22 results on '"Esposito, Giovanni"'
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2. Incidence, predictors, and prognostic significance of impaired functional status early after transcatheter aortic valve replacement.
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Nuche, Jorge, Ternacle, Julien, Avvedimento, Marisa, Cheema, Asim N., Veiga-Fernández, Gabriela, Muñoz-García, Antonio J., Vilalta, Victoria, Regueiro, Ander, Asmarats, Luis, del Trigo, María, Serra, Vicenç, Bonnet, Guillaume, Jonveaux, Melchior, Esposito, Giovanni, Rezaei, Effat, de la Torre-Hernández, José M., Fernández-Nofrerías, Eduard, Vidal, Pablo, Gutiérrez-Alonso, Lola, and Oteo, Juan Francisco
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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3. Lp(a) in the Pathogenesis of Aortic Stenosis and Approach to Therapy with Antisense Oligonucleotides or Short Interfering RNA.
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Di Costanzo, Assunta, Indolfi, Ciro, Franzone, Anna, Esposito, Giovanni, and Spaccarotella, Carmen Anna Maria
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SMALL interfering RNA ,AORTIC stenosis ,OLIGONUCLEOTIDES ,MYOCARDIAL injury ,OLDER people ,PATHOGENESIS - Abstract
To date, no medical therapy can slow the progression of aortic stenosis. Fibrocalcific stenosis is the most frequent form in the general population and affects about 6% of the elderly population. Over the years, diagnosis has evolved thanks to echocardiography and computed tomography assessments. The application of artificial intelligence to electrocardiography could further implement early diagnosis. Patients with severe aortic stenosis, especially symptomatic patients, have valve repair as their only therapeutic option by surgical or percutaneous technique (TAVI). The discovery that the pathogenetic mechanism of aortic stenosis is similar to the atherosclerosis process has made it possible to evaluate the hypothesis of medical therapy for aortic stenosis. Several drugs have been tested to reduce low-density lipoprotein (LDL) and lipoprotein(a) (Lp(a)) levels, inflammation, and calcification. The Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (PCSK9-i) could decrease the progression of aortic stenosis and the requirement for valve implantation. Great interest is related to circulating Lp(a) levels as causally linked to degenerative aortic stenosis. New therapies with ASO (antisense oligonucleotides) and siRNA (small interfering RNA) are currently being tested. Olpasiran and pelacarsen reduce circulating Lp(a) levels by 85–90%. Phase 3 studies are underway to evaluate the effect of these drugs on cardiovascular events (cardiovascular death, non-fatal myocardial injury, and non-fatal stroke) in patients with elevated Lp(a) and CVD (cardiovascular diseases). For instance, if a reduction in Lp(a) levels is associated with aortic stenosis prevention or progression, further prospective clinical trials are warranted to confirm this observation in this high-risk population. [ABSTRACT FROM AUTHOR]
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- 2023
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4. Echocardiographic Evaluation of Aortic Stenosis: A Comprehensive Review.
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Manzo, Rachele, Ilardi, Federica, Nappa, Dalila, Mariani, Andrea, Angellotti, Domenico, Immobile Molaro, Maddalena, Sgherzi, Giulia, Castiello, Domenico Simone, Simonetti, Fiorenzo, Santoro, Ciro, Canonico, Mario Enrico, Avvedimento, Marisa, Piccolo, Raffaele, Franzone, Anna, and Esposito, Giovanni
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AORTIC stenosis ,GLOBAL longitudinal strain ,ECHOCARDIOGRAPHY ,TECHNOLOGICAL innovations ,AORTIC valve - Abstract
Echocardiography represents the most important diagnostic tool in the evaluation of aortic stenosis. The echocardiographic assessment of its severity should always be performed through a standardized and stepwise approach in order to achieve a comprehensive evaluation. The latest technical innovations in the field of echocardiography have improved diagnostic accuracy, guaranteeing a better and more detailed evaluation of aortic valve anatomy. An early diagnosis is of utmost importance since it shortens treatment delays and improves patient outcomes. Echocardiography plays a key role also in the evaluation of all the structural changes related to aortic stenosis. Detailed evaluation of subtle and subclinical changes in left ventricle function has a prognostic significance: scientific efforts have been addressed to identify the most accurate global longitudinal strain cut-off value able to predict adverse outcomes. Moreover, in recent years the role of artificial intelligence is increasingly emerging as a promising tool able to assist cardiologists in aortic stenosis screening and diagnosis, especially by reducing the rate of aortic stenosis misdiagnosis. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Pitfalls and Tips in the Assessment of Aortic Stenosis by Transthoracic Echocardiography.
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Canciello, Grazia, Pate, Shabnam, Sannino, Anna, Borrelli, Felice, Todde, Gaetano, Grayburn, Paul, Losi, Maria-Angela, and Esposito, Giovanni
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AORTIC stenosis ,VENTRICULAR outflow obstruction ,ECHOCARDIOGRAPHY ,HEART valve diseases ,AORTIC valve insufficiency ,AORTIC valve ,DIAGNOSTIC errors - Abstract
Aortic stenosis (AS) is a valvular heart disease that significantly contributes to cardiovascular morbidity and mortality worldwide. The condition is characterized by calcification and thickening of the aortic valve leaflets, resulting in a narrowed orifice and increased pressure gradient across the valve. AS typically progresses from a subclinical phase known as aortic sclerosis, where valve calcification occurs without a transvalvular gradient, to a more advanced stage marked by a triad of symptoms: heart failure, syncope, and angina. Echocardiography plays a crucial role in the diagnosis and evaluation of AS, serving as the primary non-invasive imaging modality. However, to minimize misdiagnoses, it is crucial to adhere to a standardized protocol for acquiring echocardiographic images. This is because, despite continuous advances in echocardiographic technology, diagnostic errors still occur during the evaluation of AS, particularly in classifying its severity and hemodynamic characteristics. This review focuses on providing guidance for the imager during the echocardiographic assessment of AS. Firstly, the review will report on how the echo machine should be set to improve image quality and reduce noise and artifacts. Thereafter, the review will report specific emphasis on accurate measurements of left ventricular outflow tract diameter, aortic valve morphology and movement, as well as aortic and left ventricular outflow tract velocities. By considering these key factors, clinicians can ensure consistency and accuracy in the evaluation of AS using echocardiography. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Beyond Aortic Stenosis: Addressing the Challenges of Multivalvular Disease Assessment.
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Bombace, Sara, Meucci, Maria Chiara, Fortuni, Federico, Ilardi, Federica, Manzo, Rachele, Canciello, Grazia, Esposito, Giovanni, Grayburn, Paul A., Losi, Maria Angela, and Sannino, Anna
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AORTIC stenosis ,HEART valve diseases ,CARDIAC magnetic resonance imaging ,AORTIC valve insufficiency ,CARDIAC patients - Abstract
Aortic stenosis (AS) can often coexist with other valvular diseases or be combined with aortic regurgitation (AR), leading to unique pathophysiological conditions. The combination of affected valves can vary widely, resulting in a lack of standardized diagnostic or therapeutic approaches. Echocardiography is crucial in assessing patients with valvular heart disease (VHD), but careful consideration of the hemodynamic interactions between combined valvular defects is necessary. This is important as it may affect the reliability of commonly used echocardiographic parameters, making the diagnosis challenging. Therefore, a multimodality imaging approach, including computed tomography or cardiac magnetic resonance, is often not just beneficial but crucial. It represents the future of diagnostics in this intricate field due to its unprecedented capacity to quantify and comprehend valvular pathology. The absence of definitive data and guidelines for the therapeutic management of AS in the context of multiple valve lesions makes this condition particularly challenging. As a result, an individualized, case-by-case approach is necessary, guided primarily by the recommendations for the predominant valve lesion. This review aims to summarize the pathophysiology of AS in the context of multiple and mixed valve disease, with a focus on the hemodynamic implications, diagnostic challenges, and therapeutic options. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Hemodynamic Performance of Transcatheter Aortic Valves: A Comprehensive Review.
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Angellotti, Domenico, Manzo, Rachele, Castiello, Domenico Simone, Immobile Molaro, Maddalena, Mariani, Andrea, Iapicca, Cristina, Nappa, Dalila, Simonetti, Fiorenzo, Avvedimento, Marisa, Leone, Attilio, Canonico, Mario Enrico, Spaccarotella, Carmen Anna Maria, Franzone, Anna, Ilardi, Federica, Esposito, Giovanni, and Piccolo, Raffaele
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AORTIC valve ,HEART valve prosthesis implantation ,HEMODYNAMICS ,AORTIC stenosis ,AORTIC valve insufficiency - Abstract
Transcatheter aortic valve implantation (TAVI) is a widely adopted treatment option for patients with severe aortic stenosis. Its popularity has grown significantly in recent years due to advancements in technology and imaging. As TAVI use is increasingly expanded to younger patients, the need for long-term assessment and durability becomes paramount. This review aims to provide an overview of the diagnostic tools to evaluate the hemodynamic performance of aortic prosthesis, with a special focus on the comparison between transcatheter and surgical aortic valves and between self-expandable and balloon-expandable valves. Moreover, the discussion will encompass how cardiovascular imaging can effectively detect long-term structural valve deterioration. [ABSTRACT FROM AUTHOR]
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- 2023
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8. Is There Still a Role for Invasive Assessment of Aortic Gradient?
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Angellotti, Domenico, Immobile Molaro, Maddalena, Simonetti, Fiorenzo, Ilardi, Federica, Castiello, Domenico Simone, Mariani, Andrea, Manzo, Rachele, Avvedimento, Marisa, Leone, Attilio, Nappa, Dalila, Piccolo, Raffaele, Losi, Maria Angela, Franzone, Anna, and Esposito, Giovanni
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AORTIC valve transplantation ,AORTIC stenosis ,AORTA ,CARDIAC catheterization ,AORTIC valve - Abstract
Advances in technology and imaging have expanded the range of tools for diagnosing aortic stenosis (AS). The accurate assessment of aortic valve area and mean pressure gradient is crucial to determine which patients are appropriate candidates for aortic valve replacement. Nowadays, these values can be obtained noninvasively or invasively, with similar results. Contrariwise, in the past, cardiac catheterization played a major role in the evaluation of AS severity. In this review, we will discuss the historical role of the invasive assessment of AS. Moreover, we will specifically focus on tips and tricks for properly performing cardiac catheterization in patients with AS. We will also elucidate the role of invasive methods in current clinical practice and their additional value to the information provided through non-invasive techniques. [ABSTRACT FROM AUTHOR]
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- 2023
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9. Echocardiographic Evaluation after Transcatheter Aortic Valve Implantation: A Comprehensive Review.
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Angellotti, Domenico, Manzo, Rachele, Castiello, Domenico Simone, Immobile Molaro, Maddalena, Mariani, Andrea, Iapicca, Cristina, Nappa, Dalila, Simonetti, Fiorenzo, Avvedimento, Marisa, Leone, Attilio, Canonico, Mario Enrico, Spaccarotella, Carmen Anna Maria, Franzone, Anna, Ilardi, Federica, Esposito, Giovanni, and Piccolo, Raffaele
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HEART valve prosthesis implantation ,ECHOCARDIOGRAPHY ,AORTIC stenosis - Abstract
Transcatheter aortic valve implantation (TAVI) is an increasingly popular treatment option for patients with severe aortic stenosis. Recent advancements in technology and imaging tools have significantly contributed to the success of TAVI procedures. Echocardiography plays a pivotal role in the evaluation of TAVI patients, both before and after the procedure. This review aims to provide an overview of the most recent technical advancements in echocardiography and their use in the follow-up of TAVI patients. In particular, the focus will be on the examination of the influence of TAVI on left and right ventricular function, which is frequently accompanied by other structural and functional alterations. Echocardiography has proven to be key also in detecting valve deterioration during extended follow-up. This review will provide valuable insights into the technical advancements in echocardiography and their role in the follow-up of TAVI patients. [ABSTRACT FROM AUTHOR]
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- 2023
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10. Safety and feasibility of balloon aortic valvuloplasty in non-TAVI centers: The 'BAV for life' experience
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Attisano, Tiziana, Silverio, Angelo, Stabile, Eugenio, Briguori, Carlo, Tuccillo, Bernardino, Scotto Di Uccio, Fortunato, Di Lorenzo, Emilio, Tesorio, Tullio, Giordano, Arturo, Calabrò, Paolo, Cappelli Bigazzi, Maurizio, Golino, Paolo, Scherillo, Marino, Vigorito, Francesco, Quaranta, Gaetano, Esposito, Giovanni, Mauro, Ciro, Musumeci, Giuseppe, Tarantini, Giuseppe, Galasso, Gennaro, Venuti, Angela, Maione, Antongiulio, Accadia, Maria, Spadaro, Pasquale, Arnese, Maria Rosaria, Pastore, Fabio, Eusebio, Giuseppina, De Angelis, Maria Carmen, Varricchio, Attilio, Alfieri, Alfonso, Di Girolamo, Domenico, Bianchi, Renato Maria, Visconti, Gabriella, Ambrosini, Vittorio, Capasso, Michele, Formigli, Dario, Villari, Bruno, De Simone, Ciro, Manganiello, Vincenzo, Attisano, Tiziana, Silverio, Angelo, Stabile, Eugenio, Briguori, Carlo, Tuccillo, Bernardino, Scotto Di Uccio, Fortunato, Di Lorenzo, Emilio, Tesorio, Tullio, Giordano, Arturo, Calabrò, Paolo, Cappelli Bigazzi, Maurizio, Golino, Paolo, Scherillo, Marino, Vigorito, Francesco, Quaranta, Gaetano, Esposito, Giovanni, Mauro, Ciro, Musumeci, Giuseppe, Tarantini, Giuseppe, Galasso, Gennaro, Venuti, Angela, Maione, Antongiulio, Accadia, Maria, Spadaro, Pasquale, Arnese, Maria Rosaria, Pastore, Fabio, Eusebio, Giuseppina, De Angelis, Maria Carmen, Varricchio, Attilio, Alfieri, Alfonso, Di Girolamo, Domenico, Bianchi, Renato Maria, Visconti, Gabriella, Ambrosini, Vittorio, Capasso, Michele, Formigli, Dario, Villari, Bruno, De Simone, Ciro, and Manganiello, Vincenzo
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Balloon Valvuloplasty ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Balloon ,Group B ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Nuclear Medicine and Imaging ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Hospital Mortality ,Prospective Studies ,aortic stenosis ,balloon aortic valvuloplasty ,transcatheter aortic valve implantation ,Radiology, Nuclear Medicine and Imaging ,Cardiology and Cardiovascular Medicine ,030212 general & internal medicine ,Aged ,Training period ,Aged, 80 and over ,Ejection fraction ,business.industry ,Cardiogenic shock ,Aortic Valve Stenosis ,Recovery of Function ,General Medicine ,aortic stenosi ,medicine.disease ,Aortic valvuloplasty ,Treatment Outcome ,Italy ,Aortic valve stenosis ,Heart failure ,Cardiology ,Feasibility Studies ,Female ,Radiology ,business - Abstract
Objectives To evaluate the safety and the feasibility of balloon aortic valvuloplasty (BAV) procedure made by trained operators in centers not performing transcatheter aortic valve implantation (TAVI). Background BAV is a valuable therapeutic tool for patients with symptomatic severe aortic valve stenosis (AS) at prohibitive risk for TAVI or surgery. Methods Consecutive high-risk AS patients underwent BAV in five non-TAVI centers, where BAV operators had completed a 6-month training period in high-volume TAVI centers (Group A). All clinical, echocardiographic, and procedural data were prospectively collected and compared with data of patients treated in TAVI center (Group B). Results Between June 2016 and June 2017, 55 patients (83.9 ± 7.0 years) were enrolled: 25 in Group A and 30 in Group B. After BAV, a substantial reduction of the peak-to-peak aortic valve gradient was obtained in both groups (-35.3 ± 15.2 vs -28.8 ± 13.9 mmHg, P =0.25). No major bleeding or vascular complications occurred. In-hospital death was observed in three patients of Group A and two patients of Group B (P =0.493). The mean follow-up time was 303 ± 188 days; no patients were lost. The 1-year survival free from overall death (Group A 75.8% vs Group B 68.8%; P =0.682) and heart failure rehospitalization (Group A 73.0% vs Group B 66.8%; P =0.687) was similar in the two groups. At multivariable analysis, low left ventricular (LV) ejection fraction (HR: 0.943; P = 0.011) and cardiogenic shock (HR: 5.128; P = 0.002) at admission were independent predictors of mortality. Conclusions BAV is a safe and effective procedure that can be performed by trained operators in centers not performing TAVI.
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- 2018
11. Prognostic Value of Non-Invasive Global Myocardial Work in Asymptomatic Aortic Stenosis.
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Ilardi, Federica, Postolache, Adriana, Dulgheru, Raluca, Trung, Mai-Linh Nguyen, de Marneffe, Nils, Sugimoto, Tadafumi, Go, Yun Yun, Oury, Cécile, Esposito, Giovanni, and Lancellotti, Patrizio
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AORTIC stenosis ,PROGNOSIS ,ASYMPTOMATIC patients ,CARDIOVASCULAR disease related mortality ,VENTRICULAR ejection fraction - Abstract
This study aimed to evaluate the modification of non-invasive myocardial work (MW) indices related to aortic stenosis (AS) stages of cardiac damage and their prognostic value. The echocardiographic and outcome data of 170 patients, with asymptomatic moderate-to-severe AS and left ventricular ejection fraction (LVEF) ≥ 50%, and 50 age- and sex-comparable healthy controls were analysed. Primary endpoints were the occurrence of all-cause and cardiovascular death. Increased values of the global work index (GWI), global constructive work (GCW), and global wasted work (GWW) were observed in AS patients compared to controls (GWI: 2528 ± 521 vs. 2005 ± 302 mmHg%, GCW: 2948 ± 598 vs. 2360 ± 353 mmHg%, p < 0.001; GWW: 139 ± 90 vs. 90 ± 49 mmHg%, p = 0.005), with no changes in the global work efficiency. When patients were stratified according to the stages of cardiac damage, the GWI showed lower values in Stage 3–4 as compared to Stage 0 and Stage 2 (p = 0.024). During a mean follow-up of 30 months, 27 patients died. In multivariable Cox-regression analysis, adjusted for confounders, GWI (HR: 0.998, CI: 0.997–1.000; p = 0.034) and GCW (HR:0.998, CI: 0.997–0.999; p = 0.003) were significantly associated with excess mortality. When used as categorical variables, a GWI ≤ 1951 mmHg% and a GCW ≤ 2475 mmHg% accurately predicted all-cause and cardiovascular death at 4-year follow-up. In conclusion, in asymptomatic patients with moderate-to-severe AS, reduced values of GWI and GCW are associated with increased mortality. Therefore, the evaluation of MW indices may allow for a better identification of asymptomatic patients with moderate to severe AS and preserved LVEF whom are at increased risk of worse prognosis during follow-up. [ABSTRACT FROM AUTHOR]
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- 2022
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12. Impact of aortic stenosis on layer-specific longitudinal strain: relationship with symptoms and outcome.
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Ilardi, Federica, Marchetta, Stella, Martinez, Christophe, Sprynger, Muriel, Ancion, Arnaud, Manganaro, Roberta, Sugimoto, Tadafumi, Tsugu, Toshimitsu, Postolache, Adriana, Piette, Caroline, Cicenia, Marianna, Esposito, Giovanni, Galderisi, Maurizo, Oury, Cécile, Dulgheru, Raluca, and Lancellotti, Patrizio
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MYOCARDIUM physiology ,AORTIC stenosis ,ECHOCARDIOGRAPHY ,PEPTIDE hormones ,MULTIPLE regression analysis ,PROPORTIONAL hazards models ,DESCRIPTIVE statistics ,SYMPTOMS - Abstract
Aims The present study sought to assess the impact of aortic stenosis (AS) on myocardial function as assessed by layer-specific longitudinal strain (LS) and its relationship with symptoms and outcome. Methods and results We compared 211 patients (56% males, mean age 73 ± 12 years) with severe AS and left ventricular ejection fraction (LVEF) ≥50% (114 symptomatic, 97 asymptomatic) with 50 controls matched for age and sex. LS was assessed from endocardium, mid-myocardium, and epicardium by 2D speckle-tracking echocardiography. Despite similar LVEF, multilayer strain values were significantly lower in symptomatic patients, compared to asymptomatic and controls [global LS: 17.9 ± 3.4 vs. 19.1 ± 3.1 vs. 20.7 ± 2.1%; endocardial LS: 20.1 ± 4.9 vs. 21.7 ± 4.2 vs. 23.4 ± 2.5%; epicardial LS: 15.8 ± 3.1 vs. 16.8 ± 2.8 vs. 18.3 ± 1.8%; P < 0.001 for all]. On multivariable logistic regression analysis, endocardial LS was independently associated to symptoms (P = 0.012), together with indexed left atrial volume (P = 0.006) and LV concentric remodelling (P = 0.044). During a mean follow-up of 22 months, 33 patients died of a cardiovascular event. On multivariable Cox-regression analysis, age (P = 0.029), brain natriuretic peptide values (P = 0.003), LV mass index (P = 0.0065), LV end-systolic volume (P = 0.012), and endocardial LS (P = 0.0057) emerged as independently associated with cardiovascular death. The best endocardial LS values associated with outcome was 20.6% (sensitivity 70%, specificity 52%, area under the curve = 0.626, P = 0.022). Endocardial LS (19.1 ± 3.3 vs. 20.7 ± 3.3, P = 0.02) but not epicardial LS (15.2 ± 2.8 vs. 15.9 ± 2.5, P = 0.104) also predicted the outcome in patients who were initially asymptomatic. Conclusion In patients with severe AS, LS impairment involves all myocardial layers and is more prominent in the advanced phases of the disease, when the symptoms occur. In this setting, the endocardial LS is independently associated with symptoms and patient outcome. [ABSTRACT FROM AUTHOR]
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- 2020
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13. Correction to: Acute advanced aortic stenosis.
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Avvedimento, Marisa, Angellotti, Domenico, Ilardi, Federica, Leone, Attilio, Scalamogna, Maria, Castiello, Domenico Simone, Manzo, Rachele, Mariani, Andrea, Immobile Molaro, Maddalena, Simonetti, Fiorenzo, Spaccarotella, Carmen Anna Maria, Piccolo, Raffaele, Esposito, Giovanni, and Franzone, Anna
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AORTIC stenosis ,HEART failure - Abstract
The online version of the original article can be found at https://doi.org/10.1007/s10741-023-10312-7. To rectify this, we wish to clarify that the author's surname is Immobile Molaro and her name is simply Maddalena, with no middle name. B Correction to: Heart Failure Reviews b https://doi.org/10.1007/s10741-023-10312-7 Unfortunately, there was an error in the name of one of the authors. [Extracted from the article]
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- 2023
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14. Prosthesis depth and conduction disturbances after last generation balloon-expandable transcatheter aortic valve implantation.
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Iacovelli, Fortunato, Pignatelli, Antonio, Giugliano, Giuseppe, Stabile, Eugenio, Cicala, Mariangela, Salemme, Luigi, Cioppa, Angelo, Popusoi, Grigore, Pucciarelli, Armando, Verdoliva, Sebastiano, Santo Bortone, Alessandro, Losi, Maria-Angela, Coscioni, Enrico, Esposito, Giovanni, Contegiacomo, Gaetano, Tesorio, Tullio, and Bortone, Alessandro Santo
- Abstract
Aims: Preliminary data on Sapien 3 valve (S3-THV) use for transcatheter aortic valve implantation have shown an increased permanent pacemaker implantation (PPMI) rate with respect to Sapien XT valve. Aim of this study was to investigate the role of S3-THV position in the left ventricular outflow tract (LVOT) on electrocardiographic changes suggestive of atrioventricular (ΔPR) and/or intraventricular (ΔQRS) conduction abnormalities and 30 days PPMI rate.Methods and results: Eighty-six consecutive patients treated with S3-THV were included in the study. All patients underwent clinical and electrocardiogram evaluation. Left ventricular outflow tract prosthesis depth was assessed by fluoroscopy and expressed quantitatively (mm) and as aorto-ventricular ratio (AVR). Eight patients (9.3%) needed PPMI at 30 days. A low AVR (≤60/40) predicted PPMI (OR = 6.09, 95% CI 1.19-31.01, P = 0.030) and resulted into higher PPMI rate, compared with higher AVR (30.0 vs. 6.6%, P = 0.017). For each millimetre increase in the LVOT prosthesis depth PPMI risk increased by 1.41 times (95% CI 1.06-1.87, P = 0.017). In patients with low AVR, ΔPR was higher than in those with higher AVR (33.4 ± 56.7 vs. 12.1 ± 19.4 ms, P = 0.021) and ΔPR was associated to LVOT prosthesis depth (β = 0.286, P = 0.009). Furthermore, ΔPR was associated with risk of PPMI (OR = 1.03, 95% CI 1.01-1.06, P = 0.024).Conclusions: A low AVR is associated to higher ΔPR and PPMI rates. The correlation between LVOT prosthesis depth with ΔPR and higher PPMI rate suggests the need of a careful S3-THV implantation. [ABSTRACT FROM AUTHOR]- Published
- 2018
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15. Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation.
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Avvedimento, Marisa, Franzone, Anna, Leone, Attilio, Piccolo, Raffaele, Castiello, Domenico Simone, Ilardi, Federica, Mariani, Andrea, Esposito, Roberta, Iapicca, Cristina, Angellotti, Domenico, Scalamogna, Maria, Santoro, Ciro, Di Serafino, Luigi, Cirillo, Plinio, and Esposito, Giovanni
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DOPPLER echocardiography ,HEART valve prosthesis implantation ,TRICUSPID valve ,MORTALITY ,MITRAL valve ,AORTIC stenosis - Abstract
(1) Aims: We sought to assess the impact of the extent of cardiac damage on survival among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). (2) Methods: A staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-days after TAVI. The primary endpoint of the study was all-cause mortality at 1-year. Secondary endpoints included cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis, and re-hospitalization for all causes. (3) Results: At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-days after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a significant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p = 0.08). No differences were found in secondary endpoints. (4) Conclusions: TAVI has an early beneficial impact on the left ventricular diastolic and right ventricular function. However, the extent of cardiac damage at baseline significantly affects the risk of mortality at 1-year after the procedure. [ABSTRACT FROM AUTHOR]
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- 2021
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16. Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement.
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Gargiulo, Giuseppe, Capodanno, Davide, Tamburino, Corrado, Trimarco, Bruno, and Esposito, Giovanni
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AORTIC valve ,CHEMOEMBOLIZATION ,AORTIC valve surgery ,AORTIC stenosis ,CARDIAC catheterization ,PROSTHETIC heart valves ,TREATMENT effectiveness - Published
- 2017
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17. 2016 - Review: In severe aortic stenosis, TAVI and conventional surgery do not differ for ≤ 30-day or ≤ 1-year mortality.
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Vandvik, Per Olav, Guyatt, Gordon, and Esposito, Giovanni
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AORTIC stenosis ,CONFIDENCE intervals ,DATABASES ,PROSTHETIC heart valves ,MEDICAL databases ,INFORMATION storage & retrieval systems ,MEDICAL information storage & retrieval systems ,MEDLINE ,META-analysis ,SURGICAL complications ,THERAPEUTIC complications ,SYSTEMATIC reviews ,RELATIVE medical risk ,TREATMENT effectiveness ,SEVERITY of illness index ,DESCRIPTIVE statistics ,META-synthesis - Abstract
Question In adults with severe aortic stenosis, how does transcatheter aortic valve implantation (TAVI) compare with surgical aortic valve replacement (SAVR) for early and midterm mortality? Review scope Included studies compared TAVI with SAVR in adults with severe aortic stenosis and reported mortality data. Primary outcomes were early (≤ 30 d) and midterm (≤ 1 y) all-cause mortality. Other outcomes included longer-term (> 1 y) all-cause mortality; early and midterm stroke; and early cardiovascular (CV) mortality, myocardial infarction, new-onset atrial fibrillation, major bleeding, acute kidney injury, vascular complication, moderate-to-severe paravalvular leak, and permanent pacemaker implantation. Review methods MEDLINE, Scopus, and Cochrane Library (Apr 2002 to Apr 2016); Google Scholar, meeting abstracts and presentations from major CV meetings, and Web sites (Jan 2015 to Apr 2016); and reference lists from relevant publications were searched for randomized controlled trials (RCTs) or observational matched studies. 36 studies (n = 16 638, mean age 70 to 84 y, 18% to 78% men) met the inclusion criteria, including 5 RCTs (n = 3828) and 31 observational studies (n = 12 810). TAVI was usually done using a transfemoral approach; 7 studies used only transapical TAVI. All RCTs had low risk for bias for allocation concealment, incomplete outcome data, and blinded outcome assessors. 18 observational studies had low risk for bias for patient selection, comparability, and outcome. Main results The main results are in the Table. Overall, mortality did not differ (Table); the results were similar for patients at low-to-intermediate surgical risk. The risk for periprocedural myocardial infarction, major bleeding, acute kidney injury, and new-onset atrial fibrillation was lower with TAVI, whereas the risk for pacemaker implantation, vascular complications, and paravalvular leak was increased. Conclusion In severe aortic stenosis, transcatheter aortic valve implantation does not differ from surgical aortic valve replacement for ≤ 30-day or longer all-cause mortality. [ABSTRACT FROM AUTHOR]
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- 2016
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18. Meta-Analysis of Mortality Outcomes and Mitral Regurgitation Evolution in 4,839 Patients Having Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis.
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Sannino, Anna, Angela Losi, Maria, Schiattarella, Gabriele Giacomo, Gargiulo, Giuseppe, Perrino, Cinzia, Stabile, Eugenio, Toscano, Evelina, Giugliano, Giuseppe, Brevetti, Linda, Franzone, Anna, Cirillo, Plinio, Imbriaco, Massimo, Trimarco, Bruno, and Esposito, Giovanni
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AORTIC stenosis , *AORTIC stenosis treatment , *MITRAL valve insufficiency , *META-analysis , *DEATH rate , *PATIENTS - Abstract
Transcatheter aortic valve implantation (TAVI) is an effective alternative therapy in selected patients with severe aortic stenosis. The role and effects of coexistent moderate to severe mitral regurgitation (msMR) in patients who undergo TAVI remain unclear. Thirteen studies enrolling 4,839 patients who underwent TAVI, including patients with msMR, were considered in a meta-analysis and analyzed for all-cause-mortality; a further metaanalysis was performed to assess mitral regurgitation (MR) evolution after TAVI. In patients with msMR, all-cause-mortality after TAVI was significantly increased at 30-day (effect size [ES] -0.18, 95% confidence interval [CI] -0.31 to -0.04, I2 = 46.51, Q [ 7.48), 1-year (ES -0.22, 95% CI -0.36 to -0.08, I2 [ 56.20, Q [ 11.41), and 2-year (ES -0.15, 95% CI -0.27 to -0.02, I2 = 0.00, Q = 2.64) follow-up compared with patients with absent or mild MR, independent of baseline left ventricular ejection fraction. Interestingly, the impact of msMR on outcomes was statistically stronger when the CoreValve system was used. TAVI was also associated with an improvement in MR entity at 3- and 6-month follow-up (overall ES -0.19, 95% CI -0.37 to -0.01, I2 = 61.52, Q = 10.39). In conclusion, the presence of preoperative msMR in patients with severe, symptomatic aortic stenosis who undergo TAVI negatively affects outcomes after TAVI. In addition, in the same group of patients, a trend toward a reduction in MR severity was observed. Whether the decrease in MR severity affects mortality after TAVI remains to be defined. [ABSTRACT FROM AUTHOR]
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- 2014
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19. Increased mortality after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and low ejection fraction: A meta-analysis of 6898 patients.
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Sannino, Anna, Gargiulo, Giuseppe, Schiattarella, Gabriele Giacomo, Brevetti, Linda, Perrino, Cinzia, Stabile, Eugenio, Losi, Maria Angela, Toscano, Evelina, Giugliano, Giuseppe, Scudiero, Fernando, Chiacchio, Elena, Trimarco, Bruno, and Esposito, Giovanni
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MORTALITY , *AORTIC stenosis , *META-analysis , *CARDIOVASCULAR diseases , *PATIENTS , *CAUSES of death ,AORTIC valve surgery - Abstract
Background There is conflicting evidence regarding the safety and efficacy of transcatheter aortic valve implantation (TAVI) procedures in patients with severe aortic stenosis and low left ventricular ejection fraction (EF). The primary aim of this study was to determine the impact of TAVI on short- and long-term mortality in patients with low EF (EF < 50%); the secondary aim was to analyze the impact of TAVI procedure on EF recovery in the same setting of patients. Methods and results Twenty-six studies enrolling 6898 patients with severe aortic stenosis undergoing TAVI procedure were included in the meta-analysis and analyzed for 30-day, 6-month and 1-year all-cause and cardiovascular mortality; a further meta-analysis was also performed in patients with low EF to assess EF changes post TAVI. In low EF patients, both all-cause and cardiovascular short- and long-term mortality were significantly higher when compared to patients with normal EF (30-day-all-cause mortality: 0.13; 95% confidence interval [CI]: 0.01 to 0.25, I² = 49.65, Q = 21.85; 1-year-all-cause mortality: 0.25; 95% [CI]: 0.16 to 0.34, I² = 25.57, Q = 16.12; 30-day-cardiovascular mortality: 0.03; 95% [CI]: - 0.31 to 0.36, I² = 66.84, Q = 6.03; 1-year-cardiovascular mortality: 0.29; 95% [CI]: 0.12 to 0.45, I² = 0.00, Q = 1.88). Nevertheless, in low EF patients TAVI was associated with a significant recovery of EF, which started at discharge and proceeded up to 1-year-follow-up. Conclusions Patients with low EF severe aortic stenosis have higher mortality following TAVI compared to normal EF patients, despite a significant and sustained improvement in EF. [ABSTRACT FROM AUTHOR]
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- 2014
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20. Updated clinical indications for transcatheter aortic valve implantation in patients with severe aortic stenosis: Expert opinion of the Italian Society of Cardiology and GISE
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Sonia Petronio, Antonio L. Bartorelli, Carmen Spaccarotella, Giuseppe Tarantini, Roberto Violini, Corrado Vassanelli, Paolo Golino, Sergio Berti, Giovanni Esposito, Ciro Indolfi, Giuseppe Musumeci, Gianpaolo Ussia, Francesco Romeo, Giuseppe Mercuro, Corrado Tamburino, Indolfi, Ciro, Bartorelli, Antonio L., Berti, Sergio, Golino, Paolo, Esposito, Giovanni, Musumeci, Giuseppe, Petronio, Sonia, Tamburino, Corrado, Tarantini, Giuseppe, Ussia, Gianpaolo, Vassanelli, Corrado, Spaccarotella, Carmen, Violini, Roberto, Mercuro, Giuseppe, and Romeo, Francesco
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Aortic valve ,medicine.medical_specialty ,Percutaneous ,Aortic stenosi ,medicine.medical_treatment ,Cardiology ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,Aortic valve replacement ,law ,Medical ,Internal medicine ,Aortic stenosis ,Intermediate risk ,Transcatheter aortic valve implantation ,Transcatheter aortic valve replacement ,Aortic Valve ,Aortic Valve Stenosis ,Heart Valve Prosthesis ,Humans ,Italy ,Randomized Controlled Trials as Topic ,Societies, Medical ,Transcatheter Aortic Valve Replacement ,Practice Guidelines as Topic ,Clinical endpoint ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Interventional cardiology ,business.industry ,General Medicine ,medicine.disease ,Aortic valvuloplasty ,Stenosis ,medicine.anatomical_structure ,Societies ,business - Abstract
The introduction of percutaneous treatment of severe aortic stenosis with transcatheter aortic valve implantation (TAVI) remains one of the greatest achievements of interventional cardiology. In fact, TAVI emerged as a better option than either medical therapy or balloon aortic valvuloplasty for patients who cannot undergo surgical aortic valve replacement (SAVR) or are at high surgical risk. Recently, increased operator experience and improved device systems have led to a worldwide trend toward the extension of TAVI to low-risk or intermediate-risk patients. In this expert opinion paper, we first discuss the basic pathophysiology of aortic stenosis in different settings then the key results of recent clinical investigations on TAVI in intermediate-risk aortic stenosis patients are summarized. Particular emphasis is placed on the results of the nordic aortic valve intervention, placement of aortic transcatheter valves (PARTNER) 2 and Surgical Replacement and Transcatheter Aortic Valve Implantation Randomized trials. The PARTNER 2 was the first large randomized trial that evaluated the outcome of TAVI in patients at intermediate risk. The PARTNER 2 data demonstrated that TAVI is a feasible and reasonable alternative to surgery in intermediate-risk patients (Society of Thoracic Surgeons 4-8%), especially if they are elderly or frail. There was a significant interaction between TAVI approach and mortality, with transfemoral TAVI showing superiority over SAVR. Moreover, we examine the complementary results of the recently concluded Surgical Replacement and Transcatheter Aortic Valve Implantation trial. This prospective randomized trial demonstrated that TAVI is comparable with surgery (primary end point 12.6% in the TAVI group vs. 14.0% in the SAVR group) in severe aortic stenosis patients deemed to be at intermediate risk. We review the most relevant clinical evidence deriving from nonrandomized studies and meta-analyses. Altogether, clinical outcome available data suggest that TAVI with a newer generation device might be the preferred treatment option in this patient subgroup. Finally, the differences between the latest European and American Guidelines on TAVI were reported and discussed. The conclusion of this expert opinion article is that TAVI, if feasible, is the treatment of choice in patients with prohibitive or high surgical risk and may lead to similar or lower early and midterm mortality rates compared with SAVR in intermediate-risk patients with severe aortic stenosis.
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- 2018
21. Diastolic dysfunction reduces stroke volume during daily's life activities in patients with severe aortic stenosis.
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Losi, Maria Angela, Izzo, Raffaele, Stabile, Eugenio, Sannino, Anna, Canciello, Grazia, Giamundo, Alessandra, Musella, Francesca, Cirillo, Plinio, Prastaro, Maria, Galderisi, Maurizio, Trimarco, Bruno, and Esposito, Giovanni
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STROKE volume (Cardiac output) , *AORTIC stenosis , *DYSPNEA , *VALSALVA'S maneuver , *ECHOCARDIOGRAPHY , *HEMODYNAMICS , *DISEASES , *PATIENTS - Published
- 2015
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22. Impact of moderate preoperative chronic kidney disease on mortality after transcatheter aortic valve implantation.
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Gargiulo, Giuseppe, Capodanno, Davide, Sannino, Anna, Perrino, Cinzia, Capranzano, Piera, Stabile, Eugenio, Trimarco, Bruno, Tamburino, Corrado, and Esposito, Giovanni
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CHRONIC kidney failure , *MORTALITY , *AORTIC stenosis , *STROKE , *HEALTH outcome assessment ,AORTIC valve surgery - Published
- 2015
- Full Text
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