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3 results on '"Barracano R"'

1. Prognostic Relevance of Thyroid Disorders in Adults With Congenital Heart Disease.

Author

Fusco F, Scognamiglio G, Guarguagli S, Merola A, Palma M, Barracano R, Borrelli N, Correra A, Grimaldi N, Colonna D, Roma AS, Romeo E, and Sarubbi B

Subjects
Adult, Female, Humans, Male, Prognosis, Heart Defects, Congenital complications, Heart Defects, Congenital diagnosis, Heart Defects, Congenital epidemiology, Heart Failure diagnosis, Thyroid Diseases complications, Thyroid Diseases epidemiology
Abstract

Adults with congenital heart disease (ACHD) are frequently affected by thyroid diseases (TDs). However, the clinical relevance of TD in ACHD remains unknown. We aimed to describe the prevalence of TD in the ACHD population and to ascertain whether TD are associated with worse outcome. Patients with ACHD >18 years attending our tertiary center for a day-case between 2014 and 2019 were included. Clinical data between patients' first visit and December 2020 were collected. Primary end point was a combination of death, hospitalization for heart failure (HF), and new-onset of arrhythmic events. Secondary end points were each part of the primary outcome as separate end points. A total of 495 patients with ACHD (32.2 [24.5 to 45.6] years; 54% women) were included. Median follow-up was 9.4 (4.5 to 13.1) years. The prevalence of TD was 30%. TD group showed worse clinical status, as demonstrated by N-terminal pro b-type natriuretic peptide values (243.5 [96.5 to 523] vs 94 [45 to 207] pg/ml, p <0.001) and New York Heart Association class (27% vs 13% in class III to IV, p <0.0001) with higher incident rate of adverse events at follow-up (4.45 [3.43 to 5.69] % vs 1.29[0.94 to 1.75] % per person-year, p <0.001). TD were independently associated with higher risk of death (hazard ratio [HR] 4.1, p = 0.009), arrhythmic events (HR 3.8, p <0.0001), and hospitalization for HF (HR 8.02, p <0.0001). There was a fourfold increased risk of primary end point in the TD group even after propensity score matching for clinical variables including age, gender, disease complexity, physiological stage, previous palliative surgery, ventricular function, pulmonary arterial hypertension, cyanosis, and presence of systemic right ventricle (HR 4.47, p <0.0001). In conclusion, TD are predictive of adverse outcome in the ACHD population. Routine screening of thyroid function during follow-up in this population may be helpful to identify those with higher risk of death, arrhythmias, and HF., Competing Interests: Disclosures The authors have no conflicts of interest to declare., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Published
2022
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2. The management of adult congenital heart disease in the emergency department. The Task Force from the Italian Society of Pediatric Cardiology and Congenital Heart Disease

Author

Gagliardi M. G., Barracano R., Palmieri R., Chessa M., Ferraris L., Sarubbi B., D'Alto M., Assenza G. E., Donti A., Gagliardi, M. G., Barracano, R., Palmieri, R., Chessa, M., Ferraris, L., Sarubbi, B., D'Alto, M., Assenza, G. E., and Donti, A.

Subjects
Adult, Heart Defects, Congenital, Emergency department, Cardiology, Eisenmenger syndrome, Heart failure, Arrhythmias, Cardiac, Arrhythmias, Italy, Pregnancy, Humans, Adult congenital heart disease, Infective endocarditis, Child, Emergency Service, Hospital
Abstract

Over recent years, thanks to remarkable advances in pediatric cardiology, cardiac surgery and catheter interventions, survival of children with congenital heart disease has significantly increased with the majority of patients surviving into adulthood. Therefore, the prevalence of adult patients with congenital heart disease has dramatically increased, as well as the need for specific and dedicated programs. Acute heart failure, infective endocarditis and arrhythmias represent the most common causes of visit in the emergency department in this population. Our task force aimed at guiding physicians taking care of this peculiar cohort of patients in the emergency department.

Published
2021

3. Clinical Relevance of Fluid Challenge in Patients Evaluated for Pulmonary Hypertension

Author

Anna Correra, Paola Argiento, Berardo Sarubbi, Antonello D'Andrea, Yoshiki Motoji, Emanuele Romeo, Michele D'Alto, Agostino Mattera Iacono, Giovanni Maria Di Marco, Rosaria Barracano, Robert Naeije, Maria Giovanna Russo, Gaetano Rea, D'Alto, M., Romeo, E., Argiento, P., Motoji, Y., Correra, A., Di Marco, G. M., Iacono, A. M., Barracano, R., D'Andrea, A., Rea, G., Sarubbi, B., Russo, M. G., and Naeije, R.

Subjects
Pulmonary and Respiratory Medicine, Adult, Male, medicine.medical_specialty, Cardiac Catheterization, Pulmonary Circulation, Hypertension, Pulmonary, Hemodynamics, heart failure, Reproducibility of Result, 030204 cardiovascular system & hematology, Sodium Chloride, Critical Care and Intensive Care Medicine, heart catheterization, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, pulmonary hypertension, medicine, Humans, Prospective Studies, Infusions, Intravenou, Pulmonary Wedge Pressure, Infusions, Intravenous, Pulmonary wedge pressure, Fluid Shifts, Aged, business.industry, Central venous pressure, Reproducibility of Results, Fluid Shift, Middle Aged, medicine.disease, Pulmonary hypertension, fluid challenge, Prospective Studie, medicine.anatomical_structure, 030228 respiratory system, Heart failure, Heart catheterization, Pulmonary artery, Vascular resistance, Cardiology, Female, Vascular Resistance, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Background Fluid challenge may help in the differential diagnosis between pre- and postcapillary pulmonary hypertension (PH). However, the test is still in need of standardization and better defined clinical relevance. Methods Two hundred twelve patients referred for PH underwent a right-sided heart catheterization with measurements before and after rapid infusion of 7mL/kg of saline. PH was defined as mean pulmonary artery pressure≥ 25mmHg, and postcapillary PH was defined as pulmonary artery wedge pressure (PAWP) > 15mmHg. An increase in PAWP≥ 18mmHg was considered diagnostic for postcapillary PH. At baseline, 66 patients received a diagnosis of no PH; 22, of postcapillary PH; and 124, of precapillary PH (mostly pulmonary arterial hypertension). Results After fluid challenge, five of 66 patients with no PH (8%) and eight of 124 with precapillary PH (6%) had the diagnosis reclassified as postcapillary PH. Fluid challenge was associated with an increase in PAWP by 7 ± 2mmHg in postcapillary PH and 3 ± 1mmHg in both precapillary PH and no-PH groups. Between-group differences were significant, but there was overlap. There were no adverse events related to fluid challenge. Prediction bands calculated from quadratic fits of the PAWP responses in pooled control subjects with no PH and patients with precapillary PH helped confirm 18mmHg as the cutoff for diagnosing postcapillary PH. Conclusions Fluid challenge with 7mL/kg saline increases PAWP, more in postcapillary than in precapillary PH or in control subjects with no PH. A cutoff value of 18mmHg allows reclassification of 6%to 8%of patients with precapillary PH or normal hemodynamic characteristics at baseline.

Published
2017

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