ventricular free wall strain, (RVFWS) using Tomtec Arena, version TTA2 41.00, with dedicated LV/LA/RV analysis option (Tomtec, Unterschlei heim, Germany). All conventional right chambers performance indexes were also measured: TAPSE, S'- TDI, fractional area change, systolic pulmonary artery pressure (sPAP). We featured 3 patients groups based on MR grade and LA function: (a) no/mild MR and preserved PALS (above the median); (c) >mild MR and reduced PALS; (b) the remaining patients with >mild MR and low PALS or >mild MR and high PALS.
Results
A total of 102 patients with severe aortic stenosis formed the study cohort: age was 82±9, 47% were female, mean left-ventricular-ejection-fraction 56%±12, more than mild MR was present in 24% of patients, mean PALS was 19±10%, sPAP 38±12 mmHg, RVFW strain 21±6%, and RVFW/sPAP 0.62±0.25. The 3 subgroups presented similar age and sex distribution. Right ventricular function significantly worsened moving from group (a) to (c); RVFW strain decreased from 25±5 (a) to 19±7 (b) and 17±5% (c), p<0.001; sPAP increased from 34±9 (a) to 39±12 (b) and 47±13 mmhg (c), p<0.001; and RVFW/sPAP decreased from 0.76±0.21 (a) to 0.54±0.23 (b) and 0.39±0.11 (c), p<0.001. Patients in the group (c) were more symptomatic (NYHA class III/IV increase from 40% in group a and 63% in group (b) to 80% in group c, p=0.006). When added to MR grade, in a logistic regression analysis, PALS provided incremental prediction of all right ventricular parameters (p<0.01).
Conclusion
This study highlights that the combination of MR and reduced LA function is associated with symptoms and RV impairment in patients with severe AS. These preliminary results suggest that preserved LA function may modulate the adverse effects of the AS-MR combination by preventing/delaying the development of pulmonary hypertension and right ventricular dysfunction.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Urbani
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - P Springhetti
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - L Quer
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - A Dotto
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - L Ciceri
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - D Fanti
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - C Maffeis
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - E Tafciu
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - C Bergamini
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - S Nistri
- CMSR Veneto Medica, Division of Cardiology , Altavilla Vicentina , Italy
| | - R M Inciardi
- University of Brescia, Division of Cardiology , Brescia , Italy
| | - F L Ribichini
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| | - G Benfari
- Integrated University Hospital of Verona, Division of Cardiology , Verona , Italy
| |
Collapse
|
19
|
Scarsini R, Pighi M, Mainardi A, Portolan L, Mammone C, Benfari G, Springhetti P, Fanti D, Bergamini C, Tavella D, Pesarini G, Ribichini FL. Coronary microvascular dysfunction is associated with reduced cardiac performance in low flow low gradient aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1622] [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
Little is known about coronary microvascular function of patients with low-flow low-gradient aortic stenosis (LFLGAS). We hypothesized that LFLGAS is associated with more severe coronary microvascular dysfunction (CMD) compared with normal-flow high-gradient aortic stenosis (NFHGAS) and that CMD is related to reduced cardiac efficiency.
Purpose
To perform a prospective invasive assessment of CMD in patients with LFLGAS undergoing TAVI and to compare it with patients with NFHGAS. Moreover, we aimed to assess the possible acute impact of TAVI on coronary microvascular function and the interactions between CMD and of cardiac performance at speckle tracking echocardiography (STE).
Methods
Invasive thermodilution-based assessment was systematically performed in 41 consecutive patients with isolated severe AS with angiographic unobstructed coronary arteries undergoing TAVI. The index of microcirculatory resistance (IMR), resistive reserve ratio (RRR) and coronary flow reserve (CFR) were derived to assess coronary microcirculatory function before and after TAVI. Advanced echocardiographic imaging, including STE, was performed to assess cardiac function.
Results
IMR was significantly higher in patients with LFLGAS compared with patients with NFHGAS (24.1 [14.6–39.1] vs 12.8 [8.6–19.2] p=0.002). Similarly, RRR was significantly lower in LFLGAS compared with NFHGAS (1.4 [1.1–2.1] vs 2.6 [1.5–3.3] p=0.020). No significant differences were observed in CFR between the two groups.
High IMR was associated with low stroke volume index (rho=−0.427, p=0.005), low cardiac output (rho=−0.517, p=0.001), reduced peak atrial longitudinal strain (PALS) (rho=−0.610, p≤0.001) and presence of atrial fibrillation (54.6% vs 21.1%, p=0.036). Conversely, IMR was only modestly associated with the mean pressure aortic valve gradient (rho=−0.304, p=0.054). Notably, the mean gradient was significantly associated with IMR in the NFHGAS group (rho=0.632, p=0.003) but not in the LFLGAS (rho=−0.222, p=0.333). Similarly, high IMR was associated with the AVA in the NFHGAS group (rho=−0.50, p=0.025) but not in patients with LFLGAS (rho=0.157, p=0.497).
Paradoxical LFLGAS emerged as a phenotype associated with CMD, poor left ventricular longitudinal systolic function and left atrial dysfunction. TAVI determined no significant variation in microvascular function (IMR: 16.0 [10.4–26.1] vs 16.6 [10.2–25.6], p=0.403) and in PALS (15.9 [9.9–26.5] vs 20.1 [12.3–26.7], p=0.222). Conversely, left ventricular global longitudinal strain increased overall after TAVI (−13.2 [8.4–16.6] vs −15.1 [9.4–17.8], p=0.047).
Conclusions
LFLGAS is associated with impaired coronary microvascular function compared with NFHGAS. Combined invasive assessment of microvascular function and advanced non-invasive imaging contributed to define different AS phenotypes. CMD was associated with low-flow state, left atrial dysfunction and reduced cardiac efficiency in patients with AS.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Vascular
Collapse
Affiliation(s)
- R Scarsini
- Integrated University Hospital of Verona , Verona , Italy
| | - M Pighi
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - A Mainardi
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - L Portolan
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - C Mammone
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - G Benfari
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - P Springhetti
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - D Fanti
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - C Bergamini
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - D Tavella
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - G Pesarini
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| | - F L Ribichini
- University of Verona, Department of Medicine, Section of Cardiology , Verona , Italy
| |
Collapse
|
20
|
Castaldi G, Fezzi S, Widmann M, Lia M, Rizzetto F, Mammone C, Galli V, Piccolo S, Pazzi S, Pighi M, Pesarini G, Prati D, Scarsini R, Tavella D, Ribichini FL. Angiography derived index of microvascular resistance (IMR) in Takotsubo syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1133] [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 and purpose
Coronary microvascular dysfunction (CMD) has been proposed as a key driver in the etiopathogenesis of Takotsubo syndrome (TTS), likely related to an “adrenergic storm” upon a susceptible microvascular circulation. The aim of our manuscript was to assess and quantify CMD in patients with TTS through angiography-derived index of microcirculation (IMR) and evaluate its correlation with clinical presentation.
Methods
Coronary angiograms of 41 consecutive TTS patients were retrospectively offline analyzed to derive angiography-based indices of CMD. Three recently developed indices (NH-IMRangio, AngioIMR and A-IMR) were calculated and compared based on Quantitative Flow Reserve (QFR) analysis. CMD was defined as an IMRangio ≥25 units. The correlation between CMD and clinical presentation and outcomes was then assessed.
Results
Median age was 76 years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. Angiography-derived IMR was higher in Left Anterior Descending artery (LAD) than Circumflex artery (LCX) and Right Coronary artery (RCA) with either NH-IMRangio (52.7 vs 35.3 vs 41.4), AngioIMR (47.2 vs 31.8 vs 37.3) or A-IMR (52.7 vs 36.1 vs 41.8). All patients presented CMD with angiography-derived IMR ≥25 in at least one territory with each formula. Angiography-derived IMR in LAD territory was significantly higher in patients presenting with LVEF impairment (≤40%) than in those with preserved ventricular global function (NH-IMRangio: 59.3 vs 46.3, p. value=0.030; AngioIMR: 52.9 vs 41.4, p-value=0.037; A-IMR: 59.2 vs 46.3, p-value=0.035).
Conclusion
CMD, assessed with angiography-derived IMR, is a common finding in TTS and it is inversely correlated with LV function. The available formulas have a substantial superimposable diagnostic performance in assessing coronary microvascular function.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
| | - S Fezzi
- University of Verona , Verona , Italy
| | - M Widmann
- University of Verona , Verona , Italy
| | - M Lia
- University of Verona , Verona , Italy
| | | | - C Mammone
- University of Verona , Verona , Italy
| | - V Galli
- University of Verona , Verona , Italy
| | - S Piccolo
- University of Verona , Verona , Italy
| | - S Pazzi
- University of Verona , Verona , Italy
| | - M Pighi
- University of Verona , Verona , Italy
| | | | - D Prati
- University of Verona , Verona , Italy
| | | | - D Tavella
- University of Verona , Verona , Italy
| | | |
Collapse
|
21
|
Gambaro A, Lombardi G, Ribichini FL, Mantovani A, Bignamini AA, Gambaro G. Impact of early glomerular filtration rate decline in response to antihypertensive treatment on risk of end-stage kidney disease and cardiovascular outcomes: a systematic review and meta-analysis. J Hypertens 2022; 40:413-421. [PMID: 34930868 DOI: 10.1097/hjh.0000000000003066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blood pressure control, which can induce a slight decrease in the glomerular filtration rate (GFR), plays a nephron- and cardioprotective role. However, the more important early decline in GFR associated with antihypertensive therapy and strict blood pressure targets is still of concern. Since few data are available from trials and observational studies, and the phenomenon is relatively rare, we performed a meta-analysis of available studies. We conclude that major reductions in the glomerular filtration rate occurring soon after starting angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and/or under intensive blood pressure control predict end-stage kidney disease.
Collapse
Affiliation(s)
| | | | | | - Alessandro Mantovani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona
| | - Angelo A Bignamini
- Department of Pharmaceutical Sciences, School of Specialization in Hospital Pharmacy, University of Milan, Milan, Italy
| | | |
Collapse
|
22
|
Ferri L, Bergamini C, Springhetti P, Niro L, Cerrito LF, Schiavone A, Dal Porto M, Setti E, Benfari G, Rossi A, Fiorio E, Ribichini FL. Prevention of trastuzumab-related cardiotoxicity in HER-2 positive breast cancer patients. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.080] [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: None.
Background
Trastuzumab (TZ) is a key therapy for HER-2 positive breast cancer that may have different side effects on the cardiovascular system. One of the most concerning complications is cancer therapy-related cardiac dysfunction (CTRCD). In literature there are conflicting data about the efficacy of heart failure drugs like ACE-inhibitors, ARBs and beta-blockers to prevent such an event.
Purpose
Aim of this study is to describe our experience on cardioprotective drugs in preventing TZ-related CTRCD.
Methods
105 consecutive women affected by HER-2 positive breast cancer treated with TZ referring to our echo-lab were enrolled in our single center prospective study. 3 patients were excluded due to an early TZ suspension not related to cardiovascular complications. Thus 102 patients (97,1%) were eligible for analyses. 86 of these (84,3%) were also treated with Anthracyclines. All patients underwent consecutive transthoracic echocardiography (TTE) before starting TZ and then every 3 months up to 12 months. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software. A complete clinical evaluation was also performed at each follow up. LV systolic dysfunction was defined as an absolute reduction of LVEF >10% from baseline to LVEF < 53% or a relative reduction of GLS >15% from baseline and a reduction of LVEF >10% from baseline.
Results
Overall, before starting TZ, 12 patients were taking ACE-inhibitors or ARBs (11,8%) and 5 patients beta-blockers (4,9%). CTRCD occurred in 11 patients (10,8%), among these 9 (81,8%) weren’t taking any heart failure drugs and 5 (45,5%) didn’t present any cardiovascular risk factor. We observed no significant association among cardiovascular risk factors. Use of potential cardioprotective drugs before TZ administration seems to reduce the risk of development of myocardial dysfunction (relative risk 1,67; 95% confidence interval [CI], 0,41 to 6,82; P > 0.05). No clear association was found between any cardiovascular risk factors and CTRCD (relative risk 0,81; 95% confidence interval [CI], 0,26 to 2,47; P > 0.05).
Conclusions
In HER-2 positive breast cancer patients treated with TZ an early treatment with ACE-inhibitors or ARBs and/or beta-blockers is associated to the prevention of CTRCD. CTRCD seems not to be related to the presence of cardiovascular risk factors. Abstract Figure. Baseline patient characteristics
Collapse
Affiliation(s)
- L Ferri
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - C Bergamini
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - P Springhetti
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - L Niro
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - LF Cerrito
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - A Schiavone
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - M Dal Porto
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - E Setti
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - G Benfari
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - A Rossi
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| | - E Fiorio
- Azienda Ospedaliera Universitaria Integrata of Verona, Oncology, Verona, Italy
| | - FL Ribichini
- Azienda Ospedaliera Universitaria Integrata of Verona, Cardiology, Verona, Italy
| |
Collapse
|
23
|
Dal Porto M, Dematte" C, Maines M, Giovanelli C, Vinco G, Setti E, Cemin C, Rossi A, Benfari G, Fezzi S, Catanzariti D, Ribichini FL, Del Greco M. Left atrial functional remodeling assessed by echocardiography in patients undergoing ablation for atrial fibrillation: correlation with the presence of fibrosis and invasive atrial pressure. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Radiofrequency catheter ablation of pulmonary veins has become a common procedure for treatment of atrial fibrillation (AF). Nevertheless, the procedure is characterized by an extremely variable success rate, which reflects a great heterogeneity of factors implicated in AF recurrence and AF burden.
Purpose
We focused on the role of left atrium (LA) in patients with paroxysmal and persistent AF who underwent catheter pulmonary veins ablation procedure. In particular we paid attention to three factors: echocardiographic evaluation of LA function, LA scar evaluated by electroanatomic mapping and LA pressures (LAP) during ablation procedure. The aim of the study was to investigate the correlation between echocardiographic parameters indicating atrial dysfunction (LA volume indexed, E/E’, LAA contraction velocity, LA stiffness and LA longitudinal strain during reservoir phase (LASr)) and intraprocedural parameters (such as LAPpeak and the amount of fibrosis).
Methods
The study included 25 patients; mean age was 63 ± 8 years; nineteen patients (76%) had paroxysmal AF, eighteen patients (72%) were in sinus rhythm at the time of ablation. The population was divided into two subgroups according to the amount of fibrosis evaluated by electroanatomic mapping: patients with fibrosis ≥ 5% of the total LA volume were considered as having an atrial scar. All patients underwent a comprehensive transthoracic echocardiography and a transesophageal echocardiography before the ablation procedure. Intraprocedural data regarding LAPpeak and electroanatomic mapping were collected. Measurements were acquired during both sinus rhythm (SR) and AF.
Results
Patients with atrial scar had similar LA volume compared to patients without scar (44 ml vs 37.4 ml, p = 0.108) , but presented a trend towards higher LAPpeak (24.3 mmHg vs 15.9 mmHg, p = 0.053) and had higher E/E’ (11 vs 7, p = 0.037) and consequently increased LA stiffness (0.72 vs 0.23, p= 0.006). Still, they had lower LASr (16.6% vs 33.2%, p = 0.013) and tended to have reduced LAA contraction velocity (0.4 m/sec vs 0.7 m/sec, p= 0.005).
Conclusions
The present findings suggest that functional remodeling of the LA, more than morphological changes, are correlated with the presence of atrial fibrosis and elevated atrial pressure detected during ablation procedures. These parameters may represent potential criteria to guide patients’ selection for ablation procedure and deserve dedicated studies to be confirmed. Abstract Figure.
Collapse
Affiliation(s)
- M Dal Porto
- University of Verona, Cardiology, Verona, Italy
| | - C Dematte"
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - M Maines
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - C Giovanelli
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - G Vinco
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - E Setti
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - C Cemin
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | - A Rossi
- University of Verona, Cardiology, Verona, Italy
| | - G Benfari
- University of Verona, Cardiology, Verona, Italy
| | - S Fezzi
- University of Verona, Cardiology, Verona, Italy
| | - D Catanzariti
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| | | | - M Del Greco
- Santa Maria Del Carmine Hospital, Cardiology, Rovereto, Italy
| |
Collapse
|
24
|
Setti M, Nistri S, Rossi A, Mantovani F, Ribichini FL, Benfari G. Unequivocal interpretation of dobutamine stress echocardiography in low-flow, low-gradient aortic stenosis by right parasternal view. Echocardiography 2021; 39:136-139. [PMID: 34923669 DOI: 10.1111/echo.15277] [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: 09/13/2021] [Revised: 11/18/2021] [Accepted: 11/27/2021] [Indexed: 11/28/2022] Open
Abstract
We present the case of a 77-years-old man with aortic valve stenosis (AS) and reduced left ventricular ejection fraction, in whom right parasternal view provided the best hemodynamic evaluation of AS severity during dobutamine stress echocardiography.
Collapse
Affiliation(s)
- Martina Setti
- University of Verona, Section of Cardiology, Verona, Italy
| | - Stefano Nistri
- Cardiology Service-CMSR Veneto Medica, Altavilla Vicentina, Vicenza, Italy
| | - Andrea Rossi
- University of Verona, Section of Cardiology, Verona, Italy
| | | | | | | |
Collapse
|
25
|
Maffeis C, Benfari G, Nistri S, Ribichini FL, Rossi A. Clinical impact of mitral regurgitation in aortic valve stenosis: Insight from effective regurgitant orifice area. Echocardiography 2021; 38:1604-1611. [PMID: 34505313 DOI: 10.1111/echo.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/27/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Mechanisms leading to heart failure (HF) symptoms in aortic valve stenosis (AS) are contentious. We examined the impact of secondary mitral regurgitation (MR) on the symptomatic status in patients with AS. METHODS Outpatients performing echocardiography with any degree of AS, without organic mitral valve disease, mitral valve intervention, or aortic insufficiency were enrolled. MR was quantitatively defined through mitral effective regurgitant orifice area (EROA) using the proximal isovelocity surface area method. Patients were divided into two groups (New York Heart Association [NYHA] class I-II vs. NYHA class III-IV). RESULTS Five hundred and eighty-four patients were enrolled (484 NYHA I-II, 100 NYHA III-IV). More symptomatic patients had smaller aortic valve area (AVA), lower left ventricular ejection fraction (LVEF) and stroke volume, higher E/E', and LV global afterload. MR was present in 178 (30%) patients and EROA was <.20 cm2 in 158 (89%). NYHA III-IV patients showed higher prevalence of MR (78% vs 21%, P < 0.0001) and larger EROA (.13±.08 cm2 vs .09±.07 cm2 , P < 0.0001). An association between EROA and symptoms was present in the total cohort and in subgroups with preserved LVEF, AVA ≥ 1 and <1 cm2 , EE' 8-14 and ≥14 (P < 0.05 for all). EROA was associated with severe symptoms after adjustment for LVEF, E/E', and AVA in the overall population (OR 1.10 [1.06-1.15]; P < 0.0001) and in the 516 patients with preserved LVEF (OR 1.13 [1.08-1.19]; P < 0.0001). CONCLUSION In patients with AS, greater EROA values are associated with HF symptoms, even though MR degree is far from the threshold of MR severity. Therefore, even a mild MR represents a supportive marker of HF symptoms presence.
Collapse
Affiliation(s)
- Caterina Maffeis
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Stefano Nistri
- Cardiology Service, Centro Medico Strumentale Riabilitativo Veneto Medica, Altavilla Vicentina, Italy
| | - Flavio L Ribichini
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Andrea Rossi
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| |
Collapse
|
26
|
Maffeis C, Inciardi RM, Khan MS, Tafciu E, Bergamini C, Benfari G, Setti M, Ribichini FL, Cicoira M, Butler J, Rossi A. Determinants of exercise intolerance symptoms considered non-specific for heart failure in patients with stage A and B: role of the left atrium in the transition phase to overt heart failure. Int J Cardiovasc Imaging 2021; 38:103-112. [PMID: 34460024 PMCID: PMC8818638 DOI: 10.1007/s10554-021-02375-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 11/08/2022]
Abstract
To assess to what extent left atrial (LA) structure and function are associated with non-specific heart failure symptoms, so that patients were classified as HF stage A and B. Mechanisms underlying the transition to overt HF in patients with stage A and B HF are unclear. Consecutive outpatients undergoing echocardiography and clinical evaluation and classified as HF stage A and B with preserved left ventricular ejection fraction (LVEF) were included. The association between LA measures [volume (LAVi), peak longitudinal-(PALS), contraction-(PACS) and conduit-strain] and non-specific HF symptoms was assessed using adjusted logistic regression analyses. The incremental value of atrial myopathy in symptoms prediction on top of clinical or echocardiographic confounders was assessed through ROC curves analyses. The cohort comprehended 185 patients (63 ± 16 years, 47% women) of whom 133 (72%) were asymptomatic, and 52 (28%) reported non-specific HF symptoms. After adjustment for clinical and echocardiographic confounders for HF symptoms, LAVi, PALS and PACS were associated with symptoms (p < 0.05). Among echocardiographic variables, only LA parameters were significantly associated with symptoms on top of clinical confounders (for LAVi OR [95% CI] 1.56 [1.21–2.00], p < 0.0001; for PALS 1.45 (1.10–1.91), p = 0.0009; for PACS 2.10 [1.33–3.30], p = 0.002). After adjustment for age, hypertension and COPD or E/E′, LV mass-i and mitral ERO, atrial myopathy added predictive value for symptoms presence compared to the clinical variables or echocardiographic parameters described (AUC increase 0.80 to 0.88, p = 0.004, and 0.79 to 0.84, p = 0.06, respectively). In patients with HF stages A–B and preserved LVEF, measures of LA structure and function were associated with non-specific HF symptoms. A comprehensive LA remodeling evaluation may help clinicians in the appropriate identification of overt HF.
Collapse
Affiliation(s)
- Caterina Maffeis
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Riccardo M Inciardi
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | | | - Elvin Tafciu
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Martina Setti
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Mariantonietta Cicoira
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University Hospital of Verona, University of Verona, P.le Stefani 1, 37126, Verona, Italy.
| |
Collapse
|
27
|
Tafciu E, Rossi A, Pighi M, Pesarini G, Ribichini FL. Coronary obstruction after transcatheter aortic valve replacement combined with basilica procedure. Eur Heart J Cardiovasc Imaging 2021; 22:e81. [PMID: 33230548 DOI: 10.1093/ehjci/jeaa325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elvin Tafciu
- Department of Cardiology, University of Verona, Pl. Stefani 1, 37126 Verona, Italy
| | - Andrea Rossi
- Department of Cardiology, University of Verona, Pl. Stefani 1, 37126 Verona, Italy
| | - Michele Pighi
- Department of Cardiology, University of Verona, Pl. Stefani 1, 37126 Verona, Italy
| | - Gabriele Pesarini
- Department of Cardiology, University of Verona, Pl. Stefani 1, 37126 Verona, Italy
| | - Flavio L Ribichini
- Department of Cardiology, University of Verona, Pl. Stefani 1, 37126 Verona, Italy
| |
Collapse
|
28
|
Benfari G, Mantovani F, Romero-Brufau S, Setti M, Rossi A, Ribichini FL, Nistri S, Clavel MA. The right parasternal window: when Doppler-beam alignment may be life-saving in patients with aortic valve stenosis. J Cardiovasc Med (Hagerstown) 2021; 21:831-834. [PMID: 32404852 DOI: 10.2459/jcm.0000000000000971] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: The need for multiple transducer positions, especially from right parasternal windows, is consistently mentioned in the recommendations for the accurate measurement of peak velocities across a stenotic aortic valve, but yet poorly adopted.We performed a subanalysis of the largest prospective series on the right parasternal acoustic windows in patients with aortic stenosis (330 consecutive) to calculate the degree of misalignment and estimate the potential outcome implication of this often-forgotten approach.The right parasternal view was highly feasible with an average estimated misalignment from the apical view of 14 ± 16 degree; in 10 cases, an estimated misalignment >40 degree. Right parasternal assessment (vs. apical alone) provided a significant reclassification from moderate to severe or even very-severe aortic valve stenosis. Considering a wellestablished survival benefit provided by either percutaneous or surgical valve replacement in patients with severe aortic stenosis the reclassification would result in approximately 1 life-year saved for every 30-35 patients in whom parasternal view were effectively utilized.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Stefano Nistri
- Cardiology Service, Centro Medico Strumentale Riabilitativo Veneto Medica, Altavilla Vicentina, Italy
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec City, Canada
| |
Collapse
|
29
|
Scarsini R, De Maria GL, Shanmuganathan M, Kotronias R, Terentes-Printzios D, Langrish J, Lucking A, Ribichini FL, Choudhury R, Kharbanda RKK, Ferreira V, Channon K, Banning AP. Pressure-bounded coronary flow reserve to assess the extent of microvascular dysfunction in patients with ST-elevation acute myocardial infarction. EUROINTERVENTION 2021; 16:1434-1443. [PMID: 31854300 PMCID: PMC9754025 DOI: 10.4244/eij-d-19-00674] [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: 11/23/2022]
Abstract
AIMS Assessment of microvascular function in patients with ST-elevation acute myocardial infarction (STEMI) may be useful to determine treatment strategy. The possible role of pressure-bounded coronary flow reserve (pb-CFR) in this setting has not been determined. In this study we aimed to compare pb-CFR with thermodilution-derived physiology including the index of microcirculatory resistance (IMR) and CFRthermo in a consecutive series of patients enrolled in the OxAMI study. Moreover, we aimed to assess the presence of microvascular obstruction (MVO) and myocardial injury on cardiovascular magnetic resonance (CMR) imaging performed at 48 hours and six months in STEMI patients stratified according to pb-CFR. METHODS AND RESULTS Thermodilution-pressure-wire assessment of the infarct-related artery was performed in 148 STEMI patients before stenting and/or at completion of primary percutaneous coronary intervention (PPCI). The extent of the myocardial injury was assessed with CMR imaging at 48 hours and six months after STEMI. Post-PPCI pb-CFR was impaired (<2) and normal (>2) in 69.9% and 9.0% of the cases, respectively. In the remaining 21.1% of the patients, pb-CFR was "indeterminate". In this cohort, pb-CFR correlated poorly with thermodilution-derived coronary flow reserve (k=0.03, p=0.39). The IMR was significantly different across the pb-CFR subgroups. Similarly, significant differences were observed in MVO, myocardium area at risk and 48-hour infarct size (IS). A trend towards lower six-month IS was observed in patients with high (>2) post-PPCI pb-CFR. Nevertheless, pb-CFR was inferior to IMR in predicting MVO and the extent of IS. CONCLUSIONS Pb-CFR can identify microvascular dysfunction in patients after STEMI. It provided superior diagnostic performance compared to thermodilution-derived CFR in predicting MVO. However, IMR was superior to both pb-CFR and thermodilution-derived CFR and, consequently, IMR was the most accurate in predicting all of the studied CMR endpoints of myocardial injury after PPCI.
Collapse
Affiliation(s)
- Roberto Scarsini
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Mayooran Shanmuganathan
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rafail Kotronias
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom,Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | | | - Jeremy Langrish
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrew Lucking
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Flavio L. Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Robin Choudhury
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom,Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rajesh K. K. Kharbanda
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom,Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Vanessa Ferreira
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom,Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Keith Channon
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom,Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Adrian P. Banning
- Oxford Heart Centre, Oxford University Hospitals, Headley Way, Oxford, OX3 9DU, United Kingdom
| | | |
Collapse
|
30
|
Fournier S, Toth GG, De Bruyne B, Kala P, Ribichini FL, Casselman F, Ramos R, Piroth Z, Piccoli A, Penicka M, Mates M, Nemec P, Van Praet F, Stockman B, Degriek I, Pellicano M, Barbato E. Changes in surgical revascularization strategy after fractional flow reserve. Catheter Cardiovasc Interv 2021; 98:E351-E355. [PMID: 33837987 DOI: 10.1002/ccd.29694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 03/14/2021] [Indexed: 11/05/2022]
Abstract
AIMS In the randomized GRAFFITI trial, surgeons drew their strategy based on coronary angiography. When patients were randomized to fractional flow reserve (FFR)-guidance, surgeons were informed of the FFR values and asked to redraw their strategy. The aim of this study was to investigate the changes induced by FFR knowledge. METHODS AND RESULTS The intended and performed strategy (before and after FFR) were compared. Among 172 patients, 84 with 300 lesions were randomized to the FFR-guided group. The intended strategy was to bypass 236 stenoses:108 with a venous and 128 with an arterial graft. After disclosing FFR, a change in strategy occurred in 64 lesions (21.3%) of 48 (55%) patients. Among 64 lesions for which the intended strategy was medical therapy, 16 (25%) were bypassed after disclosing FFR. The number of procedures with >1 venous graft planned was significantly reduced from 37 to 27 patients (p = .031). The proportion of on-pump surgery was significantly reduced from 71 to 61 patients (p = .006). The rates of clinical events at 1 year were similar between patients with or without at least one change in strategy. DISCUSSION FFR-guided CABG is associated with a simplified surgical procedure in 55% of the patients, with similar clinical outcomes.
Collapse
Affiliation(s)
- Stephane Fournier
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland.,Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Gabor G Toth
- University Heart Center Graz, Department of Cardiology, Medical University Graz, Graz, Austria
| | - Bernard De Bruyne
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland.,Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
| | - Petr Kala
- Department of Cardiology and Internal Medicine, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Filip Casselman
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
| | - Ruben Ramos
- Department of Cardiology, Hospital Santa Marta-Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Zsolt Piroth
- Department of Cardiology, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Anna Piccoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Martin Penicka
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
| | - Martin Mates
- Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic
| | - Petr Nemec
- Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic
| | - Frank Van Praet
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bernard Stockman
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
| | - Ivan Degriek
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Emanuele Barbato
- Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| |
Collapse
|
31
|
Benfari G, Nistri S, Cerrito LF, Maritan L, Tafciu E, Setti M, Bursi F, Tadiello E, De Manna ND, Rossi A, Ribichini FL. Usefulness of the Right Parasternal Echocardiographic View to Improve the Hemodynamic Assessment After Valve Replacement for Aortic Stenosis. Am J Cardiol 2021; 142:103-108. [PMID: 33278359 DOI: 10.1016/j.amjcard.2020.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Right-parasternal-view (RPV) often provides the best hemodynamic assessment of the aortic-valve-stenosis by echocardiography. However, no detailed study on patients with aortic prosthesis is available. Thus, RPV usefulness is left as an anecdotical notion in this context. We aimed to define feasibility and clinical-impact of RPV before and soon-after percutaneous implantation (TAVI) or surgical (SAVR) aortic-valve-replacement (AVR) for AS. Patients with severe-AS electively referred for AVR between September-2019 and February-2020 were prospectively evaluated. Echocardiographic examinations inclusive of apical and RPV to measure aortic-peak-velocity , gradients and area (AVA) were performed the day before AVR and at hospital discharge and compared by matched-pair-analysis. Forty-seven patients (mean age 79 ± 8 years, 63% female, ejection-fraction 61 ± 6%) referred for SAVR (24 [51%]) or TAVI (23 [49%]) were enrolled. RPV was feasible in 45 patients (96%) before-AVR but in only 32 after-AVR (68%), particularly after SAVR (50%) than TAVI (87% p = 0.005). RPV remained the best acoustic window after TAVI in 75% of cases. Hemodynamic assessment of TAVI, but not SAVR, invariably benefit from RPV versus apical evaluation (aortic-peak-velocity: 2.57 ± 0.39 vs 2.23 ± 0.47 m/sec, p = 0.002; mean gradient: 15 ± 5 vs 12 ± 5 mm Hg, p = 0.01). Five (11%) patients presented severe patient-prosthesis-mismatch, 4 of which were detectable only by RPV. This pilot-experience demonstrates that RPV feasibility is slightly reduced after AVR. RPV can improve the hemodynamic assessment of the prosthetic valve versus apical view, including the detection of patient-prosthesis-mismatch. Furthermore, when RPV is the best acoustic windows in patients with severe AS, it generally remains so after-TAVI.
Collapse
|
32
|
Pighi M, Lunardi M, Pesarini G, Castriota F, Venturi G, Gottin L, Scarsini R, Ferrero V, Ribichini FL. Intravascular ultrasound assessment of coronary ostia following valve-in-valve transcatheter aortic valve implantation. EUROINTERVENTION 2021; 16:1148-1151. [PMID: 32894228 PMCID: PMC9724918 DOI: 10.4244/eij-d-20-00611] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Michele Pighi
- Department of Medicine, Cardiology Division, University of Verona, Verona, Italy
| | - Mattia Lunardi
- Department of Medicine, Cardiology Division, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Department of Medicine, Cardiology Division, University of Verona, Verona, Italy
| | | | - Gabriele Venturi
- Department of Medicine, Cardiology Division, University of Verona, Verona, Italy
| | - Leonardo Gottin
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, Division of Cardio-Thoracic Intensive Care, University of Verona, Verona, Italy
| | - Roberto Scarsini
- Department of Medicine, Cardiology Division, University of Verona, Verona, Italy
| | - Valeria Ferrero
- Department of Medicine, Cardiology Division, University of Verona, Verona, Italy
| | - Flavio L. Ribichini
- Department of Medicine, University of Verona, Piazzale Stefani 1, 37126 Verona, Italy
| |
Collapse
|
33
|
Marin F, Fezzi S, Gambaro A, Ederle F, Castaldi G, Widmann M, Gangemi C, Ferrero V, Pesarini G, Pighi M, Ribichini FL. Insights on safety and efficacy of renal artery denervation for uncontrolled-resistant hypertension in a high risk population with chronic kidney disease: first Italian real-world experience. J Nephrol 2021; 34:1445-1455. [PMID: 33481223 PMCID: PMC8494706 DOI: 10.1007/s40620-021-00966-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/01/2021] [Indexed: 12/16/2022]
Abstract
Aims To evaluate the safety and efficacy of catheter-based radiofrequency renal sympathetic denervation (RSD) in a daily practice population of patients with uncontrolled resistant hypertension, on top of medical therapy. Methods Consecutive unselected patients with uncontrolled resistant hypertension undergoing RSD were enrolled. Office and ambulatory blood pressure (BP) measurements were collected at baseline and 3, 6 and 12 months after RSD. Efficacy was assessed even in patients with an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2. Patients were defined as responders if systolic BP decreased by at least 5 mmHg at ambulatory BP or by 10 mmHg at office BP at their last follow-up visit. Results Forty patients with multiple comorbidities underwent RSD from 2012 to 2019. Baseline office and ambulatory BP was 159.0/84.9 ± 26.2/14.9 mmHg and 155.2/86.5 ± 20.9/14.0 mmHg, respectively. At 12-month follow up a significant reduction in office and ambulatory systolic BP, respectively by − 19.7 ± 27.1 mmHg and by − 13.9 ± 23.6 mmHg, was observed. BP reduction at 12-month follow-up among patients with eGFR < 45 mL/min was similar to that obtained in patients with higher eGFR. Twenty-nine patients (74.4%) were responders. Combined hypertension, higher ambulatory systolic BP and lower E/E’ at baseline emerged as predictors of successful RSD at univariate analysis. No major complications were observed and renal function (was stable up to 12 months), even in patients with the lowest eGFR values at baseline. Conclusion RSD is safe and feasible in patients with uncontrolled resistant hypertension on top of medical therapy, even in a high-risk CKD population with multiple comorbidities, with a significant reduction in systolic BP and a trend towards a reduction in diastolic BP lasting up to 12 months. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-00966-7.
Collapse
Affiliation(s)
- Federico Marin
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Simone Fezzi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Alessia Gambaro
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Francesco Ederle
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Gianluca Castaldi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Maddalena Widmann
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Concetta Gangemi
- Division of Nephrology, Department of Medicine, University of Verona, Verona, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| |
Collapse
|
34
|
|
35
|
Lunardi M, Franzese I, Faggian G, Ribichini FL. Hybrid treatment of aortic aneurism, type-A dissection, and aortic valve stenosis. Catheter Cardiovasc Interv 2020; 98:E466-E470. [PMID: 32979026 DOI: 10.1002/ccd.29303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/25/2020] [Accepted: 09/16/2020] [Indexed: 11/08/2022]
Abstract
Hybrid multidisciplinary interventions are attractive care options for heart valve and vascular diseases in high-risk patients. We describe the feasibility of staged hybrid aortic arch repair to treat a type Ia endoleak and transcatheter aortic valve replacement to treat an aortic valve stenosis, achieving an escape strategy to treat an unexpected type-A aortic dissection.
Collapse
Affiliation(s)
- Mattia Lunardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Ilaria Franzese
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
36
|
Franzese I, Cetera V, Pesarini G, Onorati F, Ribichini FL, Faggian G, Milano AD. Transapical mitral valve-in-valve procedure with elective venoarterial ECMO in a patient with severe kyphoscoliosis. J Card Surg 2020; 35:3217-3219. [PMID: 32790016 DOI: 10.1111/jocs.14949] [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: 06/16/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
Transcatheter mitral valve-in-valve replacement (TMVR) is a feasible alternative in high-risk patients requiring reoperation for failing mitral bioprosthesis. Such patients may present with hemodynamic instability or sudden complications, which may jeopardize the outcomes. We report a successful transapical TMVR in a patient, with severe kyphoscoliosis and on prolonged mechanical ventilation, with prophylactic extracorporeal membrane oxygenator support. This combined procedure may be helpful to reduce the complications of TMVR in critically ill subjects.
Collapse
Affiliation(s)
- Ilaria Franzese
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Vera Cetera
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Aldo D Milano
- Department of Emergency and Organ Transplants, Cardiac Surgery Unit, University of Bari Medical School, Bari, Italy
| |
Collapse
|
37
|
Venturi G, Pighi M, Pesarini G, Ferrero V, Lunardi M, Castaldi G, Setti M, Benini A, Scarsini R, Ribichini FL. Contrast-Induced Acute Kidney Injury in Patients Undergoing TAVI Compared With Coronary Interventions. J Am Heart Assoc 2020; 9:e017194. [PMID: 32787652 PMCID: PMC7660800 DOI: 10.1161/jaha.120.017194] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Differences in the impact of contrast medium on the development of contrast-induced acute kidney injury (CI-AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) or a coronary angiography/percutaneous coronary intervention (CA/PCI) have not been previously investigated. Methods and Results Patients treated with TAVI or elective CA/PCI were retrospectively analyzed in terms of baseline and procedural characteristics, including preprocedural and postprocedural kidney function. CI-AKI was defined as a relative increase in serum creatinine concentration of at least 0.3 mg/dL within 72 hours of contrast-medium administration compared with baseline. The incidence of CI-AKI in the TAVI versus CA/PCI group was compared. After the exclusion of patients in dialysis and emergency procedures, 977 patients were analyzed; there were 489 patients who had undergone TAVI (50.1%) and 488 patients who had undergone CA/PCI (49.9%). Patients treated by TAVI were older, presenting a higher rate of anemia and chronic kidney disease (P<0.001 for all comparisons). Consistently, they also had a significantly lower glomerular filtration rate and higher serum creatinine concentration (P<0.001 for all). However, the occurrence of CI-AKI was significantly lower in these patients compared with patients treated by a CA/PCI (6.7% versus 14.5%, P<0.001). At multivariate analysis, the TAVI procedure had an independent protective effect on CI-AKI incidence among total population (odds ratio, 0.334; 95% CI, 0.193-0.579; P<0.001). This observation was confirmed after propensity score matching among 360 patients (180 by TAVI and 180 by CA/PCI; P=0.002). Conclusions CI-AKI occurred less frequently in patients undergoing TAVI than in patients undergoing a CA/PCI, despite a worse-risk profile. The impact of contrast administration on kidney function in patients who had undergone TAVI may be better tolerated because of the hemodynamic changes following aortic valve replacement.
Collapse
Affiliation(s)
- Gabriele Venturi
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Michele Pighi
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Gabriele Pesarini
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Valeria Ferrero
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Mattia Lunardi
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Gianluca Castaldi
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Martina Setti
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Annachiara Benini
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Roberto Scarsini
- Division of Cardiology Department of Medicine University of Verona Italy
| | - Flavio L Ribichini
- Division of Cardiology Department of Medicine University of Verona Italy
| |
Collapse
|
38
|
Franzese I, Francica A, Pesarini G, Gottin L, Ribichini FL, Onorati F, Faggian G. Intraventricular entrapment of a Sapien-3 balloon in transapical TAVR: A near missed catastrophe. J Card Surg 2020; 35:2093-2096. [PMID: 32652566 DOI: 10.1111/jocs.14804] [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: 11/30/2022]
Abstract
Balloon rupture is an uncommon complication during balloon-expandable transcatheter aortic valve replacement (TAVR). We describe a balloon rupture and tearing with intraventricular entrapment complicating transapical-TAVR, as well as our bailout retrieval of the failed device.
Collapse
Affiliation(s)
- Ilaria Franzese
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Alessandra Francica
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Leonardo Gottin
- Division of Cardiac Anesthesiology, University of Verona, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy
| |
Collapse
|
39
|
Mejía-Rentería H, Nombela-Franco L, Paradis JM, Lunardi M, Lee JM, Amat-Santos IJ, Veiga Fernandez G, Kalra A, Bansal EJ, de la Torre Hernandez JM, Rodés-Cabau J, Ribichini FL, Escaned J. Angiography-based quantitative flow ratio versus fractional flow reserve in patients with coronary artery disease and severe aortic stenosis. EUROINTERVENTION 2020; 16:e285-e292. [DOI: 10.4244/eij-d-19-01001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
40
|
Bouisset F, Barbato E, Reczuch K, Dobrzycki S, Meyer-Gessner M, Bressollette E, Cayla G, Lhermusier T, Zajdel W, Palazuelos Molinero J, Ferenc M, Ribichini FL, Carrié D. Clinical outcomes of PCI with rotational atherectomy: the European multicentre Euro4C registry. EUROINTERVENTION 2020; 16:e305-e312. [DOI: 10.4244/eij-d-19-01129] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
41
|
Cerrito LF, Schiavone A, Moretti M, Ferri L, Bergamini C, Dal Porto M, Benfari G, Dolci G, Setti E, Comunello A, Rossi A, Fiorio E, Ribichini FL. P311 Morpho-functional myocardial alteration during trastuzumab therapy: anything beyond cardiotoxicity? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.164] [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
Trastuzumab (TZ) has a primary role in the therapy of HER-2 positive breast cancer but has potential negative effect on left ventricular (LV) function that define cardiotoxicity (CT). Decrease in LV longitudinal strain (GLS) and in left atrial (LA) function observed by peak atrial longitudinal strain (PALS), besides LA remodeling, has already been described as predictors of TZ-related CT. However these parameters haven’t been observed together and regardless of CT.
Purpose
to describe overall atrial and ventricular morpho-functional variations during TZ therapy.
Methods
HER-2 positive metastasis-free breast cancer patientsreferring to our Echo-lab were prospectively recruited. Trans-thoracic echocardiography was performed before starting TZ and every 3 up to 12 months. LV volumes and ejection fraction (LVEF), indexed LA volume (LAVI), LA deformation parameters, and multiple diastolic parameters were collected. 2D-Speckle tracking analysis was performed at baseline and at each examination using Philips’ QLAB software.
Results
Eligible patients were 64. 53 of these (82,8%) had a complete follow-up at 12 months and were included in the analysis. 42 patients (79,3%) were treated with both TZ and anthracyclines. During follow-up CT occurred in 7 patients (10,9%). Mean baseline parameters were: age 54 ± 13 years,LVEF 63,3 ±3,2%, GLS -21,2 ± 2,1%, LAVI 24,4 ±6,9 ml/mq, peak atrial contraction strain (PACS) 22,9 ±6,5%, PALS 51,1 ± 11,5%. Deformation analysis was feasible in 95% of patients. None of the echocardiographic parameters regarding diastolic function and LV volumes showed significant variations.
Analyzing overall populations data during the 1 year of follow-up, we reported a decrease trend of GLS (p for time <0.0001) with an early drop during the first 6 months of TZ therapy with a subsequent "plateau" phase, and a reductionof LVEFover time (p for time <0.0001) with a continuous gradual decreasefor the whole follow-up (but still within the normal value span). On top LA functional parameters showed a decreasing trend: PALS (p for time <0.0001) and PACS (p for time <0.0001) showed both decrease trend since the first months of therapy, lasting for the entire follow-up. Also we reported a notable LAVI dilation during the first 6 months of TZ therapy (p for time <0.0001) followed by a plateau phase, and combining LAVI and PALS (LAVI/PALS) we noted an increase trend (p for time <0.0001). These data are showed in Figure I.
Conclusions
Our results suggest that deformation analysis is useful to study LV and LA functional remodeling during TZ therapy. Actual recommendations for the identification of CT are based upon a joint evaluation of LVEF and GLS, but our study show significant variations of other morpho-functional parameters regardless of CT. These changes could be used as indicators of subclinical damage involving the entire heart and the analysis of different deformation indexes could improve the early detection of CT.
Abstract P311 Figure. Morpho-functional variations
Collapse
Affiliation(s)
- L F Cerrito
- University of Verona, Cardiology, Verona, Italy
| | - A Schiavone
- University of Verona, Cardiology, Verona, Italy
| | - M Moretti
- University of Verona, Cardiology, Verona, Italy
| | - L Ferri
- University of Verona, Cardiology, Verona, Italy
| | - C Bergamini
- University of Verona, Cardiology, Verona, Italy
| | - M Dal Porto
- University of Verona, Cardiology, Verona, Italy
| | - G Benfari
- University of Verona, Cardiology, Verona, Italy
| | - G Dolci
- University of Verona, Cardiology, Verona, Italy
| | - E Setti
- University of Verona, Cardiology, Verona, Italy
| | - A Comunello
- University of Verona, Cardiology, Verona, Italy
| | - A Rossi
- University of Verona, Cardiology, Verona, Italy
| | - E Fiorio
- University of Verona, Oncology, Verona, Italy
| | | |
Collapse
|
42
|
Inciardi RM, Rossi A, Bergamini C, Benfari G, Maffeis C, Greco C, Drago A, Guazzi M, Ribichini FL, Cicoira M. Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics. Eur J Heart Fail 2019; 22:499-506. [PMID: 31793154 DOI: 10.1002/ejhf.1677] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 07/09/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 11/08/2022] Open
Abstract
AIMS To assess the association between mitral regurgitation (MR) and left atrial (LA) structural and functional remodelling and their effect on pulmonary haemodynamics. METHODS AND RESULTS Consecutive unselected patients undergoing comprehensive echocardiography were enrolled. Parameters of cardiac structure and function were obtained as well as mitral effective regurgitant orifice area (ERO) and estimation of pulmonary artery systolic pressure (PASP). Measures of LA structure [LA volume (LAV)] and function [peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit strain (CS)] were also calculated. The study population included 102 patients (mean age 70 ± 14 years, 42% women), with a mean ejection fraction of 52 ± 13%. MR was classified as organic due to mitral valve prolapse in 14 patients (14%) and functional in 88 patients (86%). Mean ERO was 0.12 ± 0.12 cm2 and 86 patients (84%) had an ERO ≤0.2 cm2 . ERO was significantly associated with worse measures of LA structure and function. Despite the low burden of MR, the association remained significant after adjusting for clinical and echocardiographic confounders (β: 3.7, P = 0.022 for LAV; β: -3.0, P = 0.003 for PALS; β: -1.8, P = 0.027 for PACS) and was significantly related with functional MR (P for interaction <0.001). ERO was also significantly associated with PASP, and measures of LA function (PALS and PACS) significantly modified this relationship (P for interaction <0.001). CONCLUSIONS Even a mild degree of MR contributes to LA remodelling and this relationship plays an active role in pulmonary circulation, suggesting a potential mechanism by which these parameters contribute to the development of heart failure.
Collapse
Affiliation(s)
- Riccardo M Inciardi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Caterina Maffeis
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Carmen Greco
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea Drago
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Marco Guazzi
- Cardiology Department, University of Milano School of Medicine, IRCCS Policlinico San Donato, Milan, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | |
Collapse
|
43
|
Toth GG, De Bruyne B, Kala P, Ribichini FL, Casselman F, Ramos R, Piroth Z, Fournier S, Piccoli A, Van Mieghem C, Penicka M, Mates M, Nemec P, Van Praet F, Stockman B, Degriek I, Barbato E. Graft patency after FFR-guided versus angiography-guided coronary artery bypass grafting: the GRAFFITI trial. EUROINTERVENTION 2019; 15:e999-e1005. [DOI: 10.4244/eij-d-19-00463] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
44
|
Pighi M, Lunardi M, Ribichini FL. NVT ALLEGRA transcatheter heart valve for valve-in-valve procedures in failing surgical aortic bioprostheses: let us wait and see. EUROINTERVENTION 2019; 15:e739-e741. [PMID: 31579009 DOI: 10.4244/eijv15i9a137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | | |
Collapse
|
45
|
Setti E, Dolci G, Bergamini C, Schiavone A, Cerrito LF, Benfari G, Dal Porto M, Comunello A, Bragantini G, Rossi A, Fiorio E, Ribichini FL. P2460Prospective evaluation of atrial function by 2D Speckle Tracking analysis in HER-2 positive breast cancer patients during Trastuzumab therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Trastuzumab (TZ) is a key therapy for HER2+ breast cancer (BC) patients, with well known possible negative effect on left ventricular (LV) function. A decrease in LV global longitudinal strain (GLS) has been demonstrated to be a good predictor of subsequent TZ-related cardiotoxicity (CT). Early left atrial (LA) enlargement preceding LV dysfunction has also been documented. Limited data are available about LA function in this setting.
Aim
To investigate LA function by deformation indexes (strain rate) in BC patients treated with TZ.
Methods
HER-2 positive BC metastasis-free patients referring to our echo-lab were prospectively recruited. Patients underwent consecutive transthoracic echocardiography before starting TZ and then every 3 months, up to 12. LV volumes, LV ejection fraction (LVEF) with Simpson biplane methods, LA volume and diastolic parameters were measured; 2D-Speckle Tracking analysis was performed and GLS and peak atrial longitudinal strain (PALS) were analyzed using Philips' QLAB software. Different lab tests and clinical data were also collected.
Results
64 patients formed the study population. 40 (62.5%) had a complete 12 months follow up (FU). 53 patients (82.8%) were previously treated with anthracyclines. Mean age was 55.05±12.1 years. CT, as defined by current ESC guidelines, occurred in 6 patients (9.3%). Mean GLS was −21.4±2% and mean baseline PALS was 51.1±12%. GLS analysis was feasible in 91% of patients and PALS analysis in 84%, with excellent reproducibility for GLS (intra-observer ICC 0.93, p=0.8; inter-observer ICC 0.83, p=0.7). Even if during FU cardiotoxicity showed a low prevalence, a drop in LVEF over time was anyway documented, with major worsening at 6 months. Our study confirms previous data reporting a trend of decrease in GLS (p for time = 0.06), with an early drop during the first six months of TZ therapy and a subsequent “plateau” phase; we also reported a significant decrease of PALS over time (p for time = 0.008), with a continuous gradual decrease for the whole FU. A significant positive correlation between baseline PALS and LVEF at 6 months follow up was shown (R2 0.2; p=0.006). Similar result was obtained analyzing the correlation between LAVI and LVEF at 6 months (R2 0,19; p=0,02).
Conclusion
2D speckle tracking analysis is feasible and adds useful information about LV and LA functional remodeling. Actual recommendations for CT identification are based upon a joint evaluation of LVEF and GLS, but our study demonstrates that significant variations in GLS and PALS can occur independently of development of CT. Moreover baseline PALS and LAVI predict the trend of LVEF at 6 months of FU, time of the major mean LVEF drop documented. The assessment of LA function by deformation indexes (strain rate) could add further information for daily clinical practice, possibly improving the detection of early CT. More studies are needed to further investigate these exploratory data.
Collapse
Affiliation(s)
- E Setti
- University of Verona, Cardiology, Verona, Italy
| | - G Dolci
- University of Verona, Cardiology, Verona, Italy
| | - C Bergamini
- University of Verona, Cardiology, Verona, Italy
| | - A Schiavone
- University of Verona, Cardiology, Verona, Italy
| | - L F Cerrito
- University of Verona, Cardiology, Verona, Italy
| | - G Benfari
- University of Verona, Cardiology, Verona, Italy
| | - M Dal Porto
- University of Verona, Cardiology, Verona, Italy
| | - A Comunello
- University of Verona, Cardiology, Verona, Italy
| | | | - A Rossi
- University of Verona, Cardiology, Verona, Italy
| | - E Fiorio
- University of Verona, Oncology, Verona, Italy
| | | |
Collapse
|
46
|
Cerrito LF, Schiavone A, Bergamini C, Dal Porto M, Benfari G, Dolci G, Setti E, Comunello A, Rossi A, Fiorio E, Ribichini FL. P2456Role of left atrial volume as simple and early predictor of cardiotoxicity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0788] [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
It is crucial to predict and early detect Trastuzumab (TZ)-related cardiotoxicity (CT) in patients with HER2-positive breast cancer (BC). Although baseline left atrial (LA) volume and its changes over time assessed by echocardiography have been used as prognostic tool in various clinical conditions, up to now there are no well-defined LA-based parameters predictive of chemotherapy-related dysfunction.
Aim
To define the role of increased baseline LA indexed volumes (LAVI) and its changes over time as early predictors of TZ-related CT in a larger and well characterized cohort of BC patients.
Methods
HER-2 positive BC patients receiving TZ were retrospectively recruited. Patients underwent consecutive transthoracic echocardiography at baseline and then every three months. CT was defined as decrease in left ventricular ejection fraction (LVEF) to a value <50% or a decrease of >10 percentage points from baseline, according to our oncology unit.
Results
Eligible patients were 280, mean age 56±12 years. Mean follow-up (FU) was 15±5 months and CT occurred in 64 patients (22,9%). Baseline LAVI showed to be associated with development of CT (p=0,003), and to predict its onset, Odds Ratio (OR) per 5 ml/mq LAVI increase 1,32 (95% CI 1,07: 1,62), p=0,006. After multivariate adjustment (age, systolic arterial pressure, anthracycline treatment) baseline LAVI remained an independent predictor of CT: OR 1,25 (95% CI 1,00- 1,56), p=0,04. LAVI showed an increasing trend that has been evident since the very beginning (at three months) and continued over time. LAVI dilation appeared to be small on average, but became significant in patients with subsequent CT (Figure 1). Early LAVI dilation (0–3 months) was able to predict CT OR 1.22 (CI 1.03–1.47) p=0.02 per 5 ml/mq increase, Even when adjusted for baseline LAVI, age, and systolic arterial pressure, OR 1.31 (CI 1.07–1.58), p=0.004. In patients who had mitral regurgitation at baseline, there was no significant worsening of regurgitation overtime.
Conclusion
Baseline LAVI, as assessed by routine practice, provides an incremental predictive value about CT risk over the other known clinical features. On top, LAVI dilation over time seems to begin before LVEF decreases, and hence could anticipate the development of left ventricular dysfunction. Even if LAVI is a simple and well known echocardiographic measurement, it could be used in this newborn context to stratify patients after validation with prospective studies.
Collapse
Affiliation(s)
- L F Cerrito
- University of Verona, Cardiology, Verona, Italy
| | - A Schiavone
- University of Verona, Cardiology, Verona, Italy
| | - C Bergamini
- University of Verona, Cardiology, Verona, Italy
| | - M Dal Porto
- University of Verona, Cardiology, Verona, Italy
| | - G Benfari
- University of Verona, Cardiology, Verona, Italy
| | - G Dolci
- University of Verona, Cardiology, Verona, Italy
| | - E Setti
- University of Verona, Cardiology, Verona, Italy
| | - A Comunello
- University of Verona, Cardiology, Verona, Italy
| | - A Rossi
- University of Verona, Cardiology, Verona, Italy
| | - E Fiorio
- University of Verona, Oncology, Verona, Italy
| | | |
Collapse
|
47
|
Bolzan B, Morani G, Tomei R, Tomasi L, Borio G, Ribichini FL. Prolonged sustained ventricular fibrillation in a patient with dextrocardia and a left ventricular assist device. J Cardiovasc Med (Hagerstown) 2019; 20:721-724. [PMID: 31389822 DOI: 10.2459/jcm.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Bruna Bolzan
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | | | | | | | | |
Collapse
|
48
|
Cerrito LF, Bergamini C, Dolci G, Fiorio E, Ribichini FL. Early functional and structural changes of the left atrium in a patient with trastuzumab: related cardiotoxicity. Minerva Cardioangiol 2019; 67:359-360. [PMID: 31347821 DOI: 10.23736/s0026-4725.19.04919-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luca F Cerrito
- Division of Cardiology, Department of Medicine, A.O.U.I. Verona, Verona, Italy -
| | - Corinna Bergamini
- Division of Cardiology, Department of Medicine, A.O.U.I. Verona, Verona, Italy
| | - Giulia Dolci
- Division of Cardiology, Department of Medicine, A.O.U.I. Verona, Verona, Italy
| | - Elena Fiorio
- Division of Oncology, Department of Medicine, A.O.U.I Verona, Verona, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, A.O.U.I. Verona, Verona, Italy
| |
Collapse
|
49
|
Morani G, Borio G, Bolzan B, Ribichini FL. Safety and efficacy of a cardiologist-only approach to deep sedation for electrical cardioversion. J Cardiovasc Med (Hagerstown) 2019; 20:16-22. [PMID: 30394961 DOI: 10.2459/jcm.0000000000000731] [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] [Indexed: 12/13/2022]
Abstract
AIMS Electrical cardioversion is still the preferred method to restore sinus rhythm in patients with atrial fibrillation. The main disadvantage is that electrical cardioversion requires deep sedation, generally administered by anaesthesiologists, for safety concern. An exclusively cardiologic management of deep sedation should have the advantage to reduce resources and time consumed. METHODS All consecutive patients admitted to our division with persistent atrial fibrillation or atrial flutter to undergo elective electrical cardioversion from June 2002 to December 2016 were included. The sedation protocol was managed only by cardiologists and involved the administration of a 5-mg bolus of midazolam, followed by increasing doses of propofol to achieve the desired sedation level. Exclusion criteria were strictly observed. Complications were recorded. A retrospective analysis on a deidentified database has been performed. RESULTS A total of 1188 electrical cardioversions were scheduled in our centre. A total of 1195 patients were scheduled in our centre, of whom 1188 met inclusion criteria. Electrical cardioversion was performed in 1073 cases (90.3%). Electrical cardioversion was successful in restoring sinus rhythm in 1030 (96.0%) patients. Immediate recurrence of atrial fibrillation occurred in 89 patients (8.3%). 99/1073 (9.22%) patients underwent trans-oesophagel echocardiography before cardioversion. Deep sedation, according to our protocol, was effective in 100% of cases. Midazolam was administered at a dosage of 5 mg to all patients, while propofol was administered at a dosage ranging from 20 to 80 mg (25.1 ± 11.0 mg SD). No anaesthesia-related complications were observed, neither significant respiratory depression requiring intubation nor anaesthesiologist support. CONCLUSION The exclusively cardiological procedure of deep sedation seems to be safe and effective.
Collapse
Affiliation(s)
- Giovanni Morani
- Department of Cardiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | | | | |
Collapse
|
50
|
Borio G, Morani G, Benfari G, Bolzan B, Morosato M, Tomasi L, Zimelli E, Arioli L, Ribichini FL. P2890P wave dispersion is superior to atrial dimension in predicting atrial high rate events. Results from a population of dual-chamber device recipients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Borio
- Civil Hospital Maggiore at Borgo Trento, Cardiology, Verona, Italy
| | - G Morani
- Civil Hospital Maggiore at Borgo Trento, Cardiology, Verona, Italy
| | - G Benfari
- Civil Hospital Maggiore at Borgo Trento, Cardiology, Verona, Italy
| | - B Bolzan
- Civil Hospital Maggiore at Borgo Trento, Cardiology, Verona, Italy
| | - M Morosato
- Civil Hospital Maggiore at Borgo Trento, Cardiology, Verona, Italy
| | - L Tomasi
- Civil Hospital Maggiore at Borgo Trento, Cardiology, Verona, Italy
| | - E Zimelli
- Civil Hospital Maggiore at Borgo Trento, Cardiology, Verona, Italy
| | - L Arioli
- Civil Hospital Maggiore at Borgo Trento, Cardiology, Verona, Italy
| | - F L Ribichini
- Civil Hospital Maggiore at Borgo Trento, Cardiology, Verona, Italy
| |
Collapse
|