322 results on '"Michele Correale"'
Search Results
102. Disease-modifier Drugs in Patients with Advanced Heart Failure: How to Optimize Their Use?
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Massimo, Iacoviello, Enrica, Vitale, Maria Delia, Corbo, Michele, Correale, and Natale Daniele, Brunetti
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Heart Failure ,Hospitalization ,Ventricular Dysfunction, Left ,Pharmaceutical Preparations ,Humans ,Stroke Volume - Abstract
Therapy based on disease-modifier drugs is among the required criteria to diagnose advanced heart failure (AdvHF). Nevertheless, several conditions, such as hospitalization, hypotension, renal dysfunction, electrolyte abnormalities, medical inertia, and patients' adherence, can make the maintenance of optimal medical therapy in patients with AdvHF challenging. Moreover, in recent years, new classes of drugs able have been shown to be able to further modify the natural history of heart failure with reduced ejection fraction, but they are still not widely adopted. This article discusses the optimal use of disease-modifier drugs in patients with AdvHF as well as the possible usefulness of the new therapeutic opportunities.
- Published
- 2021
103. Predictors of right ventricular function improvement with sacubitril/valsartan in a real-life population of patients with chronic heart failure
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Natale Daniele Brunetti, Lucia Tricarico, Raffaele Mennella, Michele Magnesa, Michele Correale, Salvatore Tucci, Martino Fortunato, Alessandra Leopizzi, Adriana Mallardi, and Pietro Mazzeo
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Male ,medicine.medical_specialty ,Physiology ,Population ,Doppler imaging ,Sacubitril ,Ventricular Function, Left ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,education ,Aged ,Heart Failure ,education.field_of_study ,Ejection fraction ,Ventricular function ,business.industry ,Aminobutyrates ,Biphenyl Compounds ,Stroke Volume ,General Medicine ,medicine.disease ,Drug Combinations ,Valsartan ,Heart failure ,Cardiology ,Ventricular Function, Right ,Female ,business ,Sacubitril, Valsartan ,medicine.drug - Abstract
BACKGROUND Observational studies have demonstrated that treatment with sacubitril/valsartan may improve left ventricular (LV) systolic and diastolic function in subjects with reduced LV ejection fraction (LVEF) in real-world studies. Subjects with heart failure and reduced EF (HFrEF), however, are also characterized by an impaired right ventricular (RV) function. We therefore aimed to evaluate whether also RV function may improve after S/V therapy and possible predictors of RV improvement could be identified at echocardiography and tissue Doppler imaging. METHODS Fifty consecutive patients (67 ± 8 years, LVEF 28 ± 6%, male 86%) with chronic HFrEF and NYHA class II-III were followed up for 6 months after therapy with S/V. LV&RV function was assessed at baseline and after 6 months of therapy. RESULTS After 6-month therapy with S/V a significant improvement was shown in the following echocardiography parameters assessing RV function: PAsP (31 ± 11 vs. 35 ± 10 mmHg, p
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- 2021
104. Biomarkers in Cardiorenal Syndrome
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Michele Correale, Vito Di Terlizzi, Roberta Barone, Massimo Iacoviello, Natale Daniele Brunetti, and Giovanni Goffredo
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medicine.medical_specialty ,cardio-renal syndrome ,Renal function ,heart failure ,Review ,Cardiorenal syndrome ,Clinical manifestation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Cardio-Renal Syndrome ,medicine ,In patient ,030212 general & internal medicine ,Intensive care medicine ,Kidney ,business.industry ,renal function ,Acute kidney injury ,biomarkers ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,acute kidney injury ,Heart failure ,Medicine ,business - Abstract
Cardiorenal syndrome is a clinical manifestation of the bidirectional interaction between the heart and kidney diseases. Over the last years, in patients with cardiovascular diseases, several biomarkers have been studied in order to better assess renal function as well as to identify patients prone to experiencing chronic or acute worsening of renal function. The aim of this review is to focus on the possible clinical usefulness of the most recent biomarkers in the setting of cardiorenal syndrome.
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- 2021
105. Predictors of clinical improvement with sacubitril/valsartan in a real world population with chronic heart failure
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Lucia Tricarico, Matteo Di Biase, Ennio Sascia Formica, Ilenia Monaco, Giuseppina Padovano, Armando Ferraretti, Massimo Iacoviello, Natale Daniele Brunetti, Giuseppina Merolla, Michele Correale, and Valeria Tozzi
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Male ,medicine.medical_specialty ,MEDLINE ,Angiotensin Receptor Antagonists ,Heart Rate ,Outcome Assessment, Health Care ,medicine ,Humans ,Mortality ,Intensive care medicine ,business.industry ,Aminobutyrates ,Biphenyl Compounds ,General Medicine ,World population ,Middle Aged ,Prognosis ,medicine.disease ,Hospitalization ,Drug Combinations ,Treatment Outcome ,ROC Curve ,CA-125 Antigen ,Heart failure ,Valsartan ,Female ,Cardiology and Cardiovascular Medicine ,business ,Sacubitril, Valsartan ,Heart Failure, Systolic - Published
- 2020
106. Meet the Editorial Board Member
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Michele Correale
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Pharmacology ,Hematology ,Cardiology and Cardiovascular Medicine - Published
- 2022
107. Cardiac and Vascular Impairment in Patients with Mild Psoriasis: A Longitudinal Study
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Roberto Licordari, Michele Correale, Claudio Guarneri, Francesca Parisi, Francesco Borgia, Giuseppe Dattilo, Egidio Imbalzano, Elisabetta Demurtas, Matteo Casale, and Marianna Gigliotti De Fazio
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Pharmacology ,Longitudinal study ,medicine.medical_specialty ,business.industry ,MEDLINE ,Heart ,medicine.disease ,Severity of Illness Index ,Internal medicine ,Psoriasis ,Humans ,Medicine ,In patient ,Longitudinal Studies ,Cardiology and Cardiovascular Medicine ,business - Published
- 2022
108. Non-cardiovascular comorbidities in heart failure patients and their impact on prognosis
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Michele, Correale, Stefania, Paolillo, Valentina, Mercurio, Gaetano, Ruocco, Carlo G, Tocchetti, and Alberto, Palazzuoli
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Heart Failure ,Chronic Disease ,Diabetes Mellitus ,Humans ,Multicenter Studies as Topic ,Comorbidity ,Prognosis - Abstract
With the aging of the population and improvement of life expectancy of patients with heart disease, there is an increase in non-cardiovascular (CV) comorbidities affecting chronic heart failure (HF) patients. The increased prevalence of different CV and non-CV comorbidities is a rising problem in the management of patients with HF, mostly because these comorbidities may lead to poor prognosis, increase of hospitalizations and mortality rate. Recently, important data from multicenter randomized studies point to diabetes mellitus or iron deficiency as new pharmacological targets, and this highlights the need of broad expertise for the 21st-century cardiologist. The management of HF should take into account non-CV comorbidities. In this review, we discuss novel aspects of non-CV comorbidities in HF patients and emphasize the impact on prognosis.
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- 2021
109. The Evolving Phenotypes of Cardiovascular Disease during COVID-19 Pandemic
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Vincenzo Ceci, Michele Correale, Francesca Croella, Pietro Mazzeo, Martino Fortunato, Natale Daniele Brunetti, Matteo Di Biase, Massimo Iacoviello, Michele Magnesa, Alessandra Puteo, Adriana Mallardi, Alessandra Leopizzi, and Lucia Tricarico
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medicine.medical_specialty ,Acute coronary syndrome ,Coronavirus disease 2019 (COVID-19) ,Disease ,Review Article ,030204 cardiovascular system & hematology ,Arrhythmias ,03 medical and health sciences ,0302 clinical medicine ,Pandemic ,Medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Intensive care medicine ,Pharmacology ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,General Medicine ,Atrial arrhythmias ,medicine.disease ,Cardiovascular disease ,Thrombosis ,Phenotype ,Heart failure ,Cardiology and Cardiovascular Medicine ,business - Abstract
COVID-19 pandemic has negatively impacted the management of patients with acute and chronic cardiovascular disease: acute coronary syndrome patients were often not timely reperfused, heart failure patients not adequately followed up and titrated, atrial arrhythmias not efficaciously treated and became chronic. New phenotypes of cardiovascular patients were more and more frequent during COVID-19 pandemic and are expected to be even more frequent in the next future in the new world shaped by the pandemic. We therefore aimed to briefly summarize the main changes in the phenotype of cardiovascular patients in the COVID-19 era, focusing on new clinical challenges and possible therapeutic options.
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- 2021
110. New Targets in Heart Failure Drug Therapy
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Matteo Di Biase, Michele Correale, Lucia Tricarico, Martino Fortunato, Natale Daniele Brunetti, Savina Nodari, and Pietro Mazzeo
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medicine.medical_specialty ,Poor prognosis ,Hemodynamics ,heart failure ,Coronary microcirculation ,Review ,030204 cardiovascular system & hematology ,Cardiovascular Medicine ,Microcirculation ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,medicine ,Diseases of the circulatory (Cardiovascular) system ,030212 general & internal medicine ,Intensive care medicine ,business.industry ,drug therapy ,inflammation ,interstitium ,micro-circulation ,therapy targets ,medicine.disease ,Heart failure ,RC666-701 ,Cardiology and Cardiovascular Medicine ,business - Abstract
Despite recent advances in chronic heart failure management (either pharmacological or non-pharmacological), the prognosis of heart failure (HF) patients remains poor. This poor prognosis emphasizes the need for developing novel pathways for testing new HF drugs, beyond neurohumoral and hemodynamic modulation approaches. The development of new drugs for HF therapy must thus necessarily focus on novel approaches such as the direct effect on cardiomyocytes, coronary microcirculation, and myocardial interstitium. This review summarizes principal evidence on new possible pharmacological targets for the treatment of HF patients, mainly focusing on microcirculation, cardiomyocyte, and anti-inflammatory therapy.
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- 2021
111. Noncardiovascular comorbidities in patients with heart failure and their impact on prognosis
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Michele Correale, Carlo G. Tocchetti, Gaetano Ruocco, Stefania Paolillo, Alberto Palazzuoli, and Valentina Mercurio
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medicine.medical_specialty ,education.field_of_study ,Poor prognosis ,Heart disease ,business.industry ,Mortality rate ,Population ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Heart failure ,medicine ,Life expectancy ,Cardio oncology ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,education ,business - Abstract
With the aging of the population and improvement of life expectancy of patients with heart disease, there is an increase in non-cardiovascular (CV) comorbidities affecting chronic heart failure (HF) patients. The increased prevalence of different CV and non-CV comorbidities is a rising problem in the management of patients with HF, mostly because these comorbidities may lead to poor prognosis, increase of hospitalizations and mortality rate. Recently, important data from multicenter randomized studies point to diabetes mellitus or iron deficiency as new pharmacological targets, and this highlights the need of broad expertise for the 21st-century cardiologist. The management of HF should take into account non-CV comorbidities. In this review, we discuss novel aspects of non-CV comorbidities in HF patients and emphasize the impact on prognosis.
- Published
- 2021
112. Delirium in heart failure
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Claudia Altamura, Natale Daniele Brunetti, Matteo Di Biase, Michele Correale, Michela Perrella, Lucia Tricarico, Antonello Bellomo, Stefania Malerba, Mario Altamura, Raffaella Carnevale, and Anna Maria Gallotta
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Heart Failure ,medicine.medical_specialty ,business.industry ,Incidence ,health care facilities, manpower, and services ,education ,Delirium ,030204 cardiovascular system & hematology ,Global Health ,medicine.disease ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,Multidisciplinary approach ,Heart failure ,mental disorders ,medicine ,Humans ,030212 general & internal medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,health care economics and organizations - Abstract
Despite relative frequency of delirium in elderly hospitalized heart failure patients, skills and expertise in managing such complication are usually poor for physicians and nurses facing this clinical condition. International guidelines on heart failure do not provide detailed indication for such clinical condition, and evidence on this topic is limited. A multi-disciplinary approach (cardiologists, internists, geriatricians, psychologists, and psychiatrists) is often required; this review will therefore focus on diagnosis and clinical management of delirium in heart failure patients from a multidisciplinary point of view.
- Published
- 2019
113. Advanced heart failure: non-pharmacological approach
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Monica Sicuranza, Michele De Bonis, Matteo Di Biase, Ilenia Monaco, Natale Daniele Brunetti, Annamaria Maiorano, Antonio Centola, Dario Bottigliero, Antonino Teri, Michele Correale, Benedetto Del Forno, Lucia Tricarico, Giulia Godeas, Rossella Perulli, Correale, Michele, Monaco, Ilenia, Tricarico, Lucia, Bottigliero, Dario, Sicuranza, Monica, Del Forno, Benedetto, Godeas, Giulia, Teri, Antonino, Maiorano, Annamaria, Perulli, Rossella, Centola, Antonio, De Bonis, Michele, Di Biase, Matteo, and Brunetti, Natale Daniele
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Ablation Techniques ,Male ,medicine.medical_specialty ,Poor prognosis ,Advanced heart failure ,medicine.medical_treatment ,Heart transplantation ,030204 cardiovascular system & hematology ,Cardiac Resynchronization Therapy ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Non pharmacological ,Aged ,Aged, 80 and over ,Heart Failure ,business.industry ,Mitral Valve Insufficiency ,medicine.disease ,Chronic heart failure ,Ventricular assistance ,Current management ,Heart failure ,Tachycardia, Ventricular ,Heart Transplantation ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patients with advanced heart failure have poor prognosis despite traditional pharmacological therapies. The early identification of these subjects would allow them to be addressed on time in dedicated centers to select patients eligible for heart transplantation or ventricular assistance. In this article we will report the current management of these patients based on latest international guidelines, underlining some critical aspects, with reference to future perspectives.
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- 2019
114. Malignancies and outcome in Takotsubo syndrome: a meta-analysis study on cancer and stress cardiomyopathy
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Ingo Eitel, Nicola Tarantino, Francesca Guastafierro, Thomas Stiermaier, Matteo Di Biase, Michele Correale, Luisa De Gennaro, Christian Möller, Natale Daniele Brunetti, and Francesco Santoro
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medicine.medical_specialty ,Cardiomyopathy ,Comorbidity ,030204 cardiovascular system & hematology ,Malignancy ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Takotsubo Cardiomyopathy ,Neoplasms ,Internal medicine ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,business.industry ,Cancer ,Retrospective cohort study ,Prognosis ,medicine.disease ,Confidence interval ,Relative risk ,Meta-analysis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Takotsubo syndrome (TTS) can be induced by a large variety of physical/emotional triggers; several cases, however, are related to either an overt or occult malignancy, as shown in retrospective studies and case reports. The aim of this study was therefore to evaluate the clinical outcome of patients with TTS and cancer in a meta-analysis study. In June 2018, a Pubmed systematic research was conducted for studies assessing outcome in patients with TTS and cancer. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% confidence intervals (CIs) for adverse events at follow-up. After paper retrieval, four studies were included in the meta-analysis, with a total of 123,563 patients. The prevalence of current or previous malignancy among patients admitted with TTS was 6.7% (8258 patients). When compared to control patients, patients with cancer showed an increased risk of clinical events (RR 3.24, 95% CI 3.04–3.45, p
- Published
- 2019
115. Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years
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Alice Bonomi, Piergiuseppe Agostoni, Mariantonietta Cicoira, Elisabetta Salvioni, Michele Correale, Gianfranco Parati, Massimo F Piepoli, Rosa Raimondo, Domenico Scrutinio, Stefania Paolillo, Rocco Lagioia, Ugo Corrà, Andrea Di Lenarda, Maurizio Bussotti, Marco Metra, Gaia Cattadori, Fabrizio Veglia, Francesco Clemenza, Simone Binno, Claudio Passino, Michele Senni, Gianfranco Sinagra, Maria Frigerio, Michele Emdin, Angela Beatrice Scardovi, Roberto Badagliacca, Marco Guazzi, Aldo P. Maggioni, Giuseppe Limongelli, Federica Re, Pasquale Perrone Filardi, Elisa Battaia, Giuseppe Pacileo, Carlo Vignati, Susanna Sciomer, Carlo Lombardi, Chiara Minà, Damiano Magrì, and Massimo Mapelli
- Subjects
Heart transplantation ,medicine.medical_specialty ,education.field_of_study ,business.industry ,medicine.medical_treatment ,Population ,medicine.disease ,Oxygen uptake ,Confidence interval ,Ventricular assist device ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,education ,business ,human activities ,Respiratory minute volume ,Peak exercise - Abstract
Aims: Exercise-derived parameters, specifically peak exercise oxygen uptake (peak VO2) and minute ventilation/carbon dioxide relationship slope (VE/VCO2 slope), have a pivotal prognostic value in heart failure (HF). It is unknown how the prognostic threshold of peak VO2 and VE/VCO2 slope has changed over the last 20 years in parallel with HF prognosis improvement. Methods and results: Data from 6083 HF patients (81% male, age 61 ± 13 years), enrolled in the MECKI score database between 1993 and 2015, were retrospectively analysed. By enrolment year, four groups were generated: group 1 1993–2000 (n = 440), group 2 2001–2005 (n = 1288), group 3 2006–2010 (n = 2368), and group 4 2011–2015 (n = 1987). We compared the 10-year survival of groups and analysed how the overall risk (cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation) changed over time according to peak VO2 and VE/VCO2 slope and to major clinical and therapeutic variables. At 10 years, a progressively higher survival from group 1 to group 3 was observed, with no further improvement afterwards. A 20% risk for peak VO2 15 mL/min/kg (95% confidence interval 16–13), 9 (11–8), 4 (4–2) and 5 (7–4) was observed in group 1, 2, 3, and 4, respectively, while the VE/VCO2 slope value for a 20% risk was 32 (37–29), 47 (51–43), 59 (64–55), and 57 (63–52), respectively. Conclusions: Heart failure prognosis improved over time up to 2010 in a HF population followed by experienced centres. The peak VO2 and VE/VCO2 slope cut-offs identifying a definite risk progressively decreased and increased over time, respectively. The prognostic threshold of peak VO2 and VE/VCO2 slope must be updated whenever HF prognosis improves.
- Published
- 2019
116. Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation
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Michele Correale, Domenico Scrutinio, Stefania Paolillo, Gaia Cattadori, Marco Metra, Gianfranco Sinagra, Jeness Campodonico, Giuseppe Pacileo, Simone Binno, Massimo Mapelli, Angela Beatrice Scardovi, Marco Guazzi, Carlo Vignati, Susanna Sciomer, Massimo F Piepoli, Michele Emdin, Claudio Passino, Elisa Battaia, Pasquale Perrone Filardi, Andrea Di Lenarda, Piergiuseppe Agostoni, Carlo Lombardi, Fabrizio Veglia, Aldo P. Maggioni, Damiano Magrì, Giuseppe Limongelli, Chiara Minà, Federica Re, Elisabetta Salvioni, Maurizio Bussotti, Ugo Corrà, Francesco Clemenza, Michele Senni, Roberto Badagliacca, Rosa Raimondo, Rocco Lagioia, Alice Bonomi, Mariantonietta Cicoira, Maria Frigerio, Enrico Perna, Gianfranco Parati, Campodonico, Jene, Piepoli, Massimo, Clemenza, Francesco, Bonomi, Alice, Paolillo, Stefania, Salvioni, Elisabetta, Corrà, Ugo, Binno, Simone, Veglia, Fabrizio, Lagioia, Rocco, Sinagra, Gianfranco, Cattadori, Gaia, Scardovi, Angela B., Metra, Marco, Senni, Michele, Scrutinio, Domenico, Raimondo, Rosa, Emdin, Michele, Magrì, Damiano, Parati, Gianfranco, Re, Federica, Cicoira, Mariantonietta, Minà, Chiara, Limongelli, Giuseppe, Correale, Michele, Frigerio, Maria, Bussotti, Maurizio, Perna, Enrico, Battaia, Elisa, Guazzi, Marco, Badagliacca, Roberto, Di Lenarda, Andrea, Maggioni, Aldo, Passino, Claudio, Sciomer, Susanna, Pacileo, Giuseppe, Mapelli, Massimo, Vignati, Carlo, Lombardi, Carlo, Filardi, Pasquale Perrone, Agostoni, Piergiuseppe, Campodonico, J., Piepoli, M., Clemenza, F., Bonomi, A., Paolillo, S., Salvioni, E., Corra, U., Binno, S., Veglia, F., Lagioia, R., Sinagra, G., Cattadori, G., Scardovi, A. B., Metra, M., Senni, M., Scrutinio, D., Raimondo, R., Emdin, M., Magri, D., Parati, G., Re, F., Cicoira, M., Mina, C., Limongelli, G., Correale, M., Frigerio, M., Bussotti, M., Perna, E., Battaia, E., Guazzi, M., Badagliacca, R., Di Lenarda, A., Maggioni, A., Passino, C., Sciomer, S., Pacileo, G., Mapelli, M., Vignati, C., Lombardi, C., Filardi, P. P., Agostoni, P., Campodonico, J, Piepoli, M, Clemenza, F, Bonomi, A, Paolillo, S, Salvioni, E, Corrà, U, Binno, S, Veglia, F, Lagioia, R, Sinagra, G, Cattadori, G, Scardovi, A, Metra, M, Senni, M, Scrutinio, D, Raimondo, R, Emdin, M, Magrì, D, Parati, G, Re, F, Cicoira, M, Minà, C, Limongelli, G, Correale, M, Frigerio, M, Bussotti, M, Perna, E, Battaia, E, Guazzi, M, Badagliacca, R, Di Lenarda, A, Maggioni, A, Passino, C, Sciomer, S, Pacileo, G, Mapelli, M, Vignati, C, Lombardi, C, Filardi, P, and Agostoni, P
- Subjects
Male ,medicine.medical_specialty ,Prognosi ,medicine.medical_treatment ,Cardiopulmonary exercise test ,Prognosis ,β-Blockers, Atrial fibrillation ,Cardiology and Cardiovascular Medicine ,Adrenergic beta-Antagonists ,Dose dependence ,heart failure, atrial fibrillation, prognosis, beta-blocker, cardiopulmonary exercise test ,030204 cardiovascular system & hematology ,Follow-Up Studie ,03 medical and health sciences ,0302 clinical medicine ,Retrospective Studie ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Survival analysis ,Aged ,Retrospective Studies ,Heart Failure ,Entire population ,Dose-Response Relationship, Drug ,business.industry ,Confounding ,Adrenergic beta-Antagonist ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Death ,Treatment Outcome ,Ventricular assist device ,Heart failure ,beta-blocker ,Cardiology ,β-Blockers ,Female ,business ,Human ,Follow-Up Studies - Abstract
The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. Background: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. Methods and results: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577–2304) days in the entire population, 1203 (614–2420) and 1325 (569–2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). Conclusion: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.
- Published
- 2018
117. Right heart dysfunction
- Author
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Alice Ravera, Gaetano Ruocco, Andrea Passantino, Michele Correale, Rocco Lagioia, Valentina Mercurio, Carlo G. Tocchetti, Edoardo Sciatti, Marco Triggiani, Domenico Scrutinio, Savina Nodari, Carlo Lombardi, and Alberto Palazzuoli
- Subjects
medicine.medical_specialty ,Ventricular function ,business.industry ,Cardiovascular research ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Right ventricular dysfunction ,Imaging modalities ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Right heart ,medicine ,Cardiology ,Cardiac Imaging Techniques ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Ventricular remodeling - Abstract
The right ventricle has become increasingly studied in cardiovascular research. In this article, we describe specific pathophysiological characteristics of the right ventricle, with special focus on functional and molecular modifications as well as therapeutic strategies in right ventricular dysfunction, underlining the differences with the left ventricle. Then we analyze the main imaging modalities to assess right ventricular function in different clinical settings. Finally, we acknowledge main therapeutic advances for treatment of right heart diseases.
- Published
- 2018
118. Endothelin-receptor antagonists in the management of pulmonary arterial hypertension: where do we stand?
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Ilenia Monaco, Michele Correale, Davide Grazioli, Matteo Di Biase, Natale Daniele Brunetti, and Armando Ferraretti
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Endothelin Receptor Antagonists ,0301 basic medicine ,macitentan ,medicine.medical_specialty ,endothelin-receptor antagonists ,ambrisentan ,Ambrisentan ,Hypertension, Pulmonary ,Endocrinology, Diabetes and Metabolism ,Review ,Disease ,Pulmonary Artery ,030204 cardiovascular system & hematology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,pulmonary arterial hypertension ,Internal medicine ,Sitaxentan ,Animals ,Humans ,Medicine ,Arterial Pressure ,Pharmacology (medical) ,Antihypertensive Agents ,Macitentan ,Clinical Trials as Topic ,Receptors, Endothelin ,business.industry ,Endothelins ,Public Health, Environmental and Occupational Health ,Bosentan ,Hematology ,General Medicine ,Disease Models, Animal ,Treatment Outcome ,030104 developmental biology ,chemistry ,sitaxentan ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Endothelin receptor ,Endothelin Pathway ,Signal Transduction ,medicine.drug - Abstract
Pulmonary arterial hypertension, a disease largely neglected until a few decades ago, is presently the object of intense studies by several research teams. Despite considerable progress, pulmonary arterial hypertension remains a major clinical problem, because it is not always easy to diagnose, treat, and prevent. The disease was considered incurable until the late 1990s, when Epoprostenol was introduced as the first tool against this illness. More recently, therapy for pulmonary arterial hypertension gained momentum after publication of the SERAPHIN and AMBITION trials, which also highlighted the importance of upfront therapy. This review also focuses on recent substudies from these trials and progress in drugs targeting the endothelin pathway. Future perspectives with regard to endothelin-receptor antagonists are also discussed.
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- 2018
119. Cardiac contractility modulation in left ventricular systolic dysfunction: trick or treat?
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Michele, Correale, Massimo, Iacoviello, Natale D, Brunetti, and Pietro, Scicchitano
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Ventricular Dysfunction, Left ,Humans ,Pilot Projects ,Registries ,Cardiology and Cardiovascular Medicine ,Myocardial Contraction - Published
- 2021
120. mTOR inhibition improves mitochondria function/biogenesis and delays cardiovascular aging in kidney transplant recipients with chronic graft dysfunction
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Paola Pontrelli, Serena Leo, Giovanni Stallone, Francesco Bellanti, Martina Calvaruso, Elena Ranieri, Michele Correale, Giuseppe Castellano, Silvia Mercuri, Giuseppe Stefano Netti, Loreto Gesualdo, Barbara Infante, Giuseppe Grandaliano, Natale Daniele Brunetti, Gaetano Serviddio, and Rossana Franzin
- Subjects
Adult ,Graft Rejection ,Male ,Aging ,mTOR inhibitor ,kidney disease ,Population ,kidney transplantation ,Pharmacology ,cardiovascular aging ,Cardiovascular System ,Mycophenolic acid ,medicine ,Humans ,Settore MED/14 - NEFROLOGIA ,Everolimus ,education ,Klotho ,Kidney transplantation ,PI3K/AKT/mTOR pathway ,education.field_of_study ,Organelle Biogenesis ,business.industry ,TOR Serine-Threonine Kinases ,Cell Biology ,Middle Aged ,medicine.disease ,Transplant Recipients ,mitochondria ,Fibroblast Growth Factor-23 ,Concomitant ,Female ,business ,Immunosuppressive Agents ,Research Paper ,medicine.drug ,Kidney disease - Abstract
CVD remains the major cause of mortality with graft functioning in Kidney transplant recipients (KTRs), with an estimated risk of CV events about 50-fold higher than in the general population. Many strategies have been considered to reduce the CV risk such as the use of mTOR inhibitors. We evaluate whether chronic mTOR inhibition might influence CV aging in KTRs studying the molecular mechanisms involved in this effect. We retrospectively analyzed 210 KTRs with stable graft function on therapy with CNI and mycophenolic acid (Group A, 105 pts.), or with CNI and mTORi (Everolimus, Group B, 105 pts.). The presence of mTOR inhibitor in immunosuppressive therapy was associated to increase serum levels of Klotho with concomitant reduction in FGF-23, with a significant decrease in left ventricular mass. In addition, KTRs with mTORi improved mitochondrial function/biogenesis in PBMC with more efficient oxidative phosphorylation, antioxidant capacity and glutathione peroxidase activity. Finally, group B KTRs presented reduced levels of inflammaging markers such as reduced serum pentraxin-3 and p21ink expression in PBMC. In conclusion, we demonstrated that mTOR inhibition in immunosuppressive protocols prevents the occurrence and signs of CV aging in KTRs.
- Published
- 2021
121. Vascular and metabolic effects of SGLT2i and GLP‑1 in heart failure patients
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Giuseppe Dattilo, Michele Correale, Olga Lamacchia, Michele Ciccarelli, Natale Daniele Brunetti, and Lucia Tricarico
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Metabolic effect ,Cardiac function curve ,Gliflozin ,business.industry ,Protein metabolism ,Gliflozin · SGLT2i · GLP-1 RA · Heart failure · Endothelial function · Metabolic effect ,Endothelial function ,Heart failure ,Type 2 diabetes ,Pharmacology ,medicine.disease ,Pathophysiology ,chemistry.chemical_compound ,chemistry ,GLP-1 RA ,SGLT2i ,Ketone bodies ,Medicine ,Cardiology and Cardiovascular Medicine ,Receptor ,business ,medicine.drug - Abstract
Alterations of endothelial function, inflammatory activation, and nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway are involved in the pathophysiology of heart failure. Metabolic alterations have been studied in the myocardium of heart failure (HF) patients; alterations in ketone body and amino acid/protein metabolism have been described in patients affected by HF, as well as mitochondrial dysfunction and other modified metabolic signaling. However, their possible contributions toward cardiac function impairment in HF patients are not completely known. Recently, sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have emerged as a new class of drugs designed to treat patients with type 2 diabetes (T2D), but have also been shown to be protective against HF-related events and CV mortality. To date, the protective cardiovascular effects of these drugs in patients with and without T2D are not completely understood and several mechanisms have been proposed. In this review, we discuss on vascular and metabolic effects of SGLT2i and GLP-1 in HF patients.
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- 2021
122. Efficacy of new medical therapies in patients with heart failure, reduced ejection fraction and chronic kidney disease already receiving neurohormonal inhibitors: a network meta-analysis
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Pietro Ameri, Vincenzo De Marzo, Giuseppe Biondi Zoccai, Lucia Tricarico, Michele Correale, Natale Daniele Brunetti, Marco Canepa, Gaetano Maria De Ferrari, Davide Castagno, and Italo Porto
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ARNI ,Network Meta-Analysis ,Chronic kidney disease ,SGLT2 ,ivabradine ,omecamtiv ,vericiguat ,Stroke Volume ,Ventricular Dysfunction, Left ,Clinical Trials, Phase III as Topic ,Humans ,Pharmacology (medical) ,Renal Insufficiency, Chronic ,Cardiology and Cardiovascular Medicine ,Chronic kidney disease SGLT2 ARNI Ivabradine Vericiguat Omecamtiv ,Heart Failure, Systolic ,Randomized Controlled Trials as Topic - Abstract
Aims We assessed the efficacy of the drugs developed after neurohormonal inhibition (NEUi) in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant chronic kidney disease (CKD). Methods and results The literature was systematically searched for phase 3 randomized controlled trials (RCTs) involving ≥90% patients with left ventricular ejection fraction Conclusion Expanding pharmacotherapy beyond NEUi improves outcomes in HFrEF with CKD.
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- 2021
123. Effects of Sacubitril/Valsartan in Patients with High Arrhythmic Risk and an ICD: A Longitudinal Study
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Francesco Luzza, Giulia Laterra, Pasquale Crea, Vittoria Vaccaro, Matteo Casale, Claudia Morabito, Niki Katsiki, Giuseppe Dattilo, Michele Correale, Cesare de Gregorio, and Salvatore Santo Signorelli
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Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Tetrazoles ,030204 cardiovascular system & hematology ,030226 pharmacology & pharmacy ,Sacubitril ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,Natriuretic Peptide, Brain ,Outpatients ,medicine ,Natriuretic peptide ,Humans ,Pharmacology (medical) ,Longitudinal Studies ,Aged ,Aged, 80 and over ,Heart Failure ,Ejection fraction ,business.industry ,Aminobutyrates ,Biphenyl Compounds ,Stroke Volume ,General Medicine ,Middle Aged ,Implantable cardioverter-defibrillator ,medicine.disease ,Peptide Fragments ,Defibrillators, Implantable ,Heart failure ,ICD ,HFrEF ,Global longitudinal strain ,Exercise tolerance ,Left ventricular remodeling ,Drug Combinations ,Treatment Outcome ,Valsartan ,Quality of Life ,Cardiology ,Female ,business ,Sacubitril, Valsartan ,medicine.drug - Abstract
Patients affected by heart failure with reduced ejection fraction (HFrEF) receive clinical and functional beneficial effects from treatment with sacubitril/valsartan. However previous studies have shown that patients with an implantable cardioverter defibrillator (ICD) could obtain even greater benefit, but only make up a only a small proportion of patients. In the current study we evaluated the effect of sacubitril/valsartan in patients with an ICD. Thirty-five outpatients with HFrEF (aged 60 ± 11 years, 28 were males), on optimal medical therapy were studied. All patients received an ICD at least 6 months before enrollment or were non-responders to ICD plus resynchronization (CRT-D). An open-label sacubitril/valsartan treatment was established at the maximum tolerated dose. Clinical assessment, 6-min walk test (6MWT) and echocardiography, were performed during follow-up at 90, 180, and 360 days. Quality of life score and perceived fatigue on exercise were assessed. Clinical conditions dramatically improved in most patients, especially within the first 6 months of therapy (76 % were in NYHA-I and 24 % in NYHA-II at the end of study vs 71 % NYHA-II and 29 % NYHA III at enrollment, p < 0.001). Quality of life and exercise performance significantly improved according to N-terminal pro-brain natriuretic peptide (NT-proBNP) serum levels lowering. Walking distance at 6MWT increased from 274 ± 97 to 389 ± 53 m and walking speed from 0.74 ± 0.27 to 1.07 ± 0.15 m/s (p < 0.001), while oxygen saturation did not differ significantly (from 90 ± 1 % to 91 ± 2 %). More gradual was left ventricular reverse remodeling. Ejection fraction improved mildly (+ 5 points %, p < 0.001). Global longitudinal strain and diastolic function were also assessed over time. Sacubitril/valsartan therapy for HFrEF may lead to significant clinical and functional improvements even in patients with ICD at greater arrhythmic risk. Clinical improvement is obtained within the first 6 months of treatment while reverse remodeling needs more time.
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- 2021
124. Corrigendum to 'Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database' [Int J Cardiol. 2020 Oct 15; 317: 103–110. PMID: 32360652] (International Journal of Cardiology (2020) 317 (103–110), (S0167527320312663), (10.1016/j.ijcard.2020.04.079))
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Rosa Raimondo, P. Perrone Filardi, Enrico Perna, Rocco Lagioia, Piero Gentile, Alessandra Scoccia, Alice Bonomi, Elisabetta Salvioni, Paola Gugliandolo, Andrea Passantino, Piergiuseppe Agostoni, Chiara Minà, Ugo Corrà, Massimo F Piepoli, C. Cavaliere, Luca Arcari, Angela Beatrice Scardovi, Giuseppe Limongelli, Maria Frigerio, Maurizio Bussotti, Federica Re, Stefania Paolillo, Damiano Magrì, Roberto Badagliacca, Massimo Mapelli, Gaia Cattadori, Michele Correale, Gianfranco Sinagra, Nicola Cosentino, Carlo Vignati, Sergio Caravita, Rita Gravino, Paola Gargiulo, Gianfranco Parati, Francesco Clemenza, Paolillo, S., Salvioni, E., Perrone Filardi, P., Bonomi, A., Sinagra, G., Gentile, P., Gargiulo, P., Scoccia, A., Cosentino, N., Gugliandolo, P., Badagliacca, R., Lagioia, R., Correale, M., Frigerio, M., Perna, E., Piepoli, M., Re, F., Raimondo, R., Mina, C., Clemenza, F., Bussotti, M., Limongelli, G., Gravino, R., Passantino, A., Magri, D., Parati, G., Caravita, S., Scardovi, A. B., Arcari, L., Vignati, C., Mapelli, M., Cattadori, G., Cavaliere, C., Corra, U., and Agostoni, P.
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MECKI score database ,medicine.medical_specialty ,Ejection fraction ,business.industry ,MEDLINE ,heart failure ,Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,medicine.disease ,prognostic ,diabetes mellitus ,reduced ejection fraction ,Term (time) ,Heart failure ,Diabetes mellitus ,Internal medicine ,Cardiology ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Glycemic - Abstract
The authors regret that the Author Dr. Bussotti Maurizio appears with the following affiliation: Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano, Italy. But that was a mistake, the right affiliation of Dr. Bussotti Maurizio is instead: Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Milano, Italy. The authors kindly ask you to correct this affiliation also with all abstracting partners as PubMed. The authors would like to apologise for any inconvenience caused. DOI of original article: .
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- 2021
125. Determinants of pulmonary vascular resistance reduction with upfront oral therapy in idiopathic pulmonary arterial hypertension: relevance in risk assessment
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M D'Alto, Davide Stolfo, Carlo D'Agostino, Robert Naeije, Carmine Dario Vizza, G Galgano, Emanuele Romeo, S Ghio, Michele Correale, Gavino Casu, A Greco, Roberto Badagliacca, Marco Corda, Silvia Papa, and P Paciocco
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Idiopathic Pulmonary Arterial Hypertension ,medicine.anatomical_structure ,Internal medicine ,Vascular resistance ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,Risk assessment ,business ,Oral therapy ,Reduction (orthopedic surgery) - Abstract
Background In pulmonary arterial hypertension (PAH) upfront oral therapy represents the standard of care for naive patients at low and intermediate risk. However little is known about associated changes in risk assessment and prediction of low risk status achievement. Purpose To evaluate determinants of PVR reduction in patients treated with upfront oral therapy and to create a score to predict PVR reduction after upfront oral treatment and compared its additive value on top of the European and REVEAL scoring system in predicting treatment response. Methods One-hundred-eighty-one consecutive naive PAH patients treated with upfront therapy at 11 italian centers were retrospectively evaluated. Evaluation included clinical, hemodynamic and simple echocardiographic parameters, together with European and REVEAL 2.0 risk scores. Results At the time of diagnosis, the majority of the patients was idiopathic PAH (80.6%), female (66.3%), at intermediate risk, 71.8% and 55.2%, respectively, according to the European (average method) and the REVEAL 2.0 risk scores. Ambrisentan-Tadalafil was the most frequent combination used (62%). The median PVR reduction obtained after 180 days (IQR 79–394) was −40.4% (IQR −25.8; −45.3). Age ≥60 years, male-sex, baseline mPAP 48 mmHg associated with low CI (1 associated with low TAPSE ( At second evaluation 78 (43.1%) patients achieved or remained at European-derived low risk status, while 63 (34.8%) considering the REVEAL 2.0 score. Multivariate analysis for the prediction of treatment failure, defined as the absence of low-risk status at follow-up, demonstrated the incremental prognostic power of the models incorporating the treatment response score (≥3) on top of the European and REVEAL 2.0 scores, improving risk discrimination by 63.2% (IDI index 0.056) and 36.8% (IDI index 0.080), respectively. Conclusions A significant proportion of PAH patients treated with upfront oral combination are not able to achieve a low-risk status. The treatment response score helps clinicians in predicting treatment failure at the time of diagnosis. Funding Acknowledgement Type of funding source: None
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- 2020
126. Meta-analysis study on direct oral anticoagulants vs warfarin therapy in atrial fibrillation and PCI: Dual or triple approach?
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Luisa De Gennaro, Michele Correale, Massimo Iacoviello, Riccardo Ieva, Francesco Santoro, Matteo Di Biase, Lucia Tricarico, and Natale Daniele Brunetti
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Coronary angioplasty ,Review ,030204 cardiovascular system & hematology ,Lower risk ,Vitamin-K inhibitors ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,030212 general & internal medicine ,business.industry ,Incidence (epidemiology) ,Warfarin ,Atrial fibrillation ,medicine.disease ,Meta-analysis ,lcsh:RC666-701 ,Relative risk ,Conventional PCI ,Cardiology ,Direct anticoagulants ,Cardiology and Cardiovascular Medicine ,business ,Dual and triple therapy ,medicine.drug - Abstract
Background: Dual antiplatelet therapy and anticoagulants may be required in the case of coexistence of coronary artery disease and atrial fibrillation (AF) undergoing (PCI), with associated increased bleeding rates. The introduction of direct oral anticoagulants (DOACs), however, significantly reduced the incidence of bleeding complications in this clinical setting of patients. We therefore sought to assess whether the recent publication of the AUGUSTUS and ENTRUST-AF PCI studies significantly impacted current evidence on the use of DOACs in AF patients treated with PCI. Methods: We performed a meta-analysis of randomized controlled studies enrolling patients with nonvalvular AF undergoing PCI. We assessed pooled estimates of risk ratios (RRs) and 95%CIs for any bleeding (AB), cardiovascular events (CVE), and death at follow-up: 12,542 patients have been included in the analysis. We particularly analyzed data comparing dual anti-thrombotic therapy (DOAC plus single anti-platelet therapy) with triple (DOAC plus dual anti-platelet therapy). Results: When compared with patients receiving standard triple therapy with warfarin, patients receiving DOACs had a significantly lower risk of AB (RR 0.65; 95% CI, 0.61–0.70, p
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- 2020
127. Direct oral anticoagulants across the heart failure spectrum: the precision medicine era
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Marco Metra, Pasquale Perrone Filardi, Alberto Palazzuoli, Stefania Paolillo, Michele Correale, Carlo G. Tocchetti, Gaetano Ruocco, Carlo Lombardi, Savina Nodari, Paolillo, S., Ruocco, G., Filardi, P. P., Palazzuoli, A., Tocchetti, C. G., Nodari, S., Lombardi, C., Metra, M., and Correale, M.
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medicine.medical_specialty ,DOAC ,Hemorrhage ,030204 cardiovascular system & hematology ,law.invention ,Coronary artery disease ,Direct oral anticoagulants ,03 medical and health sciences ,Atrial fibrillation ,DOACs ,Heart failure ,0302 clinical medicine ,Randomized controlled trial ,law ,Diabetes mellitus ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Precision Medicine ,Intensive care medicine ,Stroke ,Randomized Controlled Trials as Topic ,Heart Failure ,business.industry ,Warfarin ,Anticoagulants ,medicine.disease ,Precision medicine ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Direct oral anticoagulant - Abstract
Heart failure (HF) is characterized by a pro-thrombotic state, which might aggravate its morbidity and, consequently, mortality. Several and commonly observed comorbidities, such as coronary artery disease, atrial fibrillation (AF), renal dysfunction, and diabetes often complicate HF, increasing the thromboembolic risk. In the past decade, direct oral anticoagulants (DOACs) have been approved for the treatment and prevention of stroke and embolic events in patients with nonvalvular AF. Due to their lower bleeding risk, these drugs are frequently used instead of warfarin; however, some controversies exist on their use in HF patients with or without comorbidities. Indeed, the management of anticoagulation in HF patients with underlying conditions is poorly investigated since these patients are underrepresented or excluded from randomized controlled trials. The aim of this research is to review current evidence on the use of DOACs in HF patients, also discussing their specific use in different clinical scenarios. [Figure not available: see fulltext.]
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- 2020
128. Switch to direct anticoagulants and improved endothelial function in patients with chronic heart failure and atrial fibrillation
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Lucia Tricarico, Damiano D’Alessandro, Alessandra Leopizzi, Guglielmo Maulucci, Salvatore Tucci, Matteo Di Biase, Michele Correale, Natale Daniele Brunetti, Miriam Pia Suriano, Giuseppe Pastore, Adriana Mallardi, Alessandro Ranieri, and Pietro Mazzeo
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medicine.medical_specialty ,Administration, Oral ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Atrial Fibrillation ,Medicine ,Humans ,In patient ,cardiovascular diseases ,Endothelial dysfunction ,Heart Failure ,business.industry ,Warfarin ,Anticoagulants ,Atrial fibrillation ,Hematology ,medicine.disease ,Stroke ,030220 oncology & carcinogenesis ,Heart failure ,Cardiology ,Observational study ,business ,Vascular function ,medicine.drug - Abstract
Chronic heart failure (CHF) is characterized by higher rates of atrial fibrillation (AF) and endothelial dysfunction (ED). First line anticoagulant therapy in AF is represented by direct oral anticoagulants (DOACs); several patients, however, are still treated with vitamin-K inhibitors. The use of DOACs is associated in previous studies with an improved vascular function. We therefore sought to evaluate possible changes in endothelial function assessed by flow-mediated dilation (FMD) in patients with CHF and AF shifting from warfarin to DOACs.Forty-three consecutive outpatients were enrolled in the study. FMD was assessed at baseline and after 4 months. Patients were compared according to AC therapy.After the first measurement of FMD, 18 patients "switched" to DOACs because of poor compliance to warfarin therapy or time in therapeutic range, 19 patients continued to use DOACs, 6 warfarin. "Switched" patients to DOACs therapy showed an improved FMD (19.0 ± 6.6% vs 3.8 ± 1.3%, p 0.0001); C-reactive protein (CRP) levels decreased in "switched" patients from 1.4 ± 0.5 to 1.0 ± 0.7 mg/dl (p 0.05). FMD and CRP changes were not significant in patients who did not changed anticoagulant therapy. In switched patients, changes in CRP levels were proportional to FMD changes (r = -0.50, p 0.05). Shifting from warfarin to DOACs was significantly correlated to improved FMD levels even at multivariable analysis (p 0.05).Switch from warfarin to DOACs in patents with CHF and AF was associated in an observational non randomized study with an improved endothelial function. Changes in FMD values were related to changes in CRP levels.
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- 2020
129. [Selection criteria to cardiac surgery, transcatheter valvular interventions, electrophysiology and pacing procedures in patients with advanced heart failure]
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Massimo, Romanò, Cosimo, Carriere, Michele, Correale, Massimo, Grimaldi, and Gianfranco, Sinagra
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Heart Failure ,Transcatheter Aortic Valve Replacement ,Frail Elderly ,Patient Selection ,Palliative Care ,Cardiac Pacing, Artificial ,Quality of Life ,Humans ,Cardiac Surgical Procedures ,Aged - Abstract
Prognosis of advanced heart failure (HF) patients, often elderly, frail and with multiple comorbidities, has significantly improved due to recent advancements in interventional cardiology. A multidisciplinary approach is essential in order to better identify patients that could benefit from invasive procedures, avoiding futility. For patients with HF, the Multidimensional Prognostic Index could help the clinician in predicting not only the prognosis but also future quality of life. For cardiac surgical candidates, predictive scores should combine traditional mortality scores with geriatric parameters including nutritional status, screening of delirium, disabilities and comorbidities, in order to help the Heart Team in taking the right approach (i.e. conservative vs invasive strategies). Similarly, the indication to the implantation of a cardioverter-defibrillator or to ablative procedures should consider both the complication rates and the real impact on the quality of life considering the expected net clinical benefit.In the terminal stages of HF the therapeutic target should be oriented to a palliative care approach. In this perspective, the figure of the palliativist plays a role of growing interest and should be integrated into the HF multidisciplinary team.
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- 2020
130. Liver disease and heart failure
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Matteo Di Biase, Davide Grazioli, Michele Correale, Pietro Mazzeo, Salvatore Tucci, Lucia Tricarico, Alessandra Leopizzi, Natale Daniele Brunetti, and Adriana Mallardi
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medicine.medical_specialty ,Hemosiderosis ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Hepatitis ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Hepatolenticular Degeneration ,Liver Function Tests ,Ischemic hepatitis ,Ischemia ,Internal medicine ,medicine ,Humans ,Heart Failure ,Inflammation ,Liver injury ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Liver Diseases ,Fatty liver ,Hemodynamics ,General Medicine ,Glycogen Storage Disease ,medicine.disease ,Congestive hepatopathy ,Heart failure ,Acute Disease ,Cardiology ,Fabry Disease ,Hemochromatosis ,Liver function ,Liver function tests ,business - Abstract
Introduction Several systemic conditions, inflammatory disease, infections and alcoholism, may affect both the heart and the liver. Common conditions, such as the non-alcoholic fatty liver disease (NAFLD), may increase the risk of cardiac dysfunction. Patients with acute decompensated HF (ADHF) may develop acute ischemic hepatitis and, chronic HF patients may develop congestive hepatopathy (CH). Evidence acquisition Laboratory anomalies of hepatic function may predict the outcome of patients with advanced HF and the evaluation of both cardiac and hepatic function is very important in the management of these patients. In clinically apparent ischemic hepatitis more than 90% of patients have some right-sided HF. There are systemic disorders characterized by the accumulation of metals or by metabolism defects that may affect primarily the liver but also the heart leading to symptomatic hypertrophic cardiomyopathy (HCM). Evidence synthesis Abnormal LFTs indicate the mechanism of liver injury: liver congestion or liver ischemia. In AHF, it's important an adequate evaluation of heart and liver function in order to choose the treatment in order to ensure stable hemodynamic as well as optimal liver function. Conclusions Measurements of LFTs should be recommended in the early phase of ADHF management. Physicians with interest in HF should be trained in the evaluation of LFTs. It's very important for cardiologists to know the systemic diseases affecting both heart and liver and the first imaging or laboratory findings useful for a diagnosis. it is very important for internists, nephrologists, cardiologists, primary physicians and any physicians with interest in treating HF to recognize such signs and symptoms belong to rare diseases and liver diseases that could be mistaken for HF.
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- 2020
131. Lower Major Bleeding Rates with Direct Oral Anticoagulants in Catheter Ablation of Atrial Fibrillation: an Updated Meta-analysis of Randomized Controlled Studies
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Francesco Santoro, Michele Correale, Roland Tilz, Riccardo Ieva, Andreas Rillig, Christian-H. Heeger, Luisa De Gennaro, Natale Daniele Brunetti, Lucia Tricarico, Matteo Di Biase, and Andreas Metzner
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0301 basic medicine ,Male ,medicine.medical_specialty ,Time Factors ,Vitamin K ,medicine.medical_treatment ,Administration, Oral ,Catheter ablation ,Hemorrhage ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Edoxaban ,Risk Factors ,Internal medicine ,Thromboembolism ,Atrial Fibrillation ,medicine ,Humans ,Pharmacology (medical) ,Randomized Controlled Trials as Topic ,Pharmacology ,business.industry ,Incidence (epidemiology) ,Anticoagulants ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,030104 developmental biology ,Treatment Outcome ,chemistry ,Meta-analysis ,Relative risk ,Cardiology ,Catheter Ablation ,Female ,Warfarin ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Major bleeding ,Factor Xa Inhibitors - Abstract
Catheter ablation (CA) of atrial fibrillation (AF) is an important rhythm control strategy for patients with drug-refractory AF. We aimed to perform an updated meta-analysis of direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs) as uninterrupted anticoagulation in patients undergoing AF ablation to assess safety and efficacy of DOAC, after the publication of recent data on edoxaban in CA of AF. We performed a meta-analysis of RCTs enrolling patients undergoing AF ablation. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for thromboembolic events, major bleeding (MB), and non-major bleeding (NMB). A total of 2118 patients have been included in the analysis. Compared with patients receiving VKA, patients receiving DOACs had a lower, although non-significant, risk of thromboembolic events (RR, 0.40; 95% CI, 0.09–1.76; P = 0.23). MB rates in patients treated with DOACs were statistically significantly lower than VKA (RR, 0.61; 95% CI, 0.39–0.93, P = 0.02). The incidence of NMB was not significantly different (RR, 0.98; 95% CI, 0.83–1.57, p n.s.). In a meta-analysis of RCTs, an uninterrupted DOACs strategy for CA of AF appears to be superior to uninterrupted VKA in terms of safety; a non-significant trend favoring DOACs in terms of efficacy is also evident.
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- 2020
132. Non invasive hemodynamic profiles and outcome in outpatients with heart failure with reduced ejection fraction treated with sacubitril/valsartan: an echocardiographic study
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Nicola Riccardo Pugliese, Erberto, Carluccio, Frank Lloyd Dini, Roberto, Bitto, Michele, Ciccarelli, Michele, Correale, D'Agostino, Andreina, Dattilo, Giuseppe, Marco, Ferretti, Arianna, Grelli, Stefania, Guida, Laura, Lupi, Lorenzo, Luschi, Daniele, Masarone, Valentina, Mercurio, Mario, Miccoli, Giuseppe, Paicileo, Antonella, Rispoli, Laura, Scelsi, Carlo Gabriele Tocchetti, Natale Daniele Brunetti, Alberto, Palazzuoli, Massimo, Piepoli, Savina, Nodari, and Giuseppe Ambrosio, and On Behalf Of The Working Group On Heart, Failure.
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- 2020
133. Comprehensive heart failure assessment: A challenge to modify the course of heart failure. Author's reply
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Gaetano Ruocco, Michele Correale, Stefania Paolillo, Savina Nodari, and Alberto Palazzuoli
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Heart Failure ,medicine.medical_specialty ,business.industry ,Cardiology ,Comorbidity ,medicine.disease ,Course (navigation) ,Italy ,Heart failure ,Chronic Disease ,Internal Medicine ,medicine ,Humans ,Intensive care medicine ,business - Published
- 2020
134. Treatment with sacubitril/valsartan is associated with hemodynamic improvement in outpatients with heart failure with reduced ejection fraction: an echocardiographic study
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Michele, Correale, Frank Lloyd Dini, Erberto, Carluccio, Bitto, Roberto, Ciccarelli, Michele, Andreina, D'Agostino, Dattilo, Giuseppe, Marco, Ferretti, Arianna, Grelli, Stefania, Guida, Lupi, Laura, Lorenzo, Luschi, Daniele, Masarone, Valentina, Mercurio, Mario, Miccoli, Giuseppe, Pacileo, Nicola Riccardo Pugliese, Antonella, Rispoli, Laura, Scelsi, Carlo Gabriele Tocchetti, Natale Daniele Brunetti, Alberto, Palazzuoli, Massimo, Piepoli, Savina, Nodari, and Giuseppe Ambrosio, and On Behalf Of The Working Group On Heart Failure
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- 2020
135. [Palliative inotrope therapy in advanced heart failure: organization and management]
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Giovanna, Gorni, Michele, Correale, Savina, Nodari, and Gianfranco, Sinagra
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Heart Failure ,Cardiotonic Agents ,Treatment Outcome ,Palliative Care ,Aged ,Heart-Assist Devices ,Humans - Abstract
A few patients in advanced or end-stage (stage D or NYHA functional class IV) heart failure are transplant or ventricular assist device eligible. Particularly for the non-operative patients (elderly or with significant comorbidities), intravenous palliative inotropes can be utilized for symptom control, for functional class and quality of life improvement. The authors report evidence-based medicine data about palliative inotrope therapy in advanced heart failure patients and they suggest a possible multidisciplinary approach in order to guarantee the best care to these patients.
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- 2020
136. The thromboembolism in COVID-19: the unsolved problem
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Marianna Gigliotti De Fazio, Salvatore Santo Signorelli, Michele Correale, Claudia Morabito, Matteo Casale, Egidio Imbalzano, Paolo Busacca, Giuseppe Dattilo, Natale Daniele Brunetti, and Maurizio Mezzetti
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medicine.medical_specialty ,macromolecular substances ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Thromboembolism ,Antithrombotic ,Pandemic ,Low Molecular Weight Heparin ,medicine ,Platelet activation ,Endothelial dysfunction ,severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Intensive care medicine ,030219 obstetrics & reproductive medicine ,Lung ,business.industry ,Thrombosis ,General Medicine ,medicine.disease ,coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Thromboembolism ,Thrombosis, Low Molecular Weight Heparin ,medicine.anatomical_structure ,coronavirus disease 2019 (COVID-19) ,Observational study ,business - Abstract
INTRODUCTION: The recent Sars-Cov-2 pandemic (COVID-19) has led to growing research to explain the poor clinical prognosis in some patients. EVIDENCE ACQUISITION: While early observational studies highlighted the role of the virus in lung failure, in a second moment thrombosis emerged as a possible explanation of the worse clinical course in some patients. Despite initial difficulties in management of such patients, the constant increase of literature in the field is to date clarifying some questions from clinicians. However, several other questions need answer. EVIDENCE SYNTHESIS: A novel disease (Covid-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was responsible for thousands of hospitalizations for severe acute respiratory syndrome, with several cases of thrombotic complications due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis. Covid-19 and hospitalizations for Covid-19 may carry several potential risk factors for thrombosis. Severe coagulation abnormalities may occur in almost all of the severe and critical ill COVID-19 cases. CONCLUSIONS: Despite a strong pathophysiological rationale, the evidences in literature are not enough to recommend an aggressive antithrombotic therapy in COVID- 19. However, it is our opinion that an early use, even at home at the beginning of the disease, could improve the clinical course.
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- 2020
137. Comorbidities in chronic heart failure: An update from Italian Society of Cardiology (SIC) Working Group on Heart Failure
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Rocco Lagioia, Carolina Lombardi, Pietro Scicchitano, Alberto Palazzuoli, Michele Correale, Damiano Magrì, Carlo G. Tocchetti, Giuseppe Limongelli, Gianfranco Parati, Daniele Masarone, Marco Matteo Ciccone, Domenico Scrutinio, Stefania Paolillo, Giuseppe Pacileo, Savina Nodari, Valentina Mercurio, Francesco Barillà, Gaetano Ruocco, Laura Lupi, Correale, Michele, Paolillo, Stefania, Mercurio, Valentina, Limongelli, Giuseppe, Barillà, Francesco, Ruocco, Gaetano, Palazzuoli, Alberto, Scutinio, Domenico, Lagioia, Rocco, Lombardi, Carolina, Lupi, Laura, Magrì, Damiano, Masarone, Daniele, Pacileo, Giuseppe, Scicchitano, Pietro, Matteo Ciccone, Marco, Parati, Gianfranco, Tocchetti, Carlo, Nodari, Savina, Correale, M., Paolillo, S., Mercurio, V., Limongelli, G., Barilla, F., Ruocco, G., Palazzuoli, A., Scrutinio, D., Lagioia, R., Lombardi, C., Lupi, L., Magri, D., Masarone, D., Pacileo, G., Scicchitano, P., Matteo Ciccone, M., Parati, G., Tocchetti, C. G., Nodari, S., Correale, M, Paolillo, S, Mercurio, V, Limongelli, G, Barilla, F, Ruocco, G, Palazzuoli, A, Scrutinio, D, Lagioia, R, Lombardi, C, Lupi, L, Magri, D, Masarone, D, Pacileo, G, Scicchitano, P, Matteo Ciccone, M, Parati, G, Tocchetti, C, and Nodari, S
- Subjects
medicine.medical_specialty ,Population ageing ,Cardiology ,Comorbidity ,Disease ,030204 cardiovascular system & hematology ,Diabete ,Coronary artery disease ,Cardio-oncology ,Chronic heart failure ,Chronic kidney disease ,COPD ,Diabetes ,Hypertension ,Sleep apnea ,Settore MED/11 ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,mental disorders ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Aged ,Heart Failure ,business.industry ,medicine.disease ,Italy ,Heart failure ,Chronic Disease ,Life expectancy ,business - Abstract
The increasing number of patients with heart failure HF and comorbidities is due to aging population and increase of life expectancy of patients with cardiovascular disease. Encouraging results derived by recent trials may suggest some comorbidities as new targets for new drugs, highlighting the need for a better understanding of the comorbidities’ effects in HF patients and the need of a multidisciplinary approach for the management of chronic HF with comorbidities. We report a brief review about main cardiovascular and non-cardiovascular comorbidities in HF patients in order to update physicians and researchers engaged in the HF research or in “fight against heart failure.”
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- 2020
138. Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test
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Magri', Damiano, Massimo, Piepol, Ugo, Corrà, Gallo, Giovanna, Maruotti, Antonello, Carlo, Vignati, Elisabetta, Salvioni, Massimo, Mapelli, Stefania, Paolillo, Pasquale Perrone Filardi, Davide, Girola, Metra, Marco, Angela, B Scardovi, Rocco, Lagioia, Giuseppe, Limongelli, Michele, Senni, Domenico, Scrutinio, Michele, Emdin, Claudio, Passino, Carlo, Lombardi, Gaia, Cattadori, Gianfranco, Parati, Mariantonietta, Cicoira, Michele, Correale, Maria, Frigerio, Francesco, Clemenza, Maurizio, Bussotti, Guazzi, Marco, Badagliacca, Roberto, Sciomer, Susanna, Andrea Di Lenarda, Aldo, Maggioni, Gianfranco, Sinagra, Volpe, Massimo, Piergiuseppe, Agostoni, MECKI score Research Group, Magri, D., Piepoli, M., Corra, U. G. O., Gallo, G., Maruotti, A., Vignati, C., Salvioni, E., Mapelli, M., Paolillo, S., PERRONE FILARDI, P., Girola, D., Metra, M., Scardovi, A. B., Lagioia, R., Limongelli, G., Senni, M., Scrutinio, D., Emdin, M., Passino, C., Lombardi, C., Cattadori, G. A. I. A., Parati, G., Cicoira, M., Correale, M., Frigerio, M., Clemenza, F., Bussotti, M., Guazzi, M., Badagliacca, R., Sciomer, S., DI LENARDA, A., Maggioni, A. L. D. O., Sinagra, G., Volpe, M., Agostoni, P., Magrì, D, Piepoli, M, Corrà, U, Gallo, G, Maruotti, A, Vignati, C, Salvioni, E, Mapelli, M, Paolillo, S, Perrone Filardi, P, Girola, D, Metra, M, Scardovi, A, Lagioia, R, Limongelli, G, Senni, M, Scrutinio, D, Emdin, M, Passino, C, Lombardi, C, Cattadori, G, Parati, G, Cicoira, M, Correale, M, Frigerio, M, Clemenza, F, Bussotti, M, Guazzi, M, Badagliacca, R, Sciomer, S, DI Lenarda, A, Maggioni, A, Sinagra, G, Volpe, M, and Agostoni, P
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medicine.medical_specialty ,Multivariate analysis ,Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,Heart failure ,030204 cardiovascular system & hematology ,Cardiovascular death ,heart failure ,mecki score ,cardiopulmonary exercise test ,prognosis ,03 medical and health sciences ,0302 clinical medicine ,MECKI score ,Internal medicine ,Cardiopulmonary exercise test ,Cause of Death ,medicine ,Humans ,030212 general & internal medicine ,Ejection fraction ,End point ,business.industry ,VO2 max ,Cardiopulmonary exercise testing ,Stroke Volume ,medicine.disease ,Cardiology ,Exercise Test ,Cardiology and Cardiovascular Medicine ,business ,prognosi - Abstract
Background Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing. Methods and Results We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th–75th range 627–2403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score's variables in HFrEF (C-index = 0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO2) remained associated to the end point (C-index = 0.745). A peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction. Conclusions: Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO2 of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.
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- 2020
139. Long-term prognostic role of diabetes mellitus and glycemic control in heart failure patients with reduced ejection fraction: Insights from the MECKI Score database
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Stefania, Paolillo, Elisabetta, Salvioni, Pasquale, Perrone Filardi, Alice, Bonomi, Gianfranco, Sinagra, Piero, Gentile, Paola, Gargiulo, Alessandra, Scoccia, Nicola, Cosentino, Paola, Gugliandolo, Roberto, Badagliacca, Rocco, Lagioia, Michele, Correale, Maria, Frigerio, Enrico, Perna, Massimo, Piepoli, Federica, Re, Rosa, Raimondo, Chiara, Minà, Francesco, Clemenza, Maurizio, Bussotti, Giuseppe, Limongelli, Rita, Gravino, Andrea, Passantino, Damiano, Magrì, Gianfranco, Parati, Sergio, Caravita, Angela B, Scardovi, Luca, Arcari, Carlo, Vignati, Massimo, Mapelli, Gaia, Cattadori, Carlo, Cavaliere, Ugo, Corrà, Piergiuseppe, Agostoni, Paolillo, S, Salvioni, E, Perrone Filardi, P, Bonomi, A, Sinagra, G, Gentile, P, Gargiulo, P, Scoccia, A, Cosentino, N, Gugliandolo, P, Badagliacca, R, Lagioia, R, Correale, M, Frigerio, M, Perna, E, Piepoli, M, Re, F, Raimondo, R, Minà, C, Clemenza, F, Bussotti, M, Limongelli, G, Gravino, R, Passantino, A, Magrì, D, Parati, G, Caravita, S, Scardovi, Ab, Arcari, L, Vignati, C, Mapelli, M, Cattadori, G, Cavaliere, C, Corrà, U, Agostoni, P, Paolillo, S., Salvioni, E., Perrone Filardi, P., Bonomi, A., Sinagra, G., Gentile, P., Gargiulo, P., Scoccia, A., Cosentino, N., Gugliandolo, P., Badagliacca, R., Lagioia, R., Correale, M., Frigerio, M., Perna, E., Piepoli, M., Re, F., Raimondo, R., Mina, C., Clemenza, F., Bussotti, M., Limongelli, G., Gravino, R., Passantino, A., Magri, D., Parati, G., Caravita, S., Scardovi, A. B., Arcari, L., Vignati, C., Mapelli, M., Cattadori, G., Cavaliere, C., Corra, U., and Agostoni, P.
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Diabetes mellitu ,Diabetes mellitus ,Glycated hemoglobin ,Humans ,Stroke Volume ,Heart failure ,Prognosis ,Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,Glycemic Control ,diabetes mellitus ,glycated hemoglobin ,heart failure ,prognosis ,glycemic control ,humans ,kidney ,stroke volume ,Kidney - Abstract
Background: The prognostic role of diabetes mellitus (DM) in heart failure (HF) patients is undefined, since DM is outweighed by several DM-related variables when confounders are considered. We determined the prognostic role of DM, treatment, and glycemic control in a real-life HF population. Methods: 3927 HF patients included in the Metabolic Exercise Cardiac Kidney Index (MECKI) score database were evaluated with a median follow-up of 3.66 years (IQR 1.70–6.67). Data analysis considered survival between DM (n = 897) vs. non-DM (n = 3030) patients, and, in diabetics, between insulin (n = 304), oral antidiabetics (n = 479), and dietary only (n = 88) treatments. The role of glycemic control was evaluated grouping DM patients according to glycated hemoglobin (HbA1c): 8% (n = 149). All analyses were performed also adjusting for ejection fraction, renal function, hemoglobin, sodium, exercise peak oxygen uptake, and ventilation/carbon dioxide relationship slope. Study primary endpoint was the composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Secondary endpoints were cardiovascular and all causes death. Results: For all endpoints, upon adjustment for confounders, DM status and insulin treatment or dietary regimen were not significantly associated with adverse long-term prognosis compared to non-DM and oral antidiabetic treated patients, respectively. A worse prognosis was observed in HbA1c >8% patients (Log-Rank p < 0.001), even after correction for confounding factors. All results were replicated by hazard ratio analysis. Conclusion: In HF patients, DM, insulin treatment and dietary regimen are not adverse outcome predictors. The only condition related to long-term prognosis, considering potential confounders, is poor glycemic control.
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- 2020
140. Early antithrombotic therapy and COVID-19:a better clinical course? New evidences from real-life cases
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Pasquale Crea, Matteo Casale, Michele Correale, Maurizio Mezzetti, Salvatore Santo Signorelli, Giuseppe Dattilo, Claudia Morabito, Paolo Busacca, Egidio Imbalzano, and Marianna Gigliotti De Fazio
- Subjects
2019-20 coronavirus outbreak ,medicine.medical_specialty ,COVID-19 ,DOAC ,Edoxaban ,Low molecular weight heparin ,Thromboembolism ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Clinical course ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antithrombotic ,Medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Recentni onemocněni COVID-19 přinasi možne rizikove faktory žilniho tromboembolismu a horsi klinický průběh u některých pacientů ma spojitost s trombozou. Zatimco nizkomolekularni hepariny jsou zkoumany s ohledem na vhodnou davku, ostatni elementy mohou být užitecne. Sdilime nasi zkusenost týkajici se dvou pacientů s neocekavaným klinickým průběhem. © 2020, CKS.
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- 2020
141. Increased serum uric acid level predicts poor prognosis in mildly severe chronic heart failure with reduced ejection fraction. An analysis from the MECKI score research group
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Angela Beatrice Scardovi, Michele Correale, Carlo Lombardi, Roberto Badagliacca, Francesco Doni, Gianfranco Sinagra, Giuseppe Limongelli, Federica Re, Piergiuseppe Agostoni, Elisabetta Salvioni, Francesco Clemenza, Stefania Paolillo, Ugo Corrà, Rocco La Gioia, Massimo Francesco Piepoli, Michele Emdin, Rosa Raimondo, Alice Bonomi, Mariantonietta Cicoira, Piepoli, M. F., Salvioni, E., Corra, U., Doni, F., Bonomi, A., La Gioia, R., Limongelli, G., Paolillo, S., Sinagra, G., Scardovi, A. B., Raimondo, R., Emdin, M., Re, F., Cicoira, M., Correale, M., Badagliacca, R., Clemenza, F., Lombardi, C., and Agostoni, P.
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Uric acid, prognosis ,medicine.medical_specialty ,Poor prognosis ,Renal function ,Heart failure ,030204 cardiovascular system & hematology ,Nyha class ,03 medical and health sciences ,Ventricular Dysfunction, Left ,heart failure ,prognosis ,uric acid ,0302 clinical medicine ,Kidney function ,male ,left ,Internal medicine ,middle aged ,Internal Medicine ,medicine ,030212 general & internal medicine ,Hyperuricemia ,Hemoglobin ,humans ,Cardiopulmonary exercise test ,Kidney ,Ejection fraction ,business.industry ,Increased serum uric acid ,ventricular dysfunction ,medicine.disease ,aged ,medicine.anatomical_structure ,stroke volume ,Cardiology ,business ,cardiopulmonary exercise test ,hemoglobin ,kidney function ,uric acid, prognosis ,ventricular dysfunction, left - Abstract
Background: Hyperuricemia prognostic impact on clinical outcomes in chronic heart failure (HF) patients has been investigated with inconclusive results. Objectives: Aim of the study was to evaluate the prognostic impact of serum uric acid (SUA) on long-term clinical outcomes in HF. Methods: An analysis of MECKI (Metabolic Exercise Cardiac Kidney Index) database, with median follow-up of 3.4 years. Results: Relation between SUA and all-cause/ cardiovascular (CV) deaths have been analysed in 4,577 patients (3,688 males, age 62.7 ± 12.9 years), with reduced ejection fraction HF (35 ± 11%), peakVO2 1151 ± 440 ml/min; NYHA class I-II (72.6%), III-IV (27.4%). SUA was associated with increased total and CV mortality (HR 1.120 and HR 1.128, respectively p < 0.0001), also after adjustment for peakVO2, VE/VCO2 slope, diuretic use and MECKI score. SUA was significantly associated with CV mortality only in NYHA class I-II (HR 1.17, p < 0.0001) while there was no association in class III-IV (HR 1.03, p = NS). No prognostic added values of SUA with respect to the MECKI score was observed at the ROC analysis. Conclusions: SUA is confirmed to be associated with increased mortality, but in less severe HF only. However SUA did not show additional prognostic power to the MECKI score
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- 2020
142. Macitentan Use in a Neurofibromatosis Type 1 Patient With Pulmonary Hypertension and External Jugular Phlebectasia
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Michele Correale, Nicola Tarantino, Giuseppe Paradiso, Ilenia Monaco, Matteo Di Biase, and Natale Daniele Brunetti
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Pharmacology ,medicine.medical_specialty ,business.industry ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Pulmonary hypertension ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,chemistry ,External Jugular ,Internal medicine ,medicine ,Cardiology ,Pharmacology (medical) ,030212 general & internal medicine ,Neurofibromatosis ,business ,Macitentan - Published
- 2018
143. Drug-Induced Pulmonary Arterial Hypertension: Mechanisms and Clinical Management
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Ennio Sascia Formica, Paola Persichella, Lucia Tricarico, Matteo Di Biase, Rossella Petrucci, Michele Correale, Davide Grazioli, and Natale Daniele Brunetti
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0301 basic medicine ,Drug ,medicine.medical_specialty ,media_common.quotation_subject ,Clinical Decision-Making ,Human immunodeficiency virus (HIV) ,030204 cardiovascular system & hematology ,Pulmonary Artery ,medicine.disease_cause ,Decision Support Techniques ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Animals ,Humans ,Pharmacology (medical) ,Arterial Pressure ,Intensive care medicine ,Drug-induced pulmonary hypertension ,Antihypertensive Agents ,media_common ,Pharmacology ,Pulmonary Arterial Hypertension ,business.industry ,General Medicine ,medicine.disease ,Pulmonary hypertension ,Antiretroviral therapy ,Pathophysiology ,Substance abuse ,030104 developmental biology ,Treatment Outcome ,Cardiology and Cardiovascular Medicine ,business ,Algorithms ,Rare disease - Abstract
Pulmonary arterial hypertension is a rare disease, with drug-induced causes even more uncommon, accounting for only 10% of cases in large registry series. Predisposing factors for drug-induced PAH have not been completely defined. This review summarizes drugs with definite, possible, or likely association to pulmonary hypertension and possible mechanisms involved in the occurrence of pulmonary hypertension. Controversies on mechanisms and on their role in pathophysiology were also shown. The possible synergism between drug abuse and HIV was discussed and the possible interactions of antiretroviral therapy in HIV subjects were analyzed. Furthermore, we reported clinical findings and possible management, specific for each class of drugs, in case of drug-induced PAH. Finally, we summarized into a unified algorithm possible management of drug-induced PAH.
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- 2019
144. Exhaled Nitric Oxide and Exhaled Breath Temperature as Potential Biomarkers in Patients with Pulmonary Hypertension
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Natale Daniele Brunetti, Giuseppe Carpagnano, Giulia Scioscia, Matteo Di Biase, Donato Lacedonia, Alessandro Radaeli, Maria Pia Foschino Barbaro, Antonio Palmiotti, Michele Correale, Mario Malerba, and Giovanna Elisiana Carpagnano
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Male ,Spirometry ,medicine.medical_specialty ,Article Subject ,Hypertension, Pulmonary ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Nitric Oxide ,Gastroenterology ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,DLCO ,Internal medicine ,medicine ,Humans ,Respiratory system ,Aged ,Asthma ,COPD ,General Immunology and Microbiology ,medicine.diagnostic_test ,business.industry ,lcsh:R ,Temperature ,Exhalation ,General Medicine ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Cross-Sectional Studies ,Breath Tests ,030228 respiratory system ,Exhaled nitric oxide ,Female ,business ,Biomarkers - Abstract
Background. Pulmonary hypertension (PH) is a progressive fatal disease thus, noninvasive prognostic tools are needed to follow these patients. The aim of our study was to evaluate fractional exhaled nitric oxide (FeNO) and exhaled breath temperature (EBT) values in patients with PH from different causes and to correlate them with respiratory functional data. Methods. Twenty-four PH patients underwent spirometry, carbon monoxide diffusion (DLCO) test, transthoracic echocardiography, right-heart catheterization, and FeNO and EBT measurements. Results. We studied 3 groups according to the type of PH: 10 patients with pulmonary arterial hypertension (PAH) (group A), 11 patients with PH due to chronic obstructive pulmonary disease (COPD) (group B), and 3 patients with PH associated with left heart disease (group C). Mean FeNO values tend to be higher in group B (15.0 ± 9.3ppb) compared with other groups (respectively, 9.9 ± 5.7 and 8.5 ± 5.2 ppb in groups A and C; p = 0.271) but no statistical significance has been reached. Mean values of alveolar NO concentration (CANO) were higher in groups A and B compared to group C (respectively, 16.9 ± 12.6; 13.9 ± 6.8; and 6.7 ± 2.0 ppb) (p = 0.045). EBT mean values were significantly lower in group C when compared with other groups (group C: 29.0 +- 1.3°C, groups A and B: 30.9 ± 1.3 and 31.2 ± 1.2°C, respectively: p = 0.041). EBT levels were inversely correlated to mean pulmonary artery pressure (PAPm) levels (Spearman coefficient -0.481; p = 0.017). Conclusions. eNO, CANO, and EBT have been evaluated in three groups of PH patients. Interestingly EBT reduction was correlated with PAPm increase, whereas FeNO was higher in COPD patients and CANO in PAH and COPD groups. Further studies are needed to clarify EBT, FeNO, and CANO roles as biomarkers in the monitoring of patients with PH.
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- 2018
145. Direct oral anticoagulants more effective than low-molecular-weight heparin for venous thrombo-embolism in cancer: an updated meta-analysis of randomized trials
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Natale Daniele Brunetti, Lucia Tricarico, Riccardo Ieva, Michele Correale, Francesco Santoro, Matteo Di Biase, and Luisa De Gennaro
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Male ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,Population ,Low molecular weight heparin ,Administration, Oral ,Hemorrhage ,030204 cardiovascular system & hematology ,Risk Assessment ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Recurrence ,Risk Factors ,Internal medicine ,Neoplasms ,Medicine ,Humans ,030212 general & internal medicine ,education ,Aged ,Randomized Controlled Trials as Topic ,education.field_of_study ,business.industry ,Mortality rate ,Incidence (epidemiology) ,Incidence ,Cancer ,Anticoagulants ,Hematology ,Venous Thromboembolism ,Heparin, Low-Molecular-Weight ,Middle Aged ,medicine.disease ,Treatment Outcome ,Meta-analysis ,Relative risk ,Female ,Cardiology and Cardiovascular Medicine ,business ,Factor Xa Inhibitors - Abstract
In the recent past, low-molecular-weight heparin (LMWH) was the first choice in the treatment of cancer related venous thrombo-embolism (VTE). Evidence supporting the preferential use of direct anticoagulants (DOACs) in patients with cancer, instead, is less robust so far. We therefore aimed to assess in an updated meta-analysis of randomized controlled trials whether the use of DOACs may be associated with a more favorable profile when compared to LMWH. We performed a meta-analysis of RCTs enrolling patients with VTE and cancer. We assessed Mantel–Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for recurrence of VTE, major bleeding, and mortality comparing subjects treated with DOACs with those with LMWH. After study selection, three RCTs (HOKUSAI-Cancer, SELECT-D and ADAM-VTE) were included for the analysis with an overall population of 1739 patients. DOACs patients had a lower incidence of 6-month recurrent VTE when compared to LMWHs (RR 0.56, 95% CI 0.40–0.79; p
- Published
- 2019
146. Redefining biomarkers in heart failure
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Marco Metra, Matteo Di Biase, Javed Butler, Mihi Gheorghiade, Ilenia Monaco, Savina Nodari, Michele Correale, and Natale Daniele Brunetti
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medicine.medical_specialty ,business.industry ,Physiopathology ,Stroke Volume ,Heart failure ,Preserved ejection fraction ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,cardiovascular system ,medicine ,Humans ,Biomarker (medicine) ,In patient ,030212 general & internal medicine ,Biomarkers ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Abstract
Heart failure (HF) is the end result of many different cardiac and non-cardiac abnormalities leading to a complex clinical entity. In this view, the use of biomarkers in HF should be deeply reconsidered; indeed, the same biomarker may carry a different significance in patients with preserved or reduced EF. The aim of this review is to reconsider the role of biomarkers in HF, based on the different clinical characteristics of this syndrome. The role of cardiac and non-cardiac biomarkers will be reviewed with respect of the different clinical manifestations of this syndrome.
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- 2018
147. Influence of various therapeutic strategies on right ventricular morphology, function and hemodynamics in pulmonary arterial hypertension
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Carlo Lombardi, Michele D'Alto, Amresh Raina, Marco Confalonieri, Paola Argiento, Michele Correale, Giuseppe Paciocco, Marco Corda, Massimiliano Mulè, Susanna Sciomer, Laura Scelsi, Carmine Dario Vizza, Raymond L. Benza, Roberto Poscia, Roberto Badagliacca, Stefano Ghio, Badagliacca, Roberto, Raina, Amresh, Ghio, Stefano, D'Alto, Michele, Confalonieri, Marco, Correale, Michele, Corda, Marco, Paciocco, Giuseppe, Lombardi, Carlo, Mulã, Massimiliano, Poscia, Roberto, Scelsi, Laura, Argiento, Paola, Sciomer, Susanna, Benza, Raymond L., and Vizza, Carmine Dario
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right ventricular morphology ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Right ventricular morphology ,Combination therapy ,Heart Ventricles ,Right ventricular systolic function ,Hemodynamics ,030204 cardiovascular system & hematology ,Pulmonary arterial hypertension ,right ventricular systolic function ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,pulmonary arterial hypertension ,Internal medicine ,Ventricular morphology ,medicine ,Humans ,Familial Primary Pulmonary Hypertension ,In patient ,echocardiography ,upfront therapy ,surgery ,pulmonary and respiratory medicine ,cardiology and cardiovascular medicine ,transplantation ,Retrospective Studies ,Transplantation ,business.industry ,Idiopathic Pulmonary Arterial Hypertension ,Prostanoid ,Middle Aged ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,chemistry ,Echocardiography ,Vascular resistance ,Cardiology ,Drug Therapy, Combination ,Female ,Upfront therapy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background In idiopathic pulmonary arterial hypertension (IPAH) treatment goals include improving right ventricular (RV) function, hemodynamics and symptoms to move patients to a low-risk category for adverse clinical outcomes. No data are available on the effect of upfront combination therapy on RV improvement as compared with monotherapy. The aim of this study was to evaluate echocardiographic RV morphology and function in patients affected by IPAH and treated with different strategies. Methods Sixty-nine consecutive, treatment-naive IPAH patients treated with first-line upfront combination therapy at 10 centers were retrospectively evaluated and compared with 2 matched cohorts treated with monotherapy after short-term follow-up. Evaluation included clinical, hemodynamic and echocardiographic parameters. Results At 155 ± 65 days after baseline evaluation, patients in the oral+prostanoid group (Group 1) had the most clinical and hemodynamic improvement compared with the double oral group (Group 2), the oral monotherapy group (Group 3) and the prostanoid monotherapy group (Group 4). The more extensive reduction of pulmonary vascular resistance in Groups 1, 2 and 4 was associated with significant improvement in all RV echocardiographic parameters compared with Group 3. Considering the number of patients who reached the target goals suggested by established guidelines, 8 of 27 (29.6%) and 7 of 42 (16.7%) patients in Groups 1 and 2, respectively, achieved low-risk status, as compared with 2 of 69 (2.8%) and 6 of 27 (22.2%) in Groups 3 and 4, respectively. Conclusions In advanced treatment-naive IPAH patients, an upfront combination therapy strategy seems to significantly improve hemodynamics and RV morphology and function compared with oral monotherapy. The most significant results seem to be achieved with prostanoids plus oral drug, whereas the use of the double oral combination and prostanoids as monotherapy seem to produce similar results.
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- 2018
148. Mineralocorticoid receptor antagonists for heart failure: a real-life observational study
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Stefania Paolillo, Giuseppe Pacileo, Massimo Mapelli, Fabrizio Veglia, Maurizio Bussotti, Carlo Vignati, Susanna Sciomer, Carlo Lombardi, Cosimo Carriere, Marco Metra, Pietro Palermo, Piero Gentile, Damiano Magrì, Maria Frigerio, Roberto Ricci, Angela Beatrice Scardovi, Romualdo Belardinelli, Piergiuseppe Agostoni, Massimo F Piepoli, Gianfranco Parati, Mauro Contini, Marco Guazzi, Pasquale Perrone Filardi, Michele Emdin, Domenico Scrutino, Rosa Raimondo, Rocco Lagioia, Noemi Bruno, Alice Bonomi, Alessandro Mezzani, Valentina Carubelli, Mariantonietta Cicoira, Anna Apostolo, Claudio Passino, Gianfranco Sinagra, Elisabetta Salvioni, Fabrizio Oliva, Gaia Cattadori, Andrea Di Lenarda, Ugo Corrà, Giuseppe Limongelli, Federica Re, Simone Binno, Roberto Badagliacca, Francesco Clemenza, Giuseppe Vergaro, and Michele Correale
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Heart transplantation ,medicine.medical_specialty ,education.field_of_study ,Ejection fraction ,New York Heart Association Class ,business.industry ,medicine.medical_treatment ,Population ,Renal function ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Ventricular assist device ,Heart failure ,Propensity score matching ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,education - Abstract
AIMS Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population-based analysis, the long-term effects of MRA treatment in HFrEF patients. METHODS AND RESULTS We analysed data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset. Analysis was performed in patients treated (n = 3163) and not treated (n = 2883) with MRA. The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Ten years' survival was analysed through Kaplan-Meier, compared by log-rank test and propensity score matching. At 10 years' follow-up, the MRA-untreated group had a significantly lower number of events than the MRA-treated group (P
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- 2018
149. Liver disease and heart failure: Back and forth
- Author
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Michele Correale, Matteo Di Biase, Rossella Petrucci, Lucia Tricarico, Irma Laonigro, Nicola Tarantino, and Natale Daniele Brunetti
- Subjects
Cardiac function curve ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Pharmacotherapy ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,Cardiovascular drug ,Heart Failure ,business.industry ,Liver Diseases ,Cardiovascular Agents ,Heart ,medicine.disease ,Pathophysiology ,Cirrhotic cardiomyopathy ,Hepatic Involvement ,Liver ,Heart failure ,Cardiology ,030211 gastroenterology & hepatology ,Chemical and Drug Induced Liver Injury ,business - Abstract
In their clinical practice, physicians can face heart diseases (chronic or acute heart failure) affecting the liver and liver diseases affecting the heart. Systemic diseases can also affect both heart and liver. Therefore, it is crucial in clinical practice to identify complex interactions between heart and liver, in order to provide the best treatment for both. In this review, we sought to summarize principal evidence explaining the mechanisms and supporting the existence of this complicate cross-talk between heart and liver. Hepatic involvement after heart failure, its pathophysiology, clinical presentation (congestive and ischemic hepatopathy), laboratory and echocardiographic prognostic markers are discussed; likewise, hepatic diseases influencing cardiac function (cirrhotic cardiomyopathy). Several clinical conditions (congenital, metabolic and infectious causes) possibly affecting simultaneously liver and heart have been also discussed. Cardiovascular drug therapy may present important side effects on the liver and hepato-biliary drug therapy on heart and vessels; post-transplantation immunosuppressive drugs may show reciprocal cardio-hepatotoxicity. A heart-liver axis is drafted by inflammatory reactants from the heart and the liver, and liver acts a source of energy substrates for the heart.
- Published
- 2018
150. Hospitalization cost reduction with sacubitril-valsartan implementation in a cohort of patients from the Daunia Heart Failure Registry
- Author
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Ennio Sascia Formica, Ilenia Monaco, Armando Ferraretti, Lucia Tricarico, Giuseppina Padovano, Davide Grazioli, Natale Daniele Brunetti, Matteo Di Biase, Valeria Tozzi, and Michele Correale
- Subjects
medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,ARNI ,030204 cardiovascular system & hematology ,Sacubitril ,03 medical and health sciences ,0302 clinical medicine ,Cost analysis ,medicine ,030212 general & internal medicine ,Original Paper ,Neprilysin inhibition ,business.industry ,Incidence (epidemiology) ,Angiotensin receptor blockers ,medicine.disease ,Chronic heart failure ,lcsh:RC666-701 ,Heart failure ,Cohort ,Hospitalization cost ,Emergency medicine ,Cardiology and Cardiovascular Medicine ,business ,Sacubitril, Valsartan ,After treatment ,medicine.drug - Abstract
Introduction: Aim of this study was to assess the impact of the introduction of new class of drugs (ARNI: angiotensin receptor-neprilysin inhibitor) on hospital related costs in a real world cohort of patients with chronic heart failure (CHF). Methods: Seventy-three consecutive patients with CHF and systolic dysfunction eligible for the treatment with ARNIs from the Daunia Heart Failure Registry were enrolled. Incidence of hospitalizations before and after treatment with ARNI, costs for drug and hospitalization for HF were recorded, indexed per year and compared. Results: Indexed mean number of hospitalizations per year was 0.93 ± 1.70 before and 0.19 ± 0.70 after introduction of ARNI (p
- Published
- 2019
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