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Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Da Ros S, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Del Giudice C, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Bella G, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi RM, Inserra CA, Iori E, Izzo A, La Rosa G, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Picano E, Carerj S. Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:125-132. [PMID: 38161775 PMCID: PMC10756319 DOI: 10.4103/jcecho.jcecho_48_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 01/03/2024] Open
Abstract
Background The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and ≥40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). Conclusions This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Francesco Antonini-Canterin
- Department of Rehabilitative Cardiology, Rehabilitative Hospital High Speciality, Motta di Livenza, TV, Italy
| | - Andrea Barbieri
- Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo Della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Rehabilitative Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Department of Medicine and Surgery, University MIlano-Bicocca, Integrated Cardiovascular Diagnosi Unit, Istituto Auxologico Italiano, IRCCS, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Division, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Pisa, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina Degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Sciences, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Siena, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | | | - Angelo Di Gioia
- Cardiology Division, St. Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, Italy
| | - Federica Donati
- Pascia Center, Polyclinic, University Hospital Modena Polyclinic, Modena, Italy
| | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Cremona, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, Italy
| | - Annibale Izzo
- Cardiology Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiology and Rehabilitative Division, Azienda Sanitaria Friuli Occidentale (ASFO), Health Care, Sacile (Pd), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St. Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St. Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St. Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città Della Salute e Della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St. Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St. Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Division, Molinette Hospital - Città della Salute e Della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St. Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, University Hospital of Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St. Giovanni Evangelista Hospital, Tivoli, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, Italy
| | - Carlo Ratti
- Cardiology Division, St. Maria Bianca Hospital, Mirandola, Italy
| | | | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St. Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St. Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St. Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St. Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Department of Cardiovascular Sciences, Responsible Research Hospital, Campobasso, Italy
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
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Zannoni J, Guazzi M, Milani V, Bandera F, Alfonzetti E, Arena R. Prognostic value of cardiopulmonary exercise testing in a European cohort with cardiovascular risk factors absent of a cardiovascular disease diagnosis. Int J Cardiol 2023; 370:402-404. [PMID: 36228767 DOI: 10.1016/j.ijcard.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/22/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cardiorespiratory fitness (CRF) is now considered a vital sign. Cardiopulmonary exercise testing (CPET) is the gold-standard assessment of CRF; peak oxygen consumption (VO2) and the minute ventilation/carbon dioxide production (VE/VCO2) slope are considered primary CPET measures of CRF. More work is needed to determine the role of this exercise assessment in the primary care setting. METHODS 695 subjects (mean age: 62 ± 13 years, body mass index: 28.9 ± 5.3 kg/m2, 375 female and 320 male) underwent CPET using a cycle ergometer. 95% of the cohort had one or more major cardiovascular risk factor (i.e., obesity, smoking, dyslipidemia, hypertension, diabetes); no subject was diagnosed with cardiovascular disease (CVD) at the time of CPET. Subjects were tracked for the composite endpoint of cardiovascular mortality or hospital admission. RESULTS Mean peak VO2, VE/VCO2 slope and peak respiratory exchange ratio were 17.8 ± 5.8 mlO2•kg-1•min-1, 26.7 ± 4.1, and 1.18 ± 0.13, respectively. There were 42 composite events during the 64 ± 18 month tracking period. Both peak VO2 (Chi-square 16.3, p < 0.001) and the VE/VCO2 slope (Chi-square 14.9, p < 0.001) were significant univariate predictors of the composite endpoint. The VE/VCO2 slope added significant predictive value to peak VO2 and was retained in the multivariate regression (residual Chi-square 7.0, p = 0.008). DISCUSSION These results support the prognostic value of CPET prior to a CVD diagnosis. The prognostic value of the VE/VCO2 slope, not commonly the focus of CPET trials in patients with one or more major cardiovascular risk factors but without a confirmed CVD diagnosis, is a particularly novel finding in the current study.
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Affiliation(s)
- Jessica Zannoni
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Guazzi
- University of Milano School of Medicine, Department of Biological Sciences, Milano, Italy; San Paolo Hospital, Cardiology Division, Milano, Italy
| | - Valentina Milani
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bandera
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy; University of Milano School of Medicine, Department of Biological Sciences, Milano, Italy; San Paolo Hospital, Cardiology Division, Milano, Italy
| | - Eleonora Alfonzetti
- University of Milano School of Medicine, Department of Biological Sciences, Milano, Italy; San Paolo Hospital, Cardiology Division, Milano, Italy
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
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Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Ros SD, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Giudice CD, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi R, Inserra CA, Iori E, Izzo A, Rosa GL, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Di Bella G, Carerj S. Organization and Activity of Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:1-9. [PMID: 37426716 PMCID: PMC10328129 DOI: 10.4103/jcecho.jcecho_16_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 07/11/2023] Open
Abstract
Background The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue Doppler imaging in 53% of the centers, and using fractional area change in 33% of the centers. When we divided into cardiology (179, 78%) and noncardiology (49, 22%) centers, we found significant differences in the SE (93% vs. 26%, P < 0.001), TEE (85% vs. 18%), UCA (67% vs. 43%, P < 0001), and STE (87% vs. 20%, P < 0.001). The incidence of LUS evaluation was similar between the cardiology and noncardiology centers (69% vs. 61%, P = NS). Conclusions This nationwide survey demonstrated that digital infrastructures and advanced echocardiography modalities, such as 3D and STE, are widely available in Italy with a notable diffuse uptake of LUS in the core TTE examination, a suboptimal diffusion of PACS recording, and conservative use of UCA, 3D, and strain. There are significant differences between northern and central-southern regions and echocardiographic laboratories that pertain to the cardiac unit. This inhomogeneous distribution of technology represents one of the main issues that must be solved to standardize the practice of echocardiography.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | - Andrea Barbieri
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Semi-Intensive Care Unit, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Integrated Cardiovascular Diagnostic Division, Auxologico San Luca IRCCS Hospital, Milano, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Department, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, MI, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Science, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Sassari, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo Nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Maria Di Fulvio
- Cardiology-ICCU Division, Ss. Annunziata Hospital, Chieti, Italy
| | | | | | - Angelo Di Gioia
- Cardiology Division, St Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, CN, Italy
| | | | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, NA, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Palermo, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Ferrara, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, MO, Italy
| | - Annibale Izzo
- Cardiology Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiological and Cardio Oncological Rehabilitation Department, Sacile (PN) CRO (PN) Hospital, Sacile (PN), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, PG, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, MI, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città della Salute e della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Department, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, St Anna University Hospital, Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, RM, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St Giovanni Evangelista Hospital, Tivoli, RM, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, VE, Italy
| | - Carlo Ratti
- Cardiology Division, St Maria Bianca Hospital, Mirandola, MO, Italy
| | - Sara Rettegno
- Cardiology Division, Hospital, Moncalieri, TO, Italy
| | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Cardiology Division, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Antonello Zugaro
- Department of Cardiology, Intensive Care Unit, St Salvatore Hospital, L’Aquila, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
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Gorla R, Oliva OA, Poletti E, Finotello A, Morganti S, Zannoni J, Agnifili M, Barletta M, Squillace M, Criscione E, Tusa M, Brambilla N, Auricchio F, Testa L, Bedogni F. Impact of Nodular Calcifications in the Aortic Annulus and Left Ventricular Outflow Tract on TAVI Outcome with New-Generation Devices. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2311358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Marcon L, Zannoni J, Tundo F, Moltrasio M, Majocchi B, Fassini G, Riva S, Casella M, Tondo C, Ribatti V. P377 CHALLENGING RISK STRATIFICATION IN BRUGADA SYNDROME: A CASE OF VENTRICULAR TACHYCARDIA IN A LOW–RISK PATIENT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.363] [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
A 22–year–old healthy athlete was referred to our hospital for electrocardiographic findings consistent with intermittent type–1 Brugada pattern. A routine electrocardiogram (ECG) performed during a check–up showed sinus rhythm, normal PR interval and QRS duration, rSR’ with a coved type ST–segment elevation in V2 lead (Figure 1).The patients denied history of syncope or palpitations and his family history did not show sudden cardiac death or Brugada syndrome (BrS). Transthoracic echocardiography was normal and a 12–lead Holter monitoring revealed the intermittence of the type–1 Brugada pattern. The patient was hospitalized for further investigation. On admission, ECG showed a type–2 Brugada pattern; therefore, Ajmaline challenge test (1 mg/kg injection in 10 minutes) was performed and resulted positive. Subsequently, the patient underwent an electrophysiological study (EPS) which was negative for induction of sustained arrhythmias. The protocol adopted consisted of double extrastimuli programmed electrical stimulation until refractoriness (drive 600/220 ms and 400/210 ms), at double sites (right ventricle apex and right ventricular outflow tract). Furthermore a genetic test was performed using next–generation sequencing, showing a heterozygous mutation in the SCN5A gene, encoding for sodium channel alpha subunit (variant c.5363delA), not previously described in the literature. Since the low arrhythmic risk, the patient was implanted with a loop recorder (ILR, Medtronic Reveal LINQ), entering a program of home monitoring. After a 15–months follow–up, an episode of ventricular polymorphic tachycardia lasting 2 minutes and 11 seconds, associated with lightheadedness and palpitations, was detected by the remote monitoring (Figure 2). The patient was therefore hospitalized. During the in–hospital stay a cardiac magnetic resonance was performed to exclude other underlying diseases, identifying an enlarged right ventricle (EDVi 114 ml/m2) and abnormal free wall motion (Figure 3), thus reaching one major criteria of arrhythmogenic cardiomyopathy (however not sufficient for the diagnosis). The patient was then implanted with a subcutaneous implantable cardiac defibrillator (Boston Scientific EMBLEM MRI S–ICD). We presented a case of complex arrhythmic risk stratification in a possible overlap of an arrhythmogenic cardiomyopathy and a Brugada Syndrome in a young athlete who experienced a sustained ventricular tachycardia during loop–recorder monitoring.
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Affiliation(s)
- L Marcon
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - J Zannoni
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - F Tundo
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - M Moltrasio
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - B Majocchi
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - G Fassini
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - S Riva
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - M Casella
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - C Tondo
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
| | - V Ribatti
- CENTRO CARDIOLOGICO MONZINO, MILANO; AZIENDA OSPEDALIERO UNIVERSITARIA OSPEDALI RIUNITI DI ANCONA, ANCONA
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6
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Zannoni J, Del Torto A, Tundo F, Assanelli E. P35 A RARE CASE OF VENTRICULAR ARRHYTHMIA STORM AND COMPLETE ATRIOVENTRICULAR BLOCK IN A PATIENT WITH BECKER MUSCULAR DYSTROPHY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A 68 year–old male presented to the Emergency Department of our Institute with palpitations for the last 20 minutes. The patient suffered from Becker’s muscular dystrophy (BMD) with hypotonic tetraparesis and dilated cardiomyopathy with moderate left ventricular dysfunction. The patient had also arterial hypertension and a previous ischemic stroke treated with thrombolysis and subsequently with warfarin. On the admission, the patient was alert, blood pressure was 90/60 mmHg and heart rate 180 bpm. An ECG (Fig. 1) showed regular, wide–complex tachycardia (QRS duration of 240 msec) with right branch block morphology with left axial deviation. A bolus of amiodarone 200 mg ev was administered without efficacy followed by a bolus of lidocaine 50 mg. The patient developed symptomatic hypotension, so external electrical cardioversion was performed with a single DC shock at 200J, effective in restoring sinus rhythm. Amiodarone and beta blocker therapy was started. On laboratory tests, the main values were normal, including the ultrasensitive troponin hs–cTnI. Echocardiography showed a mildly dilated left ventricle with diffuse hypokinesia conditioning severe reduction of systolic function (FE 35%) (Fig. 2). On subsequent telemetric ECG monitoring, no recurrences of sustained ventricular tachycardia (VT) were recorded, but it was observed an episode of complete atrioventricular (AV) block conditioning a symptomatic 9.5–second asystole, treated with atropine. Then the patient underwent CRT–D implantation in secondary prevention. The day after the procedure, an arrhythmic storm occurred and was effectively treated with multiple attempts of antitachycardia pacing and device shock. In the following days, the patient continued to present with episodes of VT despite antiarrhythmic drugs. Hence, an endo–epicardial ablation of the arrhythmic substrate was evaluated in Heart team. In view of an intubation and the high anesthesiological risk, it was indicated to continue the optimized medical therapy. Mexiletine 200 mg tid was added to metoprolol 100 mg bid and amiodarone 200 mg od. In the following days, no arrhythmic recurrences were recorded on continuous ECG monitoring. The patient was discharged from the hospital asymptomatic and with no sign of heart failure. At 2 years of follow–up, the patient remained asymptomatic, with no arrhythmic events recorded by the device and in the absence of any adverse effects caused by mexiletine.
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Affiliation(s)
- J Zannoni
- UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO, MILANO; CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO, MILANO
| | - A Del Torto
- UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO, MILANO; CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO, MILANO
| | - F Tundo
- UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO, MILANO; CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO, MILANO
| | - E Assanelli
- UNIVERSITÀ DEGLI STUDI DI MILANO, MILANO, MILANO; CENTRO CARDIOLOGICO MONZINO IRCCS, MILANO, MILANO
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7
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Zannoni J, Popolo Rubbio A, Tusa MB, Corciu AI, Casenghi M, Cannone G, Barletta M, Stefanini E, Mantovani V, Gorla R, Brambilla N, Testa L, Bedogni F, De Marco F. Mechanisms of ineffective patent foramen ovale closure using the percutaneous suture-mediated NobleStitch system. EUROINTERVENTION 2022; 18:68-70. [PMID: 35403602 PMCID: PMC9903156 DOI: 10.4244/eij-d-21-01021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jessica Zannoni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maurizio B. Tusa
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anca I. Corciu
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Matteo Casenghi
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gaspare Cannone
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marta Barletta
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Elisa Stefanini
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valentina Mantovani
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Riccardo Gorla
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nedy Brambilla
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Testa
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Federico De Marco
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
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Popolo Rubbio A, Testa L, Granata G, Salvatore T, De Marco F, Casenghi M, Guerrini M, Oliva OA, Stefanini E, Barletta M, Sisinni A, Poletti E, Zannoni J, Gorla R, Brambilla N, Tusa M, Bedogni F. Prognostic significance of right ventricle to pulmonary artery coupling in patients with mitral regurgitation treated with the MitraClip system. Catheter Cardiovasc Interv 2021; 99:1277-1286. [PMID: 34939726 DOI: 10.1002/ccd.30044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To evaluate the prognostic impact of baseline tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio, as an expression of the right ventricle-pulmonary artery (RV-PA) coupling, in patients with mitral regurgitation (MR) treated with the MitraClip. BACKGROUND Impaired RV to PA coupling is considered a marker of RV dysfunction. METHODS From February 2016 to February 2020, a total of 165 patients were evaluated and stratified in two groups according to a prespecified value of TAPSE/PASP ratio ≤ 0.36. RESULTS The median patients' age was 79 (men: 62.4%). Sixty-three patients (38.1%) presented TAPSE/PASP ≤ 0.36 and were then compared with patients with TAPSE/PASP > 0.36. Functional MR etiology was more frequent in TAPSE/PASP ≤ 0.36 (71.4%; p = 0.046). Acute technical success was achieved in 92.7% of the population, without any significant difference between the two groups of study and with sustained results at 30-day (device success: 85.5%; procedural success: 84.8%). On multivariate Cox regression analysis, after correction for body mass index, chronic kidney disease and left ventricle ejection fraction ≥30% but <50%, TAPSE/PASP ≤ 0.36 remained a sustained predictor of mortality and hospitalization for heart failure at one year after MitraClip (hazard ratio: 3.87; 95% confidence interval: 1.83-8.22; p ≤ 0.001). Kaplan-Meier all-cause mortality and heart failure hospitalization rates at one year were consequently higher in patients with TAPSE/PASP ≤ 0.36 (39.4% vs. 14.8%; log-rank p ≤ 0.001). CONCLUSION Baseline TAPSE/PASP ratio seems independently associated with all-cause mortality and heart failure hospitalization after MitraClip both in functional and degenerative MR.
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Affiliation(s)
- Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuseppina Granata
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Tanya Salvatore
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Matteo Casenghi
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Guerrini
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Omar A Oliva
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Elisa Stefanini
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marta Barletta
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Sisinni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Enrico Poletti
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Jessica Zannoni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Riccardo Gorla
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nedy Brambilla
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maurizio Tusa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Zannoni J, Bandera F, Guazzi M. AN IMPAIRED EXERCISE HEART RATE RECOVERY TYPICALLY CHARACTERIZE OVERWEIGHT SUBJECTS: FINDINGS FROM EURO-EX PREVENTION TRIAL. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02896-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Maloberti A, Piccinelli E, Zannoni J, Castelnuovo S, Vallerio P, Bassi I, Pansera G, Occhi L, Varrenti M, Masciocco G, Perna E, Cipriani M, Frigerio M, Giannattasio C. P6315Effects of chronic heart failure unconventional therapies on endothelial function. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0912] [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
Introduction
Endothelial Dysfunction (ED) of peripheral arteries in Chronic Heart Failure (CHF) subjects has been demonstrated.
Purpose
We assessed endothelial function in subjects undergoing unconventional treatments for CHF, namely Heart Transplantation (HTX), continuous-flow Left Ventricular Assist Device implantation (LVAD), and repeated levosimendan infusions (r-LEVO).
Methods
Twenty HTX recipients (median time from HTX 21 months), 20 patients supported with LVAD (median time from implant 39 months), and 20 patients receiving monthly Levosimendan infusions (median time on treatment 28 months) were enrolled and compared to a group of 20 healthy subjects. ED was evaluated with ultrasound assessment of the diameter before and after ischemic stress at the brachial artery level. The difference between the two diameters normalized for the baseline value (Flow Mediated Dilation – FMD) has been used for the analysis. All the patients were stable at the time of FMD assessment, with those on r-LEVO being evaluated prior to infusion.
Results
FMD was significantly lower in HTX and LVAD groups with respect to controls (9.8±7.4, 9.3±5.7, and 15.6±6.4% respectively, p=0.01), but not in r-LEVO group (12.5±6.9%).
When patients were analyzed according to time from the operation or on treatment, (< versus > of the median value), no differences were seen in HTX and r-LEVO group, while in LVAD group FMD was borderline significantly higher in patients with longer follow-up (8.4±6.4% versus 10.2±5.2%, p=0.05).
Conclusions
Based on this preliminary data we can inference the following: 1- FMD is abnormal in HTX recipients, despite their good functional status, probably due to factors unrelated to CHF (e.g. hypertension, renal insufficiency, denervation, and drug effects); 2- LVAD patients also show ED, with possible better adaptation in very long-term survivors; 3- Near-normal FMD values in CHF patients who remain stable with r-LEVO suggest that pulsed treatment may obtain favorable effects at peripheral level, persisting after clearance of the drug and its metabolites.
Acknowledgement/Funding
None
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Affiliation(s)
- A Maloberti
- Niguarda Ca' Granda Hospital, Cardiology 4, Milan, Italy
| | - E Piccinelli
- Niguarda Ca' Granda Hospital, Cardiology 4, Milan, Italy
| | - J Zannoni
- University of Milan-Bicocca, School of Medicine and Surgery, Milan, Italy
| | - S Castelnuovo
- Niguarda Ca' Granda Hospital, Dyslipidemia Center, Milan, Italy
| | - P Vallerio
- Niguarda Ca' Granda Hospital, Cardiology 4, Milan, Italy
| | - I Bassi
- University of Milan-Bicocca, School of Medicine and Surgery, Milan, Italy
| | - G Pansera
- University of Milan-Bicocca, School of Medicine and Surgery, Milan, Italy
| | - L Occhi
- Niguarda Ca' Granda Hospital, Cardiology 4, Milan, Italy
| | - M Varrenti
- Niguarda Ca' Granda Hospital, 2nd Section of Cardiology, DeGasperis CardioCenter, Milan, Italy
| | - G Masciocco
- Niguarda Ca' Granda Hospital, 2nd Section of Cardiology, DeGasperis CardioCenter, Milan, Italy
| | - E Perna
- Niguarda Ca' Granda Hospital, 2nd Section of Cardiology, DeGasperis CardioCenter, Milan, Italy
| | - M Cipriani
- Niguarda Ca' Granda Hospital, 2nd Section of Cardiology, DeGasperis CardioCenter, Milan, Italy
| | - M Frigerio
- Niguarda Ca' Granda Hospital, 2nd Section of Cardiology, DeGasperis CardioCenter, Milan, Italy
| | - C Giannattasio
- Niguarda Ca' Granda Hospital, Cardiology 4, Milan, Italy
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