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2. Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review

Author

Durante-Mangoni, Emanuele, Iossa, Domenico, Bertolino, Lorenzo, Ursi, Maria Paola, D'Amico, Fabiana, Karruli, Arta, Ramadan, Mohammad, Andini, Roberto, Zampino, Rosa, Bernardo, Mariano, Ruocco, Giuseppe, Dialetto, Giovanni, Covino, Franco Enrico, Manduca, Sabrina, Della Corte, Alessandro, De Feo, Marisa, De Vivo, Stefano, De Rimini, Maria Luisa, Galdieri, Nicola, and Ramadan, Mohammad Said more...

Published
2021
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4. Clinical correlates of circulating small dense low-density lipoproteins in acute infective endocarditis.

Author

Boccia, Filomena, Iossa, Domenico, Leonardi, Silvia, Peluso, Anna Maria, Bertolino, Lorenzo, Patauner, Fabian, Palmieri, Emilio, Boenzi, Rita, Zampino, Rosa, Durante-Mangoni, Emanuele, D'Amico, Fabiana, Infante, Oriana, Bernardo, Mariano, Ruocco, Giuseppe, Dialetto, Giovanni, Manduca, Sabrina, De Santo, Luca Salvatore, Carozza, Antonio, De Feo, Marisa, and Nigro, Gerardo more...

Subjects
MORTALITY, RESEARCH funding, LIPIDS, LDL cholesterol, INFECTIVE endocarditis, SYMPTOMS, SEVERITY of illness index, HEART valve diseases, DESCRIPTIVE statistics, BLOOD coagulation factors, LONGITUDINAL method, STATISTICS, CONFIDENCE intervals, COMORBIDITY, C-reactive protein, DISEASE progression, BIOMARKERS
Abstract

Background and aim: Infective endocarditis (IE) is a complex thrombo-inflammatory disorder, the pathogenesis of which involves a multifaceted interplay between vascular damage and bacterial virulence factors. This study aimed to assess the prognostic role of small dense low-density lipoprotein (sdLDL) cholesterol in patients with IE and its correlation with various disease-related features. Methods: A cohort of 198 patients with definite IE was included in this study. Clinical, laboratory, and echocardiographic parameters were meticulously analyzed, with a specific focus on comorbidities. sdLDL levels were measured using stored plasma samples obtained upon admission during the acute phase of the disease. Results: The median level of sdLDL was 24 mg/dL [with an interquartile range of 17.9–35.2 mg/dL], and this value showed a statistically significant positive correlation with LDL/HDL cholesterol and triglycerides (p < 0.01 for all). Furthermore, a remarkable inverse correlation between C-reactive protein and D-dimer levels was observed (p < 0.0001). Univariate analysis revealed that patients with sdLDL levels ≤ 24 mg/dL had 2.75 times higher odds of in-hospital mortality (95% Confidence Interval:1.08–6.98, p = 0.031). In addition, nonsurvivors had significantly lower median sdLDL levels (19.7 vs. 26.0 mg/dL, p = 0.041). Lower sdLDL levels were also associated with embolic complications, larger vegetation size, and positive blood cultures for Staphylococci (p = 0.019, p = 0.022, and p < 0.001, respectively). Conclusions: Low circulating sdLDL levels in the acute phase of IE were significantly correlated with unfavorable clinical outcomes. These results suggest that the sdLDL level may serve as an important marker of disease severity in IE and may represent a link between vascular damage, embolic complications, and disease progression. [ABSTRACT FROM AUTHOR] more...

Published
2024
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8. Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review

Author

Ramadan, Mohammad Said, primary, Bertolino, Lorenzo, additional, Zampino, Rosa, additional, Durante-Mangoni, Emanuele, additional, Iossa, Domenico, additional, Ursi, Maria Paola, additional, D'Amico, Fabiana, additional, Karruli, Arta, additional, Ramadan, Mohammad, additional, Andini, Roberto, additional, Bernardo, Mariano, additional, Ruocco, Giuseppe, additional, Dialetto, Giovanni, additional, Covino, Franco Enrico, additional, Manduca, Sabrina, additional, Della Corte, Alessandro, additional, De Feo, Marisa, additional, De Vivo, Stefano, additional, De Rimini, Maria Luisa, additional, and Galdieri, Nicola, additional more...

Published
2021
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9. Long-Term Outcome of Infective Endocarditis Involving Cardiac Implantable Electronic Devices: Impact of Comorbidities and Lead Extraction.

Author

Durante-Mangoni, Emanuele, Ursi, Maria Paola, Andini, Roberto, Mattucci, Irene, Della Ratta, Ester E., Iossa, Domenico, Bertolino, Lorenzo, De Vivo, Stefano, Manduca, Sabrina, Torella, Michele, De Feo, Marisa, and Zampino, Rosa more...

Subjects
INFECTIVE endocarditis, ELECTRONIC equipment, HOSPITAL mortality, TRICUSPID valve, SURVIVAL rate, CARDIAC surgery, ARTIFICIAL implants
Abstract

(1) Background: Management of cardiac implantable electronic device-related infective endocarditis (CIED-IE) hinges on complete hardware removal. We assessed whether long-term prognosis is affected by device removal, considering baseline patient comorbid conditions; (2) Methods: A total of 125 consecutive patients hospitalized for CIED-IE were included in this retrospective analysis. Outcomes were in-hospital, one-year, and long-term mortality. There were 109 patients who underwent device removal, 91 by transvenous lead extraction (TLE) and 18 by open heart surgery (OHS); (3) Results: TLE translated into lower hospital mortality (4.4% vs. 22.5% with OHS; p = 0.03). Septic pulmonary embolism was the only independent predictor of in-hospital mortality (OR:7.38 [1.49–36.6], p = 0.013). One-year mortality was in contrast independently associated to tricuspid valve involvement (p = 0.01) and Charlson comorbidity index (CCI, p = 0.039), but not the hardware removal modality. After a median follow-up of 41 months, mortality rose to 24%, and was significantly influenced only by CCI. Specifically, patients with a higher CCI who were also treated with TLE showed a survival rate not significantly different from those managed with medical therapy only; (4) Conclusions: In CIED-IE, TLE is the strategy of choice for hardware removal, improving early outcomes. Long-term benefits of TLE are lessened by comorbidities. In cases of CIED-IE with high CCI, a more conservative approach might be an option. [ABSTRACT FROM AUTHOR] more...

Published
2022
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10. Dissecting the correlates of N-terminal prohormone brain natriuretic peptide in acute infective endocarditis.

Author

Bertolino, Lorenzo, Ursi, Maria Paola, Iossa, Domenico, Karruli, Arta, D'Amico, Fabiana, Zampino, Rosa, Dialetto, Giovanni, De Feo, Marisa, Durante-Mangoni, Emanuele, The Monaldi Hospital Cardiovascular Infection Study Group, Ramadan, Mohammad, Andini, Roberto, Bernardo, Mariano, Ruocco, Giuseppe, Covino, Franco Enrico, Manduca, Sabrina, Della Corte, Alessandro, De Santo, Luca S., Carozza, Antonio, and De Vivo MD, Stefano more...

Subjects
C-reactive protein, PATIENT aftercare, PREDICTIVE tests, CONFIDENCE intervals, RETROSPECTIVE studies, PATIENTS, INFECTIVE endocarditis, HOSPITAL admission & discharge, HOSPITAL mortality, SURVIVAL analysis (Biometry), DESCRIPTIVE statistics, PEPTIDE hormones, ODDS ratio, ACUTE diseases, HEART failure
Abstract

Purpose: To explore the prognostic value and the correlates of NT-proBNP in patients with acute infective endocarditis, a life-threatening disease, with an often unpredictable outcome given by the lack of reliable prognostic parameters. Methods: We retrospectively studied 337 patients admitted to our centre between January 1, 2006 and September 30, 2020 with available NT-proBNP level at admission. Our analyses were performed considering NT-proBNP as both a categorical variable, using the median value as the cut-off level, and numerical variable. Study end points were in-hospital mortality, cardiac surgery and 1 year survival. Results: NT-proBNP was an independent predictor of in-hospital mortality (OR 14.9 [95%C.I. 2.46–90.9]; P =.003). Levels below 2926 pg/mL were highly predictive of a favorable in-hospital outcome (negative predictive value 96.6%). Patients with higher NT-proBNP levels showed a significantly lower survival rate at 1 year follow-up (log-rank P =.005). NT-proBNP was strongly associated with chronic kidney disease (P <.001) and significantly higher in patients with prior chronic heart failure (P =.001). NT-proBNP was tightly related to staphylococcal IE (P =.001) as well as with higher CRP and hs-troponin I (P = 0.023, P <.001, respectively). Conclusion: Our results confirm the remarkable prognostic role of NT-proBNP in patients with IE and provide novel evidences of its multifaceted correlates in this unique clinical setting. Our data strongly support the incorporation of NT-proBNP into the current diagnostic work-up of IE. [ABSTRACT FROM AUTHOR] more...

Published
2022
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11. Infective Endocarditis in Patients on Chronic Hemodialysis

Author

Pericàs, Juan M., primary, Llopis, Jaume, additional, Jiménez-Exposito, Maria Jesús, additional, Kourany, Wissam M., additional, Almirante, Benito, additional, Carosi, Giampiero, additional, Durante-Mangoni, Emanuele, additional, Fortes, Claudio Querido, additional, Giannitsioti, Efthymia, additional, Lerakis, Stamatios, additional, Montagna-Mella, Rodrigo, additional, Ambrosioni, Juan, additional, Tan, Ru-San, additional, Mestres, Carlos A., additional, Wray, Dannah, additional, Pachirat, Orathai, additional, Moreno, Asuncion, additional, Chu, Vivian H., additional, de Lazzari, Elisa, additional, Fowler, Vance G., additional, Miró, Jose M., additional, Clara, Liliana, additional, Sanchez, Marisa, additional, Casabé, José, additional, Cortes, Claudia, additional, Nacinovich, Francisco, additional, Oses, Pablo Fernandez, additional, Ronderos, Ricardo, additional, Sucari, Adriana, additional, Thierer, Jorge, additional, Altclas, Javier, additional, Kogan, Silvia, additional, Spelman, Denis, additional, Athan, Eugene, additional, Harris, Owen, additional, Kennedy, Karina, additional, Tan, Ren, additional, Gordon, David, additional, Papanicolas, Lito, additional, Korman, Tony, additional, Kotsanas, Despina, additional, Dever, Robyn, additional, Jones, Phillip, additional, Konecny, Pam, additional, Lawrence, Richard, additional, Rees, David, additional, Ryan, Suzanne, additional, Feneley, Michael P., additional, Harkness, John, additional, Post, Jeffrey, additional, Reinbott, Porl, additional, Gattringer, Rainer, additional, Wiesbauer, Franz, additional, Andrade, Adriana Ribas, additional, Passos de Brito, Ana Cláudia, additional, Guimarães, Armenio Costa, additional, Grinberg, Max, additional, Mansur, Alfredo José, additional, Siciliano, Rinaldo Focaccia, additional, Varejao Strabelli, Tania Mara, additional, Campos Vieira, Marcelo Luiz, additional, de Medeiros Tranchesi, Regina Aparecida, additional, Paiva, Marcelo Goulart, additional, de Oliveira Ramos, Auristela, additional, Weksler, Clara, additional, Ferraiuoli, Giovanna, additional, Golebiovski, Wilma, additional, Lamas, Cristiane, additional, Karlowsky, James A., additional, Keynan, Yoav, additional, Morris, Andrew M., additional, Rubinstein, Ethan, additional, Jones, Sandra Braun, additional, Garcia, Patricia, additional, Cereceda, M., additional, Fica, Alberto, additional, Mella, Rodrigo Montagna, additional, Fernandez, Ricardo, additional, Franco, Liliana, additional, Gonzalez, Javier, additional, Jaramillo, Astrid Natalia, additional, Barsic, Bruno, additional, Bukovski, Suzana, additional, Krajinovic, Vladimir, additional, Pangercic, Ana, additional, Rudez, Igor, additional, Vincelj, Josip, additional, Freiberger, Tomas, additional, Pol, Jiri, additional, Zaloudikova, Barbora, additional, Ashour, Zainab, additional, El Kholy, Amani, additional, Mishaal, Marwa, additional, Osama, Dina, additional, Rizk, Hussien, additional, Aissa, Neijla, additional, Alauzet, Corentine, additional, Alla, Francois, additional, Campagnac, CHU Catherine, additional, Doco-Lecompte, Thanh, additional, Selton-Suty, Christine, additional, Casalta, Jean-Paul, additional, Fournier, Pierre-Edouard, additional, Habib, Gilbert, additional, Raoult, Didier, additional, Thuny, Franck, additional, Delahaye, Francois, additional, Delahaye, Armelle, additional, Vandenesch, Francois, additional, Donal, Erwan, additional, Donnio, Pierre Yves, additional, Flecher, Erwan, additional, Michelet, Christian, additional, Revest, Matthieu, additional, Tattevin, Pierre, additional, Chevalier, Florent, additional, Jeu, Antoine, additional, Rémadi, Jean Paul, additional, Rusinaru, Dan, additional, Tribouilloy, Christophe, additional, Bernard, Yvette, additional, Chirouze, Catherine, additional, Hoen, Bruno, additional, Leroy, Joel, additional, Plesiat, Patrick, additional, Naber, Christoph, additional, Neuerburg, Carl, additional, Mazaheri, Bahram, additional, Sophia Athanasia, Carl Neuerburg, additional, Deliolanis, Ioannis, additional, Giamarellou, Helen, additional, Thomas, Tsaganos, additional, Mylona, Elena, additional, Paniara, Olga, additional, Papanicolaou, Konstantinos, additional, Pyros, John, additional, Skoutelis, Athanasios, additional, Papanikolaou, Konstantinos, additional, Sharma, Gautam, additional, Francis, Johnson, additional, Nair, Lathi, additional, Thomas, Vinod, additional, Venugopal, Krishnan, additional, Hannan, Margaret M., additional, Hurley, John P., additional, Wanounou, Maor, additional, Gilon, Dan, additional, Israel, Sarah, additional, Korem, Maya, additional, Strahilevitz, Jacob, additional, Iossa, Domenico, additional, Orlando, Serena, additional, Ursi, Maria Paola, additional, Pafundi, Pia Clara, additional, D’Amico, Fabiana, additional, Bernardo, Mariano, additional, Cuccurullo, Susanna, additional, Dialetto, Giovanni, additional, Covino, Franco Enrico, additional, Manduca, Sabrina, additional, Della Corte, Alessandro, additional, De Feo, Marisa, additional, Tripodi, Marie Françoise, additional, Cecchi, Enrico, additional, De Rosa, Francesco, additional, Forno, Davide, additional, Imazio, Massimo, additional, Trinchero, Rita, additional, Grossi, Paolo, additional, Lattanzio, Mariangela, additional, Toniolo, Antonio, additional, Goglio, Antonio, additional, Raglio, Annibale, additional, Ravasio, Veronica, additional, Rizzi, Marco, additional, Suter, Fredy, additional, Magri, Silvia, additional, Signorini, Liana, additional, Kanafani, Zeina, additional, Kanj, Souha S., additional, Sharif-Yakan, Ahmad, additional, Abidin, Imran, additional, Tamin, Syahidah Syed, additional, Martínez, Eduardo Rivera, additional, Soto Nieto, Gabriel Israel, additional, van der Meer, Jan T.M., additional, Chambers, Stephen, additional, Holland, David, additional, Morris, Arthur, additional, Raymond, Nigel, additional, Read, Kerry, additional, Murdoch, David R., additional, Dragulescu, Stefan, additional, Ionac, Adina, additional, Mornos, Cristian, additional, Butkevich, O.M., additional, Chipigina, Natalia, additional, Kirill, Ozerecky, additional, Vadim, Kulichenko, additional, Vinogradova, Tatiana, additional, Edathodu, Jameela, additional, Halim, Magid, additional, Liew, Yee-Yun, additional, Lejko-Zupanc, Tatjana, additional, Logar, Mateja, additional, Mueller-Premru, Manica, additional, Commerford, Patrick, additional, Commerford, Anita, additional, Deetlefs, Eduan, additional, Hansa, Cass, additional, Ntsekhe, Mpiko, additional, Almela, Manel, additional, Azqueta, Manuel, additional, Brunet, Merce, additional, Castro, Pedro, additional, De Lazzari, Elisa, additional, Falces, Carlos, additional, Fuster, David, additional, Fita, Guillermina, additional, Garcia- de- la- Maria, Cristina, additional, Garcia-Gonzalez, Javier, additional, Gatell, Jose M., additional, Marco, Francesc, additional, Miró, José M., additional, Ortiz, José, additional, Ninot, Salvador, additional, Paré, J. Carlos, additional, Pericas, Juan M., additional, Quintana, Eduard, additional, Ramirez, Jose, additional, Rovira, Irene, additional, Sandoval, Elena, additional, Sitges, Marta, additional, Tellez, Adrian, additional, Tolosana, José M., additional, Vidal, Barbara, additional, Vila, Jordi, additional, Anguera, Ignasi, additional, Font, Bernat, additional, Guma, Joan Raimon, additional, Bermejo, Javier, additional, Bouza, Emilio, additional, Garcia Fernández, Miguel Angel, additional, Gonzalez-Ramallo, Victor, additional, Marín, Mercedes, additional, Muñoz, Patricia, additional, Pedromingo, Miguel, additional, Roda, Jorge, additional, Rodríguez-Créixems, Marta, additional, Solis, Jorge, additional, Fernandez-Hidalgo, Nuria, additional, Tornos, Pilar, additional, de Alarcón, Arístides, additional, Parra, Ricardo, additional, Alestig, Eric, additional, Johansson, Magnus, additional, Olaison, Lars, additional, Snygg-Martin, Ulrika, additional, Pachirat, Pimchitra, additional, Pussadhamma, Burabha, additional, Senthong, Vichai, additional, Casey, Anna, additional, Elliott, Tom, additional, Lambert, Peter, additional, Watkin, Richard, additional, Eyton, Christina, additional, Klein, John L., additional, Bradley, Suzanne, additional, Kauffman, Carol, additional, Bedimo, Roger, additional, Corey, G. Ralph, additional, Crowley, Anna Lisa, additional, Douglas, Pamela, additional, Drew, Laura, additional, Holland, Thomas, additional, Lalani, Tahaniyat, additional, Mudrick, Daniel, additional, Samad, Zaniab, additional, Sexton, Daniel, additional, Stryjewski, Martin, additional, Wang, Andrew, additional, Woods, Christopher W., additional, Cantey, Robert, additional, Steed, Lisa, additional, Dickerman, Stuart A., additional, Bonilla, Hector, additional, DiPersio, Joseph, additional, Salstrom, Sara-Jane, additional, Baddley, John, additional, Patel, Mukesh, additional, Peterson, Gail, additional, Stancoven, Amy, additional, Levine, Donald, additional, Riddle, Jonathan, additional, Rybak, Michael, additional, and Cabell, Christopher H., additional more...

Published
2021
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13. Cardiac complications during the active phase of COVID-19: review of the current evidence.

Author

Ramadan, Mohammad Said, Bertolino, Lorenzo, Marrazzo, Tommaso, Florio, Maria Teresa, Durante-Mangoni, Emanuele, The Monaldi Hospital Cardiovascular Infection Study Group, Iossa, Domenico, Ursi, Maria Paola, D'Amico, Fabiana, Karruli, Arta, Ramadan, Mohammad, Andini, Roberto, Zampino, Rosa, Bernardo, Mariano, Ruocco, Giuseppe, Dialetto, Giovanni, Covino, Franco Enrico, Manduca, Sabrina, Corte, Alessandro Della, and De Feo, Marisa more...

Abstract

Growing reports since the beginning of the pandemic and till date describe increased rates of cardiac complications (CC) in the active phase of coronavirus disease 2019 (COVID-19). CC commonly observed include myocarditis/myocardial injury, arrhythmias and heart failure, with an incidence reaching about a quarter of hospitalized patients in some reports. The increased incidence of CC raise questions about the possible heightened susceptibility of patients with cardiac disease to develop severe COVID-19, and whether the virus itself is involved in the pathogenesis of CC. The wide array of CC seems to stem from multiple mechanisms, including the ability of the virus to directly enter cardiomyocytes, and to indirectly damage the heart through systemic hyperinflammatory and hypercoagulable states, endothelial injury of the coronary arteries and hypoxemia. The induced CC seem to dramatically impact the prognosis of COVID-19, with some studies suggesting over 50% mortality rates with myocardial damage, up from ~ 5% overall mortality of COVID-19 alone. Thus, it is particularly important to investigate the relation between COVID-19 and heart disease, given the major effect on morbidity and mortality, aiming at early detection and improving patient care and outcomes. In this article, we review the growing body of published data on the topic to provide the reader with a comprehensive and robust description of the available evidence and its implication for clinical practice. [ABSTRACT FROM AUTHOR] more...

Published
2021
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18. The ascending aorta with bicuspid aortic valve: a phenotypic classification with potential prognostic significance†.

Author

Della Corte, Alessandro, Bancone, Ciro, Dialetto, Giovanni, Covino, Franco E., Manduca, Sabrina, Montibello, Marco V., De Feo, Marisa, Buonocore, Marianna, and Nappi, Gianantonio

Subjects
AORTA, AORTIC valve, PROGNOSIS, ECHOCARDIOGRAPHY, LONGITUDINAL method
Abstract

OBJECTIVES Different methods to classify the anatomical configurations of the aorta with bicuspid aortic valve (BAV) have been proposed. We aimed to test them in terms of descriptive power (i.e. capability to identify different clusters of patients with unique associations of anatomo-clinical features) and possible prognostic significance. METHODS A consecutive echocardiographic series of 696 BAV patients (mean age 48 ± 16 years, male:female ratio 3:1) was analysed. Three possible schemes for classification of the patterns of aortic dimensions were compared. One defined the aortic shape as ‘N’ (ascending < sinuses > sinotubular junction (STJ)), ‘A’ (ascending > sinuses > STJ) or ‘E’ (sinotubular ≥ sinuses), the second as ‘non-dilated’, ‘ascending phenotype’ (dilated, with ascending > sinuses) or ‘root phenotype’ (dilated, with sinuses > ascending) and the third as normal, ‘type I’ (dilated only at the ascending tract), ‘type II’ (dilated at both ascending and sinus levels) or ‘type III’ (dilated only at the sinuses). We evaluated the correlation with valve morphotypes (right-left fusion, right-non-coronary fusion) and patient characteristics. In a smaller longitudinal study (n = 150), the occurrence of fast growth of the aorta (fifth quintile: ≥1 mm/year) during follow-up (5 ± 3 years) in the various phenotypes was assessed. RESULTS The three classification methods proved meaningful in terms of association with valve morphotypes: significant associations were found between right-left-coronary BAV and the root phenotype (P < 0.001) and between the right-non-coronary BAV and the shapes A and E (P<0.001) as well as type I aortic configuration (P < 0.001). The aortic shape showed significant association with five of the other tested clinical variables, the phenotype and the type of dilatation with eight. In the longitudinal study, the root phenotype showed the most significant association with fast growth (>1 mm/year) of the ascending diameter (50% root phenotype patients; P = 0.005). The association with the N type was weaker (P = 0.055); no association was found with types from the other classification scheme (P = 0.42). CONCLUSIONS When tested on a large population, three previously suggested phenotypic classifications of the BAV aorta proved to categorize patients into significantly different clusters, but only the classification system distinguishing between ascending phenotype and root phenotype showed a potential prognostic value. Phenotypic class of the aorta could be a factor to integrate in future comprehensive models for risk stratification of BAV aortopathy. [ABSTRACT FROM AUTHOR] more...

Published
2014
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20. Long-Term Outcome of Infective Endocarditis Involving Cardiac Implantable Electronic Devices: Impact of Comorbidities and Lead Extraction

Author

Emanuele, Durante-Mangoni, Maria Paola, Ursi, Roberto, Andini, Irene, Mattucci, Ester E, Della Ratta, Domenico, Iossa, Lorenzo, Bertolino, Stefano, De Vivo, Sabrina, Manduca, Michele, Torella, Marisa, De Feo, Rosa, Zampino, The Monaldi Hospital Cardiovascular Infection Study Group, Durante-Mangoni, Emanuele, Ursi, Maria Paola, Andini, Roberto, Mattucci, Irene, Della Ratta, Ester E, Iossa, Domenico, Bertolino, Lorenzo, De Vivo, Stefano, Manduca, Sabrina, Torella, Michele, De Feo, Marisa, Zampino, Rosa, and The Monaldi Hospital Cardiovascular Infection Study Group, Null more...

Subjects
infective endocarditi, long-term mortality, transvenous lead extraction, predictor, General Medicine, cardiac implantable electronic device, infective endocarditis, predictors
Abstract

(1) Background: Management of cardiac implantable electronic device-related infective endocarditis (CIED-IE) hinges on complete hardware removal. We assessed whether long-term prognosis is affected by device removal, considering baseline patient comorbid conditions; (2) Methods: A total of 125 consecutive patients hospitalized for CIED-IE were included in this retrospective analysis. Outcomes were in-hospital, one-year, and long-term mortality. There were 109 patients who underwent device removal, 91 by transvenous lead extraction (TLE) and 18 by open heart surgery (OHS); (3) Results: TLE translated into lower hospital mortality (4.4% vs. 22.5% with OHS; p = 0.03). Septic pulmonary embolism was the only independent predictor of in-hospital mortality (OR:7.38 [1.49–36.6], p = 0.013). One-year mortality was in contrast independently associated to tricuspid valve involvement (p = 0.01) and Charlson comorbidity index (CCI, p = 0.039), but not the hardware removal modality. After a median follow-up of 41 months, mortality rose to 24%, and was significantly influenced only by CCI. Specifically, patients with a higher CCI who were also treated with TLE showed a survival rate not significantly different from those managed with medical therapy only; (4) Conclusions: In CIED-IE, TLE is the strategy of choice for hardware removal, improving early outcomes. Long-term benefits of TLE are lessened by comorbidities. In cases of CIED-IE with high CCI, a more conservative approach might be an option. more...

Published
2022

21. The ascending aorta with bicuspid aortic valve: a phenotypic classification with potential prognostic significance

Author

Giovanni Dialetto, Sabrina Manduca, Ciro Bancone, Marianna Buonocore, F. E. Covino, Gianantonio Nappi, Marisa De Feo, Alessandro Della Corte, M.V. Montibello, DELLA CORTE, Alessandro, Bancone, Ciro, Dialetto, Giovanni, Franco, Covino E., Manduca, Sabrina, Marco, Montibello V., DE FEO, Marisa, Buonocore, Marianna, and Nappi, Gianantonio more...

Subjects
Aortic dilatation, Pulmonary and Respiratory Medicine, Adult, Male, Bicuspid aortic valve, Prognosi, Heart Valve Diseases, Patient characteristics, Classification scheme, Longitudinal Studie, Bicuspid Aortic Valve Disease, medicine.artery, Ascending aorta, Medicine, Humans, Longitudinal Studies, Sinus (anatomy), Aorta, Cross-Sectional Studie, business.industry, Sinotubular Junction, General Medicine, Anatomy, Middle Aged, medicine.disease, Classification, Prognosis, Phenotype, Heart Valve Disease, medicine.anatomical_structure, Cross-Sectional Studies, Echocardiography, Aortic Valve, Surgery, Female, business, Cardiology and Cardiovascular Medicine, Human
Abstract

Objectives: Different methods to classify the anatomical configurations of the aorta with bicuspid aortic valve (BAV) have been proposed. We aimed to test them in terms of descriptive power (i.e. capability to identify different clusters of patients with unique associations of anatomo-clinical features) and possible prognostic significance. Methods: A consecutive echocardiographic series of 696 BAV patients (mean age 48 ± 16 years, male:female ratio 3:1) was analysed. Three possible schemes for classification of the patterns of aortic dimensions were compared. One defined the aortic shape as 'N' (ascending < sinuses > sinotubular junction (STJ)), 'A' (ascending > sinuses > STJ) or 'E' (sinotubular ≥ sinuses), the second as 'non-dilated', 'ascending phenotype' (dilated, with ascending > sinuses) or 'root phenotype' (dilated, with sinuses > ascending) and the third as normal, 'type I' (dilated only at the ascending tract), 'type II' (dilated at both ascending and sinus levels) or 'type III' (dilated only at the sinuses). We evaluated the correlation with valve morphotypes (right-left fusion, right-non-coronary fusion) and patient characteristics. In a smaller longitudinal study (n = 150), the occurrence of fast growth of the aorta (fifth quintile: ≤1 mm/year) during follow-up (5 ± 3 years) in the various phenotypes was assessed. Results: The three classification methods proved meaningful in terms of association with valve morphotypes: significant associations were found between right-left-coronary BAV and the root phenotype (P < 0.001) and between the right-non-coronary BAV and the shapes A and E (P1 mm/year) of the ascending diameter (50% root phenotype patients; P = 0.005). The association with the N type was weaker (P = 0.055); no association was found with types from the other classification scheme (P = 0.42). Conclusions: When tested on a large population, three previously suggested phenotypic classifications of the BAV aorta proved to categorize patients into significantly different clusters, but only the classification system distinguishing between ascending phenotype and root phenotype showed a potential prognostic value. Phenotypic class of the aorta could be a factor to integrate in future comprehensive models for risk stratification of BAV aortopathy. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. more...

Published
2014