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1. Pulmonary Valve Stenosis: From Diagnosis to Current Management Techniques and Future Prospects

Author

Marchini F, Meossi S, Passarini G, Campo G, and Pavasini R

Subjects
pulmonary valve stenosis, percutaneous treatment, valvotomy, valvuloplasty, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Federico Marchini, Sofia Meossi, Giulia Passarini, Gianluca Campo, Rita Pavasini Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, ItalyCorrespondence: Rita Pavasini, Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, FE, 44124, Italy, Tel +39 0532237227, Email pvsrti@unife.itAbstract: Pulmonary stenosis (PS) is mainly a congenital defect that accounts for 7– 12% of congenital heart diseases (CHD). It can be isolated or, more frequently, associated with other congenital defects (25– 30%) involving anomalies of the pulmonary vascular tree. For the diagnosis of PS an integrated approach with echocardiography, cardiac computed tomography and cardiac magnetic resonance (CMR) is of paramount importance for the planning of the interventional treatment. In recent years, transcatheter approaches for the treatment of PS have increased however, meaning surgery is a possible option for complicated cases with anatomy not suitable for percutaneous treatment. The present review aims to summarize current knowledge regarding diagnosis and treatment of PS.Keywords: pulmonary valve stenosis, percutaneous treatment, valvotomy, valvuloplasty

Published
2023

2. ECG/echo indexes in the diagnostic approach to amyloid cardiomyopathy: A head-to-head comparison from the AC-TIVE study

Author

Pagura, L, Porcari, A, Cameli, M, Biagini, E, Canepa, M, Crotti, L, Imazio, M, Forleo, C, Pavasini, R, Limongelli, G, Perlini, S, Metra, M, Boriani, G, Emdin, M, Sinagra, G, Merlo, M, Longo, F, Rossi, M, Varrà, G, Saro, R, Dore, F, Girardi, F, Vergaro, G, Musumeci, B, Autore, C, Cappelli, F, Perfetto, F, Olivotto, I, Favale, S, Carella, M, Guaricci, A, Ciccone, M, Di Bella, G, Tomasoni, D, Rella, V, Branzi, G, Badano, L, Parati, G, Palmiero, G, Caiazza, M, Caponetti, A, Saturi, G, Labate, M, Andreis, A, Paneva, E, De Ferrari, G, Di Ienno, L, De Carli, G, Giacomin, E, Arzilli, C, Pagura L., Porcari A., Cameli M., Biagini E., Canepa M., Crotti L., Imazio M., Forleo C., Pavasini R., Limongelli G., Perlini S., Metra M., Boriani G., Emdin M., Sinagra G., Merlo M., Longo F., Rossi M., Varrà G. G., Saro R., Dore F., Girardi F., Vergaro G., Musumeci B., Autore C., Cappelli F., Perfetto F., Olivotto I., Favale S., Carella M. C., Guaricci A. I., Ciccone M. M., Di Bella G., Tomasoni D., Rella V., Branzi G., Badano L., Parati G., Palmiero G., Caiazza M., Caponetti A. G., Saturi G., Labate M. E., Andreis A., Paneva E., De Ferrari G. M., Di Ienno L., De Carli G., Giacomin E., Arzilli C., Pagura, L, Porcari, A, Cameli, M, Biagini, E, Canepa, M, Crotti, L, Imazio, M, Forleo, C, Pavasini, R, Limongelli, G, Perlini, S, Metra, M, Boriani, G, Emdin, M, Sinagra, G, Merlo, M, Longo, F, Rossi, M, Varrà, G, Saro, R, Dore, F, Girardi, F, Vergaro, G, Musumeci, B, Autore, C, Cappelli, F, Perfetto, F, Olivotto, I, Favale, S, Carella, M, Guaricci, A, Ciccone, M, Di Bella, G, Tomasoni, D, Rella, V, Branzi, G, Badano, L, Parati, G, Palmiero, G, Caiazza, M, Caponetti, A, Saturi, G, Labate, M, Andreis, A, Paneva, E, De Ferrari, G, Di Ienno, L, De Carli, G, Giacomin, E, Arzilli, C, Pagura L., Porcari A., Cameli M., Biagini E., Canepa M., Crotti L., Imazio M., Forleo C., Pavasini R., Limongelli G., Perlini S., Metra M., Boriani G., Emdin M., Sinagra G., Merlo M., Longo F., Rossi M., Varrà G. G., Saro R., Dore F., Girardi F., Vergaro G., Musumeci B., Autore C., Cappelli F., Perfetto F., Olivotto I., Favale S., Carella M. C., Guaricci A. I., Ciccone M. M., Di Bella G., Tomasoni D., Rella V., Branzi G., Badano L., Parati G., Palmiero G., Caiazza M., Caponetti A. G., Saturi G., Labate M. E., Andreis A., Paneva E., De Ferrari G. M., Di Ienno L., De Carli G., Giacomin E., and Arzilli C.

Abstract

Background and aims: The discordance between QRS voltages on electrocardiogram (ECG) and left ventricle (LV) wall thickness (LVWT) on echocardiogram (echo) is a recognized red flag (RF) of amyloid cardiomyopathy (AC) and can be measured by specific indexes. No head-to-head comparison of different ECG/echo indexes among subjects with echocardiographic suspicion of AC has yet been undertaken. The study aimed at evaluating the performance and the incremental diagnostic value of different ECG/echo indexes in this subset of patients. Methods: Electrocardiograms of subjects with LV hypertrophy, preserved ejection fraction and ≥ 1 echocardiographic RF of AC participating in the AC-TIVE study, an Italian prospective multicenter study, were independently analyzed by two cardiologists. Low QRS voltages and 8 different ECG/echo indexes were evaluated. Cohort specific cut-offs were computed. Results: Among 170 patients, 55 (32 %) were diagnosed with AC. Combination of low QRS voltages with interventricular septum ≥ 1,6 cm was the most specific (specificity 100 %, positive predictive value 100 %) ECG/echo index, while the ratio between the sum of all QRS voltages and LVWT <7,8 was the most sensitive and accurate (sensitivity 94 %, negative predictive value 97 %, accuracy 82 %). When the latter index was added to a model using easily-accessible clinical variables, the diagnostic accuracy for AC greatly increased (AUC from 0,84 to 0,95; p = 0,007). Conclusions: Among patients with non-dilated hypertrophic ventricles with normal ejection fraction and echocardiographic RF of AC, easily-measurable ECG/echo indexes, mainly when added to few clinical variables, can help the physician orient second level investigations. External validation of the results is warranted.

Published
2024

3. Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging

Author

Ciampi, Q, Pepi, M, Antonini-Canterin, F, Barbieri, A, Barchitta, A, Faganello, G, Miceli, S, Parato, V, Tota, A, Trocino, G, Abbate, M, Accadia, M, Alemanni, R, Angelini, A, Anglano, F, Anselmi, M, Aquila, I, Aramu, S, Avogadri, E, Azzaro, G, Badano, L, Balducci, A, Ballocca, F, Barbarossa, A, Barbati, G, Barletta, V, Barone, D, Becherini, F, Benfari, G, Beraldi, M, Bergandi, G, Bilardo, G, Binno, S, Bolognesi, M, Bongiovi, S, Bragato, R, Braggion, G, Brancaleoni, R, Bursi, F, Dessalvi, C, Cameli, M, Canu, A, Capitelli, M, Capra, A, Carbonara, R, Carbone, M, Carbonella, M, Carrabba, N, Casavecchia, G, Casula, M, Chesi, E, Cicco, S, Citro, R, Cocchia, R, Colombo, B, Colonna, P, Conte, M, Corrado, G, Cortesi, P, Cortigiani, L, Costantino, M, Cozza, F, Cucchini, U, D'Angelo, M, Da Ros, S, D'Andrea, F, D'Andrea, A, D'Auria, F, De Caridi, G, De Feo, S, De Matteis, G, De Vecchi, S, Del Giudice, C, Dell'Angela, L, Delli Paoli, L, Dentamaro, I, Destefanis, P, Di Bella, G, Di Fulvio, M, Di Gaetano, R, Di Giannuario, G, Di Gioia, A, Di Martino, L, Di Muro, C, Di Nora, C, Di Salvo, G, Dodi, C, Dogliani, S, Donati, F, Dottori, M, Epifani, G, Fabiani, I, Ferrara, F, Ferrara, L, Ferrua, S, Filice, G, Fiorino, M, Forno, D, Garini, A, Giarratana, G, Gigantino, G, Giorgi, M, Giubertoni, E, Greco, C, Grigolato, M, Marra, W, Holzl, A, Iaiza, A, Iannaccone, A, Ilardi, F, Imbalzano, E, Inciardi, R, Inserra, C, Iori, E, Izzo, A, Rosa, G, Labanti, G, Lanzone, A, Lanzoni, L, Lapetina, O, Leiballi, E, Librera, M, Lo Conte, C, Lo Monaco, M, Lombardo, A, Luciani, M, Lusardi, P, Magnante, A, Malagoli, A, Malatesta, G, Mancusi, C, Manes, M, Manganelli, F, Mantovani, F, Manuppelli, V, Marchese, V, Marinacci, L, Mattioli, R, Maurizio, C, Mazza, G, Mazza, S, Melis, M, Meloni, G, Merli, E, Milan, A, Minardi, G, Monaco, A, Monte, I, Montresor, G, Moreo, A, Mori, F, Morini, S, Moro, C, Morrone, D, Negri, F, Nipote, C, Nisi, F, Nocco, S, Novello, L, Nunziata, L, Perini, A, Parodi, A, Pasanisi, E, Pastorini, G, Pavasini, R, Pavoni, D, Pedone, C, Pelliccia, F, Pelliciari, G, Pelloni, E, Pergola, V, Perillo, G, Petruccelli, E, Pezzullo, C, Piacentini, G, Picardi, E, Pinna, G, Pizzarelli, M, Pizzuti, A, Poggi, M, Posteraro, A, Privitera, C, Rampazzo, D, Ratti, C, Rettegno, S, Ricci, F, Ricci, C, Rolando, C, Rossi, S, Rovera, C, Ruggieri, R, Russo, M, Sacchi, N, Saladino, A, Sani, F, Sartori, C, Scarabeo, V, Sciacqua, A, Scillone, A, Scopelliti, P, Scorza, A, Scozzafava, A, Serafini, F, Serra, W, Severino, S, Simeone, B, Sirico, D, Solari, M, Spadaro, G, Stefani, L, Strangio, A, Surace, F, Tamborini, G, Tarquinio, N, Tassone, E, Tavarozzi, I, Tchana, B, Tedesco, G, Tinto, M, Torzillo, D, Totaro, A, Triolo, O, Troisi, F, Tusa, M, Vancheri, F, Varasano, V, Venezia, A, Vermi, A, Villari, B, Zampi, G, Zannoni, J, Zito, C, Zugaro, A, Picano, E, Carerj, S, Ciampi Q., Pepi M., Antonini-Canterin F., Barbieri A., Barchitta A., Faganello G., Miceli S., Parato V. M., Tota A., Trocino G., Abbate M., Accadia M., Alemanni R., Angelini A., Anglano F., Anselmi M., Aquila I., Aramu S., Avogadri E., Azzaro G., Badano L., Balducci A., Ballocca F., Barbarossa A., Barbati G., Barletta V., Barone D., Becherini F., Benfari G., Beraldi M., Bergandi G., Bilardo G., Binno S. M., Bolognesi M., Bongiovi S., Bragato R. M., Braggion G., Brancaleoni R., Bursi F., Dessalvi C. C., Cameli M., Canu A., Capitelli M., Capra A. C. M., Carbonara R., Carbone M., Carbonella M., Carrabba N., Casavecchia G., Casula M., Chesi E., Cicco S., Citro R., Cocchia R., Colombo B. M., Colonna P., Conte M., Corrado G., Cortesi P., Cortigiani L., Costantino M. F., Cozza F., Cucchini U., D'Angelo M., Da Ros S., D'Andrea F., D'Andrea A., D'Auria F., De Caridi G., De Feo S., De Matteis G. M., De Vecchi S., Del Giudice C., Dell'Angela L., Delli Paoli L., Dentamaro I., Destefanis P., Di Bella G., Di Fulvio M., Di Gaetano R., Di Giannuario G., Di Gioia A., Di Martino L. F. M., Di Muro C., Di Nora C., Di Salvo G., Dodi C., Dogliani S., Donati F., Dottori M., Epifani G., Fabiani I., Ferrara F., Ferrara L., Ferrua S., Filice G., Fiorino M., Forno D., Garini A., Giarratana G. A., Gigantino G., Giorgi M., Giubertoni E., Greco C. A., Grigolato M., Marra W. G., Holzl A., Iaiza A., Iannaccone A., Ilardi F., Imbalzano E., Inciardi R. M., Inserra C. A., Iori E., Izzo A., Rosa G. L., Labanti G., Lanzone A. M., Lanzoni L., Lapetina O., Leiballi E., Librera M., Lo Conte C., Lo Monaco M., Lombardo A., Luciani M., Lusardi P., Magnante A., Malagoli A., Malatesta G., Mancusi C., Manes M. T., Manganelli F., Mantovani F., Manuppelli V., Marchese V., Marinacci L., Mattioli R., Maurizio C., Mazza G. A., Mazza S., Melis M., Meloni G., Merli E., Milan A., Minardi G., Monaco A., Monte I., Montresor G., Moreo A., Mori F., Morini S., Moro C., Morrone D., Negri F., Nipote C., Nisi F., Nocco S., Novello L., Nunziata L., Perini A. P., Parodi A., Pasanisi E. M., Pastorini G., Pavasini R., Pavoni D., Pedone C., Pelliccia F., Pelliciari G., Pelloni E., Pergola V., Perillo G., Petruccelli E., Pezzullo C., Piacentini G., Picardi E., Pinna G., Pizzarelli M., Pizzuti A., Poggi M. M., Posteraro A., Privitera C., Rampazzo D., Ratti C., Rettegno S., Ricci F., Ricci C., Rolando C., Rossi S., Rovera C., Ruggieri R., Russo M. G., Sacchi N., Saladino A., Sani F., Sartori C., Scarabeo V., Sciacqua A., Scillone A., Scopelliti P. A., Scorza A., Scozzafava A., Serafini F., Serra W., Severino S., Simeone B., Sirico D., Solari M., Spadaro G. L., Stefani L., Strangio A., Surace F. C., Tamborini G., Tarquinio N., Tassone E. J., Tavarozzi I., Tchana B., Tedesco G., Tinto M., Torzillo D., Totaro A., Triolo O. F., Troisi F., Tusa M., Vancheri F., Varasano V., Venezia A., Vermi A. C., Villari B., Zampi G., Zannoni J., Zito C., Zugaro A., Picano E., Carerj S., Ciampi, Q, Pepi, M, Antonini-Canterin, F, Barbieri, A, Barchitta, A, Faganello, G, Miceli, S, Parato, V, Tota, A, Trocino, G, Abbate, M, Accadia, M, Alemanni, R, Angelini, A, Anglano, F, Anselmi, M, Aquila, I, Aramu, S, Avogadri, E, Azzaro, G, Badano, L, Balducci, A, Ballocca, F, Barbarossa, A, Barbati, G, Barletta, V, Barone, D, Becherini, F, Benfari, G, Beraldi, M, Bergandi, G, Bilardo, G, Binno, S, Bolognesi, M, Bongiovi, S, Bragato, R, Braggion, G, Brancaleoni, R, Bursi, F, Dessalvi, C, Cameli, M, Canu, A, Capitelli, M, Capra, A, Carbonara, R, Carbone, M, Carbonella, M, Carrabba, N, Casavecchia, G, Casula, M, Chesi, E, Cicco, S, Citro, R, Cocchia, R, Colombo, B, Colonna, P, Conte, M, Corrado, G, Cortesi, P, Cortigiani, L, Costantino, M, Cozza, F, Cucchini, U, D'Angelo, M, Da Ros, S, D'Andrea, F, D'Andrea, A, D'Auria, F, De Caridi, G, De Feo, S, De Matteis, G, De Vecchi, S, Del Giudice, C, Dell'Angela, L, Delli Paoli, L, Dentamaro, I, Destefanis, P, Di Bella, G, Di Fulvio, M, Di Gaetano, R, Di Giannuario, G, Di Gioia, A, Di Martino, L, Di Muro, C, Di Nora, C, Di Salvo, G, Dodi, C, Dogliani, S, Donati, F, Dottori, M, Epifani, G, Fabiani, I, Ferrara, F, Ferrara, L, Ferrua, S, Filice, G, Fiorino, M, Forno, D, Garini, A, Giarratana, G, Gigantino, G, Giorgi, M, Giubertoni, E, Greco, C, Grigolato, M, Marra, W, Holzl, A, Iaiza, A, Iannaccone, A, Ilardi, F, Imbalzano, E, Inciardi, R, Inserra, C, Iori, E, Izzo, A, Rosa, G, Labanti, G, Lanzone, A, Lanzoni, L, Lapetina, O, Leiballi, E, Librera, M, Lo Conte, C, Lo Monaco, M, Lombardo, A, Luciani, M, Lusardi, P, Magnante, A, Malagoli, A, Malatesta, G, Mancusi, C, Manes, M, Manganelli, F, Mantovani, F, Manuppelli, V, Marchese, V, Marinacci, L, Mattioli, R, Maurizio, C, Mazza, G, Mazza, S, Melis, M, Meloni, G, Merli, E, Milan, A, Minardi, G, Monaco, A, Monte, I, Montresor, G, Moreo, A, Mori, F, Morini, S, Moro, C, Morrone, D, Negri, F, Nipote, C, Nisi, F, Nocco, S, Novello, L, Nunziata, L, Perini, A, Parodi, A, Pasanisi, E, Pastorini, G, Pavasini, R, Pavoni, D, Pedone, C, Pelliccia, F, Pelliciari, G, Pelloni, E, Pergola, V, Perillo, G, Petruccelli, E, Pezzullo, C, Piacentini, G, Picardi, E, Pinna, G, Pizzarelli, M, Pizzuti, A, Poggi, M, Posteraro, A, Privitera, C, Rampazzo, D, Ratti, C, Rettegno, S, Ricci, F, Ricci, C, Rolando, C, Rossi, S, Rovera, C, Ruggieri, R, Russo, M, Sacchi, N, Saladino, A, Sani, F, Sartori, C, Scarabeo, V, Sciacqua, A, Scillone, A, Scopelliti, P, Scorza, A, Scozzafava, A, Serafini, F, Serra, W, Severino, S, Simeone, B, Sirico, D, Solari, M, Spadaro, G, Stefani, L, Strangio, A, Surace, F, Tamborini, G, Tarquinio, N, Tassone, E, Tavarozzi, I, Tchana, B, Tedesco, G, Tinto, M, Torzillo, D, Totaro, A, Triolo, O, Troisi, F, Tusa, M, Vancheri, F, Varasano, V, Venezia, A, Vermi, A, Villari, B, Zampi, G, Zannoni, J, Zito, C, Zugaro, A, Picano, E, Carerj, S, Ciampi Q., Pepi M., Antonini-Canterin F., Barbieri A., Barchitta A., Faganello G., Miceli S., Parato V. M., Tota A., Trocino G., Abbate M., Accadia M., Alemanni R., Angelini A., Anglano F., Anselmi M., Aquila I., Aramu S., Avogadri E., Azzaro G., Badano L., Balducci A., Ballocca F., Barbarossa A., Barbati G., Barletta V., Barone D., Becherini F., Benfari G., Beraldi M., Bergandi G., Bilardo G., Binno S. M., Bolognesi M., Bongiovi S., Bragato R. M., Braggion G., Brancaleoni R., Bursi F., Dessalvi C. C., Cameli M., Canu A., Capitelli M., Capra A. C. M., Carbonara R., Carbone M., Carbonella M., Carrabba N., Casavecchia G., Casula M., Chesi E., Cicco S., Citro R., Cocchia R., Colombo B. M., Colonna P., Conte M., Corrado G., Cortesi P., Cortigiani L., Costantino M. F., Cozza F., Cucchini U., D'Angelo M., Da Ros S., D'Andrea F., D'Andrea A., D'Auria F., De Caridi G., De Feo S., De Matteis G. M., De Vecchi S., Del Giudice C., Dell'Angela L., Delli Paoli L., Dentamaro I., Destefanis P., Di Bella G., Di Fulvio M., Di Gaetano R., Di Giannuario G., Di Gioia A., Di Martino L. F. M., Di Muro C., Di Nora C., Di Salvo G., Dodi C., Dogliani S., Donati F., Dottori M., Epifani G., Fabiani I., Ferrara F., Ferrara L., Ferrua S., Filice G., Fiorino M., Forno D., Garini A., Giarratana G. A., Gigantino G., Giorgi M., Giubertoni E., Greco C. A., Grigolato M., Marra W. G., Holzl A., Iaiza A., Iannaccone A., Ilardi F., Imbalzano E., Inciardi R. M., Inserra C. A., Iori E., Izzo A., Rosa G. L., Labanti G., Lanzone A. M., Lanzoni L., Lapetina O., Leiballi E., Librera M., Lo Conte C., Lo Monaco M., Lombardo A., Luciani M., Lusardi P., Magnante A., Malagoli A., Malatesta G., Mancusi C., Manes M. T., Manganelli F., Mantovani F., Manuppelli V., Marchese V., Marinacci L., Mattioli R., Maurizio C., Mazza G. A., Mazza S., Melis M., Meloni G., Merli E., Milan A., Minardi G., Monaco A., Monte I., Montresor G., Moreo A., Mori F., Morini S., Moro C., Morrone D., Negri F., Nipote C., Nisi F., Nocco S., Novello L., Nunziata L., Perini A. P., Parodi A., Pasanisi E. M., Pastorini G., Pavasini R., Pavoni D., Pedone C., Pelliccia F., Pelliciari G., Pelloni E., Pergola V., Perillo G., Petruccelli E., Pezzullo C., Piacentini G., Picardi E., Pinna G., Pizzarelli M., Pizzuti A., Poggi M. M., Posteraro A., Privitera C., Rampazzo D., Ratti C., Rettegno S., Ricci F., Ricci C., Rolando C., Rossi S., Rovera C., Ruggieri R., Russo M. G., Sacchi N., Saladino A., Sani F., Sartori C., Scarabeo V., Sciacqua A., Scillone A., Scopelliti P. A., Scorza A., Scozzafava A., Serafini F., Serra W., Severino S., Simeone B., Sirico D., Solari M., Spadaro G. L., Stefani L., Strangio A., Surace F. C., Tamborini G., Tarquinio N., Tassone E. J., Tavarozzi I., Tchana B., Tedesco G., Tinto M., Torzillo D., Totaro A., Triolo O. F., Troisi F., Tusa M., Vancheri F., Varasano V., Venezia A., Vermi A. C., Villari B., Zampi G., Zannoni J., Zito C., Zugaro A., Picano E., and Carerj S.

Abstract

Background: The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results: Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and ≥40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: sign

Published
2023

4. Organization and Activity of Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging

Author

Ciampi, Q, Pepi, M, Antonini-Canterin, F, Barbieri, A, Barchitta, A, Faganello, G, Miceli, S, Parato, V, Tota, A, Trocino, G, Abbate, M, Accadia, M, Alemanni, R, Angelini, A, Anglano, F, Anselmi, M, Aquila, I, Aramu, S, Avogadri, E, Azzaro, G, Badano, L, Balducci, A, Ballocca, F, Barbarossa, A, Barbati, G, Barletta, V, Barone, D, Becherini, F, Benfari, G, Beraldi, M, Bergandi, G, Bilardo, G, Binno, S, Bolognesi, M, Bongiovi, S, Bragato, R, Braggion, G, Brancaleoni, R, Bursi, F, Dessalvi, C, Cameli, M, Canu, A, Capitelli, M, Capra, A, Carbonara, R, Carbone, M, Carbonella, M, Carrabba, N, Casavecchia, G, Casula, M, Chesi, E, Cicco, S, Citro, R, Cocchia, R, Colombo, B, Colonna, P, Conte, M, Corrado, G, Cortesi, P, Cortigiani, L, Costantino, M, Cozza, F, Cucchini, U, D'Angelo, M, Ros, S, D'Andrea, F, D'Andrea, A, D'Auria, F, De Caridi, G, De Feo, S, De Matteis, G, De Vecchi, S, Del Giudice, C, Dell'Angela, L, Delli Paoli, L, Dentamaro, I, Destefanis, P, Di Fulvio, M, Di Gaetano, R, Di Giannuario, G, Di Gioia, A, Di Martino, L, Di Muro, C, Di Nora, C, Di Salvo, G, Dodi, C, Dogliani, S, Donati, F, Dottori, M, Epifani, G, Fabiani, I, Ferrara, F, Ferrara, L, Ferrua, S, Filice, G, Fiorino, M, Forno, D, Garini, A, Giarratana, G, Gigantino, G, Giorgi, M, Giubertoni, E, Greco, C, Grigolato, M, Marra, W, Holzl, A, Iaiza, A, Iannaccone, A, Ilardi, F, Imbalzano, E, Inciardi, R, Inserra, C, Iori, E, Izzo, A, La Rosa, G, Labanti, G, Lanzone, A, Lanzoni, L, Lapetina, O, Leiballi, E, Librera, M, Lo Conte, C, Lo Monaco, M, Lombardo, A, Luciani, M, Lusardi, P, Magnante, A, Malagoli, A, Malatesta, G, Mancusi, C, Manes, M, Manganelli, F, Mantovani, F, Manuppelli, V, Marchese, V, Marinacci, L, Mattioli, R, Maurizio, C, Mazza, G, Mazza, S, Melis, M, Meloni, G, Merli, E, Milan, A, Minardi, G, Monaco, A, Monte, I, Montresor, G, Moreo, A, Mori, F, Morini, S, Moro, C, Morrone, D, Negri, F, Nipote, C, Nisi, F, Nocco, S, Novello, L, Nunziata, L, Perini, A, Parodi, A, Pasanisi, E, Pastorini, G, Pavasini, R, Pavoni, D, Pedone, C, Pelliccia, F, Pelliciari, G, Pelloni, E, Pergola, V, Perillo, G, Petruccelli, E, Pezzullo, C, Piacentini, G, Picardi, E, Pinna, G, Pizzarelli, M, Pizzuti, A, Poggi, M, Posteraro, A, Privitera, C, Rampazzo, D, Ratti, C, Rettegno, S, Ricci, F, Ricci, C, Rolando, C, Rossi, S, Rovera, C, Ruggieri, R, Russo, M, Sacchi, N, Saladino, A, Sani, F, Sartori, C, Scarabeo, V, Sciacqua, A, Scillone, A, Scopelliti, P, Scorza, A, Scozzafava, A, Serafini, F, Serra, W, Severino, S, Simeone, B, Sirico, D, Solari, M, Spadaro, G, Stefani, L, Strangio, A, Surace, F, Tamborini, G, Tarquinio, N, Tassone, E, Tavarozzi, I, Tchana, B, Tedesco, G, Tinto, M, Torzillo, D, Totaro, A, Triolo, O, Troisi, F, Tusa, M, Vancheri, F, Varasano, V, Venezia, A, Vermi, A, Villari, B, Zampi, G, Zannoni, J, Zito, C, Zugaro, A, Di Bella, G, Carerj, S, Ciampi Q., Pepi M., Antonini-Canterin F., Barbieri A., Barchitta A., Faganello G., Miceli S., Parato V. M., Tota A., Trocino G., Abbate M., Accadia M., Alemanni R., Angelini A., Anglano F., Anselmi M., Aquila I., Aramu S., Avogadri E., Azzaro G., Badano L., Balducci A., Ballocca F., Barbarossa A., Barbati G., Barletta V., Barone D., Becherini F., Benfari G., Beraldi M., Bergandi G., Bilardo G., Binno S. M., Bolognesi M., Bongiovi S., Bragato R. M., Braggion G., Brancaleoni R., Bursi F., Dessalvi C. C., Cameli M., Canu A., Capitelli M., Capra A. C. M., Carbonara R., Carbone M., Carbonella M., Carrabba N., Casavecchia G., Casula M., Chesi E., Cicco S., Citro R., Cocchia R., Colombo B. M., Colonna P., Conte M., Corrado G., Cortesi P., Cortigiani L., Costantino M. F., Cozza F., Cucchini U., D'Angelo M., Ros S. D., D'Andrea F., D'Andrea A., D'Auria F., De Caridi G., De Feo S., De Matteis G. M., De Vecchi S., Del Giudice C., Dell'Angela L., Delli Paoli L., Dentamaro I., Destefanis P., Di Fulvio M., Di Gaetano R., Di Giannuario G., Di Gioia A., Di Martino L. F. M., Di Muro C., Di Nora C., Di Salvo G., Dodi C., Dogliani S., Donati F., Dottori M., Epifani G., Fabiani I., Ferrara F., Ferrara L., Ferrua S., Filice G., Fiorino M., Forno D., Garini A., Giarratana G. A., Gigantino G., Giorgi M., Giubertoni E., Greco C. A., Grigolato M., Marra W. G., Holzl A., Iaiza A., Iannaccone A., Ilardi F., Imbalzano E., Inciardi R., Inserra C. A., Iori E., Izzo A., La Rosa G., Labanti G., Lanzone A. M., Lanzoni L., Lapetina O., Leiballi E., Librera M., Lo Conte C., Lo Monaco M., Lombardo A., Luciani M., Lusardi P., Magnante A., Malagoli A., Malatesta G., Mancusi C., Manes M. T., Manganelli F., Mantovani F., Manuppelli V., Marchese V., Marinacci L., Mattioli R., Maurizio C., Mazza G. A., Mazza S., Melis M., Meloni G., Merli E., Milan A., Minardi G., Monaco A., Monte I., Montresor G., Moreo A., Mori F., Morini S., Moro C., Morrone D., Negri F., Nipote C., Nisi F., Nocco S., Novello L., Nunziata L., Perini A. P., Parodi A., Pasanisi E. M., Pastorini G., Pavasini R., Pavoni D., Pedone C., Pelliccia F., Pelliciari G., Pelloni E., Pergola V., Perillo G., Petruccelli E., Pezzullo C., Piacentini G., Picardi E., Pinna G., Pizzarelli M., Pizzuti A., Poggi M. M., Posteraro A., Privitera C., Rampazzo D., Ratti C., Rettegno S., Ricci F., Ricci C., Rolando C., Rossi S., Rovera C., Ruggieri R., Russo M. G., Sacchi N., Saladino A., Sani F., Sartori C., Scarabeo V., Sciacqua A., Scillone A., Scopelliti P. A., Scorza A., Scozzafava A., Serafini F., Serra W., Severino S., Simeone B., Sirico D., Solari M., Spadaro G. L., Stefani L., Strangio A., Surace F. C., Tamborini G., Tarquinio N., Tassone E. J., Tavarozzi I., Tchana B., Tedesco G., Tinto M., Torzillo D., Totaro A., Triolo O. F., Troisi F., Tusa M., Vancheri F., Varasano V., Venezia A., Vermi A. C., Villari B., Zampi G., Zannoni J., Zito C., Zugaro A., Di Bella G., Carerj S., Ciampi, Q, Pepi, M, Antonini-Canterin, F, Barbieri, A, Barchitta, A, Faganello, G, Miceli, S, Parato, V, Tota, A, Trocino, G, Abbate, M, Accadia, M, Alemanni, R, Angelini, A, Anglano, F, Anselmi, M, Aquila, I, Aramu, S, Avogadri, E, Azzaro, G, Badano, L, Balducci, A, Ballocca, F, Barbarossa, A, Barbati, G, Barletta, V, Barone, D, Becherini, F, Benfari, G, Beraldi, M, Bergandi, G, Bilardo, G, Binno, S, Bolognesi, M, Bongiovi, S, Bragato, R, Braggion, G, Brancaleoni, R, Bursi, F, Dessalvi, C, Cameli, M, Canu, A, Capitelli, M, Capra, A, Carbonara, R, Carbone, M, Carbonella, M, Carrabba, N, Casavecchia, G, Casula, M, Chesi, E, Cicco, S, Citro, R, Cocchia, R, Colombo, B, Colonna, P, Conte, M, Corrado, G, Cortesi, P, Cortigiani, L, Costantino, M, Cozza, F, Cucchini, U, D'Angelo, M, Ros, S, D'Andrea, F, D'Andrea, A, D'Auria, F, De Caridi, G, De Feo, S, De Matteis, G, De Vecchi, S, Del Giudice, C, Dell'Angela, L, Delli Paoli, L, Dentamaro, I, Destefanis, P, Di Fulvio, M, Di Gaetano, R, Di Giannuario, G, Di Gioia, A, Di Martino, L, Di Muro, C, Di Nora, C, Di Salvo, G, Dodi, C, Dogliani, S, Donati, F, Dottori, M, Epifani, G, Fabiani, I, Ferrara, F, Ferrara, L, Ferrua, S, Filice, G, Fiorino, M, Forno, D, Garini, A, Giarratana, G, Gigantino, G, Giorgi, M, Giubertoni, E, Greco, C, Grigolato, M, Marra, W, Holzl, A, Iaiza, A, Iannaccone, A, Ilardi, F, Imbalzano, E, Inciardi, R, Inserra, C, Iori, E, Izzo, A, La Rosa, G, Labanti, G, Lanzone, A, Lanzoni, L, Lapetina, O, Leiballi, E, Librera, M, Lo Conte, C, Lo Monaco, M, Lombardo, A, Luciani, M, Lusardi, P, Magnante, A, Malagoli, A, Malatesta, G, Mancusi, C, Manes, M, Manganelli, F, Mantovani, F, Manuppelli, V, Marchese, V, Marinacci, L, Mattioli, R, Maurizio, C, Mazza, G, Mazza, S, Melis, M, Meloni, G, Merli, E, Milan, A, Minardi, G, Monaco, A, Monte, I, Montresor, G, Moreo, A, Mori, F, Morini, S, Moro, C, Morrone, D, Negri, F, Nipote, C, Nisi, F, Nocco, S, Novello, L, Nunziata, L, Perini, A, Parodi, A, Pasanisi, E, Pastorini, G, Pavasini, R, Pavoni, D, Pedone, C, Pelliccia, F, Pelliciari, G, Pelloni, E, Pergola, V, Perillo, G, Petruccelli, E, Pezzullo, C, Piacentini, G, Picardi, E, Pinna, G, Pizzarelli, M, Pizzuti, A, Poggi, M, Posteraro, A, Privitera, C, Rampazzo, D, Ratti, C, Rettegno, S, Ricci, F, Ricci, C, Rolando, C, Rossi, S, Rovera, C, Ruggieri, R, Russo, M, Sacchi, N, Saladino, A, Sani, F, Sartori, C, Scarabeo, V, Sciacqua, A, Scillone, A, Scopelliti, P, Scorza, A, Scozzafava, A, Serafini, F, Serra, W, Severino, S, Simeone, B, Sirico, D, Solari, M, Spadaro, G, Stefani, L, Strangio, A, Surace, F, Tamborini, G, Tarquinio, N, Tassone, E, Tavarozzi, I, Tchana, B, Tedesco, G, Tinto, M, Torzillo, D, Totaro, A, Triolo, O, Troisi, F, Tusa, M, Vancheri, F, Varasano, V, Venezia, A, Vermi, A, Villari, B, Zampi, G, Zannoni, J, Zito, C, Zugaro, A, Di Bella, G, Carerj, S, Ciampi Q., Pepi M., Antonini-Canterin F., Barbieri A., Barchitta A., Faganello G., Miceli S., Parato V. M., Tota A., Trocino G., Abbate M., Accadia M., Alemanni R., Angelini A., Anglano F., Anselmi M., Aquila I., Aramu S., Avogadri E., Azzaro G., Badano L., Balducci A., Ballocca F., Barbarossa A., Barbati G., Barletta V., Barone D., Becherini F., Benfari G., Beraldi M., Bergandi G., Bilardo G., Binno S. M., Bolognesi M., Bongiovi S., Bragato R. M., Braggion G., Brancaleoni R., Bursi F., Dessalvi C. C., Cameli M., Canu A., Capitelli M., Capra A. C. M., Carbonara R., Carbone M., Carbonella M., Carrabba N., Casavecchia G., Casula M., Chesi E., Cicco S., Citro R., Cocchia R., Colombo B. M., Colonna P., Conte M., Corrado G., Cortesi P., Cortigiani L., Costantino M. F., Cozza F., Cucchini U., D'Angelo M., Ros S. D., D'Andrea F., D'Andrea A., D'Auria F., De Caridi G., De Feo S., De Matteis G. M., De Vecchi S., Del Giudice C., Dell'Angela L., Delli Paoli L., Dentamaro I., Destefanis P., Di Fulvio M., Di Gaetano R., Di Giannuario G., Di Gioia A., Di Martino L. F. M., Di Muro C., Di Nora C., Di Salvo G., Dodi C., Dogliani S., Donati F., Dottori M., Epifani G., Fabiani I., Ferrara F., Ferrara L., Ferrua S., Filice G., Fiorino M., Forno D., Garini A., Giarratana G. A., Gigantino G., Giorgi M., Giubertoni E., Greco C. A., Grigolato M., Marra W. G., Holzl A., Iaiza A., Iannaccone A., Ilardi F., Imbalzano E., Inciardi R., Inserra C. A., Iori E., Izzo A., La Rosa G., Labanti G., Lanzone A. M., Lanzoni L., Lapetina O., Leiballi E., Librera M., Lo Conte C., Lo Monaco M., Lombardo A., Luciani M., Lusardi P., Magnante A., Malagoli A., Malatesta G., Mancusi C., Manes M. T., Manganelli F., Mantovani F., Manuppelli V., Marchese V., Marinacci L., Mattioli R., Maurizio C., Mazza G. A., Mazza S., Melis M., Meloni G., Merli E., Milan A., Minardi G., Monaco A., Monte I., Montresor G., Moreo A., Mori F., Morini S., Moro C., Morrone D., Negri F., Nipote C., Nisi F., Nocco S., Novello L., Nunziata L., Perini A. P., Parodi A., Pasanisi E. M., Pastorini G., Pavasini R., Pavoni D., Pedone C., Pelliccia F., Pelliciari G., Pelloni E., Pergola V., Perillo G., Petruccelli E., Pezzullo C., Piacentini G., Picardi E., Pinna G., Pizzarelli M., Pizzuti A., Poggi M. M., Posteraro A., Privitera C., Rampazzo D., Ratti C., Rettegno S., Ricci F., Ricci C., Rolando C., Rossi S., Rovera C., Ruggieri R., Russo M. G., Sacchi N., Saladino A., Sani F., Sartori C., Scarabeo V., Sciacqua A., Scillone A., Scopelliti P. A., Scorza A., Scozzafava A., Serafini F., Serra W., Severino S., Simeone B., Sirico D., Solari M., Spadaro G. L., Stefani L., Strangio A., Surace F. C., Tamborini G., Tarquinio N., Tassone E. J., Tavarozzi I., Tchana B., Tedesco G., Tinto M., Torzillo D., Totaro A., Triolo O. F., Troisi F., Tusa M., Vancheri F., Varasano V., Venezia A., Vermi A. C., Villari B., Zampi G., Zannoni J., Zito C., Zugaro A., Di Bella G., and Carerj S.

Abstract

Background: The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy. Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results: Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue

Published
2023

9. Unmasking the prevalence of amyloid cardiomyopathy in the real world: results from Phase 2 of the AC-TIVE study, an Italian nationwide survey

Author

Merlo, M, Pagura, L, Porcari, A, Cameli, M, Vergaro, G, Musumeci, B, Biagini, E, Canepa, M, Crotti, L, Imazio, M, Forleo, C, Cappelli, F, Perfetto, F, Favale, S, Di Bella, G, Dore, F, Girardi, F, Tomasoni, D, Pavasini, R, Rella, V, Palmiero, G, Caiazza, M, Carella, M, Igoren Guaricci, A, Branzi, G, Caponetti, A, Saturi, G, La Malfa, G, Merlo, A, Andreis, A, Bruno, F, Longo, F, Rossi, M, Varra, G, Saro, R, Di Ienno, L, De Carli, G, Giacomin, E, Arzilli, C, Limongelli, G, Autore, C, Olivotto, I, Badano, L, Parati, G, Perlini, S, Metra, M, Emdin, M, Rapezzi, C, Sinagra, G, Merlo M., Pagura L., Porcari A., Cameli M., Vergaro G., Musumeci B., Biagini E., Canepa M., Crotti L., Imazio M., Forleo C., Cappelli F., Perfetto F., Favale S., Di Bella G., Dore F., Girardi F., Tomasoni D., Pavasini R., Rella V., Palmiero G., Caiazza M., Carella M. C., Igoren Guaricci A., Branzi G., Caponetti A. G., Saturi G., La Malfa G., Merlo A. C., Andreis A., Bruno F., Longo F., Rossi M., Varra G. G., Saro R., Di Ienno L., De Carli G., Giacomin E., Arzilli C., Limongelli G., Autore C., Olivotto I., Badano L., Parati G., Perlini S., Metra M., Emdin M., Rapezzi C., Sinagra G., Merlo, M, Pagura, L, Porcari, A, Cameli, M, Vergaro, G, Musumeci, B, Biagini, E, Canepa, M, Crotti, L, Imazio, M, Forleo, C, Cappelli, F, Perfetto, F, Favale, S, Di Bella, G, Dore, F, Girardi, F, Tomasoni, D, Pavasini, R, Rella, V, Palmiero, G, Caiazza, M, Carella, M, Igoren Guaricci, A, Branzi, G, Caponetti, A, Saturi, G, La Malfa, G, Merlo, A, Andreis, A, Bruno, F, Longo, F, Rossi, M, Varra, G, Saro, R, Di Ienno, L, De Carli, G, Giacomin, E, Arzilli, C, Limongelli, G, Autore, C, Olivotto, I, Badano, L, Parati, G, Perlini, S, Metra, M, Emdin, M, Rapezzi, C, Sinagra, G, Merlo M., Pagura L., Porcari A., Cameli M., Vergaro G., Musumeci B., Biagini E., Canepa M., Crotti L., Imazio M., Forleo C., Cappelli F., Perfetto F., Favale S., Di Bella G., Dore F., Girardi F., Tomasoni D., Pavasini R., Rella V., Palmiero G., Caiazza M., Carella M. C., Igoren Guaricci A., Branzi G., Caponetti A. G., Saturi G., La Malfa G., Merlo A. C., Andreis A., Bruno F., Longo F., Rossi M., Varra G. G., Saro R., Di Ienno L., De Carli G., Giacomin E., Arzilli C., Limongelli G., Autore C., Olivotto I., Badano L., Parati G., Perlini S., Metra M., Emdin M., Rapezzi C., and Sinagra G.

Abstract

Aim: To investigate the prevalence of amyloid cardiomyopathy (AC) and the diagnostic accuracy of echocardiographic red flags of AC among consecutive adult patients undergoing transthoracic echocardiogram for reason other than AC in 13 Italian institutions. Methods and results: This is an Italian prospective multicentre study, involving a clinical and instrumental work-up to assess AC prevalence among patients ≥55 years old with an echocardiogram suggestive of AC (i.e. at least one echocardiographic red flag of AC in hypertrophic, non-dilated left ventricles with preserved ejection fraction). The study was registered at ClinicalTrials.gov (NCT04738266). Overall, 381 patients with an echocardiogram suggestive of AC were identified among a cohort of 5315 screened subjects, and 217 patients completed the investigations. A final diagnosis of AC was made in 62 patients with an estimated prevalence of 29% (95% confidence interval 23%–35%). Transthyretin-related AC (ATTR-AC) was diagnosed in 51 and light chain-related AC (AL-AC) in 11 patients. Either apical sparing or a combination of ≥2 other echocardiographic red flags, excluding interatrial septum thickness, provided a diagnostic accuracy >70%. Conclusion: In a cohort of consecutive adults with echocardiographic findings suggestive of AC and preserved left ventricular ejection fraction, the prevalence of AC (either ATTR or AL) was 29%. Easily available echocardiographic red flags, when combined together, demonstrated good diagnostic accuracy.

Published
2022

13. Current evidence on the diagnostic and prognostic role of native T1 mapping in heart diseases

Author

Tonet, E, Baggiano, A, Pavasini, R, Guglielmo, M, Censi, S, Cossu, A, Rapezzi, C, Muscogiuri, G, Squeri, A, Campo, G, Pontone, G, Tonet E, Baggiano A, Pavasini R, Guglielmo M, Censi S, Cossu A, Rapezzi C, Muscogiuri G, Squeri A, Campo G, Pontone G., Tonet, E, Baggiano, A, Pavasini, R, Guglielmo, M, Censi, S, Cossu, A, Rapezzi, C, Muscogiuri, G, Squeri, A, Campo, G, Pontone, G, Tonet E, Baggiano A, Pavasini R, Guglielmo M, Censi S, Cossu A, Rapezzi C, Muscogiuri G, Squeri A, Campo G, and Pontone G.

Abstract

Tissue characterization represents a prerogative of cardiac magnetic resonance. Beside late gadolinium enhancement, native T1 mapping (nT1m) reveals tissue composition. It could represent a useful tool for example when contrast medium can't be administrated. The present review summarises current evidence about nT1m in main heart diseases.

Published
2021

14. A national survey on prevalence of possible echocardiographic red flags of amyloid cardiomyopathy in consecutive patients undergoing routine echocardiography: study design and patients characterization-the first insight from the AC-TIVE Study

Author

Merlo, M, Porcari, A, Pagura, L, Cameli, M, Vergaro, G, Musumeci, B, Biagini, E, Canepa, M, Crotti, L, Imazio, M, Forleo, C, Cappelli, F, Favale, S, Di Bella, G, Dore, F, Lombardi, C, Pavasini, R, Rella, V, Palmiero, G, Caiazza, M, Albanese, M, Guaricci, A, Branzi, G, Caponetti, A, Saturi, G, La Malfa, G, Merlo, A, Andreis, A, Bruno, F, Longo, F, Sfriso, E, Di Ienno, L, De Carli, G, Giacomin, E, Spini, V, Milidoni, A, Limongelli, G, Autore, C, Olivotto, I, Badano, L, Parati, G, Perlini, S, Metra, M, Emdin, M, Rapezzi, C, Sinagra, G, Merlo, Marco, Porcari, Aldostefano, Pagura, Linda, Cameli, Matteo, Vergaro, Giuseppe, Musumeci, Beatrice, Biagini, Elena, Canepa, Marco, Crotti, Lia, Imazio, Massimo, Forleo, Cinzia, Cappelli, Francesco, Favale, Stefano, Di Bella, Gianluca, Dore, Franca, Lombardi, Carlo Mario, Pavasini, Rita, Rella, Valeria, Palmiero, Giuseppe, Caiazza, Martina, Albanese, Miriam, Guaricci, Andrea Igoren, Branzi, Giovanna, Caponetti, Angelo Giuseppe, Saturi, Giulia, La Malfa, Giovanni, Merlo, Andrea Carlo, Andreis, Alessandro, Bruno, Francesco, Longo, Francesca, Sfriso, Enrico, Di Ienno, Luca, De Carli, Giuseppe, Giacomin, Elisa, Spini, Valentina, Milidoni, Antonino, Limongelli, Giuseppe, Autore, Camillo, Olivotto, Iacopo, Badano, Luigi, Parati, Gianfranco, Perlini, Stefano, Metra, Marco, Emdin, Michele, Rapezzi, Claudio, Sinagra, Gianfranco, Merlo, M, Porcari, A, Pagura, L, Cameli, M, Vergaro, G, Musumeci, B, Biagini, E, Canepa, M, Crotti, L, Imazio, M, Forleo, C, Cappelli, F, Favale, S, Di Bella, G, Dore, F, Lombardi, C, Pavasini, R, Rella, V, Palmiero, G, Caiazza, M, Albanese, M, Guaricci, A, Branzi, G, Caponetti, A, Saturi, G, La Malfa, G, Merlo, A, Andreis, A, Bruno, F, Longo, F, Sfriso, E, Di Ienno, L, De Carli, G, Giacomin, E, Spini, V, Milidoni, A, Limongelli, G, Autore, C, Olivotto, I, Badano, L, Parati, G, Perlini, S, Metra, M, Emdin, M, Rapezzi, C, Sinagra, G, Merlo, Marco, Porcari, Aldostefano, Pagura, Linda, Cameli, Matteo, Vergaro, Giuseppe, Musumeci, Beatrice, Biagini, Elena, Canepa, Marco, Crotti, Lia, Imazio, Massimo, Forleo, Cinzia, Cappelli, Francesco, Favale, Stefano, Di Bella, Gianluca, Dore, Franca, Lombardi, Carlo Mario, Pavasini, Rita, Rella, Valeria, Palmiero, Giuseppe, Caiazza, Martina, Albanese, Miriam, Guaricci, Andrea Igoren, Branzi, Giovanna, Caponetti, Angelo Giuseppe, Saturi, Giulia, La Malfa, Giovanni, Merlo, Andrea Carlo, Andreis, Alessandro, Bruno, Francesco, Longo, Francesca, Sfriso, Enrico, Di Ienno, Luca, De Carli, Giuseppe, Giacomin, Elisa, Spini, Valentina, Milidoni, Antonino, Limongelli, Giuseppe, Autore, Camillo, Olivotto, Iacopo, Badano, Luigi, Parati, Gianfranco, Perlini, Stefano, Metra, Marco, Emdin, Michele, Rapezzi, Claudio, and Sinagra, Gianfranco

Published
2022

17. C64 UNMASKING THE PREVALENCE OF AMYLOID CARDIOMYOPATHY IN THE REAL WORLD: RESULTS FROM PHASE 2 OF AC–TIVE STUDY, AN ITALIAN NATIONWIDE SURVEY

Author

Merlo, M, primary, Pagura, L, additional, Porcari, A, additional, Cameli, M, additional, Vergaro, G, additional, Musumeci, B, additional, Biagini, E, additional, Canepa, M, additional, Crotti, L, additional, Imazio, M, additional, Forleo, C, additional, Cappelli, F, additional, Favale, S, additional, Di Bella, G, additional, Dore, F, additional, Girardi, F, additional, Tomasoni, D, additional, Pavasini, R, additional, Rella, V, additional, Palmiero, G, additional, Caiazza, M, additional, Albanese, M, additional, Igoren Guarrucci, A, additional, Branzi, G, additional, Caponetti, A, additional, Saturi, G, additional, La Malfa, G, additional, Merlo, A, additional, Andreis, A, additional, Bruno, F, additional, Longo, F, additional, Rossi, M, additional, Varra‘, G, additional, Saro, R, additional, Di Ienno, L, additional, De Carli, G, additional, Giacomin, E, additional, Spini, V, additional, Limongelli, G, additional, Autore, C, additional, Olivotto, I, additional, Badano, L, additional, Parati, G, additional, Perlini, S, additional, Metra, M, additional, Emdin, M, additional, Rapezzi, C, additional, and Sinagra, G, additional

Published
2022
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20. Frailty in patients admitted to hospital for acute coronary syndrome: when, how and why?

Author

Tonet, E., Pavasini, R., Biscaglia, S., and Campo, G.

Subjects
The elderly, Frailty, Review, Acute coronary syndrome, Acute coronary syndrome, Frailty, The elderly, NO
Abstract

Frailty is an issue of paramount importance for cardiologists, because of the aging of patients admitted to hospital for acute coronary syndrome (ACS) and the straight relationship between aging and frailty. Several tools have been provided in this setting, in order to objectively assess frailty status, but important questions are still unsolved. There are conflicting data about a unique definition of frailty in subjects with cardiovascular diseases, the timing to perform a frailty evaluation in the context of an acute myocardial infarction, the mean to assess frailty in these patients and the usefulness of the information derived from the frailty assessment. Frailty results from the analysis of several items and a multidomain evaluation including laboratory values, clinical data and physical performance assessment is required for a comprehensive frailty assessment. However, regardless of the frailty tool, the prevalence of frailty in older ACS patients is high and it could add important information to the decision-making process about invasive strategy, the multivessel disease management, dual antiplatelet therapy and secondary prevention programs. The present overview tries to summarize the current knowledge about the definition and prevalence of frailty in older adults admitted to hospital for ACS, suggesting how frailty assessment may improve the management of older ACS patients.

Published
2019

23. Prognostic Value of QFR Measured Immediately After Successful Stent Implantation: The International Multicenter Prospective HAWKEYE Study

Author

Biscaglia S., Tebaldi M., Brugaletta S., Cerrato E., Erriquez A., Passarini G., Ielasi A., Spitaleri G., Di Girolamo D., Mezzapelle G., Geraci S., Manfrini M., Pavasini R., Barbato E., Campo G., Biscaglia, S., Tebaldi, M., Brugaletta, S., Cerrato, E., Erriquez, A., Passarini, G., Ielasi, A., Spitaleri, G., Di Girolamo, D., Mezzapelle, G., Geraci, S., Manfrini, M., Pavasini, R., Barbato, E., and Campo, G.

Subjects
quantitative flow ratio, Angiography-based fractional flow reserve, percutaneous coronary intervention, outcome, vessel-oriented composite endpoint, cardiovascular diseases, second-generation drug-eluting stent, NO
Abstract

OBJECTIVES: The aim of this study was to investigate the potential role of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) measurements to predict clinical outcomes in patients with successful PCI. BACKGROUND: The prognostic value of QFR measured immediately after PCI has not been prospectively investigated. METHODS: Patients undergoing complete revascularization with successful PCI and stent implantation were eligible for acquisition of projections for QFR computation. At the end of the procedure, 2 angiographic projections for each vessel treated with PCI were acquired. Computation of QFR was performed offline by an independent core laboratory. The primary outcome was the vessel-oriented composite endpoint, defined as vessel-related cardiovascular death, vessel-related myocardial infarction, and ischemia-driven target vessel revascularization. RESULTS: Seven hundred fifty-one vessels in 602 patients were analyzed. The median value of post-PCI QFR was 0.97 (interquartile range: 0.92 to 0.99). Lesion location in the left anterior descending coronary artery, baseline SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score, lesion length, and post-PCI diameter stenosis were found to be predictors of lower post-PCI QFR. Altogether, 77 events were detected in 53 treated vessels (7%). Post-PCI QFR was significantly lower in vessels with the vessel-oriented composite endpoint during follow-up, compared with those without it (0.88 [interquartile range: 0.81 to 0.99] vs. 0.97 [interquartile range: 0.93 to 0.99], respectively; p < 0.001). Receiver-operating characteristic curve analysis identified a post-PCI QFR best cutoff of ≤0.89 (area under the curve 0.77; 95% confidence interval: 0.74 to 0.80; p < 0.001). After correction for potential confounding factors, post-PCI QFR ≤0.89 was associated with a 3-fold increase in risk for the vessel-oriented composite endpoint (hazard ratio: 2.91; 95% confidence interval: 1.63 to 5.19; p < 0.001). CONCLUSIONS: Lower values of QFR after complete and successful revascularization predict subsequent adverse events (Angio-Based Fractional Flow Reserve to Predict Adverse Events After Stent Implantation [HAWKEYE]; NCT02811796).

Published
2019

25. Corrigendum to 'Anti-anginal drugs: Systematic review and clinical implications' [Int. J. Cardiol. 283 (2019) 55–63] (International Journal of Cardiology (2019) 283 (55–63), (S0167527318360947), (10.1016/j.ijcard.2018.12.008))

Author

Pavasini, R., Camici, P. G., Crea, Filippo, Danchin, N., Fox, K., Manolis, A. J., Marzilli, M., Rosano, G. M. C., Lopez-Sendon, J. L., Pinto, F., Balla, C., and Ferrari, R.

Subjects
Beta-blockers, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Ivabradine
Published
2020

27. Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis.

Author

Pavasini, R, Serenelli, M, Celis-Morales, CA, Gray, SR, Izawa, KP, Watanabe, S, Colin-Ramirez, E, Castillo-Martínez, L, Izumiya, Y, Hanatani, S, Onoue, Y, Tsujita, K, Macdonald, PS, Jha, SR, Roger, VL, Manemann, SM, Sanchis, J, Ruiz, V, Bugani, G, Tonet, E, Ferrari, R, Volpato, S, Campo, G, Pavasini, R, Serenelli, M, Celis-Morales, CA, Gray, SR, Izawa, KP, Watanabe, S, Colin-Ramirez, E, Castillo-Martínez, L, Izumiya, Y, Hanatani, S, Onoue, Y, Tsujita, K, Macdonald, PS, Jha, SR, Roger, VL, Manemann, SM, Sanchis, J, Ruiz, V, Bugani, G, Tonet, E, Ferrari, R, Volpato, S, and Campo, G

Abstract

OBJECTIVE: Grip strength is a well-characterised measure of weakness and of poor muscle performance, but there is a lack of consensus on its prognostic implications in terms of cardiac adverse events in patients with cardiac disorders. METHODS: Articles were searched in PubMed, Cochrane Library, BioMed Central and EMBASE. The main inclusion criteria were patients with cardiac disorders (ischaemic heart disease, heart failure (HF), cardiomyopathies, valvulopathies, arrhythmias); evaluation of grip strength by handheld dynamometer; and relation between grip strength and outcomes. The endpoints of the study were cardiac death, all-cause mortality, hospital admission for HF, cerebrovascular accident (CVA) and myocardial infarction (MI). Data of interest were retrieved from the articles and after contact with authors, and then pooled in an individual patient meta-analysis. Univariate and multivariate logistic regression was performed to define predictors of outcomes. RESULTS: Overall, 23 480 patients were included from 7 studies. The mean age was 62.3±6.9 years and 70% were male. The mean follow-up was 2.82±1.7 years. After multivariate analysis grip strength (difference of 5 kg, 5× kg) emerged as an independent predictor of cardiac death (OR 0.84, 95% CI 0.79 to 0.89, p<0.0001), all-cause death (OR 0.87, 95% CI 0.85 to 0.89, p<0.0001) and hospital admission for HF (OR 0.88, 95% CI 0.84 to 0.92, p<0.0001). On the contrary, we did not find any relationship between grip strength and occurrence of MI or CVA. CONCLUSION: In patients with cardiac disorders, grip strength predicted cardiac death, all-cause death and hospital admission for HF. TRIAL REGISTRATION NUMBER: CRD42015025280.

Published
2019

28. Anti-anginal drugs: Systematic review and clinical implications

Author

Pavasini, R., Camici, P. G., Crea, Filippo, Danchin, N., Fox, K., Manolis, A. J., Marzilli, M., Rosano, G. M. C., Lopez-Sendon, J. L., Pinto, Francesco, Balla, C., Ferrari, R., Crea F. (ORCID:0000-0001-9404-8846), Pinto F., Pavasini, R., Camici, P. G., Crea, Filippo, Danchin, N., Fox, K., Manolis, A. J., Marzilli, M., Rosano, G. M. C., Lopez-Sendon, J. L., Pinto, Francesco, Balla, C., Ferrari, R., Crea F. (ORCID:0000-0001-9404-8846), and Pinto F.

Abstract

Background: The cornerstone of the treatment of patients affected by stable angina is based on drugs administration classified as first (beta-blockers, calcium channel blockers, short acting nitrates) or second line treatment (long-acting nitrates, ivabradine, nicorandil, ranolazine and trimetazidine). However, few data on comparison between different classes of drugs justify that one class of drugs is superior to another.Methods: We performed a systematic review of the literature following PRISMA guidelines. Inclusion criteria: i) paper published in English; ii) diagnosis of stable coronary disease; iii) randomized clinical trial; iv) comparison of two anti-angina drugs; v) a sample size >100 patients; vi) a follow-up lasting at least 2 weeks; vii) paper published after 1999, when a meta-analysis of trials comparing beta-blockers, calcium antagonists, and nitrates for stable angina of Heidenreich et al. was published. Outcome: to establish whether the categorization in first and second line antianginal treatment is scientifically supported.Results: Eleven trials fulfilled inclusion criteria. The results show that there is a paucity of data comparing the efficacy of antianginal agents. The little data available show that there are not compounds superior to others in terms of improvement in exercise test duration, frequency of anginal attacks, need for sub-lingual nitroglycerin.Conclusion: The categorization of antianginal drug in first and second line is not confirmed. (c) 2018 Elsevier B.V. All rights reserved.

Published
2019

29. Anti-Anginal drugs-beliefs and evidence: Systematic review covering 50 years of medical treatment

Author

Ferrari, R., Pavasini, R., Camici, P. G., Crea, Filippo, Danchin, N., Pinto, Francesco, Manolis, A., Marzilli, M., Rosano, G. M. C., Lopez-Sendon, J., Fox, K., Crea F. (ORCID:0000-0001-9404-8846), Pinto F., Ferrari, R., Pavasini, R., Camici, P. G., Crea, Filippo, Danchin, N., Pinto, Francesco, Manolis, A., Marzilli, M., Rosano, G. M. C., Lopez-Sendon, J., Fox, K., Crea F. (ORCID:0000-0001-9404-8846), and Pinto F.

Abstract

Chronic stable angina is the most prevalent symptom of ischaemic heart disease and its management is a priority. Current guidelines recommend pharmacological therapy with drugs classified as being first line (beta blockers, calcium channel blockers, short acting nitrates) or second line (long-acting nitrates, ivabradine, nicorandil, ranolazine, and trimetazidine). Second line drugs are indicated for patients who have contraindications to first line agents, do not tolerate them or remain symptomatic. Evidence that one drug is superior to another has been questioned. Between January and March 2018, we performed a systematic review of articles written in English over the past 50 years English-written articles in Medline and Embase following preferred reporting items and the Cochrane collaboration approach. We included double blind randomized studies comparing parallel groups on treatment of angina in patients with stable coronary artery disease, with a sample size of, at least, 100 patients (50 patients per group), with a minimum follow-up of 1 week and an outcome measured on exercise testing, duration of exercise being the preferred outcome. Thirteen studies fulfilled our criteria. Nine studies involved between 100 and 300 patients, (2818 in total) and a further four enrolled greater than 300 patients. Evidence of equivalence was demonstrated for the use of beta-blockers (atenolol), calcium antagonists (amlodipine, nifedipine), and channel inhibitor (ivabradine) in three of these studies. Taken all together, in none of the studies was there evidence that one drug was superior to another in the treatment of angina or to prolong total exercise duration. There is a paucity of data comparing the efficacy of anti-anginal agents. The little available evidence shows that no anti-anginal drug is superior to another and equivalence has been shown only for three classes of drugs. Guidelines draw conclusions not from evidence but from clinical beliefs.

Published
2019

31. P1138Cardiac shear wave velocity in healthy individualsP1139Do still we need E/E prime ratio in predicting left ventricular filling pressures in heart failure with reduced ejection fraction?P1140Evaluation of myocardial dysfunction in children with Beta Thalassemia majorP1141Association of left ventricular size and septal mechanics with right ventricular function and transplant-free survival in infants with hypoplastic left heart syndromeP1142Predictive value of speckle tracking of chronic rejection in middle-aged heart transplant patientsP1143Determinants of the left atrial stiffness in systemic sclerosisP1144Could right atrial peak global longitudinal strain be useful in assessment of right heart function in pulmonary arterial hypertension?P1145Utility of speckle tracked strain assessment of the right ventricle following lung resectionP1146Edge-to-edge-repair in patients with dilated cardiomyopathy and secondary mitral regurgitation: effect on myocardial function as assessed by echocardiographic speckle tracking analysisP1147Decongestion, arterial stiffness and ventricular-arterial coupling in AHFP1148Myocardial disfunction in Anderson-Fabry disease (AFD) without left ventricular hypertrophyP1149Assessment of left ventricular twist-untwist mechanics in cardiac amyloidosis using three-dimensional speckle-tracking echocardiographyP1150Three-dimensional principal strain analysis for the dependency of preload changes

Author

Strachinaru, M., primary, Romano, G., primary, Tantawy, AA., primary, Forsha, D., primary, Pavasini, R., primary, Porpaczy, A., primary, Kaznica-Wiatr, M., primary, Mccall, PJ., primary, Faber, L., primary, Sciatti, E., primary, Monte, IP., primary, Capotosto, L., primary, Park, CS., primary, Geleijnse, ML., additional, Bosch, JG., additional, De Jong, N., additional, Van Der Steen, AFW, additional, Van Dalen, BM., additional, Vos, HJ., additional, Magro, S., additional, Mina', C., additional, Novo, G., additional, Dell'oglio, S., additional, Falletta, C., additional, Di Gesaro, G., additional, Clemenza, F., additional, Bellavia, D., additional, Habeeb, N., additional, El Sherif, NHK, additional, Abdelhamid, AE., additional, Li, L., additional, Joseph, N., additional, Kutty, S., additional, Freidberg, MK., additional, Cirillo, C., additional, Mordi, I., additional, Grapsa, J., additional, Tzemos, N., additional, Nogradi, A., additional, Strenner, M., additional, Minier, T., additional, Czirjak, L., additional, Komocsi, A., additional, Faludi, R., additional, Nowacka, M., additional, Kopec, G., additional, Waligora, M., additional, Olszowska, M., additional, Podolec, P., additional, Sonecki, P., additional, Kinsella, J., additional, Shelley, BG., additional, Scholtz, S., additional, Dimitriadis, Z., additional, Graw, A., additional, Bogunovic, N., additional, Scholtz, W., additional, Boergermann, J., additional, Gummert, J., additional, Horstkotte, D., additional, Vizzardi, E., additional, Bonadei, I., additional, Platto, F., additional, Metra, M., additional, Bottari, VE., additional, Gentile, S., additional, Romano, C., additional, Rodolico, MS., additional, Losi, V., additional, Tamburino, C., additional, Ashurov, R., additional, Truscelli, G., additional, Placanica, G., additional, Lai, S., additional, Vitarelli, A., additional, Jeong, MH., additional, Ahn, HS., additional, Cho, JS., additional, and Youn, HJ., additional

Published
2016
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32. Stroke volume and myocardial contraction fraction in transthyretin amyloidosis cardiomyopathy: A systematic review

Author

Serenelli Matteo, Cantone Anna, Sanguettoli Federico, Maio Daniele, Fabbri Gioele, Dal Passo Beatrice, Pavasini Rita, Tonet Elisabetta, Passarini Giulia, Rapezzi Claudio, and Campo Gianluca

Subjects
heart failure, amyloidosis, transthyretin, prognosis, stroke volume (SV), myocardial contraction fraction (MCF), Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundCardiac amyloidosis (CA) is primarily a restrictive cardiomyopathy in which the impairment of diastolic function is dominant. Despite this, the left ventricular ejection fraction (LVEF) may be depressed in the late stage of the disease, but it poorly predicts prognosis in the earlier phases and does not represent well the pathophysiology of CA. Many echocardiographic parameters resulted important diagnostic and prognostic tools in patients with CA. Stroke volume (SV) and myocardial contraction fraction (MCF) may be obtained both with echocardiography and cardiac magnetic resonance (MRI). They reflect many factors intrinsically related to the pathophysiology of CA and are therefore potentially associated with symptoms and prognosis in CA.ObjectivesTo collect and summarize the current evidence on SV and MCF and their clinical and prognostic role in transthyretin (TTR-CA).Methods and resultsWe performed a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We searched the literature database for studies focusing on SV and MCF in patients with TTR-CA. We analysed the following databases: PUBMED, Cochrane Library, EMBASE, and Web of Science database. Fourteen studies were included in the review. Both SV and MCF have important prognostic implications and are related to mortality. Furthermore, SV is more related to symptoms than LVEF and predicts tolerability of beta-blocker therapy in TTR-CA. Finally, SV showed to be an excellent measure to suggest the presence of TTR-CA in patients with severe aortic stenosis.ConclusionStroke volume and MCF are very informative parameters that should be routinely assessed during the standard echocardiographic examination of all patients with TTR-CA. They carry a prognostic role while being associated with patients’ symptoms.Systematic review registrationhttps://doi.org/10.17605/OSF.IO/ME7DS.

Published
2023
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35. Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction.

Author

Biscaglia, S., Guiducci, V., Escaned, J., Moreno, R., Lanzilotti, V., Santarelli, A., Cerrato, E., Sacchetta, G., Jurado-Roman, A., Menozzi, A., Amat Santos, I., Díez Gil, J. L., Ruozzi, M., Barbierato, M., Fileti, L., Picchi, A., Lodolini, V., Biondi-Zoccai, G., Maietti, E., and Pavasini, R.

Subjects
*MYOCARDIAL infarction, *OLDER patients, *ST elevation myocardial infarction, *PERCUTANEOUS coronary intervention, *ACUTE kidney failure
Abstract

BACKGROUND The benefit of complete revascularization in older patients (≥ 75 years of age) with myocardial infarction and multivessel disease remains unclear. METHODS In this multicenter, randomized trial, we assigned older patients with myocardial infarction and multivessel disease who were undergoing percutaneous coronary intervention (PCI) of the culprit lesion to receive either physiology-guided complete revascularization of nonculprit lesions or to receive no further revascularization. Functionally significant nonculprit lesions were identified either by pressure wire or angiography. The primary outcome was a composite of death, myocardial infarction, stroke, or any revascularization at 1 year. The key secondary outcome was a composite of cardiovascular death or myocardial infarction. Safety was assessed as a composite of contrast-associated acute kidney injury, stroke, or bleeding. RESULTS A total of 1445 patients underwent randomization (720 to receive complete revascularization and 725 to receive culprit-only revascularization). The median age of the patients was 80 years (interquartile range, 77 to 84); 528 patients (36.5%) were women, and 509 (35.2%) were admitted for ST-segment elevation myocardial infarction. A primary-outcome event occurred in 113 patients (15.7%) in the complete-revascularization group and in 152 patients (21.0%) in the culprit-only group (hazard ratio, 0.73; 95% confidence interval [CI], 0.57 to 0.93; P = 0.01). Cardiovascular death or myocardial infarction occurred in 64 patients (8.9%) in the complete-revascularization group and in 98 patients (13.5%) in the culprit-only group (hazard ratio, 0.64; 95% CI, 0.47 to 0.88). The safety outcome did not appear to differ between the groups (22.5% vs. 20.4%; P=0.37). CONCLUSIONS Among patients who were 75 years of age or older with myocardial infarction and multivessel disease, those who underwent physiology-guided complete revascularization had a lower risk of a composite of death, myocardial infarction, stroke, or ischemia-driven revascularization at 1 year than those who received culprit-lesion-only PCI. [ABSTRACT FROM AUTHOR]

Published
2023
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36. A national survey on prevalence of possible echocardiographic red flags of amyloid cardiomyopathy in consecutive patients undergoing routine echocardiography: study design and patients characterization — the first insight from the AC-TIVE Study

Author

Matteo Cameli, Elisa Giacomin, Marco Metra, Giuseppe Limongelli, Stefano Favale, Martina Caiazza, Antonino Milidoni, Carlo Lombardi, Marco Merlo, Lia Crotti, Angelo Giuseppe Caponetti, Andrea Carlo Merlo, Francesco Cappelli, Alessandro Andreis, Valentina Spini, Camillo Autore, Rita Pavasini, Beatrice Musumeci, Iacopo Olivotto, Michele Emdin, Francesco Bruno, Marco Canepa, Luigi P. Badano, Giuseppe De Carli, Giulia Saturi, Cinzia Forleo, Giuseppe Vergaro, Miriam Albanese, Massimo Imazio, Luca Di Ienno, Giovanna Branzi, Andrea Igoren Guaricci, Claudio Rapezzi, Gianluca Di Bella, Gianfranco Sinagra, Linda Pagura, Valeria Rella, Gianfranco Parati, Giovanni La Malfa, Stefano Perlini, Enrico Sfriso, Aldostefano Porcari, Elena Biagini, Giuseppe Palmiero, Francesca Longo, Franca Dore, Merlo, Marco, Porcari, Aldostefano, Pagura, Linda, Cameli, Matteo, Vergaro, Giuseppe, Musumeci, Beatrice, Biagini, Elena, Canepa, Marco, Crotti, Lia, Imazio, Massimo, Forleo, Cinzia, Cappelli, Francesco, Favale, Stefano, Di Bella, Gianluca, Dore, Franca, Lombardi, Carlo Mario, Pavasini, Rita, Rella, Valeria, Palmiero, Giuseppe, Caiazza, Martina, Albanese, Miriam, Guaricci, Andrea Igoren, Branzi, Giovanna, Caponetti, Angelo Giuseppe, Saturi, Giulia, La Malfa, Giovanni, Merlo, Andrea Carlo, Andreis, Alessandro, Bruno, Francesco, Longo, Francesca, Sfriso, Enrico, Di Ienno, Luca, De Carli, Giuseppe, Giacomin, Elisa, Spini, Valentina, Milidoni, Antonino, Limongelli, Giuseppe, Autore, Camillo, Olivotto, Iacopo, Badano, Luigi, Parati, Gianfranco, Perlini, Stefano, Metra, Marco, Emdin, Michele, Rapezzi, Claudio, Sinagra, Gianfranco, Merlo, M, Porcari, A, Pagura, L, Cameli, M, Vergaro, G, Musumeci, B, Biagini, E, Canepa, M, Crotti, L, Imazio, M, Forleo, C, Cappelli, F, Favale, S, Di Bella, G, Dore, F, Lombardi, C, Pavasini, R, Rella, V, Palmiero, G, Caiazza, M, Albanese, M, Guaricci, A, Branzi, G, Caponetti, A, Saturi, G, La Malfa, G, Merlo, A, Andreis, A, Bruno, F, Longo, F, Sfriso, E, Di Ienno, L, De Carli, G, Giacomin, E, Spini, V, Milidoni, A, Limongelli, G, Autore, C, Olivotto, I, Badano, L, Parati, G, Perlini, S, Metra, M, Emdin, M, Rapezzi, C, and Sinagra, G

Subjects
medicine.medical_specialty, Epidemiology, Socio-culturale, Cardiac amyloidosis, Cardiac amyloidosi, Internal medicine, Prevalence, medicine, Humans, Red-flag, business.industry, MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Amyloidosis, Echocardiography, Red-flags, Cardiomyopathies, Emblems and Insignia, Cardiology, Cardiology and Cardiovascular Medicine, business, Amyloid cardiomyopathy, Red flags
Abstract

N/A

Published
2021
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37. Unmasking the prevalence of amyloid cardiomyopathy in the real world: results from Phase 2 of the AC-TIVE study, an Italian nationwide survey

Author

Marco Merlo, Linda Pagura, Aldostefano Porcari, Matteo Cameli, Giuseppe Vergaro, Beatrice Musumeci, Elena Biagini, Marco Canepa, Lia Crotti, Massimo Imazio, Cinzia Forleo, Francesco Cappelli, Federico Perfetto, Stefano Favale, Gianluca Di Bella, Franca Dore, Francesca Girardi, Daniela Tomasoni, Rita Pavasini, Valeria Rella, Giuseppe Palmiero, Martina Caiazza, Maria Cristina Carella, Andrea Igoren Guaricci, Giovanna Branzi, Angelo Giuseppe Caponetti, Giulia Saturi, Giovanni La Malfa, Andrea Carlo Merlo, Alessandro Andreis, Francesco Bruno, Francesca Longo, Maddalena Rossi, Guerino Giuseppe Varrà, Riccardo Saro, Luca Di Ienno, Giuseppe De Carli, Elisa Giacomin, Chiara Arzilli, Giuseppe Limongelli, Camillo Autore, Iacopo Olivotto, Luigi Badano, Gianfranco Parati, Stefano Perlini, Marco Metra, Michele Emdin, Claudio Rapezzi, Gianfranco Sinagra, Merlo, Marco, Pagura, Linda, Porcari, Aldostefano, Cameli, Matteo, Vergaro, Giuseppe, Musumeci, Beatrice, Biagini, Elena, Canepa, Marco, Crotti, Lia, Imazio, Massimo, Forleo, Cinzia, Cappelli, Francesco, Perfetto, Federico, Favale, Stefano, Di Bella, Gianluca, Dore, Franca, Girardi, Francesca, Tomasoni, Daniela, Pavasini, Rita, Rella, Valeria, Palmiero, Giuseppe, Caiazza, Martina, Carella, Maria Cristina, Igoren Guaricci, Andrea, Branzi, Giovanna, Caponetti, Angelo Giuseppe, Saturi, Giulia, La Malfa, Giovanni, Merlo, Andrea Carlo, Andreis, Alessandro, Bruno, Francesco, Longo, Francesca, Rossi, Maddalena, Varrà, Guerino Giuseppe, Saro, Riccardo, Di Ienno, Luca, De Carli, Giuseppe, Giacomin, Elisa, Arzilli, Chiara, Limongelli, Giuseppe, Autore, Camillo, Olivotto, Iacopo, Badano, Luigi, Parati, Gianfranco, Perlini, Stefano, Metra, Marco, Emdin, Michele, Rapezzi, Claudio, Sinagra, Gianfranco, Merlo, M, Pagura, L, Porcari, A, Cameli, M, Vergaro, G, Musumeci, B, Biagini, E, Canepa, M, Crotti, L, Imazio, M, Forleo, C, Cappelli, F, Perfetto, F, Favale, S, Di Bella, G, Dore, F, Girardi, F, Tomasoni, D, Pavasini, R, Rella, V, Palmiero, G, Caiazza, M, Carella, M, Igoren Guaricci, A, Branzi, G, Caponetti, A, Saturi, G, La Malfa, G, Merlo, A, Andreis, A, Bruno, F, Longo, F, Rossi, M, Varra, G, Saro, R, Di Ienno, L, De Carli, G, Giacomin, E, Arzilli, C, Limongelli, G, Autore, C, Olivotto, I, Badano, L, Parati, G, Perlini, S, Metra, M, Emdin, M, Rapezzi, C, Sinagra, G, and Michele, Emdin

Subjects
Amyloid cardiomyopathy, Echocardiography, Epidemiology, Light chain amyloidosis, Red flags, Transthyretin amyloidosis, Heart Failure, Left, Stroke Volume, Amyloidosis, Middle Aged, Ventricular Function, Left, Humans, Prevalence, Prospective Studies, Cardiomyopathies, Ventricular Function, Light chain amyloidosi, Red flag, Cardiology and Cardiovascular Medicine
Abstract

Aim: To investigate the prevalence of amyloid cardiomyopathy (AC) and the diagnostic accuracy of echocardiographic red flags of AC among consecutive adult patients undergoing transthoracic echocardiogram for reason other than AC in 13 Italian institutions. Methods and results: This is an Italian prospective multicentre study, involving a clinical and instrumental work-up to assess AC prevalence among patients ≥55 years old with an echocardiogram suggestive of AC (i.e. at least one echocardiographic red flag of AC in hypertrophic, non-dilated left ventricles with preserved ejection fraction). The study was registered at ClinicalTrials.gov (NCT04738266). Overall, 381 patients with an echocardiogram suggestive of AC were identified among a cohort of 5315 screened subjects, and 217 patients completed the investigations. A final diagnosis of AC was made in 62 patients with an estimated prevalence of 29% (95% confidence interval 23%–35%). Transthyretin-related AC (ATTR-AC) was diagnosed in 51 and light chain-related AC (AL-AC) in 11 patients. Either apical sparing or a combination of ≥2 other echocardiographic red flags, excluding interatrial septum thickness, provided a diagnostic accuracy >70%. Conclusion: In a cohort of consecutive adults with echocardiographic findings suggestive of AC and preserved left ventricular ejection fraction, the prevalence of AC (either ATTR or AL) was 29%. Easily available echocardiographic red flags, when combined together, demonstrated good diagnostic accuracy.

Published
2022

38. Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

Author

Matteo Tebaldi, Elisa Maietti, Graziella Pompei, Roberta Campana, Francesco Vitali, Giovanni Grazzi, Gianni Mazzoni, Matteo Serenelli, Simone Biscaglia, Giulia Bugani, Gianluca Campo, Gioele Fabbri, Paolo Cimaglia, Andrea Rubboli, Alessio Fiorio, Elisabetta Tonet, Rita Pavasini, Pavasini R., Tebaldi M., Bugani G., Tonet E., Campana R., Cimaglia P., Maietti E., Grazzi G., Pompei G., Fabbri G., Fiorio A., Rubboli A., Mazzoni G., Vitali F., Serenelli M., Campo G., and Biscaglia S.

Subjects
medicine.medical_specialty, Acute coronary syndrome, Contrast induced acute kidney injury, medicine.medical_treatment, Renal function, Socio-culturale, 030204 cardiovascular system & hematology, urologic and male genital diseases, Article, Percutaneous coronary intervention, Physical performance, 03 medical and health sciences, Older patient, 0302 clinical medicine, Older patients, Internal medicine, medicine, 030212 general & internal medicine, Mortality, Risk factor, business.industry, Acute kidney injury, General Medicine, medicine.disease, Pooled analysis, Conventional PCI, Medicine, business
Abstract

Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years, 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p &lt, 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p &lt, 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.

Published
2021

39. Current evidence on the diagnostic and prognostic role of native T1 mapping in heart diseases

Author

Andrea Baggiano, Gianluca Pontone, Elisabetta Tonet, Gianluca Campo, Marco Guglielmo, Giuseppe Muscogiuri, Claudio Rapezzi, Rita Pavasini, Angelo Squeri, Alberto Cossu, Stefano Censi, Tonet, E, Baggiano, A, Pavasini, R, Guglielmo, M, Censi, S, Cossu, A, Rapezzi, C, Muscogiuri, G, Squeri, A, Campo, G, and Pontone, G

Subjects
Pathology, medicine.medical_specialty, Heart Diseases, Cardiac magnetic resonance, Contrast Media, Magnetic Resonance Imaging, Cine, Socio-culturale, Gadolinium, 030204 cardiovascular system & hematology, NO, Cardiac magnetic resonance, T1 mapping, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Humans, Late gadolinium enhancement, Medicine, 030212 general & internal medicine, business.industry, Myocardium, Heart, Tissue characterization, T1 mapping, Prognosis, Magnetic Resonance Imaging, Contrast medium, Current (fluid), Cardiology and Cardiovascular Medicine, Tissue composition, business
Abstract

Tissue characterization represents a prerogative of cardiac magnetic resonance. Beside late gadolinium enhancement, native T1 mapping (nT1m) reveals tissue composition. It could represent a useful tool for example when contrast medium can't be administrated. The present review summarises current evidence about nT1m in main heart diseases.

Published
2020

40. Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): rationale and design of a randomized clinical trial

Author

Gianni Mazzoni, Rossella Ruggiero, Giovanni Grazzi, Ursula Corvi, Simone Biscaglia, Giulia Ricci Lucchi, Jonathan Myers, Gianluigi Sella, Elisa Maietti, Giovanni Pasanisi, Elisabetta Tonet, Matteo Serenelli, Roberto Ferrari, Francesco Vitali, Rita Pavasini, Giulia Bugani, Stefano Volpato, Giorgio Chiaranda, Giovanni Quinto Villani, Gianluca Campo, Tonet E., Maietti E., Chiaranda G., Vitali F., Serenelli M., Bugani G., Mazzoni G., Ruggiero R., Myers J., Villani G.Q., Corvi U., Pasanisi G., Biscaglia S., Pavasini R., Lucchi G.R., Sella G., Ferrari R., Volpato S., Campo G., and Grazzi G.

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, Aging, Time Factors, Handgrip, 030204 cardiovascular system & hematology, law.invention, Study Protocol, 0302 clinical medicine, Randomized controlled trial, Quality of life, law, Clinical endpoint, Multicenter Studies as Topic, Prospective Studies, 030212 general & internal medicine, Randomized Controlled Trials as Topic, Cardiac Rehabilitation, Exercise Tolerance, Age Factors, Home Care Services, Exercise Therapy, Acute coronary syndrome, Physical activity, Short physical performance battery, Cardiology and Cardiovascular Medicine, Treatment Outcome, Italy, Female, medicine.medical_specialty, Frail Elderly, Physical exercise, NO, 03 medical and health sciences, Intervention (counseling), medicine, Humans, Mobility Limitation, Adverse effect, Exercise, Geriatric Assessment, Aged, business.industry, Recovery of Function, medicine.disease, lcsh:RC666-701, Sample size determination, Quality of Life, Physical therapy, business
Abstract

Background Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance. Design HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4–9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed. Conclusions The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance. Trial registration Clinicaltrials.gov, identifier NCT03021044, first posted January, 13th 2017. Electronic supplementary material The online version of this article (10.1186/s12872-018-0839-8) contains supplementary material, which is available to authorized users.

Published
2018
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41. Echocardiographic index of left ventricular performance for prognostication in transthyretin cardiac amyloidosis: the central role of stroke volume index.

Author

Serenelli M, Cantone A, Dal Passo B, Sanguettoli F, Fabbri G, Colombi GG, Maio D, Arzenton M, Vitali M, Pavasini R, and Campo G

Subjects
Humans, Female, Male, Aged, Prospective Studies, Prognosis, Middle Aged, Heart Failure physiopathology, Heart Failure mortality, Heart Failure diagnosis, Heart Failure etiology, Echocardiography, Predictive Value of Tests, Aged, 80 and over, Hospitalization statistics & numerical data, Risk Factors, Time Factors, Stroke Volume, Amyloid Neuropathies, Familial complications, Amyloid Neuropathies, Familial physiopathology, Amyloid Neuropathies, Familial mortality, Amyloid Neuropathies, Familial diagnostic imaging, Ventricular Function, Left, Cardiomyopathies physiopathology, Cardiomyopathies diagnostic imaging, Cardiomyopathies mortality
Abstract

Introduction: Cardiac amyloidosis typically causes restrictive cardiomyopathy, in which the impairment of diastolic function is dominant. Echocardiography provides prognostic information through some important parameters: left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, LVEF often remains preserved despite disease progression, and GLS is not routinely performed as it is limited by suboptimal image quality. The stroke volume index (SVi) has already been shown to correlate with mortality in heart failure patients; still, its prognostic role in transthyretin cardiac amyloidosis (TTR-CA) is poorly studied., Purpose: This prospective study aimed to evaluate the role of SVi in predicting mortality and heart failure hospitalizations in patients with cardiac amyloidosis, comparing it to other parameters of left ventricular performance., Methods: Baseline clinical transthoracic echocardiogram and laboratory data were collected prospectively in 115 patients with diagnosed TTR-CA. The outcome was the occurrence of the composite of heart failure hospitalization and death and its association with SVi, LVEF, GLS and MCF was tested by Cox proportional hazard modelling., Results: Over a mean follow-up of 16.1 months (interquartile range 7.4-24.9 months), 29 patients died, and 19 were hospitalized for heart failure. SVi was associated with the composite outcome of death and heart failure hospitalization [hazard ratio 0.96; 95% confidence interval (CI) 0.93-0.99] and remained an independent predictor of outcome after adjustment for NAC stage, mitral regurgitation degree, age and the use of disease-modifying treatment. The best cut-off of SVi to predict outcome was 35 ml/m2 (hazard ratio 2.30; 95% CI 1.03-5.17)., Conclusion: SVi is superior to LVEF, MCF, and GLS for prognostication in patients with TTR amyloidosis., (Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.)

Published
2025
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42. Unexpected Clinically Relevant Findings Detected via Computed Tomography in Patients with Severe Aortic Stenosis Who Are Candidates for Transcatheter Aortic Valve Replacement.

Author

Bianchi N, Frascaro F, Zanarelli L, Marchini F, Sanguettoli F, Meossi S, Serenelli M, Leone A, Penzo C, Tumscitz C, Campo G, and Pavasini R

Abstract

Background: The detection of unexpected findings (UF) during CT scans of patients undergoing TAVR is frequent; however, it is unclear whether such findings have a clinical impact on the TAVR pathway. Methods: We conducted a retrospective, single-center observational study enrolling patients who were candidates for TAVR. All enrolled patients underwent a CT scan before valve implantation. The primary outcome of this study was all-cause mortality, while the secondary outcome was to determine whether the diagnosis of clinically relevant UF on CT scans results in a significant delay in the TAVR procedure. Results: A total of 284 patients were enrolled. Clinically relevant UF were identified in 15% of the patients, with the most common types being pulmonary masses or nodules. During the follow-up period, 83 patients (29.2%) died. The prognosis was worsened by chronic kidney disease (HR 1.76, p = 0.03) and left ventricular dilatation (HR 1.74, p = 0.04), while the diagnosis of clinically relevant UF did not impact all-cause mortality ( p = 0.38). No statistically significant differences were found in the delay from the diagnosis of severe aortic stenosis to TAVR between patients with and without clinically relevant UF ( p = 0.07), although patients with clinically relevant UF experienced a median delay of approximately 37 days in the TAVR procedure. Conclusions: The presence of clinically relevant UF on preoperative CT scans does not affect all-cause mortality but shows a trend toward increasing the time from diagnosis to the procedure in patients with severe aortic stenosis undergoing TAVR. Further studies are required to confirm these findings in larger patient cohorts.

Published
2025
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45. The Impact of Neurological Complications in Endocarditis: A Systematic Review and Meta-Analysis.

Author

Sanguettoli F, Marchini F, Frascaro F, Zanarelli L, Campo G, Sinning C, Tan TC, and Pavasini R

Abstract

Background: Infective endocarditis (IE) is associated with significant neurological complications (NCs). The impact of neurological sequelae due to IE, however, is not well characterized. Thus, the aim of this systematic review and meta-analysis is to determine whether patients who experienced NCs from IE had worse outcomes compared to those without neurological complications. Methods: We conducted a systematic and comprehensive literature search of MEDLINE, Cochrane Library, Google Scholar, and BioMed Central (PROSPERO registration ID: CRD42024518651). Data on the primary outcome of all-cause mortality and the secondary outcome of surgical timing were extracted from 25 observational studies on patients with confirmed IE, both with and without NC. Results: In the pooled total of patients with IE, NCs were present in 23.7% (60.8% ischaemic stroke and 16.4% haemorrhagic stroke). All-cause mortality was significantly higher in patients with IE and NCs (OR 1.78, CI 1.47-2.17, p < 0.0001) compared to those without, particularly in those with major neurological events (OR 2.18, CI 1.53-3.10, p < 0.0001). Conversely, minor or asymptomatic strokes showed no significant correlation with mortality (OR 1.10, CI 0.82-1.47, p = 0.543). There was no significant difference in the timing of surgical intervention (standardized mean difference -0.53, CI -1.67 to 0.61, p = 0.359) between the two patient groups. Conclusions: Major NCs due to infective endocarditis were associated with a significantly increased all-cause mortality. This underscores the critical importance of early recognition and management strategies tailored to the severity of neurological events.

Published
2024
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46. Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction With or Without ST-Segment Elevation.

Author

Cocco M, Campo G, Guiducci V, Casella G, Cavazza C, Cerrato E, Sacchetta G, Moreno R, Menozzi A, Amat Santos I, Díez Gil JL, Scarsini R, Picchi A, Vadalà G, Pilato G, Colaiori I, Barbierato M, Arioti M, Pavasini R, Lanzilotti V, Menozzi M, Varbella F, Erriquez A, and Biscaglia S

Subjects
Humans, Female, Male, Aged, Percutaneous Coronary Intervention methods, Aged, 80 and over, Treatment Outcome, ST Elevation Myocardial Infarction surgery, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction physiopathology, Non-ST Elevated Myocardial Infarction surgery, Non-ST Elevated Myocardial Infarction mortality, Non-ST Elevated Myocardial Infarction physiopathology, Myocardial Revascularization methods
Abstract

Background: The effectiveness of complete revascularization is well established in patients with ST-segment elevation myocardial infarction (STEMI), but it is less investigated in those with non-ST-segment elevation myocardial infarction (NSTEMI)., Objectives: This study aimed to assess whether complete revascularization, compared with culprit-only revascularization, was associated with consistent outcomes in older patients with STEMI and NSTEMI., Methods: In the FIRE (Functional Assessment in Elderly MI Patients with Multivessel Disease) trial, 1,445 older patients with myocardial infarction (MI) were randomized to culprit-only or physiology-guided complete revascularization, stratified by STEMI (n = 256 culprit-only vs n = 253 complete) and NSTEMI (n = 469 culprit-only vs n = 467 complete). The primary outcome comprised a composite of death, MI, stroke, or revascularization at 1 year. The key secondary outcome included a composite of cardiovascular death or MI at 1 year., Results: In the overall study population, physiology-guided complete revascularization reduced both primary and key secondary outcomes. The primary outcome occurred in 54 (21.1%) STEMI patients randomized to culprit-only vs 41 (16.2%) STEMI patients of the complete group (HR: 0.75; 95% CI: 0.50-1.13) and in 98 (20.9%) NSTEMI patients randomized to culprit-only vs 72 (15.4%) NSTEMI patients of the complete group (HR: 0.71; 95% CI: 0.53-0.97), with negative interaction testing (P for interaction, 0.846). Similarly, no signal of heterogeneity with respect to the initial clinical presentation was observed for the key secondary endpoint (P for interaction, 0.654)., Conclusions: Physiology-guided complete revascularization, compared with culprit-only revascularization, provided consistent benefit across the whole spectrum of patients with MI. (FIRE [Functional Assessment in Elderly MI Patients With Multivessel Disease]; NCT03772743)., Competing Interests: Funding Support and Author Disclosures Sahajanand Medical Technologies Ltd (SMT), Medis Medical Imaging Systems, Eukon S.r.l., Siemens Healthineers, General Electric (GE) Healthcare, and Insight Lifetech provided unrestricted funding to the study sponsor for the conduction of the trial. These companies had no involvement in the trial design, data collection, analysis, interpretation, or writing of the manuscript. Dr Campo has received research grants and personal fees from Abbott Vascular, GADA, Menarini, Amgen, Daichi-Sankyo, and Sanofi, outside the submitted work. Dr Moreno has received speaker/consulting fees from Abbott Vascular, AMGEN, AstraZeneca, Biosensors, Biotronik, Boston Scientific, Daiichi-Sankyo, Edwards, Medtronic, and Philips, outside the submitted work. Dr Biscaglia has received funding from the Italian Health Minister (Ricerca Finalizzata 2021, GR-2021-12372516) for the conduction of the Functional Coronary Angiography Guided Revascularization in STEMI trial; and has received personal fees from Abbott Vascular and Siemens Healthcare, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2024
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47. Complete Versus Culprit-Only Revascularization in Older Patients With ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis.

Author

Campo G, Böhm F, Engstrøm T, Smits PC, Elgendy IY, McCann GP, Wood DA, Serenelli M, James S, Høfsten DE, Boxm-de Klerk BM, Banning A, Cairns JA, Pavasini R, Stankovic G, Kala P, Kelbæk H, Barbato E, Srdanovic I, Hamza M, Banning AS, Biscaglia S, and Mehta S

Subjects
Humans, Aged, Female, Aged, 80 and over, Male, Treatment Outcome, Percutaneous Coronary Intervention mortality, Age Factors, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction surgery, ST Elevation Myocardial Infarction therapy, Myocardial Revascularization methods, Randomized Controlled Trials as Topic
Abstract

Background: Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies., Methods: PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction., Results: Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms., Conclusions: In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point., Registration: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898., Competing Interests: None.

Published
2024
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48. Impact of pre-admission physical activity on benefits of physiology-guided complete revascularization in older patients with myocardial infarction: insights from the FIRE trial.

Author

Pavasini R, Campo G, Serenelli M, Tonet E, Guiducci V, Escaned J, Moreno R, Casella G, Cavazza C, Varbella F, Sacchetta G, Arena M, Santos IA, Ibañes EG, Scarsini R, D'Amico G, Ruiz-Poveda FL, Díez Gil JL, Pignatelli G, Iannopollo G, Colaiori I, Santos RC, Marrone A, Fileti L, Rigattieri S, Barbato E, Ocaranza-Sanchez R, and Biscaglia S

Subjects
Humans, Male, Female, Aged, Aged, 80 and over, Treatment Outcome, Time Factors, Sedentary Behavior, Risk Factors, Myocardial Revascularization methods, Age Factors, Patient Admission, Risk Assessment, Myocardial Infarction physiopathology, Myocardial Infarction mortality, Exercise
Abstract

Aims: The present analysis from the Functional Assessment in Elderly Myocardial Infarction Patients with Multivessel Disease (FIRE) trial aims to explore the significance of pre-admission physical activity and assess whether the benefits of physiology-guided complete revascularization apply consistently to sedentary and active older patients., Methods and Results: Patients aged 75 years or more with myocardial infarction (MI) and multivessel disease were randomized to receive physiology-guided complete revascularization or culprit-only strategy. The primary outcome was a composite of death, MI, stroke, or any revascularization within a year. Secondary endpoints included the composite of cardiovascular death or MI, as well as single components of the primary endpoint. Pre-admission physical activity was categorized into three groups: (i) absent (sedentary), (ii) light, and (iii) vigorous. Among 1445 patients, 692 (48%) were sedentary, whereas 560 (39%) and 193 (13%) performed light and vigorous physical activity, respectively. Patients engaging in light or vigorous pre-admission physical activity exhibited a reduced risk of the primary outcome compared with sedentary individuals [light hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.55-0.91 and vigorous HR 0.14, 95% CI 0.07-0.91, respectively]. These trends were also observed for death, cardiovascular death, or MI. When comparing physiology-guided complete revascularization vs. culprit-only strategy, no significant interaction was observed for primary and secondary endpoints when stratified by sedentary or active status., Conclusion: In older patients with MI, pre-admission physical activity emerges as a robust and independent prognostic determinant. Physiology-guided complete revascularization stands out an effective strategy in reducing ischaemic adverse events, irrespective of pre-admission physical activity status., Clinical Trial Registration: ClinicalTrials.gov NCT03772743., Competing Interests: Conflict of interest: G.Cam. received research grants and personal fees from ABBOTT VASCULAR, personal fees from MENARINI, personal fees from AMGEN, personal fees from SANOFI, outside the submitted work. S.B. received personal fees from ABBOTT VASCULAR, outside the submitted work., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2024
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49. Coronary artery disease management in older adults: revascularization and exercise training.

Author

Pavasini R, Biscaglia S, Kunadian V, Hakeem A, and Campo G

Subjects
Humans, Aged, Cardiac Rehabilitation methods, Coronary Artery Disease therapy, Exercise Therapy methods, Myocardial Revascularization methods
Abstract

The mean age of patients with coronary artery disease (CAD) is steadily increasing. In older patients, there is a tendency to underutilize invasive approach, coronary revascularization, up-to-date pharmacological therapies, and secondary prevention strategies, including cardiac rehabilitation. Older adults with CAD commonly exhibit atypical symptoms, multi-vessel disease involvement, complex coronary anatomy, and a higher presence of risk factors and comorbidities. Although both invasive procedures and medical treatments are characterized by a higher risk of complications, avoidance may result in a suboptimal outcome. Often, overlooked factors, such as coronary microvascular disease, malnutrition, and poor physical performance, play a key role in determining prognosis, yet they are not routinely assessed or addressed in older patients. Historically, clinicians have relied on sub-analyses or observational findings to make clinical decisions, as older adults were frequently excluded or under-represented in clinical studies. Recently, dedicated evidence through randomized clinical trials has become available for older CAD patients. Nevertheless, the management of older CAD patients still raises several important questions. This review aims to comprehensively summarize and critically evaluate this emerging evidence, focusing on invasive management and coronary revascularization. Furthermore, it seeks to contextualize these interventions within the framework of improved risk stratification tools for older CAD patients, through user-friendly scales along with emphasizing the importance of promoting physical activity and exercise training to enhance the outcomes of invasive and medical treatments. This comprehensive approach may represent the key to improving prognosis in the complex and growing patient population of older CAD patients., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Published
2024
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50. Future of invasive and non-invasive hemodynamic assessment for coronary artery disease management.

Author

Scala A, Marchini F, Meossi S, Zanarelli L, Sanguettoli F, Frascaro F, Bianchi N, Cocco M, Erriquez A, Tonet E, Campo G, and Pavasini R

Subjects
Humans, Fractional Flow Reserve, Myocardial physiology, Coronary Angiography methods, Hemodynamics, Coronary Artery Disease physiopathology, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease diagnosis, Coronary Artery Disease therapy
Abstract

Coronary artery disease represents a global health challenge. Accurate diagnosis and evaluation of hemodynamic parameters are crucial for optimizing patient management and outcomes. Nowadays a wide range of both non-invasive and invasive methods are available to assess the hemodynamic impact of both epicardial coronary stenosis and vasomotor disorders. In fact, over the years, important developments have reshaped the nature of both invasive and non-invasive diagnostic techniques, and the future holds promises for further innovation and integration. Non-invasive techniques have progressively evolved and currently a broad spectrum of methods are available, from cardiac magnetic resonance imaging with pharmacological stress and coronary computed tomography (CT) to the newer application of FFR-CT and perfusion CT. Invasive methods, on the contrary, have developed to a full-physiology approach, able not only to identify functionally significant lesions but also to evaluate microcirculation and vasospastic disease. The aim of this review is to summarize the current state-of-the-art of invasive and non-invasive hemodynamic assessment for CAD management.

Published
2024
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