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Monda E, Diana G, Verrillo F, Rubino M, Cirillo A, Fusco A, Cirillo C, Mauriello A, Altobelli I, Caiazza M, Dongiglio F, Palmiero G, Russo MG, Limongelli G. [Clinical and genetic manifestations of left ventricular non-compaction in children]. G Ital Cardiol (Rome) 2024; 25:98-105. [PMID: 38270365 DOI: 10.1714/4187.41758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Left ventricular non-compaction (LVNC) is a myocardial disease characterized by a two-layered structure typically seen at the apical and lateral left portions of the ventricular myocardium, distal to the papillary muscles. While considered a rare disease, its prevalence in children is increasing due to the increased awareness of this condition and improved resolution of imaging techniques. The etiology is heterogeneous, ranging from inherited conditions to acquired diseases. Although many patients are asymptomatic, some patients may experience adverse events, including heart failure, arrhythmias, or thromboembolic events. Several echocardiographic or cardiac magnetic resonance imaging diagnostic criteria have been proposed for diagnosing LVNC. However, their application in children is significantly limited. This review aims to describe the clinical and genetic characteristics of children with LVNC and discuss the role of the proposed diagnostic criteria.
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Affiliation(s)
- Emanuele Monda
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli - Institute of Cardiovascular Science, University College London, Londra, UK
| | - Gaetano Diana
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Federica Verrillo
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Marta Rubino
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Annapaola Cirillo
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Adelaide Fusco
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Chiara Cirillo
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Alfredo Mauriello
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Ippolita Altobelli
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Martina Caiazza
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Francesca Dongiglio
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Giuseppe Palmiero
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Maria Giovanna Russo
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli
| | - Giuseppe Limongelli
- Unità di Malattie Genetiche e Rare Cardiovascolari, Dipartimento di Scienze Mediche Traslazionali, Università della Campania "Luigi Vanvitelli, Ospedale Monaldi, Napoli - Institute of Cardiovascular Science, University College London, Londra, UK
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Rinaldi M, Tranfa F, Chiosi F, Campagna G, De Bernardo M, Gioia M, Natale F, Caiazza M, Dongiglio F, Verrillo F, Palmiero G, Limongelli G, Costagliola C. OCT angiography indices and the choroidal vascularity index in wild-type transthyretin (TTR) amyloidosis (ATTRwt). Front Med (Lausanne) 2024; 10:1174643. [PMID: 38288300 PMCID: PMC10823855 DOI: 10.3389/fmed.2023.1174643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose Retinal angiopathy represents a well-known ocular manifestation of hereditary transthyretin amyloidosis (ATTRv). Until recently, there have been no reports on retinal changes in ATTRwt. In this retrospective observational clinical study, we aimed to determine whether vessel density (VD) indices and the choroidal vascularity index (CVI) could offer insights into retinal and choroidal vascular changes among patients affected by ATTRwt. Methods Eighteen patients with a confirmed diagnosis of ATTRwt underwent structural optical coherence tomography (OCT) and OCT angiography (OCTA). We established a control group consisting of 16 healthy subjects for statistical comparisons. The 3D OCT and OCTA datasets were analyzed to assess retinal and choroidal thickness and VD. For measuring CVI, we obtained measurements for the total choroid area (TCA), luminal area (LA), and stromal area (SA). Results The mean VD exhibited a statistically significant reduction in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) among the ATTRwt group in comparison to the control group (p < 0.0001). Notably, ATTRwt patients displayed decreased choroidal thickness (p = 0.08). Additionally, the median CVI was lower in the ATTRwt group than in the control group (p = 0.04). Conclusion The indices from OCTA and CVI have the potential to serve as non-invasive biomarkers for the quantitative evaluation of retinal and choroidal vascular involvement in patients with ATTRwt.
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Affiliation(s)
- Michele Rinaldi
- Department of Ophthalmology, Università degli studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fausto Tranfa
- Department of Neuroscience, Reproductive and Dentistry Sciences, Federico II University of Naples, Naples, Italy
| | - Flavia Chiosi
- Department of Ophthalmology, Azienda Ospedaliera dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Campagna
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome “Sapienza”, Rome, Italy
| | - Maddalena De Bernardo
- Eye Unit, Department of Medicine Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Marco Gioia
- Eye Unit, Department of Medicine Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy
| | - Francesco Natale
- Department of Cardiothoracic Sciences, Università degli studi della Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Ciro Costagliola
- Department of Neuroscience, Reproductive and Dentistry Sciences, Federico II University of Naples, Naples, Italy
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Monda E, De Michele G, Diana G, Verrillo F, Rubino M, Cirillo A, Fusco A, Amodio F, Caiazza M, Dongiglio F, Palmiero G, Buono P, Russo MG, Limongelli G. Left Ventricular Non-Compaction in Children: Aetiology and Diagnostic Criteria. Diagnostics (Basel) 2024; 14:115. [PMID: 38201424 PMCID: PMC10871098 DOI: 10.3390/diagnostics14010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Left ventricular non-compaction (LVNC) is a heterogeneous myocardial disorder characterized by prominent trabeculae protruding into the left ventricular lumen and deep intertrabecular recesses. LVNC can manifest in isolation or alongside other heart muscle diseases. Its occurrence among children is rising due to advancements in imaging techniques. The origins of LVNC are diverse, involving both genetic and acquired forms. The clinical manifestation varies greatly, with some cases presenting no symptoms, while others typically manifesting with heart failure, systemic embolism, and arrhythmias. Diagnosis mainly relies on assessing heart structure using imaging tools like echocardiography and cardiac magnetic resonance. However, the absence of a universally agreed-upon standard and limitations in diagnostic criteria have led to ongoing debates in the scientific community regarding the most reliable methods. Further research is crucial to enhance the diagnosis of LVNC, particularly in early life stages.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
- Institute of Cardiovascular Science, University College London, London WC1N 3JH, UK
| | - Gianantonio De Michele
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Federica Amodio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Pietro Buono
- Department of Maternal and Child Health, General Directorate for Health, 80131 Naples, Italy
| | - Maria Giovanna Russo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
- Institute of Cardiovascular Science, University College London, London WC1N 3JH, UK
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Monda E, Rubino M, Riccio E, Caiazza M, Iaccarino G, Dongiglio F, Graziani F, Pisani A, Limongelli G. Clinical manifestation of patients with Fabry disease and R356W GLA variant. Int J Cardiol 2023; 392:131295. [PMID: 37619881 DOI: 10.1016/j.ijcard.2023.131295] [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: 06/20/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The R356W GLA variant is an ultra-rare cause of Fabry disease (FD). The clinical manifestations of adult patients carrying this variant have never been reported. This study aims to describe the clinical phenotype of the R356W GLA variant. METHODS The cohort consisted of consecutive patients diagnosed with FD and carrying the R356W GLA variant. An observational, longitudinal, retrospective cohort study design was used. Clinical, laboratory, and imaging data have been collected from the baseline evaluation to the last clinical review. RESULTS Six families, including 36 patients with FD and the R356W GLA variant (age 41.1 ± 15.9 years, 67% females), were evaluated. Eleven patients (31%) showed left ventricular hypertrophy (LVH), and 6 (17%) had chronic kidney disease (CKD). Patients with LVH were older (53.4 ± 8.5 vs. 35.7 ± 15.5, p-value 0.001), showed a higher prevalence of CKD (45% vs. 4%, p-value 0.002), and worse structural and functional cardiac parameters at echocardiographic evaluation. During a median follow-up of 42 (IQR 21-98) months, one patient experienced advanced atrioventricular block requiring pacemaker implantation and one end-stage renal disease requiring dialysis. No patients experienced major adverse events. CONCLUSION This study suggests that the R356W GLA variant could be a late-onset FD-causing variant with incomplete penetrance and predominantly cardiac manifestations.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Institute of Cardiovascular Science, University College London, London, UK
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Eleonora Riccio
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB CNR), Palermo, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Pisani
- Department of Public Health, University Federico II, Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Institute of Cardiovascular Science, University College London, London, UK.
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Palmiero G, Monda E, Verrillo F, Dongiglio F, Caiazza M, Rubino M, Lioncino M, Diana G, Vetrano E, Fusco A, Cirillo A, Mauriello A, Ciccarelli G, Ascione L, De Rimini ML, D'Alto M, Cerciello G, D'Andrea A, Golino P, Calabrò P, Bossone E, Limongelli G. Prevalence and clinical significance of right ventricular pulmonary arterial uncoupling in cardiac amyloidosis. Int J Cardiol 2023; 388:131147. [PMID: 37423570 DOI: 10.1016/j.ijcard.2023.131147] [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: 02/23/2023] [Revised: 05/30/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND This study aims to evaluate the prevalence and the clinical significance of the right ventricular pulmonary arterial (RV-PA) uncoupling in patients with cardiac amyloidosis (CA). METHODS The study population consisted in 92 consecutive patients with CA (age 71.1 ± 12.2 years, 71% males; 47% with immunoglobulin light chain (AL), 53% with transthyretin [ATTR]). A pre-specified tricuspid anulus plane systolic excursion on pulmonary arterial systolic pressure (TAPSE/PASP) value <0.31 mm/mmHg was used to define RV-PA uncoupling and to dichotomize the study population. RESULTS Thirty-two patients (35%) showed RV-PA uncoupling at baseline evaluation (15/44 [34%] AL and 17/48 [35%] ATTR). Patients with RV-PA uncoupling, in both AL and ATTR, showed worse NYHA functional class, lower systemic blood pressure, and more pronounced left ventricular and RV systolic dysfunction than those with RV-PA coupling. During a median follow-up of 8 months (IQR 4-13), 26 patients (28%) experienced cardiovascular death. Patients with RV-PA uncoupling showed lower survival at 12 months follow-up than those with RV-PA coupling (42.7% [95%CI 21.7-63.7%] vs. 87.3% [95%CI 78.3-96.3%], p-value<0.001). Multivariate analysis identified high-sensitivity troponin I values (HR 1.01 [95%CI 1.00-1.02] per 1 pg/mL increase; p-value 0.013) and TAPSE/PASP (HR 1.07 [95%CI 1.03-1.11] per 0.01 mm/mmHg decrease; p-value 0.002) as independent predictors of cardiovascular death. CONCLUSIONS RV-PA uncoupling is common among patient with CA, and it is a marker of advanced disease and worse outcome. This study suggest that TAPSE/PASP ratio has the potential to improve risk stratification and guide management strategies in patients with CA of different etiology and advanced disease.
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Affiliation(s)
- Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy; Institute of Cardiovascular Science, University College London, London, UK
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Erica Vetrano
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Alfredo Mauriello
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Giovanni Ciccarelli
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy; Sbarro Institute for Cancer Research and Molecular Medicine, Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
| | - Luigi Ascione
- Division of Cardiology, Department of Cardiology, Monaldi Hospital, Naples, Italy
| | | | - Michele D'Alto
- Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Cerciello
- Haematology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, Viale San Francesco 2, 84014, Nocera Inferiore, SA, Italy
| | - Paolo Golino
- Vanvitelli Cardiology Unit, Department of translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Paolo Calabrò
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Eduardo Bossone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy; Institute of Cardiovascular Science, University College London, London, UK.
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Obici L, Callaghan R, Ablett J, Bibiloni C, Bueser T, Conceição I, Dongiglio F, Farrugia A, Knebel F, Lane T, Larsson LO, Morier A, Nicholas V, Coelho T. Consensus recommendations on holistic care in hereditary ATTR amyloidosis: an international Delphi survey of patient advocates and multidisciplinary healthcare professionals. BMJ Open 2023; 13:e073130. [PMID: 37669844 PMCID: PMC10481833 DOI: 10.1136/bmjopen-2023-073130] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/28/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Hereditary transthyretin-mediated amyloidosis is a rare, progressive and potentially life-limiting multisystem disease, affecting every aspect of a patient's life. OBJECTIVES This online international Delphi survey aimed to evolve clinical-patient-led practical guidance, to inspire and encourage a holistic approach to care that is managed in specialist settings by multidisciplinary teams and supported by allied healthcare professionals (HCPs) and patient advocacy groups (PAGs). DESIGN A 14-member joint patient advocate-HCP primary panel was convened including representation from PAGs and key clinical specialties (neurology, cardiology, internal medicine, physiotherapy, clinical psychology, dietetics and specialist nursing). Guidance evolved on the care provision needed to support seven core goals: early diagnosis and treatment; disease monitoring and organisation of care; maintenance of physical and mental health; family-centred care and caregiver support; patient-doctor dialogue; access to social support and social networking. PARTICIPANTS From June to October 2022, 252 HCPs and 51 PAG representatives from 27 countries were invited to participate in a Delphi survey. Of the 122 respondents who answered at least one survey question, most were HCPs (100, 82%) from specialist centres; the remainder were PAG representatives (22, 18%). MAIN OUTCOME MEASURE Both level of agreement and feasibility in practice of each recommendation was tested by two anonymised online Delphi voting rounds. RESULTS Based on an a priori threshold for consensus of ≥75% agreement, the clinical-patient community endorsed all but one recommendation. However, only 17/49 (35%) recommendations were identified by most HCPs as a core part of routine care; the remainder (32/49 (65%)) were identified as part of core care by <50% of HCPs respondents, or as largely achievable by 30%-45% of HCPs. By comparison, PAGs recorded lower implementation levels. CONCLUSIONS Further consideration is needed on how to evolve multidisciplinary services (supported by allied HCPs and PAGs) to address the complex needs of those affected by this disease.
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Affiliation(s)
- Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Catilena Bibiloni
- Asociación Balear de la Enfermedad de Andrade, Palma de Mallorca, Spain
- Amyloïdosis Alliance, Marseille, France
| | - Teofila Bueser
- Southeast Genomic Medicine Service Alliance, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Isabel Conceição
- Department of Neurosciences and Mental Health, Centro Hospitalar Universitário Lisboa Norte-HSM; Lisbon University - FML, Lisbon, Portugal
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Disease Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Agnès Farrugia
- Amyloïdosis Alliance, Marseille, France
- Association Française Contre l'Amylose, Marseille, France
| | - Fabian Knebel
- Clinic for Internal Medicine II: Cardiology, Sana Klinikum Lichtenberg, Berlin, Germany
- Amyloidosis Center Charité Berlin, Berlin, Germany
| | - Thirusha Lane
- Patient Advocacy and Engagement, Alnylam Pharmaceuticals, Maidenhead, UK
| | | | | | | | - Teresa Coelho
- Familial Amyloidosis Clinic Unit, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
- European Reference Network - Euro-NMD, Paris, France
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7
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Monda E, Falco L, Palmiero G, Rubino M, Perna A, Diana G, Verrillo F, Dongiglio F, Cirillo A, Fusco A, Caiazza M, Limongelli G. Cardiovascular Involvement in Fabry's Disease: New Advances in Diagnostic Strategies, Outcome Prediction and Management. Card Fail Rev 2023; 9:e12. [PMID: 37602190 PMCID: PMC10433112 DOI: 10.15420/cfr.2023.06] [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: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 08/22/2023] Open
Abstract
Cardiovascular involvement is common in Fabry's disease and is the leading cause of morbidity and mortality. The research is focused on identifying diagnostic clues suggestive of cardiovascular involvement in the preclinical stage of the disease through clinical and imaging markers. Different pathophysiologically driven therapies are currently or will soon be available for the treatment of Fabry's disease, with the most significant benefit observed in the early stages of the disease. Thus, early diagnosis and risk stratification for adverse outcomes are crucial to determine when to start an aetiological treatment. This review describes the cardiovascular involvement in Fabry's disease, focusing on the advances in diagnostic strategies, outcome prediction and disease management.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
- Institute of Cardiovascular Science, University College LondonLondon, UK
| | - Luigi Falco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Alessia Perna
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi HospitalNaples, Italy
- Institute of Cardiovascular Science, University College LondonLondon, UK
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8
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Monda E, Rubino M, Palmiero G, Verrillo F, Lioncino M, Diana G, Cirillo A, Fusco A, Dongiglio F, Caiazza M, Altobelli I, Mauriello A, Guarnaccia N, Scatteia A, Cesaro A, Pacileo G, Sarubbi B, Frisso G, Bauce B, D’Andrea A, Dellegrottaglie S, Russo MG, Calabrò P, Limongelli G. Multimodality Imaging in Arrhythmogenic Left Ventricular Cardiomyopathy. J Clin Med 2023; 12:jcm12041568. [PMID: 36836107 PMCID: PMC9966192 DOI: 10.3390/jcm12041568] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
The term arrhythmogenic cardiomyopathy (ACM) describes a large spectrum of myocardial diseases characterized by progressive fibrotic or fibrofatty replacement, which gives the substrate for the occurrence of ventricular tachyarrhythmias and the development of ventricular dysfunction. This condition may exclusively affect the left ventricle, leading to the introduction of the term arrhythmogenic left ventricular cardiomyopathy (ALVC). The clinical features of ALVC are progressive fibrotic replacement with the absence or mild dilation of the LV and the occurrence of ventricular arrhythmias within the left ventricle. In 2019, the diagnostic criteria for the diagnosis of ALVC, based on family history and clinical, electrocardiographic, and imaging features, have been proposed. However, since the significant clinical and imaging overlap with other cardiac diseases, genetic testing with the demonstration of a pathogenic variant in an ACM-related gene is required for diagnostic confirmation. In ALVC, the multimodality imaging approach comprises different imaging techniques, such as echocardiography, cardiac magnetic resonance, and cardiac nuclear imaging. It provides essential information for the diagnosis, differential diagnosis, sudden cardiac death risk stratification, and management purposes. This review aims to elucidate the current role of the different multimodality imaging techniques in patients with ALVC.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
- Institute of Cardiovascular Sciences, University College of London and St. Bartholomew’s Hospital, London WC1E 6DD, UK
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Ippolita Altobelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Alfredo Mauriello
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Natale Guarnaccia
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | | | - Arturo Cesaro
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Pacileo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Berardo Sarubbi
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giulia Frisso
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, University of Naples “Federico II”, 80138 Naples, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | | | - Maria Giovanna Russo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Paolo Calabrò
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
- Institute of Cardiovascular Sciences, University College of London and St. Bartholomew’s Hospital, London WC1E 6DD, UK
- Correspondence: ; Tel.: +39-0817062815
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9
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Monda E, Lioncino M, Palmiero G, Franco F, Rubino M, Cirillo A, Verrillo F, Fusco A, Caiazza M, Mazzella M, Moscarella E, Dongiglio F, Sepe J, Pacileo G, Calabrò P, Limongelli G. Bisoprolol for treatment of symptomatic patients with obstructive hypertrophic cardiomyopathy. The BASIC (bisoprolol AS therapy in hypertrophic cardiomyopathy) study. Int J Cardiol 2022; 354:22-28. [DOI: 10.1016/j.ijcard.2022.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 01/06/2023]
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10
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Palmiero G, Rubino M, Lioncino M, Monda E, Vetrano E, Verrillo F, Dongiglio F, Fusco A, Cirillo A, Caiazza M, Ascione L, Caso P, Limongelli G. Pathophysiological, haemodynamic and prognostic implications of left atrial dysfunction in cardiac amyloidosis and other cardiomyopathies with hypertrophic phenotype. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.273] [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 & PURPOSE. Left atrial function (LAF) is a determinant of clinical status and outcome in many cardiac disorders, including cardiac amyloidosis (CA). Aim of this study is to explores the LAF in CA and other cardiomyopathies with hypertrophic phenotype, and its consequences on cardiovascular haemodynamics, right ventricular function and survival.
METHODS. We enrolled 50 patients with CA (26 AL and 24 wtATTR) and 75 with hypertrophic phenotype (LVH group) [25 hypertrophic cardiomyopathy (HCM) pts, 25 hypertensive pts (HypCM), and 25 pts with aortic stenosis (AS)]. LAF was analysed using the phasic method [LAEI as reservoir, LAPEF as conduit, LAAEF as active pump and TLAEF as total emptying function; see figure 1] by LA volumes determination.
RESULTS. ATTR patients showed higher LA dimensions and impaired reservoir and total LA emptying function (TLAEF) compared to AL without differences LAF. Compared to the LVH group, CA patients showed higher LA dimension with impaired LAF in all phasic parameters, higher LV filling pressures and reduced biventricular function. We further divided CA and LVH patients into four subgroups based on the presence or absence of LA dysfunction (LADys+ for TLAEF values below the median: <50.2%; range 9.3-70.9%]. Among the groups, patients with CA/LADys+ showed worst clinical status, higher pulmonary pressures (sPAP) and lower TAPSE and TAPSE/sPAP ratio values. After a median follow-up of 24 months, 19 patients died from cardiovascular (CV) causes (15 in CA/LADys+ group and 4 in LVH/LADys+). The overall survival free of CV death was 64% in CA/LADys+ and 85% in LVH/LADys+ (4/26) group [log-rank χ2 29.6; p < 0.0001]. A sequential multivariate model was employed to assess whether LAF could predict CV deaths: TLAEF was entered together with established clinical and echocardiographic parameters (NYHA functional class, LAVI, E/Em, sPAP, TAPSE and TAPSE/sPAP ratio). At the final backward analysis, LAVI, TAPSE/sPAP and TLAEF were independent prognosticators of CV death.
CONCLUSIONS. LAF is significantly more impaired in CA than LVH group and is associated with worst clinical status, RV dysfunction and higher LV filling and pulmonary pressure. Moreover, LADys is a frequent feature of CA and significantly associated with higher CV mortality. We suggests that LADys in LVH group could results from chronic pressure overload due to LA"s exposure to high LV diastolic pressure (impaired LV compliance). In CA, LADys could also be determined by direct LA infiltration. The pathophysiological result is a progressive LA remodelling with increased LA pressure, consequent backward transmission to the pulmonary venous system and, ultimately, RV dysfunction. TLAEF is parameter of LAF that correlates with increased pulmonary vascular resistance (measured elsewhere with cardiac catheterisation) and RV dysfunction. In CA, it seems promising as marker of the haemodynamic consequences of LADys and CV mortality. Abstract Figure 1 Abstract Figure 2
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Affiliation(s)
- G Palmiero
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Rubino
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Lioncino
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - E Monda
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - E Vetrano
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - F Verrillo
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - F Dongiglio
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - A Fusco
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - A Cirillo
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Caiazza
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - L Ascione
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - P Caso
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - G Limongelli
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
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11
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Palmiero G, Rubino M, Monda E, Lioncino M, Verrillo F, Vetrano E, Caiazza M, Fusco A, Cirillo A, Dongiglio F, Ascione L, Caso P, Limongelli G. Diagnostic and prognostic implications of myocardial work in cardiac amyloidosis and in genetic and non-genetic cardiomyopathies with hypertrophic phenotype. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.271] [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 & PURPOSE. Cardiac amyloidosis (CA) is an infiltrative disorder characterized by left ventricular (LV) thickening with early systolic and diastolic dysfunction. Due to it poor prognosis, and the beneficial impact of novel treatments when started in early stages of disease, its forward detection is crucial. Aim of this study is comparing the diagnostic accuracy of classical and novel echocardiographic parameters in detecting CA among other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype.
METHODS. We enrolled 50 pts with CA (26 AL and 24 wtATTR) and 75 phenocopies (LVH group) [25 hypertrophic cardiomyopathy (HCM) pts, 25 hypertensive (HypCM) pts, and 25 pts with non-severe aortic stenosis (AS)]. Standard and novel LV morpho-functional echo parameters [LV ejection fraction (LVEF), myocardial contraction fraction (MCF), global longitudinal strain (GLS), relative regional strain ratio (RRSR), ejection fraction on strain ratio (EFSR)], and novel Myocardial Work (MW) parameters [Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE)] were analyzed.
RESULTS. LV standard, novel and MW-derived systolic parameters were more impaired in CA compared to LVH group. At ROC curve analysis, GCW showed the best performance in discriminating CA from other forms of LVH (AUC 0.886; 95% CI: 0.819-0.954; P < 0.0001), with a cut-off value < 1473 mmHg% showing 90% of sensitivity and 82% of specificity). At linear regression analysis, GCW correlated with many echocardiographic parameters (IVSD, PWD, RWT ratio, LVMi, MCF, LVESV, LVEF, EFSR and RRSR). At multivariate analysis, PWD (P < 0,029) and RWT ratio (p < 0,014) were the only parameters associated with GCW. At 24 months follow-up, there were 15 deaths in CA and 4 in LVH group. At Kaplan-Meier analysis the overall survival free of cardiovascular death was reduced in the lowest GCW interquartile ranges (log-rank χ2 21.5; p < 0.0001). At Cox hazard ratio analysis, GCW was the only prognostic parameter associated with cardiovascular mortality (β 1.006; 95% CI: 1.003-1.009; P < 0.0001).
CONCLUSIONS. Despite CA and LVH patients shows a similar phenotype, the systolic function differs greatly. In the present study, the GCW showed the best ability in detecting CA among other forms of LVH. Its reduction in CA seems reflect the infiltrative burden and its consequences on myocardial deformation properties, while its reduction in LVH group has been attributed elsewhere to fibrotic derangement. GCW showed to be a promising novel diagnostic and prognostic factor in this setting. Abstract Figure 1 Abstract Table 1
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Affiliation(s)
- G Palmiero
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Rubino
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - E Monda
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Lioncino
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - F Verrillo
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - E Vetrano
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Caiazza
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - A Fusco
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - A Cirillo
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - F Dongiglio
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - L Ascione
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - P Caso
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - G Limongelli
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
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12
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Palmiero G, Rubino M, Monda E, Lioncino M, Verrillo F, Dongiglio F, Caiazza M, Vetrano E, Cirillo A, Fusco A, Ascione L, Caso P, Limongelli G. Diagnostic and prognostic implications of right ventricular-arterial coupling in cardiac amyloidosis and in genetic and non-genetic cardiomyopathies with hypertrophic phenotype. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.272] [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 & PURPOSE. Right ventricular (RV) dysfunction in cardiomyopathies is a consequence of chronic overload (i.e. aortic stenosis, AS) or direct involvement of systemic disorders (i.e. cardiac amyloidosis, CA). The Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure (TAPSE/sPAP) ratio has been recently proposed as a surrogate of RV-arterial coupling (RVAC). This study aims to compare RVAC between CA subgroups and between CA and other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype.
METHODS. We enrolled 50 patients with CA (26 AL and 24 wtATTR) and 75 cardiomyopathies with hypertrophy phenotype (LVH group) [25 pts with hypertrophic cardiomyopathy (HCM), 25 hypertensive pts(HypCM), and 25 pts with AS]. Besides routine echocardiographic measurements, we analysed right chambers dimensions and classical and novel parameters of RV function [TAPSE, TAPSE/sPAP, St wave, global (RVGLS) and free-wall (RVFWS) strain].
RESULTS. Compared to AL, the ATTR group showed higher right chambers dimensions, without differences in all RV systolic parameters. Compared to the LVH group, CA patients showed no differences in RV dimensions while RV systolic parameters, including the TAPSE/sPAP ratio, were significantly reduced in the presence of significantly higher LV filling pressures. At ROC curve analysis, TAPSE (AUC 0.877; 95% CI: 0.811-0.943; p < 0,0001) and TAPSE/sPAP ratio (AUC 0.859; 95% CI: 0.783-0.935; p < 0,0001) showed the best ability in discriminating CA among other forms of LVH (cut-off 20.5 mm for TAPSE with sensibility of 80.5% and specificity of 78.8%, respectively; cut-off 0.62 for TAPSE/sPAP ratio with sensibility of 85.4% and specificity 81.8%). At 24 months follow-up, there were 15 deaths in CA (30%) and 4 in LVH group (5%). At Kaplan-Meier estimation, the TAPSE/sPAP ratio showed progressively a significantly reduced survival in the lowest interquartile ranges. Moreover, at multivariate analysis, TAPSE/sPAP was the only independent prognostic factor (β -5,644; 95% IC: 0,000-0,522; p < 0,027).
CONCLUSIONS. The RVAC is significantly impaired in CA compared to the LVH group but not between CA subgroups. Its reduction seems attributable to both increase LV filling pressure, due to the restrictive nature of the infiltrative cardiomyopathy, and reduced RV systolic function, due to either indirect RV chronic overload and direct myocardial infiltration. The TAPSE/sPAP ratio is a surrogate of RVAC and proved to be a novel echocardiographic parameter useful in both discriminating CA among genetic and non-genetic forms of LVH, and stratifying the prognosis. Abstract Table 1 Abstract Figure 1
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Affiliation(s)
- G Palmiero
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Rubino
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - E Monda
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Lioncino
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - F Verrillo
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - F Dongiglio
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Caiazza
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - E Vetrano
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - A Cirillo
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - A Fusco
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - L Ascione
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - P Caso
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - G Limongelli
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
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13
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Monda E, Palmiero G, Lioncino M, Rubino M, Caiazza M, Vetrano E, Di Fraia F, Mauriello A, Cirillo A, Verrillo F, Fusco A, Dongiglio F, Calabrò P, Golino P, Limongelli G. 589 External validation of the increased wall thickness score for the diagnosis of cardiac amyloidosis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
This study aimed to validate the increased wall thickness (IWT) score, a multiparametric echocardiographic score to facilitate diagnosis of cardiac amyloidosis (CA), in an independent population of patients with increased LV wall thickness suspicious for CA.
Methods and results
Between January 2019 and December 2020, 152 consecutive patients with increased LV wall thickness suspicious for CA were included. For all patient, the multiparametric echocardiographic score (IWT score) was calculated. To validate the diagnostic accuracy of an IWT score ≥8 to predict the diagnosis of CA, sensibility (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and predictive accuracy (PA) were calculated. Among the 152 patients included in the study, 50 (33%) were diagnosed as CA, 25 (16%) had severe aortic stenosis, 25 (16%) had hypertensive remodelling, and 52 (34%) had hypertrophic cardiomyopathy. Among the 50 and 102 patients with and without CA, 19 (38%) and 1 (1%) showed an IWT score ≥8, respectively. Overall, the diagnostic accuracy of an IWT score ≥8 for the diagnosis of CA in our population was the following: Se 38% (95% CI: 25–53%); Sp 99% (95% CI: 95–100%); PPV 95% (95% CI: 72–99%); NPV 77% (95% CI: 73–80%); PA 79% (95% CI: 72–85%).
Conclusions
This study reports the first external validation of the IWT score for the diagnosis of CA in patients with increased LV wall thickness. A score ≥8 showed a high Sp, PPV and PA, suggesting that the IWT score can be used to identify CA patients in those with increased LV wall thickness.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Erica Vetrano
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Francesco Di Fraia
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Alfredo Mauriello
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Paolo Calabrò
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Paolo Golino
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
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14
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Monda E, Lioncino M, Palmiero G, Rubino M, Cirillo A, Verrillo F, Fusco A, Caiazza M, Mazzella M, Moscarella E, Dongiglio F, Sepe J, Russo MG, Pacileo G, Limongelli G. 577 Bisoprolol for the treatment of symptomatic patients with obstructive hypertrophic cardiomyopathy. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
To evaluate to role of bisoprolol to control symptoms and left ventricular outflow tract obstruction (LVOTO) in a consecutive cohort of adults with hypertrophic cardiomyopathy (HCM).
Methods and results
In this retrospective study, patients with HCM with an LVOT gradient ≥50mmHg after Valsalva manoeuvre and New York Heart Association (NYHA) class II-III symptoms were assigned to receive bisoprolol (starting at 1.25 mg daily). The initial dose was increased every two weeks to achieve the target in LVOT gradient <30 mmHg or the maximum tolerated dose. The primary endpoint was the achievement of a LVOT gradient <30 mmHg and ≥1 NYHA class improvement. The secondary endpoints were proportion of patients with LVOT gradient <30 mmHg or < 50 mmHg, proportion of patients with ≥1 NYHA class improvement, and change from baseline in LVOT gradient. Between December 2001 and December 2020, 92 patients were enrolled into the study. Sixteen (17%) patients on bisoprolol met the primary endpoint. Bisoprolol reduced the LVOT gradient to less than 30 mmHg in 33 (36%) patients, to less than 50 mmHg in 57 (62%), and improved NYHA class in 30 (33%). The mean reduction of LVOT gradient on bisoprolol was 28 (±14) mmHg and the percentage reduction was 42 (±21)%. In 35 (39%) patients, bisoprolol did not reduce the gradient to less than 50 mmHg requiring disopyramide and/or myectomy to achieve this goal.
Conclusions
Treatment with bisoprolol was well-tolerated and effective in relieving obstruction and improving symptoms in a significant proportion of patients with symptomatic obstructive HCM.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Marialuisa Mazzella
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Elisabetta Moscarella
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Joseph Sepe
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases Unit, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
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15
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Palmiero G, Vetrano E, Rubino M, Monda E, Dongiglio F, Lioncino M, Di Fraia F, Caiazza M, Verrillo F, Capodicasa L, Cerciello G, Manganelli F, Catalano M, D'Arienzo D, De Rimini ML, Ascione R, Golino P, Caso P, Ascione L, Limongelli G. The Role of New Imaging Technologies in the Diagnosis of Cardiac Amyloidosis. Heart Fail Clin 2021; 18:61-72. [PMID: 34776084 DOI: 10.1016/j.hfc.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac amyloidosis is an infiltrative disorder caused by transthyretin or immunoglobulin free light-chain deposition, which determines clinical disease with similar phenotype but different time course, prognosis and therapy. Multimodality imaging is the cornerstone for disease diagnosis and management. Multimodality imaging has revolutionized the approach to the disease favoring its awareness and simplifying its diagnosis, especially in ATTR cardiac amyloidosis. This describes the different imaging tools, from the traditional to the more novel ones, and highlights the different approach in each different setting (prognosis, subtyping, prognosis, monitoring disease progression, and response to therapy).
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Affiliation(s)
- Giuseppe Palmiero
- Department of Cardiology, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy; Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy.
| | - Erica Vetrano
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Francesco Di Fraia
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Laura Capodicasa
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Giuseppe Cerciello
- Haematology Unit (Building n. 2), Department of Clinical Medicine and Surgery, AOU Policlinico "Federico II", via Sergio Pansini 5, 80131 Naples, Italy
| | - Fiore Manganelli
- Neurology Unit (Building n. 17), Department of Neurosciences, Reproductive Medicine and Odontostomatology, AOU Policlinico "Federico II", via Sergio Pansini 5, 80131 Naples, Italy
| | - Mara Catalano
- Department of Nuclear Imaging, AORN Cardarelli Hospital, via Antonio Cardarelli 9, 80131 Naples, Italy
| | - Davide D'Arienzo
- Department of Nuclear Medicine, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Maria Luisa De Rimini
- Department of Nuclear Medicine, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Paolo Golino
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pio Caso
- Department of Cardiology, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Luigi Ascione
- Department of Cardiology, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases Unit, AORN Ospedale dei Colli - Monaldi Hospital, via Leonardo Bianchi SNC, 80131 Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, UK
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16
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Rubino M, Monda E, Lioncino M, Caiazza M, Palmiero G, Dongiglio F, Fusco A, Cirillo A, Cesaro A, Capodicasa L, Mazzella M, Chiosi F, Orabona P, Bossone E, Calabrò P, Pisani A, Germain DP, Biagini E, Pieroni M, Limongelli G. Diagnosis and Management of Cardiovascular Involvement in Fabry Disease. Heart Fail Clin 2021; 18:39-49. [PMID: 34776082 DOI: 10.1016/j.hfc.2021.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Fabry disease (FD, OMIM 301500) is an X-linked lysosomal storage disease caused by pathogenic variants in the GLA gene. Cardiac involvement is common in FD and is responsible for impaired quality of life and premature death. The classic cardiac involvement is a nonobstructive form of hypertrophic cardiomyopathy, usually manifesting as concentric left ventricular hypertrophy, with subsequent arrhythmogenic intramural fibrosis. Treatment of patients with FD should be directed to prevent the disease progression to irreversible organ damage and organ failure. The aim of this review is to describe the current state of knowledge regarding cardiovascular involvement in FD, focusing on clinical and instrumental features, cardiovascular management, and targeted therapy.
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Affiliation(s)
- Marta Rubino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Michele Lioncino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Giuseppe Palmiero
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Francesca Dongiglio
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Adelaide Fusco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Annapaola Cirillo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Laura Capodicasa
- Department of Nephrology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Marialuisa Mazzella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Flavia Chiosi
- Department of Ophthalmology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Paolo Orabona
- Department of Ophthalmology, Monaldi Hospital, Via L. Bianchi, Naples 80131, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Via A. Cardarelli, Naples 80131, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy
| | - Antonio Pisani
- Department of Public Health, University Federico II of Naples, Via Pansini, Naples 80131, Italy
| | - Dominique P Germain
- French Referral Centre for Fabry Disease, Division of Medical Genetics, Hôpital Raymond-Poincare, AP-HP, Garches 92380, France
| | - Elena Biagini
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, Naples 80131, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, Grower Street, London WC1E 6DD, UK.
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17
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Lioncino M, Monda E, Palmiero G, Caiazza M, Vetrano E, Rubino M, Esposito A, Salerno G, Dongiglio F, D'Onofrio B, Verrillo F, Cerciello G, Manganelli F, Pacileo G, Bossone E, Golino P, Calabrò P, Limongelli G. Cardiovascular Involvement in Transthyretin Cardiac Amyloidosis. Heart Fail Clin 2021; 18:73-87. [PMID: 34776085 DOI: 10.1016/j.hfc.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) is a systemic disorder resulting from the extracellular deposition of amyloid fibrils of misfolded transthyretin protein in the heart. ATTR-CA is a life-threatening disease, which can be caused by progressive deposition of wild type transthyretin (wtATTR) or by aggregation of an inherited mutated variant of transthyretin (mATTR). mATTR Is a rare condition transmitted in an autosomal dominant manner with incomplete penetrance, causing heterogenous phenotypes which can range from predominant neuropathic involvement, predominant cardiomyopathy, or mixed. Diagnosis of ATTR-CA is complex and requires integration of different imaging tools (echocardiography, bone scintigraphy, magnetic resonance) with genetics, clinical signs, laboratory tests, and histology. In recent years, new therapeutic agents have shown good efficacy and impact on survival and quality of life in this subset of patients, nevertheless patients affected by ATTR-CA may still carry an unfavorable prognosis, thus highlighting the need for new therapies. This review aims to assess cardiovascular involvement, diagnosis, and management of patients affected by ATTR-CA.
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Affiliation(s)
- Michele Lioncino
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Erica Vetrano
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy; Internal Medicine Unit, Department of Translational Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Augusto Esposito
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Gemma Salerno
- Vanvitelli Cardiology Unit, Monaldi Hospital, Naples 80131, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Barbara D'Onofrio
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Cerciello
- Haematology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Via Pansini, 5, Naples 81025, Italy
| | - Giuseppe Pacileo
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Eduardo Bossone
- Division of Cardiology, "Antonio Cardarelli" Hospital, Naples 80131, Italy
| | - Paolo Golino
- Vanvitelli Cardiology Unit, Monaldi Hospital, Naples 80131, Italy; Department of Translational Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Calabrò
- Department of Translational Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna & San Sebastiano", Caserta I-81100, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London WC1E 6DD, UK.
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18
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Palmiero G, Rubino M, Monda E, Caiazza M, Di Fraia F, Lioncino M, Vetrano E, Dongiglio F, Cerciello G, Manganelli F, Ascione L, Caso P, Limongelli G. Myocardial performance is impaired in cardiac amyloidosis: role of myocardial work-derived parameter in differential diagnosis with phenocopies and prognostic implications. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac amyloidosis (CA) is an infiltrative disorder characterized by left ventricular (LV) thickening and dysfunction. Due to it poor prognosis its early detection and differential diagnosis among other forms of cardiomyopathies is fundamental.
Purpose
This study aimed to compare the diagnostic accuracy of LV classical and and novel echocardiographic parameters in differentiating CA from other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype.
Methods
We included 50 patients with CA (26 pts with AL and 24 pts with wild type ATTR form) and 75 patients with LV hypertrophy (LVH) [25 patients with hypertrophic cardiomyopathy (HCM), 25 with hypertensive cardiomyopathy (HypCM), and 25 with aortic stenosis (AS)]. Besides routine echocardiographic measurements, we analysed standard and novel echo parameters implied in LV assessment [LV ejection fraction (LVEF), myocardial contraction fraction (MCF), global longitudinal strain (GLS), relative regional strain ratio (RRSR), ejection fraction on strain ratio (EFSR)], included novel Myocardial Work (MW) parameters [Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE)].
Results
Patients in CA group showed a smallest LV cavity size, higher LV mass and, consequently, a more pronounced concentric hypertrophy compared to LVH group. All LV systolic parameters where more impaired in CA than in LVH group. At ROC curve analysis, among all others, GCW showed the best performance in discriminating CA from LVH (AUC 0.886; 95% CI: 0.819–0.954; P<0,0001), with a cut-off value <1473 mmHg% showing good sensitivity and specificity (90% and 82%, respectively). At linear regression analysis GCW correlated with IVSD (P<0,0001), PWD (p<0,0001), RWT ratio (p<0,0001), LVMi (p<0,0001), MCF (P<0,0001), LVESV (p<0,002), LVEF (P<0,0001), EFSR (p<0,0001) and RRSR (p<0,0001). At multivariate analysis, PWD (P<0,029) and RWT ratio (p<0,014) were the only parameters associated. At 24 months follow-up there were 15 deaths in the CA group and 4 in LVH group. At Kaplan-Meier analysis the overall survival free of cardiovascular death was reduced in the lowest GCW interquartile ranges (log-rank χ2 21,5; p<0,0001). At Cox hazard ratio analysis GCW (β 1,233; 95% CI: 1,201–1,246; P<0,0001) was the only prognostic parameter associated with cardiovascular mortality.
Discussion
Although CA and and LVH have with similar phenotype, they differ greatly in terms of systolic function. The MW, estimated by non-invasive pressure-strain loops, is a novel method for a load-independent LV systolic function assessment. In the present study the GCW showed the best ability in detecting CA in comparison to other parameters usually implied in clinical practice.
Conclusion
Myocardial performance is significantly reduced in CA compared to other forms of LVH. GCW showed to be a promising novel diagnostic and prognostic factor in this setting.
Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
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Affiliation(s)
- G Palmiero
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Rubino
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - E Monda
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - M Caiazza
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - F Di Fraia
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - M Lioncino
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - E Vetrano
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - F Dongiglio
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - G Cerciello
- Federico II University of Naples, Hematology Unit, Naples, Italy
| | - F Manganelli
- Federico II University of Naples, Department of Neurosciences, Naples, Italy
| | - L Ascione
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - P Caso
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - G Limongelli
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
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19
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Palmiero G, Rubino M, Monda E, Caiazza M, Vetrano E, Lioncino M, Di Fraia F, Dongiglio F, Cerciello G, Manganelli F, Ascione L, Caso P, Limongelli G. Left atrial function is impaired in cardiac amyloidosis and other cardiomyopathies with hypertrophic phenotype: haemodynamic correlations, pathophysiological consequences and prognostic implications. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1741] [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
Left atrial function (LAF) is emerging as a novel determinant of clinical status and outcome in cardiomyopathies. However, few studies compare LAF between CA subgroups and between CA and other hypertrophic cardiomyopathies.
Purpose
This study explores the LAF in cardiomyopathies with hypertrophic phenotype and between CA subgroups and its consequences on clinical status, haemodynamic consequences and survival.
Methods
We enrolled 50 patients with CA (26 with AL and 24 with wild type ATTR form), 75 patients with LV hypertrophy (LVH) [25 with hypertrophic cardiomyopathy (HCM), 25 with hypertensive cardiomyopathy (HypCM), and 25 with aortic stenosis (AS)]. Besides routine echocardiographic measurements, we analysed LAF using the phasic method (LAEI as reservoi, LAPEF as conduit, LAAEF as pump and TLAEF as total emptying LA function).
Results
The ATTR showed higher atrial dimensions with a significant reduction in the reservoir and total LA emptying function compared to the AL group (see Table 1). Instead, compared to the LVH group, CA patients showed higher atrial dimension with all LAF phasic parameters reduced, higher LV filling pressures and reduced biventricular function. Then, we further divided the CA and LVH group into subgroups based on the presence or absence of LA dysfunction (LADys+) defined as TLAEF values below the median [TLAEF <50,2%; range 9,3–70,9%]. Patients in CA/LADys+ group showed the worst NYHA class, higher sPAP and lower values of TAPSE and TAPSE/sPAP ratio (see Figure 2). After a follow-up of 24 months, 19 patients died from cardiovascular causes [0/8 in CA/LADys-, 15/42 in CA/LADys+, 0/60 in LVH/LADys- and 4/26 in LVH/LADys+ group; (log-rank χ2 29,6; p<0,0001)]. To predict whether LAF could predict cardiovascular deaths sequential multivariate model was employed, and TLAEF was entered together with established clinical and echocardiographic parameters (NYHA class, LAVI, E/Em, sPAP, TAPSE and TAPSE/sPAP ratio). At the final backward analysis, LAVI, TAPSE/sPAP and TLAEF were the independent prognosticators for adverse events.
Discussion
The LAF is significantly impaired in CA and associated with worst clinical status, higher incidence of RV dysfunction and higher LV filling and pulmonary pressure. Moreover, LADys is significant associated with higher cardiovascular mortality. LADys results from chronic pressure overload due to LA's exposition to the higher LV diastolic pressure due to impaired LV compliance, and from direct infiltration in CA The result is a progressive LA remodelling with an increased LA pressure and consequenT backward transmission to the pulmonary venous system and to RV.
Conclusions
The TLAEF is a novel parameter of LAF that correlates with increased pulmonary vascular resistance and RV dysfunction. It seems a promising novel prognosticator and amarker of the haemodynamic consequences of LADys.
Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
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Affiliation(s)
- G Palmiero
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - M Rubino
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - E Monda
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - M Caiazza
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - E Vetrano
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - M Lioncino
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - F Di Fraia
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - F Dongiglio
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - G Cerciello
- Federico II University of Naples, Hematology Unit, Naples, Italy
| | - F Manganelli
- Federico II University of Naples, Department of Neurosciences, Naples, Italy
| | - L Ascione
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - P Caso
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - G Limongelli
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
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Palmiero G, Monda E, Rubino M, Caiazza M, Vetrano E, Di Fraia F, Lioncino M, Dongiglio F, Carciello G, Manganelli F, Ascione L, Caso P, Limongelli G. The role of right ventricular-arterial coupling in cardiac amyloidosis: a comparison between subtypes and with other genetic and non-genetic hypertrophic cardiomyopathies and prognostic consequences. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1727] [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
Right ventricular (RV) dysfunction in cardiomyopathies is a consequence of chronic overload (i.e. aortic stenosis) or direct involvement of systemic disorders (i.e. cardiac amyloidosis, CA). The Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure ratio (TAPSE/sPAP) has been recently proposed as a surrogate of RV-arterial coupling (RVAC) in many cardiac disorders.
Purpose
This study aims to compare RVAC between CA subgroups and between CA and other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype.
Methods
We enrolled 50 patients with CA (26 pts with AL and 24 pts with wild type ATTR form), 75 patients with LV hypertrophy (LVH) [25 patients with HCM, 25 with hypertensive cardiomyopathy (HypCM), and 25 with aortic stenosis]. We analysed right chambers dimensions and classical and novel parameters of RV function [TAPSE, TAPSE/sPAP, St (S' wave at RV TDI), global (RVGLS) and free-wall (RVFWS) strain].
Results
The ATTR group showed higher right dimensions than AL, without differences in all RV systolic parameters (see Table 1). Compared to the LVH group, CA patients showed no differences in RV dimensions while RV systolic parameters, included the TAPSE/sPAP ratio, were significantly reduced. At ROC curve analysis TAPSE (AUC 0.877; 95% CI: 0.811–0.943; p<0,0001) and TAPSE/sPAP ratio (AUC 0.859; 95% CI: 0.783–0.935; p<0,0001) showed the best ability in discriminating CA among other forms of LVH (cut-off 20,5 mm for TAPSE with a sensibility of 80,5% and specificity of 78,8%; cut-off 0,62 for TAPSE/sPAP ratio with a sensibility of 85,4% and a specificity 81,8%). At Kaplan-Meier estimation, the TAPSE/sPAP ratio showed a significantly reduced survival in the lowest interquartile ranges. Moreover, at multivariate analysis TAPSE/sPAP was the only independent prognostic factor (β −5,644; 95% IC: 0,000–0,522; p<0,027).
Discussion
The RVAC is significantly impaired in CA compared to the LVH group but not between CA subgroups. TAPSE/sPAP proved to be a novel echocardiographic parameter useful in discriminating CA among genetic and non-genetic forms of LVH, and that also show prognostic significance.
Funding Acknowledgement
Type of funding sources: None. Figure 1. K-M for TAPSE/sPAP ratio IQ rangesTable 1
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Affiliation(s)
- G Palmiero
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - E Monda
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - M Rubino
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - M Caiazza
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - E Vetrano
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - F Di Fraia
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - M Lioncino
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - F Dongiglio
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
| | - G Carciello
- Federico II University of Naples, Hematology Unit, Naples, Italy
| | - F Manganelli
- Federico II University of Naples, Department of Neurosciences, Naples, Italy
| | - L Ascione
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - P Caso
- AORN Ospedali dei Colli - Monaldi Hospital, Department of Cardiology, Naples, Italy
| | - G Limongelli
- University of Campania “Luigi Vanvitelli”, Department of Translational Sciences, Naples, Italy
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Monda E, Palmiero G, Lioncino M, Rubino M, Caiazza M, Dongiglio F, Limongelli G. External validation of the increased wall thickness score for the diagnosis of cardiac amyloidosis. Int J Cardiol 2021; 339:99-101. [PMID: 34289405 DOI: 10.1016/j.ijcard.2021.07.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study aimed to validate the increased wall thickness (IWT) score, a multiparametric echocardiographic score to facilitate diagnosis of cardiac amyloidosis (CA), in an independent population of patients with increased LV wall thickness suspicious for CA. METHODS Between January 2019 and December 2020, 152 consecutive patients with increased LV wall thickness suspicious for CA were included. For all patient, the multiparametric echocardiographic score (IWT score) was calculated. To validate the diagnostic accuracy of an IWT score ≥ 8 to predict the diagnosis of CA, sensibility (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and predictive accuracy (PA) were calculated. RESULTS Among the 152 patients included in the study, 50 (33%) were diagnosed as CA, 25 (16%) had severe aortic stenosis, 25 (16%) had hypertensive remodeling, and 52 (34%) had hypertrophic cardiomyopathy. Among the 50 and 102 patients with and without CA, 19 (38%) and 1 (1%) showed an IWT score ≥ 8, respectively. Overall, the diagnostic accuracy of an IWT score ≥ 8 for the diagnosis of CA in our population was the following: Se 38% (95%CI 25-53%); Sp 99% (95%CI 95-100%); PPV 95% (95%CI 72-99%); NPV 77% (95%CI 73-80%); PA 79% (95%CI 72-85%). CONCLUSIONS This study reports the first external validation of the IWT score for the diagnosis of CA in patients with increased LV wall thickness. A score ≥ 8 showed a high Sp, PPV and PA, suggesting that the IWT score can be used to identify CA patients in those with increased LV wall thickness.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London, UK.
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