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Romanelli G, Giannini L, Martone R, Ambrosino R, Albanese R, Zoboli L, Zumbolo P, Di Zenobio A, Turtù S, Muzzi L, della Corte A. Estimation of the error field due to winding manufacturing and assembly tolerances of the DTT SC magnet system. Fusion Engineering and Design 2023. [DOI: 10.1016/j.fusengdes.2023.113588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Bandera F, Martone R, Chacko L, Ganesananthan S, Gilbertson JA, Ponticos M, Lane T, Martinez-Naharro A, Whelan C, Quarta C, Rowczenio D, Patel R, Razvi Y, Lachmann H, Wechelakar A, Brown J, Knight D, Moon J, Petrie A, Cappelli F, Guazzi M, Potena L, Rapezzi C, Leone O, Hawkins PN, Gillmore JD, Fontana M. The Authors' Reply. JACC Cardiovasc Imaging 2021; 14:2268-2269. [PMID: 34736599 DOI: 10.1016/j.jcmg.2021.09.025] [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] [Received: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
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Bandera F, Martone R, Chacko L, Ganesananthan S, Gilbertson JA, Ponticos M, Lane T, Martinez-Naharro A, Whelan C, Quarta C, Rowczenio D, Patel R, Razvi Y, Lachmann H, Wechelakar A, Brown J, Knight D, Moon J, Petrie A, Cappelli F, Guazzi M, Potena L, Rapezzi C, Leone O, Hawkins PN, Gillmore JD, Fontana M. Clinical Importance of Left Atrial Infiltration in Cardiac Transthyretin Amyloidosis. JACC Cardiovasc Imaging 2021; 15:17-29. [PMID: 34419399 PMCID: PMC8724534 DOI: 10.1016/j.jcmg.2021.06.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/20/2021] [Accepted: 06/01/2021] [Indexed: 01/01/2023]
Abstract
Objectives The aim of this study was to characterize left atrial (LA) pathology in explanted hearts with transthyretin amyloid cardiomyopathy (ATTR-CM); LA mechanics using echocardiographic speckle-tracking in a large cohort of patients with ATTR-CM; and to study the association with mortality. Background The clinical significance of LA involvement in ATTR-CM is of great clinical interest. Methods Congo red staining and immunohistochemistry was performed to assess the presence, type, and extent of amyloid and associated changes in 5 explanted ATTR-CM atria. Echo speckle tracking was used to assess LA reservoir, conduit, contractile function, and stiffness in 906 patients with ATTR-CM (551 wild-type (wt)-ATTR-CM; 93 T60A-ATTR-CM; 241 V122I-ATTR-CM; 21 other). Results There was extensive ATTR amyloid infiltration in the 5 atria, with loss of normal architecture, vessels remodeling, capillary disruption, and subendocardial fibrosis. Echo speckle tracking in 906 patients with ATTR-CM demonstrated increased atrial stiffness (median [25th-75th quartile] 1.83 [1.15-2.92]) that remained independently associated with prognosis after adjusting for known predictors (lnLA stiff: HR: 1.23; 95% CI: 1.03-1.49; P = 0.029). There was substantial impairment of the 3 phasic functional atrial components (reservoir 8.86% [5.94%-12.97%]; conduit 6.5% [4.53%-9.28%]; contraction function 4.0% [2.29%-6.56%]). Atrial contraction was absent in 22.1% of patients whose electrocardiograms showed sinus rhythm (SR) “atrial electromechanical dissociation” (AEMD). AEMD was associated with poorer prognosis compared with patients with SR and effective mechanical contraction (P = 0.0018). AEMD conferred a similar prognosis to patients in atrial fibrillation. Conclusions The phenotype of ATTR-CM includes significant infiltration of the atrial walls, with progressive loss of atrial function and increased stiffness, which is a strong independent predictor of mortality. AEMD emerged as a distinctive phenotype identifying patients in SR with poor prognosis.
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Affiliation(s)
- Francesco Bandera
- Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Raffaele Martone
- Tuscan Regional Amyloid Center, Careggi University Hospital (AOUC), Florence, Italy
| | - Liza Chacko
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | | | - Janet A Gilbertson
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Markella Ponticos
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Thirusha Lane
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Carol Whelan
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Cristina Quarta
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Dorota Rowczenio
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Rishi Patel
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Yousuf Razvi
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Helen Lachmann
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Ashutosh Wechelakar
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - James Brown
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Daniel Knight
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - James Moon
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Aviva Petrie
- Eastman Dental Institute, University College London, Grays Inn Road, London, United Kingdom
| | - Francesco Cappelli
- Tuscan Regional Amyloid Center, Careggi University Hospital (AOUC), Florence, Italy
| | - Marco Guazzi
- Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department for Biomedical Sciences for Health, University of Milano, Milan, Italy
| | | | - Claudio Rapezzi
- University Cardiological Center, University of Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Ornella Leone
- Academic Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom.
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Chiariello AG, Baruzzo M, Martone R, Pironti A, Terranova D. Application of the mirror procedure to the robustness and fault analysis of Divertor Tokamak Test facility. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cappelli F, Zampieri M, Fumagalli C, Nardi G, Del Monaco G, Matucci Cerinic M, Allinovi M, Taborchi G, Martone R, Gabriele M, Ungar A, Moggi Pignone A, Marchionni N, Di Mario C, Olivotto I, Perfetto F. Tenosynovial complications identify TTR cardiac amyloidosis among patients with hypertrophic cardiomyopathy phenotype. J Intern Med 2021; 289:831-839. [PMID: 33615623 DOI: 10.1111/joim.13200] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED Recent evidence suggests that carpal tunnel syndrome (CTS) and brachial biceps tendon rupture (BBTR) represent red flags for ATTR cardiac amyloidosis (ATTR-CA). The prevalence of upper limb tenosynovial complications in conditions entering differential diagnosis with CA, such as HCM or Anderson-Fabry disease (AFD), and hence their predictive accuracy in this setting, still remains unresolved. OBJECTIVE To investigate the prevalence of CTS and BBTR in a consecutive cohort of ATTR-CA patients, compared with patients with HCM or AFD and with individuals without cardiac disease history. PARTICIPANTS Consecutive patients with a diagnosis of ATTR-CA, HCM and AFD were evaluated. A control group of consecutive patients was recruited among subjects hospitalized for noncardiac reasons and no cardiac disease history. The presence of BBTR, CTS or prior surgery related to these conditions was ascertained. RESULTS 342 patients were prospectively enrolled, including 168 ATTR-CA (141 ATTRwt, 27 ATTRm), 81 with HCM/AFD (N = 72 and 9, respectively) and 93 controls. CTS was present in 75% ATTR-CA patients, compared with 13% and 10% of HCM/AFD and controls (P = 0.0001 for both comparisons). Bilateral CTS was present in 60% of ATTR-CA patients, while it was rare (2%) in the other groups. BBTR was present in 44% of ATTR-CA patients, 8% of controls and 1% in HCM/AFD. CONCLUSIONS CTS and BBTR are fivefold more prevalent in ATTR-CA patients compared with cardiac patients with other hypertrophic phenotypes. Positive predictive accuracy for ATTR-CA is highest when involvement is bilateral. Upper limb assessment of patients with HCM phenotypes is a simple and effective way to raise suspicion of ATTR-CA.
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Affiliation(s)
- F Cappelli
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.,Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - M Zampieri
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - C Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy
| | - G Nardi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - G Del Monaco
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - M Matucci Cerinic
- Dipartimento di Medicina Sperimentale e Clinica, Careggi University Hospital, Florence, Italy
| | - M Allinovi
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - G Taborchi
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - R Martone
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - M Gabriele
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - A Ungar
- Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy
| | - A Moggi Pignone
- IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - N Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Division of General Cardiology, Careggi University Hospital, Florence, Italy
| | - C Di Mario
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - I Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - F Perfetto
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.,Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy
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6
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Aimo A, Chubuchny V, Vergaro G, Barison A, Nicol M, Cohen-Solal A, Castiglione V, Spini V, Giannoni A, Petersen C, Taddei C, Pasanisi E, Chacko L, Martone R, Knight D, Brown J, Martinez-Naharro A, Passino C, Fontana M, Emdin M. A simple echocardiographic score to rule out cardiac amyloidosis. Eur J Clin Invest 2021; 51:e13449. [PMID: 33185887 DOI: 10.1111/eci.13449] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/31/2020] [Accepted: 11/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Early diagnosis of cardiac amyloidosis (CA) is warranted to initiate specific treatment and improve outcome. The amyloid light chain (AL) and inferior wall thickness (IWT) scores have been proposed to assess patients referred by haematologists or with unexplained left ventricular (LV) hypertrophy, respectively. These scores are composed of 4 or 5 variables, respectively, including strain data. METHODS Based on 2 variables common to the AL and IWT scores, we defined a simple score named AMYLoidosis Index (AMYLI) as the product of relative wall thickness (RWT) and E/e' ratio, and assessed its diagnostic performance. RESULTS In the original cohort (n = 251), CA was ultimately diagnosed in 111 patients (44%). The 2.22 value was selected as rule-out cut-off (negative likelihood ratio [LR-] 0.0). In the haematology subset, AL CA was diagnosed in 32 patients (48%), with 2.36 as rule-out cut-off (LR- 0.0). In the hypertrophy subset, ATTR CA was diagnosed in 79 patients (43%), with 2.22 as the best rule-out cut-off (LR- 0.0). In the validation cohort (n = 691), the same cut-offs proved effective: indeed, there were no patients with CA in the whole population or in the haematology or hypertrophy subsets scoring < 2.22, <2.36 or < 2.22, respectively. CONCLUSIONS The AMYLI score (RWT*E/e') may have a role as an initial screening tool for CA. A < 2.22 value excludes the diagnosis in patients undergoing a diagnostic screening for CA, while a < 2.36 and a < 2.22 value may be better considered in the subsets with suspected cardiac AL amyloidosis or unexplained hypertrophy, respectively.
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Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Andrea Barison
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Martin Nicol
- Cardiology Department, Hopital Lariboisiere, Paris, France
| | | | | | - Valentina Spini
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Christina Petersen
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Claudia Taddei
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Emilio Pasanisi
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Liza Chacko
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Raffaele Martone
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Dan Knight
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - James Brown
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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7
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Chacko L, Boldrini M, Martone R, Law S, Martinez-Naharrro A, Hutt DF, Kotecha T, Patel RK, Razvi Y, Rezk T, Cohen OC, Brown JT, Srikantharajah M, Ganesananthan S, Lane T, Lachmann HJ, Wechalekar AD, Sachchithanantham S, Mahmood S, Whelan CJ, Knight DS, Moon JC, Kellman P, Gillmore JD, Hawkins PN, Fontana M. Cardiac Magnetic Resonance-Derived Extracellular Volume Mapping for the Quantification of Hepatic and Splenic Amyloid. Circ Cardiovasc Imaging 2021; 14:CIRCIMAGING121012506. [PMID: 33876651 DOI: 10.1161/circimaging.121.012506] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systemic amyloidosis is characterized by amyloid deposition that can involve virtually any organ. Splenic and hepatic amyloidosis occurs in certain types, in some patients but not others, and may influence prognosis and treatment. SAP (serum amyloid P component) scintigraphy is uniquely able to identify and quantify amyloid in the liver and spleen, thus informing clinical management, but it is only available in 2 centers globally. The aims of this study were to examine the potential for extracellular volume (ECV) mapping performed during routine cardiac magnetic resonance to: (1) detect amyloid in the liver and spleen and (2) estimate amyloid load in these sites using SAP scintigraphy as the reference standard. METHODS Five hundred thirty-three patients referred to the National Amyloidosis Centre, London, between 2015 and 2017 with suspected systemic amyloidosis who underwent SAP scintigraphy and cardiac magnetic resonance with T1 mapping were studied. RESULTS The diagnostic performance of ECV to detect splenic and hepatic amyloidosis was high for both organs (liver: area under the curve, -0.917 [95% CI, 0.880-0.954]; liver ECV cutoff, 0.395; sensitivity, 90.7%; specificity, 77.7%; P<0.001; spleen: area under the curve, -0.944 [95% CI, 0.925-0.964]; spleen ECV cutoff, 0.385; sensitivity, 93.6%; specificity, 87.5%; P<0.001). There was good correlation between liver and spleen ECV and amyloid load assessed by SAP scintigraphy (r=0.504, P<0.001; r=0.693, P<0.001, respectively). There was high interobserver agreement for both the liver and spleen (ECV liver intraclass correlation coefficient, 0.991 [95% CI, 0.984-0.995]; P<0.001; ECV spleen intraclass correlation coefficient, 0.995 [95% CI, 0.991-0.997]; P<0.001) with little bias across a wide range of ECV values. CONCLUSIONS Our study demonstrates that ECV measurements obtained during routine cardiac magnetic resonance scans in patients with suspected amyloidosis can identify and measure the magnitude of amyloid infiltration in the liver and spleen, providing important clues to amyloid type and offering a noninvasive measure of visceral amyloid burden that can help guide and track treatment.
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Affiliation(s)
| | | | - Raffaele Martone
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
- Department of Heart, Lung and Vessels, Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy (R.M.)
| | - Steven Law
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Ana Martinez-Naharrro
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - David F Hutt
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | | | - Rishi K Patel
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Yousuf Razvi
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Tamer Rezk
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Oliver C Cohen
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - James T Brown
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Mukunthan Srikantharajah
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Sharmananthan Ganesananthan
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Thirusha Lane
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Helen J Lachmann
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Ashutosh D Wechalekar
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Sajitha Sachchithanantham
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Shameem Mahmood
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Carol J Whelan
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Daniel S Knight
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, United Kingdom. (J.C.M.)
- Barts Heart Centre, Cardiovascular Magnetic Resonance Imaging Unit, and the Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, London, United Kingdom (J.C.M.)
| | - Peter Kellman
- Department of Health and Human Services, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.K.)
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Philip N Hawkins
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom. (L.C., M.B., R.M., S.L., A.M.-N., D.F.H., T.K., R.K.P., Y.R., T.R., O.C.C., J.B., M.S., S.G., T.L., H.L., A.W., S.S., S.M., C.W., D.S.K., J.G., P.N.H., M.F.)
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8
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Bartolini S, Baldasseroni S, Fattirolli F, Silverii MV, Piccioli L, Perfetto F, Marchionni N, Di Mario C, Martone R, Taborchi G, Morini S, Vignini E, Cappelli F. Poor right ventricular function is associated with impaired exercise capacity and ventilatory efficiency in transthyretin cardiac amyloid patients. Intern Emerg Med 2021; 16:653-660. [PMID: 32918156 DOI: 10.1007/s11739-020-02474-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/08/2020] [Indexed: 01/09/2023]
Abstract
CardioPulmonary Exercise Test (CPET) is the gold standard to evaluate functional capacity in patients at high risk of heart failure (HF). Few studies with a limited number of subjects and conflicting results, analyzed the role of CPET in patients with systemic amyloidosis. Aims of our study were the assessment of the response to exercise in patients with Transthyretin amyloid (ATTR) cardiomyopathy (CA), and the correlation of clinical, biohumoral and echocardiographic parameters with CPET parameters, such as VO2 peak and VE/VCO2 slope. From February 2018 to March 2019, 72 cardiac ATTR patients were prospectively enrolled and underwent a complete clinical, biohumoral, echocardiographic and CPET assessment. All patients completed the exercise stress test protocol, without any adverse event. At CPET, they achieved a mean VO2 peak of 14 mL/Kg/min and a mean VE/VCO2 slope of 31. The blood pressure response to exercise was inadequate in 26 (36%) patients (flat in 25 and hypotensive in 1), while 49/72 patients (69%) showed an inadequate heart rate recovery. In multivariate analysis, s' tricuspidalic was the only independent predictor of VO2 peak, while in the two test models performed to avoid collinearity, both TAPSE and s' tricuspidalic were the strongest independent predictors of VE/VCO2 slope. Our data demonstrate the role of right ventricular function as an independent predictor of exercise capacity and ventilatory efficiency in ATTR. In CPET evaluation, a significant proportion of patients presented an abnormal arterial pressure response and heart rate variation to exercise.
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Affiliation(s)
- Simone Bartolini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
- Cardiology Department, Azienda Sanitaria Firenze (ASF), Florence, Italy
| | | | - Francesco Fattirolli
- Cardiac Rehabilitation Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Vittoria Silverii
- Cardiac Rehabilitation Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lucrezia Piccioli
- Cardiac Rehabilitation Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, Division of General Cardiology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Department of Experimental and Clinical Medicine, Division of General Cardiology, University of Florence, Careggi University Hospital, Florence, Italy
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Raffaele Martone
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Giulia Taborchi
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Sofia Morini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Elisa Vignini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
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9
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Bandera F, Martone R, Chacko L, Ganesananthan S, Gilbertson JA, Ponticos M, Petrie A, Cappelli F, Guazzi M, Potena L, Rapezzi C, Leone O, Hawkins P, Gillmore JD, Fontana M. Clinical importance of left atrial infiltration in cardiac transthyretin amyloidosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.176] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
INTRODUCTION
The clinical significance of left atrial (LA) involvement in ATTR amyloidosis cardiomyopathy (ATTR-CM) has not been characterized. The aims of this study were to characterize: (1)LA pathology in explanted ATTR-CM hearts; (2)LA mechanics using echocardiographic speckle-tracking in a large cohort of ATTR-CM patients; (3)to study the association with mortality.
METHODS AND RESULTS
Congo red staining and immunohistochemistry was performed to assess the presence, type and extent of amyloid and associated changes in 5 explanted ATTR-CM atria. Echo speckle-tracking was used to assess LA reservoir, conduit, contractile function and stiffness in 906 ATTR-CM patients (551 wt-ATTR-CM;93 T60A-ATTR-CM;241 V122I-ATTR-CM;21 other).
There was extensive ATTR amyloid infiltration in the 5 atria with loss of normal architecture, vessels remodelling, capillary disruption and subendocardial fibrosis. Echo speckle-tracking in 906 ATTR-CM patients demonstrated increased atrial stiffness [median(25th-75th quartile) 1.83(1.15-2.92)] that remained independently associated with prognosis, after adjusting for known predictors (lnLA stiff:HR = 1.26,CI 1.07-1.57;p = 0.009). There was substantial impairment of the three phasic functional atrial components [reservoir 8.86(5.94-12.97)%; conduit 6.5(4.53-9.28)%; contraction function 4.0(2.29-6.56)%]. Atrial contraction was absent in 21.6% of patients whose ECG showed sinus rhythm (SR)-"atrial electro-mechanical dissociation"(AEMD). AEMD was associated with poorer prognosis compared to SR patients with effective mechanical contraction (p < 0.0001). AEMD conferred a similar prognosis to patients in AF.
CONCLUSION
The phenotype of ATTR-CM includes significant infiltration of the atrial walls with progressive loss of atrial function and increased stiffness, which is a strong independent predictor of mortality. AEMD emerged as a distinctive phenotype identifying patients in SR with poor prognosis.
Abstract Figure.
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Affiliation(s)
- F Bandera
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - R Martone
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - L Chacko
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Ganesananthan
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JA Gilbertson
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ponticos
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - A Petrie
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - F Cappelli
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - M Guazzi
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - L Potena
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - C Rapezzi
- University Hospital of Ferrara, Ferrara, Italy
| | - O Leone
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - P Hawkins
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - JD Gillmore
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom of Great Britain & Northern Ireland
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10
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Gallini C, Tutino F, Martone R, Ciaccio A, Costanzo EN, Taborchi G, Morini S, Bartolini S, Farsetti S, Di Mario C, Perfetto F, Cappelli F. Semi-quantitative indices of cardiac uptake in patients with suspected cardiac amyloidosis undergoing 99mTc-HMDP scintigraphy. J Nucl Cardiol 2021; 28:90-99. [PMID: 30767162 DOI: 10.1007/s12350-019-01643-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND 99mTc-HMDP scintigraphy has proved its efficacy in non-invasive diagnosis of cardiac amyloidosis (CA) and is currently interpreted according to the Perugini qualitative assessment. Several semi-quantitative indices have been proposed to overcome inherent possible limitations of visual grading. Our aim was to comparatively evaluate six different indices and their diagnostic performance. METHODS We retrospectively reviewed scintigraphy of 76 patients (53 ATTR, 12 AL, 11 LVH) who underwent diagnostic evaluation at our centre. ROC-curve analysis was performed to identify optimal cut-off and relative diagnostic accuracy of six different indices (of which one was proposed for the first time), both in identifying CA patients and in discriminating patients according to their Perugini score. RESULTS Heart/Whole-body ratios proved to be the most accurate (100%) in identifying CA patients. Heart/Pelvis ratio (with soft tissue background correction) offered acceptable accuracy (98%), with the largest area under the curve (AUC) (0.98) in discriminating patients with Perugini ≥ 2. Heart/Contralateral Lung ratio confirmed to be exposed to confounding background noise in case of simultaneous lung uptake. Heart/Skull ratio had the worst performance, with six false-negative patients in ATTR identification. CONCLUSION Heart/Whole-body ratios may be robust and effective semi-quantitative indices for the evaluation of CA by means of scintigraphy.
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Affiliation(s)
- Chiara Gallini
- Nuclear Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Francesca Tutino
- Nuclear Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Raffaele Martone
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy
| | - Alfonso Ciaccio
- Nuclear Medicine Unit, Careggi University Hospital, Florence, Italy
| | | | - Giulia Taborchi
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy
| | - Sofia Morini
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy
| | - Simone Bartolini
- Cardiovascular and Thoracic Department, Careggi University Hospital, Florence, Italy
| | - Silvia Farsetti
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Interventional Structural Cardiology Division, Department of Heart, Lung and Vessels, Careggi University Hospital, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy.
- Intensive Cardiac Care Unit, Interventional Structural Cardiology Division, Department of Heart, Lung and Vessels, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
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11
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Aquaro GD, Morini S, Grigoratos C, Taborchi G, Di Bella G, Martone R, Vignini E, Emdin M, Olivotto I, Perfetto F, Cappelli F. Electromechanical dissociation of left atrium in patients with Cardiac Amyloidosis by Magnetic Resonance: Prognostic and clinical correlates. Int J Cardiol Heart Vasc 2020; 31:100633. [PMID: 32995476 PMCID: PMC7501430 DOI: 10.1016/j.ijcha.2020.100633] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Left atrial (LA) function is an important marker of hemodynamic status in cardiac amyloidosis (CA), and its characterization may provide relevant prognostic information. We sought to assess the prevalence and prognostic impact of LA dysfunction by cardiac magnetic resonance (CMR) in patients with CA. METHODS We performed CMR in 80 consecutive patients with CA, including 38 with AL (47%) and 42 with ATTR (53%). LA function was assessed by acquiring short axis cine steady-state free precession (SSFP) covering the entire chamber. The atrial emptying fraction (AEF) was calculated as the ratio between the difference of LA maximal and minimal volume to LA maximal volume, expressed as percentage. Severe atrial dysfunction was defined as AEF ≤ 14%. RESULTS Mean AEF was 18% (13-35%). Overall, AEF ≤ 14% was present in 19 patients (24%), including 21% of those in sinus rhythm (SR) with no history of atrial fibrillation (AF). After a median of 3 years (IQR 2-4), 36 patients (44%) died of cardiac causes. Patients with AEF ≤ 14% showed increased cardiac mortality, with an independent OR of 4.2 (95 IC 2.1-8.2, P < 0.0001). Of note, AEF ≤ 14% was the stronger independent predictor of cardiac death. Patients in SR with AEF ≤ 14% had worse outcome than those with AF. CONCLUSIONS Severe impairment of LA contractile function was present in three-quarters of patients with CA, and was prevalent irrespective of CA etiology, both in the presence and absence of AF. Severe LA dysfunction was associated with an independent 4-fold increase in risk for cardiac death at three years.
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Affiliation(s)
| | - Sofia Morini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | | | - Giulia Taborchi
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | | | - Raffaele Martone
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Elisa Vignini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | | | - Iacopo Olivotto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
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12
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Chacko L, Martinez-Naharro A, Kotecha T, Martone R, Hutt D, Lane T, Knight D, Moon J, Kellman P, Hawkins P, Gillmore J, Fontana M. Regression of cardiac amyloid deposits with novel therapeutics: reaching new frontiers in cardiac ATTR amyloidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2117] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac involvement is the main driver of outcome in ATTR amyloidosis. Advances in therapeutics hold potential in transforming the course of the disease but the impact on cardiac amyloid load is unknown. The aim of this study was to evaluate the impact of patisiran, a new double stranded RNA based gene silencing therapy and a stabilizer, diflunisal, on cardiac amyloid load as measured by CMR and T1 mapping, in patients with ATTR amyloidosis.
Methods and results
Thirty-two patients with hereditary cardiac amyloidosis were studied. Sixteen patients received treatment with patisiran, and sixteen control subjects did not receive any disease modifying treatment. Patients were assessed with echocardiogram, CMR, NT-proBNP and six-minute walk time measurements at baseline and at 1 year (Mean interval 11.45±3.08 months in treatment group, mean interval 12.82±5.06 months in the control group). CMR analysis comprised LV volumes, T1 mapping to measure the extracellular volume (ECV) occupied by amyloid, T2 mapping and late gadolinium enhancement imaging. At 1-year follow-up, there was a substantial reduction in cardiac amyloid burden, in keeping with cardiac amyloid regression in 45% of patients on treatment. Overall the treatment group showed a reduction in ECV at 1 year follow up compared to an increase in ECV at 1 year in the control group (−1.37%, 95% CI: −3.43 to 0.68% versus 5.02%, 95% CI: 2.86% to 7.18% respectively, p<0.001). The treatment group also showed an improvement in change in 6MWT at 1 year follow up compared to 6MWT at 1 year in the control group (−8.12 meters, 95% CI: −50.8 to 34.6 meters in the treatment group versus −132.27 meters, 95% CI: −216 to −48.6 meters in the control group, p=0.002). The treatment group showed a reduction in BNP at 1 year follow up compared to an increase in the control group (−567.87, 95% CI: −1288.90 to 153.15 in the treatment group versus 2004, 95% CI: 12.82 to 3995.45 in the control group, p<0.001). There was no significant difference from baseline and 1-year data between the control and treatment groups for the difference in echocardiographic parameters, native T1, T2. There was a significant reduction in the percentage of injected dose by 99Tc-DPD scintigraphy in treated patients at 1 year compared to baseline.
Conclusions
These findings provide the first compelling evidence of substantial cardiac amyloid regression in ATTR amyloidosis, as well as the potential for CMR to be used to track response in treated patients with ATTR cardiac amyloidosis. Combination therapy with transthyretin knock down and stabilizing agents may well be synergistic given enhanced stoichiometry of stabilizers in the face of much reduced plasma transthyretin concentration.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Chacko
- University College Hospital, London, United Kingdom
| | | | - T Kotecha
- University College Hospital, London, United Kingdom
| | - R Martone
- Careggi University Hospital, Florence, Italy
| | - D Hutt
- University College Hospital, London, United Kingdom
| | - T Lane
- University College Hospital, London, United Kingdom
| | - D Knight
- University College Hospital, London, United Kingdom
| | - J Moon
- Barts Heart Centre, London, United Kingdom
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - P Hawkins
- University College Hospital, London, United Kingdom
| | - J Gillmore
- University College Hospital, London, United Kingdom
| | - M Fontana
- University College Hospital, London, United Kingdom
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13
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Bandera F, Martone R, Chacko L, Ganesananthan S, Lane T, Martinez-Naharro A, Whelan C, Quarta C, Rowczenio D, Gilbertson J, Lachmann H, Guazzi M, Hawkins P, Gillmore J, Fontana M. Atrial strain in cardiacATTR amyloidosis from pathophysiology to prognosis: is it time to rethink our approach to disease? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left atrial (LA) involvement in cardiac ATTR amyloidosis (ATTR-CM) has never being explored. The aim of the study is to characterize the spectrum of changes in LA structure in ATTR-CM, the functional consequences on LA mechanics and the association with mortality.
Methods
We studied 936 patients with ATTR-CM who underwent prospective protocolized evaluations comprising ECG, full echocardiographic assessment, 6MWT, blood biomarkers sampling and survival assessment between 2000 and 2019. Reservoir (LAr), conduit (LAcd) and booster (LAcont) function were assessed according to current guidelines. LA stiffness (LAstiff) was estimated as the ratio between E/e' and LAr. The presence and extent of amyloid infiltration was assessed in two autopsied hearts from patients ATTR-CM with congo red staining and TTR antibodies.
Results
936 patients with ATTR-CM were included, 567 with wtATTR-CM and 346 with hATTR-CM, of whom 246 had the V122I variant and 100 the T60A variant. LA indexed area was similar across the 3 genotypes, whilst LAr, LAcd and LAcont were significantly reduced in V122I patients compared to Wt and T60A patients (LAr: 10.4±6.4 vs 12.8±8.5 vs 8.59±5.7%, p<0.0001; LAcd: 5.6±5.0 vs 6.9±5.7 vs 4.0±3.6%, p<0.0001; LAcont 7.5±4.1 vs 8.2±4.9 vs 6.7±4.2%, p=0.023; in Wt, T60 and V122I respectively). Similarly, LAstiff was significantly worse in V122I compared to Wt and T60A (LAstiff: 2.39±2.62 vs 2.59±4.83 vs 2.96±2.88, p<0.0001, in Wt, T60 and V122I respectively). In the overall population, LAstiff remained independently associated with mortality, after adjusting for rhythm, systolic and diastolic functional parameters, ventricular longitudinal strain, genotypes, clinical variables and NAC staging system (lnLA stiff: HR=1.26, CI: 1.07–1.57; p=0.009). In the overall population, 584 patients were in sinus rhythm and 344 in atrial fibrillation, atrial flutter or atrial tachycardia (non-sinus rhythm group – NSR). Among patients in SR, 21.6% did not show a measurable LA mechanical contraction on strain analysis (LAcont). Patients in SR without LAcont on strain analysis showed similar structural and functional LA changes, NTproBNP, NYHA class, and 6MWT to NSR patients. Mortality of patients in SR with no LAcont was significantly reduced compared to patients in SR with LAcont and similar to patients in AF (Figure 1). On the two autopsies hearts there was extensive amyloid infiltration of TTR type in the atrial wall as confirmed with CR and TTR antibodies (Figure 1).
Conclusions
ATTR-CM is characterized by primary infiltration of the atrial walls with progressive loss of atrial function and increased stiffness. LA stiffness is a strong independent predictor of mortality after adjusting for known predictors. Atrial electro-mechanical dissociation emerged as a distinctive functional phenotype identifying patients in SR with worse prognosis.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Bandera
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - R Martone
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - L Chacko
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - S Ganesananthan
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - T Lane
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - A Martinez-Naharro
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - C Whelan
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - C Quarta
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - D Rowczenio
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - J.A Gilbertson
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - H Lachmann
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - M Guazzi
- IRCCS Polyclinic San Donato, Department of University Cardiology, Milan, Italy
| | - P.N Hawkins
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - J.D Gillmore
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
| | - M Fontana
- Royal Free Hospital, National Amyloidosis Centre, University College London, London, United Kingdom
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14
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Cappelli F, Vignini E, Martone R, Perlini S, Mussinelli R, Sabena A, Morini S, Gabriele M, Taborchi G, Bartolini S, Lossi A, Nardi G, Marchionni N, Di Mario C, Olivotto I, Perfetto F. Baseline ECG Features and Arrhythmic Profile in Transthyretin Versus Light Chain Cardiac Amyloidosis. Circ Heart Fail 2020; 13:e006619. [PMID: 32164434 DOI: 10.1161/circheartfailure.119.006619] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 01/15/2023]
Affiliation(s)
- Francesco Cappelli
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Florence, Italy (F.C., E.V., R. Martone, S.M., G.T., S.B., F.P.)
| | - Elisa Vignini
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Florence, Italy (F.C., E.V., R. Martone, S.M., G.T., S.B., F.P.)
| | - Raffaele Martone
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Florence, Italy (F.C., E.V., R. Martone, S.M., G.T., S.B., F.P.)
| | - Stefano Perlini
- Emergency Department, Amyloid Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy (S.P., R. Mussinelli, A.S.)
| | - Roberta Mussinelli
- Emergency Department, Amyloid Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy (S.P., R. Mussinelli, A.S.)
| | - Anna Sabena
- Emergency Department, Amyloid Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy (S.P., R. Mussinelli, A.S.)
| | - Sofia Morini
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Florence, Italy (F.C., E.V., R. Martone, S.M., G.T., S.B., F.P.)
| | - Martina Gabriele
- Division of General Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy (M.G., A.L., G.N., N.M.)
| | - Giulia Taborchi
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Florence, Italy (F.C., E.V., R. Martone, S.M., G.T., S.B., F.P.)
| | - Simone Bartolini
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Florence, Italy (F.C., E.V., R. Martone, S.M., G.T., S.B., F.P.)
| | - Angelica Lossi
- Division of General Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy (M.G., A.L., G.N., N.M.)
| | - Giulia Nardi
- Division of General Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy (M.G., A.L., G.N., N.M.)
| | - Niccolò Marchionni
- Division of General Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy (M.G., A.L., G.N., N.M.)
| | - Carlo Di Mario
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy (I.O.)
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Florence, Italy (F.C., E.V., R. Martone, S.M., G.T., S.B., F.P.)
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15
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Cappelli F, Martone R, Gabriele M, Taborchi G, Morini S, Vignini E, Allinovi M, Di Gioia M, Bartolini S, Di Mario C, Perfetto F. Biomarkers and Prediction of Prognosis in Transthyretin-Related Cardiac Amyloidosis: Direct Comparison of Two Staging Systems. Can J Cardiol 2020; 36:424-431. [DOI: 10.1016/j.cjca.2019.12.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 01/17/2023] Open
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16
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Chacko L, Martone R, Bandera F, Lane T, Martinez-Naharro A, Boldrini M, Rezk T, Whelan C, Quarta C, Rowczenio D, Gilbertson JA, Wongwarawipat T, Lachmann H, Wechalekar A, Sachchithanantham S, Mahmood S, Marcucci R, Knight D, Hutt D, Moon J, Petrie A, Cappelli F, Guazzi M, Hawkins PN, Gillmore JD, Fontana M. Echocardiographic phenotype and prognosis in transthyretin cardiac amyloidosis. Eur Heart J 2020; 41:1439-1447. [DOI: 10.1093/eurheartj/ehz905] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [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] [Received: 07/17/2019] [Revised: 10/01/2019] [Accepted: 12/07/2019] [Indexed: 12/15/2022] Open
Abstract
Abstract
Aims
Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. We sought to characterize the structural and functional echocardiographic phenotype across the spectrum of wild-type (wtATTR-CM) and hereditary (hATTR-CM) transthyretin cardiomyopathy and the echocardiographic features predicting prognosis.
Methods and results
We studied 1240 patients with ATTR-CM who underwent prospective protocolized evaluations comprising full echocardiographic assessment and survival between 2000 and 2019, comprising 766 with wtATTR-CM and 474 with hATTR-CM, of whom 314 had the V122I variant and 127 the T60A variant. At diagnosis, patients with V122I-hATTR-CM had the most severe degree of systolic and diastolic dysfunction across all echocardiographic parameters and patients with T60AhATTR-CM the least; patients with wtATTR-CM had intermediate features. Stroke volume index, right atrial area index, longitudinal strain, and E/e’ were all independently associated with mortality (P < 0.05 for all). Severe aortic stenosis (AS) was also independently associated with prognosis, conferring a significantly shorter survival (median survival 22 vs. 53 months, P = 0.001).
Conclusion
The three distinct genotypes present with varying degrees of severity. Echocardiography indicates a complex pathophysiology in which both systolic and diastolic function are independently associated with mortality. The presence of severe AS was independently associated with significantly reduced patient survival.
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Affiliation(s)
- Liza Chacko
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Raffaele Martone
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
- Department of Heart, Lung and Vessels, Tuscan Regional Amyloid Center, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Francesco Bandera
- Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Piazza Malan, 1, San Donato Milanese, Milan 20097, Italy
- Department for Biomedical Sciences for Health, University of Milano, Via Luigi Mangiagalli, 31, Milan 20133, Italy
| | - Thirusha Lane
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Michele Boldrini
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Tamer Rezk
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Carol Whelan
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Cristina Quarta
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Dorota Rowczenio
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Janet A Gilbertson
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Tanakal Wongwarawipat
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Helen Lachmann
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Ashutosh Wechalekar
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Sajitha Sachchithanantham
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Shameem Mahmood
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Daniel Knight
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - David Hutt
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - James Moon
- Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit, and the Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Aviva Petrie
- Biostatistics Unit, UCL Eastman Dental Institute, University College London, 256 Grays Inn Road, London WC1X 8LD, UK
| | - Francesco Cappelli
- Department of Heart, Lung and Vessels, Tuscan Regional Amyloid Center, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Marco Guazzi
- Heart Failure Unit, Cardiology University Department, IRCCS Policlinico San Donato, Piazza Malan, 1, San Donato Milanese, Milan 20097, Italy
- Department for Biomedical Sciences for Health, University of Milano, Via Luigi Mangiagalli, 31, Milan 20133, Italy
| | - Philip N Hawkins
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
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Affiliation(s)
- Raffaele Martone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy
- Intensive Care Unit, Interventional Structural Cardiology Division, Department of Heart, Lung and Vessels, Careggi University Hospital, Florence, Italy
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18
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Martone R, Taborchi G, Bartolini S, Morini S, Lossi A, Perlini S, Mussinelli R, Sabena A, Palladini G, Gabriele M, Vignini E, Di Mario C, Olivotto I, Perfetto F, Cappelli F. P2732Prevalence of electrocardiographic abnormalities in patients with cardiac amyloidosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Electrocardiographic (ECG) abnormalities are common in patients presenting with Light-Chain (AL) or Transthyretin (ATTR) related Cardiac Amyloidosis (CA). Type of amyloid may differently affect electrical properties of the heart being responsible for variable patterns of ECG anomalies at presentation.
Purpose
In this retrospective, observational study we sought to compare prevalence of ECG abnormalities between AL and ATTR patients with CA.
Methods
Clinical files from two Referral Centres were reviewed; ECG recordings were analysed by trained cardiologists and relevant findings were reported about rhythm (sinus vs atrial fibrillation [AF]), grade I or grade II atrio-ventricular (AV) delays, intra-ventricular (IV) conduction abnormalities, low-voltage QRS and pseudo-necrosis pattern. Presence of pace-maker (PM) and stimulated QRS were regarded to as clinical equivalents for AV block, after review of indications to implantation.
Results
Two hundred and fifty-one patients were identified (127 ATTR vs 124 AL; among ATTR, 27 patients had mutation in TTR gene: 10 Val142Ile, 11 Ile88Leu, 6 other). As expected, most ATTR patients were male (89% vs 56% in AL, p: <0.001), and AL patients were younger (mean age 64 [53–70] vs 79 [73–83]; p: <0.001).
Pathological ECG findings were common in both subgroups, involving more than three-quarters of the overall population (82% in ATTR, vs 72% in AL, p: 0.06). Atrial fibrillation was more common in ATTR, prevailing in 39% vs 5.6% (p: <0.001). ATTR had a higher burden of AV block (53% vs 13%, p: <0.001) and IV conduction delays (43% vs 21%, p: <0.001), and consistently presented a higher prevalence of PMs (24 patients vs 1). Low-voltage QRS was more prevalent in AL patients (52% vs 28%, p: <0.001), while no significant difference was found in prevalence of pseudo-necrosis patterns (ATTR: 29%, AL: 40%; p: ns).
Due to imbalance in age and gender and relative possible confounding effect on rhythm disturbances, adjusted odds ratios (OR) were calculated. It resulted that ATTR was independently associated with a higher prevalence of AF and AV conduction delays when compared to AL (adjusted OR: 4 [95% CI: 1.4–11.2], p: 0.008, and 6.2 [95% CI: 2.6–14.9], p: <0.001; respectively), while being inversely associated with low-voltage QRS (adjusted OR: 0.4 [95% CI: 0.2–0.9], p: 0.026).
Conclusions
ECG abnormalities are common in CA. Rhythm disturbances are more prevalent in ATTR, while AL more often results in low-voltage QRS. Such differences remain relevant after adjustment for age and gender imbalance, thus suggesting an aetiology-specific link.
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Affiliation(s)
- R Martone
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - G Taborchi
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - S Bartolini
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - S Morini
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - A Lossi
- University of Florence, Florence, Italy
| | - S Perlini
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - R Mussinelli
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - A Sabena
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - G Palladini
- Amyloidosis Research and Treatment Center, Pavia, Italy
| | - M Gabriele
- Careggi University Hospital (AOUC), Florence, Italy
| | - E Vignini
- Careggi University Hospital (AOUC), Florence, Italy
| | - C Di Mario
- Careggi University Hospital (AOUC), Florence, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - F Perfetto
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Center, Florence, Italy
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19
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Cappelli F, Mazzarotto F, Frusconi S, Contini E, Polimanti R, Buxbaum J, Martone R, Morini S, Taborchi G, Bartolini S, Olivotto I, Pelo E, Di Mario C, Perfetto F. P2731Genetic ancestry analysis of the Italian founder population carrying the cardiac amyloidosis-causing variant Val122Ile in the transthyretin gene. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Transthyretin amyloidosis is a life-threatening disorder caused by the deposition of TTR amyloid in various tissues and organs. The most common worldwide pathogenic variant with almost exclusive cardiac involvement is Val122Ile (rs76992529), with an allele frequency of 3.5% in the U.S. African-American population, but rare in Caucasians. Unexpectedly, we identified 23 Caucasian individuals with Val122Ile in our amyloidosis referral center (9 affected patients, 14 carriers), belonging to 9 unrelated families.
Purpose
To determine the ancestral origin of the Tuscan founder population of TTR Val122Ile carriers.
Methods
A total of 24 individuals were included in the analysis (our 23 probands and relatives from Val122Ile families and the Caucasian reference sample NA10851 (CEU – Utah resident with European ancestry). All samples were genotyped using the EUROFORGEN Global AIM-SNP array1, inclusive of 127 highly informative SNPs to infer genetic ancestry. We have performed a principal component analysis (PCA) of the 9 unrelated probands and NA10851, compared with the Phase 3 of the 1000 Genomes Project data, comprising 2504 unrelated individuals from >20 distinct populations.(Figure 1).
Results
As shown in Figure 1, all our samples but one (from Argentina) cluster very close to the super-cluster of European populations, and distant from the populations of African ancestry. The proband from Argentina and the Caucasian reference sample NA10851 cluster close to Mexicans and Peruvians, and the super-cluster of European populations, respectively, confirming the robustness of the analysis.
Conclusion
Based on this result, we can confidently conclude that our samples from Tuscan families in which the TTR Val122Ile variant segregates are of ancestral European origin, with no mixed African ancestry, implying that the same variant originated in Africans and Europeans independently and not as result of genetic admixture. These findings suggest the presence of a mutational hot spots in TTR, with potential impact on the epidemiology of amyloidosis worldwide.
Acknowledgement/Funding
The present study was supported by an Investigator-Initiated Research to Azienda Ospedaliero Universitaria Careggi from Pfizer Srl.
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Affiliation(s)
- F Cappelli
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - F Mazzarotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - S Frusconi
- Careggi University Hospital, Florence, Italy
| | - E Contini
- Careggi University Hospital, Florence, Italy
| | - R Polimanti
- Yale School of Medicine, Department of Psychiatry, West Haven, United States of America
| | - J Buxbaum
- The Scripps Research Institute, Department of Molecular Medicine, La Jolla, United States of America
| | - R Martone
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - S Morini
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - G Taborchi
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - S Bartolini
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Cardiomyopathy Unit, Florence, Italy
| | - E Pelo
- Careggi University Hospital, Florence, Italy
| | - C Di Mario
- Careggi University Hospital, Florence, Italy
| | - F Perfetto
- Careggi University Hospital (AOUC), Tuscan Regional Amyloid Referral center, Florence, Italy
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Morini S, Aquaro GD, Taborchi G, Martone R, Gabriele M, Bartolini S, Vignini E, Vergaro G, Barison A, Emdin M, Olivotto I, Perfetto F, Di Mario C, Cappelli F. P2728Prognostic impact of left atrial function in patients with cardiac amyloidosis: a cardiac magnetic resonance study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left atrial function (AEF) is a parameter of paramount importance that has a prognostic value in a number of heart conditions. Cardiac involvement in both light-chain and transthyretin amyloidosis is the main driver of prognosis and influences treatment strategies. Cardiac magnetic resonance (CMR) provides high quality images of the left and right atria using high temporal resolution steady state free precession (SSFP) cine sequences.
Purpose
The aim of our study was to assess by CMR left atrial function and his correlation with prognosis in patients with cardiac amyloidosis.
Method
We enrolled 80 consecutive patients with diagnosis of cardiac amyloidosis: 38 patients (47%) with light-chain and 42 patients (53%) with transthyretin one. CMR was performed using a 1.5-T scanner. In all subjects, the study of atria was obtained by acquiring cine steady-state free precession (SSFP). Left Atrial function was evaluated by the ratio between the maximum and the minimum LA volume. A median follow up of 937 days was performed and 36 patients (44%) died of cardiac causes. We evaluated cardiac death as endpoint. We split out all the patient in 4 different quartiles depending on left atrial function: in the first quartile patients with AEF≤14% that reflects severe atrial dysfunction, in the second quartile patients with AEF between 14 and 19%, in the third quartile patients with AEF between 19 and 36% and in the last one patients with AEF≥36% that represent patients with normal value of left atrial function.
Results
We found that CMR assessed left atrial function allowed to individuate and stratify the prognosis in patients with cardiac amyloidosis. The most effective parameter to evaluate cardiac death was left atrial function with a cut off ≤14% that could predict cardiac related mortality with the same accuracy in both light-chain and transthyretin amyloidosis patients. Kaplan Meier analysis showed that patients with AEF≤14% had a worse prognosis as compared to patient with AEF≥14% (log rank p. 0001). Furthermore patients with AEF≤14% have a cardiac death risk of 32% at 1 year and 61% at 3 years.
Kaplan Meier analysis
Conclusion
Cardiac magnetic resonance is an imaging modality that allows to individuate with great accuracy left atrial function in patients with various heart conditions and especially cardiac amyloidosis. CMR left atrial function assessment clearly identifies a subgroup of cardiac amyloid patients with an increased risk of death.
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Affiliation(s)
- S Morini
- Careggi University Hospital (AOUC), Florence, Italy
| | - G D Aquaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - G Taborchi
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Martone
- Careggi University Hospital (AOUC), Florence, Italy
| | - M Gabriele
- Careggi University Hospital (AOUC), Florence, Italy
| | - S Bartolini
- Careggi University Hospital (AOUC), Florence, Italy
| | - E Vignini
- Careggi University Hospital (AOUC), Florence, Italy
| | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Barison
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - I Olivotto
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Perfetto
- Careggi University Hospital (AOUC), Florence, Italy
| | - C Di Mario
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Florence, Italy
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Bettini P, Chiariello AG, Formisano A, Marchiori G, Martone R, Terranova D. Real time assessment of the magnetic diagnostic system in RFX-mod. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2018.12.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mazzitelli G, Albanese R, Crisanti F, Martin P, Pizzuto A, Tuccillo A, Ambrosino R, Appi A, Di Gironimo G, Di Zenobio A, Frattolillo A, Granucci G, Innocente P, Lampasi A, Martone R, Polli G, Ramogida G, Rossi P, Sandri S, Valisa M, Villari R, Vitale V. Role of Italian DTT in the power exhaust implementation strategy. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.01.117] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Valenti R, Migliorini A, De Gregorio MG, Martone R, Berteotti M, Bernardini A, Carrabba N, Vergara R, Marchionni N, Antoniucci D. Impact of complete percutaneous revascularization in elderly patients with chronic total occlusion. Catheter Cardiovasc Interv 2019; 95:145-153. [PMID: 31430034 DOI: 10.1002/ccd.28452] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/10/2019] [Accepted: 08/01/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of the study was to assess the prognostic impact of successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and completeness of revascularization in the elderly. BACKGROUND Successful CTO-PCI is associated with clinical benefit. Notwithstanding elderly patients are currently underrepresented in CTO-PCI randomized controlled trials and registries. METHODS From the Florence CTO-PCI registry 1,405 patients underwent CTO-PCI between 2004 and 2015; out of these, 460 consecutive patients were ≥75 years. End point of the study was long-term cardiac survival. The prognostic impact of successful CTO-PCI and complete revascularization on survival was assessed by Kaplan-Meier estimation and by Cox multivariable regression analysis. RESULTS Patients were stratified according to success (72%) or failure of CTO-PCI. Completeness of revascularization was achieved in 57% of patients. Five-year cardiac survival was significantly higher in the successful CTO-PCI group (84 ± 3% vs. 72 ± 6%; p = .006) and it was further improved if complete coronary revascularization was achieved (90 ± 3% vs. 68 ± 5%; p < .001). At multivariable analysis, increasing age (hazard ratio [HR] 1.08; p = .001), diabetes (HR 1.55; p = .033), chronic kidney disease (HR 1.96, p = .002), left ventricular ejection fraction <0.40 (HR 2.10; p < .001), and completeness of revascularization (HR 0.58; p < .005) resulted independently associated with long-term cardiac survival. CONCLUSIONS In the elderly successful CTO-PCI is associated with a long-term survival benefit. The results of this study suggest that, even in the elderly, a CTO-PCI attempt should be considered to achieve complete coronary revascularization.
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Affiliation(s)
- Renato Valenti
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Angela Migliorini
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Maria Grazia De Gregorio
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Raffaele Martone
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Martina Berteotti
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Bernardini
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Nazario Carrabba
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ruben Vergara
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Niccolò Marchionni
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - David Antoniucci
- Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Abstract
PURPOSE OF REVIEW We summarize key features pertaining to the two most commonly encountered types of cardiac amyloidosis (CA), monoclonal immunoglobulin light chain (AL) and transthyretin type (ATTR), expanding upon the clinical application and utility of various imaging techniques in diagnosing CA. RECENT FINDINGS Advances in imaging have led to earlier identification, improved diagnosis of CA and higher discriminatory power to differentiate CA from other hypertrophic phenocopies. The application of cardiac magnetic resonance imaging (CMR) has led to a deeper understanding of underlying pathophysiological processes in CA, owing largely to its intrinsic tissue characterization properties. The widespread adoption of bone scintigraphy algorithms has reduced the need for cardiac biopsy and improved diagnostic confidence in ATTR CA. As new treatments for CA are rapidly developing, there will be even greater reliance on imaging, as the requirement to diagnose disease earlier, monitor response and amend treatment strategies accordingly intensifies.
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Affiliation(s)
- Liza Chacko
- National Amyloidosis Centre, University College London, Royal Free Campus, Rowland Hill Street, NW3 2PF, London, UK
| | - Raffaele Martone
- Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, Rowland Hill Street, NW3 2PF, London, UK
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Pontecorboli G, Gabriele M, Cappelli F, Acquafresca M, Pradella S, Morini S, Taborchi G, Martone R, Migliorini A, Carrabba N, Marchionni N, Marcucci R, Valenti R. P387Chest pain and mild left ventricular hypertrophy: a challenging diagnosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.028] [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)
| | - M Gabriele
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Cappelli
- Careggi University Hospital (AOUC), Florence, Italy
| | | | - S Pradella
- Careggi University Hospital (AOUC), Florence, Italy
| | - S Morini
- Careggi University Hospital (AOUC), Florence, Italy
| | - G Taborchi
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Martone
- Careggi University Hospital (AOUC), Florence, Italy
| | - A Migliorini
- Careggi University Hospital (AOUC), Florence, Italy
| | - N Carrabba
- Careggi University Hospital (AOUC), Florence, Italy
| | - N Marchionni
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Marcucci
- Careggi University Hospital (AOUC), Florence, Italy
| | - R Valenti
- Careggi University Hospital (AOUC), Florence, Italy
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Martone R, Marchionni N, Cappelli F. Heart failure with mid-range ejection fraction: Current evidence and uncertainties. Monaldi Arch Chest Dis 2019; 89. [DOI: 10.4081/monaldi.2019.1024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/27/2019] [Indexed: 11/23/2022] Open
Abstract
Heart failure (HF) with mid-range ejection fraction (HFmrEF) has been conceptualized by the European Society of Cardiology guidelines with the aim of stimulating research to fill a gap in knowledge: whether such a condition exists as a distinct pathophysiological and clinical entity, or it is just a residual category of ejection fraction indeed is still a matter of debate. Current evidence suggests that HFmrEF represents up to one fifth of patients with HF, who may ultimately result in an intermediate clinical phenotype, as for age and gender, with an intermediate prevalence of comorbidities. Nevertheless, a strong connection exists with HF with reduced ejection fraction, since ischemic aetiology is common in both categories, conveying relevant implications for prognosis and therapeutic response. Little is known about its pathophysiology: mild systolic impairment may be not enough and advocating diastolic dysfunction may be an oversimplification. An increasing amount of data is clarifying how many of HFmrEF patients are the results of deteriorating or recovering hearts, thus underscoring that aetiology may be, more than EF, the key to understand this new category. Sparse evidence points toward a potential benefit of common HF therapies in those patients, but further research is still needed.
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Cappelli F, Martone R, Taborchi G, Morini S, Bartolini S, Angelotti P, Farsetti S, Di Mario C, Perfetto F. Epigallocatechin-3-gallate tolerability and impact on survival in a cohort of patients with transthyretin-related cardiac amyloidosis. A single-center retrospective study. Intern Emerg Med 2018; 13:873-880. [PMID: 29882023 DOI: 10.1007/s11739-018-1887-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/29/2018] [Indexed: 01/11/2023]
Abstract
Transthyretin-related (ATTR) cardiac amyloidosis is currently lacking a disease-modifying therapy. Despite demonstration of effectiveness in halting amyloid deposition, no study focused on epigallocatechin-3-gallate (EGCG) impact on patient survival. We sought to explore prognostic impact of EGCG in a cohort of lone cardiac ATTR patients. From the Florence Tuscan Regional Amyloid Centre database, we retrospectively selected ATTR patients treated with EGCG (675mg daily dose) for a minimum of 9 months, between March 2013 and December 2016. As a control group, we selected ATTR patients who received guideline-directed medical therapy alone. End point of the study was time to all cause death or cardiac transplantation. Sixty-five patients (30 treatment groups vs. 35 control groups) had a median follow-up of 691 days. There were no differences in baseline characteristics between groups. Five deaths occurred in EGCG group versus eight in control group; one patient underwent effective cardiac transplantation in EGCG group. There was no difference in survival estimates between EGCG and control group (60 ± 15% vs. 61 ± 12%, p = 0.276). EGCG was well tolerated, without major safety concerns. In a real-world cohort of ATTR patients with lone cardiac involvement, EGCG was a safe therapeutic option, but was not associated with survival improvement.
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Affiliation(s)
- Francesco Cappelli
- Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy.
- Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy.
| | - Raffaele Martone
- Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy
| | - Giulia Taborchi
- Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy
| | - Sofia Morini
- Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy
| | - Simone Bartolini
- Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy
| | - Paola Angelotti
- Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy
| | - Silvia Farsetti
- Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy
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Gagliardi C, Perfetto F, Lorenzini M, Ferlini A, Salvi F, Milandri A, Quarta CC, Taborchi G, Bartolini S, Frusconi S, Martone R, Cinelli MM, Foffi S, Reggiani MLB, Fabbri G, Cataldo P, Cappelli F, Rapezzi C. Phenotypic profile of Ile68Leu transthyretin amyloidosis: an underdiagnosed cause of heart failure. Eur J Heart Fail 2018; 20:1417-1425. [DOI: 10.1002/ejhf.1285] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/22/2018] [Accepted: 06/26/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Christian Gagliardi
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum; University of Bologna; Italy
| | - Federico Perfetto
- Tuscan Regional Amyloid Center; Careggi University Hospital; Florence Italy
| | - Massimiliano Lorenzini
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum; University of Bologna; Italy
- Institute for Cardiovascular Science; University College London, and Barts Heart Centre, St. Bartholomew's Hospital; London UK
| | - Alessandra Ferlini
- Section of Medical Genetics, Department of Diagnostic and Experimental Medicine; University of Ferrara; Italy
| | - Fabrizio Salvi
- Division of Neurology, IRCCS Institute of Neurological Sciences; Bellaria Hospital; Bologna Italy
| | - Agnese Milandri
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum; University of Bologna; Italy
| | | | - Giulia Taborchi
- Tuscan Regional Amyloid Center; Careggi University Hospital; Florence Italy
| | - Simone Bartolini
- Tuscan Regional Amyloid Center; Careggi University Hospital; Florence Italy
| | - Sabrina Frusconi
- Tuscan Regional Amyloid Center; Careggi University Hospital; Florence Italy
| | - Raffaele Martone
- Tuscan Regional Amyloid Center; Careggi University Hospital; Florence Italy
| | - Michele Mario Cinelli
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum; University of Bologna; Italy
| | - Serena Foffi
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum; University of Bologna; Italy
| | - Maria Letizia Bacchi Reggiani
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum; University of Bologna; Italy
| | - Gioele Fabbri
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum; University of Bologna; Italy
| | - Paolo Cataldo
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum; University of Bologna; Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloid Center; Careggi University Hospital; Florence Italy
| | - Claudio Rapezzi
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum; University of Bologna; Italy
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Cappelli F, Gallini C, Costanzo EN, Tutino F, Ciaccio A, Vaggelli L, Bartolini S, Morini S, Martone R, Angelotti P, Frusconi S, Di Mario C, Perfetto F. Lung uptake during 99mTc- hydroxymethylene diphosphonate scintigraphy in patient with TTR cardiac amyloidosis: An underestimated phenomenon. Int J Cardiol 2018; 254:346-350. [DOI: 10.1016/j.ijcard.2017.10.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 09/25/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
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Formisano A, Albanese R, Ambrosino G, de Magistris M, De Vries P, Gribov Y, Ledda F, Martone R, Mattei M, Minucci S, Pironti A, Pizzo F, Snipes J, Villone F, Zabeo L. 3D Analysis of magnetic field lines to assess the impact of stray fields at breakdown in ITER. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Chiariello AG, Ledda F, Martone R, Murari A, Pizzo F, Rimini F. A 3D electromagnetic model of the iron core in JET. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.05.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mazzitelli G, Apicella M, Ciattaglia S, Colangeli A, Maddaluno G, Marocco D, Martone R, Villari R. The DTT device: Safety, fuelling and auxiliary system. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.05.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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35
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Bettini P, Chiariello AG, Formisano A, Ledda F, Marchiori G, Martone R, Pizzo F, Terranova D. 3D magnetic surfaces reconstruction in RFX-mod. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.04.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Migliorini A, Valenti R, Vergara R, Gabrielli E, De gregorio MG, Martone R, Morini S, Aicale MR, Bernardini A, Berteotti M, Carrabba N, Antoniucci D. TCT-837 Clinical Impact of Complete Coronary Artery Revascularization in Elderly Patients with Unprotected Left Main Disease Treated with Drug-Eluting Stent. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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37
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Valenti R, Migliorini A, Bernardini A, De gregorio MG, Martone R, Aicale MR, Morini S, Vergara R, Berteotti M, Carrabba N, Antoniucci D. TCT-460 Clinical Impact of Complete Coronary Revascularization by Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion in the First and Newer Drug-Eluting Stent Generation Era. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Valenti R, De Gregorio M, Aicale M, Morini S, Martone R, Taborchi G, Gabrielli E, Migliorini A, Vergara R, Carrabba N, Antoniucci D. P1381Prognostic impact of percutaneous coronary intervention of chronic total occlusion in the real world elderly population. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1381] [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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Martone R, Appel L, Chiariello A, Formisano A, Mattei M, Pironti A. Impact of error fields on plasma identification in ITER. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.02.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Oliva AB, Chiariello A, Formisano A, Martone R, Portone A, Testoni P. Estimation of error fields from ferromagnetic parts in ITER. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.02.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Testoni P, Oliva AB, Portone A, Carin Y, Knaster J, Matheos FR, Albanese R, Formisano A, Martone R, Rubinacci G, Villone F, Roccella M. Status of the EU DA electromagnetic analysis contribution to ITER. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.01.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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42
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Staal R, Kubek K, Sung A, Lin Q, DenBleyker M, Monaghan M, Martone R, Robichaud A, Haydar S, Pangalos M, Reinhart P, Hirst W. P2.080 Dimebon™ is neuroprotective in a model of Parkinson's disease. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70431-6] [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: 11/25/2022]
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43
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Martone R, Meehan J, Xu J, Mercado M, Staal R, Hubbell A, Kubek K, Nawoschik S, Das I, Shih H, Dunlop J, Pangalos M, Reinhart P. P3.007 Modeling synucleinopathies: intracellular delivery of alpha-synuclein oligomers via protein transfection results in intracellular alpha-synuclein inclusions. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70571-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Roccella M, Lucca F, Roccella R, Pizzuto A, Ramogida G, Portone A, Tanga A, Formisano A, Martone R. Analysis of active and passive magnetic field reduction systems (MFRS) of the ITER NBI. Fusion Engineering and Design 2007. [DOI: 10.1016/j.fusengdes.2007.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Formisano A, Ilyin Y, Muzzi L, Martone R, Gislon P, Nijhuis A, Polak M, Sborchia C, Stepanov B. DC and transient current distribution analysis from self-field measurements on ITER PFIS conductor. Fusion Engineering and Design 2005. [DOI: 10.1016/j.fusengdes.2005.06.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Lian Z, Euskirchen G, Rinn J, Martone R, Bertone P, Hartman S, Royce T, Nelson K, Sayward F, Luscombe N, Yang J, Li JL, Miller P, Urban AE, Gerstein M, Weissman S, Snyder M. Identification of novel functional elements in the human genome. Cold Spring Harb Symp Quant Biol 2004; 68:317-22. [PMID: 15338632 DOI: 10.1101/sqb.2003.68.317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Z Lian
- Department of Genetics, Yale University, New Haven, Connecticut 06520, USA
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Albanese R, Bottura L, Chiocchio S, Coccorese E, Gernhardt J, Gruber O, Fresa R, Martone R, Portone A, Seidel U. Validation of numerical codes for the analysis of plasma discharges. Fusion Engineering and Design 1994. [DOI: 10.1016/0920-3796(94)90015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Herbert J, Cavallaro T, Martone R. The distribution of retinol-binding protein and its mRNA in the rat eye. Invest Ophthalmol Vis Sci 1991; 32:302-9. [PMID: 1993581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although a constant supply of retinol is a critical requirement for the visual cycle, the molecular mechanisms underlying retinol delivery, uptake, storage, and transport in the eye are not well understood. Previously the synthesis of serum retinol-binding protein (RBP) in the mammalian eye was reported. Now the distribution of RBP and RBP mRNA in the rat eye has been studied by immunohistochemical and in situ hybridization techniques has been studied. The RBP mRNA was present only in the cytoplasm of retinal pigment epithelial (RPE) cells, terminating abruptly at the pars plana. On the other hand, RBP immunoreactivity was more widespread. The most intense immunostaining was present in retinal ganglion cells, the corneal endothelium, and under certain conditions of tissue fixation, the corneal epithelium. Consistent but less intense immunoreactivity was detected in the photoreceptors, Müller cells, inner plexiform layer, ciliary epithelium and stroma, iris epithelium, retinal pigment epithelium, lacrimal glandular epithelium, and periorbital soft tissues. These findings suggest that RBP synthesized by the RPE may be secreted to various ocular locations. However, at present, uptake from plasma cannot be excluded as another possible source of ocular RBP. In the plasma, holo-RBP (the retinol-RBP complex) is transported in complex with another plasma protein, transthyretin (TTR). This substance is also synthesized by the RPE and its distribution in the eye is similar to that described for RBP. Taken together, these findings support the proposal that ocular RBP and TTR may function cooperatively in the intraocular translocation of retinol.
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Affiliation(s)
- J Herbert
- Department of Neurology, Columbia University, College of Physicians and Surgeons, New York City, NY
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49
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Albanese R, Bottura L, Coccorese E, Martone R, Rubinacci G. Electromagnetic effects induced by plasma disruptions in the NET vacuum vessel. Fusion Engineering and Design 1991. [DOI: 10.1016/0920-3796(92)90040-b] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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