319 results on '"Elena Galli"'
Search Results
52. Tips and tricks for the non-invasive assessment of myocardial work: the good, the bad and the ugly
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Erwan Donal, Marion Taconne, Virginie Le Rolle, Elena Galli, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CHU Pontchaillou [Rennes]
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[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
International audience
- Published
- 2022
53. TAVI in the COVID-19 pandemic. How to balance waiting list concerns and straightforward management
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Elena Galli, Erwan Donal, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CHU Pontchaillou [Rennes]
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[SDV.IB]Life Sciences [q-bio]/Bioengineering ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
International audience
- Published
- 2023
54. Phenomapping Heart Failure with Preserved Ejection Fraction Using Machine Learning Cluster Analysis
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Corentin Bourg, Elena Galli, Emmanuel Oger, Wojciech Kosmala, and Erwan Donal
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Ischemia ,General Medicine ,Disease ,030204 cardiovascular system & hematology ,medicine.disease ,Disease cluster ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Innovative Therapies ,Internal medicine ,Heart failure ,medicine ,Cardiology ,030212 general & internal medicine ,Epidemiologic data ,Cardiology and Cardiovascular Medicine ,business ,Heart failure with preserved ejection fraction - Abstract
Heart failure with preserved ejection fraction (HFpEF) is characterized by a high rate of hospitalization and mortality (up to 84% at 5 years), which are similar to those observed for heart failure with reduced ejection fraction (HFrEF). These epidemiologic data claim for the development of specific and innovative therapies to reduce the burden of morbidity and mortality associated with this disease. Compared with HFrEF, which is due to a primary myocardial damage (eg ischemia, cardiomyopathies, toxicity), a heterogeneous etiologic background characterizes HFpEF. The authors discuss these phenotypes and specificities for defining therapeutic strategies that could be proposed according to phenotypes.
- Published
- 2021
55. Left atrial strain is a predictor of left ventricular systolic and diastolic reverse remodelling in CRT candidates
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Virginie Le Rolle, Arnaud Hubert, Cecilia Linde, Martin Penicka, Emmanuel Oger, Otto A. Smiseth, Elena Galli, Jens-Uwe Voigt, Alfredo Hernandez, John M Aalen, Christophe Leclercq, Alban Gallard, Elif Sade, C K Larsen, Erwan Donal, Jürgen Duchenne, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP), University of Oslo (UiO), Oslo University Hospital [Oslo], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Başkent University Hospital [Adana, Turkey], University of Pittsburgh (PITT), Pennsylvania Commonwealth System of Higher Education (PCSHE), OLV Ziekenhuis [Aslst], Karolinska Institutet [Stockholm], Centre for Cardiological Innovation, Norwegian Health Association, South-Eastern Norway Regional Health Authority, OT12/084, University Leuven, FKM1832917N, Research Foundation Flanders, Novartis, Bayer, Astra Zeneca, Medtronic, Radiodiagnostics, and Impulse Dynamics, The University Hospital of Rennes receives research facilities from GE Healthcare, Jonchère, Laurent, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)
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medicine.medical_specialty ,medicine.medical_treatment ,Heart Ventricles ,Diastole ,Cardiac resynchronization therapy ,Left atrium ,cardiac resynchronization therapy ,heart failure ,030204 cardiovascular system & hematology ,Independent predictor ,Left atrial strain ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Heart Atria ,[SDV.IB] Life Sciences [q-bio]/Bioengineering ,Ejection fraction ,Heart Murmurs ,left atrial strain ,business.industry ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Treatment Outcome ,Echocardiography ,Heart failure ,Cardiology ,cardiovascular system ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims The left atrium (LA) has a pivotal role in cardiac performance and LA deformation is a well-known prognostic predictor in several clinical conditions including heart failure with reduced ejection fraction. The aim of this study is to investigate the effect of cardiac resynchronization therapy (CRT) on both LA morphology and function and to assess the impact of LA reservoir strain (LARS) on left ventricular (LV) systolic and diastolic remodelling after CRT. Methods and results Two hundred and twenty-one CRT-candidates were prospectively included in the study in four tertiary centres and underwent echocardiography before CRT-implantation and at 6-month follow-up (FU). CRT-response was defined by a 15% reduction in LV end-systolic volume. LV systolic and diastolic remodelling were defined as the percent reduction in LV end-systolic and end-diastolic volume at FU. Indexed LA volume (LAVI) and LV-global longitudinal (GLS) strain were the main parameters correlated with LARS, with LV-GLS being the strongest determinant of LARS (r = −0.59, P < 0.0001). CRT induced a significant improvement in LAVI and LARS in responders (both P < 0.0001). LARS was an independent predictor of both LV systolic and diastolic remodelling at follow-up (r = −0.14, P = 0.049 and r = −0.17, P = 0.002, respectively). Conclusion CRT induces a significant improvement in LAVI and LARS in responders. In CRT candidates, the evaluation of LARS before CRT delivery is an independent predictor of LV systolic and diastolic remodelling at FU.
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- 2022
56. Allergic diseases and immunodeficiencies in children, lessons learnt from COVID-19 pandemic by 2022: A statement from the EAACI-section on pediatrics
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Daniel Munblit, Matthew Greenhawt, Helen A. Brough, Anna Pushkareva, Diana Karimova, Anastasia Demidova, John O. Warner, Omer Kalayci, Anna Sediva, Eva Untersmayr, Pablo Rodriguez del Rio, Marta Vazquez‐Ortiz, Stefania Arasi, Montserrat Alvaro‐Lozano, Sophia Tsabouri, Elena Galli, Burcin Beken, Philippe A. Eigenmann, and Acibadem University Dspace
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allergic diseases ,food allergy ,post-covid-19 condition ,long covid ,SARS-CoV-2 ,pandemic ,Immunology ,Immunologic Deficiency Syndromes ,COVID-19 ,MIS-C ,allergy ,vaccination ,immunodeficiencies ,Asthma ,lockdown ,Post-Acute COVID-19 Syndrome ,children ,Pediatrics, Perinatology and Child Health ,Hypersensitivity ,Immunology and Allergy ,Humans ,care ,eczema ,Child ,Pandemics - Abstract
By the April 12, 2022, the COVID-19 pandemic had resulted in over half a billion people being infected worldwide. There have been 6.1 million deaths directly due to the infection, but the pandemic has had many more short- and long-term pervasive effects on the physical and mental health of the population. Allergic diseases are among the most prevalent noncommunicable chronic diseases in the pediatric population, and health-care professionals and researchers were seeking answers since the beginning of pandemic. Children are at lower risk of developing severe COVID-19 or dying from infection. Allergic diseases are not associated with a higher COVID-19 severity and mortality, apart from severe/poorly controlled asthma. The pandemic disrupted routine health care, but many mitigation strategies, including but not limited to telemedicine, were successfully implemented to continue delivery of high-standard care. Although children faced a multitude of pandemic-related issues, allergic conditions were effectively treated remotely while reduction in air pollution and lack of contact with outdoor allergens resulted in improvement, particularly respiratory allergies. There is no evidence to recommend substantial changes to usual management modalities of allergic conditions in children, including allergen immunotherapy and use of biologicals. Allergic children are not at greater risk of multisystem inflammatory syndrome development, but some associations with Long COVID were reported, although the data are limited, and further research is needed. This statement of the EAACI Section on Pediatrics provides recommendations based on the lessons learnt from the pandemic, as available evidence.
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- 2022
57. Multi-modality imaging to guide the implantation of cardiac electronic devices in heart failure: is the sum greater than the individual components?
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Elena Galli, Anna Baritussio, Marta Sitges, Eoin Donnellan, Wael A Jaber, Alessia Gimelli, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Azienda Ospedale Università di Padova = Hospital-University of Padua (AOUP), Clinic Barcelona Hospital Universitari, and Fondazione Toscana Gabriele Monasterio
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cardiac implantable electronic devices ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,arrhythmic substrate ,cardiac resynchronization therapy ,heart failure ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,intracardiac defibrillator ,cardiac imaging - Abstract
International audience; Heart failure is a clinical syndrome with an increasing prevalence and incidence worldwide that impacts patients’ quality of life, morbidity, and mortality. Implantable cardioverter-defibrillator and cardiac resynchronization therapy are pillars of managing patients with HF and reduced left ventricular ejection fraction. Despite the advances in cardiac imaging, the assessment of patients needing cardiac implantable electronic devices relies essentially on the measure of left ventricular ejection fraction. However, multi-modality imaging can provide important information concerning the aetiology of heart failure, the extent and localization of myocardial scar, and the pathophysiological mechanisms of left ventricular conduction delay. This paper aims to highlight the main novelties and progress in the field of multi-modality imaging to identify patients who will benefit from cardiac resynchronization therapy and/or implantable cardioverter-defibrillator. We also want to underscore the boundaries that prevent the application of imaging-derived parameters to patients who will benefit from cardiac implantable electronic devices and orient the choice of the device. Finally, we aim at providing some reflections for future research in this field. © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
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- 2022
58. Could echocardiographic left atrial characterization have additive value for detecting risks of atrial arrhythmias and stroke in patients with hypertrophic cardiomyopathy?
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Adrien Al Wazzan, Elena Galli, Marion Lacout, Elise Paven, Guillaume L’official, Frederic Schnell, Emmanuel Oger, Erwan Donal, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), and Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)
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[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,atrial strain ,stroke and atrial arrhythmias ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,hypertrophic cardiomyopathy - Abstract
Background Atrial arrhythmia (AA) is considered a turning point for prognosis in hypertrophic cardiomyopathy (HCM) patients. Prediction of AA and associated stroke risk in patients with HCM is an important clinical challenge as these events can occur in young subjects and significantly impact their quality of life. (1) (2) Purpose We sought to assess whether an echocardiographic evaluation focused on the left atrial (LA) characterization could estimate the occurrence of AA and stroke in HCM patients. Methods 216 HCM-patients (52±16 years old) were enrolled between 2016 and 2019. All patients underwent transthoracic echocardiography for the evaluation of left atrial volume (LAV), left ventricular global longitudinal strain (LV-GLS), peak left atrial strain (PLAS) and peak atrial contraction strain (PACS) by speckle-tracking imaging. A composite endpoint was defined as a history of AA and/or a history of stroke or peripheral embolism and/or occurrence of AA. Results The patients were followed for 2.9 years. Among the 216 patients, 78 (36%) met the composite endpoint. These patients were older (50.3±16.7 vs. 57.1±14.4 years, p=0.0035), had a higher prevalence of arterial hypertension (42.3% vs. 62.3%; p=0.005) and had higher NT-proBNP levels. LAV (37.2±15.7 vs. 47±20 ml/m2, p=0.0001) was significantly higher in patients who met the composite endpoint, whereas PLAS and PACS were significantly impaired (26.6±9.12 vs. 19.3±9.54%; p Conclusion The impairment of LA function assessed by 2D speckle-tracking echocardiography was strongly associated with AA and the risk of stroke, even in patients without any documented AA. Its value for guiding the management of HCM-patients requires further investigation. Funding Acknowledgement Type of funding sources: None.
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- 2022
59. Specific alterations of regional myocardial work in strength-trained athletes using anabolic steroids compared to athletes with genetic hypertrophic cardiomyopathy
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Antoine Grandperrin, Frédéric Schnell, Erwan Donal, Elena Galli, Christophe Hedon, Olivier Cazorla, Stéphane Nottin, EA4278 Laboratoire de Pharm-Ecologie Cardiovasculaire (LaPEC), Avignon Université (AU), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), and MORNET, Dominique
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[SDV.TOX] Life Sciences [q-bio]/Toxicology ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.TOX]Life Sciences [q-bio]/Toxicology ,Left ventricular function ,Speckle-tracking echocardiography ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Anabolic androgenic steroids ,Myocardial work ,Hypertrophic cardiomyopathy ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system - Abstract
International audience; Purpose: Strength-trained athletes using anabolic androgenic steroids (AAS) have left ventricular (LV) hypertrophy and myocardial fibrosis that can lead to sudden cardiac death. A similar feature was described in athletes with hypertrophic cardiomyopathy (HCM), which complicates the diagnosis for clinicians. In this context, we aimed to compare the LV function of the 2 populations by measuring global and regional strain and myocardial work using speckle-tracking imaging.Methods: Twenty-four strength-trained asymptomatic athletes using AAS (AAS-Athletes), 22 athletes diagnosed with HCM (HCM-Athletes), and 20 healthy control athletes (Ctrl-Athletes) underwent a resting echocardiography to assess LV function. We evaluated LV global and regional strains and myocardial work, with an evaluation of the constructive work (CW), wasted work, and work efficiency (WE).Results: Compared to Ctrl-Athletes, both AAS-Athletes and HCM-Athletes had a thicker interventricular septum, with majored values in HCM-Athletes. LV strain was reduced in AAS-athletes and even more in HCM-Athletes. Consequently, global WE was significantly diminished in both AAS and HCM-Athletes (93 ± 2% in Ctrl-Athletes, 90 ± 4% in AAS-Athletes, and 90 ± 5% in HCM-Athletes; p < 0.05). Constructive work and WE regional analysis showed specific alterations, with the basal septal segments preferentially affected in AAS-Athletes, and both septal and apical segments affected in HCM-Athletes.Conclusion: The regional evaluation of myocardial work reported specific alterations of the major LV hypertrophy induced by the regular use of AAS compared to the LV hypertrophy due to HCM. This finding could help clinicians to differentiate between these 2 forms of pathological hypertrophies.
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- 2022
60. New insight of human-IgH 3′regulatory regions in immunoglobulins switch
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Rossella Cianci, Giorgio Mancino, Elena Galli, Eliseo Serone, Renato Massoud, Pietro D'Addabbo, Andrea Poscia, Alberto Borghetti, Ottavia Porzio, Riccardo Marmo, Giovanni Gambassi, and Domenico Frezza
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Genetics ,General Medicine - Published
- 2023
61. Takayasu arteritis and large-vessel giant cell arteritis in Italian population. Comprehensive analysis from a single institutional cohort of 184 cases
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Luigi Boiardi, Elena Galli, Pierluigi Macchioni, Francesco Muratore, Giulia Klinowski, Gene G Hunder, Massimiliano Casali, Giulia Besutti, Lucia Spaggiari, Annibale Versari, Stefania Croci, Pamela Mancuso, Paolo Giorgi Rossi, Chiara Marvisi, and Carlo Salvarani
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Imaging ,Large vessel-giant cell arteritis ,Outcomes ,Takayasu arteritis ,Anesthesiology and Pain Medicine ,Rheumatology - Published
- 2023
62. What to Know About Biopsy Sampling and Pathology in Vasculitis?
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Chiara Marvisi, Francesco Muratore, Chiara Cabassi, Elena Galli, Luigi Boiardi, Simonetta Piana, Maria Cecilia Mengoli, Carlo Salvarani, and Alberto Cavazza
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ANCA-associated vasculitis ,Biopsy ,Cutaneous vasculitis ,Immunofluorescence ,Large-vessel vasculitis ,Polyarteritis nodosa ,Humans ,Prognosis ,Vasculitis ,Rheumatology - Abstract
To summarize the histologic findings of vasculitis, and to give some practical considerations on biopsy samples.The larger use of imaging and the discoveries of serological markers in the diagnosis of vasculitis have increased the clinical recognition of these entities. Nevertheless, biopsy remains the gold standard for diagnosis in most cases. So far, biopsies are also useful to obtain information about prognosis and to guide a more specific treatment. In recent years, less invasive diagnostic approaches have become available, lowering the risks related to the procedure and permitting a definite diagnosis in most cases. Histological examination permits a definite diagnosis of vasculitis. However, the findings may be nonspecific if not evaluated in the proper clinical setting. The interaction between clinicians and pathologists is crucial to obtain a definite diagnosis.
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- 2022
63. Imagerie cardiaque avant resynchronisation biventriculaire
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Pierre-Axel Lentz, Elena Galli, Christophe Leclercq, Erwan Donal, Mathieu Lederlin, Nicolas Courtial, Thibaut Lapotre, Elise Bannier, Charlélie Erhart, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Neuroimagerie: méthodes et applications (EMPENN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAL, IMAGE ET LANGAGE (IRISA-D6), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Vision, Action et Gestion d'informations en Santé (VisAGeS), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), and CCSD, Accord Elsevier
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Gynecology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,[SDV]Life Sciences [q-bio] ,Heart failure ,Resynchronisation cardiaque échocardiographie ,Computed tomography ,Magnetic Resonance Imaging ,Tomodensitométrie ,030218 nuclear medicine & medical imaging ,3. Good health ,Cardiac Resynchronization Therapy ,Insuffisance cardiaque ,[SDV] Life Sciences [q-bio] ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Imagerie par résonance magnétique ,medicine ,Ultrasonography ,business - Abstract
Cardiac Resynchronization Therapy (CRT) is part of the therapeutic armamentarium in end-stage heart failure. It consists in implanting two leads that synchronously stimulate the right and left ventricles and thus improve cardiac hemodynamics. To date, CRT is reserved for patients in sinus rhythm with LVEF < 35% and electrical ventricular dyssynchrony defined by a QRS > 150 ms and a left bundle branch block. However, 30 to 40% of the patients are non-responders to CRT, which suggests that the selection criteria can be improved. Currently, radiologists are requested in a pre-CRT work-up mainly to perform cardiac MRI and to quantify LVEF. However, the development of ultrasound, MRI and CT cardiac techniques, has made it possible to study new parameters that could improve the selection of patients and to hope for a better response rate to CRT. These parameters may be mechanical dyssynchrony, myocardial scar and interstitial fibrosis, or coronary venous anatomy. These data can be combined or even merged in order to stratify patients more precisely and/or to serve as a guide for CRT implantation. In this article, we propose to review the various imaging techniques, which, beyond the current guidelines, could help to refine patient selection and improve their response to CRT in the future., La resynchronisation cardiaque (CRT — Cardiac Resynchronization Therapy) fait partie de l’arsenal thérapeutique dans l’insuffisance cardiaque terminale. Cette technique consiste à implanter deux sondes stimulant de façon synchrone les ventricules droit et gauche et ainsi améliorer l’hémodynamique cardiaque. À ce jour, la CRT est réservée aux patients en rythme sinusal avec une FEVG < 35 % et un asynchronisme électrique défini par un QRS > 150 ms et un aspect de bloc de branche gauche. Cependant, 30 à 40 % des patients ainsi sélectionnés sont non répondeurs, preuve de la perfectibilité des critères de sélection. Actuellement, les radiologues sont sollicités dans un bilan pré-CRT essentiellement pour faire une IRM cardiaque et déterminer précisément la FEVG. Cependant, l’évolution des techniques d’imagerie, aussi bien échocardiographiques que IRM et TDM, a permis l’émergence de nouveaux paramètres susceptibles d’améliorer la sélection des patients et d’espérer à terme un meilleur taux de réponse à la CRT. Ces paramètres sont par exemple l’étude de l’asynchronisme mécanique, l’analyse des cicatrices macroscopiques et de la fibrose interstitielle myocardique, ou encore l’étude de l’anatomie veineuse coronaire. Ces informations peuvent être combinées, voire fusionnées afin de stratifier plus précisément les patients et/ou de proposer une assistance per-procédure aux cardiologues lors de l’implantation. Nous nous proposons dans cet article de passer en revue les différentes techniques et méthodes d’imagerie qui, au-delà des critères de sélection actuellement recommandés, pourraient permettre d’affiner la sélection des patients et d’améliorer leur réponse à la CRT dans le futur.
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- 2021
64. EULAR guidelines on ANCA-associated vasculitis in the real life
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Elena Galli, Carlo Salvarani, Chiara Marvisi, Carlo Umberto Manzini, and Gilda Sandri
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030203 arthritis & rheumatology ,0301 basic medicine ,medicine.medical_specialty ,business.industry ,Disease ,medicine.disease ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Maintenance therapy ,Eosinophilic ,medicine ,General Earth and Planetary Sciences ,Rituximab ,Microscopic polyangiitis ,Granulomatosis with polyangiitis ,Intensive care medicine ,business ,Mepolizumab ,Rheumatism ,General Environmental Science ,medicine.drug - Abstract
Anti-neutrophil cytoplasmic antibodies-associated vasculitides (AAVs) are a heterogenous group of inflammatory diseases which primarily involve small vessels and include granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). They present heterogeneous clinical manifestations, while their diagnosis and management still remain a challenge for clinicians. Nowadays, the treatment is based on two different regimens: the remission-induction treatment and the remission-maintenance treatment. The therapeutic armamentarium has grown over the years, with the aim to lessen adverse effects, improve quality of life of patients and maintain the disease under control. Biological treatments are the future: they act on different pathogenic pathways and may offer in the future a personalized management approach tailored to actual clinical manifestations. The latest guidelines were published in 2015 by the European League Against Rheumatism (EULAR) and still represent the vade mecum for the management of AAVs. In this review, we will focus on the principal strategies to treat AAVs. We discuss the remission-induction therapy and the remission- maintenance therapy; we have also distinguished the management of GPA and MPA from that of EGPA, because of their different clinical pictures.
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- 2021
65. Validation of a finite element method framework for cardiac mechanics applications.
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David Danan, Virginie Le Rolle, Arnaud Hubert, Elena Galli, Anne Bernard, Erwan Donal, and Alfredo I. Hernández
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- 2017
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66. Prediction of response to cardiac resynchronization therapy using a multi-feature learning method
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Virginie Le Rolle, Auriane Bidaut, Erwan Donal, Otto A. Smiseth, Arnaud Hubert, Elena Galli, Jens-Uwe Voigt, Alfredo Hernandez, Alban Gallard, Christophe Leclercq, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Oslo University Hospital [Oslo], University Hospitals Leuven [Leuven], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and ANR-16-CE19-0008,MAESTRo,Approche à base de modèles pour l'analyse du strain obtenu en échocardiographie 3D(2016)
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Male ,2D longitudinal strain ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Heart failure ,Speckle tracking echocardiography ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Decision Support Techniques ,Electrocardiography ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Image Interpretation, Computer-Assisted ,Machine learning ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cardiac Resynchronization Therapy Devices ,030212 general & internal medicine ,Ventricular dyssynchrony ,Cardiac imaging ,Aged ,Retrospective Studies ,Cardiac cycle ,business.industry ,Speckle-tracking echocardiography ,Signal Processing, Computer-Assisted ,Stroke Volume ,Recovery of Function ,Middle Aged ,medicine.disease ,Echocardiography, Doppler ,Europe ,Treatment Outcome ,medicine.anatomical_structure ,Ventricle ,Cardiology ,Female ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Cardiology and Cardiovascular Medicine ,business - Abstract
International audience; We hypothesized that a multiparametric evaluation, based on the combination of electrocardiographic and echocardiographic parameters, could enhance the appraisal of the likelihood of reverse remodeling and prognosis of favorable clinical evolution to improve the response of cardiac resynchronization therapy (CRT). Three hundred and twenty-three heart failure patients were retrospectively included in this multicenter study. 221 patients (68%) were responders, defined by a decrease in left ventricle end-systolic volume ≥15% at the 6-month follow-up. In addition, strain data coming from echocardiography were analyzed with custom-made signal processing methods. Integrals of regional longitudinal strain signals from the beginning of the cardiac cycle to strain peak and to the instant of aortic valve closure were analyzed. QRS duration, septal flash and different other features manually extracted were also included in the analysis. The random forest (RF) method was applied to analyze the relative feature importance, to select the most significant features and to build an ensemble classifier with the objective of predicting response to CRT. The set of most significant features was composed of Septal Flash, E, E/A, E/EA, QRS, left ventricular end-diastolic volume and eight features extracted from strain curves. A Monte Carlo cross-validation method with 100 runs was applied, using, in each run, different random sets of 80% of patients for training and 20% for testing. Results show a mean area under the curve (AUC) of 0.809 with a standard deviation of 0.05. A multiparametric approach using a combination of echo-based parameters of left ventricular dyssynchrony and QRS duration helped to improve the prediction of the response to cardiac resynchronization therapy.
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- 2020
67. How myocardial work could be relevant in patients with an aortic valve stenosis?
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Marion Taconne, Virginie Le Rolle, Vasileios Panis, Arnaud Hubert, Vincent Auffret, Elena Galli, Alfredo Hernandez, Erwan Donal, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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left ventricular function ,validation study ,aortic stenosis ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,myocardial work - Abstract
Funding Acknowledgements Type of funding sources: None. Background Speckle tracking based myocardial work calculation is an attractive method to assess left ventricular (LV) myocardial function. In case of aortic stenosis (AS), assessment of work indices is challenging because it requires an accurate evaluation of LV-pressure curves. Therefore, we sought to evaluate the performances of two distinct methods for the estimation of myocardial work indices and to provide a quantitative comparison with invasively measured data. Methods Model-based and template-based methods were defined and applied for the evaluation of LV pressures on 67 AS patients. Global Constructive (GCW), Wasted (GWW), Positive (GPW), Negative (GNW) myocardial work and Global Work Efficiency (GWE) and Index (GWI) parameters were calculated using the available software computing the indices using brachial blood pressure and trans-aortic mean pressure gradient for estimating the LV pressures versus using a model-based and homemade software. A complete comparison was performed with invasive measurements. Results Patients were characterized by mean pressure gradient of 49.8 ± 14.8 mmHg, LV ejection fraction of 59 ± 8%, the global longitudinal strain was -15.0 ± 4.04%, GCW was 2107 ± 800mmHg.% (model-based method) and 2483 ± 1068mmHg.% (template-based method). The root mean square error (RMSE) and correlation were calculated for each patient and for each pressure estimation methods. The mean RMSE are 33.9mmHg and 40.4mmHg and the mean correlation coefficients are 0.81 and 0.72 for the model-based and template-based methods respectively. Correlation coefficient and Bland-Altman analysis were performed for the six work indices. The two methods present correlation coefficient r2 > 0.75 for almost all the indices. Conclusion The two non-invasive methods of LV pressure estimation and the work indices computation correlate with invasive measurements and computations for AS patients. Although the model-based approach requires less information and is associated with slightly better performances, the implementation of template-based method is easier and seems more appropriate in a clinical practice. Abstract Figure. SUMMARY
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- 2022
68. Efficacy and safety of TNF-α antagonists and tocilizumab in Takayasu arteritis: multicentre retrospective study of 209 patients
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Jean Baptiste Gaultier, Savino Sciscia, Elena Galli, Alessandro Tomelleri, Francis Gaches, Lucie Biard, Bertrand Lioger, Alberto Logullo, Elena Baldissera, Mathieu Vautier, Tiphaine Goulenok, Abid Awisat, Sergey Moiseev, Moya Alvarado, Ilya Smitienko, Le Mouel Edwige, Pascal Woaye-Hune, Corrado Campochiaro, Pavel Novikov, Ygal Benhamou, Carlo Salvarani, Arsène Mekinian, Marc Lambert, Hassold Nolan, Masataka Kuwana, Olivier Espita, François Maurier, Lorenzo Dagna, Isabelle Kone Pault, Patricia Boiardi Luigi, Antoinette Perlat, Helene Munoz Pons, Thomas Sené, Sébastien Humbert, Muratore Francesco, Sabine Berthier, Alexandre Belot, Xavier Puéchal, Achille Aouba, Martin Michaud, Alexandra Audemard-Verger, Jonathan Broner, Julie Seguier, David Saadoun, Karim Sacre, Patrice Cacoub, José Hernández-Rodríguez, Virginie Dufrost, Faten Frikha, Patrick Jego, Nicolas Schleinitz, Guillaume Denis, Olivier Fain, and Pierre Zeminsky
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Adult ,medicine.medical_specialty ,vasculitis treatment ,Antibodies, Monoclonal, Humanized ,Gastroenterology ,Antibodies ,Etanercept ,chemistry.chemical_compound ,Tocilizumab ,Rheumatology ,Prednisone ,Recurrence ,Internal medicine ,biotherapies ,Monoclonal ,medicine ,Adalimumab ,Humans ,Pharmacology (medical) ,Cumulative incidence ,Humanized ,Retrospective Studies ,business.industry ,Tumor Necrosis Factor-alpha ,Takayasu Arteritis ,Infliximab ,Golimumab ,Discontinuation ,Treatment Outcome ,Takayasu arteritis ,chemistry ,Female ,Tumor Necrosis Factor Inhibitors ,business ,medicine.drug - Abstract
Objective To assess the safety and the efficacy of TNF-α antagonists and tocilizumab in patients with Takayasu arteritis (TAK). Methods A total of 209 patients with TAK [median age 29 years (interquartile range 7–62)], 186 (89%) females] were included. They received either TNF-α antagonists [n = 132 (63%) with 172 lines; infliximab (n = 109), adalimumab (n = 45), golimumab (n = 8), certolizumab (n = 6) and etanercept (n = 5)] or tocilizumab [n = 77 (37%) with 121 lines; i.v. and s.c. in 95 and 26 cases, respectively]. Results A complete response at 6 months was evidenced in 101/152 (66%) patients on TNF-α antagonists and 75/107 (70%) patients on tocilizumab. Age ≥30 years [odds ratio 2.09 (95% CI 1.09, 3.99)] was associated with complete response, whereas vascular signs [OR 0.26 (95% CI 0.1, 0.65)], baseline prednisone ≥20 mg/day [OR 0.51 (95% CI 0.28, 0.93)] were negatively associated with the complete response to TNF-α antagonists or tocilizumab. During a median follow-up of 36 months, 103 relapses were noted. Supra-aortic branches and thoracic aorta involvement [HR 2.44 (95% CI 1.06, 5.65) and 3.66 (1.18, 11.4), respectively] and systemic signs at baseline [HR 2.01 (95% CI 1.30, 3.11)] were significantly associated with relapse. The cumulative incidence of treatment discontinuation and relapse were similar in TNF-α antagonists and tocilizumab. Fifty-eight (20%) adverse effects occurred on biologic targeted therapies [37 (21%) on TNF-α antagonists and 21 (17%) on tocilizumab (P = 0.4), respectively]. Conclusion This large multicentre study shows high efficacy of biologic targeted treatments in refractory TAK. Efficacy, relapse and drug retention rate were equivalent with TNF-α antagonists and tocilizumab.
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- 2022
69. Vessel inflammation and morphological changes in patients with large vessel vasculitis: A retrospective study
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Giulia Besutti, Francesco Muratore, Pamela Mancuso, Marco Ferrari, Elena Galli, Lucia Spaggiari, Filippo Monelli, Massimiliano Casali, Annibale Versari, Luigi Boiardi, Chiara Marvisi, Guido Ligabue, Pierpaolo Pattacini, Paolo Giorgi Rossi, and Carlo Salvarani
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Vasculitis ,Inflammation ,Male ,Immunology ,Middle Aged ,Rheumatology ,inflammation ,magnetic resonance imaging ,systemic vasculitis ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Humans ,Immunology and Allergy ,Female ,Radiopharmaceuticals ,Retrospective Studies - Abstract
ObjectiveThe aim was to identify any association between imaging signs of vessel wall inflammation (positron emission tomography–CT (PET-CT) score and CT/MR wall thickening) and synchronous and subsequent vascular damage (stenoses/dilations) in patients with large vessel vasculitis (LVV).MethodsConsecutive patients with LVV referred to a tertiary centre in 2007–2020 with baseline PET-CT and morphological imaging (CT/MR angiography) performed within 3 months were included. All available PET-CT and CT/MR scans were reviewed to assess PET-CT uptake (4-point semi-quantitative score), wall thickening, stenoses and dilations for 15 vascular segments. The associations of baseline PET score and CT/MR wall thickening with synchronous and incident stenoses/dilations at CT/MR performed 6–30 months from baseline were evaluated in per-segment and per-patient analyses. Respective areas under the receiver operating characteristic curve (AUC) were calculated.ResultsWe included 100 patients with LVV (median age: 48 years, 22% males). Baseline PET score and wall thickening were strongly associated (Cuzick non-parametric test for trend across order groups (NPtrend) ConclusionPET score and wall thickening are strongly associated, but only baseline PET score is a good predictor of incident vessel wall damage in LVV.
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- 2022
70. Managing childhood allergies and immunodeficiencies during respiratory virus epidemics – The 2020 COVID‐19 pandemic: A statement from the EAACI‐section on pediatrics
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Eva Untersmayr, Sophia Tsabouri, Omer Kalayci, Daniel Munblit, Pablo Rodríguez del Río, Burcin Beken, Marta Vazquez-Ortiz, Anna Sediva, Helen A. Brough, Elena Galli, Montserrat Alvaro-Lozano, Philippe Eigenmann, and Stefania Arasi
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Allergy ,Pediatrics ,coronavirus ,Review ,SARS‐CoV‐2 ,corticosteroids ,0302 clinical medicine ,Pandemic ,Immunology and Allergy ,030212 general & internal medicine ,Child ,Immunodeficiency ,treatment ,Academies and Institutes ,Europe ,Antiallergic agent ,Child, Preschool ,Practice Guidelines as Topic ,Respiratory virus ,Coronavirus Infections ,Telemedicine ,medicine.medical_specialty ,Adolescent ,Pneumonia, Viral ,Immunology ,Reviews ,Betacoronavirus ,03 medical and health sciences ,children ,COVID‐19 ,Hypersensitivity ,medicine ,Humans ,biologics ,Pediatrics, Perinatology, and Child Health ,Risk factor ,Pandemics ,Asthma ,SARS-CoV-2 ,business.industry ,Immunologic Deficiency Syndromes ,COVID-19 ,Infant ,asthma ,allergy ,medicine.disease ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,business ,immunodeficiency - Abstract
While the world is facing an unprecedented pandemic with COVID‐19, patients with chronic diseases need special attention and if warranted adaptation of their regular treatment plan. In children, allergy and asthma are among the most prevalent non‐communicable chronic diseases, and healthcare providers taking care of these patients need guidance. At the current stage of knowledge, children have less severe symptoms of COVID‐19, and severe asthma and immunodeficiency are classified as risk factors. In addition, there is no evidence that currently available asthma and allergy treatments, including antihistamines, corticosteroids, and bronchodilators, increase the risk of severe disease from COVID‐19. Most countries affected by COVID‐19 have opted for nationwide confinement, which means that communication with the primary clinician is often performed by telemedicine. Optimal disease control of allergic, asthmatic, and immunodeficient children should be sought according to usual treatment guidelines. This statement of the EAACI Section on Pediatrics puts forward six recommendations for the management of childhood allergies and immunodeficiencies based on six underlying facts and existing evidence.
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- 2020
71. Rational and design of the ROTAS study: a randomized study for the optimal treatment of symptomatic patients with low-gradient severe aortic valve stenosis and preserved left ventricular ejection fraction
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Thierry Le Tourneau, Emmanuel Oger, Elena Galli, Catherine Sportouch, Augustin Coisne, Mathieu Lederlin, Anne Bernard, Erwan Donal, Florent Le Ven, Patrizio Lancellotti, Loïc Bière, Christophe Tribouilloy, Gilbert Habib, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], Unité de recherche de l'institut du thorax (ITX-lab), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Biologie Neurovasculaire et Mitochondriale Intégrée (BNMI), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Timone [CHU - APHM] (TIMONE), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service de cardiologie [Liège], CHU de Liège-Domaine Universitaire du Sart Tilman, Service de Cardiologie [Amiens], CHU Amiens-Picardie, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), PHRC-N 2017, National grant from « direction generale de la sante » -ministère de la santé, France, Service de cardiologie et maladies vasculaires, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de Génomique Fonctionnelle - Montpellier GenomiX (IGF MGX), Institut de Génomique Fonctionnelle (IGF), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Soins Intensifs et Urgences Cardiologiques, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université d'Angers (UA), and Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)
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medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Doppler echocardiography ,Severity of Illness Index ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Aortic valve replacement ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Cardiac magnetic resonance imaging ,Internal medicine ,medicine ,Humans ,Randomized study ,[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,education ,ComputingMilieux_MISCELLANEOUS ,Heart Valve Prosthesis Implantation ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,education.field_of_study ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Aortic stenosis ,Low gradient ,Stroke Volume ,Aortic Valve Stenosis ,General Medicine ,Stroke volume ,Prognosis ,medicine.disease ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,3. Good health ,Stenosis ,Treatment Outcome ,Aortic Valve ,Aortic valve stenosis ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Fifteen to thirty percentage of patients with severe aortic stenosis (AS) have preserved left ventricular ejection fraction (LVEF) and a discordant AS pattern at Doppler echocardiography, which is characterized by a small ( Methods and results The ROTAS trial will be a multicentre randomized non-blinded study involving 16 reference centres. AS severity will be confirmed by a multimodality approach (rest and stress echocardiography, calcium scoring, and cardiac magnetic resonance imaging for optimally characterize the population), which could provide important inputs to improve the pathophysiological understanding of this complex disease. Well-characterized patients will be randomized according to the management strategy. The primary endpoint will be the occurrence of all-cause mortality or cardiac related-hospitalizations during 2-year FU. One hundred and eighty subjects per group will be included. Conclusion The management of patients with LS severe AS and preserved LVEF is largely debated. ROTAS trial will allow a comprehensive evaluation of this particular pattern of AS and will establish which is the most appropriate management of these patients.
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- 2020
72. Association of estimated plasma volume status with hemodynamic and echocardiographic parameters
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Patrick Rossignol, Elena Galli, Nicolas Girerd, Frédéric Schnell, Arnaud Hubert, Maxime Fournet, Olivier Huttin, Hervé Le Breton, Philippe Mabo, Kevin Duarte, Christophe Leclercq, Erwan Donal, Masatake Kobayashi, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Contrat de Plan Etat Lorraine IT2MP and FEDER Lorraine, ANR-15-IDEX-0004,LUE,Isite LUE(2015), ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), ANR-15-CE14-0032,MR-focus,Régulation, Diagnostique et Thérapeutique ciblée du récepteur minéralocorticoïde dans le remodelage cardiaque(2015), ANR-16-ECVD-0002,EXPERT,Exploring new pathways in age-related heart diseases(2016), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Jonchère, Laurent, ISITE - Isite LUE - - LUE2015 - ANR-15-IDEX-0004 - IDEX - VALID, Combattre l'insuffisance cardiaque - - FIGHT-HF2015 - ANR-15-RHUS-0004 - RHUS - VALID, Régulation, Diagnostique et Thérapeutique ciblée du récepteur minéralocorticoïde dans le remodelage cardiaque - - MR-focus2015 - ANR-15-CE14-0032 - AAPG2015 - VALID, and Exploring new pathways in age-related heart diseases - - EXPERT2016 - ANR-16-ECVD-0002 - ERA-CVD - VALID
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Male ,Plasma volume ,medicine.medical_specialty ,sex difference ,medicine.medical_treatment ,Hemodynamics ,030204 cardiovascular system & hematology ,Hematocrit ,left ventricular filling pressure ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Aged ,Cardiac catheterization ,[SDV.IB] Life Sciences [q-bio]/Bioengineering ,Aged, 80 and over ,Heart Failure ,medicine.diagnostic_test ,business.industry ,congestion ,Stroke Volume ,General Medicine ,Prognosis ,medicine.disease ,Myocardial Contraction ,3. Good health ,Blood pressure ,Echocardiography ,Heart failure ,Left-ventricular filling pressure ,Cardiology ,Female ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Hemoglobin ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
International audience; Background: Estimated plasma volume status (ePVS) has diagnostic and prognostic value in patients with heart failure (HF). However, it remains unclear which congestion markers (i.e., biological, imaging and hemodynamic markers) are preferentially associated with ePVS. In addition, there is evidence of sex differences in both the hematopoietic process and myocardial structure/function.Method and results: Patients with significant dyspnea (NYHA≥2) underwent echocardiography and lung ultrasound within four hours prior to cardiac catheterization. Patients were divided according to tertiles based on sex-specific ePVS thresholds calculated from hemoglobin and hematocrit measurements using Duarte’s formula.Among the 78 included patients (median age 74.5 years; males 69.2%; HF 48.7%), median ePVS was 4.1 (percentile25-75=3.7-4.9) ml/g in males (N=54) and 4.8 (4.4-5.3) ml/g in females (N=24). Patients with the highest ePVS had more frequently HF, higher NT-proBNP, larger left atrial volume and higher E/e’ (all p-values0.10). In multivariable analysis, higher E/e’ and lower diastolic blood pressure were significantly associated with increased ePVS. The association between ePVS and congestion variables was not sex-dependent except for left ventricular end-diastolic pressure, which was only correlated with ePVS in females (Spearman Rho=0.53, p
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- 2020
73. Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases
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Vassilios Fanos, Fabio Cardinale, Salvatore Barberi, Alberto Villani, Carlo Caffarelli, Giovanni Simeone, Elena Chiappini, Roberto Bernardini, Monica Malventano, Luca De Franciscis, Annalisa Capuano, Stefano Luciani, Renato Turra, Stefania Zanconato, Domenico Minasi, Paolo Becherucci, Annamaria Bianchi, Marzia Duse, Paolo Biasci, Marcello Bergamini, Francesca Santamaria, Giuseppe Di Mauro, Serenella Castronuovo, Adima Lamborghini, Gian Luigi Marseglia, Francesco Paravati, Giovanni Battista Pajno, Alberto Martelli, Elio Novembre, Gabriella Di Mauro, Francesco Macrì, Giorgio Piacentini, Maria Carmen Verga, Giovanna Tezza, Iride Dello Iacono, Lucia Leonardi, Mattia Doria, Michele Miraglia Del Giudice, Giovanna De Castro, Raffaele Falsaperla, Luciana Indinnimeo, Riccardo Lubrano, Valentina Ferraro, Renato Cutrera, Lucia Diaferio, Vito Leonardo Miniello, Giampaolo Ricci, Melissa Borrelli, Gabriella Pozzobon, Agostino Nocerino, Germana Nardini, Francesco Di Mauro, Fabio Decimo, Anna Maria Zicari, Diego Peroni, Mariangela Tosca, Maria Di Cicco, Fabio Midulla, Luigi Masini, Amelia Licari, Carlo Alfaro, Valeria Caldarelli, Caterina Di Mauro, Elena Galli, Carlo Capristo, Cristina Piersantelli, Sergio Renzo Morandini, Massimo Landi, Giovanni Cerimoniale, Valter Spanevello, Daniele Giovanni Ghiglioni, Ahmad Kantar, Dora Di Mauro, Cristina Di Mauro, Giovanni Corsello, Attilio Varricchio, Duse, M., Santamaria, F., Verga, M. C., Bergamini, M., Simeone, G., Leonardi, L., Tezza, G., Bianchi, A., Capuano, A., Cardinale, F., Cerimoniale, G., Landi, M., Malventano, M., Tosca, M., Varricchio, A., Zicari, A. M., Alfaro, C., Barberi, S., Becherucci, P., Bernardini, R., Biasci, P., Caffarelli, C., Caldarelli, V., Capristo, C., Castronuovo, S., Chiappini, E., Cutrera, R., De Castro, G., De Franciscis, L., Decimo, F., Iacono, I. D., Diaferio, L., Di Cicco, M. E., Di Mauro, C., Di Mauro, D., Di Mauro, F., Di Mauro, G., Doria, M., Falsaperla, R., Ferraro, V., Fanos, V., Galli, E., Ghiglioni, D. G., Indinnimeo, L., Kantar, A., Lamborghini, A., Licari, A., Lubrano, R., Luciani, S., Macri, F., Marseglia, G., Martelli, A. G., Masini, L., Midulla, F., Minasi, D., Miniello, V. L., del Giudice, M. M., Morandini, S. R., Nardini, G., Nocerino, A., Novembre, E., Pajno, G. B., Paravati, F., Piacentini, G., Piersantelli, C., Pozzobon, G., Ricci, G., Spanevello, V., Turra, R., Zanconato, S., Borrelli, M., Villani, A., Corsello, G., Peroni, D., Duse, Marzia, Santamaria, Francesca, Verga, Maria Carmen, Bergamini, Marcello, Simeone, Giovanni, Leonardi, Lucia, Tezza, Giovanna, Bianchi, Annamaria, Capuano, Annalisa, Cardinale, Fabio, Cerimoniale, Giovanni, Landi, Massimo, Malventano, Monica, Tosca, Mariangela, Varricchio, Attilio, Zicari, Anna Maria, Alfaro, Carlo, Barberi, Salvatore, Becherucci, Paolo, Bernardini, Roberto, Biasci, Paolo, Caffarelli, Carlo, Caldarelli, Valeria, Capristo, Carlo, Castronuovo, Serenella, Chiappini, Elena, Cutrera, Renato, De Castro, Giovanna, De Franciscis, Luca, Decimo, Fabio, Iacono, Iride Dello, Diaferio, Lucia, Di Cicco, Maria Elisa, Di Mauro, Caterina, Di Mauro, Cristina, Di Mauro, Dora, Di Mauro, Francesco, Di Mauro, Gabriella, Doria, Mattia, Falsaperla, Raffaele, Ferraro, Valentina, Fanos, Vassilio, Galli, Elena, Ghiglioni, Daniele Giovanni, Indinnimeo, Luciana, Kantar, Ahmad, Lamborghini, Adima, Licari, Amelia, Lubrano, Riccardo, Luciani, Stefano, Macrì, Francesco, Marseglia, Gianluigi, Martelli, Alberto Giuseppe, Masini, Luigi, Midulla, Fabio, Minasi, Domenico, Miniello, Vito Leonardo, Del Giudice, Michele Miraglia, Morandini, Sergio Renzo, Nardini, Germana, Nocerino, Agostino, Novembre, Elio, Pajno, Giovanni Battista, Paravati, Francesco, Piacentini, Giorgio, Piersantelli, Cristina, Pozzobon, Gabriella, Ricci, Giampaolo, Spanevello, Valter, Turra, Renato, Zanconato, Stefania, Borrelli, Melissa, Villani, Alberto, Corsello, Giovanni, Di Mauro, Giuseppe, Peroni, Diego, and Marzia Duse, Francesca Santamaria, Maria Carmen Verga, Marcello Bergamini, Giovanni Simeone, Lucia Leonardi, Giovanna Tezza, Annamaria Bianchi, Annalisa Capuano, Fabio Cardinale, Giovanni Cerimoniale, Massimo Landi, Monica Malventano, Mariangela Tosca, Attilio Varricchio, Anna Maria Zicari, Carlo Alfaro, Salvatore Barberi, Paolo Becherucci, Roberto Bernardini, Paolo Biasci, Carlo Caffarelli, Valeria Caldarelli, Carlo Capristo, Serenella Castronuovo, Elena Chiappini, Renato Cutrera, Giovanna De Castro, Luca De Franciscis, Fabio Decimo, Iride Dello Iacono, Lucia Diaferio, Maria Elisa Di Cicco, Caterina Di Mauro, Cristina Di Mauro, Dora Di Mauro, Francesco Di Mauro, Gabriella Di Mauro, Mattia Doria, Raffaele Falsaperla, Valentina Ferraro, Vassilios Fanos, Elena Galli, Daniele Giovanni Ghiglioni, Luciana Indinnimeo, Ahmad Kantar, Adima Lamborghini, Amelia Licari, Riccardo Lubrano, Stefano Luciani, Francesco Macrì, Gianluigi Marseglia, Alberto Giuseppe Martelli, Luigi Masini, Fabio Midulla, Domenico Minasi, Vito Leonardo Miniello, Michele Miraglia Del Giudice, Sergio Renzo Morandini, Germana Nardini, Agostino Nocerino, Elio Novembre, Giovanni Battista Pajno, Francesco Paravati, Giorgio Piacentini, Cristina Piersantelli, Gabriella Pozzobon, Giampaolo Ricci, Valter Spanevello, Renato Turra , Stefania Zanconato, Melissa Borrelli, Alberto Villani, Giovanni Corsello, Giuseppe Di Mauro, Diego Peroni
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Male ,Delphi Technique ,Rhinosinusitis ,Respiratory Tract Diseases ,Delphi method ,Rhinosinusiti ,Laryngitis ,Adrenal Cortex Hormone ,Pediatrics ,0302 clinical medicine ,Adrenal Cortex Hormones ,Multidisciplinary approach ,Inhaled corticosteroid ,030212 general & internal medicine ,Child ,Respiratory Tract Disease ,Rhiniti ,Societies, Medical ,Rhinitis ,education.field_of_study ,Inhaled corticosteroids ,Wheezing ,General Medicine ,Settore MED/38 ,Systematic review ,Italy ,Laryngotracheitis ,Child, Preschool ,Laryngotracheiti ,Female ,medicine.symptom ,Human ,medicine.medical_specialty ,Consensus ,Adolescent ,Population ,Consensu ,RJ1-570 ,03 medical and health sciences ,Intervention (counseling) ,Administration, Inhalation ,medicine ,Laryngospasm ,Humans ,Adenoid hypertrophy ,education ,Intensive care medicine ,Asthma ,business.industry ,Research ,Infant ,medicine.disease ,030228 respiratory system ,business - Abstract
Background In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research.
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- 2021
74. The role of PET/CT in disease activity assessment in patients with large vessel vasculitis
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Elena Galli, Francesco Muratore, Pamela Mancuso, Luigi Boiardi, Chiara Marvisi, Giulia Besutti, Lucia Spaggiari, Massimiliano Casali, Annibale Versari, Paolo Giorgi Rossi, and Carlo Salvarani
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PET/CT ,Giant Cell Arteritis ,GCA ,PETVAS ,Takayasu arteritis ,large vessel vasculitis ,Takayasu Arteritis ,Rheumatology ,Fluorodeoxyglucose F18 ,Recurrence ,Positron Emission Tomography Computed Tomography ,Humans ,Pharmacology (medical) ,Retrospective Studies - Abstract
Objectives To evaluate the accuracy of PET/CT and of PET vascular activity score (PETVAS) in assessing disease activity and the ability of PETVAS in predicting relapses in a large single-centre cohort of patients with large vessel vasculitis (LVV). Methods We conducted a retrospective cohort study of prospectively collected data of consecutive patients diagnosed with LVV who underwent at least one PET/CT scan between 2007 and 2020. The nuclear medicine physician’s interpretation of each PET/CT scan (active/inactive vasculitis) was compared with disease activity clinical judgement (active disease/remission). For each PET/CT scan, the PETVAS score was calculated and its accuracy in assessing disease activity was evaluated. The ability of PETVAS in predicting subsequent relapses was evaluated. Results A total of 100 consecutive LVV patients (51 large vessel GCA, 49 Takayasu arteritis) underwent a total of 476 PET/CT scans over a mean follow-up period of 97.5 months. Physician-determined PET/CT grading was able to distinguish between clinically active and inactive LVV with a sensitivity of 60% (95% CI 50.9, 68.7) and specificity of 80.1% (95% CI 75.5, 84.1); the area under the curve (AUC )was 0.70 (95% CI 0.65, 0.75). PETVAS was associated with disease activity, with an age and sex–adjusted odds ratio for active disease of 1.15 (95% CI 1.11, 1.19). A PETVAS ≥10 provided 60.8% sensitivity and 80.6% specificity in differentiating between clinically active and inactive LVV; the AUC was 0.73 (95% CI 0.68, 0.79). PETVAS was not associated with subsequent relapses, with an age and sex–adjusted hazard ratio of 1.04 (95% CI 0.97, 1.11). Conclusions The visual PET/CT grading scale and PETVAS had moderate accuracy to distinguish active LVV from remission. PETVAS did not predict disease relapses.
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- 2021
75. Multicentric randomized evaluation of a tricuspid valve percutaneous repair system (clip for the tricuspid valve) in the treatment of severe secondary tricuspid regurgitation Tri.Fr Design paper
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Erwan Donal, Guillaume Leurent, Anne Ganivet, Philip Lurz, Augustin Coisne, Pascal De Groote, Stephane Lafitte, Lionel Leroux, Nicole Karam, Loic Biere, Frederic Rouleau, Catherine Sportouch, Julien Dreyfus, Mohammed Nejjari, Jean-Michel Josselin, Amedeo Anselmi, Elena Galli, Emma Bajeux, Patrice Guerin, Jean-François Obadia, Jean-Noel Trochu, Emmanuel Oger, CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Leipzig University, CHU Lille, CHU Bordeaux [Bordeaux], Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], Centre cardiologique du Nord (CCN), Institut de recherche en santé, environnement et travail (Irset), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre hospitalier universitaire de Nantes (CHU Nantes), Hospices Civils de Lyon (HCL), Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)
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Heart Valve Prosthesis Implantation ,Cardiac Catheterization ,[SDV]Life Sciences [q-bio] ,heart failure ,General Medicine ,030204 cardiovascular system & hematology ,Surgical Instruments ,Severity of Illness Index ,Tricuspid Valve Insufficiency ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Treatment Outcome ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Tricuspid Valve ,prognosis ,transoesophageal echocardiography ,Cardiology and Cardiovascular Medicine ,tricuspid regurgitation - Abstract
Aims Tricuspid regurgitation (TR) is associated with significant morbidity and mortality. Its independent prognostic role has been repeatedly demonstrated. However, this valvular heart condition is largely undertreated because of the increased risk of surgical repair. Recently, transcatheter techniques for the treatment of TR have emerged, but their implications for the clinical endpoints are still unknown. Methods and results The Tri.fr trial will be a multicentre, controlled, randomized (1:1 ratio), superior, open-label, and parallel-group study conducted in 300 patients with severe secondary TR that is considered non-surgical by heart teams. Inclusion will be possible only after core laboratory review of transthoracic and transoesophageal echocardiography and after validation by the clinical eligibility committee. A description of the mechanisms of the TR will be conducted by the core laboratory. Atrial or ventricular impacts on the severity of the secondary TR will be taken into account for the randomization. The patients will be followed for 12-month, and the primary outcome will be the Packer composite clinical endpoint [combining New York Heart Association class, patient global assessment (PGA), and major cardiovascular events]. It will test the hypothesis that a tricuspid valve percutaneous repair strategy using a clip dedicated to the tricuspid valve is superior to best guideline-directed medical therapy in symptomatic patients with severe secondary TR. Conclusion Tri.fr will be the first randomized, academic, multicentre study testing the value of percutaneous correction in patients with severe secondary TR.
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- 2021
76. Contemporary Management of Severe Symptomatic Aortic Stenosis
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Marc Eugène, Piotr Duchnowski, Bernard Prendergast, Olaf Wendler, Cécile Laroche, Jean-Luc Monin, Yannick Jobic, Bogdan A. Popescu, Jeroen J. Bax, Alec Vahanian, Bernard Iung, Jeroen Bax, Michele De Bonis, Victoria Delgado, Michael Haude, Gerhard Hindricks, Aldo P. Maggioni, Luc Pierard, Susanna Price, Raphael Rosenhek, Frank Ruschitzka, Stephan Windecker, Souad Mekhaldi, Katell Lemaitre, Sébastien Authier, Magdy Abdelhamid, Astrid Apor, Gani Bajraktari, Branko Beleslin, Alexander Bogachev-Prokophiev, Daniela Cassar Demarco, Agnes Pasquet, Sait Mesut Dogan, Andrejs Erglis, Arturo Evangelista, Artan Goda, Nikolaj Ihlemann, Huseyin Ince, Andreas Katsaros, Katerina Linhartova, Julia Mascherbauer, Erkin Mirrakhimov, Vaida Mizariene, Shelley Rahman-Haley, Regina Ribeiras, Fuad Samadov, Antti Saraste, Iveta Simkova, Elizabeta Srbinovska Kostovska, Lidia Tomkiewicz-Pajak, Christophe Tribouilloy, Eliverta Zera, Mimoza Metalla, Ervina Shirka, Elona Dado, Loreta Bica, Jorida Aleksi, Gerti Knuti, Lidra Gjyli, Rudina Pjeci, Eritinka Shuperka, Erviola Lleshi, Joana Rustemaj, Marsjon Qordja, Mirald Gina, Senada Husi, Daniel Basic, Regina Steringer-Mascherbauer, Charlotte Huber, Christian Ebner, Elisabeth Sigmund, Andrea Ploechl, Thomas Sturmberger, Veronica Eder, Tanja Koppler, Maria Heger, Andreas Kammerlander, Franz Duca, Christina Binder, Matthias Koschutnik, Leonard Perschy, Lisa Puskas, Chen-Yu Ho, Farid Aliyev, Vugar Guluzada, Galib Imanov, Firdovsi Ibrahimov, Abbasali Abbasaliyev, Tahir Ahmedov, Fargana Muslumova, Jamil Babayev, Yasmin Rustamova, Tofig Jahangirov, Rauf Samadov, Muxtar Museyibov, Elnur Isayev, Oktay Musayev, Shahin Xalilov, Saleh Huseynov, Madina Yuzbashova, Vuqar Zamanov, Vusal Mammadov, Gery Van Camp, Martin Penicka, Hedwig Batjoens, Philippe Debonnaire, Daniel Dendooven, Sebastien Knecht, Mattias Duytschaever, Yves Vandekerckhove, Luc Missault, Luc Muyldermans, René Tavernier, Tineke De Grande, Patrick Coussement, Joyce DeTroyer, Katrien Derycker, Kelly De Jaegher, Antoine Bondue, Christophe Beauloye, Céline Goffinet, Daniela Corina Mirica, Frédéric Vanden Eynden, Philippe Van de Borne, Béatrice Van Frachen, David Vancraeynest, Jean Louis Vanoverschelde, Sophie Pierard, Mihaela Malanca, Florence Sinnaeve, Séverine Tahon, Marie De Clippel, Frederic Gayet, Jacques Loiseau, Nico Van de Veire, Veronique Moerman, Anne-Marie Willems, Bernard Cosyns, Steven Droogmans, Andreea Motoc, Dirk Kerkhove, Daniele Plein, Bram Roosens, Caroline Weytjens, Patrizio Lancellotti, Elena Raluca Dulgheru, Ilona Parenicova, Helena Bedanova, Frantisek Tousek, Stepanka Sindelarova, Julia Canadyova, Milos Taborsky, Jiri Ostransky, null Ivona simkova, Marek Vicha, Libor Jelinek, Irena Opavska, Miroslav Homza, Miriam Kvrayola, Radim Brat, Dan Mrozek, Eva Lichnerova, Iveta Docekalova, Marta Zarybnicka, Marketa Peskova, Patrik Roucka, Vlasta Stastna, Dagmar Jungwirtova Vondrackova, Alfred Hornig, Matus Niznansky, Marian Branny, Alexandra Vodzinska, Miloslav Dorda, Libor Snkouril, Krystyna Kluz, Jana Kypusova, Radka Nezvalova, Niels Thue Olsen, Hosam Hasan Ali, Salma Taha, Mohamed Hassan, Ahmed Afifi, Hamza Kabil, Amr Mady, Hany Ebaid, Yasser Ahmed, Mohammad Nour, Islam Talaat, CairoMaiy El Sayed, Ahmad Elsayed Mostafa, CairoYasser Sadek, CairoSherif Eltobgi, Sameh Bakhoum, Ramy Doss, Mahmoud Sheashea, Abd Allah Elasry, Ahmed Fouad, Mahmoud Baraka, Sameh Samir, Alaa Roshdy, Yasmin AbdelRazek, Mostafa M. Abd Rabou, Ahmed Abobakr, Moemen Moaaz, Mohamed Mokhtar, Mohamed Ashry, Khaled Elkhashab, Haytham Soliman Ghareeb, Mostafa Kamal, Gomaa AbdelRazek, GizaNabil Farag, Giza:Ahmed Elbarbary, Evette Wahib, Ghada Kazamel, Diaa Kamal, Mahmoud Tantawy, Adel Alansary, Mohammed Yahia, Raouf Mahmoud, Tamer El Banna, Mohamed Atef, Gamela Nasr, Salah Ahmed, Ehab E. El Hefny, Islam Saifelyazal, Mostafa Abd El Ghany, Abd El Rahman El Hadary, Ahmed Khairy, Jyri Lommi, Mika Laine, Minna Kylmala, Katja Kankanen, Anu Turpeinen, Juha Hartikainen, Lari Kujanen, Juhani Airaksinen, Tuija Vasankari, Catherine Szymanski, Yohann Bohbot, Mesut Gun, Justine Rousseaux, Loic Biere, Victor Mateus, Martin Audonnet, Jérémy Rautureau, Charles Cornet, Emmanuel Sorbets, BourgesKarine Mear, Adi Issa, Florent Le Ven, Marie-Claire Pouliquen, Martine Gilard, Alice Ohanessian, Ali Farhat, Alina Vlase, Fkhar Said, Caroline Lasgi, Carlos Sanchez, Romain Breil, Marc Peignon, Jean-Philippe Elkaim, Virginie Jan-Blin, Sylvain Ropars BertrandM'Ban, Hélène Bardet, Samuel Sawadogo, Aurélie Muschoot, Dieudonné Tchatchoua, Simon Elhadad, Aline Maubert, Tahar Lazizi, Kais Ourghi, Philippe Bonnet, Clarisse Menager-Gangloff, Sofiene Gafsi, Djidjiga Mansouri, Victor Aboyans, Julien Magne, Elie Martins, Sarah Karm, Dania Mohty, Guillaume Briday, Amandine David, Sylvestre Marechaux, Caroline Le Goffic, Camille Binda, Aymeric Menet, Francois Delelis, Anne Ringlé, Anne-Laure Castel, Ludovic Appert, Domitille Tristram, Camille Trouillet, Yasmine Nacer, Lucas Ngoy, MarseilleGilbert Habib, Franck Thuny, Julie Haentjens, Jennifer Cautela, Cécile Lavoute, Floriane Robin, Pauline Armangau, Ugo Vergeylen, Khalil Sanhadji, Nessim Hamed Abdallah, Hassan Kerzazi, Mariana Perianu, François Plurien, Chaker Oueslati, Mathieu Debauchez, Zannis Konstantinos, Alain Berrebi, Alain Dibie, Emmanuel Lansac, Aurélie Veugeois, Christelle Diakov, Christophe Caussin, Daniel Czitrom, Suzanna Salvi, Nicolas Amabile, Patrice Dervanian, Stéphanie Lejeune, Imane Bagdadi, Yemmi Mokrane, Gilles Rouault, Jerome Abalea, Marion Leledy, Patrice Horen, Erwan Donal, Christian Bosseau, Elise Paven, Elena Galli, Edouard Collette, Jean-Marie Urien, Valentin Bridonneau, Renaud Gervais, Fabrice Bauer, Houzefa Chopra, Arthur Charbonnier, David Attias, Nesrine Dahouathi, Moukda Khounlaboud, Magalie Daudin, Christophe Thebault, Cécile Hamon, Philippe Couffon, Catherine Bellot, Maelle Vomscheid, Anne Bernard, Fanny Dion, Djedjiga Naudin, Mohammed Mouzouri, Mathilde Rudelin, Alain Berenfeld, Thibault Vanzwaelmen, Tarik Alloui, Marija Gjerakaroska Radovikj, Slavica Jordanova, Werner Scholtz, Eva Liberda-Knoke, Melanie Wiemer, Andreas Mugge, Georg Nickenig, Jan-Malte Sinning, Alexander Sedaghat, Matthias Heintzen, Jan Ballof, Daniel Frenk, Rainer Hambrecht, Harm Wienbergen, Annemarie Seidel, Rico Osteresch, Kirsten Kramer, Janna Ziemann, Ramona Schulze, Wolfgang Fehske, Clarissa Eifler, Bahram Wafaisade, Andreas Kuhn, Sören Fischer, Lutz Lichtenberg, Mareike Brunold, Judith Simons, Doris Balling, Thomas Buck, Bjoern Plicht, Wolfgang Schols, Henning Ebelt, Marwan Chamieh, Jelena Anacker, Tienush Rassaf, Alexander Janosi, Alexander Lind, Julia Lortz, Peter Lüdike, Philipp Kahlert, Harald Rittger, Gabriele Eichinger, Britta Kuhls, Stephan B. Felix, Kristin Lehnert, Ann-Louise Pedersen, Marcus Dorr, Klaus Empen, Sabine Kaczmarek, Mathias Busch, Mohammed Baly, Fikret Er, Erkan Duman, Linda Gabriel, Christof Weinbrenner, Johann Bauersachs, Julian Wider, Tibor Kempf, Michael Bohm, Paul-Christian Schulze, C. Tudor Poerner, Sven Möbius-Winkler, Karsten Lenk, Kerstin Heitkamp, Marcus Franz, Sabine Krauspe, Burghard Schumacher, Volker Windmuller, Sarah Kurwitz, Holger Thiele, Thomas Kurz, Roza Meyer-Saraei, Ibrahim Akin, Christian Fastner, Dirk Lossnitzer, Ursula Hoffmann, Martin Borggrefe, Stefan Baumann, Brigitte Kircher, Claudia Foellinger, Heike Dietz, Bernhard Schieffer, Feraydoon Niroomand, Harald Mudra, Lars Maier, Daniele Camboni, Christoph Birner, Kurt Debl, Michael Paulus, Benedikt Seither, Nour Eddine El Mokhtari, Alper Oner, Evren Caglayan, Mohammed Sherif, Seyrani Yucel, Florian Custodis, Robert Schwinger, Marc Vorpahl, Melchior Seyfarth, Ina Nover, Till Koehler, Sarah Christiani, David Calvo Sanchez, Barbel Schanze, Holger Sigusch, Athir Salman, Jane Hancock, John Chambers, Camelia Demetrescue, Claire Prendergast, Miles Dalby, Robert Smith, Paula Rogers, Cheryl Riley, Dimitris Tousoulis, Ioannis Kanakakis, Konstantinos Spargias, Konstantinos Lampropoulos, Tolis Panagiotis, Athanasios Koutsoukis, Lampros Michalis, Ioannis Goudevenos, Vasileios Bellos, Michail Papafaklis, Lampros Lakkas, George Hahalis, Athanasios Makris, Haralampos Karvounis, Vasileios Kamperidis, Vlasis Ninios, Vasileios Sachpekidis, Pavlos Rouskas, Leonidas Poulimenos, Georgios Charalampidis, Eftihia Hamodraka, Athanasios Manolis, Robert Gabor Kiss, Tunde Borsanyi, Zoltan Jarai, Andras Zsary, Elektra Bartha, Annamaria Kosztin, Alexandra Doronina, Attila Kovacs, Barabas Janos Imre, Chun Chao, Kalman Benke, Istvan Karoczkai, Kati Keltai, Zsolt Förchécz, Zoltán Pozsonyi, Zsigmond Jenei, Adam Patthy, Laszlo Sallai, Zsuzsanna Majoros, Tamás Pál, Jusztina Bencze, Ildiko Sagi, Andrea Molnar, Anita Kurczina, Gabor Kolodzey, Istvan Edes, Valeria Szatmari, Zsuzsanna Zajacz, Attila Cziraki, Adam Nemeth, Reka Faludi, Laszlone Vegh, Eva Jebelovszki, Geza Karoly Lupkovics, Zsofia Kovacs, Andras Horvath, Gezim Berisha, Pranvera Ibrahimi, Luan Percuku, Rano Arapova, Elmira Laahunova, Kseniia Neronova, Zarema Zhakypova, Gulira Naizabekova, Gulnazik Muratova, Iveta Sime, Nikolajs Sorokins, Ginta Kamzola, Irina Cgojeva-Sproge, Gita Rancane, Ramune Valentinaviciene, Laima Rudiene, Rasa Raugaliene, Aiste Bardzilauske, Regina Jonkaitiene, Jurate Petrauskaite, Monika Bieseviciene, Raimonda Verseckaite, Ruta Zvirblyte, Danute Kalibatiene, Greta Radauskaite, Gabija Janaviciute-Matuzeviciene, Dovile Jancauskaite, Deimile Balkute, Juste Maneikyte, Ingrida Mileryte, Monika Vaisvilaite, Lina Gedvilaite, Mykolas Biliukas, Vaiva Karpaviciene, Robert George Xuereb, Elton Pllaha, Roxana Djaberi, Klaudiusz Komor, Agnieszka Gorgon-Komor, Beata Loranc, Jaroslaw Myszor, Katarzyna Mizia-Stec, Adrianna Berger-Kucza, Magdalena Mizia, Mateusz Polak, Piotr Bogacki, Piotr Podolec, Monika Komar, Ewa Sedziwy, Dorota Sliwiak, Bartosz Sobien, Beata Rog, Marta Hlawaty, Urszula Gancarczyk, Natasza Libiszewska, Danuta Sorysz, Andrzej Gackowski, Malgorzata Cieply, Agnieszka Misiuda, Franciszek Racibor, Anna Nytko, Kazimierz Widenka, Maciej Kolowca, Janusz Bak, Andrzej Curzytek, Mateusz Regulski, Malgorzata Kamela, Mateusz Wisniowski, Tomasz Hryniewiecki, Piotr Szymanski, Monika Rozewicz, Maciej Grabowski, Andrzej Budaj, Beata Zaborska, Ewa Pilichowska-Paskiet, Malgorzata Sikora-Frac, Tomasz Slomski, Isabel Joao, Ines Cruz, Hélder Pereira, Rita Cale, Ana Marques, Ana Rita Pereira, Carlos Morais, Antonio Freitas, David Roque, Nuno Antunes, Antonio Costeira Pereira, Catarina Vieira, Nuno Salome, Juliana Martins, Isabel Campos, Goncalo Cardoso, Claudia Silva, Afonso Oliveira, Mariana Goncalves, Rui Martins, Nuno Quintal, Bruno Mendes, Joseline Silva, Joao Ferreira, James Milner, Patricia Alves, Vera Marinho, Paula Gago, Jose Amado, Joao Bispo, Dina Bento, Inocencia Machado, Margarida Oliveira, Lucy Calvo, Pedro von Hate, Bebiana Faria, Ana Galrinho, Luisa Branco, Antonio Goncalves, Tiago Mendonca, Mafalda Selas, Filipe Macedo, Carla Sousa, Sofia Cabral, Filomena Oliveira, Maria Trepa, Marta Fontes-Oliveira, Alzira Nunes, Paulo Araújo, Vasco Gama Ribeiro, Joao Almeida, Alberto Rodrigues, Pedro Braga, Sonia Dias, Sofia Carvalho, Catarina Ferreira, Alberto Ferreira, Pedro Mateus, Miguel Moz, Silvia Leao, Renato Margato, Ilidio Moreira, Jose Guimanaes, Joana Ribeiro, Fernando Goncalves, Jose Cabral, Ines Almeida, Luisa Goncalves, Mariana Tarusi, Calin Pop, Claudia Matei, Diana Tint, Sanziana Barbulescu, Sorin Micu, Ioana Pop, Costica Baba, Doina Dimulescu, Maria Dorobantu, Carmen Ginghina, Roxana Onut, Andreea Popescu, Brandusa Zamfirescu, Raluca Aflorii, Mihaela Popescu, Liviu Ghilencea, Andreeea Rachieru, Monica Stoian, Nicoleta Oprescu, Silvia Iancovici, Iona Petre, Anca Doina Mateescu, Andreea Calin, Simona Botezatu, Roxana Enache, Monica Rosca, Daniela Ciuperca, Evelyn Babalac, Ruxandra Beyer, Laura Cadis, Raluca Rancea, Raluca Tomoaia, Adela Rosianu, Emese Kovacs, Constantin Militaru, Alina Craciun, Oana Mirea, Mihaela Florescu, Lucica Grigorica, Daniela Dragusin, Luiza Nechita, Mihai Marinescu, Teodor Chiscaneanu, Lucia Botezatu, Costela Corciova, Antoniu Octavian Petris, Catalina Arsenescu-Georgescu, Delia Salaru, Dan Mihai Alexandrescu, Carmjen Plesoianu, Ana Tanasa, Ovidiu Mitu, Irina Iuliana Costache, Ionut Tudorancea, Catalin Usurelu, Gabriela Eminovici, Ioan Manitiu, Oana Stoia, Adriana Mitre, Dan-Octavian Nistor, Anca Maier, Silvia Lupu, Mihaela Opris, Adina Ionac, Irina Popescu, Simina Crisan, Cristian Mornos, Flavia Goanta, Liana Gruescu, Oana Voinescu, Madalina Petcu, Ramona Cozlac, Elena Damrina, Liliya Khilova, Irina Ryazantseva, Dmitry Kozmin, Maria Kiseleva, Marina Goncharova, Kamila Kitalaeva, Victoria Demetskay, Artem Verevetinov, Mikhail Fomenko, Elena Skripkina, Viktor Tsoi, Georgii Antipov, Yuri Schneider, Denis Yazikov, Marina Makarova, Aleksei Cherkes, Natalya Ermakova, Aleksandr Medvedev, Anastasia Sarosek, Mikhail Isayan, Tatyana Voronova, Oleg Kulumbegov, Alina Tuchina, Sergei Stefanov, Margarita Klimova, Konstantin Smolyaninov, Zhargalma Dandarova, Victoriya Magamet, Natalia Spiropulos, Sergey Boldyrev, Kirill Barbukhatty, Dmitrii Buyankov, Vladimir Yurin, Yuriy Gross, Maksim Boronin, Mariya Mikhaleva, Mariya Shablovskaya, Alex Zotov, Daniil Borisov, Vasily Tereshchenko, Ekaterina Zubova, A. Kuzmin, Ivan Tarasenko, Alishir Gamzaev, Natalya Borovkova, Tatyana Koroleva, Svetlana Botova, Ilya Pochinka, Vera Dunaeva, Victoria Teplitskaya, Elena I. Semenova, Olga V. Korabel'Nikova, Denis S. Simonov, Elena Denisenko, Natalia Harina, Natalia Yarohno, Svetlana Alekseeva, Julia Abydenkova, Lyubov Shabalkina, Olga Mayorova, Valeriy Tsechanovich, Igor Medvedev, Michail Lepilin, PenzaEvgenii Nemchenko, Vadim Karnahin, Vasilya Safina, Yaroslav Slastin, Venera Gilfanova, Roman Gorbunov, Ramis Jakubov, Aigul Fazylova, Mansur Poteev, Laysan Vazetdinova, Indira Tarasova, Rishat Irgaliyev, Olga Moiseeva, Mikhail Gordeev, Olga Irtyuga, Raisa Moiseeva, Nina Ostanina, Dmitry Zverev, Patimat Murtazalieva, Dmitry Kuznetsov, Mariya Skurativa, Larisa Polyaeva, Kirill Mihaiilov, Biljana Obrenovic-Kircanski, Svetozar Putnik, Dragan Simic, Milan Petrovic, Natasa Markovic Nikolic, Ljiljana Jovovic, Dimitra Kalimanovska Ostric, Milan Brajovic, Milica Dekleva Manojlovic, Vladimir Novakovic, Danijela Zamaklar-Trifunovic, Bojana Orbovic, Olga Petrovic, Marija Boricic-Kostic, Kristina Andjelkovic, Marko Milanov, Maja Despotovic-Nikolic, Sreten Budisavljevic, Sanja Veljkovic, Nataša Cvetinovic, Daniijela Lepojevic, Aleksandra Todorovic, Aleksandra Nikolic, Branislava Borzanovic, Ljiljana Trkulja, Slobodan Tomic, Milan Vukovic, Jelica Milosavljevic, Mirjana Milanovic, Vladan Stakic, Aleksandra Cvetkovic, Suzana Milutinovic, Olivera Bozic, Miodrag Miladinovic, Zoran Nikolic, Dinka Despotovic, Dimitrije Jovanovic, Anastazija Stojsic-Milosavljevic, Aleksandra Ilic, Mirjana Sladojevic, Stamenko Susak, Srdjan Maletin, Salvo Pavlovic, Vladimir Kuzmanovic, Nikola Ivanovic, Jovana Dejanovic, Dusan Ruzicic, Dragana Drajic, Danijel Cvetanovic, Marija Mirkovic, Jon Omoran, Roman Margoczy, Katarina Sedminova, Adriana Reptova, Eva Baranova, Tatiana Valkovicova, Gabriel Valocik, Marian Kurecko, Marianna Vachalcova, Alzbeta Kollarova, Martin Studencan, Daniel Alusik, Marek Kozlej, Jana Macakova, Sergio Moral, Merce Cladellas, Daniele Luiso, Alicia Calvo, Jordi Palet, Juli Carballo, Gisela Teixido Tura, Giuliana Maldonado, Laura Gutierrez, Teresa Gonzalez-Alujas, Rodriguez Palomares Jose Fernando, Nicolas Villalva, Ma Jose Molina-Mora, Ramon Rubio Paton, Juan Jose Martinez Diaz, Pablo Ramos Ruiz, Alfonso Valle, Ana Rodriguez, Edgardo Alania, Emilio Galcera, Julia Seller, Gonzalo de la Morena Valenzuela, Daniel Saura Espin, Dolores Espinosa Garcia, Maria Jose Oliva Sandoval, Josefa Gonzalez, Miguel Garcia Navarro, Maria Teresa Perez-Martinez, Jose Ramon Ortega Trujillo, Irene Menduina Gallego, Daniel San Roman, Eliu David Perez Nogales, Olga Medina, Rodolfo Antonio Montiel Quintero, Pablo Felipe Bujanda Morun, Marta Lopez Perez, Jimmy Plasencia Huaripata, Juan Jose Morales Gonzalez, Veronica Quevedo Nelson, Jose Luis Zamorano, Ariana Gonzalez Gomez, Alfonso Fraile, Maria Teresa Alberca, Joaquin Alonso Martin, Covadonga Fernandez-Golfin, Javier Ramos, Sergio Hernandez Jimenez, Cristina Mitroi, Pedro L. Sanchez Fernandez, Elena Diaz-Pelaez, Beatriz Garde, Luis Caballero, Fermin Martinez Garcia, Francisco Cambronero, Noelia Castro, Antonio Castro, Alejandro De La Rosa, Pastora Gallego, Irene Mendez, David Villagomez Villegas, Manuel Gonzalez Correa, Roman Calvo, Francisco Florian, Rafael Paya, Esther Esteban, Francisco Buendia, Andrés Cubillos, Carmen Fernandez, Juan Pablo Cárdenas, José Leandro Pérez-Boscá, Joan Vano, Joaquina Belchi, Cristina Iglesia-Carreno, Francisco Calvo Iglesias, Aida Escudero-Gonzalez, Sergio Zapateria-Lucea, Juan Sterling Duarte, Lara Perez-Davila, Rafael Cobas-Paz, Rosario Besada-Montenegro, Maribel Fontao-Romeo, Elena Lopez-Rodriguez, Emilio Paredes-Galan, Berenice Caneiro-Queija, Alba Guitian Gonzalez, Abdi Bozkurt, Serafettin Demir, Durmus Unlu, Caglar Emre Cagliyan, Muslum Firat Ikikardes, Mustafa Tangalay, Osman Kuloglu, Necla Ozer, Ugur Canpolat, Melek Didem Kemaloglu, Abdullah Orhan Demirtas, Didar Elif Akgün, Eyup Avci, Gokay Taylan, Mustafa Adem Yilmaztepe, Fatih Mehmet Ucar, Servet Altay, Muhammet Gurdogan, Naile Eris Gudul, Mujdat Aktas, Mutlu Buyuklu, Husnu Degirmenci, Mehmet Salih Turan, Kadir Ugur Mert, Gurbet Ozge Mert, Muhammet Dural, Sukru Arslan, Nurten Sayar, Batur Kanar, Beste Ozben Sadic, Ahmet Anil Sahin, Ahmet Buyuk, Onur Kilicarslan, Cem Bostan, Tarik Yildirim, Seda Elcim Yildirim, Kahraman Cosansu, Perihan Varim, Ersin Ilguz, Recep Demirbag, Asuman Yesilay, Abdullah Cirit, Eyyup Tusun, Emre Erkus, Muhammet Rasit Sayin, Zeynep Kazaz, Selim Kul, Turgut Karabag, Belma Kalayci, Clinical sciences, Cardio-vascular diseases, and Cardiology
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Male ,medicine.medical_specialty ,Multivariate analysis ,Clinical Decision-Making ,Risk Assessment ,Severity of Illness Index ,decision making ,surgery ,Risk Factors ,Internal medicine ,Intervention (counseling) ,medicine ,Clinical endpoint ,Humans ,03.02. Klinikai orvostan ,guidelines ,Symptomatic aortic stenosis ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,valvular heart disease ,Disease Management ,aortic stenosis ,Aortic Valve Stenosis ,Odds ratio ,medicine.disease ,Europe ,Stenosis ,Treatment Outcome ,Echocardiography ,Aortic Valve ,Charlson comorbidity index ,transcatheter aortic valve replacement ,Female ,Morbidity ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,surgical aortic valve replacement - Abstract
BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.
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- 2021
77. Left bundle branch block causes left atrial dyssynchrony: a result of atrio-ventricular mechanical interaction
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Elena Galli, Jürgen Duchenne, L E R Hammersboen, Otto A. Smiseth, M Stugaard, J-U Voigt, Espen W. Remme, John M Aalen, OJ Sletten, and Erwan Donal
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medicine.medical_specialty ,Left bundle branch block ,business.industry ,medicine.medical_treatment ,Ischemia ,Cardiac resynchronization therapy ,medicine.disease ,medicine.anatomical_structure ,Left atrial ,Internal medicine ,medicine ,Cardiology ,Systole ,Cardiology and Cardiovascular Medicine ,business ,Interatrial septum - Abstract
Introduction Left bundle brach block (LBBB) leads to left ventricular (LV) mechanical dyssynchrony with septal flash and delayed lateral wall contractions. Since atrium and ventricle are anatomically connected, dyssynchronous LV contractions may be transmitted to the left atrium, thereby disturbing left (LA) function. Purpose To test the hypothesis that patients with LBBB have LA dyssynchrony induced by tethering to the dyssynchronous left ventricle. Methods Myocardial strain was measured by speckle-tracking echocardiography in 20 non-ischaemic heart failure patients with LBBB, before and 6 months after cardiac resynchronization therapy (CRT), and in 20 healthy controls. For the LA, dyssynchrony was measured as time delay between onset of the interatrial septum and the lateral wall, and for the LV, between onset septal flash and onset lateral wall contraction. White arrows in Figure indicate onset LA stretch. Results As shown in the Figure, patients with LBBB and HF had marked LA reservoir phase dyssynchrony. Before CRT time delay from onset LA septal stretch to onset lateral wall stretch was 125±71 ms (mean±SD), and decreased to 23±70 (p Conclusions Patients with LBBB had marked LA reservoir phase dyssynchrony, which was abolished with CRT. The LA dyssynchrony was attributed to direct LV-LA mechanical interaction. The observed LA resynchronization by CRT represent an additional benefit of CRT in patients with heart failure. Funding Acknowledgement Type of funding sources: None. Left atrial and ventricular dyssynchrony
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- 2021
78. Impact of sacubitril/valsartan on systolic heart failure: Right heart location and clustering analysis
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yanis, bouali, primary, elena, Galli, additional, elise, paven, additional, clement, LAURIN, additional, arnaud, hubert, additional, emmanuel, oger, additional, and Donal, Erwan, additional
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- 2021
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79. Tocilizumab or glucocorticoids treatment for patients with SARS-CoV-2 pneumonia: An observational study
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Giovanni Dolci, Giulia Cassone, Giulia Besutti, Romina Corsini, Fabio Sampaolesi, Valentina Iotti, Elena Galli, Adalgisa Palermo, Matteo Fontana, and Pamela Mancuso
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Microbiology (medical) ,SARS-CoV-2 ,COVID-19 ,Tocilizumab ,Glucocorticoids ,Methylprednisolone ,Corticosteroids ,Infectious and parasitic diseases ,RC109-216 ,Antibodies, Monoclonal, Humanized ,Microbiology ,QR1-502 ,methylprednisolone ,corticosteroids ,COVID-19 Drug Treatment ,tocilizumab ,Infectious Diseases ,Treatment Outcome ,Humans ,Original Article ,Retrospective Studies - Abstract
Objective To estimate the effect of tocilizumab or glucocorticoids in preventing death and intubation in patients hospitalized with SARS-CoV-2 pneumonia. Methods This was a retrospective cohort study enrolling all consecutive patients hospitalized at Reggio Emilia AUSL between February the 11th and April 14th 2020 for severe COVID-19 and treated with tocilizumab or glucocorticoids (at least 80 mg/day of methylprednisolone or equivalent for at least 3 days). The primary outcome was death within 30 days from the start of the considered therapies. The secondary outcome was a composite outcome of death and/or intubation. All patients have been followed-up until May 19th 2020, with a follow-up of at least 30 days for every patient. To reduce confounding due to potential non-comparability of the two groups, those receiving tocilizumab and those receiving glucocorticoids, a propensity score was calculated as the inverse probability weighting of receiving treatment conditional on the baseline covariates. Results and conclusion Therapy with tocilizumab alone was associated with a reduction of deaths (OR 0.49, 95% CI 0.21-1.17) and of the composite outcome death/intubation (OR 0.35, 95% CI 0.13-0.90) compared to glucocorticoids alone. Nevertheless, this result should be cautiously interpreted due to a potential prescription bias.
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- 2021
80. Prognostic values of exercise echocardiography and cardiopulmonary exercise testing in patients with primary mitral regurgitation
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Thomas Modine, Olivia Domanski, Elena Galli, Marion Charton, Pascal Delsart, Augustin Coisne, Marjorie Richardson, Guillaume L’official, Samy Aghezzaf, David Montaigne, Erwan Donal, Christophe Bauters, André Vincentelli, Francis Juthier, Denis Dubois, Patrizio Lancellotti, Stéphanie Mouton, Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires (RNMCD - U1011), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 (RID-AGE), Università degli studi di Bari Aldo Moro (UNIBA), Université de Liège, Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011 (RNMCD), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro (UNIBA)
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medicine.medical_specialty ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aerobic capacity ,medicine.artery ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Mitral regurgitation ,Ejection fraction ,business.industry ,Hazard ratio ,Mitral Valve Insufficiency ,Stroke Volume ,General Medicine ,Cardiac surgery ,medicine.disease ,Prognosis ,Pulmonary hypertension ,Confidence interval ,Echocardiography ,Heart failure ,Pulmonary artery ,Cardiology ,Exercise Test ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Cardiology and Cardiovascular Medicine ,business ,Exercise pulmonary hypertension - Abstract
Aims To compare the clinical significance of exercise echocardiography (ExE) and cardiopulmonary exercise testing (CPX) in patients with ≥moderate primary mitral regurgitation (MR) and discrepancy between symptoms and MR severity. Methods and results Patients consulting for ≥moderate discordant primary MR prospectively underwent low (25 W) ExE, peak ExE, and CPX within 2 months in Lille and Rennes University Hospital. Patients with Class I recommendation for surgical MR correction were excluded. Changes in MR severity, systolic pulmonary artery pressure (SPAP), left ventricular ejection fraction (LVEF), and tricuspid annular plane systolic excursion were evaluated during ExE. Patients were followed for major events (ME): cardiovascular death, acute heart failure, or mitral valve surgery. Among 128 patients included, 22 presented mild-to-moderate, 61 moderate-to-severe, and 45 severe MR. Unlike MR variation, SPAP and LVEF were successfully assessed during ExE in most patients. Forty-one patients (32%) displayed reduced aerobic capacity (peak VO2 < 80% of predicted value) with cardiac limitation in 28 (68%) and muscular or respiratory limitation in the 13 others (32%). ME occurred in 61 patients (47.7%) during a mean follow-up of 27 ± 21 months. Twenty-five Watts SPAP [hazard ratio (HR) (95% confidence interval, CI) = 1.03 (1.01–1.06), P = 0.003] and reduced aerobic capacity [HR (95% CI) = 1.74 (1.03–2.95), P = 0.04] were independently predictive of ME, even after adjustment for MR severity. The cut-off of 55 mmHg for 25 W SPAP showed the best accuracy to predict ME (area under the curve = 0.60, P = 0.05). Conclusion In patients with ≥moderate primary MR and discordant symptoms, 25 W exercise pulmonary hypertension, defined as an SPAP ≥55 mmHg, and poor aerobic capacity during CPX are independently associated with adverse events.
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- 2021
81. VEXAS Syndrome: A Case Series From a Single-Center Cohort of Italian Patients With Vasculitis
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Elena Galli, Luigi Boiardi, Peter C. Grayson, Nicholas Balanda, Chiara Marvisi, Nicolò Pipitone, David B. Beck, Orsola Bonanno, Carlo Salvarani, Enrico Farnetti, Francesco Muratore, Davide Nicoli, Piera Zaldini, Paola Castrignanò, and Rosina Longo
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Male ,Vasculitis ,medicine.medical_specialty ,Immunology ,Ubiquitin-Activating Enzymes ,Single Center ,Antibodies, Antineutrophil Cytoplasmic ,Rheumatology ,Internal medicine ,medicine ,Immunology and Allergy ,Humans ,Retrospective Studies ,Inflammation ,business.industry ,medicine.disease ,Autoinflammatory Syndrome ,medicine.anatomical_structure ,Concomitant ,Myelodysplastic Syndromes ,Cohort ,Mutation ,Who criteria ,Bone marrow ,business ,Systemic vasculitis - Abstract
To identify patients with VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic syndrome) from a single-center cohort of Italian patients with vasculitis, using a clinically oriented phenotype-first approach.We retrospectively reviewed the clinical records of 147 consecutive male patients followed up in our vasculitis clinic from 2013 to date. All patients with a diagnosis of vasculitis and treatment-resistant manifestations of inflammation, persistently elevated inflammation markers, and hematologic abnormalities were identified. Bone marrow aspirates were examined for the presence of vacuoles. Sequencing of ubiquitin-activating enzyme E1 (UBA-1) was performed using genomic DNA from peripheral blood leukocytes or bone marrow tissue.Seven patients with vasculitis and concomitant features of VEXAS syndrome were identified. A final diagnosis of VEXAS syndrome was made in 3 of the 5 patients who underwent sequencing of UBA-1 (diagnosis was made postmortem for 1 patient). In all 3 patients, examination of the bone marrow aspirate revealed vacuoles characteristic of VEXAS syndrome, and all 3 patients met the definitive World Health Organization criteria for myelodysplastic syndrome. Cytogenetic analysis showed normal karyotypes in all 3 patients.To our knowledge, this is the first report of VEXAS syndrome associated with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Our data emphasize the need to consider VEXAS syndrome when evaluating patients with various forms of systemic vasculitis. The novel association between VEXAS syndrome and ANCA-associated vasculitis reported herein warrants further investigation.
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- 2021
82. Haemodynamic evaluation: a key tool for heart failure management. Ultrasounds forever!
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Erwan Donal, Elise Paven, Elena Galli, and Leyla Elif Sade
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Heart Failure ,medicine.medical_specialty ,business.industry ,Hemodynamics ,MEDLINE ,030204 cardiovascular system & hematology ,medicine.disease ,Article ,Lung ultrasound ,03 medical and health sciences ,0302 clinical medicine ,Heart failure ,Key (cryptography) ,medicine ,Humans ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Ultrasonography - Abstract
Congestion, related to pressure and/or fluid overload, plays a central role in the pathophysiology, presentation and prognosis of heart failure and is an important therapeutic target. While symptoms and physical signs of fluid overload are required to make a clinical diagnosis of heart failure, they lack both sensitivity and specificity, which might lead to diagnostic delay and uncertainty. Over the last decades, new ultrasound methods for the detection of elevated intracardiac pressures and/or fluid overload have been developed that are more sensitive and specific, thereby enabling earlier and more accurate diagnosis and facilitating treatment strategies. Accordingly, we considered that a state-of-the-art review of ultrasound methods for the detection and quantification of congestion was timely, including imaging of the heart, lungs (B-lines), kidneys (intrarenal venous flow), and venous system (inferior vena cava and internal jugular vein diameter).
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- 2020
83. Diagnosis and management of moderate to severe atopic dermatitis in adolescents. A Consensus by the Italian Society of Dermatology and Venereology (SIDeMaST), the Italian Association of Hospital Dermatologists and Public Health (ADOI), the Italian Association of Hospital and Territorial Allergists and Immunologists (AAIITO), the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC), the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA), and the Italian Society of Pediatric Dermatology (SIDerP)
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Calzavara-Pinton, Piergiacomo, Belloni Fortina, Anna, Bonamonte, Domenico, Marseglia, Gian Luigi, Miraglia Del Giudice, Michele, Musarra, Antonino, Nettis, Eustachio, Neri, Iria, Patruno, Cataldo, Stingeni, Luca, Peris, Ketty, Giuseppe Argenziano, Anna G Burroni, Antonio Costanzo, Antonio Cristaudo, Francesco Cusano, May El Hachem, Gabriella Fabbrocini, Silvia M Ferrucci, Cesare Filippeschi, Caterina Foti, Elena Galli, Giampiero Girolomoni, Amelia Licari, Giovanna Malara, Giuseppe Micali, Luigi Naldi, Annamaria Offidani, Michela Ortoncelli, Michele Panzone, Aurora Parodi, Annalisa Patrizi, Giovanni Pellacani, Diego G Peroni, Paolo D Pigatto, Marco Romanelli, Franco Rongioletti, Gianenrico Senna, Calzavara-Pinton, Piergiacomo, Belloni Fortina, Anna, Bonamonte, Domenico, Marseglia, Gian Luigi, Miraglia Del Giudice, Michele, Musarra, Antonino, Nettis, Eustachio, Neri, Iria, Patruno, Cataldo, Stingeni, Luca, Peris, Ketty, Giuseppe, Argenziano, Anna, G Burroni, Antonio, Costanzo, Antonio, Cristaudo, Francesco, Cusano, May El Hachem, Fabbrocini, Gabriella, Silvia, M Ferrucci, Cesare, Filippeschi, Caterina, Foti, Elena, Galli, Giampiero, Girolomoni, Amelia, Licari, Giovanna, Malara, Giuseppe, Micali, Luigi, Naldi, Annamaria, Offidani, Michela, Ortoncelli, Michele, Panzone, Aurora, Parodi, Annalisa, Patrizi, Giovanni, Pellacani, Diego, G Peroni, Paolo, D Pigatto, Marco, Romanelli, Franco, Rongioletti, and Gianenrico, Senna
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Atopic dermatitis (AD) is a chronic inflammatory disease with increasing global incidence, which has a multifactorial pathogenesis and a variable expressivity. Clinical features of AD are different in adults compared to children, but it is well recognized the substantial impact of the disease on patients' quality of life at any age. Indeed, little is known about AD in adolescence, a period of life generally associated with high psychological burden and vulnerability to depression. Guidelines for the management of AD are available for both children and adults but specific guidelines for the diagnosis and treatment of AD in adolescents are lacking. Seven Italian scientific societies of dermatologists, allergists, and pediatric allergists joined in a specific meeting to provide practical guidance for the diagnosis and management of moderate-to-severe adolescent AD suitable for the Italian clinical practice. Through a modified Delphi procedure, consensus was reached by 59 Italian experts in the management of AD on 20 statements covering five areas of interest about adolescent AD, including disease complexity, burden and social impact, diagnosis and definition of severity, current treatments, and new biologic therapies. This paper reports recommendations for the diagnosis and management of AD specifically in adolescents, pointing out some peculiar clinical features and focusing on the choice of medications. Dupilumab, the first biologic approved for the treatment of adolescents with AD, represents a useful treatment option due to its efficacy and reassuring safety profile.
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- 2020
84. Lateral Wall Dysfunction Signals Onset of Progressive Heart Failure in Left Bundle Branch Block
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Espen W. Remme, John M Aalen, Erik Kongsgård, Otto A. Smiseth, Hava Izci, Jens U Voigt, C K Larsen, OJ Sletten, Erwan Donal, Per Anton Sirnes, Elena Galli, Jürgen Duchenne, Helge Skulstad, Einar Hopp, University of Oslo (UiO), Oslo University Hospital [Oslo], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], KU Leuven, Nasjonalforeningen for Folkehelsen, Jonchère, Laurent, Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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medicine.medical_specialty ,Cardiac & Cardiovascular Systems ,medicine.medical_treatment ,Bundle-Branch Block ,Cardiac resynchronization therapy ,heart failure ,cardiac resynchronization therapy ,Strain (injury) ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,strain ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,left bundle branch block ,PREDICTORS ,[SDV.IB] Life Sciences [q-bio]/Bioengineering ,Science & Technology ,CARDIOMYOPATHY ,LEFT-VENTRICULAR WORK ,business.industry ,Left bundle branch block ,septal rebound stretch ,Radiology, Nuclear Medicine & Medical Imaging ,Stroke Volume ,QUANTIFICATION ,medicine.disease ,myocardial work ,Treatment Outcome ,Bundle ,Heart failure ,Cardiovascular System & Cardiology ,Cardiology ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Cardiology and Cardiovascular Medicine ,Lateral wall ,business ,Life Sciences & Biomedicine ,SEPTAL DEFORMATION PATTERNS - Abstract
OBJECTIVES: This study sought to investigate if contractile asymmetry between septum and left ventricular (LV) lateral wall drives heart failure development in patients with left bundle branch block (LBBB) and whether the presence of lateral wall dysfunction affects potential for recovery of LV function with cardiac resynchronization therapy (CRT). BACKGROUND: LBBB may induce or aggravate heart failure. Understanding the underlying mechanisms is important to optimize timing of CRT. METHODS: In 76 nonischemic patients with LBBB and 11 controls, we measured strain using speckle-tracking echocardiography and regional work using pressure-strain analysis. Patients with LBBB were stratified according to LV ejection fraction (EF) ≥50% (EFpreserved), 36% to 49% (EFmid), and ≤35% (EFlow). Sixty-four patients underwent CRT and were re-examined after 6 months. RESULTS: Septal work was successively reduced from controls, through EFpreserved, EFmid, and EFlow (all p
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- 2021
85. Resolution of vascular inflammation in patients with new-onset giant cell arteritis: data from the RIGA study
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Georg Schett, Michael Uder, Filippo Crescentini, Massimiliano Casali, Giulia Corte, Elena Galli, Carlo Salvarani, Jessica Roth, Torsten Kuwert, Daniela Schmidt, Alexander Cavallaro, Lucia Spaggiari, Juergen Rech, Koray Tascilar, Luigi Boiardi, Francesco Muratore, Bernhard Manger, Verena Schönau, and Annibale Versari
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Male ,medicine.medical_specialty ,Combination therapy ,Prednisolone ,Giant Cell Arteritis ,Population ,Antibodies, Monoclonal, Humanized ,Gastroenterology ,methotrexate ,Antibodies ,tocilizumab ,Rheumatology ,Prednisone ,Positron Emission Tomography Computed Tomography ,Internal medicine ,Monoclonal ,80 and over ,medicine ,Humans ,Pharmacology (medical) ,education ,Glucocorticoids ,Humanized ,Aged ,Aged, 80 and over ,Inflammation ,education.field_of_study ,glucocorticoids ,treatment ,giant cell arteritis ,business.industry ,18F-fluorodeoxyglucose positron emission tomography/computed tomography ,Middle Aged ,medicine.disease ,large vessel vasculitis ,Antirheumatic Agents ,Female ,Methotrexate ,Treatment Outcome ,Discontinuation ,business ,Vasculitis ,Glucocorticoid ,medicine.drug - Abstract
Objectives Efficacy evaluation of GCA treatment is primarily based on non-specific symptoms and laboratory markers. We aimed to assess the change in vascular inflammation in patients with large vessel (LV)-GCA under different treatments using [18F]FDG PET/CT. Methods Observational study on patients with new-onset, active LV-GCA starting treatment with either prednisolone monotherapy (PRED) or combination with MTX or tocilizumab (TOC). All patients underwent baseline and follow-up PET/CT. The aorta and its major branches were assessed using PET vascular activity score (PETVAS) by independent readers. Cumulative glucocorticoid doses and cessation of glucocorticoid treatment were documented in all patients. Results We included 88 LV-GCA patients, 27 were treated with PRED, 42 with MTX and 19 with TOC. PETVAS decreased from 18.9–8.0 units at follow-up in the overall population (P Conclusion Treatment of LV-GCA inhibits vascular inflammation in the aorta and its major branches. While similar control of vascular inflammation was achieved with PRED, MTX and TOC treatments, TOC showed a strong glucocorticoid sparing effect, supporting the concept of initial combination therapy.
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- 2021
86. Definition of severe aortic stenosis: ‘A wise man points at the moon, the fool looks at the finger’ (Chinese proverb)
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Marc R. Dweck, Erwan Donal, Elena Galli, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], University of Edinburgh, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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medicine.medical_specialty ,business.industry ,General surgery ,Disease progression ,MEDLINE ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,Stenosis ,0302 clinical medicine ,Medicine ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
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- 2020
87. Myocardial work is a predictor of exercise tolerance in patients with dilated cardiomyopathy and left ventricular dyssynchrony
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Florian Schrub, Elena Galli, Erwan Donal, Frédéric Schnell, Laboratoire Traitement du Signal et de l'Image (LTSI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), CHU Pontchaillou [Rennes], and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Adult ,Cardiomyopathy, Dilated ,Male ,medicine.medical_specialty ,Dilated cardiomyopathy ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,03 medical and health sciences ,QRS complex ,Oxygen Consumption ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Exercise performance ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial work ,Ventricular dyssynchrony ,Cardiac imaging ,Aged ,Retrospective Studies ,Left ventricular dyssynchrony ,Exercise Tolerance ,Ejection fraction ,business.industry ,Stroke Volume ,Middle Aged ,Right bundle branch block ,medicine.disease ,Myocardial Contraction ,Echocardiography, Doppler ,Exercise Test ,Cardiology ,Female ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Cardiology and Cardiovascular Medicine ,business - Abstract
International audience; The assessment of myocardial work (MW) by pressure-strain loops is a recently introduced tool for the assessment of myocardial performance. Aim of the present study is to evaluate the relationship between myocardial work and exercise tolerance in patients with dilated cardiomyopathy (DCM). 51 patients with DCM (mean age 57 ± 13 years, left ventricular ejection fraction 32 ± 9%) underwent cardiopulmonary exercise test (CPET) to assess exercise performance. 22 patients (43%) had left or right bundle branch block with QRS duration > 120 ms. Trans-thoracic echocardiography (TTE) was performed before CPET. The following indices of myocardial work (MW) were measured regionally and globally constructive work (CW), wasted work (WW), and work efficiency (WE). Left ventricular dyssynchrony (LV-DYS) was defined by the presence of septal flash or apical rocking at TTE. LV-DYS was observed in 16 (31%) patients and associated with lower LV ejection fraction (LVEF), lower global and septal WE, and higher global and septal WW. In patients with LV-DYS, septal WE was the only predictor of exercise capacity at multivariable analysis (β = 0.68, p = 0.03), whereas LVEF (β = 0.47, p = 0.05) and age (β = - 0.42, p = 0.04) were predictors of exercise capacity in patients without LV-DYS. In patients with DCM, LV-DYS is associated with an heterogeneous distribution of myocardial work. Septal WE is the best predictor of exercise performance in these patients.
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- 2019
88. Response to ‘The Relevance of Restricted Inflammation in a TAB’ by Griffin KJ et al
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Alberto Cavazza, Elena Galli, Luigi Boiardi, Francesco Muratore, and Carlo Salvarani
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Anesthesiology and Pain Medicine ,Rheumatology ,business.industry ,Griffin ,Immunology ,medicine ,Inflammation ,Relevance (information retrieval) ,medicine.symptom ,business - Published
- 2021
89. Left ventricular strain for predicting the response to cardiac resynchronization therapy: two methods for one question
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Arnaud Hubert, Elena Galli, Alban Gallard, Christophe Leclercq, Jean-Uwe Voigt, Erwan Donal, Vincent Galand, Otto A. Smiseth, Alfredo Hernandez, Virginie Le Rolle, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Oslo University Hospital [Oslo], University of Oslo (UiO), Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), CHU Pontchaillou [Rennes], and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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2D longitudinal strain ,medicine.medical_specialty ,Longitudinal strain ,medicine.medical_treatment ,Cardiac resynchronization therapy ,cardiac resynchronization therapy ,heart failure ,030204 cardiovascular system & hematology ,myocardial work speckle tracking echocardiography ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Receiver operating characteristic ,business.industry ,Area under the curve ,General Medicine ,medicine.disease ,Heart failure ,Cardiology ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Cardiology and Cardiovascular Medicine ,business ,Left ventricular strain - Abstract
Aims Myocardial work (manually controlled software) and integral-derived longitudinal strain (automatic quantification of strain curves) are two promising tools to quantify dyssynchrony and potentially select the patients that are most likely to have a reverse remodelling due to cardiac resynchronization therapy (CRT). We sought to test and compare the value of these two methods in the prediction of CRT-response. Materials and results Two hundred and forty-three patients undergoing CRT-implantation from three European referral centres were considered. The characteristics from the six-segment of the four-chamber view were computed to obtain regional myocardial work and the automatically generated integrals of strain. The characteristics were studied in mono-parametric and multiparametric evaluations to predict CRT-induced 6-month reverse remodelling. For each characteristic, the performance to estimate the CRT response was determined with the receiver operating characteristic (ROC) curve and the difference between the performances was statistically evaluated. The best area under the curve (AUC) when only one characteristic used was obtained for a myocardial work (AUC = 0.73) and the ROC curve was significantly better than the others. The best AUC for the integrals was 0.63, and the ROC curve was not significantly greater than the others. However, with the best combination of works and integrals, the ROC curves were not significantly different and the AUCs were 0.77 and 0.72. Conclusion Myocardial work used in a mono-parametric estimation of the CRT-response has better performance compared to other methods. However, in a multiparametric application such as what could be done in a machine-learning approach, the two methods provide similar results.
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- 2021
90. Importance of systematic right ventricular assessment in cardiac resynchronization therapy candidates: a machine-learning approach
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Otto A. Smiseth, E. Sade, Virginie Le Rolle, C K Larsen, Martin Penicka, Erwan Donal, Elena Galli, John M Aalen, Jens-Uwe Voigt, Jürgen Duchenne, Smitha Anilkumar, Arnaud Hubert, Cecilia Linde, Alfredo Hernandez, Christophe Leclercq, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Oslo University Hospital [Oslo], University of Oslo (UiO), Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), Başkent University Hospital [Adana, Turkey], OLV Ziekenhuis [Aslst], Karolinska University Hospital [Stockholm], ANR-16-CE19-0008-01, Université de Lorraine, ANR-16-CE19-0008-01, Helse Sør-Øst RHF, ANR-16-CE19-0008-01, Agence Nationale de la Recherche, ANR-16-CE19-0008-01, Nasjonalforeningen for Folkehelsen, ANR-16-CE19-0008,MAESTRo,Approche à base de modèles pour l'analyse du strain obtenu en échocardiographie 3D(2016), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Jonchère, Laurent, and Approche à base de modèles pour l'analyse du strain obtenu en échocardiographie 3D - - MAESTRo2016 - ANR-16-CE19-0008 - AAPG2016 - VALID
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medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Cardiac resynchronization therapy ,cardiac resynchronization therapy ,heart failure ,030204 cardiovascular system & hematology ,right ventricle ,Machine learning ,computer.software_genre ,030218 nuclear medicine & medical imaging ,QRS complex ,03 medical and health sciences ,0302 clinical medicine ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Ventricular remodeling ,[SDV.IB] Life Sciences [q-bio]/Bioengineering ,Receiver operating characteristic ,business.industry ,Hazard ratio ,Area under the curve ,Stroke Volume ,General Medicine ,medicine.disease ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Treatment Outcome ,machine learning ,Feature (computer vision) ,Heart failure ,Cardiology ,cardiovascular system ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Artificial intelligence ,Cardiology and Cardiovascular Medicine ,business ,computer ,Heart Failure, Systolic - Abstract
Funding Acknowledgements Type of funding sources: None. Background Despite having all a systolic heart failure and broad QRS, patients proposed for cardiac resynchronization therapy (CRT) are highly heterogeneous and it remains extremely complicated to predict the impact of the device on left ventricular (LV) function and outcomes. Objectives We sought to evaluate the relative impact of clinical, electrocardiographic, and echocardiographic data on the left ventricular (LV) remodeling and prognosis of CRT-candidates by the application of machine learning (ML) approaches. Methods 193 patients with systolic heart failure undergoing CRT according to current recommendations were prospectively included in this multicentre study. We used a combination of the Boruta algorithm and random forest methods to identify features predicting both CRT volumetric response and prognosis (Figure 1). The model performance was tested by the area under the receiver operating curve (AUC). We also applied the K-medoid method to identify clusters of phenotypically-similar patients. Results From 28 clinical, electrocardiographic, and echocardiographic-derived variables, 16 features were predictive of CRT-response; 11 features were predictive of prognosis. Among the predictors of CRT-response, 7 variables (44%) pertained to right ventricular (RV) size or function. Tricuspid annular plane systolic excursion was the main feature associated with prognosis. The selected features were associated with a very good prediction of both CRT response (AUC 0.81, 95% CI: 0.74-0.87) and outcomes (AUC 0.84, 95% CI: 0.75-0.93) (Figure 1, Supervised Machine Learning Panel). An unsupervised ML approach allowed the identifications of two phenogroups of patients who differed significantly in clinical and parameters, biventricular size and RV function. The two phenogroups had significant different prognosis (HR 4.70, 95% CI: 2.1-10.0, p Conclusions Machine learning can reliably identify clinical and echocardiographic features associated with CRT-response and prognosis. The evaluation of both RV-size and function parameters has pivotal importance for the risk stratification of CRT-candidates and should be systematically assessed in patients undergoing CRT. Abstract Figure 1
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- 2021
91. Characterization of Responder Profiles for Cardiac Resynchronization Therapy through Unsupervised Clustering of Clinical and Strain Data
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Virginie Le Rolle, Erwan Donal, Jadranka Separovic-Hanzevacki, E. Sade, Alfredo Hernandez, Sylvestre Maréchaux, Arnaud Hubert, Elena Galli, Martha Sitges, Auriane Bidaut, Alban Gallard, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Başkent University Hospital [Adana, Turkey], Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL), Université de Picardie Jules Verne (UPJV), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Zagreb, Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
medicine.medical_specialty ,Longitudinal strain ,medicine.medical_treatment ,Cardiac resynchronization therapy ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,strain imaging ,030218 nuclear medicine & medical imaging ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Echocardiography ,Machine learning ,Mechanical dyssynchrony ,Remodeling ,Strain imaging ,Cluster Analysis ,Humans ,echocardiography ,mechanical dyssynchrony ,Radiology, Nuclear Medicine and imaging ,Cluster analysis ,remodeling ,Heart Failure ,Strain (chemistry) ,business.industry ,Significant difference ,Stroke Volume ,medicine.disease ,3. Good health ,Treatment Outcome ,machine learning ,Heart failure ,Cardiology ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Cardiology and Cardiovascular Medicine ,business ,Unsupervised clustering ,Lateral wall - Abstract
International audience; Background - The mechanisms of improvement of left ventricular (LV) function with cardiac resynchronization therapy (CRT) are not yet elucidated. The aim of this study was to characterize CRT responder profiles through clustering analysis, on the basis of clinical and echocardiographic preimplantation data, integrating automatic quantification of longitudinal strain signals. Methods - This was a multicenter observational study of 250 patients with chronic heart failure evaluated before CRT device implantation and followed up to 4 years. Clinical, electrocardiographic, and echocardiographic data were collected. Regional longitudinal strain signals were also analyzed with custom-made algorithms in addition to existing approaches, including myocardial work indices. Response was defined as a decrease of ≥15% in LV end-systolic volume. Death and hospitalization for heart failure at 4 years were considered adverse events. Seventy features were analyzed using a clustering approach (k-means clustering). Results - Five clusters were identified, with response rates between 50% in cluster 1 and 92.7% in cluster 5. These five clusters differed mainly by the characteristics of LV mechanics, evaluated using strain integrals. There was a significant difference in event-free survival at 4 years between cluster 1 and the other clusters. The quantitative analysis of strain curves, especially in the lateral wall, was more discriminative than apical rocking, septal flash, or myocardial work in most phenogroups. Conclusions - Five clusters are described, defining groups of below-average to excellent responders to CRT. These clusters demonstrate the complexity of LV mechanics and prediction of response to CRT. Automatic quantitative analysis of longitudinal strain curves appears to be a promising tool to improve the understanding of LV mechanics, patient characterization, and selection for CRT.
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- 2021
92. Association Between Specimen Length and Number of Sections and Diagnostic Yield of Temporal Artery Biopsy for Giant Cell Arteritis
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Nicolò Pipitone, Stefania Croci, Raffaella Aldigeri, Carlo Salvarani, Luigi Boiardi, Francesco Muratore, Luca Cimino, Giacomo Tiengo, Alberto Cavazza, Martina Bonacini, and Elena Galli
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Male ,Tissue Fixation ,Biopsy ,Giant Cell Arteritis ,H&E stain ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Predictive Value of Tests ,medicine ,Humans ,Aged ,030203 arthritis & rheumatology ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Mean age ,Microtomy ,Temporal artery biopsy ,Middle Aged ,medicine.disease ,Temporal Arteries ,Giant cell arteritis ,Female ,Specimen length ,Nuclear medicine ,business - Abstract
OBJECTIVE To investigate the association between specimen length and number of sections evaluated and the diagnostic yield of temporal artery biopsy (TAB) for giant cell arteritis (GCA). METHODS A pathologist reviewed all TABs performed for suspected GCA between January 1991 and December 2012. The blocks of all the inadequate and negative biopsy specimens were recut, and further slides at deeper levels were stained with hematoxylin and eosin in order to avoid missing inflammatory changes. RESULTS In total, findings from 662 TABs were included in the study (71% female; mean age 73.2 years). A total of 427 TAB specimens (65%) were classified as negative, and 235 (35%) were classified as positive for GCA. Compared to those with negative TAB results, patients with positive TAB results were older and more frequently female. There was no difference in postfixation TAB specimen length between TAB specimens negative and positive for GCA (mean 6.5 mm versus 6.9 mm; P = 0.068). Cuts of additional biopsy sections revealed inflammation at deeper levels in 26 of 408 TAB specimens (6.4%) originally reported as uninflamed. The inflamed section was the second in 14 TAB specimens, the third in 9 specimens, and the fourth in 3 specimens. Piecewise logistic regression identified 5 mm as the TAB specimen length change point for diagnostic sensitivity. Compared to a TAB specimen length of
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- 2021
93. Susceptibility to COVID-19 in Patients Treated With Antimalarials: A Population-Based Study in Emilia-Romagna, Northern Italy
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Giuliano Carrozzi, Anna Maria Marata, Nilla Viani, Francesco Muratore, Paolo Giorgi Rossi, Stefania Croci, Massimo Reta, Paolo Pandolfi, Gilda Sandri, Federica Gradellini, Massimo Costantini, Carlo Salvarani, Nicolò Pipitone, Pamela Mancuso, Luigi Boiardi, Gianluigi Bajocchi, Giulia Cassone, and Elena Galli
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Male ,Juvenile ,Arthritis, Rheumatoid ,chloroquine ,Chloroquine ,Rheumatoid ,80 and over ,Odds Ratio ,Lupus Erythematosus, Systemic ,Immunology and Allergy ,Cumulative incidence ,Aged, 80 and over ,education.field_of_study ,medicine.diagnostic_test ,Brief Report ,Discoid ,Adult ,Aged ,Antimalarials ,Antirheumatic Agents ,Arthritis, Juvenile ,Autoimmune Diseases ,COVID-19 ,Disease Susceptibility ,Female ,Humans ,Hydroxychloroquine ,Italy ,Lupus Erythematosus, Discoid ,Middle Aged ,SARS-CoV-2 ,medicine.drug ,medicine.medical_specialty ,hydroxychloroquine ,Immunology ,Population ,Throat culture ,Rheumatology ,COVID‐19 ,Internal medicine ,medicine ,Medical prescription ,education ,Lupus Erythematosus ,business.industry ,Arthritis ,Systemic ,Odds ratio ,Confidence interval ,Brief Reports ,business - Abstract
OBJECTIVE To evaluate the susceptibility to coronavirus disease 2019 (COVID-19) in patients with autoimmune conditions treated with antimalarials in a population-based study. METHODS All residents treated with chloroquine (CQ)/hydroxychloroquine (HCQ) from July through December 2019 and living in 3 provinces of Regione Emilia-Romagna were identified by drug prescription registries and matched with the registry containing all residents living in the same areas who have had swabs and tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS A total of 4,408 patients were identified. The prevalence of patients receiving antimalarials was 0.85 per 1,000 men and 3.3 per 1,000 women. The cumulative incidence of testing during the study period was 2.7% in the general population and 3.8% among those receiving CQ or HCQ, while the cumulative incidence of testing positive was 0.55% in the general population and 0.70% among those receiving CQ/HCQ. Multivariate models showed that those receiving CQ/HCQ had a slightly higher probability of being tested compared to the general population (OR 1.09 [95% CI 0.94-1.28]), the same probability of being diagnosed as having COVID-19 (OR 0.94 [95% CI 0.66-1.34]), and a slightly lower probability of being positive once tested (OR 0.83 [95% CI 0.56-1.23]). None of the differences were significant. CONCLUSION Our findings do not support the use of antimalarials as a prophylactic treatment of COVID-19.
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- 2021
94. Elevated septal wall stress - a driver of left ventricular dysfunction in left bundle branch block?
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J-U Voigt, Hava Izci, Jürgen Duchenne, Helge Skulstad, C K Larsen, Einar Hopp, OJ Sletten, Erwan Donal, Per Anton Sirnes, Espen W. Remme, John M Aalen, Elena Galli, Erik Kongsgård, and Otto A. Smiseth
- Subjects
Stress (mechanics) ,medicine.medical_specialty ,Left bundle branch block ,business.industry ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Septal wall - Abstract
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association Background Septal dysfunction is a main feature of left bundle branch block (LBBB), and increasing wall stress is a proposed mechanism of heart failure development in LBBB patients. To try to reveal the pathophysiologic pathway from dyssynchrony to heart failure, we investigated the relationship between septal and left ventricular (LV) lateral wall stress in patients with LBBB. Hypothesis Increased septal wall stress causes septal dysfunction in LBBB. Methods We included 24 LBBB-patients (65 ± 11 years, 11 males) with LV ejection fraction (EF) ranging from 18 to 67%, and 8 healthy controls (58 ± 10 years, 4 males). Wall stress was calculated at peak LV pressure (LVP) according to the law of La Place ([LVP x radius]/[wall thickness]). Wall thickness was measured using M-mode, and regional curvature was measured in mid-ventricular shortaxis from 2D echocardiographic images. We used a previously validated non-invasive method to estimate LVP from brachial blood pressure and adjusted for valvular events. Myocardial scar was ruled out by late gadolinium enhancement cardiac magnetic resonance imaging. Results Wall stress was significantly higher in septum than LV lateral wall at peak LVP (48 ± 12 vs 37 ± 11 kPa, p Conclusion Increased septal wall stress is associated with reduced systolic thickening in patients with LBBB. Septal wall thickening, in contrast to LV lateral wall thickening, was correlated to global LV function. These findings suggest that septal remodeling which could have normalized septal wall stress, was not achieved and heart failure may develop. Abstract Figure.
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- 2021
95. The management of large vessel vasculitides
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Gilda Sandri, Chiara Marvisi, Carlo Umberto Manzini, Elena Galli, and Carlo Salvarani
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030203 arthritis & rheumatology ,medicine.medical_specialty ,business.industry ,Takayasu arteritis ,Large vessel ,medicine.disease ,Treatment efficacy ,03 medical and health sciences ,Giant cell arteritis ,Therapeutic approach ,0302 clinical medicine ,Toxicity ,medicine ,General Earth and Planetary Sciences ,030212 general & internal medicine ,Vasculitis ,business ,Intensive care medicine ,Progressive disease ,General Environmental Science - Abstract
Giant cell arteritis (GCA) and Takayasu arteritis (TAK) represent the most common large vessel vasculitides (LVV). An early recognition of these conditions is crucial in order to start a prompt treatment to prevent severe ischemic complications, such as irreversible visual loss in GCA and cardiovascular or cerebrovascular accidents in TAK. Isolated glucocorticoids (GCs) still remain the cornerstone of GCA therapy. However, long-term treatment with GCs is burdened by an important toxicity. Furthermore, relapses are frequent during the follow-up period and relapsing patients have to cope with a longer duration of the GC therapy and a higher cumulative GC dose. On the other hand, TAK treatment usually relies on immunosuppressors in addition to GCs from the beginning. Also, since TAK patients are in general young women with a progressive disease, it is essential to treat this vasculitis with steroidsparing drugs in order to avoid excessive GC exposure. For this reason, efforts have been made to discover new therapeutic options able to reduce the cumulative GC dose that is strictly related to GC-toxicity. In recent years, new advances in the management of LVV have become available and have changed the therapeutic approach to these diseases. The aim of this review is to report new evidence of treatment efficacy and safety in LVV.
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- 2021
96. Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan
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Elena Galli, Arnaud Hubert, Erwan Donal, Christophe Leclercq, Yanis Bouali, and Alban Gallard
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medicine.medical_specialty ,Ejection fraction ,business.industry ,General Medicine ,medicine.disease ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Sacubitril, Valsartan - Abstract
Funding Acknowledgements Type of funding sources: None. Background the non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs). Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients. Methods 79 patients with HFrEF (mean age: 66 ± 12 years; LV ejection fraction: 28 ± 9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan. Results Sacubitril/Valsartan significantly increased myocardial constructive work (CW) (1023 ± 449 vs 1424 ± 484 mmHg%, p Conclusions in patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs. Univariable analysis Multivariable analysis HR (95% CI) p-value HR (95% CI) p-value Age, per year 0.99 (0.95-1.04) 0.81 Ischemic cardiomyopathy 1.07 (0.36-3.21) 0.89 LVEDVi*, per ml/m2 1.01 (1.00-1.03) 0.03 LVESVi, per ml/m2 1.01 (1.00-1.03) 0.009 1.01 (0.99-1.02) 0.35 LVEF, per % 0.91 (0.85-0.98) 0.01 1.02 (0.93-1.12) 0.71 CW, per mmHg% 0.99 (0.99-1.00) 0.002 0.99 (0.99-1.00) 0.04 WE, per mmHg% 0.91 (0.86-0.96) 0.001 0.95 (0.88-1.02) 0.16 Predictors of MACEs at univariable and multivariable analysis Abstract Figure 1 A and B
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- 2021
97. Incidence and prevalence of large vessel vasculitis (giant cell arteritis and Takayasu arteritis) in northern Italy: A population-based study
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Carlo Salvarani, Pamela Mancuso, Chiara Marvisi, Elena Galli, Francesco Muratore, Pierluigi Macchioni, Luigi Boiardi, Paolo Giorgi Rossi, and G. Restuccia
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medicine.medical_specialty ,Epidemiology ,Population ,Takayasu arteritis ,Giant Cell Arteritis ,Rheumatology ,immune system diseases ,Large vessel vasculitis ,Internal medicine ,medicine ,Prevalence ,Humans ,cardiovascular diseases ,skin and connective tissue diseases ,education ,Aged ,Giant cell arteritis ,Aged, 80 and over ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Incidence ,Middle Aged ,medicine.disease ,Takayasu Arteritis ,Northern italy ,Anesthesiology and Pain Medicine ,Italy ,cardiovascular system ,business ,Rare disease - Abstract
Objectives To investigate the epidemiology of the entire spectrum of large vessel vasculitis (LVV) in a well-defined population from a Northern Italian area. Methods All patients with incident giant cell arteritis (GCA) diagnosed from 2005 to 2016 and all patients with incident Takayasu arteritis (TAK) diagnosed from 1998 to 2016 living in the Reggio Emilia area were identified. Only patients satisfying the modified inclusion criteria of the GiACTA trial, and the 1990 ACR classification criteria for TAK were included. The epidemiology of cranial- and LV-GCA was separately evaluated. Results 207 patients were diagnosed with GCA and 5 with TAK. 123 patients had cranial-GCA, 53 patients had LV-GCA, and the remaining 31 patients had overlapping features. The standardized annual incidence rate of GCA was 8.3 (95% CI 7.1, 9.4) per 100,000 population ages ≥50 years. The standardized annual incidence rate of cranial-GCA (6.1 [95% CI 5.1, 7.1] per 100,000 population ages ≥50 years) was double the rate of LV-GCA (3.4 [95% CI 2.7, 4.2]). The age-specific incidence rates were similar in the 90 years age groups, but they were higher in cranial-GCA than in LV-GCA in the age groups 70–79 and 80–89 years. The age- and sex-adjusted annual incidence rate of TAK was 0.5 (95% CI 0.1, 1.2) per 1,000,000 population. Conclusion Incidence of GCA is higher than previously reported by study evaluating only biopsy-proven or ACR classification criteria confirmed cases. Cranial-GCA and LV-GCA have epidemiological differences. TAK is an extremely rare disease also in Italy.
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- 2021
98. Localizing myocardial scar on echocardiography. How good does it work in the presence of conduction delays?
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Elena Galli, Jens-Uwe Voigt, Ahmed S Beela, Oana Mirea, Jan Bogaert, Erwan Donal, A Petrescu, Serkan Ünlü, Martin Penicka, Ganna Degtiarova, Jürgen Duchenne, Marta Cvijic, and I Stankovic
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medicine.medical_specialty ,Work (thermodynamics) ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,Thermal conduction ,business - Abstract
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation - Flanders (FWO) Introduction Myocardial scar detection with echocardiography in patients with ischemic heart disease typically relies on semi-quantitative evaluation of regional systolic wall thickening. In patients scheduled for cardiac resynchronization therapy (CRT) however, such echo scar estimation is complicated by the presence of dyssynchronous contraction and differential regional remodelling. Visual assessment of myocardial shortening during systole may be an alternative approach. We tested this against cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) in patients without and with conduction delay. Methods 122 patients with ischemic heart disease were included (n = 58 without, and n = 64 with conduction delay). Scar burden of the LV was determined in all patients on a segmental level in both CMR and echo. Reading of echo was blinded for CMR data and vice versa. Myocardial scar was defined as LGE > 50% of transmural thickness. On echo, scar was assessed visually, and defined as thin, echogenic myocardium with no visible shortening during systole. Analysis was performed per segment (18 segment model), and per region (6 walls with basal and mid segment and the apex region consisting of all apical segments). An additional analysis was performed with a tolerance of one adjacent segment in order to account for potential image misalignment between modalities. Results 2196 segments were available for comparison between echo and CMR. On CMR, 548 of those segments were defined as having >50% transmural scar. In echo, 565 segments were detected as having scar. On a segmental level, no difference was found for the correct assignment of segments by echo as having scar or not between patients without or with conduction delay (AUC 0.79 vs. 0.79; p = 0.968) (Figure, top panels). See Figure for sensitivity and specificity. If one segment tolerance was allowed, segments were correctly assigned with equal accuracy in both patient groups (AUC 0.98 vs. 0.96; p = 0.999) (see Figure; w. tolerance). Agreement on the level of LV regions was comparable. 295 regions had a scar on CMR while 286 regions were identified by echo. Echo correctly identified a scar in the same LV wall or apex as compared to CMR similarly in patients without or with conduction delay (AUC 0.79 vs. 0.77; p = 0.698). If one segment tolerance was allowed, correct identification improved further and was not different between both groups (AUC 0.93 vs. 0.91; p = 0.999). The extent of a scar was slightly underestimated (9%) by echocardiography in comparison to CMR in patients without, and slightly overestimated (3%) in patients with conduction delays. Conclusions Scars can be localized on echocardiography with good agreement to CMR-LGE as gold standard. The match between echo and CMR was similar for patients with and without conduction delay. Our findings demonstrate that echo can provide a valid impression of localization and extent of myocardial scar, even in the presence of conduction delays. Abstract Figure.
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- 2021
99. Regional myocardial work as determinant of heart failure in left bundle branch block
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J-U Voigt, Hava Izci, Espen W. Remme, Einar Hopp, John M Aalen, Helge Skulstad, OJ Sletten, Erwan Donal, Per Anton Sirnes, Otto A. Smiseth, Elena Galli, Erik Kongsgård, Jürgen Duchenne, and C K Larsen
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medicine.medical_specialty ,Work (electrical) ,Left bundle branch block ,business.industry ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Abstract
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association Background Left bundle branch block (LBBB) worsen prognosis in heart failure patients. LBBB may also cause heart failure in otherwise healthy individuals. The mechanical changes induced by LBBB are potential determinants of heart failure in these patients, but their relation to left ventricular (LV) systolic function is incompletely understood. Purpose This study investigates the contribution of regional contractile function to heart failure in patients with LBBB. Methods In 76 patients with LBBB and 11 healthy controls, myocardial strain was measured by speckle-tracking echocardiography and myocardial work by pressure-strain analysis. Patients with ischemic heart disease or myocardial scarring were excluded. LBBB patients were stratified by LV ejection fraction (EF) >50% (EFpreserved), 36-50% (EFmid), and ≤35% (EFlow). 62 LBBB patients subsequently underwent cardiac resynchronization therapy (CRT) implantation and was re-examined at 6 months. Results Septal work was significantly and successively reduced from controls, EFpreserved, EFmid, to EFlow (1977 ± 506, 1025 ± 342, 601 ± 494 and -41 ± 303 mmHg·%, respectively, all p 35% (NS). At six month CRT septal work was markedly increased (165 ± 485 vs 1288 ± 523 mmHg·%, p Conclusions Heart failure in LBBB patients is determined by degree of septal dysfunction. LV lateral wall function, on the other hand, is preserved in the early phase of heart failure and was only reduced in patients with severe heart failure. Further clinical studies should investigate if measuring LV lateral wall function can increase precision in patient selection for CRT. Abstract Figure.
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- 2021
100. 1311P The role of inflammatory biomarkers in advanced non-small cell lung cancer patients treated with chemo-immunotherapy
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Sara Manglaviti, Claudia Proto, Giulia Galli, Laura Mazzeo, Mario Occhipinti, Monica Ganzinelli, F. de Braud, Giacomo Massa, Giulia Apollonio, Roberto Ferrara, A. De Toma, Elena Galli, Emma Zattarin, A. Prelaj, Marta Brambilla, G. Lo Russo, Teresa Beninato, A. Bottiglieri, and M.C. Garassino
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Oncology ,business.industry ,Cancer research ,Medicine ,Hematology ,Non small cell ,business ,Lung cancer ,medicine.disease ,Inflammatory biomarkers ,Chemo immunotherapy - Published
- 2021
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