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Boriani G, Guerra F, De Ponti R, D'Onofrio A, Accogli M, Bertini M, Bisignani G, Forleo GB, Landolina M, Lavalle C, Notarstefano P, Ricci RP, Zanotto G, Palmisano P, De Bonis S, Pangallo A, Talarico A, Maglia G, Aspromonte V, Nigro G, Bianchi V, Rapacciuolo A, Ammendola E, Solimene F, Stabile G, Biffi M, Ziacchi M, Malpighi PSO, Saporito D, Casali E, Turco V, Malavasi VL, Vitolo M, Imberti JF, Bertini M, Anna AS, Zardini M, Placci A, Quartieri F, Bottoni N, Carinci V, Barbato G, De Maria E, Borghi A, Ramazzini OB, Bronzetti G, Tomasi C, Boggian G, Virzì S, Sassone B, Corzani A, Sabbatani P, Pastori P, Ciccaglioni A, Adamo F, Scaccia A, Spampinato A, Patruno N, Biscione F, Cinti C, Pignalberi C, Calò L, Tancredi M, Di Belardino N, Ricciardi D, Cauti F, Rossi P, Cardinale M, Ansalone G, Narducci ML, Pelargonio G, Silvetti M, Drago F, Santini L, Pentimalli F, Pepi P, Caravati F, Taravelli E, Belotti G, Rordorf R, Mazzone P, Bella PD, Rossi S, Canevese LF, Cilloni S, Doni LA, Vergara P, Baroni M, Perna E, Gardini A, Negro R, Perego GB, Curnis A, Arabia G, Russo AD, Marchese P, Dell’Era G, Occhetta E, Pizzetti F, Amellone C, Giammaria M, Devecchi C, Coppolino A, Tommasi S, Anselmino M, Coluccia G, Guido A, Rillo M, Palamà Z, Luzzi G, Pellegrino PL, Grimaldi M, Grandinetti G, Vilei E, Potenza D, Scicchitano P, Favale S, Santobuono VE, Sai R, Melissano D, Candida TR, Bonfantino VM, Di Canda D, Gianfrancesco D, Carretta D, Pisanò ECL, Medico A, Giaccari R, Aste R, Murgia C, Nissardi V, Sanna GD, Firetto G, Crea P, Ciotta E, Sgarito G, Caramanno G, Ciaramitaro G, Faraci A, Fasheri A, Di Gregorio L, Campsi G, Muscio G, Giannola G, Padeletti M, Del Rosso A, Notarstefano P, Nesti M, Miracapillo G, Giovannini T, Pieragnoli P, Rauhe W, Marini M, Guarracini F, Ridarelli M, Fedeli F, Mazza A, Zingarini G, Andreoli C, Carreras G, Zorzi A, Zanotto G, Rossillo A, Ignatuk B, Zerbo F, Molon G, Fantinel M, Zanon F, Marcantoni L, Zadro M, Bevilacqua M. Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing). Intern Emerg Med 2023; 18:137-149. [PMID: 36352300 PMCID: PMC9646282 DOI: 10.1007/s11739-022-03140-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The subsequent waves of the COVID-19 pandemic in Italy had a major impact on cardiac care. METHODS A survey to evaluate the dynamic changes in arrhythmia care during the first five waves of COVID-19 in Italy (first: March-May 2020; second: October 2020-January 2021; third: February-May 2021; fourth: June-October 2021; fifth: November 2021-February 2022) was launched. RESULTS A total of 127 physicians from arrhythmia centers (34% of Italian centers) took part in the survey. As compared to 2019, a reduction in 40% of elective pacemaker (PM), defibrillators (ICD), and cardiac resynchronization devices (CRT) implantations, with a 70% reduction for ablations, was reported during the first wave, with a progressive and gradual return to pre-pandemic volumes, generally during the third-fourth waves, slower for ablations. For emergency procedures (PM, ICD, CRT, and ablations), recovery from the initial 10% decline occurred in most cases during the second wave, with some variability. However, acute care for atrial fibrillation, electrical cardioversions, and evaluations for syncope showed a prolonged reduction of activity. The number of patients with devices which started remote monitoring increased by 40% during the first wave, but then the adoption of remote monitoring declined. CONCLUSIONS The dramatic and profound derangement in arrhythmia management that characterized the first wave of the COVID-19 pandemic was followed by a progressive return to the volume of activities of the pre-pandemic periods, even if with different temporal dynamics and some heterogeneity. Remote monitoring was largely implemented during the first wave, but full implementation is needed.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121, Modena, Italy.
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | | | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, Castrovillari, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Rome, Italy
| | | | | | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Verona, Italy
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Schiavone M, Gasperetti A, Laredo M, Breitenstein A, Vogler J, Palmisano P, Gulletta S, Pignalberi C, Lavalle C, Pisanò E, Ricciardi D, Curnis A, Dello Russo A, Tondo C, Badenco N, Di Biase L, Kuschyk J, Biffi M, Tilz R, Forleo GB, Arosio R, Ruggiero D, Viecca M, Ziacchi M, Diemberger I, Angeletti A, Fierro N, Della Bella P, Mitacchione G, Compagnucci P, Casella M, Santini L, Piro A, Picarelli F, Bressi E, Calò L, Montemerlo E, Rovaris G, De Bonis S, Bisignani A, Bisignani G, Russo G, Guarracini F, Vitali F, Bertini M, Fink T, Fastenrath F, Kaiser L, Hakmi S, Waintraub X, Gandjbakhch E, Saguner A. Inappropriate Shock Rates and Long-Term Complications due to Subcutaneous Implantable Cardioverter Defibrillators in Patients With and Without Heart Failure: Results From a Multicenter, International Registry. Circ Arrhythm Electrophysiol 2023; 16:e011404. [PMID: 36595631 DOI: 10.1161/circep.122.011404] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 01/05/2023]
Affiliation(s)
- Marco Schiavone
- Luigi Sacco University Hospital, Milan (M.S., A.G., G.B.F.).,Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.S.)
| | - Alessio Gasperetti
- Luigi Sacco University Hospital, Milan (M.S., A.G., G.B.F.).,Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.G., N.B.)
| | - Mikael Laredo
- APHP, Hôpital Pitié Salpêtrière, Paris, France (M.L.)
| | | | - Julia Vogler
- Department of Elctrophysiology, Herzzentrum Lubeck, Germany (J.V., R.T.)
| | - Pietro Palmisano
- Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy (P.P.)
| | - Simone Gulletta
- Arrhythmology & Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan (S.G.)
| | | | | | - Ennio Pisanò
- U.O.S.V.D. Cardiac Electrophysiology - "V. Fazzi" Hospital, Lecce (E.P.)
| | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi," Ancona (A.D.R.)
| | - Claudio Tondo
- Heart Rhythm Centre, Monzino Cardiology Centre, IRCCS, Milan, Italy (C.T.)
| | - Nicolas Badenco
- Department of Cardiology, Johns Hopkins University, Baltimore, MD (A.G., N.B.)
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, Bronx, NY (L.D.B.)
| | - Jürgen Kuschyk
- Cardiology Unit, University Medical Center Mannheim, Germany (J.K.)
| | - Mauro Biffi
- Cardiology, IRCCS, Department of Experimental, Diagnostic & Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy (M.B.)
| | - Roland Tilz
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany (R.T.)
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Compagnucci P, Casella M, Bianchi V, Giano A, Calo' L, Bertini M, Santini L, Savarese G, Santobuono VE, Mattera A, Lavalle C, Amellone C, La Greca C, Dello Russo A. Implantable defibrillator-detected heart failure status predicts ventricular tachyarrhythmias. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The occurrence of ventricular tachyarrhythmias is associated with increased mortality and hospitalizations for heart failure in implantable cardioverter defibrillator (ICD) patients. Nonetheless, the temporal relationship between heart failure worsening and ventricular tachyarrhythmias has been scarcely explored so far.
Purpose
We hypothesized that in patients with heart failure and reduced ejection fraction with ICDs, physiological sensor-based heart failure status, as reflected in the HeartLogic index, would predict appropriate device therapies for ventricular tachyarrhythmias (shocks and antitachycardia pacing).
Methods and results
568 patients implanted with ICDs (n=410, 72%) or cardiac resynchronization therapy-defibrillators (CRT-D, n=158, 28%) endowed with the HeartLogic algorithm were included in this prospective observational multicenter analysis. Over a follow-up of 25 [25th-75th percentile: 15–35] months, 122 (21%) patients received an appropriate device therapy (shock, n=74, 13%), while the HeartLogic index crossed the threshold value 1200 times (0.71 alerts/patient-year) in 370 subjects (65%). The occurrence of at least one HeartLogic alert was significantly associated with both appropriate shocks (HR: 2.44, 95% CI: 1.49–3.97, p=0.003) and any ICD therapies (HR: 1.95, 95% CI: 1.37–2.85, p=0.003). Using a time-dependent Cox model, the weekly IN-alert state was the strongest predictor of ICD shocks (HR: 2.94, 95% CI: 1.73–5.01, p<0.001), after correction for age, secondary prevention, and use of CRT. As compared to clinically stable subjects with no therapies, patients experiencing shocks had significantly higher baseline values of the HeartLogic index, third heart sound amplitude, and respiratory rate. Beginning about one month prior to the arrhythmic event, we noticed further increase of the combined index and the third heart sound amplitude, a decrease of thoracic impedance, and higher resting heart rate (Figure 1).
Conclusions
The HeartLogic index is an independent predictor of appropriate defibrillator therapies. The combined index and its individual physiological components change well before the arrhythmic event, suggesting the existence of a window of opportunity to prevent shocks.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Compagnucci
- Marche Polytechnic University of Ancona , Ancona , Italy
| | - M Casella
- Marche Polytechnic University of Ancona , Ancona , Italy
| | - V Bianchi
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - A Giano
- San Giovanni di Dio and Ruggi d'Aragona University Hospital , Salerno , Italy
| | - L Calo'
- Polyclinic Casilino , Rome , Italy
| | - M Bertini
- Sant Anna Hospital , Ferrara , Italy
| | - L Santini
- G. B. GRASSI Hospital , Rome , Italy
| | - G Savarese
- FOLIGNO General Hospital , Foligno , Italy
| | | | - A Mattera
- Hospital Sant'anna E San Sebastiano , Caserta , Italy
| | | | | | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia , Brescia , Italy
| | - A Dello Russo
- Marche Polytechnic University of Ancona , Ancona , Italy
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Santobuono VE, Tavoletta V, Manzo M, Calo' L, Bertini M, Santini L, Savarese G, Dello Russo A, Viscusi M, Lavalle C, Amellone C, Calvanese R, Valsecchi S, Favale S. Performance of a multisensor implantable defibrillator algorithm for HF monitoring in presence of comorbidities. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiovascular and non-cardiovascular comorbidities are common in heart failure (HF) patients and impact disease severity and prognosis. Select modern implantable defibrillators (ICDs) are equipped with multisensor algorithms for HF monitoring. The HeartLogic index combines multiple ICD-based sensor data (heart rate, heart sounds, thoracic impedance, respiration, activity), and the associated alert has proved to be a sensitive and timely predictor of impending HF decompensation in cardiac resynchronization therapy (CRT-D) patients The algorithm was developed using data from CRT-D patients; the performance in non-CRT ICD patients and the impact of selected comorbidities on performance requires further study.
Methods
The HeartLogic feature was activated in 568 ICD patients (410 with CRT) from 26 centers. The median follow-up was 25 months [25th–75th percentile: 15–35].
Results
During follow-up, 97 hospitalizations were reported (53 cardiovascular) and 55 patients died. We recorded 1200 HeartLogic alerts (0.71 alerts/patient-year) in 370 patients. Overall, the time IN the alert state was 13% of the total observation period. The rate of cardiovascular hospitalizations or death was 0.48/patient-year (95% CI: 0.37–0.60) with the HeartLogic IN alert state and 0.04/patient-year (95% CI: 0.03–0.05) OUT of alert state, with an incidence rate ratio of 13.35 (95% CI: 8.83–20.51, p<0.001). Among patient characteristics, atrial fibrillation (AF) at implantation (HR: 1.62, 95% CI: 1.27–2.07, p<0.001) and chronic kidney disease (CKD) (HR: 1.53, 95% CI: 1.21–1.93, p<0.001) independently predicted alerts. HeartLogic alerts were not associated with CRT vs. non-CRT device implantation (HR: 1.03, 95% CI: 0.82–1.30, p=0.775). The comparisons of the clinical event rates in the IN alert state with those in the OUT of alert state yielded incidence rate ratios ranging from 9.72 to 14.54 (all p<0.001) in all groups of patients stratified by: CRT/non-CRT, AF/non-AF, CKD/non-CKD. Indeed, after multivariate correction for CKD and AF at implantation, the time IN the HeartLogic alert state >13% was associated with the occurrence of the combined endpoint of cardiovascular hospitalization or death (HR: 2.54, 95% CI: 1.61–4.01, p<0.001).
Conclusions
The burden of HeartLogic alerts appears similar between CRT and non-CRT patients, while patients with AF and CKD seem more exposed to alerts. Nonetheless, the ability of the HeartLogic algorithm to identify patients during periods of significantly increased risk of clinical events is confirmed regardless of the type of device, the presence of AF, or CKD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - V Tavoletta
- AO dei Colli - Monaldi Hospital , Naples , Italy
| | - M Manzo
- San Giovanni di Dio and Ruggi d'Aragona University Hospital , Salerno , Italy
| | - L Calo'
- Polyclinic Casilino , Rome , Italy
| | - M Bertini
- University Hospital of Ferrara , Ferrara , Italy
| | - L Santini
- G. B. GRASSI Hospital , Rome , Italy
| | - G Savarese
- San Giovanni Battista Hospital , Foligno , Italy
| | - A Dello Russo
- University Hospital Riuniti of Ancona , Ancona , Italy
| | - M Viscusi
- Hospital Sant'anna E San Sebastiano , Caserta , Italy
| | | | | | | | | | - S Favale
- University of Bari , Bari , Italy
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Santini L, Zocchi C, Olivotto I, Coppini R, Cerbai E. Early- and delayed-afterdepolarizations as cellular promoter of ventricular fibrillation in hypertrophic cardiomyopathy. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): In Silico project
Background
Hypertrophic cardiomyopathy (HCM) represents the commonest inherited cardiac disease, with a prevalence of 1/500 in the general population. The most devastating consequence of HCM is sudden cardiac death (SCD) due to ventricular fibrillation, particularly common in children and young adults. The positive correlation between the extent of late gadolinium enhancement (LGE, reflecting myocardial fibrosis) and the arrhythmic risk suggests that ventricular arrhythmias are held to originate from the fibrotic regions, by a mechanism of electrical re-entry. However, recent data suggest that enhanced cellular automaticity (i.e. early- or delayed-afterdepolarizations, EADs or DADs-) may be clinically more relevant in promoting ventricular arrhythmias in patients.
Purpose
Aiming to better understand the cellular and molecular mechanisms of arrhythmogenesis in HCM and to establish a reliable arrhythmic risk stratification in patients, we performed a translational and retrospective study in 61 HCM patients who underwent surgical myectomy, by combining a clinical follow-up study with in vitro assessments of cellular arrhythmogenicity.
Methods
We retrospectively studied 61 HCM patients who underwent surgical interventricular-septum myectomy to relieve refractory obstruction-related symptoms. At the time of surgery, fresh ventricular tissue was collected and used to isolate single ventricular cardiomyocytes (CMs), which were used for patch-clamp measurements and Ca2+ imaging experiments to assess the occurrence of EADs and DADs. Patients were followed up for a median time of 8 years and the occurrence of non-sustained ventricular tachycardia (NSVT) or life-threatening arrhythmic events (LAE, including sustained VT and ventricular fibrillation, VF) was monitored. Moreover, data from ECG and cardiac magnetic-resonance studies were collected.
Results
EADs occurred in CMs from 36% of patients and were associated with prolonged action potential duration while DADs occurred in 24% of patients and correlated with abnormalities of intracellular Ca2+ handling. During follow up, NSVT events occurred in 19/61 patients while LAE occurred in 4/61 patients. Their combined occurrence (37%) strongly correlated with the presence of DADs in cardiomyocytes. Patients with NSVT/LAE were more likely to show specific "pro-arrhythmic" pathological ECG-patterns. Among patients with LGE, the presence of DADs in cells behaved as a necessary pre-requisite for NSVT/LAE, as none of the patients with evidence of fibrosis but negative for DADs had arrhythmic events.
Conclusions
The presence of pro-arrhythmic changes appears to be necessary for arrhythmia generation in HCM and seems to be related with specific alterations at ECG level, that might be used as clinical arrhythmia predictors in HCM patients. Fibrosis per se is not a major predictor of arrhythmias in HCM but may contribute to generate sustained arrhythmias in the presence of substantial cellular triggers (DADs).
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Affiliation(s)
- L Santini
- University of Florence , Florence , Italy
| | - C Zocchi
- Careggi University Hospital (AOUC) , Florence , Italy
| | - I Olivotto
- Careggi University Hospital (AOUC) , Florence , Italy
| | - R Coppini
- University of Florence , Florence , Italy
| | - E Cerbai
- University of Florence , Florence , Italy
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Palandri C, Santini L, Giammarino L, Musumeci M, Olivotto I, Cerbai E, Coppini R. Electrophysiological remodeling in primary versus secondary cardiac hypertrophy: a study in human cardiomyocytes. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.095] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministero dell'università e della ricerca
Electrophysiological remodeling in primary versus secondary cardiac hypertrophy: a study in human cardiomyocytes
Introduction
Myocardial hypertrophy is an adaptive condition to hemodynamic stress, characterized by the increase in size of the cardiomyocytes and in the cardiac mass. It involves more frequently the left ventricle (LV) and leads to an enhanced risk of arrhythmias; it’s characterized by the increase walls thickness and by a large remodelling of the cardiac tissue in terms of fibrosis, impaired calcium handling and ion current balance. The LV hypertrophy could be induced by genetic abnormalities, such as in hypertrophic cardiomyopathy (HCM) or it could be secondary to other pathological conditions, like aortic stenosis (SAO-HT).
Purpose
In this work we will compare the mechanisms that mainly determine primitive (HCM samples) or secondary (to aortic stenosis: SAO-HT) LV hypertrophy to assess common points and disagreements.
Methods
Human septal specimens from HCM, SAO-HT and control (CTRL) surgical patients were collected, tissue was in part rapidly frozen, in part processed to isolate responsive single cells or trabeculae. We performed patch clamp experiments to measured action potential duration (APD) and calcium current (ICaL). To study the Ca2+ handling we performed imaging analysis; isolated cardiomyocytes were loaded with a Ca2+ sensitive dye (CAL530) by incubating cells for 30 min, then we evaluate the calcium transients at different stimulation frequencies.
Results
We evaluated APD, ICaL, and Ca2+ handling in the 3 groups: HCM, SAO-HT and CTRL cardiomyocytes. Both pathological groups show to be depolarized, to have a prolonged APD, diastolic Ca2+ concentration is higher and the kinetics are slower than in CTRL cardiomyocytes. HCM cardiomyocytes has longer APD than SAO-HT and higher diastolic Ca2+ concentration, HCM also shows longer kinetics of the decay phase of the Ca2+ transient compare to SAO-HT. The ICaL is comparable between CTRL and SAO-HT, it is higher in HCM and the inactivation kinetics are slower.
Discussion and Conclusion
We evaluate the electrophysiological differences among cardiomyocytes derived from a secondary or primary myocardial hypertrophy and from non-hypertrophic myocardia. Alterations in the two groups of pathological samples are similar. Both shows slowed Ca2+ transient kinetics, that slow down the relaxation machinery, and increase diastolic Ca2+ concentration, that could cause arrhythmic events (DAD). The increase in diastolic Ca2+ could also be responsible for the hyperactivation of the CAMK-II that has among its target ICaL channel and the Na2+ channel that are hyperactivated causing the prolongation of APD. The functional alterations observed in the hypertrophic cardiomyocytes could be considered not as disease specific response but a mechanism of adaptation to the hypertrophy and to diastolic dysfunction, those are more serious where the hypertrophy is genetic determined.
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Affiliation(s)
- C Palandri
- University of Florence , Florence , Italy
| | - L Santini
- University of Florence , Florence , Italy
| | | | - M Musumeci
- University of Florence , Florence , Italy
| | - I Olivotto
- University of Florence , Florence , Italy
| | - E Cerbai
- LENS: European Laboratory for Non-linear Spectroscopy , Florence , Italy
| | - R Coppini
- University of Florence , Florence , Italy
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Giammarino L, Santini L, Palandri C, Musumeci M, Langione M, Pioner JM, Ferrantini C, Coppini R, Cerbai E, Poggesi C. Extracellular stiffness as a determinant of cardiac dysfunction in duchenne muscular distrophy: a study on human iPSC derived cardiomyocytes. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Fondazione Intesa San Paolo
Introduction
Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive degeneration of striated muscles; in addition to skeletal muscle impairment, DMD is also characterized by progressive myocardial disfunction. The low translational value of animal models and the low availability of human samples make DMD hard to investigate; induced pluripotent stem cells (iPSCs) represent a novel tool to model this disease, preserving the genetic heritage of the patient, including the pathogenic mutation causing dystrophy.
Aim
Our aim is to characterize cardiomyocytes differentiated from iPSCs (iPSC-CMs) derived from healthy donors (CTRL) and DMD patients, to identify the pathophysiological mechanisms of DMD-related cardiomyopathy.
Materials and Methods
Cardiomyocytes are differentiated from IPSCs obtained by reprogramming isolated mononucleated blood cells from healthy donors and DMD patients. IPSC-CMs are cultured until day 60, 75 or 90 post-differentiation after plating on nanostructured substrates with two different stiffness levels: PEG-substrates, with lower rigidity, mimicking healthy extracellular tissue, and DEG-substrates, with greater rigidity, that mimic the presence of myocardial fibrosis. Through imaging techniques, we evaluated calcium handling and action potentials (AP) on DMD and CTRL iPSC-CMs by using specific fluorescent dyes for Ca2+ (CAL630) and membrane voltage (Fluovolt). Cells were stimulated at different pacing rates.
Results
The calcium transient amplitude of CTRL-iPSC-CMs became larger during maturation. This adaptation did not occur in DMD lines, showing a deficit calcium release due to poor maturation of the sarcoplasmic reticulum (SR). AP duration was shorter in the DMD line at d75 but at d90 we observed no differences when compared with the CTRL line. CTRL iPSC-CMs showed a marked ability to adapt to different substrate stiffnesses. Indeed, the calcium transient amplitude was larger and its kinetics faster when cells were grown on the rigid DEG substrates rather than on PEG plates. In the DMD line, however, no differences were observed between the substrates.
Conclusions
Our results highlight a scarce ability of DMD iPSC-CM to adapt to different substrate stiffness, resulting in mechanical and electrical impairment, especially in the presence of stiffer substrates. This might explain why cardiac impairment is usually absent in the early stages of DMD, when cardiac structural changes are still absent. However, the electrophysiological and mechanical impairment of DMD hearts may precipitate rapidly when extracellular stiffness starts to increase due to development of cardiac fibrosis.
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Affiliation(s)
| | - L Santini
- University of Florence , Florence , Italy
| | - C Palandri
- University of Florence , Florence , Italy
| | - M Musumeci
- University of Florence , Florence , Italy
| | - M Langione
- University of Florence , Florence , Italy
| | - JM Pioner
- University of Florence , Florence , Italy
| | | | - R Coppini
- University of Florence , Florence , Italy
| | - E Cerbai
- University of Florence , Florence , Italy
| | - C Poggesi
- University of Florence , Florence , Italy
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8
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Biasci V, Santini L, Hussaini S, Ferrantini C, Coppini R, Loew LM, Luther S, Campione M, Poggesi C, Pavone FS, Cerbai E, Bub G, Sacconi L. Optogenetic manipulation of cardiac electrical dynamics using sub-threshold illumination: dissecting the role of cardiac alternans in terminating rapid rhythms. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.161] [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: 11/03/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Cardiac action potential (AP) shape and propagation are regulated by several key dynamic factors such as ions channel recovery and intracellular Ca2+-cycling. Experimental methods for manipulating AP electrical dynamics commonly use ion channel inhibitors that lack spatial and temporal specificity. In this work, we propose a novel approach based on optogenetics to manipulate cardiac electrical activity employing a light-modulated depolarizing current with intensities that are too low to elicit APs (sub-threshold illumination) but are sufficient to fine-tune AP electrical dynamics. We investigated the effects of sub-threshold illumination in isolated cardiomyocytes and whole hearts by using transgenic mice constitutively expressing a light-gated ion channel (channelrhodopsins-2, ChR2). We find that ChR2-mediated depolarizing current prolongs APs and reduces conduction velocity (CV) in a space-selective and reversible manner. Sub-threshold manipulation also affects the dynamics of cardiac electrical activity, increasing the magnitude of cardiac alternans. We use an optical system that uses real-time feedback control to generate re-entrant circuits with user-defined cycle lengths to explore the role that cardiac alternans plays in spontaneous termination of ventricular tachycardias (VTs). We find that VT stability significantly decreases during sub-threshold illumination primarily due to an increase in the amplitude of electrical oscillations, which implies that cardiac alternans may be beneficial in the context of self-termination of VT.
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Affiliation(s)
- V Biasci
- LENS - European Laboratory for Non-Linear Spectroscopy, University of Florence , Sesto Fiorentino , Italy
| | - L Santini
- University of Florence, Dept NeuroFarBa , Florence , Italy
| | - S Hussaini
- Max Planck Institute for Dynamics and Self-Organization , Gottingen , Germany
| | - C Ferrantini
- University of Florence, Department of Experimental and Clinical Medicine , Firenze , Italy
| | - R Coppini
- University of Florence, Dept NeuroFarBa , Florence , Italy
| | - LM Loew
- University of Connecticut, Center for Cell Analysis and Modeling , Farmington , United States of America
| | - S Luther
- Max Planck Institute for Dynamics and Self-Organization , Gottingen , Germany
| | - M Campione
- University of Padua, Department of Biomedical Science , Padova , Italy
| | - C Poggesi
- University of Florence, Department of Experimental and Clinical Medicine , Firenze , Italy
| | - FS Pavone
- LENS - European Laboratory for Non-Linear Spectroscopy, University of Florence , Sesto Fiorentino , Italy
| | - E Cerbai
- LENS - European Laboratory for Non-Linear Spectroscopy, University of Florence , Sesto Fiorentino , Italy
| | - G Bub
- Mcgill University, Department of Physiology , Montreal , Canada
| | - L Sacconi
- LENS - European Laboratory for Non-Linear Spectroscopy, University of Florence , Sesto Fiorentino , Italy
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9
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Vitali F, Tavoletta V, Giano A, Calo L, Santini L, Savarese G, Dello Russo A, Santobuono VE, Mattera A, Lavalle C, Amellone C, Pecora D, Bertini M. Association between atrial fibrillation and cardiac implantable defibrillator detected heart failure status. Europace 2022. [DOI: 10.1093/europace/euac053.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In heart failure (HF) patients, atrial fibrillation (AF) is a common comorbidity and is associated with a worse prognosis. Implantable defibrillator (ICD) diagnostics allow continuous monitoring of atrial high-rate events (AHRE), as a surrogate of AF, and are equipped with algorithms for HF monitoring. We evaluated the association between the values of the multisensor HF HeartLogic Index and the incidence of AF, and assessed the performance of the Index in detecting follow-up periods of significantly increased AF risk.
Methods
The HeartLogic feature was activated in 568 ICD patients. The median follow-up was 25 months [25th–75th percentile: 15-35]. The HeartLogic algorithm calculates a daily HF index and identifies periods IN the alert state on the basis of a configurable threshold. The endpoints were: daily AF burden of ≥5 minutes, ≥6 hours and ≥23 hours.
Results
The HeartLogic index crossed the threshold value 1200 times (0.71 alerts/patient-year). The time IN the alert state was 13% of the total observation period. During the observation period, an AF burden of ≥5 minutes/day was documented in 183 (32%) patients, ≥6 hours/day in 118 (21%) patients, and ≥23 hours/day in 89 (16%). On using a time-dependent Cox model, the weekly time IN the alert state was independently associated with an AF burden of ≥5 minutes/day (HR:1.95, 95%CI:1.22-3.13, p=0.005), ≥6 hours/day (HR:2.66, 95%CI:1.60-4.44, p<0.001), and ≥23 hours/day (HR:3.32, 95%CI:1.83-6.02, p<0.001), after correction for baseline confounders. Comparison of the episode rates in the IN-alert state with those in the OUT-of-alert state yielded HRs ranging from 1.57 to 3.11 for AF burden from ≥5 minutes to ≥23 hours.
Conclusions
The HeartLogic alert state was independently associated with AF occurrence. The intervals of time defined by the algorithm as periods of increased risk of HF allow risk stratification of AF according to various thresholds of daily burden.
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Affiliation(s)
- F Vitali
- University Hospital of Ferrara, Cardiology, Ferrara, Italy
| | - V Tavoletta
- AORN Ospedali dei Colli - Monaldi Hospital, Cardiology, Naples, Italy
| | - A Giano
- San Giovanni di Dio and Ruggi d’Aragona University Hospital, Cardiology, Salerno, Italy
| | - L Calo
- Polyclinic Casilino, Cardiology, Rome, Italy
| | - L Santini
- G. B. GRASSI Hospital, Cardiology, Rome, Italy
| | - G Savarese
- FOLIGNO General Hospital, Cardiology, Foligno, Italy
| | - A Dello Russo
- Ancona University United Hospitals, Cardiology, Ancona, Italy
| | - VE Santobuono
- Polyclinic Hospital of Bari, Cardiology, Bari, Italy
| | - A Mattera
- Hospital Sant’anna E San Sebastiano, Cardiology, Caserta, Italy
| | - C Lavalle
- Polyclinic Umberto I, Cardiology, Rome, Italy
| | - C Amellone
- Maria Vittoria Hospital, Cardiology, Turin, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - M Bertini
- University Hospital of Ferrara, Cardiology, Ferrara, Italy
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10
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Guerra F, D’onofrio A, De Ruvo E, Manzo M, Santini L, Giubliato G, La Greca C, Petracci B, Stronati G, Bianchi V, Martino A, Franculli F, Compagnucci P, Valsecchi S, Dello Russo A. Remotely-driven management of diuretic therapy in heart failure patients with a multiparametric ICD algorithm. Europace 2022. [DOI: 10.1093/europace/euac053.511] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific
Background
HeartLogic algorithm combines data from multiple sensors to predict future heart failure (HF) decompensation in patients with an implantable defibrillator (ICD) . An optimal strategy to manage algorithm alerts is not yet known, although decongestive treatment with diuretics is the most frequent alert-triggered action reported so far.
Purpose
We describe the implementation of HeartLogic for remote monitoring of HF patients, and we evaluate the approach to diuretic dosing and timing of the intervention in patients with device alerts.
Methods
The study was conducted in eight Italian high-volume arrhythmia centers. The algorithm was activated in 229 ICD patients during a median follow-up was 17 months [25th–75th percentile: 11-24] between December 2017 and July 2020. Remote data reviews and patient phone contacts were undertaken at the time of HeartLogic alerts, to assess the patient’s status and to prevent HF worsening. The study protocol did not mandate any specific intervention algorithm, and physicians were free to remotely implement clinical actions, to schedule extra in-office visits when deemed necessary for additional investigations or for interventions, or to adopt an active monitoring approach. We analyzed alert-triggered augmented HF treatments, consisting of isolated increases in diuretics dosage.
Results
We reported 242 alerts (0.8 alerts/patient-year) in 123 patients, 137 (56%) alerts triggered clinical actions to treat HF. Overall, timely diuretic changes were associated with a shorter "in-alert" state duration in comparison with late changes, i.e. 28 days [25th-75th percentile: 20-43] versus 62 days [25th-75th percentile: 44-118], p<0.001. By contrast, major and minor diuretic augmentations resulted in comparable durations, i.e. 47 days [25th-75th percentile: 30-58] versus 38 days [25th-75th percentile: 23-79], p=0.954. Of the 56 decongestive treatment adjustments, 47 resolved the alert condition, while in the remaining 9 cases, further treatments were required (augmented HF therapy during hospitalization or unscheduled intravenous decongestive therapy in outpatients). The need of hospitalization for further treatments to resolve the alert condition was associated with higher HeartLogic index values on the day of the diuretics increase (odds ratio: 1.11, 95%CI: 1.02-1.20, p=0.013) and with late interventions (odds ratio: 5.11, 95%CI: 1.09-24.48, p=0.041). No complications were reported after drug adjustments.
Conclusions
Decongestive treatment adjustments triggered by HeartLogic alerts, even when such adjustments were completely dependent on the physicians’ clinical expertise and were not standardized. The early use of decongestive treatment and the use of high doses of diuretics seem to be associated with more favorable outcomes.
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Affiliation(s)
- F Guerra
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, "Ospedali Riuniti" University Hospital, Ancona, Italy
| | | | | | - M Manzo
- San Giovanni di Dio and Ruggi d’Aragona University Hospital, Salerno, Italy
| | | | - G Giubliato
- Hospital Fabrizio Spaziani, Frosinone, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - B Petracci
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - G Stronati
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, "Ospedali Riuniti" University Hospital, Ancona, Italy
| | - V Bianchi
- Vincenzo Monaldi Hospital, Naples, Italy
| | | | - F Franculli
- San Giovanni di Dio and Ruggi d’Aragona University Hospital, Salerno, Italy
| | - P Compagnucci
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, "Ospedali Riuniti" University Hospital, Ancona, Italy
| | | | - A Dello Russo
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, "Ospedali Riuniti" University Hospital, Ancona, Italy
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11
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Santobuono V, Tavoletta V, Manzo M, Calo’ L, Bertini M, Santini L, Savarese G, Dello Russo A, Viscusi M, Lavalle C, Amellone C, La Greca C, Valsecchi S, Favale S. Predictors of heart failure events detected by a multisensor implantable defibrillator algorithm. Europace 2022. [DOI: 10.1093/europace/euac053.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiovascular and non-cardiovascular comorbidities are common in heart failure (HF) patients and determine disease severity and prognosis. Select modern implantable defibrillators (ICDs) are equipped with multisensor algorithms for HF monitoring. The HeartLogic index combines multiple ICD-based sensor data (heart rate, heart sounds, thoracic impedance, respiration, activity), and the associated alert has proved to be a sensitive and timely predictor of impending HF decompensation in cardiac resynchronization therapy (CRT) patients.
Purpose
This analysis aims to investigate the performance of the algorithm in non-CRT patients, as well as in relation to the presence of comorbidities.
Methods
The HeartLogic feature was activated in 568 ICD patients (410 with CRT) from 26 centers. The median follow-up was 25 months [25th–75th percentile: 15-35].
Results
We recorded 1200 HeartLogic alerts (0.71 alerts per patient-year) in 370 patients. Among patient characteristics, atrial fibrillation (AF) at implantation (HR: 1.62, 95%CI: 1.27-2.07, p<0.001) and chronic kidney disease (CKD) (HR: 1.53, 95%CI: 1.21-1.93, p<0.001) independently predicted alerts. HeartLogic alerts were not associated with CRT vs. non-CRT device implantation (HR: 1.03, 95%CI: 0.82-1.30, p=0.775). Comparing the combined index and all physiologic parameters during clinically stable periods we did not notice differences between CRT and non-CRT patients. Thoracic impedance was significantly lower in CKD than non-CKD patients. (46±11ohm versus 49±10ohm; p=0.047). We found a higher S3 amplitude (0.9±0.3mG versus 0.8±0.2mG; p=0.005) and nocturnal heart rate (72±9bpm versus 66±7bpm; p<0.001), and lower S1 amplitude (2.0±0.8mG versus 2.4±0.9mG; p<0.001) in AF patients vs non-AF. These differences persisted at the time of alerts (all p<0.05). In the overall population, and in patients stratified by device type, CKD and AF, we measured significant changes of all contributing sensors (paired t-test; p<0.05) from clinically stable periods to the time of alert.
Conclusions
The burden of HeartLogic alerts appears similar between CRT and non-CRT patients, while patients with AF and CKD seem more exposed to alerts. ICD-measured thoracic impedance is sensitive to the fluid overload that characterizes kidney disease, as well as the first and third heart sound amplitudes seem sensitive to the reduced ventricular efficiency during AF. Nonetheless, ICD sensors seem to equally contribute to the HeartLogic alerts in all patient subgroups.
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Affiliation(s)
| | - V Tavoletta
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - M Manzo
- San Giovanni di Dio and Ruggi d’Aragona University Hospital, Salerno, Italy
| | - L Calo’
- Polyclinic Casilino, Rome, Italy
| | | | | | - G Savarese
- FOLIGNO General Hospital, Foligno, Italy
| | | | - M Viscusi
- Hospital Sant’anna E San Sebastiano, Caserta, Italy
| | | | | | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | - S Favale
- Polyclinic Hospital of Bari, Bari, Italy
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12
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Schiavone M, Gasperetti A, Vogler J, Mitacchione G, Gulletta S, Palmisano P, Breitenstein A, Laredo M, Compagnucci P, Angeletti A, Kaiser L, Hakmi S, Russo G, Ricciardi D, De Bonis S, Arosio R, Casella M, Santini L, Pignalberi C, Piro A, Lavalle C, Pisanò E, Denora M, Viecca M, Curnis A, Badenco N, Dello Russo A, Tondo C, Kuschyk J, Della Bella P, Tilz R, Biffi M, Forleo G. C9 SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IN PATIENTS WITH LOW BMI: REAL–WORLD DATA FROM A EUROPEAN MULTICENTER ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
One of the current limitations of the S–ICD is the relatively large size of the generator compared to the TV (transvenous) ICD. There is little evidence whether the size of the current S–ICD generator is associated with an elevated risk of device–related complications in patients with a low body mass index (BMI).
Purpose
Aim of this study was to compare the device–related complications and long–term outcomes in a large real world cohort of S–ICD recipients in patients with a BMI <18 kg/m2 compared to patients with a BMI >18 kg/m2.
Methods
All consecutive patients meeting current guideline indications for ICD implantation and undergoing implantation of a S–ICD device (Boston Scientific, Marlborough, Massachusetts, USA) at 21 European institutions enrolled in the extended ELISIR registry were used for the current analysis. Patients were classified into two cohorts, depending on the BMI at the time of device implantations: BMI < 18 kg/m2 versus > 18 kg/m2.
Results
Out of a total of 1497 pts, 58 pts (3.9%) had a BMI < 18 kg/m2. Patients with BMI <18 kg/m2 were younger (44.6±2.4 vs 50.8±0.4; p = 0.004) and more frequently female (58.6% vs 22.3%, p < 0.001). No differences in any of the other baseline characteristic were observed. Implantation techniques resulted comparable between the groups (rates of 2–incision technique: 87.8% vs 91.9%; p = 0.256; inter–muscular placement: 89.7% vs 83.3%; p = 0.198). Of note, the mean PRAETORIAN score at implantation of patients with BMI <18 kg/m2 was significantly lower (33.8±9.1 vs 54.1±47.3; p = 0.035), although the vast majority of patients in both cohorts qualified as at low risk of conversion failure (100% vs 91.4%; p = 0.436). Over a median follow up time of 22.4 [11.6–36.8] months, both overall device–related complications (5.2% vs 7.4%) and rates of inappropriate shocks (12.0% vs 8.8%) resulted comparable between the two groups (p = 0.517 and p = 0.385, respectively). Figure 1 reports Kaplan–Meier curves showing the combined incidence of device–related complications and inappropriate shocks in the two groups (log–rank p = 0.576).
Conclusion
No differences in device–related complications and long–term outcomes after S–ICD implantation were observed in patients with BMI <18 kg/m2 compared to the remaining recipients in a large multicentered real–world analysis.
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Affiliation(s)
- M Schiavone
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Gasperetti
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - J Vogler
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - G Mitacchione
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - S Gulletta
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - P Palmisano
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Breitenstein
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Laredo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - P Compagnucci
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Angeletti
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - L Kaiser
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - S Hakmi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - G Russo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - D Ricciardi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - S De Bonis
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - R Arosio
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Casella
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - L Santini
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - C Pignalberi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Piro
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - C Lavalle
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - E Pisanò
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Denora
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Viecca
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Curnis
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - N Badenco
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - A Dello Russo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - C Tondo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - J Kuschyk
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - P Della Bella
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - R Tilz
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - M Biffi
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
| | - G Forleo
- OSPEDALE LUIGI SACCO, MILANO; LUBECK, HERZZENTRUM LUBECK; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SAN RAFFAELE, MILANO; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE VITO FAZZI, LECCE; CAMPUS BIOMEDICO,
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Schiavone M, Gasperetti A, Gulletta S, Vogler J, Fastenrath F, Breitenstein A, Laredo M, Mitacchione G, Palmisano P, Compagnucci P, Kaiser L, Denora M, Hakmi S, Angeletti A, De Bonis S, Picarelli F, Casella M, Steffel J, Ferro N, Guarracini F, Santini L, Pignalberi C, Piro A, Lavalle C, Russo G, Pisanò E, Viecca M, Curnis A, Badenco N, Ricciardi D, Dello Russo A, Tondo C, Kuschyk J, Della Bella P, Biffi M, Tilz R, Forleo G. P21 AGE–RELATED DIFFERENCES AND ASSOCIATED OUTCOMES OF S–ICD: INSIGHTS FROM A LARGE, EUROPEAN, MULTICENTER REGISTRY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.019] [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
Background
The subcutaneous implantable cardioverter defibrillator (S–ICD) has become an alternative to transvenous ICDs (TV–ICD) in patients who do not need pacing. To date, there is little evidence directly comparing the rates of inappropriate shocks (IAS) in young vs old S–ICD recipients.
Purpose
Aim of our study was to assess differences in device–related complications and inappropriate shocks (IS) between teenagers/young adults and adult recipients of a subcutabeous implantable cardioverter defibrillator (S–ICD) device.
Methods
Two propensity–matched cohorts of teenagers + young adults (≤ 30–year–old) and adults (> 30–year–old) were retrieved from the ELISIR registry. The primary outcome was the comparison of the inappropriate shock (IAS) rate; complications, freedom from sustained ventricular arrhythmic events, overall and cardiovascular mortality were deemed secondary outcomes.
Results
A total of 1491 patients were extracted from the ELISIR project. Teenagers + young adults represented 11.0% of the entire cohort. Two propensity–matched groups of 161 patients each were used for the analysis (Figure 1); median follow–up was 23.1 [13.2–40.5] months. 15.2% patients experienced inappropriate S–ICD shocks and 9.3% device related complications were observed with no age–related differences in IAS (16.1% vs 14.3%; p = 0.642) and complication rates (9.9% vs 8.7%; p = 0.701); Figure 2 shows a survival analysis from inappropriate shocks in the teen–ager/young adult cohort (red) and in the adult cohort (blue). At univariate analysis, young age was not associated with increased rates of IAS (HR 1.204 [0.675–2.148]: p = 0.529). At multivariate analysis (Figure 3), the use of SMART pass algorithm was associated to a strong reduction in IAS (aHR 0.292 [0.161–0.525]; p < 0.001), while ARVC was associated with higher rates of IAS (aHR 2.380 [1.205–4.697]; p = 0.012).
Conclusion
In a large multicentered European registry of patients with S–ICD, 11.0% of all recipients were teenagers or young adults. The use of S–ICD in teenagers/young adults resulted safe and effective, and the rates of complications and IAS between teenagers/young adults and adults were not significantly different. The only predictor of increased IAS was a diagnosis of ARVC.
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Affiliation(s)
- M Schiavone
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Gasperetti
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - S Gulletta
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - J Vogler
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - F Fastenrath
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Breitenstein
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Laredo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - G Mitacchione
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - P Palmisano
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - P Compagnucci
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - L Kaiser
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Denora
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - S Hakmi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Angeletti
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - S De Bonis
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - F Picarelli
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Casella
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - J Steffel
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - N Ferro
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - F Guarracini
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - L Santini
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - C Pignalberi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Piro
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - C Lavalle
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - G Russo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - E Pisanò
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Viecca
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Curnis
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - N Badenco
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - D Ricciardi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - A Dello Russo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - C Tondo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - J Kuschyk
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - P Della Bella
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - M Biffi
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - R Tilz
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
| | - G Forleo
- OSPEDALE LUIGI SACCO, MILANO; OSPEDALE SAN RAFFAELE, MILANO; HERZZENTRUM LUBECK, LUBECK; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; UNIVERSITY HOSPITAL ZURICH, ZURICH; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE CARDINALE G. PANICO, TRICASE; UNIVERSITÀ POLITECNICA DELLE MARCHE, ANCONA; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; POLICLINICO S.ORSOLA–MALPIGHI, BOLOGNA
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Schiavone M, Gasperetti A, Mitacchione G, Angeletti A, Vogler J, Laredo M, Breitenstein A, Gulletta S, Fastenrath F, Kaiser L, Compagnucci P, Palmisano P, Ricciardi D, Santini L, De Bonis S, Piro A, Pignalberi C, Pisanò E, Hakmi S, Arosio R, Casella M, Lavalle C, Badenco N, Della Bella P, Dello Russo A, Curnis A, Tondo C, Steffel J, Viecca M, Kuschyk J, Tilz R, Biffi M, Forleo G. P25 SUBCUTANEOUS–ICD IN PATIENTS WITH HEART FAILURE: RESULTS FROM A MULTICENTER, EUROPEAN ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.023] [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
Background
Data on patients with heart failure (HF) with a subcutaneous implantable cardioverter defibrillator (S–ICD) are scarce.
Objective
Aim of this study was to assess clinical outcomes of the S–ICD in HF patients in a real–world analysis from the largest European retrospective S–ICD registry (ELISIR).
Methods
All consecutive patients undergoing S–ICD implantation at several European institutions were used for the current analysis. The population was classified into two groups: the HF (classified as HF with reduced and mid–range ejection fraction – HFrEF and HFmrEF) vs the no–HF cohort. The primary outcome of the study was the inappropriate shock (IS) rate across the two cohorts. As secondary outcomes, appropriate shocks, cardiovascular mortality and device–related complications during follow–up were assessed
Results
A total of 1409 patients from the ELISIR registry were included; HF patients represented 57.3% of the entire cohort (n = 701, 86.9% HFrEF; n = 106,13.1% HFmrEF). Over a median follow–up of approximately 2 years, a total of 133 inappropriate shocks were observed in the entire cohort, without significant differences among the two groups (9.2% vs 9.8%, p = 0.689). 133 complex ventricular arrhythmias were adequately recognized and treated, with similar rates of appropriate shocks (9.2% vs 9.8%, p = 0.689). Inappropriate and effective shocks–free survival has been represented in Figure 1 (Kaplan–Meier estimates). At multivariate analysis (Figure 2), age (HR = 0.974 [0.955–0.992], p = 0.005), LVEF (HR = 0.954 [0.926–0.984], p = 0.003), arrhythmogenic right ventricular cardiomyopathy – ARVC (HR = 3.364 [1.206–9.384], p = 0.020) and smart pass + (HR = 0.321 [0.184–0.560], p < 0.001) remained associated with inappropriate shocks. Moreover, a low number of patients (n = 76) experienced device–related complications, more frequently in the HF cohort (6.2% vs 3.8%, p = 0.031) with no significant differences regarding any specific outcome of interest: lead infection (1.1% vs 0.7%, p = 0.381), pocket infection (1.9% vs 0.8%, p = 0.107), pocket hematoma (3.2% vs 2.8%, p = 0.668).
Conclusion
The use of S–ICD in HF patients did not result in a higher rate of inappropriate shocks when compared to no–HF patients, even when stratifying for LVEF. Only age, LVEF, ARVC e Smart Pass algorithm were predictors of the primary outcome at multivariate analysis. Despite a lower overall rate of complications in the entire cohort, HF patients experienced device–related complications more frequently.
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Affiliation(s)
- M Schiavone
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Gasperetti
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - G Mitacchione
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Angeletti
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - J Vogler
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Laredo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Breitenstein
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - S Gulletta
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - F Fastenrath
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - L Kaiser
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - P Compagnucci
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - P Palmisano
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - D Ricciardi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - L Santini
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - S De Bonis
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Piro
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - C Pignalberi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - E Pisanò
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - S Hakmi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - R Arosio
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Casella
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - C Lavalle
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - N Badenco
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - P Della Bella
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Dello Russo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - A Curnis
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - C Tondo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - J Steffel
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Viecca
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - J Kuschyk
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - R Tilz
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - M Biffi
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
| | - G Forleo
- OSPEDALE LUIGI SACCO, MILANO; JOHNS HOPKINS UNIVERSITY, BALTIMORE; SPEDALI CIVILI BRESCIA, BRESCIA; OSPEDALE SANT‘ORSOLA, BOLOGNA; UNIVERSITY HOSPITAL SCHLESWIG–HOLSTEIN, LÜBECK; HÔPITAL PITIÉ SALPÊTRIÈRE, PARIS; UNIVERSITY HOSPITAL ZURICH, ZURICH; OSPEDALE SAN RAFFAELE, MILANO; UNIVERSITY MEDICAL CENTRE MANNHEIM, MANNHEIM; ST. GEORGE KLINIK ASKLEPIOS, HAMBURG; OSPEDALE UMBERTO I–SALESI–LANCISI,
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Santini L, Coppini R, Zocchi C, Ferrantini C, Olivotto I, Cerbai E. Cellular determinants of arrhythmic rysk in hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hypertrophic cardiomyopathy (HCM) is the commonest inherited cardiac disease, with a prevalence of 1/500 in the general population. The most devastating consequence of HCM is sudden cardiac death (SCD) due to ventricular fibrillation, particularly common in children and young adults (age <30 years). The positive correlation between the extent of late gadolinium enhancement (LGE, reflecting myocardial fibrosis) and the arrhythmic risk in HCM suggests that ventricular arrhythmias are held to originate from the fibrotic regions, by a mechanism of electrical re-entry. However, recent data suggest that enhanced cellular automaticity (i.e. early- or delayed-afterdepolarizations, EADs or DADs-), rather than macro-reentry, may be clinically relevant in promoting ventricular arrhythmias in patients.
Purpose
Aiming to better understand the cellular and molecular mechanisms of arrhythmogenesis in HCM and to establish a reliable arrhythmic risk stratification in patients, we performed a translational study in HCM patients who underwent surgical myectomy, by combining a clinical follow-up study with in vitro assessments of cellular arrhythmogenicity in ventricular cardiomyocytes.
Methods
We retrospectively studied 61 HCM patients who underwent surgical interventricular-septum myectomy to relieve refractory obstruction-related symptoms. At the time of surgery, fresh ventricular tissue was collected and used to isolate single ventricular cardiomyocytes (CMs), which were used for patch-clamp measurements to assess the occurrence of EADs and DADs. Patients were followed up for a median time of 8 years and the occurrence of non-sustained ventricular tachycardia (NSVT) or life-threatening arrhythmic events (LAE) was monitored. Moreover, data from ECG and contract cardiac magnetic-resonance studies were collected.
Results
EADs occurred in CMs from 36% of patients and were associated with prolonged action potential duration. DADs occurred in 24% of patients and were associated with abnormalities of CM intracellular Ca2+ handling. The occurrence of NSVT/ LAE in patients was strongly associated with the presence of DADs in cardiomyocytes but not with the presence of EADs. Patients with NSVT/LAE were more likely to show specific “pro-arrhythmic” pathological ECG-patterns. Among patients with LGE, the presence of DADs in cells behaved as a necessary pre-requisite for NSVT/LAE, as none of the patients with evidence of fibrosis who were negative for DADs had arrhythmic events.
Conclusions
The presence of pro-arrhythmic changes appears to be necessary for arrhythmia generation in HCM and seems to be related with specific alterations at ECG level, that might be used as clinical arrhythmia predictors in HCM patients. Fibrosis per se is not a major predictor of arrhythmias in HCM but may contribute to generate sustained arrhythmias in the presence of substantial cellular triggers (DADs).
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU Horizon 2020. Grant number 777204 (silico FCM).
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Affiliation(s)
- L Santini
- University of Florence, Florence, Italy
| | - R Coppini
- University of Florence, Florence, Italy
| | - C Zocchi
- Careggi University Hospital (AOUC), Florence, Italy
| | | | - I Olivotto
- Careggi University Hospital (AOUC), Florence, Italy
| | - E Cerbai
- University of Florence, Florence, Italy
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16
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Calo" L, Bianchi V, Ferraioli D, Santini L, Dello Russo A, Carriere C, Santobuono VE, Andreoli C, La Greca C, Arena G, Talarico A, Pisano" E, De Ruvo E, Campari M, D"onofrio A. A multiparametric ICD algorithm for heart failure risk stratification and management: an analysis in clinical practice. Europace 2021. [DOI: 10.1093/europace/euab116.468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The HeartLogic algorithm combines multiple implantable cardioverter defibrillator (ICD) sensors to identify patients at risk of heart failure (HF) events.
Purpose
We sought to evaluate the risk stratification ability of this algorithm in clinical practice. We also analyzed the alert management strategies adopted in the study group and their association with the occurrence of HF events.
Methods
The HeartLogic feature was activated in 366 ICD and cardiac resynchronization therapy ICD patients at 22 centers. The HeartLogic algorithm automatically calculates a daily HF index and identifies periods IN or OUT of an alert state on the basis of a configurable threshold (in this analysis set to 16).
Results
The HeartLogic index crossed the threshold value 273 times (0.76 alerts/patient-year) in 150 patients over a median follow-up of 11 months [25-75 percentile: 6-16]. Overall, the time IN the alert state was 11% of the total observation period. Patients experienced 36 HF hospitalizations and 8 patients died of HF (rate: 0.12 events/patient-year) during the observation period. Thirty-five events were associated with the IN alert state (0.92 events/patient-year versus 0.03 events/patient-year in the OUT of alert state). The hazard ratio in the IN/OUT of alert state comparison was (HR: 24.53, 95% CI: 8.55-70.38, p < 0.001), after adjustment for baseline clinical confounders. Alerts followed by clinical actions were associated with a lower rate of HF events (HR: 0.37, 95% CI: 0.14-0.99, p = 0.047). No differences in event rates were observed between in-office and remote alert management. By contrast, verification of HF symptoms during post-alert examination was associated with a higher risk of HF events (HR: 5.23, 95% CI: 1.98-13.83, p < 0.001).
Conclusions
This multiparametric ICD algorithm identifies patients during periods of significantly increased risk of HF events. The rate of HF events seemed lower when clinical actions were undertaken in response to alerts. Extra in-office visits did not seem to be required in order to effectively manage HeartLogic alerts, while post-alert verification of symptoms seemed useful in order to better stratify patients at risk of HF events.
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Affiliation(s)
- L Calo"
- Polyclinic Casilino of Rome, Rome, Italy
| | | | - D Ferraioli
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | | | - A Dello Russo
- University Hospital Riuniti of Ancona, Ancona, Italy
| | - C Carriere
- University Hospital Cattinara, Trieste, Italy
| | | | - C Andreoli
- S. Giovanni Battista Hospital, Foligno, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - G Arena
- Ospedale Civile Apuane, Massa, Italy
| | | | | | - E De Ruvo
- Polyclinic Casilino of Rome, Rome, Italy
| | - M Campari
- Boston Scientific Italy, Milan, Italy
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17
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Diemberger I, Guerra F, Calo" L, D"onofrio A, Manzo M, Santini L, Giubilato G, Carriere C, Santobuono VE, Savarese G, La Greca C, Arena G, Talarico A, Valsecchi S, Ziacchi M. Implantable cardioverter defibrillator multisensor monitoring during home confinement caused by the covid-19 pandemic. Europace 2021. [PMCID: PMC8194661 DOI: 10.1093/europace/euab116.469] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Background Utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic algorithm combines data from multiple implantable cardioverter defibrillator (ICD) sensors (first and third heart sounds, intrathoracic impedance, respirations, night heart rate, and patient activity) to provide integrated data that may allow for detection of early signs of worsening HF. Purpose We examined whether the HeartLogic platform may elucidate behavioral changes that impact HF decompensation, and the possible consequences of home confinement caused by the COVID-19 pandemic. Methods The Italian lockdown was imposed from March 8th to May 18th. On March 8th 2020, the HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from January 1st to July 19th was divided in 3 phases: Pre-Lockdown (weeks 1-11), Lockdown (weeks 12-20), Post-Lockdown (weeks 21-29). Results Immediately after the implementation of stay at home orders (week 12) we observed a significant drop in median activity level (65min [36-103] in week 12 vs. 101min [61-140] in Pre-Lockdown; p < 0.001), while there was no difference in the other contributing sensors. The median composite HeartLogic index increased at the end of Lockdown (4.7 [1.3-10.2] in week 20 vs. 2.5 [0.7-7.0] in Pre-Lockdown; p = 0.019). The weekly rate of HeartLogic alerts was significantly higher during Lockdown (1.56 alerts/week/100pts, 95%CI:1.15-2.06; IRR = 1.71, p = 0.014) and Post-Lockdown (1.37 alerts/week/100pts, 95%CI:0.99-1.84; IRR = 1.50, p = 0.072) than that reported in Pre-Lockdown (0.91 alerts/week/100pts, 95%CI:0.64-1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers (Pre-Lockdown: 31%, Lockdown: 22%, Post-Lockdown: 28%), and the proportion of alerts fully managed remotely (i.e. no in-clinic visits) (Pre-Lockdown: 89%, Lockdown: 90%, Post-Lockdown: 88%). Conclusions The system was sensitive to the behavioral changes occurred during the lockdown, i.e. decrease in activity. However, the home confinement had no impact on the other sensors. The higher rate of HeartLogic alerts during lockdown and the increase in the median index after 8 weeks of home confinement suggest the worsening of the HF status, possibly explained by the behavioral changes. Nonetheless, the management of the HF detected events (actions performed and management strategy) was not impacted by the restrictions.
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Affiliation(s)
- I Diemberger
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - F Guerra
- University Hospital Riuniti of Ancona, Ancona, Italy
| | - L Calo"
- Polyclinic Casilino of Rome, Rome, Italy
| | - A D"onofrio
- Ospedale Monaldi, Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Naples, Italy
| | - M Manzo
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
| | | | - G Giubilato
- Hospital Fabrizio Spaziani, Frosinone, Italy
| | - C Carriere
- University Hospital Riuniti, Trieste, Italy
| | | | - G Savarese
- S. Giovanni Battista Hospital, Foligno, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - G Arena
- Ospedale Civile Apuane, Massa, Italy
| | | | | | - M Ziacchi
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
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18
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Ricciardi D, Picarelli F, Forleo GB, Di Belardino N, Bisignani A, Bisignani G, Santini L, Lavalle C, Pignalberi C, Picarelli S, Aurino L, Creta A, Calabrese V, Gioia FA, Grigioni F. P529Efficacy and safety of S-ICD implantation without use of defibrillation threshold testing: a retrospective multicentric observational study. Europace 2020. [DOI: 10.1093/europace/euaa162.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The subcutaneous ICD (S-ICD) is a valid alternative to transvenous systems (TV-ICD) for the treatment of life-threatening arrhythmias, and the extravascular position of the lead allows a significant reduction of the risk of infection. Current guidelines recommend defibrillation threshold testing (DFT) at the time of S-ICD implantation (class I). Although randomised trials have proven the safety of TV-ICD implantation with no DFT, it is unclear whether such an approach could be adopted for S-ICD as well. The PRAETORIAN score, based on post-implantation chest X-ray, can accurately predict a high defibrillation threshold after S-ICD implantation. The aim of this retrospective multicentre study was to evaluate the efficacy and safety of S-ICD implantation with no DFT.
Methods
We enrolled 203 consecutive patients undergoing S-ICD implantation in six different centres between October 2012 and January 2019. It was left at discretion of the operator whether performing or not DFT at the time of the procedure. Baseline device settings were collected, and the PRAETORIAN score was retrospectively calculated whenever chest X-ray was available. Both remote or in-clinic device interrogation reports were systemically analysed, and all the shocks and arrhythmia episodes identified. All the patients provided consent form and ethical approval was obtained.
Results
The population (mean age 57.6 ± 14.2) was divided in two groups, based on whether DFT was performed at the time of the S-ICD implantation: 72 patients (35.4%) underwent DFT (DFT+ group), while 131 patients (64.5%) did not (DFT- group). In the DFT- group, mean LVEF was lower (32 ± 8% vs 42 ± 17%, p < 0.0001) and prevalence of diabetes mellitus and atrial fibrillation higher compared to the DFT+ group (27.5% vs 13.9%, p = 0.04 and 38.9% vs 19.44%, p = 0.007; respectively). In addition, the indication for S-ICD was more frequently primary prevention in the DFT- vs DFT+ group (70.8% vs 90.8%, p = 0.0004; respectively). No differences in terms of device programming were identified between the two cohorts. The PRAETORIAN score was significantly higher in the DFT- vs DFT+ patients (50 ± 26 vs 36 ± 18, p = 0.032; respectively). After a median follow-up of … months, we observed 5 appropriate shocks in 3 patients from the DFT+ group vs. 15 shocks in 8 patients from the DFT- group (p = 0.81). All the life-threatening arrhythmias were successfully recognised and treated by the device. DFT was complicated by pulseless electrical activity in one patient. One patient in the DFT- group suffered from an episode of ventricular tachycardia requiring a total of 4 shocks for being terminated. Six patients in the DFT- group died for non-arrhythmic causes. On the Kaplan-Meier analysis, cumulative survival was comparable between the two groups (log rank p value = 0.13).
Conclusions
This study suggests that implantation of S-ICD with no DFT might be reasonable. These results should be confirmed in prospective randomised trials.
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Affiliation(s)
- D Ricciardi
- University Campus Bio-Medico of Rome, Rome, Italy
| | - F Picarelli
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - G B Forleo
- Luigi Sacco Hospital, Cardiology, Milan, Italy
| | - N Di Belardino
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - A Bisignani
- Polyclinic Agostino Gemelli, Cardiology, Rome, Italy
| | | | | | - C Lavalle
- Umberto I Polyclinic of Rome, Cardiology, Rome, Italy
| | | | | | - L Aurino
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - A Creta
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - V Calabrese
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - F A Gioia
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
| | - F Grigioni
- University Campus Bio-Medico of Rome, Department of Cardiovascular Sciences, Rome, Italy
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19
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Pecora D, Tavoletta V, Dello Russo A, De Ruvo E, Ammirati F, La Greca C, Favale S, Petracci B, Molon G, Montella GM, Santini L, Nozza C, Valsecchi S, Calo L. 48Remote monitoring of Heart Failure patients with a Multisensor ICD Algorithm: value of an alert-based follow-up strategy. Europace 2020. [DOI: 10.1093/europace/euaa162.194] [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] Open
Abstract
Abstract
Background
The HeartLogic algorithm measures and combines multiple parameters, i.e. heart sounds, intrathoracic impedance, respiration pattern, night heart rate, and patient activity, in a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation, and the HeartLogic alert condition was shown to identify patients during periods of significantly increased risk of HF events.
Purpose
To report the results of a multicenter experience of remote HF management with HeartLogic algorithm and appraise the value of an alert-based follow-up strategy.
Methods
The HeartLogic feature was activated in 104 patients (76 male, 71 ± 10 years, left ventricular ejection fraction 29 ± 7%). All patients were followed according to a standardized protocol that included remote data reviews and patient phone contacts every month and at the time of HeartLogic alerts. In-office visits were performed every 6 months or when deemed necessary.
Results
During a median follow-up of 13[11-18] months, centers performed remote follow-up at the time of 1284 scheduled monthly transmissions (10.5 per pt-year) and 100 HeartLogic alerts (0.82 alerts/pt-year). The mean delay from alert to the next monthly remote data review was 14 ± 8 days. Overall, the patient time in the alert state (i.e. HeartLogic index above the threshold) was 14% of the total observation period. HF events requiring active clinical actions were detected at the time of 11 (0.9%) monthly remote data reviews and at 43 (43%, p < 0.001) HeartLogic alerts. Moderate to severe symptoms of HF were reported during 2% of remote visits when the patient was out of HeartLogic alert condition and during 15% of remote visits performed in alert condition (p < 0.001). Out of 100 alerts, 17 required an in-office visit and 5 a hospitalization to manage the clinical condition. Overall, 282 scheduled and 56 unscheduled in-office visits were performed during follow-up. Any HF sign (i.e. S3 gallop, rales, jugular venous distension, edema) was detected during 18% of in-office visits when the patient was out of HeartLogic alert condition and during 34% of visits performed in alert condition (p = 0.002).
Conclusions
HeartLogic alerts are frequently associated with relevant actionable HF events. Events are detected earlier and the volume of alert-driven remote follow-ups is limited when compared with a monthly remote follow-up scheme. The probability of detecting common signs and symptoms of HF at regular remote or in-office assessment is extremely low when the patient is out of HeartLogic alert state. These results support the adoption of an alert-based follow-up strategy.
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Affiliation(s)
- D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - V Tavoletta
- AO dei Colli-Monaldi Hospital, Naples, Italy
| | - A Dello Russo
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - E De Ruvo
- Polyclinic Casilino of Rome, Rome, Italy
| | | | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - S Favale
- Polyclinic Hospital of Bari, Bari, Italy
| | - B Petracci
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - G Molon
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | | | | | - C Nozza
- Boston Scientific, Milan, Italy
| | | | - L Calo
- Polyclinic Casilino of Rome, Rome, Italy
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D"onofrio A, Bertini M, Infusino T, D Arienzo G, Misiani A, Bianchi V, Licciardello G, Savarese G, Russo G, Ricciardi D, Manzo M, Santini L, Ospizio R, Valsecchi S, Forleo GB. P538Single- and Multi-Site Pacing Strategies for Optimal Cardiac Resynchronization Therapy: Impact on Device Longevity and Therapy Cost. Europace 2020. [DOI: 10.1093/europace/euaa162.192] [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] Open
Abstract
Abstract
Funding Acknowledgements
No funding
Introduction
Multiple left ventricular pacing strategies have been suggested for improving response to cardiac resynchronization therapy (CRT). However, these programming strategies can be obtained by accepting configurations with high pacing threshold and accelerated battery drain. We assessed the feasibility of predefined pacing programming protocols and we evaluated their impact on device longevity and their cost-impact.
Methods
We estimated battery longevity in 167 CRT-D (RESONATE, Boston Scientific) patients based on measured pacing parameters and according to multiple programming strategies: single-site pacing associated with lowest threshold, non-apical location, longest interventricular delay, pacing from two electrodes. To determine the economic impact of each programming strategy, we applied the results of a published model-based cost analysis to a 15-year time-horizon.
Results
Selecting the electrode with the lowest threshold resulted in a median device longevity of 11.5 years. Non-apical pacing and interventricular delay maximization were feasible in most patients (99% non-apical pacing, 65% RV-to-LV interval >80ms), and were obtained at the price of a few months of battery life. Device longevity of >10 years was preserved in 87% of cases of non-apical pacing and in 77% on pacing at the longest interventricular delay. The mean reduction in battery life when the second electrode was activated was 1.5 years. Single-site pacing strategies increased the therapy cost by 4-6%, and multi-site pacing by 12-13%, in comparison with the best-case scenario.
Conclusions
Modern CRT-D systems ensure effective pacing and allow multiple optimization strategies for maximizing service life or for enhancing effectiveness. Single- or multi-site pacing strategies can be implemented without compromising device service life and at an acceptable increase in therapy cost.
Abstract Figure. Image1
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Affiliation(s)
- A D"onofrio
- AORN DEI COLLI - VINCENZO MONALDI HOSPITAL, Naples, Italy
| | - M Bertini
- University Hospital of Ferrara, Ferrara, Italy
| | | | - G D Arienzo
- University Hospital Ospedali Riuniti, Foggia, Italy
| | - A Misiani
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - V Bianchi
- AORN DEI COLLI - VINCENZO MONALDI HOSPITAL, Naples, Italy
| | | | - G Savarese
- Ospedale S. Giovanni Battista, Foligno, Italy
| | - G Russo
- Ospedale San Leonardo, Castellammare di Stabia (NA), Italy
| | - D Ricciardi
- Campus Bio-Medico University Of Rome, Rome, Italy
| | - M Manzo
- AOU S. Giovanni di Dio e Ruggi d"Aragona, Salerno, Italy
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21
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Santini L, Bianchi V, Dello Russo A, Calo L, Pecora D, Mahfouz K, Favale S, Petracci B, Costa A, Cipolletta L, De Ruvo E, La Greca C, Mangone G, Campari M, D Onofrio A. 855Performance of a multisensor icd algorithm in heart failure patient management. Europace 2020. [DOI: 10.1093/europace/euaa162.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
No funding
Background
The HeartLogic index combines data from multiple implantable cardioverter-defibrillator (ICD)-based sensors and has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation.
Purpose
To describe a multicenter experience of remote HF management of patients who received a HeartLogic-enabled ICD or cardiac resynchronization therapy ICD (CRT-D).
Methods
The HeartLogic feature was activated in 104 patients (76 male, 71 ± 10 years, left ventricular ejection fraction 29 ± 7%). In accordance with a standardized follow-up protocol, remote data reviews and patient phone contacts were performed monthly and at the time of HeartLogic alerts (when the index crossed the nominal threshold value of 16), to assess the patient decompensation status. In-office visits were performed every 6 months or when deemed necessary.
Results
During a median follow-up of 13[11-18] months, 100 HeartLogic alerts were reported (0.82 alerts/pt-year) in 53 patients. 60 HeartLogic alerts were judged clinically meaningful (i.e. associated with worsening of HF or resulted in active clinical actions). Specifically, multiple associated conditions were reported: 45 (75%) symptoms or signs of clinical deterioration of HF, 13 (22%) discontinuations or reductions of prescribed HF therapy, 11 (18%) declines in CRT percentage (with or without new onset atrial fibrillation), 8 (13%) recurrences of previous HF events. For 48 out of 60 alerts the clinician was not previously aware of the condition. Of these, 43 alerts triggered multiple clinical actions. Alert-triggered actions were: 30 (70%) diuretic dosage increases, 15 (35%) other drug adjustments, 6 (14%) HF hospitalizations, 3 (7%) device reprogramming/revisions, 1 (2%) cardioversion, 1 (2%) patient education on therapy adherence. Out of 40 non-clinically meaningful alerts (0.33 alerts/pt-year), 8 (20%) were associated with non-HF therapy changes or interventions, 3 (8%) with pulmonary events, 29 (72%) remained unexplained. The overall number of HF hospitalizations was 16 (rate 0.13 hospitalizations/pt-year). Five HF hospitalizations were not preceded by HeartLogic alert (0.04 hospitalizations/pt-year).
Conclusions
The HeartLogic index provided clinically meaningful information and allowed to remotely identify relevant HF related clinical conditions, with a low rate of unexplained detections and undetected HF events. In this experience, remote monitoring using HeartLogic alerts allowed to drive HF care and take effective clinical actions.
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Affiliation(s)
| | - V Bianchi
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - A Dello Russo
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - L Calo
- Polyclinic Casilino of Rome, Rome, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | - S Favale
- Polyclinic Hospital of Bari, Bari, Italy
| | - B Petracci
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - A Costa
- Sacred Heart Hospital of Negrar, Negrar, Italy
| | - L Cipolletta
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - E De Ruvo
- Polyclinic Casilino of Rome, Rome, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | | | - A D Onofrio
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
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22
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Riviere D, Mancini J, Santini L, Loth Bouketala A, Giovanni A, Dessi P, Fakhry N. Nodal metastases distribution in laryngeal cancer requiring total laryngectomy: Therapeutic implications for the N0 Neck. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 136:S35-S38. [PMID: 30174259 DOI: 10.1016/j.anorl.2018.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Neck dissection is a controversial surgical procedure in patients with squamous cell carcinoma of the Larynx free of any node metastasis detected in preoperative staging. The aim of this study was to investigate the distributions of lymph node metastases in laryngeal squamous cell carcinoma and improve the rationale for elective treatment of N0 neck. MATERIAL AND METHODS Retrospective single-center series of Seventy-eight successive patients with laryngeal squamous cell carcinoma who underwent neck dissection between 2008 and 2015. RESULTS Surgery was first-line treatment in 37 patients (47%) and for recurrent disease in 41 (53%). The rate of occult nodal metastasis was 14% (n=11): levels IIa and/or III were affected in 9 cases (11.5%) compared with single cases of IIb and IV involvement (1.3% each). The rate of occult nodal metastasis was significantly lower among patients operated on for recurrent disease after radiotherapy than in patients who never had any radiotherapy of the cervical lymph nodes (0% vs. 16.7%, P=0.03). CONCLUSIONS Selective cervical lymph node dissection in levels IIa and III sparing levels IIb and IV seems to be ideal in total laryngectomy in patients with cN0 laryngeal squamous cell carcinoma. Omitting lymph node dissection altogether may be considered in total laryngectomy on a cN0 patient showing recurrence after radiotherapy.
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Affiliation(s)
- D Riviere
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de la conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France; École du Val-de-Grâce, 75005 Paris, France
| | - J Mancini
- UMR912, IRD, SESSTIM, 13005 Marseille, France; Inserm, UMR912, SESSTIM, 13005 Marseille, France; BiosTIC, hôpital de la Timone, Assistance publique des hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - L Santini
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de la conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France
| | - A Loth Bouketala
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de la conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France
| | - A Giovanni
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de la conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France
| | - P Dessi
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de la conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France
| | - N Fakhry
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de la conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France.
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23
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Rivière D, Mancini J, Santini L, Giovanni A, Dessi P, Fakhry N. Lymph-node metastasis following total laryngectomy and total pharyngolaryngectomy for laryngeal and hypopharyngeal squamous cell carcinoma: Frequency, distribution and risk factors. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:163-166. [DOI: 10.1016/j.anorl.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Palandri C, Coppini R, Mazzoni L, Ferrantini C, Gentile F, Pioner J, Santini L, Sartiani L, Bargelli V, Poggesi C, Mugelli A, Cerbai E. The efficacy of late sodium current blockers in hypertrophic cardiomyopathy is dependent on genotype: A study on transgenic mouse models with different mutations. Vascul Pharmacol 2018. [DOI: 10.1016/j.vph.2017.12.050] [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: 11/16/2022]
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25
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Pioner JM, Coppini R, Santini L, Palandri C, Bennati E, Regnier M, Sacconi L, Cerbai E, Poggesi C, Ferrantini C. P78Electrophysiological characterization of induced pluripotent stem cell-derived cardiomyocytes from duchenne muscular dystrophy patients. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J M Pioner
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - R Coppini
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - L Santini
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - C Palandri
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - E Bennati
- University of Florence, AOU Meyer Children's Hospital, Florence, Italy
| | - M Regnier
- University of Washington, Department of Bioengineering, Seattle, United States of America
| | - L Sacconi
- University of Florence, European Laboratory for Non-Linear Spectroscopy, Sesto Fiorentino, Italy
| | - E Cerbai
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - C Poggesi
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - C Ferrantini
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
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26
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Giuliani M, Bartolini E, Galli B, Santini L, Lo Surdo P, Buricchi F, Bruttini M, Benucci B, Pacchiani N, Alleri L, Donnarumma D, Pansegrau W, Peschiera I, Ferlenghi I, Cozzi R, Norais N, Giuliani MM, Maione D, Pizza M, Rappuoli R, Finco O, Masignani V. Human protective response induced by meningococcus B vaccine is mediated by the synergy of multiple bactericidal epitopes. Sci Rep 2018; 8:3700. [PMID: 29487324 PMCID: PMC5829249 DOI: 10.1038/s41598-018-22057-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/13/2018] [Indexed: 12/21/2022] Open
Abstract
4CMenB is the first broad coverage vaccine for the prevention of invasive meningococcal disease caused by serogroup B strains. To gain a comprehensive picture of the antibody response induced upon 4CMenB vaccination and to obtain relevant translational information directly from human studies, we have isolated a panel of human monoclonal antibodies from adult vaccinees. Based on the Ig-gene sequence of the variable region, 37 antigen-specific monoclonal antibodies were identified and produced as recombinant Fab fragments, and a subset also produced as full length recombinant IgG1 and functionally characterized. We found that the monoclonal antibodies were cross-reactive against different antigen variants and recognized multiple epitopes on each of the antigens. Interestingly, synergy between antibodies targeting different epitopes enhanced the potency of the bactericidal response. This work represents the first extensive characterization of monoclonal antibodies generated in humans upon 4CMenB immunization and contributes to further unraveling the immunological and functional properties of the vaccine antigens. Moreover, understanding the mechanistic nature of protection induced by vaccination paves the way to more rational vaccine design and implementation.
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Affiliation(s)
| | | | | | | | | | | | - M Bruttini
- GSK, Siena, Italy.,University of Siena, Siena, Italy
| | - B Benucci
- GSK, Siena, Italy.,University of Siena, Siena, Italy
| | | | | | | | | | - I Peschiera
- GSK, Siena, Italy.,University of Bologna, Bologna, Italy
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Santini L, Forleo GB, Minni V, Mafhouz K, Della Rocca DG, Fresiello L, Romeo F, Ferrari G, Di Molfetta A. Towards a Personalized and Dynamic CRT-D. Methods Inf Med 2018; 51:495-506. [DOI: 10.3414/me12-01-0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/20/2012] [Indexed: 11/09/2022]
Abstract
SummaryBackground: In spite of cardiac resynchronization therapy (CRT) benefits, 25 – 30% of patients are still non responders. One of the possible reasons could be the non optimal atrioventricular (AV) and interventricular (VV) intervals settings. Our aim was to exploit a numerical model of cardiovascular system for AV and VV intervals optimization in CRT.Methods: A numerical model of the cardiovascular system CRT-dedicated was previously developed. Echocardiographic parameters, Systemic aortic pressure and ECG were collected in 20 consecutive patients before and after CRT. Patient data were simulated by the model that was used to optimize and set into the device the intervals at the baseline and at the follow up. The optimal AV and VV intervals were chosen to optimize the simulated selected variable/s on the base of both echocardiographic and electrocardiographic parameters.Results: Intervals were different for each patient and in most cases, they changed at follow up. The model can well reproduce clinical data as verified with Bland Altman analysis and T-test (p > 0.05). Left ventricular remodeling was 38.7% and left ventricular ejection fraction increasing was 11% against the 15% and 6% reported in literature, respectively.Conclusions: The developed numerical model could reproduce patients conditions at the baseline and at the follow up including the CRT effects. The model could be used to optimize AV and VV intervals at the baseline and at the follow up realizing a personalized and dynamic CRT. A patient tailored CRT could improve patients outcome in comparison to literature data.
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Radulesco T, Penicaud M, Santini L, Thomassin JM, Dessi P, Michel J. Outcomes of septorhinoplasty: a new approach comparing functional and aesthetic results. Int J Oral Maxillofac Surg 2017; 47:175-179. [PMID: 28967532 DOI: 10.1016/j.ijom.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/16/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023]
Abstract
The aim of this study was to compare objective and subjective functional results of septorhinoplasty with subjective aesthetic results. A prospective study was performed including global and subgroup analyses (primary versus secondary septorhinoplasty). Three instruments were used to evaluate pre- and postoperative results: rhinomanometry for the objective functional analysis, the Nasal Symptom Obstruction Evaluation (NOSE) scale for the subjective functional analysis, and the Rhinoplasty Outcome Evaluation (ROE) scale for the subjective aesthetic analysis. A septorhinoplasty was performed in all cases. Thirty-five patients were included (22 female), of whom 74% underwent primary septorhinoplasty. The correlation between rhinomanometry, NOSE and ROE scores was analysed. Mean resistance of the two nasal cavities was 4.9 (standard deviation (SD) 8.35) sPa/ml before surgery and 0.8 (SD 0.7) sPa/ml after surgery. NOSE and ROE scores were, respectively, 72.5/100 (SD 21.7) and 7.5/24 (SD 11.3) before surgery and 22/100 (SD 20.6) and 18/24 (SD 17.3) after surgery. Patients complaining of postoperative nasal obstruction had a worse aesthetic evaluation. Correction of the functional disease appears to be as important as aesthetic correction. This study comparing functional and aesthetic results after septorhinoplasty could provide a basis for future studies.
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Affiliation(s)
- T Radulesco
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France; Aix-Marseille Univ, Marseille, France.
| | - M Penicaud
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France
| | - L Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France
| | - J-M Thomassin
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France; Aix-Marseille Univ, Marseille, France
| | - P Dessi
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France; Aix-Marseille Univ, Marseille, France
| | - J Michel
- Department of Otorhinolaryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille, France; Aix-Marseille Univ, Marseille, France
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Forleo G, Panattoni G, Solimene F, Schillaci V, Covino G, Sassara M, Savarese G, Santini L, Donzelli S, Badolati S, Gerosa C, Valsecchi S, Mangone G, Sergi D. P5485Effective non-apical left ventricular pacing with quadripolar leads for cardiac resynchronization therapy: a multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ferro M, Castiglione F, Panzeri W, Dispenza R, Santini L, Karlsson H, de Wit P, Mele A. Non-destructive and direct determination of the degree of substitution of carboxymethyl cellulose by HR-MAS 13C NMR spectroscopy. Carbohydr Polym 2017; 169:16-22. [DOI: 10.1016/j.carbpol.2017.03.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/17/2017] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
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Forleo GB, Panattoni G, Solimene F, Schillaci V, Covino G, Sassara M, Savarese G, Santini L, Donzelli S, Badolati S, Gerosa C, Lovecchio M, Valsecchi S, Picariello F, Sergi D. P974Effective non-apical left ventricular pacing with quadripolar leads for cardiac resynchronization therapy: a multicenter study. Europace 2017. [DOI: 10.1093/ehjci/eux151.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tontini M, Romano M, Proietti D, Balducci E, Micoli F, Balocchi C, Santini L, Masignani V, Berti F, Costantino P. Corrigendum to “Preclinical studies on new proteins as carrier for glycoconjugate vaccines” [Vaccine 34 (2016) 4235–4242]. Vaccine 2017; 35:2612. [DOI: 10.1016/j.vaccine.2017.03.011] [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: 11/25/2022]
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Radulesco T, Penicaud M, Santini L, Thomassin JM, Dessi P, Michel J. The MiRa scale, a new standardised scale for evaluating nasal deformities before and after septorhinoplasty: A prospective study comparing patient satisfaction and the surgeon's assessment. Clin Otolaryngol 2017; 42:1350-1357. [PMID: 28374943 DOI: 10.1111/coa.12885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The objective was to assess the reliability of a new standardised scale for evaluating nasal anomalies in order to compare the surgeon's assessment and patient satisfaction. DESIGN Monocentric prospective cohort study. SETTINGS First, we validated the reliability of the MiRa scale; then, we compared the surgeon's assessment and patient satisfaction. PARTICIPANTS Fifty-two patients underwent septorhinoplasty surgery and gave their written consent before inclusion. MAIN OUTCOME MEASUREMENTS Primary outcome measurement was to validate the reliability of the MiRa scale: two observers analysed all records twice. Intra-observer reproducibility and interobserver reproducibility were evaluated using the intraclass correlation coefficient (ICC). Secondary outcome measurement was to compare the surgeon's assessment and patient satisfaction: MiRa and ROE (Rhinoplasty Outcome Evaluation) scores were established for each patient prior to and 6 months after surgery. RESULTS Using the MiRa scale, ICC for intra- and interobserver reproducibility was, respectively, 95.4% and 96%, showing no statistical difference (P=.70, P=.45). Good correlation scores were, respectively, 93% and 92%. Mean ROE scores were 7.1/24 (SD=11.3) before and 19.3/24 (SD=17.3) after surgery (P<.05). We found an increase in MiRa and ROE scores of +19.75% and +51.25% (P<.05), respectively. The average postoperative ROE score in the primary septorhinoplasty group was 20.4 (SD=14.4) and 17.2 (SD=23.1) in the secondary septorhinoplasty group (P<.05). CONCLUSION MiRa scale is a reliable, standardised tool to evaluate surgical outcome in septorhinoplasty surgery. It provides an objective and reproducible score. The surgeon's assessment was more critical than patient satisfaction. Patient satisfaction is more difficult to achieve in cases involving a secondary septorhinoplasty.
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Affiliation(s)
- T Radulesco
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille Cedex, France.,Aix-Marseille University, Marseille Cedex, France
| | - M Penicaud
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille Cedex, France
| | - L Santini
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille Cedex, France.,Aix-Marseille University, Marseille Cedex, France
| | - J-M Thomassin
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille Cedex, France.,Aix-Marseille University, Marseille Cedex, France
| | - P Dessi
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille Cedex, France.,Aix-Marseille University, Marseille Cedex, France
| | - J Michel
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Assistance Publique Hôpitaux de Marseille, La Conception University Hospital, Marseille Cedex, France.,Aix-Marseille University, Marseille Cedex, France
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Loth A, Michel J, Giorgi R, Santini L, Rey M, Elbaum JM, Roux N, Giovanni A, Dessi P, Fakhry N. Prevalence of obstructive sleep apnoea syndrome following oropharyngeal cancer treatment: A prospective cohort study. Clin Otolaryngol 2017; 42:1281-1288. [DOI: 10.1111/coa.12869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/27/2022]
Affiliation(s)
- A. Loth
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - J. Michel
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - R. Giorgi
- IRD; UMR_S 912 (SESSTIM); Aix-Marseille Université; Marseille France
- INSERM; UMR_S 912 (SESSTIM); Marseille France
- Service Biostatistiques et Technologies de l'Information et de la Communication; Hôpital Timone; APHM; Marseille France
| | - L. Santini
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - M. Rey
- Centre du sommeil et Service de Neurophysiologie Clinique; Hôpital Timone; APHM; Marseille France
| | - J.-M. Elbaum
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - N. Roux
- Service Biostatistiques et Technologies de l'Information et de la Communication; Hôpital Timone; APHM; Marseille France
| | - A. Giovanni
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
- Laboratoire Parole et Langage (LPL); CNRS UMR; Aix-Marseille Université; Aix-en-Provence France
| | - P. Dessi
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
| | - N. Fakhry
- Service d'ORL et Chirurgie Cervico-Faciale; Centre Hospitalier Universitaire La Conception; APHM; Aix Marseille Univ; Marseille France
- Laboratoire Parole et Langage (LPL); CNRS UMR; Aix-Marseille Université; Aix-en-Provence France
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Andre E, Yaniz-Galende E, Hamilton C, Dusting GJ, Hellen N, Poulet CE, Diez Cunado M, Smits AM, Lowe V, Eckardt D, Du Pre B, Sanz Ruiz R, Moerkamp AT, Tribulova N, Smani T, Liskova YV, Greco S, Guzzolino E, Franco D, Lozano-Velasco E, Knorr M, Pavoine C, Bukowska A, Van Linthout S, Miteva K, Sulzgruber P, Latet SC, Portnychenko A, Cannavo A, Kamilova U, Sagach VF, Santin Y, Octavia Y, Haller PM, Octavia Y, Rubies C, Dei Zotti F, Wong KHK, Gonzalez Miqueo A, Kruithof BPT, Kadur Nagaraju C, Shaposhnikova Y, Songia P, Lindner D, Wilson C, Benzoni P, Fabbri A, Campostrini G, Jorge E, Casini S, Mengarelli I, Nikolov A, Bublikov DS, Kheloufi M, Rubies C, Walker RE, Van Dijk RA, Posthuma JJ, Dumitriu IE, Karshovska E, Sakic A, Alexandru N, Martin-Lorenzo M, Molica F, Taylor RF, Mcarthur L, Crocini C, Matsuyama TA, Mazzoni L, Lin WK, Owen TJ, Scigliano M, Sheehan A, Bezerra Gurgel AR, Bromage DI, Kiss A, Ikeda G, Pickard JMJ, Wirth G, Casos K, Khudiakov A, Nistal JF, Ferrantini C, Park SJ, Di Maggio S, Gentile F, Dini L, Buyandelger B, Larrasa-Alonso J, Schirmer I, Chin SH, Cimiotti D, Martini H, Hohensinner PJ, Garabito M, Zeni F, Licholai S, De Bortoli M, Sivitskaya L, Viczenczova C, Rainer PP, Smith LE, Suna G, Gambardella J, Cozma A, De Gonzalo Calvo D, Scoditti E, Clark BJ, Mansfield C, Eckardt D, Gomez L, Llucia-Valldeperas A, De Pauw A, Porporato P, Bouzin C, Draoui N, Sonveaux P, Balligand JL, Mougenot N, Formicola L, Nadaud S, Dierick F, Hajjar RJ, Marazzi G, Sassoon D, Hulot JS, Zamora VR, Burton FL, Macquaide N, Smith GL, Hernandez D, Sivakumaran P, Millard R, Wong RCB, Pebay A, Shepherd RK, Lim SY, Owen T, Jabbour RJ, Kloc M, Kodagoda T, Denning C, Harding SE, Ramos S, Terracciano C, Gorelik J, Wei K, Bushway P, Ruiz-Lozano P, Mercola M, Moerkamp AT, Vegh AMD, Dronkers E, Lodder K, Van Herwaarden T, Goumans MJ, Pellet-Many C, Zachary I, Noack K, Bosio A, Feyen DAM, Demkes EJ, Dierickx PJ, Doevendans PA, Vos MA, Van Veen AAB, Van Laake LW, Fernandez Santos ME, Suarez Sancho S, Fuentes Arroyo L, Plasencia Martin V, Velasco Sevillano P, Casado Plasencia A, Climent AM, Guillem M, Atienza Fernandez F, Fernandez-Aviles F, Dingenouts CKE, Lodder K, Kruithof BPT, Van Herwaarden T, Vegh AMD, Goumans MJ, Smits AM, Knezl V, Szeiffova Bacova B, Egan Benova T, Viczenczova C, Goncalvesova E, Slezak J, Calderon-Sanchez E, Diaz I, Ordonez A, Salikova SP, Zaccagnini G, Voellenkle C, Sadeghi I, Maimone B, Castelvecchio S, Gaetano C, Menicanti L, Martelli F, Hatcher C, D'aurizio R, Groth M, Baugmart M, Mercatanti A, Russo F, Mariani L, Magliaro C, Pitto L, Lozano-Velasco E, Jodar-Garcia A, Galiano-Torres J, Lopez-Navarrete I, Aranega A, Wagensteen R, Quesada A, Aranega A, Franco D, Finger S, Karbach S, Kossmann S, Muenzel T, Wenzel P, Keck M, Mougenot N, Favier S, Fuand A, Atassi F, Barbier C, Lompre AM, Hulot JS, Nikonova Y, Pluteanu F, Kockskaemper J, Chilukoti RK, Wolke C, Lendeckel U, Gardemann A, Goette A, Miteva K, Pappritz K, Mueller I, El-Shafeey M, Ringe J, Tschoepe C, Pappritz K, El-Shafeey M, Ringe J, Tschoepe C, Van Linthout S, Koller L, Richter B, Blum S, Koprak M, Huelsmann M, Pacher R, Goliasch G, Wojta J, Niessner A, Van Herck PL, Claeys MJ, Haine SE, Lenders GD, Miljoen HP, Segers VF, Vandendriescche TR, Hoymans VY, Vrints CJ, Lapikova-Bryhinska T, Gurianova V, Portnichenko H, Vasylenko M, Zapara Y, Portnichenko V, Liccardo D, Lymperopoulos A, Santangelo M, Leosco D, Koch WJ, Ferrara N, Rengo G, Alieva T, Rasulova Z, Masharipova D, Dorofeyeva NA, Drachuk KO, Sicard P, Yucel Y, Dutaur M, Vindis C, Parini A, Mialet-Perez J, Van Deel ED, De Boer M, De Waard MC, Duncker DJ, Nagel F, Inci M, Santer D, Hallstroem S, Podesser BK, Kararigas G, De Boer M, Kietadisorn R, Swinnen M, Duimel H, Verheyen F, Chrifi I, Brandt MM, Cheng C, Janssens S, Moens AL, Duncker DJ, Batlle M, Dantas AP, Sanz M, Sitges M, Mont L, Guasch E, Lobysheva I, Beauloye C, Balligand JL, Vanhoutte PM, Tang EHC, Beaumont J, Lopez B, Ravassa S, Hermida N, Valencia F, Gomez-Doblas JJ, San Jose G, De Teresa E, Diez J, Van De Merbel AF, Kruithof-De Julio M, Goumans MJ, Claus P, Dries E, Angelo Singh A, Vermeulen K, Roderick HL, Sipido KR, Driesen RB, Ilchenko I, Bobronnikova L, Myasoedova V, Alamanni F, Tremoli E, Poggio P, Becher PM, Gotzhein F, Klingel K, Blankenberg S, Westermann D, Zi M, Cartwright E, Campostrini G, Bonzanni M, Milanesi R, Bucchi A, Baruscotti M, Difrancesco D, Barbuti A, Fantini M, Wilders R, Severi S, Benzoni P, Dell' Era P, Serzanti M, Olesen MS, Muneretto C, Bisleri G, Difrancesco D, Baruscotti M, Bucchi A, Barbuti A, Amoros-Figueras G, Raga S, Campos B, Alonso-Martin C, Rodriguez-Font E, Vinolas X, Cinca J, Guerra JM, Mengarelli I, Schumacher CA, Veldkamp MW, Verkerk AO, Remme CA, Veerman C, Guan K, Stauske M, Tan H, Barc J, Wilde A, Verkerk A, Bezzina C, Tsinlikov I, Tsinlikova I, Nicoloff G, Blazhev A, Garev A, Andrienko AV, Lychev VG, Vorobova EN, Anchugina DA, Vion AC, Hammoutene A, Poisson J, Dupont N, Souyri M, Tedgui A, Codogno P, Boulanger CM, Rautou PE, Dantas AP, Batlle M, Guasch E, Torres M, Montserrat JM, Almendros I, Mont L, Austin CA, Holt CM, Rijs K, Wezel A, Hamming JF, Kolodgie FD, Virmani R, Schaapherder AF, Lindeman JHN, Posma JJN, Van Oerle R, Spronk HMH, Ten Cate H, Dinkla S, Kaski JC, Schober A, Chaabane C, Ambartsumian N, Grigorian M, Bochaton-Piallat ML, Dragan E, Andrei E, Niculescu L, Georgescu A, Gonzalez-Calero L, Maroto AS, Martinez PJ, Heredero A, Aldamiz-Echevarria G, Vivanco F, Alvarez-Llamas G, Meens MJ, Pelli G, Foglia B, Scemes E, Kwak BR, Caldwell JL, Eisner DA, Dibb KM, Trafford AW, Chilton L, Smith GL, Nicklin SA, Coppini R, Ferrantini C, Yan P, Loew LM, Poggesi C, Cerbai E, Pavone FS, Sacconi L, Tanaka H, Ishibashi-Ueda H, Takamatsu T, Coppini R, Ferrantini C, Gentile F, Pioner JM, Santini L, Sartiani L, Bargelli V, Poggesi C, Mugelli A, Cerbai E, Maciejewska M, Bolton EL, Wang Y, O'brien F, Ruas M, Lei M, Sitsapesan R, Galione A, Terrar DA, Smith JG, Garcia D, Barriales-Villa R, Monserrat L, Harding SE, Denning C, Marston SB, Watson S, Tkach S, Faggian G, Terracciano CM, Perbellini F, Eiros Zamora J, Papadaki M, Messer A, Marston S, Gould I, Johnston A, Dunne M, Smith G, Kemi OJ, Pillai M, Davidson SM, Yellon DM, Tratsiakovich Y, Jang J, Gonon AT, Pernow J, Matoba T, Koga J, Egashira K, Burke N, Davidson SM, Yellon DM, Korpisalo P, Hakkarainen H, Laidinen S, Yla-Herttuala S, Ferrer-Curriu G, Perez M, Permanyer E, Blasco-Lucas A, Gracia JM, Castro MA, Barquinero J, Galinanes M, Kostina D, Kostareva A, Malashicheva A, Merino D, Ruiz L, Gomez J, Juarez C, Gil A, Garcia R, Hurle MA, Coppini R, Pioner JM, Gentile F, Mazzoni L, Rossi A, Tesi C, Belardinelli L, Olivotto I, Cerbai E, Mugelli A, Poggesi C, Eun-Ji EJ, Lim BK, Choi DJ, Milano G, Bertolotti M, De Marchis F, Zollo F, Sommariva E, Capogrossi MC, Pompilio G, Bianchi ME, Raucci A, Pioner JM, Coppini R, Scellini B, Tardiff J, Tesi C, Poggesi C, Ferrantini C, Mazzoni L, Sartiani L, Coppini R, Diolaiuti L, Ferrari P, Cerbai E, Mugelli A, Mansfield C, Luther P, Knoell R, Villalba M, Sanchez-Cabo F, Lopez-Olaneta MM, Ortiz-Sanchez P, Garcia-Pavia P, Lara-Pezzi E, Klauke B, Gerdes D, Schulz U, Gummert J, Milting H, Wake E, Kocsis-Fodor G, Brack KE, Ng GA, Kostareva A, Smolina N, Majchrzak M, Moehner D, Wies A, Milting H, Stehle R, Pfitzer G, Muegge A, Jaquet K, Maggiorani D, Lefevre L, Dutaur M, Mialet-Perez J, Parini A, Cussac D, Douin-Echinard V, Ebenbauer B, Kaun C, Prager M, Wojta J, Rega-Kaun G, Costa G, Onetti Y, Jimenez-Altayo F, Vila E, Dantas AP, Milano G, Bertolotti M, Scopece A, Piacentini L, Bianchi ME, Capogrossi MC, Pompilio G, Colombo G, Raucci A, Blaz M, Kapelak B, Sanak M, Bauce B, Calore C, Lorenzon A, Calore M, Poloni G, Mazzotti E, Rigato I, Daliento L, Basso C, Thiene G, Melacini P, Corrado D, Rampazzo A, Danilenko NG, Vaikhanskaya TG, Davydenko OG, Szeiffova Bacova B, Kura B, Egan Benova T, Yin CH, Kukreja R, Slezak J, Tribulova N, Lee DI, Sorge M, Glabe C, Paolocci N, Guarnieri C, Tomaselli GF, Kass DA, Van Eyk JE, Agnetti G, Cordwell SJ, White MY, Wojakowski W, Lynch M, Barallobre-Barreiro J, Yin X, Mayr U, White S, Jahingiri M, Hill J, Mayr M, Sorriento D, Ciccarelli M, Fiordelisi A, Campiglia P, Trimarco B, Iaccarino G, Sitar Taut AV, Schiau S, Orasan O, Halloumi W, Negrean V, Zdrenghea D, Pop D, Van Der Meer RW, Rijzewijk LJ, Smit JWA, Revuelta-Lopez E, Nasarre L, Escola-Gil JC, Lamb HJ, Llorente-Cortes V, Pellegrino M, Massaro M, Carluccio MA, Calabriso N, Wabitsch M, Storelli C, De Caterina R, Church SJ, Callagy S, Begley P, Kureishy N, Mcharg S, Bishop PN, Unwin RD, Cooper GJS, Mawad D, Perbellini F, Tonkin J, Bello SO, Simonotto JD, Lyon AR, Stevens MM, Terracciano CM, Harding SE, Kernbach M, Czichowski V, Bosio A, Fuentes L, Hernandez-Redondo I, Guillem MS, Fernandez ME, Sanz R, Atienza F, Climent AM, Fernandez-Aviles F, Soler-Botija C, Prat-Vidal C, Galvez-Monton C, Roura S, Perea-Gil I, Bragos R, Bayes-Genis A. Poster session 1Cell growth, differentiation and stem cells - Heart72Understanding the metabolism of cardiac progenitor cells: a first step towards controlling their proliferation and differentiation?73Expression of pw1/peg3 identifies a new cardiac adult stem cell population involved in post-myocardial infarction remodeling74Long-term stimulation of iPS-derived cardiomyocytes using optogenetic techniques to promote phenotypic changes in E-C coupling75Benefits of electrical stimulation on differentiation and maturation of cardiomyocytes from human induced pluripotent stem cells76Constitutive beta-adrenoceptor-mediated cAMP production controls spontaneous automaticity of human induced pluripotent stem cell-derived cardiomyocytes77Formation and stability of T-tubules in cardiomyocytes78Identification of miRNAs promoting human cardiomyocyte proliferation by regulating Hippo pathway79A direct comparison of foetal to adult epicardial cell activation reveals distinct differences relevant for the post-injury response80Role of neuropilins in zebrafish heart regeneration81Highly efficient immunomagnetic purification of cardiomyocytes derived from human pluripotent stem cells82Cardiac progenitor cells posses a molecular circadian clock and display large 24-hour oscillations in proliferation and stress tolerance83Influence of sirolimus and everolimus on bone marrow-derived mesenchymal stem cell biology84Endoglin is important for epicardial behaviour following cardiac injuryCell death and apoptosis - Heart87Ultrastructural alterations reflecting Ca2+ handling and cell-to-cell coupling disorders precede occurrence of severe arrhythmias in intact animal heart88Urocortin-1 promotes cardioprotection through ERK1/2 and EPAC pathways: role in apoptosis and necrosis89Expression p38 MAPK and Cas-3 in myocardium LV of rats with experimental heart failure at melatonin and enalapril introductionTranscriptional control and RNA species - Heart92Accumulation of beta-amyloid 1-40 in HF patients: the role of lncRNA BACE1-AS93Role of miR-182 in zebrafish and mouse models of Holt-Oram syndrome94Mir-27 distinctly regulates muscle-enriched transcription factors and growth factors in cardiac and skeletal muscle cells95AF risk factors impair PITX2 expression leading to Wnt-microRNA-ion channel remodelingCytokines and cellular inflammation - Heart98Post-infarct survival depends on the interplay of monocytes, neutrophils and interferon gamma in a mouse model of myocardial Infarction99Inflammatory cd11b/c cells play a protective role in compensated cardiac hypertrophy by promoting an orai3-related pro-survival signal100Anti-inflammatory effects of endothelin receptor blockade in the atrial tissue of spontaneously hypertensive rats101Mesenchymal stromal cells reduce NLRP3 inflammasome activity in Coxsackievirus B3-induced myocarditis102Mesenchymal stromal cells modulate monocytes trafficking in Coxsackievirus B3-induced myocarditis103The impact of regulatory T lymphocytes on long-term mortality in patients with chronic heart failure104Temporal dynamics of dendritic cells after ST-elevation myocardial infarction relate with improvement of myocardial functionGrowth factors and neurohormones - Heart107Preconditioning of hypertrophied heart: miR-1 and IGF-1 crosstalk108Modulation of catecholamine secretion from human adrenal chromaffin cells by manipulation of G protein-coupled receptor kinase-2 activity109Evaluation of cyclic adenosin-3,5- monophosphate and neurohormones in patients with chronic heart failureNitric oxide and reactive oxygen species - Heart112Hydrogen sulfide donor inhibits oxidative and nitrosative stress, cardiohemodynamics disturbances and restores cNOS coupling in old rats113Role and mechanisms of action of aldehydes produced by monoamine oxidase A in cardiomyocyte death and heart failure114Exercise training has contrasting effects in myocardial infarction and pressure-overload due to different endothelial nitric oxide synthase regulation115S-Nitroso Human Serum Albumin dose-dependently leads to vasodilation and alters reactive hyperaemia in coronary arteries of an isolated mouse heart model116Modulating endothelial nitric oxide synthase with folic acid attenuates doxorubicin-induced cardiomyopathy119Effects of long-term very high intensity exercise on aortic structure and function in an animal model120Electron paramagnetic resonance spectroscopy quantification of nitrosylated hemoglobin (HbNO) as an index of vascular nitric oxide bioavailability in vivo121Deletion of repressor activator protein 1 impairs acetylcholine-induced relaxation due to production of reactive oxygen speciesExtracellular matrix and fibrosis - Heart124MicroRNA-19b is associated with myocardial collagen cross-linking in patients with severe aortic stenosis. Potential usefulness as a circulating biomarker125A new ex vivo model to study cardiac fibrosis126Heterogeneity of fibrosis and fibroblast differentiation in the left ventricle after myocardial infarction127Effect of carbohydrate metabolism degree compensation to the level of galectin-3 changes in hypertensive patients with chronic heart failure and type 2 diabetes mellitus128Statin paradox in association with calcification of bicuspid aortic valve interstitial cells129Cardiac function remains impaired despite reversible cardiac fibrosis after healed experimental viral myocarditisIon channels, ion exchangers and cellular electrophysiology - Heart132Identifying a novel role for PMCA1 (Atp2b1) in heart rhythm instability133Mutations of the caveolin-3 gene as a predisposing factor for cardiac arrhythmias134The human sinoatrial node action potential: time for a computational model135iPSC-derived cardiomyocytes as a model to dissect ion current alterations of genetic atrial fibrillation136Postextrasystolic potentiation in healthy and diseased hearts: effects of the site of origin and coupling interval of the preceding extrasystole137Absence of Nav1.8-based (late) sodium current in rabbit cardiomyocytes and human iPSC-CMs138hiPSC-derived cardiomyocytes from Brugada Syndrome patients without identified mutations do not exhibit cellular electrophysiological abnormalitiesMicrocirculation141Atherogenic indices, collagen type IV turnover and the development of microvascular complications- study in diabetics with arterial hypertension142Changes in the microvasculature and blood viscosity in women with rheumatoid arthritis, hypercholesterolemia and hypertensionAtherosclerosis145Shear stress regulates endothelial autophagy: consequences on endothelial senescence and atherogenesis146Obstructive sleep apnea causes aortic remodeling in a chronic murine model147Aortic perivascular adipose tissue displays an aged phenotype in early and late atherosclerosis in ApoE-/- mice148A systematic evaluation of the cellular innate immune response during the process of human atherosclerosis149Inhibition of Coagulation factor Xa increases plaque stability and attenuates the onset and progression of atherosclerotic plaque in apolipoprotein e-deficient mice150Regulatory CD4+ T cells from patients with atherosclerosis display pro-inflammatory skewing and enhanced suppression function151Hypoxia-inducible factor (HIF)-1alpha regulates macrophage energy metabolism by mediating miRNAs152Extracellular S100A4 is a key player of smooth muscle cell phenotypic transition: implications in atherosclerosis153Microparticles of healthy origins improve atherosclerosis-associated endothelial progenitor cell dysfunction via microRNA transfer154Arterial remodeling and metabolism impairment in early atherosclerosis155Role of pannexin1 in atherosclerotic plaque formationCalcium fluxes and excitation-contraction coupling158Amphiphysin II induces tubule formation in cardiac cells159Interleukin 1 beta regulation of connexin 43 in cardiac fibroblasts and the effects of adult cardiac myocyte:fibroblast co-culture on myocyte contraction160T-tubular electrical defects contribute to blunted beta-adrenergic response in heart failure161Beat-to-beat variability of intracellular Ca2+ dynamics of Purkinje cells in the infarct border zone of the mouse heart revealed by rapid-scanning confocal microscopy162The efficacy of late sodium current blockers in hypertrophic cardiomyopathy is dependent on genotype: a study on transgenic mouse models with different mutations163Synthesis of cADPR and NAADP by intracellular CD38 in heart: role in inotropic and arrhythmogenic effects of beta-adrenoceptor signalingContractile apparatus166Towards an engineered heart tissue model of HCM using hiPSC expressing the ACTC E99K mutation167Diastolic mechanical load delays structural and functional deterioration of ultrathin adult heart slices in culture168Structural investigation of the cardiac troponin complex by molecular dynamics169Exercise training restores myocardial and oxidative skeletal muscle function from myocardial infarction heart failure ratsOxygen sensing, ischaemia and reperfusion172A novel antibody specific to full-length stromal derived factor-1 alpha reveals that remote conditioning induces its cleavage by endothelial dipeptidyl peptidase 4173Attenuation of myocardial and vascular arginase activity by vagal nerve stimulation via a mechanism involving alpha-7 nicotinic receptor during cardiac ischemia and reperfusion174Novel nanoparticle-mediated medicine for myocardial ischemia-reperfusion injury simultaneously targeting mitochondrial injury and myocardial inflammation175Acetylcholine plays a key role in myocardial ischaemic preconditioning via recruitment of intrinsic cardiac ganglia176The role of nitric oxide and VEGFR-2 signaling in post ischemic revascularization and muscle recovery in aged hypercholesterolemic mice177Efficacy of ischemic preconditioning to protect the human myocardium: the role of clinical conditions and treatmentsCardiomyopathies and fibrosis180Plakophilin-2 haploinsufficiency leads to impaired canonical Wnt signaling in ARVC patient181Improved technique for customized, easier, safer and more reliable transverse aortic arch banding and debanding in mice as a model of pressure overload hypertrophy182Late sodium current inhibitors for the treatment of inducible obstruction and diastolic dysfunction in hypertrophic cardiomyopathy: a study on human myocardium183Angiotensin II receptor antagonist fimasartan has protective role of left ventricular fibrosis and remodeling in the rat ischemic heart184Role of High-Mobility Group Box 1 (HMGB1) redox state on cardiac fibroblasts activities and heart function after myocardial infarction185Atrial remodeling in hypertrophic cardiomyopathy: insights from mouse models carrying different mutations in cTnT186Electrophysiological abnormalities in ventricular cardiomyocytes from a Maine Coon cat with hypertrophic cardiomyopathy: effects of ranolazine187ZBTB17 is a novel cardiomyopathy candidate gene and regulates autophagy in the heart188Inhibition of SRSF4 in cardiomyocytes induces left ventricular hypertrophy189Molecular characterization of a novel cardiomyopathy related desmin frame shift mutation190Autonomic characterisation of electro-mechanical remodeling in an in-vitro leporine model of heart failure191Modulation of Ca2+-regulatory function by three novel mutations in TNNI3 associated with severe infant restrictive cardiomyopathyAging194The aging impact on cardiac mesenchymal like stromal cells (S+P+)195Reversal of premature aging markers after bariatric surgery196Sex-associated differences in vascular remodeling during aging: role of renin-angiotensin system197Role of the receptor for advanced glycation end-products (RAGE) in age dependent left ventricle dysfunctionsGenetics and epigenetics200hsa-miR-21-5p as a key factor in aortic remodeling during aneurysm formation201Co-inheritance of mutations associated with arrhythmogenic and hypertrophic cardiomyopathy in two Italian families202Lamin a/c hot spot codon 190: form various amino acid substitutions to clinical effects203Treatment with aspirin and atorvastatin attenuate cardiac injury induced by rat chest irradiation: Implication of myocardial miR-1, miR-21, connexin-43 and PKCGenomics, proteomics, metabolomics, lipidomics and glycomics206Differential phosphorylation of desmin at serines 27 and 31 drives the accumulation of preamyloid oligomers in heart failure207Potential role of kinase Akt2 in the reduced recovery of type 2 diabetic hearts subjected to ischemia / reperfusion injury208A proteomics comparison of extracellular matrix remodelling in porcine coronary arteries upon stent implantationMetabolism, diabetes mellitus and obesity211Targeting grk2 as therapeutic strategy for cancer associated to diabetes212Effects of salbutamol on large arterial stiffness in patients with metabolic syndrome213Circulating microRNA-1 and microRNA-133a: potential biomarkers of myocardial steatosis in type 2 diabetes mellitus214Anti-inflammatory nutrigenomic effects of hydroxytyrosol in human adipocytes - protective mechanisms of mediterranean diets in obesity-related inflammation215Alterations in the metal content of different cardiac regions within a rat model of diabetic cardiomyopathyTissue engineering218A novel conductive patch for application in cardiac tissue engineering219Establishment of a simplified and improved workflow from neonatal heart dissociation to cardiomyocyte purification and characterization220Effects of flexible substrate on cardiomyocytes cell culture221Mechanical stretching on cardiac adipose progenitors upregulates sarcomere-related genes. Cardiovasc Res 2016. [DOI: 10.1093/cvr/cvw135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tontini M, Romano MR, Proietti D, Balducci E, Micoli F, Balocchi C, Santini L, Masignani V, Berti F, Costantino P. Preclinical studies on new proteins as carrier for glycoconjugate vaccines. Vaccine 2016; 34:4235-4242. [PMID: 27317455 DOI: 10.1016/j.vaccine.2016.06.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/13/2016] [Accepted: 06/07/2016] [Indexed: 01/12/2023]
Abstract
Glycoconjugate vaccines are made of carbohydrate antigens covalently bound to a carrier protein to enhance their immunogenicity. Among the different carrier proteins tested in preclinical and clinical studies, five have been used so far for licensed vaccines: Diphtheria and Tetanus toxoids, the non-toxic mutant of diphtheria toxin CRM197, the outer membrane protein complex of Neisseria meningitidis serogroup B and the Protein D derived from non-typeable Haemophilus influenzae. Availability of novel carriers might help to overcome immune interference in multi-valent vaccines containing several polysaccharide-conjugate antigens, and also to develop vaccines which target both protein as well saccharide epitopes of the same pathogen. Accordingly we have conducted a study to identify new potential carrier proteins. Twenty-eight proteins, derived from different bacteria, were conjugated to the model polysaccharide Laminarin and tested in mice for their ability in inducing antibodies against the carbohydrate antigen and eight of them were subsequently tested as carrier for serogroup meningococcal C oligosaccharides. Four out of these eight were able to elicit in mice satisfactory anti meningococcal serogroup C titers. Based on immunological evaluation, the Streptococcus pneumoniae protein spr96/2021 was successfully evaluated as carrier for serogroups A, C, W, Y and X meningococcal capsular saccharides.
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Affiliation(s)
- M Tontini
- GSK Vaccines S.r.l., Via Fiorentina 1, 53100 Siena, Italy
| | - M R Romano
- GSK Vaccines S.r.l., Via Fiorentina 1, 53100 Siena, Italy
| | - D Proietti
- GSK Vaccines S.r.l., Via Fiorentina 1, 53100 Siena, Italy
| | - E Balducci
- GSK Vaccines S.r.l., Via Fiorentina 1, 53100 Siena, Italy
| | - F Micoli
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy
| | - C Balocchi
- GSK Vaccines S.r.l., Via Fiorentina 1, 53100 Siena, Italy
| | - L Santini
- GSK Vaccines S.r.l., Via Fiorentina 1, 53100 Siena, Italy
| | - V Masignani
- GSK Vaccines S.r.l., Via Fiorentina 1, 53100 Siena, Italy
| | - F Berti
- GSK Vaccines S.r.l., Via Fiorentina 1, 53100 Siena, Italy
| | - P Costantino
- GSK Vaccines S.r.l., Via Fiorentina 1, 53100 Siena, Italy.
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Conzo G, Docimo G, Mauriello C, Gambardella C, Esposito D, Cavallo F, Tartaglia E, Napolitano S, Santini L. The current status of lymph node dissection in the treatment of papillary thyroid cancer. A literature review. Clin Ter 2016; 164:e343-6. [PMID: 24045534 DOI: 10.7417/ct.2013.1599] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM Cervical lymph node micrometastases are observed in up to 90% of papillary thyroid cancers (PTC), showing that lymph nodal involvement is very common. Nevertheless, during the last years, the role of lymph node dissection in the treatment of PTC has been controversial and, at present, the best indications to the routine or therapeutic neck dissection remain subject of research. In order to better analyze the current role of lymph node dissection in the surgical treatment of PTC, an analysis of the most recent literature data was performed. STUDY DESIGN By using as keywords lymph node dissection, selective, lateral or central lymph node dissection, modified radical neck dissection, prophylactic or therapeutic lymph node dissection, papillary thyroid cancer, a Pub Med data base research was carried out. The most recent guidelines of different referral endocrine societies, inhering neck dissection for PTC, were also evaluated. RESULTS The role of neck dissection in PTC management remains controversial regarding routine or therapeutic indications, surgical extension, and its impact on local recurrence and long term survival. Due to inhomogeneous literature data, the current status of node dissection is still subject of research. CONCLUSIONS There is agreement between endocrine and neck surgeons about the extension of therapeutic lymph node dissection in N+ PTC patients , and also in the prophylactic treatment of N0 "high risk" patients. Considering a recent trend toward routine central lymphadenectomy avoiding radioactive treatment, prospective randomized trials are needed to evaluate the benefits of different approaches.
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Affiliation(s)
- G Conzo
- Department of Anaesthesiologic, Surgical and Emergency Sciences. Second University of Naples. Italy
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Ancillotto L, Santini L, Ranc N, Maiorano L, Russo D. Extraordinary range expansion in a common bat: the potential roles of climate change and urbanisation. Naturwissenschaften 2016; 103:15. [PMID: 26842786 DOI: 10.1007/s00114-016-1334-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/27/2015] [Accepted: 01/13/2016] [Indexed: 11/25/2022]
Abstract
Urbanisation and climate change are two global change processes that affect animal distributions, posing critical threats to biodiversity. Due to its versatile ecology and synurbic habits, Kuhl's pipistrelle (Pipistrellus kuhlii) offers a unique opportunity to explore the relative effects of climate change and urbanisation on species distributions. In a climate change scenario, this typically Mediterranean species is expected to expand its range in response to increasing temperatures. We collected 25,132 high-resolution occurrence records from P. kuhlii European range between 1980 and 2013 and modelled the species' distribution with a multi-temporal approach, using three bioclimatic variables and one proxy of urbanisation. Temperature in the coldest quarter of the year was the most important factor predicting the presence of P. kuhlii and showed an increasing trend in the study period; mean annual precipitation and precipitation seasonality were also relevant, but to a lower extent. Although urbanisation increased in recently colonised areas, it had little effect on the species' presence predictability. P. kuhlii expanded its geographical range by about 394 % in the last four decades, a process that can be interpreted as a response to climate change.
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Affiliation(s)
- L Ancillotto
- Wildlife Research Unit, Laboratorio di Ecologia Applicata, Sezione di Biologia e Protezione dei Sistemi Agrari e Forestali, Dipartimento di Agraria, Università degli Studi di Napoli Federico II, via Università 100, I-80055, Portici, Napoli, Italy
| | - L Santini
- Dipartimento di Biologia e Biotecnologie "Charles Darwin", Università degli Studi di Roma La Sapienza, Rome, Italy
| | - N Ranc
- Organismic and Evolutionary Biology Department, Harvard University, Cambridge, MA, USA
- Centro Ricerca ed Innovazione, Fondazione Edmund Mach, San Michele all'Adige, Trento, Italy
| | - L Maiorano
- Dipartimento di Biologia e Biotecnologie "Charles Darwin", Università degli Studi di Roma La Sapienza, Rome, Italy
| | - D Russo
- Wildlife Research Unit, Laboratorio di Ecologia Applicata, Sezione di Biologia e Protezione dei Sistemi Agrari e Forestali, Dipartimento di Agraria, Università degli Studi di Napoli Federico II, via Università 100, I-80055, Portici, Napoli, Italy.
- School of Biological Sciences, University of Bristol, Bristol, UK.
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Llera AS, Podhajcer OL, Breitenbach MM, Santini L, Muller B, Daneri-Navarro A, Velázquez CA, Artagaveytia N, Gómez J, Frech MS, Brown T, Gross T. Translational cancer research comes of age in Latin America. Sci Transl Med 2015; 7:319fs50. [DOI: 10.1126/scitranslmed.aad5859] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Conzo G, Tartaglia E, Gambardella C, Esposito D, Sciascia V, Mauriello C, Nunziata A, Siciliano G, Izzo G, Cavallo F, Thomas G, Musella M, Santini L. Minimally invasive approach for adrenal lesions: Systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. Int J Surg 2015; 28 Suppl 1:S118-23. [PMID: 26708860 DOI: 10.1016/j.ijsu.2015.12.042] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/18/2015] [Accepted: 05/10/2015] [Indexed: 02/06/2023]
Abstract
In the last decades, minimally invasive transperitoneal laparoscopic adrenalectomy has become the standard of care for surgical resection of the adrenal gland tumors. Recently, however, adrenalectomy by a mininvasive retroperitoneal approach has reached increasingly popularity as alternative technique. Short hospitalization, lower postoperative pain and decrease of complications and a better cosmetic resolution are the main advantages of these innovative techniques. In order to determine the better surgical management of adrenal neoplasms, the Authors analyzed and compared the feasibility and the postoperative complications of minimally invasive adrenalectomy approaches. A systematic research of the English literature, including major meta-analysis articles, clinical randomized trials, retrospective studies and systematic reviews was performed, comparing laparoscopic transperitoneal adrenalectomy versus retroperitoneoscopic adrenalectomy. Many studies support that posterior retroperitoneal adrenalectomy is superior or at least comparable to laparoscopic transperitoneal adrenalectomy in operation time, pain score, blood loss, hospitalization, complications rates and return to normal activity. However, laparoscopic transperitoneal adrenalectomy is up to now a safe and standardized procedure with a shorter learning curve and a similar low morbidity rate, even for tumors larger than 6 cm. Nevertheless, further studies are needed to objectively evaluate these techniques, excluding selection bias and bias related to differences in surgeons' experiences with this approaches.
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Affiliation(s)
- G Conzo
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - E Tartaglia
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - C Gambardella
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - D Esposito
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - V Sciascia
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - C Mauriello
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - A Nunziata
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - G Siciliano
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - G Izzo
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - F Cavallo
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - G Thomas
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - M Musella
- Advanced Biomedical Sciences Department, AOU "Federico II", Naples, Italy.
| | - L Santini
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
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Sullivan R, Olusegun I, Anderson B, Audisio R, Autier P, Aggarwal A, Balch C, Brennan M, Dare A, D'Cruz A, Eggermont A, Fleming K, Hagander L, Herrera C, Ilbawi A, Ji J, Kingham T, Liberman J, Leather A, Meara J, Murthy S, Omar S, Parham G, Pramesh C, Riviello R, Rodin D, Santini L, Shrikhande S, Shrime M, Thomas R, Tsunoda A, Watters D, Wang S, Wu Y, Van de Velde F, Veronesi U, Zeiton M, Purushotham A. 9LBA Delivering safe and affordable cancer surgery to all - a Lancet Oncology Commission. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31933-5] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maiorano L, Amori G, Montemaggiori A, Rondinini C, Santini L, Saura S, Boitani L. On how much biodiversity is covered in Europe by national protected areas and by the Natura 2000 network: insights from terrestrial vertebrates. Conserv Biol 2015; 29:986-995. [PMID: 25997522 DOI: 10.1111/cobi.12535] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/02/2015] [Indexed: 06/04/2023]
Abstract
The European Union has made extensive biodiversity conservation efforts with the Habitats and Birds Directives and with the establishment of the Natura 2000 network of protected areas, one of the largest networks of conservation areas worldwide. We performed a gap analysis of the entire Natura 2000 system plus national protected areas and all terrestrial vertebrates (freshwater fish excluded). We also evaluated the level of connectivity of both systems, providing therefore a first estimate of the functionality of the Natura 2000 system as an effective network of protected areas. Together national protected areas and the Natura 2000 network covered more than one-third of the European Union. National protected areas did not offer protection to 13 total gap species (i.e., species not covered by any protected area) or to almost 300 partial gap species (i.e., species whose representation target is not met). Together the Natura 2000 network and national protected areas left 1 total gap species and 121 partial gap species unprotected. The terrestrial vertebrates listed in the Habitats and Birds Directives were relatively well covered (especially birds), and overall connectivity was improved considerably by Natura 2000 sites that act as stepping stones between national protected areas. Overall, we found that the Natura 2000 network represents at continental level an important network of protected areas that acts as a good complement to existing national protected areas. However, a number of problems remain that are mainly linked to the criteria used to list the species in the Habitats and Birds Directives. The European Commission initiated in 2014 a process aimed at assessing the importance of the Birds and Habitats Directives for biodiversity conservation. Our results contribute to this assessment and suggest the system is largely effective for terrestrial vertebrates but would benefit from further updating of the species lists and field management.
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Affiliation(s)
- L Maiorano
- Charles Darwin Department of Biology and Biotechnologies, University of Rome, La Sapienza, viale dell'Università 32, 00185, Rome, Italy
| | - G Amori
- Institute of Ecosystem Studies, CNR, viale dell'Università 32, 00185, Rome, Italy
| | - A Montemaggiori
- Charles Darwin Department of Biology and Biotechnologies, University of Rome, La Sapienza, viale dell'Università 32, 00185, Rome, Italy
| | - C Rondinini
- Charles Darwin Department of Biology and Biotechnologies, University of Rome, La Sapienza, viale dell'Università 32, 00185, Rome, Italy
| | - L Santini
- Charles Darwin Department of Biology and Biotechnologies, University of Rome, La Sapienza, viale dell'Università 32, 00185, Rome, Italy
| | - S Saura
- Department of Natural System and Resources, Universidad Politécnica de Madrid, Ciudad Universitaria s/n, 28040, Madrid, Spain
| | - L Boitani
- Charles Darwin Department of Biology and Biotechnologies, University of Rome, La Sapienza, viale dell'Università 32, 00185, Rome, Italy
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Reyre A, Michel J, Santini L, Dessi P, Vidal V, Bartoli JM, Moulin G, Varoquaux A. Epistaxis: The role of arterial embolization. Diagn Interv Imaging 2015; 96:757-73. [DOI: 10.1016/j.diii.2015.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
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Santini L, Robert D, Lagier A, Giovanni A, Dessi P, Fakhry N. A videofluoroscopic study comparing severe swallowing disorders in patients treated surgically or with radiation for oropharyngeal cancer. Int J Oral Maxillofac Surg 2015; 44:705-9. [PMID: 25697064 DOI: 10.1016/j.ijom.2015.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/02/2014] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Abstract
The aim of this study was to analyze the causal mechanisms of severe swallowing disorders after the treatment of oropharyngeal cancer. Twenty-six patients with severe swallowing disorders at ≥12 months after treatment for oropharyngeal cancer were analyzed retrospectively using videofluoroscopy. Fourteen patients (54%) had been treated with surgery (±postoperative radiotherapy), while 12 patients (46%) had been treated with (chemo)radiotherapy. Videofluoroscopy analysis showed a localized alteration in the surgical excision area resulting in impaired tongue root retraction in the surgical group (P=0.012), while general impairment of the pharyngeal, laryngeal, and upper oesophagus sphincter was found in the non-surgical group. Aspirations in the surgical group most often occurred after swallowing, while in the non-surgical group, they occurred during and after swallowing (P=0.039). This analysis by videofluoroscopy provides important insights into the mechanisms giving rise to swallowing disorders after the treatment of oropharyngeal cancer.
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Affiliation(s)
- L Santini
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Aix-Marseille Université, Marseille, France
| | - D Robert
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Aix-Marseille Université, Marseille, France
| | - A Lagier
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Aix-Marseille Université, Marseille, France
| | - A Giovanni
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Aix-Marseille Université, Marseille, France
| | - P Dessi
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Aix-Marseille Université, Marseille, France
| | - N Fakhry
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Aix-Marseille Université, Marseille, France.
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Santini L, Varoquaux A, Giovanni A, Dessi P, Michel J. Recurrent mandibular ameloblastoma with anterior skull base invasion: Case report. Rev Laryngol Otol Rhinol (Bord) 2015; 136:41-43. [PMID: 26749605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Recurrent ameloblastoma with skull base invasion is a rare clinical entity with poor prognosis. We report a case of a mandibular ameloblastoma recurrence involving the anterior skull base. The diagnostic and therapeutic processes are presented with emphasis on the radiologic features of ameloblastoma. Another aim of this case report is to underline the importance of close and long-term follow-up after resection. Ameloblastoma recurrences are frequent and mainly occur after incomplete surgical resection. These recurrences may be diagnosed late because of lack of symptoms in the mandibular area.
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Santini L, Legramante J, Condemi F, Santucci L, Panattoni M, Crobeddu P, Sergi D, Forleo G, Romeo F. Non-invasive hemodynamic analysis in cardiac resynchronization therapy patients wearing quadripolar left ventricular leads: the importance of pacing electrode selection. Minerva Cardioangiol 2014; 62:449-459. [PMID: 25275712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Quadripolar left ventricular (LV) leads offer multiple choices for LV pacing increasing programming flexibility. Aim of this study is to assess the influence of LV pacing vector selection on hemodynamic parameters for patients who underwent cardiac resynchronization therapy (CRT) using quadripolar LV lead chronically evaluated with a non-invasive approach by Nexfin(®) system provided analysis (BMEYE B.V., Amsterdam, The Netherlands). METHODS AND RESULTS In 16 CRT patients implanted with a quadripolar LV lead (mean follow-up 8,8 ±13,4 months after implantation), we measured Cardiac Output (CO), Mean Blood Pressure (MBP), Total Peripheral Resistance (TPR), LV dP/dt max and Stroke volume (SV) from each one of the ten available bipolar pacing configurations. All the recorded parameters showed marked differences among the ten pacing configurations, but dP/dt max, SV and TPR were those showing the wider range, depending of the selected pacing vector. The average delta for the whole group of subjects between the maximum and minimum hemodynamic values for each pacing configuration were 15.9% for SV, 21.1% for dP/dt max and 20.3% for TPR. Inter-individual analysis of data failed to identify a link between a specific pacing vector and the hemodynamic response. CONCLUSION Our study demonstrates that different bipolar pacing configurations, even if arising from a single CS branch, substantially modify the hemodynamic effect of LV pacing in CRT patients. Moreover, the non-invasive hemodynamic analysis suggests the better pacing configuration should be established individually and could represent an important issue in optimizing CRT during follow-up.
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Affiliation(s)
- L Santini
- Department of Cardiology Tor Vergata University, Rome, Italy -
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Fakhry N, Santini L, Lagier A, Dessi P, Giovanni A. Response to 'Re: Fakhry et al., Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours'. Int J Oral Maxillofac Surg 2014; 44:140. [PMID: 25282595 DOI: 10.1016/j.ijom.2014.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/12/2014] [Indexed: 11/17/2022]
Affiliation(s)
- N Fakhry
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Marseille, France.
| | - L Santini
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Marseille, France
| | - A Lagier
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Marseille, France
| | - P Dessi
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Marseille, France
| | - A Giovanni
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, Marseille, France
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Tittensor DP, Walpole M, Hill SLL, Boyce DG, Britten GL, Burgess ND, Butchart SHM, Leadley PW, Regan EC, Alkemade R, Baumung R, Bellard C, Bouwman L, Bowles-Newark NJ, Chenery AM, Cheung WWL, Christensen V, Cooper HD, Crowther AR, Dixon MJR, Galli A, Gaveau V, Gregory RD, Gutierrez NL, Hirsch TL, Hoft R, Januchowski-Hartley SR, Karmann M, Krug CB, Leverington FJ, Loh J, Lojenga RK, Malsch K, Marques A, Morgan DHW, Mumby PJ, Newbold T, Noonan-Mooney K, Pagad SN, Parks BC, Pereira HM, Robertson T, Rondinini C, Santini L, Scharlemann JPW, Schindler S, Sumaila UR, Teh LSL, van Kolck J, Visconti P, Ye Y. A mid-term analysis of progress toward international biodiversity targets. Science 2014; 346:241-4. [DOI: 10.1126/science.1257484] [Citation(s) in RCA: 807] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Fakhry N, Santini L, Lagier A, Dessi P, Giovanni A. Fine needle aspiration cytology and frozen section in the diagnosis of malignant parotid tumours. Int J Oral Maxillofac Surg 2014; 43:802-5. [DOI: 10.1016/j.ijom.2014.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/17/2013] [Accepted: 01/06/2014] [Indexed: 11/30/2022]
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Conzo G, Della Pietra C, Tartaglia E, Gambardella C, Mauriello C, Palazzo A, Santini L, Fei L, Rossetti G, Docimo G, Perna A. Long-term function of parathyroid subcutaneous autoimplantation after presumed total parathyroidectomy in the treatment of secondary hyperparathyroidism. A clinical retrospective study. Int J Surg 2014; 12 Suppl 1:S165-9. [PMID: 24866066 DOI: 10.1016/j.ijsu.2014.05.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Parathyroidectomy (PTx) is recommended in patients affected by secondary hyperparathyroidism (2HPT) of chronic kidney disease-mineral bone disorders (CKD-MBD), resistant to medical treatment. Analyzing total parathyroidectomy with muscular or subcutaneous autoimplantation (TPai) outcomes in hemodialysis (HD) 2HPT patients, and monitoring intact parathyroid hormone (iPTH) levels, we evaluated long-term functional results of subcutaneous parathyroid glandular tissue autoimplantation. METHODS 40 HD 2HPT patients, resistant to medical treatment, and awaiting for renal transplantation, underwent total parathyroidectomy with subcutaneous autoimplantation of 9-12 fragments of not nodular hyperplasia parathyroid tissue in not dominant forearm. iPTH were analyzed 24 h, and 3-6-12-24 months after surgery. The 1.08-6.99 pmol/L range was taken as reference of normal iPTH level based on which eu- (1.08-6.99), hypo- (<1.08), aparathyroidism (0) and persistence or relapse (>6.99) of disease were determined. RESULTS In every case PTai determined an extraordinary improvement of quality of life, associated with a notable reduction of iPTH serum level. Immediate normalization of iPTH was achieved in 50% of cases; hypoparathyroidism in 25% of cases and persistence of disease in 25% were observed. Long term follow-up showed a reduction of hypoparathyroidism and an increase of relapse rate up to 20%. Grafting resection was never performed. DISCUSSION Subcutaneous autotrasplantation is a very simple and fast surgical technique. Nevertheless, similar success and recurrence rates were reported following muscular or subcutaneous grafting, as confirmed in our experience. CONCLUSIONS Subcutaneous grafting was effective as muscular implantation, with comparable functional results, but avoiding its potential complications.
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Affiliation(s)
- G Conzo
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - C Della Pietra
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - E Tartaglia
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - C Gambardella
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - C Mauriello
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - A Palazzo
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - L Santini
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - L Fei
- Unit of General Surgery and Digestive Physiopathology - "F. Magrassi-A. Lanzara", Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - G Rossetti
- Unit of General Surgery and Digestive Physiopathology - "F. Magrassi-A. Lanzara", Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - G Docimo
- Department of Anaesthesiologic, Surgical and Emergency Science, VII Division of General Surgery, Second University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy.
| | - A Perna
- Department of Cardio-thoracic and Respiratory Sciences First Division of Nephrology, Second University of Naples, Italy.
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