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1. Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Author

Lainšcak, M. Milinkovic, I. Polovina, M. Crespo-Leiro, M.G. Lund, L.H. Anker, S.D. Laroche, C. Ferrari, R. Coats, A.J.S. McDonagh, T. Filippatos, G. Maggioni, A.P. Piepoli, M.F. Rosano, G.M.C. Ruschitzka, F. Simic, D. Ašanin, M. Eicher, J.-C. Yilmaz, M.B. Seferovic, P.M. Gale, C.P. Chair, G.B. Branko Beleslin, R.S. Andrzej Budaj, P.L. Chioncel, R.O. Nikolaos Dagres, D.E. Nicolas Danchin, F.R. David Erlinge, S.E. Jonathan Emberson, G.B. Michael Glikson, I.L. Alastair Gray, G.B. Meral Kayikcioglu, T.R. Aldo Maggioni, I.T. Klaudia Vivien Nagy, H.U. Aleksandr Nedoshivin, R.U. Anna-Sonia Petronio, I.T. Jolien Roos-Hesselink, N.L. Lars Wallentin, S.E. Uwe Zeymer, D.E. Mebazaa, A. Coats, A. A. Goda, A.L. M. Diez, A.R. A. Fernandez, A.R. F. Fruhwald, A.T. Fazlibegovic, E. P. Gatzov, B.G. A. Kurlianskaya, B.Y. R. Hullin, C.H. T. Christodoulides, C.Y. J. Hradec, C.Z. O. Wendelboe Nielsen, D.K. R. Nedjar, D.Z. T. Uuetoa, E.E. M. Hassanein, E.G. J. F. Delgado Jimenez, E.S. V-P. Harjola, F.I. D. Logeart, F.R. V. Chumburidze, G.E. D. Tousoulis, G.R. D. Milicic, H.R. B. Merkely, H.U. O'Donoghue IE, E. O. Amir, I.L. A. Shotan, I.L. D. Shafie, I.R. M. Metra, I.T. A. Matsumori, J.P. E. Mirrakhimov, K.G. A. Kavoliuniene, L.T. A. Erglis, L.V. Vataman, E. M. Otljanska, M.K. E. Srbinovska Kostovska, M.K. D. Cassar DeMarco, M.T. J. Drozdz, P.L. Fonseca, C. M. Dekleva, R.S. E. Shkolnik, R.U. U. Dahlstrom, S.E. M. Lainscak, S.I. E. Goncalvesova, S.K. A. Temizhan, T.R. V. Estrago, U.Y. G. Bajraktari, X.K. Auer, J. Ablasser, K. Fruhwald, F. Dolze, T. Brandner, K. Gstrein, S. Poelzl, G. Moertl, D. Reiter, S. Podczeck-Schweighofer, A. Muslibegovic, A. Vasilj, M. Cesko, M. Zelenika, D. Palic, B. Pravdic, D. Cuk, D. Vitlianova, K. Katova, T. Velikov, T. Kurteva, T. Gatzov, P. Kamenova, D. Antova, M. Sirakova, V. Krejci, J. Mikolaskova, M. Spinar, J. Krupicka, J. Malek, F. Hegarova, M. Lazarova, M. Monhart, Z. Hassanein, M. Sobhy, M. El Messiry, F. El Shazly, A.H. Elrakshy, Y. Youssef, A. Moneim, A.A. Noamany, M. Reda, A. Dayem, T.K.A. Farag, N. Halawa, S.I. Hamid, M.A. Said, K. Saleh, A. Ebeid, H. Hanna, R. Aziz, R. Louis, O. Enen, M.A. Ibrahim, B.S. Nasr, G. Elbahry, A. Sobhy, H. Ashmawy, M. Gouda, M. Aboleineen, W. Bernard, Y. Luporsi, P. Meneveau, N. Pillot, M. Morel, M. Seronde, M.-F. Schiele, F. Briand, F. Delahaye, F. Damy, T. de Groote, P. Fertin, M. Lamblin, N. Isnard, R. Lefol, C. Thevenin, S. Hagege, A. Jondeau, G. Logeart, D. Le Marcis, V. Ly, J.-F. Coisne, D. Lequeux, B. Le Moal, V. Mascle, S. Lotton, P. Behar, N. Donal, E. Thebault, C. Ridard, C. Reynaud, A. Basquin, A. Bauer, F. Codjia, R. Galinier, M. Tourikis, P. Stavroula, M. Tousoulis, D. Stefanadis, C. Chrysohoou, C. Kotrogiannis, I. Matzaraki, V. Dimitroula, T. Karavidas, A. Tsitsinakis, G. Kapelios, C. Nanas, J. Kampouri, H. Nana, E. Kaldara, E. Eugenidou, A. Vardas, P. Saloustros, I. Patrianakos, A. Tsaknakis, T. Evangelou, S. Nikoloulis, N. Tziourganou, H. Tsaroucha, A. Papadopoulou, A. Douras, A. Polgar, L. Merkely, B. Kosztin, A. Nyolczas, N. Nagy, A.C. Halmosi, R. Elber, J. Alony, I. Shotan, A. Fuhrmann, A.V. Amir, O. Romano, S. Marcon, S. Penco, M. Di Mauro, M. Lemme, E. Carubelli, V. Rovetta, R. Metra, M. Bulgari, M. Quinzani, F. Lombardi, C. Bosi, S. Schiavina, G. Squeri, A. Barbieri, A. Di Tano, G. Pirelli, S. Fucili, A. Passero, T. Musio, S. Di Biase, M. Correale, M. Salvemini, G. Brognoli, S. Zanelli, E. Giordano, A. Agostoni, P. Italiano, G. Salvioni, E. Copelli, S. Modena, M.G. Reggianini, L. Valenti, C. Olaru, A. Bandino, S. Deidda, M. Mercuro, G. Dessalvi, C.C. Marino, P.N. Di Ruocco, M.V. Sartori, C. Piccinino, C. Parrinello, G. Licata, G. Torres, D. Giambanco, S. Busalacchi, S. Arrotti, S. Novo, S. Inciardi, R.M. Pieri, P. Chirco, P.R. Galifi, M.A. Teresi, G. Buccheri, D. Minacapelli, A. Veniani, M. Frisinghelli, A. Priori, S.G. Cattaneo, S. Opasich, C. Gualco, A. Pagliaro, M. Mancone, M. Fedele, F. Cinque, A. Vellini, M. Scarfo, I. Romeo, F. Ferraiuolo, F. Sergi, D. Anselmi, M. Melandri, F. Leci, E. Iori, E. Bovolo, V. Pidello, S. Frea, S. Bergerone, S. Botta, M. Canavosio, F.G. Gaita, F. Merlo, M. Cinquetti, M. Sinagra, G. Ramani, F. Fabris, E. Stolfo, D. Artico, J. Miani, D. Fresco, C. Daneluzzi, C. Proclemer, A. Cicoira, M. Zanolla, L. Marchese, G. Torelli, F. Vassanelli, C. Voronina, N. Erglis, A. Tamakauskas, V. Smalinskas, V. Karaliute, R. Petraskiene, I. Kazakauskaite, E. Rumbinaite, E. Kavoliuniene, A. Vysniauskas, V. Brazyte-Ramanauskiene, R. Petraskiene, D. Stankala, S. Switala, P. Juszczyk, Z. Sinkiewicz, W. Gilewski, W. Pietrzak, J. Orzel, T. Kasztelowicz, P. Kardaszewicz, P. Lazorko-Piega, M. Gabryel, J. Mosakowska, K. Bellwon, J. Rynkiewicz, A. Raczak, G. Lewicka, E. Dabrowska-Kugacka, A. Bartkowiak, R. Sosnowska-Pasiarska, B. Wozakowska-Kaplon, B. Krzeminski, A. Zabojszcz, M. Mirek-Bryniarska, E. Grzegorzko, A. Bury, K. Nessler, J. Zalewski, J. Furman, A. Broncel, M. Poliwczak, A. Bala, A. Zycinski, P. Rudzinska, M. Jankowski, L. Kasprzak, J.D. Michalak, L. Soska, K.W. Drozdz, J. Huziuk, I. Retwinski, A. Flis, P. Weglarz, J. Bodys, A. Grajek, S. Kaluzna-Oleksy, M. Straburzynska-Migaj, E. Dankowski, R. Szymanowska, K. Grabia, J. Szyszka, A. Nowicka, A. Samcik, M. Wolniewicz, L. Baczynska, K. Komorowska, K. Poprawa, I. Komorowska, E. Sajnaga, D. Zolbach, A. Dudzik-Plocica, A. Abdulkarim, A.-F. Lauko-Rachocka, A. Kaminski, L. Kostka, A. Cichy, A. Ruszkowski, P. Splawski, M. Fitas, G. Szymczyk, A. Serwicka, A. Fiega, A. Zysko, D. Krysiak, W. Szabowski, S. Skorek, E. Pruszczyk, P. Bienias, P. Ciurzynski, M. Welnicki, M. Mamcarz, A. Folga, A. Zielinski, T. Rywik, T. Leszek, P. Sobieszczanska-Malek, M. Piotrowska, M. Kozar-Kaminska, K. Komuda, K. Wisniewska, J. Tarnowska, A. Balsam, P. Marchel, M. Opolski, G. Kaplon-Cieslicka, A. Gil, R.J. Mozenska, O. Byczkowska, K. Gil, K. Pawlak, A. Michalek, A. Krzesinski, P. Piotrowicz, K. Uzieblo-Zyczkowska, B. Stanczyk, A. Skrobowski, A. Ponikowski, P. Jankowska, E. Rozentryt, P. Polonski, L. Gadula-Gacek, E. Nowalany-Kozielska, E. Kuczaj, A. Kalarus, Z. Szulik, M. Przybylska, K. Klys, J. Prokop-Lewicka, G. Kleinrok, A. Aguiar, C.T. Ventosa, A. Pereira, S. Faria, R. Chin, J. De Jesus, I. Santos, R. Silva, P. Moreno, N. Queirós, C. Lourenço, C. Pereira, A. Castro, A. Andrade, A. Guimaraes, T.O. Martins, S. Placido, R. Lima, G. Brito, D. Francisco, A.R. Cardiga, R. Proenca, M. Araujo, I. Marques, F. Moura, B. Leite, S. Campelo, M. Silva-Cardoso, J. Rodrigues, J. Rangel, I. Martins, E. Correia, A.S. Peres, M. Marta, L. da Silva, G.F. Severino, D. Durao, D. Leao, S. Magalhaes, P. Moreira, I. Cordeiro, A.F. Ferreira, C. Araujo, C. Ferreira, A. Baptista, A. Radoi, M. Bicescu, G. Vinereanu, D. Sinescu, C.-J. Macarie, C. Popescu, R. Daha, I. Dan, G.-A. Stanescu, C. Dan, A. Craiu, E. Nechita, E. Aursulesei, V. Christodorescu, R. Otasevic, P. Simeunovic, D. Ristic, A.D. Celic, V. Pavlovic-Kleut, M. Lazic, J.S. Stojcevski, B. Pencic, B. Stevanovic, A. Andric, A. Iric-Cupic, V. Jovic, M. Davidovic, G. Milanov, S. Mitic, V. Atanaskovic, V. Antic, S. Pavlovic, M. Stanojevic, D. Stoickov, V. Ilic, S. Ilic, M.D. Petrovic, D. Stojsic, S. Kecojevic, S. Dodic, S. Adic, N.C. Cankovic, M. Stojiljkovic, J. Mihajlovic, B. Radin, A. Radovanovic, S. Krotin, M. Klabnik, A. Goncalvesova, E. Pernicky, M. Murin, J. Kovar, F. Kmec, J. Semjanova, H. Strasek, M. Iskra, M.S. Ravnikar, T. Suligoj, N.C. Komel, J. Fras, Z. Jug, B. Glavic, T. Losic, R. Bombek, M. Krajnc, I. Krunic, B. Horvat, S. Kovac, D. Rajtman, D. Cencic, V. Letonja, M. Winkler, R. Valentincic, M. Melihen-Bartolic, C. Bartolic, A. Vrckovnik, M.P. Kladnik, M. Pusnik, C.S. Marolt, A. Klen, J. Drnovsek, B. Leskovar, B. Anguita, M.J.F. Page, J.C.G. Martinez, F.M.S. Andres, J. Bayes-Genis, A. Mirabet, S. Mendez, A. Garcia-Cosio, L. Roig, E. Leon, V. Gonzalez-Costello, J. Muntane, G. Garay, A. Alcade-Martinez, V. Fernandez, S.L. Rivera-Lopez, R. Puga-Martinez, M. Fernandez-Alvarez, M. Serrano-Martinez, J.L. Grille-Cancela, Z. Marzoa-Rivas, R. Blanco-Canosa, P. Paniagua-Martin, M.J. Barge-Caballero, E. Cerdena, I.L. Baldomero, I.F.H. Padron, A.L. Rosillo, S.O. Gonzalez-Gallarza, R.D. Montanes, O.S. Manjavacas, A.M.I. Conde, A.C. Araujo, A. Soria, T. Garcia-Pavia, P. Gomez-Bueno, M. Cobo-Marcos, M. Alonso-Pulpon, L. Cubero, J.S. Sayago, I. Gonzalez-Segovia, A. Briceno, A. Subias, P.E. Hernandez, M.V. Cano, M.J.R. Sanchez, M.A.G. Jimenez, J.F.D. Garrido-Lestache, E.B. Pinilla, J.M.G. de la Villa, B.G. Sahuquillo, A. Marques, R.B. Calvo, F.T. Perez-Martinez, M.T. Gracia-Rodenas, M.R. Garrido-Bravo, I.P. Pastor-Perez, F. Pascual-Figal, D.A. Molina, B.D. Orus, J. Gonzalo, F.E. Bertomeu, V. Valero, R. Martinez-Abellan, R. Quiles, J. Rodrigez-Ortega, J.A. Mateo, I. ElAmrani, A. Fernandez-Vivancos, C. Valero, D.B. Almenar-Bonet, L. Sanchez-Lazaro, I.J. Marques-Sule, E. Facila-Rubio, L. Perez-Silvestre, J. Garcia-Gonzalez, P. Ridocci-Soriano, F. Garcia-Escriva, D. Pellicer-Cabo, A. de la Fuente Galan, L. Diaz, J.L. Platero, A.R. Arias, J.C. Blasco-Peiro, T. Julve, M.S. Sanchez-Insa, E. Aured-Guallar, C. Portoles-Ocampo, A. Melin, M. Hägglund, E. Stenberg, A. Lindahl, I.-M. Asserlund, B. Olsson, L. Dahlström, U. Afzelius, M. Karlström, P. Tengvall, L. Wiklund, P.-A. Olsson, B. Kalayci, S. Temizhan, A. Cavusoglu, Y. Gencer, E. Gunes, H. the European Society of Cardiology Heart Failure Long-Term Registry Investigators Group

Abstract

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P ≤ 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P = 0.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P 75 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF ≤45%. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology

Published
2020

2. Unravelling the interplay between hyperkalaemia, renin–angiotensin–aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC-HFA-EORP Heart Failure Long-Term Registry

Author

Rossignol, P. Lainscak, M. Crespo-Leiro, M.G. Laroche, C. Piepoli, M.F. Filippatos, G. Rosano, G.M.C. Savarese, G. Anker, S.D. Seferovic, P.M. Ruschitzka, F. Coats, A.J.S. Mebazaa, A. McDonagh, T. Sahuquillo, A. Penco, M. Maggioni, A.P. Lund, L.H. Christopher Peter Gale, G.B. Branko Beleslin, R.S. Andrzej Budaj, P.L. Ovidiu Chioncel, R.O. Nikolaos Dagres, D.E. Nicolas Danchin, F.R. David Erlinge, S.E. Jonathan Emberson, G.B. Michael Glikson, I.L. Alastair Gray, G.B. Meral Kayikcioglu, T.R. Aldo Maggioni, I.T. Klaudia Vivien Nagy, H.U. Aleksandr Nedoshivin, R.U. Anna-Sonia Petronio, I.T. Jolien Roos-Hesselink, N.L. Lars Wallentin, S.E. Uwe Zeymer, D.E. Anker, S. Mebazaa, A. Coats, A. Filippatos, G. Ferrari, R. Maggioni, A.P. Goda, A. Diez, M. Fernandez, A. Fruhwald, F. Fazlibegovic, E. Gatzov, P. Kurlianskaya, A. Hullin, R. Christodoulides, T. Hradec, J. Nielsen, O.W. Nedjar, R. Uuetoa, T. Hassanein, M. Jimenez, J.F.D. Harjola, V.P. Logeart, D. Chumburidze, V. Tousoulis, D. Milicic, D. Merkely, B. O'Donoghue, E. Amir, O. Shotan, A. Shafie, D. Metra, M. Matsumori, A. Mirrakhimov, E. Kavoliuniene, A. Erglis, A. Vataman, E. Otljanska, M. Kostovska, E.S. DeMarco, D.C. Drozdz, J. Fonseca, C. Chioncel, O. Dekleva, M. Shkolnik, E. Dahlstrom, U. Lainscak, M. Goncalvesova, E. Temizhan, A. Estrago, V. Bajraktari, G. Auer, J. Ablasser, K. Fruhwald, F. Dolze, T. Brandner, K. Gstrein, S. Poelzl, G. Moertl, D. Reiter, S. Podczeck-Schweighofer, A. Muslibegovic, A. Vasilj, M. Fazlibegovic, E. Cesko, M. Zelenika, D. Palic, B. Pravdic, D. Cuk, D. Vitlianova, K. Katova, T. Velikov, T. Kurteva, T. Gatzov, P. Kamenova, D. Antova, M. Sirakova, V. Krejci, J. Mikolaskova, M. Spinar, J. Krupicka, J. Malek, F. Hegarova, M. Lazarova, M. Monhart, Z. Hassanein, M. Sobhy, M. El Messiry, F. El Shazly, A.H. Elrakshy, Y. Youssef, A. Moneim, A.A. Noamany, M. Reda, A. Dayem, T.K.A. Farag, N. Halawa, S.I. Hamid, M.A. Said, K. Saleh, A. Ebeid, H. Hanna, R. Aziz, R. Louis, O. Enen, M.A. Ibrahim, B.S. Nasr, G. Elbahry, A. Sobhy, H. Ashmawy, M. Gouda, M. Aboleineen, W. Bernard, Y. Luporsi, P. Meneveau, N. Pillot, M. Morel, M. Seronde, M.-F. Schiele, F. Briand, F. Delahaye, F. Damy, T. Eicher, J.-C. de Groote, P. Fertin, M. Lamblin, N. Isnard, R. Lefol, C. Thevenin, S. Hagege, A. Jondeau, G. Logeart, D. Le Marcis, V. Ly, J.-F. Coisne, D. Lequeux, B. Le Moal, V. Mascle, S. Lotton, P. Behar, N. Donal, E. Thebault, C. Ridard, C. Reynaud, A. Basquin, A. Bauer, F. Codjia, R. Galinier, M. Tourikis, P. Stavroula, M. Tousoulis, D. Stefanadis, C. Chrysohoou, C. Kotrogiannis, I. Matzaraki, V. Dimitroula, T. Karavidas, A. Tsitsinakis, G. Kapelios, C. Nanas, J. Kampouri, H. Nana, E. Kaldara, E. Eugenidou, A. Vardas, P. Saloustros, I. Patrianakos, A. Tsaknakis, T. Evangelou, S. Nikoloulis, N. Tziourganou, H. Tsaroucha, A. Papadopoulou, A. Douras, A. Polgar, L. Kosztin, A. Nyolczas, N. Nagy, A.C. Halmosi, R. Elber, J. Alony, I. Shotan, A. Fuhrmann, A.V. Amir, O. Romano, S. Marcon, S. Penco, M. Di Mauro, M. Lemme, E. Carubelli, V. Rovetta, R. Bulgari, M. Quinzani, F. Lombardi, C. Bosi, S. Schiavina, G. Squeri, A. Barbieri, A. Di Tano, G. Pirelli, S. Ferrari, R. Fucili, A. Passero, T. Musio, S. Di Biase, M. Correale, M. Salvemini, G. Brognoli, S. Zanelli, E. Giordano, A. Agostoni, P. Italiano, G. Salvioni, E. Copelli, S. Modena, M.G. Reggianini, L. Valenti, C. Olaru, A. Bandino, S. Deidda, M. Mercuro, G. Dessalvi, C.C. Marino, P.N. Di Ruocco, M.V. Sartori, C. Piccinino, C. Parrinello, G. Licata, G. Torres, D. Giambanco, S. Busalacchi, S. Arrotti, S. Novo, S. Inciardi, R.M. Pieri, P. Chirco, P.R. Galifi, M.A. Teresi, G. Buccheri, D. Minacapelli, A. Veniani, M. Frisinghelli, A. Priori, S.G. Cattaneo, S. Opasich, C. Gualco, A. Pagliaro, M. Mancone, M. Fedele, F. Cinque, A. Vellini, M. Scarfo, I. Romeo, F. Ferraiuolo, F. Sergi, D. Anselmi, M. Melandri, F. Leci, E. Iori, E. Bovolo, V. Pidello, S. Frea, S. Bergerone, S. Botta, M. Canavosio, F.G. Gaita, F. Merlo, M. Cinquetti, M. Sinagra, G. Ramani, F. Fabris, E. Stolfo, D. Artico, J. Miani, D. Fresco, C. Daneluzzi, C. Proclemer, A. Cicoira, M. Zanolla, L. Marchese, G. Torelli, F. Vassanelli, C. Voronina, N. Tamakauskas, V. Smalinskas, V. Karaliute, R. Petraskiene, I. Kazakauskaite, E. Rumbinaite, E. Kavoliuniene, A. Vysniauskas, V. Brazyte-Ramanauskiene, R. Petraskiene, D. Stankala, S. Switala, P. Juszczyk, Z. Sinkiewicz, W. Gilewski, W. Pietrzak, J. Orzel, T. Kasztelowicz, P. Kardaszewicz, P. Lazorko-Piega, M. Gabryel, J. Mosakowska, K. Bellwon, J. Rynkiewicz, A. Raczak, G. Lewicka, E. Dabrowska-Kugacka, A. Bartkowiak, R. Sosnowska-Pasiarska, B. Wozakowska-Kaplon, B. Krzeminski, A. Zabojszcz, M. Mirek-Bryniarska, E. Grzegorzko, A. Bury, K. Nessler, J. Zalewski, J. Furman, A. Broncel, M. Poliwczak, A. Bala, A. Zycinski, P. Rudzinska, M. Jankowski, L. Kasprzak, J.D. Michalak, L. Soska, K.W. Drozdz, J. Huziuk, I. Retwinski, A. Flis, P. Weglarz, J. Bodys, A. Grajek, S. Kaluzna-Oleksy, M. Straburzynska-Migaj, E. Dankowski, R. Szymanowska, K. Grabia, J. Szyszka, A. Nowicka, A. Samcik, M. Wolniewicz, L. Baczynska, K. Komorowska, K. Poprawa, I. Komorowska, E. Sajnaga, D. Zolbach, A. Dudzik-Plocica, A. Abdulkarim, A.-F. Lauko-Rachocka, A. Kaminski, L. Kostka, A. Cichy, A. Ruszkowski, P. Splawski, M. Fitas, G. Szymczyk, A. Serwicka, A. Fiega, A. Zysko, D. Krysiak, W. Szabowski, S. Skorek, E. Pruszczyk, P. Bienias, P. Ciurzynski, M. Welnicki, M. Mamcarz, A. Folga, A. Zielinski, T. Rywik, T. Leszek, P. Sobieszczanska-Malek, M. Piotrowska, M. Kozar-Kaminska, K. Komuda, K. Wisniewska, J. Tarnowska, A. Balsam, P. Marchel, M. Opolski, G. Kaplon-Cieslicka, A. Gil, R.J. Mozenska, O. Byczkowska, K. Gil, K. Pawlak, A. Michalek, A. Krzesinski, P. Piotrowicz, K. Uzieblo-Zyczkowska, B. Stanczyk, A. Skrobowski, A. Ponikowski, P. Jankowska, E. Rozentryt, P. Polonski, L. Gadula-Gacek, E. Nowalany-Kozielska, E. Kuczaj, A. Kalarus, Z. Szulik, M. Przybylska, K. Klys, J. Prokop-Lewicka, G. Kleinrok, A. Aguiar, C.T. Ventosa, A. Pereira, S. Faria, R. Chin, J. De Jesus, I. Santos, R. Silva, P. Moreno, N. Queirós, C. Lourenço, C. Pereira, A. Castro, A. Andrade, A. Guimaraes, T.O. Martins, S. Placido, R. Lima, G. Brito, D. Francisco, A.R. Cardiga, R. Proenca, M. Araujo, I. Marques, F. Fonseca, C. Moura, B. Leite, S. Campelo, M. Silva-Cardoso, J. Rodrigues, J. Rangel, I. Martins, E. Correia, A.S. Peres, M. Marta, L. da Silva, G.F. Severino, D. Durao, D. Leao, S. Magalhaes, P. Moreira, I. Cordeiro, A.F. Ferreira, C. Araujo, C. Ferreira, A. Baptista, A. Radoi, M. Bicescu, G. Vinereanu, D. Sinescu, C.-J. Macarie, C. Popescu, R. Daha, I. Dan, G.-A. Stanescu, C. Dan, A. Craiu, E. Nechita, E. Aursulesei, V. Christodorescu, R. Otasevic, P. Seferovic, P.M. Simeunovic, D. Ristic, A.D. Celic, V. Pavlovic-Kleut, M. Lazic, J.S. Stojcevski, B. Pencic, B. Stevanovic, A. Andric, A. Simić, D. Ašanin, M. Iric-Cupic, V. Jovic, M. Davidovic, G. Milanov, S. Mitic, V. Atanaskovic, V. Antic, S. Pavlovic, M. Stanojevic, D. Stoickov, V. Ilic, S. Ilic, M.D. Petrovic, D. Stojsic, S. Kecojevic, S. Dodic, S. Adic, N.C. Cankovic, M. Stojiljkovic, J. Mihajlovic, B. Radin, A. Radovanovic, S. Krotin, M. Klabnik, A. Goncalvesova, E. Pernicky, M. Murin, J. Kovar, F. Kmec, J. Semjanova, H. Strasek, M. Iskra, M.S. Ravnikar, T. Suligoj, N.C. Komel, J. Fras, Z. Jug, B. Glavic, T. Losic, R. Bombek, M. Krajnc, I. Krunic, B. Horvat, S. Kovac, D. Rajtman, D. Cencic, V. Letonja, M. Winkler, R. Valentincic, M. Melihen-Bartolic, C. Bartolic, A. Vrckovnik, M.P. Kladnik, M. Pusnik, C.S. Marolt, A. Klen, J. Drnovsek, B. Leskovar, B. Anguita, M.J.F. Page, J.C.G. Martinez, F.M.S. Andres, J. Bayes-Genis, A. Mirabet, S. Mendez, A. Garcia-Cosio, L. Roig, E. Leon, V. Gonzalez-Costello, J. Muntane, G. Garay, A. Alcade-Martinez, V. Fernandez, S.L. Rivera-Lopez, R. Puga-Martinez, M. Fernandez-Alvarez, M. Serrano-Martinez, J.L. Grille-Cancela, Z. Marzoa-Rivas, R. Blanco-Canosa, P. Paniagua-Martin, M.J. Barge-Caballero, E. Cerdena, I.L. Baldomero, I.F.H. Padron, A.L. Rosillo, S.O. Gonzalez-Gallarza, R.D. Montanes, O.S. Manjavacas, A.M.I. Conde, A.C. Araujo, A. Soria, T. Garcia-Pavia, P. Gomez-Bueno, M. Cobo-Marcos, M. Alonso-Pulpon, L. Cubero, J.S. Sayago, I. Gonzalez-Segovia, A. Briceno, A. Subias, P.E. Hernandez, M.V. Cano, M.J.R. Sanchez, M.A.G. Jimenez, J.F.D. Garrido-Lestache, E.B. Pinilla, J.M.G. de la Villa, B.G. Sahuquillo, A. Marques, R.B. Calvo, F.T. Perez-Martinez, M.T. Gracia-Rodenas, M.R. Garrido-Bravo, I.P. Pastor-Perez, F. Pascual-Figal, D.A. Molina, B.D. Orus, J. Gonzalo, F.E. Bertomeu, V. Valero, R. Martinez-Abellan, R. Quiles, J. Rodrigez-Ortega, J.A. Mateo, I. ElAmrani, A. Fernandez-Vivancos, C. Valero, D.B. Almenar-Bonet, L. Sanchez-Lazaro, I.J. Marques-Sule, E. Facila-Rubio, L. Perez-Silvestre, J. Garcia-Gonzalez, P. Ridocci-Soriano, F. Garcia-Escriva, D. Pellicer-Cabo, A. de la Fuente Galan, L. Diaz, J.L. Platero, A.R. Arias, J.C. Blasco-Peiro, T. Julve, M.S. Sanchez-Insa, E. Aured-Guallar, C. Portoles-Ocampo, A. Melin, M. Hägglund, E. Stenberg, A. Lindahl, I.-M. Asserlund, B. Olsson, L. Dahlström, U. Afzelius, M. Karlström, P. Tengvall, L. Olsson, B. Kalayci, S. Temizhan, A. Cavusoglu, Y. Gencer, E. Yilmaz, M.B. Gunes, H.

Subjects
cardiovascular diseases
Abstract

Aims: We assessed the interplay between hyperkalaemia (HK) and renin–angiotensin–aldosterone system inhibitor (RAASi) use, dose and discontinuation, and their association with all-cause or cardiovascular death in patients with chronic heart failure (HF). We hypothesized that HK-associated increased death may be related to RAASi withdrawal. Methods and results: The ESC-HFA-EORP Heart Failure Long-Term Registry was used. Among 9222 outpatients (HF with reduced ejection fraction: 60.6%, HF with mid-range ejection fraction: 22.9%, HF with preserved ejection fraction: 16.5%) from 31 countries, 16.6% had HK (≥5.0 mmol/L) at baseline. Angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) was used in 88.3%, a mineralocorticoid receptor antagonist (MRA) in 58.7%, or a combination in 53.2%; of these, at ≥50% of target dose in ACEi: 61.8%; ARB: 64.7%; and MRA: 90.3%. At a median follow-up of 12.2 months, there were 789 deaths (8.6%). Both hypokalaemia and HK were independently. associated with higher mortality, and ACEi/ARB prescription at baseline with lower mortality. MRA prescription was not retained in the model. In multivariable analyses, HK at baseline was independently associated with MRA non-prescription at baseline and subsequent discontinuation. When considering subsequent discontinuation of RAASi (instead of baseline use), HK was no longer found associated with all-cause deaths. Importantly, all RAASi (ACEi, ARB, or MRA) discontinuations were strongly associated with mortality. Conclusions: In HF, hyper- and hypokalaemia were associated with mortality. However, when adjusting for RAASi discontinuation, HK was no longer associated with mortality, suggesting that HK may be a risk marker for RAASi discontinuation rather than a risk factor for worse outcomes. © 2020 European Society of Cardiology

Published
2020

3. Clinical Case Poster session 2P608Infective endocarditis in an adult female with bicuspid aortic valve, hypertrophic cardiomyopathy and amyopathic dermatomyositisP609Left ventricular massP610A rare case of mitral stenosis - Shones syndromeP611The added value of three-dimensional echocardiography in the late diagnosis of a pacemaker complication in a patient with severe congestive heart failureP612Percutaneous paravalvular leak closure - procedure pitfallsP613A case of late left ventricular pseudoaneurysm after aortic valve replacement for infective endocarditis.P614Pseudoaneurysm of right ventricle and acute heart failure caused by prosthetic aortic valve endocarditisP615A misclassification of pulmonary stenosis severity during pregnancyP616A problematic case of left ventricular hypertrophyP617High variability of dynamic obstruction in a patient with hypertrophic obstructive cardiomyopathy and tako-tsubo-cardiomyopathyP618Arterio-venous pulmonary fistula in patient after cerebral strokeP619Rapid myocardial calcification in acute sepsisP620Acute right heart failure after delivery in patient with new-diagnosed pulmonary arterial hypertensionP621When the right ventricle plays hide-and-seekP622Adult congenital heart disease: when what grows wrong goes wrongP623Prenatal diagnosis of mixed type total anomalous pulmonary venous connection in aspleniaP624Uncorrected single ventricle in an adult patient: do coexisting valvular abnormalities matter?P625Ventricular septal aneurysm associated with bicuspid aorta: a case report

Author

HS. Kemal, DM. Dorobantu, M. Saito, C. Ruivo, N. Rojo Prieto, A. Giubertoni, S. Cuddy, M. Tomaszewski, B. Pfeiffer, A. Mursa, TUĞBA Kemaloglu Oz, TL. Wang, N. Enzan, L. Almeida Morais, A. Velcea, A. Monteiro, R. Laymouna, AL Tojino, HF. Sta Maria, RP. Tiongco, E. Elsharkawy, Y. Morsy, M. Elshafei, M. Elgowelly, A. Almaghraby, L. Branco, A. Agapito, L. Sousa, A. Galrinho, F. Pinto, P. Rio, S. Rosa, G. Portugal, R. Ferreira, S. Mihaila, N. Patrascu, A. Adronic, M. Cinteza, D. Vinereanu, A. Fiarresga, D. Cacela, R. Rodrigues, N. Banazol, L. Ferreira, T. Tsutsumi, T. Matsumoto, T. Uchida, A. Yamada, MC. Hsiung, MEHMET Eren, L. Zarma, BA. Popescu, C. Ginghina, R. Jurcut, A. Neugebauer, A. Rigopoulos, H. Seggewiss, E. Czekajska-Chehab, R. Pietura, A. Tomaszewski, V. Sullivan, J. Cosgrave, C. Daly, R. Murphy, J. Zanaboni, M. Gravellone, C. Piccinino, PN. Marino, C. Lezcano Pertejo, C. Hernandez Diez, L. Alvarez Roy, E. Martinez Paz, MG. Ascencio Lemus, M. Lopez Benito, F. Fernandez-Vazquez, E. Martin Gutierrez, M. Castano Ruiz, J. Guardado, L. Santos, F. Montenegro Sa, F. Saraiva, J. Correia, J. Morais, K. Mahara, T. Ueda, T. Ishii, Y. Hamamichi, S. Katsuragi, R. Enache, P. Platon, A. Vladaia, CD. Ginghina, A. Gunsel, L. Cerit, and HS. Duygu

Subjects
Radiology, Nuclear Medicine and imaging, General Medicine, Cardiology and Cardiovascular Medicine
Published
2016
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4. Acute heart failure congestion and perfusion status – impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry

Author

Chioncel, O. Mebazaa, A. Maggioni, A.P. Harjola, V.-P. Rosano, G. Laroche, C. Piepoli, M.F. Crespo-Leiro, M.G. Lainscak, M. Ponikowski, P. Filippatos, G. Ruschitzka, F. Seferovic, P. Coats, A.J.S. Lund, L.H. Auer, J. Ablasser, K. Fruhwald, F. Dolze, T. Brandner, K. Gstrein, S. Poelzl, G. Moertl, D. Reiter, S. Podczeck-Schweighofer, A. Muslibegovic, A. Vasilj, M. Fazlibegovic, E. Cesko, M. Zelenika, D. Palic, B. Pravdic, D. Cuk, D. Vitlianova, K. Katova, T. Velikov, T. Kurteva, T. Gatzov, P. Kamenova, D. Antova, M. Sirakova, V. Krejci, J. Mikolaskova, M. Spinar, J. Krupicka, J. Malek, F. Hegarova, M. Lazarova, M. Monhart, Z. Hassanein, M. Sobhy, M. El Messiry, F. El Shazly, A.H. Elrakshy, Y. Youssef, A. Moneim, A.A. Noamany, M. Reda, A. Dayem, T.K.A. Farag, N. Halawa, S.I. Hamid, M.A. Said, K. Saleh, A. Ebeid, H. Hanna, R. Aziz, R. Louis, O. Enen, M.A. Ibrahim, B.S. Nasr, G. Elbahry, A. Sobhy, H. Ashmawy, M. Gouda, M. Aboleineen, W. Bernard, Y. Luporsi, P. Meneveau, N. Pillot, M. Morel, M. Seronde, M.-F. Schiele, F. Briand, F. Delahaye, F. Damy, T. Eicher, J.-C. de Groote, P. Fertin, M. Lamblin, N. Isnard, R. Lefol, C. Thevenin, S. Hagege, A. Jondeau, G. Logeart, D. Le Marcis, V. Ly, J.-F. Coisne, D. Lequeux, B. Le Moal, V. Mascle, S. Lotton, P. Behar, N. Donal, E. Thebault, C. Ridard, C. Reynaud, A. Basquin, A. Bauer, F. Codjia, R. Galinier, M. Tourikis, P. Stavroula, M. Tousoulis, D. Stefanadis, C. Chrysohoou, C. Kotrogiannis, I. Matzaraki, V. Dimitroula, T. Karavidas, A. Tsitsinakis, G. Kapelios, C. Nanas, J. Kampouri, H. Nana, E. Kaldara, E. Eugenidou, A. Vardas, P. Saloustros, I. Patrianakos, A. Tsaknakis, T. Evangelou, S. Nikoloulis, N. Tziourganou, H. Tsaroucha, A. Papadopoulou, A. Douras, A. Polgar, L. Merkely, B. Kosztin, A. Nyolczas, N. Nagy, A.C. Halmosi, R. Elber, J. Alony, I. Shotan, A. Fuhrmann, A.V. Amir, O. Romano, S. Marcon, S. Penco, M. Di Mauro, M. Lemme, E. Carubelli, V. Rovetta, R. Metra, M. Bulgari, M. Quinzani, F. Lombardi, C. Bosi, S. Schiavina, G. Squeri, A. Barbieri, A. Di Tano, G. Pirelli, S. Ferrari, R. Fucili, A. Passero, T. Musio, S. Di Biase, M. Correale, M. Salvemini, G. Brognoli, S. Zanelli, E. Giordano, A. Agostoni, P. Italiano, G. Salvioni, E. Copelli, S. Modena, M.G. Reggianini, L. Valenti, C. Olaru, A. Bandino, S. Deidda, M. Mercuro, G. Dessalvi, C.C. Marino, P.N. Di Ruocco, M.V. Sartori, C. Piccinino, C. Parrinello, G. Licata, G. Torres, D. Giambanco, S. Busalacchi, S. Arrotti, S. Novo, S. Inciardi, R.M. Pieri, P. Chirco, P.R. Galifi, M.A. Teresi, G. Buccheri, D. Minacapelli, A. Veniani, M. Frisinghelli, A. Priori, S.G. Cattaneo, S. Opasich, C. Gualco, A. Pagliaro, M. Mancone, M. Fedele, F. Cinque, A. Vellini, M. Scarfo, I. Romeo, F. Ferraiuolo, F. Sergi, D. Anselmi, M. Melandri, F. Leci, E. Iori, E. Bovolo, V. Pidello, S. Frea, S. Bergerone, S. Botta, M. Canavosio, F.G. Gaita, F. Merlo, M. Cinquetti, M. Sinagra, G. Ramani, F. Fabris, E. Stolfo, D. Artico, J. Miani, D. Fresco, C. Daneluzzi, C. Proclemer, A. Cicoira, M. Zanolla, L. Marchese, G. Torelli, F. Vassanelli, C. Voronina, N. Erglis, A. Tamakauskas, V. Smalinskas, V. Karaliute, R. Petraskiene, I. Kazakauskaite, E. Rumbinaite, E. Kavoliuniene, A. Vysniauskas, V. Brazyte-Ramanauskiene, R. Petraskiene, D. Stankala, S. Switala, P. Juszczyk, Z. Sinkiewicz, W. Gilewski, W. Pietrzak, J. Orzel, T. Kasztelowicz, P. Kardaszewicz, P. Lazorko-Piega, M. Gabryel, J. Mosakowska, K. Bellwon, J. Rynkiewicz, A. Raczak, G. Lewicka, E. Dabrowska-Kugacka, A. Bartkowiak, R. Sosnowska-Pasiarska, B. Wozakowska-Kaplon, B. Krzeminski, A. Zabojszcz, M. Mirek-Bryniarska, E. Grzegorzko, A. Bury, K. Nessler, J. Zalewski, J. Furman, A. Broncel, M. Poliwczak, A. Bala, A. Zycinski, P. Rudzinska, M. Jankowski, L. Kasprzak, J.D. Michalak, L. Soska, K.W. Drozdz, J. Huziuk, I. Retwinski, A. Flis, P. Weglarz, J. Bodys, A. Grajek, S. Kaluzna-Oleksy, M. Straburzynska-Migaj, E. Dankowski, R. Szymanowska, K. Grabia, J. Szyszka, A. Nowicka, A. Samcik, M. Wolniewicz, L. Baczynska, K. Komorowska, K. Poprawa, I. Komorowska, E. Sajnaga, D. Zolbach, A. Dudzik-Plocica, A. Abdulkarim, A.-F. Lauko-Rachocka, A. Kaminski, L. Kostka, A. Cichy, A. Ruszkowski, P. Splawski, M. Fitas, G. Szymczyk, A. Serwicka, A. Fiega, A. Zysko, D. Krysiak, W. Szabowski, S. Skorek, E. Pruszczyk, P. Bienias, P. Ciurzynski, M. Welnicki, M. Mamcarz, A. Folga, A. Zielinski, T. Rywik, T. Leszek, P. Sobieszczanska-Malek, M. Piotrowska, M. Kozar-Kaminska, K. Komuda, K. Wisniewska, J. Tarnowska, A. Balsam, P. Marchel, M. Opolski, G. Kaplon-Cieslicka, A. Gil, R.J. Mozenska, O. Byczkowska, K. Gil, K. Pawlak, A. Michalek, A. Krzesinski, P. Piotrowicz, K. Uzieblo-Zyczkowska, B. Stanczyk, A. Skrobowski, A. Jankowska, E. Rozentryt, P. Polonski, L. Gadula-Gacek, E. Nowalany-Kozielska, E. Kuczaj, A. Kalarus, Z. Szulik, M. Przybylska, K. Klys, J. Prokop-Lewicka, G. Kleinrok, A. Aguiar, C.T. Ventosa, A. Pereira, S. Faria, R. Chin, J. De Jesus, I. Santos, R. Silva, P. Moreno, N. Queirós, C. Lourenço, C. Pereira, A. Castro, A. Andrade, A. Guimaraes, T.O. Martins, S. Placido, R. Lima, G. Brito, D. Francisco, A.R. Cardiga, R. Proenca, M. Araujo, I. Marques, F. Fonseca, C. Moura, B. Leite, S. Campelo, M. Silva-Cardoso, J. Rodrigues, J. Rangel, I. Martins, E. Correia, A.S. Peres, M. Marta, L. da Silva, G.F. Severino, D. Durao, D. Leao, S. Magalhaes, P. Moreira, I. Cordeiro, A.F. Ferreira, C. Araujo, C. Ferreira, A. Baptista, A. Radoi, M. Bicescu, G. Vinereanu, D. Sinescu, C.-J. Macarie, C. Popescu, R. Daha, I. Dan, G.-A. Stanescu, C. Dan, A. Craiu, E. Nechita, E. Aursulesei, V. Christodorescu, R. Otasevic, P. Seferovic, P.M. Simeunovic, D. Ristic, A.D. Celic, V. Pavlovic-Kleut, M. Lazic, J.S. Stojcevski, B. Pencic, B. Stevanovic, A. Andric, A. Iric-Cupic, V. Jovic, M. Davidovic, G. Milanov, S. Mitic, V. Atanaskovic, V. Antic, S. Pavlovic, M. Stanojevic, D. Stoickov, V. Ilic, S. Ilic, M.D. Petrovic, D. Stojsic, S. Kecojevic, S. Dodic, S. Adic, N.C. Cankovic, M. Stojiljkovic, J. Mihajlovic, B. Radin, A. Radovanovic, S. Krotin, M. Klabnik, A. Goncalvesova, E. Pernicky, M. Murin, J. Kovar, F. Kmec, J. Semjanova, H. Strasek, M. Iskra, M.S. Ravnikar, T. Suligoj, N.C. Komel, J. Fras, Z. Jug, B. Glavic, T. Losic, R. Bombek, M. Krajnc, I. Krunic, B. Horvat, S. Kovac, D. Rajtman, D. Cencic, V. Letonja, M. Winkler, R. Valentincic, M. Melihen-Bartolic, C. Bartolic, A. Vrckovnik, M.P. Kladnik, M. Pusnik, C.S. Marolt, A. Klen, J. Drnovsek, B. Leskovar, B. Anguita, M.J.F. Page, J.C.G. Martinez, F.M.S. Andres, J. Bayes-Genis, A. Mirabet, S. Mendez, A. Garcia-Cosio, L. Roig, E. Leon, V. Gonzalez-Costello, J. Muntane, G. Garay, A. Alcade-Martinez, V. Fernandez, S.L. Rivera-Lopez, R. Puga-Martinez, M. Fernandez-Alvarez, M. Serrano-Martinez, J.L. Crespo-Leiro, M. Grille-Cancela, Z. Marzoa-Rivas, R. Blanco-Canosa, P. Paniagua-Martin, M.J. Barge-Caballero, E. Cerdena, I.L. Baldomero, I.F.H. Padron, A.L. Rosillo, S.O. Gonzalez-Gallarza, R.D. Montanes, O.S. Manjavacas, A.M.I. Conde, A.C. Araujo, A. Soria, T. Garcia-Pavia, P. Gomez-Bueno, M. Cobo-Marcos, M. Alonso-Pulpon, L. Cubero, J.S. Sayago, I. Gonzalez-Segovia, A. Briceno, A. Subias, P.E. Hernandez, M.V. Cano, M.J.R. Sanchez, M.A.G. Jimenez, J.F.D. Garrido-Lestache, E.B. Pinilla, J.M.G. de la Villa, B.G. Sahuquillo, A. Marques, R.B. Calvo, F.T. Perez-Martinez, M.T. Gracia-Rodenas, M.R. Garrido-Bravo, I.P. Pastor-Perez, F. Pascual-Figal, D.A. Molina, B.D. Orus, J. Gonzalo, F.E. Bertomeu, V. Valero, R. Martinez-Abellan, R. Quiles, J. Rodrigez-Ortega, J.A. Mateo, I. ElAmrani, A. Fernandez-Vivancos, C. Valero, D.B. Almenar-Bonet, L. Sanchez-Lazaro, I.J. Marques-Sule, E. Facila-Rubio, L. Perez-Silvestre, J. Garcia-Gonzalez, P. Ridocci-Soriano, F. Garcia-Escriva, D. Pellicer-Cabo, A. de la Fuente Galan, L. Diaz, J.L. Platero, A.R. Arias, J.C. Blasco-Peiro, T. Julve, M.S. Sanchez-Insa, E. Aured-Guallar, C. Portoles-Ocampo, A. Melin, M. Hägglund, E. Stenberg, A. Lindahl, I.-M. Asserlund, B. Olsson, L. Dahlström, U. Afzelius, M. Karlström, P. Tengvall, L. Wiklund, P.-A. Olsson, B. Kalayci, S. Temizhan, A. Cavusoglu, Y. Gencer, E. Yilmaz, M.B. Gunes, H. on behalf of the ESC-EORP-HFA Heart Failure Long-Term Registry Investigators

Abstract

Aims: Classification of acute heart failure (AHF) patients into four clinical profiles defined by evidence of congestion and perfusion is advocated by the 2016 European Society of Cardiology (ESC)guidelines. Based on the ESC-EORP-HFA Heart Failure Long-Term Registry, we compared differences in baseline characteristics, in-hospital management and outcomes among congestion/perfusion profiles using this classification. Methods and results: We included 7865 AHF patients classified at admission as: ‘dry-warm’ (9.9%), ‘wet-warm’ (69.9%), ‘wet-cold’ (19.8%) and ‘dry-cold’ (0.4%). These groups differed significantly in terms of baseline characteristics, in-hospital management and outcomes. In-hospital mortality was 2.0% in ‘dry-warm’, 3.8% in ‘wet-warm’, 9.1% in ‘dry-cold’ and 12.1% in ‘wet-cold’ patients. Based on clinical classification at admission, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: ‘wet-warm’ vs. ‘dry-warm’ 1.78 (1.43–2.21) and ‘wet-cold’ vs. ‘wet-warm’ 1.33 (1.19–1.48). For profiles resulting from discharge classification, the adjusted hazard ratios (95% confidence interval) for 1-year mortality were: ‘wet-warm’ vs. ‘dry-warm’ 1.46 (1.31–1.63) and ‘wet-cold’ vs. ‘wet-warm’ 2.20 (1.89–2.56). Among patients discharged alive, 30.9% had residual congestion, and these patients had higher 1-year mortality compared to patients discharged without congestion (28.0 vs. 18.5%). Tricuspid regurgitation, diabetes, anaemia and high New York Heart Association class were independently associated with higher risk of congestion at discharge, while beta-blockers at admission, de novo heart failure, or any cardiovascular procedure during hospitalization were associated with lower risk of residual congestion. Conclusion: Classification based on congestion/perfusion status provides clinically relevant information at hospital admission and discharge. A better understanding of the clinical course of the two entities could play an important role towards the implementation of targeted strategies that may improve outcomes. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology

Published
2019

5. Stress testing in the period after infarction

Author

L, Bolognese, G, Sarasso, A S, Bongo, D, Aralda, C, Piccinino, L, Rossi, and P, Rossi

Subjects
Electrocardiography, Echocardiography, Exercise Test, Myocardial Infarction, Humans, Coronary Disease, Dipyridamole, Radionuclide Imaging
Abstract

Dipyridamole echocardiography is gaining popularity as an exercise-independent diagnostic method in patients with suspected or demonstrable coronary artery disease. To assess its safety, feasibility, and diagnostic accuracy in patients recovering from uncomplicated acute myocardial infarction, 131 patients had the test before hospital discharge. The results were compared with those of maximum treadmill testing. We found that dipyridamole-induced transient asynergy remote from the infarct zone was more sensitive (74% versus 53%, p less than 0.05) and specific (97% versus 68%, p less than 0.01) than treadmill testing for detecting multivessel coronary artery disease. In a subgroup of 42 patients treated with thrombolytic therapy, dipyridamole echocardiography was able to detect in 27 the presence of jeopardized but viable myocardium in the infarct zone. An excellent correlation was found between dipyridamole echocardiography responses and infarct vessel patency. Finally, the prognostic impact of dipyridamole echocardiography on patients recovering from acute myocardial infarction was assessed in a consecutive series of 151 patients. Eighteen months of event-free survival was significantly different in patients with positive versus negative dipyridamole echocardiography results (76.1% versus 50.8%, p less than 0.01). The test was also superior to treadmill testing in predicting cardiac events. Thus, dipyridamole echocardiography performed early after acute myocardial infarction is safe, feasible, and accurate for predicting the extent of coronary artery disease and 18-month clinical outcome.

Published
1991

7. Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry.

Author

Toma M, Miceli R, Bonsante E, Colombo D, Confalonieri M, Garascia A, Ghio S, Lattanzio M, Lombardi CM, Paciocco G, Piccinino C, Rota I, Santolamazza C, Scelsi L, Scuri P, Stolfo D, Vincenzi A, Volpiano L, Vicenzi M, and Ameri P

Abstract

Pulmonary arterial hypertension (PAH) in the elderly is often associated with left heart disease (LHD), prompting concerns about the use of pulmonary vasodilators. The PATRIARCA registry enrolled ≥70 year-old PAH or chronic thromboembolic pulmonary hypertension (CTEPH) patients at 11 Italian centers from 1 December 2019 through 15 September 2022. After excluding those with CTEPH, post-capillary PH at the diagnostic right heart catheterization (RHC), and/or incomplete data, 23 (33%) of a total of 69 subjects met the criteria proposed in the AMBITION trial to suspect LHD. Diabetes [9 (39%) vs. 6 (13%), p = 0.01] and chronic kidney disease [14 (61%) vs. 12 (26%), p = 0.003] were more common, and the last RHC pulmonary artery wedge pressure [14 ± 5 vs. 10 ± 3 mmHg, p < 0.001] was higher and pulmonary vascular resistance [5.56 ± 3.31 vs. 8.30 ± 4.80, p = 0.02] was lower in LHD than non-LHD patients. However, PAH therapy was similar, with 13 (57%) and 23 (50%) subjects, respectively, taking two oral drugs. PAH medication patterns remained comparable between LHD and non-LHD patients also when the former [37, 54%] were identified by atrial fibrillation and echocardiographic features of LHD, in addition to the AMBITION criteria. In this real-world snapshot, elderly PAH patients were treated with pulmonary vasodilators, including combinations, despite a remarkable prevalence of a LHD phenotype.

Published
2022
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8. Increased Levels of ICOS and ICOSL Are Associated to Pulmonary Arterial Hypertension in Patients Affected by Connective Tissue Diseases.

Author

Bellan M, Murano F, Ceruti F, Piccinino C, Tonello S, Minisini R, Giubertoni A, Sola D, Pedrazzoli R, Maglione V, Manfredi GF, Acquaviva A, Piffero R, Patti G, Pirisi M, and Sainaghi PP

Abstract

Background: Pulmonary hypertension (PH) is a life-threatening complication of connective tissue diseases (CTD); in this study, we aimed at investigating the potential role of inducible co-stimulator (ICOS) and its ligand (ICOS-L) as biomarkers of PH in CTD., Materials and Methods: We recruited 109 patients: 84 CTD patients, 13 patients with CTD complicated by pulmonary arterial hypertension (PAH), and 12 subjects with PAH alone. All recruited patients underwent a complete clinical and instrumental assessment along with quantitative measurement of serum ICOS and ICOS-L., Results: Independently of the underlying cause, patients with PAH were older and had a lower glomerular filtration rate. Interestingly, patients with both CTD-related and CTD-unrelated PAH had higher ICOS and ICOS-L serum concentrations than CTD patients (0.0001 for both). When compared to CTD patients, those affected by CTD-PAH showed higher ICOS (440 (240-600) vs. 170 (105-275) pg/mL, p = 0.0001) and ICOS-L serum concentrations (6000 (4300-7000) vs. 2450 (1500-4100) pg/mL; p = 0.0001). In a logistic regression, ICOS and ICOS-L were associated with a diagnosis of PAH, independently from age, gender, and renal function. The corresponding receiver operating characteristic (ROC) curves demonstrated a good diagnostic performance for both ICOS and ICOS-L., Conclusions: ICOS and ICOS-L are increased in patients with PAH, irrespectively from the underlying cause, and represent promising candidate biomarkers for the diagnostic screening for PAH among CTDs patients.

Published
2022
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9. Role of Osteopontin as a Potential Biomarker of Pulmonary Arterial Hypertension in Patients with Systemic Sclerosis and Other Connective Tissue Diseases (CTDs).

Author

Bellan M, Piccinino C, Tonello S, Minisini R, Giubertoni A, Sola D, Pedrazzoli R, Gagliardi I, Zecca E, Calzaducca E, Mazzoleni F, Piffero R, Patti G, Pirisi M, and Sainaghi PP

Abstract

Pulmonary arterial hypertension (PAH) is a severe complication of connective tissue diseases (CTD). Its early diagnosis is essential to start effective treatment. In the present paper, we aimed to evaluate the role of plasma osteopontin (OPN) as a candidate biomarker of PAH in a cohort of CTD patients. OPN is a pleiotropic protein involved in inflammation and fibrogenesis and, therefore, potentially promising in this specific clinical context. We performed a cross-sectional observational study on a cohort of 113 CTD patients (females N = 101, 89.4%) affected by systemic sclerosis N = 88 (77.9%), mixed connective tissue disease N = 10 (8.8%), overlap syndrome N = 10 (8.8%) or undifferentiated connective tissue disease N = 5 (4.4%). CTD-PAH patients showed significantly higher OPN plasma values than patients with CTD alone (241.0 (188.8-387.2) vs. 200.7 (133.5-281.6) ng/mL; p = 0.03). Although OPN levels were directly correlated with age and inversely with glomerular filtration rate, they remained associated with PAH at multivariate analysis. In conclusion, OPN was significantly associated with PAH among patients with CTD, suggesting it may have a role as a non-invasive disease biomarker of PAH.

Published
2021
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10. Cardiopulmonary Exercise Testing Is an Accurate Tool for the Diagnosis of Pulmonary Arterial Hypertension in Scleroderma Related Diseases.

Author

Bellan M, Giubertoni A, Piccinino C, Buffa M, Cromi D, Sola D, Pedrazzoli R, Gagliardi I, Calzaducca E, Zecca E, Patrucco F, Patti G, Sainaghi PP, and Pirisi M

Abstract

The early diagnosis of pulmonary arterial hypertension (PAH) is a major determinant of prognosis in patients affected by connective tissue diseases (CTDs) complicated by PAH. In the present paper we investigated the diagnostic accuracy of cardiopulmonary exercise testing (CPET) in this specific setting. We recorded clinical and laboratory data of 131 patients who underwent a CPET at a pulmonary hypertension clinic. Out of them, 112 (85.5%) had a diagnosis of CTDs; 8 (6.1%) received a diagnosis of CTDs-PAH and 11 (8.4%) were affected PH of different etiology. Among CPET parameters the following parameters showed the best diagnostic performance for PAH: peak volume of oxygen uptake (VO 2 ; AUC: 0.845, CI95% 0.767-0.904), ratio between ventilation and volume of exhaled carbon dioxide (VE/VCO 2 slope; AUC: 0.888, CI95%: 0.817-0.938) and end-tidal partial pressures (PetCO 2 ; AUC: 0.792, CI95%: 0.709-0.861). These parameters were comparable among CTDs-PAH and PH of different etiology. The diagnostic performance was even improved by creating a composite score which included all the three parameters identified. In conclusion, CPET is a very promising tool for the stratification of risk of PAH among CTDs patients; the use of composite measures may improve diagnostic performance.

Published
2021
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11. Role of Gas6 and TAM Receptors in the Identification of Cardiopulmonary Involvement in Systemic Sclerosis and Scleroderma Spectrum Disorders.

Author

Bellan M, Dimagli A, Piccinino C, Giubertoni A, Ianniello A, Grimoldi F, Sguazzotti M, Nerviani A, Barini M, Carriero A, Smirne C, Burlone ME, Rigamonti C, Minisini R, Salmi L, Barbaglia MN, Castello LM, Sola D, Marino P, Avanzi GC, Pirisi M, and Sainaghi PP

Subjects
Aged, Biomarkers blood, Cross-Sectional Studies, Female, Gene Expression Regulation, Humans, Hypertension, Pulmonary blood, Hypertension, Pulmonary complications, Hypertension, Pulmonary genetics, Intercellular Signaling Peptides and Proteins blood, Lung Diseases, Interstitial blood, Lung Diseases, Interstitial complications, Lung Diseases, Interstitial genetics, Male, Middle Aged, Proto-Oncogene Proteins blood, Receptor Protein-Tyrosine Kinases blood, Scleroderma, Systemic blood, Scleroderma, Systemic complications, Scleroderma, Systemic genetics, Sensitivity and Specificity, Severity of Illness Index, c-Mer Tyrosine Kinase blood, Axl Receptor Tyrosine Kinase, Hypertension, Pulmonary diagnosis, Intercellular Signaling Peptides and Proteins genetics, Lung Diseases, Interstitial diagnosis, Proto-Oncogene Proteins genetics, Receptor Protein-Tyrosine Kinases genetics, Scleroderma, Systemic diagnosis, c-Mer Tyrosine Kinase genetics
Abstract

Background: Few biomarkers are available for early identification of pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) in systemic sclerosis (SS) and scleroderma spectrum disorders (SSD)., Aims: To evaluate Gas6, sAxl, and sMer as biomarkers for cardiopulmonary complications of SS and SSD., Methods: In a cross-sectional observational study, we recruited 125 consecutive patients, affected by SS and SSD and referred to a tertiary-level pulmonary hypertension outpatient clinic. All patients underwent a comprehensive evaluation for identification of PAH and ILD. Gas6, sMer, and sAxl concentrations were measured with ELISA protocols, and concentrations were compared according to PAH or ILD., Results: Nineteen subjects had pulmonary hypertension (PH) (14 PAH), and 39 had ILD (6 severe). Plasma sMer was increased in PAH (18.6 ng/ml IQR [11.7-20.3]) with respect to the absence (12.4 [8.0-15.8]) or other form of pulmonary hypertension (9.6 [7.4-12.5]; K-W variance p < 0.04). Conversely, Gas6 and sAxl levels were slightly increased in mild ILD (25.8 ng/ml [19.5-32.1] and 24.6 [20.1-32.5]) and reduced in severe ILD (16.6 [15.0-22.1] and 15.5 [14.9-22.4]) in comparison to no evidence of ILD (23.4 [18.8-28.1] and 21.6 [18.1-28.4]; K-W, p ≤ 0.05). Plasma sMer ≥ 19 ng/ml has 50% sensitivity and 92% specificity in PAH identification (area under the ROC curve (AUC) 0.697, p < 0.03). Values of Gas6 ≤ 24.5 ng/ml and of sAxl ≤ 15.5 ng/ml have 100% and 67% sensitivity and 47% and 86% specificity, respectively, in identifying severe ILD (Gas6 AUC 0.787, p < 0.001; sAxl AUC 0.705, p < 0.05)., Conclusions: The assay of Gas6 sAxl and sMer may be useful to help in the identification of PAH and ILD in SS and SSD patients. The Gas6/TAM system seems to be relevant in cardiopulmonary complications of SS and SSD and merits further investigations., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article., (Copyright © 2020 Mattia Bellan et al.)

Published
2020
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12. Red Cell Distribution Width and Platelet Count as Biomarkers of Pulmonary Arterial Hypertension in Patients with Connective Tissue Disorders.

Author

Bellan M, Giubertoni A, Piccinino C, Dimagli A, Grimoldi F, Sguazzotti M, Burlone ME, Smirne C, Sola D, Marino P, Pirisi M, and Sainaghi PP

Subjects
Aged, Biomarkers blood, Connective Tissue Diseases blood, Erythrocyte Count, Female, Humans, Hypertension, Pulmonary etiology, Male, Middle Aged, Platelet Count, Connective Tissue Diseases complications, Hypertension, Pulmonary blood
Abstract

Introduction/objective: In the present paper, we aimed to test the value of the red cell distribution width (RDW) coefficient of variation as a candidate biomarker for pulmonary arterial hypertension (PAH) in patients with connective tissue disorders (CTD), correlating it with the degree of cardiopulmonary impairment in these patients., Methods: The study population included N = 141 patients with CTD and N = 59 patients affected by pulmonary hypertension of other etiologies, all referred to the Pulmonary Hypertension Clinic of the Cardiology Division of an Academic Hospital in Northern Italy for evaluation (including right catheterization). Clinical, instrumental, and laboratory data were collected and related to RDW and other full blood count indexes., Results: Twenty out of 141 CTD patients (14%) received a diagnosis of PAH. In comparison to those without PAH, CTD patients with PAH displayed a larger RDW (14.9% (13.5-17.2) vs. 13.8% (13.1-15.0); p = 0.02) and a lower platelet count (205 (177-240) × 10 9 /l vs. 244 (197.5-304.2) × 10 9 /l; p = 0.005). Moreover, with respect to CTD patients without PAH, RDW was significantly larger also in PH of other etiologies. In contrast, the platelet count was significantly lower only in CTD-related PAH, with a value > 276 × 10 9 /l being 100% sensitive in ruling out PAH. Finally, RDW, but not the platelet count, was related directly to systolic pulmonary arterial pressure ( r = 0.381; p = 0.0008) and right ventricle diameter ( r = 0.283; p = 0.015) and inversely to diffusing capacity of the lung for carbon monoxide ( r = -0.325; p = 0.014)., Conclusion: RDW is a promising candidate biomarker for the screening and the prognostic stratification of PAH in CTD patients.

Published
2019
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13. Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing.

Author

Occhetta E, Bortnik M, Magnani A, Francalacci G, Piccinino C, Plebani L, and Marino P

Subjects
Aged, Aged, 80 and over, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac physiopathology, Arrhythmias, Cardiac prevention & control, Atrial Fibrillation complications, Atrial Fibrillation physiopathology, Atrioventricular Node, Bundle of His, Cardiac Pacing, Artificial adverse effects, Chronic Disease, Cross-Over Studies, Electrocardiography, Exercise Tolerance, Feasibility Studies, Female, Follow-Up Studies, Hemodynamics, Humans, Male, Middle Aged, Mitral Valve Insufficiency etiology, Quality of Life, Single-Blind Method, Treatment Outcome, Tricuspid Valve Insufficiency etiology, Ventricular Dysfunction, Left complications, Atrial Fibrillation therapy, Cardiac Pacing, Artificial methods, Catheter Ablation adverse effects
Abstract

Objectives: The aim of our study was to evaluate the feasibility, the safety, and hemodynamic improvements induced by permanent para-Hisian pacing in patients with chronic atrial fibrillation and narrow QRS who underwent atrioventricular (AV) node ablation., Background: Right ventricular apical pacing, inducing asynchronous ventricular contraction, may impair cardiac function; permanent para-Hisian pacing could preserve interventricular synchrony and improve left ventricular function., Methods: After AV node ablation, 16 patients were implanted with a dual-chamber pacemaker connected to a screw-in lead positioned in close proximity to the His bundle and to a right ventricular apical lead. Clinical and echocardiographic data were collected at baseline and after two randomized six-month periods (with para-Hisian and conventional pacing)., Results: During para-Hisian pacing, the interventricular electromechanical delay improved as well (34 +/- 18 ms) as during right apical pacing (47 +/- 19 ms), p < 0.05. Para-Hisian pacing allowed an improvement in New York Heart Association functional class (1.75 +/- 0.4 vs. 2.33 +/- 0.6 at baseline and 2.5 +/- 0.4 during apical pacing, p < 0.05 for both), in quality-of-life score (16.2 +/- 8.7 vs. 32.5 +/- 15.0 at baseline, p < 0.05), and in the 6-min walk test (431 +/- 73 m vs. 378 +/- 60 m at baseline and 360 +/- 71 m during apical pacing, p < 0.5 for both). Mitral and tricuspid regurgitation improved during para-Hisian pacing (1.22 +/- 0.8 and 1.46 +/- 0.5 index, respectively, vs. 1.68 +/- 0.6 [p < 0.05] and 1.62 +/- 0.7 [p = NS] index at baseline, respectively), with a slight worsening during apical pacing (1.93 +/- 1 and 1.93 +/- 0.7 index, respectively, p < 0.05 for both)., Conclusions: Permanent para-Hisian pacing is feasible and safe. Compared with conventional right apical pacing, it allows an improvement in functional and hemodynamic parameters over long-term follow-up.

Published
2006
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14. Dipyridamole echocardiography test. A new tool for detecting jeopardized myocardium after thrombolytic therapy.

Author

Bolognese L, Sarasso G, Bongo AS, Rossi L, Aralda D, Piccinino C, and Rossi P

Subjects
Coronary Angiography, Female, Humans, Male, Middle Aged, Myocardial Contraction drug effects, Myocardial Infarction drug therapy, Sensitivity and Specificity, Urokinase-Type Plasminogen Activator therapeutic use, Dipyridamole, Echocardiography methods, Myocardial Infarction diagnostic imaging, Myocardial Reperfusion Injury diagnostic imaging, Thrombolytic Therapy
Abstract

Background: We wished to assess whether dipyridamole echocardiography test (DET) can detect jeopardized myocardium after thrombolytic therapy., Methods and Results: Seventy-six consecutive patients with a first acute myocardial infarction (AMI) were treated with 2 million IU urokinase i.v. within 4 hours of the onset of AMI and underwent high-dose (as much as 0.84 mg/kg over 10 minutes) DET 8-10 days after AMI. The results were correlated to the anatomy of the infarct-related vessel (IRV). In patients with positive DET, we evaluated the wall motion score index (WMSI; a semiquantitative integrated estimation of extent and severity of the stress-induced dyssynergy). WMSI was derived by summation of individual segment scores divided by the number of interpreted segments. In a 13-segment model, each segment was assigned a score ranging from 1 (normal) to 4 (dyskinetic). Fifty-three patients had positive results on DET. Of these, 42 had dipyridamole-induced new wall motion abnormalities (WMAs) confined to the infarct zone or adjacent segments. In these patients, mean WMSI increased from 1.46 +/- 0.26 (at resting conditions) to 1.73 +/- 0.35 (at peak dipyridamole) (p less than 0.01), whereas no significant change was detected in negative patients (1.6 +/- 0.34 versus 1.57 +/- 0.34, p = NS). Coronary angiography showed a patent IRV (TIMI grade 2 or 3) in 53 patients and no or minimal reperfusion (TIMI grade 0 or 1) in 23 patients. A patent IRV with critical residual stenosis was found in 35 of 42 patients with dipyridamole-induced WMAs in the infarct zone and in 18 of 34 patients without WMAs (p less than 0.05). Among the 23 patients with occluded IRVs, nine had collateral flow to the distal vessel; six of these had a positive DET. Thus, the sensitivity and specificity for identifying a critically stenotic but patent IRV or the presence of a collateral-dependent zone were 66% and 93%, respectively. In a subset of nine patients with a positive DET in the infarct zone or adjacent segments, DET and a control coronary angiography were repeated 1-3 months after an angiographically successful (residual stenosis, 50% or less) coronary angioplasty in the IRV. The repeat DET was negative in eight patients (all with patent IRV at control angiography) and again positive in one patient, who showed restenosis at angiography. The WMSI, at resting conditions was similar before and after angioplasty, whereas it differed significantly at peak dipyridamole (1.7 +/- 0.2 versus 1.4 +/- 0.2, p less than 0.01)., Conclusions: DET can identify the anatomy of the IRV, and dipyridamole-induced WMAs within the infarct zone detect regions with jeopardized myocardium that may benefit from intervention.

Published
1991
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15. Stress testing in the period after infarction.

Author

Bolognese L, Sarasso G, Bongo AS, Aralda D, Piccinino C, Rossi L, and Rossi P

Subjects
Coronary Disease complications, Coronary Disease diagnostic imaging, Dipyridamole, Echocardiography, Electrocardiography, Exercise Test, Humans, Radionuclide Imaging, Coronary Disease diagnosis, Myocardial Infarction complications
Abstract

Dipyridamole echocardiography is gaining popularity as an exercise-independent diagnostic method in patients with suspected or demonstrable coronary artery disease. To assess its safety, feasibility, and diagnostic accuracy in patients recovering from uncomplicated acute myocardial infarction, 131 patients had the test before hospital discharge. The results were compared with those of maximum treadmill testing. We found that dipyridamole-induced transient asynergy remote from the infarct zone was more sensitive (74% versus 53%, p less than 0.05) and specific (97% versus 68%, p less than 0.01) than treadmill testing for detecting multivessel coronary artery disease. In a subgroup of 42 patients treated with thrombolytic therapy, dipyridamole echocardiography was able to detect in 27 the presence of jeopardized but viable myocardium in the infarct zone. An excellent correlation was found between dipyridamole echocardiography responses and infarct vessel patency. Finally, the prognostic impact of dipyridamole echocardiography on patients recovering from acute myocardial infarction was assessed in a consecutive series of 151 patients. Eighteen months of event-free survival was significantly different in patients with positive versus negative dipyridamole echocardiography results (76.1% versus 50.8%, p less than 0.01). The test was also superior to treadmill testing in predicting cardiac events. Thus, dipyridamole echocardiography performed early after acute myocardial infarction is safe, feasible, and accurate for predicting the extent of coronary artery disease and 18-month clinical outcome.

Published
1991

16. Inhibition of dipyridamole-induced ischemia by antianginal therapy in humans. Correlation with exercise electrocardiography.

Author

Lattanzi F, Picano E, Bolognese L, Piccinino C, Sarasso G, Orlandini A, and L'Abbate A

Subjects
Angina Pectoris drug therapy, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Adrenergic beta-Antagonists therapeutic use, Coronary Disease diagnostic imaging, Dipyridamole, Echocardiography, Electrocardiography, Exercise Test, Vasodilator Agents therapeutic use
Abstract

Background: Dipyridamole echocardiography test (DET: two-dimensional echocardiographic monitoring with dipyridamole infusion up to 0.84 mg/kg in 10 minutes) is a useful tool for the noninvasive diagnosis of coronary artery disease. Aims of the present study were to assess the effects of antianginal drugs on dipyridamole-induced ischemia and to evaluate whether drug-induced changes in DET response may predict variations in exercise tolerance., Methods and Results: Fifty-seven patients with angiographically assessed significant coronary artery disease (greater than 70% lumen reduction in at least one major coronary vessel) performed a DET and an exercise electrocardiography test (EET) in random order both off treatment and on antianginal drugs (beta-blockers, calcium antagonists and nitrates, alone or in various combinations). The criterion for DET positivity was a transient dyssynergy of contraction absent or of a lesser degree in the baseline examination. In DET, two parameters were evaluated: the dipyridamole time (i.e., the time from onset of dipyridamole infusion to obvious dyssynergy) and the wall motion score index. DET sensitivity was 91% off therapy and fell to 65% under therapy (p less than 0.01). In the 37 patients who had a positive DET both off and on therapy, the dipyridamole time increased from 6 +/- 3 (off therapy) to 8 +/- 3 minutes (on therapy) (p less than 0.01). The wall motion score index at peak dipyridamole went from 1.38 +/- 0.14 to 1.31 +/- 0.14 (p less than 0.01). EET and DET yielded concordant (positive versus negative) results in 41 of 57 (71%) patients off and in 35 of 57 (61%) on therapy (p = NS). In the subgroup of 38 patients with both positive DET and EET without treatment, the therapy-induced variations in exercise time were significantly correlated with the variations in dipyridamole time (r = 0.5; p less than 0.01), not with variations in wall motion score index (r = 0.3; p = NS)., Conclusions: 1) Antianginal therapy can protect from dipyridamole-induced ischemia and 2) the therapy-induced changes in DET response parallel variations in exercise tolerance and might be useful for the objective, exercise-independent assessment of the therapy efficacy.

Published
1991
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