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1. The chronic heart failure evolutions: Different fates and routes

Author

Agostoni, P, Chiesa, M, Salvioni, E, Emdin, M, Piepoli, M, Sinagra, G, Senni, M, Bonomi, A, Adamopoulos, S, Miliopoulos, D, Mapelli, M, Campodonico, J, Attanasio, U, Apostolo, A, Pestrin, E, Rossoni, A, Magri, D, Paolillo, S, Corra, U, Raimondo, R, Cittadini, A, Iorio, A, Salzano, A, Lagioia, R, Vignati, C, Badagliacca, R, Filardi, P, Correale, M, Perna, E, Metra, M, Cattadori, G, Guazzi, M, Limongelli, G, Parati, G, De Martino, F, Matassini, M, Bandera, F, Bussotti, M, Re, F, Lombardi, C, Scardovi, A, Sciomer, S, Passantino, A, Santolamazza, C, Girola, D, Passino, C, Karsten, M, Nodari, S, Pompilio, G, Agostoni P., Chiesa M., Salvioni E., Emdin M., Piepoli M., Sinagra G., Senni M., Bonomi A., Adamopoulos S., Miliopoulos D., Mapelli M., Campodonico J., Attanasio U., Apostolo A., Pestrin E., Rossoni A., Magri D., Paolillo S., Corra U., Raimondo R., Cittadini A., Iorio A., Salzano A., Lagioia R., Vignati C., Badagliacca R., Filardi P. P., Correale M., Perna E., Metra M., Cattadori G., Guazzi M., Limongelli G., Parati G., De Martino F., Matassini M. V., Bandera F., Bussotti M., Re F., Lombardi C. M., Scardovi A. B., Sciomer S., Passantino A., Santolamazza C., Girola D., Passino C., Karsten M., Nodari S., Pompilio G., Agostoni, P, Chiesa, M, Salvioni, E, Emdin, M, Piepoli, M, Sinagra, G, Senni, M, Bonomi, A, Adamopoulos, S, Miliopoulos, D, Mapelli, M, Campodonico, J, Attanasio, U, Apostolo, A, Pestrin, E, Rossoni, A, Magri, D, Paolillo, S, Corra, U, Raimondo, R, Cittadini, A, Iorio, A, Salzano, A, Lagioia, R, Vignati, C, Badagliacca, R, Filardi, P, Correale, M, Perna, E, Metra, M, Cattadori, G, Guazzi, M, Limongelli, G, Parati, G, De Martino, F, Matassini, M, Bandera, F, Bussotti, M, Re, F, Lombardi, C, Scardovi, A, Sciomer, S, Passantino, A, Santolamazza, C, Girola, D, Passino, C, Karsten, M, Nodari, S, Pompilio, G, Agostoni P., Chiesa M., Salvioni E., Emdin M., Piepoli M., Sinagra G., Senni M., Bonomi A., Adamopoulos S., Miliopoulos D., Mapelli M., Campodonico J., Attanasio U., Apostolo A., Pestrin E., Rossoni A., Magri D., Paolillo S., Corra U., Raimondo R., Cittadini A., Iorio A., Salzano A., Lagioia R., Vignati C., Badagliacca R., Filardi P. P., Correale M., Perna E., Metra M., Cattadori G., Guazzi M., Limongelli G., Parati G., De Martino F., Matassini M. V., Bandera F., Bussotti M., Re F., Lombardi C. M., Scardovi A. B., Sciomer S., Passantino A., Santolamazza C., Girola D., Passino C., Karsten M., Nodari S., and Pompilio G.

Abstract

Aims: Individual prognostic assessment and disease evolution pathways are undefined in chronic heart failure (HF). The application of unsupervised learning methodologies could help to identify patient phenotypes and the progression in each phenotype as well as to assess adverse event risk. Methods and results: From a bulk of 7948 HF patients included in the MECKI registry, we selected patients with a minimum 2-year follow-up. We implemented a topological data analysis (TDA), based on 43 variables derived from clinical, biochemical, cardiac ultrasound, and exercise evaluations, to identify several patients' clusters. Thereafter, we used the trajectory analysis to describe the evolution of HF states, which is able to identify bifurcation points, characterized by different follow-up paths, as well as specific end-stages conditions of the disease. Finally, we conducted a 5-year survival analysis (composite of cardiovascular death, left ventricular assist device, or urgent heart transplant). Findings were validated on internal (n = 527) and external (n = 777) populations. We analyzed 4876 patients (age = 63 [53–71], male gender n = 3973 (81.5%), NYHA class I–II n = 3576 (73.3%), III–IV n = 1300 (26.7%), LVEF = 33 [25.5–39.9], atrial fibrillation n = 791 (16.2%), peak VO2% pred = 54.8 [43.8–67.2]), with a minimum 2-year follow-up. Nineteen patient clusters were identified by TDA. Trajectory analysis revealed a path characterized by 3 bifurcation and 4 end-stage points. Clusters survival rate varied from 44% to 100% at 2 years and from 20% to 100% at 5 years, respectively. The event frequency at 5-year follow-up for each study cohort cluster was successfully compared with those in the validation cohorts (R = 0.94 and R = 0.84, P < 0.001, for internal and external cohort, respectively). Finally, we conducted a 5-year survival analysis (composi

Published
2024

2. A matter of sex—persistent predictive value of MECKI score prognostic power in men and women with heart failure and reduced ejection fraction: a multicenter study

Author

Grilli, G, Salvioni, E, Moscucci, F, Bonomi, A, Sinagra, G, Schaeffer, M, Campodonico, J, Mapelli, M, Rossi, M, Carriere, C, Emdin, M, Piepoli, M, Paolillo, S, Senni, M, Passino, C, Apostolo, A, Re, F, Santolamazza, C, Magri, D, Lombardi, C, Corra, U, Raimondo, R, Cittadini, A, Iorio, A, Salzano, A, Lagioia, R, Vignati, C, Badagliacca, R, Passantino, A, Filardi, P, Correale, M, Perna, E, Girola, D, Metra, M, Cattadori, G, Guazzi, M, Limongelli, G, Parati, G, De Martino, F, Matassini, M, Bandera, F, Bussotti, M, Scardovi, A, Sciomer, S, Agostoni, P, Grilli G., Salvioni E., Moscucci F., Bonomi A., Sinagra G., Schaeffer M., Campodonico J., Mapelli M., Rossi M., Carriere C., Emdin M., Piepoli M., Paolillo S., Senni M., Passino C., Apostolo A., Re F., Santolamazza C., Magri D., Lombardi C. M., Corra U., Raimondo R., Cittadini A., Iorio A., Salzano A., Lagioia R., Vignati C., Badagliacca R., Passantino A., Filardi P. P., Correale M., Perna E., Girola D., Metra M., Cattadori G., Guazzi M., Limongelli G., Parati G., De Martino F., Matassini M. V., Bandera F., Bussotti M., Scardovi A. B., Sciomer S., Agostoni P., Grilli, G, Salvioni, E, Moscucci, F, Bonomi, A, Sinagra, G, Schaeffer, M, Campodonico, J, Mapelli, M, Rossi, M, Carriere, C, Emdin, M, Piepoli, M, Paolillo, S, Senni, M, Passino, C, Apostolo, A, Re, F, Santolamazza, C, Magri, D, Lombardi, C, Corra, U, Raimondo, R, Cittadini, A, Iorio, A, Salzano, A, Lagioia, R, Vignati, C, Badagliacca, R, Passantino, A, Filardi, P, Correale, M, Perna, E, Girola, D, Metra, M, Cattadori, G, Guazzi, M, Limongelli, G, Parati, G, De Martino, F, Matassini, M, Bandera, F, Bussotti, M, Scardovi, A, Sciomer, S, Agostoni, P, Grilli G., Salvioni E., Moscucci F., Bonomi A., Sinagra G., Schaeffer M., Campodonico J., Mapelli M., Rossi M., Carriere C., Emdin M., Piepoli M., Paolillo S., Senni M., Passino C., Apostolo A., Re F., Santolamazza C., Magri D., Lombardi C. M., Corra U., Raimondo R., Cittadini A., Iorio A., Salzano A., Lagioia R., Vignati C., Badagliacca R., Passantino A., Filardi P. P., Correale M., Perna E., Girola D., Metra M., Cattadori G., Guazzi M., Limongelli G., Parati G., De Martino F., Matassini M. V., Bandera F., Bussotti M., Scardovi A. B., Sciomer S., and Agostoni P.

Abstract

Background: A sex-based evaluation of prognosis in heart failure (HF) is lacking. Methods and results: We analyzed the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score registry, which includes HF with reduced ejection fraction (HFrEF) patients. A cross-validation procedure was performed to estimate weights separately for men and women of all MECKI score parameters: left ventricular ejection fraction (LVEF), hemoglobin, kidney function assessed by Modification of Diet in Renal Disease, blood sodium level, ventilation vs. carbon dioxide production slope, and peak oxygen consumption (peakVO2). The primary outcomes were the composite of all-cause mortality, urgent heart transplant, and implant of a left ventricle assist device. The difference in predictive ability between the native and sex recalibrated MECKI (S-MECKI) was calculated using a receiver operating characteristic (ROC) curve at 2 years and a calibration plot. We retrospectively analyzed 7,900 HFrEF patients included in the MECKI score registry (mean age 61 ± 13 years, 6,456 men/1,444 women, mean LVEF 33% ± 10%, mean peakVO2 56.2% ± 17.6% of predicted) with a median follow-up of 4.05 years (range 1.72–7.47). Our results revealed an unadjusted risk of events that was doubled in men compared to women (9.7 vs. 4.1) and a significant difference in weight between the sexes of most of the parameters included in the MECKI score. S-MECKI showed improved risk classification and accuracy (area under the ROC curve: 0.7893 vs. 0.7799, p = 0.02) due to prognostication improvement in the high-risk settings in both sexes (MECKI score >10 in men and >5 in women). Conclusions: S-MECKI, i.e., the recalibrated MECKI according to sex-specific differences, constitutes a further step in the prognostic assessment of patients with severe HFrEF.

Published
2024

3. Clinical outcomes and predictors of success with Impella weaning in cardiogenic shock: a single-center experience

Author

Matassini, M. V., primary, Marini, M., additional, Angelozzi, A., additional, Angelini, L., additional, Shkoza, M., additional, Compagnucci, P., additional, Falanga, U., additional, Battistoni, I., additional, Pongetti, G., additional, Francioni, M., additional, Piva, T., additional, Mucaj, A., additional, Nicolini, E., additional, Maolo, A., additional, Di Eusanio, M., additional, Munch, C., additional, Dello Russo, A., additional, and Perna, G., additional

Published
2023
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4. Heart failure patients with improved ejection fraction: Insights from the MECKI score database

Author

Agostoni, P, Pluchinotta, F, Salvioni, E, Mapelli, M, Galotta, A, Bonomi, A, Magri, D, Perna, E, Paolillo, S, Corra, U, Raimondo, R, Lagioia, R, Badagliacca, R, Perrone Filardi, P, Apostolo, A, Senni, M, Iorio, A, Correale, M, Campodonico, J, Palermo, P, Cicoira, M, Metra, M, Guazzi, M, Limongelli, G, Contini, M, Pezzuto, B, Sinagra, G, Parati, G, Cattadori, G, Carriere, C, Cittar, M, Matassini, M, Salzano, A, Cittadini, A, Mase, M, Bandera, F, Bussotti, M, Mattavelli, I, Re, F, Vignati, C, Lombardi, C, Scardovi, A, Sciomer, S, Passantino, A, Emdin, M, Di Lenarda, A, Passino, C, Santolamazza, C, Moscucci, F, Zaffalon, D, Piepoli, M, Agostoni P., Pluchinotta F. R., Salvioni E., Mapelli M., Galotta A., Bonomi A., Magri D., Perna E., Paolillo S., Corra U., Raimondo R., Lagioia R., Badagliacca R., Perrone Filardi P., Apostolo A., Senni M., Iorio A., Correale M., Campodonico J., Palermo P., Cicoira M., Metra M., Guazzi M., Limongelli G., Contini M., Pezzuto B., Sinagra G., Parati G., Cattadori G., Carriere C., Cittar M., Matassini M. V., Salzano A., Cittadini A., Mase M., Bandera F., Bussotti M., Mattavelli I., Re F., Vignati C., Lombardi C., Scardovi A. B., Sciomer S., Passantino A., Emdin M., Di Lenarda A., Passino C., Santolamazza C., Moscucci F., Zaffalon D., Piepoli M., Agostoni, P, Pluchinotta, F, Salvioni, E, Mapelli, M, Galotta, A, Bonomi, A, Magri, D, Perna, E, Paolillo, S, Corra, U, Raimondo, R, Lagioia, R, Badagliacca, R, Perrone Filardi, P, Apostolo, A, Senni, M, Iorio, A, Correale, M, Campodonico, J, Palermo, P, Cicoira, M, Metra, M, Guazzi, M, Limongelli, G, Contini, M, Pezzuto, B, Sinagra, G, Parati, G, Cattadori, G, Carriere, C, Cittar, M, Matassini, M, Salzano, A, Cittadini, A, Mase, M, Bandera, F, Bussotti, M, Mattavelli, I, Re, F, Vignati, C, Lombardi, C, Scardovi, A, Sciomer, S, Passantino, A, Emdin, M, Di Lenarda, A, Passino, C, Santolamazza, C, Moscucci, F, Zaffalon, D, Piepoli, M, Agostoni P., Pluchinotta F. R., Salvioni E., Mapelli M., Galotta A., Bonomi A., Magri D., Perna E., Paolillo S., Corra U., Raimondo R., Lagioia R., Badagliacca R., Perrone Filardi P., Apostolo A., Senni M., Iorio A., Correale M., Campodonico J., Palermo P., Cicoira M., Metra M., Guazzi M., Limongelli G., Contini M., Pezzuto B., Sinagra G., Parati G., Cattadori G., Carriere C., Cittar M., Matassini M. V., Salzano A., Cittadini A., Mase M., Bandera F., Bussotti M., Mattavelli I., Re F., Vignati C., Lombardi C., Scardovi A. B., Sciomer S., Passantino A., Emdin M., Di Lenarda A., Passino C., Santolamazza C., Moscucci F., Zaffalon D., and Piepoli M.

Abstract

Aims: Improvement of left ventricular ejection fraction is a major goal of heart failure (HF) treatment. However, data on clinical characteristics, exercise performance and prognosis in HF patients who improved ejection fraction (HFimpEF) are scarce. The study aimed to determine whether HFimpEF patients have a distinct clinical phenotype, biology and prognosis than HF patients with persistently reduced ejection fraction (pHFrEF). Methods and results: A total of 7948 patients enrolled in the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database were evaluated (median follow-up of 1490 days). We analysed clinical, laboratory, electrocardiographic, echocardiographic, exercise, and survival data from HFimpEF (n = 1504) and pHFrEF (n = 6017) patients. The primary endpoint of the study was the composite of cardiovascular death, left ventricular assist device implantation, and urgent heart transplantation. HFimpEF patients had lower HF severity: left ventricular ejection fraction 44.0 [41.0–47.0] versus 29.7 [24.1–34.5]%, B-type natriuretic peptide 122 [65–296] versus 373 [152–888] pg/ml, haemoglobin 13.5 [12.2–14.6] versus 13.7 [12.5–14.7] g/dl, renal function by the Modification of Diet in Renal Disease equation 72.0 [56.7–89.3] versus 70.4 [54.5–85.3] ml/min, peak oxygen uptake 62.2 [50.7–74.1] versus 52.6 [41.8–64.3]% predicted, minute ventilation-to-carbon dioxide output slope 30.0 [26.9–34.4] versus 32.1 [28.0–38.0] in HFimpEF and pHFrEF, respectively (p < 0.001 for all). Cardiovascular mortality rates were 26.6 and 46.9 per 1000 person-years for HFimpEF and pHFrEF, respectively (p < 0.001). Kaplan–Meier analysis showed that HFimpEF had better a long-term prognosis compared with pHFrEF patients. After adjustment for variables differentiating HFimpEF from pHFrEF, except echocardiographic parameters, the Kaplan–Meier curves showed the same prognosis. Conclusions: Heart failure with improved ejection fraction represents a peculiar group of HF patients w

Published
2023

5. Temporal trend mortality and in-hospital mortality predictors in an ischemic cardiogenic shock population: a 10 years single-centre retrospective study

Author

Belfioretti, L, primary, Marini, M, additional, Francioni, M, additional, Battistoni, I, additional, Angelini, L, additional, Matassini, M V, additional, Angelozzi, A, additional, Pongetti, G, additional, Shkoza, M, additional, Piva, T, additional, Compagnucci, P, additional, Munch, C, additional, Dello Russo, A, additional, Di Eusanio, M, additional, and Perna, G P, additional

Published
2022
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6. Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis

Author

Ammirati, E, Lupi, L, Palazzini, M, Hendren, N, Grodin, J, Cannistraci, C, Schmidt, M, Hekimian, G, Peretto, G, Bochaton, T, Hayek, A, Piriou, N, Leonardi, S, Guida, S, Turco, A, Sala, S, Uribarri, A, Van De Heyning, C, Mapelli, M, Campodonico, J, Pedrotti, P, Barrionuevo Sanchez, M, Ariza Sole, A, Marini, M, Matassini, M, Vourc'H, M, Cannata, A, Bromage, D, Briguglia, D, Salamanca, J, Diez-Villanueva, P, Lehtonen, J, Huang, F, Russel, S, Soriano, F, Turrini, F, Cipriani, M, Bramerio, M, Di Pasquale, M, Grosu, A, Senni, M, Farina, D, Agostoni, P, Rizzo, S, De Gaspari, M, Marzo, F, Duran, J, Adler, E, Giannattasio, C, Basso, C, Mcdonagh, T, Kerneis, M, Combes, A, Camici, P, De Lemos, J, Metra, M, Ammirati E., Lupi L., Palazzini M., Hendren N. S., Grodin J. L., Cannistraci C. V., Schmidt M., Hekimian G., Peretto G., Bochaton T., Hayek A., Piriou N., Leonardi S., Guida S., Turco A., Sala S., Uribarri A., Van De Heyning C. M., Mapelli M., Campodonico J., Pedrotti P., Barrionuevo Sanchez M. I., Ariza Sole A., Marini M., Matassini M. V., Vourc'H M., Cannata A., Bromage D. I., Briguglia D., Salamanca J., Diez-Villanueva P., Lehtonen J., Huang F., Russel S., Soriano F., Turrini F., Cipriani M., Bramerio M., Di Pasquale M., Grosu A., Senni M., Farina D., Agostoni P., Rizzo S., De Gaspari M., Marzo F., Duran J. M., Adler E. D., Giannattasio C., Basso C., McDonagh T., Kerneis M., Combes A., Camici P. G., De Lemos J. A., Metra M., Ammirati, E, Lupi, L, Palazzini, M, Hendren, N, Grodin, J, Cannistraci, C, Schmidt, M, Hekimian, G, Peretto, G, Bochaton, T, Hayek, A, Piriou, N, Leonardi, S, Guida, S, Turco, A, Sala, S, Uribarri, A, Van De Heyning, C, Mapelli, M, Campodonico, J, Pedrotti, P, Barrionuevo Sanchez, M, Ariza Sole, A, Marini, M, Matassini, M, Vourc'H, M, Cannata, A, Bromage, D, Briguglia, D, Salamanca, J, Diez-Villanueva, P, Lehtonen, J, Huang, F, Russel, S, Soriano, F, Turrini, F, Cipriani, M, Bramerio, M, Di Pasquale, M, Grosu, A, Senni, M, Farina, D, Agostoni, P, Rizzo, S, De Gaspari, M, Marzo, F, Duran, J, Adler, E, Giannattasio, C, Basso, C, Mcdonagh, T, Kerneis, M, Combes, A, Camici, P, De Lemos, J, Metra, M, Ammirati E., Lupi L., Palazzini M., Hendren N. S., Grodin J. L., Cannistraci C. V., Schmidt M., Hekimian G., Peretto G., Bochaton T., Hayek A., Piriou N., Leonardi S., Guida S., Turco A., Sala S., Uribarri A., Van De Heyning C. M., Mapelli M., Campodonico J., Pedrotti P., Barrionuevo Sanchez M. I., Ariza Sole A., Marini M., Matassini M. V., Vourc'H M., Cannata A., Bromage D. I., Briguglia D., Salamanca J., Diez-Villanueva P., Lehtonen J., Huang F., Russel S., Soriano F., Turrini F., Cipriani M., Bramerio M., Di Pasquale M., Grosu A., Senni M., Farina D., Agostoni P., Rizzo S., De Gaspari M., Marzo F., Duran J. M., Adler E. D., Giannattasio C., Basso C., McDonagh T., Kerneis M., Combes A., Camici P. G., De Lemos J. A., and Metra M.

Abstract

Background: Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19-associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe. Methods: A total of 112 patients with suspected AM from 56 963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19-associated AM. Results: AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19-associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (P=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge

Published
2022

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

Author

Salvioni, E., Mapelli, M., Bonomi, A., Magri, D., Piepoli, M., Frigerio, M., Paolillo, S., Corra, U., Raimondo, R., Lagioia, R., Badagliacca, R., Filardi, P. P., Senni, M., Correale, M., Cicoira, M., Perna, E., Metra, M., Guazzi, M., Limongelli, G., Sinagra, G., Parati, G., Cattadori, G., Bandera, F., Bussotti, M., Re, F., Vignati, C., Lombardi, C., Scardovi, A. B., Sciomer, S., Passantino, A., Emdin, M., Passino, C., Santolamazza, C., Girola, D., Zaffalon, D., De Martino, F., Agostoni, P., Farina, S., Pezzuto, B., Apostolo, A., Palermo, P., Contini, M., Gugliandolo, P., Mattavelli, I., Della Rocca, M., Gallo, G., Moscucci, F., Iorio, A., Halasz, G., Capelli, B., Binno, S., Pacileo, G., Valente, F., Vastarella, R., Carriere, C., Mase, M., Cittar, M., Di Lenarda, A., Caravita, S., Vigano, E., Marchese, G., Ricci, R., Arcari, L., Scrutinio, D., Battaia, E., Moretti, M., Matassini, M. V., Shkoza, M., Herberg, R., Cittadini, A., Salzano, A., Marra, A., Lafranca, E., and Vitale, G.

Subjects
heart failure, prognosis, anaerobic threshold, cardiopulmonary exercise test
Published
2022

10. Current Therapeutic Options for Heart Failure in Elderly Patients

Author

Guerra, F., Brambatti, M., Matassini, M. V., and Capucci, A.

Subjects
Article Subject
Abstract

Heart failure (HF) is a major and growing public health problem with high morbidity and mortality (Ponikowski et al., 2016). It affects 1-2% of the general population in developed countries, and the average age at diagnosis is 76 years. Because of a better management of acute phase and comorbidities, HF incidence is increasing in elderly patients, with a prevalence rising to 10% among people aged 65 years or older (Mozaffarian et al., 2014). Therefore, a substantial number of elderly patients need to be treated. However, because of clinical trial exclusion criteria or coexisting comorbidities, currently recommended therapies are widely based on younger population with a much lower mean age. In this review, we will focus on available pharmacological, electrical, and mechanical therapies, underlining pros, cons, and practical considerations of their use in this specific patient population.

Published
2017
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