115 results on '"Daniele Masarone"'
Search Results
2. Beyond Medical Therapy—An Update on Heart Failure Devices
- Author
-
Luigi Falco, Fabio Valente, Aldo De Falco, Raffaele Barbato, Luigi Marotta, Davide Soviero, Luigi Mauro Cantiello, Carla Contaldi, Benedetta Brescia, Enrico Coscioni, Giuseppe Pacileo, and Daniele Masarone
- Subjects
heart failure ,devices ,teer ,ccm ,atrial shunt ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Heart failure (HF) is a complex and progressive disease marked by substantial morbidity and mortality rates, frequent episodes of decompensation, and a reduced quality of life (QoL), with severe financial burden on healthcare systems. In recent years, several large-scale randomized clinical trials (RCTs) have widely expanded the therapeutic armamentarium, underlining additional benefits and the feasibility of rapid titration regimens. This notwithstanding, mortality is not declining, and hospitalizations are constantly increasing. It is widely acknowledged that even with guideline-directed medical therapy (GDMT) on board, HF patients have a prohibitive residual risk, which highlights the need for innovative treatment options. In this scenario, groundbreaking devices targeting valvular, structural, and autonomic abnormalities have become crucial tools in HF management. This has led to a full-fledged translational boost with several novel devices in development. Thus, the aim of this review is to provide an update on both approved and investigated devices.
- Published
- 2024
- Full Text
- View/download PDF
3. Testosterone deficiency independently predicts mortality in women with HFrEF: insights from the T.O.S.CA. registry
- Author
-
Alberto M. Marra, Roberta D'Assante, Andrea Salzano, Massimo Iacoviello, Vincenzo Triggiani, Giuseppe Rengo, Giuseppe Limongelli, Daniele Masarone, Maria Perticone, Antonio Cimellaro, Pasquale Perrone Filardi, Stefania Paolillo, Paola Gargiulo, Antonio Mancini, Maurizio Volterrani, Olga Vriz, Roberto Castello, Andrea Passantino, Michela Campo, Pietro A. Modesti, Alfredo De Giorgi, Michele Arcopinto, Anna D'Agostino, Valeria Raparelli, Andrea M. Isidori, Valeria Valente, Federica Giardino, Giulia Crisci, Angela Sciacqua, Marcella Savoia, Toru Suzuki, Eduardo Bossone, Antonio Cittadini, and T.O.S.CA. Investigators
- Subjects
Anabolic deficiency ,Heart failure ,HFrEF ,Multiple hormonal and metabolic deficiency syndrome ,Testosterone ,Women ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims Testosterone deficiency (TD) is associated with increased morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). However, data in women are scanty. The aim of this study was to investigate the prognostic impact of TD on women with HFrEF. Methods Among 480 patients prospectively enrolled in the T.O.S.CA. (Terapia Ormonale Scompenso CArdiaco) registry, a prospective, multicentre, nationwide, observational study, 94 women were included in the current analysis. The TD was defined as serum testosterone levels lower than 25 ng/dl. Data regarding clinical status, echocardiography, exercise performance, cardiovascular hospitalization, and survival after an average follow‐up of 36 months were analysed. Results Thirty patients (31.9%) displayed TD. TD was associated with lower tricuspid annular plane excursion (TAPSE) to pulmonary arterial systolic pressure PASP ratio (TAPSE/PASP) (P = 0.008), peak oxygen consumption (VO2 peak) (P = 0.03) and estimated glomerular filtration rate (P
- Published
- 2023
- Full Text
- View/download PDF
4. Pathophysiology-Based Management of Acute Heart Failure
- Author
-
Luigi Falco, Maria Luigia Martucci, Fabio Valente, Marina Verrengia, Giuseppe Pacileo, and Daniele Masarone
- Subjects
acute heart failure ,pathophysiology ,tailored treatment ,Medicine (General) ,R5-920 - Abstract
Even though acute heart failure (AHF) is one of the most common admission diagnoses globally, its pathogenesis is poorly understood, and there are few effective treatments available. Despite an heterogenous onset, congestion is the leading contributor to hospitalization, making it a crucial therapeutic target. Complete decongestion, nevertheless, may be hard to achieve, especially in patients with reduced end organ perfusion. In order to promote a personalised pathophysiological-based therapy for patients with AHF, we will address in this review the pathophysiological principles that underlie the clinical symptoms of AHF as well as examine how to assess them in clinical practice, suggesting that gaining a deeper understanding of pathophysiology might result in significant improvements in HF therapy.
- Published
- 2023
- Full Text
- View/download PDF
5. Recent Advances across the Spectrum of Heart Failure and Heart Transplant
- Author
-
Daniele Masarone, Carlo Lombardi, Luigi Falco, Enrico Coscioni, and Marco Metra
- Subjects
n/a ,Medicine - Abstract
In recent years, remarkable progress has been accomplished in the heart failure (HF) landscape, with novel drugs and groundbreaking device approaches [...]
- Published
- 2024
- Full Text
- View/download PDF
6. Predictors of sacubitril/valsartan high dose tolerability in a real world population with HFrEF
- Author
-
Valeria Visco, Ilaria Radano, Alfonso Campanile, Amelia Ravera, Angelo Silverio, Daniele Masarone, Giuseppe Pacileo, Michele Correale, Pietro Mazzeo, Giuseppe Dattilo, Francesco Giallauria, Alessandra Cuomo, Valentina Mercurio, Carlo Gabriele Tocchetti, Paola Di Pietro, Albino Carrizzo, Rodolfo Citro, Gennaro Galasso, Carmine Vecchione, and Michele Ciccarelli
- Subjects
Heart failure ,ARNI ,Neprilysin inhibitors ,Right ventricular function ,Sacubitril valsartan ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aims The angiotensin receptor‐neprilysin inhibitor (ARNI) sacubitril/valsartan (Sac/Val) demonstrated to be superior to enalapril in reducing hospitalizations, cardiovascular and all‐cause mortality in patients with ambulatory heart failure and reduced ejection fraction (HFrEF), in particular when it is maximally up‐titrated. Unfortunately, the target dose is achieved in less than 50% of HFrEF patients, thus undermining the beneficial effects on the outcomes. In this study, we aimed to evaluate the role of Sac/Val and its titration dose on reverse cardiac remodelling and determine which echocardiographic index best predicts the up‐titration success. Methods and results From January 2020 to June 2021, we retrospectively identified 95 patients (65.6 [59.1–72.8] years; 15.8% females) with chronic HFrEF who were prescribed Sac/Val from the HF Clinics of 5 Italian University Hospitals and evaluated the tolerability of Sac/Val high dose (the ability of the patient to achieve and stably tolerate the maximum dose) as the primary endpoint in the cohort. We used a multivariable logistic regression analysis, with a stepwise backward selection method, to determine the independent predictors of Sac/Val maximum dose tolerability, using, as candidate predictors, only variables with a P‐value < 0.1 in the univariate analyses. Candidate predictors identified for the multivariable backward logistic regression analysis were age, sex, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dyslipidaemia, atrial fibrillation, systolic blood pressure (SBP), baseline tolerability of ACEi/ARBs maximum dose, left ventricle global longitudinal strain (LVgLS), LV ejection fraction (EF), tricuspid annulus plane systolic excursion (TAPSE), right ventricle (RV) fractional area change (FAC), RV global and free wall longitudinal strain (RVgLS and RV‐FW‐LS). After the multivariable analysis, only one categorical (ACEi/ARBs maximum dose at baseline) and three continuous (younger age, higher SBP, and higher TAPSE), resulted significantly associated with the study outcome variable with a strong discriminatory capacity (area under the curve 0.874, 95% confidence interval (CI) (0.794–0.954) to predict maximum Sac/Val dose tolerability. Conclusions Our study is the first to analyse the potential role of echocardiography and, in particular, of RV dysfunction, measured by TAPSE, in predicting Sac/Val maximum dose tolerability. Therefore, patients with RV dysfunction (baseline TAPSE
- Published
- 2022
- Full Text
- View/download PDF
7. Multimodality Cardiovascular Imaging of Cardiotoxicity Due to Cancer Therapy
- Author
-
Carla Contaldi, Vincenzo Montesarchio, Dario Catapano, Luigi Falco, Francesca Caputo, Carmine D’Aniello, Daniele Masarone, and Giuseppe Pacileo
- Subjects
cardiotoxicity ,echocardiography ,cardiac magnetic resonance ,cardiac computed tomography ,nuclear imaging ,cancer therapy ,Science - Abstract
Cancer therapies have revolutionized patient survival rates, yet they come with the risk of cardiotoxicity, necessitating effective monitoring and management. The existing guidelines offer a limited empirical basis for practical approaches in various clinical scenarios. This article explores the intricate relationship between cancer therapy and the cardiovascular system, highlighting the role of advanced multimodality imaging in monitoring patients before, during, and after cancer treatment. This review outlines the cardiovascular effects of different cancer therapy classes, offering a comprehensive understanding of their dose- and time-dependent impacts. This paper delves into diverse imaging modalities such as echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, and nuclear imaging, detailing their strengths and limitations in various conditions due to cancer treatment, such as cardiac dysfunction, myocarditis, coronary artery disease, Takotsubo cardiomyopathy, pulmonary hypertension, arterial hypertension, valvular heart diseases, and heart failure with preserved ejection fraction. Moreover, it underscores the significance of long-term follow-up for cancer survivors and discusses future directions.
- Published
- 2023
- Full Text
- View/download PDF
8. Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry
- Author
-
Andrea Salzano, Roberta D’Assante, Massimo Iacoviello, Vincenzo Triggiani, Giuseppe Rengo, Francesco Cacciatore, Ciro Maiello, Giuseppe Limongelli, Daniele Masarone, Angela Sciacqua, Pasquale Perrone Filardi, Antonio Mancini, Maurizio Volterrani, Olga Vriz, Roberto Castello, Andrea Passantino, Michela Campo, Pietro A. Modesti, Alfredo De Giorgi, Michele Arcopinto, Paola Gargiulo, Maria Perticone, Annamaria Colao, Salvatore Milano, Agnese Garavaglia, Raffaele Napoli, Toru Suzuki, Eduardo Bossone, Alberto M. Marra, Antonio Cittadini, and T.O.S.CA. Investigators
- Subjects
Chronic heart failure ,TOSCA ,Diabetes ,Insulin resistance ,Cardiopulmonary exercise test ,Right ventricle ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p
- Published
- 2022
- Full Text
- View/download PDF
9. Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan
- Author
-
Frank L. Dini, Erberto Carluccio, Roberto Bitto, Michele Ciccarelli, Michele Correale, Andreina D'Agostino, Giuseppe Dattilo, Marco Ferretti, Arianna Grelli, Stefania Guida, Francesca Jacoangeli, Laura Lupi, Lorenzo Luschi, Daniele Masarone, Valentina Mercurio, Giuseppe Pacileo, Nicola Riccardo Pugliese, Antonella Rispoli, Laura Scelsi, Carlo Gabriele Tocchetti, Natale Daniele Brunetti, Alberto Palazzuoli, Massimo Piepoli, Savina Nodari, Giuseppe Ambrosio, and Working Group on Heart Failure of the Italian Society of Cardiology
- Subjects
heart failure ,ejection fraction ,haemodynamic ,prognosis ,sacubitril/valsartan ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Aim Echo‐derived haemodynamic classification, based on forward‐flow and left ventricular (LV) filling pressure (LVFP) correlates, has been proposed to phenotype patients with heart failure and reduced ejection fraction (HFrEF). To assess the prognostic relevance of baseline echocardiographically defined haemodynamic profile in ambulatory HFrEF patients before starting sacubitril/valsartan. Methods and results In our multicentre, open‐label study, HFrEF outpatients were classified into 4 groups according to the combination of forward flow (cardiac index; CI:< or ≥2.0 L/min/m2) and early transmitral Doppler velocity/early diastolic annular velocity ratio (E/e′: ≥ or
- Published
- 2022
- Full Text
- View/download PDF
10. Vericiguat: The Fifth Harmony of Heart Failure with Reduced Ejection Fraction
- Author
-
Luigi Falco, Benedetta Brescia, Dario Catapano, Maria Luigia Martucci, Fabio Valente, Rita Gravino, Carla Contaldi, Giuseppe Pacileo, and Daniele Masarone
- Subjects
heart failure with reduced ejection fraction ,worsening heart failure ,vericiguat ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Heart failure with reduced ejection fraction is a chronic and progressive syndrome that continues to be a substantial financial burden for health systems in Western countries. Despite remarkable advances in pharmacologic and device-based therapy over the last few years, patients with heart failure with reduced ejection fraction have a high residual risk of adverse outcomes, even when treated with optimal guideline-directed medical therapy and in a clinically stable state. Worsening heart failure episodes represent a critical event in the heart failure trajectory, carrying high residual risk at discharge and dismal short- or long-term prognosis. Recently, vericiguat, a soluble guanylate cyclase stimulator, has been proposed as a novel drug whose use is already associated with a reduction in heart failure-related hospitalizations in patients in guideline-directed medical therapy. In this review, we summarized the pathophysiology of the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate cascade in patients with heart failure with reduced ejection fraction, the pharmacology of vericiguat as well as the evidence regarding their use in patients with HFrEF. Finally, tips and tricks for its use in standard clinical practice are provided.
- Published
- 2023
- Full Text
- View/download PDF
11. How to Select Patients for Left Ventricular Assist Devices? A Guide for Clinical Practice
- Author
-
Daniele Masarone, Brian Houston, Luigi Falco, Maria L. Martucci, Dario Catapano, Fabio Valente, Rita Gravino, Carla Contaldi, Andrea Petraio, Marisa De Feo, Ryan J. Tedford, and Giuseppe Pacileo
- Subjects
advanced heart failure ,left ventricular assist device ,patient’s selection ,red flags ,golden window ,Medicine - Abstract
In recent years, a significant improvement in left ventricular assist device (LVAD) technology has occurred, and the continuous-flow devices currently used can last more than 10 years in a patient. Current studies report that the 5-year survival rate after LVAD implantation approaches that after a heart transplant. However, the outcome is influenced by the correct selection of the patients, as well as the choice of the optimal time for implantation. This review summarizes the indications, the red flags for prompt initiation of LVAD evaluation, and the principles for appropriate patient screening.
- Published
- 2023
- Full Text
- View/download PDF
12. The ABC of Heart Transplantation—Part 1: Indication, Eligibility, Donor Selection, and Surgical Technique
- Author
-
Daniele Masarone, Michelle M. Kittleson, Luigi Falco, Maria L. Martucci, Dario Catapano, Benedetta Brescia, Andrea Petraio, Marisa De Feo, and Giuseppe Pacileo
- Subjects
advanced heart failure ,heart transplant ,patient referral ,patient selection ,Medicine - Abstract
Cardiac transplantation represents the gold standard of treatment for selected patients with advanced heart failure who have poor functional capacity and prognosis despite guideline-directed medical therapy and device-based therapy. Proper patient selection and appropriate referral of patients to centers for the treatment of advanced heart failure are the first but decisive steps for screening patients eligible for cardiac transplantation. The eligibility and the decision to list for cardiac transplantation, even for patients with relative contraindications, are based on a multidisciplinary evaluation of a transplant team. This review will discuss the practical indications, the process of patient eligibility for cardiac transplantation, the principle of donor selection, as well as the surgical technique.
- Published
- 2023
- Full Text
- View/download PDF
13. Use of Cardiac Contractility Modulation in an Older Patient with Non-Ischemic Dilated Cardiomyopathy: A Case Report
- Author
-
Gianvito Manganelli, Antonio Fiorentino, Gianluca Ceravolo, Stefana Minichiello, Giuseppe Bianchino, Gennaro Bellizzi, Giuseppe Pacileo, and Daniele Masarone
- Subjects
cardiac contractility modulation ,chronic heart failure ,non-ischemic dilated cardiomyopathy ,quality of life ,Medicine (General) ,R5-920 - Abstract
Cardiac contractility modulation (CCM) is a novel device-based therapy used in patients with HFrEF. CCM therapy is associated with an improvement in exercise tolerance, increased quality of life, reduced HF hospitalizations, and reverse remodelling of the left ventricle in patients with HFrEF. In this case, we report the clinical benefit of CCM in an older patient with advanced HFrEF due to ischemic dilated cardiomyopathy with frequent heart failure-related hospitalizations and poor quality of life despite optimal medical therapy.
- Published
- 2021
- Full Text
- View/download PDF
14. Left Ventricular Assist Device Implantation in a Thrombosed Apical Aneurysm
- Author
-
Daniele Masarone, Enrico Melillo, Rita Gravino, Rossella Vastarella, Angelo Caiazzo, Fabio Ursomando, Giuseppe Pacileo, and Andrea Petraio
- Subjects
advanced heart failure ,apical aneurysm ,HeartMate III ,left ventricular assist device ,Medicine (General) ,R5-920 - Abstract
Left ventricular assist device implantation is a challenging procedure in the presence of a giant thrombosed aneurysm, and no standard surgical techniques are currently recommended in this setting. In this case, we report the successful implantation of a left ventricular assist device (HeartMate III) in a patient with a massive thrombosed apical aneurysm. The patient presented with extended antero-apical necrosis as a result of a delay in hospital admission for acute coronary syndrome due to the patient’s concerns about the COVID-19 pandemic outbreak.
- Published
- 2021
- Full Text
- View/download PDF
15. Use of Cardiac Contractility Modulation as Bridge to Transplant in an Obese Patient With Advanced Heart Failure: A Case Report
- Author
-
Daniele Masarone, Andrea Petraio, Antonio Fiorentino, Santo Dellegrottaglie, Fabio Valente, Ernesto Ammendola, Gerardo Nigro, and Giuseppe Pacileo
- Subjects
heart failure reduced ejection fraction ,advanced heart failure ,cardiac contractility modulation ,obesity ,dilated cardiomyopathy ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Cardiac contractility modulation (CCM) is a novel device-based therapy in patients with heart failure with reduced ejection fraction (HFrEF). In randomized clinical trials and real-life studies, CCM has been shown to improve exercise tolerance and quality of life, reverse left ventricular remodeling and reduce hospitalization in patients with HFrEF. In this case report, we describe for the first time the use of CCM as a “bridge to transplant” in a young obese patient with advanced heart failure due to non-ischemic dilated cardiomyopathy. The patient had a poor quality of life and frequent heart failure-related hospitalizations despite the optimal medical therapy and, due to obesity, a suitable heart donor was unlikely to be identified in the short term and due to severe obesity risk of complications after implantation of a left ventricular assist device (LVAD) was very high.
- Published
- 2022
- Full Text
- View/download PDF
16. Effects of Cardiac Contractility Modulation Electrodes on Tricuspid Regurgitation in Patients with Heart Failure with Reduced Ejection Fraction: A Pilot Study
- Author
-
Daniele Masarone, Michelle M. Kittleson, Stefano De Vivo, Antonio D’Onofrio, Ishu Rao, Ernesto Ammendola, Vittoria Errigo, Maria L. Martucci, Gerardo Nigro, and Giuseppe Pacileo
- Subjects
cardiac contractility modulation ,optimizer smart ,heart failure reduced ejection fraction ,tricuspid regurgitation ,Medicine - Abstract
Background: Cardiac contractility modulation (CCM) is an innovative therapy for heart failure with reduced ejection fraction delivered by a cardiac implantable device (Optimizer Smart®). One of the most prominent periprocedural complications common to all cardiac implantable devices (CIDs) is tricuspid regurgitation (TR) due to the placement of the right ventricular endocardial leads. To date, no published studies have assessed the changes in the TR degree in patients with heart failure with reduced ejection fraction (HFrEF) who received an implantable cardioverter-defibrillator (ICD) after the implantation of cardiac contractility modulation therapy devices. Objective: This study aimed to evaluate the effect of the implantation of the trans-tricuspid leads required to deliver CCM therapy on the severity of TR in patients with HFrEF who previously underwent ICD implantation. Methods: We enrolled 30 HFrEF patients who underwent CCM therapy between November 2020 and October 2021. For all the patients, echocardiographic evaluations of TR were performed according to current guidelines 24 h before and six months after the Optimizer Smart® implant was applied. Results: At the 6-month follow-up, the grade of TR remained unchanged compared to the preimplant grade. The value of the vena contracta (VC) of TR was 0.40 ± 0.19 cm in the preimplant period and 0.45 ± 0.21 cm at the 6-month follow-up (p = 0.33). Similarly, the TR proximal isovelocity surface area (PISA) radius value was unchanged at follow-up (0.54 ± 0.22 cm vs. 0.62 ± 0.20 cm; p = 0.18). No statistically significant difference existed between the preimplant VC and PISA radius values, irrespective of the device type. Conclusions: The implantation of right ventricular electrodes for the delivery of CCM therapy did not worsen tricuspid regurgitation in patients with HFrEF and ICD.
- Published
- 2022
- Full Text
- View/download PDF
17. Use of Levosimendan in Patients with Advanced Heart Failure: An Update
- Author
-
Daniele Masarone, Michelle M. Kittleson, Piero Pollesello, Marco Marini, Massimo Iacoviello, Fabrizio Oliva, Angelo Caiazzo, Andrea Petraio, and Giuseppe Pacileo
- Subjects
advanced heart failure ,inodilators ,levosimendan ,pharmacologic therapy ,Medicine - Abstract
Levosimendan is an inodilator drug that, given its unique pharmacological actions and safety profile, represents a viable therapeutic option in patients with heart failure with reduced ejection fraction in the advanced stage of the disease (advHFrEF). Pulsed levosimendan infusion in patients with advHFrEF improves symptoms and clinical and hemodynamic status, prevents recurrent hospitalizations, and enables optimization of guidelines-directed medical therapy. Furthermore, considering its proprieties on right ventricular function and pulmonary circulation, levosimendan could be helpful for the prevention and treatment of the right ventricular dysfunction post-implanting a left ventricular assist device. However, to date, evidence on this issue is scarce and has yielded mixed results. Finally, preliminary experiences indicate that treatment with levosimendan at scheduled intervals may serve as a “bridge to transplant” strategy in patients with advHFrEF. In this review, we summarized the clinical pharmacology of levosimendan, the available evidence in the treatment of patients with advHFrEF, as well as a hypothesis for its use in patients with advanced heart failure with preserved ejection fraction.
- Published
- 2022
- Full Text
- View/download PDF
18. The Effects of Device-Based Cardiac Contractility Modulation Therapy on Left Ventricle Global Longitudinal Strain and Myocardial Mechano-Energetic Efficiency in Patients with Heart Failure with Reduced Ejection Fraction
- Author
-
Daniele Masarone, Michelle M. Kittleson, Stefano De Vivo, Antonio D’Onofrio, Ernesto Ammendola, Gerardo Nigro, Carla Contaldi, Maria L. Martucci, Vittoria Errigo, and Giuseppe Pacileo
- Subjects
cardiac contractility modulation ,heart failure with reduced ejection fraction ,global longitudinal strain ,myocardial mechano-energetics efficiency ,Medicine - Abstract
Background: Virtually all patients with heart failure with reduced ejection fraction have a reduction of myocardial mechano-energetic efficiency (MEE). Cardiac contractility modulation (CCM) is a novel therapy for the treatment of patients with HFrEF, in whom it improves the quality of life and functional capacity, reduces hospitalizations, and induces biventricular reverse remodeling. However, the effects of CCM on MEE and global longitudinal strain (GLS) are still unknown; therefore, this study aims to evaluate whether CCM therapy can improve the MEE of patients with HFrEF. Methods: We enrolled 25 patients with HFrEF who received an Optimizer Smart implant (the device that develops CCM therapy) between January 2018 and January 2021. Clinical and echocardiographic evaluations were performed in all patients 24 h before and six months after CCM therapy. Results: At six months, follow-up patients who underwent CCM therapy showed an increase of left ventricular ejection fraction (30.8 ± 7.1 vs. 36.1 ± 6.9%; p = 0.032) as well a rise of GLS 10.3 ± 2.7 vs. −12.9 ± 4.2; p = 0.018), of MEE (32.2 ± 10.1 vs. 38.6 ± 7.6 mL/s; p = 0.013) and of MEE index (18.4 ± 6.3 vs. 24.3 ± 6.7 mL/s/g; p = 0.022). Conclusions: CCM therapy increased left ventricular performance, improving left ventricular ejection fraction, GLS, as well as MEE and MEEi.
- Published
- 2022
- Full Text
- View/download PDF
19. Effects of Cardiac Contractility Modulation Therapy on Right Ventricular Function: An Echocardiographic Study
- Author
-
Carla Contaldi, Stefano De Vivo, Maria L. Martucci, Antonio D’Onofrio, Ernesto Ammendola, Gerardo Nigro, Vittoria Errigo, Giuseppe Pacileo, and Daniele Masarone
- Subjects
cardiac contractility modulation ,right ventricular function ,right ventricle–pulmonary artery coupling ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
Background. Cardiac contractility modulation (CCM) is a novel device-based therapy for patients with heart failure with reduced and mild reduced ejection fraction (HFrEF/HFmrEF). CCM increases cardiac performance and produces reverse left ventricular remodeling, with improved symptoms, functional capacity, quality of life, and reduced HF-related hospitalizations. However, to date, little evidence is available on the effects of CCM on right ventricle (RV) function. Therefore, we analyzed the effects of CCM on RV systolic function and RV–pulmonary artery (PA) coupling. Methods. Twenty-one (65 ± 12.5 years) patients with NYHA class III, ejection fraction < 40% and QRS < 120 ms were assessed at baseline. During follow up, two patients had died, and so nineteen patients were evaluated six months after CCM therapy. Using echocardiography, tricuspid annular systolic excursion (TAPSE), myocardial systolic excursion velocity (RVs), and RV free-wall strain was measured. PA systolic pressure (PASP) was estimated from tricuspid regurgitation, adding the right atrial pressure estimation. The RV-PA coupling was calculated as TAPSE/PASP ratio. Results. After six months, patients who underwent CCM therapy showed a reduction in RV diameters and improved RV systolic function, as evidenced by the increase in both TAPSE (16.6 ± 4.2 mm vs. 18.5 ± 3.6 mm; p < 0.05), RVs (10.1 ± 1.8 cm/s vs. 11.3 ± 11.4 cm/s; p < 0.05), and RV strain (−13.7 ± 1.8% vs. −15.6 ± 2.3%; p < 0.05). CCM also determined a reduction in PASP (34.2 ± 9.8 mmHg vs. 28 ± 6.2 mmHg; p < 0.05) and an increase in the TAPSE/PASP ratio (0.52 ± 0.14 mm/mmHg vs. 0.66 ± 0.23 mm/mmHg; p < 0.05). Conclusions. At six months, CCM increases RV reverse remodeling and performance, reducing RV size and improving RV systolic function, PASP, and RV-PA coupling.
- Published
- 2022
- Full Text
- View/download PDF
20. Levosimendan as a 'Bridge to Optimization' in Patients with Advanced Heart Failure with Reduced Ejection—A Single-Center Study
- Author
-
Daniele Masarone, Michelle M. Kittleson, Maria L. Martucci, Fabio Valente, Rita Gravino, Marina Verrengia, Ernesto Ammendola, Carla Contaldi, Vito Di Palma, Angelo Caiazzo, Andrea Petraio, Piero Pollesello, and Giuseppe Pacileo
- Subjects
levosimendan ,disease modifier drugs ,advanced heart failure ,heart failure reduced ejection fraction ,Medicine - Abstract
Background: Patients with advanced heart failure with reduced ejection fraction often cannot tolerate target doses of guideline-directed medical therapy due to symptomatic hypotension, renal dysfunction, and associated electrolyte abnormalities. While levosimendan can facilitate the titration of β-blockers in patients with advanced HFrEF, it is unclear whether ambulatory levosimendan infusions would offer the same benefit. In this prospective study, we investigate the effects of intermittent ambulatory levosimendan infusions on the uptitration of disease-modifying drugs. Methods: We enrolled 37 patients with advanced HFrEF who received repeated ambulatory infusions of levosimendan between January 2018 and January 2021. The demographic, clinical, and laboratory data were acquired 24 h before the first and the last ambulatory levosimendan infusion. Results: At the 1 year follow-up, the enrolled patients were on significantly higher doses of guideline-directed medical therapy, including bisoprolol (3.2 ± 2.8 mg vs. 5.9 ± 4.1 mg; p = 0.02), sacubitril/valsartan (41.67 ± 32.48 mg vs. 68.5 ± 35.72 mg; p = 0.01), and eplerenone (12.7 ± 8.5 mg vs. 22.8 ± 13.6 mg; p = 0.03). Furthermore, a substantial decrease in the furosemide dose was observed (123.2 ± 32.48 mg vs. 81.6 ± 19.47 mg; p < 0.0001). Conclusions: Levosimendan facilitates the optimization of disease-modifying heart failure medications in previously intolerant advanced HFrEF patients.
- Published
- 2022
- Full Text
- View/download PDF
21. Berlin Heart EXCOR® pediatric ventricular assist device in a patient with Sotos syndrome: a case report
- Author
-
Rita Gravino, Giuseppe Limongelli, Andrea Petraio, Daniele Masarone, Maria Giovanna Russo, Ciro Maiello, Marina Verrengia, Danilo De Paulis, and Giuseppe Pacileo
- Subjects
Sotos syndrome ,NSD1 gene ,Berlin Heart EXCOR® pediatric ventricular assist device ,Medicine - Abstract
Abstract Introduction Berlin Heart EXCOR® pediatric ventricular assist device is a mechanical circulatory support device currently used in pediatric patients. Sotos syndrome is a well-described multiple anomaly syndrome characterized by overgrowth, distinctive craniofacial appearance, cardiac abnormalities, and variable learning disabilities. Case presentation We describe a 7-year-old female Caucasian child with classic Sotos syndrome features subjected to implantation of Berlin Heart EXCOR® pediatric biventricular assist device mechanical support. A heart transplant was carried out after a support time of 459 days. After 5 years of follow-up, our patient is clinically stable and the performance of the transplanted heart is excellent. Conclusion This case confirms that Berlin Heart EXCOR® pediatric ventricular assist device can provide satisfactory and safe circulatory support for children with end-stage heart diseases, even in those with Sotos syndrome. The syndrome is not a contraindication to implantation, since the complications are the same as those observed in patients without the syndrome and the prognosis is not affected by the disease.
- Published
- 2019
- Full Text
- View/download PDF
22. Advanced heart failure: state of the art and future directions
- Author
-
Daniele Masarone, Michelle Kittleson, Andrea Petraio, and Giuseppe Pacileo
- Subjects
advanced heart failure ,acutely decompensated heart failure ,inotropes ,left ventricular assist device ,heartmate 3 ,heart transplant ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Advanced heart failure is a clinical challenge that requires a pathophysiological-based approach. As the field has been the subject of multiple reviews, the objective of this paper is not to duplicate these publications but rather to offer practical tips for the clinical cardiologist to enable the optimal management of patients with advanced heart failure. Advanced heart failure is defined as a clinical syndrome characterized by severe and persistent symptoms, most commonly with severe ventricular dysfunction, despite optimized medical therapy. This review covers the management of the advanced heart failure patient from pharmacologic therapy with disease-modifying drugs, to the use of electrical therapy devices, percutaneous valve repair and finally to the role of left ventricular assist devices and heart transplantation. The review also explores future directions in the management of advanced heart failure, including translational perspectives for the treatment of this syndrome.
- Published
- 2022
- Full Text
- View/download PDF
23. The Role of Echocardiography in the Management of Heart Transplant Recipients
- Author
-
Daniele Masarone, Michelle Kittleson, Rita Gravino, Fabio Valente, Andrea Petraio, and Giuseppe Pacileo
- Subjects
echocardiography ,heart transplant ,cardiac allograft vasculopathy ,heart transplant rejection ,Medicine (General) ,R5-920 - Abstract
Transthoracic echocardiography is the primary non-invasive modality for the investigation of heart transplant recipients. It is a versatile tool that provides comprehensive information on cardiac structure and function. Echocardiography is also helpful in diagnosing primary graft dysfunction and evaluating the effectiveness of therapeutic approaches for this condition. In acute rejection, echocardiography is useful with suspected cellular or antibody-mediated rejection, with findings confirmed and quantified by endomyocardial biopsy. For identifying chronic rejection, ultrasound has a more significant role and, in some specific patients (e.g., patients with renal failure), it may offer a role comparable to coronary angiography to identify cardiac allograft vasculopathy. This review highlights the usefulness of echocardiography in evaluating normal graft function and its role in the management of heart transplant recipients.
- Published
- 2021
- Full Text
- View/download PDF
24. The Use of β-Blockers in Heart Failure with Reduced Ejection Fraction
- Author
-
Daniele Masarone, Maria Luigia Martucci, Vittoria Errigo, and Giuseppe Pacileo
- Subjects
β-blockers ,heart failure with reduced ejection fraction ,pharmacologic therapy ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Treatment with β-blockers is the main strategy for managing patients with heart failure and reduced ejection fraction because of their ability to reverse the neurohumoral effects of the sympathetic nervous system, with consequent prognostic and symptomatic benefits. However, to date, they are underused, mainly because of the misconception that hypotension and bradycardia may worsen the haemodynamic status of patients with HFrEF and because of the presence of comorbidities falsely believed to be absolute contraindications to their use. To promote proper use of β-blockers in this article, we review the clinical pharmacology of β-blockers, the evidence of the beneficial effects of these drugs in heart failure with reduced ejection fraction, and the current guidelines for their use in clinical practice and in the presence of comorbidities (e.g., pulmonary disease, diabetes, atrial fibrillation, peripheral arterial disease, etc.). It is hoped that the practical approach discussed in this review will allow for a proper diffusion of knowledge about the correct use of β-blockers and the drug-disease interactions to achieve their increased use and titration, as well as for the selection of a specific agent with a view to a properly tailored approach for HFrEF patients.
- Published
- 2021
- Full Text
- View/download PDF
25. Pediatric Heart Failure: A Practical Guide to Diagnosis and Management
- Author
-
Daniele Masarone, Fabio Valente, Marta Rubino, Rossella Vastarella, Rita Gravino, Alessandra Rea, Maria Giovanna Russo, Giuseppe Pacileo, and Giuseppe Limongelli
- Subjects
cardiomyopathies ,congenital heart diseases ,pediatric cardiac transplantation ,pediatric heart failure ,Pediatrics ,RJ1-570 - Abstract
Pediatric heart failure represents an important cause of morbidity and mortality in childhood. Currently, there are well-established guidelines for the management of heart failure in the adult population, but an equivalent consensus in children is lacking. In the clinical setting, ensuring an accurate diagnosis and defining etiology is essential to optimal treatment. Diuretics and angiotensin-converting enzyme inhibition are the first-line therapies, whereas beta-blockers and devices for electric therapy are less used in children than in adults. In the end-stage disease, heart transplantation is the best choice of treatment, while a left ventricular assist device can be used as a bridge to transplantation (due to the difficulties in finding organ donors), recovery (in the case of myocarditis), or destination therapy (for patients with systemic disease).
- Published
- 2017
- Full Text
- View/download PDF
26. Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction
- Author
-
Daniele Masarone, Vittoria Errigo, Enrico Melillo, Fabio Valente, Rita Gravino, Marina Verrengia, Ernesto Ammendola, Rossella Vastarella, and Giuseppe Pacileo
- Subjects
sacubitril/valsartan ,heart failure reduced ejection fraction ,right ventricle ,right ventricular arterial coupling ,Medicine - Abstract
Background: right ventricle-pulmonary artery (RV-PA) coupling assessed by measuring the tricuspid anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been recently proposed as an early marker of right ventricular dysfunction in patients with heart failure with a reduced ejection fraction (HFrEF). Methods: As the effects of sacubitril/valsartan therapy on RV-PA coupling remain unknown, this study aimed to analyse the effect of this drug on TAPSE/PASP in patients with HFrEF. We retrospectively analysed all outpatients with HFrEF referred to our unit between October 2016 and July 2018. Results: At the 1-year follow-up, sacubitril/valsartan therapy was associated with a significant improvement in TAPSE (18.26 ± 3.7 vs. 19.6 ± 4.2 mm, p < 0.01), PASP (38.3 ± 15.7 vs. 33.7 ± 13.6, p < 0.05), and RV-PA coupling (0.57 ± 0.25 vs. 0.68 ± 0.30 p < 0.01). These improvements persisted at the 2-year follow-up. In the multivariable analysis, the improvement in the RV-PA coupling was independent of the left ventricular remodelling. Conclusions: in patients with HFrEF, sacubitril/valsartan improved the RV-PA coupling; however, further trials are necessary to evaluate the role of sacubitril/valsartan in the treatment of right ventricle (RV) dysfunction either associated or not associated with left ventricular dysfunction.
- Published
- 2020
- Full Text
- View/download PDF
27. A therapeutic genome editing primer for cardiologists
- Author
-
Martina Caiazza, Daniele Masarone, and Giuseppe Limongelli
- Subjects
Therapeutic genome editing ,cardiovascular disease. ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Genome editing, or genome engineering is a type of genetic engineering in which DNA is inserted, deleted or replaced in the genome of a living organism using engineered nucleases, or molecular scissors. Genome editing is being rapidly adopted into all fields of biomedical research, including the cardiovascular field, where it has facilitated a greater understanding of lipid metabolism, electrophysiology, cardiomyopathies, and other cardiovascular disorders, has helped to create a wider variety of cellular and animal models, and has opened the door to a new class of therapies. In this review, we discuss the applications of in vivo genome-editing therapies for cardiovascular disorder.
- Published
- 2018
- Full Text
- View/download PDF
28. Pathogenesis of Takotsubo syndrome
- Author
-
Daniele Masarone, Valeria Maddaloni, Marta Rubino, Fiorella Fratta, Annapaola Cirillo, Ludovica Spinelli Barrile, Roberta Pacileo, Adelaide Fusco, Guido Coppola, Francesca Pisacane, Paolo Calabrò, Raffaele Calabrò, Edoardo Bossone, Maria Giovanna Russo, and Giuseppe Pacileo
- Subjects
Takotsubo syndrome ,catecholamine induced myocardial toxicity ,pathophysiology. ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Takotsubo syndrome (TTS) is an enigmatic disease with a multifactorial and still unresolved pathogenesis. Postulated mechanisms include catecholamine excess, coronary artery spasm, and microvascular dysfunction, however catecholamines seem to play a central role in the pathophysiology of TTS. In facts catecholamines have relevant effects on the vasculature and myocardium. Toxic direct effects of catecholamine on myocardium are mediated by multiple pathway including functional hypoxia, metabolic changes and changes in membrane permeability leading to various electrolytic imbalances. Recently report of familial cases has suggested a genetic component. Further research is required to help clarify the proposed hypotheses and to increase our understanding of the cardiovascular responses to acute stress and the pathophysiology underpinning TTS.
- Published
- 2017
- Full Text
- View/download PDF
29. Growth Hormone Deficiency Is Associated with Worse Cardiac Function, Physical Performance, and Outcome in Chronic Heart Failure: Insights from the T.O.S.CA. GHD Study.
- Author
-
Michele Arcopinto, Andrea Salzano, Francesco Giallauria, Eduardo Bossone, Jörgen Isgaard, Alberto M Marra, Emanuele Bobbio, Olga Vriz, David N Åberg, Daniele Masarone, Amato De Paulis, Lavinia Saldamarco, Carlo Vigorito, Pietro Formisano, Massimo Niola, Francesco Perticone, Domenico Bonaduce, Luigi Saccà, Annamaria Colao, Antonio Cittadini, and T.O.S.CA. (Trattamento Ormonale Scompenso CArdiaco) Investigators
- Subjects
Medicine ,Science - Abstract
Although mounting evidence supports the concept that growth hormone (GH) deficiency (GHD) affects cardiovascular function, no study has systematically investigated its prevalence and role in a large cohort of chronic heart failure (CHF) patients. Aim of this study is to assess the prevalence of GHD in mild-to-moderate CHF and to explore clinical and functional correlates of GHD.One-hundred thirty CHF patients underwent GH provocative test with GHRH+arginine and accordingly categorized into GH-deficiency (GHD, n = 88, age = 61.6±1.1 years, 68% men) and GH-sufficiency (GHS, n = 42, age = 63.6±1.5 years, 81% men) cohorts. Both groups received comprehensive cardiovascular examination and underwent Doppler echocardiography, cardiopulmonary exercise testing, and biochemical and hormonal assay.GHD was detected in roughly 30% of CHF patients. Compared to GHD, GHS patients showed smaller end-diastolic and end-systolic LV volumes (-28%, p = .008 and -24%, p = .015, respectively), lower LV end-systolic wall stress (-21%, p = .03), higher RV performance (+18% in RV area change, p = .03), lower estimated systolic pulmonary artery pressure (-11%, p = .04), higher peak VO2 (+20%, p = .001) and increased ventilatory efficiency (-12% in VE/VCO2 slope, p = .002). After adjusting for clinical covariates (age, gender, and tertiles of LV ejection fraction, IGF-1, peak VO2, VE/VCO2 slope, and NT-proBNP), logistic multivariate analysis showed that peak VO2 (β = -1.92, SE = 1.67, p = .03), VE/VCO2 slope (β = 2.23, SE = 1.20, p = .02) and NT-proBNP (β = 2.48, SE = 1.02, p = .016), were significantly associated with GHD status. Finally, compared to GHS, GHD cohort showed higher all-cause mortality at median follow-up of 3.5 years (40% vs. 25%, p < .001, respectively), independent of age, sex, NT-proBNP, peak VO2 and LVEF.GH deficiency identifies a subgroup of CHF patients characterized by impaired functional capacity, LV remodeling and elevated NT-proBNP levels. GHD is also associated with increased all-cause mortality.
- Published
- 2017
- Full Text
- View/download PDF
30. Beta Blockers Up-Titration in Patients with Heart Failure Reduced Ejection Fraction and Cardiac Resynchronization Therapy, a Single Center Study
- Author
-
Daniele Masarone, Marina Verrengia, Ernesto Ammendola, Rita Gravino, Fabio Valente, Rossella Vastarella, Marta Rubino, Giuseppe Limongelli, and Giuseppe Pacileo
- Subjects
heart failure reduced ejection fraction ,beta-blockers ,cardiac resynchronization therapy ,Medicine - Abstract
Clinical trials have shown the benefits of β-blockers therapy in patients with heart failure reduced ejection fraction. These benefits include improved survival and a reduced need for hospitalization. Cardiac resynchronization therapy has emerged as an essential device-based therapy for symptomatic patients with heart failure reduced ejection fraction despite optimal pharmacologic treatment. The extent to which β-blockers are being utilized in patients receiving cardiac resynchronization therapy is not well known. In this study, we evaluate the possibility of increasing β-blockers doses in an unselected cohort of heart failure reduced ejection patients after cardiac resynchronization therapy capable defibrillator system implantation and the correlation between β-blockers treatments and clinical outcome. Methods and results: Patients with heart failure reduced ejection fraction in β-blockers therapy that underwent cardiac resynchronization therapy capable defibrillator system implantation between July 2008, and December 2016 were enrolled in the study. The β-blockers dose was determined at the time of discharge and during follow-up. Cardiovascular mortality, hospitalization for worsening heart failure or arrhythmic storm and appropriate intervention of the device, were recorded. The study cohort included 480 patients, 289 patients (60.3%) had β-blockers doses equal to the dose before CRT (Group 1), 191 patients (39.7%) had higher β-blockers doses than those before the CRT implant (Group 2). Comparing the two groups, Group 2 have lower cardiovascular mortality, heart failure-related hospitalization, and arrhythmic events than Group 1. Conclusion: After initiating CRT, β-blockers could be safely up-titrated at higher doses with the reduction in mortality, heart failure-related hospitalization, and arrhythmic events.
- Published
- 2019
- Full Text
- View/download PDF
31. Risk Stratification of Sudden Cardiac Death in Patients with Heart Failure: An update
- Author
-
Daniele Masarone, Giuseppe Limongelli, Ernesto Ammendola, Marina Verrengia, Rita Gravino, and Giuseppe Pacileo
- Subjects
sudden cardiac death ,heart failure reduced ejection fraction ,heart failure preserved ejection fraction ,Medicine - Abstract
Heart failure (HF) is a complex clinical syndrome in which structural/functional myocardial abnormalities result in symptoms and signs of hypoperfusion and/or pulmonary or systemic congestion at rest or during exercise. More than 80% of deaths in patients with HF recognize a cardiovascular cause, with most being either sudden cardiac death (SCD) or death caused by progressive pump failure. Risk stratification of SCD in patients with HF and preserved (HFpEF) or reduced ejection fraction (HFrEF) represents a clinical challenge. This review will give an update of current strategies for SCD risk stratification in both HFrEF and HFpEF.
- Published
- 2018
- Full Text
- View/download PDF
32. Mutations in the GLA Gene and LysoGb3: Is It Really Anderson-Fabry Disease?
- Author
-
Giovanni Duro, Carmela Zizzo, Giuseppe Cammarata, Alessandro Burlina, Alberto Burlina, Giulia Polo, Simone Scalia, Roberta Oliveri, Serafina Sciarrino, Daniele Francofonte, Riccardo Alessandro, Antonio Pisani, Giuseppe Palladino, Rosa Napoletano, Maurizio Tenuta, Daniele Masarone, Giuseppe Limongelli, Eleonora Riccio, Andrea Frustaci, Cristina Chimenti, Claudio Ferri, Federico Pieruzzi, Maurizio Pieroni, Marco Spada, Cinzia Castana, Marina Caserta, Ines Monte, Margherita Stefania Rodolico, Sandro Feriozzi, Yuri Battaglia, Luisa Amico, Maria Angela Losi, Camillo Autore, Marco Lombardi, Carmine Zoccali, Alessandra Testa, Maurizio Postorino, Renzo Mignani, Elisabetta Zachara, Antonello Giordano, and Paolo Colomba
- Subjects
Fabry disease ,GLA gene ,LysoGb3 ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Anderson-Fabry disease (FD) is a rare, progressive, multisystem storage disorder caused by the partial or total deficit of the lysosomal enzyme α-galactosidase A (α-Gal A). It is an X-linked, lysosomal enzymopathy due to mutations in the galactosidase alpha gene (GLA), encoding the α-Gal A. To date, more than 900 mutations in this gene have been described. In our laboratories, the study of genetic and enzymatic alterations related to FD was performed in about 17,000 subjects with a symptomatology referable to this disorder. The accumulation of globotriaosylsphingosine (LysoGb3) was determined in blood of positives. Exonic mutations in the GLA gene were detected in 471 patients (207 Probands and 264 relatives): 71.6% of mutations were associated with the classic phenotype, 19.8% were associated with the late-onset phenotype, and 8.6% of genetic variants were of unknown significance (GVUS). The accumulation of LysoGb3 was found in all male patients with a mutation responsible for classic or late-onset FD. LysoGb3 levels were consistent with the type of mutations and the symptomatology of patients. α-Gal A activity in these patients is absent or dramatically reduced. In recent years, confusion about the pathogenicity of some mutations led to an association between non-causative mutations and FD. Our study shows that the identification of FD patients is possible by associating clinical history, GLA gene analysis, α-Gal A assay, and blood accumulation of LysoGB3. In our experience, LysoGB3 can be considered a reliable marker, which is very useful to confirm the diagnosis of Fabry disease.
- Published
- 2018
- Full Text
- View/download PDF
33. Management of Arrhythmias in Heart Failure
- Author
-
Daniele Masarone, Giuseppe Limongelli, Marta Rubino, Fabio Valente, Rossella Vastarella, Ernesto Ammendola, Rita Gravino, Marina Verrengia, Gemma Salerno, and Giuseppe Pacileo
- Subjects
heart failure ,tachyarrhythmias ,bradyarrhythmias ,sudden cardiac death ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Heart failure patients are predisposed to develop arrhythmias. Supraventricular arrhythmias can exacerbate the heart failure symptoms by decreasing the effective cardiac output and their control require pharmacological, electrical, or catheter-based intervention. In the setting of atrial flutter or atrial fibrillation, anticoagulation becomes paramount to prevent systemic or cerebral embolism. Patients with heart failure are also prone to develop ventricular arrhythmias that can present a challenge to the managing clinician. The management strategy depends on the type of arrhythmia, the underlying structural heart disease, the severity of heart failure, and the range from optimization of heart failure therapy to catheter ablation. Patients with heart failure, irrespective of ejection fraction are at high risk for developing sudden cardiac death, however risk stratification is a clinical challenge and requires a multiparametric evaluation for identification of patients who should undergo implantation of a cardioverter defibrillator. Finally, patients with heart failure can also develop symptomatic bradycardia, caused by sinus node dysfunction or atrio-ventricular block. The treatment of bradycardia in these patients with pacing is usually straightforward but needs some specific issue.
- Published
- 2017
- Full Text
- View/download PDF
34. HOPE for a better selection of patients for cardiac contractility modulation
- Author
-
Daniele Masarone, Ishu Rao, and Giuseppe Pacileo
- Subjects
Biomedical Engineering ,Surgery ,General Medicine - Published
- 2023
35. Artificial intelligence in cardiovascular prevention: new ways will open new doors
- Author
-
Michele Ciccarelli, Francesco Giallauria, Albino Carrizzo, Valeria Visco, Angelo Silverio, Arturo Cesaro, Paolo Calabrò, Nicola De Luca, Costantino Mancusi, Daniele Masarone, Giuseppe Pacileo, Nidal Tourkmani, Carlo Vigorito, and Carmine Vecchione
- Subjects
General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
36. Use of Levosimendan in Patients with Pulmonary Hypertension: What is the Current Evidence?
- Author
-
Daniele Masarone, Michelle Kittleson, Piero Pollesello, Ryan J. Tedford, and Giuseppe Pacileo
- Subjects
Pharmacology (medical) - Published
- 2023
37. Interatrial Septal Devices for HFpEF: What We Learned from REDUCE LAP-HF
- Author
-
Alec Biscopink, William Mostertz, Jagpreet Grewal, Daniel N. Silverman, Daniele Masarone, and Ryan J. Tedford
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2022
38. Use of Cardiac Contractility Modulation in an Older Patient with Non-Ischemic Dilated Cardiomyopathy: A Case Report
- Author
-
Gianluca Ceravolo, Stefana Minichiello, Antonio Fiorentino, Gianvito Manganelli, Giuseppe Bianchino, Daniele Masarone, Giuseppe Pacileo, and Gennaro Bellizzi
- Subjects
medicine.medical_specialty ,Medicine (General) ,business.industry ,non-ischemic dilated cardiomyopathy ,Case Report ,Dilated cardiomyopathy ,General Medicine ,medicine.disease ,Poor quality ,cardiac contractility modulation ,Cardiac contractility modulation ,chronic heart failure ,medicine.anatomical_structure ,R5-920 ,Quality of life ,quality of life ,Ventricle ,Internal medicine ,medicine ,Cardiology ,In patient ,Non ischemic ,business ,Medical therapy - Abstract
Cardiac contractility modulation (CCM) is a novel device-based therapy used in patients with HFrEF. CCM therapy is associated with an improvement in exercise tolerance, increased quality of life, reduced HF hospitalizations, and reverse remodelling of the left ventricle in patients with HFrEF. In this case, we report the clinical benefit of CCM in an older patient with advanced HFrEF due to ischemic dilated cardiomyopathy with frequent heart failure-related hospitalizations and poor quality of life despite optimal medical therapy.
- Published
- 2021
39. Echocardiography in Advanced Heart Failure for Diagnosis, Management, and Prognosis
- Author
-
Daniele Masarone, Ernesto Ammendola, Marina Verrengia, Enrico Melillo, Jae K. Oh, Giuseppe Pacileo, Fabio Valente, Rossella Vastarella, and Roberta Pacileo
- Subjects
Heart Failure ,medicine.medical_specialty ,business.industry ,High mortality ,Advanced stage ,Hemodynamics ,General Medicine ,Disease ,Prognosis ,medicine.disease ,Clinical Practice ,Echocardiography ,Heart failure ,Diagnosis management ,Circulatory system ,Heart Transplantation ,Humans ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Abstract
Advanced heart failure, an end-stage disease characterized by high mortality and morbidity despite standard medical therapy, requires various therapeutic strategies like heart transplant and long-term mechanical circulatory support. Echocardiography is the main imaging technique to identify transitions to advanced stages of disease and guide risk stratification and therapeutic decision-making processes. Progressive development of advanced echocardiographic techniques allows more comprehensive assessment of the hemodynamic and structural profiles of patients with advanced heart failure, and its use in clinical practice continues to expand. This article provides an overview of basic and emerging echocardiographic tools to assess patients with advanced heart failure.
- Published
- 2021
40. Inotropes in Patients with Advanced Heart Failure
- Author
-
Gerhard Pölzl, Daniele Masarone, Vittoria Errigo, Andrea Petraio, Maria Luigia Martucci, Giuseppe Pacileo, Rita Gravino, Enrico Melillo, and Angelo Caiazzo
- Subjects
Inotrope ,medicine.medical_specialty ,Palliative care ,business.industry ,medicine.medical_treatment ,General Medicine ,Levosimendan ,medicine.disease ,Heart failure ,Ventricular assist device ,Internal medicine ,medicine ,Cardiology ,Milrinone ,Dobutamine ,Cardiology and Cardiovascular Medicine ,Adverse effect ,business ,medicine.drug - Abstract
Patients with advanced heart failure suffer from severe and persistent symptoms, often not responding disease-modifying drugs, a marked limitation of functional capacity and poor quality of life that can ameliorate with inotropic drugs therapy. In small studies, pulsed infusions of classical inotropes (ie, dobutamine and milrinone) are associated with improvement in hemodynamic parameters and quality of life in patients with advanced heart failure. However, because of the adverse effects of these drugs, serious safety issues have been raised. Levosimendan is a calcium-sensitizing inodilators with a triple mechanism of action, whose infusion results in hemodynamic, neurohormonal, and inflammatory cytokine improvements in patients with chronic advanced HF. In addition, levosimendan has important pleiotropic effects, including protection of myocardial, renal, and liver cells from ischemia-reperfusion injury, and anti-inflammatory and antioxidant effects; these properties possibly make levosimendan an "organ protective" inodilator. In clinical trials and real-world evidence, infusion of levosimendan at fixed intervals is safe and effective in patients with advanced HF, alleviating clinical symptoms, reducing hospitalizations, and improving the quality of life. Therefore, the use of repeated doses of levosimendan could represent the therapy of choice as a bridge to transplant/left ventricular assist device implantation or as palliative therapy in patients with advanced heart failure.
- Published
- 2021
41. Genome Editing and Heart Failure
- Author
-
Daniele Masarone, Martina Caiazza, Federica Amodio, Enrico Melillo, Roberta Pacileo, Giuseppe Limongelli, and Giuseppe Pacileo
- Published
- 2022
42. Genome Editing and Heart Failure
- Author
-
Daniele, Masarone, Martina, Caiazza, Federica, Amodio, Enrico, Melillo, Roberta, Pacileo, Giuseppe, Limongelli, and Giuseppe, Pacileo
- Subjects
Gene Editing ,Heart Failure ,Risk Factors ,Humans ,Heart ,Syndrome - Abstract
Heart failure is a leading and growing cause of morbidity and mortality worldwide and clinically is defined by the presence of typical symptoms and signs due structural or functional cardiac abnormalities. In addition to family history of heart failure, genetic predisposition to cardiomyopathies and exposure to cardiotoxic agents, risk factors for heart failure with reduced ejection fraction are the same as for chronic coronary syndrome. Genome editing technologies can provide the tools to correct genetic defects responsible for various diseases, including cardiomyopathies. These technologies aim to reverse specific mutations. The same methods can also be applied to modulate and improve heart function. This chapter will briefly explain the pathophysiological and genetic aspects of heart failure and then discuss the clinical applications of genome editing in patients with heart failure.
- Published
- 2022
43. Left Ventricular Assist Device Implantation in a Thrombosed Apical Aneurysm
- Author
-
Giuseppe Pacileo, Daniele Masarone, Rita Gravino, Rossella Vastarella, Andrea Petraio, Enrico Melillo, Angelo Caiazzo, and F Ursomando
- Subjects
Acute coronary syndrome ,2019-20 coronavirus outbreak ,Apical aneurysm ,medicine.medical_specialty ,Medicine (General) ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,Thrombosed aneurysm ,Case Report ,General Medicine ,medicine.disease ,advanced heart failure ,Surgery ,R5-920 ,Ventricular assist device ,Hospital admission ,cardiovascular system ,left ventricular assist device ,Medicine ,cardiovascular diseases ,business ,apical aneurysm ,HeartMate III - Abstract
Left ventricular assist device implantation is a challenging procedure in the presence of a giant thrombosed aneurysm, and no standard surgical techniques are currently recommended in this setting. In this case, we report the successful implantation of a left ventricular assist device (HeartMate III) in a patient with a massive thrombosed apical aneurysm. The patient presented with extended antero-apical necrosis as a result of a delay in hospital admission for acute coronary syndrome due to the patient’s concerns about the COVID-19 pandemic outbreak.
- Published
- 2021
44. Levosimendan as a “Bridge to Optimization” in Patients with Advanced Heart Failure with Reduced Ejection—A Single-Center Study
- Author
-
Pacileo, Daniele Masarone, Michelle M. Kittleson, Maria L. Martucci, Fabio Valente, Rita Gravino, Marina Verrengia, Ernesto Ammendola, Carla Contaldi, Vito Di Palma, Angelo Caiazzo, Andrea Petraio, Piero Pollesello, and Giuseppe
- Subjects
levosimendan ,disease modifier drugs ,advanced heart failure ,heart failure reduced ejection fraction - Abstract
Background: Patients with advanced heart failure with reduced ejection fraction often cannot tolerate target doses of guideline-directed medical therapy due to symptomatic hypotension, renal dysfunction, and associated electrolyte abnormalities. While levosimendan can facilitate the titration of β-blockers in patients with advanced HFrEF, it is unclear whether ambulatory levosimendan infusions would offer the same benefit. In this prospective study, we investigate the effects of intermittent ambulatory levosimendan infusions on the uptitration of disease-modifying drugs. Methods: We enrolled 37 patients with advanced HFrEF who received repeated ambulatory infusions of levosimendan between January 2018 and January 2021. The demographic, clinical, and laboratory data were acquired 24 h before the first and the last ambulatory levosimendan infusion. Results: At the 1 year follow-up, the enrolled patients were on significantly higher doses of guideline-directed medical therapy, including bisoprolol (3.2 ± 2.8 mg vs. 5.9 ± 4.1 mg; p = 0.02), sacubitril/valsartan (41.67 ± 32.48 mg vs. 68.5 ± 35.72 mg; p = 0.01), and eplerenone (12.7 ± 8.5 mg vs. 22.8 ± 13.6 mg; p = 0.03). Furthermore, a substantial decrease in the furosemide dose was observed (123.2 ± 32.48 mg vs. 81.6 ± 19.47 mg; p < 0.0001). Conclusions: Levosimendan facilitates the optimization of disease-modifying heart failure medications in previously intolerant advanced HFrEF patients.
- Published
- 2022
- Full Text
- View/download PDF
45. Angiotensin‐converting enzyme inhibitor therapy after heart transplant: From molecular basis to clinical effects
- Author
-
Daniele, Masarone, Ryan J, Tedford, Enrico, Melillo, Andrea, Petraio, and Giuseppe, Pacileo
- Subjects
Heart Failure ,Renin-Angiotensin System ,Angiotensin Receptor Antagonists ,Transplantation ,Aminobutyrates ,Biphenyl Compounds ,Hypertension ,Heart Transplantation ,Humans ,Multicenter Studies as Topic ,Angiotensin-Converting Enzyme Inhibitors - Abstract
The use of angiotensin-converting enzyme inhibitors is an important therapy for various cardiovascular diseases, such as hypertension, ischemic heart disease and heart failure (HF). In heart transplant recipients, angiotensin-converting enzyme inhibitors have been demonstrated to be a keystone for the treatment of hypertension with a wide spectrum of pleiotropic molecular effects ranging from improvement of the peripheral vascular system to regulation of the fluid and sodium balance. In addition, angiotensin-converting enzyme inhibitors may be also useful in the prevention of graft failure, cardiac allograft vasculopathy (CAV) and chronic kidney disease (CKD) progression. Further tailored multicenter and randomized studies are warranted to confirm the pleiotropic clinical effects of ACEi therapy in HTRs and to support more extended use in daily clinical practice. Finally in the near future, the use of novel pharmacological agents that inhibit the renin-angiotensin-aldosterone system (RAAS) such as the neprilysin inhibitor sacubitril should be investigated in heart transplant recipients.
- Published
- 2022
46. Insulin-like growth factor-1 (IGF-1) as predictor of cardiovascular mortality in heart failure patients: data from the T.O.S.CA. registry
- Author
-
Alfredo, De Giorgi, Alberto Maria, Marra, Massimo, Iacoviello, Vincenzo, Triggiani, Giuseppe, Rengo, Francesco, Cacciatore, Ciro, Maiello, Giuseppe, Limongelli, Daniele, Masarone, Francesco, Perticone, Pasquale Perrone, Filardi, Stefania, Paolillo, Antonio, Mancini, Maurizio, Volterrani, Olga, Vriz, Roberto, Castello, Andrea, Passantino, Michela, Campo, Pietro Amedeo, Modesti, Andrea, Salzano, Roberta, D'Assante, Michele, Arcopinto, Valeria, Raparelli, Fabio, Fabbian, Angela, Sciacqua, Annamaria, Colao, Toru, Suzuki, Eduardo, Bossone, Antonio, Cittadini, and D, Bruzzese
- Subjects
Adult ,Heart Failure ,Humans ,Kidney Diseases ,Stroke Volume ,Registries ,Insulin-Like Growth Factor I ,Prognosis - Abstract
Data from the "Trattamento Ormonale nello Scompenso CArdiaco" (T.O.S.CA) registry showed that heart failure (HF) represents a complex clinical syndrome with different hormonal alterations. Renal failure represents a frequent complication in HF. We evaluated the relationship between renal function and insuline-like growth factor-1 (IGF-1) deficiency and its impact on cardiovascular mortality (CVM) in patients enrolled in the T.O.S.CA. registry.At the enrolment, all subjects underwent chemistry examinations, including circulating hormones and cardiovascular functional tests. COX regression analysis was used to evaluate factors related to CVM during the follow-up period in all populations, in high-risk patients and in the young-adult population. Also, we evaluate the effects of renal function on the CVM.337 patients (41 deceased) were analyzed. CVM was related to severe renal dysfunction (HR stages IV-V = 4.86), high-risk conditions (HR 2.25), serum IGF-1 (HR 0.42), and HF etiology (HR 5.85 and HR 1.63 for valvular and ischemic etiology, respectively). In high-risk patients, CVM was related to IGF-1 levels, severe renal dysfunction and valvular etiology, whereas in young patients CMV was related to the high-risk pattern and serum IGF-1 levels.Our study showed the clinical and prognostic utility of the IGF-1 assay in patients with HF.
- Published
- 2022
47. Benefit from sacubitril/valsartan is associated with hemodynamic improvement in heart failure with reduced ejection fraction: An echocardiographic study
- Author
-
Erberto, Carluccio, Dini, Frank L., Bitto, Roberto, Michele, Ciccarelli, Michele, Correale, Andreina, D’Agostino, Dattilo, Giuseppe, Marco, Ferretti, Arianna, Grelli, Stefania, Guida, Francesca, Jacoangeli, Laura, Lupi, Lorenzo, Luschi, Daniele, Masarone, Valentina, Mercurio, Giuseppe, Pacileo, Nicola Riccardo Pugliese, Antonella, Rispoli, Laura, Scelsi, Carlo Gabriele Tocchetti, Natale Daniele Brunetti, Alberto, Palazzuoli, Massimo, Piepoli, Savina, Nodari, Giuseppe, Ambrosio, Working Group on Heart Failure of the Italian Society of, Cardiology., Carluccio, Erberto, Dini, Frank L., Bitto, Roberto, Ciccarelli, Michele, Correale, Michele, D'Agostino, Andreina, Dattilo, Giuseppe, Ferretti, Marco, Grelli, Arianna, Guida, Stefania, Jacoangeli, Francesca, Lupi, Laura, Luschi, Lorenzo, Masarone, Daniele, Mercurio, Valentina, Pacileo, Giuseppe, Pugliese, Nicola Riccardo, Rispoli, Antonella, Scelsi, Laura, Tocchetti, Carlo Gabriele, Brunetti, Natale Daniele, Palazzuoli, Alberto, Piepoli, Massimo, Nodari, Savina, and Ambrosio, Giuseppe
- Subjects
Ejection fraction ,Heart failure ,Hemodynamic ,Prognosis ,Sacubitril/valsartan ,Aminobutyrates ,Biphenyl Compounds ,Hemodynamics ,Tetrazoles ,Heart failure, Ejection fraction, Hemodynamic, Prognosis, Sacubitril/valsartan ,Stroke Volume ,Angiotensin Receptor Antagonists ,Drug Combinations ,Treatment Outcome ,Echocardiography ,Humans ,Valsartan ,Cardiology and Cardiovascular Medicine - Abstract
Sacubitril/valsartan improves outcome in patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (EF, HFrEF). However, little is known about possible mechanisms underlying this favourable effect.To assess changes in echocardiographically-derived hemodynamic profiles induced by sacubitril/valsartan and their impact on outcome.In this multicenter, open-label study, 727 HFrEF outpatients underwent comprehensive echocardiography at baseline (before starting sacubitril/valsartan) and after 12 months. Estimated LV filling pressure (E/e') and cardiac index (CI, l/min/mAt baseline, 29% had profile-A, 15% had profile-B, 32% profile-C, and 24% profile-D. After 12 months, the hemodynamic profile improved in 53% of patients (all profile-A achievers, or profile-D patients achieving either C or B profile), while it remained unchanged in 39% patients and worsened in 9%. Prevalence of improved profile progressively increased with increasing dose of sacubitril/valsartan (P 0.0001). After the second echocardiography, patients were followed up 12.6 ± 7.6 months: event-rate was lower in patients with improved profile (12.3%, 95%CI: 9.4-16.1) compared to patients in whom hemodynamic profile remained unchanged (29.9%, 24.0-37.3) or worsened (31.2%, 20.7-46.9, P 0.0001). Improved hemodynamic profile was associated with favourable outcome independent of LVEF and other covariates (HR 0.65, 95%CI: 0.45-0.95, P 0.05).In HFrEF patients, the beneficial prognostic effects of sacubitril/valsartan are associated with improvement in hemodynamic conditions.
- Published
- 2022
48. Add-on Therapy With Sacubitril/Valsartan and Clinical Outcomes in CRT-D Nonresponder Patients
- Author
-
Vincenzo Russo, Ernesto Ammendola, Alessio Gasperetti, Roberta Bottino, Marco Schiavone, Daniele Masarone, Giuseppe Pacileo, Gerardo Nigro, Paolo Golino, Gregory Y. H. Lip, Antonello D'Andrea, Giuseppe Boriani, Riccardo Proietti, Russo, V., Ammendola, E., Gasperetti, A., Bottino, R., Schiavone, M., Masarone, D., Pacileo, G., Nigro, G., Golino, P., Lip, G. Y. H., D'Andrea, A., Boriani, G., and Proietti, R.
- Subjects
Pharmacology ,Heart Failure ,Aminobutyrates ,Biphenyl Compounds ,Aminobutyrate ,cardiac resynchronization therapy ,Stroke Volume ,arrhythmias ,heart failure ,sacubitril/valsartan ,ventricular remodeling ,arrhythmia ,Ventricular Function, Left ,Treatment Outcome ,Atrial Fibrillation ,Biphenyl Compound ,Humans ,Valsartan ,Cardiology and Cardiovascular Medicine ,Human - Abstract
No data on the add-on sacubitril/valsartan (S/V) therapy among cardiac resynchronization therapy with a defibrillator (CRT-D) nonresponder patients are currently available in literature. We conducted a prospective observational study including 190 CRT-D nonresponder patients with symptomatic heart failure with reduced ejection fraction despite the optimal medical therapy from at least 1 year. The primary endpoint was the rate of additional responders (left ventricular end-systolic volume reduction >15%) at 12 months from the introduction of S/V therapy. At the end of the 12 months follow-up, 37 patients (19.5%) were deemed as "additional responders" to the combination use of CRT + S/V therapy. The only clinical predictor of additional response was a lower left ventricular ejection fraction [OR 0.881 (0.815-0.953), P = 0.002] at baseline. At 12 months follow-up, there were significant improvements in heart failure (HF) symptoms and functional status [New York Heart Association 2 (2-3) vs. 1 (1-2), P < 0.001; physical activity duration/day: 10 (8-12) vs. 13 (10-18) hours, P < 0.001]. Compared with the 12 months preceding S/V introduction, there were significant reductions in the rate of HF rehospitalization (35.5% vs. 19.5%, P < 0.001), in atrial tachycardia/atrial fibrillation burden [6.0 (5.0-8.0) % vs. 0 (0-2.0) %, P < 0.001] and in the proportions of patients experiencing ventricular arrhythmias (21.6% vs. 6.3%; P < 0.001). Our results indicate that S/V add-on therapy in CRT-D nonresponder patients is associated with 19.5% of additional responders, a reduction in HF symptoms and rehospitalizations, AF burden, and ventricular arrhythmias.
- Published
- 2022
49. Prevalence and clinical significance of red flags in patients with hypertrophic cardiomyopathy
- Author
-
Giuseppe Limongelli, Emanuele Monda, Paolo Calabrò, Giuseppe Pacileo, Stefania Tramonte, Rita Gravino, Mariagiovanna Russo, Augusto Esposito, Perry M. Elliott, Ernesto Ammendola, Giulia Frisso, Daniele Masarone, Gemma Salerno, Marta Rubino, Felice Gragnano, Martina Caiazza, Limongelli, G., Monda, E., Tramonte, S., Gragnano, F., Masarone, D., Frisso, G., Esposito, A., Gravino, R., Ammendola, E., Salerno, G., Rubino, M., Caiazza, M., Russo, M., Calabro, P., Elliott, P. M., and Pacileo, G.
- Subjects
Adult ,Male ,Systemic disease ,medicine.medical_specialty ,Adolescent ,Population ,030204 cardiovascular system & hematology ,hypertrophic cardiomyopathy, red flags, genetic background ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Prevalence ,medicine ,Humans ,Clinical significance ,030212 general & internal medicine ,Family history ,Child ,education ,Aged ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Hypertrophic cardiomyopathy ,Infant ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Child, Preschool ,Cohort ,Etiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography - Abstract
Introduction: We sought to determine prevalence and predictive accuracy of clinical markers (red flags, RF), known to be associated with specific systemic disease in a consecutive cohort of patients with hypertrophic cardiomyopathy (HCM). Methods: We studied 129 consecutive patients (23.7 ± 20.9 years, range 0–74 years; male/female 68%/32%). Pre-specified RF were categorized into five domains: family history; signs/symptoms; electrocardiography; imaging; and laboratory. Sensitivity (Se), specificity (Sp), negative predictive value (NPV), positive predictive value (PPV), and predictive accuracy of RF were analyzed in the genotyped population. Results: In the overall cohort of 129 patients, 169 RF were identified in 62 patients (48%). Prevalence of RF was higher in infants (78%) and in adults >55 years old (58%). Following targeted genetic and clinical evaluation, 94 patients (74%) had a definite diagnosis (sarcomeric HCM or specific causes of HCM). We observed 14 RF in 13 patients (21%) with sarcomeric gene disease, 129 RF in 34 patients (97%) with other specific causes of HCM, and 26 RF in 15 patients (45%) with idiopathic HCM (p < 0.0001). Non-sarcomeric causes of HCM were the most prevalent in ages 55yo. Se, Sp, PPV, NPV and PA of RF were 97%, 70%, 55%, 98% and 77%, respectively. Single and clinical combination of RF (clusters) had an high specificity, NPV and predictive accuracy for the specific etiologies (syndromes/metabolic/infiltrative disorders associated with HCM). Conclusions: An extensive diagnostic work up, focused on analysis of specific diagnostic RF in patients with unexplained LVH facilitates a clinical diagnosis in 74% of patients with HCM.
- Published
- 2020
50. 164 Effect of cardiac contractility modulation therapy on myocardial work in patients with heart failure with reduced ejection fraction
- Author
-
Daniele Masarone, Stefano De Vivo, Vittoria Errigo, Antonio D’ Onofrio, Giuliano D’Alterio, Ernesto Ammedola, Gerardo Nigro, and Giuseppe Pacileo
- Subjects
Cardiology and Cardiovascular Medicine - Abstract
Aims Cardiac contractility modulation therapy (CCMT) has been shown to reduce hospitalizations and to improve quality of life in heart failure patients with reduced ejection fraction (HFrEF) who remain symptomatic despite disease-modifying therapies. Strain imaging derived myocardial work (MW) is an emerging tool for evaluating left ventricular mechanics by incorporating systolic deformation and afterload burden in the analysis. To evaluate prospectively the impact of CCMT in HFrEF patients on MW derived parameters in relation to standard echocardiographic indices. Methods and results We recruited 12 HFrEF patients with indications to CCMT according to current clinical practice. A comprehensive echo-Doppler evaluation, including speckle tracking derived assessment of global longitudinal strain (GLS), was performed before and after three months from the CCM device implantation. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW), and global work efficiency (GWE) were calculated according to standardized procedures. Median values (interquartile range) were compared for all those parameters from baseline and 3-month follow-up with Wilcoxon Rank Sum test for continuous variables. At three months from CCM implant an improvement of LVEF [from 32% (27–34) to 36% (29–39), P Conclusions At 3 months, CCMT significantly improves standard and advanced left ventricular systolic function indices. This improvement is due to the increase of constructive work and a reduction of wasted work. In addition, the increase of left ventricular ejection fraction can be predicted by the global constructive work levels at baseline.
- Published
- 2021
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.