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Golino L, Caiazzo G, Calabrò P, Colombo A, Contarini M, Fedele F, Gabrielli G, Galassi AR, Golino P, Scotto di Uccio F, Tarantini G, Argentino V, Balbi M, Bernardi G, Boccalatte M, Bonmassari R, Bottiglieri G, Caramanno G, Cesaro F, Cigala E, Chizzola G, Di Lorenzo E, Intorcia A, Fattore L, Galli S, Gerosa G, Giannotta D, Grossi P, Monda V, Mucaj A, Napodano M, Nicosia A, Perrotta R, Pieri D, Prati F, Ramazzotti V, Romeo F, Rubino A, Russolillo E, Spedicato L, Tuccillo B, Tumscitz C, Vigna C, Bertinato L, Armigliato P, Ambrosini V. Excimer laser technology in percutaneous coronary interventions: Cardiovascular laser society's position paper. Int J Cardiol 2022; 350:19-26. [PMID: 34995700 DOI: 10.1016/j.ijcard.2021.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
Abstract
Excimer Laser Coronary Atherectomy (ELCA) is a well-established therapy that emerged for the treatment of peripheral vascular atherosclerosis in the late 1980s, at a time when catheters and materials were rudimentary and associated with the most serious complications. Refinements in catheter technology and the introduction of improved laser techniques have led to their effective use for the treatment of a wide spectrum of complex coronary lesions, such as thrombotic lesions, severe calcific lesions, non-crossable or non-expandable lesions, chronic occlusions, and stent under-expansion. The gradual introduction of high-energy strategies combined with the contrast infusion technique has enabled us to treat an increasing number of complex cases with a low rate of periprocedural complications. Currently, the use of the ELCA has also been demonstrated to be effective in acute coronary syndrome (ACS), especially in the context of large thrombotic lesions.
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Affiliation(s)
- L Golino
- UOC Cardiologia/UTIC, Laboratorio di Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero S. Giuseppe Moscati, Aversa, Caserta, Italy.
| | - G Caiazzo
- UOC Cardiologia/UTIC, Laboratorio di Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero S. Giuseppe Moscati, Aversa, Caserta, Italy
| | - P Calabrò
- Cattedra di Cardiologia, Dipartimento di Medicina Traslazionale, Università degli Studi della Campania "Luigi Vanvitelli" - U.O.C. di Cardiologia Clinica a Direzione Universitaria A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
| | - A Colombo
- Cardiologia Interventistica, Centro Cuore Columbus, Milano, Italy
| | - M Contarini
- Cardiologia e Laboratorio di Emodinamica, Presidio Ospedaliero Umberto I° Siracusa, Italy
| | - F Fedele
- Cattedra di Cardiologia, Azienda Ospedaliero Universitaria Policlinico Umberto I°, Roma, Italy
| | - G Gabrielli
- Cardiologia Interventistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | - A R Galassi
- Cattedra di Cardiologia, Azienda Ospedaliera Universitaria, Policlinico "P. Giaccone", Palermo, Italy
| | - P Golino
- Cattedra di Cardiologia, Dipartimento di Scienze Medico-Translazionali, Università degli Studi della Campania "Luigi Vanvitelli", Sezione di Cardiologia, c/o Ospedale Monaldi, Napoli, Italy
| | | | - G Tarantini
- Unità Operativa Semplice Dipartimentale di "Emodinamica e Cardiologia Interventistica", Dipartimento Strutturale Aziendale Cardio-Toraco-Vascolare, Azienda Ospedaliera di Padova, Italy
| | - V Argentino
- Cardiologia Interventistica, Azienda Ospedaliera per l'Emergenza Cannizzaro, Catania, Italy
| | - M Balbi
- Cardiologia Interventistica, IRCCS Azienda Ospedaliera Universitaria S. Martino, Genova, Italy
| | - G Bernardi
- Associazione per la Ricerca in Cardiologia, Ospedale S. Maria degli Angeli, Pordenone, Italy
| | - M Boccalatte
- Laboratorio Emodinamica P.O. S. Maria delle Grazie ASL NA2, Pozzuoli, Napoli, Italy
| | - R Bonmassari
- Cardiologia Interventistica, Presidio Ospedaliero S. Chiara, Trento, Italy
| | - G Bottiglieri
- Cardiologia Interventistica, Ospedale "SS.Addolorata", Eboli, Salerno, Italy
| | - G Caramanno
- Cardiologia Interventistica, Presidio Ospedaliero S. Giovanni di Dio, Agrigento, Italy
| | - F Cesaro
- Cardiologia Università "Luigi Vanvitelli", Caserta, Italy
| | - E Cigala
- Cardiologia Interventistica, Azienda Ospedaliera dei Colli, Ospedale Monaldi, Napoli, Italy
| | - G Chizzola
- Cardiologia Interventistica, Azienda ospedaliera Universitaria Spedali Civili, Brescia, Italy
| | - E Di Lorenzo
- Cardiologia e Laboratorio di Emodinamica, AORN S. Giuseppe Moscati, Avellino, Italy
| | - A Intorcia
- Cardiologia e Laboratorio di Emodinamica, AORN S. Giuseppe Moscati, Avellino, Italy
| | - L Fattore
- UOC Cardiologia/UTIC, Laboratorio di Emodinamica e Cardiologia Interventistica, Presidio Ospedaliero S. Giuseppe Moscati, Aversa, Caserta, Italy
| | - S Galli
- Cardiologia Interventistica, IRCCS Centro Cardiologico Monzino, Milano, Italy
| | - G Gerosa
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università di Padova, Italy
| | - D Giannotta
- Cardiologia, Presidio Ospedaliero Gravina e Santo Pietro, Caltagirone, Catania, Italy
| | - P Grossi
- Cardiologia e Laboratorio di Emodinamica, Presidio Ospedaliero Mazzoni, Ascoli Piceno, Italy
| | - V Monda
- Cardiologia Interventistica, Azienda Ospedaliera dei Colli, Ospedale Monaldi, Napoli, Italy
| | - A Mucaj
- Cardiologia Interventistica, Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | - M Napodano
- Unità Operativa Semplice Dipartimentale di "Emodinamica e Cardiologia Interventistica", Dipartimento Strutturale Aziendale Cardio-Toraco-Vascolare, Azienda Ospedaliera di Padova, Italy
| | - A Nicosia
- Cardiologia Interventistica, Presidio Ospedaliero Giovanni Paolo II°, Ragusa, Italy
| | - R Perrotta
- Cardiologia Interventistica, Azienda Ospedaliera S. Anna e S. Sebastiano, Caserta, Italy
| | - D Pieri
- Cardiologia Interventistica, Presidio Ospedaliero G.F. Ingrassia, Palermo, Italy
| | - F Prati
- Cardiologia d'Urgenza ed Interventistica, Azienda Ospedaliera S. Giovanni Addolorata, Roma, Italy
| | - V Ramazzotti
- Cardiologia d'Urgenza ed Interventistica, Azienda Ospedaliera S. Giovanni Addolorata, Roma, Italy
| | - F Romeo
- UniCamillus International Medical University, Rome, Italy
| | - A Rubino
- Cardiologia Interventistica, Presidio Ospedaliero G.F. Ingrassia, Palermo, Italy
| | - E Russolillo
- Cardiologia Interventistica, Ospedale S. Giovanni Bosco, Napoli, Italy
| | - L Spedicato
- Cardiologia Interventistica, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - B Tuccillo
- Cardiologia Interventistica Ospedale del Mare, Napoli, Italy
| | - C Tumscitz
- Cattedra di Cardiologia, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - C Vigna
- Cardiologia Interventistica, IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Foggia, Italy
| | - L Bertinato
- Clinical Governance, Istituto Superiore di Sanità, Italy
| | - P Armigliato
- Scientific Board Cardiovascular Laser Society, Italy
| | - V Ambrosini
- Cardiologia e Laboratorio di Emodinamica, AORN S. Giuseppe Moscati, Avellino, Italy
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Valente S, Mattesini A, Rossini R, Berti S, Sorini Dini C, Politi A, Golino L, Romeo F, Musumeci G, Gensini GF, Di Mario C. [Fractional flow reserve: a practical guide for interventional cardiologists and the cardiologist's point of view]. G Ital Cardiol (Rome) 2017; 18:2S-8S. [PMID: 28845857 DOI: 10.1714/2743.27964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fractional flow reserve (FFR) is considered the gold standard for functional assessment of coronary stenosis in stable coronary artery disease. The use of FFR enables an ischemia-guided revascularization with improvement of clinical outcomes in a cost-effective fashion. Both clinical and interventional cardiologists should be aware of the advantages and potential pitfalls of this technique. We focus on FFR with the aim to provide the clinical cardiologist with information on indications and technical aspects to confirm a correct execution of FFR in different coronary anatomical settings.
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Affiliation(s)
- Serafina Valente
- Unità di Cardiologia Interventistica Strutturale, AOU Careggi, Firenze
| | - Alessio Mattesini
- Unità di Cardiologia Interventistica Strutturale, AOU Careggi, Firenze - Ospedale Moriggia-Pelascini, Gravedona ed Uniti, Como
| | - Roberta Rossini
- Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo
| | - Sergio Berti
- U.O. Cardiologia Interventistica, G. Pasquinucci Heart Hospital, Fondazione Toscana G. Monasterio, Massa
| | | | | | - Luca Golino
- Ospedale Moriggia-Pelascini, Gravedona ed Uniti, Como
| | - Francesco Romeo
- U.O.C. Cardiologia e Cardiologia Interventistica, Policlinico "Tor Vergata", Roma
| | | | | | - Carlo Di Mario
- Unità di Cardiologia Interventistica Strutturale, AOU Careggi, Firenze
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Rengo G, Galasso G, Vitale DF, Furgi G, Zincarelli C, Golino L, Femminella GD, Piscione F, Rengo F, Leosco D. An active lifestyle prior to coronary surgery is associated with improved survival in elderly patients. J Gerontol A Biol Sci Med Sci 2010; 65:758-63. [PMID: 20106960 DOI: 10.1093/gerona/glp216] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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
BACKGROUND An active lifestyle is associated with a reduced cardiovascular risk in middle-aged as well as in elderly patients. In the present study, we investigated the association between physical activity habits of elderly participants prior to coronary artery bypass grafting (CABG) and survival free from both all-cause and cardiac death. METHODS AND RESULTS Study population consisted of 587 elderly patients (>or=70 years) CABG patients stratified, according to the Physical Activity Scale for the Elderly (PASE), into less active (low PASE) and exercised (high PASE) groups. At follow-up (mean: 44.3 +/- 21.0 months), 33 (37.1%) of 89 total deaths occurred for cardiac causes. Sixty-month survival rate was 65% and 96% for low-PASE and high-PASE groups, respectively (log rank = 49.460, p < .0001). Cox survival analysis indicated a significant (p < .0001) nonlinear association between PASE score increments and improved survival with the most evident differences in the lowest score categories. A robust association was also found between low PASE score and increased cardiac-related mortality (p < .0001). CONCLUSIONS Our data indicate that a more active lifestyle is significantly associated with improved survival in elderly CABG patients. The nonlinearity of the relation suggests that more sedentary patients could have the most benefit on survival by increasing their exercise lifestyle habits. The improved outcome is explained by both cardiac and overall mortality reduction.
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Affiliation(s)
- Giuseppe Rengo
- Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Federico II University, Via Pansini 5, 80131 Naples, Italy.
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Leosco D, Rengo G, Iaccarino G, Filippelli A, Lymperopoulos A, Zincarelli C, Fortunato F, Golino L, Marchese M, Esposito G, Rapacciuolo A, Rinaldi B, Ferrara N, Koch WJ, Rengo F. Exercise training and β-blocker treatment ameliorate age-dependent impairment of β-adrenergic receptor signaling and enhance cardiac responsiveness to adrenergic stimulation. Am J Physiol Heart Circ Physiol 2007; 293:H1596-603. [PMID: 17557919 DOI: 10.1152/ajpheart.00308.2007] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiac β-adrenergic receptor (β-AR) signaling and left ventricular (LV) responses to β-AR stimulation are impaired with aging. It is shown that exercise and β-AR blockade have a favorable effect on cardiac and vascular β-AR signaling in several cardiovascular diseases. In the present study, we examined the effects of these two different strategies on β-AR dysregulation and LV inotropic reserve in the aging heart. Forty male Wistar-Kyoto aged rats were randomized to sedentary, exercise (12 wk treadmill training), metoprolol (250 mg·kg−1·day−1 for 4 wk), and exercise plus metoprolol treatment protocols. Ten male Wistar-Kyoto sedentary young rats were also used as a control group. Old trained, old metoprolol-treated, and old trained plus metoprolol-treated rats showed significantly improved LV maximal and minimal first derivative of the pressure rise responses to β-AR stimulation (isoproterenol) compared with old untrained animals. We found a significant reduction in cardiac sarcolemmal membrane β-AR density and adenylyl cyclase activity in old untrained animals compared with young controls. Exercise training and metoprolol, alone or combined, restored cardiac β-AR density and G-protein-dependent adenylyl cyclase activation in old rats. Although cardiac membrane G-protein-receptor kinase 2 levels were not upregulated in untrained old compared with young control rats, both exercise and metoprolol treatment resulted in a dramatic reduction of G-protein-receptor kinase 2 protein levels, which is a further indication of β-AR signaling amelioration in the aged heart induced by these treatment modalities. In conclusion, we demonstrate for the first time that exercise and β-AR blockade can similarly ameliorate β-AR signaling in the aged heart, leading to improved β-AR responsiveness and corresponding LV inotropic reserve.
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Affiliation(s)
- Dario Leosco
- Department of Internal Medicine, Cardiovascular Sciences and Immunology, University Federico II, Via Pansini 5, Edificio 2, 80131 Naples, Italy.
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Leosco D, Rengo G, Iaccarino G, Sanzari E, Golino L, De Lisa G, Zincarelli C, Fortunato F, Ciccarelli M, Cimini V, Altobelli GG, Piscione F, Galasso G, Trimarco B, Koch WJ, Rengo F. Prior Exercise Improves Age-Dependent Vascular Endothelial Growth Factor Downregulation and Angiogenesis Responses to Hind-Limb Ischemia in Old Rats. J Gerontol A Biol Sci Med Sci 2007; 62:471-80. [PMID: 17522350 DOI: 10.1093/gerona/62.5.471] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Downregulation of hypoxia-inducible factor 1 (HIF-1) and vascular endothelial growth factor (VEGF) are shown to be involved in age-dependent impairment of angiogenesis. In this study, we explore whether prior exercise is able to affect these molecular patterns favorably and to enhance neoangiogenesis in old Wistar rats with hind-limb ischemia. At day 7 after surgery, HIF-1alpha and VEGF expression increased in the ischemic muscle of trained animals. Exercise increased capillary density and limb perfusion as revealed by histologic, angiographic, and dyed bead techniques. Furthermore, exercise capacity and limb trophism have significantly improved in trained aged rats. In these animals, the reduction of VEGF serum levels has reflected the comprehensive improvement in local ischemia evoked by exercise. In conclusion, prior exercise represents a valid tool to counteract age-related molecular alterations resulting in impaired angiogenesis in response to ischemia.
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Affiliation(s)
- Dario Leosco
- Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Federico II University, Via Pansini 5, Edificio 2, 80131 Naples, Italy.
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