Dott. Andrea Garascia

Pubblicazioni su PubMed

• Impact of biological sex on heart transplant patients admitted to cardiac rehabilitation: A 10-year retrospective cohort study.
  Int J Cardiol Cardiovasc Risk Prev

  2024 Dec;23():200345. doi: 200345.
  
  Tedeschi Andrea, Cusmano Ignazio, Di Salvo Francesca, Oreni Letizia, Toccafondi Anastasia, Tavanelli Monica, Grati Paola, Mapelli Luca, Arrondini Luisa, Cannadoro Gianmarco, Gonella Matteo, Barcella Chiara, Stilo Leone, Verde Alessandro, Masciocco Gabriella, Ruzzenenti Giacomo, Biolcati Marco, Garascia Andrea, Morici Nuccia
  
  Abstract
  
  INTRODUCTION:
  Heart transplantation (HTx) serves as the gold-standard therapy for end-stage heart failure, yet patients often experience physical deconditioning and cognitive impairments post-surgery. Cardiac rehabilitation (CR) has shown promise in the HTx context. However, uncertainty surrounds the impact of biological sex. Accordingly, the aim of this paper was to investigate the impact of biological sex in a cohort of patients with HTx early admitted to a residential CR program.
  
  METHODS:
  This was a retrospective analysis involving patients who underwent HTx at Niguarda Hospital and who subsequently participated in a CR program at IRCCS Fondazione Don Gnocchi, Milan, Italy, between 2010 and 2022. The primary endpoint was time to event (in months), with an event defined as a composite outcome of whichever occurred first of death, allograft rejection, or cardiac allograft vasculopathy up to 30 months follow-up.
  
  RESULTS:
  In a total of 129 patients, 60 % male, and 40 % female, baseline characteristics presented comparably between the sexes. At 6 months, no significant sex differences were observed for the primary composite outcome. However, at 30 months, females exhibited a significantly lower incidence of the primary composite outcome and an increased survival rate. Multivariable analysis confirmed a protective effect of female sex against mortality (F vs. M, HR 0.164, 95 % CI 0.038-0.716, P = 0.0161).
  
  CONCLUSIONS:
  Despite limitations, our findings emphasize that sex affects post-HTx long-term follow-up following CR discharge, with more favorable outcomes for female recipients. In an era of tailored management algorithms, it is imperative to take into account the gender gap even in cardiac rehabilitation.
  
  © 2024 The Authors.
  
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• Hypertrophic cardiomyopathy secondary to hydroxychloroquine toxicity in a patient with rheumatoid arthritis.
  Lancet

  2024 Oct;404(10462):1560. doi: 10.1016/S0140-6736(24)02190-1.
  
  Cartella Iside, Palazzini Matteo, Sirico Domenico, Buono Andrea, Petrella Duccio, Oliva Fabrizio, Garascia Andrea, Ammirati Enrico
  
  
  
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• Long-term prognostic performance of cardiac magnetic resonance imaging markers versus complicated clinical presentation after an acute myocarditis.
  Int J Cardiol

  2024 Dec;417():132567. doi: 10.1016/j.ijcard.2024.132567.
  
  Ammirati Enrico, Varrenti Marisa, Sormani Paola, Bernasconi Davide, Moro Claudio, Grosu Aurelia, D'Elia Saverio, Raineri Claudia, Quattrocchi Giuseppina, Milazzo Angela, Turco Annalisa, Maestroni Alberto, Valsecchi Maria Grazia, Oliva Fabrizio, Garascia Andrea, Giannattasio Cristina, Camici Paolo G, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  Identifying markers associated with adverse events after acute myocarditis (AM) is relevant to plan follow-up. We assessed the prognostic performance of previously described cardiac magnetic resonance imaging (CMRI) markers and their combination: septal late gadolinium enhancement (LGE) localization and left ventricular ejection fraction (LVEF) 
  METHODS:
  We retrospectively assessed 248 AM patients (median age of 34 years, 87.1 % male) from 6 hospitals with onset of cardiac symptoms
  RESULTS:
  Thirteen patients (5.2 %) experienced at least one major cardiac event after a median follow-up of 4.7 years with a significant hazard ratio of 35.8 for CCP vs. 9.2 for septal LGE vs. 12.4 for LVEF
  CONCLUSIONS:
  Major cardiac events after an AM are relatively low, and CCP, septal LGE, and LVEF
  Copyright © 2024. Published by Elsevier B.V.
  
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• A fearsome evolution of presumed cardiac sarcoidosis: The sarcoid-lymphoma syndrome.
  Int J Cardiol Heart Vasc

  2024 Oct;54():101496. doi: 101496.
  
  Sormani Paola, Ammirati Enrico, Giannattasio Cristina, Garascia Andrea, Pedrotti Patrizia
  
  
  
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• Gaps in evidence in the treatment of prevalent patients with pulmonary arterial hypertension at intermediate risk: An expert consensus.
  Vascul Pharmacol

  2024 Sep;157():107432. doi: 10.1016/j.vph.2024.107432.
  
  Manzi Giovanna, Benza Raymond L, Argiento Paola, Casu Gavino, Corda Marco, Correale Michele, D'Alto Michele, Galgano Giuseppe, Garascia Andrea, Ghio Stefano, Gomberg-Maitland Mardi, Mulé Massimiliano, Paciocco Giuseppe, Papa Silvia, Prati Daniele, Preston Ioana R, Raineri Claudia, Romeo Emanuele, Scelsi Laura, Stolfo Davide, Vitulo Patrizio, White R James, Badagliacca Roberto, Vizza Carmine Dario
  
  Abstract
  
  Despite the innovations introduced in the 2022 European Society of Cardiology/European Respiratory Society Guidelines on Pulmonary Hypertension, risk discrimination and management of pulmonary arterial hypertension (PAH) patients at intermediate risk still represents a grey zone. Additionally, clinical evidence derived from currently available studies is limited. This expert panel survey intends to aid physicians in choosing the best therapeutic strategy for patients at intermediate risk despite ongoing oral therapy. An expert panel of 24 physicians, specialized in cardiology and/or pulmonology with expertise in handling all drugs available for the treatment of PAH participated in the survey. All potential therapeutic options for patients at intermediate risk were explored and analyzed to produce graded consensus statements regarding: the switch from endothelin receptor antagonist (ERA) or phosphodiesterase 5 inhibitor (PDE5i) to another oral drug of the same class; the addition of a drug targeting the prostacyclin pathway administered by different routes; the switch from PDE5i to riociguat.
  
  Copyright © 2024 Elsevier Inc. All rights reserved.
  
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• Charting the Unseen: How Non-Invasive Imaging Could Redefine Cardiovascular Prevention.
  J Cardiovasc Dev Dis

  2024 Aug;11(8):. doi: 245.
  
  Trimarchi Giancarlo, Pizzino Fausto, Paradossi Umberto, Gueli Ignazio Alessio, Palazzini Matteo, Gentile Piero, Di Spigno Francesco, Ammirati Enrico, Garascia Andrea, Tedeschi Andrea, Aschieri Daniela
  
  Abstract
  
  Cardiovascular diseases (CVDs) remain a major global health challenge, leading to significant morbidity and mortality while straining healthcare systems. Despite progress in medical treatments for CVDs, their increasing prevalence calls for a shift towards more effective prevention strategies. Traditional preventive approaches have centered around lifestyle changes, risk factors management, and medication. However, the integration of imaging methods offers a novel dimension in early disease detection, risk assessment, and ongoing monitoring of at-risk individuals. Imaging techniques such as supra-aortic trunks ultrasound, echocardiography, cardiac magnetic resonance, and coronary computed tomography angiography have broadened our understanding of the anatomical and functional aspects of cardiovascular health. These techniques enable personalized prevention strategies by providing detailed insights into the cardiac and vascular states, significantly enhancing our ability to combat the progression of CVDs. This review focuses on amalgamating current findings, technological innovations, and the impact of integrating advanced imaging modalities into cardiovascular risk prevention, aiming to offer a comprehensive perspective on their potential to transform preventive cardiology.
  
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• Phenotype and outcomes according to loop diuretic use in pulmonary arterial hypertension.
  ESC Heart Fail

  2024 Oct;11(5):3146-3154. doi: 10.1002/ehf2.14818.
  
  Savonitto Giulio, Barbisan Davide, Ameri Pietro, Lombardi Carlo Maria, Monti Simonetta, Driussi Mauro, Gentile Piero, Howard Luke, Toma Matteo, Pagnesi Matteo, Collini Valentino, Bauleo Carolina, Adamo Marianna, D'Angelo Luciana, Nalli Chiara, Giannoni Alberto, Vecchiato Veronica, Di Poi Emma, Airo Edoardo, Metra Marco, Garascia Andrea, Sinagra Gianfranco, Lo Giudice Francesco, Stolfo Davide
  
  Abstract
  
  AIMS:
  The use of loop diuretics in pulmonary arterial hypertension (PAH) is less frequent compared with heart failure. The clinical and prognostic characteristics of PAH patients according to loop diuretic use remain unexplored. In this study, we retrospectively analysed the characteristics and survival of PAH patients requiring different doses of loop diuretics.
  
  METHODS AND RESULTS:
  Patients diagnosed with PAH between 2001 and 2022 at seven European centres for the management of PAH. According to the median equivalent dose of furosemide in the overall cohort, patients were divided into two subgroups: no/low-dose loop diuretic and high-dose loop diuretic. Primary outcome was 5 year all-cause mortality. Among the 397 patients included, 227 (57%) were treated with loop diuretics. Median daily furosemide equivalent dose was 25 mg, and accordingly patients were divided in no/low dose (i.e. ?25 mg, n = 257, 65%) vs. high dose (i.e. >25 mg, n = 140, 35%). Patients in the high-dose group were older, more likely to have comorbidities, and had a more severe disease according to the ESC/ERS risk category. Crude 5 year survival was significantly shorter in patients in the high-dose group, but after adjustment for age, sex, and risk category, high loop diuretic dose was not significantly associated with the primary outcome.
  
  CONCLUSIONS:
  Use of high dose of loop diuretics in PAH is associated with a higher burden of comorbidities, more severe disease, and worse survival. However, in PAH, the need of high loop diuretic dose is a marker of disease severity and not an independent prognostic factor.
  
  © 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
  
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• Recurrent Coronary Artery Vasospasm Complicated by Cardiac Arrests in Heart Transplant Recipient: An Unusual Enemy.
  Transplantation

  2024 Jun;108(6):e86-e87. doi: 10.1097/TP.0000000000004975.
  
  Tedeschi Andrea, Ianni Umberto, Gentile Piero, Palazzini Matteo, Masciocco Gabriella, Ammirati Enrico, Garascia Andrea
  
  
  
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• Heart Failure Management through Telehealth: Expanding Care and Connecting Hearts.
  J Clin Med

  2024 Apr;13(9):. doi: 2592.
  
  Tedeschi Andrea, Palazzini Matteo, Trimarchi Giancarlo, Conti Nicolina, Di Spigno Francesco, Gentile Piero, D'Angelo Luciana, Garascia Andrea, Ammirati Enrico, Morici Nuccia, Aschieri Daniela
  
  Abstract
  
  Heart failure (HF) is a leading cause of morbidity worldwide, imposing a significant burden on deaths, hospitalizations, and health costs. Anticipating patients' deterioration is a cornerstone of HF treatment: preventing congestion and end organ damage while titrating HF therapies is the aim of the majority of clinical trials. Anyway, real-life medicine struggles with resource optimization, often reducing the chances of providing a patient-tailored follow-up. Telehealth holds the potential to drive substantial qualitative improvement in clinical practice through the development of patient-centered care, facilitating resource optimization, leading to decreased outpatient visits, hospitalizations, and lengths of hospital stays. Different technologies are rising to offer the best possible care to many subsets of patients, facing any stage of HF, and challenging extreme scenarios such as heart transplantation and ventricular assist devices. This article aims to thoroughly examine the potential advantages and obstacles presented by both existing and emerging telehealth technologies, including artificial intelligence.
  
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• Gaps in evidence in the management of patients with intermediate-risk pulmonary arterial hypertension: Considerations following the ESC/ERS 2022 guidelines.
  Vascul Pharmacol

  2024 Jun;155():107374. doi: 10.1016/j.vph.2024.107374.
  
  D'Alto Michele, Badagliacca Roberto, Airò Edoardo, Ameri Pietro, Argiento Paola, Garascia Andrea, Lombardi Carlo Mario, Mulè Massimiliano, Raineri Claudia, Scelsi Laura, Vizza Carmine Dario, Ghio Stefano
  
  Abstract
  
  A comprehensive evaluation of risk, using multiple indices, is necessary to provide reliable prognostic information and guide therapy in pulmonary arterial hypertension (PAH). The current ESC/ERS guidelines suggest using a three-strata model for incident (newly diagnosed) patients and a four-strata model for prevalent patients with PAH. The four-strata model serves as a fundamental risk-stratification tool and relies on a minimal dataset of indicators that must be considered during follow-up. Nevertheless, there are still areas of vagueness and ambiguity when classifying and managing patients in the intermediate-risk category. For these patients, considerations should include right heart imaging, hemodynamics, as well as individual factors such as age, sex, genetic profile, disease type, comorbidities, and kidney function. The aim of this report is to present case studies, with a specific focus on patients ultimately classified as intermediate risk. We aim to emphasize the challenges and complexities encountered in the realms of diagnosis, classification, and treatment for these particular patients.
  
  Copyright © 2024 Elsevier Inc. All rights reserved.
  
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• SARS-CoV2 infections in heart transplant recipients: Vaccines still are our greatest weapon.
  Int J Cardiol Heart Vasc

  2024 Apr;51():101379. doi: 101379.
  
  Tedeschi Andrea, Gentile Piero, Palazzini Matteo, Masciocco Gabriella, Leidi Filippo, Monticelli Massimiliano, Ammirati Enrico, Garascia Andrea
  
  
  
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• Frequency, characteristics and risk assessment of pulmonary arterial hypertension with a left heart disease phenotype.
  Clin Res Cardiol

  2024 Apr;():. doi: 10.1007/s00392-024-02448-9.
  
  Toma Matteo, Savonitto Giulio, Lombardi Carlo Maria, Airò Edoardo, Driussi Mauro, Gentile Piero, Howard Luke, Moschella Martina, Di Poi Emma, Pagnesi Matteo, Monti Simonetta, Collini Valentino, D'Angelo Luciana, Vecchiato Veronica, Giannoni Alberto, Adamo Marianna, Barbisan Davide, Bauleo Carolina, Garascia Andrea, Metra Marco, Sinagra Gianfranco, Giudice Francesco Lo, Stolfo Davide, Ameri Pietro
  
  Abstract
  
  AIM:
  To obtain real-world evidence about the features and risk stratification of pulmonary arterial hypertension (PAH) with a left heart disease (LHD) phenotype (PAH-LHD).
  
  METHODS AND RESULTS:
  By reviewing the records of consecutive incident PAH patients at 7 tertiary centers from 2001 to 2021, we selected 286 subjects with all parameters needed to determine risk of death at baseline and at first follow-up with COMPERA and COMPERA 2.0 scores. Fifty seven (20%) had PAH-LHD according to the AMBITION definition. Compared with no-LHD ones, they were older, had higher BMI, more cardiovascular comorbidities, higher E/e' ratio and left atrial area, but lower BNP concentrations and better right ventricular function and pulmonary hemodynamics. Survival was comparable between PAH-LHD and no-LHD patients, although the former were less commonly treated with dual PAH therapy. Both COMPERA and COMPERA 2.0 discriminated all-cause mortality risk of PAH-LHD at follow-up, but not at baseline. Risk profile significantly improved during follow-up only when assessed by COMPERA 2.0. At multivariable analysis with low-risk status as reference, intermediate-high and high-risk, but not LHD phenotype, were associated with higher hazard of all-cause mortality. Results were comparable in secondary analyses including patients in the last 10 years and atrial fibrillation and echocardiographic abnormalities as additional criteria for PAH-LHD.
  
  CONCLUSIONS:
  In real life, PAH-LHD patients are frequent, have less severe disease and are less likely treated with PAH drug combinations than no-LHD. The COMPERA 2.0 model may be more appropriate to evaluate their mortality risk during follow-up and how it is modulated by therapy.
  
  © 2024. The Author(s).
  
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• [ANMCO/SIC Consensus statement on pulmonary arterial hypertension].
  G Ital Cardiol (Rome)

  2024 Mar;25(3):192-201. doi: 10.1714/4209.42007.
  
  Vatrano Marco, Manzi Giovanna, Picariello Claudio, D'Alto Michele, Enea Iolanda, Ghio Stefano, Caravita Sergio, Argiento Paola, Garascia Andrea, Vitulo Patrizio, Gabrielli Domenico, Agostoni Piergiuseppe, Corda Marco, Sinagra Gianfranco, Grimaldi Massimo, Scelsi Laura, Badagliacca Roberto, D'Agostino Carlo, Perrone Filardi Pasquale, Colivicchi Furio, Indolfi Ciro, Roncon Loris, Galiè Nazzareno, Oliva Fabrizio, Vizza Carmine Dario
  
  Abstract
  
  Pulmonary hypertension (PH) is a frequent pathological condition worldwide, mainly secondary to cardiovascular and respiratory diseases, with a poor prognosis. Pulmonary arterial hypertension (PAH) is a rare form that affects the arterial pulmonary vasculature. PH and PAH are characterized by non-specific symptoms and a progressive increase of pulmonary vascular resistance that results in progressive, sometimes irreversible, right ventricular dysfunction. In recent years, a growing medical and social commitment on this disease allowed more accurate diagnosis in shorter times. However, the gap between guidelines and clinical practice remains a challenge for all medical doctors involved in the disease management. Considering the needs to share and describe diagnostic and therapeutic pathways, to measure the results obtained and to address the economical and organizational problems of this disease, all involved figures should collaborate to improve its prognostic impact and health expenses. In this consensus document, the PH experts of the Italian Association of Hospital Cardiologists (ANMCO) together with those of the Italian Society of Cardiology (SIC), address 1) definition, classification and unmet needs of PH and PAH; 2) classification and characteristics of centers involved in the diagnosis and treatment of the disease; 3) proposal of organization of a diagnostic-therapeutic pathway, based on robust and recent scientific evidence.
  
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• Fulminant Myocarditis Temporally Associated with COVID-19 Vaccination.
  Curr Cardiol Rep

  2024 Mar;26(3):97-112. doi: 10.1007/s11886-024-02021-w.
  
  Ammirati Enrico, Conti Nicolina, Palazzini Matteo, Rocchetti Matteo, Spangaro Andrea, Garascia Andrea, Lupi Laura, Cereda Alberto
  
  Abstract
  
  PURPOSE OF REVIEW:
  Coronavirus disease-2019 (COVID-19) vaccines have been related to rare cases of acute myocarditis, occurring between 1 in 10,000 and 1 in 100,000 individuals, approximately. Incidence of COVID-19 vaccine-associated myocarditis varies with age, sex, and type of vaccine. Although most patients with acute myocarditis temporally associated with COVID-19 vaccines have an uneventful course, a small subpopulation presents with cardiogenic shock (termed fulminant myocarditis [FM]). This review explored the prevalence, clinical presentation, management, and prognosis of COVID-19 vaccine-associated acute myocarditis, specifically focusing on FM and comparing patients with fulminant versus non-fulminant myocarditis.
  
  RECENT FINDINGS:
  Cases of FM represent about 2-4% (0 to 7.5%) of COVID-19 vaccine-associated acute myocarditis cases, and mortality is around 1%, ranging between 0 and 4.4%. First, we identified 40 cases of FM up to February 2023 with sufficient granular data from case reports and case series of COVID-19 vaccine-associated acute myocarditis that occurred within 30 days from the last vaccine injection. This population was compared with 294 cases of non-fulminant acute myocarditis identified in the literature during a similar time. Patients with FM were older (48 vs. 27 years), had a larger proportion of women (58% vs. 9%), and mainly occurred after the first shot compared with non-fulminant cases (58% vs. 16%). The reported mortality was 27% (11 out of 40), in line with non-vaccine-associated fulminant myocarditis. These data were in agreement with 36 cases of FM from a large Korean registry. Herein, we reviewed the clinical features, imaging results, and histological findings of COVID-19 vaccine-associated fulminant myocarditis. In conclusion, COVID-19 vaccine-associated FM differs from non-fulminant forms, suggesting potential specific mechanisms in these rare and severe forms. Mortality in vaccine-associated FM remains high, in line with other forms of FM.
  
  © 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
  
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• Estimation of Right Atrial Pressure by Ultrasound-Assessed Jugular Vein Distensibility in Patients With Heart Failure.
  Circ Heart Fail

  2024 Feb;17(2):e010973. doi: 10.1161/CIRCHEARTFAILURE.123.010973.
  
  Ammirati Enrico, Marchetti Davide, Colombo Giada, Pellicori Pierpaolo, Gentile Piero, D'Angelo Luciana, Masciocco Gabriella, Verde Alessandro, Macera Francesca, Brunelli Dario, Occhi Lucia, Musca Francesco, Perna Enrico, Bernasconi Davide P, Moreo Antonella, Camici Paolo G, Metra Marco, Oliva Fabrizio, Garascia Andrea
  
  Abstract
  
  BACKGROUND:
  Clinical evaluation of central venous pressure is difficult, depends on experience, and is often inaccurate in patients with chronic advanced heart failure. We assessed the ultrasound-assessed internal jugular vein (JV) distensibility by ultrasound as a noninvasive tool to identify patients with normal right atrial pressure (RAP ?7 mm?Hg) in this population.
  
  METHODS:
  We measured JV distensibility as the Valsalva-to-rest ratio of the vein diameter in a calibration cohort (N=100) and a validation cohort (N=101) of consecutive patients with chronic heart failure with reduced ejection fraction who underwent pulmonary artery catheterization for advanced heart failure therapies workup.
  
  RESULTS:
  A JV distensibility threshold of 1.6 was identified as the most accurate to discriminate between patients with RAP ?7 versus >7 mm?Hg (area under the receiver operating characteristic curve, 0.74 [95% CI, 0.64-0.84]) and confirmed in the validation cohort (receiver operating characteristic, 0.82 [95% CI, 0.73-0.92]). A JV distensibility ratio >1.6 had predictive positive values of 0.86 and 0.94, respectively, to identify patients with RAP ?7 mm?Hg in the calibration and validation cohorts. Compared with patients from the calibration cohort with a high JV distensibility ratio (>1.6; n=42; median RAP, 4 mm?Hg; pulmonary capillary wedge pressure, 11 mm?Hg), those with a low JV distensibility ratio (?1.6; n=58; median RAP, 8 mm?Hg; pulmonary capillary wedge pressure, 22 mm?Hg;
  CONCLUSIONS:
  Ultrasound-assessed JV distensibility identifies patients with chronic advanced heart failure with normal RAP and better outcomes.
  
  REGISTRATION:
  URL: https://www.clinicaltrials.gov; Unique identifier: NCT03874312.
  
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• Ultrasound-Assisted, Catheter-Directed Thrombolysis for Acute Intermediate/High-Risk Pulmonary Embolism: Design of the Multicenter USAT IH-PE Registry and Preliminary Results.
  J Clin Med

  2024 Jan;13(2):. doi: 619.
  
  Colombo Claudia, Capsoni Nicolò, Russo Filippo, Iannaccone Mario, Adamo Marianna, Viola Giovanna, Bossi Ilaria Emanuela, Villanova Luca, Tognola Chiara, Curci Camilla, Morelli Francesco, Guerrieri Rossella, Occhi Lucia, Chizzola Giuliano, Rampoldi Antonio, Musca Francesco, De Nittis Giuseppe, Galli Mario, Boccuzzi Giacomo, Savio Daniele, Bernasconi Davide, D'Angelo Luciana, Garascia Andrea, Chieffo Alaide, Montorfano Matteo, Oliva Fabrizio, Sacco Alice
  
  Abstract
  
  Catheter-based revascularization procedures were developed as an alternative to systemic thrombolysis for patients with intermediate-high- and high-risk pulmonary embolisms. USAT IH-PE is a retrospective and prospective multicenter registry of such patients treated with ultrasound-facilitated, catheter-directed thrombolysis, whose preliminary results are presented in this study. The primary endpoint was the incidence of pulmonary hypertension (PH) at follow-up. Secondary endpoints were short- and mid-term changes in the echocardiographic parameters of right ventricle (RV) function, in-hospital and all-cause mortality, and procedure-related bleeding events. Between March 2018 and July 2023, 102 patients were included. The majority were at intermediate-high-risk PE (86%), were mostly female (57%), and had a mean age of 63.7 ± 14.5 years, and 28.4% had active cancer. Echocardiographic follow-up was available for 70 patients, and in only one, the diagnosis of PH was confirmed by right heart catheterization, resulting in an incidence of 1.43% (CI 95%, 0.036-7.7). RV echocardiographic parameters improved both at 24 h and at follow-up. In-hospital mortality was 3.9% (CI 95%, 1.08-9.74), while all-cause mortality was 11% (CI 95%, 5.4-19.2). Only 12% had bleeding complications, of whom 4.9% were BARC ? 3. Preliminary results from the USAT IH-PE registry showed a low incidence of PH, improvement in RV function, and a safe profile.
  
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• [Pulmonary hypertension associated with left heart diseases: pathophysiology, diagnosis, treatment].
  G Ital Cardiol (Rome)

  2024 Feb;25(2):88-97. doi: 10.1714/4187.41757.
  
  Caravita Sergio, Gori Mauro, Garascia Andrea, Baratto Claudia, Camassa Nino, Carigi Samuela, De Gennaro Luisa, De Maria Renata, Enea Iolanda, Gentile Piero, Giordana Francesca, Leonardi Giuseppe, Lo Giudice Francesco, Orso Francesco, Romaniello Antonella, Roncon Loris, Tinti Maria Denitza, Vatrano Marco, Vedovati Maria Cristina, Marini Marco, Picariello Claudio
  
  Abstract
  
  Pulmonary hypertension (PH) is a common complication of diseases affecting the left heart, mostly found in patients suffering from heart failure. Left atrial hypertension is the initial driver of post-capillary PH. However, several mechanisms may lead in a subset of patients to structural changes in the pulmonary vessels with development of a pre-capillary component. The right ventricle may be frequently affected, leading to right ventricular failure and a worse outcome. The differential diagnosis of PH associated with left heart disease vs pulmonary arterial hypertension (PAH) is challenging in patients with cardiovascular comorbidities, risk factors for PAH and/or a preserved left ventricular ejection fraction. Multidimensional clinical phenotyping is needed to identify patients in whom hemodynamic confirmation is deemed necessary, that may be completed by provocative testing in the cath lab. In contrast with PAH, management of PH associated with left heart disease should focus on the treatment of the underlying condition. There is currently no approved therapy for PH associated with left heart disease: some PAH-specific treatments have led to an increase in adverse events in these patients.
  
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• Real-world data of patients affected by advanced heart failure treated with implantable cardioverter defibrillator and left ventricular assist device: Results of a multicenter observational study.
  Artif Organs

  2024 May;48(5):525-535. doi: 10.1111/aor.14708.
  
  Rordorf Roberto, Pignalosa Leonardo, Casula Matteo, Perna Enrico, Baroni Matteo, Garascia Andrea, Guida Stefania, Gazzoli Fabrizio, Pini Daniela, Cannata Francesco, Pellegrino Marta, Vittori Claudia, De Filippo Paolo, Malanchini Giovanni, Vergara Pasquale, Della Bella Paolo, Gulletta Simone,
  
  Abstract
  
  BACKGROUND:
  Left ventricular assist device (L-VAD) implantation is increasingly used in patients with heart failure (HF) and most patients also have an implantable cardioverter defibrillator (ICD). Limited data are available on the incidence of ICD therapies and complications in this special setting. The aim of this study was to analyze the real-world incidence and predictors of ICD therapies, complications and interactions between ICD and L-VAD.
  
  METHODS:
  We conducted a multicenter retrospective observational study in patients with advanced HF implanted with ICD and a continuous-flow L-VAD, followed-up in five advanced HF centers in Northern Italy.
  
  RESULTS:
  A total of 234 patients (89.7% male, median age 59, 48.3% with ischemic etiology) were enrolled. After a median follow-up of 21?months, 66 patients (28.2%) experienced an appropriate ICD therapy, 22 patients (9.4%) an inappropriate ICD therapy, and 17 patients (7.3%) suffered from an interaction between ICD and L-VAD. The composite outcome of all ICD-related complications was reported in 41 patients (17.5%), and 121 (51.7%) experienced an L-VAD-related complication. At multivariable analysis, an active ventricular tachycardia (VT) zone and a prior ICD generator replacement were independent predictors of ICD therapies and of total ICD-related complications, respectively.
  
  CONCLUSIONS:
  Real-world patients with both L-VAD and ICD experience a high rate of ICD therapies and complications. Our findings suggest the importance of tailoring device programming in order to minimize the incidence of unnecessary ICD therapies, thus sparing the need for ICD generator replacement, a procedure associated to a high risk of complications.
  
  © 2024 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
  
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• The Exercise aNd hEArt transplant (ENEA) trial - a registry-based randomized controlled trial evaluating the safety and efficacy of cardiac telerehabilitation after heart transplant.
  Contemp Clin Trials

  2024 Jan;136():107415. doi: 10.1016/j.cct.2023.107415.
  
  Pedersini Paolo, Picciolini Silvia, Di Salvo Francesca, Toccafondi Anastasia, Novembre Giulia, Gualerzi Alice, Cusmano Ignazio, Garascia Andrea, Tavanelli Monica, Verde Alessandro, Masciocco Gabriella, Ricci Cristian, Mannini Andrea, Bedoni Marzia, Morici Nuccia
  
  Abstract
  
  BACKGROUND:
  Heart transplant (HTx) is gold-standard therapy for patients with end-stage heart failure. Cardiac rehabilitation (CR) is a multidisciplinary intervention shown to improve cardiovascular prognosis and quality of life. The aim in this randomized controlled trial is to explore the safety and efficacy of cardiac telerehabilitation after HTx. In addition, biomarkers of rehabilitation outcomes will be identified, as data that will enable treatment to be tailored to patient phenotype.
  
  METHODS:
  Patients after HTx will be recruited at IRCCS S. Maria Nascente - Fondazione Don Gnocchi, Milan, Italy (n = 40). Consenting participants will be randomly allocated to either of two groups (1:1): an intervention group who will receive on-site CR followed by 12 weeks of telerehabilitation, or a control group who will receive on-site CR followed by standard homecare and exercise programme. Recruitment began on 20th May 2023 and is expected to continue until 20th May 2025. Socio-demographic characteristics, lifestyle, health status, cardiovascular events, cognitive function, anxiety and depression symptoms, and quality of life will be assessed, as well as exercise capacity and muscular endurance. Participants will be evaluated before the intervention, post-CR and after 6 months. In addition, analysis of circulating extracellular vesicles using Surface Plasmon Resonance imaging (SPRi), based on a rehabilomic approach, will be applied to both groups pre- and post-CR.
  
  CONCLUSION:
  This study will explore the safety and efficacy of cardiac telerehabilitation after HTx. In addition, a rehabilomic approach will be used to investigate biomolecular phenotypization in HTx patients.
  
  TRIAL REGISTRATION NUMBER:
  ClinicalTrials.gov Identifier: NCT05824364.
  
  Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.
  
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• Intravenous continuous home inotropic therapy in advanced heart failure: Insights from an observational retrospective study.
  Eur J Intern Med

  2023 Oct;116():65-71. doi: 10.1016/j.ejim.2023.06.010.
  
  Gentile Piero, Masciocco Gabriella, Palazzini Matteo, Tedeschi Andrea, Ruzzenenti Giacomo, Conti Nicolina, D'Angelo Luciana, Foti Grazia, Perna Enrico, Verde Alessandro, Ammirati Enrico, Sinagra Gianfranco, Oliva Fabrizio, Garascia Andrea
  
  Abstract
  
  INTRODUCTION:
  Intravenous inotropic support represents an important therapeutic option in advanced heart failure (HF) as bridge to heart transplantation, bridge to mechanical circulatory support, bridge to candidacy or as palliative therapy. Nevertheless, evidence regarding risks and benefits of its use is lacking.
  
  METHODS:
  we conducted a retrospective single center study, analysing the effect of inotropic therapies in an outpatient cohort, evaluating the burden of hospitalizations, the improvement in quality of life, the incidence of adverse events and the evolution of organ damage.
  
  RESULTS:
  twenty-seven patients with advanced HF were treated in our Day Hospital service from 2014 to 2021. Nine patients were treated as bridge to heart transplant while eighteen as palliation. Comparing data regarding the year before and after the beginning of inotropic infusion, we observed a reduction of hospitalization (46 vs 25, p
  CONCLUSIONS:
  in a selected population of advanced HF patients, continuous home inotropic infusion were able to reduce hospitalizations, improving end organ damage and quality of life. We provide a practical guidance on starting and maintaining home inotropic infusion while monitoring a challenging group of patients.
  
  Copyright © 2023. Published by Elsevier B.V.
  
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• Efficacy and Safety of Anticoagulant Therapy in COVID-19-Related Pulmonary Embolism with Different Extension.
  Biomedicines

  2023 Apr;11(5):. doi: 1282.
  
  Gatto Maria Chiara, Oliva Alessandra, Palazzolo Claudia, Picariello Claudio, Garascia Andrea, Nicastri Emanuele, Girardi Enrico, Antinori Andrea
  
  Abstract
  
  Pulmonary embolism (PE) has been associated with SARS-CoV-2 infection, and its incidence is highly variable. The aim of our study was to describe the radiological and clinical presentations, as well as the therapeutic management, of PEs that occurred during SARS-CoV-2 infection in a cohort of hospitalized patients. In this observational study, we enrolled patients with moderate COVID-19 who developed PE during hospitalization. Clinical, laboratory, and radiological features were recorded. PE was diagnosed on clinical suspicion and/or CT angiography. According to CT angiography results, two groups of patients were further distinguished: those with proximal or central pulmonary embolism (cPE) and those with distal or micro-pulmonary embolism (mPE). A total of 56 patients with a mean age of 78 ± 15 years were included. Overall, PE occurred after a median of 2 days from hospitalization (range 0-47 days) and, interestingly, the majority of them (89%) within the first 10 days of hospitalization, without differences between the groups. Patients with cPE were younger ( = 0.02), with a lower creatinine clearance ( = 0.04), and tended to have a higher body weight ( = 0.059) and higher D-Dimer values ( = 0.059) than patients with mPE. In all patients, low-weight molecular heparin (LWMH) at anticoagulant dosage was promptly started as soon as PE was diagnosed. After a mean of 16 ± 9 days, 94% of patients with cPE were switched to oral anticoagulant (OAC) therapy, which was a direct oral anticoagulant (DOAC) in 86% of cases. In contrast, only in 68% of patients with mPE, the prosecution with OAC was indicated. The duration of treatment was at least 3 months from PE diagnosis in all patients who started OAC. At the 3-month follow-up, no persistence or recurrence of PE as well as no clinically relevant bleedings were found in both groups. In conclusion, pulmonary embolism in patients with SARS-CoV-2 may have different extensions. Used with clinical judgment, oral anticoagulant therapy with DOAC was effective and safe.
  
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• Outcome and Morphofunctional Changes on Cardiac Magnetic Resonance in Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination.
  Circ Heart Fail

  2023 Jun;16(6):e010315. doi: 10.1161/CIRCHEARTFAILURE.122.010315.
  
  Ammirati Enrico, Lupi Laura, Palazzini Matteo, Ciabatti Michele, Rossi Valentina A, Gentile Piero, Uribarri Aitor, Vecchio Chiara R, Nassiacos Daniele, Cereda Alberto, Conca Cristina, Tumminello Gabriele, Piriou Nicolas, Lelarge Coline, Pedrotti Patrizia, Stucchi Miriam, Peretto Giovanni, Galasso Michele, Huang Florent, Ianni Umberto, Procopio Antonio, Saponara Gianluigi, Cimaglia Paolo, Tomasoni Daniela, Moroni Francesco, Turco Annalisa, Sala Simone, Di Tano Giuseppe, Bollano Entela, Moro Claudio, Abbate Antonio, Della Bona Roberta, Porto Italo, Carugo Stefano, Campodonico Jeness, Pontone Gianluca, Grosu Aurelia, Bolognese Leonardo, Salamanca Jorge, Diez-Villanueva Pablo, Ozieranski Krzysztof, Tyminska Agata, Sardo Infirri Loren, Bromage Daniel, Cannatà Antonio, Hong Kimberly N, Adamo Marianna, Quattrocchi Giuseppina, Foà Alberto, Potena Luciano, Garascia Andrea, Giannattasio Cristina, Adler Eric D, Sinagra Gianfranco, Ruschitzka Frank, Camici Paolo G, Metra Marco, Pieroni Maurizio
  
  
  
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• Advanced heart failure: from definitions to therapeutic options.
  Eur Heart J Suppl

  2023 May;25(Suppl C):C283-C291. doi: 10.1093/eurheartjsupp/suad028.
  
  Garascia Andrea, Palazzini Matteo, Tedeschi Andrea, Sacco Alice, Oliva Fabrizio, Gentile Piero
  
  Abstract
  
  Advanced heart failure (AHF) represents an ominous stage of heart failure (HF), where the expected prognosis remains poor regardless of the improvement in medical knowledge. In this review, we summarize the definition, prognosis, physiopathology, and clinical/therapeutic management of the disease, focusing on the fast and timely referral of the patient to the AHF facilities. We provide an insight of the diagnostic and therapeutic 'work up' performed in an Italian AHF hub, implying a deep phenotypical patients characterization in order to evaluate candidacy to the therapeutic gold standards as heart transplantation (HTx) and left ventricular assist device (LVAD).
  
  © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Immune checkpoint inhibitor-associated myocarditis: from pathophysiology to rechallenge of therapy - a narrative review.
  Future Cardiol

  2023 Feb;19(2):91-103. doi: 10.2217/fca-2022-0120.
  
  Tedeschi Andrea, Camilli Massimiliano, Ammirati Enrico, Gentile Piero, Palazzini Matteo, Conti Nicolina, Verde Alessandro, Masciocco Gabriella, Foti Grazia, Giannattasio Cristina, Garascia Andrea
  
  Abstract
  
  Even if immune checkpoint inhibitors have revolutionized the landscape of cancer therapy, their use may be complicated by immune-related adverse events. Among these, myocarditis is the most severe complication. The clinical suspicion often arises after clinical symptoms onset and increase in cardiac biomarkers or electrocardiographic manifestations. Echocardiography and cardiac magnetic resonance imaging are recommended for each patient. However, since they may be misleadingly normal, endomyocardial biopsy remains the gold standard for establishing the diagnosis. Until now, treatment has been based on glucocorticoids even if increasing interest has risen in other immunosuppressive agents. Although myocarditis currently imposes immunotherapy discontinuation, case reports have suggested a safety rechallenge in low-grade myocarditis paving the way for further studies to respond to this unmet clinical need.
  
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• Performance of risk stratification scores and role of comorbidities in older vs younger patients with pulmonary arterial hypertension.
  J Heart Lung Transplant

  2023 Aug;42(8):1082-1092. doi: 10.1016/j.healun.2023.02.1707.
  
  Stolfo Davide, Barbisan Davide, Ameri Pietro, Lombardi Carlo Mario, Monti Simonetta, Driussi Mauro, Zovatto Isabella Carlotta, Gentile Piero, Howard Luke, Toma Matteo, Pagnesi Matteo, Collini Valentino, Bauleo Carolina, Guglielmi Giulia, Adamo Marianna, D'Angelo Luciana, Nalli Chiara, Sciarrone Paolo, Moschella Martina, Zorzi Barbara, Vecchiato Veronica, Milani Martina, Di Poi Emma, Airò Edoardo, Metra Marco, Garascia Andrea, Sinagra Gianfranco, Lo Giudice Francesco
  
  Abstract
  
  BACKGROUND:
  Risk scores are important tools for the prognostic stratification of pulmonary arterial hypertension (PAH). Their performance and the additional impact of comorbidities across age groups is unknown.
  
  METHODS:
  Patients with PAH enrolled from 2001 to 2021 were divided in ?65 years old vs
  RESULTS:
  Among 383 patients, 152 (40%) were ?65 years old. They had more comorbidities (number of comorbidities 2, IQR 1-3, vs 1, IQR 0-2 in
  CONCLUSIONS:
  Risk scores have similar accuracy in the prognostic stratification of older vs younger PAH patients. REVEAL 2.0 had the best performance in older patients and COMPERA 2.0 had it in younger patients. Comorbidities increased the accuracy of risk scores only in younger patients.
  
  Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
  
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• [Anticoagulation therapy during pulmonary embolism follow-up in clinical practice].
  G Ital Cardiol (Rome)

  2023 Apr;24(4):275-284. doi: 10.1714/4004.39818.
  
  Picariello Claudio, Garascia Andrea, Giordana Francesca, Lo Giudice Francesco, Romaniello Antonella, Vedovati Maria Cristina, Enea Iolanda, Caravita Sergio, Camassa Nino, Vatrano Marco, Bongarzoni Amedeo, Roncon Loris, Gabrielli Domenico, Colivicchi Furio
  
  Abstract
  
  Patients with pulmonary embolism are a heterogeneous population and, after the acute phase and the first 3-6 months, the main issue is whether to continue, and hence how long and at what dose, or to stop anticoagulation therapy. In patients with venous thromboembolism (VTE), direct oral anticoagulants (DOACs) are the recommended treatment (class I, level of evidence B in the latest European guidelines), and in most cases, an "extended" or "long-term" low-dose therapy is warranted. This paper aims to provide a practical management tool to the clinician dealing with pulmonary embolism follow-up: from the evidence behind the most used exams (D-dimer, ultrasound Doppler of the lower limbs, imaging tests, recurrence and bleeding risk scores), and the use of DOACs in the extended phase, to six real clinical scenarios with the relative management in the acute phase and at follow-up. Lastly, a practical algorithm is shown to deal with anticoagulation therapy in the follow-up of VTE patients in a simple, schematic, and pragmatic way.
  
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• Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry.
  J Clin Med

  2022 Nov;11(23):. doi: 7136.
  
  Toma Matteo, Miceli Roberta, Bonsante Edoardo, Colombo Davide, Confalonieri Marco, Garascia Andrea, Ghio Stefano, Lattanzio Mariangela, Lombardi Carlo Maria, Paciocco Giuseppe, Piccinino Cristina, Rota Irene, Santolamazza Caterina, Scelsi Laura, Scuri Piermario, Stolfo Davide, Vincenzi Antonella, Volpiano Lorenzo, Vicenzi Marco, Ameri Pietro
  
  Abstract
  
  Pulmonary arterial hypertension (PAH) in the elderly is often associated with left heart disease (LHD), prompting concerns about the use of pulmonary vasodilators. The PATRIARCA registry enrolled ?70 year-old PAH or chronic thromboembolic pulmonary hypertension (CTEPH) patients at 11 Italian centers from 1 December 2019 through 15 September 2022. After excluding those with CTEPH, post-capillary PH at the diagnostic right heart catheterization (RHC), and/or incomplete data, 23 (33%) of a total of 69 subjects met the criteria proposed in the AMBITION trial to suspect LHD. Diabetes [9 (39%) vs. 6 (13%), p = 0.01] and chronic kidney disease [14 (61%) vs. 12 (26%), p = 0.003] were more common, and the last RHC pulmonary artery wedge pressure [14 ± 5 vs. 10 ± 3 mmHg, p
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• Scenarios in precision medicine: proteomics in heart failure.
  Eur Heart J Suppl

  2022 Nov;24(Suppl I):I111-I113. doi: 10.1093/eurheartjsupp/suac083.
  
  Gentile Piero, Palazzini Matteo, Garascia Andrea, Oliva Fabrizio
  
  Abstract
  
  Proteomics in heart failure (HF) is aimed to study and identify proteins involved in the pathophysiology of this clinical syndrome. Proteins have a role as diagnostic, prognostic and therapeutic markers. This review will unravel the developments and impact of proteomics in HF, focusing on its role in the diagnosis, prognosis and definition of new HF therapies. Proteomics promises to change our approach to HF in the near future, accepting the need for precision medicine, tailored on the characteristics of the single patient.
  
  © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Fulminant Lymphocytic Myocarditis During Pregnancy Treated With Temporary Mechanical Circulatory Supports and Aggressive Immunosuppression.
  Circ Heart Fail

  2022 Dec;15(12):e009810. doi: 10.1161/CIRCHEARTFAILURE.122.009810.
  
  Veronese Giacomo, Nonini Sandra, Cannata Aldo, Aresta Francesca, Olivieri Guido, Montrasio Elisa, De Caria Daniele, Perna Enrico, Calini Angelo, Bottiroli Maurizio, Cislaghi Francesca, Pedrazzini Giovanna, Baltaro Federica, Quattrocchi Giuseppina, Pedrotti Patrizia, Russo Claudio F, Garascia Andrea, Mondino Michele, Ammirati Enrico
  
  
  
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• Does moderate hyperkalemia influence survival in HF? Insights from the MECKI score data base.
  Int J Cardiol

  2023 Jan;371():273-277. doi: 10.1016/j.ijcard.2022.09.030.
  
  Toto Federica, Salvioni Elisabetta, Magrì Damiano, Sciomer Susanna, Piepoli Massimo, Badagliacca Roberto, Galotta Arianna, Baracchini Nikita, Paolillo Stefania, Corrà Ugo, Raimondo Rosa, Lagioia Rocco, Filardi Pasquale Perrone, Iorio Annamaria, Senni Michele, Correale Michele, Cicoira Mariantonietta, Perna Enrico, Metra Marco, Guazzi Marco, Limongelli Giuseppe, Sinagra Gianfranco, Parati Gianfranco, Cattadori Gaia, Bandera Francesco, Bussotti Maurizio, Mapelli Massimo, Cipriani Manlio, Bonomi Alice, Cunha Gonçalo, Re Federica, Vignati Carlo, Garascia Andrea, Lombardi Carlo, Scardovi Angela B, Passantino Andrea, Emdin Michele, Passino Claudio, Santolamazza Caterina, Girola Davide, Zaffalon Denise, Vizza Dario, De Martino Fabiana, Agostoni Piergiuseppe,
  
  Abstract
  
  BACKGROUND:
  The prognostic role of moderate hyperkalemia in reduced ejection fraction (HFrEF) patients is still controversial. Despite this, it affects the use of renin-angiotensin-aldosterone system inhibitors (RAASi) with therapy down-titration or discontinuation.
  
  OBJECTIVES:
  Aim of the study was to assess the prognostic impact of moderate hyperkalemia in chronic HFrEF optimally treated patients.
  
  METHODS AND RESULTS:
  We retrospectively analyzed MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) database, with median follow-up of 4.2 [IQR 1.9-7.5] years. Data on K levels were available in 7087 cases. Patients with K plasma level ? 5.6 mEq/L and 4 and 
  CONCLUSIONS:
  Moderate hyperkalemia does not influence patients' outcome in a large cohort of ambulatory HFrEF patients.
  
  Copyright © 2022 Elsevier B.V. All rights reserved.
  
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• A heart of iron: juvenile haemochromatosis presents with cardiac failure.
  Lancet

  2022 Aug;400(10352):616. doi: 10.1016/S0140-6736(22)01285-5.
  
  Cartella Iside, Tavecchia Giovanni A, Quattrocchi Giuseppina, Giannattasio Cristina, Volpato Elisabetta, Palazzini Matteo, Garascia Andrea, Cipriani Manlio, Frigerio Maria, Ammirati Enrico, Pedrotti Patrizia
  
  
  
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• [Pulmonary hypertension: pre- or post-capillary? The role of provocative tests in the cath lab].
  G Ital Cardiol (Rome)

  2022 Jul;23(7):533-541. doi: 10.1714/3831.38171.
  
  Caravita Sergio, Picariello Claudio, Garascia Andrea, Misuraca Leonardo, De Tommasi Elisabetta, Imbalzano Egidio, Enea Iolanda, Roncon Loris, Vatrano Marco,
  
  Abstract
  
  The discrimination between heart failure with preserved ejection fraction (HFpEF) and pulmonary arterial hypertension (PAH) requires a multiparametric approach, eventually culminating in right heart catheterization. Solving this differential diagnosis is crucial in order to properly tailor patient treatment, with relevant clinical implications. However, it is not uncommon to be confronted with patients at intermediate or high risk of having HFpEF whose pulmonary artery wedge pressure (PAWP) falls in a grey zone in between 13 and 15 mmHg. In these patients, a provocative test in the cath lab might be considered, with the aim of unmasking an occult form of HFpEF with non-overt hemodynamic manifestations, or to definitely exclude it.Saline load and physical exercise can be viewed as the most suitable provocative tests seeking to help for the differential diagnosis in this specific patient population. Although normative values for the hemodynamic response to these maneuvers have been proposed, supporting evidence is still preliminary or equivocal. In this paper, we will review the pathophysiological background for the application of provocative tests in the cath lab, as well as methodological and interpretative aspects to discriminate between HFpEF and PAH, highlighting strengths and weaknesses of fluid load and physical exercise.
  
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• Takotsubo syndrome after BNT162b2 mRNA Covid-19 vaccine: Emotional or causative relationship with vaccination?
  Int J Cardiol Heart Vasc

  2022 Jun;40():101002. doi: 101002.
  
  Tedeschi Andrea, Camilli Massimiliano, Ianni Umberto, Tavecchia Giovanni, Palazzini Matteo, Cartella Iside, Gentile Piero, Quattrocchi Giuseppina, Maria Spanò Francesca, Cipriani Manlio, Garascia Andrea, Ammirati Enrico
  
  
  
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• State-of-the-Art of Endomyocardial Biopsy on Acute Myocarditis and Chronic Inflammatory Cardiomyopathy.
  Curr Cardiol Rep

  2022 May;24(5):597-609. doi: 10.1007/s11886-022-01680-x.
  
  Ammirati Enrico, Buono Andrea, Moroni Francesco, Gigli Lorenzo, Power John R, Ciabatti Michele, Garascia Andrea, Adler Eric D, Pieroni Maurizio
  
  Abstract
  
  PURPOSE OF REVIEW:
  Histologic evidence of myocardial inflammatory infiltrate not secondary to an ischemic injury is required by current diagnostic criteria to reach a definite diagnosis of myocarditis. Endomyocardial biopsy (EMB) is therefore often indicated for the diagnosis of myocarditis, although it may lack sufficient sensitivity considering the limited possibility of myocardial sampling. Improving the diagnostic yield and utility of EMB is of high priority in the fields of heart failure cardiology and myocarditis in particular. The aim of the present review is to highlight indications, strengths, and shortcomings of current EMB techniques, and discuss innovations currently being tested in ongoing clinical studies, especially in the setting of acute myocarditis and chronic inflammatory cardiomyopathy.
  
  RECENT FINDINGS:
  EMB provides unique diagnostic elements and prognostic information which can effectively guide the treatment of myocarditis. Issues affecting the diagnostic performance in the setting of acute myocarditis and chronic inflammatory cardiomyopathies will be discussed in this review in the light of recent expert consensus documents on the management of these conditions and on indication to EMB. Recent innovations using electroanatomic mapping (EAM)-guided EMB and fluoroscopic-guided EMB during temporary mechanical circulatory support have improved the utility of the procedure. EMB remains an important diagnostic test whose results need to be interpreted in the context of (1) clinical pre-test probability, (2) timing of sampling, (3) quality of sampling (4) site of sampling, (5) histologic type of myocarditis, and (6) analytic methods that are applied. Herein we will review these caveats as well as perspectives and innovations related to the use of this diagnostic tool.
  
  © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
  
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• Haemodynamic effects of sacubitril/valsartan in advanced heart failure.
  ESC Heart Fail

  2022 Apr;9(2):894-904. doi: 10.1002/ehf2.13755.
  
  Gentile Piero, Cantone Rosaria, Perna Enrico, Ammirati Enrico, Varrenti Marisa, D'Angelo Luciana, Verde Alessandro, Foti Grazia, Masciocco Gabriella, Garascia Andrea, Frigerio Maria, Cipriani Manlio
  
  Abstract
  
  AIMS:
  The angiotensin receptor-neprilysin inhibitor (ARNI), sacubitril/valsartan, has been shown to be effective in treatment of patients with heart failure (HF), but limited data are available in patients with advanced disease. This retrospective observational study assessed the effects of ARNI treatment in patients with advanced HF.
  
  METHODS AND RESULTS:
  We reviewed medical records of all advanced HF patients evaluated at our centre for unconventional therapies from September 2016 to January 2019. We studied 44 patients who started ARNI therapy and who had a haemodynamic assessment before beginning ARNI and after 6 ± 2 months. The primary endpoint was variation in pulmonary pressures and filling pressures at 6 months after starting ARNI therapy. Mean patient age was 51.6 ± 7.4 years; 84% were male. At 6 ± 2 months after starting ARNI, there was significant reduction of systolic pulmonary artery pressure [32 mmHg, interquartile range (IQR) 27-45 vs. 25 mmHg, IQR 22.3-36.5; P 
  CONCLUSIONS:
  Sacubitril/valsartan is effective in reducing filling pressures and pulmonary pressures in patients with advanced HF. The absence of adverse events during follow-up suggests that sacubitril/valsartan is safe and well-tolerated in this cohort of patients.
  
  © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
  
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• Post-discharge arrhythmic risk stratification of patients with acute myocarditis and life-threatening ventricular tachyarrhythmias.
  Eur J Heart Fail

  2021 Dec;23(12):2045-2054. doi: 10.1002/ejhf.2288.
  
  Gentile Piero, Merlo Marco, Peretto Giovanni, Ammirati Enrico, Sala Simone, Della Bella Paolo, Aquaro Giovanni Donato, Imazio Massimo, Potena Luciano, Campodonico Jeness, Foà Alberto, Raafs Anne, Hazebroek Mark, Brambatti Michela, Cercek Andreja Cerne, Nucifora Gaetano, Shrivastava Sanskriti, Huang Florent, Schmidt Matthieu, Muser Daniele, Van de Heyning Caroline M, Van Craenenbroeck Emeline, Aoki Tatsuo, Sugimura Koichiro, Shimokawa Hiroaki, Cannatà Antonio, Artico Jessica, Porcari Aldostefano, Colopi Marzia, Perkan Andrea, Bussani Rossana, Barbati Giulia, Garascia Andrea, Cipriani Manlio, Agostoni Piergiuseppe, Pereira Naveen, Heymans Stephane, Adler Eric D, Camici Paolo Guido, Frigerio Maria, Sinagra Gianfranco
  
  Abstract
  
  AIMS:
  The outcomes of patients presenting with acute myocarditis and life-threatening ventricular arrhythmias (LT-VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population.
  
  METHODS AND RESULTS:
  We retrospectively analysed 156 patients (median age 44?years; 77% male) discharged with a diagnosis of acute myocarditis and LT-VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter-defibrillator therapy or synchronized external cardioversion. Median follow-up was 23?months [first to third quartile (Q1-Q3) 7-60]. Fifty-eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1-Q3 2.5-24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38-6.11]; late gadolinium enhancement involving ?2 myocardial segments (HR 4.51, 95% CI 2.39-8.53), and absence of positive short-tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40-4.79) at first CMR.
  
  CONCLUSIONS:
  Among patients discharged with a diagnosis of myocarditis and LT-VA, 37.2% had recurrences of MAEs during follow-up. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
  
  © 2021 European Society of Cardiology.
  
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• Long-term administration of intravenous inotropes in advanced heart failure.
  ESC Heart Fail

  2021 Oct;8(5):4322-4327. doi: 10.1002/ehf2.13394.
  
  Gentile Piero, Marini Claudia, Ammirati Enrico, Perna Enrico, Saponara Gianluigi, Garascia Andrea, D'Angelo Luciana, Verde Alessandro, Foti Grazia, Masciocco Gabriella, Frigerio Maria, Cipriani Manlio
  
  Abstract
  
  BACKGROUND:
  Patients in heart transplantation (HTx) waiting list for advanced heart failure (HF) are susceptible to acute deterioration refractory to standard HF medical therapies. Limited data are available on long-term in-hospital continuous intravenous (IV) inotropic therapy as bridge to definite therapies.
  
  METHODS AND RESULTS:
  We reviewed medical records of all heart transplant recipients treated in the pre-HTx phase with in-hospital continuous IV inotropes at our institution between 2012 and 2018. We analysed data before the beginning of continuous IV therapy and at the moment of HTx. We report data of 24 patients (mean age of 43.5 ± 15.7 years) treated with IV inotropes as bridge to HTx (median follow-up of 28 months after HTx). The main length of IV inotropic therapy was 84 ± 66 days (min 22; max 264 days). At the beginning, the most frequently used inotrope was dopamine (median dosage of 3 mcg/kg/min, interquartile range 2.5-3.75), alone (n = 11, 46%) or in combination with other inotropes (n = 13, 54%). In 18 patients, the class of inotropes was changed during the hospitalization. We registered a progressive improvement of perfusion markers and neuro-hormonal activation.
  
  CONCLUSION:
  In-hospital continuous parenteral inotropic therapy may serve as a temporary pharmacological bridge to HTx in patients with advanced HF that are actively listed to HTx with good reply in terms of prognosis and perfusion markers.
  
  © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
  
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• Prevalence and outcome of patients with acute myocarditis and positive viral search on nasopharyngeal swab.
  Eur J Heart Fail

  2021 Jul;23(7):1242-1245. doi: 10.1002/ejhf.2247.
  
  Ammirati Enrico, Varrenti Marisa, Veronese Giacomo, Fanti Diana, Nava Alice, Cipriani Manlio, Pedrotti Patrizia, Garascia Andrea, Bottiroli Maurizio, Oliva Fabrizio, Bramerio Manuela, Veronese Silvio, Giannattasio Cristina, Bonoldi Emanuela, Perno Carlo F, Camici Paolo G, Frigerio Maria
  
  
  
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• Nonresponse to Acute Vasodilator Challenge and Prognosis in Heart Failure With Pulmonary Hypertension.
  J Card Fail

  2021 Aug;27(8):869-876. doi: 10.1016/j.cardfail.2021.01.021.
  
  Ghio Stefano, Crimi Gabriele, Houston Brian, Montalto Claudio, Garascia Andrea, Boffini Massimo, Temporelli Pier Luigi, La Rovere Maria Teresa, Pacileo Giuseppe, Panneerselvam Kavin, Santolamazza Caterina, D'angelo Luciana, Moschella Martina, Scelsi Laura, Marro Matteo, Masarone Daniele, Ameri Pietro, Rinaldi Mauro, Guazzi Marco, D'alto Michele, Tedford Ryan J
  
  Abstract
  
  BACKGROUND:
  An acute vasodilator challenge is recommended in patients with heart failure and pulmonary hypertension during heart transplant evaluation. The aim of the study was to assess which hemodynamic parameters are associated with nonresponsiveness to the challenge.
  
  METHODS AND RESULTS:
  This study is a retrospective analysis of 402 patients with heart failure with pulmonary hypertension who underwent right heart catheterization and a pulmonary vasodilator challenge. Among the 140 who fulfilled the transplant guidelines eligibility criteria for the vasodilator challenge, 38 were responders and 102 nonresponders. At multivariable analysis, a diastolic blood pressure of 5 Woods units, and pulmonary artery compliance of
  CONCLUSIONS:
  In patients with heart failure and pulmonary hypertension, low pulmonary arterial compliance, high pulmonary vascular resistance, and low diastolic blood pressure predict the nonresponsiveness to acute vasodilator challenge whilst a poor right ventricular function predicts a dismal prognosis.
  
  Copyright © 2021 Elsevier Inc. All rights reserved.
  
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• Autoimmune Polyendocrine Syndrome Complicated by Pulmonary Hypertension.
  Endocr Metab Immune Disord Drug Targets

  2021 ;21(3):561-565. doi: 10.2174/1871530320666200801033106.
  
  Disoteo Olga E, Zampetti Benedetta, Garascia Andrea, Attanasio Roberto, Cozzi Renato
  
  Abstract
  
  A 24-years old female was admitted for acute renal failure, melanoderma, hyponatremia, and hyperkalemia. The clinical suspicion of Addison's disease was confirmed by laboratory test and the appropriate replacement therapy with corticosteroids and fludrocortisone was started. In the meantime primary hypothyroidism and diabetes mellitus type 1 were disclosed and treated, thus fulfilling a diagnosis of autoimmune polyendocrine syndrome type 2. Eighteen months later she was admitted for right-sided heart failure. The work-up allowed to diagnose pulmonary arterial hypertension. Here, we report the clinical course and discuss the putative link between these two rare diseases.
  
  Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
  
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• [Proposal for a standardized discharge letter after hospital stay for acute pulmonary embolism].
  G Ital Cardiol (Rome)

  2020 Aug;21(8):607-618. doi: 10.1714/3405.33895.
  
  Vatrano Marco, Picariello Claudio, Enea Iolanda, Roncon Loris, Caravita Sergio, De Tommasi Elisabetta, Imbalzano Egidio, Garascia Andrea, Manes Maria Teresa, Misuraca Leonardo, Urbinati Stefano, Colivicchi Furio, Gulizia Michele Massimo, Gabrielli Domenico
  
  Abstract
  
  Pulmonary embolism represents the third leading cause of cardiovascular mortality in developed countries. It requires, in most cases, hospital treatment and always a structured follow-up program. Therefore, at the time of discharge, the communication and the transfer of information from the specialist to the general practitioner, through the discharge letter, represents a crucial opportunity. The aim is to improve the quality of the transmitted content, including information regarding initial assessment, procedures during hospitalization, residual risks, discharge treatments, therapeutic goals and follow-up plan in accordance with the latest guidelines. The discharge letter after hospitalization for pulmonary embolism must include personalized information, especially regarding the anticoagulant regimen in the specific onset setting. Finally, the follow-up program should be accurately described. A standardized discharge letter template, accompanied by some final notes addressed to the general practitioner and patient, could represent a useful tool to improve the quality and time of transmission of information between health professionals after pulmonary embolism.
  
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• [ANMCO Position paper: Pulmonary circulation diseases and COVID-19].
  G Ital Cardiol (Rome)

  2020 Aug;21(8):575-583. doi: 10.1714/3405.33888.
  
  Picariello Claudio, Caravita Sergio, Vatrano Marco, Enea Iolanda, Roncon Loris, De Tommasi Elisabetta, Imbalzano Egidio, Garascia Andrea, Manes Maria Teresa, Misuraca Leonardo, Urbinati Stefano, Colivicchi Furio, Gulizia Michele Massimo, Gabrielli Domenico,
  
  Abstract
  
  The new coronavirus disease 2019 (COVID-19), which is causing hundreds of thousands of deaths worldwide, is complex and can present with a multi-organ localization. One of its worst complications is an interstitial pneumonia with acute respiratory failure also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which requires non-invasive or invasive ventilation. A severe coagulopathy with poor prognosis is found in 5-10% of cases. SARS-CoV-2 is manifesting as a multi-dimensional disease and, recently, unique co-existing pathophysiological and clinical aspects are being defined: (i) an increased immune and inflammatory response with the activation of a cytokine storm and consequent coagulopathy, which promote both venous thromboembolic events and in situ thrombosis localized in small arterioles and pulmonary alveolar capillaries; (ii) a high intrapulmonary shunt, which often accounts for the severity of respiratory failure, due to reduced hypoxic pulmonary vasoconstriction with pulmonary neo-angiogenetic phenomena. Furthermore, the high incidence of venous thromboembolism in COVID-19 patients admitted to the intensive care unit and the autoptic findings of in situ micro-thrombosis at the pulmonary vascular level, suggest that in this disease coagulopathy, unlike septic disseminated intravascular coagulation, is driven towards a hyper-thrombogenic state, giving rise to a debate (with ongoing studies) about the preventive use of anticoagulant doses of heparin to reduce mortality. The aim of this position paper from the Italian Association of Hospital Cardiologists (ANMCO) is to highlight the main implications that COVID-19 infection has on the pulmonary circulation from a pathophysiological, clinical and management point of view.
  
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• Update on acute myocarditis.
  Trends Cardiovasc Med

  2021 Aug;31(6):370-379. doi: 10.1016/j.tcm.2020.05.008.
  
  Ammirati Enrico, Veronese Giacomo, Bottiroli Maurizio, Wang Dao Wen, Cipriani Manlio, Garascia Andrea, Pedrotti Patrizia, Adler Eric D, Frigerio Maria
  
  Abstract
  
  Acute myocarditis (AM), a recent-onset inflammation of the heart, has heterogeneous clinical presentations, varying from minor symptoms to high-risk cardiac conditions with severe heart failure, refractory arrhythmias, and cardiogenic shock. AM is moving from being a definitive diagnosis based on histological evidence of inflammatory infiltrates on cardiac tissue to a working diagnosis supported by high sensitivity troponin increase in association with specific cardiac magnetic resonance imaging (CMRI) findings. Though experts still diverge between those advocating for histological definition versus those supporting a mainly clinical definition of myocarditis, in the real-world practice the diagnosis of AM has undoubtedly shifted from being mainly biopsy-based to solely CMRI-based in most of clinical scenarios. It is thus important to clearly define selected settings where EMB is a must, as information derived from histology is essential for an optimal management. As in other medical conditions, a risk-based approach should be promoted in order to identify the most severe AM cases requiring appropriate bundles of care, including early recognition, transfer to tertiary centers, aggressive circulatory supports with inotropes and mechanical devices, histologic confirmation and eventual immunosuppressive therapy. Despite improvements in recognition and treatment of AM, including a broader use of promising mechanical circulatory supports, severe forms of AM are still burdened by dismal outcomes. This review is focused on recent clinical studies and registries that shed new insights on AM. Attention will be paid to contemporary outcomes and predictors of prognosis, the emerging entity of immune checkpoint inhibitors-associated myocarditis, updated CMRI diagnostic criteria, new data on the use of temporary mechanical circulatory supports in fulminant myocarditis. The role of viruses as etiologic agents will be reviewed and a brief update on pediatric AM is also provided. Finally, we summarize a risk-based approach to AM, based on available evidence and clinical experience.
  
  Copyright © 2020. Published by Elsevier Inc.
  
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• Fulminant myocarditis triggered by OC43 subtype coronavirus: a disease deserving evidence-based care bundles.
  J Cardiovasc Med (Hagerstown)

  2020 Jul;21(7):529-531. doi: 10.2459/JCM.0000000000000989.
  
  Veronese Giacomo, Cipriani Manlio, Bottiroli Maurizio, Garascia Andrea, Mondino Michele, Pedrotti Patrizia, Pini Daniela, Cozzi Ottavia, Messina Antonio, Droandi Ginevra, Petrella Duccio, Frigerio Maria, Ammirati Enrico
  
  
  
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• Viral genome search in myocardium of patients with fulminant myocarditis.
  Eur J Heart Fail

  2020 Jul;22(7):1277-1280. doi: 10.1002/ejhf.1738.
  
  Veronese Giacomo, Ammirati Enrico, Brambatti Michela, Merlo Marco, Cipriani Manlio, Potena Luciano, Sormani Paola, Aoki Tatsuo, Sugimura Koichiro, Sawamura Akinori, Okumura Takahiro, Pinney Sean, Hong Kimberly, Shah Palak, Braun Oscar Ö, Van de Heyning Caroline M, Montero Santiago, Petrella Duccio, Huang Florent, Schmidt Matthieu, Raineri Claudia, Lala Anuradha, Varrenti Marisa, Foà Alberto, Leone Ornella, Gentile Piero, Artico Jessica, Agostini Valentina, Patel Rajiv, Garascia Andrea, Van Craenenbroeck Emeline M, Hirose Kaoru, Isotani Akihiro, Murohara Toyoaki, Arita Yoh, Sionis Alessandro, Fabris Enrico, Hashem Sherin, Garcia-Hernando Victor, Oliva Fabrizio, Greenberg Barry, Shimokawa Hiroaki, Sinagra Gianfranco, Adler Eric D, Frigerio Maria, Camici Paolo G
  
  
  
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• Fulminant Versus Acute Nonfulminant Myocarditis in Patients With Left Ventricular Systolic Dysfunction.
  J Am Coll Cardiol

  2019 Jul;74(3):299-311. doi: 10.1016/j.jacc.2019.04.063.
  
  Ammirati Enrico, Veronese Giacomo, Brambatti Michela, Merlo Marco, Cipriani Manlio, Potena Luciano, Sormani Paola, Aoki Tatsuo, Sugimura Koichiro, Sawamura Akinori, Okumura Takahiro, Pinney Sean, Hong Kimberly, Shah Palak, Braun Öscar, Van de Heyning Caroline M, Montero Santiago, Petrella Duccio, Huang Florent, Schmidt Matthieu, Raineri Claudia, Lala Anuradha, Varrenti Marisa, Foà Alberto, Leone Ornella, Gentile Piero, Artico Jessica, Agostini Valentina, Patel Rajiv, Garascia Andrea, Van Craenenbroeck Emeline M, Hirose Kaoru, Isotani Akihiro, Murohara Toyoaki, Arita Yoh, Sionis Alessandro, Fabris Enrico, Hashem Sherin, Garcia-Hernando Victor, Oliva Fabrizio, Greenberg Barry, Shimokawa Hiroaki, Sinagra Gianfranco, Adler Eric D, Frigerio Maria, Camici Paolo G
  
  Abstract
  
  BACKGROUND:
  Fulminant myocarditis (FM) is a form of acute myocarditis characterized by severe left ventricular systolic dysfunction requiring inotropes and/or mechanical circulatory support. A single-center study found that a patient with FM had better outcomes than those with acute nonfulminant myocarditis (NFM) presenting with left ventricular systolic dysfunction, but otherwise hemodynamically stable. This was recently challenged, so disagreement still exists.
  
  OBJECTIVES:
  This study sought to provide additional evidence on the outcome of FM and to ascertain whether patient stratification based on the main histologic subtypes can provide additional prognostic information.
  
  METHODS:
  A total of 220 patients (median age 42 years, 46.3% female) with histologically proven acute myocarditis (onset of symptoms 
  RESULTS:
  Patients with FM (n = 165) had significantly higher rates of cardiac death and heart transplantation compared with those with NFM (n = 55), both at 60 days (28.0% vs. 1.8%, p = 0.0001) and at 7-year follow-up (47.7% vs. 10.4%, p 
  CONCLUSIONS:
  This international registry confirms that patients with FM have higher rates of cardiac death and heart transplantation both in the short- and long-term compared with patients with NFM. Furthermore, we provide evidence that the histologic subtype of FM carries independent prognostic value, highlighting the need for timely endomyocardial biopsy in this condition.
  
  Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
  
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• Recurrent cardiac sarcoidosis after heart transplantation.
  Clin Res Cardiol

  2019 Oct;108(10):1171-1173. doi: 10.1007/s00392-019-01485-z.
  
  Veronese Giacomo, Cipriani Manlio, Petrella Duccio, Geniere Nigra Stefano, Pedrotti Patrizia, Garascia Andrea, Masciocco Gabriella, Bramerio Manuela A, Klingel Karin, Frigerio Maria, Ammirati Enrico
  
  
  
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• Cardiogenic shock: old and new circulatory assist devices: the role of counter-pulsation.
  Eur Heart J Suppl

  2019 Mar;21(Suppl B):B59-B60. doi: 10.1093/eurheartj/suz020.
  
  Viola Giovanna, Morici Nuccia, Sacco Alice, Stucchi Miriam, Brunelli Dario, Cipriani Manlio, Garascia Andrea, Bottiroli Maurizio, Frigerio Maria, Oliva Fabrizio
  
  
  
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• Acute and Fulminant Myocarditis: a Pragmatic Clinical Approach to Diagnosis and Treatment.
  Curr Cardiol Rep

  2018 Sep;20(11):114. doi: 10.1007/s11886-018-1054-z.
  
  Ammirati Enrico, Veronese Giacomo, Cipriani Manlio, Moroni Francesco, Garascia Andrea, Brambatti Michela, Adler Eric D, Frigerio Maria
  
  Abstract
  
  PURPOSE OF REVIEW:
  To review the clinical features of acute myocarditis, including its fulminant presentation, and present a pragmatic approach to the diagnosis and treatment, considering indications of American and European Scientific Statements and recent data derived by large contemporary registries.
  
  RECENT FINDINGS:
  Patients presenting with acute uncomplicated myocarditis (i.e., without left ventricular dysfunction, heart failure, or ventricular arrhythmias) have a favorable short- and long-term prognosis: these findings do not support the indication to endomyocardial biopsy in this clinical scenario. Conversely, patients with complicated presentations, especially those with fulminant myocarditis, require an aggressive and comprehensive management, including endomyocardial biopsy and availability of advanced therapies for circulatory support. Although several immunomodulatory or immunosuppressive therapies have been studied and are actually prescribed in the real-world practice, their effectiveness has not been clearly demonstrated. Patients with specific histological subtypes of acute myocarditis (i.e., giant cell and eosinophilic myocarditis) or those affected by sarcoidosis or systemic autoimmune disorders seem to benefit most from immunosuppression. On the other hand, no clear evidence supports the use of immunosuppressive agents in patients with lymphocytic acute myocarditis, even though small series suggest a potential benefit. Acute myocarditis is a heterogeneous condition with distinct pathophysiological pathways. Further research is mandatory to identify factors and mechanisms that may trigger/maintain or counteract/repair the myocardial damage, in order to provide a rational for future evidence-based treatment of patients affected by this condition.
  
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• Management of cardiogenic shock in acute decompensated chronic heart failure: The ALTSHOCK phase II clinical trial.
  Am Heart J

  2018 Oct;204():196-201. doi: 10.1016/j.ahj.2018.07.009.
  
  Morici Nuccia, Oliva Fabrizio, Ajello Silvia, Stucchi Miriam, Sacco Alice, Cipriani Manlio Gianni, De Bonis Michele, Garascia Andrea, Gagliardone Maria Pia, Melisurgo Giulio, Russo Claudio Francesco, La Vecchia Carlo, Frigerio Maria, Pappalardo Federico
  
  Abstract
  
  Management of acute decompensated heart failure patients presenting with cardiogenic shock (CS) is not straightforward, as few data are available from clinical trials. Stabilization before left ventricle assist device (LVAD) or heart transplantation (HTx) is strongly advocated, as patients undergoing LVAD implant or HTx in critical status have worse outcomes. This was a multicenter phase II study with a Simon 2-stage design, including 24 consecutive patients treated with low-moderate epinephrine doses, whose refractory CS prompted implantation of intra-aortic balloon pump (IABP) which was subsequently upgraded with peripheral venoarterial extracorporeal membrane oxygenation. At admission, patients had severe left ventricular dysfunction and overt CS, 7 patients could be managed only with inotropic therapy, and 16 patients were transitioned to IABP and 1 to IABP and venoarterial extracorporeal membrane oxygenation; the median duration of epinephrine therapy was 7?days (interquartile range 6-15), and the median dose was 0.08 ?g/kg/min (interquartile range 0.05-0.1); 21 patients (87.5%) survived at 60?days (primary outcome); among them, 13 (61.9%) underwent LVAD implantation, 2 (9.5%) underwent HTx, and 6 (28.6%) improved on medical treatment, indicating that early and intensive treatment of CS in chronic advanced heart failure patients with low-dose epinephrine and timely short-term mechanical circulatory support leads to satisfactory outcomes.
  
  Copyright © 2018 Elsevier Inc. All rights reserved.
  
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• Not every fulminant lymphocytic myocarditis fully recovers.
  J Cardiovasc Med (Hagerstown)

  2018 Aug;19(8):453-454. doi: 10.2459/JCM.0000000000000664.
  
  Veronese Giacomo, Cipriani Manlio, Petrella Duccio, Pedrotti Patrizia, Giannattasio Cristina, Garascia Andrea, Oliva Fabrizio, Klingel Karin, Frigerio Maria, Ammirati Enrico
  
  
  
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• Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis.
  Circulation

  2017 Aug;136(6):529-545. doi: 10.1161/CIRCULATIONAHA.117.026386.
  
  Ammirati Enrico, Cipriani Manlio, Lilliu Marzia, Sormani Paola, Varrenti Marisa, Raineri Claudia, Petrella Duccio, Garascia Andrea, Pedrotti Patrizia, Roghi Alberto, Bonacina Edgardo, Moreo Antonella, Bottiroli Maurizio, Gagliardone Maria P, Mondino Michele, Ghio Stefano, Totaro Rossana, Turazza Fabio M, Russo Claudio F, Oliva Fabrizio, Camici Paolo G, Frigerio Maria
  
  Abstract
  
  BACKGROUND:
  Previous reports have suggested that despite their dramatic presentation, patients with fulminant myocarditis (FM) might have better outcome than those with acute nonfulminant myocarditis (NFM). In this retrospective study, we report outcome and changes in left ventricular ejection fraction (LVEF) in a large cohort of patients with FM compared with patients with NFM.
  
  METHODS:
  The study population consists of 187 consecutive patients admitted between May 2001 and November 2016 with a diagnosis of acute myocarditis (onset of symptoms
  RESULTS:
  In the whole population (n=187), the rate of in-hospital death or heart transplantation was 25.5% versus 0% in FM versus NFM, respectively (
  CONCLUSIONS:
  Patients with FM have an increased mortality and need for heart transplantation compared with those with NFM. From a functional viewpoint, patients with FM have a more severely impaired LVEF at admission that, despite steep improvement during hospitalization, remains lower than that in patients with NFM at long-term follow-up. These findings also hold true when only the viral forms are considered and are different from previous studies showing better prognosis in FM.
  
  © 2017 American Heart Association, Inc.
  
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• [Psychological evaluation and support in patients with left ventricular assist devices: preliminary data at 6-month follow-up].
  G Ital Cardiol (Rome)

  2016 Nov;17(11):940-946. doi: 10.1714/2498.26204.
  
  Voltolini Alessandra, Minotti Anna, Verde Alessandro, Cipriani Manlio, Garascia Andrea, Turazza Fabio, Macera Francesca, Perna Enrico, Russo Claudio F, Fumagalli Emilia, Frigerio Maria
  
  Abstract
  
  BACKGROUND:
  Heart disease has an impact on patient's identity and self-perception. Taking into account the wide literature about psychological aspects before and after heart transplant, it clearly emerges that there is a lack of data and results for patients up to implantation of ventricular assist devices (VAD). The aim of the present study was to explore quality of life and factors correlated with psychological adjustment in patients supported with VAD.
  
  METHODS:
  From February 2013 to August 2014, 18 patients (17 male, mean age 57 years) under clinical evaluation before and after VAD implantation were enrolled. During interviews, patients were assessed with EuroQoL-5D questionnaire to monitor improvement of quality of life before implantation and at 3 and 6 months; critical issues, needs and point of views of patients have been described.
  
  RESULTS:
  A significant improvement in the quality of life score was observed at 3 (score 38 [interquartile range 30-40] vs 75 [60-80], p
  CONCLUSIONS:
  Successful treatment and efficient psychological care are closely related to assessment and continuous clinical support. This approach ensures a better selection of patients and improves their compliance. Further data are needed to support our preliminary observations and to explore long-term quality of life.
  
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• A prospective comparison of mid-term outcomes in patients treated with heart transplantation with advanced age donors versus left ventricular assist device implantation.
  Interact Cardiovasc Thorac Surg

  2016 Oct;23(4):584-92. doi: 10.1093/icvts/ivw164.
  
  Ammirati Enrico, Cipriani Manlio G, Varrenti Marisa, Colombo Tiziano, Garascia Andrea, Cannata Aldo, Pedrazzini Giovanna, Benazzi Elena, Milazzo Filippo, Oliva Fabrizio, Gagliardone Maria P, Russo Claudio F, Frigerio Maria
  
  Abstract
  
  OBJECTIVES:
  In Europe, the age of heart donors is constantly increasing. Ageing of heart donors limits the probability of success of heart transplantation (HTx). The aim of this study is to compare the outcome of patients with advanced heart failure (HF) treated with a continuous-flow left ventricular assist device (CF-LVAD) with indication as bridge to transplantation (BTT) or bridge to candidacy (BTC) versus recipients of HTx with the donor's age above 55 years (HTx with donors >55 years).
  
  METHODS:
  we prospectively evaluated 301 consecutive patients with advanced HF treated with a CF-LVAD (n = 83) or HTx without prior bridging (n = 218) in our hospital from January 2006 to January 2015. We compared the outcome of CF-LVAD-BTT (n = 37) versus HTx with donors >55 years (n = 45) and the outcome of CF-LVAD-BTT plus BTC (n = 62) versus HTx with donors >55 years at the 1- and 2-year follow-up. Survival was evaluated according to the first operation.
  
  RESULTS:
  The perioperative (30-day) mortality rate was 0% in the LVAD-BTT group vs 20% (n = 9) in the HTx group with donors >55 years (P = 0.003). Perioperative mortality occurred in 5% of the LVAD-BTT/BTC patients (n = 3) and in 20% of the HTx with donors >55 year group (P = 0.026). Kaplan-Meier curves estimated a 2-year survival rate of 94.6% in CF-LVAD-BTT vs 68.9% in HTx with donors >55 years [age- and sex-adjusted hazard ratio (HR) 0.25; 95% confidence interval (CI) 0.08-0.81; P = 0.02 in favour of CF-LVAD]. Considering the post-HTx outcome, a trend in favour of CF-LVAD-BTT was also observed (age- and sex-adjusted HR 0.45; 95% CI 0.17-1.16; P = 0.09 in favour of CF-LVAD), whereas CF-LVAD-BTT/BTC showed a similar survival at 2 years compared with HTx with donors >55 years, both censoring the follow-up at the time of HTx and considering the post-HTx outcome.
  
  CONCLUSIONS:
  Early and mid-term outcomes of patients treated with a CF-LVAD with BTT indication seem better than HTx with old donors. It must be emphasized that up to 19% of patients in the CF-LVAD/BTT group underwent transplantation in an urgent condition due to complications related to the LVAD. At the 2-year follow-up, CF-LVAD with BTT and BTC indications have similar outcome than HTx using old heart donors. These results must be confirmed in a larger and multicentre population and extending the follow-up.
  
  © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
  
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• Embolic myocardial infarction due to coronary artery aneurysm in a patient with Loeys-Dietz syndrome.
  EuroIntervention

  2016 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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• [Endomyocardial biopsy should be performed in selected patients with suspected myocarditis].
  G Ital Cardiol (Rome)

  2015 Oct;16(10):539-43. doi: 10.1714/2028.22034.
  
  Ammirati Enrico, Cipriani Manlio, Bonacina Edgardo, Garascia Andrea, Oliva Fabrizio
  
  Abstract
  
  Endomyocardial biopsy (EMB) is the gold standard for the diagnosis of myocarditis. Patients with clinical presentation consistent with myocarditis and acute heart failure should undergo EMB, in particular to exclude giant-cell myocarditis or necrotizing eosinophilic myocarditis that are life-threatening conditions. The indication for EMB is debatable in case of suspected myocarditis with infarct-like presentation and preserved left ventricular ejection fraction. In fact, in this group of patients the prognosis is fairly good, and the clinical advantage to reach a histological diagnosis by means of an invasive procedure with potential complications such as EMB is limited. In this article we discuss the indication for EMB in the light of current guidelines based on existing consensus documents.
  
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• CoreValve Evolut R implantation as valve-in-valve in an Edwards SAPIEN 3 to treat paravalvular regurgitation.
  EuroIntervention

  2015 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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• Cardiogenic shock: How to overcome a clinical dilemma. Unmet needs in Emergency medicine.
  Int J Cardiol

  2015 ;186():19-21. doi: 10.1016/j.ijcard.2015.02.111.
  
  Morici Nuccia, Sacco Alice, Paino Roberto, Oreglia Jacopo Andrea, Bottiroli Maurizio, Senni Michele, Nichelatti Michele, Canova Paolo, Russo Claudio, Garascia Andrea, Kulgmann Silvio, Frigerio Maria, Oliva Fabrizio
  
  
  
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• Mid-term survival after continuous-flow left ventricular assist device versus heart transplantation.
  Heart Vessels

  2016 May;31(5):722-33. doi: 10.1007/s00380-015-0654-4.
  
  Ammirati Enrico, Oliva Fabrizio G, Colombo Tiziano, Russo Claudio F, Cipriani Manlio G, Garascia Andrea, Guida Valentina, Colombo Giulia, Verde Alessandro, Perna Enrico, Cannata Aldo, Paino Roberto, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  There is a paucity of data about mid-term outcome of patients with advanced heart failure (HF) treated with left ventricular assist device (LVAD) in Europe, where donor shortage and their aging limit the availability and the probability of success of heart transplantation (HTx). The aim of this study is to compare Italian single-centre mid-term outcome in prospective patients treated with LVAD vs. HTx. We evaluated 213 consecutive patients with advanced HF who underwent continuous-flow LVAD implant or HTx from 1/2006 to 2/2012, with complete follow-up at 1 year (3/2013). We compared outcome in patients who received a LVAD (n = 49) with those who underwent HTx (n = 164) and in matched groups of 39 LVAD and 39 HTx patients. Patients that were treated with LVAD had a worse risk profile in comparison with HTx patients. Kaplan-Meier survival curves estimated a one-year survival of 75.5 % in LVAD vs. 82.3 % in HTx patients, a difference that was non-statistically significant [hazard ratio (HR) 1.46; 95 % confidence interval (CI) 0.74-2.86; p = 0.27 for LVAD vs. HTx]. After group matching 1-year survival was similar between LVAD (76.9 %) and HTx (79.5 %; HR 1.15; 95 % CI 0.44-2.98; p = 0.78). Concordant data was observed at 2-year follow-up. Patients treated with LVAD as bridge-to-transplant indication (n = 22) showed a non significant better outcome compared with HTx with a 95.5 and 90.9 % survival, at 1- and 2-year follow-up, respectively. Despite worse preoperative conditions, survival is not significantly lower after LVAD than after HTx at 2-year follow-up. Given the scarce number of donors for HTx, LVAD therapy represents a valid option, potentially affecting the current allocation strategy of heart donors also in Europe.
  
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• Levosimendan reverted severe pulmonary hypertension in one patient on waiting list for heart transplantation.
  Int J Cardiol

  2013 Oct;168(4):4518-9. doi: 10.1016/j.ijcard.2013.06.106.
  
  Ammirati Enrico, Musca Francesco, Oliva Fabrizio, Garascia Andrea, Pacher Valentina, Verde Alessandro, Cipriani Manlio, Moreo Antonella, Martinelli Luigi, Frigerio Maria
  
  
  
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• Limited changes in severe functional mitral regurgitation and pulmonary hypertension after left ventricular assist device implantation: a clue to consider concurrent mitral correction?
  Int J Cardiol

  2013 Jul;167(2):e35-7. doi: 10.1016/j.ijcard.2013.03.098.
  
  Ammirati Enrico, Musca Francesco, Cannata Aldo, Garascia Andrea, Verde Alessandro, Pacher Valentina, Moreo Antonella, Oliva Fabrizio, Martinelli Luigi, Frigerio Maria
  
  
  
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• Heart transplantation: 25 years' single-centre experience.
  J Cardiovasc Med (Hagerstown)

  2013 Sep;14(9):637-47. doi: 10.2459/JCM.0b013e32835dbd74.
  
  Bruschi Giuseppe, Colombo Tiziano, Oliva Fabrizio, Botta Luca, Morici Nuccia, Cannata Aldo, Vittori Claudia, Turazza Fabio, Garascia Andrea, Pedrazzini Giovanna, Frigerio Maria, Martinelli Luigi
  
  Abstract
  
  OBJECTIVES:
  Heart transplantation (HTx) is still one of the most effective therapies for end-stage heart disease for patients with no other medical or surgical therapy. We report the results of our 25-year orthotropic HTx single-centre experience.
  
  METHODS:
  From November 1985, 905 orthotopic heart transplants have been performed at our centre. We exclude from the present analysis 13 patients who underwent re-transplantation and 14 pediatric cases (age at HTx
  RESULTS:
  The present study collected the data of 878 primary adult orthotopic HTx performed at our centre. Mean age at HTx was of 49.6?±?11.6 years. Mean donor age was 36.9?±?14.8 years. Hospital mortality was 11.6% (102 patients), early graft failure was the principal cause of death (58 patients) followed by infections (18 cases) and acute rejection (7 patients). Overall actuarial survival was 78.1% at 5 years and 63.8% and 47.5%, respectively, at 10 and 15 years from HTx. Mean survival was 10.74 years; 257 late deaths were reported (33.1%); main causes were neoplasm in 83 patients, and cardiac causes included coronary allograft vasculopathy in 78 patients. Freedom from any infection at 5, 10 and 15 years was 52.2, 44.1 and 40.1%, respectively. Freedom from rejection at 5 years was 36.2%, with 493 patients experiencing at last one episode of rejection, the majority occurring during the first 2 months after transplantation. The long-term survival of HTx recipients is limited in large part by the development of coronary artery vasculopathy and malignancies. In our experience freedom from coronary allograft vasculopathy at 10 years was 66.9%, and 85 patients underwent percutaneous coronary revascularization. In our study population, 44 patients experienced posttransplant lymphoproliferative disorder and 91 patients experienced a solid neoplasm, mean survival free from neoplasm was 12.23 years.
  
  CONCLUSION:
  Over the past four decades the field of HTx has evolved considerably, with improvements in surgical techniques and postoperative patients' care. A careful patient selection and treatment of candidates for transplantation as well as accurate clinical follow-up combined with real multidisciplinary teamwork that involved different heart failure specialists, allowed us to obtain our excellent long-term results.
  
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• [What's essential, what's useful and what's superfluous in patients with dilated cardiomyopathy].
  Ital Heart J

  2005 May;6 Suppl 2():28S-34S.
  
  Frigerio Maria, Garascia Andrea, Foti Grazia, Masciocco Gabriella, Distefano Giada, Roubina Elena, Resta Davide
  
  
  
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• [Advanced heart failure: therapeutic options. Opinion of the surgeon cardiologist].
  Ital Heart J

  2002 Oct;3 Suppl 6():65S-70S.
  
  Bruschi Giuseppe, Colombo Tiziano, Garatti Andrea, Fratto Pasquale, Ribera Elena, Garascia Andrea, Oliva Fabrizio, Frigerio Maria, Vitali Ettore
  
  
  
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