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2. Computed tomography predictors of structural valve degeneration in patients undergoing transcatheter aortic valve implantation with balloon-expandable prostheses

Author

Guglielmo, M, Fusini, L, Muratori, M, Tamborini, G, Mantegazza, V, Andreini, D, Annoni, A, Babbaro, M, Baggiano, A, Conte, E, Carriero, S, Formenti, A, Guaricci, A, Mancini, E, Mollace, R, Muscogiuri, G, Mushtaq, S, Ricci, F, Rossi, A, Scafuri, S, Alushi, B, Cau, C, Cau, R, Cesarano, M, Saba, L, Rabbat, M, Pepi, M, Pontone, G, Guglielmo M., Fusini L., Muratori M., Tamborini G., Mantegazza V., Andreini D., Annoni A., Babbaro M., Baggiano A., Conte E., Carriero S., Formenti A., Guaricci A. I., Mancini E., Mollace R., Muscogiuri G., Mushtaq S., Ricci F., Rossi A., Scafuri S., Alushi B., Cau C., Cau R., Cesarano M., Saba L., Rabbat M., Pepi M., Pontone G., Guglielmo, M, Fusini, L, Muratori, M, Tamborini, G, Mantegazza, V, Andreini, D, Annoni, A, Babbaro, M, Baggiano, A, Conte, E, Carriero, S, Formenti, A, Guaricci, A, Mancini, E, Mollace, R, Muscogiuri, G, Mushtaq, S, Ricci, F, Rossi, A, Scafuri, S, Alushi, B, Cau, C, Cau, R, Cesarano, M, Saba, L, Rabbat, M, Pepi, M, Pontone, G, Guglielmo M., Fusini L., Muratori M., Tamborini G., Mantegazza V., Andreini D., Annoni A., Babbaro M., Baggiano A., Conte E., Carriero S., Formenti A., Guaricci A. I., Mancini E., Mollace R., Muscogiuri G., Mushtaq S., Ricci F., Rossi A., Scafuri S., Alushi B., Cau C., Cau R., Cesarano M., Saba L., Rabbat M., Pepi M., and Pontone G.

Abstract

Objectives: Computed tomography (CT) provides excellent anatomy assessment of the aortic annulus (AoA) and is utilized for pre-procedural planning of transcatheter aortic valve implantation (TAVI). We sought to investigate if geometrical characteristics of the AoA determined by CT may represent predictors of structural valve degeneration (SVD) in patients undergoing TAVI with balloon-expandable valves. Methods: This is a retrospective study on 124 consecutive patients (mean age: 79 ± 7 years; female: 61%) undergoing balloon-expandable TAVI prospectively enrolled in a registry. AoA maximum diameter (Dmax), minimum diameter (Dmin), and area were assessed using pre-procedural CT. SVD was identified during follow-up with transthoracic echocardiography documenting structural prosthetic valve abnormalities with or without hemodynamic changes. Results: The mean follow-up was 5.9 ± 1.7 years. SVD was found in 48 out of 124 patients (38%). AoA Dmax, Dmin, and area were significantly smaller in patients with SVD compared to patients without SVD (25.6 ± 2.2 mm vs. 27.1 ± 2.8 mm, p = 0.012; 20.5 ± 2.1 mm vs. 21.8 ± 2.1 mm, p = 0.001 and 419 ± 77 mm2 vs. 467 ± 88 mm2, p = 0.002, respectively). At univariable analysis, female sex, BSA, 23-mm prosthetic valve size, Dmax < 27.1 mm, and a Dmin < 19.9 mm were associated with SVD, whereas at multivariable analysis, only Dmin < 19.9 mm (OR = 2.873, 95% CI: 1.191–6.929, p = 0.019) and female sex (OR = 2.659, 95% CI: 1.095–6.458, p = 0.031) were independent predictors of SVD. Conclusions: Female sex and AoA Dmin < 19.9 mm are associated with SVD in patients undergoing TAVI with balloon-expandable valves. When implanting large prostheses in order to avoid paraprosthetic regurgitation, caution should be observed due to the risk of excessive stretching of the AoA Dmin, which may play a role in SVD. Key Points: • Long-term durability is a concern for transcatheter aortic valve bioprosthesis. • CT provides an excellent assessment

Published
2022

4. P72 A CASE OF DRAMATIC HEART CHAMBERS REVERSE REMODELING AND DISEASE REGRESSION IN A PATIENT WITH HEART FAILURE AND END–STAGE RENAL FAILURE TREATED WITH SACUBITRIL/VALSARTAN AND SGLT2I: THE IMPORTANCE OF PUSHING THE BOUNDARIES

Author

Mapelli, M, primary, Mantegazza, V, additional, Ferrari, C, additional, Cimino, R, additional, Maragna, R, additional, Pontone, G, additional, Palermo, P, additional, Amelotti, N, additional, Matteo, S, additional, Pepi, M, additional, and Agostoni, P, additional

Published
2023
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6. P217 SHORT–TERM EFFECTS OF DAPAGLIFLOZIN ON CARDIAC BIOMARKERS, FLUID RETENTION, RENAL AND PULMONARY FUNCTION IN HFREF PATIENTS: NOT AS GOOD AS EXPECTED

Author

Mapelli, M, primary, Capovilla, T, additional, Marongiu, A, additional, Maranzano, G, additional, Salvioni, E, additional, Mattavelli, I, additional, Paganin, C, additional, Vignati, C, additional, Gugliandolo, P, additional, Mantegazza, V, additional, Garlaschè, A, additional, Sinagra, G, additional, and Agostoni, P, additional

Published
2023
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7. Improving assessment of different flow state of aortic stenosis: implication for prognosis in patients undergoing transcatheter aortic valve replacement

Author

Fusini, L, primary, Muratori, M, additional, Tamborini, G, additional, Ghulam Ali, S, additional, Gripari, P, additional, Mantegazza, V, additional, Roberto, M, additional, Trabattoni, P, additional, Agrifoglio, M, additional, Bartorelli, A L, additional, Pontone, G, additional, and Pepi, M, additional

Published
2022
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8. Utility and futility of MitraClip implantation in secondary mitral regurgitation in a real-world population: the role of 3D transthoracic echocardiography

Author

Mantegazza, V, primary, Muratori, M, additional, Ghulam Ali, S, additional, Garlasche', A, additional, Gripari, P, additional, Fusini, L, additional, Vignati, C, additional, De Martino, F, additional, Agostoni, P, additional, Ferrari, C, additional, Bartorelli, A L, additional, Pontone, G, additional, Pepi, M, additional, and Tamborini, G, additional

Published
2022
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10. Old and new equations for maximal heart rate prediction in patients with heart failure and reduced ejection fraction on beta-blockers treatment: results from the MECKI score data set

Author

Magri D., Piepoli M., Gallo G., Corra U., Metra M., Paolillo S., Filardi P. P., Maruotti A., Salvioni E., Mapelli M., Vignati C., Senni M., Limongelli G., Lagioia R., Scrutinio D., Emdin M., Passino C., Parati G., Sinagra G., Correale M., Badagliacca R., Sciomer S., Di Lenarda A., Agostoni P., Apostolo A., Palermo P., Contini M., Farina S., De Martino F., Mantegazza V., Bonomi A., Mattavelli I., Rocca M. D., Pezzuto B., Bandera F., Rovai S., Giordano A., Ricci R., Ferraironi A., Arcari L., Lombardi C., Carubelli V., Matassini M., Shkoza M., Malfatto G., Caravita S., Pacileo G., Cicoira M., Passantino A., Raimondo R., Confalonieri M., Zaffalon D., Carriere C., Ferraretti A., Bussotti M., Marchese G., Iorio A., Pastormerlo L., Gargiulo P., Halasz G., Capelli B., Villani G. Q., Oliva F., Santolamazza C., Re F., La Franca E., Herberg R., Magri, D., Piepoli, M., Gallo, G., Corra, U., Metra, M., Paolillo, S., Filardi, P. P., Maruotti, A., Salvioni, E., Mapelli, M., Vignati, C., Senni, M., Limongelli, G., Lagioia, R., Scrutinio, D., Emdin, M., Passino, C., Parati, G., Sinagra, G., Correale, M., Badagliacca, R., Sciomer, S., Di Lenarda, A., Agostoni, P., Apostolo, A., Palermo, P., Contini, M., Farina, S., De Martino, F., Mantegazza, V., Bonomi, A., Mattavelli, I., Rocca, M. D., Pezzuto, B., Bandera, F., Rovai, S., Giordano, A., Ricci, R., Ferraironi, A., Arcari, L., Lombardi, C., Carubelli, V., Matassini, M., Shkoza, M., Malfatto, G., Caravita, S., Pacileo, G., Cicoira, M., Passantino, A., Raimondo, R., Confalonieri, M., Zaffalon, D., Carriere, C., Ferraretti, A., Bussotti, M., Marchese, G., Iorio, A., Pastormerlo, L., Gargiulo, P., Halasz, G., Capelli, B., Villani, G. Q., Oliva, F., Santolamazza, C., Re, F., La Franca, E., and Herberg, R.

Subjects
MECKI score, cardiopulmonary exercise test, chronotropic incompetence, heart failure, maximal heart rate, kidney, Epidemiology, exercise test, Chronotropic incompetence, ventricular dysfunction, Heart failure, test, mecki score, adrenergic beta-antagonists, heart rate, humans, stroke volume, left, Ventricular Dysfunction, Left, Cardiology and Cardiovascular Medicine, Maximal heart rate, Cardiopulmonary exercise test
Abstract

Aims Predicting maximal heart rate (MHR) in heart failure with reduced ejection fraction (HFrEF) still remains a major concern. In such a context, the Keteyian equation is the only one derived in a HFrEF cohort on optimized β-blockers treatment. Therefore, using the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) data set, we looked for a possible MHR equation, for an external validation of Keteyien formula and, contextually, for accuracy of the historical MHR formulas and their relationship with the HR measured at the anaerobic threshold (AT). Methods and results Data from 3487 HFrEF outpatients on optimized β-blockers treatment from the MECKI data set were analyzed. Besides excluding all possible confounders, the new equation was derived by using HR data coming from maximal cardiopulmonary exercise test. The simplified derived equation was [109–(0.5*age) + (0.5*HR rest) + (0.2*LVEF)–(5 if haemoglobin Conclusion The derived equation to estimate the MHR in HFrEF patients, by accounting also for the systolic dysfunction degree and anaemia, improved slightly the Keteyian formula. Both formulas might be helpful in identifying the true maximal effort during an exercise test and the intensity domain during a rehabilitation programme.

Published
2022

11. Arrhythmic Mitral Valve Prolapse: Introducing an Era of Multimodality Imaging-Based Diagnosis and Risk Stratification

Author

Kukavica, D, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Muratori, M, Tamborini, G, Mantegazza, V, Trancuccio, A, Arnò, C, Mazzanti, A, Pepi, M, Priori, S, Pontone, G, Kukavica D, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Muratori M, Tamborini G, Mantegazza V, Trancuccio A, Arnò C, Mazzanti A, Pepi M, Priori SG, Pontone G, Kukavica, D, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Muratori, M, Tamborini, G, Mantegazza, V, Trancuccio, A, Arnò, C, Mazzanti, A, Pepi, M, Priori, S, Pontone, G, Kukavica D, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Muratori M, Tamborini G, Mantegazza V, Trancuccio A, Arnò C, Mazzanti A, Pepi M, Priori SG, and Pontone G

Abstract

Mitral valve prolapse is a common cardiac condition, with an estimated prevalence between 1% and 3%. Most patients have a benign course, but ever since its initial description mitral valve prolapse has been associated to sudden cardiac death. Although the causal relationship between mitral valve prolapse and sudden cardiac death has never been clearly demonstrated, different factors have been implicated in arrhythmogenesis in patients with mitral valve prolapse. In this work, we offer a comprehensive overview of the etiology and the genetic background, epidemiology, pathophysiology, and we focus on the state-of-the-art imaging-based diagnosis of mitral valve prolapse. Going beyond the classical, well-described clinical factors, such as young age, female gender and auscultatory findings, we investigate multimodality imaging features, such as alterations of anatomy and function of the mitral valve and its leaflets, the structural and contractile anomalies of the myocardium, all of which have been associated to sudden cardiac death.

Published
2021

13. P330 A CASE OF SEVERE AORTIC STENOSIS IN A YOUNG PATIENT WITH BICUSPID AORTIC VALVE, FAMILIAL HYPERCHOLESTEROLEMIA AND CALCIFICATION AT THE SINOTUBULAR JUNCTION

Author

Brusamolino, M, primary, Muratori, M, additional, Apostolo, A, additional, Mapelli, M, additional, Bonalumi, G, additional, Nanci, G, additional, Werba, J, additional, Pepi, M, additional, Mantegazza, V, additional, Calligaris, G, additional, Formenti, A, additional, Agrifoglio, M, additional, and Agostoni, P, additional

Published
2022
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14. C89 A CASE OF MYOPERICARDITIS RECURRENCE AFTER THIRD DOSE OF BNT162B2 VACCINE AGAINST SARS–COV–2 IN A YOUNG SUBJECT: LINK OR CASUALITY?

Author

Mapelli, M, primary, Amelotti, N, additional, Andreini, D, additional, Baggiano, A, additional, Campodonico, J, additional, Moltrasio, M, additional, Majocchi, B, additional, Mantegazza, V, additional, Vignati, C, additional, Ribatti, V, additional, Catto, V, additional, Sicuso, R, additional, Pontone, G, additional, and Agostoni, P, additional

Published
2022
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15. Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

Author

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

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

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

Published
2019

18. Computed tomography for the prediction of structural valve deterioration in patients undergoing transcatheter aortic valve implantation

Author

Guglielmo, M, primary, Fusini, L, additional, Muratori, M, additional, Tamborini, G, additional, Mantegazza, V, additional, Muscogiuri, G, additional, Baggiano, A, additional, Stefano, S, additional, Babbaro, M, additional, Mollace, R, additional, Mushtaq, S, additional, Conte, E, additional, Guaricci, AI, additional, Pepi, M, additional, and Pontone, G, additional

Published
2021
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22. P1799 The importance of 3D imaging techniques in left atrial appendage closure: landing zone eccentricity influence on peri-device leak incidence and its implication in long-term clinical outcomes

Author

Italiano, G, primary, Maltagliati, A, additional, Mantegazza, V, additional, Gasperetti, A, additional, Fusini, L, additional, Arioli, L, additional, Susini, F, additional, Brusoni, D, additional, Fassini, G, additional, Tondo, C, additional, and Pepi, M, additional

Published
2020
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23. P638 Short term reverse remodeling and exercise capacity improvement in a patient with valvular heart failure treated with Sacubitril Valsartan

Author

Mapelli, M, primary, Mantegazza, V, additional, Volpato, V, additional, Sassi, V, additional, De Martino, F, additional, Salvioni, E, additional, Mattavelli, I, additional, Fusini, L, additional, Vignati, C, additional, Paolillo, S, additional, Corrieri, N, additional, Alimento, M, additional, Magini, A, additional, Pepi, M, additional, and Agostoni, P, additional

Published
2020
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31. Heart failure prognosis over time: how the prognostic role of oxygen consumption and ventilatory efficiency during exercise has changed in the last 20 years

Author

Paolillo, S, Veglia, F, Salvioni, E, Corrà, U, Piepoli, M, Lagioia, R, Limongelli, G, Sinagra, G, Cattadori, G, Scardovi, A, Metra, M, Senni, M, Bonomi, A, Scrutinio, D, Raimondo, R, Emdin, M, Magrì, D, Parati, G, Re, F, Cicoira, M, Minà, C, Correale, M, Frigerio, M, Bussotti, M, Battaia, E, Guazzi, M, Badagliacca, R, Di Lenarda, A, Maggioni, A, Passino, C, Sciomer, S, Pacileo, G, Mapelli, M, Vignati, C, Clemenza, F, Binno, S, Lombardi, C, Perrone Filardi, P, Agostoni, P, Apostolo, A, Palermo, P, Contini, M, Farina, S, Mantegazza, V, Spadafora, E, Lattarulo, M, Giordano, A, Mezzani, A, Ricci, R, Ferraironi, A, Carubelli, V, Pietrucci, F, Malfatto, G, Caravita, S, Vigano', E, Valente, F, Vastarella, R, Gravino, R, Roselli, T, Buono, A, De Maria, R, Passantino, A, Santoro, D, Campanale, S, Caputo, D, Bertipaglia, D, Confalonieri, M, Gentile, P, Zambon, E, Morosin, M, Carriere, C, Ferraretti, A, Marchese, G, Iorio, A, Pastormerlo, L, Gargiulo, P, Villani, G, Oliva, F, Perna, E, Scardovi, AB, Lattarulo, MS, VIGANO', ELENA, Villani, GQ, Paolillo, S, Veglia, F, Salvioni, E, Corrà, U, Piepoli, M, Lagioia, R, Limongelli, G, Sinagra, G, Cattadori, G, Scardovi, A, Metra, M, Senni, M, Bonomi, A, Scrutinio, D, Raimondo, R, Emdin, M, Magrì, D, Parati, G, Re, F, Cicoira, M, Minà, C, Correale, M, Frigerio, M, Bussotti, M, Battaia, E, Guazzi, M, Badagliacca, R, Di Lenarda, A, Maggioni, A, Passino, C, Sciomer, S, Pacileo, G, Mapelli, M, Vignati, C, Clemenza, F, Binno, S, Lombardi, C, Perrone Filardi, P, Agostoni, P, Apostolo, A, Palermo, P, Contini, M, Farina, S, Mantegazza, V, Spadafora, E, Lattarulo, M, Giordano, A, Mezzani, A, Ricci, R, Ferraironi, A, Carubelli, V, Pietrucci, F, Malfatto, G, Caravita, S, Vigano', E, Valente, F, Vastarella, R, Gravino, R, Roselli, T, Buono, A, De Maria, R, Passantino, A, Santoro, D, Campanale, S, Caputo, D, Bertipaglia, D, Confalonieri, M, Gentile, P, Zambon, E, Morosin, M, Carriere, C, Ferraretti, A, Marchese, G, Iorio, A, Pastormerlo, L, Gargiulo, P, Villani, G, Oliva, F, Perna, E, Scardovi, AB, Lattarulo, MS, VIGANO', ELENA, and Villani, GQ

Abstract

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

Published
2019

36. Prognostic value of indeterminable anaerobic threshold in heart failure

Author

Agostoni, P., Corrà, U., Cattadori, G., Veglia, F., Battaia, E., Gioia, R. L., Scardovi, A. B., Emdin, M., Metra, M., Sinagra, G., Limongelli, G., Raimondo, R., Re, F., Guazzi, M., Belardinelli, R., Parati, G., Magrì, D., Fiorentini, C., Cicoira, Mariantonietta, Salvioni, E., Giovannardi, M., Mezzani, A., Scrutinio, D., Lenarda, A. D., Mantegazza, V., Ricci, R., Apostolo, A., Iorio, A., Paolillo, S., Palermo, P., Contini, M., Vassanelli, Corrado, Passino, C., Piepoli, M. F., M. E. C., Agostoni, P, Corrà, U, Cattadori, G, Veglia, F, Battaia, E, La Gioia, R, Scardovi, A, Emdin, M, Metra, M, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Cicoira, M, Salvioni, E, Giovannardi, M, Mezzani, A, Scrutinio, D, Di Lenarda, A, Mantegazza, V, Ricci, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Vassanelli, C, Passino, C, Piepoli, M, Scardovi, Ab, Sinagra, Gianfranco, Piepoli, Mf, Gargiulo, P, Agostoni, P., Corra, U., Cattadori, G., Veglia, F., Battaia, E., Gioia, R. L., Scardovi, A. B., Emdin, M., Metra, M., Sinagra, G., Limongelli, G., Raimondo, R., Re, F., Guazzi, M., Belardinelli, R., Parati, G., Magri, D., Fiorentini, C., Cicoira, M., Salvioni, E., Giovannardi, M., Mezzani, A., Scrutinio, D., Lenarda, A. D., Mantegazza, V., Ricci, R., Apostolo, A., Iorio, A., Paolillo, S., Palermo, P., Contini, M., Vassanelli, C., Passino, C., and Piepoli, M. F.

Subjects
Male, Time Factors, Left, heart failure, Predictive Value of Test, Kaplan-Meier Estimate, Kidney, Severity of Illness Index, Ventricular Function, Left, Risk Factors, Cardiopulmonary exercise test, Exercise, follow-up studies, heart failure, oxygen, prognosis, Ventricular Function, Prospective Studies, Multivariate Analysi, exercise, Follow up studies, follow-up studies, oxygen, prognosis, Aged, Chi-Square Distribution, Energy Metabolism, Female, Heart Failure, Heart Transplantation, Humans, Italy, Logistic Models, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Stroke Volume, Anaerobic Threshold, Exercise Test, Cardiology, Cardiology and Cardiovascular Medicine, Anaerobic exercise, Prognostic value, Human, medicine.medical_specialty, Logistic Model, Time Factor, Prognosi, follow-up studie, anaerobic threshold, Internal medicine, medicine, Intensive care medicine, Follow-up studie, business.industry, Risk Factor, MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, medicine.disease, Prospective Studie, Heart failure, Proportional Hazards Model, business, Value (mathematics)
Abstract

Background— In patients with heart failure (HF), during maximal cardiopulmonary exercise test, anaerobic threshold (AT) is not always identified. We evaluated whether this finding has a prognostic meaning. Methods and Results— We recruited and prospectively followed up, in 14 dedicated HF units, 3058 patients with systolic (left ventricular ejection fraction P P P =0.01; HR=1.02; CI=1.01–1.03), hemoglobin ( P P P P P P Conclusions— The inability to identify AT most often occurs in patients with severe HF, and it has an independent prognostic role in HF.

Published
2013

38. Management of heart failure in the new era: The role of scores

Author

Mantegazza, V, Badagliacca, R, Nodari, S, Parati, G, Lombardi, C, Somma, S, Carluccio, E, Dini, F, Correale, M, Magri, D, Agostoni, P, PARATI, GIANFRANCO, LOMBARDI, CAROLINA, Agostoni, P., Mantegazza, V, Badagliacca, R, Nodari, S, Parati, G, Lombardi, C, Somma, S, Carluccio, E, Dini, F, Correale, M, Magri, D, Agostoni, P, PARATI, GIANFRANCO, LOMBARDI, CAROLINA, and Agostoni, P.

Abstract

Heart failure is a widespread syndrome involving several organs, still characterized by high mortality and morbidity, and whose clinical course is heterogeneous and hardly predictable. In this scenario, the assessment of heart failure prognosis represents a fundamental step in clinical practice. A single parameter is always unable to provide a very precise prognosis. Therefore, risk scores based on multiple parameters have been introduced, but their clinical utility is still modest. Methods In this review, we evaluated several prognostic models for acute, right, chronic, and end-stage heart failure based on multiple parameters. In particular, for chronic heart failure we considered risk scores essentially based on clinical evaluation, comorbidities analysis, baroreflex sensitivity, heart rate variability, sleep disorders, laboratory tests, echocardiographic imaging, and cardiopulmonary exercise test parameters. Results What is at present established is that a single parameter is not sufficient for an accurate prediction of prognosis in heart failure because of the complex nature of the disease. However, none of the scoring systems available is widely used, being in some cases complex, not user-friendly, or based on expensive or not easily available parameters. Conclusion We believe that multiparametric scores for risk assessment in heart failure are promising but their widespread use needs to be experienced.

Published
2016

41. Prognostic value of indeterminable anaerobic threshold in heart failure

Author

Agostoni, P, Corrà, U, Cattadori, G, Veglia, F, Battaia, E, La Gioia, R, Scardovi, A, Emdin, M, Metra, M, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Cicoira, M, Salvioni, E, Giovannardi, M, Mezzani, A, Scrutinio, D, Di Lenarda, A, Mantegazza, V, Ricci, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Vassanelli, C, Passino, C, Piepoli, M, Scardovi, AB, Piepoli, MF, PARATI, GIANFRANCO, Agostoni, P, Corrà, U, Cattadori, G, Veglia, F, Battaia, E, La Gioia, R, Scardovi, A, Emdin, M, Metra, M, Sinagra, G, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Magrì, D, Fiorentini, C, Cicoira, M, Salvioni, E, Giovannardi, M, Mezzani, A, Scrutinio, D, Di Lenarda, A, Mantegazza, V, Ricci, R, Apostolo, A, Iorio, A, Paolillo, S, Palermo, P, Contini, M, Vassanelli, C, Passino, C, Piepoli, M, Scardovi, AB, Piepoli, MF, and PARATI, GIANFRANCO

Abstract

BACKGROUND: In patients with heart failure (HF), during maximal cardiopulmonary exercise test, anaerobic threshold (AT) is not always identified. We evaluated whether this finding has a prognostic meaning. METHODS AND RESULTS: We recruited and prospectively followed up, in 14 dedicated HF units, 3058 patients with systolic (left ventricular ejection fraction <40%) HF in stable clinical conditions, New York Heart Association class I to III, who underwent clinical, laboratory, echocardiographic, and cardiopulmonary exercise test investigations at study enrollment. We excluded 921 patients who did not perform a maximal exercise, based on lack of achievement of anaerobic metabolism (peak respiratory quotient ≤1.05). Primary study end point was a composite of cardiovascular death and urgent cardiac transplant, and secondary end point was all-cause death. Median follow-up was 3.01 (1.39-4.98) years. AT was identified in 1935 out of 2137 patients (90.54%). At multivariable logistic analysis, failure in detecting AT resulted significantly in reduced peak oxygen uptake and higher metabolic exercise and cardiac and kidney index score value, a powerful prognostic composite HF index (P<0.001). At multivariable analysis, the following variables were significantly associated with primary study end point: peak oxygen uptake (% pred; P<0.001; hazard ratio [HR]=0.977; confidence interval [CI]=0.97-0.98), ventilatory efficiency slope (P=0.01; HR=1.02; CI=1.01-1.03), hemoglobin (P<0.05; HR=0.931; CI=0.87-1.00), left ventricular ejection fraction (P<0.001; HR=0.948; CI=0.94-0.96), renal function (modification of diet in renal disease; P<0.001; HR=0.990; CI=0.98-0.99), sodium (P<0.05; HR=0.967; CI=0.94-0.99), and AT nonidentification (P<0.05; HR=1.41; CI=1.06-1.89). Nonidentification of AT remained associated to prognosis also when compared with metabolic exercise and cardiac and kidney index score (P<0.01; HR=1.459; CI=1.09-1.10). Similar results were obtained for the secondary study e

Published
2013

48. Impact of Sacubitril/Valsartan on surfactant binding proteins, central sleep apneas, lung function tests and heart failure biomarkers: Hemodynamic or pleiotropism?

Author

Massimo Mapelli, Irene Mattavelli, Elisabetta Salvioni, Cristina Banfi, Stefania Ghilardi, Fabiana De Martino, Paola Gugliandolo, Valentina Mantegazza, Valentina Volpato, Christian Basile, Maria Inês Fiuza Branco Pires, Valentina Sassi, Benedetta Nusca, Carlo Vignati, Mauro Contini, Chiarella Sforza, Maria Luisa Biondi, Pasquale Perrone Filardi, Piergiuseppe Agostoni, Mapelli, M., Mattavelli, I., Salvioni, E., Banfi, C., Ghilardi, S., De Martino, F., Gugliandolo, P., Mantegazza, V., Volpato, V., Basile, C., Branco Pires, M. I. F., Sassi, V., Nusca, B., Vignati, C., Contini, M., Sforza, C., Biondi, M. L., Perrone Filardi, P., and Agostoni, P.

Subjects
hemodynamic, pleiotropic, surfactant binding proteins, biomarkers, biomarker, heart failure, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, hemodynamics, Sacubitril/Valsartan, Cardiology and Cardiovascular Medicine
Abstract

PurposeLittle is known about the mechanism underlying Sacubitril/Valsartan effects in patients with heart failure (HFrEF). Aim of the study is to assess hemodynamic vs. non-hemodynamic Sacubitril/Valsartan effects by analyzing several biological and functional parameters.MethodsSeventy-nine patients (86% males, age 66 ± 10 years) were enrolled. At baseline and 6 months after reaching the maximum Sacubitril/Valsartan tolerated dose, we assessed biomarkers, transthoracic echocardiography, polysomnography, spirometry, and carbon monoxide diffusing capacity of the lung (DLCO).ResultsMean follow-up was 8.7 ± 1.4 months with 83% of patients reaching Sacubitril/Valsartan maximum dose (97/103 mg b.i.d). Significant improvements were observed in cardiac performance and biomarkers: left ventricular ejection fraction increased (31 ± 5 vs. 37 ± 9 %; p < 0.001), end-diastolic and end-systolic volumes decreased; NT-proBNP decreased (1,196 [IQR 648–2891] vs. 958 [IQR 424-1,663] pg/ml; p < 0.001) in parallel with interleukin ST-2 (28.4 [IQR 19.4–36.6] vs. 20.4 [IQR 15.1–29.2] ng/ml; p < 0.001) and circulating surfactant binding proteins (proSP-B: 58.43 [IQR 40.42–84.23] vs. 50.36 [IQR 37.16–69.54] AU; p = 0.014 and SP-D: 102.17 [IQR 62.85–175.34] vs. 77.64 [IQR 53.55-144.70] AU; p < 0.001). Forced expiratory volume in 1 second and forced vital capacity improved. DLCO increased in the patients' subgroup (n = 39) with impaired baseline values (from 65.3 ± 10.8 to 70.3 ± 15.9 %predicted; p = 0.013). We also observed a significant reduction in central sleep apneas (CSA).ConclusionSacubitril/Valsartan effects share a double pathway: hemodynamic and systemic. The first is evidenced by NT-proBNP, proSP-B, lung mechanics, and CSA improvement. The latter is confirmed by an amelioration of DLCO, ST-2, SP-D as well as by reverse remodeling echocardiographic parameters.

Published
2022

49. Computed tomography predictors of structural valve degeneration in patients undergoing transcatheter aortic valve implantation with balloon-expandable prostheses

Author

Marco Guglielmo, Laura Fusini, Manuela Muratori, Gloria Tamborini, Valentina Mantegazza, Daniele Andreini, Andrea Annoni, Mario Babbaro, Andrea Baggiano, Edoardo Conte, Serena Carriero, Alberto Formenti, Andrea Igoren Guaricci, Elisabetta Mancini, Rocco Mollace, Giuseppe Muscogiuri, Saima Mushtaq, Francesca Ricci, Alexia Rossi, Stefano Scafuri, Brunilda Alushi, Claudio Cau, Riccardo Cau, Margherita Cesarano, Luca Saba, Mark Rabbat, Mauro Pepi, Gianluca Pontone, Guglielmo, M, Fusini, L, Muratori, M, Tamborini, G, Mantegazza, V, Andreini, D, Annoni, A, Babbaro, M, Baggiano, A, Conte, E, Carriero, S, Formenti, A, Guaricci, A, Mancini, E, Mollace, R, Muscogiuri, G, Mushtaq, S, Ricci, F, Rossi, A, Scafuri, S, Alushi, B, Cau, C, Cau, R, Cesarano, M, Saba, L, Rabbat, M, Pepi, M, and Pontone, G

Subjects
Aged, 80 and over, Heart Valve Prosthesis Implantation, Transcatheter aortic valve implantation, Computed tomography, Structural valve degeneration, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, General Medicine, Aortic Valve Stenosis, Prosthesis Design, Transcatheter Aortic Valve Replacement, Treatment Outcome, Aortic Valve, Heart Valve Prosthesis, Humans, Radiology, Nuclear Medicine and imaging, Female, Tomography, X-Ray Computed, Aged, Retrospective Studies
Abstract

Objectives: Computed tomography (CT) provides excellent anatomy assessment of the aortic annulus (AoA) and is utilized for pre-procedural planning of transcatheter aortic valve implantation (TAVI). We sought to investigate if geometrical characteristics of the AoA determined by CT may represent predictors of structural valve degeneration (SVD) in patients undergoing TAVI with balloon-expandable valves. Methods: This is a retrospective study on 124 consecutive patients (mean age: 79 ± 7 years; female: 61%) undergoing balloon-expandable TAVI prospectively enrolled in a registry. AoA maximum diameter (Dmax), minimum diameter (Dmin), and area were assessed using pre-procedural CT. SVD was identified during follow-up with transthoracic echocardiography documenting structural prosthetic valve abnormalities with or without hemodynamic changes. Results: The mean follow-up was 5.9 ± 1.7 years. SVD was found in 48 out of 124 patients (38%). AoA Dmax, Dmin, and area were significantly smaller in patients with SVD compared to patients without SVD (25.6 ± 2.2 mm vs. 27.1 ± 2.8 mm, p = 0.012; 20.5 ± 2.1 mm vs. 21.8 ± 2.1 mm, p = 0.001 and 419 ± 77 mm2 vs. 467 ± 88 mm2, p = 0.002, respectively). At univariable analysis, female sex, BSA, 23-mm prosthetic valve size, Dmax < 27.1 mm, and a Dmin < 19.9 mm were associated with SVD, whereas at multivariable analysis, only Dmin < 19.9 mm (OR = 2.873, 95% CI: 1.191–6.929, p = 0.019) and female sex (OR = 2.659, 95% CI: 1.095–6.458, p = 0.031) were independent predictors of SVD. Conclusions: Female sex and AoA Dmin < 19.9 mm are associated with SVD in patients undergoing TAVI with balloon-expandable valves. When implanting large prostheses in order to avoid paraprosthetic regurgitation, caution should be observed due to the risk of excessive stretching of the AoA Dmin, which may play a role in SVD. Key Points: • Long-term durability is a concern for transcatheter aortic valve bioprosthesis. • CT provides an excellent assessment of the aortic annulus’s geometrical characteristics for prosthesis sizing before transcatheter aortic valve implantation (TAVI). • Female sex and a small minimum aortic annulus diameter measured with CT are independent predictors of structural valve degeneration in patients undergoing TAVI with balloon-expandable valves.

Published
2021

50. Arrhythmic Mitral Valve Prolapse: Introducing an Era of Multimodality Imaging-Based Diagnosis and Risk Stratification

Author

Mauro Pepi, Andrea Baggiano, Andrea Mazzanti, Marco Guglielmo, Manuela Muratori, Deni Kukavica, Silvia G. Priori, Valentina Mantegazza, Alessandro Trancuccio, Giuseppe Muscogiuri, Carlo Arnò, Gianluca Pontone, Laura Fusini, Gloria Tamborini, Kukavica, D, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Muratori, M, Tamborini, G, Mantegazza, V, Trancuccio, A, Arnò, C, Mazzanti, A, Pepi, M, Priori, S, and Pontone, G

Subjects
medicine.medical_specialty, Clinical Biochemistry, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Review, 030204 cardiovascular system & hematology, arrhythmia, cardiovascular magnetic resonance, echocardiography, mitral valve prolapse, multimodality imaging, risk factors, sudden cardiac death, Sudden cardiac death, 03 medical and health sciences, 0302 clinical medicine, Mitral valve, Internal medicine, Epidemiology, medicine, Mitral valve prolapse, In patient, 030212 general & internal medicine, cardiovascular diseases, lcsh:R5-920, business.industry, medicine.disease, Young age, medicine.anatomical_structure, Risk stratification, Etiology, Cardiology, cardiovascular system, Risk factor, business, lcsh:Medicine (General)
Abstract

Mitral valve prolapse is a common cardiac condition, with an estimated prevalence between 1% and 3%. Most patients have a benign course, but ever since its initial description mitral valve prolapse has been associated to sudden cardiac death. Although the causal relationship between mitral valve prolapse and sudden cardiac death has never been clearly demonstrated, different factors have been implicated in arrhythmogenesis in patients with mitral valve prolapse. In this work, we offer a comprehensive overview of the etiology and the genetic background, epidemiology, pathophysiology, and we focus on the state-of-the-art imaging-based diagnosis of mitral valve prolapse. Going beyond the classical, well-described clinical factors, such as young age, female gender and auscultatory findings, we investigate multimodality imaging features, such as alterations of anatomy and function of the mitral valve and its leaflets, the structural and contractile anomalies of the myocardium, all of which have been associated to sudden cardiac death. This research received no external funding Sí

Published
2021

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