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3. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry

Author

Gili, S, Cammann, Vl, Schlossbauer, Sa, Kato, K, D'Ascenzo, F, Di Vece, D, Jurisic, S, Micek, J, Obeid, S, Bacchi, B, Szawan, Ka, Famos, F, Sarcon, A, Levinson, R, Ding, Kj, Seifert, B, Lenoir, O, Bossone, E, Citro, R, Franke, J, Napp, Lc, Jaguszewski, M, Noutsias, M, Munzel, T, Knorr, M, Heiner, S, Katus, Ha, Burgdorf, C, Schunkert, H, Thiele, H, Bauersachs, J, Tschope, C, Pieske, Bm, Rajan, L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Hasenfuss, G, Karakas, M, Koenig, W, Rottbauer, W, Said, Sm, Braun-Dullaeus, Rc, Banning, A, Cuculi, F, Kobza, R, Fischer, Ta, Vasankari, T, Airaksinen, Kej, Opolski, G, Dworakowski, R, MacCarthy, P, Kaiser, C, Osswald, S, Galiuto, L, Crea, F, Dichtl, W, Empen, K, Felix, Sb, Delmas, C, Lairez, O, El-Battrawy, I, Akin, I, Borggrefe, M, Gilyarova, E, Shilova, A, Gilyarov, M, Horowitz, Jd, Kozel, M, Tousek, P, Widimsky, P, Winchester, De, Ukena, C, Gaita, F, Di Mario, C, Wischnewsky, Mb, Bax, Jj, Prasad, A, Bohm, M, Ruschitzka, F, Luscher, Tf, Ghadri, Jr, Templin, C, Galiuto, L (ORCID:0000-0002-6831-479X), Crea, F (ORCID:0000-0001-9404-8846), Gili, S, Cammann, Vl, Schlossbauer, Sa, Kato, K, D'Ascenzo, F, Di Vece, D, Jurisic, S, Micek, J, Obeid, S, Bacchi, B, Szawan, Ka, Famos, F, Sarcon, A, Levinson, R, Ding, Kj, Seifert, B, Lenoir, O, Bossone, E, Citro, R, Franke, J, Napp, Lc, Jaguszewski, M, Noutsias, M, Munzel, T, Knorr, M, Heiner, S, Katus, Ha, Burgdorf, C, Schunkert, H, Thiele, H, Bauersachs, J, Tschope, C, Pieske, Bm, Rajan, L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Hasenfuss, G, Karakas, M, Koenig, W, Rottbauer, W, Said, Sm, Braun-Dullaeus, Rc, Banning, A, Cuculi, F, Kobza, R, Fischer, Ta, Vasankari, T, Airaksinen, Kej, Opolski, G, Dworakowski, R, MacCarthy, P, Kaiser, C, Osswald, S, Galiuto, L, Crea, F, Dichtl, W, Empen, K, Felix, Sb, Delmas, C, Lairez, O, El-Battrawy, I, Akin, I, Borggrefe, M, Gilyarova, E, Shilova, A, Gilyarov, M, Horowitz, Jd, Kozel, M, Tousek, P, Widimsky, P, Winchester, De, Ukena, C, Gaita, F, Di Mario, C, Wischnewsky, Mb, Bax, Jj, Prasad, A, Bohm, M, Ruschitzka, F, Luscher, Tf, Ghadri, Jr, Templin, C, Galiuto, L (ORCID:0000-0002-6831-479X), and Crea, F (ORCID:0000-0001-9404-8846)

Abstract

Aims We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS).Methods and results We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission.Conclusions Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.

Published
2019

4. Prevention Italy 2021 - An update of the 2018 Consensus document and recommendations for the prevention of cardiovascular disease in Italy

Author

Battistoni, A., Gallo, G., Aragona, C. O., Barchiesi, F., Basolo, A., Bellone, S., Bellotti, P., Bertolotti, M., Bianco, A., Biffi, A., Borghi, C., Cicero, A. F. G., Consoli, A., Corsini, A., Desideri, G., Di Giacinto, B., Fernando, F., Ferri, C., Galiuto, L., Grassi, D., Grassi, G., Icardi, G., Indolfi, C., Lodi, E., Modena, M. G., Muiesan, M. L., Nati, G., Orsi, A., Palermi, S., Parati, G., Passantino, A., Patelli, A., Pelliccia, A., Pengo, M., Filardi, P. P., Perseghin, G., Pirro, M., Pontremoli, R., Rengo, G., Ricotti, R., Rizzoni, D., Rocca, B., Rotella, C., Rubattu, S., Salvetti, G., Sciacqua, A., Serdoz, A., Sirico, F., Squeo, M. R., Tocci, G., Trimarco, B., Vigili de Kreutzenberg, S., Volpe, R., and Volpe, M.

Subjects
Consensus, Italy, Humans, Risk Assessment, Risk Factors, Cardiovascular Diseases
Published
2021

6. Gut Microbiota and Cardiovascular Diseases: A Critical Review

Author

Anselmi, G., Gagliardi, Lucilla, Egidi, Gabriele, Leone, S., Gasbarrini, Antonio, Miggiano, Giacinto Abele Donato, Galiuto, Leonarda, Gagliardi L., Egidi G., Gasbarrini A. (ORCID:0000-0002-7278-4823), Miggiano G. A. D. (ORCID:0000-0002-8627-5528), Galiuto L. (ORCID:0000-0002-6831-479X), Anselmi, G., Gagliardi, Lucilla, Egidi, Gabriele, Leone, S., Gasbarrini, Antonio, Miggiano, Giacinto Abele Donato, Galiuto, Leonarda, Gagliardi L., Egidi G., Gasbarrini A. (ORCID:0000-0002-7278-4823), Miggiano G. A. D. (ORCID:0000-0002-8627-5528), and Galiuto L. (ORCID:0000-0002-6831-479X)

Abstract

The human intestine contains the largest and most diverse ecosystem of microbes. The main function of the intestinal bacterial flora is to limit the growth of potentially pathogenic microorganisms. However, the intestinal microbiota is increasingly emerging as a risk factor for the development of cardiovascular disease (CVD). The gut microbiota-derived metabolites, such as short-chain fatty acids, trimethylamine-N-oxide, bile acids, and polyphenols play a pivotal role in maintaining healthy cardiovascular function, and when dysregulated, can potentially lead to CVD. In particular, changes in the composition and diversity of gut microbiota, known as dysbiosis, have been associated with atherosclerosis, hypertension, and heart failure. Nonetheless, the underlying mechanisms remain yet to be fully understood. Therefore, the microbiota and its metabolites have become a new therapeutic target for the prevention and treatment of CVD. In addition to a varied and balanced diet, the use of prebiotic and probiotic treatments or selective trimethylamine-N-oxide inhibitors could play a pivotal role in the prevention of CVD, especially in patients with a high metabolic risk.

Published
2021

7. Impact of atrial fibrillation on outcome in takotsubo syndrome: Data from the international Takotsubo registry

Author

El-Battrawy, I., Cammann, V. L., Kato, K., Szawan, K. A., Di Vece, D., Rossi, A., Wischnewsky, M., Hermes-Laufer, J., Gili, S., Citro, R., Bossone, E., Neuhaus, M., Franke, J., Meder, B., Jaguszewski, M., Noutsias, M., Knorr, M., Heiner, S., D'Ascenzo, F., Dichtl, W., Burgdorf, C., Kherad, B., Tschope, C., Sarcon, A., Shinbane, J., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Karakas, M., Koenig, W., Pott, A., Meyer, P., Arroja, J. D., Banning, A., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Juhani Airaksinen, K. E., Napp, L. C., Budnik, M., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Chan, C., Bridgman, P., Beug, D., Delmas, C., Lairez, O., Gilyarova, E., Shilova, A., Gilyarov, M., Kozel, M., Tousek, P., Winchester, D. E., Galuszka, J., Ukena, C., Poglajen, G., Carrilho-Ferreira, P., Hauck, C., Paolini, C., Bilato, C., Kobayashi, Y., Prasad, A., Rihal, C. S., Liu, K., Schulze, P. C., Bianco, M., Jorg, L., Rickli, H., Pestana, G., Nguyen, T. H., Bohm, M., Maier, L. S., Pinto, F. J., Widimsky, P., Felix, S. B., Opolski, G., Braun-Dullaeus, R. C., Rottbauer, W., Hasenfuss, G., Pieske, B. M., Schunkert, H., Thiele, H., Bauersachs, J., Katus, H. A., Horowitz, J. D., Di Mario, C., Munzel, T., Crea, Filippo, Bax, J. J., Luscher, T. F., Ruschitzka, F., Duru, F., Borggrefe, M., Ghadri, J. R., Akin, I., Templin, C., Galiuto L. (ORCID:0000-0002-6831-479X), Crea F. (ORCID:0000-0001-9404-8846), El-Battrawy, I., Cammann, V. L., Kato, K., Szawan, K. A., Di Vece, D., Rossi, A., Wischnewsky, M., Hermes-Laufer, J., Gili, S., Citro, R., Bossone, E., Neuhaus, M., Franke, J., Meder, B., Jaguszewski, M., Noutsias, M., Knorr, M., Heiner, S., D'Ascenzo, F., Dichtl, W., Burgdorf, C., Kherad, B., Tschope, C., Sarcon, A., Shinbane, J., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Karakas, M., Koenig, W., Pott, A., Meyer, P., Arroja, J. D., Banning, A., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Juhani Airaksinen, K. E., Napp, L. C., Budnik, M., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Chan, C., Bridgman, P., Beug, D., Delmas, C., Lairez, O., Gilyarova, E., Shilova, A., Gilyarov, M., Kozel, M., Tousek, P., Winchester, D. E., Galuszka, J., Ukena, C., Poglajen, G., Carrilho-Ferreira, P., Hauck, C., Paolini, C., Bilato, C., Kobayashi, Y., Prasad, A., Rihal, C. S., Liu, K., Schulze, P. C., Bianco, M., Jorg, L., Rickli, H., Pestana, G., Nguyen, T. H., Bohm, M., Maier, L. S., Pinto, F. J., Widimsky, P., Felix, S. B., Opolski, G., Braun-Dullaeus, R. C., Rottbauer, W., Hasenfuss, G., Pieske, B. M., Schunkert, H., Thiele, H., Bauersachs, J., Katus, H. A., Horowitz, J. D., Di Mario, C., Munzel, T., Crea, Filippo, Bax, J. J., Luscher, T. F., Ruschitzka, F., Duru, F., Borggrefe, M., Ghadri, J. R., Akin, I., Templin, C., Galiuto L. (ORCID:0000-0002-6831-479X), and Crea F. (ORCID:0000-0001-9404-8846)

Abstract

BACKGROUND: Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. METHODS AND RESULTS: Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in-hospital (P<0.001) and long-term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50– 3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. CONCLUSIONS: In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. REGISTRATION: URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT01947621.

Published
2021

8. Prognostic impact of acute pulmonary triggers in patients with takotsubo syndrome: new insights from the International Takotsubo Registry

Author

Kato, K., Cammann, V. L., Napp, L. C., Szawan, K. A., Micek, J., Dreiding, S., Levinson, R. A., Petkova, V., Wurdinger, M., Patrascu, A., Sumalinog, R., Gili, S., Clarenbach, C. F., Kohler, M., Wischnewsky, M., Citro, R., Vecchione, C., Bossone, E., Neuhaus, M., Franke, J., Meder, B., Jaguszewski, M., Noutsias, M., Knorr, M., Heiner, S., D'Ascenzo, Francesca, Dichtl, W., Burgdorf, C., Kherad, B., Tschope, C., Sarcon, A., Shinbane, J., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Karakas, M., Koenig, W., Pott, A., Meyer, P., Roffi, M., Banning, A., Wolfrum, M., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Budnik, M., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Chan, C., Bridgman, P., Beug, D., Delmas, C., Lairez, O., Gilyarova, E., Shilova, A., Gilyarov, M., El-Battrawy, I., Akin, I., Kozel, M., Tousek, P., Winchester, D. E., Galuszka, J., Ukena, C., Poglajen, G., Carrilho-Ferreira, P., Hauck, C., Paolini, C., Bilato, C., Sano, M., Ishibashi, I., Takahara, M., Himi, T., Kobayashi, Y., Prasad, A., Rihal, C. S., Liu, K., Schulze, P. C., Bianco, M., Jorg, L., Rickli, H., Pestana, G., Nguyen, T. H., Bohm, M., Maier, L. S., Pinto, F. J., Widimsky, P., Felix, S. B., Opolski, G., Braun-Dullaeus, R. C., Rottbauer, W., Hasenfuss, G., Pieske, B. M., Schunkert, H., Borggrefe, M., Thiele, H., Bauersachs, J., Katus, H. A., Horowitz, J. D., Di Mario, Clara, Munzel, T., Crea, Filippo, Bax, J. J., Luscher, T. F., Ruschitzka, F., Ghadri, J. R., Templin, C., D'Ascenzo F., Galiuto L. (ORCID:0000-0002-6831-479X), Di Mario C., Crea F. (ORCID:0000-0001-9404-8846), Kato, K., Cammann, V. L., Napp, L. C., Szawan, K. A., Micek, J., Dreiding, S., Levinson, R. A., Petkova, V., Wurdinger, M., Patrascu, A., Sumalinog, R., Gili, S., Clarenbach, C. F., Kohler, M., Wischnewsky, M., Citro, R., Vecchione, C., Bossone, E., Neuhaus, M., Franke, J., Meder, B., Jaguszewski, M., Noutsias, M., Knorr, M., Heiner, S., D'Ascenzo, Francesca, Dichtl, W., Burgdorf, C., Kherad, B., Tschope, C., Sarcon, A., Shinbane, J., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Karakas, M., Koenig, W., Pott, A., Meyer, P., Roffi, M., Banning, A., Wolfrum, M., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Budnik, M., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Chan, C., Bridgman, P., Beug, D., Delmas, C., Lairez, O., Gilyarova, E., Shilova, A., Gilyarov, M., El-Battrawy, I., Akin, I., Kozel, M., Tousek, P., Winchester, D. E., Galuszka, J., Ukena, C., Poglajen, G., Carrilho-Ferreira, P., Hauck, C., Paolini, C., Bilato, C., Sano, M., Ishibashi, I., Takahara, M., Himi, T., Kobayashi, Y., Prasad, A., Rihal, C. S., Liu, K., Schulze, P. C., Bianco, M., Jorg, L., Rickli, H., Pestana, G., Nguyen, T. H., Bohm, M., Maier, L. S., Pinto, F. J., Widimsky, P., Felix, S. B., Opolski, G., Braun-Dullaeus, R. C., Rottbauer, W., Hasenfuss, G., Pieske, B. M., Schunkert, H., Borggrefe, M., Thiele, H., Bauersachs, J., Katus, H. A., Horowitz, J. D., Di Mario, Clara, Munzel, T., Crea, Filippo, Bax, J. J., Luscher, T. F., Ruschitzka, F., Ghadri, J. R., Templin, C., D'Ascenzo F., Galiuto L. (ORCID:0000-0002-6831-479X), Di Mario C., and Crea F. (ORCID:0000-0001-9404-8846)

Abstract

Aims: Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes. Methods and results: Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes. Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In-hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long-term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long-term mortality (hazard ratio 2.12, 95% confidence interval 1.33–3.38; P = 0.002). Conclusions: The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in-hospital course and a worse long-term outcome.

Published
2021

9. Prevention Italy 2021 - An update of the 2018 Consensus document and recommendations for the prevention of cardiovascular disease in Italy [Prevenzione Italia 2021 Un update del Documento di consenso e raccomandazioni per la prevenzione cardiovascolare in Italia]

Author

Battistoni, A, Gallo, G, Aragona, C, Barchiesi, F, Basolo, A, Bellone, S, Bellotti, P, Bertolotti, M, Bianco, A, Biffi, A, Borghi, C, Cicero, A, Consoli, A, Corsini, A, Desideri, G, Di Giacinto, B, Fernando, F, Ferri, C, Galiuto, L, Grassi, D, Grassi, G, Icardi, G, Indolfi, C, Lodi, E, Modena, M, Muiesan, M, Nati, G, Orsi, A, Palermi, S, Parati, G, Passantino, A, Patelli, A, Pelliccia, A, Pengo, M, Filardi, P, Perseghin, G, Pirro, M, Pontremoli, R, Rengo, G, Ricotti, R, Rizzoni, D, Rocca, B, Rotella, C, Rubattu, S, Salvetti, G, Sciacqua, A, Serdoz, A, Sirico, F, Squeo, M, Tocci, G, Trimarco, B, Vigili de Kreutzenberg, S, Volpe, R, Volpe, M, Battistoni, Allegra, Gallo, Giovanna, Aragona, Caterina Oriana, Barchiesi, Fabio, Basolo, Alessio, Bellone, Simonetta, Bellotti, Paolo, Bertolotti, Marco, Bianco, Andrea, Biffi, Alessandro, Borghi, Claudio, Cicero, Arrigo Francesco Giuseppe, Consoli, Agostino, Corsini, Alberto, Desideri, Giovambattista, Di Giacinto, Barbara, Fernando, Fredrik, Ferri, Claudio, Galiuto, Leonarda, Grassi, Davide, Grassi, Guido, Icardi, Giancarlo, Indolfi, Ciro, Lodi, Elisa, Modena, Maria Grazia, Muiesan, Maria Lorenza, Nati, Giulio, Orsi, Andrea, Palermi, Stefano, Parati, Gianfranco, Passantino, Andrea, Patelli, Alessandra, Pelliccia, Antonio, Pengo, Martino, Filardi, Pasquale Perrone, Perseghin, Gianluca, Pirro, Matteo, Pontremoli, Roberto, Rengo, Giuseppe, Ricotti, Roberta, Rizzoni, Damiano, Rocca, Bianca, Rotella, Carlo, Rubattu, Speranza, Salvetti, Guido, Sciacqua, Angela, Serdoz, Andrea, Sirico, Felice, Squeo, Maria Rosaria, Tocci, Giuliano, Trimarco, Bruno, Vigili de Kreutzenberg, Saula, Volpe, Roberto, Volpe, Massimo, Battistoni, A, Gallo, G, Aragona, C, Barchiesi, F, Basolo, A, Bellone, S, Bellotti, P, Bertolotti, M, Bianco, A, Biffi, A, Borghi, C, Cicero, A, Consoli, A, Corsini, A, Desideri, G, Di Giacinto, B, Fernando, F, Ferri, C, Galiuto, L, Grassi, D, Grassi, G, Icardi, G, Indolfi, C, Lodi, E, Modena, M, Muiesan, M, Nati, G, Orsi, A, Palermi, S, Parati, G, Passantino, A, Patelli, A, Pelliccia, A, Pengo, M, Filardi, P, Perseghin, G, Pirro, M, Pontremoli, R, Rengo, G, Ricotti, R, Rizzoni, D, Rocca, B, Rotella, C, Rubattu, S, Salvetti, G, Sciacqua, A, Serdoz, A, Sirico, F, Squeo, M, Tocci, G, Trimarco, B, Vigili de Kreutzenberg, S, Volpe, R, Volpe, M, Battistoni, Allegra, Gallo, Giovanna, Aragona, Caterina Oriana, Barchiesi, Fabio, Basolo, Alessio, Bellone, Simonetta, Bellotti, Paolo, Bertolotti, Marco, Bianco, Andrea, Biffi, Alessandro, Borghi, Claudio, Cicero, Arrigo Francesco Giuseppe, Consoli, Agostino, Corsini, Alberto, Desideri, Giovambattista, Di Giacinto, Barbara, Fernando, Fredrik, Ferri, Claudio, Galiuto, Leonarda, Grassi, Davide, Grassi, Guido, Icardi, Giancarlo, Indolfi, Ciro, Lodi, Elisa, Modena, Maria Grazia, Muiesan, Maria Lorenza, Nati, Giulio, Orsi, Andrea, Palermi, Stefano, Parati, Gianfranco, Passantino, Andrea, Patelli, Alessandra, Pelliccia, Antonio, Pengo, Martino, Filardi, Pasquale Perrone, Perseghin, Gianluca, Pirro, Matteo, Pontremoli, Roberto, Rengo, Giuseppe, Ricotti, Roberta, Rizzoni, Damiano, Rocca, Bianca, Rotella, Carlo, Rubattu, Speranza, Salvetti, Guido, Sciacqua, Angela, Serdoz, Andrea, Sirico, Felice, Squeo, Maria Rosaria, Tocci, Giuliano, Trimarco, Bruno, Vigili de Kreutzenberg, Saula, Volpe, Roberto, and Volpe, Massimo

Published
2021

10. Coronary plaque instability assessed by positron emission tomography and optical coherence tomography

Author

Galiuto, Leonarda, Leccisotti, Lucia, Locorotondo, Gabriella, Porto, Italo, Burzotta, Francesco, Trani, Carlo, Niccoli, Giampaolo, Leone, Antonio Maria, Danza, M. L., Melita, V., Fedele, Elisa, Stefanelli, Alessandro, Giordano, Alessandro, Crea, Filippo, Galiuto L. (ORCID:0000-0002-6831-479X), Leccisotti L. (ORCID:0000-0002-6000-2898), Locorotondo G., Porto I. (ORCID:0000-0002-9854-5046), Burzotta F. (ORCID:0000-0002-6569-9401), Trani C. (ORCID:0000-0001-9777-013X), Niccoli G. (ORCID:0000-0002-3187-6262), Leone A. M. (ORCID:0000-0002-1276-9883), Fedele E., Stefanelli A. (ORCID:0000-0001-8323-3798), Giordano A. (ORCID:0000-0002-6978-0880), Crea F. (ORCID:0000-0001-9404-8846), Galiuto, Leonarda, Leccisotti, Lucia, Locorotondo, Gabriella, Porto, Italo, Burzotta, Francesco, Trani, Carlo, Niccoli, Giampaolo, Leone, Antonio Maria, Danza, M. L., Melita, V., Fedele, Elisa, Stefanelli, Alessandro, Giordano, Alessandro, Crea, Filippo, Galiuto L. (ORCID:0000-0002-6831-479X), Leccisotti L. (ORCID:0000-0002-6000-2898), Locorotondo G., Porto I. (ORCID:0000-0002-9854-5046), Burzotta F. (ORCID:0000-0002-6569-9401), Trani C. (ORCID:0000-0001-9777-013X), Niccoli G. (ORCID:0000-0002-3187-6262), Leone A. M. (ORCID:0000-0002-1276-9883), Fedele E., Stefanelli A. (ORCID:0000-0001-8323-3798), Giordano A. (ORCID:0000-0002-6978-0880), and Crea F. (ORCID:0000-0001-9404-8846)

Abstract

Background: Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) are caused often by destabilization of non-flow limiting inflamed coronary artery plaques. 18F-fluorodeoxyglucose (FDG) uptake with positron emission tomography/computed tomography (PET/CT) reveals plaque inflammation, while intracoronary optical coherence tomography (OCT) reliably identifies morphological features of coronary instability, such as plaque rupture or erosion. We aimed to prospectively compare these two innovative biotechnologies in the characterization of coronary artery inflammation, which has never been attempted before. Methods: OCT and FDG PET/CT were performed in 18 patients with single vessel coronary artery disease, treated by percutaneous coronary intervention (PCI) with stent implantation, divided into 2 groups: NSTEMI/UA (n = 10) and stable angina (n = 8) patients. Results: Plaque rupture/erosion recurred more frequently [100% vs 25%, p = 0.001] and FDG uptake was greater [TBR median 1.50 vs 0.87, p = 0.004] in NSTEMI/UA than stable angina patients. FDG uptake resulted greater in patients with than without plaque rupture/erosion [1.2 (0.86–1.96) vs 0.87 (0.66–1.07), p = 0.013]. Among NSTEMI/UA patients, no significant difference in FDG uptake was found between ruptured and eroded plaques. The highest FDG uptake values were found in ruptured plaques, belonging to patients with NSTEMI/UA. OCT and PET/CT agreed in 72% of patients [p = 0.018]: 100% of patients with plaque rupture/erosion and increased FDG uptake had NSTEMI/UA. Conclusion: For the first time, we demonstrated that the correspondence between increased FDG uptake with PET/CT and morphology of coronary plaque instability at OCT is high.

Published
2021

13. Impact of aspirin on takotsubo syndrome: a propensity score-based analysis of the InterTAK Registry

Author

D'Ascenzo, Francesca, Gili, S., Bertaina, M., Iannaccone, M., Cammann, V. L., Di Vece, D., Kato, K., Saglietto, A., Szawan, K. A., Frangieh, A. H., Boffini, B., Annaratone, M., Sarcon, A., Levinson, R. A., Franke, J., Napp, L. C., Jaguszewski, M., Noutsias, M., Munzel, T., Knorr, M., Heiner, S., Katus, H. A., Burgdorf, C., Schunkert, H., Thiele, H., Bauersachs, J., Tschope, C., Pieske, B. M., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Hasenfuss, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S. M., Braun-Dullaeus, R. C., Banning, A., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Opolski, G., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Crea, Filippo, Dichtl, W., Franz, W. M., Empen, K., Felix, S. B., Delmas, C., Lairez, O., El-Battrawy, I., Akin, I., Borggrefe, M., Horowitz, J. D., Kozel, M., Tousek, P., Widimsky, P., Gilyarova, E., Shilova, A., Gilyarov, M., Biondi-Zoccai, G., Winchester, D. E., Ukena, C., Neuhaus, M., Bax, J. J., Prasad, A., Di Mario, C., Bohm, M., Gasparini, M., Ruschitzka, F., Bossone, E., Citro, R., Rinaldi, M., De Ferrari, G. M., Luscher, T., Ghadri, J. R., Templin, C., D'Ascenzo F., Galiuto L. (ORCID:0000-0002-6831-479X), Crea F. (ORCID:0000-0001-9404-8846), D'Ascenzo, Francesca, Gili, S., Bertaina, M., Iannaccone, M., Cammann, V. L., Di Vece, D., Kato, K., Saglietto, A., Szawan, K. A., Frangieh, A. H., Boffini, B., Annaratone, M., Sarcon, A., Levinson, R. A., Franke, J., Napp, L. C., Jaguszewski, M., Noutsias, M., Munzel, T., Knorr, M., Heiner, S., Katus, H. A., Burgdorf, C., Schunkert, H., Thiele, H., Bauersachs, J., Tschope, C., Pieske, B. M., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Hasenfuss, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S. M., Braun-Dullaeus, R. C., Banning, A., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Opolski, G., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Crea, Filippo, Dichtl, W., Franz, W. M., Empen, K., Felix, S. B., Delmas, C., Lairez, O., El-Battrawy, I., Akin, I., Borggrefe, M., Horowitz, J. D., Kozel, M., Tousek, P., Widimsky, P., Gilyarova, E., Shilova, A., Gilyarov, M., Biondi-Zoccai, G., Winchester, D. E., Ukena, C., Neuhaus, M., Bax, J. J., Prasad, A., Di Mario, C., Bohm, M., Gasparini, M., Ruschitzka, F., Bossone, E., Citro, R., Rinaldi, M., De Ferrari, G. M., Luscher, T., Ghadri, J. R., Templin, C., D'Ascenzo F., Galiuto L. (ORCID:0000-0002-6831-479X), and Crea F. (ORCID:0000-0001-9404-8846)

Abstract

Aims: The aim of the present study was to investigate the impact of aspirin on prognosis in takotsubo syndrome (TTS). Methods and results: Patients from the International Takotsubo (InterTAK) Registry were categorized into two groups based on aspirin prescription at discharge. A comparison of clinical outcomes between groups was performed using an adjusted analysis with propensity score (PS) stratification; results from the unadjusted analysis were also reported to note the effect of the PS adjustment. Major adverse cardiac and cerebrovascular events (MACCE: a composite of death, myocardial infarction, TTS recurrence, stroke or transient ischaemic attack) were assessed at 30-day and 5-year follow-up. A total of 1533 TTS patients with known status regarding aspirin prescription at discharge were included. According to the adjusted analysis based on PS stratification, aspirin was not associated with a lower hazard of MACCE at 30-day [hazard ratio (HR) 1.24, 95% confidence interval (CI) 0.50–3.04, P = 0.64] or 5-year follow-up (HR 1.11, 95% CI 0.78–1.58, P = 0.58). These results were confirmed by sensitivity analyses performed with alternative PS-based methods, i.e. covariate adjustment and inverse probability of treatment weighting. Conclusion: In the present study, no association was found between aspirin use in TTS patients and a reduced risk of MACCE at 30-day and 5-year follow-up. These findings should be confirmed in adequately powered randomized controlled trials. ClinicalTrials.gov Identifier: NCT01947621.

Published
2020

14. Age-Related Variations in Takotsubo Syndrome

Author

Cammann, V. L., Szawan, K. A., Stahli, B. E., Kato, K., Budnik, M., Wischnewsky, M., Dreiding, S., Levinson, R. A., Di Vece, D., Gili, S., Citro, R., Bossone, E., Neuhaus, M., Franke, J., Meder, B., Jaguszewski, M., Noutsias, M., Knorr, M., Heiner, S., D'Ascenzo, F., Dichtl, W., Burgdorf, C., Kherad, B., Tschope, C., Sarcon, A., Shinbane, J., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Karakas, M., Koenig, W., Pott, A., Meyer, P., Roffi, M., Banning, A., Wolfrum, M., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Napp, L. C., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Chan, C., Bridgman, P., Beug, D., Delmas, C., Lairez, O., Gilyarova, E., Shilova, A., Gilyarov, M., El-Battrawy, I., Akin, I., Polednikova, K., Tousek, P., Winchester, D. E., Galuszka, J., Ukena, C., Poglajen, G., Carrilho-Ferreira, P., Hauck, C., Paolini, C., Bilato, C., Kobayashi, Y., Shoji, T., Ishibashi, I., Takahara, M., Himi, T., Din, J., Al-Shammari, A., Prasad, A., Rihal, C. S., Liu, K., Schulze, P. C., Bianco, M., Jorg, L., Rickli, H., Pestana, G., Nguyen, T. H., Bohm, M., Maier, L. S., Pinto, F. J., Widimsky, P., Felix, S. B., Braun-Dullaeus, R. C., Rottbauer, W., Hasenfuss, G., Pieske, B. M., Schunkert, H., Borggrefe, M., Thiele, H., Bauersachs, J., Katus, H. A., Horowitz, J. D., Di Mario, C., Munzel, T., Crea, Filippo, Bax, J. J., Luscher, T. F., Ruschitzka, F., Ghadri, J. R., Opolski, G., Templin, C., Galiuto L. (ORCID:0000-0002-6831-479X), Crea F. (ORCID:0000-0001-9404-8846), Cammann, V. L., Szawan, K. A., Stahli, B. E., Kato, K., Budnik, M., Wischnewsky, M., Dreiding, S., Levinson, R. A., Di Vece, D., Gili, S., Citro, R., Bossone, E., Neuhaus, M., Franke, J., Meder, B., Jaguszewski, M., Noutsias, M., Knorr, M., Heiner, S., D'Ascenzo, F., Dichtl, W., Burgdorf, C., Kherad, B., Tschope, C., Sarcon, A., Shinbane, J., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Karakas, M., Koenig, W., Pott, A., Meyer, P., Roffi, M., Banning, A., Wolfrum, M., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Napp, L. C., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Chan, C., Bridgman, P., Beug, D., Delmas, C., Lairez, O., Gilyarova, E., Shilova, A., Gilyarov, M., El-Battrawy, I., Akin, I., Polednikova, K., Tousek, P., Winchester, D. E., Galuszka, J., Ukena, C., Poglajen, G., Carrilho-Ferreira, P., Hauck, C., Paolini, C., Bilato, C., Kobayashi, Y., Shoji, T., Ishibashi, I., Takahara, M., Himi, T., Din, J., Al-Shammari, A., Prasad, A., Rihal, C. S., Liu, K., Schulze, P. C., Bianco, M., Jorg, L., Rickli, H., Pestana, G., Nguyen, T. H., Bohm, M., Maier, L. S., Pinto, F. J., Widimsky, P., Felix, S. B., Braun-Dullaeus, R. C., Rottbauer, W., Hasenfuss, G., Pieske, B. M., Schunkert, H., Borggrefe, M., Thiele, H., Bauersachs, J., Katus, H. A., Horowitz, J. D., Di Mario, C., Munzel, T., Crea, Filippo, Bax, J. J., Luscher, T. F., Ruschitzka, F., Ghadri, J. R., Opolski, G., Templin, C., Galiuto L. (ORCID:0000-0002-6831-479X), and Crea F. (ORCID:0000-0001-9404-8846)

Abstract

Background: Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. Objectives: This study aimed to investigate age-related differences in TTS. Methods: Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. Results: Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. Conclusions: A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.

Published
2020

15. Special Article - Emotional versus physical Takotsubo syndrome: Two faces of the same medal or two different syndromes?

Author

Montone, Rocco Antonio, Niccoli, Giampaolo, Del Buono, Marco Giuseppe, Galiuto, Leonarda, Crea, Filippo, Montone R. A., Niccoli G. (ORCID:0000-0002-3187-6262), Del Buono M. G., Galiuto L. (ORCID:0000-0002-6831-479X), Crea F. (ORCID:0000-0001-9404-8846), Montone, Rocco Antonio, Niccoli, Giampaolo, Del Buono, Marco Giuseppe, Galiuto, Leonarda, Crea, Filippo, Montone R. A., Niccoli G. (ORCID:0000-0002-3187-6262), Del Buono M. G., Galiuto L. (ORCID:0000-0002-6831-479X), and Crea F. (ORCID:0000-0001-9404-8846)

Abstract

N/A

Published
2020

24. Coronary slow flow is associated with a worse clinical outcome in patients with Takotsubo syndrome

Author

Montone, Rocco Antonio, Galiuto, Leonarda, Meucci, Maria Chiara, Del Buono, Marco Giuseppe, Vergni, F., Camilli, Massimiliano, Sanna, Tommaso, Pedicino, Daniela, Buffon, Antonino Maria Tommaso, D'Amario, Domenico, Giraldi, Luca, Trani, Carlo, Liuzzo, Giovanna, Rebuzzi, Antonio Giuseppe, Niccoli, Giampaolo, Crea, Filippo, Montone R. A., Galiuto L. (ORCID:0000-0002-6831-479X), Meucci M. C., Del Buono M. G., Camilli M., Sanna T. (ORCID:0000-0002-5760-6885), Pedicino D., Buffon A. (ORCID:0000-0002-6910-8357), D'Amario D., Giraldi L., Trani C. (ORCID:0000-0001-9777-013X), Liuzzo G. (ORCID:0000-0002-5714-0907), Rebuzzi A. G. (ORCID:0000-0002-9873-957X), Niccoli G. (ORCID:0000-0002-3187-6262), Crea F. (ORCID:0000-0001-9404-8846), Montone, Rocco Antonio, Galiuto, Leonarda, Meucci, Maria Chiara, Del Buono, Marco Giuseppe, Vergni, F., Camilli, Massimiliano, Sanna, Tommaso, Pedicino, Daniela, Buffon, Antonino Maria Tommaso, D'Amario, Domenico, Giraldi, Luca, Trani, Carlo, Liuzzo, Giovanna, Rebuzzi, Antonio Giuseppe, Niccoli, Giampaolo, Crea, Filippo, Montone R. A., Galiuto L. (ORCID:0000-0002-6831-479X), Meucci M. C., Del Buono M. G., Camilli M., Sanna T. (ORCID:0000-0002-5760-6885), Pedicino D., Buffon A. (ORCID:0000-0002-6910-8357), D'Amario D., Giraldi L., Trani C. (ORCID:0000-0001-9777-013X), Liuzzo G. (ORCID:0000-0002-5714-0907), Rebuzzi A. G. (ORCID:0000-0002-9873-957X), Niccoli G. (ORCID:0000-0002-3187-6262), and Crea F. (ORCID:0000-0001-9404-8846)

Abstract

Objective: Patients with Takotsubo syndrome (TTS) present an acute microvascular dysfunction that leads to an impaired myocardial perfusion and, in more severe forms, an impaired epicardial flow. However, clinical relevance of a delayed coronary flow, the coronary slow flow (CSF), has never been investigated. We studied the prognostic value of CSF occurring in the acute phase of TTS. Methods: This cohort study prospectively evaluated patients with a diagnosis of TTS. CSF was defined as angiographically non-obstructive coronary arteries with thrombolysis in myocardial infarction-2 flow. The incidence of overall mortality and major adverse cardiovascular events (MACEs), defined as the composite of TTS recurrence, cardiac rehospitalisation, cerebrovascular events and mortality, was assessed at follow-up. Results: We enrolled 101 patients (mean age 71.0±11.1 years, 86 (85.1%) female); CSF occurred in 18 (17.8%) patients. At admission, patients with CSF presented more frequently with Killip class III/IV, moderate-to-severe left ventricle systolic dysfunction and right ventricle dysfunction. During the index admission, patients with CSF had a higher rate of intrahospital complications (12 (66.7%) vs 28 (33.7%), p=0.01). At long-term follow-up, patients with CSF had a significantly higher occurrence of overall mortality (9 (50%) vs 19 (22.9%), p=0.011), mainly due to non-cardiac causes (89.3%), and a higher rate of MACE (10 (55.5%) vs 27 (32.5%), p=0.06). At multivariable Cox regression, CSF was independently associated with death from any causes. Conclusions: Patients with TTS presenting with CSF have a worse clinical presentation with a higher rate of intrahospital complications and a poor long-term clinical outcome.

Published
2019

25. Outcomes Associated With Cardiogenic Shock in Takotsubo Syndrome: Results From the International Takotsubo Registry

Author

Di Vece, D., Citro, R., Cammann, V. L., Kato, K., Gili, S., Szawan, K. A., Micek, J., Jurisic, S., Ding, K. J., Bacchi, B., Schwyzer, M., Candreva, A., Bossone, E., D'Ascenzo, F., Sarcon, A., Franke, J., Napp, L. C., Jaguszewski, M., Noutsias, M., Munzel, T., Knorr, M., Heiner, S., Katus, H. A., Burgdorf, C., Schunkert, H., Thiele, H., Bauersachs, J., Tschope, C., Pieske, B. M., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Hasenfuss, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S. M., Braun-Dullaeus, R. C., Banning, A., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Opolski, G., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Crea, Filippo, Dichtl, W., Empen, K., Felix, S. B., Delmas, C., Lairez, O., El-Battrawy, I., Akin, I., Borggrefe, M., Gilyarova, E., Shilova, A., Gilyarov, M., Horowitz, J., Kozel, M., Tousek, P., Widimsky, P., Winchester, D. E., Ukena, C., Di Mario, Clara, Prasad, A., Bohm, M., Bax, J. J., Luscher, T. F., Ruschitzka, F., Ghadri, J. R., Templin, C., Galiuto L. (ORCID:0000-0002-6831-479X), Crea F. (ORCID:0000-0001-9404-8846), Di Mario C., Di Vece, D., Citro, R., Cammann, V. L., Kato, K., Gili, S., Szawan, K. A., Micek, J., Jurisic, S., Ding, K. J., Bacchi, B., Schwyzer, M., Candreva, A., Bossone, E., D'Ascenzo, F., Sarcon, A., Franke, J., Napp, L. C., Jaguszewski, M., Noutsias, M., Munzel, T., Knorr, M., Heiner, S., Katus, H. A., Burgdorf, C., Schunkert, H., Thiele, H., Bauersachs, J., Tschope, C., Pieske, B. M., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Hasenfuss, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S. M., Braun-Dullaeus, R. C., Banning, A., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Opolski, G., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, Leonarda, Crea, Filippo, Dichtl, W., Empen, K., Felix, S. B., Delmas, C., Lairez, O., El-Battrawy, I., Akin, I., Borggrefe, M., Gilyarova, E., Shilova, A., Gilyarov, M., Horowitz, J., Kozel, M., Tousek, P., Widimsky, P., Winchester, D. E., Ukena, C., Di Mario, Clara, Prasad, A., Bohm, M., Bax, J. J., Luscher, T. F., Ruschitzka, F., Ghadri, J. R., Templin, C., Galiuto L. (ORCID:0000-0002-6831-479X), Crea F. (ORCID:0000-0001-9404-8846), and Di Mario C.

Abstract

n/a

Published
2019

29. Exercise prescription for the heart

Author

Galiuto, L., Fedele, E., Vitale, E., Ionescu Anca Mirela, Lucini, D., Onciul, S., and Vasilescu, M.

Subjects
sport medicine, exercise prescription, heart
Published
2018

30. Long-Term Prognosis of Patients With Takotsubo Syndrome

Author

Ghadri, Jr, Kato, K, Cammann, Vl, Gili, S, Jurisic, S, Di Vece, D, Candreva, A, Ding, Kj, Micek, J, Szawan, Ka, Bacchi, B, Bianchi, R, Levinson, Ra, Wischnewsky, M, Seifert, B, Schlossbauer, Sa, Citro, R, Bossone, E, Münzel, T, Knorr, M, Heiner, S, D'Ascenzo, F, Franke, J, Sarcon, A, Napp, Lc, Jaguszewski, M, Noutsias, M, Katus, Ha, Burgdorf, C, Schunkert, H, Thiele, H, Bauersachs, J, Tschöpe, C, Pieske, Bm, Rajan, L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Hasenfuß, G, Karakas, M, Koenig, W, Rottbauer, W, Said, Sm, Braun-Dullaeus, Rc, Banning, A, Cuculi, F, Kobza, R, Fischer, Ta, Vasankari, T, Airaksinen, Kej, Opolski, G, Dworakowski, R, Maccarthy, P, Kaiser, C, Osswald, S, Galiuto, Leonarda, Crea, Filippo, Dichtl, W, Empen, K, Felix, Sb, Delmas, C, Lairez, O, El-Battrawy, I, Akin, I, Borggrefe, M, Horowitz, J, Kozel, M, Tousek, P, Widimský, P, Gilyarova, E, Shilova, A, Gilyarov, M, Winchester, De, Ukena, C, Bax, Jj, Prasad, A, Böhm, M, Lüscher, Tf, Ruschitzka, F, Templin, C., Galiuto L (ORCID:0000-0002-6831-479X), Crea F (ORCID:0000-0001-9404-8846), Ghadri, Jr, Kato, K, Cammann, Vl, Gili, S, Jurisic, S, Di Vece, D, Candreva, A, Ding, Kj, Micek, J, Szawan, Ka, Bacchi, B, Bianchi, R, Levinson, Ra, Wischnewsky, M, Seifert, B, Schlossbauer, Sa, Citro, R, Bossone, E, Münzel, T, Knorr, M, Heiner, S, D'Ascenzo, F, Franke, J, Sarcon, A, Napp, Lc, Jaguszewski, M, Noutsias, M, Katus, Ha, Burgdorf, C, Schunkert, H, Thiele, H, Bauersachs, J, Tschöpe, C, Pieske, Bm, Rajan, L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Hasenfuß, G, Karakas, M, Koenig, W, Rottbauer, W, Said, Sm, Braun-Dullaeus, Rc, Banning, A, Cuculi, F, Kobza, R, Fischer, Ta, Vasankari, T, Airaksinen, Kej, Opolski, G, Dworakowski, R, Maccarthy, P, Kaiser, C, Osswald, S, Galiuto, Leonarda, Crea, Filippo, Dichtl, W, Empen, K, Felix, Sb, Delmas, C, Lairez, O, El-Battrawy, I, Akin, I, Borggrefe, M, Horowitz, J, Kozel, M, Tousek, P, Widimský, P, Gilyarova, E, Shilova, A, Gilyarov, M, Winchester, De, Ukena, C, Bax, Jj, Prasad, A, Böhm, M, Lüscher, Tf, Ruschitzka, F, Templin, C., Galiuto L (ORCID:0000-0002-6831-479X), and Crea F (ORCID:0000-0001-9404-8846)

Abstract

Background: Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. Objectives: This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. Methods: Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. Results: Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. Conclusions: Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621)

Published
2018

31. International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

Author

Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, Filippo, Galiuto, Leonarda, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Y-Hassan, S, Migliore, F, Horowitz, Jd, Shimokawa, H, Lüscher, Tf, Templin, C, Crea F (ORCID:0000-0001-9404-8846), Galiuto L (ORCID:0000-0002-6831-479X), Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, Filippo, Galiuto, Leonarda, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Y-Hassan, S, Migliore, F, Horowitz, Jd, Shimokawa, H, Lüscher, Tf, Templin, C, Crea F (ORCID:0000-0001-9404-8846), and Galiuto L (ORCID:0000-0002-6831-479X)

Abstract

The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians.

Published
2018

32. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology

Author

Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, Filippo, Galiuto, Leonarda, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Y-Hassan, S, Migliore, F, Horowitz, Jd, Shimokawa, H, Lüscher, Tf, Templin, C, Crea F (ORCID:0000-0001-9404-8846), Galiuto L (ORCID:0000-0002-6831-479X), Ghadri, Jr, Wittstein, I, Prasad, A, Sharkey, S, Dote, K, Akashi, Yj, Cammann, Vl, Crea, Filippo, Galiuto, Leonarda, Desmet, W, Yoshida, T, Manfredini, R, Eitel, I, Kosuge, M, Nef, Hm, Deshmukh, A, Lerman, A, Bossone, E, Citro, R, Ueyama, T, Corrado, D, Kurisu, S, Ruschitzka, F, Winchester, D, Lyon, Ar, Omerovic, E, Bax, Jj, Meimoun, P, Tarantini, G, Rihal, C, Y-Hassan, S, Migliore, F, Horowitz, Jd, Shimokawa, H, Lüscher, Tf, Templin, C, Crea F (ORCID:0000-0001-9404-8846), and Galiuto L (ORCID:0000-0002-6831-479X)

Abstract

Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy.

Published
2018

33. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry

Author

Ghadri, J.R., Cammann, V.L., Jurisic, S., Seifert, B., Napp, L.C., Diekmann, J., Bataiosu, D.R., D'Ascenzo, F., Ding, K.J., Sarcon, A., Kazemian, E., Birri, T., Ruschitzka, F., Luscher, T.F., Templin, C., Jaguszewski, M., Franke, J., Katus, H.A., Burgdorf, C., Schunkert, H., Thiele, H., Bauersachs, J., Tschope, C., Rajan, L., Michels, G., Pfister, R., Ukena, C., Bohm, M., Erbel, R., Cuneo, A., Jacobshagen, C., Hasenfuss, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S.M., Braun-Dullaeus, R.C., Cuculi, F., Banning, A., Fischer, T.A., Vasankari, T., Airaksinen, K.E.J., Fijalkowski, M., Rynkiewicz, A., Opolski, G., Dworakowski, R., MacCarthy, P., Kaiser, C., Osswald, S., Galiuto, L., Crea, F., Dichtl, W., Franz, W.M., Empen, K., Felix, S.B., Delmas, C., Lairez, O., Erne, P., Frantz, S., Prasad, A., Bax, J.J., and InterTAK Co-Investigators

Subjects
Broken heart syndrome, Clinical score, Takotsubo (stress) syndrome, Acute coronary syndrome, Disease prevalence
Published
2017

34. EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: A report of literature and current practice review

Author

Steeds, R.P. Garbi, M. Cardim, N. Kasprzak, J.D. Sade, E. Nihoyannopoulos, P. Popescu, B.A. Stefanidis, A. Cosyns, B. Monaghan, M. Aakhus, S. Edvardsen, T. Flachskampf, F. Galiuto, L. Athanassopoulos, G. Lancellotti, P. Delgado, V. Donal, E. Galderisi, M. Lombardi, M. Muraru, D. Haugaa, K. EACVI Scientific Documents Committee

Abstract

The European Association for Cardiovascular Imaging (EACVI) has outlined the rationale for setting appropriate use criteria (AUC) in cardiovascular (CV) imaging. Transthoracic echocardiography (TTE) is the most common imaging modality in CV disease and is a central tool in diagnosis, follow-up, management planning and intervention. The purpose of AUC is to inform referrers, both to avoid under-use, which may result in incomplete or incorrect diagnosis and treatment, and also over-use, which may delay correct diagnosis, lead to 'treatment cascade', and wastes resources. The first step in defining AUC for TTE in the adult has been for a panel of experts in echocardiography to review the evidence, guidelines, recommendations, and position papers from the European Society of Cardiology, EACVI and other specialist societies, and current state-of-the-art clinical practice. The attached document summarizes this work, which will be used to under-pin the development of AUC. © The Author 2017.

Published
2017

36. Methods to investigate coronary microvascular function in clinical practice

Author

Lanza, Ga, Camici, Pg, Galiuto, L, Niccoli, G, Pizzi, C, Di Monaco, A, Sestito, A, Novo, S, Piscione, F, Tritto, Isabella, Ambrosio, Giuseppe, Bugiardini, R, Crea, F, Marzilli, M, Microcircolazione Societ? Italiana di Cardiologia, Gruppo di Studio di Fisiopatologia Coronarica e., Lanza, Ga, Camici, Paolo, Galiuto, L, Niccoli, G, Pizzi, C, Di Monaco, A, Sestito, A, Novo, S, Piscione, F, Tritto, I, Ambrosio, G, Bugiardini, R, Crea, F, Marzilli, M., Lanza GA, Camici PG, Galiuto L, Niccoli G, Pizzi C, Di Monaco A, Sestito A, Novo S, Piscione F, Tritto I, Ambrosio G, Bugiardini R, Crea F, Marzilli M., Lanza, GA, Camici, PG, and Marzilli, M

Subjects
Diagnostic Imaging, medicine.medical_specialty, myocardial contrast echocardiography, Coronary microcirculation, Coronary Artery Disease, Coronary microvascular function, Diagnostic tools, intracoronary Doppler ultrasound, Microcirculation, coronary microcirculation, transthoracic Doppler echocardiography, Coronary artery disease, Coronary circulation, cardiovascular magnetic resonance, Internal medicine, Coronary Circulation, medicine, DIAGNOSTIC TOOLS, Humans, Normal coronary arteries, business.industry, General Medicine, medicine.disease, Settore MED/11 - Malattie Dell'Apparato Cardiovascolare, diagnostic investigation, Clinical Practice, Myocardial contrast echocardiography, medicine.anatomical_structure, PET, Cardiology and Cardiovascular Medicine, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Cardiology, microvascular function, HEART, CORONARY, business
Abstract

A growing amount of data is increasingly showing the relevance of coronary microvascular dysfunction (CMVD) in several clinical contexts. This article reviews techniques and clinical investigations of the main noninvasive and invasive methods proposed to study coronary microcirculation and to identify CMVD in the presence of normal coronary arteries, also trying to provide indications for their application in clinical practice.

Published
2013

38. EACVI appropriateness criteria for the use of transthoracic echocardiography in adults: A report of literature and current practice review

Author

Steeds Richard, P, Garbi, M, Cardim, N, Kasprzak Jaroslaw, D, Sade, E, Nihoyannopoulos, P, Popescu Bogdan, A, Stefanidis, A, Cosyns, B, Monaghan, M, Aakhus, S, Edvardsen, T, Flachskampf, F, Galiuto, L, Athanassopoulos, G, Lancellotti, P, Delgado, V, Donal, E, Galderisi, M, Lombardi, M, Muraru, D, Haugaa, K, Steeds Richard P, Garbi Madalina, Cardim Nuno, Kasprzak Jaroslaw D, Sade Elif, Nihoyannopoulos Petros, Popescu Bogdan Alexandru, Stefanidis Alexandros, Cosyns Bernard, Monaghan Mark, Aakhus Svend, Edvardsen Thor, Flachskampf Frank, Galiuto Leonarda, Athanassopoulos George, Lancellotti Patrizio, Delgado Victoria, Donal Erwan, Galderisi Maurizio, Lombardi Massimo, Muraru Denisa, Haugaa Kristina, Steeds Richard, P, Garbi, M, Cardim, N, Kasprzak Jaroslaw, D, Sade, E, Nihoyannopoulos, P, Popescu Bogdan, A, Stefanidis, A, Cosyns, B, Monaghan, M, Aakhus, S, Edvardsen, T, Flachskampf, F, Galiuto, L, Athanassopoulos, G, Lancellotti, P, Delgado, V, Donal, E, Galderisi, M, Lombardi, M, Muraru, D, Haugaa, K, Steeds Richard P, Garbi Madalina, Cardim Nuno, Kasprzak Jaroslaw D, Sade Elif, Nihoyannopoulos Petros, Popescu Bogdan Alexandru, Stefanidis Alexandros, Cosyns Bernard, Monaghan Mark, Aakhus Svend, Edvardsen Thor, Flachskampf Frank, Galiuto Leonarda, Athanassopoulos George, Lancellotti Patrizio, Delgado Victoria, Donal Erwan, Galderisi Maurizio, Lombardi Massimo, Muraru Denisa, and Haugaa Kristina

Abstract

The European Association for Cardiovascular Imaging (EACVI) has outlined the rationale for setting appropriate use criteria (AUC) in cardiovascular (CV) imaging. Transthoracic echocardiography (TTE) is the most common imaging modality in CV disease and is a central tool in diagnosis, follow-up, management planning and intervention. The purpose of AUC is to inform referrers, both to avoid under-use, which may result in incomplete or incorrect diagnosis and treatment, and also over-use, which may delay correct diagnosis, lead to 'treatment cascade', and wastes resources. The first step in defining AUC for TTE in the adult has been for a panel of experts in echocardiography to review the evidence, guidelines, recommendations, and position papers from the European Society of Cardiology, EACVI and other specialist societies, and current state-of-the-art clinical practice. The attached document summarizes this work, which will be used to under-pin the development of AUC.

Published
2017

39. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry

Author

Ghadri, Jr, Cammann, Vl, Jurisic, S, Seifert, B, Napp, Lc, Diekmann, J, Bataiosu, Dr, D'Ascenzo, F, Ding, Kj, Sarcon, A, Kazemian, E, Birri, T, Ruschitzka, F, Lüscher, Tf, Templin, C, InterTAK co-investigators: Jaguszewski, M, Franke, J, Katus, Ha, Burgdorf, C, Schunkert, H, Thiele, H, Bauersachs, J, Tschöpe, C, Rajan, L, Michels, G, Pfister, R, Ukena, C, Böhm, M, Erbel, R, Cuneo, A, Jacobshagen, C, Hasenfuß, G, Karakas, M, Koenig, W, Rottbauer, W, Said, Sm, Braun-Dullaeus, Rc, Cuculi, F, Banning, A, Fischer, Ta, Vasankari, T, Airaksinen, Kej, Fijalkowski, M, Rynkiewicz, A, Opolski, G, Dworakowski, R, Maccarthy, P, Kaiser, C, Osswald, S, Galiuto, L, Crea, F, Dichtl, W, Franz, Wm, Empen, K, Felix, Sb, Delmas, C, Lairez, O, Erne, P, Frantz, S, Prasad, A, and Bax, Jj

Subjects
Male, Clinical score, tako tsubo, broken heart syndrome, acute coronary syndromeacute syndrome, Medizin, Takotsubo (stress) syndrome, Diagnosis, Differential, Electrocardiography, Takotsubo Cardiomyopathy, Natriuretic Peptide, Brain, Humans, Prospective Studies, Registries, Acute Coronary Syndrome, Propensity Score, Aged, Broken heart syndrome, Acute coronary syndrome, Disease prevalence, Cardiology and Cardiovascular Medicine, Middle Aged, Peptide Fragments, Troponin, ROC Curve, Female, Biomarkers
Abstract

Aims Clinical presentation of takotsubo syndrome (TTS) mimics acute coronary syndrome (ACS) and does not allow differentiation. We aimed to develop a clinical score to estimate the probability of TTS and to distinguish TTS from ACS in the acute stage. Methods and results Patients with TTS were recruited from the International Takotsubo Registry ( www.takotsubo-registry.com) and ACS patients from the leading hospital in Zurich. A multiple logistic regression for the presence of TTS was performed in a derivation cohort (TTS, n = 218; ACS, n = 436). The best model was selected and formed a score (InterTAK Diagnostic Score) with seven variables, and each was assigned a score value: female sex 25, emotional trigger 24, physical trigger 13, absence of ST-segment depression (except in lead aVR) 12, psychiatric disorders 11, neurologic disorders 9, and QTc prolongation 6 points. The area under the curve (AUC) for the resulting score was 0.971 [95% confidence interval (CI) 0.96–0.98] and using a cut-off value of 40 score points, sensitivity was 89% and specificity 91%. When patients with a score of ≥50 were diagnosed as TTS, nearly 95% of TTS patients were correctly diagnosed. When patients with a score ≤31 were diagnosed as ACS, ∼95% of ACS patients were diagnosed correctly. The score was subsequently validated in an independent validation cohort (TTS, n = 173; ACS, n = 226), resulting in a score AUC of 0.901 (95% CI 0.87–0.93). Conclusion The InterTAK Diagnostic Score estimates the probability of the presence of TTS and is able to distinguish TTS from ACS with a high sensitivity and specificity. OA hybrid

Published
2016

41. Nutrire il cuore

Author

Galiuto, L, Miggiano, G, and Beck, H

Subjects
dietoterapia, malattie, cuore
Published
2016

42. P2535Granulocyte colony-stimulating factor in patients with a large anterior wall acute myocardial infarction to prevent left ventricular remodeling (the RIGENERA trial): 10 years follow-up – Final results

Author

D'Amario, D., primary, Leone, A.M., additional, Cannata, F., additional, Graziani, F., additional, Cobianchi Bellisari, F., additional, Massetti, M., additional, Galiuto, L., additional, Rebuzzi, A.G., additional, and Crea, F., additional

Published
2017
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43. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Author

Templin, C., Ghadri, J. R., Diekmann, J., Napp, L. C., Bataiosu, D. R., Jaguszewski, M., Cammann, V. L., Sarcon, A., Geyer, V., Neumann, C. A., Seifert, B., Hellermann, J., Schwyzer, M., Eisenhardt, K., Jenewein, J., Franke, J., Katus, H. A., Burgdorf, C., Schunkert, H., Moeller, C., Thiele, H., Bauersachs, J., Tschoepe, C., Schultheiss, H-P., Laney, C. A., Rajan, L., Michels, G., Pfister, R., Ukena, C., Boehm, M., Erbel, R., Cuneo, A., Kuck, K-H., Jacobshagen, C., Hasenfuss, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S. M., Braun-Dullaeus, R. C., Cuculi, F., Banning, A., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Fijalkowski, M., Rynkiewicz, A., Pawlak, M., Opolski, G., Dworakowski, R., MacCarthy, P., Kaiser, C., Osswald, S., Galiuto, L., Crea, F., Dichtl, W., Franz, W. M., Empen, K., Felix, S. B., Delmas, C., Lairez, O., Erne, P., Bax, J. J., Ford, I., Ruschitzka, F., Prasad, A., Luescher, T. F., Templin, C., Ghadri, J. R., Diekmann, J., Napp, L. C., Bataiosu, D. R., Jaguszewski, M., Cammann, V. L., Sarcon, A., Geyer, V., Neumann, C. A., Seifert, B., Hellermann, J., Schwyzer, M., Eisenhardt, K., Jenewein, J., Franke, J., Katus, H. A., Burgdorf, C., Schunkert, H., Moeller, C., Thiele, H., Bauersachs, J., Tschoepe, C., Schultheiss, H-P., Laney, C. A., Rajan, L., Michels, G., Pfister, R., Ukena, C., Boehm, M., Erbel, R., Cuneo, A., Kuck, K-H., Jacobshagen, C., Hasenfuss, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S. M., Braun-Dullaeus, R. C., Cuculi, F., Banning, A., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Fijalkowski, M., Rynkiewicz, A., Pawlak, M., Opolski, G., Dworakowski, R., MacCarthy, P., Kaiser, C., Osswald, S., Galiuto, L., Crea, F., Dichtl, W., Franz, W. M., Empen, K., Felix, S. B., Delmas, C., Lairez, O., Erne, P., Bax, J. J., Ford, I., Ruschitzka, F., Prasad, A., and Luescher, T. F.

Abstract

BACKGROUND The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. METHODS The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome. RESULTS Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7 +/- 11.2% vs. 51.5 +/- 12.3%) (P < 0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P = 0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year. CONCLUSIONS Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.)

Published
2015

45. Cardiac MR

Author

Galiuto, L, Locorotondo, G, and Fedele, E

Published
2012

47. La RM cardiaca

Author

Galiuto, L and Locorotondo, G

Subjects
risonanza magnetica cardiaca, cardiomiopatia, medicina dello sport
Published
2011

50. Contrast Echocardiogrphy

Author

Galiuto, L, Senior, R, and Becher, H

Subjects
echocardiography, contrast, perfusion
Published
2010

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