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1. PCSK9 inhibitors: effectiveness of treatment and changes in background lipid-lowering therapy in a real world Italian population. The AT-TARGET-IT study

Author

P Perrone-Filardi, C Basile, G Asile, C Abbate, A Catalano, P A Merlini, P Calabro', G Iannuzzo, M M Ciccone, L Paloscia, F Varbella, N D Brunetti, C Indolfi, S Paolillo, and P Gargiulo

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Introduction PCSK9 inhibitors (PCSK9i) significantly decrease LDL cholesterol (LDL-C), either as monotherapy or in addition to the maximally tolerated dose of statin and/or ezetimibe. Yet, few data are available on efficacy and background lipid-lowering therapy (LLT) adjustment in patients treated with PCSK9i in real-world observations. Purpose AT-TARGET-IT is an Italian multicenter registry involving 9 Italian centers, designed to assess efficacy, adherence, and persistence of PCSK9i, as well as prescribing doctors' behavior in patients with atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia (FH). The aim of the present analysis was to assess efficacy and changes in background LLT therapy in patients on PCSK9i in a real-world single country observation. Methods From June through November 2021, we enrolled patients with PCSK9i first prescription from 6 months before inclusion through starting of PCSK9i use. Clinical and demographic characteristics, concomitant therapies, blood chemistry, were recorded at the time of first prescription and at the latest observation preceding inclusion in the study. Background therapy was assessed at baseline and during follow-up, evaluating treatment withdrawal, reduction of doses, or changes from statin-ezetimibe association to single drug therapy. Results We enrolled 798 patients (27% with FH) receiving either alirocumab or evolocumab and followed for a median time of 19.3 months. At the time of PCSK9i first prescription LDL-C was 147.6 mg/dl and reached 51.5 mg/dl at the time of latest observation (64% reduction), and 129 patients (16%) were not receiving any LLT, 669 patients received background LLT, of them 246 (31%) were taking ezetimibe alone and 423 (53%) were taking statins with or without ezetimibe. At the end of the observation period, 785 patients (98%) were still receiving PCSK9i and 550 (69%) did not change background LLT. Of 248 patients changing background LLT, 116 (47%) withdrew therapy, 132 (53%) changed dose or type of LLT. After stratification by achievement of LDL-C target according CV risk class, 483 patients achieved the target (60%). Target was achieved at the end of the observation period in 63% of patients taking triple therapy, 65% patients receiving PCSK9i plus statins, 62% of patients receiving PCSK9i plus ezetimibe and 55% receiving PCSK9i alone (Figure 1). No significant differences in terms of percentage of patients changing background LLT during PCSK9i treatment were found between patients at target for LDL-C and those not at target. Conclusion AT-TARGET-IT study shows that PCSK9i therapy is effective in reaching LDL-C target in the majority of patients, yet a sizable number of them (40%) remains undertreated. LLT background therapy is either reduced or withdrawn in 31% of patients, being responsible for not reaching target. Reasons for inappropriate LLT changes in patients receiving PCSK9i should be identified and removed to optimize lipid control. Funding Acknowledgement Type of funding sources: None.

Published
2022
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2. Influence of obesity and overweight on the association between sleep-disordered breathing and atrial fibrillation: the DASAP-HF study

Author

G Boriani, I Diemberger, E C L Pisano', P Pieragnoli, A Locatelli, A Capucci, A Talarico, M Zecchin, A Rapacciuolo, M Piacenti, C Indolfi, M A Arias, C Checchinato, and A D'Onofrio

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background The association between sleep apnea (SA) and atrial fibrillation (AF) has been well described. However, it remains unclear whether the association is causative or primarily dependent on shared comorbidities such as obesity. The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, whether central or obstructive in origin. Purpose In the present analysis we studied in patients with heart failure the contribution of obesity in the relationship between SA, measured by RDI, and AF. Methods Patients with ejection fraction ≤35% implanted with an ICD endowed with an algorithm (ApneaScan) that calculates the RDI each night, were enrolled and followed-up for 24 months. The weekly mean RDI value was considered, as calculated during the entire follow-up period. The endpoint was daily AF burden of ≥6 hours. Results 164 patients (age 67±10 years, 75% male, ejection fraction 29±5%) had usable RDI values during the entire follow-up period. Body mass index (BMI) was Conclusions In heart failure patients, we confirmed the association between ICD-detected SA and AF, an association that persisted independent of patient body habitus. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The study is supported by a research grant from Boston Scientific

Published
2022
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3. P288 TREATMENT OF HEART FAILURE IN CLINICAL PRACTICE: NON–INTERVENTIONAL OBSERVATIONAL STUDY ON PATIENTS WITH HEART FAILURE TREATED WITH DAPAGLIFLOZIN (EVOLUTION–HF ITALY)

Author

F Orso, P Ameri, S Carugo, A Di Lenarda, M Iacoviello, C Indolfi, A Mortara, P Perrone Filardi, A Ungar, M Volpe, M Volterrani, V Granelli, F Mastromauro, F Pluchinotta, M Gnesi, and G Rosano

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background Heart Failure (HF) is a relevant issue for public health issue: it affects more than 64 million people worldwide1, and its burden is anticipated to increase as the population ages. Dapagliflozin is an inhibitor of the sodium–glucose cotransporter–2 (SGLT2i). In the DAPA–HF trial, dapagliflozin reduced the risk of hospitalisation for HF and death in patients with HFrEF (with or without Type 2 Diabetes) compared to placebo2,3,4. Currently, there is a lack of data on characteristics, treatment profiles, and patient reported outcomes (PROs) of patients initiated on dapagliflozin for HFrEF in clinical practice: the EVOLUTION–HF programme is aimed at answering those questions by collecting real–world data in 13 European Countries, including Italy. The primary objective is to characterise patients initiated on dapagliflozin for the treatment of HFrEF and to estimate occurrence of treatment discontinuations. Secondary objectives include an assessment of Health–related Quality of Life (HR–QoL) by means of the Kansas City Cardiomyopathy Questionnaire (KCCQ), patient–reported adherence to prescriptions of pharmacological treatments for HF (Medication Adherence Report Scale – 5 Item), performance on 6–Minutes Walking Test. Methods The study has an observational, longitudinal, descriptive design. To be enrolled, patients must be 18 years old or older and have initiated treatment with dapagliflozin according to the approved HFrEF label. Patients with a diagnosis of Type 1 Diabetes or previously treated with any SGLT2i are excluded from the study. Follow–up lasts one year from start of treatment. Sample size has been estimated in 250 patients, that will be enrolled in 11 centres. Results The study is currently ongoing, and it will generate evidences on the use and tolerability of dapagliflozin, as well as on treatment patterns of other pharmacological therapies for HF and diabetes. Also, the study will generate data from PROs regarding change of KCCQ across time, adherence to HF therapies in clinical practice, and 6–Minutes Walking Tesst. Multivariate analyses will evaluate association between patients’ characteristics and interruption of treatment, adherence and HR–QoL. The interim analysis will be available in the first months of 2023. Conclusions The EVOLUTION–HF Italy study Il programma di studio EVOLUTION–HF supporterà la pratica clinica con dati originali sull‘uso nel mondo reale delle nuove terapie farmacologiche per l‘HFrEF.

Published
2023
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4. Poster session 1

Author

J. Schlueter, T. Brand, D. J. Henderson, V. Boczonadi, P. Humbert, B. Chaudhry, D. Sedmera, J. Svatunkova, R. Kockova, B. Sankova, C. Lopez Sanchez, D. Franco, A. Aranega, V. Garcia-Martinez, E. Demina, V. Miroshikova, A. Denisenko, A. Schwarzman, F. Sanchez-Cabo, C. Torroja, A. Benguria, R. Buchan, P. Srivastava, F. Martinez, P. Barton, S. Cook, A. Dopazo, E. Lara-Pezzi, H. Rai, S. Kumar, A. K. Sharma, S. Mastana, A. Kapoor, C. M. Pandey, S. Agrawal, N. Sinha, J. Lipkova, M. Goldbergova, J. Parenica, J. Bienertova Vasku, A. Vasku, P. Kala, J. Spinar, L. Perez-Cabornero, D. Cantalapiedra, A. Forteza, R. Saez-Villaverde, J. Zumalde, V. Fernandez-Pedrosa, S. Zuniga-Trejos, M. Gil-Borja, M. Lazaro, S. Santillan, M. Costa, N. Cortez-Dias, P. Carrilho-Ferreira, D. Silva, C. Jorge, R. Placido, C. Calisto, M. Fiuza, A. Nunes Diogo, F. J. Enguita, H. H. W. Sillje, B. Lu, H. Yu, M. Zwartbol, W. P. Ruifrok, W. H. Van Gilst, R. A. De Boer, D. Zaliaduonyte-Peksiene, S. Simonyte, V. Lesauskaite, J. Vaskelyte, V. Mizariene, R. Zaliunas, W. Tigchelaar, E. Barlaka, A. Lazou, C. Del Giudice, E. Cipolletta, A. Anastasio, G. Santulli, M. Rusciano, A. S. Maione, P. Campiglia, M. Illario, B. Trimarco, G. Iaccarino, G. A. Frentzou, M. J. Drinkhill, N. A. Turner, S. G. Ball, J. F. X. Ainscough, L. Bertrand, F. Mailleux, J. Hammond, A. Ginion, L. Hue, J. L. Balligand, S. Horman, J. L. Vanoverschelde, C. Beauloye, B. Demeulder, S. L. Puhl, A. Mueller, Y. Devaux, D. R. Wagner, K. Roemer, M. Boehm, C. Maack, D. Miranda-Silva, I. Falcao-Pires, N. Goncalves, D. Moreira-Goncalves, A. F. Leite-Moreira, F. Mraiche, L. Fliegel, J. Xue, G. G. Haddad, L. C. Hsiao, C. Carr, Z. F. Cui, K. Clarke, M. A. D'amico, P. Izzicupo, A. Di Fonso, A. Bascelli, S. Gallina, A. Di Baldassarre, C. Silvestre, P. Fernandez, O. M. Pello, C. Indolfi, F. Civeira, R. Hutter, B. Ibanez, J. Chaves, J. Martinez-Gonzalez, V. Andres Garcia, A. Zabirnik, N. Smolina, A. Malashicheva, E. Omelchenko, T. Sejersen, A. Kostareva, C. Noack, M. P. Zafiriou, A. Renger, R. Dietz, H. J. Schaeffer, M. B. Bergmann, C. Zelarayan, S. Van Linthout, K. Miteva, M. P. Becher, M. Haag, J. Ringe, H.-P. schultheiss, M. Sittinger, C. Tschoepe, T. Kakuchaya, L. Bockeria, E. Golukhova, M. Eremeeva, N. Chigogidze, I. Aslanidi, I. Shurupova, A. Svobodov, A. A. Ramkisoensing, D. A. Pijnappels, J. Swildens, M. J. Goumans, M. J. Schalij, A. A. F. De Vries, D. E. Atsma, A. Gomes, G. M. Costa, C. A. Cordeiro, A. Matsuada, L. B. Rosario, A. P. Freire, M. Bousquenaud, M. Rolland-Turner, F. Maskali, L. Zhang, P. Y. Marie, F. Azuaje, A. J. Smith, G. M. Ellison, C. D. Waring, S. Purushothaman, D. Torella, B. Nadal-Ginard, M. H. Van Marion, D. W. J. Van Der Schaft, M.-J. Goumans, F. P. T. Baaijens, C. V. C. Bouten, N. Kraenkel, K. Kuschnerus, M. Mueller, T. Speer, S. Briand, M. Bader, P. Madeddu, T. F. Luescher, U. Landmesser, A. Papalamprou, C. Vicinanza, D. F. Goldspink, M. Noseda, S. J. Mcsweeney, T. Leja, E. Belian, I. Macaulay, F. Al-Beidh, S. Koenemann, M. S. Abreu Pavia, S. E. Jacobsen, M. D. Schneider, G. Foldes, Z. Bagyura, Z. Lendvai, D. Mathe, T. Nemeth, J. Skopal, I. Foldes, B. Merkely, S. E. Harding, A. J. Candasamy, R. S. Haworth, A. Boguslavsky, F. Cuello, M. J. Shattock, M. Mayr, M. Gautel, M. Avkiran, P. Leszek, B. Sochanowicz, M. Szperl, P. Kolsut, K. Brzoska, W. Piotrowski, T. Rywik, B. Danko, J. Rozanski, M. Kruszewski, N. Bouteldja, R. J. Woodman, C. L. Hewitson, E. Domingo, J. A. Barbara, A. A. Mangoni, R. Carnicer Hijazo, A. B. Hale, X. Liu, S. Suffredini, J. K. Bendall, G. B. S. Lim, N. J. Alp, K. M. Channon, B. Casadei, L. R. Moltzau, J. M. Aronsen, S. Meier, I. Sjaastad, T. Skomedal, J.-B. Osnes, F. O. Levy, E. Qvigstad, P. T. Wright, L. M. K. Pannell, A. R. Lyon, J. Gorelik, A. Guellich, S. F. Vatner, R. Fischmeister, B. Manoury, E. Dubois, J. Hamelet, A. Vanderper, P. Herijgers, D. Langin, F. Gartner, J. Gummert, H. Milting, G. Euler, M. Priess, J. Heger, T. Noll, R. Schulz, T. Doi, T. Akagami, T. Naka, T. Masuyama, M. Ohyanagi, M. Massaro, E. Scoditti, M. Pellegrino, M. A. Carluccio, C. Martines, C. Storelli, R. De Caterina, M. Falck-Hansen, M. E. Goddard, J. E. Cole, N. Astola, A. J. Cross, R. Krams, C. Monaco, M. F. Corsten, W. Verhesen, A. P. Papageorgiou, P. Carai, M. Lindow, S. Obad, G. Summer, L. De Rijck, S. Coort, M. Hazebroek, R. Van Leeuwen, M. Gijbels, M. P. J. De Winther, F. R. M. Stassen, S. Kauppinen, B. Schroen, S. Heymans, Z. Husti, V. Juhasz, L. Virag, A. Kristof, I. Koncz, T. Szel, I. Baczko, N. Jost, J. G. Y. Papp, A. Varro, A. Ghigo, A. Perino, F. Damilano, J. Leroy, V. O. Nikolaev, W. Richter, M. Conti, G. Vandecasteele, E. Hirsch, R. Ang, S. Sebastian, A. Ludwig, L. Birnbaumer, A. Tinker, E. A. Ertel, R. Sube, A. Opel, C. L-H Huang, A. Grace, N. Tribulova, J. Radosinska, B. Bacova, T. Benova, V. Knezl, J. Slezak, T. A. Matsuyama, T. Tanaka, T. Adachi, Y. Jiang, H. Ishibashi-Ueda, T. Takamatsu, J. Kornej, C. Reihardt, J. Kosiuk, A. Arya, G. Hindricks, V. Adams, D. Husser, A. Bollmann, S. Severi, M. Fantini, E. Ravagli, L. A. Charawi, D. Difrancesco, C. Poulet, L. Lu, U. R. Ravens, M. Hoch, T. Koenig, A. Gardiwal, B. Stapel, S. Erschow, A. Froese, B. Weinhold, R. Gerardy-Schahn, G. Klein, D. Hilfiker-Kleiner, K. Chinda, S. Palee, S. Surinkaew, M. Phornphutkul, S. Chattipakorn, N. Chattipakorn, B. Tuana, Z. Kohajda, A. A. Kristof, C. Corici, F. Fulop, N. L. Jost, V. Szuts, D. Menesi, G. L. Puskas, A. Zvara, N. Houshmand, J. G. Papp, N. Al-Shanti, M. Hancock, A. Venturini, C. Stewart, R. Ascione, G. Angelini, M.-S. Suleiman, A. Gonzalez-Tendero, I. Torre, F. Crispi, E. Gratacos, T. Tzanavari, E. Varela, A. Economides, S. Theocharis, C. Pantos, D. V. Cokkinos, A. Karalis, P. Hecker, V. Lionetti, W. C. Stanley, C. Ferrara, N. Piroddi, B. Scellini, C. Ferrantini, V. Sequiera, C. Remedios, L. Carrier, C. Tesi, J. Van Der Velden, C. Poggesi, V. Kooij, G. J. M. Stienen, D. Dooijes, s. Marston, C. Redwood, C. Dos Remedios, I. Diakonov, S. Tokar, M. Sikkel, S. Schlossarek, M. Sauer, A. Papageorgiou, S. Velthuis, E. Lutgens, M. Swinnen, N. Van Rooijen, J. Kzhyshkowska, P. Carmeliet, P. Garcia-Canadilla, F. Garcia-Garcia, I. Iruretagoiena, J. Dopazo, I. Amat-Roldan, M. H. Zhang, Y. H. Zhang, C. E. Sears, B. Wojtas, A. Llach, L. Hove-Madsen, V. Spinelli, L. Sartiani, M. Bucciantini, R. Coppini, E. Russo, A. Mugelli, E. Cerbai, M. Stefani, M. Ibrahim, P. Kukadia, M. Navaratnarajah, U. Siedlecka, C. Van Doorn, M. Yacoub, C. Terracciano, W. Song, N. Curtin, R. Woledge, S. Marston, M. Balteau, N. Tajeddine, G. Behets-Wydemans, C. Dessy, P. Gailly, W. J. Van Der Laarse, S. J. P. Bogaards, D. Van Groen, Y. Y. Wong, I. Schalij, A. Vonk Noordegraaf, F. M. Faz, B. Littlejohns, P. Pasdois, A. P. Halestrap, G. D. Angelini, S. Lemoine, V. Jaspard-Vinassa, F. Vigneron, P. Dos Santos, M. Popescu, A. Vlad, G. Isvoranu, L. Suciu, B. Marinescu, D. Dimulescu, L. Zagrean, P. W. M. Kleikers, K. Wingler, K. Radermacher, A. Sydykov, H. A. Ghofrani, N. Weissmann, H. H. W. Schmidt, A. Poddubnaya, K. E. M. Khurs, S. O. G. Smolenskaya, G. Szucs, Z. Murlasits, S. Torok, G. F. Kocsis, T. Csont, C. Csonka, P. Ferdinandy, R. Dongworth, D. M. Yellon, D. J. Hausenloy, Y. Y. Chen, W. S. Lian, C. F. Cheng, K. H. Khoo, T. C. Meng, G. Youcef, E. Belaidi, L. Fazal, M. P. Vinvent, D. De Paulis, G. Zadigue, C. Richer-Giudicelli, F. Alhenc-Gelas, M. Ovize, A. Pizard, R. Cal, J. Castellano, J. Farre, G. Vilahur, L. Badimon, V. Llorente-Cortes, H. Naz, M. Gharanei, C. Mee, H. Maddock, A. Hussain, O. Pisarenko, V. Shulzhenko, L. Serebryakova, I. Studneva, Y. Pelogeykina, D. Khatri, O. Tskitishvili, E. Barnucz, G. Veres, P. Hegedus, T. Radovits, S. Korkmaz, S. Klein, R. Zoller, M. Karck, G. Szabo, S. Morel, M. A. Frias, C. Rosker, R. W. James, S. Rohr, B. R. Kwak, V. Braunersreuther, B. Foglia, F. Mach, E. Shantsila, S. Montoro-Garcia, L. D. Tapp, S. Apostolakis, B. J. Wrigley, G. Y. H. Lip, E. Sokolowska, K. Przyborowski, K. Kramkowski, W. Buczko, A. Mogielnicki, U. Simonsen, E. R. Hedegaard, B. D. Nielsen, A. Kun, A. Hughes, C. Kroigaard, S. Mogensen, O. Frobert, K. Ait Aissa, J. P. Max, D. Wahl, T. Lecompte, P. Lacolley, V. Regnault, A. Novakovic, M. Pavlovic, A. Vranic, P. Milojevic, I. Stojanovic, M. Jovic, D. Nenezic, N. Ugresic, Q. Yang, G. W. He, L. Calvier, P. Reboul, B. Martin-Fernandez, V. Lahera, F. Zannad, V. Cachofeiro, P. Rossignol, N. Lopez-Andres, V. K. Pulakazhi Venu, R. Baetta, A. Bonomo, A. F. Muro, A. Corsini, A. L. Catapano, G. D. Norata, L. E. Viiri, L. E. Full, T. J. Navin, A. Didangelos, I. Seppala, T. Lehtimaki, A. H. Davies, R. Wait, D. Sedding, P. Stieger, C. Thoelen, S. Fischer, J. M. Daniel, R. Widmer-Teske, K. T. Preissner, N. Alenina, L. A. Rabelo, M. Todiras, V. N. Souza, J. M. Penninger, R. A. Santos, I. A. Leonova, S. A. Boldueva, V. S. Feoktistova, O. V. Sirotkina, M. G. Kolesnichenko, Z. Springo, P. Toth, P. Cseplo, G. Szijjarto, A. Koller, S. Puthenkalam, M. K. Frey, I. M. Lang, R. Madonna, H. Shelat, Y. J. Geng, T. Ziegler, V. Pfetsch, J. Horstkotte, C. Schwab, I. Rohwedde, R. Hinkel, Q. Di, S. Dietzel, U. Deutsch, C. Kupatt, I. Ernens, B. Lenoir, O. Fortunato, A. Caporali, E. Sangalli, D. Cordella, M. Marchetti, G. Spinetti, C. Emanueli, G. Arderiu, E. Pena, M. J. Forteza, V. Bodi, S. Novella, C. Alguero, I. Trapero, I. Benet, C. Hermenegildo, J. Sanchis, F. J. Chorro, A. Nemeth, S. Szabados, A. Cziraki, E. Sulyok, I. G. Horvath, M. Rauh, W. Rascher, I. Sikharulidze, I. B. Bakhlishvili, J. T. T. Laitinen, J. P. Hytonen, O. Leppanen, J. Taavitsainen, A. Partanen, P. Korpisalo, S. Yla-Herttuala, J. Lonn, J. Hallstrom, T. Bengtsson, M. C. Guisasola, E. Dulin, S. Stojkovic, C. Kaun, G. Maurer, K. Huber, J. Wojta, S. Demyanets, T. B. Opstad, A. Pettersen, S. Aakra, H. Arnesen, I. Seljeflot, M. Borrell-Pages, C. Romero, A. Toso, M. Leoncini, L. Tanini, T. Pizzetti, F. Tropeano, M. Maioli, P. Casprini, F. Bellandi, R. F. Antunes, J. C. Kaski, I. E. Dumitriu, E. Wu, A. A. L. Tareen, M. Udovychenko, I. Rudyk, K. Riches, L. Franklin, A. Maqbool, J. Bond, M. L. Koschinsky, D. J. O'regan, K. E. Porter, I. R. Parepa, A. I. Suceveanu, A. Suceveanu, L. Mazilu, L. Cojocaru, A. Rusali, L. A. Tuta, E. Craiu, D. Lindner, C. Zietsch, H.-P. Schultheiss, C. Tschope, D. Westermann, M. Miana, E. Martinez, R. Jurado, C. Delgado, N. Gomez-Hurtado, A. Briones, J. Young, T. J. Geng, A. Brodehl, T. Schmidt, O. Smolenskaya, C. Stegemann, D. Byzov, I. Mikhaylova, N. Chizh, E. Pushkova, O. Synchykova, B. Sandomirsky, O. Freylikhman, O. Rotar, N. Chromova, E. Moguchaya, V. Ivanenko, E. Kolesova, A. Erina, M. Boyarinova, A. Konradi, S. D. Preston, D. Baskaran, A. M. Plonczak, K. Norita, S. V. De Noronha, M. N. Sheppard, A. Haghikia, S. F. Hill, M. Hoepfner, B. Nitzsche, M. Schrader, F. Zengerling, B. Hoffmann, A. Pries, S. Gao, J. T. Laitinen, S. Laidinen, H. Markkanen, H. Karvinen, V. Marjomaki, I. Vajanto, T. T. Rissanen, K. Alitalo, P. Mello Ferrao, M. C. Waghabi, L. R. Garzoni, J. Ritterhoff, C. Weidenhammer, M. Voelkers, W. H. Zimmermann, J. Rabinowitz, P. Most, S. C. Gordts, I. Muthuramu, F. Jacobs, E. Van Craeyveld, E. Nefyodova, B. De Geest, D. R. Tribuddharat, D. R. Sathitkarnmanee, M. R. Buddhisa, M. S. Suwannasaen, D. R. Silarat, D. R. Ngamsangsirisup, D. R. Hawrylowicz, D. R. Lertmemongkolchai, S. Rain, M. L. Handoko, N. Westerhof, A. Vonk-Noordegraaf, F. S. De Man, A. S. Iakovleva, O. A. Mirolyubova, A. Berezin, T. A. Samura, Suwannasaen, Tippayawat, Ngamsangsirisup, D. R. Sutra, Hawrylowicz, Lertmemongkolchai, L. M. Lima, M. G. Carvalho, D. R. G. Junqueira, M. O. Sousa, A. Zampetaki, P. Willeit, L. Tilling, I. Drozdov, M. Prokopi, A. Shah, C. Boulanger, P. Chowienczyk, S. Kiechl, S. H. V. Oliveira, V. Kirillova, E. Prosviryakov, C. T. M. Van Der Pouw Kraan, F. J. P. Bernink, J. M. Baggen, L. Timmers, A. M. Beek, M. Diamant, A. C. Van Rossum, N. Van Royen, A. J. G. Horrevoets, J. E. A. Appelman, A. Zyatenkov, L. S. Kokov, Y. U. D. Volynskiy, M. Krestjyaninov, V. I. Ruzov, A. V. Villar, E. Martinez-Laorden, A. Almela, M. A. Hurle, M. L. Laorden, N. Apaijai, M. K. Mcmullen, J. M. Whitehouse, G. Shine, and A. Towell

Subjects
Gerontology, Physiology, business.industry, Physiology (medical), Cancer research, Medicine, SCRIB gene, Cardiology and Cardiovascular Medicine, business
Published
2012
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5. Oral abstract presentations & Young Investigators Competition

Author

A. Leone, I. Aquila, C. Vicinanza, C. Iaconetti, A. Bochicchio, S. Ottolenghi, C. Indolfi, B. Nadal-Ginard, G. M. Ellison, D. Torella, C. Mias, G. Genet, C. Guilbeau-Frugier, A. Pathak, J. M. Senard, C. Gales, A. D. Egorova, P. S. J. Khedoe, M. T. H. Goumans, S. M. Nauli, P. Ten Dijke, R. E. Poelmann, B. P. Hierck, M. Miragoli, M. J. Lab, A. Singh, M. Sikkel, A. Lyon, J. Gorelik, C. Cheung, A. S. Bernardo, M. W. Trotter, R. A. Pedersen, S. Sinha, M. Mioulane, G. Foldes, S. E. Harding, B. Reglin, T. W. Secomb, A. R. Pries, M. Buckingham, F. Lescroart, S. Meilhac, J.-F. Le Garrec, N. Rozmaritsa, T. Christ, E. Wettwer, M. Knaut, U. Ravens, S. Tokar, S. Schobesberger, P. T. Wright, A. R. Lyon, A. Van Mil, S. Grundmann, M.-J. Goumans, S. Jaksani, P. A. Doevendans, J. P. Sluijter, A. J. Tijsen, A. S. Amin, J. R. Giudicessi, M. W. Tanck, C. R. Bezzina, E. E. Creemers, A. M. Wilde, M. J. Ackerman, Y. M. Pinto, C. Gedicke-Hornung, V. Behrens-Gawlik, D. Khajetoorians, G. Mearini, S. Reischmann, B. Geertz, T. Voit, P. Dreyfus, T. Eschenhagen, L. Carrier, G. D. Duerr, J. C. Heinemann, D. Wenzel, A. Ghanem, J. C. Alferink, A. Zimmer, B. Lutz, A. Welz, B. K. Fleischmann, O. Dewald, M. Sbroggio', A. Bertero, L. Giuliano, M. Brancaccio, G. Tarone, M. Meiser, M. Kohlhaas, Y. Chen, G. Csordas, G. Dorn, C. Maack, B. Stapel, M. Hoch, A. Haghikia, P. Fischer, D. Hilfiker-Kleiner, B. Schroen, M. Corsten, W. Verhesen, L. De Windt, S. Zacchigna, T. Thum, P. Carmeliet, A. Papageorgiou, S. Heymans, I. G. Lunde, A. V. Finsen, G. Florholmen, B. Skrbic, H. Kvaloy, H. O. Jarstadmarken, I. Sjaastad, T. Tonnessen, C. R. Carlson, G. Christensen, J. Paavola, S. Schliffke, S. Rossetti, I. Kuo, S. Yuan, Z. Sun, P. Harris, V. Torres, B. Ehrlich, P. Robinson, K. Adams, Y.-H. Zhang, B. Casadei, H. Watkins, C. Redwood, A. N. Seneviratne, J. E. Cole, M. E. Goddard, Z. Mohri, A. J. Cross, R. Krams, C. Monaco, B. R. Everaert, S. J. Van Laere, V. Y. Hoymans, J. P. Timmermans, and C. J. Vrints

Subjects
Competition (economics), medicine.medical_specialty, Pathology, Physiology, business.industry, Physiology (medical), Family medicine, medicine, Cardiology and Cardiovascular Medicine, business
Published
2012
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6. Mannitol bronchial challenge test in asthmatic children

Author

M, Miraglia Del Giudice, C, Capristo, F, Decimo, A, Coronella, C, Indolfi, G, Parisi, and N, Maiello

Abstract

Bronchial asthma is a chronic inflammatory disease characterized by bronchial obstruction, usually reversible spontaneously or after therapy, bronchial hyperreactivity and accelerated decrease of lung function that may possibly evolve into irreversible obstruction of the respiratory tract. Bronchial provocation tests can be used in order to assess the presence and degree of bronchial hyper reactivity. The recently introduced mannitol powder inhalation indirect test seems to have an interesting and promising role, especially in childhood, because of its high diagnostic specificity, easiness of execution and best standardization. In this study the authors focused on the significance and clinical use of mannitol bronchial challenge test in asthmatic children.

Published
2015

12. Extensive endovascular repair of thoracic aorta: observational analysis of the results and effects on spinal cord perfusion

Author

P, Mastroroberto, S, Ciranni, and C, Indolfi

Subjects
Aged, 80 and over, Male, Aortic Aneurysm, Thoracic, Spinal Cord Ischemia, Aortic Rupture, Endovascular Procedures, Collateral Circulation, Aorta, Thoracic, Kaplan-Meier Estimate, Middle Aged, Prosthesis Design, Blood Vessel Prosthesis, Aortic Dissection, Blood Vessel Prosthesis Implantation, Treatment Outcome, Spinal Cord, Regional Blood Flow, Humans, Female, Stents, Aged, Retrospective Studies
Abstract

The study aims to analyze retrospective results of extensive endovascular repair of the descending thoracic aorta with special attention to spinal cord malperfusion.From April 2002 through November 2011, 21 patients underwent stent-graft coverage of the thoracic aorta from the aortic arch at the origin of the left subclavian artery to the celiac trunk, 6 (mean age =72.3±8.1) for aneurysm disease, 13 (mean age =74.3±8.4) for type B aortic dissection and 2 (mean age =52.1±6.5) for aortic rupture. The mean of aortic diameter in cases with aneurysm disease was 7.1±1.6 cm and the causes of aortic rupture were post-traumatic and aneurysm pathology respectively. In all cases needing coverage of the left subclavian artery duplex ultrasonography and flowmetry were performed to evaluate patency and flow of both the vertebral arteries.Technical success was 100% with 0% in-hospital mortality. The left subclavian artery was crossed with the uncovered portion of the stent-graft in 11 cases (52.4%) and the covered segment in the other 10 patients (47.6%) without subclavian revascularization because no pre-operative hemodynamic alterations of vertebral arteries were revealed by duplex ultrasonography. The incidence of paraplegia was 9.5% in 2 patients who had prior abdominal aortic aneurysm repair: the first case with preoperative type B aortic dissection presented significant lower extremity paresis within 24 hours after the procedure and in the second patient with a large thoracic aneurysm the signs of paraplegia were evident 3 weeks after discharge from Hospital probably due to delayed occlusion of a major medullary artery. The cumulative survival rate after 1, 3 and 9 years was 91%, 81%, and 71%.The coverage of the entire thoracic aorta is an effective procedure with high probability of success. Spinal cord malperfusion remains a serious complication especially in patients with prior aortic surgery but if collateral blood supply is maintained the occlusion of intercostal arteries do not determine paraplegia or paraparesis. In order to consider acute or chronic occlusion of subclavian, lumbar or hypogastric arteries so preventing spinal cord ischemia, strong preoperative evaluation including analysis of previous surgery for abdominal aortic aneurysm repair and avoidance of T12 aortic segment coverage if feasible is mandatory.

Published
2013

13. Effetto dell’angioplastica sperimentale sulla formazione di neointima dopo somministrazione di streptozotocina in ratti neonati ed in ratti adulti

Author

L. Cavuto, C. Indolfi, A. Chieffo, F. Pardo, PERRINO, CINZIA, C. Coppola, AM Stingone, E. Stabile, RAPACCIUOLO, ANTONIO, CHIARIELLO, MASSIMO, Cavuto, L., C., Indolfi, A., Chieffo, Rapacciuolo, Antonio, F., Pardo, Perrino, Cinzia, C., Coppola, Am, Stingone, E., Stabile, and Chiariello, Massimo

Subjects
angioplastica, streptozotocina, neointima
Published
1997

14. Gene therapy for cardiovascular disorders

Author

C, Indolfi and M, Chiariello

Subjects
Cardiomyopathy, Dilated, Disease Models, Animal, Mice, Cardiovascular Diseases, Gene Transfer Techniques, ras Proteins, Animals, Humans, Mice, Transgenic, Genetic Therapy, Cardiomyopathy, Hypertrophic
Published
1998

15. Mechanisms of restenosis after angioplasty and approach to therapy (Review)

Author

M. Chiariello, Eugenio Stabile, C. Perrino, C Indolfi, Indolfi, C, Stabile, Eugenio, Perrino, Cinzia, and Chiariello, M.

Subjects
Neointima, business.industry, medicine.medical_treatment, General Medicine, Cell cycle, Pharmacology, medicine.disease, Amrinone, Radiation therapy, Restenosis, Angioplasty, Immunology, Genetics, medicine, Systemic administration, business, Protein kinase A, medicine.drug
Abstract

Angioplasty is a principal treatment for occlusive vascular disease but 30-50% of patients show a restenosis of the vessel. There is no clinical effective therapy for this disease. It has been demonstrated, in animal models, that various drugs such as NO-donor, plasminogen inhibitor tranexamic acid and MMP (matrix metalloproteinases) reduce the rate of restenosis. Other therapeutic approaches are cytotoxic therapy, and strategies to inhibit cell cycle progression. Systemic administration of conventional pharmacologic agents inhibit cell cycle kinases and vascular lesion formation in animal models. As cell cycle progression is accompanied by fluctuations in the concentration of adenosine 3',5-monophospate (cAMP) and in the activity of the cAMP dependent protein kinase (PKA), local administration of cAMP and phospodiesterase-inhibitor drugs (aminophylline or amrinone) markedly inhibit neointima formation. The successful use of local radiation therapy to inhibit neointima formation after vascular injury may reflect a similar combination of cell-cycle arrest and vascular cell apoptosis. The most effective therapy for occlusive vascular disease will likely combine intravascular stenting with an antiproliferative therapy.

Published
1998

16. [Gene therapy for the treatment of restenosis after coronary angioplasty]

Author

A, Rapacciuolo, C, Indolfi, E, Di Lorenzo, G, Esposito, E, Stabile, A M, Stingone, E V, Avvedimento, M, Condorelli, and M, Chiariello

Subjects
Male, Time Factors, Blood Pressure, Coronary Disease, Genetic Therapy, Coronary Vessels, Rats, Inbred WKY, Muscle, Smooth, Vascular, Rats, Gene Expression Regulation, Recurrence, Animals, Angioplasty, Balloon, Coronary, Proto-Oncogene Proteins c-fos
Abstract

Accumulation and proliferation of vascular smooth muscle cells are associated with atherosclerosis and hypertension. Proliferation of smooth muscle cells constitutes a major pathological event responsible for long-term failure of coronary and peripheral arterial bypass graft as well as the development of restenosis after percutaneous transluminal coronary angioplasty (PTCA). The incidence of restenosis after PTCA has been reported to be as high as 40-45% within 3-6 months. Major advantages in recombinant deoxyribonucleic acid (DNA) technology and eukaryotic gene regulation allow to hypothesize gene therapy as a potential treatment for inherited and acquired diseases. Gene therapy is the introduction of genes into somatic cells to correct an inherited or acquired disorder through the synthesis of missing or defective protein. Although no disease has yet been treated by gene therapy, several gene transfer protocols have recently been undertaken. We have studied the expression of foreign DNA that has been introduced into smooth muscle cells after balloon carotid injury in a rat model of angioplasty. The effects of different degree of balloon injury on neointima formation and c-fos expression was also assessed. Our data demonstrate that site-specific gene expression can be achieved by direct gene transfer in vivo and could be applied to the treatment of restenosis after PTCA.

Published
1994

17. Alfa-adrenergic control of coronary circulation in man

Author

C, Indolfi, A, Rapacciuolo, M, Condorelli, M, Chiariello, Indolfi, C., Rapacciuolo, Antonio, Condorelli, M., and Chiariello, M.

Subjects
Adrenergic Antagonists, circolazione coronarica, Regional Blood Flow, Coronary Circulation, Humans, Receptors, Adrenergic, alpha, Adrenergic alpha-Agonists, sistema alfa adrenergico, uomo
Published
1994

18. [The effects of the selective intracoronary administration of nifedipine on left ventricular filling anomalies during coronary angioplasty]

Author

G, Esposito, F, Piscione, A, Giunta, C, Indolfi, S, Maione, M R, Arnese, M, Condorelli, and M, Chiariello

Subjects
Adult, Male, Analysis of Variance, Nifedipine, Coronary Disease, Middle Aged, Coronary Angiography, Coronary Vessels, Echocardiography, Doppler, Ventricular Function, Left, Double-Blind Method, Diastole, Humans, Infusions, Intra-Arterial, Female, Angioplasty, Balloon, Coronary
Abstract

Eighteen patients with isolated stenosis of left anterior descending artery, were randomly given 0.2 mg of nifedipine (Group II) or its solvent (Group I) via balloon catheter positioned across the lesion immediately prior balloon occlusion. Peak velocity of early (E peak) and late (A peak) filling, velocity flow integral at early (E area) and late (A area) filling and their ratios (by echo-Doppler) and heart rate, mean aortic and wedge (W) pressures were measured at baseline, 15 and 30 s during balloon occlusion and 10 min after balloon deflation. In Group I we observed a significant decrease in either E peak at 15 and 30 s (-24.7%, -29.3% respectively) and E area (-32.8%, -40.0% respectively) with a non significant increase in both A peak and A area. Accordingly, either E/A peak ratio and E/A area ratio decreased significantly. In Group II no significant changes were observed in the echo-Doppler parameters of left ventricular filling. Wedge pressure also significantly increased in Group I at 15 and 30 s (68.7% and 97.9% respectively), while a significant increase in Group II occurred only at 30 s (32.5%). Heart rate significantly increased only in Group I at 15 and 30 s (10.3% and 11% respectively), while aortic pressure remained unchanged in both groups. Thus, nifedipine given intracoronary in the post-stenotic area just before balloon occlusion prevents left ventricular filling dynamic alteration by preserving early filling.

Published
1993

19. [Coronary vasoconstriction induced by digoxin in normal subjects and in patients with coronary atherosclerosis]

Author

A, Rapacciuolo, C, Indolfi, G, Esposito, E, Di Lorenzo, N, Esposito, A, Maione, V, Ambrosini, F, Piscione, and M, Chiariello

Subjects
Adult, Male, Analysis of Variance, Digoxin, Hemodynamics, Coronary Artery Disease, Middle Aged, Receptors, Adrenergic, alpha, Coronary Angiography, Coronary Vessels, Reference Values, Vasoconstriction, Humans, Female, Aged
Abstract

This study evaluated the effects of digoxin infusion (0.014 mg/kg in 10 min i.v.) on large coronary arteries measured by quantitative digital angiography. Twenty-two patients (aged 47 +/- 12), divided in 3 groups were studied. The effects of digoxin infusion (after 10 and 20 min) and sublingual administration of isosorbide dinitrate were investigated in Group I (patients with angiographically normal coronary arteries, n = 9) and in Group II (patients with atherosclerotic coronary arteries, n = 8). In Group III (n = 5) to determine whether or not the effects of digoxin were mediated by activation of alpha-adrenergic receptors, coronary angiographies were performed after alpha-adrenoceptor blockade (phentolamine 0.11 mg/kg, i.v.). In Group I, 10 min after the end of digoxin infusion, cross-sectional area decreased from 7.7 +/- 4.1 mm2 to 6.0 +/- 2.2 mm2, and after 20 min to 5.6 +/- 2.6 mm2 (p0.05). Isosorbide dinitrate reverted digoxin-induced vasoconstriction as cross-sectional area increased to 8.5 +/- 3.4 mm2 (NS versus baseline). By 20 min after digoxin infusion heart rate was significantly reduced from 79 +/- 16 to 74 +/- 13 b/min (p0.01). Peripheral vascular resistances increased significantly 10 min after digoxin infusion (from 1396 +/- 693 to 1693 +/- 984 dyne*s*cm-5, p0.05), whereas cardiac output did not change. In Group II, minimal stenosis diameter decreased significantly 20 min after digoxin infusion from 1.6 +/- 0.5 mm to 1.4 +/- 0.5 mm (p0.05). Again, isosorbide dinitrate reverted digoxin-induced vasoconstriction as minimal stenosis diameter increased (NS versus control).(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1993

20. [Effect of alpha-adrenergic receptor blockade on peripheral vasoconstriction induced by the cold pressor test. Evidence for functional integrity of alpha 1 and alpha 2 adrenergic receptors in patients with congestive heart failure]

Author

A, Maione, A, Rapacciuolo, G, Esposito, E, Di Lorenzo, R, Ceravolo, C, Indolfi, and M, Chiariello

Subjects
Adult, Cold Temperature, Heart Failure, Analysis of Variance, Vasoconstriction, Humans, Middle Aged, Receptors, Adrenergic, alpha, Adrenergic alpha-Antagonists, Aged
Abstract

Central sympathetic stimulation results in direct vascular vasoconstriction mediated by activation of alpha-adrenergic receptors. However, it is unknown whether this vasoconstriction is mediated by alpha 1 or alpha 2-adrenoceptor subtypes. In patients with congestive heart failure (CHF), both circulating and neuronally released catecholamines produces vasoconstriction via alpha-adrenergic stimulation. This vasoconstriction produces detrimental hemodynamic effect in CHF patients since it increases right and left ventricular filling pressures and pulmonary and systemic vascular resistances. While the myocardial alpha 1-adrenoceptors seems not to be down-regulated in heart failure, the functional integrity of vascular alpha 1 and alpha 2-adrenoceptors in CHF remains to be elucidated. Accordingly, the present study was designed to assess whether the limb vascular response to alpha 1 or alpha 2-adrenoceptor stimulation is impaired in patients with CHF. We studied 25 control subjects and 19 patients with CHF due to primary dilated cardiomyopathy. Forearm blood flow was measured by venous occlusion plethysmography. Sympathetic stimulation was produced by cold. The intraarterial pump-infusions of BHT 933 (a selective alpha 2-adrenoceptors agonist agent, 0.1, 1, 10 micrograms/kg/min for 5 min) produced the same peripheral vasoconstriction in CHF and in control subjects: 32 +/- 23.9%, 47.3 +/- 20% and 55 +/- 26.1% respectively at I, II, and III dose in CHF and 28.7 +/- 38.6%, 36 +/- 14.5%, and 57 +/- 13.8% respectively at I, II, and III dose in control subjects. The dose response to BHT 933 was not different in the 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1992

21. Poster Session 2: CRT: techniques and imaging

Author

R. P. Beynon, R. A. Argyle, R. Aghamohammadzadeh, K. A. Pearce, S. G. Ray, N. C. Davidson, P. A. Scott, N. G. Turner, A. M. Yue, P. R. Roberts, J. M. Morgan, A. Duparc, N. Delarche, G. Froehlig, J. Brachmann, P. Mondoly, F. Ziglio, S. Cazeau, D. Thomas, A. G. Fraser, A. Penny, Z. R. Yousef, A. Ciarka, M. Bertini, V. Delgado, R. J. Van Bommel, C. J. W. Borleffs, N. Van De Veire, M. J. Schalij, J. Bax, N. Ajmone Marsan, G. Nucifora, J. J. Bax, P. Dabrowski, A. Kleinrok, P. Bordachar, M. De Guillebon, J. B. Thambo, S. Ploux, A. Deplagne, P. Ritter, M. Haissaguerre, J. Clementy, Q. Parisi, L. Messano, M. Santamaria, G. Angeloni, F. Alessandrini, R. Mlynarski, A. Wlodyka, W. Kargul, M. Sosnowski, C. Tomasi, R. Mosconi, C. Corsi, S. Severi, F. Veronesi, V. Ricci, R. Pepoli, M. Margheri, S. Greenberg, M. Gupta, J. Burke, M. Seifert, T. Schau, W. Koglek, M. Neuss, J. Meyhoefer, C. Butter, A. Curcio, G. L. Cascini, S. Cipullo, A. Restuccia, G. Santarpia, A. Cuko, A. Leone, C. Indolfi, K. Gutleben, G. N. Noelker, H. M. Marschang, M. S. Schmidt, G. R. Ritscher, C. R. Rohkohl, J. B. Brachmann, A. M. S. Sinha, X. Min, H. Hellman, C. Lall, S. Rosenberg, M. Ginks, P. Chinchapatnam, S. Hamid, S. Sinclair, J. Totman, G. Carr-White, R. Razavi, C. A. Rinaldi, A. Sztaniszlav, O. Przibille, B. Nowak, B. Schulte-Hahn, M. D. Bogaard, P. A. Doevendans, H. Van Wessel, R. N. Hauer, M. Meine, K. Ryu, A. D'avila, E. K. Heist, J. Chou, M. Yang, and J. P. Singh

Subjects
medicine.medical_specialty, business.industry, Physiology (medical), medicine, Medical physics, Session (computer science), Cardiology and Cardiovascular Medicine, business
Published
2009
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22. Poster Session 4: Miscellaneous

Author

P. A. Brady, P. Erne, J. Val-Mejias, J. Schwab, R. Schimpf, M. Orlov, T. Mattioni, J. Amlie, H. Itou, M. Igarashi, A. Iga, T. Tubota, J. Yamazaki, K. Yoshihara, C. I. Santos De Sousa, L. Carpinteiro, P. Marques, M. R. Almeida, G. Miltemberger, M. J. Correia, J. Sousa, M. Lopes, R. Teixeira, M. J. Ferreira, P. Donato, M. Ventura, J. Cristovao, L. Elvas, L. A. Providencia, D. Chang, S. Zhang, L. Gao, D. Yang, Y. Lin, Z. Chu, Y. Yang, R. Pecini, S. Pehrson, X. Chen, A. M. Thoegersen, A. Kjaer, J. Hastrup-Svendsen, J. J. Sanchez-Munoz, A. Garcia-Alberola, J. Martinez-Sanchez, P. Penafiel-Verdu, J. A. Giner-Caro, F. J. Pastor-Perez, M. Valdes-Chavarri, S. Sorrentino, C. Forleo, M. Iacoviello, P. Guida, V. D'andria, S. Favale, E. Pasceri, A. Curcio, F. Achille, D. De Serio, S. Zinzi, D. Torella, P. Mastroroberto, C. Indolfi, O. Ozcan Celebi, A. Canbay, S. Aydogdu, E. Diker, A. De Sisti, J. Tonet, A. Benkaci, R. Frank, P. Penafiel Verdu, J. A. Giner Caro, N. Maroz-Vadalazhskaya, T. Denissevich, I. Ostrovskiy, N. Sharashidze, Z. Pagava, G. Saatashvili, R. Agladze, M. Noda, S. Yoshikawa, T. Fujinami, Y. Yamamoto, H. Tashiro, M. Usui, K. Ichikawa, M. Isobe, C. Meyer, E. Saygili, O. Rana, J. Floege, M. Hennersdorf, T. Rassaf, M. Kelm, P. Schauerte, B. Sredniawa, S. Cebula, J. Kowalczyk, A. Musialik-Lydka, A. Wozniak, M. Zakliczynski, M. Zembala, Z. Kalarus, O. I. Gumenyuk, Y. V. Chernenkov, I. V. Kosenkova, N. V. Bolotova, and A. P. Averyanov

Subjects
medicine.medical_specialty, business.industry, Physiology (medical), medicine, Medical physics, Session (computer science), Cardiology and Cardiovascular Medicine, business
Published
2009
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24. Mechanisms of benefit in the ischemic myocardium due to heart rate reduction

Author

B D, Guth, C, Indolfi, G, Heusch, R, Seitelberger, and J, Ross

Subjects
Dogs, Atenolol, Heart Rate, Swine, Coronary Circulation, Physical Exertion, Receptors, Adrenergic, beta, Animals, Coronary Disease, Myocardial Contraction
Abstract

The studies reviewed here examine the role of heart rate reduction in the beneficial effect observed following beta-adrenoceptor blockade during exercise-induced ischemia in conscious dogs. To further study the effects of heart rate reduction on regional blood flow in an ischemic bed without collateral circulation, anesthetized swine with controlled coronary perfusion were also studied. Measurements of regional myocardial blood flow (microspheres) and contractile function (sonomicrometers) during steady state exercise in dogs with chronic coronary artery stenosis indicated the existence of severe regional contractile dysfunction and subendocardial ischemia. The administration of beta-adrenoceptor blockade (1.0 mg/kg atenolol) improved regional contractile function when heart rate was reduced from 220 to 165 beats/min. Atrial pacing during exercise to prevent the bradycardia following beta-adrenoceptor blockade eliminated the improved regional function and blood flow. Thus, the beneficial effect of beta-blockade was only apparent when exercise heart rate was reduced. In anesthetized swine with constant inflow coronary perfusion, two levels of coronary hypoperfusion were examined at heart rates of 91 beats/min or 55 beats/min. Bradycardia was produced using the bradycardic agent UL-FS 49 (0.3 mg/kg). Regional contractile function and subendocardial blood flow were markedly improved at the lower heart rate for either level of reduced coronary perfusion, indicating a redistribution of blood flow towards the subendocardium. The improvement in contractile function was larger than predicted on the basis of the improvement in blood flow per min to the subendocardium. Independent relationships between regional contractile function and the subendocardial blood flow per min were observed for each heart rate. Thus, the studies in conscious exercising dogs indicated that heart rate reduction is an essential mechanism for the improvement of ischemic regional myocardial contractile function during exercise by beta-blockade. This is likely the result of the marked improvement in subendocardial blood flow per beat which accompanies the reduced heart rate; regional myocardial blood flow per beat appears to be a predictor of regional contractile function during ischemia both at rest and during exercise.

Published
1990

27. [Effects of atrial natriuretic peptide on left ventricular function in man]

Author

C, Indolfi, F, Piscione, M, Volpe, A, Focaccio, B, Trimarco, M, Condorelli, and M, Chiariello

Subjects
Adult, Male, Hemodynamics, Humans, Blood Pressure, Female, Stroke Volume, Cardiac Output, Middle Aged, Atrial Natriuretic Factor, Peptide Fragments, Aged
Abstract

The effects of atrial natriuretic peptide (ANP) infusion were determined in 9 subjects undergoing cardiac catheterization which did not disclose heart disease. Data were obtained at rest and during the steady-state phase of alpha-human-(1-28)-atrial natriuretic peptide infusion (0.5 microgram/Kg bolus dose, 0.05 microgram Kg/min iv for 20 min). Mean blood pressure decreased from 105 +/- 3 to 98 +/- 4 mmHg (p less than 0.05); pressure measurements and left ventricular (LV) angiograms suitable for analysis were available in 7 of 9 subjects at matched heart rate. The infusion of ANP reduced LV end-diastolic and end-systolic volume indices from 93 +/- 6 to 80 +/- 6 ml/m2 (p less than 0.01) and from 25 +/- 3 to 17 +/- 1 ml/m2 (p less than 0.05), respectively. Left ventricular ejection fraction insignificantly increased from 72 +/- 5 to 77 +/- 4%. End-systolic pressure/volume ratio showed a slight but not significant rise (from 3 +/- 0.4 to 4 +/- 0.8). Initial plasma levels of ANP (48 +/- 12 pg/ml) rose to 1890 +/- 423 pg/ml (p less than 0.001) during the infusion and individual hemodynamic responses were not related to plasma concentrations of the peptide. These data suggest that the administration of ANP has no negative effects on LV function and the ANP-induced changes on cardiac performance are related to the reduced cardiac load.

Published
1989

28. [Severe mitral insufficiency without left atrial hypertension]

Author

F, Piscione, S, Betocchi, A, Caruso, P, Golino, C, Indolfi, and M, Chiariello

Subjects
Adult, Adolescent, Heart Ventricles, Pressure, Humans, Mitral Valve Insufficiency, Female, Vascular Resistance, Heart Atria, Pulmonary Wedge Pressure, Middle Aged, Child
Published
1984

30. [Percutaneous brachial approach in left heart catheterization with 5 French catheters. Preliminary experience]

Author

F, Piscione, B, Villari, A, Focaccio, M, Cappelli-Bigazzi, C, Indolfi, and M, Chiariello

Subjects
Adult, Male, Cardiac Catheterization, Random Allocation, Brachial Artery, Evaluation Studies as Topic, Humans, Female, Middle Aged, Coronary Angiography, Aged
Abstract

This describes our preliminary experience with percutaneous brachial approach for cardiac catheterization, by using 5 French (F) preformed catheters. Thirty patients (pts) were studied from the left arm (Group A) with a 5F sheath and 5F Judkins catheters and 30 from the right arm (Group B) with 5F sheath and 5F Amplatz catheters. Pigtail catheters (5F) were used for the left ventricular angiograms in all patients. In 10 patients arterial velocity signals and radial and ulnar artery blood pressures were monitored with the Doppler ultrasonic velocity detector before and immediately after each procedure, and 24 hours later. Arterial puncture was carried out successfully in each patient by using a 18-gauge Potts-Cournand needle. The puncture site was as close as possible to the ante cubital fossa where the artery is less mobile. Both coronary arteries were selectively opacified and the left ventricular angiography was done on every patient. The diagnostic quality of the angiograms was evaluated by the visual analogue scale and the results were not different from those obtained with the femoral approach in our catheterization laboratory. In 3 out of 30 pts in group B it was impossible to obtain a good left coronary opacification with Amplatz catheters for anatomical reasons, thus the right femoral approach was preferred. Brachial artery occlusion occurred in 1 patient from group B and needed surgical thrombectomy carried out to restore normal radial and ulnar pulses.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1988

31. International longitudinal registry of patients with atrial fibrillation and treated with rivaroxaban: RIVaroxaban Evaluation in Real life setting (RIVER)

Author

Beyer-Westendorf, J., Camm, A. J., Fox, K. A. A., Le Heuzey, J. -Y., Haas, S., Turpie, A. G. G., Virdone, S., Kakkar, A. K., Pieper, K. S., Kayani, G., Gersh, B. J., Hildebrandt, P., Dominguez, H., Comuth, W., Frost, L., Moller, D. S., Christensen, H., Bruun, L. M., Milhem, A., Gauthier, J., Mielot, C., Chanseaume, S., Chopra, S., Amlaiky, A., Tricot, O., Sierra, V., Dompnier, A., Zannad, N., Pinzani, A., Quatre, A., Mansourati, J., Fauchier, L., Badenco, N., Gandjbakhch, E., Chachoua, K. F., Malquarti, V., Pierron, F., Sacher, F., Taieb, J., Davy, J. M., Marijon, E., Lellouche, N., Leenhardt, A., Salem, A., Lesto, I., Muller, J. J., Garcia, R., Neau, J. P., Berneau, J. B., Schon, N., Gulba, D., Appel, K. F., Merke, J., Dshabrailov, J., Bauknecht, C., Scheuermann, O., Schroder, T., Jung, W., Kopf, A., Brachmann, J., Leschke, M., Taggeselle, J., Seige, M., Lassig, T., Appel, S., Schmiedl, M., Muller, K., Heinz, G. U., Axthelm, C., Eberhard, K., Hugl, B., Schwarz, T., Sechtem, U., Falanga, A., Rubino, V., Calo, L., Ageno, W., Massari, F., Imberti, D., Di Gennaro, L., Gaita, F., Margonato, A., Cannava, G., Capasso, F., Diemberger, I., Pelliccia, F., Cafolla, A., Bardari, S., Mattei, L., Ruocco, L., Boriani, G., Poli, D., Testa, S., Indolfi, C., Quintavalla, R., Mos, L., Ladyjanskaia, G., Aksoy, I., Van De Wetering, M., Theunissen, L., Den Hartog, F., Nijmeijer, R., Van De Wal, R., Reinders, S., Patterson, M., Melker, E. D., Troquay, R., Korecki, J., Szyszka, A., Diks, F., Sumis, J., Cygler, J., Miklaszewicz, B., Litwiejko-Pietrynczak, E., Napora, P., Drelich, G., Kawka-Urbanek, T., Wranicz, J. K., Mierzejewski, M., Drzewiecka, A., Wronska, D., Fares, I., Baska, J., Stania, K., Krzyzanowski, W., Miekus, P., Tyminski, M., Dronov, D., Zenin, S., Isaeva, E., Lopukhov, A., Yakusevich, V., Kuznetsov, D., Kameneva, T., Pokushalov, E., Karetnikova, V., Dik, I., Karpushina, I., Nikolin, D., Doletsky, A., Ardashev, A., Timofeeva, A., Miller, O., Lyamina, N., Shubik, Y., Boldueva, S., Blanco Coronado, J. L., Gonzalez Juanatey, C., Otero, E., Alonso, D., Torres Llergo, J., Gonzalez Lama, J., De Prada Tiffe, J. A. V., Garcia Seara, F. J., Gomez Doblas, J. J., Riancho, J. A., Clua-Espuny, J. L., Motero, J., Arrarte, V. I., Martin Raymondi, D., Isasti Aizpurua, G., Marin, F., Nieto, J. A., Fernandez Portales, J., Alvarez Garcia, P., Torstensson, I., Cederin, B., Kalm, T., Rosenqvist, U., Thulin, J., Hajimirsadeghi, A., Crisby, M., Manoj, A., Bakhai, A., Mistri, A., Krishnan, M., Kumar, S., Kirubakaran, S., Thomas, H., Camm, J., Ahmed, F., Ross, A. M., Barry, K., Stockwell, R., Broadley, A., Mamun, M., Chatterjee, K., Cooke, J., Mccready, J., Dutta, D., John, K., Pandya, P., Howlett, R., Vinson, P., Lim, Foley, P., Bruce, D., Dixit, A., Broughton, D., Taylor, J., Schilling, R., Leon, K., Saeed, K., Shaheen, S., Tawfik, M., Mortadda, A., Seleem, M., Aly, M. S. I., Kazamel, G., Elbadry, M., Kamal, S., Hassan, M., Mostafa, M., Medhat, M. E. S., Ekhlas, Ghaleb, R., Taha, M. O., Daoud, I., Al Din, H., Imam, A. M., El Hameed, M. A., Helmy, Al-Murayeh, M., Akhtar, N., Matto, B. M., Ghani, M. A., Amoudi, O. A., Morsy, M. M., Bashir, A. A. F., Al Hossni, Y. M., Al Ghamdi, B., Zia-Ul-Sabah, Mir, S., Dardir, D., Masswary, A., Al Shehri, A. R., Iqbal, J., Almansori, M. A. J., Venkitachalam, C. G., Kurian, J., Rao, J., Aisheh, A., Albawab, A. A., Subbaraman, B., Amanat, A., Esfehani, K. J., Lochan, R., Bin Brek, A., Mittal, B., Ghazi, Y., Krishna, M., Tabatabaei, S. B., Thoppil, P. S., Nasim, S., El Khider Nour, S., Barros, P., Almeida, A. P., Andrade, M., Garbelini, B., Silvestrini, T. L., Alves, A. R., De Lima, C. E. B., Kormann, A., De Lima, G. G., Halperin, C., Salvadori Junior, D., Freitas, A. F., Gemelli, J. R., Ornelas, C. E., Dantas, J. M. M., Aziz, J. L., Backes, L. M., Barroso, W. S., Paiva, M. S., De Figueiredo Neto, J. A., Dos Santos, F. R., De Lima Neto, J. A., Bergo, R., Salvador Junior, P. R., Lopez, A. G., Alva, J. C. P., Gamba, M. A. A., Padilla-Padilla, F. G., Ruiz, A. E. B., Berlingieri, J., Bakbak, A., Gupta, M., Saunders, K., Costa-Vitali, A., Beaudry, P. R., Bhargava, R., Khaykin, Y., Healey, J. S., Crystal, E., Nadeau, Dhillon, Begg, A., Anderson, C., Baveja, S., Cross, D., Catanchin, A., Brieger, D., Lim, K. T., Davidson, P., Tan, R., Bhindi, R., Hickey, J., Layland, J., Bloch, M., Itty, C., Singh, B., Carroll, P., Lee, A., Starmer, G., Lehman, R., Universidad de Cantabria, Beyer-Westendorf J., Camm A.J., Fox K.A.A., Le Heuzey J.-Y., Haas S., Turpie A.G.G., Virdone S., Kakkar A.K., RIVER Registry Investigators: [..], A. Falanga, V. Rubino, L. Calo, W. Ageno, F. Massari, D. Imberti, L. Di Gennaro, F. Gaita, A. Margonato, G. Cannava, F. Capasso, I. Diemberger, F. Pelliccia, A. Cafolla, S. Bardari, L. Mattei, L. Ruocco, G. Boriani, D. Poli, S. Testa, C. Indolfi, R. Quintavalla, L. Mo, .., Beyer-Westendorf, J, Camm, A, Fox, K, Le Heuzey, J, Haas, S, Turpie, A, Virdone, S, Kakkar, A, Pieper, K, Kayani, G, Gersh, B, Hildebrandt, P, Dominguez, H, Comuth, W, Frost, L, Moller, D, Christensen, H, Bruun, L, Milhem, A, Gauthier, J, Mielot, C, Chanseaume, S, Chopra, S, Amlaiky, A, Tricot, O, Sierra, V, Dompnier, A, Zannad, N, Pinzani, A, Quatre, A, Mansourati, J, Fauchier, L, Badenco, N, Gandjbakhch, E, Chachoua, K, Malquarti, V, Pierron, F, Sacher, F, Taieb, J, Davy, J, Marijon, E, Lellouche, N, Leenhardt, A, Salem, A, Lesto, I, Muller, J, Garcia, R, Neau, J, Berneau, J, Schon, N, Gulba, D, Appel, K, Merke, J, Dshabrailov, J, Bauknecht, C, Scheuermann, O, Schroder, T, Jung, W, Kopf, A, Brachmann, J, Leschke, M, Taggeselle, J, Seige, M, Lassig, T, Appel, S, Schmiedl, M, Muller, K, Heinz, G, Axthelm, C, Eberhard, K, Hugl, B, Schwarz, T, Sechtem, U, Falanga, A, Rubino, V, Calo, L, Ageno, W, Massari, F, Imberti, D, Di Gennaro, L, Gaita, F, Margonato, A, Cannava, G, Capasso, F, Diemberger, I, Pelliccia, F, Cafolla, A, Bardari, S, Mattei, L, Ruocco, L, Boriani, G, Poli, D, Testa, S, Indolfi, C, Quintavalla, R, Mos, L, Ladyjanskaia, G, Aksoy, I, Van De Wetering, M, Theunissen, L, Den Hartog, F, Nijmeijer, R, Van De Wal, R, Reinders, S, Patterson, M, Melker, E, Troquay, R, Korecki, J, Szyszka, A, Diks, F, Sumis, J, Cygler, J, Miklaszewicz, B, Litwiejko-Pietrynczak, E, Napora, P, Drelich, G, Kawka-Urbanek, T, Wranicz, J, Mierzejewski, M, Drzewiecka, A, Wronska, D, Fares, I, Baska, J, Stania, K, Krzyzanowski, W, Miekus, P, Tyminski, M, Dronov, D, Zenin, S, Isaeva, E, Lopukhov, A, Yakusevich, V, Kuznetsov, D, Kameneva, T, Pokushalov, E, Karetnikova, V, Dik, I, Karpushina, I, Nikolin, D, Doletsky, A, Ardashev, A, Timofeeva, A, Miller, O, Lyamina, N, Shubik, Y, Boldueva, S, Blanco Coronado, J, Gonzalez Juanatey, C, Otero, E, Alonso, D, Torres Llergo, J, Gonzalez Lama, J, De Prada Tiffe, J, Garcia Seara, F, Gomez Doblas, J, Riancho, J, Clua-Espuny, J, Motero, J, Arrarte, V, Martin Raymondi, D, Isasti Aizpurua, G, Marin, F, Nieto, J, Fernandez Portales, J, Alvarez Garcia, P, Torstensson, I, Cederin, B, Kalm, T, Rosenqvist, U, Thulin, J, Hajimirsadeghi, A, Crisby, M, Manoj, A, Bakhai, A, Mistri, A, Krishnan, M, Kumar, S, Kirubakaran, S, Thomas, H, Camm, J, Ahmed, F, Ross, A, Barry, K, Stockwell, R, Broadley, A, Mamun, M, Chatterjee, K, Cooke, J, Mccready, J, Dutta, D, John, K, Pandya, P, Howlett, R, Vinson, P, Lim, Foley, P, Bruce, D, Dixit, A, Broughton, D, Taylor, J, Schilling, R, Leon, K, Saeed, K, Shaheen, S, Tawfik, M, Mortadda, A, Seleem, M, Aly, M, Kazamel, G, Elbadry, M, Kamal, S, Hassan, M, Mostafa, M, Medhat, M, Ekhlas, Ghaleb, R, Taha, M, Daoud, I, Al Din, H, Imam, A, El Hameed, M, Helmy, Al-Murayeh, M, Akhtar, N, Matto, B, Ghani, M, Amoudi, O, Morsy, M, Bashir, A, Al Hossni, Y, Al Ghamdi, B, Zia-Ul-Sabah, Mir, S, Dardir, D, Masswary, A, Al Shehri, A, Iqbal, J, Almansori, M, Venkitachalam, C, Kurian, J, Rao, J, Aisheh, A, Albawab, A, Subbaraman, B, Amanat, A, Esfehani, K, Lochan, R, Bin Brek, A, Mittal, B, Ghazi, Y, Krishna, M, Tabatabaei, S, Thoppil, P, Nasim, S, El Khider Nour, S, Barros, P, Almeida, A, Andrade, M, Garbelini, B, Silvestrini, T, Alves, A, De Lima, C, Kormann, A, De Lima, G, Halperin, C, Salvadori Junior, D, Freitas, A, Gemelli, J, Ornelas, C, Dantas, J, Aziz, J, Backes, L, Barroso, W, Paiva, M, De Figueiredo Neto, J, Dos Santos, F, De Lima Neto, J, Bergo, R, Salvador Junior, P, Lopez, A, Alva, J, Gamba, M, Padilla-Padilla, F, Ruiz, A, Berlingieri, J, Bakbak, A, Gupta, M, Saunders, K, Costa-Vitali, A, Beaudry, P, Bhargava, R, Khaykin, Y, Healey, J, Crystal, E, Nadeau, D, Begg, A, Anderson, C, Baveja, S, Cross, D, Catanchin, A, Brieger, D, Lim, K, Davidson, P, Tan, R, Bhindi, R, Hickey, J, Layland, J, Bloch, M, Itty, C, Singh, B, Carroll, P, Lee, A, Starmer, G, Lehman, R, Beyer-Westendorf, J., Camm, A. J., Fox, K. A. A., Le Heuzey, J. -Y., Haas, S., Turpie, A. G. G., Virdone, S., Kakkar, A. K., Pieper, K. S., Kayani, G., Gersh, B. J., Hildebrandt, P., Dominguez, H., Comuth, W., Frost, L., Moller, D. S., Christensen, H., Bruun, L. M., Milhem, A., Gauthier, J., Mielot, C., Chanseaume, S., Chopra, S., Amlaiky, A., Tricot, O., Sierra, V., Dompnier, A., Zannad, N., Pinzani, A., Quatre, A., Mansourati, J., Fauchier, L., Badenco, N., Gandjbakhch, E., Chachoua, K. F., Malquarti, V., Pierron, F., Sacher, F., Taieb, J., Davy, J. M., Marijon, E., Lellouche, N., Leenhardt, A., Salem, A., Lesto, I., Muller, J. J., Garcia, R., Neau, J. P., Berneau, J. B., Schon, N., Gulba, D., Appel, K. F., Merke, J., Dshabrailov, J., Bauknecht, C., Scheuermann, O., Schroder, T., Jung, W., Kopf, A., Brachmann, J., Leschke, M., Taggeselle, J., Seige, M., Lassig, T., Appel, S., Schmiedl, M., Muller, K., Heinz, G. U., Axthelm, C., Eberhard, K., Hugl, B., Schwarz, T., Sechtem, U., Falanga, A., Rubino, V., Calo, L., Ageno, W., Massari, F., Imberti, D., Di Gennaro, L., Gaita, F., Margonato, A., Cannava, G., Capasso, F., Diemberger, I., Pelliccia, F., Cafolla, A., Bardari, S., Mattei, L., Ruocco, L., Boriani, G., Poli, D., Testa, S., Indolfi, C., Quintavalla, R., Mos, L., Ladyjanskaia, G., Aksoy, I., Van De Wetering, M., Theunissen, L., Den Hartog, F., Nijmeijer, R., Van De Wal, R., Reinders, S., Patterson, M., Melker, E. D., Troquay, R., Korecki, J., Szyszka, A., Diks, F., Sumis, J., Cygler, J., Miklaszewicz, B., Litwiejko-Pietrynczak, E., Napora, P., Drelich, G., Kawka-Urbanek, T., Wranicz, J. K., Mierzejewski, M., Drzewiecka, A., Wronska, D., Fares, I., Baska, J., Stania, K., Krzyzanowski, W., Miekus, P., Tyminski, M., Dronov, D., Zenin, S., Isaeva, E., Lopukhov, A., Yakusevich, V., Kuznetsov, D., Kameneva, T., Pokushalov, E., Karetnikova, V., Dik, I., Karpushina, I., Nikolin, D., Doletsky, A., Ardashev, A., Timofeeva, A., Miller, O., Lyamina, N., Shubik, Y., Boldueva, S., Blanco Coronado, J. L., Gonzalez Juanatey, C., Otero, E., Alonso, D., Torres Llergo, J., Gonzalez Lama, J., De Prada Tiffe, J. A. V., Garcia Seara, F. J., Gomez Doblas, J. J., Riancho, J. A., Clua-Espuny, J. L., Motero, J., Arrarte, V. I., Martin Raymondi, D., Isasti Aizpurua, G., Marin, F., Nieto, J. A., Fernandez Portales, J., Alvarez Garcia, P., Torstensson, I., Cederin, B., Kalm, T., Rosenqvist, U., Thulin, J., Hajimirsadeghi, A., Crisby, M., Manoj, A., Bakhai, A., Mistri, A., Krishnan, M., Kumar, S., Kirubakaran, S., Thomas, H., Camm, J., Ahmed, F., Ross, A. M., Barry, K., Stockwell, R., Broadley, A., Mamun, M., Chatterjee, K., Cooke, J., Mccready, J., Dutta, D., John, K., Pandya, P., Howlett, R., Vinson, P., Foley, P., Bruce, D., Dixit, A., Broughton, D., Taylor, J., Schilling, R., Leon, K., Saeed, K., Shaheen, S., Tawfik, M., Mortadda, A., Seleem, M., Aly, M. S. I., Kazamel, G., Elbadry, M., Kamal, S., Hassan, M., Mostafa, M., Medhat, M. E. S., Ghaleb, R., Taha, M. O., Daoud, I., Al Din, H., Imam, A. M., El Hameed, M. A., Al-Murayeh, M., Akhtar, N., Matto, B. M., Ghani, M. A., Amoudi, O. A., Morsy, M. M., Bashir, A. A. F., Al Hossni, Y. M., Al Ghamdi, B., Mir, S., Dardir, D., Masswary, A., Al Shehri, A. R., Iqbal, J., Almansori, M. A. J., Venkitachalam, C. G., Kurian, J., Rao, J., Aisheh, A., Albawab, A. A., Subbaraman, B., Amanat, A., Esfehani, K. J., Lochan, R., Bin Brek, A., Mittal, B., Ghazi, Y., Krishna, M., Tabatabaei, S. B., Thoppil, P. S., Nasim, S., El Khider Nour, S., Barros, P., Almeida, A. P., Andrade, M., Garbelini, B., Silvestrini, T. L., Alves, A. R., De Lima, C. E. B., Kormann, A., De Lima, G. G., Halperin, C., Salvadori Junior, D., Freitas, A. F., Gemelli, J. R., Ornelas, C. E., Dantas, J. M. M., Aziz, J. L., Backes, L. M., Barroso, W. S., Paiva, M. S., De Figueiredo Neto, J. A., Dos Santos, F. R., De Lima Neto, J. A., Bergo, R., Salvador Junior, P. R., Lopez, A. G., Alva, J. C. P., Gamba, M. A. A., Padilla-Padilla, F. G., Ruiz, A. E. B., Berlingieri, J., Bakbak, A., Gupta, M., Saunders, K., Costa-Vitali, A., Beaudry, P. R., Bhargava, R., Khaykin, Y., Healey, J. S., Crystal, E., Nadeau, Dhillon, Begg, A., Anderson, C., Baveja, S., Cross, D., Catanchin, A., Brieger, D., Lim, K. T., Davidson, P., Tan, R., Bhindi, R., Hickey, J., Layland, J., Bloch, M., Itty, C., Singh, B., Carroll, P., Lee, A., Starmer, G., and Lehman, R.

Subjects
medicine.medical_specialty, Registry, medicine.drug_class, Population, Thromboembolic stroke, Outcomes, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Antithrombotic, Rivaroxaban, Anticoagulant, Atrial fibrillation, medicine, 030212 general & internal medicine, Risk factor, education, Stroke, Outcome, education.field_of_study, business.industry, lcsh:RC633-647.5, Research, Hematology, lcsh:Diseases of the blood and blood-forming organs, medicine.disease, ddc, Clinical trial, Emergency medicine, business, medicine.drug
Abstract

Background: Real-world data on non-vitamin K oral anticoagulants (NOACs) are essential in determining whether evidence from randomised controlled clinical trials translate into meaningful clinical benefits for patients in everyday practice. RIVER (RIVaroxaban Evaluation in Real life setting) is an ongoing international, prospective registry of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) and at least one investigator-determined risk factor for stroke who received rivaroxaban as an initial treatment for the prevention of thromboembolic stroke. The aim of this paper is to describe the design of the RIVER registry and baseline characteristics of patients with newly diagnosed NVAF who received rivaroxaban as an initial treatment. Methods and results: Between January 2014 and June 2017, RIVER investigators recruited 5072 patients at 309 centres in 17 countries. The aim was to enroll consecutive patients at sites where rivaroxaban was already routinely prescribed for stroke prevention. Each patient is being followed up prospectively for a minimum of 2-years. The registry will capture data on the rate and nature of all thromboembolic events (stroke / systemic embolism), bleeding complications, all-cause mortality and other major cardiovascular events as they occur. Data quality is assured through a combination of remote electronic monitoring and onsite monitoring (including source data verification in 10% of cases). Patients were mostly enrolled by cardiologists (n = 3776, 74.6%), by internal medicine specialists 14.2% (n = 718) and by primary care/general practice physicians 8.2% (n = 417). The mean (SD) age of the population was 69.5 (11.0) years, 44.3% were women. Mean (SD) CHADS2 score was 1.9 (1.2) and CHA2DS2-VASc scores was 3.2 (1.6). Almost all patients (98.5%) were prescribed with once daily dose of rivaroxaban, most commonly 20 mg (76.5%) and 15 mg (20.0%) as their initial treatment; 17.9% of patients received concomitant antiplatelet therapy. Most patients enrolled in RIVER met the recommended threshold for AC therapy (86.6% for 2012 ESC Guidelines, and 79.8% of patients according to 2016 ESC Guidelines). Conclusions: The RIVER prospective registry will expand our knowledge of how rivaroxaban is prescribed in everyday practice and whether evidence from clinical trials can be translated to the broader cross-section of patients in the real world. Funding: This work is supported by an unrestricted research grant from Bayer AG (Berlin, Germany) to the Thrombosis Research Institute (London, UK), which sponsors the RIVER registry. The funding source had no involvement in the data collection, data analysis or data interpretation.

Published
2019

32. Assessment of Left Ventricular Function Using Radionuclide Angiography After Dipyridamole Infusion

Author

Ciro Indolfi, Marco Salvatore, Massimo Chiariello, Pasquale Perrone-Filardi, Federico Piscione, Sandro Betocchi, Indolfi, C, Betocchi, S, Piscione, F, PERRONE FILARDI, Pasquale, Salvatore, Marco, Chiariello, M., C., Indolfi, Betocchi, Sandro, F., Piscione, and M., Chiariello

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Coronary Disease, Radionuclide ventriculography, Constriction, Pathologic, Critical Care and Intensive Care Medicine, Radionuclide angiography, Internal medicine, Infusion Procedure, medicine, Humans, Myocardial infarction, Angiocardiography, Radionuclide Angiography, Aged, Ejection fraction, medicine.diagnostic_test, business.industry, Stroke Volume, Dipyridamole, Middle Aged, medicine.disease, Myocardial Contraction, Stenosis, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Thirty-six patients with significant coronary artery stenosis and no previous myocardial infarction and 25 subjects with normal coronary arteries underwent 99mTc RNV before and after coronary vasodilatation induced by dipyridamole, 0.75 mg/kg, given IV over 10 min. In subjects with normal coronary arteries, dipyridamole induced an increase in LVEF (from 66 +/- 8 to 76 +/- 8 percent; mean +/- SD; p less than 0.001); in patients with significant coronary artery stenosis (greater than or equal to 75 percent narrowing of at least one major vessel), dipyridamole injection did not affect LVEF (from 63 +/- 12 to 62 +/- 12 percent). In ten patients a complete, successful PTCA was performed and the RNV with the dipyridamole test repeated. The EF did not change with the dipyridamole test before PTCA (63 +/- 7 to 65 +/- 9 percent), but increased significantly after PTCA (62 +/- 11 to 70 +/- 9 percent; p less than 0.01). Sensitivity and specificity of EF changes after dipyridamole infusion were 75 and 76 percent, respectively. The test produced no major side effects or complications. Radionuclide angiography with dipyridamole helps to detect coronary artery stenosis and might be used to assess the effects of angioplasty on coronary flow reserve.

Published
1989
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33. Challenges and preventive strategies in pediatric drug hypersensitivity reactions: where do we stand?

Author

Klain A, Galletta F, Mori F, Bettini I, Tomei L, Senatore AA, Manti S, Licari A, Miraglia Del Giudice M, and Indolfi C

Subjects
Humans, Child, Premedication, Desensitization, Immunologic methods, Drug Hypersensitivity prevention & control, Drug Hypersensitivity diagnosis
Abstract

Drug hypersensitivity reactions (DHRs) in pediatric patients present significant clinical challenges due to their potential for severe, life-threatening reactions such as anaphylaxis. Although less common than in adults, DHRs in children are more difficult to diagnose and manage due to limited pediatric-specific research. This study focuses on the role of premedication as a preventive strategy for DHRs, exploring its potential benefits and limitations. While approaches like H1-antihistamines combined with gradual drug dose escalation show promise for reducing mild histamine-mediated reactions, evidence regarding premedication's effectiveness, particularly for non-IgE-mediated mechanisms, remains inconclusive. Rapid drug desensitization (RDD) protocols demonstrate high success rates in certain cases; however, there are no strong recommendations for or against premedication, and controlled studies documenting its real efficacy are lacking. Further research is crucial to establish clear guidelines and improve the safety and outcomes of pediatric drug allergy management., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests., (© 2025. The Author(s).)

Published
2025
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34. From Mechanisms to Management: Tackling In-Stent Restenosis in the Drug-Eluting Stent Era.

Author

Spadafora L, Quarta R, Martino G, Romano L, Greco F, Curcio A, Gori T, Spaccarotella C, Indolfi C, and Polimeni A

Subjects
Humans, Coronary Angiography, Risk Factors, Incidence, Coronary Artery Disease therapy, Coronary Artery Disease surgery, Drug-Eluting Stents, Coronary Restenosis prevention & control, Coronary Restenosis diagnostic imaging, Percutaneous Coronary Intervention instrumentation, Percutaneous Coronary Intervention methods
Abstract

Purpose of Review: Drug-eluting stent (DES) technology has greatly enhanced the safety and effectiveness of percutaneous coronary interventions (PCI). The aim of the present paper is to provide a comprehensive review of in-stent restenosis (ISR), focusing on the contemporary DES era, including its incidence, mechanisms, and imaging characterization., Recent Findings: Despite the widespread use of DES and numerous improvements, recent clinical data indicate that ISR still occurs in 5-10% of PCI procedures, posing a considerable public health issue. The incidence, morphology, and clinical implications of ISR are determined by a complex interplay of several factors: the patient, stent, procedure, and vessel and lesion-related factors. Advancements in intracoronary imaging have provided greater insight into its patterns and underlying causes. Over time, treatment strategies have evolved, and current guidelines recommend an individualized approach using intracoronary imaging to characterize ISR's underlying substrate., Competing Interests: Declarations. Conflicts of Interest: The authors declare no competing interests. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors., (© 2025. The Author(s).)

Published
2025
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35. Real-World Efficacy and Safety of Inclisiran: A Single-Country, Multicenter, Observational Study (CHOLINET Registry).

Author

Gargiulo P, Marzano F, Crisci M, Marcucci R, Bruzzese D, Maloberti A, Sarullo FM, Galasso G, Indolfi C, Musumeci G, Corleto A, Calabrò P, Carugo S, Casu G, Picciolo A, Ciccone MM, Bilato C, Polimeni A, Giallauria F, Catalano A, De Luca L, Niccoli G, Venturini E, Pepe M, Montisci R, Brunetti ND, Patti G, Porto I, Margonato A, Floresta M, Muscoli S, Cameli M, Andò G, Di Lorenzo E, Berteotti M, Giannattasio C, Sarullo S, Formisano C, Di Costanzo A, Delnevo F, Varbella F, Cesaro A, Franzese M, Mancusi C, Fontanarosa S, Di Santo M, Cotticelli C, Perrone Filardi F, Paolillo S, Esposito G, Corsini A, and Perrone Filardi P

Abstract

Competing Interests: Funding Support and Author Disclosures Dr Corsini has received consulting fees and lecture fees from Algorithm, Amarin, Amgen, DOC, Fidia, Novartis, Merck Sharp & Dohme, Recordati Spa, Sanofi, Servier, and Viatris; and has received grant support from Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Published
2025
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36. Implementation of guideline-directed medical therapy in patients with heart failure with reduced ejection fraction (OpTIMa-HF Registry).

Author

Paolillo S, Basile C, Marzano F, Bruzzese D, Agostoni P, Mattavelli I, Aloisio A, Ameri P, Solimano M, Brunetti ND, Calabrò P, Cesaro A, Cameli M, Mandoli GE, Carluccio E, Belardinelli C, Carugo S, Casalino L, Chiuini E, Cosmi D, Dini FL, Di Santo M, Esposito G, Ferrara F, Fierro MF, Galasso G, Gallo L, Rispoli A, Gargiulo P, Grigioni F, Segreti A, Guarnaccia F, Guarnaccia N, Guerra F, Cicchirillo E, Indolfi C, Larcher M, Lillo A, Metra M, Montisci R, Marchetti MF, Nodari S, Fioretti F, Nardi E, Oliviero U, Palazzuoli A, Patti G, Pepe M, Pacelli F, Perrone Filardi F, Putortì G, Santoro G, Senni M, D'Elia E, Severino P, D'Amato A, Soriano S, Sinagra G, Rossi M, Franzese M, Smaldone G, Zito GB, and Perrone Filardi P

Abstract

Aims: The last released European guidelines on the management of heart failure (HF) recommend in patients with chronic HF with reduced ejection fraction (HFrEF) a pharmacological approach based on four fundamental drugs to be rapidly implemented and then uptitrated to modify disease progression. The aim of the Optimization of Therapy in the Italian Management of Heart Failure (OPTIMA-HF) registry is to collect data on chronic HF outpatients in different settings of care. In the present analysis, we report the first analysis of the OPTIMA-HF registry, focusing on the real-life use of guideline-directed medical therapy in patients affected by HFrEF., Methods: OPTIMA-HF is an observational, cross-sectional, multicentre, real-life Italian registry conducted in two different clinical settings: HF outpatients' clinics of Italian hospitals and community HF outpatients' services. The study comprises a T0 phase-retrospective data collection, in which data of consecutive HF outpatients seen between January and October 2022 were collected; an educational activity phase; and a T1 phase-prospective data collection, in which data of consecutive HF outpatients seen between September 2023 and November 2023 were collected. In the present analysis, we describe the T0 phase focusing on HFrEF drug prescription rates, types, doses, combination therapy, the presence of contraindications and reasons of non-optimized treatment., Results: Twenty-nine centres enrolled 2110 HF patients, of which 1390 (65.9%) had HFrEF [69.5 ± 11.9 years, 76.2% males, 4.1 years since HF diagnosis, median ejection fraction (EF) 33%]. Among HFrEF patients, 89.1% were on treatment with renin-angiotensin-aldosterone system inhibitor (RAASi)/angiotensin receptor neprilysin inhibitor (ARNI) (72% ARNI and 17.1% RAASi), 95.1% with beta-blockers, 75.8% with mineralocorticoid receptor antagonists (MRA) and 63.2% with sodium/glucose cotransporter 2 inhibitors (SGLT2i). Despite high prescription rates, a non-negligible number of patients with no contraindications were not treated with each specific drug. Patients taking all four drug classes, as recommended by guidelines, were mere 46.9%. Regarding doses, a still low number of patients on RAASi/ARNI and beta-blockers were treated with a dose ≥50% of the target doses recommended by the European guidelines., Conclusions: The OPTIMA-HF registry reported that HFrEF fundamental drugs are prescribed in most Italian patients; however, <50% of patients receive optimal combination therapy, and still not a satisfying number of patients receive target doses. Strategies to improve implementation of guideline-directed medical therapy are needed to improve HF prognosis., (© 2025 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Published
2025
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38. Biologics and small molecules: the re-evolution in the treatment of atopic dermatitis in children and adolescents. Current state of the art and future perspectives.

Author

D'Auria E, Indolfi C, Acunzo M, Dinardo G, Comberiati P, Peroni D, Zuccotti GV, and Miraglia Del Giudice M

Abstract

Introduction: In recent years, the understanding of atopic dermatitis (AD) pathogenetic mechanisms has expanded, and now it is recognized that Th2 immune axis dysregulation is pivotal to AD pathogenesis. The advent of biological drugs and small molecules has marked a revolution in the treatment of AD. Dupilumab, targeting IL-4 and IL-13, has been the first to demonstrate efficacy in treating moderate to severe AD by modulating type-2 inflammation pathways. Increasing knowledge of different immune axis and cytokines has fueled the development of new biologics and small molecules. JAK inhibitors, which target the JAK-STAT pathway, involved in cytokine signaling, represent a promising novel therapeutic strategy, enlarging the treatment options for moderate to severe atopic dermatitis., Areas Covered: This comprehensive review aims to provide an updated and critical overview of the drugs currently in use and under investigation for the treatment of moderate to severe AD in children and adolescents, along with addressing the unmet needs and future research perspectives., Expert Opinion: Biologics and small molecules offer the promise to enlarge the arsenal options for the treatment of AD. Since the patients' response to biologics depends on AD pheno-endotype, choosing the right biologic is crucial for ensuring therapy success.

Published
2025
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39. Eosinophilic Esophagitis and Cow's Milk: Mechanisms, Challenges, and Treatment Perspectives.

Author

Dinardo G, Fiocchi A, Artesani MC, De Angelis P, Rea F, Tambucci R, Dahdah L, Fierro V, Valluzzi RL, Arasi S, Pecora V, Cafarotti A, Mazzuca C, Indolfi C, Miraglia Del Giudice M, and Urbani S

Subjects
Humans, Animals, Cattle, Allergens immunology, Child, Immunoglobulin E immunology, Eosinophilic Esophagitis therapy, Eosinophilic Esophagitis immunology, Eosinophilic Esophagitis diet therapy, Milk Hypersensitivity therapy, Milk Hypersensitivity immunology, Milk immunology
Abstract

Eosinophilic esophagitis is a chronic, antigen-driven, immune-mediated disease characterized by esophageal dysfunction and significant eosinophilic infiltration. Its rising incidence and prevalence over recent decades reflect both increased clinical awareness and the influence of environmental factors such as dietary patterns and allergen exposure. Among food allergens, cow's milk proteins are the most commonly implicated triggers, contributing to esophageal inflammation through complex immunological pathways involving both IgE-mediated and non-IgE-mediated mechanisms. Dietary elimination of cow's milk has been shown to induce histologic remission in over 60% of pediatric patients, underscoring its pivotal role in eosinophilic esophagitis management. Despite these promising results, challenges persist, including variability in individual responses, the burden of adherence to restrictive diets, and gaps in understanding the molecular mechanisms driving cow's milk-induced esophageal inflammation. This review examines the complex relationship between eosinophilic esophagitis and cow's milk, focusing on its role in disease pathogenesis and management, offering insights into its therapeutic implications. Understanding the interplay between eosinophilic esophagitis and dietary allergens, particularly cow's milk, may inform the development of targeted interventions and improve clinical outcomes for affected patients.

Published
2025
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40. Physiology-Versus Angiography-Guided Complete Coronary Revascularization in STEMI Patients with Multivessel Disease: A Network Meta-Analysis.

Author

Martino G, Quarta R, Greco F, Spaccarotella C, Indolfi C, Curcio A, and Polimeni A

Abstract

Background : In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD), complete revascularization (CR) is recommended over culprit-only PCI to reduce adverse cardiovascular outcomes. However, the optimal strategy for CR, whether angiography (Angio)-guided or physiology-guided, remains uncertain. Methods : This network meta-analysis included 14 randomized controlled trials (RCTs) with 11,568 patients to compare the efficacy of angio-guided CR, physiology-guided CR, and culprit-only PCI in reducing major adverse cardiovascular events (MACE), all-cause mortality, recurrent myocardial infarction (MI), cardiovascular (CV) death, and unplanned revascularization. The frequentist and Bayesian approaches were applied to assess the effectiveness of each strategy. Results : The pairwise meta-analysis showed that angio-guided CR showed superior efficacy, significantly reducing MACE (OR = 0.44; 95% CI: 0.37-0.52), recurrent myocardial infarction, and unplanned revascularization compared to culprit-only PCI. Physiology-guided CR also reduced MACE (OR = 0.64, 95% CI: 0.45-0.91) and unplanned revascularization. The network metanalysis showed that CV death was lower in the physiology-guided CR group (OR 0.56; 95% CI 0.25-1.05), suggesting a protective effect, but the difference did not reach statistical significance. Furthermore, physiology-guided CR was not significantly better than angio-guided CR in most outcomes. Conclusions : Angio-guided CR appears to provide the best overall outcomes for patients with STEMI and MVD, outperforming physiology-guided CR in most endpoints. Further large-scale trials are needed to clarify the relative efficacy of angio-guided CR and physiology-guided CR in this patient population.

Published
2025
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42. Validation of the Valve Academic Research Consortium High Bleeding Risk Definition in Patients Undergoing TAVR.

Author

Avvedimento M, Cepas-Guillén P, Ternacle J, Urena M, Alperi A, Cheema A, Veiga-Fernandez G, Nombela-Franco L, Vilalta V, Esposito G, Campelo-Parada F, Indolfi C, Del Trigo M, Muñoz-Garcia A, Maneiro N, Asmarats L, Regueiro A, Del Val D, Serra V, Auffret V, Modine T, Bonnet G, Mesnier J, Suc G, Avanzas P, Rezaei E, Fradejas-Sastre V, Tirado-Conte G, Fernández-Nofrerias E, Franzone A, Guitteny T, Sorrentino S, Francisco Oteo J, Nuche J, Gutiérrez-Alonso L, Flores-Umanzor E, Alfonso F, Monastyrski A, Nolf M, Côté M, Mehran R, Morice MC, Capodanno D, Garot P, and Rodés-Cabau J

Subjects
Humans, Risk Assessment, Male, Female, Risk Factors, Aged, Aged, 80 and over, Treatment Outcome, Reproducibility of Results, Time Factors, Prevalence, Hemorrhage mortality, Hemorrhage epidemiology, Consensus, Postoperative Hemorrhage epidemiology, Postoperative Hemorrhage etiology, Postoperative Hemorrhage mortality, Decision Support Techniques, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality, Aortic Valve Stenosis surgery, Aortic Valve Stenosis mortality, Aortic Valve Stenosis diagnostic imaging, Predictive Value of Tests, Aortic Valve surgery, Aortic Valve diagnostic imaging, Aortic Valve physiopathology
Abstract

Background: The Valve Academic Research Consortium for High Bleeding Risk (VARC-HBR) has recently introduced a consensus document that outlines risk factors to identify high bleeding risk in patients undergoing transcatheter aortic valve replacement. The objective of the present study was to evaluate the prevalence and predictive value of the VARC-HBR definition in a contemporary, large-scale transcatheter aortic valve replacement population., Methods: Multicenter study including 10 449 patients undergoing transcatheter aortic valve replacement. Based on consensus, 21 clinical and laboratory criteria were identified and classified as major or minor. Patients were stratified as at low, moderate, high, and very high bleeding risk according to the VARC-HBR definition. The primary end point was the rate of Bleeding Academic Research Consortium type 3 or 5 bleeding at 1 year, defined as the composite of periprocedural (within 30 days) or late (after 30 days) bleeding., Results: Patients with at least 1 VARC-HBR criterion (n=9267, 88.7%) had a higher risk of Bleeding Academic Research Consortium 3 or 5 bleeding, proportional to the severity of risk assessment (10.8%, 16.1%, and 24.6% for moderate, high, and very-high-risk groups, respectively). However, a comparable rate of bleeding events was observed in the low-risk and moderate-risk groups. The area under receiver operating characteristic curve was 0.58. Patients with VARC-HBR criteria also exhibited a gradual increase in 1-year all-cause mortality, with an up to 2-fold increased mortality risk for high and very-high-risk groups (hazard ratio, 1.33 [95% CI, 1.04-1.70] and 1.97 [95% CI, 1.53-2.53], respectively)., Conclusions: The VARC-HBR consensus offered a pragmatic approach to guide bleeding risk stratification in transcatheter aortic valve replacement. The results of the present study would support the predictive validity of the new definition and promote its application in clinical practice to minimize bleeding risk and improve patient outcomes., Competing Interests: Dr Ternacle is a consultant for Abbott. Dr Modine is a consultant for Abbott, Edwards Lifesciences, and Medtronic. Dr Asmarats has received speaker fees from Edwards Lifesciences. Dr Capodanno has received payments to the institution from Medtronic and personal fees from Sanofi, Novo Nordisk, and Terumo. Dr Morice served as a shareholder and chief executive officer (CEO) of Cardiovascular European Research Center (CERC) and minor shareholder of Electroducer. Dr Garot has received proctor/advisory fees from Abbott, Biosensors, Boston Scientific, Cordis, General Electric HealthCare, and Terumo. He served as co-medical director and shareholder of CERC Contract Research Organization (CRO), organizing the Valve Academic Research Consortium for High Bleeding Risk initiative (nonprofit initiative, as per Academic Research Consortium [ARC] Charter). Dr Rodés-Cabau has received institutional research grants and consultant/speaker fees from Edwards Lifesciences and Medtronic. The other authors report no conflicts.

Published
2025
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43. Clinical Outcomes in Atrial Fibrillation Patients Undergoing Transcatheter Aortic Valve Replacement With Contemporary Devices.

Author

Mengi S, Cepas-Guillén P, Ternacle J, Urena M, Alperi A, Cheema AN, Veiga-Fernandez G, Nombela-Franco L, Vilalta V, Esposito G, Campelo-Parada F, Indolfi C, Del Trigo M, Muñoz-Garcia A, Maneiro N, Asmarats L, Regueiro A, Del Val D, Serra V, Auffret V, Leroux L, Modine T, Mesnier J, Suc G, Avanzas P, Rezaei E, Fradejas-Sastre V, Tirado-Conte G, Fernández-Nofrerias E, Angellotti D, Guitteny T, Sorrentino S, Oteo JF, Díez-Delhoyo F, Gutiérrez-Alonso L, Vidal-Calés P, Alfonso F, Monastyrski A, Nolf M, Avvedimento M, and Rodés-Cabau J

Abstract

Background: Atrial fibrillation (AF) has been identified as a marker of advanced cardiac damage in patients with aortic stenosis. However, the factors associated with poorer outcomes among AF patients in contemporary transcatheter aortic valve replacement (TAVR) practice, particularly regarding mortality and heart failure (HF)-related hospitalizations, remain largely unknown., Methods: In this multicenter study, we assessed consecutive patients with a history of AF and evaluated the clinical outcomes of those who underwent TAVR with newer generation devices using either balloon- or self-expandable valves., Results: A total of 3476 patients were included in the study. After a median follow-up of 2 (interquartile range, 1-4) years, 36.1% patients had died, with 51.5% of deaths being cardiovascular-related, including 15.6% from HF. HF-related hospitalizations post-TAVR accounted for 34.8% of all hospitalizations and were associated with a higher mortality risk (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.32-1.81; P < 0.001). Permanent AF was identified as an independent predictor of all-cause mortality or HF-related hospitalizations (HR, 1.25; 95% CI, 1.10-1.40; P < 0.001), as did other baseline characteristics, including chronic kidney disease (HR, 1.23; 95% CI, 1.09-1.38; P = 0.001), anemia (HR, 1.21; 95% CI, 1.07-1.36; P = 0.002), and New York Heart Association functional class III or IV (HR, 1.13; 95% CI, 1.01-1.27; P = 0.045). In addition, early postprocedural complications, including stroke and bleeding, also significantly increased the risk of mortality (HR, 5.52; 95% CI, 3.12-9.79; P < 0.001) and HF-related hospitalizations (HR, 1.17; 95% CI, 1.03-1.33; P = 0.014)., Conclusions: AF patients exhibited a high risk of mortality and HF-related hospitalizations in a contemporary TAVR cohort. Several baseline comorbidities and periprocedural complications, along with permanent (vs paroxysmal) AF, were associated with poorer outcomes. These findings confirm the negative impact of AF despite the continued improvements in TAVR technology and underscore the importance of early intervention and optimization of HF management to improve outcomes in this high-risk population., (Copyright © 2024 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Published
2024
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44. [Diagnostic-therapeutic care pathways for patients with cardiac amyloidosis - SIC/ANMCO Consensus document. Edited by the Italian Cardiac Amyloidosis Network (RIAC)].

Author

Porcari A, Chimenti C, Merlo M, Musca F, Vergaro G, Iacoviello M, Aimo A, Di Lenarda A, Canepa M, Cappelli F, Cipriani A, Di Bella G, Forleo C, Imazio M, Limongelli G, Longhi S, Musumeci B, Obici L, Perfetto F, Perlini S, Serenelli M, Tomasoni D, Vagnarelli F, Merlini G, Palladini G, Metra M, Colivicchi F, Indolfi C, Grimaldi M, Perrone Filardi P, Emdin M, Sinagra G, and Oliva F

Subjects
Humans, Italy, Prognosis, Critical Pathways, Immunoglobulin Light-chain Amyloidosis diagnosis, Immunoglobulin Light-chain Amyloidosis therapy, Amyloidosis diagnosis, Amyloidosis therapy, Cardiomyopathies diagnosis, Cardiomyopathies therapy
Abstract

The perspective on cardiac amyloidosis has deeply changed over the last 10 years following major advances in diagnosis and treatment options. This heterogeneous disease requires the interaction among experts of different specialties and subspecialties. Suspicion of disease, timely recognition and confirmation of final diagnosis, prognostic stratification, overall management and therapeutic strategies represent ongoing challenges in the clinical setting. Missing or delayed diagnosis may have significant impact on patient outcome, especially in light-chain amyloidosis. The present inter-society consensus document aims to provide a standardized approach to the diagnosis of cardiac amyloidosis in Italy, and to discuss the challenging clinical scenarios encountered in routine activity for cardiologists and physicians of different specialties dealing with patients with suspected or established cardiac amyloidosis. This document may be adapted to the setting of each specific region.

Published
2024
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46. Smartwatch ECG and artificial intelligence in detecting acute coronary syndrome compared to traditional 12-lead ECG.

Author

Choi J, Kim J, Spaccarotella C, Esposito G, Oh IY, Cho Y, and Indolfi C

Abstract

Background: Acute coronary syndromes (ACS) require prompt diagnosis through initial electrocardiograms (ECG), but ECG machines are not always accessible. Meanwhile, smartwatches offering ECG functionality have become widespread. This study evaluates the feasibility of an image-based ECG analysis artificial intelligence (AI) system with smartwatch-based multichannel, asynchronous ECG for diagnosing ACS., Methods: Fifty-six patients with ACS and 15 healthy participants were included, and their standard 12-lead and smartwatch-based 9-lead ECGs were analyzed. The ACS group was categorized into ACS with acute total occlusion (ACS-O(+), culprit stenosis ≥ 99 %, n = 44) and ACS without occlusion (ACS-O(-), culprit stenosis 70 % to < 99 %, n = 12) based on coronary angiography. A deep learning-based AI-ECG tool interpreting 2-dimensional ECG images generated probability scores for ST-elevation myocardial infarction (qSTEMI), ACS (qACS), and myocardial injury (qMI: troponin I > 0.1 ng/mL)., Results: The AI-driven qSTEMI, qACS, and qMI demonstrated correlation coefficients of 0.882, 0.874, and 0.872 between standard and smartwatch ECGs (all P  < 0.001). The qACS score effectively distinguished ACS-O(±) from control, with AUROC for both ECGs (0.991 for standard and 0.987 for smartwatch, P = 0.745). The AUROC of qSTEMI in identifying ACS-O(+) from control was 0.989 and 0.982 with 12-lead and smartwatch ( P  = 0.617). Discriminating ACS-O(+) from ACS-O(-) or control presented a slight challenge, with an AUROC for qSTEMI of 0.855 for 12-lead and 0.880 for smartwatch ECGs ( P  = 0.352)., Conclusion: AI-ECG scores from standard and smartwatch-based ECGs showed high concordance with comparable diagnostic performance in differentiating ACS-O(+) and ACS-O(-). With increasing accessibility smartwatch accessibility, they may hold promise for aiding ACS diagnosis, regardless of location., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Youngjin Cho reports financial support was provided by Korea Health Industry Development Institute. Joonghee Kim reports a relationship with ARPI Inc. that includes: employment. Youngjin Cho reports a relationship with ARPI Inc. that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper]., (© 2024 The Author(s).)

Published
2024
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47. Strike early-strike strong lipid-lowering strategy with proprotein convertase subtilisin/kexin type 9 inhibitors in acute coronary syndrome patients: real-world evidence from the AT-TARGET-IT registry.

Author

Gargiulo P, Basile C, Galasso G, Bellino M, D'Elia D, Patti G, Bosco M, Prinetti M, Andò G, Campanella F, Taverna G, Calabrò P, Cesaro A, Fimiani F, Catalano A, Varbella F, Corleto A, Barillà F, Muscoli S, Musumeci G, Delnevo F, Giallauria F, Napoli R, Porto I, Polimeni A, Quarta R, Maloberti A, Merlini PA, De Luca L, Casu G, Brunetti ND, Crisci M, Paloscia L, Bilato C, Indolfi C, Marzano F, Fontanarosa S, Buonocore D, Parlati ALM, Nardi E, Prastaro M, Soricelli A, Salvatore M, Paolillo S, Perrone-Filardi P, Cuomo G, Testa C, Passaretti G, Vallefuoco G, Romano A, Dell'Anno R, Merolla A, and Iannone FP

Subjects
Humans, Male, Female, Aged, Middle Aged, Time Factors, Treatment Outcome, Risk Factors, Anticholesteremic Agents therapeutic use, Anticholesteremic Agents adverse effects, Serine Proteinase Inhibitors therapeutic use, Serine Proteinase Inhibitors adverse effects, Dyslipidemias drug therapy, Dyslipidemias blood, Dyslipidemias mortality, Dyslipidemias diagnosis, Proprotein Convertase 9, Acute Coronary Syndrome blood, Acute Coronary Syndrome drug therapy, Acute Coronary Syndrome mortality, PCSK9 Inhibitors, Registries, Cholesterol, LDL blood, Biomarkers blood
Abstract

Aims: No data are available on early initiation of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with acute coronary syndrome (ACS) in the real world. This study investigates the effects of PCSK9i started at time of ACS hospitalization on lipid control and major cardiovascular (CV) events in the real world., Methods and Results: The lipid control outcome was the percentage of patients reaching the LDL-C target of <55 mg/dL at first lipid control. The clinical outcome was the incidence of composite major CV events (all-cause death, non-fatal MI, non-fatal stroke, and ischaemia-driven revascularization) during a follow-up in relation to quartiles of LDL-C at first lipid control. We included 771 patients with ACS from the AT-TARGET-IT registry, receiving PCSK9i prescription during hospitalization or at discharge. Median LDL-C was 137 mg/dL and decreased to 43 mg/dL at first lipid control. 527 (68.3%) patients achieved LDL-C target at the first lipid control at a median time of 37 days from hospitalization; of them, 404 (76.8%) were discharged on statin plus ezetimibe background therapy. Event curves through a median follow-up of 11 months across quartiles of LDL-C showed a stepwise lower risk of 4P-MACE, 3P-MACE, all-cause mortality, and ischaemia-driven revascularization in lower quartile of LDL-C values at first lipid control (<23 mg/dL) and in patients reaching LDL-C < 55 mg/dL., Conclusion: Intensive and early lipid-lowering therapy using PCSK9i in patients with ACS (strike early-strike strong strategy) is safe and effective in clinical practice and associated with a reduction of residual CV risk., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Published
2024
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48. Coronary microvascular dysfunction beyond the spectrum of chronic coronary syndromes.

Author

Belmonte M, Foà A, Paolisso P, Bergamaschi L, Gallinoro E, Polimeni A, Scarsini R, Muscoli S, Amicone S, De Vita A, Villano A, Angeli F, Armillotta M, Sucato V, Tremamunno S, Morrone D, Indolfi C, Filardi PP, Ribichini F, Lanza GA, Chieffo A, Barbato E, and Pizzi C

Subjects
Humans, Prognosis, Prevalence, Takotsubo Cardiomyopathy physiopathology, Takotsubo Cardiomyopathy diagnosis, Takotsubo Cardiomyopathy therapy, Takotsubo Cardiomyopathy epidemiology, Heart Failure physiopathology, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure therapy, Coronary Vessels physiopathology, Cardiomyopathies physiopathology, Cardiomyopathies therapy, Cardiomyopathies diagnosis, Cardiomyopathies epidemiology, Risk Factors, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis epidemiology, Aortic Valve Stenosis diagnosis, Coronary Circulation, Microcirculation
Abstract

The prevalence of coronary microvascular dysfunction (CMD) beyond the spectrum of chronic coronary syndromes (CCS) is non-negligible, pertaining to pathophysiological and therapeutical implications. Thanks to the availability of accurate and safe non-invasive technique, CMD can be identified as a key player in heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis. While CMD is widely recognized as a cause of myocardial ischemia leading to a worse prognosis even in the absence of obstructive coronary artery disease, the characterization of CMD patterns beyond CCS might provide valuable insights on the underlying disease progression, being potentially a "red flag" of adverse cardiac remodeling and a major determinant of response to therapy and outcomes. In this review, we aimed to provide an overview of the latest evidence on the prevalence, mechanistic and prognostic implications of CMD beyond the spectrum of CCS (i.e. heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis)., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Inc.)

Published
2024
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49. One-month DAPT after biodegradable-polymer everolimus-eluting stent implantation in women at high-bleeding risk: Insights from the POEM trial.

Author

Maurina M, Pivato CA, Kunadian V, Testa L, Briguori C, Pacchioni A, Latini AC, Cesani N, Piccolo R, Musto C, Sardella G, Indolfi C, Regazzoli D, Paradies V, and Stefanini G

Subjects
Humans, Female, Male, Aged, Time Factors, Risk Factors, Middle Aged, Treatment Outcome, Risk Assessment, Sex Factors, Coronary Thrombosis etiology, Coronary Thrombosis prevention & control, Purinergic P2Y Receptor Antagonists administration & dosage, Purinergic P2Y Receptor Antagonists adverse effects, Anticoagulants adverse effects, Anticoagulants administration & dosage, Prospective Studies, Administration, Oral, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention instrumentation, Percutaneous Coronary Intervention mortality, Drug-Eluting Stents, Everolimus administration & dosage, Everolimus adverse effects, Absorbable Implants, Prosthesis Design, Dual Anti-Platelet Therapy, Hemorrhage chemically induced, Platelet Aggregation Inhibitors administration & dosage, Platelet Aggregation Inhibitors adverse effects, Coronary Artery Disease therapy, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Drug Administration Schedule
Abstract

Aims: We conducted a prespecified subanalysis of the POEM trial to assess the association between sex and clinical outcomes following a short 1-month dual-antiplatelet-therapy (DAPT) period after percutaneous coronary intervention (PCI) with bioresorbable polymer everolimus-eluting stent (BP-EES) among patients at high bleeding risk (HBR)., Background: Shortening the DAPT period after PCI is an effective bleeding avoidance strategy with contemporary drug-eluting stents. Whether sex affects the risk of adverse events following PCI is still debated., Methods: Patients at HBR undergoing PCI with BP-EES were enrolled and treated with 1-month DAPT. If anticoagulation was needed, study participants received an oral anticoagulant (OAC) in addition to a P2Y 12 inhibitor for 1 month, followed by OAC only thereafter. The primary endpoint was a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis at 12 months. We report sex-based outcomes of patients included in the POEM study., Results: We enrolled 129 (29.1%) women and 314 (70.9%) men. Women were older, with lower hemoglobin levels, and worse renal function. Accordingly, they had a trend for a greater number of HBR criteria fulfilled and a higher PARIS bleeding score. However, they were not at a significantly higher risk for the primary endpoint (men vs. women: 5.17% vs. 3.94%; HR 1.30; 95% CI: 0.48-3.54, p = 0.61), or any of the hemorrhagic and ischemic secondary endpoints., Conclusions: This prespecified subanalysis of the POEM trial suggests that 1-month DAPT following PCI with BP-EES may be a safe and effective therapeutic strategy for women at HBR., (© 2024 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)

Published
2024
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50. The clinical relevance of the reversal of coronary atherosclerotic plaque.

Author

Cesaro A, Acerbo V, Indolfi C, Filardi PP, and Calabrò P

Subjects
Humans, PCSK9 Inhibitors, Cholesterol, LDL blood, Clinical Relevance, Plaque, Atherosclerotic diagnostic imaging, Plaque, Atherosclerotic drug therapy, Tomography, Optical Coherence, Coronary Artery Disease drug therapy, Ultrasonography, Interventional, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Spectroscopy, Near-Infrared
Abstract

Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of death globally despite advances in preventive therapies. Understanding of the initiation and progression of atherosclerosis, the interplay between lipoproteins, endothelial dysfunction, inflammation, and immune responses is critical to treating this disease. The development of vulnerable coronary plaques prone to thrombosis, can lead to acute coronary syndromes, for these reasons, the potential plaque stabilization and regression through pharmacological interventions, particularly lipid-lowering agents like statins and PCSK9 inhibitors is crucial. The imaging techniques such as intravascular ultrasound (IVUS), near-infrared spectroscopy (NIRS), and optical coherence tomography (OCT) play a key role in assessing plaque composition and guiding interventional therapeutic strategies. Clinical evidence supports the efficacy of intensive lipid-lowering therapy in inducing plaque regression, with studies demonstrating reductions in plaque volume and improvements in plaque morphology assessed by IVUS, OCT and NIRS. While pharmacological interventions show promise in promoting plaque regression and stabilization, their impact on long-term cardiovascular events requires further investigation. Multimodality imaging and comprehensive outcome trials are proposed as essential tools for elucidating the relationship between plaque modification and clinical benefit in coronary atherosclerosis. The stabilization or regression of atherosclerotic plaque might serve as the phenomenon linking the reduction in LDL-C levels to the decrease in cardiovascular events. Overall, this review emphasizes the ongoing efforts to advance our understanding of ASCVD pathophysiology and optimize therapeutic approaches for improving patient outcomes., Competing Interests: Declaration of competing interests The authors declare they have no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2024
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