Search

Your search keyword '"Guazzi, Marco"' showing total 48 results
Start Over Author "Guazzi, Marco" Database OpenAIRE
48 results on '"Guazzi, Marco"'

2. Effects of sildenafil on symptoms and exercise capacity for heart failure with reduced ejection fraction and pulmonary hypertension (the SilHF study): a randomized placebo-controlled multicentre trial

Author

Cooper, Trond J., Cleland, John G.F., Guazzi, Marco, Pellicori, Pierpaolo, Ben Gal, Tuvia, Amir, Offer, Al‐Mohammad, Abdallah, Clark, Andrew L, McConnachie, Alex, Steine, Kjetil, and Dickstein, Kenneth

Subjects
Heart Failure, Exercise Tolerance, Hypertension, Pulmonary, Stroke Volume, Middle Aged, Phosphodiesterase 5 Inhibitors, Sildenafil Citrate, Ventricular Function, Left, Ventricular Dysfunction, Left, Double-Blind Method, Quality of Life, Humans, Female, Cardiology and Cardiovascular Medicine, Aged
Abstract

Aims\ud \ud Pulmonary hypertension (PHT) may complicate heart failure with reduced ejection fraction (HFrEF) and is associated with a substantial symptom burden and poor prognosis. Sildenafil, a phosphodiesterase-5 (PDE-5) inhibitor, might have beneficial effects on pulmonary haemodynamics, cardiac function and exercise capacity in HFrEF and PHT. The aim of this study was to determine the safety, tolerability, and efficacy of sildenafil in patients with HFrEF and indirect evidence of PHT.\ud \ud \ud \ud Methods and results\ud \ud The Sildenafil in Heart Failure (SilHF) trial was an investigator-led, randomized, multinational trial in which patients with HFrEF and a pulmonary artery systolic pressure (PASP) ≥40 mmHg by echocardiography were randomly assigned in a 2:1 ratio to receive sildenafil (up to 40 mg three times/day) or placebo. The co-primary endpoints were improvement in patient global assessment by visual analogue scale and in the 6-min walk test at 24 weeks. The planned sample size was 210 participants but, due to problems with supplying sildenafil/placebo and recruitment, only 69 patients (11 women, median age 68 (interquartile range [IQR] 62–74) years, median left ventricular ejection fraction 29% (IQR 24–35), median PASP 45 (IQR 42–55) mmHg) were included. Compared to placebo, sildenafil did not improve symptoms, quality of life, PASP or walk test distance. Sildenafil was generally well tolerated, but those assigned to sildenafil had numerically more serious adverse events (33% vs. 21%).\ud \ud \ud \ud Conclusion\ud \ud Compared to placebo, sildenafil did not improve symptoms, quality of life or exercise capacity in patients with HFrEF and PHT.

Published
2022

3. 2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease : The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)

Author

Pelliccia, Antonio, Sharma, Sanjay, Gati, Sabiha, Bäck, Maria, Börjesson, Mats, Caselli, Stefano, Collet, Jean-Philippe, Corrado, Domenico, Drezner, Jonathan A., Halle, Martin, Hansen, Dominique, Heidbüchel, Hein, Myers, Jonathan, Niebauer, Josef, Papadakis, Michael, Piepoli, Massimo Francesco, Prescott, Eva, Roos-Hesselink, Jolien W., Graham Stuart, A., Taylor, Rod S., Thompson, Paul D., Tiberi, Monica, Vanhees, Luc, Wilhelm, Matthias, Guazzi, Marco, La Gerche, André, Aboyans, Victor, Adami, Paolo Emilio, Backs, Johannes, Baggish, Aaron, Basso, Cristina, Biffi, Alessandro, Bucciarelli-Ducci, Chiara, Camm, A. John, Claessen, Guido, Delgado, Victoria, Elliott, Perry M., Galderisi, Maurizio, Gale, Chris P., Gray, Belinda, Haugaa, Kristina Hermann, Iung, Bernard, Katus, Hugo A., Keren, Andre, Leclercq, Christophe, Lewis, Basil S., Mont, Lluis, Mueller, Christian, Petersen, Steffen E., Petronio, Anna Sonia, Roffi, Marco, Savonen, Kai, Serratosa, Luis, Shlyakhto, Evgeny, Simpson, Iain A., Sitges, Marta, Solberg, Erik Ekker, Sousa-Uva, Miguel, van Craenenbroeck, Emeline, Van De Heyning, Caroline, Wijns, William, and ESC Scientific Document Group

Subjects
Human medicine
Published
2021

4. Right Ventricular Functional Reserve in Early-Stage Idiopathic Pulmonary Fibrosis: An Exercise Two-Dimensional Speckle Tracking Doppler Echocardiography Study

Author

D'Andrea, Antonello, Stanziola, Anna Agnese, Saggar, Rajan, Saggar, Rajeev, Sperlongano, Simona, Conte, Marianna, D'Alto, Michele, Ferrara, Francesco, Gargani, Luna, Lancellotti, Patrizio, Bossone, Eduardo, Naeije, Robert, Armstrong, William F., Kolias, Theodore John, Caliendo, Luigi, Cocchia, Rosangela, Citro, Rodolfo, Bellino, Michele, Radano, Ilaria, Cittadini, Antonio, Argiento, Paola, Carbone, Andreina, Dellegrottaglie, Santo, De Luca, Nicola, Grazia, Montuori Maria, Rozza, Francesco, Russo, Valentina, Di Salvo, Giovanni, Ghio, Stefano, Grunig, Ekkerard, Marra, Alberto, Guazzi, Marco, Bandera, Francesco, Labate, Valentina, La Gerche, André, Limongelli, Giuseppe, Pacileo, Giuseppe, Verrengia, Marina, Kasprzak, Jaroslaw D., Wierzbowska Drabik, Karina, Kovacs, Gabor, Moreo, Antonella, Casadei, Francesca, De Chiara, Benedetta, Ostenfeld, Ellen, Pieri, Francesco, Pratali, Lorenza, Selton-Suty, Christine, Huttin, Olivier, Venner, Clément, Serra, Walter, Stanziola, Anna, DI MARTINO, Maria Consiglia, Caccavo, Giovanna, Szabó, István, Varga, Albert, Agoston, Gergely, Voilliot, Darmien, Vriz, Olga, Galzerano, Domenico, Scalese, Marco, Carannante, Luca, D'Andrea, A., Stanziola, A. A., Saggar, R., Sperlongano, S., Conte, M., D'Alto, M., Ferrara, F., Gargani, L., Lancellotti, P., Bossone, E., Naeije, R., Armstrong, W. F., Kolias, T. J., Caliendo, L., Cocchia, R., Citro, R., Bellino, M., Radano, Flora, Cittadini, A., Argiento, P., Carbone, A., Dellegrottaglie, S., De Luca, N., Grazia, M. M., Rozza, F., Russo, V., Di Salvo, G., Ghio, S., Grunig, E., Marra, A., Guazzi, M., Bandera, F., Labate, V., La Gerche, A., Limongelli, G., Pacileo, G., Verrengia, Valentina, Kasprzak, J. D., Wierzbowska Drabik, K., Kovacs, G., Moreo, A., Casadei, F., De Chiara, B., Ostenfeld, E., Pieri, F., Pratali, L., Selton-Suty, C., Huttin, O., Venner, C., Serra, W., Stanziola, A., Martino, M., Caccavo, Giovanna, Szabo, I., Varga, A., Agoston, G., Voilliot, D., Vriz, O., Galzerano, D., Scalese, M., Carannante, L., D'Andrea, Antonello, Stanziola, Anna Agnese, Saggar, Rajan, Saggar, Rajeev, Sperlongano, Simona, Conte, Marianna, D'Alto, Michele, Ferrara, Francesco, Gargani, Luna, Lancellotti, Patrizio, Bossone, Eduardo, Naeije, Robert, Armstrong, William F., Kolias, Theodore John, Caliendo, Luigi, Cocchia, Rosangela, Citro, Rodolfo, Bellino, Michele, Radano, Ilaria, Cittadini, Antonio, Argiento, Paola, Carbone, Andreina, Dellegrottaglie, Santo, De Luca, Nicola, Grazia, Montuori Maria, Rozza, Francesco, Russo, Valentina, Di Salvo, Giovanni, Ghio, Stefano, Grunig, Ekkerard, Marra, Alberto, Guazzi, Marco, Bandera, Francesco, Labate, Valentina, La Gerche, André, Limongelli, Giuseppe, Pacileo, Giuseppe, Verrengia, Marina, Kasprzak, Jaroslaw D., Wierzbowska Drabik, Karina, Kovacs, Gabor, Moreo, Antonella, Casadei, Francesca, De Chiara, Benedetta, Ostenfeld, Ellen, Pieri, Francesco, Pratali, Lorenza, Selton-Suty, Christine, Huttin, Olivier, Venner, Clément, Serra, Walter, Stanziola, Anna, DI MARTINO, Maria Consiglia, Szabó, István, Varga, Albert, Agoston, Gergely, Voilliot, Darmien, Vriz, Olga, Galzerano, Domenico, Scalese, Marco, and Carannante, Luca

Subjects
Adult, Male, Functional Residual Capacity, Physiological, Hypertension, Pulmonary, Ventricular Dysfunction, Right, stress echocardiography, Kaplan-Meier Estimate, right ventricle, Stress, Risk Assessment, Severity of Illness Index, Computer-Assisted, Image Interpretation, Computer-Assisted, Ventricular Dysfunction, Humans, Adaptation, Image Interpretation, Proportional Hazards Models, idiopathic pulmonary fibrosi, 2D speckle tracking echocardiography, idiopathic pulmonary fibrosis, Adaptation, Physiological, Blood Gas Analysis, Case-Control Studies, Disease Progression, Echocardiography, Doppler, Echocardiography, Stress, Female, Hemodynamics, Idiopathic Pulmonary Fibrosis, Italy, Middle Aged, Prognosis, Survival Analysis, Vascular Resistance, Doppler, Pulmonary, Right, Echocardiography, Hypertension
Abstract

BRACKGROUND: The most important determinant of long-term survival in patients with idiopathic pulmonary fibrosis is the right ventricular (RV) adaptation to the increased pulmonary vascular resistance. Our aim was to explore RV contractile reserve during stress echocardiography in early-stage IPF.METHOD: Fifty early-stage patients with IPF and 50 healthy control patients underwent rest and stress echocardiography, including RV two-dimensional speckle tracking echocardiography. At peak exertion, blood gas analysis and spirometry were also assessed.RESULTS: At rest, RV diameters were mildly increased in IPF; however, although RV conventional systolic function indexes were similar between the IPF and control groups, RV global longitudinal strain and RV lateral wall longitudinal strain (LWLS) were significantly reduced in the IPF cohort. During physical exercise, patients with IPF showed a reduced exercise tolerance with lower maximal workload (P < .01), level of oxygen saturation (P < .001), and peak heart rate (P < .01). Systolic and diastolic BP values were similar in both groups. Systolic pulmonary artery pressure (PAPs) increase (Delta PAPs) during exertion was higher in IPF vs healthy subjects (P < .0001); RV LWLS increase (Delta RV LWLS) during exercise was lower in patients with IPF vs control patients (P < .00001). By multivariable analysis, RV LWLS at rest and Delta RV LWLS were directly related to peak exertion capacity, PAPs, and blood oxygen saturation level (Spo(2) ; P < .0001). Delta RV LWLS was directly related to diffusion lung carbon monoxide (P < .0001).CONCLUSION RV myocardial dysfunction is already present at rest in early-stage IPF and worsens during exertion as detected by two-dimensional speckle-tracking echocardiography. The RV altered contractile reserve appears to be related to reduced exercise tolerability and impaired pulmonary hemodynamic.

Published
2019

5. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular diseaseThe Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)

Author

Pelliccia, Antonio, Sharma, Sanjay, Gati, Sabiha, Bäck, Maria, Börjesson, Mats, Caselli, Stefano, Collet, Jean-Philippe, Corrado, Domenico, Drezner, Jonathan, Halle, Martin, Hansen, Dominique, Heidbuchel, Hein, Myers, Jonathan, Niebauer, Josef, Papadakis, Michael, Piepoli, Massimo Francesco, Prescott, Eva, Roos-Hesselink, Jolien, Graham Stuart, A, Taylor, Rod, Thompson, Paul, Tiberi, Monica, Vanhees, Luc, Wilhelm, Matthias, Guazzi, Marco, La Gerche, André, Aboyans, Victor, Adami, Paolo Emilio, Backs, Johannes, Baggish, Aaron, Basso, Cristina, Biffi, Alessandro, Bucciarelli-Ducci, Chiara, Camm, A John, Claessen, Guido, Delgado, Victoria, Elliott, Perry, Galderisi, Maurizio, Gale, Chris, Gray, Belinda, Haugaa, Kristina Hermann, Iung, Bernard, Katus, Hugo, Keren, Andre, Leclercq, Christophe, Lewis, Basil, Mont, Lluis, Mueller, Christian, Petersen, Steffen, Petronio, Anna Sonia, Roffi, Marco, Savonen, Kai, Serratosa, Luis, Shlyakhto, Evgeny, Simpson, Iain, Sitges, Marta, Solberg, Erik Ekker, Sousa-Uva, Miguel, van Craenenbroeck, Emeline, Van De Heyning, Caroline, Wijns, William, Stuart, A Graham, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Institute of cardiometabolism and nutrition (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
cardiovascular risk factors, exercise, chronic coronary syndromes, aortopathies, [SDV]Life Sciences [q-bio], heart failure, risk stratification, Guidelines, valvular heart disease, peripheral vascular disease, sport – special environments, recommendations, adult congenital heart disease, cancer, pregnancy, cardiomyopathy, arrhythmias, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2020

7. 4_Supplementary_material – Supplemental material for Extracorporeal membrane oxygenation without therapeutic anticoagulation in adults: A systematic review of the current literature

Author

Fina, Dario, Matteucci, Matteo, Jiritano, Federica, Meani, Paolo, Coco, Valeria Lo, Kowalewski, Mariusz, Maessen, Jos, Guazzi, Marco, Ballotta, Andrea, Ranucci, Marco, and Lorusso, Roberto

Subjects
FOS: Biological sciences, 69999 Biological Sciences not elsewhere classified
Abstract

Supplemental material, 4_Supplementary_material for Extracorporeal membrane oxygenation without therapeutic anticoagulation in adults: A systematic review of the current literature by Dario Fina, Matteo Matteucci, Federica Jiritano, Paolo Meani, Valeria Lo Coco, Mariusz Kowalewski, Jos Maessen, Marco Guazzi, Andrea Ballotta, Marco Ranucci and Roberto Lorusso in The International Journal of Artificial Organs

Published
2020
Full Text
View/download PDF

8. Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test

Author

Magri', Damiano, Massimo, Piepol, Ugo, Corrà, Gallo, Giovanna, Maruotti, Antonello, Carlo, Vignati, Elisabetta, Salvioni, Massimo, Mapelli, Stefania, Paolillo, Pasquale Perrone Filardi, Davide, Girola, Metra, Marco, Angela, B Scardovi, Rocco, Lagioia, Giuseppe, Limongelli, Michele, Senni, Domenico, Scrutinio, Michele, Emdin, Claudio, Passino, Carlo, Lombardi, Gaia, Cattadori, Gianfranco, Parati, Mariantonietta, Cicoira, Michele, Correale, Maria, Frigerio, Francesco, Clemenza, Maurizio, Bussotti, Guazzi, Marco, Badagliacca, Roberto, Sciomer, Susanna, Andrea Di Lenarda, Aldo, Maggioni, Gianfranco, Sinagra, Volpe, Massimo, Piergiuseppe, Agostoni, MECKI score Research Group, Magri, D., Piepoli, M., Corra, U. G. O., Gallo, G., Maruotti, A., Vignati, C., Salvioni, E., Mapelli, M., Paolillo, S., PERRONE FILARDI, P., Girola, D., Metra, M., Scardovi, A. B., Lagioia, R., Limongelli, G., Senni, M., Scrutinio, D., Emdin, M., Passino, C., Lombardi, C., Cattadori, G. A. I. A., Parati, G., Cicoira, M., Correale, M., Frigerio, M., Clemenza, F., Bussotti, M., Guazzi, M., Badagliacca, R., Sciomer, S., DI LENARDA, A., Maggioni, A. L. D. O., Sinagra, G., Volpe, M., Agostoni, P., Magrì, D, Piepoli, M, Corrà, U, Gallo, G, Maruotti, A, Vignati, C, Salvioni, E, Mapelli, M, Paolillo, S, Perrone Filardi, P, Girola, D, Metra, M, Scardovi, A, Lagioia, R, Limongelli, G, Senni, M, Scrutinio, D, Emdin, M, Passino, C, Lombardi, C, Cattadori, G, Parati, G, Cicoira, M, Correale, M, Frigerio, M, Clemenza, F, Bussotti, M, Guazzi, M, Badagliacca, R, Sciomer, S, DI Lenarda, A, Maggioni, A, Sinagra, G, Volpe, M, and Agostoni, P

Subjects
medicine.medical_specialty, Multivariate analysis, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Heart failure, 030204 cardiovascular system & hematology, Cardiovascular death, heart failure, mecki score, cardiopulmonary exercise test, prognosis, 03 medical and health sciences, 0302 clinical medicine, MECKI score, Internal medicine, Cardiopulmonary exercise test, Cause of Death, medicine, Humans, 030212 general & internal medicine, Ejection fraction, End point, business.industry, VO2 max, Cardiopulmonary exercise testing, Stroke Volume, medicine.disease, Cardiology, Exercise Test, Cardiology and Cardiovascular Medicine, business, prognosi
Abstract

Background Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing. Methods and Results We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th–75th range 627–2403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index = 0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO2) remained associated to the end point (C-index = 0.745). A peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction. Conclusions: Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO2 of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.

Published
2020

9. The metabolic exercise test data combined with Cardiac And Kidney Indexes (MECKI) score and prognosis in heart failure. A validation study

Author

Corrà, Ugo, Agostoni, Piergiuseppe, Giordano, Andrea, Cattadori, Gaia, Battaia, Elisa, La Gioia, Rocco, Scardovi, Angela B., Emdin, Michele, Metra, Marco, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Federica, Re, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Magri', Damiano, Fiorentini, Cesare, Cicoira, Mariantonietta, Salvioni, Elisabetta, Giovannardi, Marta, Veglia, Fabrizio, Mezzani, Alessandro, Scrutinio, Domenico, Di Lenarda, Andrea, Ricci, Roberto, Apostolo, Anna, Iorio, Anna Maria, Paolillo, Stefania, Palermo, Pietro, Contini, Mauro, Vassanelli, Corrado, Passino, Claudio, Giannuzzi, Pantaleo, Piepoli, Massimo F., MECKI ScoreResearch Group, Other Members of the MECKI Score research Group, Antonioli, L., Segurini, C., Bertella, E., Farina, S., Bovis, F., Pietrucci, F., Malfatto, G., Roselli, T., Buono, A., Calabrò, R., De Maria, R., Santoro, D., Campanale, S., Caputo, D., Bertipaglia, D., Berton, E., Corrà, Ugo, Agostoni, Piergiuseppe, Giordano, Andrea, Cattadori, Gaia, Battaia, Elisa, La Gioia, Rocco, Scardovi, Angela B., Emdin, Michele, Metra, Marco, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Re, Federica, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Magrì, Damiano, Fiorentini, Cesare, Cicoira, Mariantonietta, Salvioni, Elisabetta, Giovannardi, Marta, Veglia, Fabrizio, Mezzani, Alessandro, Scrutinio, Domenico, DI LENARDA, Andrea, Ricci, Roberto, Apostolo, Anna, Iorio, Anna Maria, Paolillo, Stefania, Palermo, Pietro, Contini, Mauro, Vassanelli, Corrado, Passino, Claudio, Giannuzzi, Pantaleo, Piepoli, Massimo F., Corra, U., Agostoni, P., Giordano, A., Cattadori, G., Battaia, E., La Gioia, R., Scardovi, A. B., Emdin, M., Metra, M., Sinagra, G., Limongelli, G., Raimondo, R., Re, F., Guazzi, M., Belardinelli, R., Parati, G., Magri, D., Fiorentini, C., Cicoira, M., Salvioni, E., Giovannardi, M., Veglia, F., Mezzani, A., Scrutinio, D., Di Lenarda, A., Ricci, R., Apostolo, A., Iorio, A. M., Paolillo, S., Palermo, P., Contini, M., Vassanelli, C., Passino, C., Giannuzzi, P., Piepoli, M. F., Corrà, U, Agostoni, P, Giordano, A, Cattadori, G, Battaia, E, La Gioia, R, Scardovi, A, Emdin, M, Metra, M, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Cicoira, M, Salvioni, E, Giovannardi, M, Veglia, F, Mezzani, A, Scrutinio, D, Di Lenarda, A, Ricci, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Vassanelli, C, Passino, C, Giannuzzi, P, and Piepoli, M

Subjects
Male, medicine.medical_treatment, Predictive Value of Test, 030204 cardiovascular system & hematology, Kidney Function Tests, Severity of Illness Index, 0302 clinical medicine, score, 030212 general & internal medicine, Heart transplantation, education.field_of_study, Ejection fraction, Heart Function Test, Stroke volume, Middle Aged, Prognosis, Predictive value of tests, Heart Function Tests, Cardiology, Female, Cardiology and Cardiovascular Medicine, Human, medicine.medical_specialty, Prognosi, Population, Renal function, Heart failure, Prognosis, score, Lower risk, Follow-Up Studie, 03 medical and health sciences, Oxygen Consumption, Predictive Value of Tests, Internal medicine, medicine, Humans, medicine (all), education, Aged, Kidney Function Test, business.industry, heart failure, prognosis, score, aged, exercise test, female, follow-up studies, heart function tests, heart transplantation, humans, kidney function tests, male, middle aged, oxygen consumption, predictive value of tests, prognosis, severity of illness index, stroke volume, cardiology and cardiovascular medicine, Stroke Volume, medicine.disease, Exercise Test, Follow-Up Studies, Heart Failure, Heart Transplantation, business
Abstract

Background The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a prognostic model to identify heart failure (HF) patients at risk for cardiovascular mortality (CVM) and urgent heart transplantation (uHT) based on 6 routine clinical parameters: hemoglobin, sodium, kidney function by the Modification of Diet in Renal Disease (MDRD) equation, left ventricle ejection fraction (LVEF), percentage of predicted peak oxygen consumption (VO2) and VE/VCO2 slope. Objectives MECKI score must be generalizable to be considered useful: therefore, its performance was validated in a new sequence of HF patients. Methods Both the development (MECKI-D) and the validation (MECKI-V) cohorts were composed of consecutive HF patients with LVEF < 40% able to perform a symptom-limited cardiopulmonary exercise testing. The CVM or uHT rates were analyzed at one, two and three years in both cohorts: all patients with a censoring time shorter than the scheduled follow-up were excluded, while those with events occurring after 1, 2 and 3 years were considered as censored. Results MECKI-D and MECKI-V consisted of 2009 and 992 patients, respectively. MECKI-V patients had a higher LVEF, higher peak VO2 and lower VE/VCO2 slope, higher prescription of beta-blockers and device therapy: after the 3-year follow-up, CVM or uHT occurred in 206 (18%) MECKI-D and 44 (13%) MECKI-V patients (p < 0.000), respectively. MECKI-V AUC values at one, two and three years were 0.81 ± 0.04, 0.76 ± 0.04, and 0.80 ± 0.03, respectively, not significantly different from MECKI-D. Conclusions MECKI score preserves its predictive ability in a HF population at a lower risk.

Published
2016

10. Mineralocorticoid receptor antagonists for heart failure: a real-life observational study

Author

Bruno, Noemi, Sinagra, Gianfranco, Paolillo, Stefania, Bonomi, Alice, Corrà, Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Cattadori, Gaia, Scardovi, Angela B, Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Guazzi, Marco, Raimondo, Rosa, Gentile, Piero, Magrì, Damiano, Correale, Michele, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Vignati, Carlo, Oliva, Fabrizio, Mezzani, Alessandro, Vergaro, Giuseppe, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Mapelli, Massimo, Carriere, Cosimo, Clemenza, Francesco, Binno, Simone, Belardinelli, Romualdo, Lombardi, Carlo, Perrone Filardi, Pasquale, Emdin, Michele, Agostoni, Piergiuseppe, Bruno, N, Sinagra, G, Paolillo, S, Bonomi, A, Corrà, U, Piepoli, M, Veglia, F, Salvioni, E, Lagioia, R, Metra, M, Limongelli, G, Cattadori, G, Scardovi, A, Carubelli, V, Scrutino, D, Badagliacca, R, Guazzi, M, Raimondo, R, Gentile, P, Magrì, D, Correale, M, Parati, G, Re, F, Cicoira, M, Frigerio, M, Bussotti, M, Vignati, C, Oliva, F, Mezzani, A, Vergaro, G, Di Lenarda, A, Passino, C, Sciomer, S, Pacileo, G, Ricci, R, Contini, M, Apostolo, A, Palermo, P, Mapelli, M, Carriere, C, Clemenza, F, Binno, S, Belardinelli, R, Lombardi, C, Perrone Filardi, P, Emdin, M, Agostoni, P, Scardovi, Ab, Agostoni, P., Bruno, Noemi, Sinagra, Gianfranco, Paolillo, Stefania, Bonomi, Alice, Corrà, Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Cattadori, Gaia, Scardovi, Angela B, Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Guazzi, Marco, Raimondo, Rosa, Gentile, Piero, Magrì, Damiano, Correale, Michele, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Vignati, Carlo, Oliva, Fabrizio, Mezzani, Alessandro, Vergaro, Giuseppe, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Mapelli, Massimo, Carriere, Cosimo, Clemenza, Francesco, Binno, Simone, Belardinelli, Romualdo, Lombardi, Carlo, Perrone Filardi, Pasquale, Emdin, Michele, and Agostoni, Piergiuseppe

Subjects
Male, Heart failure, Hyperkalaemia, Mineralocorticoid receptor antagonists, Worsening renal function, Mineralocorticoid receptor antagonist, Stroke Volume, Middle Aged, Ventricular Function, Left, Cardiology and Cardiovascular Medicine, Treatment Outcome, Original Research Articles, cardiovascular system, Humans, Female, mineralocorticoid receptor antagonists, heart failure, worsening renal function, hyperkalaemia, cardiovascular diseases, Original Research Article, Prospective Studies, Propensity Score, Follow-Up Studies, Forecasting
Abstract

Aims Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population‐based analysis, the long‐term effects of MRA treatment in HFrEF patients. Methods and results We analysed data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset. Analysis was performed in patients treated (n = 3163) and not treated (n = 2883) with MRA. The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Ten years' survival was analysed through Kaplan–Meier, compared by log‐rank test and propensity score matching. At 10 years' follow‐up, the MRA‐untreated group had a significantly lower number of events than the MRA‐treated group (P

Published
2018

11. Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long-term comparison

Author

Agostoni, Piergiuseppe, Paolillo, Stefania, Mapelli, Massimo, Gentile, Piero, Salvioni, Elisabetta, Veglia, Fabrizio, Bonomi, Alice, Corrà , Ugo, Lagioia, Rocco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Carubelli, Valentina, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Piepoli, Massimo, Magrì, Damiano, Parati, Gianfranco, Caravita, Sergio, Re, Federica, Cicoira, Mariantonietta, Minà , Chiara, Correale, Michele, Frigerio, Maria, Bussotti, Maurizio, Oliva, Fabrizio, Battaia, Elisa, Belardinelli, Romualdo, Mezzani, Alessandro, Pastormerlo, Luigi, Guazzi, Marco, Badagliacca, Roberto, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Zambon, Elena, Pacileo, Giuseppe, Ricci, Roberto, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Clemenza, Francesco, Marchese, Giovanni, Gargiulo, Paola, Binno, Simone, Lombardi, Carlo, Passantino, Andrea, Filardi, Pasquale Perrone, Agostoni, P, Paolillo, S, Mapelli, M, Gentile, P, Salvioni, E, Veglia, F, Bonomi, A, Corrà, U, Lagioia, R, Limongelli, G, Sinagra, G, Cattadori, G, Scardovi, A, Metra, M, Carubelli, V, Scrutinio, D, Raimondo, R, Emdin, M, Piepoli, M, Magrì, D, Parati, G, Caravita, S, Re, F, Cicoira, M, Minà, C, Correale, M, Frigerio, M, Bussotti, M, Oliva, F, Battaia, E, Belardinelli, R, Mezzani, A, Pastormerlo, L, Guazzi, M, Badagliacca, R, Di Lenarda, A, Passino, C, Sciomer, S, Zambon, E, Pacileo, G, Ricci, R, Apostolo, A, Palermo, P, Contini, M, Clemenza, F, Marchese, G, Gargiulo, P, Binno, S, Lombardi, C, Passantino, A, Filardi, P, Scardovi, Ab, CARAVITA DI TORITTO, Beniamino, Perrone Filardi, P., Agostoni, P., Paolillo, S., Mapelli, M., Gentile, P., Salvioni, E., Veglia, F., Bonomi, A., Corra, U., Lagioia, R., Limongelli, G., Sinagra, G., Cattadori, G., Scardovi, A. B., Metra, M., Carubelli, V., Scrutinio, D., Guarino, Raimondo, Emdin, M., Piepoli, M., Magri, D., Parati, G., Caravita, S., Re, F., Cicoira, M., Mina, C., Correale, M., Frigerio, M., Bussotti, M., Oliva, F., Battaia, E., Belardinelli, R., Mezzani, A., Pastormerlo, L., Guazzi, M., Badagliacca, R., Di Lenarda, A., Passino, C., Sciomer, S., Zambon, E., Pacileo, G., Ricci, R., Apostolo, A., Palermo, P., Contini, M., Clemenza, F., Marchese, G., Gargiulo, P., Binno, S., Lombardi, C., Passantino, A., Filardi, P. P., Agostoni, Piergiuseppe, Paolillo, Stefania, Mapelli, Massimo, Gentile, Piero, Salvioni, Elisabetta, Veglia, Fabrizio, Bonomi, Alice, Corrã , Ugo, Lagioia, Rocco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Carubelli, Valentina, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Piepoli, Massimo, Magrã¬, Damiano, Parati, Gianfranco, Caravita, Sergio, Re, Federica, Cicoira, Mariantonietta, Minã , Chiara, Correale, Michele, Frigerio, Maria, Bussotti, Maurizio, Oliva, Fabrizio, Battaia, Elisa, Belardinelli, Romualdo, Mezzani, Alessandro, Pastormerlo, Luigi, Guazzi, Marco, Badagliacca, Roberto, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Zambon, Elena, Pacileo, Giuseppe, Ricci, Roberto, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Clemenza, Francesco, Marchese, Giovanni, Gargiulo, Paola, Binno, Simone, Lombardi, Carlo, Passantino, Andrea, and Filardi, Pasquale Perrone

Subjects
Male, Time Factors, Heart-Assist Device, Time Factor, Prognosi, Reproducibility of Result, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Heart failure, Risk Assessment, Follow-Up Studie, Oxygen Consumption, HFSS, Cause of Death, MECKI score, Prognosis, Risk score, SHFM, Exercise Test, Female, Follow-Up Studies, Heart Failure, Heart Transplantation, Heart-Assist Devices, Humans, Italy, Middle Aged, Morbidity, Prospective Studies, Reproducibility of Results, Stroke Volume, Survival Rate, Disease Management, heart failure, prognosis, heart failure, prognosis, risk score, cardiology and cardiovascular medicine, Prospective Studie, Human
Abstract

Aims: Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A multiparametric approach is the best method to stratify prognosis. In 2012, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was proposed to assess the risk of cardiovascular mortality and urgent heart transplantation. The aim of the present study was to compare the prognostic accuracy of MECKI score to that of HF Survival Score (HFSS) and Seattle HF Model (SHFM) in a large, multicentre cohort of HF patients with reduced ejection fraction. Methods and results: We collected data on 6112 HF patients and compared the prognostic accuracy of MECKI score, HFSS, and SHFM at 2- and 4-year follow-up for the combined endpoint of cardiovascular death, urgent cardiac transplantation, or ventricular assist device implantation. Patients were followed up for a median of 3.67 years, and 931 cardiovascular deaths, 160 urgent heart transplantations, and 12 ventricular assist device implantations were recorded. At 2-year follow-up, the prognostic accuracy of MECKI score was significantly superior [area under the curve (AUC) 0.781] to that of SHFM (AUC 0.739) and HFSS (AUC 0.723), and this relationship was also confirmed at 4 years (AUC 0.764, 0.725, and 0.720, respectively). Conclusion: In this cohort, the prognostic accuracy of the MECKI score was superior to that of HFSS and SHFM at 2- and 4-year follow-up in HF patients in stable clinical condition. The MECKI score may be useful to improve resource allocation and patient outcome, but prospective evaluation is needed.

Published
2018

12. Prognostic role of beta-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database

Author

Paolillo, Stefania, Mapelli, Massimo, Bonomi, Alice, Corrà, Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Gentile, Piero, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B, Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Raimondo, Rosa, Emdin, Michele, Magri', Damiano, Correale, Michele, Parati, Gianfranco, Caravita, Sergio, Spadafora, Emanuele, Federica, Re, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Minà, Chiara, Oliva, Fabrizio, Battaia, Elisa, Belardinelli, Romualdo, Mezzani, Alessandro, Pastormerlo, Luigi, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Iorio, Annamaria, Zambon, Elena, Guazzi, Marco, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Clemenza, Francesco, Marchese, Giovanni, Binno, Simone, Lombardi, Carlo, Passantino, Andrea, Perrone Filardi, Pasquale, Agostoni, Piergiuseppe, Paolillo, Stefania, Mapelli, Massimo, Bonomi, Alice, Corrã , Ugo, Piepoli, Massimo, Veglia, Fabrizio, Salvioni, Elisabetta, Gentile, Piero, Lagioia, Rocco, Metra, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Carubelli, Valentina, Scrutino, Domenico, Badagliacca, Roberto, Raimondo, Rosa, Emdin, Michele, Magrã¬, Damiano, Correale, Michele, Parati, Gianfranco, Caravita, Sergio, Spadafora, Emanuele, Re, Federica, Cicoira, Mariantonietta, Frigerio, Maria, Bussotti, Maurizio, Minã , Chiara, Oliva, Fabrizio, Battaia, Elisa, Belardinelli, Romualdo, Mezzani, Alessandro, Pastormerlo, Luigi, Di Lenarda, Andrea, Passino, Claudio, Sciomer, Susanna, Iorio, Annamaria, Zambon, Elena, Guazzi, Marco, Pacileo, Giuseppe, Ricci, Roberto, Contini, Mauro, Apostolo, Anna, Palermo, Pietro, Clemenza, Francesco, Marchese, Giovanni, Binno, Simone, Lombardi, Carlo, Passantino, Andrea, Perrone Filardi, Pasquale, Agostoni, Piergiuseppe, Corrà, Ugo, Scardovi, Angela B, Magrì, Damiano, Minà, Chiara, PERRONE FILARDI, Pasquale, Paolillo, S, Mapelli, M, Bonomi, A, Corrã , U, Piepoli, M, Veglia, F, Salvioni, E, Gentile, P, Lagioia, R, Metra, M, Limongelli, G, Sinagra, G, Cattadori, G, Scardovi, A, Carubelli, V, Scrutino, D, Badagliacca, R, Raimondo, R, Emdin, M, Magrã¬, D, Correale, M, Parati, G, Caravita, S, Spadafora, E, Re, F, Cicoira, M, Frigerio, M, Bussotti, M, Minã , C, Oliva, F, Battaia, E, Belardinelli, R, Mezzani, A, Pastormerlo, L, Di Lenarda, A, Passino, C, Sciomer, S, Iorio, A, Zambon, E, Guazzi, M, Pacileo, G, Ricci, R, Contini, M, Apostolo, A, Palermo, P, Clemenza, F, Marchese, G, Binno, S, Lombardi, C, Passantino, A, Perrone Filardi, P, and Agostoni, P

Subjects
Male, equivalent dose, heart failure, prognosis, β-blocker selectivity, β-blockers, Time Factors, Prognosi, Adrenergic beta-Antagonists, Carbazoles, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Heart failure, β-Blocker, β-Blocker, Ventricular Function, Left, β-Blocker selectivity, Propanolamines, Heart Rate, Humans, Prospective Studies, Equivalent dose, Prognosis, β-Blocker selectivity, β-Blockers, Cardiology and Cardiovascular Medicine, β-Blockers, Dose-Response Relationship, Drug, Stroke Volume, Middle Aged, Treatment Outcome, Echocardiography, Carvedilol, Female, Follow-Up Studies
Abstract

Aims: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. Methods and results: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P < 0.0001], while also considering potential confounders. A comparable prognosis was observed at 5 years in the β1-/β2-receptor-blocker (n = 2219) vs. β1-selective group (n = 2216) (HR 0.95, P = ns). A better prognosis was observed in high-dose (>2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5–25 mg, n = 1431) and low dose (

Published
2017

13. Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Author

Gorter, Thomas M, van Veldhuisen, Dirk J, Bauersachs, Johann, Borlaug, Barry A, Celutkiene, Jelena, Coats, Andrew J S, Crespo-Leiro, Marisa G, Guazzi, Marco, Harjola, Veli-Pekka, Heymans, Stephane, Hill, Loreena, Lainscak, Mitja, Lam, Carolyn S P, Lund, Lars H, Lyon, Alexander R, Mebazaa, Alexandre, Mueller, Christian, Paulus, Walter J, Pieske, Burkert, Piepoli, Massimo F, Ruschitzka, Frank, et al, and University of Zurich

Subjects
10209 Clinic for Cardiology, 610 Medicine & health, Cardiology and Cardiovascular Medicine, 2705 Cardiology and Cardiovascular Medicine
Published
2018

15. Exercise tolerance can explain the obesity paradox in patients with systolic heart failure: data from the MECKI Score Research Group

Author

Piepoli, Massimo F., Corrà, Ugo, Veglia, Fabrizio, Bonomi, Alice, Salvioni, Elisabetta, Cattadori, Gaia, Metra, Marco, Lombardi, Carlo, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Federica, Re, Magri', Damiano, Belardinelli, Romualdo, Parati, Gianfranco, Minà, Chiara, Scardovi, Angela B., Guazzi, Marco, Cicoira, Mariantonietta, Scrutinio, Domenico, Di Lenarda, Andrea, Bussotti, Maurizio, Frigerio, Maria, Correale, Michele, Villani, Giovanni Quinto, Paolillo, Stefania, Passino, Claudio, Agostoni, Piergiuseppe, Piepoli, Massimo F., Corrã , Ugo, Veglia, Fabrizio, Bonomi, Alice, Salvioni, Elisabetta, Cattadori, Gaia, Metra, Marco, Lombardi, Carlo, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Re, Federica, Magrã¬, Damiano, Belardinelli, Romualdo, Parati, Gianfranco, Minã , Chiara, Scardovi, Angela B., Guazzi, Marco, Cicoira, Mariantonietta, Scrutinio, Domenico, Di Lenarda, Andrea, Bussotti, Maurizio, Frigerio, Maria, Correale, Michele, Villani, Giovanni Quinto, Paolillo, Stefania, Passino, Claudio, Agostoni, Piergiuseppe, Piepoli, M, Corrà, U, Veglia, F, Bonomi, A, Salvioni, E, Cattadori, G, Metra, M, Lombardi, C, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Magrì, D, Belardinelli, R, Parati, G, Minà, C, Scardovi, A, Guazzi, M, Cicoira, M, Scrutinio, D, Di Lenarda, A, Bussotti, M, Frigerio, M, Correale, M, Villani, G, Paolillo, S, Passino, C, Agostoni, P, Corrà, Ugo, Magrì, Damiano, Minà, Chiara, and DI LENARDA, Andrea

Subjects
Male, Prognosi, Matching analysi, Heart failure, Cohort Studies, Oxygen Consumption, Exercise tolerance, Cause of Death, Humans, Cardiopulmonary exercise testing, MECKI score, Matching analysis, Prognosis, Obesity, Aged, Cardiology and Cardiovascular Medicine, cardiopulmonary exercise testing, exercise tolerance, heart failure, matching analysis, prognosis, ardiology and cardiovascular medicineC, Middle Aged, Protective Factors, Cardiorespiratory Fitness, Italy, Multivariate Analysis, Exercise Test, Heart Transplantation, Female, Heart Failure, Systolic
Abstract

AIMS: Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HF patients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF. METHODS AND RESULTS: A total of 4623 systolic HF patients (LVEF 31.5 ± 9.5%, BMI 26.2 ± 3.6 kg/m(2) ) were recruited and prospectively followed in 24 Italian HF centres belonging to the MECKI Score Research Group. Besides full clinical examination, patients underwent maximal cardiopulmonary exercise test at study enrolment. Median follow-up was 1113 (553-1803) days. The study population was divided according to BMI (30 to ≤35 kg/m(2) ) and predicted peak oxygen consumption (peak VO2 , 80%). Study endpoints were all-cause and cardiovascular deaths including urgent cardiac transplant. All-cause and cardiovascular deaths occurred in 951 (28.6%, 57.4 per person-years) and 802 cases (17.4%, 48.4 per 1000 person-years), respectively. In the high BMI groups, several prognostic parameters presented better values [LVEF, peak VO2 , ventilation/carbon dioxide slope, renal function, and haemoglobin (P < 0.01)] compared with the lower BMI groups. Both BMI and peak VO2 were significant positive predictors of longer survival: both higher BMI and peak VO2 groups showed lower mortality (P < 0.001). At multivariable analysis and using a matching procedure (age, gender, LVEF, and peak VO2 ), the protective role of BMI disappeared. CONCLUSION: Exercise tolerance affects the relationship between BMI and survival. Cardiorespiratory fitness mitigates the obesity paradox observed in HF patients.

Published
2016

17. Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction

Author

Ghio, Stefano, Guazzi, Marco, Scardovi, Angela Beatrice, Klersy, Catherine, Clemenza, Francesco, Carluccio, Erberto, Temporelli, Pier Luigi, Rossi, Andrea, Faggiano, Pompilio, Traversi, Egidio, Vriz, Olga, and Dini, Frank Lloyd

Subjects
Heart Failure, Male, Time Factors, Systole, Stroke Volume, Middle Aged, Prognosis, Echocardiography, Heart failure, Pulmonary hypertension, Right ventricle, Aged, Female, Follow-Up Studies, Heart Rate, Humans, Retrospective Studies, Ventricular Dysfunction, Right, Ventricular Function, Right, Cardiology and Cardiovascular Medicine, Right, Ventricular Dysfunction, Ventricular Function
Published
2017

18. Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction

Author

Scrutinio, Domenico, Agostoni, Piergiuseppe, Gesualdo, Loreto, Corra, Ugo, Mezzani, Alessandro, Piepoli, Massimo, Di Lenarda, Andrea, Iorio, Annamaria, Passino, Claudio, Magri, Damiano, Masarone, Daniele, Battaia, Elisa, Girola, Davide, Re, Federica, Cattadori, Gaia, Parati, Gianfranco, Sinagra, Gianfranco, Villani, Giovanni Quinto, LIMONGELLI, Giuseppe, Pacileo, Giuseppe, Guazzi, Marco, Metra, Marco, Frigerio, Maria, Cicoira, Mariantonietta, Miná, Chiara, Malfatto, Gabriella, Caravita, Sergio, Bussotti, Maurizio, Salvioni, Elisabetta, Veglia, Fabrizio, Correale, Michele, Scardovi, Angela B., Emdin, Michele, Giannuzzi, Pantaleo, Gargiulo, Paola, Giovannardi, Marta, Perrone Filardi, Pasquale, Raimondo, Rosa, Ricci, Roberto, Paolillo, Stefania, Farina, Stefania, Belardinelli, Romualdo, Passantino, Andrea, La Gioia, Rocco, Fiorentini, Cesare, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Bertella, Erika, Mantegazza, Valentina, Pietrucci, Francesca, Ferraironi, Aessandro, Casenghi, Matteo, Clemenza, Francesco, Roselli, Teo, Buono, Andrea, Santoro, Daniela, Campanale, Saba, Caputo, Domenica, Bertipaglia, Donatella, Vaninetti, Raffaella, Confalonieri, Marco, Zambon, Elena, Berton, Emanuela, Torregiani, Chiara, Cas, Livio Dei, Carubelli, Valentina, Binno, Simone, Marchese, Giovanni, Oliva, Fabrizio, Pastormerlo, Luigi, CALABRO', Raffaele, Scrutinio, Domenico, Agostoni, Piergiuseppe, Gesualdo, Loreto, Corra, Ugo, Mezzani, Alessandro, Piepoli, Massimo, Di Lenarda, Andrea, Iorio, Annamaria, Passino, Claudio, Magri, Damiano, Masarone, Daniele, Battaia, Elisa, Girola, Davide, Re, Federica, Cattadori, Gaia, Parati, Gianfranco, Sinagra, Gianfranco, Villani, Giovanni Quinto, Limongelli, Giuseppe, Pacileo, Giuseppe, Guazzi, Marco, Metra, Marco, Frigerio, Maria, Cicoira, Mariantonietta, Miná, Chiara, Malfatto, Gabriella, Caravita, Sergio, Bussotti, Maurizio, Salvioni, Elisabetta, Veglia, Fabrizio, Correale, Michele, Scardovi, Angela B., Emdin, Michele, Giannuzzi, Pantaleo, Gargiulo, Paola, Giovannardi, Marta, Perrone Filardi, Pasquale, Raimondo, Rosa, Ricci, Roberto, Paolillo, Stefania, Farina, Stefania, Belardinelli, Romualdo, Passantino, Andrea, La Gioia, Rocco, Fiorentini, Cesare, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Bertella, Erika, Mantegazza, Valentina, Pietrucci, Francesca, Ferraironi, Aessandro, Casenghi, Matteo, Clemenza, Francesco, Roselli, Teo, Buono, Andrea, Calabro', Raffaele, Santoro, Daniela, Campanale, Saba, Caputo, Domenica, Bertipaglia, Donatella, Vaninetti, Raffaella, Confalonieri, Marco, Zambon, Elena, Berton, Emanuela, Torregiani, Chiara, Cas, Livio Dei, Carubelli, Valentina, Binno, Simone, Marchese, Giovanni, Oliva, Fabrizio, Pastormerlo, Luigi, Corrà, Ugo, Lenarda, Andrea Di, Magrì, Damiano, Minà, Chiara, Scrutinio, D, Agostoni, P, Gesualdo, L, Corra, U, Mezzani, A, Piepoli, M, Di Lenarda, A, Iorio, A, Passino, C, Magri, D, Masarone, D, Battaia, E, Girola, D, Re, F, Cattadori, G, Parati, G, Sinagra, G, Villani, G, Limongelli, G, Pacileo, G, Guazzi, M, Metra, M, Frigerio, M, Cicoira, M, Miná, C, Malfatto, G, Caravita, S, Bussotti, M, Salvioni, E, Veglia, F, Correale, M, Scardovi, A, Emdin, M, Giannuzzi, P, Gargiulo, P, Giovannardi, M, Perrone Filardi, P, Raimondo, R, Ricci, R, Paolillo, S, Farina, S, Belardinelli, R, Passantino, A, La Gioia, R, Fiorentini, C, Apostolo, A, Palermo, P, Contini, M, Bertella, E, Mantegazza, V, Pietrucci, F, Ferraironi, A, Casenghi, M, Clemenza, F, Roselli, T, Buono, A, Calabrò, R, Santoro, D, Campanale, S, Caputo, D, Bertipaglia, D, Vaninetti, R, Confalonieri, M, Zambon, E, Berton, E, Torregiani, C, Cas, L, Carubelli, V, Binno, S, Marchese, G, Oliva, F, Pastormerlo, L, Scardovi, Angela B, and PERRONE FILARDI, Pasquale

Subjects
Adult, Male, medicine.medical_specialty, Kidney Disease, Aged, Chronic Disease, Female, Follow-Up Studies, Humans, Kidney Function Tests, Middle Aged, Exercise, Heart Failure, Kidney Diseases, Oxygen Consumption, Stroke Volume, Prognosi, medicine.medical_treatment, Renal function, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Heart failure, Follow-Up Studie, Peak exercise oxygen consumption, Prognosis, Cardiology and Cardiovascular Medicine, Internal medicine, medicine, Heart transplantation, Ejection fraction, Kidney Function Test, business.industry, Hazard ratio, Atrial fibrillation, General Medicine, Stroke volume, medicine.disease, heart failure, exercise capacity, renal function, exercise capacity, Cardiology, business, Kidney disease, Human
Abstract

Background: Chronic kidney disease is associated with sympathetic activation and muscle abnormalities, which may contribute to decreased exercise capacity. We investigated the correlation of renal function with peak exercise oxygen consumption (V˙O2) in heart failure (HF) patients. Methods and Results: We recruited 2,938 systolic HF patients who underwent clinical, laboratory, echocardiographic and cardiopulmonary exercise testing. The patients were stratified according to estimated glomerular filtration rate (eGFR). Mean follow-up was 3.7 years. The primary outcome was a composite of cardiovascular death and urgent heart transplantation at 3 years. On multivariable regression, eGFR was predictor of peakV˙O2 (P

Published
2015

19. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure [Guía ESC 2016 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica]

Author

Ponikowski, Autores/Miembros del Grupo de Trabajo: Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G. F., Coats, Andrew J. S., Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli-Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M. C., Ruilope, Luis M., Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Revisores del documento: Gerasimos, Mcmurray, John J. V., Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, James Atherton, John, Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin, Fernández-Golfín, Covadonga, Fitzsimons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y. H., Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, and Zamorano, José Luis

Subjects
Cardiology, Cardiovascular Medicine, Cardiology, Cardiovascular Medicine, NO
Published
2016

20. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Gailure of the European Society of Cardiology (ESC)

Author

Ponikowski, Piotr, Voors, Adriaan A., Anker, Stefan D., Bueno, Héctor, Cleland, John G. F., Coats, Andrew J. S., Falk, Volkmar, González-Juanatey, José Ramón, Harjola, Veli-Pekka, Jankowska, Ewa A., Jessup, Mariell, Linde, Cecilia, Nihoyannopoulos, Petros, Parissis, John T., Pieske, Burkert, Riley, Jillian P., Rosano, Giuseppe M. C., Ruilope, Luis Miguel, Ruschitzka, Frank, Rutten, Frans H., van der Meer, Peter, Filippatos, Gerasimos S., McMurray, John. J. V., Aboyans, Victor, Achenbach, Stephan, Agewall, Stefan, Al-Attar, Nawwar, Atherton, John J., Bauersachs, Johann, Camm, A. John, Carerj, Scipione, Ceconi, Claudio, Coca, Antonio, Elliott, Perry, Erol, Çetin, Ezekowitz, Justin A., Fernández-Golfín, Covadonga, Fitzsimmons, Donna, Guazzi, Marco, Guenoun, Maxime, Hasenfuss, Gerd, Hindricks, Gerhard, Hoes, Arno W., Iung, Bernard, Jaarsma, Tiny, Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Konstantinides, Stavros, Lainscak, Mitja, Lancellotti, Patrizio, Lip, Gregory Y. H., Maisano, Francesco, Mueller, Christian, Petrie, Mark C., Piepoli, Massimo F., Priori, Silvia G., Torbicki, Adam, Tsutsui, Hiroyuki, van Veldhuisen, Dirk J., Windecker, Stephan, Yancy, Clyde, and Zamorano, Jose Luis

Subjects
mechanical circulatory support, diagnosis, heart failure, cardiac resynchronization therapy, pharmacotherapy, co-morbidities, neuro-hormonal antagonists, multidisciplinary management, guidelines, natriuretic peptides, ejection fraction, arrhythmias, transplantation, hospitalization
Published
2016

21. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes

Author

Senni, Michele Paulus, Walter J. Gavazzi, Antonello Fraser, Alan G. Diez, Javier Solomon, Scott D. Smiseth, Otto A. and Guazzi, Marco Lam, Carolyn S. P. Maggioni, Aldo P. Tschoepe, Carsten Metra, Marco Hummel, Scott L. Edelmann, Frank and Ambrosio, Giuseppe Coats, Andrew J. Stewart Filippatos, Gerasimos S. Gheorghiade, Mihai Anker, Stefan D. Levy, Daniel Pfeffer, Marc A. Stough, Wendy Gattis Pieske, Burkert M.

Subjects
respiratory tract diseases
Abstract

The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed.

Published
2014

22. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. EACPR/AHA Joint Scientific Statement

Author

Meyers, Jonathan, Forman, Daniel, Lavie, Carl, Arena, Ross, Conraads, Viviane, Kitzman, Dalane, Vanhees, Luc, Guazzi, Marco, Fletcher, Gerald, Mezzani, Alessandro, Adams, Volker, and Halle, Martin

Abstract

From an evidence-based perspective, cardiopulmonary exercise testing (CPX) is a well-supported assessment technique in both the United States (US) and Europe. The combination of standard exercise testing (ET) [i.e. progressive exercise provocation in association with serial electrocardiograms (ECGs), haemodynamics, oxygen saturation, and subjective symptoms] and measurement of ventilatory gas exchange amounts to a superior method to: (i) accurately quantify cardiorespiratory fitness (CRF), (ii) delineate the physiologic system(s) underlying exercise responses, which can be applied as a means to identify the exercise-limiting pathophysiological mechanism(s) and/or performance differences, and (iii) formulate function-based prognostic stratification. Cardiopulmonary ET certainly carries an additional cost as well as competency requirements and is not an essential component of evaluation in all patient populations. However, there are several conditions of confirmed, suspected, or unknown aetiology where the data gained from this form of ET is highly valuable in terms of clinical decision making.1

Published
2012

24. EACPR/AHA scientific statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations

Author

Conraads, Viviane, Myers, Jonathan, Lavie, Carl, Guazzi, Marco, Forman, Daniel, Mezzani, Alessandro, Kitzman, Dalane, Arena, Ross, Halle, Martin, Fletcher, Gerald, Adams, Volker, and Vanhees, Luc

Abstract

From an evidence-based perspective, cardiopulmonary exercise testing (CPX) is a well-supported assessment technique in both the United States (US) and Europe. The combination of standard exercise testing (ET) (ie, progressive exercise provocation in association with serial electrocardiograms [ECG], hemodynamics, oxygen saturation, and subjective symptoms) and measurement of ventilatory gas exchange amounts to a superior method to: 1) accurately quantify cardiorespiratory fitness (CRF), 2) delineate the physiologic system(s) underlying exercise responses, which can be applied as a means to identify the exercise-limiting pathophysiologic mechanism(s) and/or performance differences, and 3) formulate function-based prognostic stratification. Cardiopulmonary ET certainly carries an additional cost as well as competency requirements and is not an essential component of evaluation in all patient populations. However, there are several conditions of confirmed, suspected, or unknown etiology where the data gained from this form of ET is highly valuable in terms of clinical decision making

Published
2012

28. Does moderate hyperkalemia influence survival in HF? Insights from the MECKI score data base

Author

Federica Toto, Elisabetta Salvioni, Damiano Magrì, Susanna Sciomer, Massimo Piepoli, Roberto Badagliacca, Arianna Galotta, Nikita Baracchini, Stefania Paolillo, Ugo Corrà, Rosa Raimondo, Rocco Lagioia, Pasquale Perrone Filardi, Annamaria Iorio, Michele Senni, Michele Correale, Mariantonietta Cicoira, Enrico Perna, Marco Metra, Marco Guazzi, Giuseppe Limongelli, Gianfranco Sinagra, Gianfranco Parati, Gaia Cattadori, Francesco Bandera, Maurizio Bussotti, Massimo Mapelli, Manlio Cipriani, Alice Bonomi, Gonçalo Cunha, Federica Re, Carlo Vignati, Andrea Garascia, Carlo Lombardi, Angela B. Scardovi, Andrea Passantino, Michele Emdin, Claudio Passino, Caterina Santolamazza, Davide Girola, Denise Zaffalon, Dario Vizza, Fabiana De Martino, Piergiuseppe Agostoni, Toto, Federica, Salvioni, Elisabetta, Magrì, Damiano, Sciomer, Susanna, Piepoli, Massimo, Badagliacca, Roberto, Galotta, Arianna, Baracchini, Nikita, Paolillo, Stefania, Corrà, Ugo, Raimondo, Rosa, Lagioia, Rocco, Filardi, Pasquale Perrone, Iorio, Annamaria, Senni, Michele, Correale, Michele, Cicoira, Mariantonietta, Perna, Enrico, Metra, Marco, Guazzi, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Parati, Gianfranco, Cattadori, Gaia, Bandera, Francesco, Bussotti, Maurizio, Mapelli, Massimo, Cipriani, Manlio, Bonomi, Alice, Cunha, Gonçalo, Re, Federica, Vignati, Carlo, Garascia, Andrea, Lombardi, Carlo, Scardovi, Angela B, Passantino, Andrea, Emdin, Michele, Passino, Claudio, Santolamazza, Caterina, Girola, Davide, Zaffalon, Denise, Vizza, Dario, De Martino, Fabiana, Agostoni, Piergiuseppe, Toto, F., Salvioni, E., Magri, D., Sciomer, S., Piepoli, M., Badagliacca, R., Galotta, A., Baracchini, N., Paolillo, S., Corra, U., Raimondo, R., Lagioia, R., Filardi, P. P., Iorio, A., Senni, M., Correale, M., Cicoira, M., Perna, E., Metra, M., Guazzi, M., Limongelli, G., Sinagra, G., Parati, G., Cattadori, G., Bandera, F., Bussotti, M., Mapelli, M., Cipriani, M., Bonomi, A., Cunha, G., Re, F., Vignati, C., Garascia, A., Lombardi, C., Scardovi, A. B., Passantino, A., Emdin, M., Passino, C., Santolamazza, C., Girola, D., Zaffalon, D., Vizza, D., De Martino, F., and Agostoni, P.

Subjects
Renin angiotensin aldosterone system inhibitor, Prognosi, Heart failure, Hyperkalemia, Prognosis, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Cardiology and Cardiovascular Medicine
Abstract

Background: The prognostic role of moderate hyperkalemia in reduced ejection fraction (HFrEF) patients is still controversial. Despite this, it affects the use of renin–angiotensin–aldosterone system inhibitors (RAASi) with therapy down-titration or discontinuation. Objectives: Aim of the study was to assess the prognostic impact of moderate hyperkalemia in chronic HFrEF optimally treated patients. Methods and results: We retrospectively analyzed MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) database, with median follow-up of 4.2 [IQR 1.9–7.5] years. Data on K+ levels were available in 7087 cases. Patients with K+ plasma level ≥ 5.6 mEq/L and < 4 mEq/L were excluded. Remaining patients were categorized into normal >4 and < 5 mEq/L (n = 4826, 68%) and moderately high ≥5.0 and ≤ 5.5 mEq/L (n = 496, 7%) K+. Then patients were matched by propensity score in 484 couplets of patients. MECKI score value was 7% [IQR 3.1–14.1%] and 7.3% [IQR 3.4–15%] (p = 0.678) in patients with normal and moderately high K+ values while cardiovascular mortality events at two years follow-up were 41 (4.2%) and 33 (3.4%) (p = 0.333) in each group respectively. Conclusions: Moderate hyperkalemia does not influence patients' outcome in a large cohort of ambulatory HFrEF patients.

Published
2023

29. Machine learning for prediction of in-hospital mortality in coronavirus disease 2019 patients: results from an Italian multicenter study

Author

Marika Vezzoli, Riccardo Maria Inciardi, Chiara Oriecuia, Sara Paris, Natalia Herrera Murillo, Piergiuseppe Agostoni, Pietro Ameri, Antonio Bellasi, Rita Camporotondo, Claudia Canale, Valentina Carubelli, Stefano Carugo, Francesco Catagnano, Giambattista Danzi, Laura Dalla Vecchia, Stefano Giovinazzo, Massimiliano Gnecchi, Marco Guazzi, Anita Iorio, Maria Teresa La Rovere, Sergio Leonardi, Gloria Maccagni, Massimo Mapelli, Davide Margonato, Marco Merlo, Luca Monzo, Andrea Mortara, Vincenzo Nuzzi, Matteo Pagnesi, Massimo Piepoli, Italo Porto, Andrea Pozzi, Giovanni Provenzale, Filippo Sarullo, Michele Senni, Gianfranco Sinagra, Daniela Tomasoni, Marianna Adamo, Maurizio Volterrani, Roberto Maroldi, Marco Metra, Carlo Mario Lombardi, Claudia Specchia, Vezzoli, Marika, Inciardi, Riccardo Maria, Oriecuia, Chiara, Paris, Sara, Murillo, Natalia Herrera, Agostoni, Piergiuseppe, Ameri, Pietro, Bellasi, Antonio, Camporotondo, Rita, Canale, Claudia, Carubelli, Valentina, Carugo, Stefano, Catagnano, Francesco, Danzi, Giambattista, Dalla Vecchia, Laura, Giovinazzo, Stefano, Gnecchi, Massimiliano, Guazzi, Marco, Iorio, Anita, La Rovere, Maria Teresa, Leonardi, Sergio, Maccagni, Gloria, Mapelli, Massimo, Margonato, Davide, Merlo, Marco, Monzo, Luca, Mortara, Andrea, Nuzzi, Vincenzo, Pagnesi, Matteo, Piepoli, Massimo, Porto, Italo, Pozzi, Andrea, Provenzale, Giovanni, Sarullo, Filippo, Senni, Michele, Sinagra, Gianfranco, Tomasoni, Daniela, Adamo, Marianna, Volterrani, Maurizio, Maroldi, Roberto, Metra, Marco, Lombardi, Carlo Mario, and Specchia, Claudia

Subjects
Aged, 80 and over, Male, SARS-CoV-2, adult, COVID-19, General Medicine, aged, aged, 80 and over, creatinine, female, hospital mortality, humans, machine learning, male, middle aged, SARS-Cov-2, troponin, Middle Aged, Troponin, Machine Learning, Creatinine, 80 and over, Humans, Female, Aged, Hospital Mortality, Cardiology and Cardiovascular Medicine, Human
Abstract

Several risk factors have been identified to predict worse outcomes in patients affected by SARS-CoV-2 infection. Machine learning algorithms represent a novel approach to identifying a prediction model with a good discriminatory capacity to be easily used in clinical practice. The aim of this study was to obtain a risk score for in-hospital mortality in patients with coronavirus disease infection (COVID-19) based on a limited number of features collected at hospital admission.We studied an Italian cohort of consecutive adult Caucasian patients with laboratory-confirmed COVID-19 who were hospitalized in 13 cardiology units during Spring 2020. The Lasso procedure was used to select the most relevant covariates. The dataset was randomly divided into a training set containing 80% of the data, used for estimating the model, and a test set with the remaining 20%. A Random Forest modeled in-hospital mortality with the selected set of covariates: its accuracy was measured by means of the ROC curve, obtaining AUC, sensitivity, specificity and related 95% confidence interval (CI). This model was then compared with the one obtained by the Gradient Boosting Machine (GBM) and with logistic regression. Finally, to understand if each model has the same performance in the training and test set, the two AUCs were compared using the DeLong's test. Among 701 patients enrolled (mean age 67.2 ± 13.2 years, 69.5% male individuals), 165 (23.5%) died during a median hospitalization of 15 (IQR, 9-24) days. Variables selected by the Lasso procedure were: age, oxygen saturation, PaO2/FiO2, creatinine clearance and elevated troponin. Compared with those who survived, deceased patients were older, had a lower blood oxygenation, lower creatinine clearance levels and higher prevalence of elevated troponin (all P 0.001). The best performance out of the samples was provided by Random Forest with an AUC of 0.78 (95% CI: 0.68-0.88) and a sensitivity of 0.88 (95% CI: 0.58-1.00). Moreover, Random Forest was the unique model that provided similar performance in sample and out of sample (DeLong test P = 0.78).In a large COVID-19 population, we showed that a customizable machine learning-based score derived from clinical variables is feasible and effective for the prediction of in-hospital mortality.

Published
2022

30. Altered Hemodynamics and End-Organ Damage in Heart Failure

Author

Marco Guazzi, Barry A. Borlaug, Frederik H. Verbrugge, Jeffrey M. Testani, Clinical sciences, Medicine and Pharmacy academic/administration, Cardiology, Intensive Care, Verbrugge, Frederik Hendrik/0000-0003-0599-9290, Borlaug, Barry/0000-0001-9375-0596, VERBRUGGE, Frederik, Guazzi, Marco, Testani, Jeffrey M., and Borlaug, Barry A.

Subjects
Lung Diseases, kidney, lung disease, medicine.medical_specialty, Cardiac output, End organ damage, heart failure, Hemodynamics, Article, lung, Physiology (medical), Internal medicine, Humans, Medicine, Myocytes, Cardiac, Cardiac Output, Lung, Ejection fraction, business.industry, Cardiogenic shock, medicine.disease, medicine.anatomical_structure, Nephrology, Heart failure, Cardiology, Kidney Diseases, Cardiology and Cardiovascular Medicine, business, Perfusion
Abstract

Heart failure is characterized by pathologic hemodynamic derangements, including elevated cardiac filling pressures ("backward" failure), which may or may not coexist with reduced cardiac output ("forward" failure). Even when normal during unstressed conditions such as rest, hemodynamics classically become abnormal during stressors such as exercise in patients with heart failure. This has important upstream and downstream effects on multiple organ systems, particularly with respect to the lungs and kidneys. Hemodynamic abnormalities in heart failure are affected by processes that extend well beyond the cardiac myocyte, including important roles for pericardial constraint, ventricular interaction, and altered venous capacity. Hemodynamic perturbations have widespread effects across multiple heart failure phenotypes, ranging from reduced to preserved ejection fraction, acute to chronic disease, and cardiogenic shock to preserved perfusion states. In the lung, hemodynamic derangements lead to the development of abnormalities in ventilatory control and efficiency, pulmonary congestion, capillary stress failure, and eventually pulmonary vascular disease. In the kidney, hemodynamic perturbations lead to sodium and water retention and worsening renal function. Improved understanding of the mechanisms by which altered hemodynamics in heart failure affect the lungs and kidneys is needed in order to design novel strategies to improve clinical outcomes. Dr Verbrugge is supported by a Fellowship of the Belgian American Educational Foundation and by the Special Research Fund of Hasselt University (grant no. BOF19PD04). Dr Borlaug is supported by grants R01 HL128526 and U01 HL125205, both from the US National Heart, Lung, and Blood Institute. Borlaug, BA (corresponding author), Mayo Clin & Mayo Fdn, 200 First St SW, Rochester, MN 55905 USA. borlaug.barry@mayo.edu

Published
2020

31. Pick Your Threshold: A Comparison Among Different Methods of Anaerobic Threshold Evaluation in Heart Failure Prognostic Assessment

Author

Elisabetta, Salvioni, Massimo, Mapelli, Alice, Bonomi, Damiano, Magrì, Massimo, Piepoli, Maria, Frigerio, Stefania, Paolillo, Ugo, Corrà, Rosa, Raimondo, Rocco, Lagioia, Roberto, Badagliacca, Pasquale Perrone, Filardi, Michele, Senni, Michele, Correale, Mariantonietta, Cicoira, Enrico, Perna, Marco, Metra, Marco, Guazzi, Giuseppe, Limongelli, Gianfranco, Sinagra, Gianfranco, Parati, Gaia, Cattadori, Francesco, Bandera, Maurizio, Bussotti, Federica, Re, Carlo, Vignati, Carlo, Lombardi, Angela B, Scardovi, Susanna, Sciomer, Andrea, Passantino, Michele, Emdin, Claudio, Passino, Caterina, Santolamazza, Davide, Girola, Denise, Zaffalon, Fabiana, De Martino, Piergiuseppe, Agostoni, Giuseppe, Vitale, Salvioni, Elisabetta, Mapelli, Massimo, Bonomi, Alice, Magrì, Damiano, Piepoli, Massimo, Frigerio, Maria, Paolillo, Stefania, Corrà, Ugo, Raimondo, Rosa, Lagioia, Rocco, Badagliacca, Roberto, Filardi, Pasquale Perrone, Senni, Michele, Correale, Michele, Cicoira, Mariantonietta, Perna, Enrico, Metra, Marco, Guazzi, Marco, Limongelli, Giuseppe, Sinagra, Gianfranco, Parati, Gianfranco, Cattadori, Gaia, Bandera, Francesco, Bussotti, Maurizio, Re, Federica, Vignati, Carlo, Lombardi, Carlo, Scardovi, Angela B, Sciomer, Susanna, Marra, Alberto, Passantino, Andrea, Emdin, Michele, Passino, Claudio, Santolamazza, Caterina, Girola, Davide, Zaffalon, Denise, De Martino, Fabiana, and Agostoni, Piergiuseppe

Subjects
Heart Failure, Oxygen Consumption, Anaerobic Threshold, Anaerobic threshold, cardiopulmonary exercise test, heart failure, prognosis, Exercise Test, Humans, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Prognosis
Abstract

Background: In clinical practice, anaerobic threshold (AT) is used to guide training and rehabilitation programs, to define risk of major thoracic or abdominal surgery, and to assess prognosis in heart failure (HF). AT of oxygen uptake (V.O2; V.O2AT) has been reported as an absolute value (V.O2ATabs), as a percentage of predicted peak V.O2 (V.O2AT%peak_pred), or as a percentage of observed peak V.O2 (V.O2AT%peak_obs). A direct comparison of the prognostic power among these different ways to report AT is missing. Research question: What is the prognostic power of these different ways to report AT? Study design and methods: In this observational cohort study, we screened data of 7,746 patients with HF with a history of reduced ejection fraction (< 40%) recruited between 1998 and 2020 and enrolled in the Metabolic Exercise Combined With Cardiac and Kidney Indexes register. All patients underwent a maximum cardiopulmonary exercise test, executed using a ramp protocol on an electronically braked cycle ergometer. Results: This study considered 6,157 patients with HF with identified AT. Follow-up was median, 4.2 years (25th-75th percentiles, 1.9-5.0 years). Both V.O2ATabs (mean ± SD, 823 ± 305 mL/min) and V.O2AT%peak_pred (mean ± SD, 39.6 ± 13.9%), but not V.O2AT%peak_obs (mean ± SD, 69.2 ± 17.7%), well stratified the population regarding prognosis (composite end point: cardiovascular death, urgent heart transplant, or left ventricular assist device). Comparing area under the receiver operating characteristic curve (AUC) values, V.O2ATabs (0.680) and V.O2AT%peak_pred (0.688) performed similarly, whereas V.O2AT%peak_obs (0.538) was significantly weaker (P < .001). Moreover, the V.O2AT%peak_pred AUC value was the only one performing as well as the AUC based on peak V.O2 (0.710), with an even a higher AUC (0.637 vs 0.618, respectively) in the group with severe HF (peak V.O2 < 12 mL/min/kg). Finally, the combination of V.O2AT%peak_pred with peak V.O2 and V. per CO2 production shows the highest prognostic power. Interpretation: In HF, V.O2AT%peak_pred is the best way to report V.O2 at AT in relationship to prognosis, with a prognostic power comparable to that of peak V.O2 and, remarkably, in patients with severe HF.

Published
2022

32. Changes in Right Ventricular-to-Pulmonary Artery Coupling After Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation

Author

Marianna Adamo, Riccardo Maria Inciardi, Daniela Tomasoni, Lucia Dallapellegrina, Rodrigo Estévez-Loureiro, Davide Stolfo, Laura Lupi, Edoardo Pancaldi, Antonio Popolo Rubbio, Cristina Giannini, Tomás Benito-González, Felipe Fernández-Vázquez, Berenice Caneiro-Queija, Cosmo Godino, Andrea Munafò, Isaac Pascual, Pablo Avanzas, Simone Frea, Paolo Boretto, Vanessa Moñivas Palomero, Maria del Trigo, Elena Biagini, Alessandra Berardini, Luis Nombela-Franco, Pilar Jimenez-Quevedo, Erik Lipsic, Francesco Saia, Anna Sonia Petronio, Francesco Bedogni, Gianfranco Sinagra, Marco Guazzi, Adriaan Voors, Marco Metra, Adamo, Marianna, Inciardi, Riccardo Maria, Tomasoni, Daniela, Dallapellegrina, Lucia, Estévez-Loureiro, Rodrigo, Stolfo, Davide, Lupi, Laura, Pancaldi, Edoardo, Popolo Rubbio, Antonio, Giannini, Cristina, Benito-González, Tomá, Fernández-Vázquez, Felipe, Caneiro-Queija, Berenice, Godino, Cosmo, Munafò, Andrea, Pascual, Isaac, Avanzas, Pablo, Frea, Simone, Boretto, Paolo, Moñivas Palomero, Vanessa, Del Trigo, Maria, Biagini, Elena, Berardini, Alessandra, Nombela-Franco, Lui, Jimenez-Quevedo, Pilar, Lipsic, Erik, Saia, Francesco, Petronio, Anna Sonia, Bedogni, Francesco, Sinagra, Gianfranco, Guazzi, Marco, Voors, Adriaan, Metra, Marco, and Cardiovascular Centre (CVC)

Subjects
right ventricular to pulmonary artery coupling, secondary mitral regurgitation, transcatheter edge-to-edge mitral valve repair, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine
Abstract

Background: Preprocedural right ventricular–to–pulmonary artery (RV-PA) coupling is a major predictor of outcome in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER). However, clinical significance of changes in RV-PA coupling after M-TEER is unknown. Objectives: The aim of this study was to evaluate changes in RV-PA coupling after M-TEER, their prognostic value, and predictors of improvement. Methods: This was a retrospective observational study, including patients undergoing successful M-TEER (residual mitral regurgitation ≤2+ at discharge) for SMR at 13 European centers and with complete echocardiographic data at baseline and short-term follow-up (30-180 days). RV-PA coupling was assessed with the use of echocardiography as the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). All-cause death was assessed at the longest available follow-up starting from the time of the echocardiographic reassessment. Results: Among 501 patients included, 331 (66%) improved their TAPSE/PASP after M-TEER (responders) at short-term follow-up (median: 89 days; IQR: 43-159 days), whereas 170 (34%) did not (nonresponders). Lack of previous cardiac surgery, low postprocedural mitral mean gradient, low baseline TAPSE, high baseline PASP, and baseline tricuspid regurgitation were independently associated with TAPSE/PASP improvement after M-TEER. Compared with nonresponders, responders had lower New York Heart Association functional class and less heart failure hospitalizations at short-term follow-up. Improvement in TAPSE/PASP was independently associated with reduced risk of mortality at long-term follow-up (584 days; IQR: 191-1,243 days) (HR: 0.65 [95% CI: 0.42-0.92]; P = 0.017). Conclusions: In patients with SMR, improvement in TAPSE/PASP after successful M-TEER is predicted by baseline clinical and echocardiographic variables and postprocedural mitral gradient, and is associated with a better outcome.

Published
2022

33. Revisiting a Prognosticating Algorithm from Cardiopulmonary Exercise Testing in Chronic Heart Failure (from the MECKI Score Population)

Author

Ugo Corrà, Massimo Francesco Piepoli, Andrea Giordano, Francesco Doni, Alessandra Magini, Alice Bonomi, Elisabetta Salvioni, Rocco Lagioia, Giuseppe Limongelli, Stefania Paolillo, Damiano Magrì, Pasquale Perrone Filardi, Gianfranco Sinagra, Angela B. Scardovi, Marco Metra, Michele Senni, Domenico Scrutinio, Rosa Raimondo, Michele Emdin, Gaia Cattadori, Gianfranco Parati, Federica Re, Mariantonietta Cicoira, Chiara Minà, Michele Correale, Maria Frigerio, Enrico Perna, Maurizio Bussotti, Elisa Battaia, Marco Guazzi, Francesco Bandera, Roberto Badagliacca, Andrea Di Lenarda, Aldo Maggioni, Claudio Passino, Susanna Sciomer, Giuseppe Pacileo, Massimo Mapelli, Carlo Vignati, Francesco Clemenza, Carlo Lombardi, Piergiuseppe Agostoni, Corrà, Ugo, Piepoli, Massimo Francesco, Giordano, Andrea, Doni, Francesco, Magini, Alessandra, Bonomi, Alice, Salvioni, Elisabetta, Lagioia, Rocco, Limongelli, Giuseppe, Paolillo, Stefania, Magrì, Damiano, Filardi, Pasquale Perrone, Sinagra, Gianfranco, Scardovi, Angela B, Metra, Marco, Senni, Michele, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Cattadori, Gaia, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Minà, Chiara, Correale, Michele, Frigerio, Maria, Perna, Enrico, Bussotti, Maurizio, Battaia, Elisa, Guazzi, Marco, Bandera, Francesco, Badagliacca, Roberto, Lenarda, Andrea Di, Maggioni, Aldo, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Mapelli, Massimo, Vignati, Carlo, Clemenza, Francesco, Lombardi, Carlo, and Agostoni, Piergiuseppe

Subjects
Heart Failure, Oxygen Consumption, Adrenergic beta-Antagonists, Exercise Test, Humans, Stroke Volume, HFrEF, Prognosis, Cardiology and Cardiovascular Medicine, Algorithms, Ventricular Function, Left
Abstract

Cardiopulmonary exercise testing is a prognostic tool in heart failure with reduced left ventricular ejection fraction (HFrEF). Prognosticating algorithms have been proposed, but none has been validated. In 2017, a predictive algorithm, based on peak oxygen consumption (VO2), ventilatory response to exercise (ventilation [VE] carbon dioxide production [VCO2], the VE/VCO2 slope), exertional oscillatory ventilation (EOV), and peak respiratory exchange ratio, was recommended, according treatment with β blockers: patients with HFrEF registered in the metabolic exercise test data combined with cardiac and kidney indexes (MECKIs) database were used to validated this algorithm. According to the inclusion/exclusion criteria, 4,683 MECKI patients with HFrEF were enrolled. At 3years follow-up, the end point was cardiovascular death and urgent heart transplantation (cardiovascular events [CV]). CV events occurred in 25% in patients without β blockers, whereas those with β-blockers had 11% (p 10

Published
2022

34. Combined Role of Troponin and Natriuretic Peptides Measurements in Patients With Covid-19 (from the Cardio-COVID-Italy Multicenter Study)

Author

Annamario Iorio, Carlo Mario Lombardi, Caludia Specchia, Marco Merlo, Vincenzo Nuzzi, Ilenia Ferraro, Giulia Peveri, Chiara Oriecuia, Andrea Pozzi, Riccardo Maria Inciardi, Valentina Carubelli, Antonio Bellasi, Claudia Canale, Rita Camporotondo, Francesco Catagnano, Laura Dalla Vecchia, Stefano Giovinazzo, Gloria Maccagni, Massimo Mapelli, Davide Margonato, Luca Monzo, Giovanni Provenzale, Filippo Sarullo, Daniela Tomasoni, Pietro Ameri, Massimiliano Gnecchi, Sergio Leonardi, Piergiuseppe Agostoni, Stefano Carugo, Gian Battista Danzi, Marco Guazzi, Maria Teresa La Rovere, Andrea Mortara, Massimo Piepoli, Italo Porto, Maurizio Volterrani, Gianfranco Sinagra, Michele Senni, Marco Metra, Iorio, A, Lombardi, C, Specchia, C, Merlo, M, Nuzzi, V, Ferraro, I, Peveri, G, Oriecuia, C, Pozzi, A, Inciardi, R, Carubelli, V, Bellasi, A, Canale, C, Camporotondo, R, Catagnano, F, Dalla Vecchia, L, Giovinazzo, S, Maccagni, G, Mapelli, M, Margonato, D, Monzo, L, Provenzale, G, Sarullo, F, Tomasoni, D, Ameri, P, Gnecchi, M, Leonardi, S, Agostoni, P, Carugo, S, Danzi, G, Guazzi, M, La Rovere, M, Mortara, A, Piepoli, M, Porto, I, Volterrani, M, Sinagra, G, Senni, M, Metra, M, Iorio, Annamario, Lombardi, Carlo Mario, Specchia, Caludia, Merlo, Marco, Nuzzi, Vincenzo, Ferraro, Ilenia, Peveri, Giulia, Oriecuia, Chiara, Pozzi, Andrea, Inciardi, Riccardo Maria, Carubelli, Valentina, Bellasi, Antonio, Canale, Claudia, Camporotondo, Rita, Catagnano, Francesco, Dalla Vecchia, Laura, Giovinazzo, Stefano, Maccagni, Gloria, Mapelli, Massimo, Margonato, Davide, Monzo, Luca, Provenzale, Giovanni, Sarullo, Filippo, Tomasoni, Daniela, Ameri, Pietro, Gnecchi, Massimiliano, Leonardi, Sergio, Agostoni, Piergiuseppe, Carugo, Stefano, Danzi, Gian Battista, Guazzi, Marco, La Rovere, Maria Teresa, Mortara, Andrea, Piepoli, Massimo, Porto, Italo, Volterrani, Maurizio, Sinagra, Gianfranco, Senni, Michele, and Metra, Marco

Subjects
Male, Covid-19, COVID-19 outcome, myocardial injury, troponin trajectories, Prognosi, Risk Assessment, Article, Peptide Fragment, Troponin T, Natriuretic Peptide, Natriuretic Peptide, Brain, 80 and over, Humans, Hospital Mortality, Aged, Proportional Hazards Models, Aged, 80 and over, Heart Failure, COVID-19, Female, Italy, Middle Aged, Peptide Fragments, Prognosis, SARS-CoV-2, Troponin I, Brain, Proportional Hazards Model, Cardiology and Cardiovascular Medicine, Human
Abstract

Data concerning the combined prognostic role of natriuretic peptide (NP) and troponin in patients with COVID-19 are lacking. The aim of the study is to evaluate the combined prognostic value of NPs and troponin in hospitalized COVID-19 patients. From March 1, 2020 to April 9, 2020, consecutive patients with COVID-19 and available data on cardiac biomarkers at admission were recruited. Patients admitted for acute coronary syndrome were excluded. Troponin levels were defined as elevated when greater than the 99th percentile of normal values. NPs were considered elevated if above the limit for ruling in acute heart failure (HF). A total of 341 patients were included in this study, mean age 68 +/-& nbsp;13 years, 72% were men. During a median follow-up period of 14 days, 81 patients (24%) died. In the Cox regression analysis, patients with elevated both NPs and troponin levels had higher risk of death compared with those with normal levels of both (hazard ratio 2.94; 95% confidence interval 1.31 to 6.64; p = 0.009), and this remained significant after adjustment for age, gender, oxygen saturation, HF history, and chronic kidney disease. Interestingly, NPs provided risk stratification also in patients with normal troponin values (hazard ratio 2.86; 95% confidence interval 1.21 to 6.72; p = 0.016 with high NPs levels). These data show the combined prognostic role of troponin and NPs in COVID-19 patients. NPs value may be helpful in identifying patients with a worse prognosis among those with normal troponin values. Further, NPs' cut-point used for diagnosis of acute HF has a predictive role in patients with COVID-19.

Published
2022

35. Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

Author

Michele Correale, Domenico Scrutinio, Stefania Paolillo, Gaia Cattadori, Marco Metra, Gianfranco Sinagra, Jeness Campodonico, Giuseppe Pacileo, Simone Binno, Massimo Mapelli, Angela Beatrice Scardovi, Marco Guazzi, Carlo Vignati, Susanna Sciomer, Massimo F Piepoli, Michele Emdin, Claudio Passino, Elisa Battaia, Pasquale Perrone Filardi, Andrea Di Lenarda, Piergiuseppe Agostoni, Carlo Lombardi, Fabrizio Veglia, Aldo P. Maggioni, Damiano Magrì, Giuseppe Limongelli, Chiara Minà, Federica Re, Elisabetta Salvioni, Maurizio Bussotti, Ugo Corrà, Francesco Clemenza, Michele Senni, Roberto Badagliacca, Rosa Raimondo, Rocco Lagioia, Alice Bonomi, Mariantonietta Cicoira, Maria Frigerio, Enrico Perna, Gianfranco Parati, Campodonico, Jene, Piepoli, Massimo, Clemenza, Francesco, Bonomi, Alice, Paolillo, Stefania, Salvioni, Elisabetta, Corrà, Ugo, Binno, Simone, Veglia, Fabrizio, Lagioia, Rocco, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Senni, Michele, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Magrì, Damiano, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Minà, Chiara, Limongelli, Giuseppe, Correale, Michele, Frigerio, Maria, Bussotti, Maurizio, Perna, Enrico, Battaia, Elisa, Guazzi, Marco, Badagliacca, Roberto, Di Lenarda, Andrea, Maggioni, Aldo, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Mapelli, Massimo, Vignati, Carlo, Lombardi, Carlo, Filardi, Pasquale Perrone, Agostoni, Piergiuseppe, Campodonico, J., Piepoli, M., Clemenza, F., Bonomi, A., Paolillo, S., Salvioni, E., Corra, U., Binno, S., Veglia, F., Lagioia, R., Sinagra, G., Cattadori, G., Scardovi, A. B., Metra, M., Senni, M., Scrutinio, D., Raimondo, R., Emdin, M., Magri, D., Parati, G., Re, F., Cicoira, M., Mina, C., Limongelli, G., Correale, M., Frigerio, M., Bussotti, M., Perna, E., Battaia, E., Guazzi, M., Badagliacca, R., Di Lenarda, A., Maggioni, A., Passino, C., Sciomer, S., Pacileo, G., Mapelli, M., Vignati, C., Lombardi, C., Filardi, P. P., Agostoni, P., Campodonico, J, Piepoli, M, Clemenza, F, Bonomi, A, Paolillo, S, Salvioni, E, Corrà, U, Binno, S, Veglia, F, Lagioia, R, Sinagra, G, Cattadori, G, Scardovi, A, Metra, M, Senni, M, Scrutinio, D, Raimondo, R, Emdin, M, Magrì, D, Parati, G, Re, F, Cicoira, M, Minà, C, Limongelli, G, Correale, M, Frigerio, M, Bussotti, M, Perna, E, Battaia, E, Guazzi, M, Badagliacca, R, Di Lenarda, A, Maggioni, A, Passino, C, Sciomer, S, Pacileo, G, Mapelli, M, Vignati, C, Lombardi, C, Filardi, P, and Agostoni, P

Subjects
Male, medicine.medical_specialty, Prognosi, medicine.medical_treatment, Cardiopulmonary exercise test, Prognosis, β-Blockers, Atrial fibrillation, Cardiology and Cardiovascular Medicine, Adrenergic beta-Antagonists, Dose dependence, heart failure, atrial fibrillation, prognosis, beta-blocker, cardiopulmonary exercise test, 030204 cardiovascular system & hematology, Follow-Up Studie, 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Internal medicine, Atrial Fibrillation, medicine, Humans, In patient, 030212 general & internal medicine, Survival analysis, Aged, Retrospective Studies, Heart Failure, Entire population, Dose-Response Relationship, Drug, business.industry, Confounding, Adrenergic beta-Antagonist, Atrial fibrillation, Middle Aged, medicine.disease, Death, Treatment Outcome, Ventricular assist device, Heart failure, beta-blocker, Cardiology, β-Blockers, Female, business, Human, Follow-Up Studies
Abstract

The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. Background: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. Methods and results: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577–2304) days in the entire population, 1203 (614–2420) and 1325 (569–2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). Conclusion: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.

Published
2018

36. Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

Author

Valentina Carubelli, Carlo Lombardi, Marco Metra, Davide Margonato, Massimiliano Gnecchi, Antonio Bellasi, Maurizio Volterrani, Marco Guazzi, Gregorio Zaccone, Riccardo M. Inciardi, Massimo F Piepoli, Mattia Di Pasquale, Laura Adelaide Dalla Vecchia, Francesco Catagnano, Stefano Carugo, Michele Senni, Sergio Leonardi, Vincenzo Nuzzi, Pietro Ameri, Filippo M. Sarullo, Stefano Giovinazzo, Luca Monzo, Rita Camporotondo, Gianfranco Sinagra, Andrea Mortara, Giovanni Provenzale, Daniela Tomasoni, Marco Merlo, Anita Iorio, Maria Teresa La Rovere, Chiara Tedino, Andrea Pozzi, Claudia Canale, Giambattista Danzi, Piergiuseppe Agostoni, Italo Porto, Gloria Maccagni, Massimo Mapelli, Ameri, Pietro, Inciardi, Riccardo M, Di Pasquale, Mattia, Agostoni, Piergiuseppe, Bellasi, Antonio, Camporotondo, Rita, Canale, Claudia, Carubelli, Valentina, Carugo, Stefano, Catagnano, Francesco, Danzi, Giambattista, Vecchia, Laura Dalla, Giovinazzo, Stefano, Gnecchi, Massimiliano, Guazzi, Marco, Iorio, Anita, La Rovere, Maria Teresa, Leonardi, Sergio, Maccagni, Gloria, Mapelli, Massimo, Margonato, Davide, Merlo, Marco, Monzo, Luca, Mortara, Andrea, Nuzzi, Vincenzo, Piepoli, Massimo, Porto, Italo, Pozzi, Andrea, Provenzale, Giovanni, Sarullo, Filippo, Sinagra, Gianfranco, Tedino, Chiara, Tomasoni, Daniela, Volterrani, Maurizio, Zaccone, Gregorio, Lombardi, Carlo Mario, Senni, Michele, Metra, Marco, Ameri, P, Inciardi, R, Di Pasquale, M, Agostoni, P, Bellasi, A, Camporotondo, R, Canale, C, Carubelli, V, Carugo, S, Catagnano, F, Danzi, G, Dalla Vecchia, L, Giovinazzo, S, Gnecchi, M, Guazzi, M, Iorio, A, La Rovere, M, Leonardi, S, Maccagni, G, Mapelli, M, Margonato, D, Merlo, M, Monzo, L, Mortara, A, Nuzzi, V, Piepoli, M, Porto, I, Pozzi, A, Provenzale, G, Sarullo, F, Sinagra, G, Tedino, C, Tomasoni, D, Volterrani, M, Zaccone, G, Lombardi, C, Senni, M, and Metra, M

Subjects
Male, 030204 cardiovascular system & hematology, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Coagulopathy, 80 and over, Medicine, 030212 general & internal medicine, Hospital Mortality, Anticoagulant, COVID-19, d-dimer, Death, Thromboembolism, Tomography, Aged, 80 and over, education.field_of_study, Incidence (epidemiology), Incidence, Respiration, General Medicine, Middle Aged, Pulmonary embolism, X-Ray Computed, Hospitalization, Italy, Artificial, Breathing, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.drug, medicine.medical_specialty, Population, Hemorrhage, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Tocilizumab, Internal medicine, Humans, D-dimer, Aged, Follow-Up Studies, Pulmonary Embolism, Respiration, Artificial, Retrospective Studies, Tomography, X-Ray Computed, education, Original Paper, business.industry, medicine.disease, chemistry, Heart failure, Ritonavir, business, Kidney disease
Abstract

Background Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. Methods Data were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models. Results The study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involvement, and higher admission d-dimer [4344 (1099–15,118) vs. 818.5 (417–1460) ng/mL, p p p = 0.06). In multivariate regression, only d-dimer was associated with PE (HR 1.72, 95% CI 1.13–2.62; p = 0.01). The relation between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer Conclusions PE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of d-dimer in this population need to be clarified. Graphic abstract

Published
2021

37. Implications of atrial fibrillation on the clinical course and outcomes of hospitalized COVID-19 patients. results of the Cardio-COVID-italy multicentre study

Author

Luca Monzo, Carlo Lombardi, Sara Paris, Chiara Tedino, Maurizio Volterrani, Rita Camporotondo, Marco Metra, Filippo M. Sarullo, Piergiuseppe Agostoni, Antonio Bellasi, Marco Guazzi, Mattia Di Pasquale, Daniela Tomasoni, Sergio Leonardi, Francesco Catagnano, Vincenzo Nuzzi, Riccardo M. Inciardi, Pietro Ameri, Gianfranco Sinagra, Stefano Carugo, Valentina Carubelli, Annamaria Iorio, Claudia Specchia, Italo Porto, Laura Adelaide Dalla Vecchia, Giovanni Provenzale, Michele Senni, Andrea Mortara, Stefano Giovinazzo, Maria Teresa La Rovere, Andrea Pozzi, Massimiliano Gnecchi, Marco Merlo, Gregorio Zaccone, Gloria Maccagni, Davide Margonato, Massimo Mapelli, Claudia Canale, Giambattista Danzi, Massimo F Piepoli, Paris, Sara, Inciardi, Riccardo M, Lombardi, Carlo Mario, Tomasoni, Daniela, Ameri, Pietro, Carubelli, Valentina, Agostoni, Piergiuseppe, Canale, Claudia, Carugo, Stefano, Danzi, Giambattista, Di Pasquale, Mattia, Sarullo, Filippo, La Rovere, Maria Teresa, Mortara, Andrea, Piepoli, Massimo, Porto, Italo, Sinagra, Gianfranco, Volterrani, Maurizio, Gnecchi, Massimiliano, Leonardi, Sergio, Merlo, Marco, Iorio, Annamaria, Giovinazzo, Stefano, Bellasi, Antonio, Zaccone, Gregorio, Camporotondo, Rita, Catagnano, Francesco, Dalla Vecchia, Laura, Maccagni, Gloria, Mapelli, Massimo, Margonato, Davide, Monzo, Luca, Nuzzi, Vincenzo, Pozzi, Andrea, Provenzale, Giovanni, Specchia, Claudia, Tedino, Chiara, Guazzi, Marco, Senni, Michele, Metra, Marco, Paris, S, Inciardi, R, Lombardi, C, Tomasoni, D, Ameri, P, Carubelli, V, Agostoni, P, Canale, C, Carugo, S, Danzi, G, Di Pasquale, M, Sarullo, F, La Rovere, M, Mortara, A, Piepoli, M, Porto, I, Sinagra, G, Volterrani, M, Gnecchi, M, Leonardi, S, Merlo, M, Iorio, A, Giovinazzo, S, Bellasi, A, Zaccone, G, Camporotondo, R, Catagnano, F, Dalla Vecchia, L, Maccagni, G, Mapelli, M, Margonato, D, Monzo, L, Nuzzi, V, Pozzi, A, Provenzale, G, Specchia, C, Tedino, C, Guazzi, M, Senni, M, and Metra, M

Subjects
Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Hospitalized patients, Cardiovascular risk factors, Atrial fibrillation, Coronavirus disease 2019, Outcome, Severe acute respiratory syndrome coronavirus-2 infection, Aged, Aged, 80 and over, Female, Hospital Mortality, Humans, Italy, Middle Aged, Risk Factors, SARS-CoV-2, Atrial Fibrillation, COVID-19, Heart Failure, 030204 cardiovascular system & hematology, 03 medical and health sciences, coronavirus disease 2019, 0302 clinical medicine, Interquartile range, Clinical Research, Physiology (medical), Internal medicine, severe acute respiratory syndrome coronavirus-2 infection, 80 and over, Medicine, Clinical significance, AcademicSubjects/MED00200, atrial fibrillation, 030212 general & internal medicine, Stroke, business.industry, outcome, Clinical course, medicine.disease, Cardiology and Cardiovascular Medicine, business
Abstract

Aims To assess the clinical relevance of a history of atrial fibrillation (AF) in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods and results We enrolled 696 consecutive patients (mean age 67.4 ± 13.2 years, 69.7% males) admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. One hundred and six patients (15%) had a history of AF and the median hospitalization length was 14 days (interquartile range 9–24). Patients with a history of AF were older and with a higher burden of cardiovascular risk factors. Compared to patients without AF, they showed a higher rate of in-hospital death (38.7% vs. 20.8%; P 0.05 for both) and was not related to stroke or bleeding events. Conclusion Among hospitalized patients with COVID-19, a history of AF contributes to worse clinical course with a higher mortality and in-hospital events including new-onset AF, acute HF, and multiorgan failure. The mortality risk remains significant after adjustment for variables associated with COVID-19 severity and comorbidities.

Published
2021

38. Cardiopulmonary Exercise Test Parameters in Athletic Population: A Review

Author

David Niederseer, Christian Schmied, Marco Guazzi, Reza Mazaheri, University of Zurich, and Guazzi, Marco

Subjects
medicine.medical_specialty, sports performance, Population, Oxygen pulse, 610 Medicine & health, 2700 General Medicine, Review, medicine, Exercise physiology, education, exercise physiology, Subclinical infection, education.field_of_study, biology, Athletes, Overtraining, business.industry, Cardiorespiratory fitness, General Medicine, biology.organism_classification, medicine.disease, athletes, 10209 Clinic for Cardiology, Physical therapy, Medicine, Exercise prescription, business, cardiopulmonary exercise test
Abstract

Although still underutilized, cardiopulmonary exercise testing (CPET) allows the most accurate and reproducible measurement of cardiorespiratory fitness and performance in athletes. It provides functional physiologic indices which are key variables in the assessment of athletes in different disciplines. CPET is valuable in clinical and physiological investigation of individuals with loss of performance or minor symptoms that might indicate subclinical cardiovascular, pulmonary or musculoskeletal disorders. Highly trained athletes have improved CPET values, so having just normal values may hide a medical disorder. In the present review, applications of CPET in athletes with special attention on physiological parameters such as VO2max, ventilatory thresholds, oxygen pulse, and ventilatory equivalent for oxygen and exercise economy in the assessment of athletic performance are discussed. The role of CPET in the evaluation of possible latent diseases and overtraining syndrome, as well as CPET-based exercise prescription, are outlined.

Published
2021

39. Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

Author

Paolillo, S., Veglia, F., Salvioni, E., Corra, U., Piepoli, M., Lagioia, R., Limongelli, G., Sinagra, G., Cattadori, G., Scardovi, A. B., Metra, M., Senni, M., Bonomi, A., Scrutinio, D., Raimondo, R., Emdin, M., Magri, D., Parati, G., Re, F., Cicoira, M., Mina, C., Correale, M., Frigerio, M., Bussotti, M., Battaia, E., Guazzi, M., Badagliacca, R., Di Lenarda, A., Maggioni, A., Passino, C., Sciomer, S., Pacileo, G., Mapelli, M., Vignati, C., Clemenza, F., Binno, S., Lombardi, C., Filardi, P. P., Agostoni, P., Apostolo, A., Palermo, P., Contini, M., Farina, S., Mantegazza, V., Spadafora, E., Lattarulo, M. S., Giordano, A., Mezzani, A., Ricci, R., Ferraironi, A., Carubelli, V., Pietrucci, F., Malfatto, G., Caravita, Sergio, Vigano, E., Valente, F., Vastarella, R., Gravino, R., Roselli, T., Buono, A., De Maria, R., Passantino, A., Santoro, D., Campanale, S., Caputo, D., Bertipaglia, D., Confalonieri, M., Gentile, P., Zambon, E., Morosin, M., Carriere, C., Ferraretti, A., Marchese, G., Iorio, A., Pastormerlo, L., Gargiulo, P., Villani, G. Q., Oliva, F., Perna, E., Paolillo, Stefania, Veglia, Fabrizio, Salvioni, Elisabetta, Corrà, Ugo, Piepoli, Massimo, Lagioia, Rocco, Limongelli, Giuseppe, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Senni, Michele, Bonomi, Alice, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Magrì, Damiano, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Minà, Chiara, Correale, Michele, Frigerio, Maria, Bussotti, Maurizio, Battaia, Elisa, Guazzi, Marco, Badagliacca, Roberto, Di Lenarda, Andrea, Maggioni, Aldo, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Mapelli, Massimo, Vignati, Carlo, Clemenza, Francesco, Binno, Simone, Lombardi, Carlo, Filardi, Pasquale Perrone, Agostoni, Piergiuseppe, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Farina, Stefania, Mantegazza, Valentina, Spadafora, Emanuele, Lattarulo, Maria Silvia, Giordano, Andrea, Mezzani, Alessandro, Ricci, Roberto, Ferraironi, Alessandro, Carubelli, Valentina, Pietrucci, Francesca, Malfatto, Gabriella, Caravita, Sergio, Viganò, Elena, Valente, Fabio, Vastarella, Rossella, Gravino, Rita, Roselli, Teo, Buono, Andrea, De Maria, Renata, Passantino, Andrea, Santoro, Daniela, Campanale, Saba, Caputo, Domenica, Bertipaglia, Donatella, Confalonieri, Marco, Gentile, Piero, Zambon, Elena, Morosin, Marco, Carriere, Cosimo, Ferraretti, Armando, Marchese, Giovanni, Iorio, Annamaria, Pastormerlo, Luigi, Gargiulo, Paola, Villani, Giovanni Quinto, Oliva, Fabrizio, Perna, Enrico, Paolillo, S, Veglia, F, Salvioni, E, Corrà, U, Piepoli, M, Lagioia, R, Limongelli, G, Sinagra, G, Cattadori, G, Scardovi, A, Metra, M, Senni, M, Bonomi, A, Scrutinio, D, Raimondo, R, Emdin, M, Magrì, D, Parati, G, Re, F, Cicoira, M, Minà, C, Correale, M, Frigerio, M, Bussotti, M, Battaia, E, Guazzi, M, Badagliacca, R, Di Lenarda, A, Maggioni, A, Passino, C, Sciomer, S, Pacileo, G, Mapelli, M, Vignati, C, Clemenza, F, Binno, S, Lombardi, C, Perrone Filardi, P, Agostoni, P, Apostolo, A, Palermo, P, Contini, M, Farina, S, Mantegazza, V, Spadafora, E, Lattarulo, M, Giordano, A, Mezzani, A, Ricci, R, Ferraironi, A, Carubelli, V, Pietrucci, F, Malfatto, G, Caravita, S, Vigano', E, Valente, F, Vastarella, R, Gravino, R, Roselli, T, Buono, A, De Maria, R, Passantino, A, Santoro, D, Campanale, S, Caputo, D, Bertipaglia, D, Confalonieri, M, Gentile, P, Zambon, E, Morosin, M, Carriere, C, Ferraretti, A, Marchese, G, Iorio, A, Pastormerlo, L, Gargiulo, P, Villani, G, Oliva, F, Perna, E, Paolillo, S., Veglia, F., Salvioni, E., Corra, U., Piepoli, M., Lagioia, R., Limongelli, G., Sinagra, G., Cattadori, G., Scardovi, A. B., Metra, M., Senni, M., Bonomi, A., Scrutinio, D., Raimondo, R., Emdin, M., Magri, D., Parati, G., Re, F., Cicoira, M., Mina, C., Correale, M., Frigerio, M., Bussotti, M., Battaia, E., Guazzi, M., Badagliacca, R., Di Lenarda, A., Maggioni, A., Passino, C., Sciomer, S., Pacileo, G., Mapelli, M., Vignati, C., Clemenza, F., Binno, S., Lombardi, C., Filardi, P. P., Agostoni, P., Apostolo, A., Palermo, P., Contini, M., Farina, S., Mantegazza, V., Spadafora, E., Lattarulo, M. S., Giordano, A., Mezzani, A., Ricci, R., Ferraironi, A., Carubelli, V., Pietrucci, F., Malfatto, G., Caravita, S., Vigano, E., Valente, F., Vastarella, R., Gravino, R., Roselli, T., Buono, A., De Maria, R., Passantino, A., Santoro, D., Campanale, S., Caputo, D., Bertipaglia, D., Confalonieri, M., Gentile, P., Zambon, E., Morosin, M., Carriere, C., Ferraretti, A., Marchese, G., Iorio, A., Pastormerlo, L., Gargiulo, P., Villani, G. Q., Oliva, F., and Perna, E.

Subjects
Male, Prognosi, Cardiopulmonary exercise test, Heart failure, Peak oxygen uptake, Prognosis, VE/VCO2 slope, cardiopulmonary exercise test, heart failure, peak oxygen uptake, prognosis, ve/vco, 2, slope, disease progression, exercise test, female, follow-up studies, humans, male, middle aged, oxygen consumption, pulmonary ventilation, roc curve, respiratory function tests, retrospective studies, forecasting, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Follow-Up Studie, VE/VCO, Oxygen Consumption, Cardiology and Cardiovascular Medicine, Retrospective Studie, Humans, Respiratory Function Test, Retrospective Studies, VE/VCO 2 slope, Middle Aged, Respiratory Function Tests, ROC Curve, Disease Progression, Exercise Test, Female, Pulmonary Ventilation, Human, Follow-Up Studies, Forecasting
Abstract

Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO 2 ) and minute ventilation/carbon dioxide relationship slope (VE/VCO 2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO 2 and VE/VCO 2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO 2 and VE/VCO 2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO 2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO 2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO 2 and VE/VCO 2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO 2 and VE/VCO 2 slope must be updated whenever HF prognosis improves.

Published
2019

40. The Right Heart International Network (RIGHT-NET) Rationale, Objectives, Methodology, and Clinical Implications

Author

Ferrara, F., Gargani, L., Armstrong, W., Agoston, G., Cittadini, A., Citro, R., D'Alto, M., D'Andrea, A., Dellegrottaglie, S., De Luca, N., DI SALVO, M.G., Ghio, S., Grünig, E., Guazzi, M., Kasprzak, J., Kolias, T., Kovacs, G., Lancellotti, P., La Gerche, A., Limongelli, G., Marra, A., Moreo, A., Ostenfeld, E., Pieri, F., Pratali, L., Rudski, L., Saggar, R., Scalese, M., Selton-Suty, C., Serra, W., Stanziola, A., Voilliot, D., Vriz, O., Naeije, R., Bossone, E., Ferrara, Francesco, Gargani, Luna, Armstrong, William F., Agoston, Gergely, Cittadini, Antonio, Citro, Rodolfo, D'Alto, Michele, D'Andrea, Antonello, Dellegrottaglie, Santo, De Luca, Nicola, Di Salvo, Giovanni, Ghio, Stefano, Grünig, Ekkehard, Guazzi, Marco, Kasprzak, Jaroslaw D., Kolias, Theodore John, Kovacs, Gabor, Lancellotti, Patrizio, La Gerche, Andrè, Limongelli, Giuseppe, Marra, Alberto Maria, Moreo, Antonella, Ostenfeld, Ellen, Pieri, Francesco, Pratali, Lorenza, Rudski, Lawrence G., Saggar, Rajan, Saggar, Rajeev, Scalese, Marco, Selton-Suty, Christine, Serra, Walter, Stanziola, Anna Agnese, Voilliot, Damien, Vriz, Olga, Naeije, Robert, Bossone, Eduardo, Armstrong, William F, Kasprzak, Jaroslaw D, and Rudski, Lawrence G

Subjects
Male, Hypertension, Pulmonary, Heart Ventricles, Doppler, right heart, pulmonary circulation, pulmonary hypertension, exercise doppler echocardiography, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Right heart, Pulmonary, Stress, Exercise doppler echocardiography, Echocardiography, Doppler, Pulmonary hypertension, Right, Echocardiography, Research Design, Hypertension, Ventricular Function, Right, Pulmonary circulation, Humans, Ventricular Function, Female, Prospective Studies, Exercise, Echocardiography, Stress, Pulmonary Circulation
Abstract

The Right Heart International Network is a multicenter international study aiming to prospectively collect exercise Doppler echocardiography tests of the right heart-pulmonary circulation unit (RH-PCU) in large cohorts of healthy subjects, elite athletes, and individuals at risk of or with overt pulmonary hypertension. It is going to provide standardization of exercise stress echocardiography of RH-PCU and explore the full physiopathologic response.

Published
2018

41. Pulmonary hypertension in heart failure with preserved ejection fraction:A plea for proper phenotyping and further research

Author

Christian Gerges, Stephan Rosenkranz, Christian Opitz, M. Louis Handoko, Alessandra Manes, Stavros Konstantinides, Rolf Wachter, Nazzareno Galiè, Irene M. Lang, Jean-Luc Vachiery, J. Simon R. Gibbs, Carolyn S.P. Lam, Mareike Lankeit, Diana Bonderman, Marius M. Hoeper, Peter Dorfmüller, Anton Vonk-Noordegraaf, Karen M. Olsson, Marco Guazzi, Johann Bauersachs, Hoeper, Marius M, Lam, Carolyn S. P, Vachiery, Jean Luc, Bauersachs, Johann, Gerges, Christian, Lang, Irene M, Bonderman, Diana, Olsson, Karen M, Gibbs, J. Simon R, Dorfmuller, Peter, Guazzi, Marco, Galie', Nazzareno, Manes, Alessandra, Handoko, M. Loui, Vonk Noordegraaf, Anton, Lankeit, Mareike, Konstantinides, Stavro, Wachter, Rolf, Opitz, Christian, and Rosenkranz, Stephan

Subjects
medicine.medical_specialty, Framingham Risk Score, Ejection fraction, business.industry, Diastole, pulmonary hypertensionheart failure with preserved ejection fractionphenotype determination, 030204 cardiovascular system & hematology, medicine.disease, Pulmonary hypertension, 3. Good health, Clinical trial, 03 medical and health sciences, 0302 clinical medicine, Heart failure, Internal medicine, medicine, Left atrial enlargement, Cardiology, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Heart failure with preserved ejection fraction, business
Abstract

Heart failure (HF) with preserved ejection fraction (HFpEF) is a common disease affecting the elderly in particular. Up to 80% of these patients develop pulmonary hypertension (PH), which is associated with worse symptoms and increased mortality.1 It is a matter of concern that drugs approved for pulmonary arterial hypertension (PAH) are sometimes used in such patients despite insufficient data for their safety and efficacy. On the other hand, the impact of PH and right ventricular (RV) dysfunction on morbidity and mortality in HFpEF call for proper attention both at the clinical and scientific level. Here we discuss the clinical problem, pathophysiology, diagnostic shortfalls, gaps in evidence, and future strategies for PH-HFpEF. HFpEF is currently the dominant form of HF in aging societies globally. Epidemiologic trends over the past two decades showed that HFpEF increased relative to HF with reduced ejection fraction (HFrEF).2 Overall mortality did not improve over time, with more than 50% dead in 5 years from diagnosis.2 Differences between epidemiologic and trial populations of HFpEF reflect potential selection bias and lack of uniformity of diagnostic criteria. Epidemiologic studies utilize the most widely applicable definition of HFpEF: (i) clinically diagnosed HF (e.g. by Framingham criteria) and (ii) preserved EF (e.g. ≥50%).2 While such definitions capture the broad unselected population with the syndrome of HFpEF, they are rarely specific enough for clinical trials since the accurate diagnosis relies on symptoms and signs of HFpEF, both non-discriminating particularly in elderly patients with multiple comorbidities. The ESC guidelines included additional criteria, i.e. elevated levels of natriuretic peptides or objective evidence of left ventricular (LV) hypertrophy, left atrial enlargement, and/or LV diastolic dysfunction.3 Yet, the diagnosis of HFpEF remains difficult as many presumably healthy elderly patients fulfil at least some of these echocardiographic criteria. Invasive demonstration of increased pulmonary …

Published
2017

42. Heart failure and anemia: Effects on prognostic variables

Author

Giovanni Marchese, Simone Binno, Fabrizio Oliva, Pantaleo Giannuzzi, Stefania Farina, Alessandro Mezzani, Michele Emdin, Elisa Battaia, Michele Correale, Chiara Minà, Roberto Badagliacca, Claudio Passino, Piergiuseppe Agostoni, Gianfranco Sinagra, Giuseppe Pacileo, Alice Bonomi, Elisabetta Salvioni, Mauro Contini, Marco Metra, Alessandro Ferraironi, Davide Girola, Anna Maria Iorio, Rocco La Gioia, Susanna Sciomer, Mariantonietta Cicoira, Ugo Corrà, Sergio Caravita, Angela Beatrice Scardovi, Domenico Scrutinio, Marco Guazzi, Stefania Paolillo, Maria Frigerio, Damiano Magrì, Pasquale Perrone Filardi, Fabrizio Veglia, Gaia Cattadori, Francesco Clemenza, Rosa Raimondo, Massimo Mapelli, Romualdo Belardinelli, Pietro Palermo, Andrea Di Lenarda, Anna Apostolo, Massimo F Piepoli, Maurizio Bussotti, Giuseppe Limongelli, Federica Re, Gianfranco Parati, Carlo Lombardi, Paola Gargiulo, Cattadori, G, Agostoni, P, Corrà, U, Sinagra, G, Veglia, F, Salvioni, E, Bonomi, A, La Gioia, R, Scardovi, Ab, Ferraironi, A, Emdin, M, Metra, M, Di Lenarda, A, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Caravita, S, Magrì, D, Lombardi, C, Frigerio, M, Oliva, F, Girola, D, Mezzani, A, Farina, S, Mapelli, M, Scrutinio, D, Pacileo, G, Apostolo, A, Iorio, A, Paolillo, S, Filardi, Pp, Gargiulo, P, Bussotti, M, Marchese, G, Correale, M, Badagliacca, R, Sciomer, S, Palermo, P, Contini, M, Giannuzzi, P, Battaia, E, Cicoira, M, Clemenza, F, Minà, C, Binno, S, Passino, C, Piepoli, M, Cattadori, Gaia, Agostoni, Piergiuseppe, Corrã , Ugo, Sinagra, Gianfranco, Veglia, Fabrizio, Salvioni, Elisabetta, Bonomi, Alice, La Gioia, Rocco, Scardovi, Angela B., Ferraironi, Alessandro, Emdin, Michele, Metra, Marco, Di Lenarda, Andrea, Limongelli, Giuseppe, Raimondo, Rosa, Re, Federica, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Caravita, Sergio, Magrã¬, Damiano, Lombardi, Carlo, Frigerio, Maria, Oliva, Fabrizio, Girola, Davide, Mezzani, Alessandro, Farina, Stefania, Mapelli, Massimo, Scrutinio, Domenico, Pacileo, Giuseppe, Apostolo, Anna, Iorio, Annamaria, Paolillo, Stefania, Filardi, Pasquale Perrone, Gargiulo, Paola, Bussotti, Maurizio, Marchese, Giovanni, Correale, Michele, Badagliacca, Roberto, Sciomer, Susanna, Palermo, Pietro, Contini, Mauro, Giannuzzi, Pantaleo, Battaia, Elisa, Cicoira, Mariantonietta, Clemenza, Francesco, Minã , Chiara, Binno, Simone, Passino, Claudio, Piepoli, Massimo F., Corrà, Ugo, DI LENARDA, Andrea, Magrì, Damiano, Minà, Chiara, Scardovi, A, and Filardi, P

Subjects
Male, Prognostic variable, medicine.medical_specialty, Anemia, Prognosi, Renal function, Heart failure, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Comorbidity, 030204 cardiovascular system & hematology, Cohort Studies, Prognosis, Hemoglobins, 03 medical and health sciences, Oxygen Consumption, 0302 clinical medicine, Internal medicine, medicine, Internal Medicine, Humans, Prospective Studies, 030212 general & internal medicine, Aged, Proportional Hazards Models, Entire population, Ejection fraction, business.industry, Sodium, Hazard ratio, Stroke Volume, Carbon Dioxide, Middle Aged, medicine.disease, Italy, Multivariate Analysis, Exercise Test, Cardiology, Female, Hemoglobin, Pulmonary Ventilation, business
Abstract

Background: Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown. Methods: Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (b11 g/dL), low (11–12 for females, 11–13 for males), normal (12–15 for females, 13–15 for males) and high (N15) Hb, respectively. Results: Median follow-up was 1363 days (606–1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR) = 0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire popula- tion. Considering Hb groups separately, peakVO2 (very low Hb HR = 0.549, low Hb HR = 0.613, normal Hb HR = 0.618, high Hb HR = 0.542) and LVEF (very low Hb HR = 0.49, low Hb HR = 0.692, normal Hb HR = 0.697, high Hb HR = 0.694) maintained their prognostic roles. High VE/VCO2 slope was associated with poor prognosis only in patients with low and normal Hb. Conclusions: Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb b 11 g/dL, suggesting CPET use and a multiparametric approach in HF patients with low Hb. However, the prognostic effect of an anemia-oriented follow-up is unknown.

Published
2017

43. Metabolic exercise data combined with cardiac and kidney indexes: MECKI score. Predictive role in cardiopulmonary exercise testing with low respiratory exchange ratio in heart failure

Author

Corrà, U, Agostoni, P, Piepoli, Mf, Giordano, A, Mezzani, A, Giannuzzi, P, Cattadori, G, Fiorentini, C, Salvioni, E, Giovannardi, M, Veglia, F, Apostolo, A, Palermo, P, Contini, M, Vignati, C, Farina, S, Bovis, F, Cicoira, M, Vassanelli, C, La Gioia, R, Scrutinio, D, Passantino, A, Santoro, D, Campanale, S, Caputo, D, Scardovi, Ab, Ricci, R, Emdin, Michele, Metra, M, Dei Cas, L, Sinagra, G, Berton, E, Limongelli, G, Iorio, Am, Roselli, T, Buono, A, Calabrò, R, Raimondo, R, Vaninetti, R, Bertipaglia, D, Re, F, Guazzi, M, Belardinelli, R, Pietrucci, F, Parati, G, Magrì, D, Di Lenarda, A, Paolillo, S, Perrone Filardi, P, Passino, Claudio, Pastormerlo, Luigi Emilio, Malfatto, G, Caravita, S., Corrà, Ugo, Agostoni, Piergiuseppe, Piepoli, Massimo F., Giordano, Andrea, Mezzani, Alessandro, Giannuzzi, Pantaleo, Cattadori, Gaia, Fiorentini, Cesare, Salvioni, Elisabetta, Giovannardi, Marta, Veglia, Fabrizio, Apostolo, Anna, Palermo, Pietro, Contini, Mauro, Vignati, Carlo, Farina, Stefania, Bovis, Francesca, Cicoira, Mariantonietta, Vassanelli, Corrado, La Gioia, Rocco, Scrutinio, Domenico, Passantino, Andrea, Santoro, Daniela, Campanale, Saba, Caputo, Domenica, Scardovi, Angela B., Ricci, Roberto, Emdin, Michele, Metra, Marco, Dei Cas, Livio, Sinagra, Gianfranco, Berton, Emanuela, Limongelli, Giuseppe, Iorio, Anna Maria, Roselli, Teo, Buono, Andrea, Calabro', Raffaele, Raimondo, Rosa, Vaninetti, Raffaella, Bertipaglia, Donatella, Re, Federica, Guazzi, Marco, Belardinelli, Milano Romualdo, Pietrucci, Francesca, Parati, Gianfranco, Magrì, Damiano, Di Lenarda, Andrea, Paolillo, Stefania, Perrone Filardi, Pasquale, Passino, Claudio, Pastormerlo, Luigi E., Malfatto, Gabriella, Corrà, U, Agostoni, P, Piepoli, M, Giordano, A, Mezzani, A, Giannuzzi, P, Cattadori, G, Fiorentini, C, Salvioni, E, Giovannardi, M, Veglia, F, Apostolo, A, Palermo, P, Contini, M, Vignati, C, Farina, S, Bovis, F, Cicoira, M, Vassanelli, C, La Gioia, R, Scrutinio, D, Passantino, A, Santoro, D, Campanale, S, Caputo, D, Scardovi, A, Ricci, R, Emdin, M, Metra, M, Dei Cas, L, Sinagra, G, Berton, E, Limongelli, G, Iorio, A, Roselli, T, Buono, A, Calabrò, R, Raimondo, R, Vaninetti, R, Bertipaglia, D, Re, F, Guazzi, M, Belardinelli, M, Pietrucci, F, Parati, G, Magrì, D, Di Lenarda, A, Paolillo, S, Perrone Filardi, P, Passino, C, Pastormerlo, L, Malfatto, G, Calabrò, Raffaele, and DI LENARDA, Andrea

Subjects
Male, medicine.medical_specialty, Cardiopulmonary exercise, Heart failure, Oxygen consumption, Prognosis, Respiratory quotient, Prognosi, Renal function, Respiratory physiology, Kidney Function Tests, Severity of Illness Index, Predictive Value of Tests, Internal medicine, Severity of illness, medicine, Humans, Respiratory exchange ratio, Aged, Kidney, business.industry, Medicine (all), Middle Aged, medicine.disease, medicine.anatomical_structure, Predictive value of tests, Exercise Test, Respiratory Mechanics, Cardiology, Female, Energy Metabolism, Cardiology and Cardiovascular Medicine, business, cardiopulmonary exercise, heart failure, oxygen consumption, prognosis, respiratory quotient, aged, energy metabolism, exercise test, female, humans, kidney function tests, male, middle aged, predictive value of tests, respiratory mechanics, severity of illness index, cardiology and cardiovascular medicine
Abstract

n/a

Published
2015

44. Sex Profile and Risk Assessment With Cardiopulmonary Exercise Testing in Heart Failure: Propensity Score Matching for Sex Selection Bias

Author

Domenico Scrutinio, Stefania Paolillo, Marco Metra, Cesare Fiorentini, Mariantonietta Cicoira, Michele Emdin, Corrado Vassanelli, Massimo F Piepoli, Angela Beatrice Scardovi, Alessandro Mezzani, Anna Maria Iorio, Marco Guazzi, Elisa Battaia, Rosa Raimondo, Andrea Di Lenarda, Pietro Palermo, Rocco La Gioia, Giuseppe Limongelli, Gianfranco Sinagra, Damiano Magrì, Federica Re, Piergiuseppe Agostoni, Andrea Giordano, Pantaleo Giannuzzi, Claudio Passino, Anna Apostolo, Elisabetta Salvioni, Gianfranco Parati, Fabrizio Veglia, Gaia Cattadori, Marta Giovannardi, Roberto Ricci, Mauro Contini, Ugo Corrà, Romualdo Belardinelli, Corrà, Ugo, Agostoni, Piergiuseppe, Giordano, Andrea, Cattadori, Gaia, Battaia, Elisa, La Gioia, Rocco, Scardovi, Angela B., Emdin, Michele, Metra, Marco, Sinagra, Gianfranco, Limongelli, Giuseppe, Raimondo, Rosa, Re, Federica, Guazzi, Marco, Belardinelli, Romualdo, Parati, Gianfranco, Magrì, Damiano, Fiorentini, Cesare, Cicoira, Mariantonietta, Salvioni, Elisabetta, Giovannardi, Marta, Veglia, Fabrizio, Mezzani, Alessandro, Scrutinio, Domenico, DI LENARDA, Andrea, Ricci, Roberto, Apostolo, Anna, Iorio, Anna Maria, Paolillo, Stefania, Palermo, Pietro, Contini, Mauro, Vassanelli, Corrado, Passino, Claudio, Giannuzzi, Pantaleo, Piepoli, Massimo F., Corrà, U, Agostoni, P, Giordano, A, Cattadori, G, Battaia, E, La Gioia, R, Scardovi, A, Emdin, M, Metra, M, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Cicoira, M, Salvioni, E, Giovannardi, M, Veglia, F, Mezzani, A, Scrutinio, D, Di Lenarda, A, Ricci, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Vassanelli, C, Passino, C, Giannuzzi, P, Piepoli, M, Corra, U., Agostoni, P., Giordano, A., Cattadori, G., Battaia, E., La Gioia, R., Scardovi, A. B., Emdin, M., Metra, M., Sinagra, G., Limongelli, G., Raimondo, R., Re, F., Guazzi, M., Belardinelli, R., Parati, G., Magri, D., Fiorentini, C., Cicoira, M., Salvioni, E., Giovannardi, M., Veglia, F., Mezzani, A., Scrutinio, D., Di Lenarda, A., Ricci, R., Apostolo, A., Iorio, A. M., Paolillo, S., Palermo, P., Contini, M., Vassanelli, C., Passino, C., Giannuzzi, P., and Piepoli, M. F.

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Databases, Factual, media_common.quotation_subject, Heart Failure, Cardiopulmonary exercise testing, Selection Bia, 030204 cardiovascular system & hematology, Risk Assessment, Ventricular Function, Left, Body Mass Index, Follow-Up Studie, 03 medical and health sciences, 0302 clinical medicine, Oxygen Consumption, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, cardiology and cardiovascular medicine, cardiopulmonary exercise test, sex selection, Propensity Score, Selection Bias, media_common, Aged, Selection bias, Heart Failure, Univariate analysis, business.industry, Risk Factor, Middle Aged, medicine.disease, Cardiopulmonary exercise testing, Italy, Heart failure, Propensity score matching, Cardiology, Physical therapy, Exercise Test, Population study, Female, business, Risk assessment, Cardiology and Cardiovascular Medicine, Body mass index, Follow-Up Studies, Human
Abstract

Background In heart failure (HF), women show better survival despite a comparatively low peak oxygen consumption ( V ˙ o 2 ): this raises doubt about the accuracy of risk assessment by cardiopulmonary exercise testing (CPET) in women. Accordingly, we aimed to check (1) whether the predictive role of well-known CPET risk indexes, ie, peak V ˙ o 2 and ventilatory response ( V ˙ e/ V ˙ co 2 slope), is sex independent and (2) if sex-related characteristics that impact outcome in HF should be considered as associations that may confound the effect of sex on survival. Methods The study population consisted of 2985 patients with HF, 498 (17%) of whom were women, from the multicentre Metabolic Exercise Test Data Combined with Cardiac and Kidney Indexes (MECKI): the end point was cardiovascular death within a 3-year period. Results During the follow-up, 305 (12%) men and 39 (8%) women ( P = 0.005) died, and female sex was linked to better survival on univariate analysis ( P = 0.008) and independent of peak V ˙ o 2 and V ˙ e/ V ˙ co 2 slope on multivariate analysis. According to propensity score matching for female sex to exclude a sex selection bias and sample discrepancy, 498 men were selected: the standardized percentage bias ranged from 20.8 ( P P = 0.667). After clinical profile harmonizing, female sex was predictive of HF at univariate analysis. Conclusions The low peak V ˙ o 2 and female association with better outcome in HF might be counterfeit: the female prognostic advantage is lost when sex-specific differences are correctly taken into account with propensity score matching, suggesting that for an effective and efficient HF model, adjustment must be made for sex-related characteristics.

Published
2016

45. Prognostic role of atrial fibrillation in patients affected by chronic heart failure. Data from the MECKI score research group

Author

Marco Metra, Angela Beatrice Scardovi, Francesco Clemenza, Marco Guazzi, Giuseppe Limongelli, Federica Re, Claudio Passino, Piergiuseppe Agostoni, Rosa Raimondo, Massimo F Piepoli, Maria Frigerio, Romualdo Belardinelli, Domenico Scrutinio, Stefania Paolillo, Andrea Di Lenarda, Daniele Masarone, Rocco La Gioia, Davide Girola, Marta Giovannardi, Gianfranco Parati, Gaia Cattadori, Michele Correale, Pasquale Perrone-Filardi, Giuseppe Pacileo, Michele Emdin, Mariantonietta Cicoira, Gianfranco Sinagra, Paola Gargiulo, Carlo Lombardi, Annamaria Iorio, Elisabetta Salvioni, Ugo Corrà, Paolillo, S, Agostoni, P, Masarone, D, Corrà, U, Passino, C, Scrutinio, D, Correale, M, Cattadori, G, Metra, M, Girola, D, Piepoli, M, Salvioni, E, Giovannardi, M, Iorio, A, Emdin, M, Raimondo, R, Re, F, Cicoira, M, Belardinelli, R, Guazzi, M, Clemenza, F, Parati, G, Scardovi, A, Di Lenarda, A, La Gioia, R, Frigerio, M, Lombardi, C, Gargiulo, P, Sinagra, G, Pacileo, G, Perrone Filardi, P, Limongelli, G, Piepoli, Mf, Iorio, Annamaria, Scardovi, Ab, DI LENARDA, Andrea, Sinagra, Gianfranco, Limongelli, G., Paolillo, Stefania, Agostoni, Piergiuseppe, Masarone, Daniele, Corrà, Ugo, Passino, Claudio, Scrutinio, Domenico, Correale, Michele, Cattadori, Gaia, Metra, Marco, Girola, Davide, Piepoli, Massimo F, Salvioni, Elisabetta, Giovannardi, Marta, Emdin, Michele, Raimondo, Rosa, Re, Federica, Cicoira, Mariantonietta, Belardinelli, Romualdo, Guazzi, Marco, Clemenza, Francesco, Parati, Gianfranco, Scardovi, Angela B, Di Lenarda, Andrea, La Gioia, Rocco, Frigerio, Maria, Lombardi, Carlo, Gargiulo, Paola, Pacileo, Giuseppe, PERRONE FILARDI, Pasquale, Limongelli, Giuseppe, Piepoli, Massimo F., Scardovi, Angela B., and Perrone Filardi, Pasquale

Subjects
Male, medicine.medical_specialty, Digoxin, Prognosi, Left, Renal function, Heart failure, Matching analysi, Kaplan-Meier Estimate, Severity of Illness Index, Regression Analysi, Ventricular Function, Left, Atrial fibrillation, MECKI score, Matching analysis, Prognosis, Aged, Atrial Fibrillation, Biomarkers, Chronic Disease, Female, Heart Failure, Hospitalization, Humans, Middle Aged, Multivariate Analysis, Regression Analysis, Internal medicine, medicine, Clinical endpoint, Internal Medicine, Ventricular Function, Sinus rhythm, Multivariate Analysi, Ejection fraction, business.industry, Biomarker, medicine.disease, medicine.anatomical_structure, Ventricle, Cardiology, business, medicine.drug, Human
Abstract

Background Atrial fibrillation (AF) is common in heart failure (HF). It is unclear whether AF has an independent prognostic role in HF. The aim of the present study was to assess the prognostic role of AF in HF patients with reduced ejection fraction (EF). Methods HF patients were followed in 17 centers for 3.15 years (1.51–5.24). Study endpoints were the composite of cardiovascular (CV) death and heart transplant (HTX) and all-cause death. Data analysis was performed considering the entire population and a 1 to 1 match between sinus rhythm (SR) and AF patients. Match process was done for age ± 5, gender, left ventricle EF ± 5, peakVO 2 ± 3 (ml/min/kg) and recruiting center. Results A total of 3447 patients (SR = 2882, AF = 565) were included in the study. Considering the entire population, CV death and HTX occurred in 114 (20%) AF vs. 471 (16%) SR (p = 0.026) and all-cause death in 130 (23%) AF vs. 554 (19.2%) SR patients (p = 0.039). At univariable Cox analysis, AF was significantly related to prognosis. Applying a multivariable model based on all variables significant at univariable analysis (EF, peakVO 2 , ventilation/carbon dioxide relationship slope, sodium, kidney function, hemoglobin, beta-blockers and digoxin) AF was no longer associated with adverse outcomes. Matching procedure resulted in 338 couples. CV death and HTX occurred in 63 (18.6%) AF vs. 74 (21.9%) SR (p = 0.293) and all-cause death in 71 (21%) AF vs. 80 (23.6%) SR (p = 0.406), with no survival differences between groups. Conclusion In systolic HF AF is a marker of disease severity but not an independent prognostic indicator.

Published
2015

46. Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation

Author

Damiano, Magrì, Piergiuseppe, Agostoni, Ugo, Corrà, Claudio, Passino, Domenico, Scrutinio, Pasquale, Perrone-Filardi, Michele, Correale, Gaia, Cattadori, Marco, Metra, Davide, Girola, Massimo F, Piepoli, AnnaMaria, Iorio, Michele, Emdin, Rosa, Raimondo, Federica, Re, Mariantonietta, Cicoira, Romualdo, Belardinelli, Marco, Guazzi, Giuseppe, Limongelli, Francesco, Clemenza, Gianfranco, Parati, Maria, Frigerio, Matteo, Casenghi, Angela B, Scardovi, Alessandro, Ferraironi, Andrea, Di Lenarda, Maurizio, Bussotti, Anna, Apostolo, Stefania, Paolillo, Rocco, La Gioia, Paola, Gargiulo, Pietro, Palermo, Chiara, Minà, Stefania, Farina, Elisa, Battaia, Antonello, Maruotti, Giuseppe, Pacileo, Mauro, Contini, Fabrizio, Oliva, Roberto, Ricci, Gianfranco, Sinagra, Corrado, Vassanelli, Magrì, D, Agostoni, P, Corrà, U, Passino, C, Scrutinio, D, Perrone Filardi, P, Correale, M, Cattadori, G, Metra, M, Girola, D, Piepoli, M, Iorio, A, Emdin, M, Raimondo, R, Re, F, Cicoira, M, Belardinelli, R, Guazzi, M, Limongelli, G, Clemenza, F, Parati, G, Frigerio, M, Casenghi, M, Scardovi, A, Ferraironi, A, Di Lenarda, A, Bussotti, M, Apostolo, A, Paolillo, S, La Gioia, R, Gargiulo, P, Palermo, P, Minà, C, Farina, S, Battaia, E, Maruotti, A, Pacileo, G, Contini, M, Oliva, F, Ricci, R, Sinagra, G, Magrì, Damiano, Agostoni, Piergiuseppe, Corrà, Ugo, Passino, Claudio, Scrutinio, Domenico, Perrone Filardi, Pasquale, Correale, Michele, Cattadori, Gaia, Metra, Marco, Girola, Davide, Piepoli, Massimo F., Iorio, Annamaria, Emdin, Michele, Raimondo, Rosa, Re, Federica, Cicoira, Mariantonietta, Belardinelli, Romualdo, Guazzi, Marco, Limongelli, Giuseppe, Clemenza, Francesco, Parati, Gianfranco, Frigerio, Maria, Casenghi, Matteo, Scardovi, Angela B., Ferraironi, Alessandro, DI LENARDA, Andrea, Bussotti, Maurizio, Apostolo, Anna, Paolillo, Stefania, La Gioia, Rocco, Gargiulo, Paola, Palermo, Pietro, Minà, Chiara, Farina, Stefania, Battaia, Elisa, Maruotti, Antonello, Pacileo, Giuseppe, Contini, Mauro, Oliva, Fabrizio, Ricci, Roberto, Sinagra, Gianfranco, PERRONE FILARDI, Pasquale, Piepoli, Massimo F, Scardovi, Angela B, Di Lenarda, Andrea, Magri', D, Corra', U, PERRONE FILARDI, P, Correal, M, Piepoli, Mf, Iorio, Am, Raimonod, R, Cicoria, M, Scardovi, Ab, DI LENARDA, A, LA GIOIA, R, Mina', C, and Sinagra, G.

Subjects
Male, Time Factors, Digoxin, Anaerobic Threshold, Epidemiology, medicine.medical_treatment, Heart failure, anaerobic threshold, atrial fibrillation, exercise, prognosis, Predictive Value of Test, Kaplan-Meier Estimate, Risk Factors, Atrial Fibrillation, Sinus rhythm, Prospective Studies, Multivariate Analysi, Heart transplantation, Ejection fraction, Cardiology and Cardiovascular Medicine, Atrial fibrillation, Middle Aged, Prognosis, Italy, Area Under Curve, Cardiology, Female, Anaerobic exercise, prognosi, medicine.drug, Human, medicine.medical_specialty, Time Factor, Prognosi, Reproducibility of Result, Oxygen Consumption, Predictive Value of Tests, Internal medicine, Aged, Heart Failure, Systolic, Heart Transplantation, Humans, Multivariate Analysis, Proportional Hazards Models, ROC Curve, Reproducibility of Results, Exercise Test, medicine, business.industry, Risk Factor, medicine.disease, Transplantation, Prospective Studie, Proportional Hazards Model, business, Systolic
Abstract

Background: Oxygen uptake at the anaerobic threshold (VO 2 AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO 2 AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. Design: We tested the prognostic role of VO 2 AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. Methods: Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). Results: The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p=0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO 2 ) showed a prognostic capacity (C-index) similar to that obtained including VO 2 AT (0.76 vs 0.72). Also, left ventricular ejection fraction, ventilation vs carbon dioxide production slope, β-blocker and digoxin therapy proved to be significant prognostic indexes. The receiver-operating characteristic (ROC) curves analysis showed that the best predictive VO 2 AT cut-off for the SR group was 11.7 ml/kg/min, while it was 12.8 ml/kg/min for the AF group. Conclusions: VO 2 AT, a submaximal CPET-derived parameter, is reliable for long-term cardiovascular mortality prognostication in stable systolic HF. However, different VO 2 AT cut-off values between SR and AF HF patients should be adopted.

Published
2015

47. A contribution to the study of sympathetic dysregulation in pulmonary hypertension and after cardiac transplantation. Thèse annexe :Mechanisms of endothelial dysfunction in patients with pulmonary arterial hypertension

Author

Ciarka, Agnieszka, Guazzi, Marco, Fagard, Robert, Detroyer, André, Van der Linden, P, Motte, Serge, Boeynaems, JM, Gevenois, Pierre-Alain, van de Borne, Philippe, and Naeije, Robert

Subjects
pulmonary arterial hyperension, sympathetic nervous system, heart transplantation
Abstract

A. INTRODUCTION A.1. The sympathetic nervous system. A.1.1. General considerations and historical perspective. A.1.1.1. Historical perspective A.1.1.2. Reflex regulation of the autonomic nervous system A.1.1.3. Central control of the autonomic nervous system A.1.1.4. Sympathetic and parasympathetic components of the autonomic nervous system A.1.1.5. Organisation of the sympathetic nervous system A.1.1.6. Functions of the sympathetic nervous system A.1.1.7. Neurotransmitters of the sympathetic nervous system A.1.1.8. Neurotransmitter secretion at effectors organ synapse A.1.1.9. Adrenoreceptors A.1.2. Control mechanisms A.1.2.1. Aortic arch and carotid baroreceptors A.1.2.2. Low pressure baroreceptors A.1.2.3. Chemoreceptors A.1.2.4. Effects of exercise on sympathetic nervous system activation A.1.2.5. Effects of left ventricular dysfunction on sympathetic nervous system activation A.1.2.6. Effects of right ventricular dysfunction and heart transplantation on sympathetic nervous system activity A.2. Methodological considerations. A.2.1. Assessment of sympathetic activity in humans A.2.2. Circulating catecholamines A.2.3. Microneurography A.3. Ergospirometry A.3.1. Several aspects of physiology of exercise A.3.2. Principles of exercise testing A.3.3. Exercise ventilation A.4. Assessment of chemoreceptor regulation in humans A.4.1. Peripheral chemoreceptor inhibition A.4.2. Peripheral and central chemoreceptor activation A.5. Brief summary of still unresolved questions A.5.1. Pulmonary arterial hypertension A.5.2. Heart transplantation B. SYMPATHETIC CONTROL IN PULMONARY ARTERIAL HYPERTENSION B.1. Hypothesis tested B.2. Study populations B.2.1. Study investigating sympathetic activity in PAH patients B.2.2. Study investigating the effects of atrial septostomy on MSNA in PAH patients B.3. Material, methods and study protocols B.3.1. Particular measurements in the study investigating sympathetic activity in PAH patients B.3.2. Particular measurements in the study investigating effects of atrial septostomy on MSNA in PAH patients B.4. Sympathetic nervous activity in PAH and effects of disease severity B.5. Effects of chemoreflex activation B.6. Effects of atrial septostomy C. SYMPATHETIC CONTROL AFTER HEART TRANSPLANTATION C.1. Hypothesis tested C.2. Patient population C.3. Material and methods C.4. Effects of chemoreflex activation on sympathetic activity and blood pressure C.5. Effects of chemoreflex activation on exercise intolerance D. DISCUSSION D.1. Sympathetic nervous system activation in patients with pulmonary arterial hypertension D.2. Effects of atrial septostomy on sympathetic nervous system activation D.3. Chemoreceptors in heart transplant recipients D.3.1. Peripheral chemoreceptors deactivation D.3.2. Peripheral and central chemoreceptors sensitivity E. CONCLUSIONS F. REFERENCE LIST G. ANNEXES G.1. Publications G.1.1. Velez-Roa and Ciarka et al, Increased sympathetic nerve activity in pulmonary artery hypertension, Circulation. 2004 Sep 7;110(10):1308- 12. G.1.2. Ciarka et al, Atrial septostomy decreases sympathetic overactivity in pulmonary arterial hypertension, Chest. 2007 Jun;131(6):1831-7. G.1.3. Ciarka et al, Effects of peripheral chemoreceptors deactivation on sympathetic activity in heart transplant recipients. Hypertension. 2005 May;45(5):894-900. G.1.4. Ciarka et al, Increased peripheral chemoreceptors sensitivity and exercise ventilation in heart transplant recipients. Circulation. 2006 Jan 17;113(2):252-7. G.2. Annexe thesis title. G.3. Brief summary in French of described research, Doctorat en Sciences médicales, info:eu-repo/semantics/published

Published
2008

48. Contribution to the study of sympathetic dysregulation in pulmonary hypertension and after cardiac transplantation

Author

Ciarka, Agnieszka, Naeije, Robert, Van De Borne, Philippe, Gevenois, Pierre-Alain, Guazzi, Marco M., Fagard, Robert, Detroyer, André, Van der Linden, P, Motte, Serge, and Boeynaems, Jean-Marie

Subjects
Heart -- Transplantation, pulmonary arterial hyperension, sympathetic nervous system, Système nerveux sympathique, Hypertension, Hypertension pulmonaire, Médecine pathologie humaine, Coeur -- Greffe, heart transplantation, Hypertension artérielle, Pulmonary hypertension
Abstract

A. INTRODUCTIONA.1. The sympathetic nervous system.A.1.1. General considerations and historical perspective.A.1.1.1. Historical perspectiveA.1.1.2. Reflex regulation of the autonomic nervous systemA.1.1.3. Central control of the autonomic nervous systemA.1.1.4. Sympathetic and parasympathetic components of the autonomicnervous systemA.1.1.5. Organisation of the sympathetic nervous systemA.1.1.6. Functions of the sympathetic nervous systemA.1.1.7. Neurotransmitters of the sympathetic nervous systemA.1.1.8. Neurotransmitter secretion at effectors organ synapseA.1.1.9. AdrenoreceptorsA.1.2. Control mechanismsA.1.2.1. Aortic arch and carotid baroreceptorsA.1.2.2. Low pressure baroreceptorsA.1.2.3. ChemoreceptorsA.1.2.4. Effects of exercise on sympathetic nervous system activationA.1.2.5. Effects of left ventricular dysfunction on sympathetic nervoussystem activationA.1.2.6. Effects of right ventricular dysfunction and hearttransplantation on sympathetic nervous system activityA.2. Methodological considerations.A.2.1. Assessment of sympathetic activity in humansA.2.2. Circulating catecholaminesA.2.3. MicroneurographyA.3. ErgospirometryA.3.1. Several aspects of physiology of exerciseA.3.2. Principles of exercise testingA.3.3. Exercise ventilationA.4. Assessment of chemoreceptor regulation in humansA.4.1. Peripheral chemoreceptor inhibitionA.4.2. Peripheral and central chemoreceptor activationA.5. Brief summary of still unresolved questionsA.5.1. Pulmonary arterial hypertensionA.5.2. Heart transplantationB. SYMPATHETIC CONTROL IN PULMONARY ARTERIAL HYPERTENSIONB.1. Hypothesis testedB.2. Study populationsB.2.1. Study investigating sympathetic activity in PAH patientsB.2.2. Study investigating the effects of atrial septostomy on MSNA in PAHpatientsB.3. Material, methods and study protocolsB.3.1. Particular measurements in the study investigating sympathetic activityin PAH patientsB.3.2. Particular measurements in the study investigating effects of atrialseptostomy on MSNA in PAH patientsB.4. Sympathetic nervous activity in PAH and effects of disease severityB.5. Effects of chemoreflex activationB.6. Effects of atrial septostomyC. SYMPATHETIC CONTROL AFTER HEART TRANSPLANTATIONC.1. Hypothesis testedC.2. Patient populationC.3. Material and methodsC.4. Effects of chemoreflex activation on sympathetic activity and blood pressureC.5. Effects of chemoreflex activation on exercise intoleranceD. DISCUSSIOND.1. Sympathetic nervous system activation in patients with pulmonary arterialhypertensionD.2. Effects of atrial septostomy on sympathetic nervous system activationD.3. Chemoreceptors in heart transplant recipientsD.3.1. Peripheral chemoreceptors deactivationD.3.2. Peripheral and central chemoreceptors sensitivityE. CONCLUSIONSF. REFERENCE LISTG. ANNEXESG.1. PublicationsG.1.1. Velez-Roa and Ciarka et al, Increased sympathetic nerve activity inpulmonary artery hypertension, Circulation. 2004 Sep 7;110(10):1308-12.G.1.2. Ciarka et al, Atrial septostomy decreases sympathetic overactivity inpulmonary arterial hypertension, Chest. 2007 Jun;131(6):1831-7.G.1.3. Ciarka et al, Effects of peripheral chemoreceptors deactivation onsympathetic activity in heart transplant recipients. Hypertension. 2005May;45(5):894-900.G.1.4. Ciarka et al, Increased peripheral chemoreceptors sensitivity andexercise ventilation in heart transplant recipients. Circulation. 2006 Jan17;113(2):252-7.G.2. Annexe thesis title.G.3. Brief summary in French of described research, Doctorat en Sciences médicales, info:eu-repo/semantics/nonPublished

Published
2008

Catalog

Books, media, physical & digital resources
See catalog results