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Porcari A, Fontana M, Canepa M, Biagini E, Cappelli F, Gagliardi C, Longhi S, Pagura L, Tini G, Dore F, Bonfiglioli R, Bauckneht M, Miceli A, Girardi F, Martini AL, Barbati G, Costanzo EN, Caponetti AG, Paccagnella A, Sguazzotti M, La Malfa G, Zampieri M, Sciagrà R, Perfetto F, Rowczenio D, Gilbertson J, Hutt DF, Hawkins PN, Rapezzi C, Merlo M, Sinagra G, Gillmore JD. Clinical and Prognostic Implications of Right Ventricular Uptake on Bone Scintigraphy in Transthyretin Amyloid Cardiomyopathy. Circulation 2024; 149:1157-1168. [PMID: 38328945 PMCID: PMC11000629 DOI: 10.1161/circulationaha.123.066524] [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: 07/28/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The extent of myocardial bone tracer uptake with technetium pyrophosphate, hydroxymethylene diphosphonate, and 3,3-diphosphono-1,2-propanodicarboxylate in transthyretin amyloid cardiomyopathy (ATTR-CM) might reflect cardiac amyloid burden and be associated with outcome. METHODS Consecutive patients with ATTR-CM who underwent diagnostic bone tracer scintigraphy with acquisition of whole-body planar and cardiac single-photon emission computed tomography (SPECT) images from the National Amyloidosis Centre and 4 Italian centers were included. Cardiac uptake was defined according to the Perugini classification: 0=absent cardiac uptake; 1=mild uptake less than bone; 2=moderate uptake equal to bone; and 3=high uptake greater than bone. Extent of right ventricular (RV) uptake was defined as focal (basal segment of the RV free wall only) or diffuse (extending beyond basal segment) on the basis of SPECT imaging. The primary outcome was all-cause mortality. RESULTS Among 1422 patients with ATTR-CM, RV uptake accompanying left ventricular uptake was identified by SPECT imaging in 100% of cases at diagnosis. Median follow-up in the whole cohort was 34 months (interquartile range, 21 to 50 months), and 494 patients died. By Kaplan-Meier analysis, diffuse RV uptake on SPECT imaging (n=936) was associated with higher all-cause mortality compared with focal (n=486) RV uptake (77.9% versus 22.1%; P<0.001), whereas Perugini grade was not associated with survival (P=0.27 in grade 2 versus grade 3). On multivariable analysis, after adjustment for age at diagnosis (hazard ratio [HR], 1.03 [95% CI, 1.02-1.04]; P<0.001), presence of the p.(V142I) TTR variant (HR, 1.42 [95% CI, 1.20-1.81]; P=0.004), National Amyloidosis Centre stage (each category, P<0.001), stroke volume index (HR, 0.99 [95% CI, 0.97-0.99]; P=0.043), E/e' (HR, 1.02 [95% CI, 1.007-1.03]; P=0.004), right atrial area index (HR, 1.05 [95% CI, 1.02-1.08]; P=0.001), and left ventricular global longitudinal strain (HR, 1.06 [95% CI, 1.03-1.09]; P<0.001), diffuse RV uptake on SPECT imaging (HR, 1.60 [95% CI, 1.26-2.04]; P<0.001) remained an independent predictor of all-cause mortality. The prognostic value of diffuse RV uptake was maintained across each National Amyloidosis Centre stage and in both wild-type and hereditary ATTR-CM (P<0.001 and P=0.02, respectively). CONCLUSIONS Diffuse RV uptake of bone tracer on SPECT imaging is associated with poor outcomes in patients with ATTR-CM and is an independent prognostic marker at diagnosis.
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Affiliation(s)
- Aldostefano Porcari
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (A.P., L.P., M.M., G.S.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (A.P., L.P., M.M., G.S.)
| | - Marco Canepa
- Cardiovascular Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy (M.C., G.L.M.)
- Department of Internal Medicine, University of Genova, Italy (M.C.)
| | - Elena Biagini
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (E.B., C.G., S.L.)
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy (F.C., F.P.)
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Italy (F.C., M.Z.)
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (F.D., F.G.)
| | - Christian Gagliardi
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (E.B., C.G., S.L.)
| | - Simone Longhi
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (E.B., C.G., S.L.)
| | - Linda Pagura
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (A.P., L.P., M.M., G.S.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
| | - Giacomo Tini
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliera Universitaria Sant’Andrea, Italy (G.T.)
| | - Franca Dore
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (F.D., F.G.)
| | - Rachele Bonfiglioli
- Department of Nuclear Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Italy (R.B., A.P.)
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy (M.B.)
- Nuclear Medicine, Department of Health Sciences (DISSAL), University of Genova, Italy (M.B.)
| | - Alberto Miceli
- Nuclear Medicine Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (A.M.)
| | - Francesca Girardi
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (F.D., F.G.)
| | - Anna Lisa Martini
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” University of Florence, Careggi University Hospital, Italy (A.L.M., E.N.C., R.S.)
| | - Giulia Barbati
- Department of Medical Sciences, Biostatistics Unit, University of Trieste, Italy (G.B.)
| | - Egidio Natalino Costanzo
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” University of Florence, Careggi University Hospital, Italy (A.L.M., E.N.C., R.S.)
| | - Angelo Giuseppe Caponetti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy (A.G.C., M.S.)
| | - Andrea Paccagnella
- Department of Nuclear Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Italy (R.B., A.P.)
| | - Maurizio Sguazzotti
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy (A.G.C., M.S.)
| | - Giovanni La Malfa
- Cardiovascular Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy (M.C., G.L.M.)
| | - Mattia Zampieri
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Italy (F.C., M.Z.)
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” University of Florence, Careggi University Hospital, Italy (A.L.M., E.N.C., R.S.)
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy (F.C., F.P.)
| | - Dorota Rowczenio
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
| | - Janet Gilbertson
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
| | - David F. Hutt
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
| | - Philip N. Hawkins
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
| | - Claudio Rapezzi
- Cardiothoracic Department, University of Ferrara, Italy (C.R.)
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy (C.R.)
| | - Marco Merlo
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
| | - Gianfranco Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (A.P., L.P., M.M., G.S.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (A.P., E.B., C.G., S.L., L.P., A.G.C., M.S., M.M., G.S.)
| | - Julian D. Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)
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Porcari A, Fontana M, Canepa M, Biagini E, Cappelli F, Gagliardi C, Longhi S, Pagura L, Tini G, Dore F, Bonfiglioli R, Bauckneht M, Miceli A, Girardi F, Martini AL, Barbati G, Costanzo EN, Caponetti AG, Paccagnella A, Sguazzotti M, La Malfa G, Zampieri M, Sciagrà R, Perfetto F, Hutt D, Rapezzi1 C, Merlo M, Sinagra G, Gillmore JD. 172 CLINICAL AND PROGNOSTIC IMPLICATIONS OF RV UPTAKE WITH RADIONUCLIDE SCINTIGRAPHY IN TRANSTHYRETIN CARDIAC AMYLOIDOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Aims
The prognostic role of bone tracer uptake in transthyretin cardiac amyloidosis (ATTR-CA) is controversial. The study investigated the potential prognostic significance of biventricular (BiV) uptake in ATTR-CA.
Methods
Consecutive ATTR-CA patients who had cardiac scintigraphy with acquisition of planar and single-photon emission computed tomography (SPECT) images from the National Amyloidosis Centre (NAC) and four Italian centres were included. Planar BiV uptake was defined in presence of right ventricle (RV) uptake and graded in combination with SPECT imaging. The primary outcome was all-cause mortality.
Results
Among 1422 patients with ATTR-CA, BiV uptake was found in 85% of cases on planar scintigraphy and in 100% of cases on SPECT images. During a median follow-up of 39 months, BiV uptake at planar scintigraphy was associated with a higher all-cause mortality compared to isolated LV uptake (40.5% vs 10.7%, p<0.001), whereas the Perugini scale was not (p=0.27 in grade 2 vs 3). At multivariable analysis, RV uptake at planar scintigraphy leading to BiV uptake (HR 2.80, p=0.001), together with higher age at diagnosis (HR 1.03, p=0.001), V122I TTR variant (HR 1.60, p=0.001), NAC ATTR Stage (HR 1.29, p=0.003), E/e’ (HR 1.02, p=0.044), right atrium area index (HR 1.04, p=0.018) and GLS (HR 1.05, p=0.003) were independently associated with all-cause death. At time-dependent ROC curve analysis, the addition of planar BiV uptake to the NAC stage resulted in improved accuracy of the model for prediction of all-cause death (from AUC 0.74 to 0.79; p<0.001).
Conclusions
Planar RV uptake leading to BiV uptake identified ATTR-CA patients with worse outcome, potentially serving as a novel prognostic marker.
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Affiliation(s)
- Aldostefano Porcari
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And University Of Trieste , Trieste , Italy
- National Amyloidosis Centre, Division Of Medicine, University College Of London , London , United Kingdom
| | - Marianna Fontana
- National Amyloidosis Centre, Division Of Medicine, University College Of London , London , United Kingdom
| | - Marco Canepa
- Cardiovascular Unit, Department Of Internal Medicine, University Of Genova, Ospedale Policlinico San Martino Irccs , Genova , Italy
| | - Elena Biagini
- Department Of Experimental, Diagnostic And Specialty Medicine, Cardiology Unit, Irccs, University Sant’orsola Hospital, University Of Bologna , Bologna , Italy
- European Reference Network For Rare , Low Prevalence And Complex Diseases Of The Heart-Ern Guard- Heart
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital , Florence , Italy
- Cardiomyopathy Unit, Careggi University Hospital, University Of Florence , Florence , Italy
| | - Christian Gagliardi
- Department Of Experimental, Diagnostic And Specialty Medicine, Cardiology Unit, Irccs, University Sant’orsola Hospital, University Of Bologna , Bologna , Italy
- European Reference Network For Rare , Low Prevalence And Complex Diseases Of The Heart-Ern Guard- Heart
| | - Simone Longhi
- Department Of Experimental, Diagnostic And Specialty Medicine, Cardiology Unit, Irccs, University Sant’orsola Hospital, University Of Bologna , Bologna , Italy
- European Reference Network For Rare , Low Prevalence And Complex Diseases Of The Heart-Ern Guard- Heart
| | - Linda Pagura
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And University Of Trieste , Trieste , Italy
| | - Giacomo Tini
- Cardiovascular Unit, Department Of Internal Medicine, University Of Genova, Ospedale Policlinico San Martino Irccs , Genova , Italy
| | - Franca Dore
- Department Of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina (Asugi) And University Of Trieste , Trieste , Italy
| | - Rachele Bonfiglioli
- Department Of Nuclear Medicine, Ircss, University Sant’orsola Hospital, University Of Bologna , Bologna , Italy
| | - Matteo Bauckneht
- Nuclear Medicine, Ircss, Ospedale Policlinico San Martino , Genova , Italy
- Department Of Health Sciences (Dissal), University Of Genova , Genova , Italy
| | - Alberto Miceli
- Nuclear Medicine, Ircss, Ospedale Policlinico San Martino , Genova , Italy
- Department Of Health Sciences (Dissal), University Of Genova , Genova , Italy
| | - Francesca Girardi
- Department Of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina (Asugi) And University Of Trieste , Trieste , Italy
| | - Anna Lisa Martini
- Nuclear Medicine Unit, Department Of Experimental And Clinic Biomedical Sciences ”Mario Serio”, University Of Florence, Careggi University Hospital , Florence , Italy
| | - Giulia Barbati
- Department Of Medical Sciences, Biostatistics Unit, University Of Trieste , Trieste , Italy
| | - Egidio Natalino Costanzo
- Nuclear Medicine Unit, Department Of Experimental And Clinic Biomedical Sciences ”Mario Serio”, University Of Florence, Careggi University Hospital , Florence , Italy
| | - Angelo Giuseppe Caponetti
- Department Of Experimental, Diagnostic And Specialty Medicine, Cardiology Unit, Irccs, University Sant’orsola Hospital, University Of Bologna , Bologna , Italy
- Department Of Experimental, Diagnostic And Specialty Medicine, University Of Bologna , Bologna , Italy
| | - Andrea Paccagnella
- Department Of Nuclear Medicine, Ircss, University Sant’orsola Hospital, University Of Bologna , Bologna , Italy
| | - Maurizio Sguazzotti
- Department Of Experimental, Diagnostic And Specialty Medicine, Cardiology Unit, Irccs, University Sant’orsola Hospital, University Of Bologna , Bologna , Italy
- Department Of Experimental, Diagnostic And Specialty Medicine, University Of Bologna , Bologna , Italy
| | - Giovanni La Malfa
- Cardiovascular Unit, Department Of Internal Medicine, University Of Genova, Ospedale Policlinico San Martino Irccs , Genova , Italy
| | - Mattia Zampieri
- Cardiomyopathy Unit, Careggi University Hospital, University Of Florence , Florence , Italy
| | - Roberto Sciagrà
- Nuclear Medicine Unit, Department Of Experimental And Clinic Biomedical Sciences ”Mario Serio”, University Of Florence, Careggi University Hospital , Florence , Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital , Florence , Italy
| | - David Hutt
- National Amyloidosis Centre, Division Of Medicine, University College Of London , London , United Kingdom
| | - Claudio Rapezzi1
- European Reference Network For Rare , Low Prevalence And Complex Diseases Of The Heart-Ern Guard- Heart
- Maria Cecilia Hospital, Gvm Care & Research , Cotignola, Ravenna , Italy
| | - Marco Merlo
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And University Of Trieste , Trieste , Italy
| | - Gianfranco Sinagra
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi) And University Of Trieste , Trieste , Italy
| | - Julian D Gillmore
- National Amyloidosis Centre, Division Of Medicine, University College Of London , London , United Kingdom
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3
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Merlo M, Pagura L, Porcari A, Cameli M, Vergaro G, Musumeci B, Biagini E, Canepa M, Crotti L, Imazio M, Forleo C, Cappelli F, Perfetto F, Favale S, Di Bella G, Dore F, Girardi F, Tomasoni D, Pavasini R, Rella V, Palmiero G, Caiazza M, Carella MC, Igoren Guaricci A, Branzi G, Caponetti AG, Saturi G, La Malfa G, Merlo AC, Andreis A, Bruno F, Longo F, Rossi M, Varrà GG, Saro R, Di Ienno L, De Carli G, Giacomin E, Arzilli C, Limongelli G, Autore C, Olivotto I, Badano L, Parati G, Perlini S, Metra M, Michele E, Rapezzi C, Sinagra G. Unmasking the Prevalence of Amyloid Cardiomyopathy in the Real World: Results from Phase 2 of AC-TIVE Study, an Italian Nationwide Survey. Eur J Heart Fail 2022; 24:1377-1386. [PMID: 35417089 DOI: 10.1002/ejhf.2504] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 02/18/2022] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 11/07/2022] Open
Abstract
AIM To investigate the prevalence of amyloid cardiomyopathy (AC) and the diagnostic accuracy of echocardiographic red flags of AC among consecutive adult patients undergoing transthoracic echocardiogram for reason other than AC in 13 Italian institutions. METHODS AND RESULTS This is an Italian prospective multicentric study, involving a clinical and instrumental work-up to assess AC prevalence among patients ≥ 55 years old with an "AC suggestive" echocardiogram (i.e. at least one echocardiographic red flag of AC in hypertrophic, non-dilated left ventricles with preserved ejection fraction). The study was registered at ClinicalTrials.gov (#NCT04738266). 381 patients with an "AC suggestive" echocardiogram were identified among a cohort of 5315 screened subjects. 217 patients completed the investigations. A final diagnosis of AC was made in 62 patients with an estimated prevalence of 29% (95% CI: 23%-35%). Transthyretin-related AC (ATTR-AC) was diagnosed in 51 and light chain related AC (AL-AC) in 11 patients. Either apical sparing or a combination of ≥ 2 other echocardiographic red flags, excluding interatrial septum thickness, provided a diagnostic accuracy > 70%. CONCLUSION In a cohort of consecutive adults with echocardiographic findings suggestive of AC and preserved LVEF, the prevalence of AC (either ATTR or AL) was 29%. Easily available echocardiographic red flags, when combined together, demonstrated good diagnostic accuracy.
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Affiliation(s)
- Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Linda Pagura
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giuseppe Vergaro
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Beatrice Musumeci
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Elena Biagini
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Canepa
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,Cardiovascular Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lia Crotti
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Massimo Imazio
- University Cardiology A.O.U. , Città della Salute e della Scienza di Torino, Turin, Italy.,Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Cinzia Forleo
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy Bari, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Stefano Favale
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy Bari, Italy
| | | | - Franca Dore
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Francesca Girardi
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Valeria Rella
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giuseppe Palmiero
- Department of Translational Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Cristina Carella
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy Bari, Italy
| | - Andrea Igoren Guaricci
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Italy Bari, Italy
| | - Giovanna Branzi
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Angelo Giuseppe Caponetti
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Saturi
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | - Alessandro Andreis
- University Cardiology A.O.U. , Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Bruno
- University Cardiology A.O.U. , Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesca Longo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Maddalena Rossi
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Guerino Giuseppe Varrà
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Riccardo Saro
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Luca Di Ienno
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Giuseppe De Carli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Elisa Giacomin
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Chiara Arzilli
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Luigi Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Stefano Perlini
- Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Emdin Michele
- Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Claudio Rapezzi
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
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4
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Merlo M, Pagura L, Porcari A, Cameli M, Vergaro G, Musumeci B, Biagini E, Canepa M, Crotti L, Imazio M, Forleo C, Cappelli F, Favale S, Di Bella G, Dore F, Girardi F, Tomasoni D, Pavasini R, Rella V, Palmiero G, Caiazza M, Carella MC, Guaricci AI, Branzi G, Caponetti AG, Saturi G, La Malfa G, Merlo AC, Andreis A, Bruno F, Longo F, Rossi M, Varrà GG, Saro R, Di Ienno L, De Carli G, Giacomin E, Spini V, Limongelli G, Autore C, Olivotto I, Badano L, Parati G, Perlini S, Metra M, Emdin M, Rapezzi C, Sinagra G. 465 Unmasking the prevalence of cardiac amyloidosis in the real world: first insights from the phase 2 of active study, an Italian nationwide survey. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.033] [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
Clinicians needs to identify patients with cardiac amyloidosis (CA) at an early stage, due to the availability of disease modifying therapies. Some echocardiographic findings may rise the suspicion of CA, also in patients with mild or no symptoms, addressing second level diagnostic tests. To investigate the prevalence of CA in consecutive patients ≥55 years undergoing clinically indicated, routine transthoracic echocardiogram (TTE) in Italy with echocardiographic signs suggestive of CA.
Methods and results
This is a prospective multicentric study conducted in Italy. It comprises two phases: 1) an observational phase consisting in a national survey on prevalence of possible echocardiographic red flags of CA in consecutive patients ≥55 years undergoing routine TTE (previously published) and 2) a CA diagnostic phase. Preliminary results of phase 2 are herein presented. Patients that in the phase 1 presented a CA-suggestive TTE (i.e. at least one red flag of CA in hypertrophic, non-dilated left ventricles) were re-evaluated for a cardiological visit. Those who consented to proceed in the study, underwent clinical evaluation, blood and urine tests and scintigraphy with bone tracer. Diagnosis of transthyretin related-CA (TTR-CA) was made in presence of Grades 2–3 Perugini uptake at scintigraphy and absence of monoclonal protein. The study was registered at ClinicalTrials.gov (#NCT04738266). Of the 5315 screened echocardiograms, 381 exams (7.2%) were classified as AC-suggestive. Two-hundred-twelve of the 381 patients with a CA-suggestive TTE underwent phase 2 study. Main reasons for the 169 non-entering patients into the phase 2 were death (n = 53) and refusal to participate (n = 85). Sixty-five of these 212 patients (31%; 17% considering also the 169 non-entering patients into the phase 2) had a diagnosis of CA. Finally, TTR-CA was diagnosed in 53 (25%) and AL-CA in 12 (5.7%) patients.
Conclusions
Among a cohort of consecutive unselected patients ≥55 years with echocardiographic findings suggestive of CA, the real prevalence of CA ranged from 17 up to 31%. Although TTR-CA was predominant, AL-CA was diagnosed in a significant amount of cases. TTE has a fundamental role in screening patients, raising the suspicion of CA and orienting diagnostic work-up for CA.
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Affiliation(s)
- Marco Merlo
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Linda Pagura
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Aldostefano Porcari
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giuseppe Vergaro
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio and Istituto di Scienze della Vita, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Beatrice Musumeci
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Elena Biagini
- Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Marco Canepa
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Genova, Italy
| | - Lia Crotti
- Cardiomyopathy Unit, Department of Cardiovascular, Istituto Auxologico, Neural and Metabolic Sciences, Milan, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Massimo Imazio
- Division of Cardiology, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Cinzia Forleo
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Stefano Favale
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | | | - Franca Dore
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Francesca Girardi
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Daniela Tomasoni
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Valeria Rella
- Cardiomyopathy Unit, Department of Cardiovascular, Istituto Auxologico, Neural and Metabolic Sciences, Milan, Italy
| | - Giuseppe Palmiero
- Department of Translation Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Martina Caiazza
- Department of Translation Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Maria Cristina Carella
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Igoren Guaricci
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Giovanna Branzi
- Cardiomyopathy Unit, Department of Cardiovascular, Istituto Auxologico, Neural and Metabolic Sciences, Milan, Italy
| | - Angelo Giuseppe Caponetti
- Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giulia Saturi
- Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giovanni La Malfa
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Genova, Italy
| | - Andrea Carlo Merlo
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Genova, Italy
| | - Alessandro Andreis
- Division of Cardiology, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesca Longo
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Maddalena Rossi
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Giuseepe Guerino Varrà
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Riccardo Saro
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Luca Di Ienno
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Ferrara, Italy
| | - Giuseppe De Carli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elisa Giacomin
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Valentina Spini
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio and Istituto di Scienze della Vita, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Giuseppe Limongelli
- Department of Translation Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Luigi Badano
- Cardiomyopathy Unit, Department of Cardiovascular, Istituto Auxologico, Neural and Metabolic Sciences, Milan, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Gianfranco Parati
- Cardiomyopathy Unit, Department of Cardiovascular, Istituto Auxologico, Neural and Metabolic Sciences, Milan, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Stefano Perlini
- Emergency Department and Amyloid Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio and Istituto di Scienze della Vita, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Claudio Rapezzi
- Cardiovascular Center, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, 48033 Cotignola, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
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5
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Porcari A, Pagura L, Canepa M, Biagini E, Cappelli F, Gagliardi C, Longhi S, Tini G, Dore F, Bonfiglioli R, Bauckneht M, Miceli A, Girardi F, Martini AL, Caponetti AG, Paccagnella A, Sguazzotti M, Malfa GL, Zampieri M, Alessia A, Porto I, Perfetto F, Rapezzi C, Merlo M, Sinagra G. 351 Prevalence and prognostic significance of RV uptake (biventricular uptake) at planar scintigraphy in patients with ATTR cardiac amyloidosis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
The validation of cardiac scintigraphy with bone tracers for nonbiopsy confirmation of transthyretin cardiac amyloidosis (ATTR-CA) has revolutionized the diagnosis of this condition. While most studies focused on left ventricle (LV) uptake, the significance of bone tracers uptake in the right ventricle (RV) leading to biventricular (BiV) uptake has not been investigated so far. BiV uptake at planar scintigraphy might reflect a more advanced ATTR-CA. To estimate the prevalence of BiV uptake and its potential prognostic role in ATTR-CA.
Methods and results
Multicentre, retrospective, observational study performed among four Italian referral centres for CA. Data of ATTR-CA patients who underwent bone tracers scintigraphy with acquisition of planar and SPECT imaging between November 2014 and June 2020 at participating centres were centrally revised. ATTR-CA was diagnosed according to the Gilmore’s algorithm. LV uptake was assessed by Perugini visual scale. RV uptake was defined as: 0 = absent, 1 ≤ bone uptake, 2 = equal to bone uptake, and 3 ≥ bone uptake. Images were independently assessed by six experienced operators, blinded to all patients’ data. Cardiological data included clinical examination, ECG, echocardiography and blood tests. The primary outcome was a composite of cardiac death and hospitalization for heart failure. Of the 124 patients with ATTR-CA included in this analysis, 93 (75%) had BiV uptake at planar scintigraphy and all had RV free wall uptake confirmed at SPECT imaging. The prevalence of planar BiV uptake increased along with the LV Perugini grade: 14% in Perugini grade 1, 70% in Perugini grade 2, and 92% in Perugini grade 3. Compared to those with planar LV uptake, patients with planar BiV uptake were older (81 vs. 77 years, P = 0.006), more frequently in NYHA ≥3 (32% vs. 10%, P = 0.018), had increased NT-proBNP values (4293 vs. 2492 pg/ml, P = 0.046), LV wall thickness (18 vs. 17 mm, P = 0.007). They had higher rates of LV ejection fraction <50% (42% vs. 10%, P = 0.001) and lower TAPSE (16 vs. 20 mm, P = 0.048). At 18 months, patients with BiV uptake experienced the primary endpoint more frequently than those with LV uptake (P = 0.021, Figure), with the highest risk observed in patients with grade 2–3 RV uptake (P = 0.010). The LV Perugini grade did not affect prognosis (P = 0.20). At multivariate analysis, NYHA ≥3, eGFR <60 ml/min and BiV uptake had independent prognostic value (HR 8.0, P = 0.007; HR 2.1, P = 0.025; HR 1.7, P = 0.007; respectively).
Conclusions
The presence of BiV uptake at planar scintigraphy identified ATTR-CA patients at worse cardiovascular outcome, potentially serving as novel marker for prognostic stratification in this population.
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Affiliation(s)
- Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Linda Pagura
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Marco Canepa
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Genova, Italy
- Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Elena Biagini
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Christian Gagliardi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simone Longhi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Tini
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Genova, Italy
| | - Franca Dore
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Rachele Bonfiglioli
- Department of Nuclear Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Alberto Miceli
- Nuclear Medicine, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Girardi
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Anna Lisa Martini
- Nuclear Medicine Unit, Departmento of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
| | - Angelo Giuseppe Caponetti
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Andrea Paccagnella
- Department of Nuclear Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Maurizio Sguazzotti
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS, University Sant’Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giovanni La Malfa
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Genova, Italy
| | - Mattia Zampieri
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Argiro Alessia
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Italo Porto
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Genova, Italy
- Ospedale Policlinico San Martino IRCCS, Genova, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy
| | - Claudio Rapezzi
- Cardiovascular Center, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GMV Care & Research, Cotignola, Italy
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Trieste, Italy
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6
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Merlo M, Porcari A, Pagura L, Cameli M, Vergaro G, Musumeci B, Biagini E, Canepa M, Crotti L, Imazio M, Forleo C, Cappelli F, Favale S, Di Bella G, Dore F, Lombardi CM, Pavasini R, Rella V, Palmiero G, Caiazza M, Albanese M, Guaricci AI, Branzi G, Caponetti AG, Saturi G, La Malfa G, Merlo AC, Andreis A, Bruno F, Longo F, Sfriso E, Di Ienno L, De Carli G, Giacomin E, Spini V, Milidoni A, Limongelli G, Autore C, Olivotto I, Badano L, Parati G, Perlini S, Metra M, Emdin M, Rapezzi C, Sinagra G. A national survey on prevalence of possible echocardiographic red flags of amyloid cardiomyopathy in consecutive patients undergoing routine echocardiography: study design and patients characterization-the first insight from the AC-TIVE Study. Eur J Prev Cardiol 2021; 29:e173-e177. [PMID: 34499711 DOI: 10.1093/eurjpc/zwab127] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/01/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Marco Merlo
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Via Valdoni 1, 34149 Trieste, Italy
| | - Aldostefano Porcari
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Via Valdoni 1, 34149 Trieste, Italy
| | - Linda Pagura
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Via Valdoni 1, 34149 Trieste, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Giuseppe Vergaro
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio and Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Via Giuseppe Moruzzi 1, 56124, Pisa, Italy
| | - Beatrice Musumeci
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Elena Biagini
- Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit, IRCCS, University Sant'Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Marco Canepa
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Viale Benedetto XV 10, 16132, Genova, Italy.,Ospedale Policlinico San Martino IRCCS, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Lia Crotti
- Department of Cardiovascular, Neural and Metabolic Sciences, Cardiomyopathy Unit, Istituto Auxologico Italiano, Piazzale Brescia, 20, 20149, Milan, Italy.,Department of Medicine and Surgery, University Milano, Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Massimo Imazio
- Division of Cardiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Cinzia Forleo
- Department of Emergency and Organ Transplantation, Cardiology Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Stefano Favale
- Department of Emergency and Organ Transplantation, Cardiology Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Gianluca Di Bella
- Department of Cardiology, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Franca Dore
- Department of Nuclear Medicine, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Strada di Fiume 447, 34129, Trieste, Italy
| | - Carlo Mario Lombardi
- Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Valeria Rella
- Department of Cardiovascular, Neural and Metabolic Sciences, Cardiomyopathy Unit, Istituto Auxologico Italiano, Piazzale Brescia, 20, 20149, Milan, Italy
| | - Giuseppe Palmiero
- Department of Translational Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, 80138, Napoli, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, 80138, Napoli, Italy
| | - Miriam Albanese
- Department of Emergency and Organ Transplantation, Cardiology Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Cardiology Unit, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giovanna Branzi
- Department of Cardiovascular, Neural and Metabolic Sciences, Cardiomyopathy Unit, Istituto Auxologico Italiano, Piazzale Brescia, 20, 20149, Milan, Italy
| | - Angelo Giuseppe Caponetti
- Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit, IRCCS, University Sant'Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Giulia Saturi
- Department of Experimental, Diagnostic and Specialty Medicine, Cardiology Unit, IRCCS, University Sant'Orsola Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Giovanni La Malfa
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Viale Benedetto XV 10, 16132, Genova, Italy
| | - Andrea Carlo Merlo
- Department of Internal Medicine, Cardiovascular Unit, University of Genova, Viale Benedetto XV 10, 16132, Genova, Italy
| | - Alessandro Andreis
- Division of Cardiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Francesca Longo
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Via Valdoni 1, 34149 Trieste, Italy
| | - Enrico Sfriso
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Via Valdoni 1, 34149 Trieste, Italy
| | - Luca Di Ienno
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Giuseppe De Carli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Elisa Giacomin
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Mario Bracci 16, 53100, Siena, Italy
| | - Valentina Spini
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio and Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Via Giuseppe Moruzzi 1, 56124, Pisa, Italy
| | - Antonino Milidoni
- Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, Inherited and Rare Heart Disease, Vanvitelli Cardiology, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, 80138, Napoli, Italy
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Luigi Badano
- Department of Cardiovascular, Neural and Metabolic Sciences, Cardiomyopathy Unit, Istituto Auxologico Italiano, Piazzale Brescia, 20, 20149, Milan, Italy.,Department of Medicine and Surgery, University Milano, Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Cardiomyopathy Unit, Istituto Auxologico Italiano, Piazzale Brescia, 20, 20149, Milan, Italy.,Department of Medicine and Surgery, University Milano, Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Stefano Perlini
- Emergency Department and Amyloid Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100, Pavia, Italy.,Department of Internal Medicine, University of Pavia, Via Aselli 43/45, 27100, Pavia, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio and Istituto di Scienze della Vita, Scuola Superiore Sant'Anna, Via Giuseppe Moruzzi 1, 56124, Pisa, Italy
| | - Claudio Rapezzi
- Cardiovascular Center, University of Ferrara, Via Savonarola 9, 44121, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Via Corriera, 1, 48033, Cotignola, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Center for Diagnosis and Treatment of Cardiomyopathies, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Via Valdoni 1, 34149 Trieste, Italy
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7
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Della Bona R, Valbusa A, La Malfa G, Giacobbe DR, Ameri P, Patroniti N, Robba C, Gilad V, Insorsi A, Bassetti M, Pelosi P, Porto I. Systemic fibrinolysis for acute pulmonary embolism complicating acute respiratory distress syndrome in severe COVID-19: a case series. Eur Heart J Cardiovasc Pharmacother 2021; 7:78-80. [PMID: 32663257 PMCID: PMC7454495 DOI: 10.1093/ehjcvp/pvaa087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Roberta Della Bona
- CardioThoracoVascular Department (DICATOV), Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Alberto Valbusa
- CardioThoracoVascular Department (DICATOV), Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Giovanni La Malfa
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Pietro Ameri
- CardioThoracoVascular Department (DICATOV), Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Niccolò Patroniti
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Chiara Robba
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Vered Gilad
- CardioThoracoVascular Department (DICATOV), Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Angelo Insorsi
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Italo Porto
- CardioThoracoVascular Department (DICATOV), Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
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8
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Robba C, Battaglini D, Ball L, Valbusa A, Porto I, Della Bona R, La Malfa G, Patroniti N, Brunetti I, Loconte M, Bassetti M, Giacobbe DR, Vena A, Silva CLM, Rocco PRM, Pelosi P. Coagulative Disorders in Critically Ill COVID-19 Patients with Acute Distress Respiratory Syndrome: A Critical Review. J Clin Med 2021; 10:E140. [PMID: 33401632 PMCID: PMC7795033 DOI: 10.3390/jcm10010140] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
In critically ill patients with acute respiratory distress syndrome (ARDS) coronavirus disease 2019 (COVID-19), a high incidence of thromboembolic and hemorrhagic events is reported. COVID-19 may lead to impairment of the coagulation cascade, with an imbalance in platelet function and the regulatory mechanisms of coagulation and fibrinolysis. Clinical manifestations vary from a rise in laboratory markers and subclinical microthrombi to thromboembolic events, bleeding, and disseminated intravascular coagulation. After an inflammatory trigger, the mechanism for activation of the coagulation cascade in COVID-19 is the tissue factor pathway, which causes endotoxin and tumor necrosis factor-mediated production of interleukins and platelet activation. The consequent massive infiltration of activated platelets may be responsible for inflammatory infiltrates in the endothelial space, as well as thrombocytopenia. The variety of clinical presentations of the coagulopathy confronts the clinician with the difficult questions of whether and how to provide optimal supportive care. In addition to coagulation tests, advanced laboratory tests such as protein C, protein S, antithrombin, tissue factor pathway inhibitors, D-dimers, activated factor Xa, and quantification of specific coagulation factors can be useful, as can thromboelastography or thromboelastometry. Treatment should be tailored, focusing on the estimated risk of bleeding and thrombosis. The aim of this review is to explore the pathophysiology and clinical evidence of coagulation disorders in severe ARDS-related COVID-19 patients.
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Affiliation(s)
- Chiara Robba
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.B.); (L.B.); (N.P.); (I.B.); (M.L.); (P.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Denise Battaglini
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.B.); (L.B.); (N.P.); (I.B.); (M.L.); (P.P.)
| | - Lorenzo Ball
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.B.); (L.B.); (N.P.); (I.B.); (M.L.); (P.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Alberto Valbusa
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (A.V.); (I.P.); (R.D.B.); (G.L.M.)
| | - Italo Porto
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (A.V.); (I.P.); (R.D.B.); (G.L.M.)
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Roberta Della Bona
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (A.V.); (I.P.); (R.D.B.); (G.L.M.)
| | - Giovanni La Malfa
- Dipartimento CardioToracoVascolare, Ospedale Policlinico San Martino IRCCS, 16132 Genoa, Italy; (A.V.); (I.P.); (R.D.B.); (G.L.M.)
- Dipartimento di Medicina Interna e Specialità Mediche (DIMI), University of Genoa, 16132 Genoa, Italy
| | - Nicolò Patroniti
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.B.); (L.B.); (N.P.); (I.B.); (M.L.); (P.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Iole Brunetti
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.B.); (L.B.); (N.P.); (I.B.); (M.L.); (P.P.)
| | - Maurizio Loconte
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.B.); (L.B.); (N.P.); (I.B.); (M.L.); (P.P.)
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS, 16132 Genoa, Italy; (M.B.); (D.R.G.); (A.V.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Daniele R. Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS, 16132 Genoa, Italy; (M.B.); (D.R.G.); (A.V.)
| | - Antonio Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino, IRCCS, 16132 Genoa, Italy; (M.B.); (D.R.G.); (A.V.)
| | - Claudia Lucia M. Silva
- Laboratory of Biochemical and Molecular Pharmacology, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil;
| | - Patricia R. M. Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil;
| | - Paolo Pelosi
- Department of Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (D.B.); (L.B.); (N.P.); (I.B.); (M.L.); (P.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
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9
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Vianello PF, La Malfa G, Tini G, Mazzola V, Miceli A, Santolini E, Briano S, Porto I, Canepa M. Prevalence of transthyretin amyloid cardiomyopathy in male patients who underwent bilateral carpal tunnel surgery: The ACTUAL study. Int J Cardiol 2020; 329:144-147. [PMID: 33358831 DOI: 10.1016/j.ijcard.2020.12.044] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Bilateral carpal tunnel syndrome (CTS), particularly in male individuals with left ventricular hypertrophy (LVH), has been recognized as a red flag for transthyretin cardiac amyloidosis (TTR-CA). Nonetheless, the opportunity of screening CTS patients for TTR has yet to be determined. METHODS Medical records of 1689 CTS surgeries performed at our institution between 2008 and 2018 were reviewed. Eighty-three males who underwent bilateral CTS surgery were considered eligible for the study, and offered a screening examination including electrocardiography and echocardiography. Individuals with LVH (diastolic septal wall thickness > 12 mm) were offered second-line diagnostic testing including blood testing and bone scintigraphy. RESULTS Study population consisted of 53 bilateral CTS male patients, with median age of 73 years. LVH was found in 6 (11%) individuals. None of them had monoclonal gammopathy or reported CTS occupational risk factors. Two declined to undergo further testing, whereas 2 had negative and 2 had positive bone scintigraphy (both Perugini 2 uptake) and tested negative for TTR gene mutations (wild-type TTR-CA). CONCLUSIONS Prevalence of TTR-CA in the entire study population was 4%, but among bilateral CTS patients with LVH peaked at 33%. In this latter population, screening for TTR-CA appeared feasible and effective.
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Affiliation(s)
- Pier Filippo Vianello
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy
| | - Giovanni La Malfa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Giacomo Tini
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Vittoria Mazzola
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Alberto Miceli
- Nuclear Medicine Unit, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Emmanuele Santolini
- Academic Unit of Trauma and Orthopaedics, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefania Briano
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy.
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10
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Ricciardi E, La Malfa G, Guglielmi G, Cenni E, Micali M, Corsello LM, Lopena P, Manco L, Pontremoli R, Moscatelli P, Murdaca G, Musso N, Montecucco F, Ameri P, Porto I, Pende A, Canepa M. Characteristics of current heart failure patients admitted to internal medicine vs. cardiology hospital units: the VASCO study. Intern Emerg Med 2020; 15:1219-1229. [PMID: 32172459 DOI: 10.1007/s11739-020-02304-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/06/2019] [Accepted: 02/26/2020] [Indexed: 12/17/2022]
Abstract
The majority of patients hospitalized for heart failure (HF) are admitted to internal medicine (IM) rather than to cardiology (CA) units, but to date few studies have analyzed the characteristics of these two populations. In this snapshot survey, we compared consecutive patients admitted for HF in six IM units vs. one non-intensive CA unit. During the 6-month survey period, 467 patients were enrolled (127 in CA, 27.2% vs. 340 in IM, 72.8%). IM patients were almost 10 years older (CA 75 ± 10, IM 82 ± 8 years; p < 0.001), more frequently female (CA 39%, IM 55%; p = 0.002) and living at home alone (CA 12%, IM 21%; p = 0.017). The leading cause of hospitalization in both groups was acute worsening of HF (CA 42%, IM 53%; p = 0.031), followed by atrial fibrillation (CA 29%, IM 12%; p < 0.001) and infections (CA 24%, IM 27%; p = 0.563). Ischemic (CA 43%, IM 30%; p = 0.008) and dilated cardiomyopathy patients (CA 21%, IM 12%; p < 0.001) were primarily admitted to CA unit, whereas those with hypertensive heart disease to IM (CA 3%, IM 39%; p < 0.001). Left ventricular ejection fraction (LVEF) was available in 96% of CA patients, but only in 60% of IM patients (p = 0.001). Among patients with LVEF measured, those with LVEF < 40% were predominantly admitted to CA (CA 60%, IM 14%; p < 0.001), whereas those with LVEF ≥ 50% were admitted to IM (CA 21%, IM 33%; p = 0.019); 26% of IM patients were discharged without a known LVEF. Medical treatments also significantly differed, according to patients' clinical and instrumental characteristics in each unit. This study demonstrates important differences between HF patients hospitalized in CA vs. IM, and the need for a greater interaction between these two medical specialties for a better care of HF patients.
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Affiliation(s)
- Elisa Ricciardi
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni La Malfa
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Giulia Guglielmi
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Elisabetta Cenni
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Micali
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Moisio Corsello
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Patrizia Lopena
- Clinica di Medicina Interna 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Manco
- Clinica di Medicina Interna 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Roberto Pontremoli
- Clinica di Medicina Interna 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Moscatelli
- Divisione di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giuseppe Murdaca
- Clinica di Medicina Interna ad Orientamento Immunologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Natale Musso
- Clinica Endocrinologica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabrizio Montecucco
- Clinica di Medicina Interna 1, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Ameri
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Italo Porto
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Aldo Pende
- Clinica di Medicina d'Urgenza, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Canepa
- Clinica di Malattie dell'Apparato Cardiovascolare con UTIC, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Department of Internal Medicine, University of Genova, Genoa, Italy.
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11
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Tini G, Vianello PF, Rizzola G, La Malfa G, Porto I, Canepa M. Telehealth monitoring for hypertrophic cardiomyopathy and amyloid cardiomyopathy patients: lessons from the coronavirus disease 2019 lockdown in Italy. J Cardiovasc Med (Hagerstown) 2020; 21:622-623. [DOI: 10.2459/jcm.0000000000001024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Rosa GM, D'Agostino A, Giovinazzo S, La Malfa G, Fontanive P, Miccoli M, Dini FL. Echocardiography of right ventricular-arterial coupling predicts survival of elderly patients with heart failure and reduced to mid-range ejection fraction. Monaldi Arch Chest Dis 2020; 90. [PMID: 32425012 DOI: 10.4081/monaldi.2020.1269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022] Open
Abstract
Echocardiography of right ventricular (RV)-arterial coupling obtained by the estimation of the ratio of the longitudinal annular systolic excursion of the tricuspid annular plane and pulmonary artery systolic pressure (TAPSE/PASP) has been found to be a remarkable prognostic indicator in patients with HF. Our aim was to evaluate the impact of TAPSE, PASP and their ratio in the prognostic stratification of outpatients with HF aged ≥70 years and reduced to mid-range ejection fraction (EF). A complete echocardiographic examination was performed in 400 outpatients with chronic HF and left ventricular (LV) EF ≤50% who averaged 77 years in age. During a median follow-up period of 25 months (interquartile range: 8-46), there were 135 cardiovascular deaths. Two different Cox regression models were evaluated, one including TAPSE and PASP, separately, and the other with TAPSE/PASP. In the first model, LV end-systolic volume index, age, no angiotensin converting enzyme (ACE) inhibitor use, TAPSE, PASP and gender were found to be independently associated with the outcome after adjustment for demographics, clinical, biochemical, echocardiographic data. In the second model, TAPSE/PASP resulted the most important independent predictor of outcome (hazard ratio [HR]:0.07, p<0.0001) followed by LV end-systolic volume index, no ACE inhibitor use, age and gender. The use of the variable TASPE/PASP improved the predictive value of the new multivariable model (area under the curve [AUC] of 0.74 vs AUC of 0.71; p<0.05). TASPE/PASP improved the net reclassification (NRI = 14.7%; p<0.01) and the integrated discrimination (IDI = 0.04; p<0.01). In conclusion, the study findings showed that assessment of RV-arterial coupling by TAPSE/PASP was of major importance to assess the prognosis of patients with chronic HF and LV EF ≤50% aged ≥70 years.
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Affiliation(s)
- Gian Marco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa.
| | | | - Stefano Giovinazzo
- Department of Internal Medicine and Medical Specialities, University of Genoa.
| | - Giovanni La Malfa
- Department of Internal Medicine and Medical Specialities, University of Genoa.
| | - Paolo Fontanive
- Cardiac, Thoracic and Vascular Department, University Hospital of Pisa.
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa.
| | - Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University Hospital of Pisa.
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