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1. Multidistrict atherosclerotic disease: epidemiological and clinical framework

Author

Di Fusco, S, Abrignani, M, Amico, A, Luca, F, Mureddu, G, Ceravolo, R, Temporelli, P, Acerbo, V, Altamura, V, Baccino, D, Binaghi, G, Bugani, G, Cesaro, A, Ciccirillo, F, Cocozza, S, D'Errigo, P, Di Martino, M, Di Nora, C, Fileti, L, Lopriore, V, Maloberti, A, Monitillo, F, Gulizia, M, Grimaldi, M, Gabrielli, D, Oliva, F, Colivicchi, F, Di Fusco S. A., Abrignani M. G., Amico A. F., Luca F., Mureddu G. F., Ceravolo R., Temporelli P. L., Acerbo V., Altamura V., Baccino D., Binaghi G., Bugani G., Cesaro A., Ciccirillo F., Cocozza S., D'Errigo P., Di Martino M., Di Nora C., Fileti L., Lopriore V., Maloberti A., Monitillo F., Gulizia M. M., Grimaldi M., Gabrielli D., Oliva F., Colivicchi F., Di Fusco, S, Abrignani, M, Amico, A, Luca, F, Mureddu, G, Ceravolo, R, Temporelli, P, Acerbo, V, Altamura, V, Baccino, D, Binaghi, G, Bugani, G, Cesaro, A, Ciccirillo, F, Cocozza, S, D'Errigo, P, Di Martino, M, Di Nora, C, Fileti, L, Lopriore, V, Maloberti, A, Monitillo, F, Gulizia, M, Grimaldi, M, Gabrielli, D, Oliva, F, Colivicchi, F, Di Fusco S. A., Abrignani M. G., Amico A. F., Luca F., Mureddu G. F., Ceravolo R., Temporelli P. L., Acerbo V., Altamura V., Baccino D., Binaghi G., Bugani G., Cesaro A., Ciccirillo F., Cocozza S., D'Errigo P., Di Martino M., Di Nora C., Fileti L., Lopriore V., Maloberti A., Monitillo F., Gulizia M. M., Grimaldi M., Gabrielli D., Oliva F., and Colivicchi F.

Abstract

Atherosclerosis is a systemic disease that can involve different arterial districts. Traditionally, the focus of cardiologists has been on the diagnosis and treatment of atherosclerotic coronary artery disease (CAD). However, atherosclerosis localization in other districts is increasingly common and is associated with an increased risk of CAD and, more generally, of adverse cardiovascular events. Although the term peripheral arterial disease (PAD) commonly refers to the localization of atherosclerotic disease in the arterial districts of the lower limbs, in this document, in accordance with the European Society of Cardiology guidelines, the term PAD will be used for all the locations of atherosclerotic disease excluding coronary and aortic ones. The aim of this review is to report updated data on PAD epidemiology, with particular attention to the prevalence and its prognostic impact on patients with CAD. Furthermore, the key points for an appropriate diagnostic framework and a correct pharmacological therapeutic approach are summarized, while surgical/interventional treatment goes beyond the scope of this review.

Published
2024

2. Heart Failure with Preserved Ejection Fraction: How to Deal with This Chameleon

Author

Luca, F, Oliva, F, Abrignani, M, Di Fusco, S, Gori, M, Giubilato, S, Ceravolo, R, Temporelli, P, Cornara, S, Rao, C, Caretta, G, Pozzi, A, Binaghi, G, Maloberti, A, Di Nora, C, Di Matteo, I, Pilleri, A, Gelsomino, S, Riccio, C, Grimaldi, M, Colivicchi, F, Gulizia, M, Luca F., Oliva F., Abrignani M. G., Di Fusco S. A., Gori M., Giubilato S., Ceravolo R., Temporelli P. L., Cornara S., Rao C. M., Caretta G., Pozzi A., Binaghi G., Maloberti A., Di Nora C., Di Matteo I., Pilleri A., Gelsomino S., Riccio C., Grimaldi M., Colivicchi F., Gulizia M. M., Luca, F, Oliva, F, Abrignani, M, Di Fusco, S, Gori, M, Giubilato, S, Ceravolo, R, Temporelli, P, Cornara, S, Rao, C, Caretta, G, Pozzi, A, Binaghi, G, Maloberti, A, Di Nora, C, Di Matteo, I, Pilleri, A, Gelsomino, S, Riccio, C, Grimaldi, M, Colivicchi, F, Gulizia, M, Luca F., Oliva F., Abrignani M. G., Di Fusco S. A., Gori M., Giubilato S., Ceravolo R., Temporelli P. L., Cornara S., Rao C. M., Caretta G., Pozzi A., Binaghi G., Maloberti A., Di Nora C., Di Matteo I., Pilleri A., Gelsomino S., Riccio C., Grimaldi M., Colivicchi F., and Gulizia M. M.

Abstract

Heart failure with preserved ejection fraction (HFpEF) is characterized by a notable heterogeneity in both phenotypic and pathophysiological features, with a growing incidence due to the increase in median age and comorbidities such as obesity, arterial hypertension, and cardiometabolic disease. In recent decades, the development of new pharmacological and non-pharmacological options has significantly impacted outcomes, improving clinical status and reducing mortality. Moreover, a more personalized and accurate therapeutic management has been demonstrated to enhance the quality of life, diminish hospitalizations, and improve overall survival. Therefore, assessing the peculiarities of patients with HFpEF is crucial in order to obtain a better understanding of this disorder. Importantly, comorbidities have been shown to influence symptoms and prognosis, and, consequently, they should be carefully addressed. In this sense, it is mandatory to join forces with a multidisciplinary team in order to achieve high-quality care. However, HFpEF remains largely under-recognized and under-treated in clinical practice, and the diagnostic and therapeutic management of these patients remains challenging. The aim of this paper is to articulate a pragmatic approach for patients with HFpEF focusing on the etiology, diagnosis, and treatment of HFpEF.

Published
2024

3. Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios

Author

Luca, F, Oliva, F, Abrignani, M, Di Fusco, S, Parrini, I, Canale, M, Giubilato, S, Cornara, S, Nesti, M, Rao, C, Pozzi, A, Binaghi, G, Maloberti, A, Ceravolo, R, Bisceglia, I, Rossini, R, Temporelli, P, Amico, A, Calvanese, R, Gelsomino, S, Riccio, C, Grimaldi, M, Colivicchi, F, Gulizia, M, Luca F., Oliva F., Abrignani M. G., Di Fusco S. A., Parrini I., Canale M. L., Giubilato S., Cornara S., Nesti M., Rao C. M., Pozzi A., Binaghi G., Maloberti A., Ceravolo R., Bisceglia I., Rossini R., Temporelli P. L., Amico A. F., Calvanese R., Gelsomino S., Riccio C., Grimaldi M., Colivicchi F., Gulizia M. M., Luca, F, Oliva, F, Abrignani, M, Di Fusco, S, Parrini, I, Canale, M, Giubilato, S, Cornara, S, Nesti, M, Rao, C, Pozzi, A, Binaghi, G, Maloberti, A, Ceravolo, R, Bisceglia, I, Rossini, R, Temporelli, P, Amico, A, Calvanese, R, Gelsomino, S, Riccio, C, Grimaldi, M, Colivicchi, F, Gulizia, M, Luca F., Oliva F., Abrignani M. G., Di Fusco S. A., Parrini I., Canale M. L., Giubilato S., Cornara S., Nesti M., Rao C. M., Pozzi A., Binaghi G., Maloberti A., Ceravolo R., Bisceglia I., Rossini R., Temporelli P. L., Amico A. F., Calvanese R., Gelsomino S., Riccio C., Grimaldi M., Colivicchi F., and Gulizia M. M.

Abstract

It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug–drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.

Published
2023

11. ANMCO/SICI-GISE/SIC/SIECVI/SIRM Consensus document: Appropriateness of multimodality imaging in cardiovascular disease [Documento di consenso ANMCO/SICI-GISE/SIC/SIECVI/SIRM: Appropriatezza dell’imaging multimodale nelle patologie cardiovascolari]

Author

Nardi, F, Pino, P, Gabrielli, D, Colivicchi, F, Abrignani, M, Amico, A, Aspromonte, N, Benedetto, F, Bertella, E, Boccardi, L, Bucciarelli Ducci, C, Caldarola, P, Campana, M, Caso, P, Citro, R, Costante, A, De Chiara, B, Di Cesare, E, Di Fusco, S, Domenicucci, S, Enea, I, Erba, P, Faganello, G, Favilli, S, Geraci, G, Giubbini, R, Giunta, N, Guido, V, Imazio, M, Khoury, G, La Canna, G, Mele, D, Moreo, A, Mercuro, G, Musumeci, G, Neglia, D, Parrini, I, Pinamonti, B, Pollarolo, L, Pontone, G, Privitera, C, Riccio, C, Sinagra, G, Urbinati, S, Varbella, F, Berisso, M, Zuin, G, Di Lenarda, A, Gulizia, M, Nardi F., Pino P. G., Gabrielli D., Colivicchi F., Abrignani M. G., Amico A. F., Aspromonte N., Benedetto F. A., Bertella E., Boccardi L. M., Bucciarelli Ducci C., Caldarola P., Campana M., Caso P., Citro R., Costante A. M., De Chiara B. C., Di Cesare E., Di Fusco S. A., Domenicucci S., Enea I., Erba P., Faganello G., Favilli S., Geraci G., Giubbini R., Giunta N., Guido V., Imazio M., Khoury G., La Canna G., Mele D., Moreo A. M., Mercuro G. G., Musumeci G., Neglia D., Parrini I., Pinamonti B., Pollarolo L., Pontone G., Privitera C., Riccio C., Sinagra G., Urbinati S., Varbella F., Berisso M. Z., Zuin G., Di Lenarda A., Gulizia M. M., Nardi, F, Pino, P, Gabrielli, D, Colivicchi, F, Abrignani, M, Amico, A, Aspromonte, N, Benedetto, F, Bertella, E, Boccardi, L, Bucciarelli Ducci, C, Caldarola, P, Campana, M, Caso, P, Citro, R, Costante, A, De Chiara, B, Di Cesare, E, Di Fusco, S, Domenicucci, S, Enea, I, Erba, P, Faganello, G, Favilli, S, Geraci, G, Giubbini, R, Giunta, N, Guido, V, Imazio, M, Khoury, G, La Canna, G, Mele, D, Moreo, A, Mercuro, G, Musumeci, G, Neglia, D, Parrini, I, Pinamonti, B, Pollarolo, L, Pontone, G, Privitera, C, Riccio, C, Sinagra, G, Urbinati, S, Varbella, F, Berisso, M, Zuin, G, Di Lenarda, A, Gulizia, M, Nardi F., Pino P. G., Gabrielli D., Colivicchi F., Abrignani M. G., Amico A. F., Aspromonte N., Benedetto F. A., Bertella E., Boccardi L. M., Bucciarelli Ducci C., Caldarola P., Campana M., Caso P., Citro R., Costante A. M., De Chiara B. C., Di Cesare E., Di Fusco S. A., Domenicucci S., Enea I., Erba P., Faganello G., Favilli S., Geraci G., Giubbini R., Giunta N., Guido V., Imazio M., Khoury G., La Canna G., Mele D., Moreo A. M., Mercuro G. G., Musumeci G., Neglia D., Parrini I., Pinamonti B., Pollarolo L., Pontone G., Privitera C., Riccio C., Sinagra G., Urbinati S., Varbella F., Berisso M. Z., Zuin G., Di Lenarda A., and Gulizia M. M.

Abstract

The complexity of cardiovascular diseases has led to an extensive use of technological instruments and the development of multimodality imaging. This extensive use of different cardiovascular imaging tests in the same patient has increased costs and waiting times.The concept of appropriateness has changed over time. Appropriateness criteria address the need for specific cardiovascular imaging tests in well-defined clinical scenarios, and define the kind of cardiovascular imaging that is appropriated for each clinical scenario in different stages of the disease. The concept of appropriateness criteria has replaced the old idea of appropriate use criteria and reflects the increasing effort of the international Scientific Societies to create and review in a critical way the management of diagnostic tests used by clinicians.The aim of this Italian consensus document is to address the use of multimodality imaging in the diagnosis and management of the major cardiovascular clinical scenarios, taking into consideration not only the international guidelines and scientific documents already published, but also the reality of Italian laws as well as the various professional profiles involved in patient management and availability of technological diagnostic instruments.

Published
2020

18. ANOMALY OF ORIGIN AND COURSE OF THE CIRCUMFLEX ARTERY: AN ECHOCARDIOGRAPHIC DIAGNOSIS

Author

Marino, G, Di Fusco, S, Cianfrocca, C, and Colivicchi, F

Abstract

Coronary artery anomalies are often incidental findings. Most anomalies are benign, but some can cause sudden death. It is important to identify them especially before invasive procedures and cardiac surgery. The echocardiogram, as in this case report, provides a high diagnostic accuracy. We describe three typical echocardiographic signs that we find when the circumflex artery originates from the right coronary cusp and has a retroaortic course. A 42–year–old man presented to the emergency department with oppressive chest pain at rest lasting 1 h. In his medical history, the patient reported the following cardiovascular risk factors: smoking, family history of coronary heart disease, hypertension, type 2 diabetes mellitus for 10 years and hypercholesterolemia. Electrocardiogram showed sinus rhythm at 70 bpm without signs of myocardial ischemia. Troponin, D–dimer, C–reactive protein were normal in consecutive blood samples. The echocardiogram documented a left ventricle with normal size and wall thickness, preserved systolic function and absence of significant valvular disease and pericardial effusion. Apical 4–chamber view showed a tubular structure on the atrial side of the mitral valve (Figure 1A, RAC sign). The same structure was identified in parasternal short–axis view just below the noncoronary aortic cusp (Figure 1B, crossed aorta). The tubular shape suggested a vascular structure in an anomalous position. In the parasternal long–axis view, a transverse section of this vessel was visible near aortic valve (Figure 1C, bleb sign). Patient underwent coronary angiography due to persistence of symptoms. Angiography did not reveal significant coronary stenoses, but documented anomalies in the origin and course of the coronary arteries. The circumflex artery shared its origin from the right coronary cusp with the right coronary artery and had a retroaortic course while the only anterior descending artery originated from the left coronary cusp. Anomalies of origin and/or course of the coronary arteries can be detected in 1.3% of the population undergoing coronary angiography. On echocardiogram “RAC sign”, “crossed aorta” and “bleb sign” are often misdiagnosed as artefacts, calcifications or catheter. In case of suspected coronary anomalies, CT is the reference diagnostic test. The abnormal origin and course found in our patient are considered benign and not associated with an increased risk of sudden death and myocardial ischemia.

Published
2024
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20. ANMCO/GISE/SICCH Inter-Society Consensus Document: Antithrombotic therapy in patients undergoing surgery and/or interventional procedures for valvular heart diseases. How to treat complications

Author

Patane, L., Di Lenarda, A., Aspromonte, N., Bianca, I., Capranzano, P., Di Eusanio, M., Di Fusco, S., Di Tano, G., Gabrielli, D., Garatti, A., Geraci, G., Gerometta, P., Miceli, A., Montalto, A., Musumeci, F., Musumeci, G., Nardi, F., Parolari, A., Pino, P.G., Rubino, A.S., Savini, C., Troise, G., Tarantini, G., Urbinati, S., Varbella, F., and Gulizia, M.M.

Subjects
Settore MED/23 - Chirurgia Cardiaca, Blood coagulation, Cardiac catheterization, Cardiac surgical procedures, Heart valve prosthesis, Platelet aggregation inhibitors, Anticoagulants, Consensus, Female, Fibrinolytic Agents, Heart Valve Diseases, Heart Valve Prosthesis Implantation, Humans, Postoperative Complications, Pregnancy, Pregnancy Complications, Cardiovascular, Thromboembolism, Practice Guidelines as Topic
Published
2019

23. DILATED CARDIOMYOPATHY, GUIDELINES PERSONALIZATION OF CARE

Author

Spinelli, A, Macchiusi, A, Marino, G, Di Fusco, S, Pignalberi, C, and Colivicchi, F

Abstract

The term Dilated cardiomyopathy (CMD) refers to a family of diseases characterized by complex interactions between environment and genetic predisposition. Diagnostic tools as cardiac magnetic resonance imaging (MRI) must be systematically implemented in clinical practice to define the etiological cause and undertake a specific therapeutic treatment. We present the case of a young man with CMD and severe left ventricular dysfunction (ejection fraction, EF: 14%; left ventricular end–diastolic volume (LVEDV): 251 ml/m2; left ventricular end–systolic volume (LVESV): 197 ml/m2. The patient has a family history of sudden cardiac death (SCD). He is affected by a psychiatric pathology (ADHD) and has a history of alcohol and drug addiction. Many diagnostic hypotheses have been considered for etiological research (viral myocarditis, genetic or alcoholic–induced cardiomyopathy, toxic substances such as narcotics and psychiatric drug–induced cardiomyopathy). MRI after 11 days in hospital confirmed FE 14%, LVEDV: 320 ml/m2, LVESV: 275 ml/m2; reduction of the wall thickness at the antero–septal wall to the middle tract; areas of altered signal, hyperintense in T2W sequences, at the left ventricular myocardial wall suspected of myocardial edema, associated with extended signal hyperintensity of periventricular tissue, which show marked enhancement immediately after intravenous contrast agent administration (Fig. 1). The underlying psychiatric pathology and the possibility of poor adherence to the maintenance of the wearable defibrillator did not facilitate the clinical follow–up which should have included the identification of the etiological cause and the appropriate treatment guaranteeing the temporary prevention of SCD. So, it was decided to make a personalized therapeutic choice, the patient underwent implantation of a subcutaneous defibrillator, pending a better diagnostic definition and the possible need of other therapies as cardiac transplantation/implantation of mechanical assistance device.

Published
2024
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28. Update on Management of Cardiovascular Diseases in Women

Author

Fabiana Lucà, Maurizio Giuseppe Abrignani, Iris Parrini, Stefania Angela Di Fusco, Simona Giubilato, Carmelo Massimiliano Rao, Laura Piccioni, Laura Cipolletta, Bruno Passaretti, Francesco Giallauria, Angelo Leone, Giuseppina Maura Francese, Carmine Riccio, Sandro Gelsomino, Furio Colivicchi, Michele Massimo Gulizia, Luca, F., Abrignani, M. G., Parrini, I., Di Fusco, S. A., Giubilato, S., Rao, C. M., Piccioni, L., Cipolletta, L., Passaretti, B., Giallauria, F., Leone, A., Francese, G. M., Riccio, C., Gelsomino, S., Colivicchi, F., and Gulizia, M. M.

Subjects
SEX-BASED DIFFERENCES, cardiovascular risk factors, GENDER-DIFFERENCES, IRON-DEFICIENCY ANEMIA, General Medicine, POLYCYSTIC-OVARY-SYNDROME, 2021 ESC GUIDELINES, Cardiovascular risk factor, ESTROGEN PLUS PROGESTIN, MYOCARDIAL-INFARCTION, cardiovascular disease, ESC WORKING GROUP, gender, CORONARY-HEART-DISEASE, women, PRIMARY PREVENTION, RISK-FACTOR CONTROL
Abstract

Cardiovascular diseases (CVD) have a lower prevalence in women than men; although, a higher mortality rate and a poorer prognosis are more common in women. However, there is a misperception of CVD female risk since women have commonly been considered more protected so that the real threat is vastly underestimated. Consequently, female patients are more likely to be treated less aggressively, and a lower rate of diagnostic and interventional procedures is performed in women than in men. In addition, there are substantial sex differences in CVD, so different strategies are needed. This review aims to evaluate the main gender-specific approaches in CVD.

Published
2022
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29. Appropriate use of wearable defibrillators with multiparametric evaluation to avoid unnecessary defibrillator implantation.

Author

Matteucci A, Pignalberi C, Di Fusco S, Aiello A, Aquilani S, Nardi F, and Colivicchi F

Subjects
Humans, Male, Female, Middle Aged, Follow-Up Studies, Aged, Defibrillators, Implantable, Unnecessary Procedures, Risk Factors, Treatment Outcome, Wearable Electronic Devices, Electric Countershock instrumentation, Electric Countershock adverse effects, Death, Sudden, Cardiac prevention & control, Death, Sudden, Cardiac etiology, Defibrillators, Arrhythmias, Cardiac therapy, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac physiopathology
Abstract

Introduction: Wearable cardioverter-defibrillators (WCD) have emerged as a valuable tool in the management of patients at risk for life-threatening arrhythmias. These devices offer a non-invasive and temporary solution, providing continuous monitoring and the potential for prompt defibrillation when needed. In this study, we explore the use of WCD and evaluate arrhythmic events through comprehensive monitoring., Methods: From November 2022 to May 2024, we conducted an outpatient follow-up of 41 patients receiving WCD. Regular check-ups, remote monitoring and comprehensive echocardiography were performed to optimise a tailored therapy., Results: The average age of the patients was 59.2.4±16.5 years, with 78% being male. Among the cohort, 54% had hypertension, 41% were smokers and 66% had dyslipidaemia, while 27% were diabetic. WCD was assigned according to the Italian Association of Hospital Cardiologists position paper focussing on the appropriate use of WCD and European Society of Cardiology guidelines on ventricular arrhythmias and the prevention of sudden cardiac death: 24 (58%) patients had a de novo diagnosis of heart failure with reduced ejection fraction, 11 (27%) patients had a recent acute coronary syndrome and ejection fraction <35%, 3 (7%) patients had a cardiac electronic device extraction and 3 (7%) patients had myocarditis with features of electrical instability. The average follow-up was 62±38 days according to specific aetiology, with a daily wearing time of 22.7±1.3 hours. No device interventions were recorded. At the end of the follow-up period, 15 patients still required an implantable cardioverter-defibrillator (ICD). Among these, 12 patients (29%) underwent ICD implantation. Two patients (5%) declined the procedure., Conclusions: The use of WCD for patients at high risk of arrhythmias allowed to optimise therapy and limit the indications for ICD. Inappropriate implantation of ICD was avoided in 69% of patients who received WCD. The device showed a good safety profile, low incidence of device interventions and adequate patients' adherence to WCD use., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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30. Corrigendum: Cardio-oncology in the COVID Era (Co & Co): The never-ending story.

Author

Bisceglia I, Canale ML, Gallucci G, Turazza FM, Lestuzzi C, Parrini I, Russo G, Maurea N, Quagliariello V, Oliva S, Angela Di Fusco S, Lucà F, Tarantini L, Trambaiolo P, Moreo A, Geraci G, Gabrielli D, Gulizia MM, Oliva F, and Colivicchi F

Abstract

[This corrects the article DOI: 10.3389/fcvm.2022.821193.]., (© 2023 Bisceglia, Canale, Gallucci, Turazza, Lestuzzi, Parrini, Russo, Maurea, Quagliariello, Oliva, Angela Di Fusco, Lucà, Tarantini, Trambaiolo, Moreo, Geraci, Gabrielli, Gulizia, Oliva and Colivicchi.)

Published
2023
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31. ANMCO POSITION PAPER: Prognostic and therapeutic relevance of non-obstructive coronary atherosclerosis.

Author

Casolo G, Gabrielli D, Colivicchi F, Murrone A, Grosseto D, Gulizia MM, Di Fusco S, Domenicucci S, Scotto di Uccio F, Di Tano G, Orso F, Grippo G, Abrignani M, Valente S, and Corda M

Abstract

Atherosclerosis often affects the coronary arterial tree. Frequently the disease does not translate in significant narrowing of the vessels, thus determining only a non-obstructive disease. This condition that is described as non-obstructive coronary artery disease (NobsCAD) should be distinguished from the absence of disease (i.e. smooth coronary arteries) as it carries a specific prognostic value. The detection and reporting of NobsCAD should prompt preventive measures that can be individualized upon the degree of the underlying burden of disease. The accompanying clinical condition, the other cardiovascular risk factors present, and the description of the severity and extent of NobsCAD should provide the framework for an individualized treatment that should also consider the best available scientific evidence and guidelines. The description of NobsCAD represents important information to be collected whenever a coronary angiogram (both invasive and non-invasive) is performed. Treating the patient according to the presence and extent of NobsCAD offers prognostic benefits well beyond those offered by considering only the traditional cardiovascular risk factors. In order to reach this goal, NobsCAD should not be confused with the absence of coronary atherosclerosis or even ignored when detected as if it was a trivial information to provide., (Published on behalf of the European Society of Cardiology. © The Author(s) 2021.)

Published
2021
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32. Hydroquinidine therapy in Brugada syndrome.

Author

Hermida JS, Denjoy I, Clerc J, Extramiana F, Jarry G, Milliez P, Guicheney P, Di Fusco S, Rey JL, Cauchemez B, and Leenhardt A

Subjects
Adolescent, Adult, Aged, Arrhythmias, Cardiac complications, Cohort Studies, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac prevention & control, Female, Humans, Male, Middle Aged, Treatment Outcome, Ventricular Fibrillation etiology, Ventricular Fibrillation prevention & control, Anti-Arrhythmia Agents therapeutic use, Arrhythmias, Cardiac drug therapy, Quinidine analogs & derivatives, Quinidine therapeutic use
Abstract

Objectives: We sought to assess hydroquinidine (HQ) efficacy in selected patients with Brugada syndrome (BrS)., Background: Management of asymptomatic patients with BrS and inducible arrhythmias remains a key issue. Effectiveness of class Ia antiarrhythmic drugs, which inhibit the potassium transient outward current of the action potential, has been suggested in BrS., Methods: From a cohort of 106 BrS patients, we studied 35 who received HQ (32 men; mean age 48 +/- 11 years). Patients had asymptomatic BrS and inducible arrhythmia (n = 31) or multiple appropriate shocks from an implantable cardioverter-defibrillator (ICD) (n = 4). Asymptomatic patients with inducible arrhythmia underwent electrophysiologic (EP)-guided therapy. When ventricular tachycardia (VT)/ventricular fibrillation (VF) inducibility was not prevented, or in case of HQ intolerance, an ICD was placed., Results: Hydroquinidine prevented VT/VF inducibility in 76% of asymptomatic patients who underwent EP-guided therapy. Syncope occurred in two of the 21 patients who received long-term (17 +/- 13 months) HQ therapy (1 syncope associated with QT interval prolongation and 1 unexplained syncope associated with probable noncompliance). In asymptomatic patients who received an ICD (n = 10), one appropriate shock occurred during a follow-up period of 13 +/- 8 months. In patients with multiple ICD shocks, HQ prevented VT/VF recurrence in all cases during a mean follow-up of 14 +/- 8 months., Conclusions: Hydroquinidine therapy prevented VT/VF inducibility in 76% of asymptomatic patients with BrS and inducible arrhythmia, as well as VT/VF recurrence in all BrS patients with multiple ICD shocks. These preliminary data suggest that preventive treatment by HQ may be an alternative strategy to ICD placement in asymptomatic patients with BrS and inducible arrhythmia.

Published
2004
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