Soriano Dott. Francesco Stefano
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[Contemporary diagnosis and treatment of tricuspid regurgitation: from neglected valve to primetime].
G Ital Cardiol (Rome)2024 Aug;25(8):576-589. doi: 10.1714/4309.42927.
Montalto Claudio, Tognola Chiara, Ghidini Simone, Monticelli Massimiliano, Nava Stefano, Soriano Francesco, Munafò Andrea R, Tavoletta Pasquale, Bruschi Giuseppe, Esposito Giuseppe, Mangieri Antonio, Giannattasio Cristina, De Marco Federico, Oliva Fabrizio, Oreglia Jacopo A
Abstract
Tricuspid insufficiency has long been considered an entity with low prognostic importance and associated with symptoms and signs only secondarily to left heart pathology. Scientific research in recent years has debunked this myth, demonstrating a key role in determining symptoms and signs of right heart failure, even in advanced stages. In parallel, advances in transcatheter technologies have opened up treatment options even for patients with increased surgical risk, who were previously excluded from traditional surgical options, with increasingly convincing results in reducing symptoms and improving the quality of life of our patients. The contemporary challenge is to translate these messages into everyday clinical practice and to encourage the centralization of patients in centers that currently have the expertise for feasibility evaluation and subsequent treatment. In this Review, we will analyze the most recent evidence on the pathophysiology and diagnosis of tricuspid insufficiency, the latest recommendations from European guidelines, and we will try to illustrate the most common technologies for percutaneous treatment and the abundant evidence supporting them.
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Use of cangrelor for complex percutaneous coronary intervention in the context of concomitant severe aortic stenosis: a case series.
Eur Heart J Case Rep2024 May;8(5):ytae237. doi: ytae237.
Soriano Francesco, Munafò Andrea R, Baydaroglu Nurcan, Nava Stefano, Bruschi Giuseppe, Esposito Giuseppe, Oreglia Jacopo A, Montalto Claudio
Abstract
BACKGROUND:
There is a growing need for percutaneous coronary intervention (PCI) to be performed within the same transcatheter aortic valve implantation (TAVI) procedure. In such cases, cangrelor, a fast-acting intravenous P2Y12-inhibitor with a short offset, is potential clinical utility to minimize bleeding and vascular complications during large-bore arterial access (LBAA) as well as the thrombotic risk associated with concomitant PCI.
CASE SUMMARY:
We report two cases of TAVI with an indication to concomitant, high-risk PCI. In the first one, cangrelor was started only after LBAA was secured and TAVI completed, just before the initiation of complex PCI. In the second case, due to predicted complex coronary cannulation after TAVI, complex PCI was performed before TAVI and cangrelor started just after LBAA. In both cases, use of cangrelor (vs. pre-treatment with oral P2Y12-i) allowed for a tailored minimization of the risk of bleeding and vascular complications during LBAA while offering full platelet inhibition during a complex/high-risk PCI.
DISCUSSION:
In this case series, we illustrate a possible approach to the use of cangrelor for patients undergoing TAVI and complex/high-risk PCI. In such complex cases, thorough pre-procedural planning might include a cangrelor to minimize vascular, bleeding, and ischaemic complications.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Atrial fibrillation and ischemic heart disease: (un)solved therapeutic dilemma?
Minerva Cardiol Angiol2024 Jun;72(3):225-236. doi: 10.23736/S2724-5683.23.06275-0.
Gritti Valeria, Pierini Simona, Ferlini Marco, Mauri Silvia, Barbieri Lucia, Castiglioni Battistina, Lettieri Corrado, Mircoli Luca, Mortara Andrea, Nassiacos Daniele, Oltrona Visconti Luigi, Paggi Anita, Soriano Francesco, Sponzilli Carlo, Corsini Alberto
Abstract
Concomitant presence of atrial fibrillation and coronary artery disease requiring percutaneous coronary intervention is a frequent occurrence. The choice of optimal antithrombotic therapy, in this context, is still challenging. To offer the best protection both in terms of stroke and stent thrombosis, triple therapy with oral anticoagulation and dual antiplatelet therapy would be required. Several drug combinations have been tested in recent years, including direct oral anticoagulants, with the aim of balancing ischemic and bleeding risk. Both pharmacokinetic aspects of the molecules and patient's characteristics should be analyzed in choosing oral anticoagulation. Then, as suggested by guidelines, triple therapy should start with a seven-day duration and the aim to prolong to thirty days in high thrombotic risk patients. Dual therapy should follow to reach twelve months after coronary intervention. Even not fully discussed by the guidelines, in order to balance ischemic and bleeding risk it should also be considered: 1) integrated assessment of coronary artery disease and procedural complexity of coronary intervention; 2) appropriateness to maintain the anticoagulant drug dosage indicated in technical data sheet; the lack of data on the suspension of antiplatelet drugs one year after percutaneous intervention; 3) the possibility of combination therapy with ticagrelor; and 4) the need to treat the occurrence of paroxysmal atrial fibrillation during acute coronary syndrome. With data provided clinician should pursue a therapy as personalized as possible, both in terms of drug choice and treatment duration, in order to balance ischemic and bleeding risk.
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Anatomical relationship after transcatheter aortic valve implantation with commissural alignment and left main percutaneous coronary intervention.
Eur Heart J Case Rep2023 Sep;7(9):ytad465. doi: ytad465.
Bauer Dávid, Montalto Claudio, Tavoletta Pasquale, Soriano Francesco
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Transcatheter aortic valve replacement with the self-expanding ACURATE Neo2 in patients with horizontal aorta: Insights from the ITAL-neo registry.
Int J Cardiol2023 Oct;389():131236. doi: 10.1016/j.ijcard.2023.131236.
Barki Monica, Ielasi Alfonso, Buono Andrea, Maffeo Diego, Montonati Carolina, Pellegrini Dario, Pellicano Mariano, Gorla Riccardo, Costa Giuliano, Cozzi Ottavia, Ancona Marco, Soriano Francesco, De Carlo Marco, Ferrara Erica, Giannini Francesco, Massussi Mauro, Fovino Luca Nai, Messina Antonio, Sgroi Carmelo, Gallo Francesco, Nerla Roberto, Saccocci Matteo, D'Ascenzo Fabrizio, Conrotto Federico, Bettari Luca, Fiorina Claudia, Castriota Fausto, Poli Arnaldo, Petronio Anna Sonia, Oreglia Jacopo, Montorfano Matteo, Regazzoli Damiano, Reimers Bernhard, Barbanti Marco, Tamburino Corrado, Bedogni Francesco, Tarantini Giuseppe, Tespili Maurizio
Abstract
BACKGROUND:
Horizontal aorta (HA), defined by an aortic angulation (AA) ?48°, is associated with worse outcomes particularly after self-expanding (SE) trans-catheter heart valve (THV) implantation. Although the SE ACURATE Neo THV demonstrated favorable procedural success rates in patients with HA, it remains associated with a non-negligible rate of moderate or greater paravalvular leak (PVL).
OBJECTIVES:
Aim of the study was to assess the performance of ACURATE Neo2 in the setting of HA.
METHODS:
We performed a multicenter cohort analysis on patients with severe aortic valve stenosis and HA undergoing transcatheter aortic valve replacement (TAVR) with the Neo or Neo2 THV enrolled in the ITAL-neo registry. The primary endpoint was a composite of early safety and clinical efficacy at 30 days according to the Valve Academic Research Consortium-3 (VARC-3). Secondary endpoints included the occurrence of moderate or severe PVL and 90-day clinical outcomes.
RESULTS:
Among 900 patients included in the ITAL-neo registry, 407 exhibited HA; of these, 300 received a Neo THV and 107 a Neo2 THV. HA, irrespective of the THV implanted, emerged as an independent risk factor for developing ? moderate PVL. Technical and device success at 30-day follow-up was comparable between groups. However, Neo2 was associated with a significantly lower rate of ?moderate PVL vs. Neo: (5% vs. 15%; p
CONCLUSION:
In patients with HA, the new generation Acurate Neo2 THV was associated with a comparable device success rate and a significantly lower rate of ?moderate PVL, when compared with its predecessor.
Copyright © 2023 Elsevier B.V. All rights reserved.
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Natural history and clinical burden of moderate aortic stenosis: a systematic review and explorative meta-analysis.
J Cardiovasc Med (Hagerstown)2023 Sep;24(9):659-665. doi: 10.2459/JCM.0000000000001490.
Morelli Martina, Galasso Michele, Esposito Giuseppe, Soriano Francesco Stefano, Nava Stefano, Da Pozzo Caterina, Bossi Irene, Piccaluga Emanuela, Bruschi Giuseppe, Maloberti Alessandro, Oliva Fabrizio, Oreglia Jacopo Andrea, Giannattasio Cristina, Montalto Claudio
Abstract
AIMS:
The mortality risk of patients with moderate aortic stenosis is not well known, but recent studies suggested that it might negatively affect prognosis. We aimed to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of patients' baseline characteristics with prognosis.
METHODS:
Systematic research was conducted on PubMed. The inclusion criteria were inclusion of patients with moderate aortic stenosis; and report of the survival at 1-year follow-up (minimum). Incidence ratios related to all-cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. All patients with mild aortic stenosis or without aortic stenosis were considered controls. Meta-regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis.
RESULTS:
Fifteen studies and 11?596 patients with moderate aortic stenosis were included. All-cause mortality was significantly higher among patients with moderate aortic stenosis than in controls in all timeframes analysed (all P ?0.0001). Left ventricular ejection fraction and sex did not significantly impact on the prognosis of patients with moderate aortic stenosis ( P ?=?0.4584 and P ?=?0.5792), while increasing age showed a significant interaction with mortality (estimate = 0.0067; 95% confidence interval: 0.0007-0.0127; P ?=?0.0323).
CONCLUSION:
Moderate aortic stenosis is associated with reduced survival. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of aortic valve replacement.
Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.
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Bi-Caval Valve Implantation to Palliate Symptoms in a Case of Massive Tricuspid Regurgitation.
Cardiovasc Revasc Med2023 Aug;53S():S139-S143. doi: 10.1016/j.carrev.2023.01.014.
Galasso Michele, Cartella Iside, Soriano Francesco, Nava Stefano, Tavoletta Pasquale, De Chiara Benedetta, Oliva Fabrizio, Bruschi Giuseppe, Oreglia Jacopo A, Giannattasio Cristina, Mangieri Antonio, Montalto Claudio
Abstract
Severe tricuspid regurgitation is associated with the occurrence of right failure and increased morbidity and mortality. Transcatheter heterotopic bi-caval valve implantation might offer symptom relief in these patients that are often at prohibitive surgical risk.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Transcatheter treatment of severe aortic stenosis in patients with complex coronary artery disease: case series and proposed therapeutic algorithm.
Eur Heart J Case Rep2022 Oct;6(10):ytac399. doi: ytac399.
Soriano Francesco, Montalto Claudio, Calderone Dario, Nava Stefano, Esposito Giuseppe, Saia Francesco, Oreglia Jacopo A, Søndergaard Lars
Abstract
BACKGROUND:
Patients with severe aortic stenosis (AS) and complex coronary artery disease with a clinical indication to both transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) pose a clinical dilemma since it is unclear which lesion should be treated first and careful planning is required.
CASE SUMMARY:
We report two cases of AS with complex PCI (ASCoP) features. In the first one, easy coronary cannulation with an Acurate Neo2 valve and commissural alignment was predicted; therefore, TAVI was performed first, and subsequently complex high-risk PCI of the left main was performed in the same procedure but without the burden of ongoing severe AS. In the second case, complex coronary cannulation after TAVI with an Evolut PRO valve was predicted; therefore, balloon aortic valvuloplasty and Impella placement were performed first to allow for complex, high-risk multivessel PCI and subsequent TAVI. In both cases, a single-stage approach was preferred to reduce the use of large-bore arterial access with possible consequent adverse events.
DISCUSSION:
In this case series, we illustrate a possible approach to the treatment of ASCoP patients. In such complex cases, a thorough preprocedural planning is mandatory, and clinical decision-making should be centred upon the predicted chance of cannulation of coronary arteries after TAVI.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Acute Kidney Injury After Transcatheter Aortic Valve Replacement Mediates the Effect of Chronic Kidney Disease.
J Am Heart Assoc2022 Oct;11(19):e024589. doi: e024589.
Crimi Gabriele, De Marzo Vincenzo, De Marco Federico, Conrotto Federico, Oreglia Jacopo, D'Ascenzo Fabrizio, Testa Luca, Gorla Riccardo, Esposito Giuseppe, Sorrentino Sabato, Spaccarotella Carmen, Soriano Francesco, Bruno Francesco, Vercellino Matteo, Balbi Manrico, Morici Nuccia, Indolfi Ciro, De Ferrari Gaetano Maria, Bedogni Francesco, Porto Italo
Abstract
Background Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) is associated with increased mortality. However, it is controversial whether AKI affects prognosis per se, being linked to baseline chronic kidney disease (CKD) and bleeding complications. The aim of this study was to disentangle, applying mediation analysis, the association between AKI and clinical outcome, considering CKD and bleedings. Methods and Results Consecutive patients undergoing TAVR were prospectively enrolled at 5 high-volume centers in Italy. AKI was defined according to Valve Academic Research Consortium-3 consensus, whereas bleeding with Bleeding Academic Research Consortium. Primary outcome was all-cause mortality after 1-year follow-up. Among 2621 patients undergoing TAVR, AKI occurrence was associated with 1-year mortality. This association of AKI with the primary end points remained significant after adjusting for baseline risk estimators, either Society of Thoracic Surgeons score (hazard ratio [HR], 2.78 [95% CI, 1.95-3.80],
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Large-bore arterial access closure after transcatheter aortic valve replacement: a systematic review and network meta-analysis.
Eur Heart J Open2022 Jul;2(4):oeac043. doi: oeac043.
Montalto Claudio, Munafò Andrea Raffaele, Arzuffi Luca, Soriano Francesco, Mangieri Antonio, Nava Stefano, De Maria Giovanni Luigi, Burzotta Francesco, D'Ascenzo Fabrizio, Colombo Antonio, Latib Azeem, Oreglia Jacopo Andrea, Banning Adrian P, Porto Italo, Crimi Gabriele
Abstract
AIMS:
As the indications to transcatheter aortic valve replacement (TAVR) expand to patients at increasingly lower risk, procedure-related vascular and bleeding complications events must be minimized. We aimed to evaluate the impact of different large-bore arterial access closure devices on clinical outcomes after TAVR.
METHODS AND RESULTS:
We searched for papers that reported outcomes according to the type of vascular closure device/technique used after TAVR and performed a Bayesian network meta-analysis (NMA). Fifteen studies involving 9259 patients who underwent access site closure using PROSTAR? XL percutaneous vascular surgical system (Abbott Vascular, Santa Clara, CA, USA), Perclose ProGlide? suture-mediated closure system (Abbott), or MANTA vascular closure device (Teleflex, Morrisville, NC, USA) were included. NMA showed MANTA to have the highest likelihood of reducing a primary composite endpoint of intra-hospital death, major vascular complications, and major or life-threatening bleedings [surface under the cumulative ranking curve analysis (SUCRA) 94.8%], but this was mitigated when only randomized clinical trials and propensity-matched cohorts were included (SUCRA 56.1%). The ProGlide showed the highest likelihood to reduce major or life-threatening bleedings, especially with increasing procedural complexity, and the MANTA device to reduce major and minor vascular complications. The ProStar XL device performed poorly in all explored endpoints.
CONCLUSION:
Available evidence summarized through a NMA shows that ProGlide and MANTA devices appear to be both valid vascular closure devices globally and to be the best options to minimize vascular complications and reduce bleeding in patients undergoing TAVR, respectively.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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Transcatheter Aortic Valve Replacement With Self-Expanding ACURATE neo2: Postprocedural Hemodynamic and Short-Term Clinical Outcomes.
JACC Cardiovasc Interv2022 Jun;15(11):1101-1110. doi: 10.1016/j.jcin.2022.02.027.
Buono Andrea, Gorla Riccardo, Ielasi Alfonso, Costa Giuliano, Cozzi Ottavia, Ancona Marco, Soriano Francesco, De Carlo Marco, Ferrara Erica, Giannini Francesco, Massussi Mauro, Fovino Luca Nai, Pero Gaetano, Bettari Luca, Acerbi Elena, Messina Antonio, Sgroi Carmelo, Pellicano Mariano, Sun Jinwei, Gallo Francesco, Franchina Antonio Gabriele, Bruno Francesco, Nerla Roberto, Saccocci Matteo, Villa Emmanuel, D'Ascenzo Fabrizio, Conrotto Federico, Cuccia Claudio, Tarantini Giuseppe, Fiorina Claudia, Castriota Fausto, Poli Arnaldo, Petronio Anna Sonia, Oreglia Jacopo, Montorfano Matteo, Regazzoli Damiano, Reimers Bernhard, Tamburino Corrado, Tespili Maurizio, Bedogni Francesco, Barbanti Marco, Maffeo Diego,
Abstract
BACKGROUND:
The first-generation ACURATE neo transcatheter heart valve (THV) (Boston Scientific) was associated with a non-negligible occurrence of moderate or greater paravalvular aortic regurgitation (AR) following transcatheter aortic valve replacement. To overcome this issue, the ACURATE neo2 iteration, which incorporates a taller outer skirt aimed at reducing the occurrence of paravalvular AR, has recently been developed.
OBJECTIVES:
The aim of this study was to assess the efficacy and safety of the ACURATE neo2 (Boston Scientific) THV in patients with severe aortic valve stenosis.
METHODS:
ITAL-neo was an observational, retrospective, multicenter registry enrolling consecutive patients with severe aortic valve stenosis, treated with first- and second-generation ACURATE neo THVs, via transfemoral and trans-subclavian access, in 13 Italian centers. One-to-one propensity score matching was applied to account for baseline characteristics unbalance. The primary endpoint was the occurrence of moderate or greater paravalvular AR on predischarge echocardiographic assessment. Secondary endpoints included postprocedural technical success and 90-day device success and safety.
RESULTS:
Among 900 patients included in the registry, 220 received the ACURATE neo2 THV, whereas 680 were treated with the first-generation device. A total of 410 patients were compared after 1:1 propensity score matching. The ACURATE neo2 THV was associated with a 3-fold lower frequency of postprocedural moderate or greater paravalvular AR (11.2% vs 3.5%; P
CONCLUSIONS:
Transfemoral transcatheter aortic valve replacement using the ACURATE neo2 was associated with a significant lower frequency of moderate or greater paravalvular AR compared with the earlier generation ACURATE neo device, with encouraging short-term safety and efficacy.
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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[Use of anticoagulants in patients with atrial fibrillation undergoing transcatheter aortic valve implantation].
Rev Med Chil2022 May;150(5):618-624. doi: 10.4067/s0034-98872022000500618.
Veas Nicolás, Winter José, Soriano Francesco, Valdebenito Martín, Piccaluga Emanuela, Nava Stefano, Muñoz Rodrigo, Cruz-González Ignacio, Puentes Angel, Lindefjeld Dante
Abstract
BACKGROUND:
Transcatheter Aortic Valve Implantation (TAVI) is beneficial in patients with symptomatic severe Aortic Stenosis (AS). There is no consensus about the best anticoagulation strategy for patients with a recent TAVI and with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) are effective to prevent embolic events with a significant lower incidence of bleeding. There is scarce evidence about the use of these drugs in patients undergoing TAVI.
AIM:
To assess the management of anticoagulation at the moment of discharge of patients with AF and TAVI.
MATERIAL AND METHODS:
A four question survey was sent to cardiologists involved in TAVI programs in different international centers.
RESULTS:
The survey was answered by 72 interventional cardiologists. Even with the lack of randomized evidence, in most of the scenarios DOACs are prescribed at discharge in patients with indication for anticoagulation. Also, in patients with high bleeding risk, most cardiologists would perform a left atrial appendage closure. In patients with concomitant coronary artery disease, if a stent was recently implanted, prescription of the combination of a DOAC and one antiplatelet drug was the most common answer. In patients with a former coronary angioplasty, DOAC or Warfarin was the therapy of choice.
CONCLUSIONS:
In the absence of randomized data, interventional cardiologists prescribe DOACs at discharge to patients with AF and TAVI, without following current guidelines in most cases.
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Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis.
Circulation2022 Apr;145(15):1123-1139. doi: 10.1161/CIRCULATIONAHA.121.056817.
Ammirati Enrico, Lupi Laura, Palazzini Matteo, Hendren Nicholas S, Grodin Justin L, Cannistraci Carlo V, Schmidt Matthieu, Hekimian Guillaume, Peretto Giovanni, Bochaton Thomas, Hayek Ahmad, Piriou Nicolas, Leonardi Sergio, Guida Stefania, Turco Annalisa, Sala Simone, Uribarri Aitor, Van de Heyning Caroline M, Mapelli Massimo, Campodonico Jeness, Pedrotti Patrizia, Barrionuevo Sánchez Maria Isabel, Ariza Sole Albert, Marini Marco, Matassini Maria Vittoria, Vourc'h Mickael, Cannatà Antonio, Bromage Daniel I, Briguglia Daniele, Salamanca Jorge, Diez-Villanueva Pablo, Lehtonen Jukka, Huang Florent, Russel Stéphanie, Soriano Francesco, Turrini Fabrizio, Cipriani Manlio, Bramerio Manuela, Di Pasquale Mattia, Grosu Aurelia, Senni Michele, Farina Davide, Agostoni Piergiuseppe, Rizzo Stefania, De Gaspari Monica, Marzo Francesca, Duran Jason M, Adler Eric D, Giannattasio Cristina, Basso Cristina, McDonagh Theresa, Kerneis Mathieu, Combes Alain, Camici Paolo G, de Lemos James A, Metra Marco
Abstract
BACKGROUND:
Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19-associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe.
METHODS:
A total of 112 patients with suspected AM from 56?963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19-associated AM.
RESULTS:
AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19-associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47;
CONCLUSIONS:
AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
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Percutaneous paravalvular leak closure after transcatheter aortic valve implantation: multiimage guidance.
J Cardiovasc Med (Hagerstown)2022 Mar;23(3):203-204. doi: 10.2459/JCM.0000000000001197.
Veas Nicolás, Soriano Francesco, Nava Stefano, Oreglia Jacopo
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Rare Causes of Acute Coronary Syndrome: The JAK2 V617F Mutation-Positive Myeloproliferative Neoplasms: A Cardio-Hematological Perspective.
Thromb Haemost2022 Aug;122(8):1429-1431. doi: 10.1055/a-1742-0361.
Cantoni Silvia, Colombo Claudia, Soriano Francesco, Oreglia Jacopo Andrea, Sacco Alice, Veronese Silvio, Brunelli Dario, Rubboli Andrea, Morici Nuccia
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The Role of Uric Acid in Acute and Chronic Coronary Syndromes.
J Clin Med2021 Oct;10(20):. doi: 4750.
Maloberti Alessandro, Biolcati Marco, Ruzzenenti Giacomo, Giani Valentina, Leidi Filippo, Monticelli Massimiliano, Algeri Michela, Scarpellini Sara, Nava Stefano, Soriano Francesco, Oreglia Jacopo, Sacco Alice, Morici Nuccia, Oliva Fabrizio, Piani Federica, Borghi Claudio, Giannattasio Cristina
Abstract
Uric acid (UA) is the final product of the catabolism of endogenous and exogenous purine nucleotides. While its association with articular gout and kidney disease has been known for a long time, new data have demonstrated that UA is also related to cardiovascular (CV) diseases. UA has been identified as a significant determinant of many different outcomes, such as all-cause and CV mortality, and also of CV events (mainly Acute Coronary Syndromes (ACS) and even strokes). Furthermore, UA has been related to the development of Heart Failure, and to a higher mortality in decompensated patients, as well as to the onset of atrial fibrillation. After a brief introduction on the general role of UA in CV disorders, this review will be focused on UA's relationship with CV outcomes, as well as on the specific features of patients with ACS and Chronic Coronary Syndrome. Finally, two issues which remain open will be discussed: the first is about the identification of a CV UA cut-off value, while the second concerns the possibility that the pharmacological reduction of UA is able to lower the incidence of CV events.
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Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy.
Cardiovasc Ultrasound2021 Aug;19(1):31. doi: 31.
Belli Oriana, Ardissino Maddalena, Bottiroli Maurizio, Soriano Francesco, Blanda Calogero, Oreglia Jacopo, Mondino Michele, Moreo Antonella
Abstract
BACKGROUND:
Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing.
CONCLUSION:
This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.
© 2021. The Author(s).
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Temporal Relation Between Second Dose BNT162b2 mRNA Covid-19 Vaccine and Cardiac involvement in a Patient with Previous SARS-COV-2 Infection.
Int J Cardiol Heart Vasc2021 Apr;():100778. doi: 100778.
Ammirati Enrico, Cavalotti Cristina, Milazzo Angela, Pedrotti Patrizia, Soriano Francesco, Schroeder Jan W, Morici Nuccia, Giannattasio Cristina, Frigerio Maria, Metra Marco, Camici Paolo G, Oliva Fabrizio
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ijcha.2021.100774. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at
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Temporal relation between second dose BNT162b2 mRNA Covid-19 vaccine and cardiac involvement in a patient with previous SARS-COV-2 infection.
Int J Cardiol Heart Vasc2021 Jun;34():100774. doi: 100774.
Ammirati Enrico, Cavalotti Cristina, Milazzo Angela, Pedrotti Patrizia, Soriano Francesco, Schroeder Jan W, Morici Nuccia, Giannattasio Cristina, Frigerio Maria, Metra Marco, Camici Paolo G, Oliva Fabrizio
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Uric acid in chronic coronary syndromes: Relationship with coronary artery disease severity and left ventricular diastolic parameter.
Nutr Metab Cardiovasc Dis2021 May;31(5):1501-1508. doi: 10.1016/j.numecd.2021.01.023.
Maloberti Alessandro, Bossi Irene, Tassistro Elena, Rebora Paola, Racioppi Angelo, Nava Stefano, Soriano Francesco, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo, Vallerio Paola, Pirola Roberto, De Chiara Benedetta, Oliva Fabrizio, Moreo Antonella, Valsecchi Maria Grazia, Giannattasio Cristina
Abstract
BACKGROUND AND AIMS:
Uric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation.
METHODS AND RESULTS:
231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function.
CONCLUSIONS:
In conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.
Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
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Late-sequalae of Kawasaki disease characterized by optical coherence tomography.
J Cardiovasc Med (Hagerstown)2021 Jul;22(7):597-599. doi: 10.2459/JCM.0000000000001083.
Soriano Francesco, Veas Nicolas, Nava Stefano, Piccinelli Enrico, Pedrotti Patrizia, Oreglia Jacopo, Vignati Gabriele, Winter José, Ammirati Enrico, Burns Jane C, Gordon John B
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[Iliac-femoral lithoplasty for a transcatheter aortic valve implantation. Report of one case].
Rev Med Chil2020 Apr;148(4):548-552. doi: 10.4067/s0034-98872020000400548.
Veas NicolÁs, Soriano Francesco, Winter JosÉ, Nava Stefano, Hameau RenÉ, Lidefjeld Dante, Valdebenito MartÍn, MuÑoz Rodrigo, Oreglia Jacopo
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[Combined use of left ventricular assist devices in cardiogenic shock. Report of one case].
Rev Med Chil2020 Mar;148(3):409-413. doi: 10.4067/S0034-98872020000300409.
Hameau D René, Soriano Francesco, Oreglia Jacopo, Muñoz Rodrigo, Winter José Luis, Valdebenito Martín, Quitral Jorge, Lindefjeld Dante, Veas Nicolas
Abstract
We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.
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Thoracic radiotherapy as a risk factor for heart ischemia in subjects treated with chest irradiation and chemotherapy and without classic cardiovascular RISK factors.
Radiother Oncol2020 Nov;152():146-150. doi: 10.1016/j.radonc.2020.07.004.
Vallerio Paola, Maloberti Alessandro, Palazzini Matteo, Occhi Lucia, Peretti Alessio, Nava Stefano, Soriano Francesco, Musca Francesco, De Chiara Benedetta, Belli Oriana, Moreo Antonella, Bisceglia Irma, Lestuzzi Chiara, Giannattasio Cristina
Abstract
BACKGROUND AND PURPOSE:
Radiation Induced Heart Disease (RIHD) represents a late effect of chest irradiation, contributing in increasing mortality rate in oncological patients by affecting pericardium, myocardium, valvs and coronaries. Currently, regarding the risk of Coronary Artery Disease (CAD), a cardiological screening involving exercise stress electrocardiography after 5-10 years from radiotherapy is advised. We sought to determine the rate of ischemia at exercise stress electrocardiography in a population of patients without cardiovascular risk factors who sustained radiotherapy, using a cohort of patients presenting with at least one cardiovascular risk factor as control group.
DESIGN AND METHODS:
A population of 115 patients who sustained chest irradiation (and associated chemotherapy), presenting without classic cardiovascular risk factors or typical symptoms suggesting CAD, was evaluated with exercise stress electrocardiography. 135 patients with at least one risk factor for cardiovascular disease candidate to stress testing for primary prevention or for atypical symptoms served as control group.
RESULTS:
The cohort of irradiated patients without classical cardiovascular risk factors is younger (48.7 ± 10.1 vs 60.5 ± 10.8 years, p
CONCLUSIONS:
Chest irradiation represents a strong cardiovascular risk factor. In fact, prevalence of positive ECG-stress test is not different (nor higher and nor lower) in irradiated subjects without cardiovascular risk and not irradiated patients with classic cardiovascular risk.
Copyright © 2020 Elsevier B.V. All rights reserved.
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[Concomitant deployment of MitraClip devices and left atrial appendage closure. Report of one case].
Rev Med Chil2019 Oct;147(10):1350-1354. doi: 10.4067/s0034-98872019001001350.
Veas Nicolás, Hameau René, Nava Stefano, Winter José, Soriano Francesco, Oreglia Jacopo
Abstract
We report a 65-years old woman with a history of permanent atrial fibrillation with high risk for ischemic and bleeding events. She developed a heart failure with severely impaired left ventricular ejection fraction and severe secondary mitral regurgitation. Given her high surgical risk, using transesophageal echocardiography guidance, a concomitant deployment of two MitraClip devices using a high-posterior septal puncture and a left atrial appendage closure with an Amplatzer Amulet occluder were performed through the same access.
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Cangrelor use in a 6-year-old patient undergoing complex percutaneous coronary intervention after post-surgical myocardial infarction.
Platelets2020 Nov;31(8):1090-1093. doi: 10.1080/09537104.2020.1732323.
Sirico Domenico, Morici Nuccia, Soriano Francesco, Marianeschi Stefano Maria, Pedrazzini Giovanna, Leonardi Sergio, Vignati Gabriele
Abstract
Cangrelor is an intravenously administered P2Y receptor antagonist, which has been approved for adult patients undergoing percutaneous coronary intervention and, due to its unique pharmacokinetics, it allows effective and controllable peri-procedural platelet inhibition. We report the case of a 6-year-old child with anomalous origin of right coronary artery from aortic left coronary sinus, who underwent elective surgical replacement of stenotic and calcified conduit between the right ventricle and the main pulmonary artery. The surgery was complicated by acute myocardial infarction secondary to coronary extrinsic compression. The patient was successfully treated with urgent percutaneous coronary intervention (simultaneous V-stenting) and cangrelor infusion, subsequently switched to clopidogrel therapy.
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[Relevance of complete blood count parameters in the assessment of acute coronary syndromes: a combined hematological and cardiological perspective].
G Ital Cardiol (Rome)2019 Dec;20(12):694-705. doi: 10.1714/3271.32379.
Morici Nuccia, Cantoni Silvia, Soriano Francesco, Viola Giovanna, De Stefano Valerio, Veas Nicolas, Oreglia Jacopo A, Esposito Giuseppe, Sacco Alice, Savonitto Stefano
Abstract
The aim of this review is to explore the available evidence concerning the relationship between the different parameters of the complete blood count, its pathophysiological changes and cardiovascular disease, specifically focusing on the acute ischemic setting. Erythrocytes, leukocytes and platelets undergo significant and more or less durable changes over time in response to conditions of systemic inflammatory, infectious and neoplastic disease. This is the reason why blood cell count parameters can (and should) be implemented in the global assessment of the patient with acute coronary syndrome.From the literature review it emerges that anemia and thrombocytopenia have an independent negative prognostic role in the medium and long term, being markers of the overall frailty of patients with ischemic heart disease. On the other hand, essential thrombocythemia and polycythemia vera, two chronic myeloproliferative neoplasms, are characterized by an important increase in thrombotic risk. Both conditions are given a brief description for the particular importance of the close collaboration between cardiologists and hematologists in the diagnosis and treatment of these diseases in the context of ischemic heart disease.
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Recurrent stent thrombosis in a patient with acute coronary syndrome and ischemic colitis: between life-threatening thrombosis and life-threatening bleeding.
Platelets2020 Aug;31(6):820-824. doi: 10.1080/09537104.2019.1678122.
Morici Nuccia, Cantoni Silvia, Soriano Francesco, Sacco Alice, Viola Giovanna, Esposito Giuseppe, Oreglia Jacopo A, Cattaneo Marco, Savonitto Stefano
Abstract
Complete blood count should always be considered to tailor diagnosis and appropriate management in patients with acute ischemic heart disease. We present a challenging case of recurrent acute coronary syndrome, in the context of very high thrombotic risk due to concomitant inflammatory disease. Although no general guidelines exist for the switch between antiplatelet agents, particularly in the acute setting, in specific cases, the availability of different orally- and i.v.-acting agents and platelet function tests may allow to discriminate among multiple possible mechanisms of drug failure or side effects in the individual patient.
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[Myocardial infarction with non-obstructive coronary arteries (MINOCA): diagnosis, pathogenesis, therapy and prognosis].
G Ital Cardiol (Rome)2019 Sep;20(9):499-511. doi: 10.1714/3207.31839.
Buono Andrea, Pedrotti Patrizia, Soriano Francesco, Veas Nicolas, Oliva Fabrizio, Oreglia Jacopo, Ammirati Enrico
Abstract
The term MINOCA (myocardial infarction with non-obstructive coronary arteries) defines acute myocardial infarction with angiographic evidence of no significant coronary artery stenosis. Heterogeneous diseases are labelled as MINOCA. Incidence and epidemiological aspects differ on the basis of etiological causes. MINOCA include plaque (causing
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Coronary dissection due to intravascular lithoplasty balloon rupture.
EuroIntervention2019 Aug;15(6):e558-e559. doi: 10.4244/EIJ-D-19-00383.
Soriano Francesco, Veas Nicolas, Piccinelli Enrico, Oreglia Jacopo
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Patterns of cardiovascular variability after long-term sino-aortic denervation in unanesthetized adult rats.
Sci Rep2019 Feb;9(1):1232. doi: 1232.
Radaelli Alberto, Mancia Giuseppe, De Carlini Caterina, Soriano Francesco, Castiglioni Paolo
Abstract
Baroreflex dysfunction is a diffuse chronic condition that is expected to be followed by a profound loss of organization of BP and HR variability. Nevertheless, long-term effects of baroreflex withdrawal are still debated. Aim of our work was to study BP and HR changes long term after sino-aortic denervation (SAD). Inter-beat-interval (IBI) and intra-arterial BP were recorded beat-by-beat in 43 Wistar-Kyoto rats (Controls, n?=?33; SAD rats, n?=?10). Power spectra were calculated in controls and in SAD rats within three days and at seven months from denervation. Compared to controls, chronic SAD rats showed 1) similar mean BP (control vs SAD: 95?±?16 vs 87?±?22?mmHg) and IBI (171?±?22 vs 181?±?15?ms) values, 2) dramatically higher values of BP variance (12?±?2 vs 64?±?2?mmHg, p?0.01) and of ultra- (ULF) and very-low-frequency (VLF) BP oscillations, 3) dramatically higher values of IBI variability (24?±?2 vs 71?±?4?ms, p?0.01) and of ULF-IBI oscillations that were synchronized with BP oscillations. Chronic SAD rats reveal a marked change in the pattern of cardiovascular variability characterized by the appearance of synchronized slower oscillations of BP and HR. The cardiovascular system, therefore, retains a high level of organization despite the absence of a reflex control mechanism.
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[Paclitaxel-coated balloons for in-stent restenosis treatment: long-term clinical results and predictors of recurrent target lesion revascularization].
G Ital Cardiol (Rome)2018 Apr;19(4):232-238. doi: 10.1714/2898.29217.
Bossi Irene, D'Anna Margherita, Vaccaro Valentina, Caria Maria Paola, Colombo Paola, De Marco Federico, Oreglia Jacopo, Piccalò Giacomo, Piccaluga Emanuela, Soriano Francesco, Oliva Fabrizio, Klugmann Silvio
Abstract
BACKGROUND:
The aim of this study was to report clinical outcomes in patients treated with paclitaxel-coated balloons (PCB) for in-stent restenosis (ISR) in both bare metal (BMS) and drug-eluting stent (DES).
METHODS:
Between May 2009 and December 2015, we treated 155 ISR in 140 patients. At recruitment, 35% of patients had diabetes. Among the lesions, 125 were first occurrence (55 within BMS and 70 within DES) and 30 recurrent; 24 ISR were multi-metal layered. Mean reference diameter was 2.79 ± 0.52 mm and mean lesion length 13.2 ± 7.1 mm. PCB use included 32 Dior I, 97 InPact Falcon, 18 Panthera Lux, and 8 Restore DEB.
RESULTS:
At a median follow-up of 442 days, we observed 18 target lesion revascularizations (TLR), one myocardial infarction, 3 cardiac deaths, and 5 non-cardiac deaths. TLR occurrence differed according to type of ISR (4% within BMS, 14% within DES, 28% within recurrent ISR; p
CONCLUSIONS:
Our results confirm the safety and efficacy of PCB for ISR treatment both within BMS and DES. PCB type and recurrent ISR correlate with subsequent TLR.
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Coronary Artery Aneurysm After Bioresorbable Scaffold Implantation in a Woman With an Acute Coronary Syndrome.
J Invasive Cardiol2017 Jul;29(7):E77-E78.
Cereda Alberto F, Canova Paolo A, Oreglia Jacopo A, Soriano Francesco S
Abstract
We herein report the case of an ST-elevation myocardial infarction due to bioresorbable vascular scaffold (BRS) failure. Optical coherence tomography (OCT) revealed the exact mechanism of late BRS stent thrombosis due to an acquired coronary aneurysm related to BRS. A drug eluting OCT-guided stenting over a failed BRS in the context of an acute coronary syndrome, with the simultaneous presence of a BRS thrombosis and coronary artery aneurysm, proved to be effective.
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Spontaneous Coronary Artery Dissection After Pregnancy as First Manifestation of a Vascular Ehlers-Danlos Syndrome.
J Invasive Cardiol2017 Jun;29(6):E67-E68.
Cereda Alberto F, Canova Paolo A, Soriano Francesco S
Abstract
We report the case of a myocardial infarction in the post-partum period due to a spontaneous coronary artery dissection. The role of intracoronary imaging was critical: OCT imaging led us to formulate the right diagnosis.OCT imaging revealed a multiple coronary artery dissection in the left main non-detectable on angiography and in the circumflex, with evidence of coronary hematoma in the circumflex and left anterior descending. Beside dissection, OCT showed evidence of a thrombus near the coronary tear in the left main. Our invasive OCT-based strategy proved to be non-harmful and gave an excellent clinical result in the clinical context of a spontaneous multivessel coronary dissection with left main involvement in a rare connective tissue disorder.
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Portico Sheathless Transcatheter Aortic Valve Implantation via Distal Axillary Artery.
Ann Thorac Surg2017 Feb;103(2):e175-e177. doi: 10.1016/j.athoracsur.2016.07.065.
Bruschi Giuseppe, Colombo Paola, Botta Luca, Nava Stefano, Merlanti Bruno, Belli Oriana, Musca Francesco, Soriano Francesco, Russo Claudio F, Oliva Fabrizio
Abstract
Transcatheter aortic valve implantation has been designed to treat older patients affected by severe aortic stenosis who are considered high-risk surgical candidates because of multiple comorbidities. The least invasive approach for transcatheter aortic valves implantation should be considered the transfemoral retrograde route, because it is minimally invasive and is feasible with local anesthesia and mild sedation. Despite significant technical improvements in recent years, the transfemoral approach is contraindicated in cases of severe peripheral artery disease. We describe the first case of a Portico transcatheter aortic valve implantation system (St. Jude Medical, Minneapolis, MN) made through the distal axillary artery in a 90-year-old patient affected by severe aortic stenosis.
Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Evolut R Implantation to Treat Severe Pure Aortic Regurgitation in a Patient With Mitral Bioprosthesis.
Ann Thorac Surg2016 Dec;102(6):e521-e524. doi: 10.1016/j.athoracsur.2016.05.054.
Bruschi Giuseppe, Colombo Paola, Nava Stefano, Musca Francesco, Merlanti Bruno, Belli Oriana, Soriano Francesco, Botta Luca, De Caria Danile, Giannattasio Cristina, Russo Claudio F
Abstract
Transcatheter aortic valves have been designed to treat high-risk surgical candidates affected by severe aortic stenosis, but little is known about the use of transcatheter valves in patients with severe pure aortic regurgitation. We describe the implantation of Medtronic CoreValve Evolut R (Medtronic, Minneapolis, MN) to treat an 82-year-old patient affected by severe pure aortic regurgitation who underwent prior mitral valve replacement with a biological valve protruding into the left ventricular outflow tract.
Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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A new access for transcatheter aortic valve implantation: Distal axillary artery.
Int J Cardiol2016 Nov;223():810-812. doi: 10.1016/j.ijcard.2016.08.290.
Bruschi Giuseppe, Colombo Paola, Merlanti Bruno, Nava Stefano, Belli Oriana, Musca Francesco, Soriano Francesco, Botta Luca, Calini Angelo, De Caria Daniele F, Oliva Fabrizio, Russo Claudio F
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Allogeneic peripheral blood stem cell transplantation and accelerated atherosclerosis: An intriguing association needing targeted surveillance. Lessons from a rare case of acute anterior myocardial infarction.
Eur Heart J Acute Cardiovasc Care2020 Oct;9(7):NP3-NP7. doi: 10.1177/2048872616652311.
Scudiero Laura, Soriano Francesco, Morici Nuccia, Grillo Giovanni, Belli Oriana, Sacco Alice, Cipriani Manlio, Pedrotti Patrizia, Quattrocchi Giuseppina, Klugmann Silvio, Oliva Fabrizio
Abstract
We report the case of a 23-year-old man who developed an acute ST-elevation myocardial infarction secondary to acute thrombotic occlusion of the proximal left anterior descending coronary artery five years after undergoing chemotherapy, radiotherapy, haematopoietic stem cell transplantation for acute lymphoblastic leukaemia and bulky mediastinal mass involving the pleura and pericardium. His medical history also included Graft versus Host Disease developed 13 months after transplantation and acute myocarditis three months before the actual hospital admission. To the best of our knowledge, coronary artery disease as a complication of haematopoietic stem cell transplantation and low-dose mediastinal radiation therapy in young patients has been rarely reported in the medical literature. Clinicians should have a high degree of suspicion of coronary artery disease in patients treated with allogeneic haematopoietic stem cell transplantation, especially in patients previously treated with target mediastinal radiotherapy, as a group at risk of premature and significantly accelerated atherosclerosis, in order to make a timely and correct diagnosis.
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Embolic myocardial infarction due to coronary artery aneurysm in a patient with Loeys-Dietz syndrome.
EuroIntervention2016 May;12(1):61. doi: 10.4244/EIJV12I1A11.
Cereda Alberto, Garascia Andrea, Sormani Paola, Klugmann Silvio, Artioli Diana, Soriano Francesco, Oreglia Jacopo Andrea
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Direct Flow Implantation in a Patient With Mechanical Mitral Prostheses.
Ann Thorac Surg2016 Feb;101(2):753-6. doi: 10.1016/j.athoracsur.2015.02.139.
Bruschi Giuseppe, Barosi Alberto, Colombo Paola, Montorsi Emanuela, Nava Stefano, Soriano Francesco, Botta Luca, Fratto Pasquale, Klugmann Silvio, de Marco Federico
Abstract
We describe a case of Direct Flow (Direct Flow Medical Inc, Santa Rosa, CA) transcatheter aortic valve implantation in a patient with a mechanical valve in a mitral position.
Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Erratum to: Effects of Renal Sympathetic Denervation on Arterial Stiffness and Blood Pressure Control in Resistant Hypertensive Patients: A Single Centre Prospective Study.
High Blood Press Cardiovasc Prev2015 Dec;22(4):451. doi: 10.1007/s40292-015-0124-1.
Baroni Matteo, Nava Stefano, Giupponi Luca, Meani Paolo, Panzeri Francesco, Varrenti Marisa, Maloberti Alessandro, Soriano Francesco, Agrati Antonio Maria, Ferraro Giovanni, Colombo Fabrizio, Rampoldi Antonio, Mancia Giuseppe, Colombo Paola, Klugmann Silvio, Giannattasio Cristina
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Effects of Renal Sympathetic Denervation on Arterial Stiffness and Blood Pressure Control in Resistant Hypertensive Patients: A Single Centre Prospective Study.
High Blood Press Cardiovasc Prev2015 Dec;22(4):411-6. doi: 10.1007/s40292-015-0121-4.
Baroni Matteo, Nava Stefano, Giupponi Luca, Meani Paolo, Panzeri Francesco, Varrenti Marisa, Maloberti Alessandro, Soriano Francesco, Agrati Antonio Maria, Ferraro Giovanni, Colombo Fabrizio, Rampoldi Antonio, Mancia Giuseppe, Colombo Paola, Klugmann Silvio, Giannattasio Cristina
Abstract
Renal denervation (RD) is an intriguing treatment strategy for resistant hypertension. However, limited data are available about its long time efficacy as well as its effects on intermediate phenotypes like arterial stiffness and carotid IMT. 12 patients (9 males, mean 69 years) with resistant hypertension underwent bilateral RDN (Medtronic System) since April 2012 in Niguarda Ca' Granda Hospital (Milan). Patients were studied before intervention, and at 1, 3, 6 and 12 months after RD. Carotid intima media thickness (Esaote Mylab) and carotid-femoral pulse wave velocity (Complior, Alam medical) were assessed at each step. Compared to baseline, patients showed a marked reduction of office systolic blood pressure at each follow-up step (p
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[A novel standard protocol of long-term follow-up shared with general practitioners after percutaneous coronary intervention: appropriateness and economic impact].
G Ital Cardiol (Rome)2015 Oct;16(10):565-73. doi: 10.1714/2028.22042.
Lettieri Corrado, Colombo Paola, Rosiello Renato, Morici Nuccia, Parogni Pierpaolo, Musumeci Giuseppe, Tabaglio Erminio, Zadra Alessandro, Cattaneo Maria Grazia, Soriano Francesco, Galavotti Maurizio, Klugmann Silvio, Senni Michele, Valsecchi Orazio, Zanini Roberto, Rossini Roberta
Abstract
BACKGROUND:
Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI) are not well defined and standard protocols have been not established. The purpose of this study was to assess: a) the frequency and patterns of cardiology visits, echocardiographic examinations and stress tests after PCI in clinical practice; b) the impact of a multidisciplinary protocol of long-term follow-up after PCI shared with general practitioners on the appropriateness and reduction in healthcare costs.
METHODS:
A total of 780 patients who underwent PCI in 2010 in two Italian hospitals were analyzed. The number of cardiological examinations (total, routine and clinically driven) performed during 2 years of follow-up were recorded and stratified according to the patient's risk profile. The latter was defined according to the multidisciplinary protocol. In addition, a simulation of the spread between provided and necessary tests (according to the multidisciplinary protocol) was carried out.
RESULTS:
The mean number of cardiological examinations per patient provided during follow-up was 5, of which 4.4 were routine tests in asymptomatic patients. Routine tests were performed more frequently in patients at low risk compared to those at higher risk. By applying the multidisciplinary protocol to the case mix and by merging clinical visit and stress test or echocardiographic examination, a reduction of 0.87 tests per patient/year would be expected. This reduction would result in a 39% decrease in follow-up examinations in this specific clinical setting.
CONCLUSIONS:
This observational study demonstrates that unnecessary cardiological clinical and functional tests are often performed in long-term follow-up of patients submitted to PCI. The application of a standard protocol of follow-up shared with general practitioners may help avoiding unnecessary consultations, thus reducing healthcare costs.
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CoreValve Evolut R implantation as valve-in-valve in an Edwards SAPIEN 3 to treat paravalvular regurgitation.
EuroIntervention2015 Sep;11(5):e1. doi: 10.4244/EIJV11I5A116.
Bruschi Giuseppe, Soriano Francesco, Musca Francesco, Nava Stefano, Einaudi Arturo, Garascia Andrea, Belli Oriana, Barosi Alberto, Fratto Pasquale, Colombo Paola, Russo Claudio Francesco, Gagliardone Maria Pia, Klugmann Silvio
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Iron Stores, Hepcidin, and Aortic Stiffness in Individuals with Hypertension.
PLoS One2015 ;10(8):e0134635. doi: e0134635.
Valenti Luca, Maloberti Alessandro, Signorini Stefano, Milano Marta, Cesana Francesca, Cappellini Fabrizio, Dongiovanni Paola, Porzio Marianna, Soriano Francesco, Brambilla Maura, Cesana Giancarlo, Brambilla Paolo, Giannattasio Cristina, Fargion Silvia
Abstract
BACKGROUND & AIMS:
Iron accumulation within the arterial wall has been hypothesized to promote atherosclerosis progression. Aim of this study was to evaluate whether the hormone hepcidin and iron stores are associated with arterial stiffness in subjects with essential hypertension.
METHODS:
Circulating hepcidin, ferritin, and mutations in the hemochromatosis gene were compared between subjects included in the first vs. third tertile (n=284 each) of carotid-femoral pulse wave velocity (PWV) in an unselected cohort of patients with arterial hypertension.
RESULTS:
At univariate logistic regression analysis, high PWV was associated with higher ferritin levels (p=0.010), but lower hepcidin (p=0.045), and hepcidin ferritin/ratio (p
CONCLUSIONS:
In conclusion, hyperferritinemia is associated with high aortic stiffness and cardiac diastolic dysfunction, while low circulating hepcidin with high aortic stiffness.
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Direct Flow valve-in-valve implantation in a degenerated mitral bioprosthesis.
EuroIntervention2016 Apr;11(13):1549-53. doi: 10.4244/EIJY15M07_05.
Bruschi Giuseppe, Cannata Aldo, Barosi Alberto, Colombo Paola, Soriano Francesco, Nava Stefano, Montrasio Elisa, Botta Luca, Gagliardone Maria Pia, Klugmann Silvio, De Marco Federico
Abstract
AIMS:
Mitral valve reoperations due to failing bioprostheses, in patients affected by multiple comorbidities, are associated with high morbidity and mortality. Transcatheter techniques may evolve as complementary approaches to surgery in these patients at high risk for surgery.
METHODS AND RESULTS:
We describe a case of Direct Flow 25 mm transcatheter valve implantation as valve-in-valve in a degenerated mitral bioprosthesis through a transapical approach in a 63-year-old man affected by dilated cardiomyopathy. The patient was affected by Carpentier-Edwards 29 mm severe regurgitation. The 25 mm Direct Flow bioprosthesis was advanced through the mitral bioprosthesis into the left atrium and then positioned using the three independent positioning wires. Transoesophageal echocardiography evidenced normal Direct Flow function with no paravalvular regurgitation and a low transmitral gradient of 4 mmHg.
CONCLUSIONS:
Our successful experience, characterised by a Heart Team approach and multidisciplinary patient care, demonstrated the technical feasibility and procedural safety of Direct Flow valve-in-valve mitral implantation.
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[A simple but very complicated angioplasty: management of coronary artery perforation and dual antiplatelet therapy. A case report and literature review].
G Ital Cardiol (Rome)2015 May;16(5):311-5. doi: 10.1714/1870.20436.
Soriano Francesco, Oreglia Jacopo, Bossi Irene, Colombo Paola, Piccalò Giacomo, De Marco Federico, Bruschi Giuseppe, Klugmann Silvio
Abstract
Coronary artery perforation is a rare but potentially fatal complication. Therefore, it is crucial for interventional cardiologists to have knowledge of this condition and what management strategies are available, particularly in the case of procedures with a high level of complexity. Notwithstanding this, even simple procedures are not immune to serious complications, as described in this case report where coronary angioplasty was complicated by left anterior descending artery perforation with cardiac tamponade, giving rise to multiple complications of difficult management. The case presented here also provides the opportunity to investigate the optimal duration of dual antiplatelet therapy after implantation of drug-eluting stents, a topic much debated in recent years.
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Direct aortic Direct Flow implantation via right anterior thoracotomy in a patient with patent bilateral mammary artery coronary grafts.
Int J Cardiol2015 Apr;185():22-4. doi: 10.1016/j.ijcard.2015.03.083.
Bruschi Giuseppe, Merlanti Bruno, Barosi Alberto, Colombo Paola, Fratto Pasquale, Nava Stefano, Soriano Francesco, Montrasio Elisa, Klugmann Silvio, de Marco Federico
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Right anterior mini-thoracotomy direct aortic self-expanding trans-catheter aortic valve implantation: A single center experience.
Int J Cardiol2015 Feb;181():437-42. doi: 10.1016/j.ijcard.2014.11.108.
Bruschi Giuseppe, De Marco Federico, Botta Luca, Barosi Alberto, Colombo Paola, Mauri Silvia, Cannata Aldo, Morici Nuccia, Colombo Tiziano, Fratto Pasquale, Nonini Sandra, Soriano Francesco, Mondino Michele, Giannattasio Cristina, Klugmann Silvio
Abstract
OBJECTIVE:
Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery. These patients are also often affected by severe iliac-femoral arteriopathy, rendering the trans-femoral approach unusable. We report our experience with the direct-aortic approach to treat these patients.
METHODS:
From May 2008 to November 2013 two hundred and thirty-two patients (131 female, 56%) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk were evaluated for TAVI at our department. Of these patients, 202 were deemed eligible for TAVI. Of this group, 50 underwent CoreValve implantation by the direct aortic approach through a right anterior mini-thoracotmy (28 female, 56%), mean age 81.2±6.9. A combined team of cardiologists, cardiac surgeons with expertise in hybrid procedures, and anesthetists performed all the procedures.
RESULTS:
Twenty-eight (56%) patients were female and 11 (22%) were redo at TAVI. We used a 23-mm CoreValve Evolute in 3 patients (6%), and the most used valve size was the 29mm in 46% of patients. Mean hemodynamic trans-aortic gradient was less than 5mmHg. The paravalvular regurgitation was ? grade 1 in 46 patients as assessed by peri-procedural transesophageal echocardiography (TEE). Seven patients (7/43, 16%) required a permanent pacemaker implantation; 30-day mortality was 6% (3 patients). Seven patients (14.8%) died during follow-up. Actuarial survival at 2years is 84.7±5.3%.
CONCLUSIONS:
Transcatheter aortic valve implantation with the direct aortic approach is safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a re-do procedure.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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First case of trans-axillary direct flow implantation.
Int J Cardiol2014 Dec;177(3):e176-8. doi: 10.1016/j.ijcard.2014.08.097.
Bruschi Giuseppe, Botta Luca, Cannata Aldo, Colombo Paola, Barosi Alberto, Soriano Francesco, Bottiroli Maurizio, Nava Stefano, Klugmann Silvio, De Marco Federico
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Impact of blood glucose variability on carotid artery intima media thickness and distensibility in type 1 diabetes mellitus.
Blood Press2013 Dec;22(6):355-61. doi: 10.3109/08037051.2013.791413.
Cesana Francesca, Giannattasio Cristina, Nava Stefano, Soriano Francesco, Brambilla Gianmaria, Baroni Matteo, Meani Paolo, Varrenti Marisa, Paleari Felice, Gamba Pierluigi, Facchetti Rita, Alloni Marta, Grassi Guido, Mancia Giuseppe
Abstract
AIMS:
Diabetes mellitus is characterized by structural and functional alterations of the large- and medium-size arteries. Whether blood glucose variability, i.e. the glycemic oscillations occurring during the 24-h period, represents a risk factor for vascular alterations additional to and independent on HbA1c in type 1 diabetes mellitus is still undefined. The present study was carried out with the aim at investigating the impact of different measures of blood glucose variability on arterial structure and function. We studied 17 non-complicated type 1 diabetic patients (11 males, six females) with an age of 40.8 ± 7.6 years (mean ± SD). In each patient, 24-h glucose profile was obtained by continuous glucose monitoring system and glucose variability was expressed as mean ± SD of 24-h blood glucose levels, mean amplitude of glycemic excursions and postprandial hyperglycemic spikes. Arterial structure and function was measured as carotid IMT and stiffness.
MAJOR FINDINGS:
The different approaches to assessing blood glucose variability well correlated between and with HbA1c. Carotid IMT and stiffness showed significant correlations with age, blood pressure, heart rate and daily insulin intake but a non- significant correlation with blood glucose variability.
PRINCIPAL CONCLUSION:
Thus, in type 1 diabetes mellitus, measures of glycemic variability are useful in predicting both actual and long-lasting glycemic control. In absence of diabetes-related complications and of any intima-media thickness alterations, the major predictors of arterial distensibility are represented by traditional risk factors beside glycemic 24-h control.
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Infusion of Escherichia coli lipopolysaccharide toxin in rats produces an early and severe impairment of baroreflex function in absence of blood pressure changes.
Shock2013 Feb;39(2):204-9. doi: 10.1097/SHK.0b013e3182767daf.
Radaelli Alberto, Castiglioni Paolo, Cerrito Maria Grazia, De Carlini Caterina, Soriano Francesco, Di Rienzo Marco, Lavitrano Maria Luisa, Paolini Giovanni, Mancia Giuseppe
Abstract
The assessment of baroreflex function since the first appearance of endotoxemia is important because the arterial baroreflex should exert a protective role during sepsis. Nevertheless, contrasting results were previously reported. This could be due to the hemodynamic instability characterizing this condition that may per se interfere with reflex cardiovascular adjustments. The aim of our study was therefore to study the baroreflex function (a) since the very beginning of infusion of Escherichia coli lipopolysaccharide (LPS) toxin and (b) in absence of the unloading effect produced by a decrease in blood pressure. Lipopolysaccharide was infused in 10 rats for 20 min at the infusion rate of 0.05 mg · kg · min. Blood pressure was continuously measured before, during, and after infusion, and the baroreflex function was evaluated analyzing spontaneous fluctuations of systolic blood pressure and pulse interval by the sequence and transfer-function techniques. Plasma concentrations of inflammatory (interleukin 6, tumor necrosis factor ?) and anti-inflammatory (interleukin 10) cytokines were measured in other eight rats, similarly instrumented, four of which receiving the same LPS infusion. We found that blood pressure levels did not change with the infusion of LPS, whereas inflammatory cytokines increased significantly. The baroreflex sensitivity was significantly reduced 10 min after the beginning of LPS infusion, reached values about half those at baseline within 15 min after the start of infusion, and remained significantly low after the end of infusion. In conclusion, we documented that septic shock inducing LPS infusion is responsible for a very rapid impairment of the baroreflex function, independent from the level of blood pressure.
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Increased pulse wave velocity and not reduced ejection fraction is associated with impaired baroreflex control of heart rate in congestive heart failure.
J Hypertens2010 Sep;28(9):1908-12. doi: 10.1097/HJH.0b013e32833c2088.
Radaelli Alberto, Castiglioni Paolo, Balestri Giulia, Cesana Francesca, De Carlini Caterina, Soriano Francesco, Azzellino Arianna, Di Rienzo Marco, Paolini Giovanni, Ferrari Alberto U, Mancia Giuseppe
Abstract
BACKGROUND:
It is known that baroreflex sensitivity (BRS) is impaired in cardiac patients with myocardial infarction (MI). Nevertheless, it is unknown whether factors other than a reduced ejection fraction play a role in the baroreflex impairment of these patients.
METHODS AND RESULTS:
Heart failure patients [congestive heart failure (CHF), n = 31, age 63 +/- 1.2 years, mean +/- SEM)], age-matched controls (n = 29) and coronary artery disease (CAD) patients without MI (n = 29) had RR interval and arterial blood pressure (BP) continuously monitored. Baroreflex function was assessed by the slope of the regression of RR interval, and BP responses to graded (-10, -20 and -40 mmHg) neck suction stimulation, the slope of bradycardic or tachycardic responses to spontaneous increases or reductions of SBP (sequence analysis) and the baroreflex efficiency index. Pulse wave velocity (PWV) was also measured.Compared with controls, CHF patients had RR interval and BP reflex responses to neck suction reduced by -36 and -54%, respectively (P
CONCLUSION:
The baroreflex function is impaired in CHF patients, the extent and the degree of baroreflex impairment being similar to that of CAD patients without MI. In CHF and CAD patients, the baroreflex impairment correlates significantly with the increased PWV and not with ejection fraction.
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