63 results on '"Moccetti, M."'
Search Results
2. Baseline Predictors of Renal Failure in Transcatheter Aortic Valve Implantation
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Langfritz, M., Shahin, M., Nietlispach, F., Taramasso, M., Denegri, A., Moccetti, M., Pedrazzini, G., Moccetti, T., Keller, L. S., Ruschitzka, F., Francesco Maisano, Obeid, S., Langfritz, M, Shahin, M, Nietlispach, F, Taramasso, M, Denegri, A, Moccetti, M, Pedrazzini, G, Moccetti, T, Keller, L, Ruschitzka, F, Maisano, F, Obeid, S, University of Zurich, and Obeid, Slayman
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2741 Radiology, Nuclear Medicine and Imaging ,610 Medicine & health ,11171 Cardiocentro Ticino ,2705 Cardiology and Cardiovascular Medicine ,10020 Clinic for Cardiac Surgery - Published
- 2019
3. Heavy drinking habits are associated with worse in-hospital outcomes in patients with acute coronary syndrome
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Tersalvi, G, primary, Biasco, L, additional, Radovanovic, D, additional, Rickli, H, additional, Roffi, M, additional, Eberli, F, additional, Moccetti, M, additional, Jeger, R, additional, Moccetti, T, additional, Erne, P, additional, and Pedrazzini, G.B, additional
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- 2020
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4. HEART VALVE DISEASESP1 SEX AND GENDER DIFFERENCES IN TAVI PATIENTS: FROM CLINICAL PRESENTATION TO PROCEDURAL OUTCOMES
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Quagliana, A, primary, Grego, S, additional, Pasotti, E, additional, Araco, M, additional, Moccetti, M, additional, Pedrazzini, G, additional, and Moccetti, T, additional
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- 2020
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5. The Role of the Central Autonomic Nervous System and Psychosocial Factors in Microvascular Angina and Takotsubo Syndrome
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Cattaneo, MM, primary, Pravatà, E, additional, Provenzi, M, additional, Moccetti, M, additional, Kaelin, A, additional, Sudano, I, additional, Crea, F, additional, Biasucci, L, additional, Limoni, C, additional, Calanchini, C, additional, Cattaneo, M, additional, and Gallino, A, additional
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- 2020
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6. 463Temporal trends in latecomer ST-segment elevation myocardial infarction patients: Insights from the AMIS Plus Registry 1997–2017
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Roberto, M, primary, Radovanovic, D, additional, Biasco, L, additional, Quagliana, A, additional, Erne, P, additional, Rickli, H, additional, Pedrazzini, G, additional, and Moccetti, M, additional
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- 2019
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7. Insufficienza cardiaca cronica: le novità importanti delle linee guida 2016 della società europea di cardiologia
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Scopigni, F, Ferrari, N, Pasotti, E, Demertzis, S, Moccetti, M, Pedrazzini, G B, Moccetti, T, and University of Zurich
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610 Medicine & health ,11171 Cardiocentro Ticino - Published
- 2017
8. Cardiopoietic cell therapy for advanced ischemic heart failure : results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial
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Bartunek, Jozef, Terzic, Andre, Davison, Beth A, Filippatos, Gerasimos S, Radovanovic, Slavica, Beleslin, Branko, Merkely, Bela, Musialek, Piotr, Wojakowski, Wojciech, Andreka, Peter, Horvath, Ivan G, Katz, Amos, Dolatabadi, Dariouch, El Nakadi, Badih, Arandjelovic, Aleksandra, Edes, Istvan, Seferovic, Petar M, Obradovic, Slobodan, Vanderheyden, Marc, Jagic, Nikola, Petrov, Ivo, Atar, Shaul, Halabi, Majdi, Gelev, Valeri L, Shochat, Michael K, Kasprzak, Jaroslaw D, Sanz Ruiz, Ricardo, Heyndrickx, Guy R, Nyolczas, Noémi, Legrand, Victor, Guédès, Antoine, Heyse, Alex, Moccetti, Tiziano, Fernandez Aviles, Francisco, Jimenez Quevedo, Pilar, Bayes Genis, Antoni, Hernandez Garcia, Jose Maria, Ribichini, Flavio, Gruchala, Marcin, Waldman, Scott A, Teerlink, John R, Gersh, Bernard J, Povsic, Thomas J, Henry, Timothy D, Metra, Marco, Hajjar, Roger J, Tendera, Michal, Behfar, Atta, Alexandre, Bertrand, Seron, Aymeric, Stough, Wendy Gattis, Sherman, Warren, Cotter, Gad, Wijns, W. i. l. l. i. a. m. Collaborators Clinical investigators, Dens, sites Belgium: Ziekenhuis Oost Limburg: J., Dupont, M., Mullens, W., Janssens, M., Dolatabadi, Hoˆpital Civil de Charleroi: D., De Bruyne, Y., Lalmand, J., Dubois, P., El Nakadi, B., Aminian, A., De Vuyst, E., Gurnet, P., Gujic, M., Blankoff, I., Guedes, CHU Mont Godinne UCL: A., Gabriel, L., Seldrum, S., Doyen, C., Andre´, M., Heyse, AZ Glorieux: A., Van Durme, F., Verschuere, J., Legrand, Domaine Universitaire du Sart Tilman: V., Gach, O., D’Orio, V., Davin, L., Lancellotti, P., Baudoux, E., Ancion, A., Dulgheru, R., Vanderheyden, OLV Ziekenhuis Aalst – Cardiologie: M., Bartunek, J., Wijns, W., Verstreken, S., Penicka, . M., Gelev, P. Meeus Bulgaria: Tokuda Hospital Sofia: V., Zheleva Kichukova, I., Parapunova, R., Melamed, R., Sardovski, S., Radev, O., Yordanov, A., Radinov, A., Nenov, D., Amine, I., Petrov, City Hospital Clinic Cardiology Center: I., Kichukov, K., Nikitasov, L., Stankov, Z., Stoyanov, H., Tasheva Dimitrova, I., Angelova, M., Dimitrov, E., Minchev, M., Garvanski, I., Botev, C., Polomski, P., Alexandrovska University Hospital, Vassilev, Sofia: D., Karamfiloff, K., Tarnovska Kadreva, R., Vladimirova, L., Dimitrov, G., Hadzhiev, E., Tzvetkova, G., Andreka, . M. Atanasova Hungary: Gottsegen Gyo¨ rgy Orszagos Kardiologiai Inte´zet: P., Fontos, G., Fabian, J., Csepregi, A., Uzonyi, G., Gelei, A., Edes, Debreceni Egyetem Orvos e´s Ege´szse´gtudomanyi Centrum Altalanos Orvostudomanyi Kar Kardiologia Inte´zet: I., Balogh, L., Vajda, G., Darago, A., Gergely, S., Fulop, T., Jenei, C., Horvath, Pe´csi Tudomanyegyetem Klinikai Ko¨zpont Szıvgyogyaszati Klinika: I., Magyari, B., Nagy, A., Cziraki, A., Faludi, R., Kittka, B., Alizadeh, H., Merkely, Semmelweis Egyetem Varosmajori Szıv e´s Ergyogyaszati Klinika: B., Geller, L., Farkas, P., Szombath, G., Foldes, G., Skopal, J., Kovacs, A., Kosztin, A., Gara, E., Sydo, N., Nyolczas, MH Ege´szse´gu¨gyi Ko¨zpont Kardiologiai Osztaly: N., Kerecsen, G., Korda, A., Kiss, . M., Borsanyi, T., Polgar, B., Muk, B., Sharif, Z. Bari Ireland: HRB Clinical Research Facility: F., Atar, Y. M. Smyth Israel:Western Galilee Hospital: S., Shturman, A., Akria, L., Kilimnik, M., Brezins, M., Halabi, Ziv Medical Center: M., Dally, N., Goldberg, A., Aehab, K., Rosenfeld, I., Levinas, T., Saleem, D., Katz, Barzilai Medical Center: A., Plaev, T., Drogenikov, T., Nemetz, A., Barshay, Y., Jafari, J., Orlov, I., Nazareth Hospital EMMS: M. Omory, N. Kogan Nielsen, Shochat, Hillel Yaffe Medical Center: M., Shotan, A., Frimerman, A., Meisel, S., Asif, A., Sofer, O., Blondheim, D. S., Vazan, A., Metra, L. Arobov Italy: A. O. Spedali Civili di Brescia: M., Bonadei, I., Inama, L., Chiari, E., Lombardi, C., Magatelli, M., Russo, D., Lazzarini, V., Carubelli, V., Vassanelli, AOUI Verona – Borgo Trento Hospital: C., Ribichini, Flavio Luciano, Bergamini, C., Krampera, Mauro, Cicoria, M. A., Zanolla, L., Dalla Mura, D., Gambaro, A., Rossi, A., Pesarini Poland: Jagiellonian University Department of Cardiac, G., Musialek, Vascular Diseases at John Paul II Hospital in Krakow: P., Mazurek, A., Drabik, L., Ka˛dzielski, A., Walter, Z., Dzieciuch Rojek, M., Rubis, P., Plazak, . W., Tekieli, L., Podolec, J., Orczyk, W., Sutor, U., Zmudka, K., Olszowska, M., Podolec, P., Gruchala, Uniwersyteckie Centrum Kliniczne: M., Ciecwierz, D., Mielczarek, M., Burakowski, S., Chmielecki, M., Zielinska, M., Frankiewicz, A., Wdowczyk, J., Stopczynska, I., Bellwon, J., Mosakowska, K., Nadolna, R., Wroblewska, J., Rozmyslowska, M., Rynkiewicz, M., Marciniak, I., Raczak, G., Tarnawska, M., Taszner, M., Kasprzak, Bieganski Hospital: J., Plewka, M., Fiutowska, D., Rechcinski, T., Lipiec, P., Sobczak, M., Weijner Mik, P., Wraga, M., Krecki, R., Markiewicz, M., Haval Qawoq, D., Wojakowski, Gornosla˛skie Centrum Medyczne Sla˛skie j. Akademii Medycznej: W., Ciosek, J., Dworowy, S., Gaszewska Zurek, E., Ochala, A., Cybulski, W., Jadczyk, T., Wanha, W., Parma, Z., Kozlowski, M., Dzierzak, M., Markiewicz Serbia: Clinical Hospital Center Zvezdara, M., Arandjelovic, Cardiology Clinic: A., Sekularac, N., Boljevic, D., Bogdanovic, A., Zivkovic, S., Cvetinovic, N., Loncar, G., Clinical Centre of Serbia, Beleslin, Cardiology Clinic: B., Nedeljkovic, M., Trifunovic, D., Giga, V., Banovic, M., Nedeljkovic, I., Stepanovic, J., Vukcevic, V., Djordjevic Dikic, A., Dobric, M., Obrenovic Kircanski, B., Seferovic, Cardiology Clinic: P., Orlic, D., Tesic, M., Petrovic, O., Milinkovic, I., Simeunovic, D., Jagic, Clinical Center of Kragujevac: N., Tasic, M., Nikolic, D., Miloradovic, V., Djurdjevic, P., Sreckovic, M., Zornic, N., Clinical Hospital Center Bezanijska Kosa, Radovanovic, Cardiology Department: S., Saric, J., Hinic, S., Djokovic, A., Ðordevic, S., Bisenic, V., Markovic, O., Stamenkovic, S., Malenkovic, V., Tresnjak, J., Misic, G., Cotra, D., Tomovic, L., Vuckovic, V., Clinic of Emergency Internal Medicine, Obradovic, Military Medical Academy: S., Jovic, Z., Vukotic, S., Markovic, D., Djenic, N., Ristic Andjelkov, A., Bayes Genis, D. Ljubinka Spain: Hospital Universitario Germans Trias I. Pujol: A., Rodriguez Leor, O., Labata, C., Vallejo, N., Ferrer, E., Batlle, M., Fernandez Aviles, Hospital General Universitario Gregorio Mara~non: F., Sanz Ruiz, R., Casado, A., Loughlin, G., Zatarain, E., Anguita, J., Ferna ndez Santos, M. E., Pascual, C., Bermejo, J., Hernandez Garcia, Hospital Clinico Universitario Virgen de la Victoria: J. M., Jimenez Navarro, M., Dominguez, A., Carrasco, F., Mu~noz, A., Garcia Pinilla, J. M., Ruiz, J., Queipo de Llano, M. P., Hernandez, A., Fernandez, A., Jimenez Quevedo, Hospital Clinico San Carlos: P., Guerra, R., Biagioni, C., Gonzalez, R. A., Gomez deDiego, J. J., Mansson Broberg, L. Perez de Isla Sweden: Karolinska University Hospital: A., Sylve´n, C., Leblanc, K., Winter, R., Blomberg, P., Gunyeli, E., Ruck, A., Silva, C., Fo¨rstedt Switzerland: CardioCentro Ticino, J., Moccetti, Switzerland: T., Rossi, M., Pasotti, E., Petrova, I., Crljenica, C., Monti, C., Murzilli, R., Su¨rder, D., Moccetti, M., Turchetto, L., Locicero, V., Chiumiento, L., Maspoli, S., Mombelli, M., Anesini, A., Biggiogero, M., Ponti, G., Camporini, C., Polledri, S., Hill, G. Dolci United Kingdom: Kings College Hospital: J., Plymen, C., Amin Youssef, G., Mcdonagh, T., Drasar, E., Mijovic, A., Jouhra, F., Mcloman, D., Dworakowski, R., Webb, I., Byrne, J., and Potter, V.
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0301 basic medicine ,Male ,Cardiopoiesis ,Cardiovascular disease ,Disease severity ,Marker ,Precision medicine ,Regenerative medicine ,Stem cell ,Target population ,Adult ,Aged ,Double-Blind Method ,Female ,Heart Failure ,Humans ,Mesenchymal Stem Cell Transplantation ,Middle Aged ,Myocardial Ischemia ,Prospective Studies ,Treatment Outcome ,Young Adult ,Cardiology and Cardiovascular Medicine ,Cell- and Tissue-Based Therapy ,mesenchymal stem-cells ,030204 cardiovascular system & hematology ,Cardiorespiratory Medicine and Haematology ,outcomes ,Fast-Track Clinical Research ,Sudden cardiac death ,0302 clinical medicine ,Ischemia ,cardiovascular disease ,Clinical endpoint ,target population ,CHART Program ,Ejection fraction ,bone-marrow ,Heart Failure/Cardiomyopathy ,3. Good health ,Cohort ,Cardiology ,Fast Track ,disease severity ,delivery ,medicine.medical_specialty ,precision medicine ,Clinical Sciences ,regenerative medicine ,03 medical and health sciences ,cardiopoiesis ,Internal medicine ,medicine ,Adverse effect ,marker ,disease ,business.industry ,medicine.disease ,mortality ,Confidence interval ,Clinical trial ,stem cell ,Editor's Choice ,030104 developmental biology ,predictors ,Cardiovascular System & Hematology ,Heart failure ,business - Abstract
Altres ajuts: This work was supported by Celyad, SA (Mont-Saint-Guibert, Belgium). Celyad has received research grants from the Walloon Region (Belgium, DG06 funding). Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort. This multinational, randomized, double-blind, sham-controlled study was conducted in 39 hospitals. Patients with symptomatic ischaemic heart failure on guideline-directed therapy (n = 484) were screened; n = 348 underwent bone marrow harvest and mesenchymal stem cell expansion. Those achieving > 24 million mesenchymal stem cells (n = 315) were randomized to cardiopoietic cells delivered endomyocardially with a retention-enhanced catheter (n = 157) or sham procedure (n = 158). Procedures were performed as randomized in 271 patients (n = 120 cardiopoietic cells, n = 151 sham). The primary efficacy endpoint was a Finkelstein–Schoenfeld hierarchical composite (all-cause mortality, worsening heart failure, Minnesota Living with Heart Failure Questionnaire score, 6-min walk distance, left ventricular end-systolic volume, and ejection fraction) at 39 weeks. The primary outcome was neutral (Mann–Whitney estimator 0.54, 95% confidence interval [CI] 0.47–0.61 [value > 0.5 favours cell treatment], P = 0.27). Exploratory analyses suggested a benefit of cell treatment on the primary composite in patients with baseline left ventricular end-diastolic volume 200–370 mL (60% of patients) (Mann–Whitney estimator 0.61, 95% CI 0.52–0.70, P = 0.015). No difference was observed in serious adverse events. One (0.9%) cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted or sudden cardiac death. The primary endpoint was neutral, with safety demonstrated across the cohort. Further evaluation of cardiopoietic cell therapy in patients with elevated end-diastolic volume is warranted.
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- 2017
9. P2617Global radiological exposure of TAVI: an unresolved issue with potential drawbacks in low and intermediate risk patients
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Biasco, L., primary, Badini, M., additional, Pedrazzini, G.B., additional, Moccetti, T., additional, Pasotti, E., additional, Faletra, F., additional, Ferrari, E., additional, Trunfio, R., additional, Aviano, D., additional, and Moccetti, M., additional
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- 2017
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10. Images in cardiovascular medicine. Posttraumatic cardiac contrecoup: in vivo evidence by cardiac magnetic resonance imaging
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Moccetti, M, Wyttenbach, R, Santini, P, Previsdomini, M, Corti, R, Gallino, A, University of Zurich, and Gallino, A
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2737 Physiology (medical) ,10209 Clinic for Cardiology ,610 Medicine & health ,2705 Cardiology and Cardiovascular Medicine - Published
- 2009
11. Progression of human carotid and femoral atherosclerosis: a prospective follow-up study by magnetic resonance vessel wall imaging
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Bianda, N., primary, Di Valentino, M., additional, Periat, D., additional, Segatto, J. M., additional, Oberson, M., additional, Moccetti, M., additional, Sudano, I., additional, Santini, P., additional, Limoni, C., additional, Froio, A., additional, Stuber, M., additional, Corti, R., additional, Gallino, A., additional, and Wyttenbach, R., additional
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- 2011
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12. Acute haemodynamic changes after percutaneous mitral valve repair: relation to mid-term outcomes.
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Gaemperli O, Moccetti M, Surder D, Biaggi P, Hurlimann D, Kretschmar O, Buehler I, Bettex D, Felix C, Luscher TF, Falk V, Grunenfelder J, and Corti R
- Abstract
Background Percutaneous mitral valve repair (MVR) using the Evalve MitraClip has been recently introduced as a potential alternative to surgical MVR. Objective To assess immediate haemodynamic changes after percutaneous MVR using right heart catheterisation. Design Single-centre longitudinal cohort study. Setting Tertiary referral centre. Patients Fifty consecutive non-surgical patients (age 74±14 years, EuroSCORE 26±14) with moderate to severe (3+) and severe (4+) mitral regurgitation (MR) due to functional (56%), degenerative (30%) or mixed (14%) disease were selected. Interventions MitraClip implantation was performed under general anaesthesia with fluoroscopy and echocardiographic guidance. Haemodynamic variables were obtained before and after MVR using standard right heart catheterisation and oximetry. Main outcome measures Haemodynamic changes immediately before and after MVR. Results Acute procedural success (reduction in MR to grade 2+ or less) was achieved in 46 (92%) patients. Mitral valve clipping reduced mean pulmonary capillary wedge pressure (mPCWP) (from 17±7 to 12±5 mm Hg), PCWP v-wave (from 24±11 to 16±7 mm Hg) and mean pulmonary artery pressure (mPAP) (from 29±12 to 24±6 mm Hg), and increased the cardiac index (CI) (from 3.1±1.0 to 3.9±1.1 l/min/m(2)) (all p<0.05). On Cox univariate regression analysis, mPCWP, PCWP v-wave- and mPAP-changes were associated with death, open-heart surgery for MR and/or hospitalisation for heart failure on follow-up. Conclusion In a heterogeneous population with predominantly functional MR, percutaneous MVR with the Evalve MitraClip system lowers mPCWP, PCWP v-wave and mPAP by 20%, 20% and 8%, respectively, and increases the CI by 32%. [ABSTRACT FROM AUTHOR]
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- 2012
13. Images in cardiovascular medicine. Posttraumatic cardiac contrecoup: in vivo evidence by cardiac magnetic resonance imaging.
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Moccetti M, Wyttenbach R, Santini P, Previsdomini M, Corti R, Gallino A, Moccetti, Marco, Wyttenbach, Rolf, Santini, Paolo, Previsdomini, Marco, Corti, Roberto, and Gallino, Augusto
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- 2009
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14. Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction.
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Stähli, B. E., Varbella, F., Linke, A., Schwarz, B., Felix, S. B., Seiffert, M., Kesterke, R., Nordbeck, P., Witzenbichler, B., Lang, I. M., Kessler, M., Valina, C., Dibra, A., Rohla, M., Moccetti, M., Vercellino, M., Gaede, L., Bott-Flügel, L., Jakob, P., and Stehli, J.
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MYOCARDIAL infarction , *DRUG-eluting stents , *ST elevation myocardial infarction , *PERCUTANEOUS coronary intervention , *CORONARY artery disease - Abstract
BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) with multigrees, vessel coronary artery disease, the time at which complete revascularization of nonculprit lesions should be performed remains unknown. METHODS: We performed an international, open-label, randomized, noninferiority trial at 37 sites in Europe. Patients in a hemodynamically stable condition who had STEMI and multivessel coronary artery disease were randomly assigned to undergo immediate multivessel percutaneous coronary intervention (PCI; immediate group) or PCI of the culprit lesion followed by staged multivessel PCI of nonculprit lesions within 19 to 45 days after the index procedure (staged group). The primary end point was a composite of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year after randomization. The percentages of patients with a primary or secondary end-point event are provided as Kaplan-Meier estimates at 6 months and at 1 year. RESULTS: We assigned 418 patients to undergo immediate multivessel PCI and 422 to undergo staged multivessel PCL A primary end-point event occurred in 35 patients (8.590) in the immediate group as compared with 68 patients (16.396) in the staged group (risk ratio, 0.52; 95% confidence interval, 0.38 to 0.72; P<0.001 for noninferiority and P< 0.001 for superiority). Nonfatal myocardial infarction and unplanned ischemia-driven revascularization occurred in 8 patients (2.090) and 17 patients (4.1°6), respectively, in the immediate group and in 22 patients (5.3°6) and 39 patients (9.3°6), respectively, in the staged group. The risk of death from any cause, the risk of stroke, and the risk of hospitalization for heart failure appeared to be similar in the two groups. A total of 104 patients in the immediate group and 145 patients in the staged group had a serious adverse event. CONCLUSIONS: Among patients in hemodynamically stable condition with STEMI and multivessel coronary artery disease, immediate multivessel PCI was noninferior to staged multivessel PCI with respect to the risk of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. [ABSTRACT FROM AUTHOR]
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- 2023
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15. Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis
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Ayman Jubran, Didier Tchetche, Ronen Jaffe, Thomas Pilgrim, Jasmin Shamekhi, Matteo Pagnesi, Ran Kornowski, Danny Dvir, Oren Zusman, Francesco Maisano, Jan Malte Sinning, Daniella Vronsky, Sung Han Yoon, Mayra Guerrero, Marco Moccetti, Edo Bedzra, Antonio Colombo, Chiara De Biase, Pablo Codner, Raj Makkar, Azeem Latib, Corrado Tamburino, Yusuke Watanabe, Omer Iftikhar, Paolo D' Arrigo, Darren Mylotte, Martin B. Leon, Susheel Kodali, Johan Bosmans, Marco Russo, Hanna Dagnegård, Luigi Biasco, Alon Barsheshet, Zaza Iakobishvili, Stephan Windecker, Maurizio Taramasso, Horst Sievert, Uri Landes, Giovanni Pedrazzini, Lars Sondergaard, Landes, U, Iakobishvili, Z, Vronsky, D, Zusman, O, Barsheshet, A, Jaffe, R, Jubran, A, Yoon, Sh, Makkar, Rr, Taramasso, M, Russo, M, Maisano, F, Sinning, Jm, Shamekhi, J, Biasco, L, Pedrazzini, G, Moccetti, M, Latib, A, Pagnesi, M, Colombo, A, Tamburino, C, P, Da, Windecker, S, Pilgrim, T, Tchetche, D, De Biase, C, Guerrero, M, Iftikhar, O, Bosmans, J, Bedzra, E, Dvir, D, Mylotte, D, Sievert, H, Watanabe, Y, Sondergaard, L, Dagnegard, H, Codner, P, Kodali, S, Leon, M, and Kornowski, R
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Malignancy ,Risk Assessment ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Risk Factors ,Cause of Death ,Neoplasms ,Severity of illness ,medicine ,Humans ,Registries ,030212 general & internal medicine ,Stage (cooking) ,610 Medicine & health ,Aged ,Neoplasm Staging ,Cause of death ,Aged, 80 and over ,business.industry ,Remission Induction ,Cancer ,Aortic Valve Stenosis ,Recovery of Function ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Aortic Valve ,Cohort ,Disease Progression ,Female ,Human medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS). BACKGROUND Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option. METHODS A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 "no-cancer" patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias. RESULTS Cancer patients' age was 78.8 +/- 7.5 years, STS score 4.9 +/- 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients. CONCLUSIONS TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Amongthis cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer. (Outcomes of Transcatheter Aortic Valve Implantation in Oncology Patients With Severe Aortic Stenosis [TOP-AS]; NCT03181997) (c) 2019 by the American College of Cardiology Foundation.
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- 2019
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16. Progression of human carotid and femoral atherosclerosis: a prospective follow-up study by magnetic resonance vessel wall imaging
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Augusto Gallino, Isabella Sudano, Matthias Stuber, Rolf Wyttenbach, Nicola Bianda, Roberto Corti, Paolo Santini, Alberto Froio, Marco Moccetti, Michel Oberson, Daniel Périat, Costanzo Limoni, Jeanne Marie Segatto, Marcello Di Valentino, Bianda, N, Di Valentino, M, Periat, D, Segatto, J, Oberson, M, Moccetti, M, Sudano, I, Santini, P, Limoni, C, Froio, A, Stuber, M, Corti, R, Gallino, A, Wyttenbach, R, University of Zurich, and Gallino, Augusto
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Male ,medicine.medical_specialty ,Carotid Artery, Common ,Lumen (anatomy) ,610 Medicine & health ,Femoral artery ,2705 Cardiology and Cardiovascular Medicine ,Framingham Heart Study ,Internal medicine ,medicine.artery ,MED/22 - CHIRURGIA VASCOLARE ,Humans ,Medicine ,Carotid Stenosis ,Prospective Studies ,Prospective cohort study ,Aged ,Observer Variation ,Framingham Risk Score ,medicine.diagnostic_test ,business.industry ,Follow up studies ,Magnetic resonance imaging ,Middle Aged ,Atherosclerosis ,Carotid, atherosclerosis, magnetic resonance, stroke ,Plaque, Atherosclerotic ,Atherosclerosis/pathology ,Carotid Artery, Common/pathology ,Carotid Artery, Internal/pathology ,Carotid Stenosis/pathology ,Disease Progression ,Female ,Femoral Artery/pathology ,Follow-Up Studies ,Magnetic Resonance Angiography/methods ,Plaque, Atherosclerotic/pathology ,Femoral Artery ,10076 Center for Integrative Human Physiology ,Cohort ,10209 Clinic for Cardiology ,Cardiology ,570 Life sciences ,biology ,Cardiology and Cardiovascular Medicine ,business ,Carotid Artery, Internal ,Magnetic Resonance Angiography - Abstract
AIMS: The time course of atherosclerosis burden in distinct vascular territories remains poorly understood. We longitudinally evaluated the natural history of atherosclerotic progression in two different arterial territories using high spatial resolution magnetic resonance imaging (HR-MRI), a powerful, safe, and non-invasive tool. METHODS AND RESULTS: We prospectively studied a cohort of 30 patients (mean age 68.3, n = 9 females) with high Framingham general cardiovascular disease 10-year risk score (29.5%) and standard medical therapy with mild-to-moderate atherosclerosis intra-individually at the level of both carotid and femoral arteries. A total of 178 HR-MRI studies of carotid and femoral arteries performed at baseline and at 1- and 2-year follow-up were evaluated in consensus reading by two experienced readers for lumen area (LA), total vessel area (TVA), vessel wall area (VWA = TVA - LA), and normalized wall area index (NWI = VWA/TVA). At the carotid level, LA decreased (-3.19%/year, P = 0.018), VWA increased (+3.83%/year, P = 0.019), and TVA remained unchanged. At the femoral level, LA remained unchanged, VWA and TVA increased (+5.23%/year and +3.11%/year, both P < 0.01), and NWI increased for both carotid and femoral arteries (+2.28%/year, P = 0.01, and +1.8%/year, P = 0.033). CONCLUSION: The atherosclerotic burden increased significantly in both carotid and femoral arteries. However, carotid plaque progression was associated with negative remodelling, whereas the increase in femoral plaque burden was compensated by positive remodelling. This finding could be related to anatomic and flow differences and/or to the distinct degree of obstruction in the two arterial territories.
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- 2012
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17. Patients With AMI and Severely Reduced LVEF, a Well-Defined, Still Extremely Vulnerable Population (Insights from AMIS Plus Registry).
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Roberto M, Hoepli A, Cattaneo M, Radovanovic D, Rickli H, Erne P, Pedrazzini GB, and Moccetti M
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- Humans, Ventricular Function, Left, Stroke Volume, Vulnerable Populations, Registries, Ventricular Dysfunction, Left, Myocardial Infarction epidemiology, Myocardial Infarction therapy
- Abstract
Left ventricular ejection fraction (LVEF) represents one of the strongest predictors of both in-hospital and long-term prognosis in acute myocardial infarction (AMI). Temporal trends data coming from real-world experiences focused on patients with AMI with severely reduced LVEF (i.e., <30%) are lacking. In a total of 48,543 screened patients with AMI included in the Acute Myocardial Infarction in Switzerland Plus Registry between 2005 and 2020, data on LVEF were available for 23,510 patients. Study patients were classified according to LVEF as patients with AMI with or without severely reduced LVEF (i.e., patients with LVEF <30% and ≥30%, respectively). Overall, 1,657 patients with AMI (7%) displayed severely reduced LVEF. The prevalence of severe LVEF reduction constantly decreased over the study period (from 11% to 4%, p <0.001). In the subgroup of patients with severely reduced LVEF, a significant increase in revascularization rate was observed (from 61% to 84%, p <0.001); however, in-hospital mortality did not significantly decrease and remained well above 20% over the study period (from 23% to 26%, p = 0.65). At discharge, prescription of optimal cardioprotective therapy (defined as an association of renin-angiotensin-aldosterone-system inhibitors, β-blocker, and mineral corticoid receptor antagonist) remained low across the study period (from 17% in 2011 to 20%, p = 0.96). In conclusion, patients with AMI with severely reduced LVEF remain a fragile subgroup of patients with an in-hospital mortality that did not significantly decrease and remained well above 20% over the study period. Moreover, access at discharge to optimal cardioprotective therapy remains suboptimal. Efforts are, therefore, needed to improve prognosis and access to guidelines-directed therapies in this fragile population., Competing Interests: Declaration of Competing Interest Dr. Rickli reports institutional research grants from Biotronik, Boston, Braun, Terumo, and Medtronic, all outside the submitted work. The remaining authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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18. One- and two-year clinical outcomes of treatment with resorbable magnesium scaffolds for coronary artery disease: the prospective, international, multicentre BIOSOLVE-IV registry.
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Wlodarczak A, Montorsi P, Torzewski J, Bennett J, Starmer G, Buck T, Haude M, Moccetti M, Wiemer M, Lee MK, and Verheye S
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- Humans, Middle Aged, Aged, Magnesium therapeutic use, Prospective Studies, Absorbable Implants, Treatment Outcome, Registries, Coronary Artery Disease surgery, Coronary Artery Disease etiology, Non-ST Elevated Myocardial Infarction, Diabetes Mellitus, Thrombosis etiology, Percutaneous Coronary Intervention adverse effects
- Abstract
Background: Bioresorbable scaffolds have been developed to overcome the limitations of drug-eluting stents and to reduce long-term adverse events., Aims: We aimed to assess the long-term safety and efficacy of a sirolimus-eluting resorbable magnesium scaffold to ensure its safe rollout into clinical routine., Methods: BIOSOLVE-IV is a prospective, international, multicentre registry including more than 100 centres in Europe, Asia, and Asia-Pacific. Enrolment started directly after the commercialisation of the device. Follow-up assessments are scheduled at 6 and 12 months, and annually for up to 5 years; we herein report the 24-month outcomes., Results: Overall, 2,066 patients with 2,154 lesions were enrolled. Patients were 61.9±10.5 years old, 21.6% had diabetes, and 18.5% had non-ST-elevation myocardial infarction (NSTEMI). Lesions were 14.8±4.0 mm long with a reference vessel diameter of 3.2±0.3 mm. Device and procedure success were 97.5%, and 99.1%, respectively. The 24-month target lesion failure (TLF) rate was 6.8%, mainly consisting of clinically driven target lesion revascularisations (6.0%). Patients with NSTEMI had significantly higher TLF rates than those without (9.3% vs 6.2%; p=0.025), whereas there were no significant differences observed for patients with diabetes or with type B2/C lesions (a 24-month TLF rate of 7.0% and 7.9%, respectively). The 24-month rate of definite or probable scaffold thrombosis was 0.8%. Half of the scaffold thromboses occurred after premature discontinuation of antiplatelet/anticoagulation therapy, and only one scaffold thrombosis occurred beyond the 6-month follow-up, on day 391., Conclusions: The BIOSOLVE-IV registry showed good safety and efficacy outcomes, confirming a safe rollout of the Magmaris into clinical practice.
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- 2023
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19. A prospective, first-in-human use of the NeVa mechanical thrombectomy device for patients with acute coronary syndromes.
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Spirito A, Quagliana A, Coiro M, Melaku GD, Vandenberghe S, Leibundgut G, Häner J, Moccetti M, Araco M, Garcia-Garcia HM, and Valgimigli M
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- Coronary Angiography, Coronary Circulation, Humans, Prospective Studies, Thrombectomy methods, Treatment Outcome, Acute Coronary Syndrome complications, Acute Coronary Syndrome surgery, Coronary Thrombosis etiology, Coronary Thrombosis surgery
- Abstract
Background: There is no established technique for managing large thrombus burden (LTB) in patients with acute coronary syndrome (ACS)., Aims: The aim of this study was to assess the safety and efficacy of the NeVa (Vesalio) mechanical thrombectomy device (MTD) in ACS patients with LTB., Methods: Consecutive patients with ACS and LTB were treated with the NeVa MTD as the primary vessel recanalisation and thrombus removal modality, followed by conventional intervention. We further developed a bench model and applied to a subset of patients, a vacuum-assisted aspiration technique, exploiting 6 Fr-compatible conventional guiding catheter extensions, as an adjudicative manoeuvre to the use of stent-based MTD. A core laboratory reviewed the angiographic images for procedural complications, Thrombolysis In Myocardial Infarction (TIMI) flow, myocardial blush grade (MBG) and TIMI thrombus grade (TTG)., Results: Between November 2019 and March 2021, 61 patients underwent thrombectomy with the NeVa device. Non-flow limiting and reversible coronary spasm occurred in 14 (23%) patients. One patient (#10) suffered from side branch embolisation, which was successfully treated with the NeVa, triggering the development of a vacuum-assisted aspiration technique in a bench model, which was then applied to the subsequent 51 patients. No other device-related complications occurred. After NeVa use, TIMI flow <3 decreased from 68.3% at baseline to 10.3% (p<0.001), MBG <2 from 65% to 27.6% (p<0.001), TTG ≥3 from 96.7% to 43.2% (p<0.001), respectively., Conclusions: In patients with LTB, the NeVa MTD was safe and associated with high rates of vessel recanalisation and thrombus removal. The concomitant use of vacuum-assisted aspiration has potential to improve the effectiveness and safety of the technique.
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- 2022
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20. A prospective, multicentre first-in-man study of the polymer-free ultrathin-strut BIOrapid stent (BIOVITESSE).
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Räber L, Häner JD, Lüscher TF, Moccetti M, Roffi M, Stortecky S, Muller O, Garcia-Garcia HM, Waksman R, and Siegrist P
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- Adult, Aged, Aged, 80 and over, Coronary Angiography, Humans, Middle Aged, Polymers, Prospective Studies, Stents, Treatment Outcome, Coronary Artery Disease surgery, Coronary Restenosis, Percutaneous Coronary Intervention
- Abstract
Background: Polymer-free drug-coated stents aim to avoid the inflammatory potential of durable polymers, thereby improving the long-term safety profile, and allowing a shorter duration of dual antiplatelet therapy., Aims: The BIOVITESSE study was conducted to assess the safety and clinical performance of the BIOrapid polymer-free coronary stent system coated with a novel highly lipophilic sirolimus derivate., Methods: BIOVITESSE was a prospective, multicentre, first-in-man study that enrolled subjects with de novo coronary lesions in two cohorts of 33 patients each. The primary endpoint of the first cohort was strut coverage at one month as assessed by optical coherence tomography. The primary endpoint of the second cohort was late lumen loss at nine-month follow-up., Results: Patients were on average 63 years old (range: 42-87) and 12% had diabetes. The 66 patients had 70 lesions with an average lesion length of 12.5±5.4 mm. Predilatation was performed in 91.4% and post-dilatation in 87.1% lesions; device success was obtained in 97.4%. At one month, 95.2±5.6% (95% CI: 93.2-97.2) of struts were covered and at nine months, in-stent late lumen loss was 0.31±0.30 mm (95% CI: 0.20-0.42) and in-segment late lumen loss was 0.20±0.29 mm. Two target lesion failures occurred (3.1%): one at day 1 (to cover an asymptomatic stent edge dissection), and one at day 288 post-procedure for restenosis. No stent thrombosis was reported during the 12-month study duration., Conclusions: The BIOrapid stent system exhibited an excellent safety profile, high strut coverage at one-month, and moderate angiographic efficacy according to the late lumen loss at nine-month angiographic follow-up.
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- 2022
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21. A patient-centered multidisciplinary cardiac rehabilitation program improves glycemic control and functional outcome in coronary artery disease after percutaneous and surgical revascularization.
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Denegri A, Rossi VA, Vaghi F, Di Muro P, Regazzi M, Moccetti T, Pasotti E, Pedrazzini GB, Capoferri M, and Moccetti M
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- Glycated Hemoglobin, Glycemic Control, Humans, Patient-Centered Care, Cardiac Rehabilitation adverse effects, Coronary Artery Disease surgery, Diabetes Mellitus diagnosis
- Abstract
Background: Cardiac rehabilitation (CR) is strongly associated with all-cause mortality reduction in patients with coronary artery disease (CAD). The impact of CR on pathological risk factors, such as impaired glucose tolerance (IGT) and functional recovery remains under debate. The aim of the present study is to determine whether CR had a positive effect beside physical exercise improvement on pathological risk factors in IGT and diabetic patients with CAD., Methods: One hundred and seventy-one consecutive patients participating in a 3-month CR from January 2014 to June 2015 were enrolled. The primary endpoint was defined as an improvement of peak workload and VO2-peak; glycated hemoglobin (HbA1c) reduction was considered as secondary endpoint., Results: Euglycemic patients presented a significant improvement in peak workload compared to diabetic patients (from 5.75 ± 1.45 to 6.65 ± 1.84 METs vs. 4.8 ± 0.8 to 4.9 ± 1.4 METs , p = 0.018). VO2-peak improved in euglycemic patients (VO2-peak from 19.3 ± 5.3 to 22.5 ± 5.9 mL/min/kg, p = 0.003), while diabetic patients presented only a statistically significant trend (VO2-peak from 16.9 ± 4.4 to 18.0 ± 3.8 mL/min/kg, p < 0.056). Diabetic patients have benefited more in terms of blood glucose control compared to IGT patients (HbA1c from 7.7 ± 1.0 to 7.4 ± 1.1 compared to 5.6 ± 0.4 to 5.9 ± 0.5, p = 0.02, respectively)., Conclusions: A multidisciplinary CR program improves physical functional capacity in CAD setting, particularly in euglycemic patients. IGT patients as well as diabetic patients may benefit from a CR program, but long-term outcome needs to be clarified in larger studies.
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- 2022
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22. Dual antiplatelet therapy is under-prescribed in patients with surgically treated acute myocardial infarction.
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Roberto M, Radovanovic D, Buttà C, Tersalvi G, Krüll J, Erne P, Rickli H, Pedrazzini GB, and Moccetti M
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- Aspirin, Drug Therapy, Combination, Humans, Platelet Aggregation Inhibitors, Prasugrel Hydrochloride, Prospective Studies, Treatment Outcome, Acute Coronary Syndrome drug therapy, Acute Coronary Syndrome surgery, Dual Anti-Platelet Therapy, Myocardial Infarction drug therapy, Myocardial Infarction surgery
- Abstract
Objectives: Despite guideline recommendations, previous reports, coming mainly from outside Europe, showed low rates of prescriptions for dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI) undergoing surgical revascularization. The present study assesses this issue in the era of potent P2Y12 inhibitors in Switzerland., Methods: All patients with a diagnosis of AMI included in the Acute Myocardial Infarction in Switzerland Plus Registry from January 2014 to December 2019 were screened; 9050 patients undergoing either percutaneous (8727, 96.5%) or surgical (323, 3.5%) revascularization were included in the analysis., Results: Surgically treated patients were significantly less likely to receive DAPT at discharge (56.3% vs 96.7%; P < 0.001). Even when discharged with a prescription for DAPT, those patients were significantly less likely to receive a regimen containing a new P2Y12 inhibitor (67/182 [36.8%] vs 6945/8440 [83.2%]; P < 0.001). At multivariate analysis, surgical revascularization was independently associated with a lower likelihood of receiving a prescription for DAPT at discharge (odds ratio 0.03, 95% confidence interval 0.02-0.06)., Conclusions: DAPT prescriptions for patients with AMI undergoing surgical revascularization are not in line with current guideline recommendations. Efforts are necessary to clarify the role of DAPT for secondary prevention in these patients and increase the confidence of treating physicians in guideline recommendations., Clinical Trial Registration: Acute Myocardial Infarction in Switzerland Plus Registry; registration number at ClinicalTrials.gov: NCT01305785., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2021
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23. Rationale and design of the MULTISTARS AMI Trial: A randomized comparison of immediate versus staged complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease.
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Stähli BE, Varbella F, Schwarz B, Nordbeck P, Felix SB, Lang IM, Toma A, Moccetti M, Valina C, Vercellino M, Rigopoulos AG, Rohla M, Schindler M, Wischnewsky M, Linke A, Schulze PC, Richardt G, Laugwitz KL, Weidinger F, Rottbauer W, Achenbach S, Huber K, Neumann FJ, Kastrati A, Ford I, Ruschitzka F, and Maier W
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- Coronary Angiography methods, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Randomized Controlled Trials as Topic, Risk Factors, Severity of Illness Index, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention methods, Postoperative Complications diagnosis, Postoperative Complications prevention & control, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction surgery, Time-to-Treatment standards
- Abstract
About half of patients with acute ST-segment elevation myocardial infarction (STEMI) present with multivessel coronary artery disease (MVD). Recent evidence supports complete revascularization in these patients. However, optimal timing of non-culprit lesion revascularization in STEMI patients is unknown because dedicated randomized trials on this topic are lacking. STUDY DESIGN: The MULTISTARS AMI trial is a prospective, international, multicenter, randomized, two-arm, open-label study planning to enroll at least 840 patients. It is designed to investigate whether immediate complete revascularization is non-inferior to staged (within 19-45 days) complete revascularization in patients in stable hemodynamic conditions presenting with STEMI and MVD and undergoing primary percutaneous coronary intervention (PCI). After successful primary PCI of the culprit artery, patients are randomized in a 1:1 ratio to immediate or staged complete revascularization. The primary endpoint is a composite of all-cause death, non-fatal myocardial infarction, ischemia-driven revascularization, hospitalization for heart failure, and stroke at 1 year. CONCLUSIONS: The MULTISTARS AMI trial tests the hypothesis that immediate complete revascularization is non-inferior to staged complete revascularization in stable patients with STEMI and MVD., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2020
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24. Temporal trends in latecomer STEMI patients: insights from the AMIS Plus registry 1997-2017.
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Roberto M, Radovanovic D, de Benedetti E, Biasco L, Halasz G, Quagliana A, Erne P, Rickli H, Pedrazzini G, and Moccetti M
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- Hospital Mortality, Humans, Patient Discharge, Registries, Risk Factors, Treatment Outcome, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction epidemiology, ST Elevation Myocardial Infarction therapy
- Abstract
Introduction and Objectives: A substantial proportion of patients experiencing ST-segment elevation myocardial infarction (STEMI) have a late presentation. There is a lack of temporal trends drawn from large real-word scenarios in these patients., Methods: All STEMI patients included in the AMIS Plus registry from January 1997 to December 2017 were screened and patient-related delay was assessed. STEMI patients were classified as early or latecomers according to patient-related delay (≤ or> 12hours, respectively)., Results: A total of 27 231 STEMI patients were available for the analysis. During the study period, the prevalence of late presentation decreased from 22% to 12.3% (P <.001). In latecomer STEMI patients, there was a gradual uptake of evidence-based pharmacological treatments (rate of P2Y
12 inhibitors at discharge, from 6% to 90.6%, P <.001) and a marked increase in the use of percutaneous coronary intervention (PCI), particularly in 12- to 48-hour latecomers (from 11.9%-87.9%; P <.001). In-hospital mortality was reduced from 12.4% to 4.5% (P <.001). On multivariate analysis, PCI had a strong independent protective effect on in-hospital mortality in 12- to 48-hour latecomers (OR, 0.29; 95%CI, 0.15-0.55)., Conclusions: During the 20-year study period, there was a progressive reduction in the prevalence of late presentation, a gradual uptake of main evidence-based pharmacological treatments, and a marked increase in PCI rate in latecomer STEMI patients. In-hospital mortality was reduced to a third (to an absolute rate of 4.5%); in 12- to 48-hour latecomers, this reduction seemed to be mainly associated with the increasing implementation of PCI., (Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)- Published
- 2020
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25. Role of the central autonomic nervous system intrinsic functional organisation and psychosocial factors in primary microvascular angina and Takotsubo syndrome.
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Cattaneo MM, Pravatà E, Provenzi M, Moccetti M, Kaelin A, Sudano I, Biasucci L, Gallino C, Limoni C, Calanchini C, Gallino A, Crea F, and Cattaneo M
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- Aged, Brain Mapping, Cross-Sectional Studies, Female, Humans, Magnetic Resonance Imaging, Male, Mental Health, Microvascular Angina diagnosis, Microvascular Angina psychology, Neuropsychological Tests, Pain Perception, Prospective Studies, Stress, Psychological diagnosis, Stress, Psychological psychology, Takotsubo Cardiomyopathy diagnosis, Takotsubo Cardiomyopathy psychology, Autonomic Nervous System physiopathology, Cerebral Cortex physiopathology, Microvascular Angina physiopathology, Psychosocial Functioning, Stress, Psychological physiopathology, Takotsubo Cardiomyopathy physiopathology
- Abstract
Introduction and Objective: Dysfunctional central autonomic nervous system network (CAN) at rest may result in aberrant autonomic responses to psychosocial stressors. We hypothesised that patients with primary microvascular angina (MVA) or Takotsubo syndrome (TTS) would exhibit a peculiar functional organisation of the CAN, potentially associated with psychological patterns., Methods: Patients underwent a psychosocial evaluation: a clinical diagnostic interview, Millon Clinical Multiaxial Inventory III, State-Trait Anxiety Inventory form Y and Short Form 36 Health Survey (SF-36). The strength of intrinsic functional connectivity (FC) between various nodes of the CAN was investigated using cerebral resting state functional MRI (RS-fMRI)., Results: We evaluated 50 (46 women) stable patients: 16 patients with MVA, 17 patients with TTS and 17 patients with previous acute myocardial infarction (AMI). Compared with AMI, patients with MVA showed a lower (higher impairment) SF-36 Body-Pain score (p 0.046) and a higher SF-36 Mental-Health score (p 0.039). Patients with TTS showed the strongest FC between two nodes of the CAN (sympathetic midcingulate cortex and parasympathetic primary motor area) (F 6.25, p 0.005) using RS-fMRI., Conclusions: The study implements an innovative collaborative research among cardiologists, neuroscientists and psychiatrists ('Neuro-psycho-heart Team'). MVA showed a discrepancy between the highest level of self-reported body pain and the best mental health score, which might suggest a mechanism of somatisation. TTS exhibited an increased functional integration between two areas of the CAN involved in interoceptive pain awareness and negative emotional status. We implemented an innovative research collaboration among cardiologists, neuroscientists and psychiatrists. These data are hypothesis generating and suggest potential prospective investigations on pathophysiology and implementation of psychotherapy and stress-reducing techniques as therapeutic strategies., Trial Registration Number: NCT02759341., Competing Interests: Competing interests: AG reports grants from the Swiss Heart Foundation and the ABREOC for unrelated work; IS reports grants from Swiss Heart Foundation and Swiss National Foundation for unrelated work., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2020
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26. Early cardiac unloading with ImpellaCP™ in acute myocardial infarction with ventricular septal defect.
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Via G, Buson S, Tavazzi G, Halasz G, Quagliana A, Moccetti M, Demertzis S, and Cassina T
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- Heart, Hemodynamics, Humans, Heart Septal Defects, Ventricular surgery, Heart-Assist Devices, Myocardial Infarction complications, Myocardial Infarction diagnosis
- Abstract
Despite a relative contraindication, mechanical support with Impella™ left ventricular assist device has already been described for ischaemic ventricular septal defect treatment, either as a bridge to surgery, as intraoperative mechanical haemodynamic support, or to ensure intraprocedural haemodynamic stability during device closure. We describe two cases of ventricular septal defect complicating acute myocardial infarction, where the percutaneous ImpellaCP was implanted early (differently than previously described) with the aim of preventing haemodynamic instability, while deferring surgical repair. We present a report of haemodynamic, echocardiographic, biochemical, and clinical data of two consecutive cases of ImpellaCP use, within a minimally invasive monitoring and therapeutic approach. In two cases of subacute myocardial infarction-related ventricular septal defect not amenable to percutaneous device closure, the use ImpellaCP was successful: it was followed by effective and rapid right and left ventricular unloading, by major haemodynamic instability prevention and protection from systemic venous congestion, from kidney and splanchnic organ failures. This allowed bridging to appropriately timed surgical repair. These cases suggest a potentially effective, clinically grounded strategy in the early management of ischaemic ventricular septal defect patients, with the aim of deferring surgery beyond the safer 7 days cutoff associated with a lower perioperative mortality., (© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2020
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27. Intractable coronary fibromuscular dysplasia leading to end-stage heart failure and fatal heart transplantation.
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Cattaneo MM, Moccetti M, Cattaneo M, Sürder D, Suter T, Martinelli M, Roost E, Schmidli J, Banz Y, Schneiders C, Pedrazzini G, Corti R, Räber L, Crea F, Mohacsi P, and Gallino A
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- Coronary Angiography, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Female, Humans, Middle Aged, Fibromuscular Dysplasia complications, Fibromuscular Dysplasia diagnosis, Heart Failure etiology, Heart Transplantation
- Abstract
Coronary fibromuscular dysplasia is uncommon, and even rarer its unstable and recurrent course. We present the unique case of a 52-year-old woman who underwent in total 12 coronary angiographies and three percutaneous coronary intervention within 24 months because of repetitive acute coronary syndromes due to refractory spasm, dissection, restenosis all leading to end-stage heart failure, and heart transplantation. The patient died 12 days after the heart transplantation complicated by intraoperative acute thrombotic occlusion of left anterior descending artery of the graft despite normal pretransplant coronary angiography. Autopsy of the recipient heart confirmed coronary fibromuscular dysplasia with massive intimal hyperplasia and restenosis., (© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
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- 2020
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28. Heavy Drinking Habits Are Associated with Worse In-Hospital Outcomes in Patients with Acute Coronary Syndrome: An Insight from the AMIS Plus Registry.
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Tersalvi G, Biasco L, Radovanovic D, Rickli H, Roffi M, Eberli F, Moccetti M, Jeger R, Moccetti T, Erne P, and Pedrazzini G
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- Habits, Hospitals, Humans, Male, Registries, Retrospective Studies, Risk Factors, Switzerland, Acute Coronary Syndrome, Alcohol Drinking, Myocardial Infarction
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Background: The association between alcohol consumption and the occurrence of coronary heart disease is well described in the literature, while data regarding the impact of regular alcohol consumption on in-hospital outcomes in the setting of acute coronary syndrome (ACS) are lacking. We aimed to evaluate the impact of self-reported alcohol consumption on in-hospital outcomes in patients with ACS., Methods: Data derived from patients enrolled between 2007 and 2019 in the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry were retrospectively analyzed. Patients were stratified based on alcohol drinking pattern. Primary outcome was all-cause in-hospital mortality, while secondary outcomes were set as incidence of major adverse cardiac and cerebrovascular events (MACCEs). Outcome comparisons according to quantity of daily alcohol intake were also performed., Results: Records concerning alcohol consumption were available in 25,707 patients; 5,298 of them (21%) fulfilled the criteria of regular alcohol consumption. Regular drinkers were predominantly male, younger, smokers, more comorbid and with a worse clinical presentation as compared with abstainers/occasional drinkers. Daily alcohol intake was reported in 4,059 (77%) of these patients (regular drinkers). Among them, 2,640 were light drinkers (≤2 drinks/day) and 1,419 heavy drinkers (>2 drinks/day). In-hospital mortality and MACCEs of heavy drinkers were significantly higher compared with those of light drinkers (5.4 vs. 3.3% and 7.0 vs. 4.4%, both p = 0.001). When tested together with Global Registry of Acute Coronary Events risk score parameters, heavy alcohol consumption was independently associated with in-hospital mortality (p = 0.004)., Conclusions: Our results support that heavy alcohol consumption is an independent predictor of in-hospital mortality in patients presenting with ACS., (© 2020 S. Karger AG, Basel.)
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- 2020
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29. Baseline Predictors of Renal Failure in Transcatheter Aortic Valve Implantation.
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Langfritz M, Shahin M, Nietlispach F, Taramasso M, Denegri A, Moccetti M, Pedrazzini G, Moccetti T, Keller LS, Ruschitzka F, Maisano F, and Obeid S
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- Acute Kidney Injury diagnosis, Acute Kidney Injury etiology, Adult, Aged, Aged, 80 and over, Creatinine blood, Female, Follow-Up Studies, Glomerular Filtration Rate, Hospital Mortality, Humans, Incidence, Male, Middle Aged, Postoperative Complications diagnosis, Postoperative Complications etiology, Prognosis, Retrospective Studies, Risk Factors, Survival Rate trends, Switzerland epidemiology, Time Factors, Acute Kidney Injury epidemiology, Aortic Valve Stenosis surgery, Postoperative Complications epidemiology, Risk Assessment methods, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Background: Acute kidney injury (AKI) post transcatheter aortic valve implantation (TAVI) is associated with worsened short- and long-term outcomes. We sought to identify significant baseline predictors of AKI and establish a high-risk group within patients enrolled in the multicenter SWISS-TAVI cohort., Methods and Results: A total of 526 patients who underwent TAVI were included in our analysis. Patients on hemodialysis were excluded. Within the first week after valve implantation, fifty patients (9.5%) developed AKI. There was a significantly higher prevalence of diabetes mellitus in the AKI group (45% vs 28%; P=.02). The odds ratio (OR) for patients suffering from diabetes mellitus who developed AKI was 1.9 after multivariable binary regression analysis (95% confidence interval, 1.018-3.553; P=.04). Chronic kidney disease (CKD) stage ≥4 was more prevalent in the AKI group (26% vs 14%; P=.04). Every 1 mg/dL creatinine above normal level at baseline increased AKI risk by a factor of 1.6 (OR, 1.605; 95% CI, 1.111-2.319; P=.01). Age, gender, body mass index, history of dyslipidemia, and history of hypertension were similar between the groups. In the diabetic population of 155 patients (29.5%), AKI developed in 22 patients (14.2%), compared with the non-diabetic population of 370 patients (70.5%), where AKI developed in 27 patients (7.3%). In the diabetic population, an elevation by 1 mg/dL in baseline creatinine was an independent predictor of developing kidney injury (OR, 2.061; 95% CI, 1.154-3.683; P=.02, while in non-diabetic patients, neither baseline glomerular filtration rate, CKD grade, STS score, EuroScore II, ACEF score, nor procedural contrast usage were predictors of AKI., Conclusion: Diabetics with CKD stage ≥4 (as defined by the Kidney Disease: Improving Global Outcomes criteria) constitute a high-risk group for developing AKI after TAVI. In this high-risk subgroup, baseline creatinine in combination with amount of contrast agent used were strong risk factors for developing AKI. AKI in non-diabetics was less predictable by baseline characteristics.
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- 2019
30. New-onset or Pre-existing Atrial Fibrillation in Acute Coronary Syndromes: Two Distinct Phenomena With a Similar Prognosis.
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Biasco L, Radovanovic D, Moccetti M, Rickli H, Roffi M, Eberli F, Jeger R, Moccetti T, Erne P, and Pedrazzini G
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- Acute Coronary Syndrome mortality, Acute Coronary Syndrome therapy, Aged, Atrial Fibrillation mortality, Atrial Fibrillation therapy, Cardiotonic Agents, Female, Hospital Mortality, Hospitalization statistics & numerical data, Humans, Male, Patient Discharge, Percutaneous Coronary Intervention, Prognosis, Prospective Studies, Referral and Consultation statistics & numerical data, Registries, Risk Factors, ST Elevation Myocardial Infarction complications, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction therapy, Switzerland epidemiology, Treatment Outcome, Acute Coronary Syndrome complications, Atrial Fibrillation complications
- Abstract
Introduction and Objectives: The management and risk stratification of patients with atrial fibrillation (AF) and acute coronary syndromes constitute a challenge. We aimed to evaluate the prognostic impact of AF whether present at admission or occurring during hospitalization for acute coronary syndromes, as well as trends in treatments and outcome., Methods: Data derived from 35 958 patients enrolled between 2004 and 2015 in the AMIS Plus registry were retrospectively analyzed., Results: Pre-existing AF (pre-AF) was present in 1644 (4.7%) while new-onset AF (new-AF) was evident in 309 (0.8%). Presentation with ST-segment elevation myocardial infarction and need for hemodynamic support was frequent in patients with AF, especially in those with new onset of the arrhythmia. A change of the medical and interventional approaches was observed with a progressive increase in oral anticoagulation prescription and referral for angiography and percutaneous coronary interventions in pre-AF patients. Despite different baseline risk profile and clinical presentations, both AF groups showed high in-hospital and 1-year mortality (in-hospital new-AF vs pre-AF [OR, 0.79; 95%CI, 0.53-1.17; P = .246]; 1-year mortality new-AF vs pre-AF [OR, 0.72; 95%CI, 0.31-1.67; P = .448]) Pre-AF but not new-AF independently predicted in-hospital mortality. While mortality declined over the study period for patients with pre-AF, it remained stable among new-AF patients., Conclusions: While pre-AF is independently associated with in-hospital mortality, new-AF may reflect a worse hemodynamic impact of the acute coronary syndromes, with the latter ultimately driving the prognosis., (Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2019
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31. Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis.
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Landes U, Iakobishvili Z, Vronsky D, Zusman O, Barsheshet A, Jaffe R, Jubran A, Yoon SH, Makkar RR, Taramasso M, Russo M, Maisano F, Sinning JM, Shamekhi J, Biasco L, Pedrazzini G, Moccetti M, Latib A, Pagnesi M, Colombo A, Tamburino C, D' Arrigo P, Windecker S, Pilgrim T, Tchetche D, De Biase C, Guerrero M, Iftikhar O, Bosmans J, Bedzra E, Dvir D, Mylotte D, Sievert H, Watanabe Y, Søndergaard L, Dagnegård H, Codner P, Kodali S, Leon M, and Kornowski R
- Subjects
- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Cause of Death, Disease Progression, Female, Humans, Male, Neoplasm Staging, Neoplasms mortality, Neoplasms pathology, Recovery of Function, Registries, Remission Induction, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Neoplasms therapy, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality
- Abstract
Objectives: The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS)., Background: Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option., Methods: A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 "no-cancer" patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias., Results: Cancer patients' age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients., Conclusions: TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer. (Outcomes of Transcatheter Aortic Valve Implantation in Oncology Patients With Severe Aortic Stenosis [TOP-AS]; NCT03181997)., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2019
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32. Radiological exposure of patients undergoing transcatheter aortic valve implantation in contemporary practice.
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Biasco L, Pedrazzini G, De Backer O, Klersy C, Bellesi L, Presilla S, Badini M, Faletra F, Pasotti E, Ferrari E, Demertzis S, Moccetti T, Aviano D, and Moccetti M
- Subjects
- Age Factors, Aged, Aged, 80 and over, Aortic Valve physiopathology, Aortic Valve Stenosis physiopathology, Female, Humans, Male, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Coronary Angiography adverse effects, Multidetector Computed Tomography adverse effects, Radiation Dosage, Radiation Exposure adverse effects, Radiography, Interventional adverse effects, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Background: Radiological exposure associated with transcatheter aortic valve implantation (TAVI) is unknown and might impact on broadening indications to lower risk patients. Radiological exposure of TAVI patients and its predictors are herein reported., Methods: Radiological exposure derived from exams/procedures performed within 30 days preceding/following TAVI were acquired and converted into effective-dose. Total effective-dose was defined as the sum of each single dose derived from diagnostic/therapeutic sources. Univariable and multivariable analyses were performed to recognize correlates of exposure., Results: Seventy-five patients aged 82.6 ± 6.0 years with a median Euroscore II 3.6 [IQR 1.93-6.65] were analysed. Median total effective-dose was 41.39 mSv [IQR 27.93-60.88], with TAVI accounting for 47% of it. Age (coefficient -0.031, 95% CI -0.060 to -0.002; P = 0.031) and previous history of cerebrovascular accidents (CVA; coefficient -0.545; 95% CI -1.039 to -0.010; P = 0.046) resulted as inversely correlated to total effective-dose (log-transformed), whereas left ventricular ejection fraction (LVEF) less than 50% (coefficient 0.430, 95% CI 0.031-0.828; P = 0.035) was directly associated., Conclusion: Multiple radiological sources are responsible for the observed exposure, with TAVI being the prominent source. Age is inversely related to the radiological exposure.
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- 2018
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33. Transcatheter Mitral Valve Replacement in Patients With Previous Aortic Valve Replacement.
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Cheung A, Webb J, Schaefer U, Moss R, Deuschl FG, Conradi L, Denti P, Latib A, Kiaii B, Bagur R, Ferrari E, Moccetti M, Biasco L, Blanke P, Ben-Gal Y, and Banai S
- Subjects
- Aged, Aged, 80 and over, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Bioprosthesis, Cardiac Catheterization adverse effects, Cardiac Catheterization instrumentation, Echocardiography, Three-Dimensional, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation instrumentation, Hemodynamics, Humans, Male, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency physiopathology, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Severity of Illness Index, Tomography, X-Ray Computed, Treatment Outcome, Aortic Valve surgery, Cardiac Catheterization methods, Heart Valve Prosthesis Implantation methods, Mitral Valve surgery, Mitral Valve Insufficiency surgery
- Abstract
Background: Transcatheter mitral valve replacement (TMVR) may mature to become a therapeutic option for high-risk patients with severe mitral regurgitation (MR), particularly in patients at high or prohibitive surgical risk. MR patients with preexisting aortic valve prosthesis have been excluded from most TMVR trials because of the potential risks of left ventricular outflow tract obstruction or interaction between the TMVR anchoring mechanism and the aortic prosthesis. We describe the procedural and short-term outcomes of transapical TMVR with the Tiara valve in patients experiencing severe symptomatic MR with previous aortic valve replacement (AVR)., Methods and Results: Twelve consecutive high surgical risk patients (11 men; mean age, 75±6 years) with aortic valve prosthesis and severe MR underwent TMVR with Tiara valve. Aortic valves were mechanical in 5 and biological in 7 patients, while 1 patient had previously undergone implantation of a transcatheter valve within a failed bioprosthetic surgical valve. Six patients (50%) had undergone redo surgical aortic valve replacement. Clinical characteristics of the group include prior mitral valve repair in 2, prior coronary bypass grafting surgery in 5, chronic atrial fibrillation in 7, renal failure in 9, and pacemaker/cardiac resynchronization device in 9 patients. Mean Society of Thoracic Surgery score and EuroSCORE II were 10.5±4.4 and 12.4±3.7, respectively. Mean baseline left ventricular ejection fraction was 35.5±5.3% (range, 30%-45%). The Tiara valve was implanted uneventfully in all patients. Device migration or left ventricular outflow tract obstruction was not observed. No patient required conversion to open heart surgery or periprocedural hemodynamic support. Procedural success was 100% with no death, MI, stroke, major bleeding, or access site complications at 30 days. MR was eliminated in all 12 patients immediately after implantation., Conclusions: Transapical mitral valve replacement with the Tiara valve in high-risk patients with severe MR and aortic valve prostheses is technically feasible and can be performed safely.
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- 2018
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34. Access Sites for TAVI: Patient Selection Criteria, Technical Aspects, and Outcomes.
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Biasco L, Ferrari E, Pedrazzini G, Faletra F, Moccetti T, Petracca F, and Moccetti M
- Abstract
During the last ten years, transcatheter aortic valve implantation (TAVI) has become a reliable and valid alternative treatment for elderly patients with severe symptomatic aortic valve stenosis requiring valve replacement and being at high or intermediate surgical risk. While common femoral arteries are the access site of choice in the vast majority of TAVI patients, in up to 15-20% of TAVI candidates this route might be precluded due to the presence of diffuse atherosclerotic disease, tortuosity or small vessel diameter. Therefore, in order to achieve an antegrade or retrograde implant, several alterative access routes have been described, namely trans-axillary, trans-aortic, trans-apical, trans-carotid, trans-septal, and trans-caval. The aim of this paper is to give a concise overview on vascular access sites for TAVI, with a particular focus on patient's selection criteria, imaging, technical aspects, and clinical outcome.
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- 2018
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35. Echocardiographic-fluoroscopic fusion imaging for transcatheter mitral valve repair guidance.
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Faletra FF, Pozzoli A, Agricola E, Guidotti A, Biasco L, Leo LA, Taramasso M, Pasotti E, Kuwata S, Moccetti M, Tanner FC, Pedrazzini G, Nietlispach F, Moccetti T, Zuber M, and Maisano F
- Subjects
- Cardiac Catheterization methods, Cardiac Imaging Techniques, Female, Fluoroscopy, Humans, Male, Mitral Valve Insufficiency surgery, Radiographic Image Interpretation, Computer-Assisted, Sensitivity and Specificity, Echocardiography, Three-Dimensional methods, Heart Valve Prosthesis Implantation methods, Mitral Valve Insufficiency diagnostic imaging, Multimodal Imaging methods, Surgery, Computer-Assisted
- Abstract
The echocardiographic-fluoroscopic fusion imaging is a new imaging system which has recently become available, with the proposal to facilitate catheters and device navigation during catheter-based structural heart disease interventions. Several reports have described the early developments and the first clinical experiences, but literature focusing on the practical applications of fusion imaging technology to mitral valve transcatheter interventions, and on its potential advantages and current limitations, is still limited. In this review, we, therefore, describe the role of this novel imaging system during Mitraclip, Cardioband, and paravalvular leak closure interventions. The technical principles and the fluoroscopic anatomy of the interatrial septum and mitral valve are also described.
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- 2018
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36. Tiara Valve Implantation in a Patient With Previously Implanted Mono-disk Mechanical Aortic Prosthesis.
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Ferrari E, Biasco L, Faletra F, Cheung A, Moccetti M, Pedrazzini G, Demertzis S, and Moccetti T
- Subjects
- Aged, Aortic Valve physiopathology, Cardiac Catheterization methods, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Heart Valve Prosthesis Implantation methods, Humans, Male, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve Insufficiency diagnostic imaging, Mitral Valve Insufficiency physiopathology, Models, Anatomic, Models, Cardiovascular, Patient-Specific Modeling, Printing, Three-Dimensional, Prosthesis Design, Tomography, X-Ray Computed, Treatment Outcome, Aortic Valve transplantation, Cardiac Catheterization instrumentation, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Mitral Valve transplantation, Mitral Valve Insufficiency surgery
- Abstract
Transcatheter mitral valve replacement with the Tiara valve can be performed in inoperable patients with severe functional regurgitation. Risk of left ventricular outflow tract obstruction can be prevented using preoperative 3D imaging and 3D-printed models. However, in the case of mono-disk mechanical prostheses previously implanted in aortic position (Bjork-Shiley), there is an additional risk of mechanical interference leading to reduced leaflet motion and aortic valve dysfunction. Hereafter, we describe the case of a patient with a 27-mm mono-disk mechanical aortic valve implanted in 1978, a EuroSCORE II of 18%, and a Society of Thoracic Surgeon score (mortality) of 16% who successfully underwent a transapical Tiara valve implantation., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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37. Echocardiographic-Fluoroscopic Fusion Imaging in Transseptal Puncture: A New Technology for an Old Procedure.
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Faletra FF, Biasco L, Pedrazzini G, Moccetti M, Pasotti E, Leo LA, Cautilli G, Moccetti T, and Monaghan MJ
- Subjects
- Echocardiography, Three-Dimensional, Heart Diseases diagnosis, Heart Septum diagnostic imaging, Humans, Ultrasonography, Interventional methods, Cardiac Catheterization methods, Echocardiography, Transesophageal methods, Fluoroscopy methods, Heart Diseases surgery, Heart Septum surgery, Punctures methods, Surgery, Computer-Assisted methods
- Abstract
In an era of catheter-based structural heart disease and left-side electrophysiologic interventions, transseptal puncture (TSP) is probably the most common transcatheter procedure. Experienced interventional cardiologists and electrophysiologists may safely perform TSP using fluoroscopic guidance alone. However, at present TSP is usually the first step in complex percutaneous catheter-based structural heart disease procedures and necessitate a precise site-specific TSP. Thus, in these procedures most interventional cardiologists perform TSP under fluoroscopic and two- or three-dimensional transesophageal echocardiographic guidance. The EchoNavigator system may provide a solution by fusing fluoroscopic and transesophageal echocardiographic images. In this review, the authors describe advantages and limitations of this new imaging system in guiding TSP and suggest specific echocardiographic-fluoroscopic fusion imaging perspectives that may facilitate TSP, making it potentially easier and safer., (Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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38. Evaluation of a protocol for same-day discharge after radial lounge monitoring in a southern Swiss referral percutaneous coronary intervention centre.
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Biasco L, Pedrazzini GB, Araco M, Petracca F, Del Monte D, Sürder D, Bomio F, Berto MB, Montrasio G, Del Bufalo A, Pasotti E, Moccetti T, and Moccetti M
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- Aged, Coronary Angiography adverse effects, Coronary Artery Disease diagnostic imaging, Female, Humans, Male, Middle Aged, Patient Safety, Retrospective Studies, Switzerland, Time Factors, Coronary Artery Disease surgery, Patient Discharge standards, Patient Satisfaction statistics & numerical data, Percutaneous Coronary Intervention
- Abstract
Aims: The aim of the study was to retrospectively evaluate safety and patient satisfaction of same-day discharge after elective radial coronary angiography/percutaneous coronary intervention (PCI) after the implementation of a radial lounge facility., Methods: All patients admitted to our radial lounge with a planned same-day discharge after an uncomplicated coronary angiography/PCI, having a co-living caregiver, were day enrolled in the study. Rates of same-day discharge, unplanned overnight stay, and in-hospital and first complications [death, myocardial infarction (MI), unplanned coronary angiography, access site hematoma, bleedings requiring hospitalization] were analysed; satisfaction was also evaluated through a questionnaire., Results: From February 2015 to January 2016, 312 patients with a mean age of 66.6 ± 10.8 years were admitted to the radial lounge (coronary angiography, n = 232; PCIs, n = 80). Of them, 245 (78.5%) were discharged the same day. Mean radial lounge monitoring was 6:35 h (interquartile range 5:30-7:30 h). No episodes of death/MI/unplanned coronary angiography were observed both in same-day discharged and postponed patients. Reasons to postpone discharge were: PCI deemed to need prolonged monitoring in 31, patient's preference in 14, femoral shift in 13, surgery in four, chest pain in four, and bleeding in one. At day 1, 11 access site hematoma and one hospitalization for access site bleeding were reported. Patients reported complete satisfaction in 97% of cases. Unplanned overnight stay was common among PCIs patients (RR 6.2, 95% CI 3.9-9.9, P < 0.001)., Conclusion: A low rate of minor complications was observed in elective radial coronary angiography and PCIs showing the feasibility and safety of the development of an institutional protocol for same-day discharge after the implementation of a radial lounge facility.
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- 2017
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39. Potential Clinical Utility and Feasibility of Combined Left Atrial Appendage Closure and Positioning of Miniaturized Pacemaker Through a Single Right Femoral Vein Access.
- Author
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Regoli F, Araco M, Moccetti T, Caputo ML, Conte G, Auricchio A, and Moccetti M
- Subjects
- Aged, Aged, 80 and over, Atrial Appendage diagnostic imaging, Echocardiography, Three-Dimensional, Echocardiography, Transesophageal, Feasibility Studies, Female, Femoral Vein, Follow-Up Studies, Humans, Male, Miniaturization, Retrospective Studies, Time Factors, Treatment Outcome, Atrial Appendage surgery, Cardiac Catheterization methods, Cardiac Surgical Procedures methods, Pacemaker, Artificial, Septal Occluder Device
- Abstract
This study assessed the clinical utility and feasibility of concomitant of combined left atrial appendage (LAA) closure and positioning of miniaturized pacemaker (Micra TPS). All consecutive patients who underwent VVI-PM implant from November 2015 to October 2016 were considered. VVI-PM implant was conducted either using transvenous approach or by positioning Micra TPS. In selected patients with concomitant contraindication to OAC, Micra TPS was combined with LAA occlusion ("combined approach"), performed in general anesthesia and guided by multimodality imaging; procedural and follow-up data of these specific patients were registered. Sixty patients were treated with VVI-PM implant. Six patients (10.0%) presented OAC contraindication, of which 4 (6.7%) were eligible for the "combined procedure"; 2 of 4 of these patients presented chronic hemodialysis-dependent renal failure. The combined approach was successful in all 4 patients without intra- or periprocedural complications. No adverse events linked to the combined approach occurred during mid-term follow-up (7.5, interquartile range 5.0 to 7.9 months). In conclusion, VVI-PM indication and concomitant contraindication to OAC is not uncommon; in selected patients, combined LAA closure and positioning of Micra TPS may be a feasible therapeutic option., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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40. [Inhibitors of PCSK9].
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Petrova-Slater I, Denegri A, Pasotti E, Rossi MG, Spirk D, Riesen WF, Moccetti T, and Moccetti M
- Subjects
- Anticholesteremic Agents adverse effects, Anticholesteremic Agents pharmacology, Cardiovascular Diseases etiology, Cholesterol, LDL blood, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors adverse effects, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Hypercholesterolemia complications, Hypercholesterolemia drug therapy, Anticholesteremic Agents therapeutic use, Cardiovascular Diseases prevention & control, PCSK9 Inhibitors
- Abstract
Observational data show a consistent association between elevated low density lipoproteins (LDL-C) and cardiovascular disease (CVD). Reduction of LDL-C reduces the risk of CVD as has been shown by many trials. Statins are currently the most effective drugs for lowering LDL-C, but can present side effects which might limit the prescribed dosage and prevent patients from reaching the recommended LDL levels. Although treated with statins important residual cardiovascular event risk remains in patients in primary and secondary prevention for CVD. The discovery of protein convertase subtilisin kexin 9 antibodies is a very promising new hypolipidemic treatment and the aim of this review is to explain their mechanism of action and to discuss safety and efficacy results of some phase III studies., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.
- Published
- 2017
41. Stent valve implantation in conventional redo aortic valve surgery to prevent patient-prosthesis mismatch.
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Ferrari E, Franciosi G, Clivio S, Faletra F, Moccetti M, Moccetti T, Pedrazzini G, and Demertzis S
- Subjects
- Aged, Aortic Valve Stenosis diagnosis, Echocardiography, Female, Humans, Male, Middle Aged, Prosthesis Design, Treatment Outcome, Aortic Valve surgery, Aortic Valve Stenosis surgery, Heart Valve Prosthesis Implantation methods, Patient Selection, Postoperative Complications prevention & control, Stents
- Abstract
Objectives: The goal was to show the technical details, feasibility and clinical results of balloon-expandable stent valve implantation in the aortic position during conventional redo open-heart surgery in selected obese patients with a small aortic prosthesis and severe patient-prosthesis mismatch., Methods: Two symptomatic overweight patients (body mass index of 31 and 38), each with a small aortic prosthesis (a 4-year-old, 21-mm Hancock II biological valve and a 29-year-old, 23-mm Duromedic mechanical valve), increased transvalvular gradients (59/31 and 74/44 mmHg) and a reduced indexed effective orifice area (0.50 and 0.43 cm 2 /m 2 ) underwent implantation of two 26-mm balloon-expandable Sapien 3 valves during standard on-pump redo valve surgery., Results: Using full re-sternotomy, cardiopulmonary bypass and cardioplegic arrest, the two balloon-expandable stent valves were implanted under direct view using a standard aortotomy, after prosthesis removal and without annulus enlargement. Aortic cross-clamp times were 162 and 126 min; cardiopulmonary bypass times were 178 and 180 min; total surgical times were 360 and 318 min. At discharge, echocardiograms showed transvalvular peak and mean gradients of 13/9 and 23/13 mmHg and indexed effective orifice areas of 0.64 and 1.08 cm 2 /m 2 . The 3-month echocardiographic follow-up showed transvalvular peak and mean gradients of 18/9 and 19/11 mmHg and indexed effective orifice areas of 0.78 cm 2 /m 2 and 0.84 cm 2 /m 2 , with improved symptoms (New York Heart Association class 1)., Conclusions: Implantation of a balloon-expandable stent valve during redo aortic valve surgery is feasible in selected cases and prevents patient-prosthesis mismatch in obese patients without need for aortic annulus enlargement. Moreover, in the case of stent valve degeneration, this approach permits additional valve-in-valve procedures with large stent valves and prevents re-redo surgery., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2017
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42. Remodeling the Human Adult Stem Cell Niche for Regenerative Medicine Applications.
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Bardelli S and Moccetti M
- Abstract
The interactions between stem cells and their surrounding microenvironment are pivotal to determine tissue homeostasis and stem cell renewal or differentiation and regeneration in vivo . Ever since they were postulated in 1978, stem cell niches have been identified and characterized in many germline and adult tissues. Comprehensive studies over the last decades helped to clarify the critical components of stem cell niches that include cellular, extracellular, biochemical, molecular, and physical regulators. This knowledge has direct impact on their inherent regenerative potential. Clinical applications demand readily available cell sources that, under controlled conditions, provide a specific therapeutic function. Thus, translational medicine aims at optimizing in vitro or in vivo the various components and complex architecture of the niche to exploit its therapeutic potential. Accordingly, the objective is to recreate the natural niche microenvironment during cell therapy process development and closely comply with the requests of regulatory authorities. In this paper, we review the most recent advances of translational medicine approaches that target the adult stem cell natural niche microenvironment for regenerative medicine applications.
- Published
- 2017
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43. Stem and Progenitor Cells in Human Cardiopulmonary Development and Regeneration.
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Bardelli S and Moccetti M
- Abstract
Already during embryonic development, the heart and the lung are thoroughly connected organs. Their interdependence allows our survival in the terrestrial environment by coupling cardiac output and gas exchange. The knowledge on developmental processes involving stem and progenitor cells is crucial to understand the onset of human cardiopulmonary diseases. The precise identification of various adult endogenous progenitors is still incomplete. Thus, caution should be exercised on newly available stem cell-based treatments until specific mechanisms of action are disclosed. The objective is to provide in the nearest future feasible and safer cell therapeutics for the complex pathological condition of human cardiopulmonary diseases. In this paper, we highlight the significant knowledge advancement concerning stem and progenitor cells in the cardiopulmonary field: from embryonic development to adult progenitors until early preclinical models for cardiopulmonary regeneration.
- Published
- 2017
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44. A combined "in vivo" noninvasive evaluation of carotid plaques using ultrasonography and high-resolution magnetic resonance - new insight into plaque burden and vulnerability.
- Author
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Porretta AP, Bianda N, Di Valentino M, Segatto JM, Santini P, Cattaneo M, Moccetti M, Limoni C, Wyttenbach R, and Gallino A
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Rupture, Spontaneous, Severity of Illness Index, Time Factors, Carotid Arteries diagnostic imaging, Carotid Stenosis diagnostic imaging, Magnetic Resonance Imaging, Multimodal Imaging methods, Plaque, Atherosclerotic, Ultrasonography, Doppler, Duplex
- Abstract
Background: Qualitative change in carotid plaques was prospectively evaluated by Gray Scale Median (GSM) analysis at repeated examinations "in vivo", in relation to quantitative change in carotid arterial geometry, as assessed by high-resolution magnetic resonance imaging (HR-MRI)., Patients and Methods: Duplex ultrasound with GSM analysis and HR-MRI at the carotid level were performed at baseline and 1- and 2-year follow up in 30 patients with < 70% carotid stenosis. Changes in GSM values (ΔGSM) were evaluated as the intra-individual difference between 2-year and baseline values. HR-MRI studies were evaluated for lumen area (LA), total vessel area (TVA), vessel wall area (VWA = TVA-LA) and normalized wall index (NWI = VWA/TVA)., Results: ΔGSM value distribution was divided into quartiles. Predominantly echolucent plaques with ΔGSM value in the lowest quartile (ΔGSM ≤- 8) showed a significantly greater mean 2-year LA (28.62 ± 10.9 mm2 vs. 17.88 ± 4.8 mm2, p = 0.04) and a greater mean 2-year TVA (83.64 ± 19.4 mm2 vs. 63.26 ± 9.2 mm2, p = 0.02) than predominantly echogenic plaques with ΔGSM value in the highest quartile (ΔGSM ≥8)., Conclusions: Increasing echolucency during the 2-year follow up was associated with a 2-year lower degree of stenosis and higher tendency toward lumen preservation. By corroborating that plaque vulnerability is highly independent of stenosis severity, our study provided a possible new combined "in vivo" noninvasive approach for the assessment of carotid plaque vulnerability.
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- 2016
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45. Combined Left Atrial Appendage Closure and Pacemaker Implant through a Single Right Femoral Vein Access.
- Author
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Regoli F, Moccetti T, Pasotti E, Auricchio A, and Moccetti M
- Subjects
- Aged, Cardiac Catheterization instrumentation, Cardiac Catheterization methods, Combined Modality Therapy instrumentation, Combined Modality Therapy methods, Humans, Male, Treatment Outcome, Wireless Technology instrumentation, Atrial Appendage surgery, Atrial Fibrillation therapy, Femoral Vein surgery, Pacemaker, Artificial, Prosthesis Implantation methods, Vascular Closure Devices
- Abstract
Left atrial appendage (LAA) closure is indicated in patients with atrial fibrillation (AF) and high bleeding as well as thromboembolic risks. A subgroup of these patients may also present an indication for a single-chamber permanent pacemaker due to symptomatic low-rate AF or when "ablate and pace" strategy is indicated for rate control. A miniaturized wireless transcatheter pacing system (TPS) is now available as a single-chamber permanent pacemaker. This case presents how combined LAA closure and permanent pacemaker implant, by means of TPS, is feasible through a single femoral venous access., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
- Full Text
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46. Transaortic transcatheter aortic valve replacement through a right minithoracotomy with the balloon-expandable Sapien 3 valve.
- Author
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Ferrari E, Muller O, Demertzis S, Moccetti M, Moccetti T, Pedrazzini G, and Eeckhout E
- Subjects
- Cardiac Catheterization methods, Humans, Prosthesis Design, Transcatheter Aortic Valve Replacement methods, Aortic Valve Stenosis surgery, Thoracotomy methods, Transcatheter Aortic Valve Replacement instrumentation
- Abstract
Transaortic transcatheter aortic valve replacement performed through a right anterolateral minithoracotomy at the second intercostal space is a safe and standardized minimally invasive procedure carrying important clinical advantages for the patient, in particular, no damage to the ventricular apex, preservation of the diseased peripheral arteries and no cross of the aortic arch with the delivery system, meaning a lower risk of calcium dislodgement and neurological complications. Using the third-generation, balloon-expandable Edwards Sapien™ 3 transcatheter heart valve and the Certitude™ delivery system, the transaortic procedure is easily performed under fluoroscopic and echocardiographic guidance. Compared with the transapical procedure, the transaortic technique requires an inversely mounted stent valve and follows the standard guidelines for valve positioning and deployment under rapid pacing. The transaortic approach through a right anterolateral minithoracotomy at the second intercostal space combines the positive aspects of both transfemoral and transapical valve replacements without the risks of either procedure (left ventricular, coronary and peripheral vascular injuries)., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2016
- Full Text
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47. Response to Letters Regarding Article, "Three Recurrent Episodes of Apical-Ballooning Takotsubo Cardiomyopathy in a Man".
- Author
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Cattaneo M, Moccetti M, Pasotti E, Faletra F, Porretta AP, Kobza R, and Gallino A
- Subjects
- Humans, Male, Recurrence, Electrocardiography, Takotsubo Cardiomyopathy
- Published
- 2016
- Full Text
- View/download PDF
48. Cardiac toxicity of trastuzumab in elderly patients with breast cancer.
- Author
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Denegri A, Moccetti T, Moccetti M, Spallarossa P, Brunelli C, and Ameri P
- Abstract
Breast cancer (BC) is diagnosed in ≥ 65 year old women in about half of cases. Experts currently recommend that systemic therapy is offered to elderly patients with BC, if, based on their overall conditions and life expectancy, it can be reasonably anticipated that the benefits will outweigh the risks of treatment. Like for young subjects, the monoclonal antibody against human epidermal growth factor receptor-2 (HER-2), trastuzumab, represents a valid therapeutic option when BC over-expresses this receptor. Unfortunately, administration of trastuzumab is associated with the occurrence of left ventricular dysfunction and chronic heart failure (CHF), possibly because of interference with the homeostatic functions of HER-2 in the heart. Registry-based, retrospective analyses have reported an incidence of CHF around 25% in elderly women receiving trastuzumab compared with 10%-15% in those not given any therapy for BC, and the risk of CHF has been estimated to be two-fold higher in > 60-65 year old trastuzumab users vs. non-users. Extremely advanced age and preexisting cardiac disease have been shown to predispose to trastuzumab cardiotoxicity. Therefore, selection of older patients for treatment with trastuzumab should be primarily based on their general status and the presence of comorbidities; previous chemotherapy, especially with anthracyclines, should be also taken into account. Once therapy has started, efforts should be made to ensure regular cardiac surveillance. The role of selected biomarkers, such as cardiac troponin, or new imaging techniques (three-dimension, tissue Doppler echocardiography, magnetic resonance imaging) is promising, but must be further investigated especially in the elderly. Moreover, additional studies are needed in order to better understand the mechanisms by which trastuzumab affects the old heart.
- Published
- 2016
- Full Text
- View/download PDF
49. PCSK9 inhibitors: an overview on a new promising lipid-lowering therapy.
- Author
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Denegri A, Petrova-Slater I, Pasotti E, Rossi MG, Pedrazzini GB, Moccetti T, and Moccetti M
- Subjects
- Antibodies, Monoclonal therapeutic use, Antibodies, Monoclonal, Humanized therapeutic use, Anticholesteremic Agents pharmacology, Cholesterol, LDL metabolism, Humans, Hypercholesterolemia metabolism, Proprotein Convertase 9, Proprotein Convertases physiology, Serine Endopeptidases physiology, Anticholesteremic Agents therapeutic use, Hypercholesterolemia drug therapy, Proprotein Convertases antagonists & inhibitors
- Abstract
Atherosclerosis is characterized by cholesterol deposition in the arterial intima, with subsequent plaque formation and arterial disease. Low-density lipoprotein cholesterol (LDL-C) plays the most important role in the atherogenesis process, which is the substrate of cardiovascular disease and is the leading cause of death worldwide. Several studies show that a strict control of risk factors, particularly the reduction of LDL-C levels, is a cornerstone in primary and secondary prevention of coronary heart disease. Statins are currently the most effective drugs for lowering LDL-C, but the discovery of proprotein convertase subtilisin kexin 9 (PCSK9) has opened up new therapeutic options in lipid management. PCSK9 reduces LDL-receptors' recycling resulting in a decrease of LDL-C receptors on the surface of hepatocytes and an increase of LDL-C levels in plasma. Obviously, inhibition of PCSK9 has been associated with an increase of LDL-C receptors with subsequent lowering of plasma levels of LDL-C. The clinical development of monoclonal antibodies against PCSK9 has been achieved through phase I and II studies, and nowadays there are many ongoing phase III trials with promising preliminary results. The aim of this review is to update the evidence for PCSK9 monoclonal antibodies, such as evolocumab, alirocumab and bococizumab, in LDL-C management and to discuss their therapeutic perspectives based on the most recent clinical studies, with attention to side-effects.
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- 2016
- Full Text
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50. J-wave duration and slope as potential tools to discriminate between benign and malignant early repolarization.
- Author
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Cristoforetti Y, Biasco L, Giustetto C, De Backer O, Castagno D, Astegiano P, Ganzit G, Gribaudo CG, Moccetti M, and Gaita F
- Subjects
- Diagnosis, Differential, Humans, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac physiopathology, Electrocardiography methods, Heart Conduction System physiopathology
- Published
- 2016
- Full Text
- View/download PDF
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