71 results on '"Alunni, G."'
Search Results
2. Transthyretin cardiac amyloidosis in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: a single center experience
- Author
-
Scudeler, L, primary, Gallone, G, additional, Bongiovanni, C, additional, Bruno, F, additional, Landra, F, additional, Andreis, A, additional, Fava, A, additional, Pidello, S, additional, Raineri, C, additional, Giorgi, M, additional, D'Ascenzo, F, additional, Conrotto, F, additional, Alunni, G, additional, Rinaldi, M, additional, and De Ferrari, G M, additional
- Published
- 2022
- Full Text
- View/download PDF
3. C39 ECHOCARDIOGRAPHIC PREDICTORS OF MALIGNANT EVENTS IN ARRHYTHMIC MITRAL VALVE PROLAPSE POPULATION
- Author
-
Desalvo, P, primary, Vairo, A, additional, Piroli, F, additional, Gaiero, L, additional, Fioravanti, F, additional, De Lio, F, additional, Bellettini, M, additional, Montali, N, additional, Alunni, G, additional, Giustetto, C, additional, and De Ferrari, G, additional
- Published
- 2022
- Full Text
- View/download PDF
4. P102 NEW THREE–DIMENSIONAL ECHOCARDIOGRAPHIC PREDICTING PARAMETERS IN TRANS–VENTRICULAR HEART–BEATING MITRAL VALVE REPAIR WITH NEOCHORDAE: A MONOCENTRIC RETROSPECTIVE STUDY
- Author
-
Gaiero, L, primary, Vairo, A, additional, Fioravanti, F, additional, Piroli, F, additional, Gallone, G, additional, D‘Ascenzo, F, additional, Desalvo, P, additional, Marro, M, additional, Sebastiano, V, additional, Alunni, G, additional, De Ferrari, G, additional, Rinaldi, M, additional, and Salizzoni, S, additional
- Published
- 2022
- Full Text
- View/download PDF
5. P316 TRANSTHYRETIN CARDIAC AMYLOIDOSIS IN PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT: A SINGLE CENTER EXPERIENCE
- Author
-
Gallone, G, primary, Bongiovanni, F, additional, Bruno, F, additional, Scudeler, L, additional, Landra, F, additional, Andreis, A, additional, Casoni, R, additional, Fava, A, additional, Pidello, S, additional, Raineri, C, additional, Usmiani, T, additional, Alunni, G, additional, Conrotto, F, additional, D‘ascenzo, F, additional, and De Ferrari, G, additional
- Published
- 2022
- Full Text
- View/download PDF
6. C40 THREE–DIMENSIONAL FINGER TEST: A NEW ECHOCARDIOGRAPHIC METHOD TO LOCATE THE BEST ACCESS SITE DURING NEOCHORD PROCEDURE
- Author
-
Vairo, A, primary, Alunni, G, additional, Franchin, L, additional, Fortuni, F, additional, Gaiero, L, additional, Desalvo, P, additional, Avondo, S, additional, Marro, M, additional, Sebastiano, V, additional, De Ferrari, G, additional, Rinaldi, M, additional, and Salizzoni, S, additional
- Published
- 2022
- Full Text
- View/download PDF
7. Relative prognostic importance of longitudinal strain of right ventricle and tricuspid annular plane systolic excursion in systolic heart failure: 170
- Author
-
Riccini, C, Carluccio, Erberto E, Biagioli, P, Bardelli, G, Lauciello, R, D’antonio, A, Cerasa, M F, Mengoni, A, Alunni, G, and Ambrosio, G
- Published
- 2016
8. Clinical outcomes following isolated transcatheter tricuspid valve repair: a meta-analysis and meta-regression study
- Author
-
Bocchino, P P, primary, Angelini, F, additional, Vairo, A, additional, Andreis, A, additional, Fortuni, F, additional, Franchin, L, additional, Frea, S, additional, Raineri, C, additional, Pidello, S, additional, Conrotto, F, additional, Montefusco, A, additional, Alunni, G, additional, and De Ferrari, G M, additional
- Published
- 2021
- Full Text
- View/download PDF
9. Documento di consenso ANMCO/FADOI/SIAARTI/SIC/SIMG/SIMI/SIMEU: Il percorso clinico-diagnostico e terapeutico del paziente con scompenso cardiaco acuto dal domicilio alla dimissione dal Pronto Soccorso/ Dipartimento di Emergenza-Accettazione
- Author
-
Mortara, A., Gabrielli, D., Pugliese, F. R., Corcione, A., Perticone, F., Fontanella, A., Mercuro, G., Cricelli, C., Iacoviello, M., D'Ambrosio, G., Guarracino, F., Modesti, P. A., Vescovo, G., De Maria, R., Iacovoni, A., Macera, F., Palmieri, V., Pasqualucci, D., Battistoni, I., Alunni, G., Aspromonte, N., Caldarola, P., Campanini, M., Caporale, R., Casolo, G., Cipriani, M., Di Tano, G., Domenicucci, S., Murrone, A., Nardi, F., Navazio, A., Oliva, F., Parretti, D., Urbinati, S., Valente, S., Valeriano, V., Zuin, G., Metra, M., Sinagra, G., Gulizia, M. M., Di Lenarda, A., Mortara, A., Gabrielli, D., Pugliese, F. R., Corcione, A., Perticone, F., Fontanella, A., Mercuro, G., Cricelli, C., Iacoviello, M., D'Ambrosio, G., Guarracino, F., Modesti, P. A., Vescovo, G., De Maria, R., Iacovoni, A., Macera, F., Palmieri, V., Pasqualucci, D., Battistoni, I., Alunni, G., Aspromonte, N., Caldarola, P., Campanini, M., Caporale, R., Casolo, G., Cipriani, M., Di Tano, G., Domenicucci, S., Murrone, A., Nardi, F., Navazio, A., Oliva, F., Parretti, D., Urbinati, S., Valente, S., Valeriano, V., Zuin, G., Metra, M., Sinagra, G., Gulizia, M. M., and Di Lenarda, A.
- Subjects
Heart Failure ,Patient Transfer ,Emergency Service ,Care pathway ,Emergency department ,Acute heart failure ,Patient Discharge ,Hospital ,Italy ,Acute Disease ,Practice Guidelines as Topic ,Critical Pathways ,Care transitions ,Hospital discharge ,Emergency Service, Hospital ,Humans ,Care transition ,Human - Abstract
Lo scompenso cardiaco (SC) acuto impegna le strutture ospedaliere in tutto il mondo e, a confronto con altre patologie cardiache acute come le sindromi coronariche, determina esiti a distanza marcatamente sfavorevoli: il tasso di mortalità o riospedalizzazione a 3 mesi è pari al 33%, la mortalità ad 1 anno dal ricovero varia tra 25% e 50%. Un fattore critico nella gestione dello SC acuto è rappresentato dalla molteplicità di professionisti sanitari coinvolti nel percorso diagnostico-terapeutico di questa sindrome, medici di medicina generale, medici di emergenza, cardiologi, internisti, anestesisti-rianimatori, e quindi dalla necessità di integrare conoscenze e competenze diverse e di convergere su obiettivi assistenziali in grado di migliorare gli esiti clinici. Questo documento di consenso origina dal lavoro congiunto delle Società Scientifiche espressione delle diverse figure professionali coinvolte nell’assistenza ai pazienti con SC acuto e ha condiviso strategie e percorsi volti a garantire sia livelli assistenziali di qualità che esiti migliori. Il documento dettaglia l’intero percorso del paziente con SC acuto dall’esordio dei sintomi a domicilio, dalla diagnosi, gestione domiciliare o invio in Pronto Soccorso/Dipartimento di Emergenza-Accettazione (PS/DEA), modalità di trasporto, terapia precoce, attraverso i percorsi clinici strumentali per la diagnosi in PS/DEA e il trattamento, la stratificazione del rischio e la dimissione del paziente in degenza ordinaria o a domicilio. Si analizza il possibile ruolo del “fast-track” cardiologico, dell’Osservazione Breve Intensiva e la presa in carico dell’assistenza territoriale attraverso la medicina generale e l’ambulatorio specialistico per la cura dello SC. Il crescente carico assistenziale e le complesse problematiche generate dallo SC acuto non possono trovare adeguata soluzione al di fuori di un approccio integrato multidisciplinare che ponga efficacemente in rete le strutture di emergenza con le unità di degenza intensiva e ordinaria e con il contesto delle cure territoriali. Il documento, grazie all’apporto delle più qualificate Società Scientifiche, persegue questo obiettivo proponendo un percorso strutturato, condiviso ed applicabile, in grado di contribuire ad una gestione del problema omogenea sul territorio nazionale.
- Published
- 2019
10. Valve-in-valve-in-ring: A bailout strategy to tackle paravalvular leaks due to device malapposition
- Author
-
Vairo, A., Conrotto, F., Franchin, L., Fortuni, F., Bruno, F., Montefusco, A., D'Ascenzo, F., Milan, A., Torre, M., Alunni, G., Rinaldi, M., and De Ferrari, G.
- Subjects
Mitral regurgitation ,valve-in-ring ,valve-in-valve ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2021
- Full Text
- View/download PDF
11. ANMCO / FADOI / SIAARTI / SIC / SIMG / SIMI / SIMEU Consensus Document: The clinical-diagnostic and therapeutic pathway of the patient with acute heart failure from home to discharge from the Emergency Room / Emergency Department-Acceptance
- Author
-
Mortara, A., Gabrielli, D., Pugliese, F. R., Corcione, A., Perticone, F., Fontanella, A., Mercuro, G., Cricelli, C., Iacoviello, M., D'Ambrosio, G., Guarracino, F., Modesti, P. A., Vescovo, G., De Maria, R., Iacovoni, A., Macera, F., Palmieri, V., Pasqualucci, D., Battistoni, I., Alunni, G., Aspromonte, N., Caldarola, P., Campanini, M., Caporale, R., Casolo, G., Cipriani, Michele, Di Tano, G., Domenicucci, S., Murrone, A., Nardi, Fabio, Navazio, A., Oliva, Federica, Parretti, D., Urbinati, S., Valente, S., Valeriano, V., Zuin, G., Metra, M., Sinagra, G., Gulizia, M. M., and Di Lenarda, A.
- Published
- 2019
12. P2685Improving myocardial perfusion in refractory angina: extracorporeal shockwave myocardial revascularization in a monocentric cohort
- Author
-
D'Amico, S, primary, Alunni, G, additional, D'Amico, M, additional, Fu, M, additional, Celentani, D, additional, Pidello, S, additional, Brustio, A, additional, Campana, M, additional, Baccega, M, additional, Giustetto, C, additional, Marra, S, additional, and Rinaldi, M, additional
- Published
- 2019
- Full Text
- View/download PDF
13. Atrial fibrillation, cognitive impairment, frailty and disability in older heart failure patients
- Author
-
Pulignano, G, Del Sindaco, D, Tinti, M, Di Lenarda, A, Alunni, G, Senni, M, Tarantini, L, Cioffi, G, Barbati, G, Minardi, G, Murrone, A, Ciurluini, P, Uguccioni, M, Pulignano G, Del Sindaco D, Tinti MD, Di Lenarda A, Alunni G, Senni M, Tarantini L, Cioffi G, Barbati G, Minardi G, Murrone A, Ciurluini P, Uguccioni M, Pulignano, G, Del Sindaco, D, Tinti, M, Di Lenarda, A, Alunni, G, Senni, M, Tarantini, L, Cioffi, G, Barbati, G, Minardi, G, Murrone, A, Ciurluini, P, Uguccioni, M, Pulignano G, Del Sindaco D, Tinti MD, Di Lenarda A, Alunni G, Senni M, Tarantini L, Cioffi G, Barbati G, Minardi G, Murrone A, Ciurluini P, and Uguccioni M
- Abstract
Aim of the study was to prospectively assess the relation between atrial fibrillation, cognitive impairment, frailty and disability in older patients with chronic heart failure. Methods Three hundred thirty-one ambulatory community-living patients aged 70 years and older (mean 78 ± 6; range 70-93; 43% women) in stable conditions and optimized therapy were enrolled in seven heart failure cardiology clinics. Cognitive impairment was defined by a corrected Mini Mental State Examination score less than 24. Gait speed was used as marker of frailty and measured on a 4 m distance at usual pace. Results Ninety-eight patients (30%) were on atrial fibrillation at enrolment and 20 (6%) had a history of paroxysmal/persistent atrial fibrillation. Patients with atrial fibrillation were more frequently women with severe valvular disease, preserved left ventricular ejection fraction and less frequently on beta-blockers. At multivariable analyses, atrial fibrillation emerged as independently related to cognitive impairment [odds ratio (OR) 1.909 (1.072-3.397); P = 0.028], as well as to reduced gait speed [OR 4.366 (2.104-9.060); P < 0.001]. Furthermore, atrial fibrillation was significantly associated with disability in either basic or instrumental activities of daily living. No differences were found in mortality and morbidity. Conclusion Among patients with chronic heart failure, those with atrial fibrillation present a high prevalence of frailty, cognitive impairment and disability. The hypothetical mechanisms by which atrial fibrillation and heart failure may affect these conditions are multiple and further studies are warranted. However, screening for these variables in clinical practice is simple and inexpensive and may allow better strategies for intervention in this high-risk population.
- Published
- 2016
14. Incremental Value of Gait Speed in Predicting Prognosis of Older Adults With Heart Failure Insights From the IMAGE-HF Study
- Author
-
Pulignano, G, Del Sindaco, D, Di Lenarda, A, Alunni, G, Senni, M, Tarantini, L, Cioffi, G, Tinti, M, Barbati, G, Minardi, G, Uguccioni, M, Pulignano G, Del Sindaco D, Di Lenarda A, Alunni G, Senni M, Tarantini L, Cioffi G, Tinti MD, Barbati G, Minardi G, Uguccioni M, Pulignano, G, Del Sindaco, D, Di Lenarda, A, Alunni, G, Senni, M, Tarantini, L, Cioffi, G, Tinti, M, Barbati, G, Minardi, G, Uguccioni, M, Pulignano G, Del Sindaco D, Di Lenarda A, Alunni G, Senni M, Tarantini L, Cioffi G, Tinti MD, Barbati G, Minardi G, and Uguccioni M
- Abstract
Objectives The aim of this study was to assess the relationship between gait speed and the risk for death and/or hospital admission in older patients with heart failure (HF). Background Gait speed is a reliable single marker of frailty in older people and can predict falls, disability, hospital admissions, and mortality. Methods In total, 331 community-living patients ≥70 years of age (mean age 78 ± 6 years, 43% women, mean ejection fraction 35 ± 11%, mean New York Heart Association functional class 2.7 ± 0.6) in stable condition and receiving optimized therapy for chronic HF were prospectively enrolled and followed for 1 year. Gait speed was measured at the usual pace over 4 m, and cutoffs were defined by tertiles: ≤0.65, 0.66 to 0.99, and ≥1.0 m/s. Results There was a significant association between gait speed tertiles and 1-year mortality: 38.3%, 21.9%, and 9.1% (p < 0.001), respectively. On multivariate analysis, gait speed was associated with a lower risk for all-cause death (hazard ratio: 0.62; 95% confidence interval: 0.43 to 0.88) independently of age, ejection fraction <20%, systolic blood pressure, anemia, and absence of beta-blocker therapy. Gait speed was also associated with a lower risk for hospitalization for HF and all-cause hospitalization. When gait speed was added to the multiparametric Cardiac and Comorbid Conditions Heart Failure risk score, it improved the accuracy of risk stratification for all-cause death (net reclassification improvement 0.49; 95% confidence interval: 0.26 to 0.73, p < 0.001) and HF admissions (net reclassification improvement 0.37; 95% confidence interval: 0.15 to 0.58; p < 0.001). Conclusions Gait speed is independently associated with death, hospitalization for HF, and all-cause hospitalization and improves risk stratification in older patients with HF evaluated using the Cardiac and Comorbid Conditions Heart Failure score. Assessment of frailty using gait speed is simple and should be part of the clinical eva
- Published
- 2016
15. Incremental Value of Gait Speed in Predicting Prognosis of Older Adults With Heart Failure Insights From the IMAGE-HF Study
- Author
-
Pulignano G, Del Sindaco D, Di Lenarda A, Alunni G, Senni M, Tarantini L, Cioffi G, Tinti MD, Barbati G, Minardi G, Uguccioni M, Pulignano, G, Del Sindaco, D, Di Lenarda, A, Alunni, G, Senni, M, Tarantini, L, Cioffi, G, Tinti, M, Barbati, G, Minardi, G, and Uguccioni, M
- Subjects
heart failure ,elderly ,gait speed ,prognosi ,hospitalization - Abstract
Objectives The aim of this study was to assess the relationship between gait speed and the risk for death and/or hospital admission in older patients with heart failure (HF). Background Gait speed is a reliable single marker of frailty in older people and can predict falls, disability, hospital admissions, and mortality. Methods In total, 331 community-living patients ≥70 years of age (mean age 78 ± 6 years, 43% women, mean ejection fraction 35 ± 11%, mean New York Heart Association functional class 2.7 ± 0.6) in stable condition and receiving optimized therapy for chronic HF were prospectively enrolled and followed for 1 year. Gait speed was measured at the usual pace over 4 m, and cutoffs were defined by tertiles: ≤0.65, 0.66 to 0.99, and ≥1.0 m/s. Results There was a significant association between gait speed tertiles and 1-year mortality: 38.3%, 21.9%, and 9.1% (p < 0.001), respectively. On multivariate analysis, gait speed was associated with a lower risk for all-cause death (hazard ratio: 0.62; 95% confidence interval: 0.43 to 0.88) independently of age, ejection fraction
- Published
- 2016
16. Does physical activity influence Brugada pattern at 12-lead holter 24-hour monitoring?
- Author
-
Tarditi, F, Toso, E, Koumantakis, E, Jorfida, M, Alunni, G, Gaita, F, Benso, A, and Giustetto, C
- Published
- 2024
- Full Text
- View/download PDF
17. Persistence of Residual Circulating CD26+Leukemia Stem Cells in Chronic Myeloid Leukemia Patients in Treatment Free Remission
- Author
-
Bocchia, M, Defina, M, Sirianni, S, Martino, B, Abruzzese, E, Pregno, P, Galimberti, S, Alunni, G, Sicuranza, A, Gozzini, A, Fava, C, Puccetti, L, Sora, F, Barate, C, Castagnetti, F, Aprile, L, Iurlo, A, Cattaneo, D, Sica, S, Luciano, L, Crugnola, M, Annunziata, M, Caocci, G, Mulas, O, Usala, E, Sgherza, N, Rosti, G, and Raspadori, D
- Published
- 2017
18. HAEMODYNAMIC FORCES ANALYSIS IN PATIENTS WITH PARAVALVULAR REGURGITATION AFTER TAVR: A PROPENSITY–SCORE MATCHED RETROSPECTIVE STUDY
- Author
-
Scudeler, L, Alessandro, V, Miccoli, D, Mascaretti, D, Airale, L, De Ferrari, G, and Alunni, G
- Published
- 2024
- Full Text
- View/download PDF
19. Elevated serum uric acid concentration at discharge confers additive prognostic value in elderly patients with acute heart failure
- Author
-
Adriano Murrone, Giuseppe Ambrosio, Stefano Coiro, Erberto Carluccio, Antonella D’Antonio, Gianfranco Alunni, Anna Mengoni, Nicolas Girerd, Cinzia Zuchi, Paolo Biagioli, Claudio Borghi, Coiro, S., Carluccio, E., Biagioli, P., Alunni, G., Murrone, A., D'Antonio, A., Zuchi, C., Mengoni, A., Girerd, N., Borghi, C., and Ambrosio, G.
- Subjects
Male ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Medicine (miscellaneous) ,030204 cardiovascular system & hematology ,chemistry.chemical_compound ,Endocrinology ,0302 clinical medicine ,Elderly ,Risk Factors ,Cause of Death ,Nutrition and Dietetic ,030212 general & internal medicine ,Outcome ,Aged, 80 and over ,Nutrition and Dietetics ,Age Factors ,Middle Aged ,Patient Discharge ,Progression-Free Survival ,Net reclassification improvement ,Up-Regulation ,Diabetes and Metabolism ,Echocardiography ,Disease Progression ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Adverse outcomes ,Heart failure ,Hyperuricemia ,Patient Readmission ,Decision Support Techniques ,Elevated serum ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,medicine.disease ,chemistry ,Uric acid ,business ,Risk classification ,Biomarkers - Abstract
Background and aims Elevated serum uric acid (sUA) concentrations have been associated with worse prognosis in heart failure (HF) but little is known about elderly patients. We aimed to assess long-term additive prognostic value of sUA in elderly patients hospitalized for HF. Methods and results Clinical and echocardiographic characteristics of 310 consecutive elderly patients hospitalized for HF were collected. During index period, 206 had sUA concentrations available, which were obtained within 24 h prior to discharge; 10 patients were lost to follow-up, leaving 196 patients available. Patients had a median age of 77 (IQR 69–83) years, and were mostly male (64.5%). sUA ranges for tertiles I–III were: 1.5–6.1, 6.2–8.3, and 8.4–18.9 mg/dl, respectively. During a median follow-up of 27 months (IQR 10.5–39.5), 122 combined events occurred (87 deaths and 73 HF rehospitalizations). Four-year event-free survival for the combined endpoint was 46 ± 7% for tertile I, 34 ± 7% for tertile II, and 21 ± 5% for tertile III (P = 0.001). By multivariable Cox backward analysis, sUA was retained as a significant predictor. Compared with the lowest sUA tertile, tertile III showed a strong association with outcome, also after adjustment for other predictors (HR 1.84, 95% CI 1.16–2.93; P = 0.01). Importantly, addition of sUA to the other significant predictors of outcome resulted in improved risk classification (net reclassification improvement 0.19, P = 0.017). Conclusions High sUA at discharge is a strong predictor of adverse outcome in elderly hospitalized for HF, and it significantly improves risk classification. Measuring sUA can be a simple and useful tool to identify high-risk elderly hospitalized for HF.
- Published
- 2018
20. Atrial fibrillation, cognitive impairment, frailty and disability in older heart failure patients
- Author
-
Maria Denitza Tinti, Giulia Barbati, Michele Senni, Giovanni Minardi, Giovanni Pulignano, Paola Ciurluini, Giovanni Cioffi, Andrea Di Lenarda, Luigi Tarantini, Donatella Del Sindaco, Massimo Uguccioni, Gianfranco Alunni, Adriano Murrone, Pulignano, Giovanni, Del Sindaco, Donatella, Tinti, Maria D., DI LENARDA, Andrea, Alunni, Gianfranco, Senni, Michele, Tarantini, Luigi, Cioffi, Giovanni, Barbati, Giulia, Minardi, Giovanni, Murrone, Adriano, Ciurluini, Paola, Uguccioni, Massimo, Pulignano, G, Del Sindaco, D, Tinti, M, Di Lenarda, A, Alunni, G, Senni, M, Tarantini, L, Cioffi, G, Barbati, G, Minardi, G, Murrone, A, Ciurluini, P, and Uguccioni, M
- Subjects
Male ,medicine.medical_specialty ,Pediatrics ,Activities of daily living ,Frail Elderly ,heart failure ,Kaplan-Meier Estimate ,frailty ,030204 cardiovascular system & hematology ,Neuropsychological Tests ,elderly ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Older patients ,Internal medicine ,Activities of Daily Living ,medicine ,Humans ,Cognitive Dysfunction ,030212 general & internal medicine ,Longitudinal Studies ,Cognitive impairment ,Gait ,Aged ,cognitive impairment ,Aged, 80 and over ,Psychiatric Status Rating Scales ,business.industry ,Atrial fibrillation ,General Medicine ,medicine.disease ,Logistic Models ,disability ,Heart failure ,Psychiatric status rating scales ,Ambulatory ,Chronic Disease ,Multivariate Analysis ,Cardiology ,Female ,gait speed ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND: Aim of the study was to prospectively assess the relation between atrial fibrillation, cognitive impairment, frailty and disability in older patients with chronic heart failure . METHODS: Three hundred thirty-one ambulatory community-living patients aged 70 years and older (mean 78 ± 6; range 70-93; 43% women) in stable conditions and optimized therapy were enrolled in seven heart failure cardiology clinics. Cognitive impairment was defined by a corrected Mini Mental State Examination score less than 24. Gait speed was used as marker of frailty and measured on a 4 m distance at usual pace. RESULTS: Ninety-eight patients (30%) were on atrial fibrillation at enrolment and 20 (6%) had a history of paroxysmal/persistent atrial fibrillation. Patients with atrial fibrillation were more frequently women with severe valvular disease, preserved left ventricular ejection fraction and less frequently on beta-blockers. At multivariable analyses, atrial fibrillation emerged as independently related to cognitive impairment [odds ratio (OR) 1.909 (1.072-3.397); P = 0.028], as well as to reduced gait speed [OR 4.366 (2.104-9.060); P
- Published
- 2016
21. Mitral Transcatheter Edge-to-Edge Repair in INTERMACS 3-4 Profile Patients with Severe Mitral Regurgitation.
- Author
-
Frea S, Pidello S, Angelini F, Boretto P, Bocchino PP, Melis D, Giannino G, Cavallone E, Giordana F, Rettegno S, Gravinese C, De Lio G, Gallone G, Dusi V, Alunni G, Montefusco A, D'Ascenzo F, Boffini M, Raineri C, Rinaldi M, and De Ferrari GM
- Abstract
Background: Heart transplantation and left ventricular assist device (LVAD) implementation are effective treatments for advanced heart failure (HF), although their use is limited by organ availability and the high incidence of adverse events. The efficacy of mitral transcatheter edge-to-edge repair (TEER) as a bridge to transplantation or as a destination therapy in advanced HF is still debated., Methods: A total of 63 patients with INTERMACS class 3 or 4 with contraindications for LVAD and severe functional mitral regurgitation (FMR) were evaluated for TEER implantation eligibility. The primary endpoint was a composite of death, urgent heart transplantation and LVAD implantation at 12 months., Results: A total of 36 patients underwent TEER, while 27 patients received optimal medical therapy (MT) alone. In the intervention group, 35 patients (97%) were discharged alive. In the MT group, two in-hospital deaths occurred, two patients underwent urgent heart transplantation, and three patients were discharged on inotropes. At the 12-month follow-up, the incidence of the primary endpoint occurring was lower in the TEER group (25% vs. 70%, HR 0.25, 95% CI 0.11-0.60, p < 0.01) and the tolerance to neurohormonal therapy was higher (53% vs. 30%, p = 0.03)., Conclusions: In advanced HF patients with INTERMACS profile 3 or 4 and severe FMR, TEER on top of optimal MT was associated with a lower incidence of death, urgent heart transplantation or LVAD implantation at 12 months compared to optimal MT alone.
- Published
- 2024
- Full Text
- View/download PDF
22. Anakinra-Dependent Recurrent Pericarditis: The Role of the R202Q Variant of the MEFV Gene.
- Author
-
Andreis A, Dossi FC, De Ferrari GM, Alunni G, and Imazio M
- Abstract
Background : the role of the R202Q (c.605G>A, p.Arg202Gln) missense variant of the MEFV gene has been debated as either a benign polymorphism or a potentially pathogenic mutation. We report and discuss here the case of a young female with corticosteroid-dependent recurrent pericarditis carrying the homozygous R202Q variant, exhibiting distinctive clinical features possibly influenced by this genetic variant. Methods : a 30-year-old woman with a previous diagnosis of cancer and recent respiratory infection presented with severe pleuritic chest pain, hypotension, tachycardia, and fever. Initial diagnostic evaluation indicated cardiac tamponade, and emergent pericardiocentesis was performed. Despite initial treatment with NSAIDs, colchicine, and corticosteroids, the patient experienced multiple recurrences. Genetic testing identified homozygous R202Q variant in the MEFV gene. Given the corticosteroid dependency and recurrent nature of her condition, IL-1 inhibitor anakinra was introduced, leading to significant improvement, although tapering below 150 mg per week failed to prevent recurrences. Results : the introduction of anakinra resulted in rapid symptom relief and resolution of pericardial effusion. However, attempts to taper or discontinue anakinra led to pericarditis recurrences. Ultimately, a maintenance dose of 50 mg every three days was established, which maintained remission for 18 months without recurrence. Despite multiple tapering attempts, further reduction in anakinra dosage was unsuccessful without triggering relapses. Conclusions : the R202Q variant, although typically considered benign, may contribute to an autoinflammatory phenotype resembling familial Mediterranean fever. This case underscores the potential pathogenicity of the homozygous R202Q variant in recurrent pericarditis and its responsiveness to IL-1 inhibition. In patients with corticosteroid-dependent recurrent pericarditis, genetic testing for the R202Q variant should be considered when anti-IL-1 drugs cannot be withdrawn. Further studies are warranted to elucidate the variant's role in pericardial inflammation and guide personalized treatment strategies.
- Published
- 2024
- Full Text
- View/download PDF
23. INFLA-score: A new diagnostic paradigm to identify pericarditis.
- Author
-
Andreis A, Solano A, Balducci M, Picollo C, Ghigliotti M, Giordano M, Agosti A, Collini V, Anselmino M, De Ferrari GM, Rinaldi M, Alunni G, and Imazio M
- Abstract
Background: Diagnosis of pericarditis may be challenging because not all patients meet the conventional criteria. An overlooked diagnosis implies a longer course of symptoms and an increased risk of recurrences. C-reactive protein (CRP), widely used as an inflammation marker, has some limitations. This study aimed to assess the usefulness and prognostic value of INFLA-score, a validated index assessing low-grade inflammation, in the definite diagnosis of pericarditis., Methods: Patients with suspected pericarditis were included. The INFLA-score was computed based on white blood cells and platelet count, neutrophil-to-lymphocyte ratio, and CRP, ranging from -16 to +16. An INFLA-score > 0 was considered positive for the presence of pericardial inflammation. The primary end point was the association of INFLA-score with diagnosis of pericarditis according to conventional criteria. The recurrence of pericarditis at 6 months was the secondary end point., Results: A total of 202 patients were included, aged 47 ± 17 years, and 57% were females. Among 72 (36%) patients with a diagnosis of pericarditis, an INFLA-score > 0 was observed in 86% (vs. 36%, p < 0.001), abnormal CRP in 42% (vs. 10%, p < 0.001), pericardial effusion in 44% (vs. 19%, p < 0.001), abnormal electrocardiogram in 56% (vs. 24%, p < 0.001), and rubs in 5% (vs. 0.1%, p = 0.072). INFLA-score > 0 had the strongest predictive value for the diagnosis of pericarditis (hazard ratio 8.48, 95% confidence interval [CI] 3.39-21.21), with 86% sensitivity and 64% specificity, as opposed to CRP (hazard ratio 1.72, non-significant 95% CI 0.69-4.29). Recurrent pericarditis at 6 months was more frequent in patients with a positive INFLA-score (37% vs. 8%, p < 0.001, rate ratio 4.15, 95% CI 2.81-6.12). In patients with normal CRP, INFLA-score-confirmed ongoing inflammation in 78% of the cases. Compared with the conventional criteria, the INFLA-score had the highest accuracy (area under the curve = 0.82). Different cutoffs were valuable to rule out (INFLA-score > 0, sensitivity 86%, and negative likelihood ratio 0.22) or rule in (INFLA-score ≥ 10, specificity 97%, and positive likelihood ratio 13) the diagnosis., Conclusions: The INFLA-score is a useful diagnostic tool to assess the probability of pericarditis, with a strong prognostic value for further recurrences, outperforming CRP., Competing Interests: Declarations of interest None., (Copyright © 2024 Hellenic Society of Cardiology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
24. Transthyretin cardiac amyloidosis in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: experience of a single center.
- Author
-
Gallone G, Bongiovanni C, Bruno F, Landra F, Andreis A, Fava A, Scudeler L, DE Filippo O, Califaretti E, Cioffi M, Pidello S, Vairo A, Raineri C, Frea S, Giorgi M, Alunni G, Casoni R, Salizzoni S, Conrotto F, D'Ascenzo F, Rinaldi M, and DE Ferrari GM
- Subjects
- Humans, Prealbumin, Retrospective Studies, Tomography, X-Ray Computed, Transcatheter Aortic Valve Replacement adverse effects, Cardiomyopathies diagnostic imaging, Cardiomyopathies epidemiology, Cardiomyopathies surgery, Amyloid Neuropathies, Familial complications, Amyloid Neuropathies, Familial epidemiology, Amyloid Neuropathies, Familial surgery, Aortic Valve Stenosis epidemiology, Aortic Valve Stenosis surgery
- Abstract
Background: Even if prevalent among patients with severe aortic stenosis (AS), the clinical suspicion for transthyretin cardiac amyloidosis (ATTR-CA) remains difficult in this subset. We report our single center experience on ATTR-CA detection among TAVR candidates to provide insights on the prevalence and clinical features of dual pathology as compared to lone AS., Methods: Consecutive severe AS patients undergoing transcatheter aortic valve replacement (TAVR) evaluation at a single center were prospectively included. Those with suspected ATTR-CA based on clinical assessment underwent
99m Tc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) bone scintigraphy. The RAISE score, a novel screening tool with high sensitivity for ATTR-CA in AS, was retrospectively calculated to rule-out ATTR-CA in the remaining patients. Patients were categorized as follow: "ATTR-CA+": patients with confirmed ATTR-CA at DPD bone scintigraphy; "ATTR-CA-": patients with negative DPD bone scintigraphy or a negative RAISE score; "ATTR-CA indeterminate": patients not undergoing ATTR-CA assessment with a positive RAISE score. The characteristics of ATTR-CA+ and ATTR-CA- patients were compared., Results: Of 107 included patients, ATTR-CA suspicion was posed in 13 patients and confirmed in six. Patients were categorized as follow: 6 (5.6%) ATTR-CA+, 79 (73.8%) ATTR-CA-, 22 (20.6%) ATTR-CA indeterminate. Excluding ATTR-CA indeterminate patients, the prevalence of ATTR-CA was 7.1% (95% CI 2.6-14.7%). As compared to ATTR-CA - patients, ATTR-CA + patients were older, had higher procedural risk and more extensive myocardial and renal damage. They had higher left ventricle mass index and lower ECG voltages, translating into a lower voltage to mass ratio. Moreover, we describe for the first time bifascicular block as an ECG feature highly specific of patients with dual pathology (50.0% vs. 2.7%, P<0.001). Of note, pericardial effusion was rarely found in patients with lone AS (16.7% vs. 1.2%, P=0.027). No difference in procedural outcomes was observed between groups., Conclusions: Among severe AS patients, ATTR-CA is prevalent and presents with phenotypic features that may aid to differentiate it from lone AS. A clinical approach based on routine search of amyloidosis features might lead to selective DPD bone scintigraphy with a satisfactory positive predictive value.- Published
- 2024
- Full Text
- View/download PDF
25. A Mono-Leaflet, Low-Profile Transcatheter Mitral Prosthesis: First-in-Human Implantation.
- Author
-
Salizzoni S, Vairo A, Montefusco A, Alunni G, La Torre M, Agostini G, Pistono M, Faletti R, Rinaldi M, and Vola M
- Subjects
- Humans, Treatment Outcome, Mitral Valve diagnostic imaging, Mitral Valve surgery, Prostheses and Implants, Cardiac Catheterization adverse effects, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency surgery, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis, Ventricular Outflow Obstruction
- Abstract
Competing Interests: Funding Support and Author Disclosures Prof Vola is a clinical consultant for Affluent Medical. Prof Salizzoni is a surgical proctor for Epygon. Dr Vairo is an echocardiography proctor for Epygon. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Published
- 2023
- Full Text
- View/download PDF
26. Minimally Invasive Surgery: Standard of Care for Mitral Valve Endocarditis.
- Author
-
Barbero C, Pocar M, Brenna D, Parrella B, Baldarelli S, Aloi V, Costamagna A, Trompeo AC, Vairo A, Alunni G, Salizzoni S, and Rinaldi M
- Subjects
- Humans, Mitral Valve surgery, Retrospective Studies, Standard of Care, Endocarditis surgery, Endocarditis, Bacterial, Heart Valve Diseases
- Abstract
Background . Minimally invasive surgery via right mini-thoracotomy has become the standard of care for the treatment of mitral valve disease worldwide, particularly at high-volume centers. In recent years, the spectrum of indications has progressively shifted and extended to fragile and higher-risk patients, also addressing more complex mitral valve disease and ultimately including patients with native or prosthetic infective endocarditis. The rationale for the adoption of the minimally invasive approach is to minimize surgical trauma, promote an earlier postoperative recovery, and reduce the incidence of surgical wound infection and other nosocomial infections. The aim of this retrospective observational study is to evaluate the effectiveness and the early and late outcome in patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Methods . Prospectively collected data regarding minimally invasive surgery in patients with mitral valve infective endocarditis were entered into a dedicated database for the period between January 2007 and December 2022 and retrospectively analyzed. All comers during the study period underwent a preoperative evaluation based on their clinical history and anatomy for the allocation to the most appropriate surgical strategy. The selection of the mini-thoracotomy approach was primarily driven by a thorough transthoracic and especially transesophageal echocardiographic evaluation, coupled with total body and vascular imaging. Results . During the study period, 92 patients underwent right mini-thoracotomy to treat native (80/92, 87%) or prosthetic (12/92, 13%) mitral valve endocarditis at our institution, representing 5% of the patients undergoing minimally invasive mitral surgery. Twenty-six (28%) patients had undergone previous cardiac operations, whereas 18 (20%) presented preoperatively with complications related to endocarditis, most commonly systemic embolization. Sixty-nine and twenty-three patients, respectively, underwent early surgery (75%) or were operated on after the completion of the targeted antibiotic treatment (25%). A conservative procedure was feasible in 16/80 (20%) patients with native valve endocarditis. Conversion to standard sternotomy was necessary in a single case (1.1%). No cases of intraoperative iatrogenic aortic dissection were reported. Four patients died perioperatively, accounting for a thirty-day mortality of 4.4%. The causes of death were refractory heart or multiorgan failure and/or septic shock. A new onset stroke was observed postoperatively in one case (1.1%). Overall actuarial survival rate at 1 and 5 years after operation was 90.8% and 80.4%, whereas freedom from mitral valve reoperation at 1 and 5 years was 96.3% and 93.2%, respectively. Conclusions . This present study shows good early and long-term results in higher-risk patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Total body, vascular, and echocardiographic screening represent the key points to select the optimal approach and allow for the extension of indications for minimally invasive surgery to sicker patients, including active endocarditis and sepsis.
- Published
- 2023
- Full Text
- View/download PDF
27. Three-Dimensional Finger Test: A New Echocardiographic Method to Locate the Best Access Site During NeoChord Procedure.
- Author
-
Vairo A, Manai R, Gaiero L, Desalvo P, Bellettini M, Zaccaro L, Rinaudo A, Franchin L, Piroli F, Bruno F, Sebastiano V, Cura Stura E, Barbero C, Marro M, Faletti R, Alunni G, De Ferrari GM, Rinaldi M, and Salizzoni S
- Subjects
- Humans, Echocardiography, Echocardiography, Transesophageal methods, Mitral Valve Insufficiency surgery, Mitral Valve Prolapse surgery, Echocardiography, Three-Dimensional methods
- Abstract
Objective: Transventricular beating-heart mitral valve repair (TBMVR) with artificial chordae implantation is a technique to treat mitral valve prolapse. Two-dimensional (2D) echocardiography completed with simultaneous biplane view during surgeon finger pushing on the left ventricular (LV) wall (finger test [FT]) is currently used to localize the desired LV access, on the inferior-lateral wall, between the papillary muscles (PMs). We aimed to compare a new three-dimensional (3D) method with conventional FT in terms of safety and better localization of LV access., Methods: During TBMVR, conventional FT was completed using 3D transesophageal echocardiography by placing the sample box in the bicommissural view of the LV, including the PMs and the apex. The 3D volume was subsequently edited to visualize the LV from above (surgical view) to localize the bulge of the operator's finger pushing on the LV. We asked the first operator, the second operator, and the cardiac surgery fellow, separately, to evaluate the location of their finger pushing, both with the 2D method and the 3D method, to estimate the interoperator concordance., Results: From 2019 to 2021, 42 TBMVRs were performed without complications related to access using FT completed with the 3D method. Regarding the choice of the right and safe entry site, the operator's agreement was higher using 3D rendering compared with conventional FT (mean agreement 0.59 ± 0.29 for 2D vs 0.83 ± 0.20 for 3D), while full operator agreement was 10 of 42 for 2D and 23 of 42 for 3D ( P = 0.004)., Conclusions: Three-dimensional FT is easy to perform and facilitates surgeons choosing the best access for TBMVR in term of anatomical localization and safety.
- Published
- 2023
- Full Text
- View/download PDF
28. Cardiac imaging for the prediction of sudden cardiac arrest in patients with heart failure.
- Author
-
De Lio F, Andreis A, De Lio G, Bellettini M, Pidello S, Raineri C, Gallone G, Alunni G, Frea S, Imazio M, Castagno D, and De Ferrari GM
- Abstract
The identification of heart failure (HF) patients at risk for arrhythmic sudden cardiac arrest (SCA) is a major challenge in the cardiovascular field. In addition to optimal medical treatment for HF, implantable cardioverter defibrillator (ICD) is currently recommended to prevent SCA in patients with reduced left ventricular ejection fraction (LVEF). The indication for an ICD implantation, in addition to HF etiology, New York Health Association (NYHA) class and life expectancy, mainly depends on LVEF value at echocardiography. However, the actual role of LVEF in the prediction of SCA has recently been debated, while newer multimodality imaging techniques with increased prognostic accuracy have been developed. Speckle tracking imaging allows the quantification of mechanical dispersion, a marker of electrophysiological heterogeneity predisposing to malignant arrhythmias, while advanced cardiac magnetic resonance techniques such as myocardial T1-mapping and extracellular volume fraction assessment allow the evaluation of interstitial diffuse fibrosis. Nuclear imaging is helpful for the appraisal of sympathetic nervous system dysfunction, while newer computed tomography techniques assessing myocardial delayed enhancement allow the identification of focal myocardial scar. This review will focus on the most modern advances in the field of cardiovascular imaging along with its applications for the prediction of SCA in patients with HF. Modern artificial intelligence applications in cardiovascular imaging will also be discussed., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)
- Published
- 2023
- Full Text
- View/download PDF
29. New Echocardiographic Parameters Predicting Successful Trans-Ventricular Beating-Heart Mitral Valve Repair with Neochordae at 3 Years: Monocentric Retrospective Study.
- Author
-
Vairo A, Gaiero L, Marro M, Russo C, Bolognesi M, Soro P, Gallone G, Fioravanti F, Desalvo P, D'Ascenzo F, Alunni G, Sebastiano V, Barbero C, Pocar M, De Ferrari GM, Rinaldi M, and Salizzoni S
- Abstract
The NeoChord procedure is an echo-guided trans-ventricular beating-heart mitral valve repair technique to treat degenerative mitral regurgitation (MR) due to prolapse and/or flail. The aim of this study is to analyze echocardiographic images to find pre-operative parameters to predict procedural success (≤moderate MR) at 3-year follow-up. Seventy-two consecutive patients with severe MR underwent the NeoChord procedure between 2015 and 2021. MV pre-operative morphological parameters were assessed using 3D transesophageal echocardiography with dedicated software (QLAB, Philips). Three patients died during their hospitalization. The remaining 69 patients were retrospectively analyzed. At follow-up, MR > moderate was found in 17 patients (24.6%). In the univariate analysis, end-systolic annulus area (12.5 ± 2.5 vs. 14.1 ± 2.6 cm
2 ; p = 0.038), end-systolic annulus circumference (13.2 ± 1.2 vs. 14 ± 1.3 cm; p = 0.042), indexed left atrial volume (59 ± 17 vs. 76 ± 7 mL/m2 ; p = 0.041), and AF (25% vs. 53%; p = 0.042) were lower in the 52 patients with ≤ MR compared to those with > moderate MR. Annular dysfunction parameters were the best predictors of procedural success: 3D early-systolic annulus area (AUC 0.74; p = 0.004), 3D early-systolic annulus circumference (AUC 0.75; p = 0.003), and 3D annulus area fractional change (AUC 0.73; p = 0.035). Patient selection relying on 3D dynamic and static MA dimensions may improve the maintenance of procedural success at follow-up.- Published
- 2023
- Full Text
- View/download PDF
30. Echocardiographic Parameters to Predict Malignant Events in Arrhythmic Mitral Valve Prolapse Population.
- Author
-
Vairo A, Desalvo P, Rinaudo A, Piroli F, Tribuzio A, Ballatore A, Marcelli G, Pistelli L, Dusi V, Montali N, Alunni G, Barbero C, Salizzoni S, Pocar M, Rinaldi M, Gaita F, De Ferrari GM, and Giustetto C
- Abstract
Bileaflet Mitral Valve Prolapse (bMVP) has been linked to major arrhythmic events and sudden cardiac death (SCD). Consistent predictors in this field are still lacking. Echocardiography is the best tool for the analysis of the prolapse and its impact on the ventricular mechanics. The aim of this study was to find new echocardiographic predictors of malignant events within an arrhythmic MVP population. We evaluated 22 patients with arrhythmic bMVP with a transthoracic echocardiogram focused on mitral valve anatomy and ventricular contraction. Six of them had major arrhythmic events that required ICD implantation (ICD-MVP group), while sixteen presented with a high arrhythmic burden without major events (A-MVP group). The best predictors of malignant events were the Anterior Mitral Leaflet (AML) greater length and greater Mechanical Dispersion (MD) of basal and mid-ventricular segments, while other significant predictors were the larger mitral valve annulus (MVA) indexed area, lower MVA anteroposterior diameter/AML length ratio, higher inferolateral basal segment S3 velocity.
- Published
- 2023
- Full Text
- View/download PDF
31. Acute Modification of Hemodynamic Forces in Patients with Severe Aortic Stenosis after Transcatheter Aortic Valve Implantation.
- Author
-
Vairo A, Zaccaro L, Ballatore A, Airale L, D'Ascenzo F, Alunni G, Conrotto F, Scudeler L, Mascaretti D, Miccoli D, Torre M, Rinaldi M, Pedrizzetti G, Salizzoni S, and De Ferrari GM
- Abstract
Transcatheter aortic valve implantation (TAVI) is the established first-line treatment for patient with severe aortic stenosis not suitable for surgery. Echocardiographic evaluation of hemodynamic forces (HDFs) is a growing field, holding the potential to early predict improvement in LV function. A prospective observational study was conducted. Transthoracic echocardiography was performed before and after TAVI. HDFs were analyzed along with traditional left ventricular (LV) function parameters. Twenty-five consecutive patients undergoing TAVI were enrolled: mean age 83 ± 5 years, 74.5% male, mean LV Ejection Fraction (LVEF) at baseline 57 ± 8%. Post-TAVI echocardiographic evaluation was performed 2.4 ± 1.06 days after the procedure. HDF amplitude parameters improved significantly after the procedure: LV Longitudinal Forces (LF) apex-base [mean difference (MD) 1.79%; 95% CI 1.07-2.5; p -value < 0.001]; LV systolic LF apex-base (MD 2.6%; 95% CI 1.57-3.7; p -value < 0.001); LV impulse (LVim) apex-base (MD 2.9%; 95% CI 1.48-4.3; p -value < 0.001). Similarly, HDFs orientation parameters improved: LVLF angle (MD 1.5°; 95% CI 0.07-2.9; p -value = 0.041); LVim angle (MD 2.16°; 95% CI 0.76-3.56; p -value = 0.004). Conversely, global longitudinal strain and LVEF did not show any significant difference before and after the procedure. Echocardiographic analysis of HDFs could help differentiate patients with LV function recovery after TAVI from patients with persistent hemodynamic dysfunction.
- Published
- 2023
- Full Text
- View/download PDF
32. Successful Percutaneous Retrieval of an Embolized Left Atrial Appendage Occluder.
- Author
-
Ferraris F, Millesimo M, Anselmino M, Castagno D, Vairo A, Alunni G, and De Ferrari GM
- Abstract
A 75-year-old man with a previous mitral valve repair experienced embolization of a left atrial appendage occlusion device in the left atrium. The device was successfully retrieved using a double snaring technique, without the need for open surgery. This is an unusual report of left atrial appendage occluder retrieval, confirming the feasibility of the technique and the high flexibility of the device. ( Level of Difficulty: Advanced. )., Competing Interests: This research was supported by a grant from the Italian Ministry of Health: “Giovani Ricercatori—Ricerca Finalizzata”, project number GR-2016-02362088; the funder had no role in this study. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)
- Published
- 2022
- Full Text
- View/download PDF
33. Imaging of Cardiac Masses: An Updated Overview.
- Author
-
Parato VM, Nocco S, Alunni G, Becherini F, Conti S, Cucchini U, Di Giannuario G, Di Nora C, Fabiani D, La Carrubba S, Leonetti S, Montericcio V, Tota A, and Petrella L
- Abstract
Studying cardiac masses is one of the most challenging tasks for cardiac imagers. The aim of this review article is to focus on the modern imaging of cardiac masses proceeding through the most frequent ones. Cardiac benign masses such as myxoma, cardiac papillary fibroelastoma, rhabdomyoma, lipoma, and hemangioma are browsed considering the usefulness of most common cardiovascular imaging tools, such as ultrasound techniques, cardiac computed tomography, cardiac magnetic resonance, and in the diagnostic process. In the same way, the most frequent malignant cardiac masses, such as angiosarcoma and metastases, are highlighted. Then, the article browses through nontumoral masses such as cysts, mitral caseous degenerative formations, thrombi, and vegetations, highlighting the differential diagnosis between them. In addition, the article helps in recognizing anatomic normal variants that should not be misdiagnosed as pathological entities., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Cardiovascular Echography.)
- Published
- 2022
- Full Text
- View/download PDF
34. Clinical Outcomes Following Isolated Transcatheter Tricuspid Valve Repair: A Meta-Analysis and Meta-Regression Study.
- Author
-
Bocchino PP, Angelini F, Vairo A, Andreis A, Fortuni F, Franchin L, Frea S, Raineri C, Pidello S, Conrotto F, Montefusco A, Alunni G, and De Ferrari GM
- Subjects
- Aged, Aged, 80 and over, Cardiac Catheterization adverse effects, Humans, Severity of Illness Index, Time Factors, Treatment Outcome, Tricuspid Valve diagnostic imaging, Tricuspid Valve surgery, Heart Valve Prosthesis Implantation adverse effects, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency surgery
- Abstract
Objectives: The aim of this study was to assess the pooled clinical and echocardiographic outcomes of different isolated transcatheter tricuspid valve repair (ITTVR) strategies for significant (moderate or greater) tricuspid regurgitation (TR)., Background: Significant TR is a common valvular heart disease worldwide., Methods: Published research was systematically searched for studies evaluating the efficacy and safety of ITTVR for significant TR in adults. The primary outcomes were improvement in New York Heart Association (NYHA) functional class and 6-minute walking distance and the presence of severe or greater TR at the last available follow-up of each individual study. Random-effect meta-analysis was performed comparing outcomes before and after ITTVR., Results: Fourteen studies with 771 patients were included. The mean age was 77 ± 8 years, and the mean European System for Cardiac Operative Risk Evaluation II score was 6.8% ± 5.4%. At a weighted mean follow-up of 212 days, 209 patients (35%) were in NYHA functional class III or IV compared with 586 patients (84%) at baseline (risk ratio: 0.23; 95% CI: 0.13-0.40; P < 0.001). Six-minute walking distance significantly improved from 237 ± 113 m to 294 ± 105 m (mean difference +50 m; 95% CI: +34 to +66 m; P < 0.001). One hundred forty-seven patients (24%) showed severe or greater TR after ITTVR compared with 616 (96%) at baseline (risk ratio: 0.29; 95% CI: 0.20-0.42; P < 0.001)., Conclusions: Patients undergoing ITTVR for significant TR experienced significant improvements in NYHA functional status and 6-minute walking distance and a significant reduction in TR severity at mid-term follow-up., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
35. Myocardial longitudinal strain as the first herald of cardiac impairment in very early iron overload state: an echocardiography and biosusceptometry study on beta-thalassemia patients.
- Author
-
Barbero U, Fornari F, Gagliardi M, Fava A, Giorgi M, Alunni G, Gaglioti CM, Piga A, Ferrero GB, and Longo F
- Abstract
Background: Heart diseases due to iron overload are still the main cause of mortality in patients affected by beta-thalassemia. Detection of cardiac iron overload in pre-clinical stage allows tailoring of chelation therapy and follow-up strategies. Echocardiographic longitudinal strain analysis may be a useful tool for early detection of cardiac functional impairment iron-related., Methods: We examined 58 patients with beta-thalassemia on regular blood transfusion and iron chelation, without overt cardiac disease who had recent Biosusceptometry SQUID to quantify liver iron concentration and cardiac assessment by CMR T2*., Results: Average global longitudinal strain (GLS) was able to identify abnormal (<20 ms) cardiac T2* values with 96% specificity and negative predictive value of 92% (AUC 0.84, P=0.01). Apical 4-ch GLS may help identify early longitudinal impairment associated with severe liver iron overload with 96% specificity and negative predictive value of 92% (AUC 0.84, P=0.02). Patients with severe liver iron overload had lower average Global Longitudinal Strain values compared to other patients ( P -value =0.005)., Conclusion: GLS was a sensitive marker to detect both myocardial and liver iron overload in a population that is still free from cardiac symptoms. Thus, strain echocardiography may be a useful tool for early detection of iron overload in Beta-thalassemia., Competing Interests: None., (AJCD Copyright © 2021.)
- Published
- 2021
36. Another Brick in the Wall: Percutaneous Balloon Valvuloplasty for Flow-Limiting Mitral Stenosis in a Patient With LVAD.
- Author
-
Boretto P, Vairo A, Cusenza V, Alunni G, Frea S, Pidello S, Lodo V, D'Ascenzo F, Orzan F, De Ferrari GM, and Montefusco A
- Subjects
- Heart Valves, Humans, Treatment Outcome, Balloon Valvuloplasty adverse effects, Mitral Valve Stenosis diagnostic imaging, Mitral Valve Stenosis therapy, Rheumatic Heart Disease
- Abstract
Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Published
- 2021
- Full Text
- View/download PDF
37. Transient Complete Atrioventricular Block due to Rupture of the Right Sinus of Valsalva.
- Author
-
Bocchino PP, Fasano R, Fortuni F, Franchin L, Bellettini M, Alunni G, and De Ferrari GM
- Subjects
- Aortic Rupture diagnostic imaging, Aortic Rupture surgery, Aortography, Atrioventricular Block diagnosis, Blood Vessel Prosthesis Implantation, Computed Tomography Angiography, Echocardiography, Transesophageal, Electrocardiography, Heart Valve Prosthesis Implantation, Humans, Male, Middle Aged, Tissue Adhesives therapeutic use, Treatment Outcome, Ventricular Septal Rupture diagnostic imaging, Ventricular Septal Rupture surgery, Aortic Rupture complications, Atrioventricular Block etiology, Sinus of Valsalva diagnostic imaging, Sinus of Valsalva surgery, Ventricular Septal Rupture complications
- Published
- 2021
- Full Text
- View/download PDF
38. Hemodynamic Assessment in the Cardiac Intensive Care Unit: May Echocardiography Solve the Conundrum?
- Author
-
Fortuni F, Vairo A, Alunni G, and De Ferrari GM
- Subjects
- Humans, Intensive Care Units, Predictive Value of Tests, Echocardiography, Hemodynamics
- Published
- 2021
- Full Text
- View/download PDF
39. Impact of extracorporeal shockwave myocardial revascularization on the ischemic burden of refractory angina patients: a single photon emission computed tomography study.
- Author
-
Alunni G, D'''''Amico S, Castelli C, De Lio G, Fioravanti F, Gallone G, Marra S, and De Ferrari GM
- Subjects
- Canada, Humans, Ischemia, Prospective Studies, Tomography, Emission-Computed, Single-Photon, Treatment Outcome, Angina, Unstable therapy, High-Energy Shock Waves, Myocardial Revascularization
- Abstract
Background: Extracorporeal shockwave myocardial revascularization (ESMR) is a non-invasive treatment designed to improve symptoms in refractory angina (RA) patients. Enhanced perfusion through local vasodilation and neo-capillarization is postulated to be the mechanism of the observed clinical benefit. However, the impact of ESMR on the ischemic burden of RA patients has not been adequately assessed., Methods: One-hundred twenty-one consecutive RA patients suitable for ESMR were treated. Twenty-nine RA patients not suitable for treatment were clinically followed-up as a control group for clinical endpoints. ESMR-treated patients underwent baseline and 6-month single photon emission computed tomography (SPECT) to evaluate the changes in ischemic burden. The operator was blinded to the pre/post-treatment status of the SPECT exam. The primary endpoint was the difference in summed stress score (SSS) and summed difference score (SDS) between follow-up and baseline SPECTs. Secondary endpoints included the changes in Canadian Cardiovascular Society (CCS) angina class and nitroglycerin use between 6-month follow-up and baseline. Clinical endpoints were further compared between ESMR-treated patients and the control group., Results: Following ESMR, a significant reduction in the ischemic burden was observed (follow-up SSS: 14.2±10 vs. baseline SSS: 21.2±9.42, P<0.0001; follow-up SDS: 4.6±5.9 vs. baseline SDS 10.2±7.9, P<0.0001) including less patients with moderate to severe ischemia (19% vs. 46% P<0.0001). CCS class and nitroglycerin use were significantly reduced (CCS: 1.5±0.6 vs. 2.7±0.6, P<0.0001; patients needing nitroglycerin: 24% vs. 64%, P<0.0001). When compared to the control group, CCS class reduction, nitroglycerin use and hospitalizations were significantly lower for ESMR treated vs. non-treated RA patients at 6-month follow-up., Conclusions: In this single-center cohort of RA patients undergoing ESMR treatment and serial myocardial perfusion imaging, ESMR was associated with a significant reduction in the ischemic burden. These findings provide a physiological rationale and mechanism for the observed clinical benefit.
- Published
- 2020
- Full Text
- View/download PDF
40. In the midst of a dangerous intersection with unclear therapeutic strategies: a challenging case of severe aortic stenosis.
- Author
-
Gallone G, Landra F, D'Ascenzo F, Conrotto F, Casoni R, Bruno F, Omedè P, Alunni G, Andreis A, Vairo A, Giorgi M, Fava A, and De Ferrari GM
- Subjects
- Aged, 80 and over, Amyloid Neuropathies, Familial diagnostic imaging, Amyloid Neuropathies, Familial drug therapy, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis drug therapy, Cardiomyopathies diagnostic imaging, Cardiomyopathies drug therapy, Cardiovascular Agents therapeutic use, Conservative Treatment, Humans, Male, Severity of Illness Index, Treatment Outcome, Amyloid Neuropathies, Familial complications, Aortic Valve Stenosis complications, Cardiomyopathies complications
- Abstract
Background: One out of seven patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) may be affected by transthyretin cardiac amyloidosis (ATTR-CA), mostly presenting with low-flow low-gradient AS with mildly reduced ejection fraction. The complex interaction of these two pathologies poses specific diagnostic and management challenges. The prognostic implications of this clinical intersection are not defined yet. Moreover, whether TAVR may have a prognostic benefit in ATTR-CA patients with symptomatic severe AS remains unclear, posing doubts on the best management strategy in this increasingly recognized subset of patients., Clinical Case: We present a case of an 87-year old man with low-flow low-gradient severe AS, for whom a diagnosis of ATTR-CA was suspected based on clinical and echocardiographic criteria specific to coexisting AS and ATTR-CA. The diagnosis was eventually confirmed by positive bone tracer scintigraphy imaging. Following in-depth Heart team discussion, integrating frailty and prognostic information from combined cardiomyopathy states, a decision was made to manage the patient's severe AS conservatively., Conclusion: In the presented case, we deemed the natural history of ATTR-CA amyloidosis to negatively affect both the patient' prognosis and procedural risk, adversing TAVR indication despite symptomatic severe AS. No clear evidence is currently available to guide decision making in this setting, advocating for prospective studies to clarify if TAVR may have a prognostic benefit in ATTR-CA - and which ATTR-CA - patients.
- Published
- 2020
- Full Text
- View/download PDF
41. Real-world experience with decitabine as a first-line treatment in 306 elderly acute myeloid leukaemia patients unfit for intensive chemotherapy.
- Author
-
Bocchia M, Candoni A, Borlenghi E, Defina M, Filì C, Cattaneo C, Sammartano V, Fanin R, Sciumè M, Sicuranza A, Imbergamo S, Riva M, Fracchiolla N, Latagliata R, Caizzi E, Mazziotta F, Alunni G, Di Bona E, Crugnola M, Rossi M, Consoli U, Fontanelli G, Greco G, Nadali G, Rotondo F, Todisco E, Bigazzi C, Capochiani E, Molteni A, Bernardi M, Fumagalli M, Rondoni M, Scappini B, Ermacora A, Simonetti F, Gottardi M, Lambertenghi Deliliers D, Michieli M, Basilico C, Galeone C, Pelucchi C, and Rossi G
- Subjects
- Aged, Aged, 80 and over, Antimetabolites, Antineoplastic adverse effects, Antimetabolites, Antineoplastic therapeutic use, Cause of Death, Decitabine adverse effects, Disease Progression, Female, Humans, Infections etiology, Kaplan-Meier Estimate, Leukemia, Myeloid, Acute mortality, Male, Multicenter Studies as Topic statistics & numerical data, Observational Studies as Topic statistics & numerical data, Prognosis, Proportional Hazards Models, Risk Factors, Treatment Outcome, Decitabine therapeutic use, Leukemia, Myeloid, Acute drug therapy
- Abstract
Despite widespread use of decitabine to treat acute myeloid leukaemia (AML), data on its effectiveness and safety in the real-world setting are scanty. Thus, to analyze the performance of decitabine in clinical practice, we pooled together patient-level data of three multicentric observational studies conducted since 2013 throughout Italy, including 306 elderly AML patients (median age 75 years), unfit for intensive chemotherapy, treated with first-line decitabine therapy at the registered schedule of 20 mg/m
2 /iv daily for 5 days every 4 weeks. Overall response rate (ORR), overall survival (OS) curves, and multivariate hazard ratios (HRs) of all-cause mortality were computed. Overall, 1940 cycles of therapy were administered (median, 5 cycles/patient). A total of 148 subjects were responders and, therefore, ORR was 48.4%. Seventy-one patients (23.2%) had complete remission, 32 (10.5%) had partial remission, and 45 (14.7%) had haematologic improvement. Median OS was 11.6 months for patients with favourable-intermediate cytogenetic risk and 7.9 months for those with adverse cytogenetic risk. Median relapse-free survival after CR was 10.9 months (95% confidence interval [CI]: 8.7-16.0). In multivariate analysis, mortality was higher in patients with adverse cytogenetic risk (HR=1.58; 95% CI: 1.13-2.21) and increased continuously with white blood cell (WBC) count (HR=1.12; 95% CI: 1.06-1.18). A total of 183 infectious adverse events occurred in 136 patients mainly (>90%) within the first five cycles of therapy. This pooled analysis of clinical care studies confirmed, outside of clinical trials, the effectiveness of decitabine as first-line therapy for AML in elderly patients unfit for intensive chemotherapy. An adverse cytogenetic profile and a higher WBC count at diagnosis were, in this real life setting, unfavourable predictors of survival., (© 2019 John Wiley & Sons, Ltd.)- Published
- 2019
- Full Text
- View/download PDF
42. [ANMCO Position paper: From acute to chronic disease: the needs of complex cardiac patients].
- Author
-
Radini D, Mennuni M, Accardo S, Alunni G, Barro S, Boscolo Anzoletti A, Capecchi A, D'Errico A, Egman S, Francese GM, Iacoviello M, Imazio M, Lukic V, Magro B, Manieri A, Morichelli L, Pirazzini MC, Pugiotto S, Pulignano G, Sanna F, Sasso L, Tarantini L, Tosoni S, Zumbo P, Gabrielli D, and Di Lenarda A
- Subjects
- Acute Disease, Chronic Disease, Forms as Topic, Health Services Needs and Demand, Heart Diseases complications, Humans, Health Status, Heart Diseases diagnosis, Heart Diseases therapy, Surveys and Questionnaires
- Abstract
Managing a patient suffering from a chronic disease requires a multidisciplinary team that can take care of them beyond the simple coordination of various specialties. In this context, a central role in the treatment of chronic heart disease is the continuity of care that should promote organic integration among different hospital departments, hospital and community. This position paper of the Italian Association of Hospital Cardiologists (ANMCO) aims at defining the general principles to inspire care for complex cardiac patients at different phases of the disease. A multidisciplinary integrated holistic approach uses analytical tools able to understand the elements that characterize complexity and therefore suggest appropriate management strategies: (i) care pathways aimed at optimizing treatments; (ii) care pathways in intensive care and ward in a multidisciplinary perspective; (iii) integration of social and health needs; (iv) nursing role in the context of continuity of outpatient, community and home care; (v) promotion of educational interventions.
- Published
- 2019
- Full Text
- View/download PDF
43. Addenda online<br> Position paper ANMCO: Bisogni assistenziali del malato cardiopatico complesso: dalla fase acuta alla fase cronica.
- Author
-
Radini D, Mennuni M, Accardo S, Alunni G, Barro S, Boscolo Anzoletti A, Capecchi A, D'Errico A, Egman S, Francese GM, Iacoviello M, Imazio M, Lukic V, Magro B, Manieri A, Morichelli L, Pirazzini MC, Pugiotto S, Pulignano G, Sanna F, Sasso L, Tarantini L, Tosoni S, Zumbo P, Gabrielli D, and Di Lenarda A
- Published
- 2019
- Full Text
- View/download PDF
44. Prognostic impact of MitraClip in patients with left ventricular dysfunction and functional mitral valve regurgitation: A comprehensive meta-analysis of RCTs and adjusted observational studies.
- Author
-
Bertaina M, Galluzzo A, D'Ascenzo F, Conrotto F, Grosso Marra W, Frea S, Alunni G, Crimi G, Moretti C, Montefusco A, D'Amico M, Perl L, Rinaldi M, Giustetto C, and De Ferrari GM
- Subjects
- Humans, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency epidemiology, Patient Readmission trends, Prognosis, Ventricular Dysfunction, Left diagnosis, Ventricular Dysfunction, Left epidemiology, Mitral Valve Insufficiency surgery, Observational Studies as Topic methods, Randomized Controlled Trials as Topic methods, Surgical Instruments trends, Ventricular Dysfunction, Left surgery
- Abstract
The real prognostic impact of MitraClip in patients with significant functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction remains to be elucidated. Two randomized controlled trials (RCTs) with conflicting results have been recently published. We conducted a comprehensive meta-analysis of all RCTs and adjusted observational studies to evaluate the clinical impact of percutaneous mitral valve repair when compared with optimal medical therapy (OMT) alone, in patients with symptomatic FMR and LV dysfunction. Death from any cause and heart failure rehospitalizations at the longest available follow-up were the primary endpoints. Cardiac death, one year and short-term death were the secondary ones. 2255 patients (1207 for MitraClip and 1048 for OMT-only) from 8 studies (2 RCTs and 6 observational studies) were included. At a median (mid-term) follow-up of 438 days (IQR 360-625) MitraClip was associated with a significant reduction of all-cause death (odds Ratio [OR] 0.55, 95%CI 0.41-0.73, p < 0.001; [ORadj] 0.66, 95%CI 0.49-0.90, p = 0.009) and rehospitalization (OR 0.49, 95%CI 0.24-1.00, p = 0.05 and ORadj 0.63, 95%CI 0.43-0.94, p = 0.02). At one year, adjusted analysis demonstrated a trend favoring the experimental cohort (ORadj 0.73, 95%CI 0.53-1.02, p = 0.07). Meta-regression suggested that benefit of MitraClip on mid-term survival persists even after accounting for the prevalence of implanted CRT, burden of comorbidities, NYHA class, cardiomyopathy etiology and LV function and dimensions. In conclusion, MitraClip for FMR in patients with LV dysfunction is associated with a considerable reduction of death and HF hospitalization at mid-term follow-up. Further ongoing RCTs are needed to strengthen present results., (Copyright © 2019 Elsevier B.V. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
45. Superior Prognostic Value of Right Ventricular Free Wall Compared to Global Longitudinal Strain in Patients With Heart Failure.
- Author
-
Carluccio E, Biagioli P, Lauciello R, Zuchi C, Mengoni A, Bardelli G, Alunni G, Gronda EG, and Ambrosio G
- Subjects
- Aged, Algorithms, Female, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases physiopathology, Humans, Male, Prognosis, Prospective Studies, Stroke Volume, Echocardiography methods, Heart Failure diagnostic imaging, Heart Failure physiopathology, Ventricular Dysfunction, Right diagnostic imaging, Ventricular Dysfunction, Right physiopathology
- Abstract
Background: Global right ventricular (RV) longitudinal strain (RVGLS) and free wall RV longitudinal strain (RVFWS) have both been advocated as sensitive tools to evaluate RV function and predict prognosis in patients with heart failure and reduced ejection fraction (HFrEF). However, because the interventricular septum is an integral part of the left ventricle (LV) also, RVGLS might be influenced by LV dysfunction. Thus, we compared the prognostic performance of either RV strain parameter in HFrEF patients, also taking into account the degree of LV systolic dysfunction., Methods: In 288 prospectively enrolled outpatients with stable HFrEF, RVGLS and RVFWS were assessed by speckle-tracking and LV systolic function by global longitudinal strain and LV ejection fraction. Patients were followed up for 30.2 ± 23.0 months; the primary endpoint was all-cause death/heart failure-related hospitalization. Prognostic performance was assessed by C-statistic and net reclassification improvement., Results: There were 95 events during follow-up. By univariable analysis, both RVGLS (hazard ratio × 1 SD, 1.60; 95% CI, 1.29-1.99; P < .0001) and RVFWS (hazard ratio × 1 SD, 1.82; 95% CI, 1.45-2.29; P < .0001) were associated with outcome, and both remained significant after correction for EMPHASIS risk score, New York Heart Association class, natriuretic peptides, and therapy. However, after further correction for LV systolic function parameters, only RVFWS remained significantly associated with outcome (P < .01). A basic prediction model was improved by adding RVFWS (net reclassification improvement 0.390; P < .05), but not RVGLS., Conclusions: Although both RVGLS and RVFWS have prognostic value, RVFWS better predicts outcome in HFrEF patients, mainly because it is less influenced by LV longitudinal dysfunction., (Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
46. [ANMCO/FADOI/SIAARTI/SIC/SIMG/SIMI/SIMEU consensus document: The clinical care pathway of acute heart failure patients from symptom onset to discharge from the emergency department].
- Author
-
Mortara A, Gabrielli D, Pugliese FR, Corcione A, Perticone F, Fontanella A, Mercuro G, Cricelli C, Iacoviello M, D'Ambrosio G, Guarracino F, Modesti PA, Vescovo G, De Maria R, Iacovoni A, Macera F, Palmieri V, Pasqualucci D, Battistoni I, Alunni G, Aspromonte N, Caldarola P, Campanini M, Caporale R, Casolo G, Cipriani M, Di Tano G, Domenicucci S, Murrone A, Nardi F, Navazio A, Oliva F, Parretti D, Urbinati S, Valente S, Valeriano V, Zuin G, Metra M, Sinagra G, Gulizia MM, and Di Lenarda A
- Subjects
- Acute Disease, Humans, Italy, Patient Discharge, Patient Transfer standards, Practice Guidelines as Topic, Critical Pathways, Emergency Service, Hospital standards, Heart Failure therapy
- Abstract
Acute heart failure (AHF) represents a relevant burden for emergency departments worldwide. AHF patients have markedly worse long-term outcomes than patients with other acute cardiac diseases (e.g. acute coronary syndromes); mortality or readmissions rates at 3 months approximate 33%, whereas 1-year mortality from index discharge ranges from 25% to 50%.The multiplicity of healthcare professionals acting across the care pathway of AHF patients represents a critical factor, which generates the need for integrating the different expertise and competence of general practitioners, emergency physicians, cardiologists, internists, and intensive care physicians to focus on care goals able to improve clinical outcomes.This consensus document results from the cooperation of the scientific societies representing the different healthcare professionals involved in the care of AHF patients and describes shared strategies and pathways aimed at ensuring both high quality care and better outcomes. The document describes the patient journey from symptom onset to the clinical suspicion of AHF and home management or referral to emergency care and transportation to the hospital, through the clinical diagnostic pathway in the emergency department, acute treatment, risk stratification and discharge from the emergency department to ordinary wards or home. The document analyzes the potential role of a cardiology fast-track and Observation Units and the transition to outpatient care by general practitioners and specialist heart failure clinics.The increasing care burden and complex problems generated by AHF are unlikely to be solved without an integrated multidisciplinary approach. Efficient networking among emergency departments, intensive care units, ordinary wards and primary care settings is crucial to achieve better outcomes. Thanks to the joint effort of qualified scientific societies, this document aims to achieve this goal through an integrated, shared and applicable pathway that will contribute to a homogeneous care management of AHF patients across the country.
- Published
- 2019
- Full Text
- View/download PDF
47. Left Atrial Reservoir Function and Outcome in Heart Failure With Reduced Ejection Fraction.
- Author
-
Carluccio E, Biagioli P, Mengoni A, Francesca Cerasa M, Lauciello R, Zuchi C, Bardelli G, Alunni G, Coiro S, Gronda EG, and Ambrosio G
- Subjects
- Aged, Diastole, Echocardiography, Doppler methods, Female, Follow-Up Studies, Heart Atria diagnostic imaging, Heart Failure diagnosis, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Systole, Ventricular Function, Left physiology, Heart Atria physiopathology, Heart Failure physiopathology, Stroke Volume physiology, Ventricular Function, Right physiology
- Abstract
Background Left atrial (LA) volume is a marker of cardiac remodeling and prognosis in heart failure (HF) with reduced ejection fraction (EF), but LA function is rarely measured or characterized. We investigated determinants and prognostic impact of LA reservoir function in patients with HF with reduced EF. Methods and Results In 405 patients with stable HF with reduced EF (EF, ≤40%) in sinus rhythm, we assessed LA reservoir function by both LA total EF (by phasic volume changes) and peak atrial longitudinal strain (PALS; by speckle tracking echocardiography); LA functional index was also calculated. During follow-up (median, 30 months; Q1-Q3, 13-52), 139 patients (34%) reached the composite end point (all-cause death/HF hospitalization). Median PALS was 15.5% (interquartile range, 11.2-20.6). By univariable analysis, all LA function parameters significantly predicted outcome ( P <0.01 for all), with PALS showing the highest predictive accuracy (area under the curve, 0.75; sensitivity, 73%; specificity, 70%). Impaired PALS was associated with greater left ventricular and LA volumes, worse left ventricular EF, left ventricular global longitudinal strain, right ventricular systolic function, and more severe diastolic dysfunction. After multivariable adjustment (including LA volume and left ventricular global longitudinal strain), PALS, but not LA total EF or LA functional index, remained significantly associated with outcome (hazard ratio per 1-SD decrease, 1.38; 95% CI, 1.05-1.84; P=0.030). Adding PALS to a base model, including age, sex, LA volume, EF, E/E' ratio, and global longitudinal strain, provided incremental predictive value (continuous net reclassification improvement, 0.449; P=0.0009). Conclusions In HF with reduced EF, assessment of LA reservoir function by PALS allows powerful prognostication, independently of LA volume and left ventricular longitudinal contraction.
- Published
- 2018
- Full Text
- View/download PDF
48. Residual Peripheral Blood CD26 + Leukemic Stem Cells in Chronic Myeloid Leukemia Patients During TKI Therapy and During Treatment-Free Remission.
- Author
-
Bocchia M, Sicuranza A, Abruzzese E, Iurlo A, Sirianni S, Gozzini A, Galimberti S, Aprile L, Martino B, Pregno P, Sorà F, Alunni G, Fava C, Castagnetti F, Puccetti L, Breccia M, Cattaneo D, Defina M, Mulas O, Baratè C, Caocci G, Sica S, Gozzetti A, Luciano L, Crugnola M, Annunziata M, Tiribelli M, Pacelli P, Ferrigno I, Usala E, Sgherza N, Rosti G, Bosi A, and Raspadori D
- Abstract
Chronic myeloid leukemia (CML) patients in sustained "deep molecular response" may stop TKI treatment without disease recurrence; however, half of them lose molecular response shortly after TKI withdrawing. Well-defined eligibility criteria to predict a safe discontinuation up-front are still missing. Relapse is probably due to residual quiescent TKI-resistant leukemic stem cells (LSCs) supposedly transcriptionally low/silent and not easily detectable by BCR-ABL1 qRT-PCR. Bone marrow Ph+ CML CD34
+ /CD38- LSCs were found to specifically co-express CD26 (dipeptidylpeptidase-IV). We explored feasibility of detecting and quantifying CD26+ LSCs by flow cytometry in peripheral blood (PB). Over 400 CML patients (at diagnosis and during/after therapy) entered this cross-sectional study in which CD26 expression was evaluated by a standardized multiparametric flow cytometry analysis on PB CD45+ /CD34+ /CD38- stem cell population. All 120 CP-CML patients at diagnosis showed measurable PB CD26+ LSCs (median 19.20/μL, range 0.27-698.6). PB CD26+ LSCs were also detectable in 169/236 (71.6%) CP-CML patients in first-line TKI treatment (median 0.014 cells/μL; range 0.0012-0.66) and in 74/112 (66%), additional patients studied on treatment-free remission (TFR) (median 0.015/μL; range 0.006-0.76). Notably, no correlation between BCR-ABL/ABLIS ratio and number of residual LSCs was found both in patients on or off TKIs. This is the first evidence that "circulating" CML LSCs persist in the majority of CML patients in molecular response while on TKI treatment and even after TKI discontinuation. Prospective studies evaluating the dynamics of PB CD26+ LSCs during TKI treatment and the role of a "stem cell response" threshold to achieve and maintain TFR are ongoing.- Published
- 2018
- Full Text
- View/download PDF
49. Prognostic Value of Right Ventricular Dysfunction in Heart Failure With Reduced Ejection Fraction: Superiority of Longitudinal Strain Over Tricuspid Annular Plane Systolic Excursion.
- Author
-
Carluccio E, Biagioli P, Alunni G, Murrone A, Zuchi C, Coiro S, Riccini C, Mengoni A, D'Antonio A, and Ambrosio G
- Subjects
- Aged, Female, Humans, Male, Prognosis, Sensitivity and Specificity, Stroke Volume, Echocardiography, Doppler methods, Heart Failure diagnostic imaging, Heart Failure physiopathology, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency physiopathology, Tricuspid Valve diagnostic imaging, Tricuspid Valve physiopathology, Ventricular Dysfunction, Right diagnostic imaging, Ventricular Dysfunction, Right physiopathology
- Abstract
Background: In heart failure (HF) with reduced ejection fraction, right ventricular (RV) impairment, as defined by reduced tricuspid annular plane systolic excursion, is a predictor of poor outcome. However, peak longitudinal strain of RV free wall (RVFWS) has been recently proposed as a more accurate and sensitive tool to evaluate RV function. Accordingly, we investigated whether RVFWS could help refine prognosis of patients with HF with reduced ejection fraction in whom tricuspid annular plane systolic excursion is still preserved., Methods and Results: A total of 200 patients with HF with reduced ejection fraction (age, 66±11 years; ejection fraction, 30±7%) with preserved tricuspid annular plane systolic excursion (>16 mm) underwent RV function assessment using speckle-tracking echocardiography to measure peak RVFWS. After a median follow-up period of 28 months, 62 (31%) patients reached the primary composite end point of all-cause death/HF rehospitalization. Median RVFWS was -19.3% (interquartile range, -23.3% to -15.0%). By lasso-penalized Cox-hazard model, RVFWS was an independent predictor of outcome, along with Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure-HF score, Echo-HF score, and severe mitral regurgitation. The best cutoff value of RVFWS for prediction of outcome was -15.3% (area under the curve, 0.68; P <0.001; sensitivity, 50%; specificity, 80%). In 50 patients (25%), RVFWS was impaired (ie, ≥-15.3%); event rate (per 100 patients per year) was greater in them than in patients with RVFWS <-15.3% (29.5% [95% confidence interval, 20.4-42.7] versus 9.4% [95% confidence interval, 6.7-13.1]; P <0.001). RVFWS yielded a significant net reclassification improvement (0.584 at 3 years; P <0.001), with 68% of nonevents correctly reclassified., Conclusions: In patients with HF with reduced ejection fraction with preserved tricuspid annular plane systolic excursion, RV free-wall strain provides incremental prognostic information and improved risk stratification., (© 2018 American Heart Association, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
50. The beneficial effect of extracorporeal shockwave myocardial revascularization: Two years of follow-up.
- Author
-
Alunni G, Barbero U, Vairo A, D'Amico S, Pianelli M, Zema D, Bongiovanni F, and Gaita F
- Subjects
- Aged, Aged, 80 and over, Angina Pectoris diagnostic imaging, Angina Pectoris physiopathology, Echocardiography, Female, Follow-Up Studies, Hospitalization, Humans, Male, Middle Aged, Myocardial Ischemia diagnostic imaging, Myocardial Ischemia physiopathology, Myocardial Perfusion Imaging methods, Myocardial Revascularization adverse effects, Prospective Studies, Time Factors, Tomography, Emission-Computed, Single-Photon, Treatment Outcome, Angina Pectoris therapy, Extracorporeal Shockwave Therapy adverse effects, Myocardial Ischemia therapy, Myocardial Revascularization methods
- Abstract
Objectives: Despite the advancements achieved by revascularization technique and pharmacological therapies, the number of patients with refractory angina (RA) is still high, carrying together a poor prognosis. Experimental data and small clinical studies suggest that the use of extracorporeal shockwave myocardial revascularization (ESMR) might improve symptoms of angina in patients with RA. The aim of our study is to evaluate the efficacy of cardiac shock wave therapy in a long term follow-up of patients with coronary artery disease (CAD) otherwise not suitable for revascularization., Methods: We performed a prospective study enrolling patients with RA despite optimal medical therapy and without indication for further PCI or CABG. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization were compared at baseline and 1, 6 and 12months after ESMR therapy., Results: We enroll 72 patients with a mean age of 74.6±14.7years. We treated 440 echocardiographical segments of ischemical myocardium. During the longest published follow-up (2.88±1.65years, range 0.63-6.11) there was a significant reduction of medium CCS class score (from 2.78±0.67 to 1.44±0.6; p=0.0002), nitroglycerin consumption (67% vs 21%; p<0.001) and hospitalization rate (40% vs 18%; p<0.03)., Conclusion: Our study confirms the beneficial effect of ESMR therapy on cardiac symptoms and the possibility to reduce hospitalizations in patients with refractory angina also in a long term follow up. It supports a role for ESMR as a non-invasive therapeutic option for patients with RA., (Copyright © 2017. Published by Elsevier Inc.)
- Published
- 2017
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.