Dott. Oliva Fabrizio

Pubblicazioni su PubMed

• Sex-related differences in demographics, diagnosis and management of patients with chronic coronary syndromes.
  J Cardiovasc Med (Hagerstown)

  2024 Dec;25(12):845-853. doi: 10.2459/JCM.0000000000001675.
  
  Mojoli Marco, Temporelli Pier Luigi, Pavan Daniela, Abrignani Maurizio Giuseppe, Gonzini Lucio, Lucci Donata, Piscione Federico, Provasoli Stefano, Gulizia Michele Massimo, Gabrielli Domenico, Colivicchi Furio, Oliva Fabrizio, De Luca Leonardo,
  
  Abstract
  
  AIMS:
  The impact of sex-related factors on current clinical management and outcomes of chronic coronary syndromes (CCS) are unclear.
  
  METHODS:
  All patients belonging to the prospective, nationwide START registry were included. Their baseline characteristics, diagnostic workup, revascularization strategy, pharmacological treatment and 1-year clinical outcomes were compared with respect to sex overall and in age tertiles.
  
  RESULTS:
  A total of 5070 consecutive patients were included. Most patients were males (80.1%). As expected, the prevalence of females increased with age. Distribution of risk factors and history of cardiovascular disease were different depending on sex, as well as diagnostic workup, with lower use of exercise stress testing in women (25.1% vs. 36.7%, P?0.0001). The use of coronary angiography was similar in the two groups. Women had lower rates of multivessel coronary artery disease (CAD) (33.0% vs. 40.6% P?0.0001) and higher rates of nonobstructive CAD (18.3% vs. 11.3%, P?0.0001). Rates of myocardial revascularization were similar, but women were more likely to receive percutaneous coronary intervention than men (84.3% vs. 77.8%, P?0.0001) and less likely to receive surgical/hybrid revascularization (10.0% vs. 15.1%, P?0.0001). At 12-month follow-up, no differences were observed for the combined endpoint of all-cause mortality, re-hospitalization for myocardial infarction, heart failure, stroke or myocardial revascularization between males and females; however, a significantly worse perceived quality of life was observed in women.
  
  CONCLUSIONS:
  In a large nationwide cohort of patients with CCS, clinical outcomes were not different depending on sex. However, several differences in the diagnostic work-up, treatment strategies and quality of life were found between sexes.
  
  Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.
  
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• Temporal trends (2003-2018) of in-hospital and 30-day mortality in patients hospitalized with acute heart failure.
  Int J Cardiol

  2024 Nov;419():132693. doi: 10.1016/j.ijcard.2024.132693.
  
  Marenzi Giancarlo, Cosentino Nicola, Imparato Livio, Trombara Filippo, Leoni Olivia, Bortolan Francesco, Franchi Matteo, Rurali Erica, Poggio Paolo, Campodonico Jeness, Oliva Fabrizio, Bonomi Alice, Agostoni Piergiuseppe
  
  Abstract
  
  BACKGROUND:
  Limited temporal data on in-hospital mortality trends of patients hospitalized with acute heart failure (AHF) have been reported. We evaluated whether, in AHF hospitalized patients, the rate of in-hospital and 30-day mortality, and 30-day re-hospitalization for AHF have changed in the past 15 years.
  
  METHODS AND RESULTS:
  We examined administrative data from the Lombardy region, Italy and analysed data of all adults hospitalized for AHF from 2003 to 2018. Patients were stratified according to the hospitalization period: 2003-2006; 2007-2010; 2011-2014; 2015-2018. Primary endpoint was the comparison of in-hospital mortality rates among periods. Secondary endpoints were 30-day mortality rates and temporal trends of re-hospitalization for AHF. During this period, 414,164 hospitalizations with a primary diagnosis of AHF were identified, involving 286,028 patients aged 18 and older. In-hospital and 30-day mortality in the entire cohort showed a progressive increase over time (from 6.7 % to 8.5 % and from 12.4 % to 14.5 %, respectively). Thirty-day re-hospitalization for AHF was 2 %, showing a progressive decrease over the years. However, patient' age and complexity increased in the most recently hospitalized patients. After adjusting for major confounders, in-hospital and 30-day mortality risks were similar moving from one study period to the next (relative risk for trend 1.00 [95 % CI 0.99-1.01] and 1.00 [95 % CI 0.98-1.01], respectively), while that of 30-day AHF re-hospitalization decreased progressively (hazard ratio for trend 0.86 [95 % CI 0.84-0.88]).
  
  CONCLUSIONS:
  In our study, the increasing age and complexity of patients largely accounted for the continued rise in early mortality observed in patients hospitalized with AHF.
  
  Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.
  
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• [Polygenic risk score: a new approach to cardiovascular prevention?].
  G Ital Cardiol (Rome)

  2024 Nov;25(11):775-782. doi: 10.1714/4352.43387.
  
  Amico Antonio Francesco, Abrignani Maurizio Giuseppe, Colivicchi Furio, Di Fusco Stefania Angela, Geraci Giovanna, Grimaldi Massimo, Lucà Fabiana, Oliva Fabrizio, Nardi Federico, Rao Carmelo Massimiliano, Riccio Carmine
  
  Abstract
  
  Long-lasting epidemiological studies showed that prevention of coronary artery disease (CAD) is highly feasible with the management of several conditions called "risk factors", such as hypertension, cholesterol, smoking, etc. Nevertheless, risk stratification for primary prevention using a statistical combination of risk factors is suboptimal, as conventional risk factors are age-dependent, so that their treatment would be too late to be effective. Genetic risk stratification, built on the genetic variants linked to CAD, has the advantage of being embedded in DNA and then it is independent of age. The rapid advancement of DNA analysis techniques has made it possible to identify many variants and to produce easily a statistical combination of them to obtain a polygenic risk score (PRS). Prospective clinical trials based on risk stratification for CAD using the PRS have shown that statin therapy is associated with a higher reduction in cardiac events in the high genetic risk group compared with the low genetic risk group. A wide clinical use of the PRS, however, is presently not possible, basically due to the lack of a standard in production and validation of the PRS, but genetic risk stratification has the potential to revolutionize primary prevention.
  
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• Italian Cardiological Guidelines (COCIS) for Competitive Sport Eligibility in athletes with heart disease: update 2024.
  Minerva Med

  2024 Oct;115(5):533-564. doi: 10.23736/S0026-4806.24.09519-3.
  
  Zeppilli Paolo, Biffi Alessandro, Cammarano Michela, Castelletti Silvia, Cavarretta Elena, Cecchi Franco, Colivicchi Furio, Contursi Maurizio, Corrado Domenico, D'Andrea Antonello, Deferrari Francesco, Delise Pietro, Dello Russo Antonio, Gabrielli Domenico, Giada Franco, Indolfi Ciro, Maestrini Viviana, Mascia Giuseppe, Mos Lucio, Oliva Fabrizio, Palamà Zefferino, Palermi Stefano, Palmieri Vincenzo, Patrizi Giampiero, Pelliccia Antonio, Perrone Filardi Pasquale, Porto Italo, Schwartz Peter J, Scorcu Marco, Sollazzo Fabrizio, Spampinato Andrea, Verzeletti Andrea, Zorzi Alessandro, D'Ascenzi Flavio, Casasco Maurizio, Sciarra Luigi
  
  Abstract
  
  Nearly 35 years after its initial publication in 1989, the Italian Society of Sports Cardiology and the Italian Federation of Sports Medicine (FMSI), in collaboration with other leading Italian Cardiological Scientific Associations (ANCE - National Association of Outpatient Cardiology, ANMCO - National Association of Inpatient Cardiology, SIC - Italian Society of Cardiology), proudly present the 2023 version of the Cardiological Guidelines for Competitive Sports Eligibility. This publication is an update of the previous guidelines, offering a comprehensive and detailed guide for the participation of athletes with heart disease in sports. This edition incorporates the latest advances in cardiology and sports medicine, providing current information and recommendations. It addresses various topics, including the details of the pre-participation screening in Italy and recommendations for sports eligibility and disqualification in competitive athletes with various heart conditions. This revised version of the Cardiological Guidelines for Competitive Sports Eligibility, recorded in the Italian Guidelines Registry of the Italian Minister of Health, stands as a crucial resource for sports medicine professionals, cardiologists, and healthcare providers, marked by its completeness, reliability, and scientific thoroughness. It is an indispensable tool for those involved in the care, management and eligibility process of competitive athletes with heart conditions.
  
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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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• Acute Coronary Syndrome in Elderly Patients: How to Tackle Them?
  J Clin Med

  2024 Oct;13(19):. doi: 5935.
  
  Lucà Fabiana, Andreotti Felicita, Rao Carmelo Massimiliano, Pelaggi Giuseppe, Nucara Mariacarmela, Ammendolea Carlo, Pezzi Laura, Ingianni Nadia, Murrone Adriano, Del Sindaco Donatella, Lettino Maddalena, Geraci Giovanna, Riccio Carmine, Bilato Claudio, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio, Gulizia Michele Massimo, Parrini Iris,
  
  Abstract
  
  Elderly patients diagnosed with acute coronary syndromes (ACS) represent a growing demographic population. These patients typically present more comorbidities and experience poorer outcomes compared to younger patients. Furthermore, they are less frequently subjected to revascularization procedures and are less likely to receive evidence-based medications in both the short and long-term periods. Assessing frailty is crucial in elderly patients with ACS because it can influence management decisions, as well as risk stratification and prognosis. Indeed, treatment decisions should consider geriatric syndromes, frailty, polypharmacy, sarcopenia, nutritional deficits, prevalence of comorbidities, thrombotic risk, and, at the same time, an increased risk of bleeding. Rigorous clinical assessments, clear revascularization criteria, and tailored approaches to antithrombotic therapy are essential for guiding personalized treatment decisions in these individuals. Assessing frailty helps healthcare providers identify patients who may benefit from targeted interventions to improve their outcomes and quality of life. Elderly individuals who experience ACS remain significantly underrepresented and understudied in randomized controlled trials. For this reason, the occurrence of ACS in the elderly continues to be a particularly complex issue in clinical practice, and one that clinicians increasingly have to address, given the general ageing of populations. This review aims to address the complex aspects of elderly patients with ACS to help clinicians make therapeutic decisions when faced with such situations.
  
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• Role of PCSK9 Inhibitors in Venous Thromboembolism: Current Evidence and Unmet Clinical Needs.
  Eur Heart J Cardiovasc Pharmacother

  2024 Oct;():. doi: pvae076.
  
  Zuin Marco, Corsini Alberto, Dalla Valle Chiara, De Rosa Catia, Maloberti Alessandro, Mojoli Marco, Rizzo Massimiliano, Ciccirillo Francesco, Madrid Alfredo, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio, Temporelli Pier Luigi
  
  Abstract
  
  Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have recently emerged as promising therapeutic agents for lowering low-density lipoprotein cholesterol and reducing the risk of cardiovascular events. Moreover, preliminary evidence from randomized controlled trials (RCTs) suggests that PCSK9i may also offer beneficial effects for patients following venous thromboembolism (VTE), with the most significant reductions in risk appearing over time, particularly beyond the first year of treatment. However, there is a lack of randomized controlled data supporting their efficacy and safety in conjunction with standard anticoagulation therapy. This article aims to critically evaluate the existing evidence for the use of PCSK9i as a complementary therapy for VTE risk reduction, while also identifying unmet clinical and research needs and proposing potential strategies to address these knowledge gaps.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Low-Density Lipoprotein Cholesterol Goal Achievement and Self-Reported Medication Adherence: Insights from the JET-LDL Registry.
  Am J Cardiol

  2024 Sep;233():55-61. doi: 10.1016/j.amjcard.2024.09.022.
  
  Munafò Andrea Raffaele, Ferlini Marco, Varbella Ferdinando, Delnevo Fabrizio, Solli Martina, Trabattoni Daniela, Raone Luca, Cardile Antonio, Canova Paolo, Rossini Roberta, Celentani Dario, Maltese Ludovica, Taglialatela Vittorio, Pierini Simona, Rognoni Andrea, Oliva Fabrizio, Porto Italo, Carugo Stefano, Castiglioni Battistina, Lettieri Corrado, Chinaglia Alessandra, Currao Alessia, Patti Giuseppe, Visconti Luigi Oltrona, Musumeci Giuseppe
  
  Abstract
  
  In patients with recent acute coronary syndromes (ACS), current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level 50% from baseline or level
  Copyright © 2024 Elsevier Inc. All rights reserved.
  
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• Clinical profile and management of patients with acute myocardial infarction admitted to cardiac care units: The EYESHOT-2 registry.
  Int J Cardiol

  2025 Jan;418():132601. doi: 10.1016/j.ijcard.2024.132601.
  
  De Luca Leonardo, Maggioni Aldo Pietro, Cavallini Claudio, Leonardi Sergio, Lucci Donata, Sacco Alice, di Uccio Fortunato Scotto, Valente Serafina, Navazio Alessandro, Pascale Vittorio, Geraci Giovanna, Lanni Francesca, Gulizia Michele Massimo, Colivicchi Furio, Gabrielli Domenico, Oliva Fabrizio,
  
  Abstract
  
  BACKGROUND:
  The clinical governance of patients with acute myocardial infarction (AMI) has markedly changed in the last few years. We sought to assess the contemporary in-hospital management patterns of patients with AMI at a country level.
  
  METHODS:
  EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units)-2 was a nationwide, prospective registry aimed to evaluate the current management of patients admitted to intensive cardiac care units (CCUs) for an AMI in Italy.
  
  RESULTS:
  Over a 4-week period (February 1st-29th, 2024), 183 CCUs enrolled 2806 consecutive patients: 52.6 % with non-ST elevation myocardial infarction (NSTEMI) and 47.4 % with ST-elevation myocardial infarction (STEMI). The median time from hospital admission to angiography in NSTEMI was 22.3 h (IQR 10.9-46.1), while for STEMI was 1.1 h (IQR 0.5-2.2) with significant difference between hospitals with and without catheterization laboratories. In both NSTEMI and STEMI patients, percutaneous coronary intervention (PCI) was the preferred management strategy (73.3 % and 94.2 %, respectively). An optimal secondary prevention therapy, including dual antiplatelet therapy, inhibition of the renin-angiotensin system, a beta-blocker and a high-intensity statin was prescribed at discharge in more than 75 % of patients with AMI. In-hospital major bleedings occurred in 2.0 % and 2.3 % (p = 0.58), while death in 1.8 % and 2.8 % (p = 0.09) of NSTEMI and STEMI patients, respectively.
  
  CONCLUSIONS:
  The EYESHOT-2 registry shows the current management strategies and outcome of AMI patients admitted to Italian CCUs and provides insights to improve the clinical care of such patients.
  
  CLINICAL TRIAL REGISTRATION:
  URL: http://www.
  
  CLINICALTRIALS:
  gov. Unique identifier: NCT06316128.
  
  Copyright © 2024 Elsevier B.V. All rights reserved.
  
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• [Reply to "Shortage of specialists in cardiology and interaction between hospitals: some considerations"].
  G Ital Cardiol (Rome)

  2024 Oct;25(10):763-764. doi: 10.1714/4336.43221.
  
  Zuin Marco, Di Fusco Stefania Angela, Zilio Filippo, Bilato Claudio, Oliva Fabrizio
  
  
  
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• [Atherosclerosis, cancer and immune checkpoint inhibitors].
  G Ital Cardiol (Rome)

  2024 Oct;25(10):711-719. doi: 10.1714/4336.43213.
  
  Canale Maria Laura, Greco Alessandra, Inno Alessandro, Tedeschi Andrea, De Biasio Marzia, Oliva Stefano, Bisceglia Irma, Maurea Nicola, Tarantini Luigi, Gallucci Giuseppina, Gulizia Michele Massimo, Turazza Fabio Maria, Lucà Fabiana, Di Fusco Stefania Angela, Riccio Carmine, Navazio Alessandro, De Luca Leonardo, Gabrielli Domenico, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio
  
  Abstract
  
  Immunotherapy has revolutionized the treatment of various cancers leading to a clear survival benefit with cured or long-surviving patients. Atherosclerosis and cancer share risk factors and molecular mechanisms and have as their common thread a state of chronic inflammation linked to a deregulation of the immune system. A growing body of evidence is accumulating on the potential worsening effect of immune checkpoint inhibitors on atherosclerosis, with subsequent worsening of patients' long-term cardiovascular risk. The molecular pathways implicated in the growth and deregulation of atherosclerotic plaques seem to be the same (CTLA-4, PD-1, PD-L1) as those on which the anti-tumor effect is exerted. Owing to the increasing number of cancer patients treated with immunotherapy and the improved survival with the possibility of prolonged disease control, it is necessary to know the potential increase in cardiovascular risk for atherosclerosis-related events and to establish all prevention measures to reduce it.
  
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• [Ten questions about infective endocarditis].
  G Ital Cardiol (Rome)

  2024 Oct;25(10):699-710. doi: 10.1714/4336.43212.
  
  Fortuni Federico, Ciliberti Giuseppe, Marsan Nina Ajmone, Delgado Victoria, Franchin Luca, Magnesa Michele, Spinelli Antonella, Vitale Enrica, Cangemi Stefano, Cornara Stefano, Gabrielli Domenico, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio
  
  Abstract
  
  Infective endocarditis (IE) is an infective process involving the endocardium and, more frequently, the native heart valves, valvular prostheses and cardiac implantable electronic devices. IE can manifest with various non-specific symptoms making the diagnosis challenging. This condition is associated with high in-hospital and long-term mortality. Therefore, it is particularly important to prevent it by implementing an adequate antibiotic prophylaxis especially in patients at high risk undergoing invasive procedures. Moreover, it is pivotal to promptly diagnose IE, detect the presence of local and systemic complications, establish appropriate antibiotic therapy and identify the indication and timing for surgical treatment. In this focused review, we will provide answers to the most common questions regarding the epidemiology, causes, prophylaxis, diagnosis and antibiotic and surgical treatment of IE.
  
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• Unveiling an insidious diagnosis and its implications for clinical practice: Individual patient data systematic review of pregnancy-associated spontaneous coronary artery dissection.
  Int J Cardiol

  2025 Jan;418():132582. doi: 10.1016/j.ijcard.2024.132582.
  
  Milani Martina, Bertaina Maurizio, Ardissino Maddalena, Iannaccone Mario, Boccuzzi Giacomo Giovanni, Tavecchia Giovanni, Oliva Fabrizio, Sacco Alice
  
  Abstract
  
  BACKGROUND:
  Pregnancy-Associated Spontaneous Coronary Artery Dissection (P-SCAD) is the most common cause of myocardial infarction in pregnancy and postpartum. Aim of this systematic review is to provide a descriptive picture of P-SCAD presentation, clinical course, management and outcomes.
  
  METHODS:
  International databases were systematically screened up to November 2023 and all published P-SCAD case reports/series identified; additionally, we gathered four original cases, establishing a new database for the derived cohort.
  
  RESULTS:
  253 studies (215 case reports, 38 case series) were included for the analysis, enrolling 316 patients admitted between 1952 and 2023. Median age was 34 (SD 5) years old, 64 (20.4 %) were prepartum, 249 (79.6 %) postpartum. Most common presentation was ST-elevation myocardial infarction (72.6 %). Cardiac arrest and cardiogenic shock occurred in 18.4 % and 16.1 %, respectively. Multivessel dissection was present in 45.2 % of cases, with left anterior descending artery being most frequently affected (74.4 %). Initial therapeutic strategy was medical therapy in 54.8 % while upfront revascularization was performed in 45.2 % of cases. Excluding autoptic studies, mortality rate was 4.1 %, without significant differences between pre and postpartum SCAD (p-value 0.6) or according to initial therapeutic approach (p-value 0.5). Recurrences after index event were registered in 74 patients (23.4 %), being more common after medical treatment than in case of immediate revascularization (30.8 versus 18.3 %, p-value 0.02).
  
  CONCLUSIONS:
  P-SCAD is a complex clinical scenario: timely diagnosis is difficult, therapeutic management not well-defined, rate of recurrences not negligible. Additional observational studies and dedicated registries are necessary to enhance the management of this rare but severe condition.
  
  Copyright © 2024 Elsevier B.V. All rights reserved.
  
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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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• [Low and very low cholesterol levels: what we need to know].
  G Ital Cardiol (Rome)

  2024 Sep;25(9):650-659. doi: 10.1714/4318.43039.
  
  Di Fusco Stefania Angela, Leggio Massimo, Gil Ad Vered, Giubilato Simona, Aquilani Stefano, Nardi Federico, Grimaldi Massimo, Gabrielli Domenico, Oliva Fabrizio, Imperoli Giuseppe, Colivicchi Furio,
  
  Abstract
  
  Due to the growing evidence of clinical benefits conferred by the reduction of low-density lipoprotein cholesterol (LDL-C) levels, the availability of multiple effective lipid-lowering agents, and guideline recommendations, clinicians not infrequently have to manage patients with low or very low LDL-C levels. In clinical practice it is essential to consider that, when LDL-C plasma concentrations are low, the Friedewald formula commonly used for LDL-C level calculation is less accurate, hence risk assessment should be integrated by using different methods for LDL-C level quantification and other parameters, such as non-high-density lipoprotein cholesterol and, where possible, apolipoprotein B, should be measured. As regards the clinical impact of low LDL-C levels, genetically determined hypocholesterolemia forms provide reassuring data on the effects of this condition in the long term, except for the forms with extremely low or undetectable LDL-C levels. Evidence from clinical studies that used highly effective lipid-lowering drugs, such as proprotein convertase subtilisin/kexin type 9 inhibitors, goes in the same direction. In these studies, the incidence of non-cardiovascular adverse events in patients who reached very low LDL-C levels was similar to that in the placebo arm. Overall, the fear of adverse effects should not deter intensive lipid-lowering treatment when indicated to reduce the risk of cardiovascular events.
  
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• Current use of echocardiography in cardio-oncology: nationwide real-world data from an ANMCO/SIECVI joint survey.
  Eur Heart J Imaging Methods Pract

  2024 Jul;2(3):qyae081. doi: qyae081.
  
  Barbieri Andrea, Camilli Massimiliano, Bisceglia Irma, Mantovani Francesca, Ciampi Quirino, Zito Concetta, Canale Maria Laura, Khoury Georgette, Antonini-Canterin Francesco, Carerj Scipione, Campana Marco, Riccio Carmine, Gulizia Michele Massimo, Grimaldi Massimo, Gabrielli Domenico, Colivicchi Furio, Pepi Mauro, Oliva Fabrizio
  
  Abstract
  
  AIMS:
  The need for cardio-oncology competencies is constantly growing, and with the establishment of cardio-oncology services, cardiovascular imaging, particularly transthoracic echocardiography (TTE), has become pivotal in patients' management. However, care pathways for oncologic patients largely depend on local health structures' resources. This survey from Associazione Italiana Medici Cardiologi Ospedalieri and the Italian Society of Echocardiography and Cardiovascular Imaging aimed at investigating the use of echocardiography in cardio-oncology services and knowledge levels on cancer patients' care.
  
  METHODS AND RESULTS:
  Data were obtained via an electronic survey based on a structured questionnaire uploaded to the promoting societies' websites. Responses came from 159 centres with echocardiography. According to one-third of participating centres, workload related to cancer patients represented >30% of the total requests. The most common TTE indication (85%) was left ventricular ejection fraction (LVEF) evaluation. Many centres (55%) still assessed LVEF solely by bidimensional method or visual estimation in case of inadequate acoustic windows. At the same time, almost 40% of centres reported routinely using global longitudinal strain when feasible. We further performed a sub-analysis according to the presence (33%) or absence (77%) of dedicated cardio-oncologists, revealing significant differences in cardiovascular surveillance strategies and cardiotoxicity management.
  
  CONCLUSION:
  This survey on echocardiography practice for cancer patients reveals a significant gap between actual clinical practice and standards proposed by recommendations, underlying the need for stronger partnerships between cardiologists and oncologists and dedicated, well-structured cardio-oncology services.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Takotsubo Syndrome and Gender Differences: Exploring Pathophysiological Mechanisms and Clinical Differences for a Personalized Approach in Patient Management.
  J Clin Med

  2024 Aug;13(16):. doi: 4925.
  
  Giubilato Simona, Francese Giuseppina Maura, Manes Maria Teresa, Rossini Roberta, Della Bona Roberta, Gatto Laura, Di Monaco Antonio, Zilio Filippo, Gasparetto Nicola, Sorini Dini Carlotta, Borrello Francesco, Mannarini Antonia, Scardovi Angela Beatrice, Pavan Daniela, Amico Francesco, Geraci Giovanna, Riccio Carmine, Colivicchi Furio, Grimaldi Massimo, Gulizia Michele Massimo, Oliva Fabrizio
  
  Abstract
  
  Takotsubo syndrome (TTS), also known as the broken-heart syndrome, is a reversible condition typically observed in female patients presenting for acute coronary syndromes (ACS). Despite its increasing incidence, TTS often remains undiagnosed due to its overlap with ACS. The pathophysiology of TTS is complex and involves factors such as coronary vasospasm, microcirculatory dysfunction, increased catecholamine levels, and overactivity of the sympathetic nervous system. Diagnosing TTS requires a comprehensive approach, starting with clinical suspicion and progressing to both non-invasive and invasive multimodal tests guided by a specific diagnostic algorithm. Management of TTS should be personalized, considering potential complications, the presence or absence of coronary artery disease (CAD), diagnostic test results, and the patient's clinical course. The current data primarily derive from case series, retrospective analyses, prospective registries, and expert opinions. In recent years, there has been growing recognition of gender differences in the pathophysiology, presentation, and outcomes of TTS. This review provides an updated overview of gender disparities, highlighting the importance of tailored diagnostic and management strategies.
  
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• Multidisciplinary Approach in Atrial Fibrillation: As Good as Gold.
  J Clin Med

  2024 Aug;13(16):. doi: 4621.
  
  Lucà Fabiana, Abrignani Maurizio Giuseppe, Oliva Fabrizio, Canale Maria Laura, Parrini Iris, Murrone Adriano, Rao Carmelo Massimiliano, Nesti Martina, Cornara Stefano, Di Matteo Irene, Barisone Michela, Giubilato Simona, Ceravolo Roberto, Pignalberi Carlo, Geraci Giovanna, Riccio Carmine, Gelsomino Sandro, Colivicchi Furio, Grimaldi Massimo, Gulizia Michele Massimo
  
  Abstract
  
  Atrial fibrillation (AF) represents the most common sustained arrhythmia necessitating dual focus: acute complication management and sustained longitudinal oversight to modulate disease progression and ensure comprehensive patient care over time. AF is a multifaceted disorder; due to such a great number of potential exacerbating conditions, a multidisciplinary team (MDT) should manage AF patients by cooperating with a cardiologist. Effective management of AF patients necessitates the implementation of a well-coordinated and tailored care pathway aimed at delivering optimized treatment through collaboration among various healthcare professionals. Management of AF should be carefully evaluated and mutually agreed upon in consultation with healthcare providers. It is crucial to recognize that treatment may evolve due to the emergence of new risk factors, symptoms, disease progression, and advancements in treatment modalities. In the context of multidisciplinary AF teams, a coordinated approach involves assembling a diverse team tailored to meet individual patients' unique needs based on local services' availability.
  
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• The relative impact of components of high residual risk on the long-term prognosis after AMI.
  Int J Cardiol Cardiovasc Risk Prev

  2024 Sep;22():200310. doi: 200310.
  
  Mureddu Gian Francesco, D'Errigo Paola, Rosato Stefano, Faggiano Pompilio, Badoni Gabriella, Ceravolo Roberto, Altamura Vito, Di Martino Mirko, Ambrosetti Marco, Oliva Fabrizio, Ciccarelli Paola, Baglio Giovanni
  
  Abstract
  
  BACKGROUND:
  The reduction in long-term mortality after acute myocardial infarction (AMI) is less pronounced than that of in-hospital mortality among patients with AMI complicated by heart failure (HF) and/or in those with a high residual thrombotic risk (HTR).
  
  AIM:
  To investigate the relative prognostic significance of HTR and HF in AMI survivors.
  
  METHODS:
  This retrospective cohort study enrolled patients admitted for AMI in 2014-2015 in all Italian hospitals. HTR was defined as at least one of the following conditions: previous AMI, ischemic stroke or other vascular disease, type 2 diabetes, renal failure. Patients were classified into four categories: uncomplicated AMI; AMI with HTR; AMI with HF and AMI with both HTR and HF (HTR + HF). Cox proportional hazard model was used to evaluate the impact of HTR, HF and HTR + HF on the 5-year prognosis. A time-varying coefficient analysis was performed to estimate the 5-year trend of HR for major averse cardiac and cerebrovascular events (MACCE).
  
  RESULTS:
  a total of 174.869 AMI events were identified. The adjusted 5-year HR for MACCE was 1.74 (p 
  CONCLUSION:
  Either HRT and HF confer an increased 5-year hazard of MACCE after AMI. The coexistence of HTR and HF doubled the overall 5-year risk of MACCE after AMI.
  
  © 2024 The Authors. Published by Elsevier B.V.
  
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• Ventilation strategies in cardiogenic shock: Insights from the AltShock-2 registry.
  Eur J Heart Fail

  2024 Aug;():. doi: 10.1002/ejhf.3409.
  
  Sacco Alice, Montisci Andrea, Tavecchia Giovanni, Frea Simone, Bernasconi Davide, Colombo Costanza N J, Bertolin Stephanie, Viola Giovanna, Villanova Luca, Briani Martina, Patrini Lisa, Bocchino Pier Paolo, Sorini Dini Carlotta, D'Ettore Nicoletta, Bertaina Maurizio, Iannaccone Mario, Potena Luciano, Bertoldi Letizia, Valente Serafina, Camporotondo Rita, Marini Marco, Pagnesi Matteo, Metra Marco, De Ferrari Gaetano, Oliva Fabrizio, Morici Nuccia, Pappalardo Federico, Tavazzi Guido,
  
  Abstract
  
  AIMS:
  To describe the use and the relation to outcome of different ventilation strategies in a contemporary, large, prospective registry of cardiogenic shock patients.
  
  METHODS AND RESULTS:
  Among 657 patients enrolled from March 2020 to November 2023, 198 (30.1%) received oxygen therapy (OT), 96 (14.6%) underwent non-invasive ventilation (NIV), and 363 (55.3%) underwent invasive mechanical ventilation (iMV). Patients in the iMV group were significantly younger compared to those in the NIV and OT groups (63 vs. 69?years, p?0.001). There were no significant differences between groups regarding cardiovascular risk factors. Patients with SCAI B and C were more frequently treated with OT and NIV compared to iMV (65.1% and 65.4% vs. 42.6%, respectively, p?>?0.001), while the opposite trend was observed in SCAI D patients (12% and 12.2% vs. 30.9%, respectively, p?0.001). All-cause mortality at 24?h did not differ amongst the three groups. The 60-day mortality rates were 40.2% for the iMV group, 26% for the OT group, and 29.3% for the NIV group (p?=?0.005), even after excluding patients with cardiac arrest at presentation. In the multivariate analysis including SCAI stages, NIV was not associated with worse mortality compared to iMV (hazard ratio 1.97, 95% confidence interval 0.85-4.56), even in more severe SCAI stages such as D.
  
  CONCLUSIONS:
  Compared to previous studies, we observed a rising trend in the utilization of NIV among cardiogenic shock patients, irrespective of aetiology and SCAI stages. In this clinical scenario, NIV emerges as a safe option for appropriately selected patients.
  
  © 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
  
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• The Challenge of Managing Atrial Fibrillation during Pregnancy.
  Rev Cardiovasc Med

  2023 Oct;24(10):279. doi: 279.
  
  Lucà Fabiana, Oliva Fabrizio, Abrignani Maurizio Giuseppe, Russo Maria Giovanna, Parrini Iris, Cornara Stefano, Ceravolo Roberto, Rao Carmelo Massimiliano, Favilli Silvia, Pozzi Andrea, Giubilato Simona, Di Fusco Stefania Angela, Sarubbi Berardo, Calvanese Raimondo, Chieffo Alaide, Gelsomino Sandro, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Gulizia Michele Massimo, The Management And Quality Working Group Pediatric Cardiology Working Group And Arrhythmias Working Groups Anmco On Behalf Of
  
  Abstract
  
  The incidence of atrial fibrillation (AF) during pregnancy increases with maternal age and with the presence of structural heart disorders. Early diagnosis and prompt therapy can considerably reduce the risk of thromboembolism. The therapeutic approach to AF during pregnancy is particularly challenging, and the maternal and fetal risks associated with the use of antiarrhythmic and anticoagulant drugs must be carefully evaluated. Moreover, the currently used thromboembolic risk scores have yet to be validated for the prediction of stroke during pregnancy. At present, electrical cardioversion is considered to be the safest and most effective strategy in women with hemodynamic instability. Beta-selective blockers are also recommended as the first choice for rate control. Antiarrhythmic drugs such as flecainide, propafenone and sotalol should be considered for rhythm control if atrioventricular nodal-blocking drugs fail. AF catheter ablation is currently not recommended during pregnancy. Overall, the therapeutic strategy for AF in pregnancy must be carefully assessed and should take into consideration the advantages and drawbacks of each aspect. A multidisciplinary approach with a "Pregnancy-Heart Team" appears to improve the management and outcome of these patients. However, further studies are needed to identify the most appropriate therapeutic strategies for AF in pregnancy.
  
  Copyright: © 2023 The Author(s). Published by IMR Press.
  
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• [Contemporary diagnosis and treatment of tricuspid regurgitation: from neglected valve to primetime].
  G Ital Cardiol (Rome)

  2024 Aug;25(8):576-589. doi: 10.1714/4309.42927.
  
  Montalto Claudio, Tognola Chiara, Ghidini Simone, Monticelli Massimiliano, Nava Stefano, Soriano Francesco, Munafò Andrea R, Tavoletta Pasquale, Bruschi Giuseppe, Esposito Giuseppe, Mangieri Antonio, Giannattasio Cristina, De Marco Federico, Oliva Fabrizio, Oreglia Jacopo A
  
  Abstract
  
  Tricuspid insufficiency has long been considered an entity with low prognostic importance and associated with symptoms and signs only secondarily to left heart pathology. Scientific research in recent years has debunked this myth, demonstrating a key role in determining symptoms and signs of right heart failure, even in advanced stages. In parallel, advances in transcatheter technologies have opened up treatment options even for patients with increased surgical risk, who were previously excluded from traditional surgical options, with increasingly convincing results in reducing symptoms and improving the quality of life of our patients. The contemporary challenge is to translate these messages into everyday clinical practice and to encourage the centralization of patients in centers that currently have the expertise for feasibility evaluation and subsequent treatment. In this Review, we will analyze the most recent evidence on the pathophysiology and diagnosis of tricuspid insufficiency, the latest recommendations from European guidelines, and we will try to illustrate the most common technologies for percutaneous treatment and the abundant evidence supporting them.
  
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• [Substance abuse and cardiovascular risk: energy drinks].
  G Ital Cardiol (Rome)

  2024 Aug;25(8):546-556. doi: 10.1714/4309.42924.
  
  Ciliberti Giuseppe, Abrignani Maurizio Giuseppe, Zilio Filippo, Temporelli Pier Luigi, Ciccirillo Francesco, Fortuni Federico, Binaghi Giulio, Iannopollo Gianmarco, Cappelletto Chiara, Albani Stefano, Maloberti Alessandro, Ceriello Laura, Musella Francesca, Manfredi Roberto, Scicchitano Pietro, Riccio Carmine, Grimaldi Massimo, Gabrielli Domenico, Colivicchi Furio, Oliva Fabrizio,
  
  Abstract
  
  The consumption of energy drinks (ED) has become a growing public health issue, since potentially ED-related serious adverse cardiovascular events, including arrhythmias, myocardial infarction, cardiomyopathies, and sudden cardiac death, have been reported in recent years. The substances contained in ED include caffeine, taurine, sugars, B group vitamins and phyto-derivatives, which, especially if taken in large quantities and in a short amount of time, could cause serious side effects through various mechanisms of action, such as increased blood pressure and QT interval prolongation. Although there are still many open questions on ED that require further specific investigations, there is an urgent need for information and educational plans to the population, as well as for regulatory actions, particularly regarding transparency of substances and possible adverse effects.
  
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• A Comprehensive Geriatric Workup and Frailty Assessment in Older Patients with Severe Aortic Stenosis.
  J Clin Med

  2024 Jul;13(14):. doi: 4169.
  
  Brunetti Enrico, Lucà Fabiana, Presta Roberto, Marchionni Niccolò, Boccanelli Alessandro, Ungar Andrea, Rao Carmelo Massimiliano, Ingianni Nadia, Lettino Maddalena, Del Sindaco Donatella, Murrone Adriano, Riccio Carmine, Colivicchi Furio, Grimaldi Massimo, Gulizia Michele Massimo, Oliva Fabrizio, Bo Mario, Parrini Iris,
  
  Abstract
  
  Aortic stenosis (AS) represents a notable paradigm for cardiovascular (CV) and geriatric disorders owing to comorbidity. Transcatheter aortic valve replacement (TAVR) was initially considered a therapeutic strategy in elderly individuals deemed unsuitable for or at high risk of surgical valve replacement. The progressive improvement in TAVR technology has led to the need to refine older patients' stratification, progressively incorporating the concept of frailty and other geriatric vulnerabilities. Recognizing the intricate nature of the aging process, reliance exclusively on chronological age for stratification resulted in an initial but inadequate tool to assess both CV and non-CV risks effectively. A comprehensive geriatric evaluation should be performed before TAVR procedures, taking into account both physical and cognitive capabilities and post-procedural outcomes through a multidisciplinary framework. This review adopts a multidisciplinary perspective to delve into the diagnosis and holistic management of AS in elderly populations in order to facilitate decision-making, thereby optimizing outcomes centered around patient well-being.
  
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• Aspirin in Primary Prevention: Looking for Those Who Enjoy It.
  J Clin Med

  2024 Jul;13(14):. doi: 4148.
  
  Della Bona Roberta, Giubilato Simona, Palmieri Marco, Benenati Stefano, Rossini Roberta, Di Fusco Stefania Angela, Novarese Filippo, Mascia Giuseppe, Gasparetto Nicola, Di Monaco Antonio, Gatto Laura, Zilio Filippo, Sorini Dini Carlotta, Borrello Francesco, Geraci Giovanna, Riccio Carmine, De Luca Leonardo, Colivicchi Furio, Grimaldi Massimo, Giulizia Michele Massimo, Porto Italo, Oliva Fabrizio Giovanni
  
  Abstract
  
  Based on a wealth of evidence, aspirin is one of the cornerstones of secondary prevention of cardiovascular disease. However, despite several studies showing efficacy also in primary prevention, an unopposed excess risk of bleeding leading to a very thin safety margin is evident in subjects without a clear acute cardiovascular event. Overall, the variability in recommendations from different scientific societies for aspirin use in primary prevention is a classic example of failure of simple risk stratification models based on competing risks (atherothrombosis vs. bleeding), perceived to be opposed but intertwined at the pathophysiological level. Notably, cardiovascular risk is dynamic in nature and cannot be accurately captured by scores, which do not always consider risk enhancers. Furthermore, the widespread use of other potent medications in primary prevention, such as lipid-lowering and anti-hypertensive drugs, might be reducing the benefit of aspirin in recent trials. Some authors, drawing from specific pathophysiological data, have suggested that specific subgroups might benefit more from aspirin. This includes patients with diabetes and those with obesity; sex-based differences are considered as well. Moreover, molecular analysis of platelet reactivity has been proposed. A beneficial effect of aspirin has also been demonstrated for the prevention of cancer, especially colorectal. This review explores evidence and controversies concerning the use of aspirin in primary prevention, considering new perspectives in order to provide a comprehensive individualized approach.
  
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• Prognostic role of coronary angiography and revascularization in patients firstly admitted for heart failure in Italy.
  Int J Cardiol

  2024 Oct;413():132369. doi: 10.1016/j.ijcard.2024.132369.
  
  D'Errigo Paola, De Luca Leonardo, Rosato Stefano, Giordani Barbara, Badoni Gabriella, Oliva Fabrizio, Baglio Giovanni
  
  Abstract
  
  BACKGROUND:
  Coronary artery disease (CAD) is a common underlying cause of de novo heart failure (HF) and is associated with poor outcome despite advances in medical therapy. There are no data clearly supporting coronary angiogram (CVG) and revascularization in this setting.
  
  METHODS:
  We analysed a nationwide, comprehensive, and universal administrative database of consecutive patients for the first time admitted in hospital for HF, without a history of CAD, who survived 30 days after index admission from 2015 to 2019 in Italy. Enrolled patients were classified into subjects who did not undergo CVG; those who underwent CVG without coronary revascularization; those who underwent percutaneous coronary intervention (PCI); and those who underwent coronary artery bypass grafting (CABG).
  
  RESULTS:
  During the study period, 342,090 patients were hospitalized for the first time due to HF and survived 30 days after admission, in Italy. Among them, 30,806 (9.0%) patients underwent CVG without undergoing coronary revascularization, 5855 (1.7%) underwent PCI and 1594 (0.5%) underwent CABG. After adjusting for age, gender and comorbidity, the hazard ratio (HR) for 1-year all-cause mortality in patients undergoing CVG vs no CVG were 0.56 (p 
  CONCLUSIONS:
  This study provides evidence that CVG and coronary revascularization may be beneficial for patients with de novo HF.
  
  Copyright © 2024. Published by Elsevier B.V.
  
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• Management of temporary mechanical circulatory support devices in cath-lab and cardiac intensive care unit.
  Eur Heart J Imaging Methods Pract

  2023 May;1(1):qyad011. doi: qyad011.
  
  Fortuni Federico, Zilio Filippo, Iannopollo Gianmarco, Ciliberti Giuseppe, Trambaiolo Paolo, Ceriello Laura, Musella Francesca, Scicchitano Pietro, Albani Stefano, Di Fusco Stefania Angela, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Different temporary mechanical circulatory support (tMCS) devices are available and can be used to maintain end-organ perfusion while reducing cardiac work and myocardial oxygen demand. tMCS can provide support to the right ventricle, left ventricle, or both, and its use can be considered in emergency situations such as cardiogenic shock or in elective procedures such as high-risk percutaneous coronary intervention to prevent haemodynamic deterioration. Invasive and, most importantly, non-invasive haemodynamic parameters should be taken into account when choosing the type of tMCS device and its initiation and weaning timing, determining the need for a device upgrade, and screening for complications. In this context, ultrasound tools, specifically echocardiography, can provide important data. This review aims to provide a description of the different tMCS devices, the invasive and non-invasive tools and parameters to guide their management, and their advantages and drawbacks.
  
  © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Inotropic Agents: Are We Still in the Middle of Nowhere?
  J Clin Med

  2024 Jun;13(13):. doi: 3735.
  
  Iorio Anna Maria, Lucà Fabiana, Pozzi Andrea, Rao Carmelo Massimiliano, Di Fusco Stefania Angela, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio, Gulizia Michele Masssimo
  
  Abstract
  
  Inotropes are prescribed to enhance myocardial contractility while vasopressors serve to improve vascular tone. Although these medications remain a life-saving therapy in cardiovascular clinical scenarios with hemodynamic impairment, the paucity of evidence on these drugs makes the choice of the most appropriate vasoactive agent challenging. As such, deep knowledge of their pharmacological and hemodynamic effects becomes crucial to optimizing hemodynamic profile while reducing the potential adverse effects. Given this perspective, it is imperative for cardiologists to possess a comprehensive understanding of the underlying mechanisms governing these agents and to discern optimal strategies for their application across diverse clinical contexts. Thus, we briefly review these agents' pharmacological and hemodynamic properties and their reasonable clinical applications in cardiovascular settings. Critical interpretation of available data and the opportunities for future investigations are also highlighted.
  
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• [Blood gas analysis in the intensive cardiac care unit].
  G Ital Cardiol (Rome)

  2024 Jul;25(7):499-508. doi: 10.1714/4282.42637.
  
  Ebert Alberto Genovesi, Valente Serafina, Sorini Dini Carlotta, Ferro Baldassare, Matteucci Amedeo, Colivicchi Furio, Oliva Fabrizio,
  
  Abstract
  
  Arterial blood gas (ABG) analysis is a simple and quick test that can provide multiple respiratory and metabolic parameters. The interpretation of ABG analysis and acid-base disorders represents one of the most complex chapters of clinical medicine. In this brief review, the authors propose a rational approach that sequentially analyzes the information offered by the ABG to allow a rapid classification of the respiratory, metabolic or mixed disorder. The patient's history and clinical-instrumental assessment are the framework in which to insert the information derived from the ABG analysis in order to characterize the critical heart patient.
  
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• [Use of empagliflozin after acute myocardial infarction: the EMPACT-MI trial].
  G Ital Cardiol (Rome)

  2024 Jul;25(7):465-467. doi: 10.1714/4282.42630.
  
  Tavecchia Giovanni Amedeo, Oliva Fabrizio
  
  
  
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• Exploring the Perioperative Use of DOACs, off the Beaten Track.
  J Clin Med

  2024 May;13(11):. doi: 3076.
  
  Lucà Fabiana, Oliva Fabrizio, Giubilato Simona, Abrignani Maurizio Giuseppe, Rao Carmelo Massimiliano, Cornara Stefano, Caretta Giorgio, Di Fusco Stefania Angela, Ceravolo Roberto, Parrini Iris, Murrone Adriano, Geraci Giovanna, Riccio Carmine, Gelsomino Sandro, Colivicchi Furio, Grimaldi Massimo, Gulizia Michele Massimo
  
  Abstract
  
  A notable increase in direct oral anticoagulant (DOAC) use has been observed in the last decade. This trend has surpassed the prescription of vitamin K antagonists (VKAs) due to the absence of the need for regular laboratory monitoring and the more favorable characteristics in terms of efficacy and safety. However, it is very common that patients on DOACs need an interventional or surgical procedure, requiring a careful evaluation and a challenging approach. Therefore, perioperative anticoagulation management of patients on DOACs represents a growing concern for clinicians. Indeed, while several surgical interventions require temporary discontinuation of DOACs, other procedures that involve a lower risk of bleeding can be conducted, maintaining a minimal or uninterrupted DOAC strategy. Therefore, a comprehensive evaluation of patient characteristics, including age, susceptibility to stroke, previous bleeding complications, concurrent medications, renal and hepatic function, and other factors, in addition to surgical considerations, is mandatory to establish the optimal discontinuation and resumption timing of DOACs. A multidisciplinary approach is required for managing perioperative anticoagulation in order to establish how to face these circumstances. This narrative review aims to provide physicians with a practical guide for DOAC perioperative management, addressing the most controversial issues.
  
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• The role of sodium-glucose co-transporter 2 inhibitors in myocardial infarction: available evidence and future perspectives.
  Eur Heart J Suppl

  2024 Apr;26(Suppl 1):i84-i87. doi: 10.1093/eurheartjsupp/suae008.
  
  Tavecchia Giovanni Amedeo, Gualini Elena, Sacco Alice, Oliva Fabrizio
  
  Abstract
  
  There is an unmet need for new treatment options for patients with acute myocardial infarction (AMI) as progress in patients' outcomes has plateaued over the past 15 years. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have demonstrated cardio-renal benefits in various disease states, encompassing diabetes mellitus, chronic kidney disease, and heart failure. Experimental studies further support their use in AMI, demonstrating beneficial effects in animal models by reducing infarct size and mitigating adverse cardiac remodelling. Recently, two clinical trials have been published thus paving the way for a new field to explore. This paper briefly outlines the available evidence and future perspectives regarding the use of SGLT2 inhibitors in this clinical scenario.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• ANMCO/SIMEU consensus document on the use of reversal agents for antithrombotic therapies in patients with ongoing bleeding or at high risk of haemorrhagic events.
  Eur Heart J Suppl

  2024 Apr;26(Suppl 2):ii211-ii220. doi: 10.1093/eurheartjsupp/suae033.
  
  De Luca Leonardo, Pugliese Francesco Rocco, Susi Beniamino, Navazio Alessandro, Corda Marco, Fabbri Andrea, Scicchitano Pietro, Voza Antonio, Vanni Simone, Bilato Claudio, Geraci Giovanna, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, De Iaco Fabio, Oliva Fabrizio
  
  Abstract
  
  In recent decades, an incredible evolution in antithrombotic therapies used for treating patients with atherosclerosis, atrial fibrillation, and venous thromboembolism has been observed, leading to the availability of increasingly safe drugs. Nonetheless, bleeding complications remain a significant concern, with considerable health, social, and economic implications. To improve the acute management of patients experiencing or at risk for major bleeding events, specific reversal agents for antithrombotic drugs have been recently developed. While these agents demonstrate effectiveness in small-scale pharmacodynamic studies and clinical trials, it is imperative to balance the benefits of reversing antiplatelet or anticoagulant therapy against the risk of prothrombotic effects. These risks include the potential loss of antithrombotic protection and the prothrombotic tendencies associated with bleeding, major surgery, or trauma. This joint document of the Italian Association of Hospital Cardiologists () and the Italian Society of Emergency Medicine () delineates the key features and efficacy of available reversal agents. It also provides practical flowcharts to guide their use in patients with active bleeding or those at elevated risk of major bleeding events.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Cardio-oncology rehabilitation: are we ready?
  Eur Heart J Suppl

  2024 Apr;26(Suppl 2):ii252-ii263. doi: 10.1093/eurheartjsupp/suae030.
  
  Bisceglia Irma, Venturini Elio, Canale Maria Laura, Ambrosetti Marco, Riccio Carmine, Giallauria Francesco, Gallucci Giuseppina, Abrignani Maurizio G, Russo Giulia, Lestuzzi Chiara, Mistrulli Raffaella, De Luca Giovanni, Maria Turazza Fabio, Mureddu Gianfrancesco, Di Fusco Stefania Angela, Lucà Fabiana, De Luca Leonardo, Camerini Andrea, Halasz Geza, Camilli Massimiliano, Quagliariello Vincenzo, Maurea Nicola, Fattirolli Francesco, Gulizia Michele Massimo, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  Cardio-oncology rehabilitation (CORE) is not only an essential component of cancer rehabilitation but also a pillar of preventive cardio-oncology. Cardio-oncology rehabilitation is a comprehensive model based on a multitargeted approach and its efficacy has been widely documented; when compared with an 'exercise only' programme, comprehensive CORE demonstrates a better outcome. It involves nutritional counselling, psychological support, and cardiovascular (CV) risk assessment, and it is directed to a very demanding population with a heavy burden of CV diseases driven by physical inactivity, cancer therapy-induced metabolic derangements, and cancer therapy-related CV toxicities. Despite its usefulness, CORE is still underused in cancer patients and we are still at the dawning of remote models of rehabilitation (tele-rehabilitation). Not all CORE is created equally: a careful screening procedure to identify patients who will benefit the most from CORE and a multidisciplinary customized approach are mandatory to achieve a better outcome for cancer survivors throughout their cancer journey. The aim of this paper is to provide an updated review of CORE not only for cardiologists dealing with this peculiar population of patients but also for oncologists, primary care providers, patients, and caregivers. This multidisciplinary team should help cancer patients to maintain a healthy and active life before, during, and after cancer treatment, in order to improve quality of life and to fight health inequities.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Italian Association of Hospital Cardiologists position paper-obesity in adults: a clinical primer.
  Eur Heart J Suppl

  2024 Apr;26(Suppl 2):ii221-ii235. doi: 10.1093/eurheartjsupp/suae031.
  
  Di Fusco Stefania Angela, Mocini Edoardo, Gori Mauro, Iacoviello Massimo, Bilato Claudio, Corda Marco, De Luca Leonardo, Di Marco Massimo, Geraci Giovanna, Iacovoni Attilio, Milli Massimo, Navazio Alessandro, Pascale Vittorio, Riccio Carmine, Scicchitano Pietro, Tizzani Emanuele, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  Obesity is a chronic and relapsing disease characterized by the interaction between individual predispositions and an obesogenic environment. Recent advances in understanding the mechanisms of energetic homoeostasis paved the way to more effective therapeutic approaches compared with traditional treatments. Since obesity is a complex disease, it necessitates a multi-disciplinary approach whose implementation remains challenging. Nonetheless, emerging pharmacological interventions appear promising. Currently, therapeutic success is discreet in the short term but often fails to maintain long-term weight loss due to a high likelihood of weight regain. Cardiologists play a key role in managing patients with obesity, yet often lack familiarity with its comprehensive management. The aim of this document is to summarize knowledge to consolidate essential knowledge for clinicians to effectively treat patients living with obesity. The paper emphasizes the pivotal role of a strong patient-clinician relationship in navigating successful treatment. We analyse the criteria commonly used to diagnose obesity and point out the strengths and limitations of different criteria. Furthermore, we discuss the role of obesiologists and the contributions of cardiologists. In addition, we detail key components of effective therapeutic strategies, including educational aspects and pharmacological options.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Italian Association of Hospital Cardiologists Position Paper 'Gender discrepancy: time to implement gender-based clinical management'.
  Eur Heart J Suppl

  2024 Apr;26(Suppl 2):ii264-ii293. doi: 10.1093/eurheartjsupp/suae034.
  
  Lucà Fabiana, Pavan Daniela, Gulizia Michele Massimo, Manes Maria Teresa, Abrignani Maurizio Giuseppe, Benedetto Francesco Antonio, Bisceglia Irma, Brigido Silvana, Caldarola Pasquale, Calvanese Raimondo, Canale Maria Laura, Caretta Giorgio, Ceravolo Roberto, Chieffo Alaide, Chimenti Cristina, Cornara Stefano, Cutolo Ada, Di Fusco Stefania Angela, Di Matteo Irene, Di Nora Concetta, Fattirolli Francesco, Favilli Silvia, Francese Giuseppina Maura, Gelsomino Sandro, Geraci Giovanna, Giubilato Simona, Ingianni Nadia, Iorio Annamaria, Lanni Francesca, Montalto Andrea, Nardi Federico, Navazio Alessandro, Nesti Martina, Parrini Iris, Pilleri Annarita, Pozzi Andrea, Rao Carmelo Massimiliano, Riccio Carmine, Rossini Roberta, Scicchitano Pietro, Valente Serafina, Zuccalà Giuseppe, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  It has been well assessed that women have been widely under-represented in cardiovascular clinical trials. Moreover, a significant discrepancy in pharmacological and interventional strategies has been reported. Therefore, poor outcomes and more significant mortality have been shown in many diseases. Pharmacokinetic and pharmacodynamic differences in drug metabolism have also been described so that effectiveness could be different according to sex. However, awareness about the gender gap remains too scarce. Consequently, gender-specific guidelines are lacking, and the need for a sex-specific approach has become more evident in the last few years. This paper aims to evaluate different therapeutic approaches to managing the most common women's diseases.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on the simplification of the drug regimen for secondary cardiovascular prevention.
  Eur Heart J Suppl

  2024 Apr;26(Suppl 2):ii236-ii251. doi: 10.1093/eurheartjsupp/suae032.
  
  De Luca Leonardo, Di Fusco Stefania Angela, Iannopollo Gianmarco, Mistrulli Raffaella, Rizzello Vittoria, Aimo Alberto, Navazio Alessandro, Bilato Claudio, Corda Marco, Di Marco Massimo, Geraci Giovanna, Iacovoni Attilio, Milli Massimo, Pascale Vittorio, Riccio Carmine, Scicchitano Pietro, Tizzani Emanuele, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  The issue of suboptimal drug regimen adherence in secondary cardiovascular prevention presents a significant barrier to improving patient outcomes. To address this, the utilization of drug combinations, specifically single pill combinations (SPCs) and polypills, was proposed as a strategy to simplify treatment regimens. This approach aims to enhance treatment accessibility, affordability, and adherence, thereby reducing healthcare costs and improving patient health. The document is an Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on simplifying drug regimens for secondary cardiovascular prevention. It discusses the underuse of treatments despite available, effective, and accessible options, highlighting a significant gap in secondary prevention across different socio-economic statuses and countries. The statement explores barriers to implementing evidence-based treatments, including patient, healthcare provider, and system-related challenges. The paper also reviews international guidelines, the role of SPCs and polypills in clinical practice, and their economic impact, advocating for their use in secondary prevention to improve patient outcomes and adherence.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Coagulation Tests and Reversal Agents in Patients Treated with Oral Anticoagulants: The Challenging Scenarios of Life-Threatening Bleeding and Unplanned Invasive Procedures.
  J Clin Med

  2024 Apr;13(9):. doi: 2451.
  
  Pozzi Andrea, Lucà Fabiana, Gelsomino Sandro, Abrignani Maurizio Giuseppe, Giubilato Simona, Di Fusco Stefania Angela, Rao Carmelo Massimiliano, Cornara Stefano, Caretta Giorgio, Ceravolo Roberto, Parrini Iris, Geraci Giovanna, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio, Gulizia Michele Massimo
  
  Abstract
  
  In clinical practice, the number of patients treated with direct oral anticoagulants (DOACs) has consistently increased over the years. Since anticoagulant therapy has been associated with an annual incidence of major bleeding (MB) events of approximately 2% to 3.5%, it is of paramount importance to understand how to manage anticoagulated patients with major or life-threatening bleeding. A considerable number of these patients' conditions necessitate hospitalization, and the administration of reversal agents may be imperative to manage and control bleeding episodes effectively. Importantly, effective strategies for reversing the anticoagulant effects of DOACs have been well recognized. Specifically, idarucizumab has obtained regulatory approval for the reversal of dabigatran, and andexanet alfa has recently been approved for reversing the effects of apixaban or rivaroxaban in patients experiencing life-threatening or uncontrolled bleeding events. Moreover, continuous endeavors are being made to develop supplementary reversal agents. In emergency scenarios where specific reversal agents might not be accessible, non-specific hemostatic agents such as prothrombin complex concentrate can be utilized to neutralize the anticoagulant effects of DOACs. However, it is paramount to emphasize that specific reversal agents, characterized by their efficacy and safety, should be the preferred choice when suitable. Moreover, it is worth noting that adherence to the guidelines for the reversal agents is poor, and there is a notable gap between international recommendations and actual clinical practices in this regard. This narrative review aims to provide physicians with a practical approach to managing specific reversal agents.
  
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• [ANMCO Scientific statement on combination therapies and polypill in secondary prevention].
  G Ital Cardiol (Rome)

  2024 May;25(5):367-381. doi: 10.1714/4252.42301.
  
  De Luca Leonardo, Di Fusco Stefania Angela, Iannopollo Gianmarco, Mistrulli Raffaella, Rizzello Vittoria, Aimo Alberto, Navazio Alessandro, Bilato Claudio, Corda Marco, Di Marco Massimo, Geraci Giovanna, Iacovoni Attilio, Milli Massimo, Pascale Vittorio, Riccio Carmine, Scicchitano Pietro, Tizzani Emanuele, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  The issue of suboptimal drug regimen adherence in secondary cardiovascular prevention presents a significant barrier to improving patient outcomes. To address this, the utilization of drug combinations, specifically single pill combinations (SPCs) and polypills, was proposed as a strategy to simplify treatment regimens. This approach aims to enhance treatment accessibility, affordability, and adherence, thereby reducing healthcare costs and improving patient health. The document is an ANMCO scientific statement on simplifying drug regimens for secondary cardiovascular prevention. It discusses the underuse of treatments despite available, effective, and accessible options, highlighting a significant gap in secondary prevention across different socioeconomic statuses and countries. The statement explores barriers to implementing evidence-based treatments, including patient, healthcare provider, and system-related challenges. The paper also reviews international guidelines, the role of SPCs and polypills in clinical practice, and their economic impact, advocating for their use in secondary prevention to improve patient outcomes and adherence.
  
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• [ANMCO Position paper: Obesity in adults - A clinical primer].
  G Ital Cardiol (Rome)

  2024 May;25(5):352-366. doi: 10.1714/4252.42300.
  
  Di Fusco Stefania Angela, Mocini Edoardo, Gori Mauro, Iacoviello Massimo, Bilato Claudio, Corda Marco, De Luca Leonardo, Di Marco Massimo, Geraci Giovanna, Iacovoni Attilio, Milli Massimo, Navazio Alessandro, Pascale Vittorio, Riccio Carmine, Scicchitano Pietro, Tizzani Emanuele, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  Obesity is a chronic and relapsing disease due to the coexistence of a patient with predisposing individual characteristics and an obesogenic environment. The recent acquisition of detailed knowledge on the mechanisms underlying the energetic homeostasis paved the way to more effective therapeutic hypotheses as compared to traditional treatments. Since obesity is a complex issue, it requires a multidisciplinary approach which is difficult to implement. However, new drugs appear promising. Currently, therapeutic success is discrete in the short term, but unsatisfying in the long term due to the high probability of body weight gain. Cardiologists play a key role in managing patients with obesity, but they are not used to manage them. The aim of this document is to summarize knowledge that clinicians need to have to appropriately manage these patients. The paper emphasizes the pivotal role of an appropriate relationship with the patient to embark on a successful treatment journey. We analyze the criteria commonly used to diagnose obesity and point out strengths and limitations of different criteria. Furthermore, we discuss the figure of the obesitologist and the role of the cardiologist. In addition, we report the main components of an effective therapeutic strategy, from educational questions to pharmacological options.
  
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• [Optimizing the care management pathway of patients with ischemia and non-obstructive coronary arteries].
  G Ital Cardiol (Rome)

  2024 May;25(5):309-317. doi: 10.1714/4252.42294.
  
  Oliva Fabrizio, Boriani Giuseppe, Calabrò Paolo, Caldarola Pasquale, Carugo Stefano, Castiglioni Battistina, Celentani Dario, Comeglio Marco, De Luca Leonardo, De Maria Renata, Di Muro Michele, Ignone Gianfranco, Leonardo Filippo, Margonato Alberto, Massari Francesco, Murrone Adriano, Nardi Federico, Patti Giuseppe, Perna Gianpiero, Pinna Paolo, Poli Marco, Prati Francesco, Raddino Riccardo, Pierdomenico Sante Donato, Tammaro Paolo, Porto Italo
  
  Abstract
  
  Ischemia with non-obstructive coronary arteries (INOCA) is defined by the coexistence of anginal symptoms and demonstrable ischemia, with no evidence of obstructive coronary arteries. The underlying mechanism of INOCA is coronary microvascular dysfunction with or without associated vasospasm. INOCA patients have recurrent symptoms, functional limitations, repeated access to the emergency department, impaired quality of life and a higher incidence of cardiovascular events than the general population. Although well described in chronic coronary syndrome guidelines, INOCA remains underdiagnosed in clinical practice because of insufficient awareness, lack of accurate diagnostic tools, and poorly standardized and consistent definitions to diagnose, both invasively and non-invasively, coronary microvascular dysfunction.To disseminate current scientific evidence on INOCA as a distinct clinical entity, during 2022 we conducted at 30 cardiology units all over the country a clinical practice improvement initiative, with the aim of developing uniform and shared management pathways for INOCA patients across different operational settings. The present document highlights the outcomes of this multidisciplinary initiative.
  
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• How to Manage Beta-Blockade in Older Heart Failure Patients: A Scoping Review.
  J Clin Med

  2024 Apr;13(7):. doi: 2119.
  
  Parrini Iris, Lucà Fabiana, Rao Carmelo Massimiliano, Cacciatore Stefano, Riccio Carmine, Grimaldi Massimo, Gulizia Michele Massimo, Oliva Fabrizio, Andreotti Felicita
  
  Abstract
  
  Beta blockers (BBs) play a crucial role in enhancing the quality of life and extending the survival of patients with heart failure and reduced ejection fraction (HFrEF). Initiating the therapy at low doses and gradually titrating the dose upwards is recommended to ensure therapeutic efficacy while mitigating potential adverse effects. Vigilant monitoring for signs of drug intolerance is necessary, with dose adjustments as required. The management of older HF patients requires a case-centered approach, taking into account individual comorbidities, functional status, and frailty. Older adults, however, are often underrepresented in randomized clinical trials, leading to some uncertainty in management strategies as patients with HF in clinical practice are older than those enrolled in trials. The present article performs a scoping review of the past 25 years of published literature on BBs in older HF patients, focusing on age, outcomes, and tolerability. Twelve studies (eight randomized-controlled and four observational) encompassing 26,426 patients were reviewed. The results indicate that BBs represent a viable treatment for older HFrEF patients, offering benefits in symptom management, cardiac function, and overall outcomes. Their role in HF with preserved EF, however, remains uncertain. Further research is warranted to refine treatment strategies and address specific aspects in older adults, including proper dosing, therapeutic adherence, and tolerability.
  
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• Heart Failure with Preserved Ejection Fraction: How to Deal with This Chameleon.
  J Clin Med

  2024 Feb;13(5):. doi: 1375.
  
  Lucà Fabiana, Oliva Fabrizio, Abrignani Maurizio Giuseppe, Di Fusco Stefania Angela, Gori Mauro, Giubilato Simona, Ceravolo Roberto, Temporelli Pier Luigi, Cornara Stefano, Rao Carmelo Massimiliano, Caretta Giorgio, Pozzi Andrea, Binaghi Giulio, Maloberti Alessandro, Di Nora Concetta, Di Matteo Irene, Pilleri Anna, Gelsomino Sandro, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Gulizia Michele Massimo
  
  Abstract
  
  Heart failure with preserved ejection fraction (HFpEF) is characterized by a notable heterogeneity in both phenotypic and pathophysiological features, with a growing incidence due to the increase in median age and comorbidities such as obesity, arterial hypertension, and cardiometabolic disease. In recent decades, the development of new pharmacological and non-pharmacological options has significantly impacted outcomes, improving clinical status and reducing mortality. Moreover, a more personalized and accurate therapeutic management has been demonstrated to enhance the quality of life, diminish hospitalizations, and improve overall survival. Therefore, assessing the peculiarities of patients with HFpEF is crucial in order to obtain a better understanding of this disorder. Importantly, comorbidities have been shown to influence symptoms and prognosis, and, consequently, they should be carefully addressed. In this sense, it is mandatory to join forces with a multidisciplinary team in order to achieve high-quality care. However, HFpEF remains largely under-recognized and under-treated in clinical practice, and the diagnostic and therapeutic management of these patients remains challenging. The aim of this paper is to articulate a pragmatic approach for patients with HFpEF focusing on the etiology, diagnosis, and treatment of HFpEF.
  
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• Implementation of the Care Bundle for the Management of Chronic Obstructive Pulmonary Disease with/without Heart Failure.
  J Clin Med

  2024 Mar;13(6):. doi: 1621.
  
  Bianco Andrea, Canepa Marco, Catapano Giosuè Angelo, Marvisi Maurizio, Oliva Fabrizio, Passantino Andrea, Sarzani Riccardo, Tarsia Paolo, Versace Antonio Giovanni
  
  Abstract
  
  Chronic obstructive pulmonary disease (COPD) is often part of a more complex cardiopulmonary disease, especially in older patients. The differential diagnosis of the acute exacerbation of COPD and/or heart failure (HF) in emergency settings is challenging due to their frequent coexistence and symptom overlap. Both conditions have a detrimental impact on each other's prognosis, leading to increased mortality rates. The timely diagnosis and treatment of COPD and coexisting factors like left ventricular overload or HF in inpatient and outpatient care can improve prognosis, quality of life, and long-term outcomes, helping to avoid exacerbations and hospitalization, which increase future exacerbation risk. This work aims to address existing gaps, providing management recommendations for COPD with/without HF, particularly when both conditions coexist. During virtual meetings, a panel of experts (the authors) discussed and reached a consensus on the differential and paired diagnosis of COPD and HF, providing suggestions for risk stratification, accurate diagnosis, and appropriate therapy for inpatients and outpatients. They emphasize that when COPD and HF are concomitant, both conditions should receive adequate treatment and that recommended HF treatments are not contraindicated in COPD and have favorable effects. Accurate diagnosis and therapy is crucial for effective treatment, reducing hospital readmissions and associated costs. The management considerations discussed in this study can potentially be extended to address other cardiopulmonary challenges frequently encountered by COPD patients.
  
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• [ANMCO Position paper in collaboration with ITACARE-P: Cardio-oncology rehabilitation. Are we ready?].
  G Ital Cardiol (Rome)

  2024 Apr;25(4):281-293. doi: 10.1714/4244.42210.
  
  Bisceglia Irma, Venturini Elio, Canale Maria Laura, Ambrosetti Marco, Riccio Carmine, Giallauria Francesco, Gallucci Giuseppina, Abrignani Maurizio Giuseppe, Russo Giulia, Lestuzzi Chiara, Mistrulli Raffaella, De Luca Giovanni, Turazza Fabio, Mureddu Gian Francesco, Di Fusco Stefania Angela, Lucà Fabiana, De Luca Leonardo, Camerini Andrea, Halasz Geza, Camilli Massimiliano, Quagliariello Vincenzo, Maurea Nicola, Fattirolli Francesco, Gulizia Michele Massimo, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  Cardio-oncology rehabilitation (CORE) is not only an essential component of cancer rehabilitation, but also a pillar of preventive cardio-oncology. CORE is a comprehensive model based on a multitargeted approach and its efficacy has been widely documented; when compared to an "exercise only" program, comprehensive CORE demonstrates a better outcome. It involves nutritional counseling, psychological support and cardiovascular risk assessment, and it is directed to a very demanding population with a heavy burden of cardiovascular diseases driven by physical inactivity, cancer therapy-induced metabolic derangements and cancer therapy-related cardiovascular toxicities. Despite its usefulness, CORE is still underused in cancer patients and we are still at the dawning of remote models of rehabilitation (telerehabilitation). Not all cardio-oncology rehabilitation is created equal: a careful screening procedure to identify patients who will benefit the most from CORE and a multidisciplinary customized approach are mandatory to achieve a better outcome for cancer survivors throughout their cancer journey.The aim of this position paper is to provide an updated review of CORE not only for cardiologists dealing with this peculiar patient population, but also for oncologists, primary care providers, patients and caregivers. This multidisciplinary team should help cancer patients to maintain a healthy and active life before, during and after cancer treatment, in order to improve quality of life and to fight health inequities.
  
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• [ANMCO Position paper: States General 2023 - Scientific societies and training: the role of ANMCO].
  G Ital Cardiol (Rome)

  2024 Apr;25(4):274-280. doi: 10.1714/4244.42209.
  
  Di Fusco Stefania Angela, Zilio Filippo, Zuin Marco, Bilato Claudio, Cavallini Claudio, Corda Marco, De Luca Leonardo, Di Marco Massimo, Geraci Giovanna, Iacovoni Attilio, Milli Massimo, Musumeci Giuseppe, Navazio Alessandro, Pascale Vittorio, Riccio Carmine, Scicchitano Pietro, Tizzani Emanuele, Gabrielli Domenico, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio
  
  Abstract
  
  Scientific societies promote numerous activities, including the training of professionals. With the continuous growing of knowledge and the availability of new evidence in the cardiological field, the achievement and maintenance of knowledge and know-how is difficult. The evolving educational needs of professionals in cardiology have been analyzed during the 2023 ANMCO General States. Furthermore, the initiatives implemented to meet professionals' needs after the university medical training have been discussed. In this document, we report the main and most innovative training activities promoted by ANMCO, from distance training to simulation training, including courses for master's degree, training to and through clinical research and the potential role of teaching hospitals.
  
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• [Multidistrict atherosclerotic disease: epidemiological and clinical framework].
  G Ital Cardiol (Rome)

  2024 Apr;25(4):239-251. doi: 10.1714/4244.42205.
  
  Di Fusco Stefania Angela, Abrignani Maurizio Giuseppe, Amico Antonio Francesco, Lucà Fabiana, Mureddu Gian Francesco, Ceravolo Roberto, Temporelli Pier Luigi, Acerbo Vincenzo, Altamura Vito, Baccino Danilo, Binaghi Giulio, Bugani Giulia, Cesaro Arturo, Ciccirillo Francesco, Cocozza Sara, D'Errigo Paola, Di Martino Mirko, Di Nora Concetta, Fileti Luca, Lopriore Vincenzo, Maloberti Alessandro, Monitillo Francesco, Gulizia Michele Massimo, Grimaldi Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Atherosclerosis is a systemic disease that can involve different arterial districts. Traditionally, the focus of cardiologists has been on the diagnosis and treatment of atherosclerotic coronary artery disease (CAD). However, atherosclerosis localization in other districts is increasingly common and is associated with an increased risk of CAD and, more generally, of adverse cardiovascular events. Although the term peripheral arterial disease (PAD) commonly refers to the localization of atherosclerotic disease in the arterial districts of the lower limbs, in this document, in accordance with the European Society of Cardiology guidelines, the term PAD will be used for all the locations of atherosclerotic disease excluding coronary and aortic ones. The aim of this review is to report updated data on PAD epidemiology, with particular attention to the prevalence and its prognostic impact on patients with CAD. Furthermore, the key points for an appropriate diagnostic framework and a correct pharmacological therapeutic approach are summarized, while surgical/interventional treatment goes beyond the scope of this review.
  
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• Sex differences in patients presenting with acute coronary syndrome: a state-of-the-art review.
  Curr Probl Cardiol

  2024 May;49(5):102486. doi: 10.1016/j.cpcardiol.2024.102486.
  
  Zilio Filippo, Musella Francesca, Ceriello Laura, Ciliberti Giuseppe, Pavan Daniela, Manes Maria Teresa, Selimi Adelina, Scicchitano Pietro, Iannopollo Gianmarco, Albani Stefano, Fortuni Federico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  Cardiovascular conditions in the spectrum of acute coronary syndromes are characterized by sex differences with regard to pathophysiology, risk factors, clinical presentation, invasive and pharmacologic treatment, and outcomes. This review delves into these differences, including specific subsets like myocardial infarction with non-obstructed coronary arteries or Spontaneous Coronary Artery Dissection, and alternative diagnoses like Takotsubo cardiomyopathy or myocarditis. Moreover, practical considerations are enclosed, on how a sex-specific approach should be integrated in clinical practice: in fact, personal history should focus on female-specific risk factors, and hormonal status and hormonal therapy should be assessed. Moreover, physical and psychological stressors should be investigated, particularly in the event of Spontaneous Coronary Artery Dissection or Takotsubo cardiomyopathy.
  
  Copyright © 2024 Elsevier Inc. All rights reserved.
  
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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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• [ANMCO Position paper: States General 2023 - Role of ANMCO in the setting of clinical research in Cardiology in Italy: current state and future perspectives].
  G Ital Cardiol (Rome)

  2024 Mar;25(3):187-191. doi: 10.1714/4209.42006.
  
  Zilio Filippo, Di Fusco Stefania Angela, Zuin Marco, Ammirati Enrico, Bilato Claudio, Corda Marco, De Luca Leonardo, Di Marco Massimo, Geraci Giovanna, Iacovoni Attilio, Maggioni Aldo Pietro, Milli Massimo, Navazio Alessandro, Pascale Vittorio, Riccio Carmine, Scicchitano Pietro, Tizzani Emanuele, Gabrielli Domenico, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio
  
  Abstract
  
  For over 40 years, clinical research has been one of the most important aims of the Italian Association of Hospital Cardiologists (ANMCO), being an essential tool in pursuing promotion and fulfillment of good clinical practices in prevention, treatment and rehabilitation of cardiovascular diseases. Since 1992, with the creation of the Research Center (now part of the Heart Care Foundation), ANMCO is capable of independently and professionally managing all the aspects related to planning, management, and publication of the results of clinical studies. The other strength of ANMCO is the network built in Cardiology Departments on the whole territory of Italy, a human capital that allows ANMCO to deal with the new scientific challenges, in a context of profound changes in the social, economic, technological, and methodological setting. This document is based on the debate about the state of clinical research in Italy and the role of ANMCO in this setting that took place during the 2023 ANMCO States General.
  
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• [ANMCO Position paper: States General 2023 - Digital medicine in cardiology: evidence and state of progress in Italy].
  G Ital Cardiol (Rome)

  2024 Mar;25(3):179-186. doi: 10.1714/4209.42005.
  
  Di Fusco Stefania Angela, Zilio Filippo, Zuin Marco, Bilato Claudio, Corda Marco, De Luca Leonardo, Di Lenarda Andrea, Di Marco Massimo, Francese Giuseppina Maura, Gensini Gian Franco, Geraci Giovanna, Giubilato Simona, Iacovoni Attilio, Lucà Fabiana, Mazzanti Marco, Milli Massimo, Navazio Alessandro, Orso Francesco, Pascale Vittorio, Riccio Carmine, Rocca Patrizia, Scicchitano Pietro, Tavazzi Luigi, Tizzani Emanuele, Gabrielli Domenico, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio
  
  Abstract
  
  Technological innovation provides easily accessible tools capable of simplifying healthcare processes. Notably, digital technology application in the cardiology field can improve prognosis, reduce costs, and lead to an overall improvement in healthcare. The digitization of health data, with the use of electronic health records and of electronic health files in Italy, represents one of the fields of application of digital technologies in medicine. The 2023 States General of the Italian Association of Hospital Cardiologists (ANMCO) provided an opportunity to focus attention on the potential benefits and critical issues associated with the implementation of the aforementioned digital tools, artificial intelligence, and telecardiology. This document summarizes key aspects that emerged during the event.
  
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• [New policies and laws for cardiac rehabilitation in Italy: time to reaffirm the unity of cardiology?].
  G Ital Cardiol (Rome)

  2024 Mar;25(3):146-147. doi: 10.1714/4209.41998.
  
  Ambrosetti Marco, Morici Nuccia, Riccio Carmine, Oliva Fabrizio
  
  
  
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• Recent Advances and Future Directions in Syncope Management: A Comprehensive Narrative Review.
  J Clin Med

  2024 Jan;13(3):. doi: 727.
  
  Martone Anna Maria, Parrini Iris, Ciciarello Francesca, Galluzzo Vincenzo, Cacciatore Stefano, Massaro Claudia, Giordano Rossella, Giani Tommaso, Landi Giovanni, Gulizia Michele Massimo, Colivicchi Furio, Gabrielli Domenico, Oliva Fabrizio, Zuccalà Giuseppe
  
  Abstract
  
  Syncope is a highly prevalent clinical condition characterized by a rapid, complete, and brief loss of consciousness, followed by full recovery caused by cerebral hypoperfusion. This symptom carries significance, as its potential underlying causes may involve the heart, blood pressure, or brain, leading to a spectrum of consequences, from sudden death to compromised quality of life. Various factors contribute to syncope, and adhering to a precise diagnostic pathway can enhance diagnostic accuracy and treatment effectiveness. A standardized initial assessment, risk stratification, and appropriate test identification facilitate determining the underlying cause in the majority of cases. New technologies, including artificial intelligence and smart devices, may have the potential to reshape syncope management into a proactive, personalized, and data-centric model, ultimately enhancing patient outcomes and quality of life. This review addresses key aspects of syncope management, including pathogenesis, current diagnostic testing options, treatments, and considerations in the geriatric population.
  
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• Unveiling the gender gap in ST-elevation myocardial infarction: a retrospective analysis of a single Italian center gender disparities in STEMI-ACS.
  J Cardiovasc Med (Hagerstown)

  2024 Mar;25(3):239-242. doi: 10.2459/JCM.0000000000001594.
  
  Garatti Laura, Tavecchia Giovanni, Milani Martina, Rizzi Ilaria, Tondelli Daniele, Bernasconi Davide, Maloberti Alessandro, Oliva Fabrizio, Sacco Alice
  
  
  
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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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• [8th Census of cardiology centers in Italy. Italian Association of Hospital Cardiologists (ANMCO). Year 2022].
  G Ital Cardiol (Rome)

  2024 Feb;25(2 Suppl 1):19S-103S. doi: 10.1714/4195.41821.
  
  Oliva Fabrizio, Di Pasquale Giuseppe, Lucci Donata, De Luca Leonardo, Navazio Alessandro, Crialesi Roberta, Perrone Filardi Pasquale, Grimaldi Massimo, Gabrielli Domenico, Maggioni Aldo Pietro, Colivicchi Furio
  
  
  
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• [Preface].
  G Ital Cardiol (Rome)

  2024 Feb;25(2 Suppl 1):1S-3S. doi: 10.1714/4195.41818.
  
  Oliva Fabrizio
  
  
  
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• Hyperkalaemia in Cardiological Patients: New Solutions for an Old Problem.
  Cardiovasc Drugs Ther

  2024 Jan;():. doi: 10.1007/s10557-024-07551-7.
  
  Abrignani Maurizio Giuseppe, Gronda Edoardo, Marini Marco, Gori Mauro, Iacoviello Massimo, Temporelli Pier Luigi, Benvenuto Manuela, Binaghi Giulio, Cesaro Arturo, Maloberti Alessandro, Tinti Maria Denitza, Riccio Carmine, Colivicchi Furio, Grimaldi Massimo, Gabrielli Domenico, Oliva Fabrizio,
  
  Abstract
  
  Hyperkalaemia is one of the most common electrolyte disorders in patients with cardiovascular disease (CVD). The true burden of hyperkalaemia in the real-world setting can be difficult to assess, but in population-based cohort studies up to 4 in 10 patients developed hyperkalaemia. In addition to drugs interfering with potassium metabolism and food intake, several conditions can cause or worsen hyperkalaemia, such as advanced age, diabetes, and chronic kidney disease. Mortality, cardiovascular morbidity, and hospitalisation are higher in patients with hyperkalaemia. Hyperkalaemia represents a major contraindication or a withholding cause for disease-modifying therapies like renin-angiotensin-aldosterone inhibitors (RAASi), mainly mineralocorticoid receptor antagonists. Hyperkalaemia can be also classified as acute and chronic, according to the onset. Acute hyperkalaemia is often a life-threatening emergency requiring immediate treatment to avoid lethal arrhythmias. Therapy goal is cell membrane stabilisation by calcium administration, cellular intake, shift of extracellular potassium to the intracellular space (insulin, beta-adrenergic agents, sodium bicarbonate), and increased elimination with diuretics or dialysis. Chronic hyperkalaemia was often managed with dietary counselling to prevent potassium-rich food intake and tapering of potassium-increasing drugs, mostly RAASi. Sodium polystyrene sulphonate, a potassium binder, was the only therapeutic option. Recently, new drugs such as patiromer and sodium zirconium cyclosilicate give new opportunities for the treatment of hyperkalaemia, as they proved to be safe, well tolerated, and effective. Aim of this review is to describe the burden of hyperkalaemia in cardiovascular patients, its direct and indirect effects, and the therapeutic options now available in the acute and chronic setting.
  
  © 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
  
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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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• [Gender discrepancy: time to implement gender-based clinical management].
  G Ital Cardiol (Rome)

  2024 Feb;25(2):126-139. doi: 10.1714/4187.41763.
  
  Lucà Fabiana, Pavan Daniela, Gulizia Michele Massimo, Manes Maria Teresa, Abrignani Maurizio Giuseppe, Benedetto Francesco Antonio, Bisceglia Irma, Brigido Silvana, Caldarola Pasquale, Calvanese Raimondo, Canale Maria Laura, Caretta Giorgio, Ceravolo Roberto, Chieffo Alaide, Chimenti Cristina, Cornara Stefano, Cutolo Ada, Di Fusco Stefania Angela, Di Matteo Irene, Di Nora Concetta, Fattirolli Francesco, Favilli Silvia, Francese Giuseppina Maura, Gelsomino Sandro, Geraci Giovanna, Giubilato Simona, Ingianni Nadia, Iorio Annamaria, Lanni Francesca, Montalto Andrea, Nardi Federico, Navazio Alessandro, Nesti Martina, Parrini Iris, Pilleri Annarita, Pozzi Andrea, Rao Carmelo Massimiliano, Riccio Carmine, Rossini Roberta, Scicchitano Pietro, Valente Serafina, Zuccalà Giuseppe, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  It is well established that gender strongly influences cardiovascular risk factors, playing a crucial role in cardiovascular prevention, clinical pathways, diagnostic approach and treatment. Beyond the sex, which is a biological factor, gender entails a socio-cultural condition that impacts access and quality of care due to structural and institutional barriers. However, despite its great importance, this issue has not been adequately covered. Indeed sex and gender differences scarcely impact the clinical approach, creating a lot of disparities in care and outcomes of patients. Therefore, it becomes essential to increase the awareness of the importance of sex and gender influences on cardiovascular diseases. Moreover, new strategies for reducing disparities should be developed. Importantly, these differences should be taken into account in guideline recommendations. In this regard, it is crucial to include a greater number of women in clinical trials, since they are currently underrepresented. Furthermore, more women should be involved as member of international boards in order to develop recommendations and guidelines with more attention to this important topic.The aim of this ANMCO position paper is to shed light on gender differences concerning many cardiovascular drugs in order to encourage a more personalized therapeutic approach.
  
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• [ANMCO Position paper - 2023 ANMCO States General: Towards a modern Cardiological Community Care].
  G Ital Cardiol (Rome)

  2024 Feb;25(2):121-125. doi: 10.1714/4187.41762.
  
  Zuin Marco, Di Fusco Stefania Angela, Zilio Filippo, Bilato Claudio, Corda Marco, De Luca Leonardo, Di Marco Massimo, Geraci Giovanna, Iacovoni Attilio, Milli Massimo, Navazio Alessandro, Pascale Vittorio, Riccio Carmine, Scicchitano Pietro, Urbinati Stefano, Caldarola Pasquale, Tizzani Emanuele, Gabrielli Domenico, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio
  
  Abstract
  
  Over the last two decades, cardiovascular diseases have become the leading cause of chronic disease morbidity and mortality in Italy. Therefore, the chronic cardiovascular care landscape has evolved rapidly in an era of unprecedented demand. Furthermore, the COVID-19 pandemic has highlighted significant deficiencies in existing health and social care systems, especially in the management of chronic cardiovascular disease. In this scenario, the National Reform for Recovery and Resilience (PNRR) may represent a unique opportunity for the development of a new integrated care system between hospital and community. The Italian Association of Hospital Cardiologists (ANMCO) recognizes the need for a statement on the integrated cardiological community care to guide health professionals caring for people with chronic cardiovascular conditions. The aim of the present statement is to outline the evidence for a modern integrated cardiological community care identifying challenges and offering advice for a future transdisciplinary and multi-organizational approach to ensure best practice in the management of chronic cardiovascular disease.
  
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• [ANMCO Position paper - 2023 ANMCO States General: The shortage of healthcare personnel in the cardiology field].
  G Ital Cardiol (Rome)

  2024 Feb;25(2):115-120. doi: 10.1714/4187.41761.
  
  Zuin Marco, Di Fusco Stefania Angela, Zilio Filippo, Barisone Michela, Bilato Claudio, Corda Marco, De Luca Leonardo, Di Marco Massimo, Geraci Giovanna, Iacovoni Attilio, Milli Massimo, Navazio Alessandro, Pascale Vittorio, Riccio Carmine, Scicchitano Pietro, Scherillo Marino, Tizzani Emanuele, Gabrielli Domenico, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio
  
  Abstract
  
  Over the latest years, a worrying progressive reduction of medical specialists has been observed in Italy and in other European and non-European countries. This trend is assuming alarming proportions, especially considering the continuous population aging and the concomitant increase in the prevalence of chronic cardiovascular disease. The underlying reasons are complex and multifactorial. The purpose of this document, derived from the collegial discussion held during the 2023 ANMCO States General is to highlight the current critical issues regarding the lack of healthcare personnel in the cardiology field, examining the current and future Italian situation and proposing some potential strategies to counteract this alarming phenomenon.
  
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• [Lipoprotein(a): relationships with atherosclerosis and valvular heart disease, and emerging therapies].
  G Ital Cardiol (Rome)

  2024 Feb;25(2):76-87. doi: 10.1714/4187.41756.
  
  Abrignani Maurizio Giuseppe, Maloberti Alessandro, Di Fusco Stefania Angela, Lucà Fabiana, Cesaro Arturo, Acerbo Vincenzo, Fabbri Saverio, Di Matteo Irene, Amico Antonio F, Temporelli Pier Luigi, Riccio Carmine, Colivicchi Furio, Grimaldi Massimo, Gabrielli Domenico, Oliva Fabrizio
  
  Abstract
  
  Lipoprotein(a) [Lp(a)] is a well-established cardiovascular risk factor, whose relationship with atherosclerotic disease has been confirmed by epidemiological, genome-wide association, Mendelian randomization, and meta-analysis studies. This association is determined by its pro-atherogenic, pro-thrombotic and pro-inflammatory properties. Lp(a) is the most common monogenic risk factor for atherosclerosis, with a prevalence of about 1 in 5 people. Recently, its etiopathogenetic relationship with calcific and degenerative valvular heart diseases, particularly with aortic and mitral stenosis, has been suspected. It has not yet been demonstrated whether its reduction translates into a lower risk of cardiovascular events. Up to now, Lp(a) has been considered a non-modifiable risk factor, as current lipid-lowering drugs have limited effects on its levels. New specific lipid-lowering therapies with high efficacy in reducing circulating Lp(a) levels are being investigated in randomized trials; however, the effects of this reduction on cardiovascular outcomes are still being studied.
  
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• Anderson-Fabry Disease: Red Flags for Early Diagnosis of Cardiac Involvement.
  Diagnostics (Basel)

  2024 Jan;14(2):. doi: 208.
  
  Iorio Annamaria, Lucà Fabiana, Pozzi Andrea, Rao Carmelo Massimiliano, Chimenti Cristina, Di Fusco Stefania Angela, Rossini Roberta, Caretta Giorgio, Cornara Stefano, Giubilato Simona, Di Matteo Irene, Di Nora Concetta, Pilleri Anna, Gelsomino Sandro, Ceravolo Roberto, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio, Gulizia Michele Massimo, , The Cardiac Rare Diseases Working Group Associazione Nazionale Medici Cardiologi Ospedalieri Anmco
  
  Abstract
  
  Anderson-Fabry disease (AFD) is a lysosome storage disorder resulting from an X-linked inheritance of a mutation in the galactosidase A (GLA) gene encoding for the enzyme alpha-galactosidase A (?-GAL A). This mutation results in a deficiency or absence of ?-GAL A activity, with a progressive intracellular deposition of glycosphingolipids leading to organ dysfunction and failure. Cardiac damage starts early in life, often occurring sub-clinically before overt cardiac symptoms. Left ventricular hypertrophy represents a common cardiac manifestation, albeit conduction system impairment, arrhythmias, and valvular abnormalities may also characterize AFD. Even in consideration of pleiotropic manifestation, diagnosis is often challenging. Thus, knowledge of cardiac and extracardiac diagnostic "red flags" is needed to guide a timely diagnosis. Indeed, considering its systemic involvement, a multidisciplinary approach may be helpful in discerning AFD-related cardiac disease. Beyond clinical pearls, a practical approach to assist clinicians in diagnosing AFD includes optimal management of biochemical tests, genetic tests, and cardiac biopsy. We extensively reviewed the current literature on AFD cardiomyopathy, focusing on cardiac "red flags" that may represent key diagnostic tools to establish a timely diagnosis. Furthermore, clinical findings to identify patients at higher risk of sudden death are also highlighted.
  
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• Working in interventional cardiology laboratories: The perceived impact of radiation exposure as a health and gender hazard. A NEXT generation ANMCO initiative.
  Int J Cardiol

  2024 Apr;401():131682. doi: 10.1016/j.ijcard.2023.131682.
  
  Bernelli Chiara, Di Fusco Stefania Angela, Matteucci Andrea, Zilio Filippo, Nesti Martina, Barbero Umberto, Maccagni Davide, Di Pasquale Giuseppe, Oliva Fabrizio, Colivicchi Furio, Maggioni Aldo Pietro
  
  Abstract
  
  BACKGROUND:
  Gender-related discrepancies in personal and professional life have been reported among radio-exposed workers. We assessed this topic among cardiac catheterization workers in Italy, with a focus on gender and working position.
  
  METHODS:
  Radio-exposed workers affiliated with the Italian Association of Hospital Cardiologists were invited to answer an online survey, which included 41 questions formatted as multiple choice.
  
  RESULTS:
  Overall, 237 workers responded. The proportion of males was significantly higher than that of females in the population aged >50 years. A greater portion of females than males perceived female-gender discrimination regarding career advancement (77.2% vs 30.9%, p 
  CONCLUSIONS:
  Gender-based career disparities were perceived among physicians and non-physician staff of cardiology interventional laboratories. Strategies should be implemented to ensure gender equality in career opportunities and to increase knowledge of radioprotection and the laws regulating access to laboratories during pregnancy.
  
  Copyright © 2023 Elsevier B.V. All rights reserved.
  
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• ANMCO (Italian Association of Hospital Cardiologists) scientific statement: obesity in adults-an approach for cardiologists.
  Eat Weight Disord

  2024 Jan;29(1):1. doi: 1.
  
  Di Fusco Stefania Angela, Mocini Edoardo, Gulizia Michele Massimo, Gabrielli Domenico, Grimaldi Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Obesity is a complex, chronic disease requiring a multidisciplinary approach to its management. In clinical practice, body mass index and waist-related measurements can be used for obesity screening. The estimated prevalence of obesity among adults worldwide is 12%. With the expected further increase in overall obesity prevalence, clinicians will increasingly be managing patients with obesity. Energy balance is regulated by a complex neurohumoral system that involves the central nervous system and circulating mediators, among which leptin is the most studied. The functioning of these systems is influenced by both genetic and environmental factors. Obesity generally occurs when a genetically predisposed individual lives in an obesogenic environment for a long period. Cardiologists are deeply involved in evaluating patients with obesity. Cardiovascular risk profile is one of the most important items to be quantified to understand the health risk due to obesity and the clinical benefit that a single patient can obtain with weight loss. At the individual level, appropriate patient involvement, the detection of potential obesity causes, and a multidisciplinary approach are tools that can improve clinical outcomes. In the near future, we will probably have new pharmacological tools at our disposal that will facilitate achieving and maintaining weight loss. However, pharmacological treatment alone cannot cure such a complex disease. The aim of this paper is to summarize some key points of this field, such as obesity definition and measurement tools, its epidemiology, the main mechanisms underlying energy homeostasis, health consequences of obesity with a focus on cardiovascular diseases and the obesity paradox.Level of evidence V: report of expert committees.
  
  © 2024. The Author(s).
  
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• [ANMCO/SIMEU Consensus document on the use of reversal agents of antithrombotic therapies in patients with active bleeding or at high-risk of major bleeding events].
  G Ital Cardiol (Rome)

  2024 Jan;25(1):60-69. doi: 10.1714/4165.41594.
  
  De Luca Leonardo, Pugliese Francesco Rocco, Susi Beniamino, Navazio Alessandro, Corda Marco, Fabbri Andrea, Scicchitano Pietro, Voza Antonio, Vanni Simone, Bilato Claudio, Geraci Giovanna, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, De Iaco Fabio, Oliva Fabrizio
  
  Abstract
  
  In recent decades, an incredible evolution in antithrombotic therapies for the treatment of patients suffering from atherosclerosis, atrial fibrillation and venous thromboembolism occurred, leading to the availability of increasingly safe drugs. However, bleeding complications associated with these drugs still have an important health, social and economic impact. Recently, with the aim of improving the acute management of patients with or at risk of major bleeding events, specific reversal agents of antithrombotic drugs have been developed. Although these agents have demonstrated their effectiveness in small pharmacodynamic studies or clinical trials, it is important to consider that the benefit of reversal of an antiplatelet or anticoagulant drug must always be counterbalanced by the possible prothrombotic effect caused by the removal of antithrombotic protection as well as by prothrombotic mechanisms related to bleeding, major surgery or trauma.In this ANMCO/SIMEU consensus document we summarize the main characteristics and efficacy studies of the currently available reversal agents and present practical flow-charts in which we suggest their possible use in patients with active bleeding or at high risk of major bleeding events.
  
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• Achievement of target LDL-cholesterol level in patients with acute coronary syndrome undergoing percutaneous coronary intervention: The JET-LDL registry.
  Int J Cardiol

  2024 Feb;397():131659. doi: 10.1016/j.ijcard.2023.131659.
  
  Ferlini Marco, Munafò Andrea, Varbella Ferdinando, Delnevo Fabrizio, Solli Martina, Trabattoni Daniela, Piccaluga Emanuela, Cardile Antonino, Canova Paolo, Rossini Roberta, Celentani Dario, Ugo Fabrizio, Taglialatela Vittorio, Airoldi Falvio, Rognoni Andrea, Oliva Fabrizio, Porto Italo, Carugo Stefano, Castiglioni Battistina, Lettieri Corrado, Chinaglia Alessandra, Currao Alessia, Patti Giuseppe, Oltrona Visconti Luigi, Musumeci Giuseppe
  
  Abstract
  
  BACKGROUND:
  In patients with acute coronary syndromes (ACS), current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level 
  METHODS:
  The JET-LDL is a multicenter, observational, prospective registry created to investigate levels of LDL-C in consecutive patients with ACS undergoing PCI at 35 Italian hospitals, and to report their lipid lowering therapies (LLT). Follow-up was planned at 1 and 3 months. LDL-C reduction >50% from baseline or level 
  RESULTS:
  A total of 1095 patients were included: median age was 67 (58-75); 33.7% were already on LLT. Baseline LDL-C levels was 105 (76.5-137) mg/dL. At hospital discharge all patients were on LLT: 98.1% received statins (as mono or combination therapy), ezetimibe and PCSK9i were used in 60.1% and 8.5% of cases, respectively. Primary endpoint was achieved in 62% (95% CI 58-65) of cases. At 1-month LDL-C levels dropped to 53 (38-70) mg/dL (p 
  CONCLUSIONS:
  In this real-world registry of ACS patients undergoing PCI, recommend LDL-C levels were obtained in 62% of patients, but PCSK9i prescription was limited to 10% of cases. As LLT pattern appeared mainly improved at hospital discharge, an early and strong treatment should be considered.
  
  Copyright © 2023 Elsevier B.V. All rights reserved.
  
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• [ANMCO Scientific statement: Differences and similarities between direct oral anticoagulants - 10 years of scientific evidence and clinical practice].
  G Ital Cardiol (Rome)

  2023 Dec;24(12):1004-1013. doi: 10.1714/4139.41349.
  
  Di Fusco Stefania Angela, Scicchitano Pietro, Grimaldi Massimo, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  The advent of direct oral anticoagulants (DOACs) has revolutionized the approach to thromboembolism prevention and treatment. The analysis of the evolution of the use of DOACs over the last decade has highlighted an overtaking in the DOAC use compared to vitamin K antagonists, with greater overall adherence to anticoagulant treatment and a reduction in ischemic events associated with atrial fibrillation. In clinical practice, particular attention should be paid to the use of the appropriate dosage based on the clinical characteristics of the individual patient, in order to avoid over- or under-treatment with a consequent increase in adverse event risk. In general, the four currently available DOACs have different pharmacokinetic and pharmacodynamic characteristics that should be taken into consideration when choosing the drug and its dosage. This review summarizes differences and similarities of DOACs in complex clinical scenarios such as elderly patients, patients with chronic kidney disease, cancer patients, and multi-treated patients.
  
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• Corrigendum: Cancer survivorship at heart: a multidisciplinary cardio-oncology roadmap for healthcare professionals.
  Front Cardiovasc Med

  2023 ;10():1309921. doi: 1309921.
  
  Bisceglia Irma, Canale Maria Laura, Silvestris Nicola, Gallucci Giuseppina, Camerini Andrea, Inno Alessandro, Camilli Massimiliano, Turazza Fabio Maria, Russo Giulia, Paccone Andrea, Mistrulli Raffaella, De Luca Leonardo, Di Fusco Stefania Angela, Tarantini Luigi, Lucà Fabiana, Oliva Stefano, Moreo Antonella, Maurea Nicola, Quagliariello Vincenzo, Ricciardi Giuseppina Rosaria, Lestuzzi Chiara, Fiscella Damiana, Parrini Iris, Racanelli Vito, Russo Antonio, Incorvaia Lorena, Calabrò Fabio, Curigliano Giuseppe, Cinieri Saverio, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  [This corrects the article DOI: 10.3389/fcvm.2023.1223660.].
  
  © 2023 Bisceglia, Canale, Silvestris, Gallucci, Camerini, Inno, Camilli, Turazza, Russo, Paccone, Mistrulli, De Luca, Di Fusco, Tarantini, Lucà, Oliva, Moreo, Maurea, Quagliariello, Ricciardi, Lestuzzi, Fiscella, Parrini, Racanelli, Russo, Incorvaia, Calabrò, Curigliano, Cinieri, Gulizia, Gabrielli, Oliva and Colivicchi.
  
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• [ANMCO Position paper: Ionizing radiation exposure and radioprotection in the cath-lab].
  G Ital Cardiol (Rome)

  2023 Nov;24(11):915-932. doi: 10.1714/4129.41234.
  
  Lucà Fabiana, Andreassi Maria Grazia, Gulizia Michele Massimo, Borghini Andrea, Colombo Paola Enrica, Benedetto Francesco Antonio, Bernelli Chiara, Bisceglia Irma, Bisignani Giovanni, Caldarola Pasquale, Canale Maria Laura, Caporale Roberto, Caretta Giorgio, Ceravolo Roberto, Ciconte Vincenzo Antonio, Corda Marco, Cornara Stefano, De Bonis Silvana, De Luca Leonardo, Di Fusco Stefania Angela, Di Matteo Irene, Di Nora Concetta, Favilli Silvia, Gelsomino Sandro, Geraci Giovanna, Giubilato Simona, Matteucci Andrea, Nardi Federico, Navazio Alessandro, Parrini Iris, Pilleri Annarita, Pozzi Andrea, Rao Carmelo Massimiliano, Riccio Carmine, Rossini Roberta, Turazza Fabio Maria, Grimaldi Massimo, Gabrielli Domenico, Picano Eugenio, Colivicchi Furio, Oliva Fabrizio
  
  Abstract
  
  In the last decades, because of the improvements in the percutaneous treatment of coronary heart disease, valvular heart disease, congenital heart defects, and the increasing number of cardiac resynchronization therapy and cardioverter-defibrillator implantations, the interventional cardiologists' radio-exposure has importantly risen, causing concerns for ionizing radiation-associated diseases such as cancer and neurodegenerative disorders. Consequently, the radiation exposure issue importantly affects operators' safety. However, our knowledge of this field is poor and most operators are unaware to be at risk, especially because of the absence of effective preventive measures. The aim of this ANMCO position paper is to improve the awareness of operators and identify new ways of reducing operator ionizing radiation dose and minimizing the risk.
  
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• Prevalence and predictive role of hypertriglyceridemia in statin-treated patients at very high risk: Insights from the START study.
  Nutr Metab Cardiovasc Dis

  2023 Dec;33(12):2398-2405. doi: 10.1016/j.numecd.2023.07.036.
  
  De Luca Leonardo, Temporelli Pier Luigi, Gulizia Michele Massimo, Gonzini Lucio, Ammaturo Tiziana Anita, Tedesco Luigi, Pede Silvia, Oliva Fabrizio, Gabrielli Domenico, Colivicchi Furio, Averna Maurizio R,
  
  Abstract
  
  BACKGROUND AND AIM:
  Elevated triglyceride (TG) levels seem to identify subjects at increased cardiovascular risk, independent of LDL-C levels. We sought to evaluate the predictive role of hypertriglyceridemia, defined as TG levels ?150 mg/dl, in very high risk (VHR) patients with chronic coronary syndromes (CCS) treated with statins.
  
  METHODS AND RESULTS:
  Using the data from the STable Coronary Artery Diseases RegisTry (START) study, an Italian nationwide registry, we assessed the association between the TG levels and baseline clinical characteristics, pharmacological treatment and major adverse cardio-cerebrovascular events (MACCE) at 1 year in a large cohort of statin-treated patients at VHR. Of the 4751 consecutive patients with CCS enrolled in the registry and classified as VHR, 2652 (55.8%) had TG values available (mean 120.6 ± 54.9) and were treated with at least a statin at baseline: 2019 (76.1%) with TG 
  CONCLUSIONS:
  In the present large, nationwide cohort of consecutive CCS patients at VHR with statin-controlled LDL-C levels, hypertriglyceridemia was present in around 24% of cases and did not result as predictor of MACCE at 1 year. Further studies with a longer follow-up and larger sample size are needed to better define the prognostic role of TG levels when intensive LDL lowering therapies are used.
  
  Copyright © 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
  
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• Cancer survivorship at heart: a multidisciplinary cardio-oncology roadmap for healthcare professionals.
  Front Cardiovasc Med

  2023 ;10():1223660. doi: 1223660.
  
  Bisceglia Irma, Canale Maria Laura, Silvestris Nicola, Gallucci Giuseppina, Camerini Andrea, Inno Alessandro, Camilli Massimiliano, Turazza Fabio Maria, Russo Giulia, Paccone Andrea, Mistrulli Raffaella, De Luca Leonardo, Di Fusco Stefania Angela, Tarantini Luigi, Lucà Fabiana, Oliva Stefano, Moreo Antonella, Maurea Nicola, Quagliariello Vincenzo, Ricciardi Giuseppina Rosaria, Lestuzzi Chiara, Fiscella Damiana, Parrini Iris, Racanelli Vito, Russo Antonio, Incorvaia Lorena, Calabrò Fabio, Curigliano Giuseppe, Cinieri Saverio, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  In cancer, a patient is considered a survivor from the time of initial diagnosis until the end of life. With improvements in early diagnosis and treatment, the number of cancer survivors (CS) has grown considerably and includes: (1) Patients cured and free from cancer who may be at risk of late-onset cancer therapy-related cardiovascular toxicity (CTR-CVT); (2) Patients with long-term control of not-curable cancers in whom CTR-CVT may need to be addressed. This paper highlights the importance of the cancer care continuum, of a patient-centered approach and of a prevention-oriented policy. The ultimate goal is a personalized care of CS, achievable only through a multidisciplinary-guided survivorship care plan, one that replaces the fragmented management of current healthcare systems. Collaboration between oncologists and cardiologists is the pillar of a framework in which primary care providers and other specialists must be engaged and in which familial, social and environmental factors are also taken into account.
  
  © 2023 Bisceglia, Canale, Silvestris, Gallucci, Camerini, Inno, Camilli, Turazza, Russo, Paccone, Mistrulli, De Luca, Di Fusco, Tarantini, Lucà, Oliva, Moreo, Maurea, Quagliariello, Ricciardi, Lestuzzi, Fiscella, Parrini, Racanelli, Russo, Incorvaia, Calabrò, Curigliano, Cinieri, Gulizia, Gabrielli, Oliva and Colivicchi.
  
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• [Practical approach to the patient with fever in the intensive cardiac care unit: diagnostic framework and therapy notes].
  G Ital Cardiol (Rome)

  2023 Oct;24(10):800-809. doi: 10.1714/4100.40980.
  
  Gasparetto Nicola, Trambaiolo Paolo, Sorini Dini Carlotta, Scotton Piergiorgio, Chiappetta Daniela, Ferlini Marco, Giubilato Simona, Rossini Roberta, Valente Serafina, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  The management of the patient with fever in the intensive cardiac care unit begins with a thorough evaluation of the patient, particularly symptoms, clinical history and physical examination, to provide information regarding the origin of the fever. The global evaluation of the patient should be integrated with blood and microbiological tests, in particular blood culture and swab. The laboratory, microbiologic or radiologic tests could be more or less detailed and targeted depending on the type of suspected infection and clinical conditions of the patient. When therapy is necessary, it is crucial to switch, as soon as possible, from broad spectrum antibiotic therapy to antibiotic therapy based on the results of the microbiological exams. Antibiotic therapy could be associated with antipyretic and specific organ support therapy when necessary.
  
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• Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention.
  J Clin Med

  2023 Sep;12(18):. doi: 5989.
  
  Giubilato Simona, Lucà Fabiana, Abrignani Maurizio Giuseppe, Gatto Laura, Rao Carmelo Massimiliano, Ingianni Nadia, Amico Francesco, Rossini Roberta, Caretta Giorgio, Cornara Stefano, Di Matteo Irene, Di Nora Concetta, Favilli Silvia, Pilleri Anna, Pozzi Andrea, Temporelli Pier Luigi, Zuin Marco, Amico Antonio Francesco, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio, Gulizia Michele Massimo
  
  Abstract
  
  Chronic coronary syndrome (CCS), which encompasses a broad spectrum of clinical presentations of coronary artery disease (CAD), is the leading cause of morbidity and mortality worldwide. Recent guidelines for the management of CCS emphasize the dynamic nature of the CAD process, replacing the term "stable" with "chronic", as this disease is never truly "stable". Despite significant advances in the treatment of CAD, patients with CCS remain at an elevated risk of major cardiovascular events (MACE) due to the so-called residual cardiovascular risk. Several pathogenetic pathways (thrombotic, inflammatory, metabolic, and procedural) may distinctly contribute to the residual risk in individual patients and represent a potential target for newer preventive treatments. Identifying the level and type of residual cardiovascular risk is essential for selecting the most appropriate diagnostic tests and follow-up procedures. In addition, new management strategies and healthcare models could further support available treatments and lead to important prognostic benefits. This review aims to provide an overview of the diagnostic and therapeutic challenges in the management of patients with CCS and to promote more effective multidisciplinary care.
  
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• Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios.
  J Clin Med

  2023 Sep;12(18):. doi: 5955.
  
  Lucà Fabiana, Oliva Fabrizio, Abrignani Maurizio Giuseppe, Di Fusco Stefania Angela, Parrini Iris, Canale Maria Laura, Giubilato Simona, Cornara Stefano, Nesti Martina, Rao Carmelo Massimiliano, Pozzi Andrea, Binaghi Giulio, Maloberti Alessandro, Ceravolo Roberto, Bisceglia Irma, Rossini Roberta, Temporelli Pier Luigi, Amico Antonio Francesco, Calvanese Raimondo, Gelsomino Sandro, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Gulizia Michele Massimo
  
  Abstract
  
  It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug-drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.
  
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• Comprehensive diagnostic workup in patients with suspected heart failure and preserved ejection fraction.
  Hellenic J Cardiol

  2024 ;75():60-73. doi: 10.1016/j.hjc.2023.09.013.
  
  Albani Stefano, Zilio Filippo, Scicchitano Pietro, Musella Francesca, Ceriello Laura, Marini Marco, Gori Mauro, Khoury Georgette, D'Andrea Antonello, Campana Marco, Iannopollo Gianmarco, Fortuni Federico, Ciliberti Giuseppe, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Diagnosis of heart failure with preserved ejection fraction (HFpEF) can be challenging and it could require different tests, some of which are affected by limited availability. Nowadays, considering that new therapies are available for HFpEF and related conditions, a prompt and correct diagnosis is relevant. However, the diagnostic role of biomarker level, imaging tools, score-based algorithms and invasive evaluation, should be based on the strengths and weaknesses of each test. The aim of this review is to help the clinician in diagnosing HFpEF, overcoming the diagnostic uncertainty and disentangling among the different underlying causes, in order to properly treat this kind of patient.
  
  Copyright © 2023 Hellenic Society of Cardiology. Published by Elsevier Inc. All rights reserved.
  
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• Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction.
  ESC Heart Fail

  2023 Dec;10(6):3472-3482. doi: 10.1002/ehf2.14510.
  
  Bertaina Maurizio, Morici Nuccia, Frea Simone, Garatti Laura, Briani Martina, Sorini Carlotta, Villanova Luca, Corrada Elena, Sacco Alice, Moltrasio Marco, Ravera Amelia, Tedeschi Michele, Bertoldi Letizia, Lettino Maddalena, Saia Francesco, Corsini Anna, Camporotondo Rita, Colombo Costanza Natalia Julia, Bertolin Stephanie, Rota Matteo, Oliva Fabrizio, Iannaccone Mario, Valente Serafina, Pagnesi Matteo, Metra Marco, Sionis Alessandro, Marini Marco, De Ferrari Gaetano Maria, Kapur Navin K, Pappalardo Federico, Tavazzi Guido
  
  Abstract
  
  AIMS:
  The present analysis from the multicentre prospective Altshock-2 registry aims to better define clinical features, in-hospital course, and management of cardiogenic shock complicating acutely decompensated heart failure (ADHF-CS) as compared with that complicating acute myocardial infarction (AMI-CS).
  
  METHODS AND RESULTS:
  All patients with AMI-CS or ADHF-CS enrolled in the Altshock-2 registry between March 2020 and February 2022 were selected. The primary objective was the characterization of ADHF-CS patients as compared with AMI-CS. In-hospital length of stay and mortality were secondary endpoints. One-hundred-ninety of the 238 CS patients enrolled in the aforementioned period were considered for the present analysis: 101 AMI-CS (80% ST-elevated myocardial infarction and 20% non-ST-elevated myocardial infarction) and 89 ADHF-CS. As compared with AMI-CS, ADHF-CS patients were younger [63 (IQR 59-76) vs. 67 (IQR 54-73) years, P = 0.01], but presented with higher creatinine [1.6 (IQR 1.0-2.6) vs. 1.2 (IQR 1.0-1.4) mg/dL, P 
  CONCLUSIONS:
  ADHF-CS is characterized by a higher prevalence of end-organ and biventricular dysfunction at presentation, a longer hospital length of stay, and higher need of heart replacement therapies when compared with AMI-CS. In-hospital mortality was similar between the two aetiologies. Our data warrant development of new management protocols focused on CS aetiology.
  
  © 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
  
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• Bridging the gap in the symptomatic heart failure patient journey: insights from the Italian scenario.
  Expert Rev Med Devices

  2023 ;20(11):951-961. doi: 10.1080/17434440.2023.2258786.
  
  Ziacchi Matteo, Spadotto Alberto, Ghio Stefano, Pellegrino Marta, Potena Luciano, Masarone Daniele, Merlo Marco, Stolfo Davide, Caracciolo Maria Michela, Inserra Corinna, Ammirati Fabrizio, Ciccarelli Michele, Colivicchi Furio, Bianchi Stefano, Patti Giuseppe, Oliva Fabrizio, Arcidiacono Giuseppe, Rordorf Roberto, Pini Daniela, Pacileo Giuseppe, D'Onofrio Antonio, Forleo Giovanni Battista, Mariani Matteo, Adamo Francesco, Alonzo Alessandro, Ruzzolini Matteo, Ghiglieno Chiara, Cipriani Manlio, Firetto Giorgio, Aspromonte Nadia, Clemenza Francesco, Maria De Ferrari Gaetano, Senni Michele, Grazia Bongiorni Maria, Tondo Claudio, Grimaldi Massimo, Giallauria Francesco, Rametta Francesco, Marchese Procolo, Biffi Mauro, Sinagra Gianfranco
  
  Abstract
  
  BACKGROUND:
  The prognosis for heart failure (HF) patients remains poor, with a high mortality rate, and a marked reduction in quality of life (QOL) and functional status. This study aims to explore the ongoing needs of HF management and the epidemiology of patients followed by Italian HF clinics, with a specific focus on cardiac contractility modulation (CCM).
  
  RESEARCH DESIGN AND METHODS:
  Data from patients admitted to 14 HF outpatients clinics over 4 weeks were collected and compared to the results of a survey open to physicians involved in HF management operating in Italian centers.
  
  RESULTS:
  One hundred and five physicians took part in the survey. Despite 94% of patients receive a regular follow-up every 3-6?months, available therapies are considered insufficient in 30% of cases. Physicians reported a lack of treatment options for 23% of symptomatic patients with reduced ejection fraction (EF) and for 66% of those without reduced EF. Approximately 3% of HF population (two patients per month per HF clinic) meets the criteria for immediate CCM treatment, which is considered a useful option by 15% of survey respondents.
  
  CONCLUSIONS:
  Despite this relatively small percentage, considering total HF population, CCM could potentially benefit numerous HF patients, particularly the elderly, by reducing hospitalizations, improving functional capacity and QOL.
  
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• [ANMCO Position paper: Choosing Wisely - ANMCO proposals for 2023].
  G Ital Cardiol (Rome)

  2023 Sep;24(9):754-765. doi: 10.1714/4084.40686.
  
  Lucà Fabiana, Gulizia Michele Massimo, Abrignani Maurizio Giuseppe, Benedetto Francesco Antonio, Bisceglia Irma, Bisignani Giovanni, Bobbio Marco Carlo, Caldarola Pasquale, Canale Maria Laura, Caretta Giorgio, Ceravolo Roberto, Chimenti Cristina, Ciconte Vincenzo Antonio, Corda Marco, Cornara Stefano, Di Fusco Stefania Angela, Di Matteo Irene, Di Nora Concetta, Favilli Silvia, Francese Giuseppina Maura, Gelsomino Sandro, Gensini Gian Franco, Giubilato Simona, Grimaldi Massimo, Nardi Federico, Navazio Alessandro, Parrini Iris, Pilleri Annarita, Pozzi Andrea, Rao Carmelo Massimiliano, Riccio Carmine, Rossini Roberta, Vernero Sandra, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Nowadays, a progressive and exponential increase in the use of invasive and non-invasive instrumental diagnostics and therapeutic services has been shown. Although unnecessary, instrumental examinations are often largely prescribed, replacing clinical evaluation. Their correct use, on the contrary, would address precise epidemiological and clinical contexts. Therefore identifying whether a test or procedure is appropriate or not plays a crucial role in clinical practice. Several documents from scientific societies and expert groups indicate the most appropriate cardiovascular diagnostic and therapeutic procedures. The international Choosing Wisely campaign invited the main scientific societies to identify five techniques or treatments used in their field that are often unnecessary and may potentially damage patients. The Italian Association of Hospital Cardiologists (ANMCO) joined the project identifying the five cardiological practices in our country at greater risk of inappropriateness in 2014. This list has recently been updated. Moreover, possible solutions to this problem have been proposed.
  
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• [Electrical storm management in the cardiac care unit].
  G Ital Cardiol (Rome)

  2023 Sep;24(9):711-730. doi: 10.1714/4084.40681.
  
  Dusi Veronica, De Ferrari Gaetano Maria, Vergara Pasquale, Gravinese Carol, Frea Simone, Nesti Martina, Valente Serafina, Calvanese Raimondo, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Electrical storm (ES) is characterized by at least three separate episodes of ventricular arrhythmia (VA) over 24 h that require treatment or an incessant VA lasting >12 h. The incidence is higher in patients with implantable cardioverter-defibrillators (ICDs) in secondary prevention and the main manifestation is monomorphic VA. ES onset represents a major event in the history of patients with cardiomyopathies that significantly worsens prognosis. The management of ES is complex and requires a multidisciplinary approach including a comprehensive clinical assessment, resuscitation and sedation management skills, ICD reprogramming, ablation, and neuromodulation procedures. ES early recognition and prompt treatment initiation increase the chances of therapeutic success. Each one of these aspects will be properly discussed in the present decalogue. Notably, ES management remains a challenge, with only limited available evidence from small retrospective series and a substantial lack/limited number of randomized or prospective trials. The spectrum of available antiarrhythmic drugs is limited, as well as their efficacy. The future hope is that larger prospective studies will be able to answer important questions, concerning the most effective pharmacologic strategies, the timing for the invasive treatment, the indications for acute neuromodulation strategies and for the circulatory support tools.
  
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• External validity of the PRECISE-DAPT score in patients undergoing PCI: a systematic review and meta-analysis.
  Eur Heart J Cardiovasc Pharmacother

  2023 Dec;9(8):709-721. doi: 10.1093/ehjcvp/pvad063.
  
  Munafò Andrea Raffaele, Montalto Claudio, Franzino Marco, Pistelli Lorenzo, Di Bella Gianluca, Ferlini Marco, Leonardi Sergio, D'Ascenzo Fabrizio, Gragnano Felice, Oreglia Jacopo A, Oliva Fabrizio, Ortega-Paz Luis, Calabrò Paolo, Angiolillo Dominick J, Valgimigli Marco, Micari Antonio, Costa Francesco
  
  Abstract
  
  AIMS:
  To summarize the totality of evidence validating the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, ascertaining its aggregate discrimination and validation power in multiple population subsets.
  
  METHODS AND RESULTS:
  We searched electronic databases from 2017 (PRECISE-DAPT proposal) up to March 2023 for studies that reported the occurrence of out-of-hospital bleedings according to the PRECISE-DAPT score in patients receiving DAPT following percutaneous coronary intervention (PCI). Pooled odds ratios (OR) with 95% confidence interval (CI) were used as summary statistics and were calculated using a random-effects model. Primary and secondary endpoints were the occurrence of any and major bleeding, respectively. A total of 21 studies and 67 283 patients were included; 24.7% of patients (N = 16 603) were at high bleeding risk (PRECISE-DAPT score ?25), and when compared to those at low bleeding risk, they experienced a significantly higher rate of any out-of-hospital bleeding (OR: 2.71; 95% CI: 2.24-3.29; P-value 
  CONCLUSION:
  This systematic review and meta-analysis confirms the external validity of the PRECISE-DAPT score in predicting out-of-hospital bleeding outcomes in patients on DAPT following PCI. The moderate discriminative ability highlights the need for future improved risk prediction tools in the field.
  
  © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Appropriateness of Dyslipidemia Management Strategies in Post-Acute Coronary Syndrome: A 2023 Update.
  Metabolites

  2023 Aug;13(8):. doi: 916.
  
  Lucà Fabiana, Oliva Fabrizio, Rao Carmelo Massimiliano, Abrignani Maurizio Giuseppe, Amico Antonio Francesco, Di Fusco Stefania Angela, Caretta Giorgio, Di Matteo Irene, Di Nora Concetta, Pilleri Anna, Ceravolo Roberto, Rossini Roberta, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Gulizia Michele Massimo,
  
  Abstract
  
  It has been consistently demonstrated that circulating lipids and particularly low-density lipoprotein cholesterol (LDL-C) play a significant role in the development of coronary artery disease (CAD). Several trials have been focused on the reduction of LDL-C values in order to interfere with atherothrombotic progression. Importantly, for patients who experience acute coronary syndrome (ACS), there is a 20% likelihood of cardiovascular (CV) event recurrence within the two years following the index event. Moreover, the mortality within five years remains considerable, ranging between 19 and 22%. According to the latest guidelines, one of the main goals to achieve in ACS is an early improvement of the lipid profile. The evidence-based lipid pharmacological strategy after ACS has recently been enhanced. Although novel lipid-lowering drugs have different targets, the result is always the overexpression of LDL receptors (LDL-R), increased uptake of LDL-C, and lower LDL-C plasmatic levels. Statins, ezetimibe, and PCSK9 inhibitors have been shown to be safe and effective in the post-ACS setting, providing a consistent decrease in ischemic event recurrence. However, these drugs remain largely underprescribed, and the consistent discrepancy between real-world data and guideline recommendations in terms of achieved LDL-C levels represents a leading issue in secondary prevention. Although the cost-effectiveness of these new therapeutic advancements has been clearly demonstrated, many concerns about the cost of some newer agents continue to limit their use, affecting the outcome of patients who experienced ACS. In spite of the fact that according to the current recommendations, a stepwise lipid-lowering approach should be adopted, several more recent data suggest a "strike early and strike strong" strategy, based on the immediate use of statins and, eventually, a dual lipid-lowering therapy, reducing as much as possible the changes in lipid-lowering drugs after ACS. This review aims to discuss the possible lipid-lowering strategies in post-ACS and to identify those patients who might benefit most from more powerful treatments and up-to-date management.
  
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• Screening and management of dyslipidemia in oncologic patients undergoing cardiotoxic therapies: results from an Italian survey.
  Cardiooncology

  2023 Aug;9(1):32. doi: 32.
  
  Camilli Massimiliano, Bisceglia Irma, Canale Maria Laura, Turazza Fabio Maria, De Luca Leonardo, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  BACKGROUND:
  Baseline cardiovascular risk factors correction is recommended in all cancer patients undergoing potentially cardiotoxic therapies. Despite available guidelines, real-world data on dyslipidemia prevalence and management in the oncologic population are still sparse.
  
  METHODS:
  This survey was an Italian, investigator-initiated survey initially designed and drafted by the Cardio-Oncology section of the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), comprising 10 individual multi-choice questions and spread after validation through the ANMCO mailing list. The survey was sent to cardiologists working in cardio-oncology units and/or managing patients with cancer.
  
  RESULTS:
  Our survey included 139 Italian cardiologists. The majority of them routinely ask for the baseline lipidic profile of their patients, regardless of previous clinical history and planned treatment. According to our participants, the estimated prevalence of dyslipidemia in this population is between 20% and 60%. Although this high prevalence, our results highlight that there is poor harmony in terms of scores for CV risk prediction used in clinical practice to guide drug prescription and baseline therapy optimization. On the same line, coronary artery calcium score is poorly used in this setting. At the same time, more than 30% of interrogated physicians do not prescribe adequate statin doses, even though necessary, and have uncertainties on the use of other anti-dyslipidemic drugs in this population.
  
  CONCLUSIONS:
  Our results highlight the necessity of strong evidences on dyslipidemia screening and management in the cancer population, as well as the need of knowledge diffusion from scientific societies to clinicians treating these patients.
  
  © 2023. BioMed Central Ltd., part of Springer Nature.
  
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• [ANMCO Position paper: Colchicine as a therapeutic agent in coronary syndromes].
  G Ital Cardiol (Rome)

  2023 Aug;24(8):665-674. doi: 10.1714/4068.40536.
  
  Di Fusco Stefania Angela, Imazio Massimo, Rizzello Vittoria, Gatto Laura, Spinelli Antonella, Aquilani Stefano, Riccio Carmine, Caldarola Pasquale, Nardi Federico, De Luca Leonardo, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  With the growing knowledge about the role of inflammatory processes in the pathogenesis of atherosclerotic lesions, inflammation has been identified as a cardiovascular risk factor and therapeutic target to reduce the residual risk in patients with atherosclerotic disease. Several therapeutic agents with anti-inflammatory action have been tested to evaluate their efficacy and safety in the context of atherosclerotic cardiovascular diseases. Among these, colchicine, a drug with multiple therapeutic effects including anti-inflammatory action, in randomized clinical trials conducted in the setting of atherosclerotic cardiovascular disease secondary prevention, significantly reduced the risk of adverse cardiovascular events.This position paper of the Italian Association of Hospital Cardiologists (ANMCO) summarizes the main biological mechanisms through which colchicine contributes to the inhibition of inflammatory processes that increase the atherosclerotic cardiovascular risk. Furthermore, the document reports the available evidence on clinical impact of colchicine treatment in the reduction of residual cardiovascular risk in chronic and acute coronary syndromes. Finally, practical information is provided regarding the use of this drug in this specific clinical setting, emphasizing precautions and possible side effects.
  
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• [Cardiac contractility modulation therapy: molecular mechanisms and rationale for clinical application in heart failure with systolic and diastolic dysfunction].
  G Ital Cardiol (Rome)

  2023 Aug;24(8):646-652. doi: 10.1714/4068.40533.
  
  Guarnaccia Alberto, Dal Ferro Matteo, Biffi Mauro, Aspromonte Nadia, Bongiorni Maria Grazia, Clemenza Francesco, D'Onofrio Antonio, De Ferrari Gaetano Maria, Giallauria Francesco, Grimaldi Massimo, Matta Mario, Marchese Procolo, Occhetta Eraldo, Oliva Fabrizio, Porcari Aldostefano, Rametta Francesco, Senni Michele, Tondo Claudio, Ziacchi Matteo, Sinagra Gianfranco
  
  Abstract
  
  This review illustrates the pathophysiological aspects and available scientific evidence on molecular mechanisms about cardiac contractility modulation (CCM) therapy. The main advances in understanding the effect of this electrical therapy at cellular level in the heart are critically discussed in light of the data from clinical trials supporting the use of CCM therapy in patients with heart failure across a wide range of left ventricular ejection fraction values. This electrical therapy triggers a physiological cellular response leading to an improvement of cardiac performance and reverse ventricular remodeling, with no increase in oxygen consumption. The present review deals with the new potential applications of CCM for patients with chronic heart failure and paves the way for the development of a longitudinal Italian registry of patients implanted with this cardiac device.
  
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• Natural history and clinical burden of moderate aortic stenosis: a systematic review and explorative meta-analysis.
  J Cardiovasc Med (Hagerstown)

  2023 Sep;24(9):659-665. doi: 10.2459/JCM.0000000000001490.
  
  Morelli Martina, Galasso Michele, Esposito Giuseppe, Soriano Francesco Stefano, Nava Stefano, Da Pozzo Caterina, Bossi Irene, Piccaluga Emanuela, Bruschi Giuseppe, Maloberti Alessandro, Oliva Fabrizio, Oreglia Jacopo Andrea, Giannattasio Cristina, Montalto Claudio
  
  Abstract
  
  AIMS:
  The mortality risk of patients with moderate aortic stenosis is not well known, but recent studies suggested that it might negatively affect prognosis. We aimed to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of patients' baseline characteristics with prognosis.
  
  METHODS:
  Systematic research was conducted on PubMed. The inclusion criteria were inclusion of patients with moderate aortic stenosis; and report of the survival at 1-year follow-up (minimum). Incidence ratios related to all-cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. All patients with mild aortic stenosis or without aortic stenosis were considered controls. Meta-regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis.
  
  RESULTS:
  Fifteen studies and 11?596 patients with moderate aortic stenosis were included. All-cause mortality was significantly higher among patients with moderate aortic stenosis than in controls in all timeframes analysed (all P ?0.0001). Left ventricular ejection fraction and sex did not significantly impact on the prognosis of patients with moderate aortic stenosis ( P ?=?0.4584 and P ?=?0.5792), while increasing age showed a significant interaction with mortality (estimate = 0.0067; 95% confidence interval: 0.0007-0.0127; P ?=?0.0323).
  
  CONCLUSION:
  Moderate aortic stenosis is associated with reduced survival. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of aortic valve replacement.
  
  Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.
  
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• 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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• [ANMCO Position paper: Inclisiran: an innovative therapeutic approach for the clinical management of hypercholesterolemia].
  G Ital Cardiol (Rome)

  2023 Jul;24(7):581-588. doi: 10.1714/4060.40437.
  
  Di Fusco Stefania Angela, Scicchitano Pietro, Spinelli Antonella, Conte Edoardo, Aquilani Stefano, Aiello Alessandro, Nardi Federico, Riccio Carmine, Caldarola Pasquale, De Luca Leonardo, Roncon Loris, Valente Serafina, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Research focused on lipid-lowering treatments has led to the development of new therapeutic options aimed at cardiovascular risk reduction. Gene silencing represents one of the most innovative approaches to reduce low-density lipoprotein cholesterol (LDL-C). Inclisiran is a small interfering RNA that inhibits proprotein convertase subtilisin/kexin type 9 synthesis and promotes LDL-C clearance by enhancing LDL-C receptor expression on hepatocyte cell surface. Several clinical studies have demonstrated inclisiran efficacy in terms of LDL-C reduction (~50%) with a dosage regimen of 300 mg administered twice a year after the first two doses administered at time 0 and after 90 days. Inclisiran use has recently been approved by the European and American drug regulatory agencies as a therapeutic option in addition to the maximum tolerated statin therapy in adults with primary hypercholesterolemia or mixed dyslipidemia who need further LDL-C reduction.
  
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• [ANMCO Position paper in collaboration with ITACARE-P: Anti-ischemic treatment in patients with chronic coronary syndrome].
  G Ital Cardiol (Rome)

  2023 Jul;24(7):571-580. doi: 10.1714/4060.40436.
  
  Riccio Carmine, Mureddu Gian Francesco, Di Fusco Stefania Angela, Abrignani Maurizio Giuseppe, Orso Francesco, Temporelli Pier Luigi, De Luca Leonardo, Fattirolli Francesco, Faggiano Pompilio, Ambrosetti Marco, Nardi Federico, Caldarola Pasquale, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Over the last decade, pharmacological therapies for primary and secondary prevention of chronic coronary syndromes enriched with new agents have been demonstrated to be effective in reducing cardiovascular adverse events. However, currently available evidence on treatment for anginal symptom control is weaker. This position paper of the Italian Association of Hospital Cardiologists (ANMCO) aims to briefly report evidence that supports the use of anti-ischemic drugs for chronic coronary syndromes. Furthermore, we propose a therapeutic algorithm for the choice of the most appropriate drug on the basis of the clinical characteristics of the individual patient.
  
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• [The hypoxic patient in the intensive cardiac care unit: from nasal cannulas to oro-tracheal intubation].
  G Ital Cardiol (Rome)

  2023 Jul;24(7):538-546. doi: 10.1714/4060.40433.
  
  Sorini Dini Carlotta, Valente Serafina, Trambaiolo Paolo, Ebert Alberto Genovesi, Tizzani Emanuele, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio,
  
  Abstract
  
  Acute respiratory failure is a frequent complication of patients admitted to the intensive cardiac care unit and it is associated with a poor short- and long-term outcome. Acute respiratory failure can be managed with traditional oxygen therapy, with high-flow nasal cannula, continuous positive airway pressure, non-invasive ventilation or invasive ventilation according to clinical and blood gas condition. The use of advanced respiratory therapies is associated with both respiratory and hemodynamic effects, therefore the intensivist cardiologist should know deeply these respiratory devices. The intensivist cardiologist should perform an early diagnosis of acute respiratory failure, an appropriate selection of the respiratory device, and accurate monitoring and management to obtain clinical improvement and to avoid mechanical invasive ventilation.
  
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• Management of oral anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation.
  Front Cardiovasc Med

  2023 ;10():1061618. doi: 1061618.
  
  Lucà Fabiana, Colivicchi Furio, Oliva Fabrizio, Abrignani Maurizio, Caretta Giorgio, Di Fusco Stefania Angela, Giubilato Simona, Cornara Stefano, Di Nora Concetta, Pozzi Andrea, Di Matteo Irene, Pilleri Anna, Rao Carmelo Massimiliano, Parlavecchio Antonio, Ceravolo Roberto, Benedetto Francesco Antonio, Rossini Roberta, Calvanese Raimondo, Gelsomino Sandro, Riccio Carmine, Gulizia Michele Massimo
  
  Abstract
  
  Intracranial hemorrhage (ICH) is considered a potentially severe complication of oral anticoagulants (OACs) and antiplatelet therapy (APT). Patients with atrial fibrillation (AF) who survived ICH present both an increased ischemic and bleeding risk. Due to its lethality, initiating or reinitiating OACs in ICH survivors with AF is challenging. Since ICH recurrence may be life-threatening, patients who experience an ICH are often not treated with OACs, and thus remain at a higher risk of thromboembolic events. It is worthy of mention that subjects with a recent ICH and AF have been scarcely enrolled in randomized controlled trials (RCTs) on ischemic stroke risk management in AF. Nevertheless, in observational studies, stroke incidence and mortality of patients with AF who survived ICH had been shown to be significantly reduced among those treated with OACs. However, the risk of hemorrhagic events, including recurrent ICH, was not necessarily increased, especially in patients with post-traumatic ICH. The optimal timing of anticoagulation initiation or restarting after an ICH in AF patients is also largely debated. Finally, the left atrial appendage occlusion option should be evaluated in AF patients with a very high risk of recurrent ICH. Overall, an interdisciplinary unit consisting of cardiologists, neurologists, neuroradiologists, neurosurgeons, patients, and their families should be involved in management decisions. According to available evidence, this review outlines the most appropriate anticoagulation strategies after an ICH that should be adopted to treat this neglected subset of patients.
  
  © 2023 Lucà, Colivicchi, Oliva, Abrignani, Caretta, Di Fusco, Giubilato, Cornara, Di Nora, Pozzi, Di Matteo, Pilleri, Rao, Parlavecchio, Ceravolo, Benedetto, Rossini, Calvanese, Gelsomino, Riccio and Gulizia.
  
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• [ANMCO Expert opinion: Bempedoic acid place in therapy for hypercholesterolemia management].
  G Ital Cardiol (Rome)

  2023 Jun;24(6):490-498. doi: 10.1714/4041.40210.
  
  Di Fusco Stefania Angela, Aquilani Stefano, Spinelli Antonella, Alonzo Alessandro, Castello Lorenzo, Caldarola Pasquale, De Luca Leonardo, Riccio Carmine, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Growing evidence supporting the central role of hypercholesterolemia in atherosclerotic disease pathogenesis and progression has led to the development of new therapeutic approaches. Bempedoic acid has recently been approved for marketing following several studies that demonstrated its efficacy and safety. This drug represents a new therapeutic option that, like statins, acts on the enzymatic cascade that is involved in cholesterol synthesis. However, its hepatic selectivity of action reduces the risk of muscle adverse effects. This ANMCO document highlights clinical settings in which bempedoic acid represents a particularly useful therapeutic option. Furthermore, the document discusses the possibilities of use based on both international recommendations and current national regulations. Finally, we report practical guidance on hypercholesterolemia management in light of the available therapeutic armamentarium.
  
  Guarda su PubMed

• [ANMCO statement: Uric acid and cardiovascular disease: evidence and therapeutic approach].
  G Ital Cardiol (Rome)

  2023 Jun;24(6):483-489. doi: 10.1714/4041.40209.
  
  Di Fusco Stefania Angela, Castello Lorenzo, Marino Gaetano, Flori Marco, Aquilani Stefano, Riccio Carmine, Nardi Federico, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Pathophysiologic processes promoted by uric acid, including inflammation and oxidative stress, play a key role in the pathogenesis of several cardiovascular diseases. Furthermore, a number of epidemiological studies have shown an association between uric acid plasma levels and multiple cardiovascular risk factors. This ANMCO statement provides an update on available evidence regarding the association between elevated plasma uric acid levels and cardiovascular disease risk and the safety and efficacy of uric acid lowering agents (allopurinol and febuxostat) used in patients with urate crystal deposits. In addition, it summarizes practical indications for the use of these drugs in at-risk patients or in patients with cardiovascular disease.
  
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• [Substances of abuse and cardiovascular risk: cannabinoids].
  G Ital Cardiol (Rome)

  2023 Jun;24(6):455-465. doi: 10.1714/4041.40205.
  
  Abrignani Maurizio G, Ciccirillo Francesco, Temporelli Pier Luigi, Cesaro Arturo, Binaghi Giulio, Maloberti Alessandro, Cappelletto Chiara, Oliva Fabrizio, Riccio Carmine, Caldarola Pasquale, Gabrielli Domenico, Colivicchi Furio
  
  Abstract
  
  Progressive legalization for medical conditions or recreational use has led to an increased use of cannabis and synthetic cannabinoids over the past years. Most consumers are young and healthy, without cardiovascular risk factors; however, this population is expected to include older individuals. Thus, concerns have arisen about safety and short- and long-term potential adverse effects, with special emphasis on vulnerable groups. Studies show that cannabis might be linked with thrombosis, inflammation, and atherosclerosis, and many reports have associated cannabis and synthetic cannabinoids use with serious adverse cardiovascular complications, including myocardial infarction, cardiomyopathy, arrhythmias, stroke, and cardiac arrest. A clearly defined causal role cannot be demonstrated, because of confounding variables. Physicians need to become aware of the possible spectrum of clinical presentations, not only for timely diagnosis and treatment, but also for effective counseling and prevention.In this review, we aim to provide a basic understanding of the physiological effects of cannabis, the role of the endocannabinoid system in cardiovascular disease, and the cardiovascular consequences of cannabis and synthetic cannabinoid use, including a comprehensive review of the studies and case reports that provide supportive evidence for cannabis as a trigger of adverse cardiovascular events according to the current literature.
  
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• ANMCO position paper on vericiguat use in heart failure: from evidence to place in therapy.
  Eur Heart J Suppl

  2023 May;25(Suppl D):D278-D286. doi: 10.1093/eurheartjsupp/suad106.
  
  Di Fusco Stefania Angela, Alonzo Alessandro, Aimo Alberto, Matteucci Andrea, Intravaia Rita Cristina Myriam, Aquilani Stefano, Cipriani Manlio, De Luca Leonardo, Navazio Alessandro, Valente Serafina, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  In the growing therapeutic armamentarium for heart failure (HF) management, vericiguat represents an innovative therapeutic option. The biological target of this drug is different from that of other drugs for HF. Indeed, vericiguat does not inhibit neuro-hormonal systems overactivated in HF or sodium-glucose co-transporter 2 but stimulates the biological pathway of nitric oxide and cyclic guanosine monophosphate, which is impaired in patients with HF. Vericiguat has recently been approved by international and national regulatory authorities for the treatment of patients with HF and reduced ejection fraction who are symptomatic despite optimal medical therapy and have worsening HF. This ANMCO position paper summarises key aspects of vericiguat mechanism of action and provides a review of available clinical evidence. Furthermore, this document reports use indications based on international guideline recommendations and local regulatory authority approval at the time of writing.
  
  © The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Cardiology.
  
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• Italian Association of Hospital Cardiologists practical guidance for sodium-glucose cotransporter 2 inhibitors use in patients with heart failure.
  Eur Heart J Suppl

  2023 May;25(Suppl D):D287-D293. doi: 10.1093/eurheartjsupp/suad107.
  
  Di Fusco Stefania Angela, Spinelli Antonella, Aquilani Stefano, Borrelli Nunzia, Iannopollo Gianmarco, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Sodium-glucose cotransporter 2 inhibitors (SGLT2-is) have recently been included among the first-line drugs for the treatment of heart failure with reduced ejection fraction. International guidelines recommend SGLT2-i use in association with neuro-hormonal modulators (renin-angiotensin blockers, beta blockers, and aldosterone antagonists). Although SGLT2-is are well tolerated, it is important to know potential side effects and conditions that may lead to an increased risk of adverse events in order to maximize clinical benefits. The aim of this Italian Association of Hospital Cardiologists document is to briefly report clinical evidence that supports SGLT2-i use in patients with heart failure and provide practical indications for clinical implementation.
  
  © The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Cardiology.
  
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• ANMCO position paper on the management of hypercholesterolaemia in patients with acute coronary syndrome.
  Eur Heart J Suppl

  2023 May;25(Suppl D):D312-D322. doi: 10.1093/eurheartjsupp/suad100.
  
  De Luca Leonardo, Riccio Carmine, Navazio Alessandro, Valente Serafina, Cipriani Manlio, Corda Marco, De Nardo Alfredo, Francese Giuseppina Maura, Napoletano Cosimo, Tizzani Emanuele, Roncon Loris, Caldarola Pasquale, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Patients suffering from acute coronary syndrome (ACS) present a high risk of recurrence and new adverse cardiovascular events after hospital discharge. Elevated plasma LDL-cholesterol (LDL-C) levels have been shown to be a causal factor for the development of coronary heart disease, and robust clinical evidence has documented that LDL-C levels decrease linearly correlates with a reduction in cardiovascular events. Recent studies have also demonstrated the safety and efficacy of an early and significant reduction in LDL-C levels in patients with ACS. In this position paper, Italian Association of Hospital Cardiologists proposes a decision algorithm on early adoption of lipid-lowering strategies at hospital discharge and short-term follow-up of patients with ACS, in the light of the multiple evidence generated in recent years on the treatment of hypercholesterolaemia and the available therapeutic options, considering current reimbursement criteria.
  
  © The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Cardiology.
  
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• ANMCO position paper: guide to the appropriate use of the wearable cardioverter defibrillator in clinical practice for patients at high transient risk of sudden cardiac death.
  Eur Heart J Suppl

  2023 May;25(Suppl D):D294-D311. doi: 10.1093/eurheartjsupp/suad101.
  
  Casolo Giancarlo, Gulizia Michele Massimo, Aschieri Daniela, Chinaglia Alessandra, Corda Marco, Nassiacos Daniele, Caico Salvatore Ivan, Chimenti Cristina, Giaccardi Marzia, Gotti Enrico, Maffé Stefano, Magnano Roberta, Solarino Gianluca, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Extended risk stratification and optimal management of patients with a permanently increased risk of sudden cardiac death (SCD) are becoming increasingly important. There are several clinical conditions where the risk of arrhythmic death is present albeit only transient. As an example, patients with depressed left ventricular function have a high risk of SCD that may be only transient if there will be a significant recovery of function. It is important to protect the patients while receiving and titrating to the optimal dose the recommended drugs that may lead to an improved left ventricular function. In several other conditions, a transient risk of SCD can be observed even if the left ventricular function is not compromised. Examples are patients with acute myocarditis, during the diagnostic work-up of some arrhythmic conditions or after extraction of infected catheters while eradicating the associated infection. In all these conditions, it is important to offer a protection to these patients. The wearable cardioverter defibrillator (WCD) is of particular importance as a temporary non-invasive technology for both arrhythmia monitoring and therapy in patients with increased risk of SCD. Previous studies have shown the WCD to be an effective and safe therapy for the prevention of SCD caused by ventricular tachycardia/fibrillation. The aim of this ANMCO position paper is to provide a recommendation for clinical utilization of the WCD in Italy, based upon current data and international guidelines. In this document, we will review the WCD functionality, indications, clinical evidence, and guideline recommendations. Finally, a recommendation for the utilization of the WCD in routine clinical practice will be presented, in order to provide physicians with a practical guidance for SCD risk stratification in patients who may benefit from this device.
  
  © The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Cardiology.
  
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• ANMCO-SIMEU consensus document: appropriate management of atrial fibrillation in the emergency department.
  Eur Heart J Suppl

  2023 May;25(Suppl D):D255-D277. doi: 10.1093/eurheartjsupp/suad110.
  
  Caldarola Pasquale, De Iaco Fabio, Pugliese Francesco Rocco, De Luca Leonardo, Fabbri Andrea, Riccio Carmine, Scicchitano Pietro, Vanni Simone, Di Pasquale Giuseppe, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Atrial fibrillation (AF) accounts for 2% of the total presentations to the emergency department (ED) and represents the most frequent arrhythmic cause for hospitalization. It steadily increases the risk of thromboembolic events and is often associated with several comorbidities that negatively affect patient's quality of life and prognosis. AF has a considerable impact on healthcare resources, making the promotion of an adequate and coordinated management of this arrhythmia necessary in order to avoid clinical complications and to implement the adoption of appropriate technological and pharmacological treatment options. AF management varies across regions and hospitals and there is also heterogeneity in the use of anticoagulation and electric cardioversion, with limited use of direct oral anticoagulants. The ED represents the first access point for early management of patients with AF. The appropriate management of this arrhythmia in the acute setting has a great impact on improving patient's quality of life and outcomes as well as on rationalization of the financial resources related to the clinical course of AF. Therefore, physicians should provide a well-structured clinical and diagnostic pathway for patients with AF who are admitted to the ED. This should be based on a tight and propositional collaboration among several specialists, i.e. the ED physician, cardiologist, internal medicine physician, anesthesiologist. The aim of this ANMCO-SIMEU consensus document is to provide shared recommendations for promoting an integrated, accurate, and up-to-date management of patients with AF admitted to the ED or Cardiology Department, in order to make it homogeneous across the national territory.
  
  © The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Cardiology.
  
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• The role of the pregnancy heart team in clinical practice.
  Front Cardiovasc Med

  2023 ;10():1135294. doi: 1135294.
  
  Lucà Fabiana, Colivicchi Furio, Parrini Iris, Russo Maria Giovanna, Di Fusco Stefania Angela, Ceravolo Roberto, Riccio Carmine, Favilli Silvia, Rossini Roberta, Gelsomino Sandro, Oliva Fabrizio, Gulizia Michele Massimo
  
  Abstract
  
  Significant maternal and fetal morbidity and mortality risk has been shown to be associated with cardiovascular disease in pregnancy. Several determinants, such as the increasing number of females with corrected congenital heart disease in reproductive age, a more advanced maternal age associated with cardiovascular risk factors, and a greater prevalence of preexisting comorbidities related to cardiac disorders such as cancer and COVID-19), lead to a higher incidence of cardiac complications in pregnancy in the last few decades. However, adopting a multidisciplinary strategy may influence maternal and neonatal outcomes. This review aims at assessing the role of the Pregnancy Heart Team, which should ensure careful pre-pregnancy counseling, pregnancy monitoring, and delivery planning for both congenital and other cardiac or metabolic disorders, addressing several emerging aspects in the multidisciplinary team-based approach.
  
  © 2023 Lucà, Colivicchi, Parrini, Russo, Di Fusco, Ceravolo, Riccio, Favilli, Rossini, Gelsomino, Oliva and Gulizia.
  
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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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• [ANMCO Position paper: Wearable cardioverter defibrillator appropriate use guidance for the management of patients at high transient risk of sudden cardiac death].
  G Ital Cardiol (Rome)

  2023 May;24(5):394-411. doi: 10.1714/4026.40015.
  
  Casolo Giancarlo, Gulizia Michele Massimo, Aschieri Daniela, Chinaglia Alessandra, Corda Marco, Nassiacos Daniele, Caico Salvatore Ivan, Chimenti Cristina, Giaccardi Marzia, Gotti Enrico, Maffè Stefano, Magnano Roberta, Solarino Gianluca, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Extended risk stratification and optimal management of patients with a permanently increased risk of sudden cardiac death (SCD) is becoming increasingly important. There are several clinical conditions where the risk of arrhythmic death is present albeit only transient. As an example, patients with depressed left ventricular function have a high risk of SCD that may be only transient when there is a significant recovery of function. It is important to protect the patients while receiving the recommended measures and drugs that may either lead or not to an improved left ventricular function. In several other conditions a transient risk of SCD can be observed even if the left ventricular function is not compromised. Examples are patients with acute myocarditis, during the diagnostic work-up of some arrhythmic conditions or after extraction of infected catheters while eradicating the associated infection. In all these conditions it is important to offer a protection to these patients. The wearable cardioverter-defibrillator (WCD) is of particular importance as a temporary non-invasive technology for both arrhythmia monitoring and therapy in patients with increased risk of SCD. Previous studies have shown the WCD to be an effective and safe therapy for the prevention of SCD caused by ventricular tachycardia/fibrillation. The aim of this ANMCO position paper is to provide a recommendation for clinical utilization of the WCD in Italy, based upon current data and international guidelines. In this document we will review the WCD functionality, indications, clinical evidence as well as guideline recommendations. Finally, a recommendation for the utilization of the WCD in routine clinical practice will be presented, in order to provide physicians with a practical guidance for SCD risk stratification in patients who may benefit from this device.
  
  Guarda su PubMed

• Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks.
  J Clin Med

  2023 Mar;12(7):. doi: 2522.
  
  Pino Paolo G, Madeo Andrea, Lucà Fabiana, Ceravolo Roberto, di Fusco Stefania Angela, Benedetto Francesco Antonio, Bisignani Giovanni, Oliva Fabrizio, Colivicchi Furio, Gulizia Michele Massimo, Gelsomino Sandro
  
  Abstract
  
  Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice.
  
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• The Key Role of a Psychoactive Substance Use History in Comprehensive Cardiovascular Risk Assessment, Diagnosis, Treatment, and Prevention.
  Cardiology

  2023 ;148(3):257-268. doi: 10.1159/000530246.
  
  Ciccirillo Francesco, Abrignani Maurizio G, Temporelli Pier Luigi, Binaghi Giulio, Cappelletto Chiara, Lopriore Vincenzo, Cesaro Arturo, Maloberti Alessandro, Cozzoli Danilo, Riccio Carmine, Caldarola Pasquale, Oliva Fabrizio, Gabrielli Domenico, Colivicchi Furio
  
  Abstract
  
  BACKGROUND:
  Psychoactive substances have toxic effects resulting different cardiovascular and non-cardiovascular organ damage. Through a variety of mechanisms, they can trigger the onset of various forms of cardiovascular disease: acute or chronic, transient or permanent, subclinical or symptomatic. Hence, a thorough knowledge of the patient's drug habits is essential for a more complete clinical-etiopathogenetic diagnosis and consequent therapeutic, preventive, and rehabilitative management.
  
  SUMMARY:
  The prime reason for taking a psychoactive substance use history in the cardiovascular context is to identify those people who use substances (whether habitual or occasional users, symptomatic or not) and adequately assess their overall cardiovascular risk profile in terms of "user status" and type of substance(s) used. A psychoactive substance history could also alert the physician to suspect, and eventually diagnose, cardiovascular disease related to the intake of psychoactive substances, so optimizing the medical management of users. This anamnesis could finally assess the likelihood of patients persisting in the habit as a user or relapse, while maintaining high their cardiovascular risk profile. Taking such a history should be mandatory when a causal connection is suspected between intake of psychoactive substances and the observed symptoms or pathology, regardless of whether the individual is a declared user or not.
  
  KEY MESSAGES:
  The purpose of this article was to provide practical information on when, how, and why to perform a psychoactive substance use history.
  
  © 2023 S. Karger AG, Basel.
  
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• [ANMCO Position paper: Vericiguat use in heart failure: from evidence to place in therapy].
  G Ital Cardiol (Rome)

  2023 Apr;24(4):323-331. doi: 10.1714/4004.39824.
  
  Di Fusco Stefania Angela, Alonzo Alessandro, Aimo Alberto, Matteucci Andrea, Intravaia Rita Cristina Myriam, Aquilani Stefano, Cipriani Manlio, De Luca Leonardo, Navazio Alessandro, Valente Serafina, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  In the growing therapeutic armamentarium for heart failure management, vericiguat represents an innovative therapeutic option. The biological target of this drug is different from that of other drugs for heart failure. Indeed, vericiguat does not inhibit neurohormonal systems overactivated in heart failure or sodium-glucose cotransporter 2 but stimulates the biological pathway of nitric oxide and cyclic guanosine monophosphate, which is impaired in patients with heart failure. Vericiguat has recently been approved by international and national regulatory authorities for the treatment of patients with heart failure and reduced ejection fraction who are symptomatic despite optimal medical therapy and have worsening heart failure. This ANMCO position paper summarizes key aspects of vericiguat mechanism of action and provides a review of available clinical evidence. Furthermore, this document reports use indications based on international guideline recommendations and local regulatory authority approval at the time of writing.
  
  Guarda su PubMed

• [Degenerative aortic valve stenosis: looking for a pharmacological prevention].
  G Ital Cardiol (Rome)

  2023 Apr;24(4):293-304. doi: 10.1714/4004.39820.
  
  Di Fusco Stefania Angela, Borrelli Nunzia, Poli Stefano, Bernelli Chiara, Perone Francesco, Aquilani Stefano, Maggioni Aldo Pietro, Di Pasquale Giuseppe, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Degenerative calcific aortic valve stenosis (CAVS) is a chronic disease whose prevalence has increased over the last decade because of the aging of the general population. CAVS pathogenesis is characterized by complex molecular and cellular mechanisms that promote valve fibro-calcific remodeling. During the first phase, referred to as initiation, the valve undergoes collagen deposition and lipid and immune cell infiltration due to mechanical stress. Subsequently, during the progression phase, the aortic valve undergoes chronic remodeling through osteogenic and myofibroblastic differentiation of interstitial cells and matrix calcification. Knowledge of the mechanisms underlying CAVS development supports the resort to potential therapeutic strategies that interfere with fibro-calcific progression. Currently, no medical therapy has demonstrated the ability to significantly prevent CAVS development or slow its progression. The only treatment available in symptomatic severe stenosis is surgical or percutaneous aortic valve replacement. The aim of this review is to highlight the pathophysiological mechanisms involved in CAVS pathogenesis and progression and to discuss potential pharmacological treatments able to inhibit the main pathophysiological mechanisms of CAVS, including lipid-lowering treatment with lipoprotein(a) as emergent therapeutic target.
  
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• [The early use of glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes and high cardiovascular risk].
  G Ital Cardiol (Rome)

  2023 Apr;24(4):285-292. doi: 10.1714/4004.39819.
  
  Nardi Federico, Di Fusco Stefania Angela, Spinelli Antonella, Aquilani Stefano, Riccio Carmine, Caldarola Pasquale, De Luca Leonardo, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Patients with type 2 diabetes mellitus are at an increased risk of cardiovascular disease and microvascular and macrovascular complications. Although multiple classes of antidiabetic drugs are currently available, cardiovascular complications of diabetes still cause considerable morbidity and premature cardiovascular mortality in diabetic patients. The development of new drugs represented a conceptual breakthrough in the treatment of patients with type 2 diabetes mellitus. In addition to improving glycemic homeostasis, these new treatments have consistently demonstrated relevant cardiovascular and renal benefits due to their multiple pleiotropic effects. The aim of this review is to analyze the direct and indirect mechanisms by which glucagon-like peptide 1 receptor agonists favorably impact cardiovascular outcome and report current indications for their implementation in clinical practice based on national and international guidelines.
  
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• Corrigendum: Cardio-oncology in the COVID Era (Co & Co): The never-ending story.
  Front Cardiovasc Med

  2023 ;10():1169176. doi: 1169176.
  
  Bisceglia Irma, Canale Maria Laura, Gallucci Giuseppina, Turazza Fabio Maria, Lestuzzi Chiara, Parrini Iris, Russo Giulia, Maurea Nicola, Quagliariello Vincenzo, Oliva Stefano, Angela Di Fusco Stefania, Lucà Fabiana, Tarantini Luigi, Trambaiolo Paolo, Moreo Antonella, Geraci Giovanna, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  [This corrects the article DOI: 10.3389/fcvm.2022.821193.].
  
  © 2023 Bisceglia, Canale, Gallucci, Turazza, Lestuzzi, Parrini, Russo, Maurea, Quagliariello, Oliva, Angela Di Fusco, Lucà, Tarantini, Trambaiolo, Moreo, Geraci, Gabrielli, Gulizia, Oliva and Colivicchi.
  
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• Effect of a quality-improvement intervention on end-of-life care in cardiac intensive care unit.
  Eur J Clin Invest

  2023 Jul;53(7):e13982. doi: 10.1111/eci.13982.
  
  Sacco Alice, Tavecchia Giovanni, Ditali Valentina, Garatti Laura, Villanova Luca, Colombo Claudia, Viola Giovanna, Scavelli Francesca, Varrenti Marisa, Milani Martina, Morici Nuccia, Tavazzi Guido, Lissoni Barbara, Forni Lorena, Gorni Giovanna, Saporetti Giorgia, Oliva Fabrizio
  
  
  
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• Patent Foramen Ovale and Cryptogenic Stroke: Integrated Management.
  J Clin Med

  2023 Mar;12(5):. doi: 1952.
  
  Lucà Fabiana, Pino Paolo G, Parrini Iris, Di Fusco Stefania Angela, Ceravolo Roberto, Madeo Andrea, Leone Angelo, La Mair Mark, Benedetto Francesco Antonio, Riccio Carmine, Oliva Fabrizio, Colivicchi Furio, Gulizia Michele Massimo, Gelsomino Sandro
  
  Abstract
  
  Patent foramen ovale (PFO) is a common cardiac abnormality with a prevalence of 25% in the general population. PFO has been associated with the paradoxical embolism causing cryptogenic stroke and systemic embolization. Results from clinical trials, meta-analyses, and position papers support percutaneous PFO device closure (PPFOC), especially if interatrial septal aneurysms coexist and in the presence of large shunts in young patients. Remarkably, accurately evaluating patients to refer to the closure strategy is extremely important. However, the selection of patients for PFO closure is still not so clear. The aim of this review is to update and clarify which patients should be considered for closure treatment.
  
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• [ANMCO Position paper: Management of hypercholesterolemia in patients with acute coronary syndrome].
  G Ital Cardiol (Rome)

  2023 Mar;24(3):229-240. doi: 10.1714/3980.39627.
  
  De Luca Leonardo, Riccio Carmine, Navazio Alessandro, Valente Serafina, Cipriani Manlio, Corda Marco, De Nardo Alfredo, Francese Giuseppina Maura, Napoletano Cosimo, Tizzani Emanuele, Roncon Loris, Caldarola Pasquale, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Patients suffering from acute coronary syndromes (ACS) present a high risk of recurrence and new adverse cardiovascular events after hospital discharge. Elevated plasma LDL-cholesterol (LDL-C) levels have been shown to be a causal factor for the development of coronary heart disease, and robust clinical evidence has documented that a decrease of LDL-C levels correlates linearly with a reduction in cardiovascular events. Recent studies have also demonstrated the safety and efficacy of an early and significant reduction in LDL-C levels in patients with ACS.In this position paper, ANMCO proposes a decision algorithm on early adoption of lipid-lowering strategies at hospital discharge and short-term follow-up of patients with ACS, in the light of the multiple evidence generated in recent years on the treatment of hypercholesterolemia and the available therapeutic options, considering current reimbursement criteria.
  
  Guarda su PubMed

• [ANMCO-SIMEU Consensus document: Appropriate management of atrial fibrillation in the emergency department].
  G Ital Cardiol (Rome)

  2023 Feb;24(2):136-159. doi: 10.1714/3963.39422.
  
  Caldarola Pasquale, De Iaco Fabio, Pugliese Francesco Rocco, De Luca Leonardo, Fabbri Andrea, Riccio Carmine, Scicchitano Pietro, Vanni Simone, Di Pasquale Giuseppe, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Atrial fibrillation (AF) accounts for 2% of the total presentations to the emergency department (ED) and represents the most frequent arrhythmic cause for hospitalization. It steadily increases the risk of thromboembolic events and is often associated with several comorbidities that negatively affect patient's quality of life and prognosis. AF has a considerable on healthcare resources, making the promotion of an adequate and coordinated management of this arrhythmia necessary in order to avoid clinical complications and to implement the adoption of appropriate technological and pharmacological treatment options. AF management varies across regions and hospitals and there is also heterogeneity in the use of anticoagulation and electric cardioversion, with limited use of direct oral anticoagulants. The ED represents the first access point for early management of patients with AF. The appropriate management of this arrhythmia in the acute setting has a great impact on improving patient's quality of life and outcomes as well as on rationalization of the financial resources related to the clinical course of AF. Therefore, physicians should provide a well-structured clinical and diagnostic pathway for patients with AF who are admitted to the ED. This should be based on a tight and propositional collaboration among several specialists, i.e. the ED physician, cardiologist, internal medicine physician, anesthesiologist. The aim of this ANMCO-SIMEU consensus document is to provide shared recommendations for promoting an integrated, accurate, and up-to-date management of patients with AF admitted to the ED or Cardiology Department, so as to make it homogeneous across the national territory.
  
  Guarda su PubMed

• [ANMCO Position paper: Amyloidosis for the clinical cardiologist. A "clinical primer" from the ANMCO Rare Disease Working Group].
  G Ital Cardiol (Rome)

  2023 Feb;24(2):127-135. doi: 10.1714/3963.39421.
  
  Chimenti Cristina, Grego Susanna, Di Fusco Stefania, De Luca Leonardo, Caldarola Pasquale, Cannillo Margherita, Cipriani Manlio, Di Lenarda Andrea, Donato Domenica, Leone Simona, Limongelli Giuseppe, Navazio Alessandro, Riccio Carmine, Valente Serafina, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Cardiac amyloidosis, in the three forms of immunoglobulin light chain (AL), transthyretin (ATTR) wild type (ATTRwt) and mutated (ATTRv) amyloidosis, is an increasingly known and recognized disease in the cardiovascular setting. The first stage of the patient's journey is the clinical suspicion of the disease, which is placed, in presence of a hypertrophic phenotype, by the identification of red flags, both extracardiac and cardiac clues whose presence increase the probability of being faced with a patient with this disease. The second stage is represented by diagnosis, which occurs with certainty through the identification of amyloid substance in cardiac tissue. This stage is spotted in wo parts, i.e. disease confirmation and disease etiology definition (AL vs ATTRwt vs ATTRv). However, it is possible in some selected cases to make a diagnosis of ATTR without the need for tissue assessment, in presence of a positive grade 2-3 bisphosphonate scintigraphy and absence of monoclonal component. Once the diagnosis has been made, the third stage is the assessment of prognosis, the fourth is the patient therapy pathway and fifth is the follow-up plan. Prognosis evaluation is based on different staging systems at the onset of the disease, whose applicability in the era of new effective therapies is still to be defined. To date, the transthyretin tetramer stabilizer tafamidis is the only approved treatment for both wild-type and mutant ATTR cardiomyopathy without polyneuropathy, while ATTRv with associated neuropathy can benefit from treatment with patisiran, an inhibitor of hepatic protein synthesis. Therapies for complications and comorbidities, must be addressed individually, due to the lack of specific clinical trials on this category of patients. In fact, it is important to take into consideration the risks linked to the use of some drugs due to the infiltration of the conduction tissue by the amyloid substance, which increases the risk of bradycardia and heart blocks, the tendency towards hypotension and the increased thromboembolic risk. It is also essential to follow the course of the disease and the efficacy of the treatment in affected patients with a standardized follow-up, and to identify early the signs/symptoms of the disease in asymptomatic TTR mutation carriers.This ANMCO position paper on amyloidosis aims to provide the clinical cardiologist with a practical summary of the disease, to accompany the patient with amyloidosis in the various stages of his journey.
  
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• [Circulatory shock: early diagnosis and therapy].
  G Ital Cardiol (Rome)

  2023 Feb;24(2):110-121. doi: 10.1714/3963.39418.
  
  Valente Serafina, Ghionzoli Nicolò, Sorini Dini Carlotta, Rossini Roberta, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio,
  
  Abstract
  
  Circulatory shock is a clinical condition characterized by hypotension and organ hypoperfusion, potentially fatal if the underlying cause is not promptly identified and corrected. Circulatory shock outcome is certainly conditioned from early diagnosis and early and adequate therapy. The aim of this review is to provide a tool for a rapid differential diagnosis among the various phenotypes of circulatory shock, based on the clinical, hemodynamic and biochemical profile. We also prompt to emphasize the role of multiparametric monitoring from the early phases of the management and the need to implement the time-dependent network to improve the outcome of these critical patients.
  
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• [Rationale and significance of the Italian Network for Cardiac Amyloidosis].
  G Ital Cardiol (Rome)

  2023 Feb;24(2):93-98. doi: 10.1714/3963.39416.
  
  Sinagra Gianfranco, Emdin Michele, Merlo Marco, Vergaro Giuseppe, Aimo Alberto, Biagini Elena, Imazio Massimo, Porcari Aldostefano, Limongelli Giuseppe, Cipriani Alberto, Canepa Marco, Musumeci Beatrice, Cameli Matteo, Crotti Lia, Di Bella Gianluca, Di Lenarda Andrea, Cappelli Francesco, Chimenti Cristina, Obici Laura, Iacoviello Massimo, Perlini Stefano, Pieroni Maurizio, Metra Marco, Oliva Fabrizio, Perrone Filardi Pasquale, Colivicchi Furio, Indolfi Ciro
  
  Abstract
  
  The perspective on amyloidosis has changed deeply over the last 10 years following major advances in diagnosis and treatment options, especially in cardiac amyloidosis. This intrinsically heterogeneous disease exposes to the risk of fragmentation of knowledge and requires the interaction among experts of different specialties and subspecialties. Suspicion of disease, timely recognition and confirmation of final diagnosis, prognostic stratification, clinical management and therapeutic strategies represent essential steps to be taken. Missing or delaying the diagnosis may have dramatic impact on patient outcome, as in the case of chemotherapy in unrecognized light-chain amyloidosis. Therefore, there is an urgent need for the foundation of an Italian Amyloidosis Network to deal with the challenges of this condition and orient clinical management at national and local levels. The present consensus document aims to provide the rationale and scopes of the Italian Amyloidosis Network, which has been conceived as an organizational framework for professionals managing patients with amyloidosis.
  
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• Bi-Caval Valve Implantation to Palliate Symptoms in a Case of Massive Tricuspid Regurgitation.
  Cardiovasc Revasc Med

  2023 Aug;53S():S139-S143. doi: 10.1016/j.carrev.2023.01.014.
  
  Galasso Michele, Cartella Iside, Soriano Francesco, Nava Stefano, Tavoletta Pasquale, De Chiara Benedetta, Oliva Fabrizio, Bruschi Giuseppe, Oreglia Jacopo A, Giannattasio Cristina, Mangieri Antonio, Montalto Claudio
  
  Abstract
  
  Severe tricuspid regurgitation is associated with the occurrence of right failure and increased morbidity and mortality. Transcatheter heterotopic bi-caval valve implantation might offer symptom relief in these patients that are often at prohibitive surgical risk.
  
  Copyright © 2023 Elsevier Inc. All rights reserved.
  
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• Dapagliflozin in Heart Failure with Preserved Ejection Fraction.
  N Engl J Med

  2023 Jan;388(3):287-288. doi: 10.1056/NEJMc2213974.
  
  Gabrielli Domenico, Oliva Fabrizio, Zuccalà Giuseppe
  
  
  
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• Hemodynamic effects of heart rate lowering in patients admitted for acute heart failure: the RedRate-HF Study (Reduction of heart Rate in Heart Failure).
  J Cardiovasc Med (Hagerstown)

  2023 Feb;24(2):113-122. doi: 10.2459/JCM.0000000000001427.
  
  Mortara Andrea, Rossi Jessica, Mazzetti Simone, Catagnano Francesco, Cavalotti Cristina, Malerba Gianluigi, Vecchio Chiara, Morandi Fabrizio, Nassiacos Daniele, Oliva Fabrizio
  
  Abstract
  
  BACKGROUND:
  In patients admitted for acute heart failure (HF) indication for drugs which reduce the heart rate (HR) is debated. The multicentre prospective study Reduction of heart Rate in Heart Failure (RedRate-HF) was designed to analyse the hemodynamic effects of an early reduction of HR in acute HF.
  
  METHODS:
  Hemodynamic parameters were recorded by using the bioimpedance technique, which was shown to be accurate, highly reproducible and sensitive to intra-observer changes. Lowering HR was obtained by ivabradine 5?mg bd, given 48-72?h after admission on the top of optimized treatment. Patients were followed at 24, 48, 72?h after drug assumption and at hospital discharge.
  
  RESULTS:
  Twenty patients of a mean age of 67?±?15 years, BNP at entry 1348?±?1198?pg/ml were enrolled. Despite a clinical stabilization, after 48-72?h from admission, HR was persistently >70?bpm. Ivabradine was well tolerated in all patients with a significant increase in RR interval from 747?±?69?ms at baseline to 948?±?121 ms at discharge, P?0.0001. Change in HR was associated with a significant increase in stroke volume (baseline 73?±?22 vs. 84?±?19?ml at discharge, P?=?0.03), and reduction in left cardiac work index (baseline 3.6?±?1.2 vs. 3.1?±?1.1?kg/m2 at discharge, P?=?0.04). Other measures of heart work were also significantly affected while cardiac output remained unchanged.
  
  CONCLUSION:
  The strategy of an early lowering of HR in patients admitted for acute HF on top of usual care is feasible and safe. The HR reduction causes a positive increase in stroke volume and may contribute to saving energy without affecting cardiac output.
  
  Copyright © 2022 Italian Federation of Cardiology - I.F.C. All rights reserved.
  
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• [ANMCO practical guide for sodium-glucose cotransporter 2 inhibitor use in patients with heart failure].
  G Ital Cardiol (Rome)

  2023 Jan;24(1):66-74. doi: 10.1714/3934.39183.
  
  Di Fusco Stefania Angela, Spinelli Antonella, Aquilani Stefano, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Sodium-glucose cotransporter 2 inhibitors (SGLT2-i), initially developed as glucose-lowering agents for the treatment of type 2 diabetes, based on significant clinical benefits shown in patients with heart failure, have recently been included among the first-line drugs for the treatment of heart failure with reduced ejection fraction. International guidelines recommend SGLT2-i use in association with neuro-hormonal modulators (renin-angiotensin blockers, beta-blockers, and aldosterone antagonists). Although SGLT2-i are well tolerated, for an appropriate use and to maximize clinical benefits, it is important to know potential side effects and conditions that may lead to an increased risk of adverse events. The aim of this ANMCO document is to briefly report clinical evidence that support SGLT2-i use in patients with heart failure and provide practical indications for clinical implementation.
  
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• [Gut microbiota as an atherosclerotic risk factor: from biological mechanisms to potential therapeutic interventions].
  G Ital Cardiol (Rome)

  2023 Jan;24(1):47-55. doi: 10.1714/3934.39179.
  
  Di Fusco Stefania Angela, Zuccalà Giuseppe, Amico Antonio Francesco, Cocozza Sara, Bugani Giulia, Spinelli Antonella, Lucà Fabiana, Aquilani Stefano, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Gut microbiota impacts host health by mediating beneficial physiological processes. However, growing evidence supports the potential role of microbiota in disease development and progression. In this review, we report current knowledge on pathophysiologic processes mediated by gut microbiota that may be implicated in atherosclerosis development and progression. We also summarize findings provided by clinical studies that indicate an association between gut microbiota composition and/or function and atherosclerotic cardiovascular diseases. Finally, we discuss potential strategies to impact gut microbiota composition and/or function in order to reduce the atherosclerotic cardiovascular risk.
  
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• [Identifying possible homozygous familial hypercholesterolemia patients: an Italian experts' opinion].
  G Ital Cardiol (Rome)

  2023 Jan;24(1):5-10. doi: 10.1714/3934.39174.
  
  Bilato Claudio, Zambon Alberto, Pisciotta Livia, Citroni Nadia, Carubbi Francesca, Zambon Sabina, Zenti Maria Grazia, Vinci Pierandrea, Biolo Gianni, Bonomo Katia, Egalini Filippo, Passaro Angelina, Nascimbeni Fabio, Negri Emanuele, D'Addato Sergio, Averna Maurizio, Arca Marcello, Oliva Fabrizio, Colivicchi Furio, Catapano Alberico
  
  Abstract
  
  Homozygous familial hypercholesterolemia (HoFH) is a rare genetic disease characterized by high plasma levels of low-density lipoprotein cholesterol (LDL-C) and massive risk of premature atheromasia and cardiovascular events. HoFH is caused by mutations in several genes, such as LDLR, APOB, PCSK9 and LDLRAP1. If untreated, the average age of death is 18 years old, but fatalities within the first 5 years of age have been recorded. Therefore, early diagnosis and treatment are crucial, in order to prevent and/or delay the cardiovascular complications of LDL-C exposure. Because HoFH is a rare disorder, it is not frequently encountered in daily clinical practice at the primary/secondary unspecialized cardiological centers. Then the availability of practical indications helping to identify HoFH patients or to arise a suspect of HoFH is particularly strategic to promptly start the appropriate lipid-lowering therapy. For such a purpose, a group of Italian experts suggests three useful algorithms to identify cases requiring accurate and specialized clinical evaluation as potential HoFH patients. These cases with suspected HoFH should be addressed to specialized centres for the optimal management of these patients.
  
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• Women at heart: Introducing gender cardio-oncology.
  Front Cardiovasc Med

  2022 ;9():974123. doi: 974123.
  
  Canale Maria Laura, Bisceglia Irma, Gallucci Giuseppina, Russo Giulia, Camerini Andrea, Di Fusco Stefania Angela, Paccone Andrea, Camilli Massimiliano, Fiscella Damiana, Lestuzzi Chiara, Turazza Fabio Maria, Gulizia Michele Massimo, Pavan Daniela, Maurea Nicola, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  As cardio-oncology imposed itself as the reference specialty for a comprehensive cardiovascular approach to all patients with cancer, a more specific and careful cardiac evaluation of women entering their journey into cancer care is needed. Gender medicine refers to the study of how sex-based biological and gender-based socioeconomic and cultural differences influence people's health. Gender-related aspects could account for differences in the development, progression, and clinical signs of diseases as well as in the treatment of adverse events. Gender also accounts for major differences in access to healthcare. As for medicine and healthcare in general, gender-related characteristics have gained significance in cardio-oncology and should no longer be neglected in both clinical practice and research. We aimed to review the most relevant cardiovascular issues in women related to the cardio-oncology approach to offer a specific gender-related point of view for clinicians involved in the care process for both cancer and cardiovascular disease.
  
  Copyright © 2022 Canale, Bisceglia, Gallucci, Russo, Camerini, Di Fusco, Paccone, Camilli, Fiscella, Lestuzzi, Turazza, Gulizia, Pavan, Maurea, Gabrielli, Oliva and Colivicchi.
  
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• [ANMCO Position paper: Evidence and practical indications for the use of low-dose rivaroxaban in stable coronary artery disease and peripheral artery disease].
  G Ital Cardiol (Rome)

  2022 Dec;23(12):967-976. doi: 10.1714/3913.38965.
  
  Di Fusco Stefania Angela, Rizzello Vittoria, Scicchitano Pietro, Lucà Fabiana, Altamura Vito, Bianco Matteo, De Luca Leonardo, Valente Serafina, Riccio Carmine, Caldarola Pasquale, Cipriani Manlio, Francese Giuseppina Maura, Navazio Alessandro, Nardi Federico, Ceravolo Roberto, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  In patients with atherosclerotic disease, the occurrence of atherothrombotic events is the main determinant of morbidity and mortality. Growing evidence suggests the involvement of the coagulation pathway in the atherosclerotic process and the benefit of antithrombotic agents, such as direct oral anticoagulants, which interfere with both platelet aggregation and the coagulation cascade. The COMPASS trial has shown that in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD), low-dose rivaroxaban (2.5 mg twice daily) added to acetylsalicylic acid (ASA) 100 mg reduces major vascular events and mortality, with an increase in major bleeding but not in fatal bleeding or involving a critical organ. The reduction in major cardiovascular events has been confirmed in the overall population with CAD and in both patients with and without a previous percutaneous coronary revascularization, and also in patients with previous coronary bypass surgery. In patients with PAD, the combination of rivaroxaban 2.5 mg twice daily and ASA was found to reduce both major adverse cardiovascular events and major adverse limb events, including major limb amputations. In clinical practice, the use of rivaroxaban 2.5 mg co-administered with ASA has been approved in both patients with CAD and symptomatic PAD at high risk of ischemic events. However, in Italy, the national health system reimbursement is provided only for patients with PAD. In patients treated with rivaroxaban 2.5 mg, assessment and monitoring of bleeding risk is crucial to achieve the maximum clinical benefit.
  
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• [Heart failure with improved ejection fraction: practical guidance for the clinician].
  G Ital Cardiol (Rome)

  2022 Dec;23(12):924-931. doi: 10.1714/3913.38959.
  
  Gori Mauro, Tinti Maria Denitza, Gentile Piero, De Maria Renata, Carigi Samuela, De Gennaro Luisa, Leonardi Giuseppe, Orso Francesco, Navazio Alessandro, Marini Marco, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Heart failure with improved ejection fraction (HFimpEF) represents a nosological entity that has recently been recognized and has little evidence from the literature. Available data indicate an increasing incidence of this patient group, consistent with the progressive improvement and implementation of medical therapy of heart failure with reduced ejection fraction (HFrEF). Furthermore, it is important to underline that the therapy itself should not be suspended after ejection fraction recovery, to avoid the recurrence of worse systolic dysfunction and patient outcomes. Only recently a randomized clinical study has been published, which enrolled also this patient subgroup, the DELIVER trial. Other data will soon become available, given the interest of the scientific community for this subgroup of patients, whose best management remains controversial. Since many studies suggest that the probability of myocardial recovery in HFrEF patients might be as high as 40%, depending on the case series taken into account, whereas the time to recovery might even be 12 months, the appropriate timing of device implantation, such as the defibrillator, in this setting deserves careful consideration.
  
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• [Ten questions on cardiac magnetic resonance in patients with heart failure: from etiological diagnosis to prognostic stratification].
  G Ital Cardiol (Rome)

  2022 Dec;23(12):912-923. doi: 10.1714/3913.38958.
  
  Carigi Samuela, De Gennaro Luisa, Gentile Piero, De Maria Renata, Di Giannuario Giovanna, Khoury Georgette, Polizzi Vincenzo, Gori Mauro, Orso Francesco, Tinti Maria Denitza, Leonardi Giuseppe, D'Andrea Antonello, Mantovani Francesca, Pergola Valeria, Rabia Granit, Gimelli Alessia, Rizzo Massimiliano, Campana Marco, Marini Marco, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Cardiac magnetic resonance (CMR) imaging has progressively become part of the imaging methods recommended in patients with heart failure. CMR represents the gold standard for assessing volumes, function, biventricular kinetics and providing tissue characterization through scans with and without contrast medium. In patients with heart failure with reduced ejection fraction (HFrEF) and ischemic dilated cardiomyopathy, CMR allows to search for viability, accurately estimate volumes and ejection fraction. It can assess scar extent for predicting response to cardiac resynchronization therapy and for establishing an indication for implanting a defibrillator in borderline cases. In patients with HFrEF and non-ischemic dilated cardiomyopathy, CMR helps to identify specific etiological subgroups and to estimate the arrhythmic risk beyond ejection fraction. In patients with heart failure with preserved ejection fraction, CMR offers the possibility of diagnosing specific phenotypes, including sarcomeric hypertrophic cardiomyopathy, amyloidosis or Fabry disease, and adds prognostic information. Both clinical and scientific interest in this imaging method is constantly expanding; the clinicians dealing with heart failure cannot fail to know the technique, the indications and all the potential that CMR can offer.
  
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• Type of hospitalisations and in-hospital outcomes in the Italian coronary care unit network at the time of COVID-19 pandemic: the BLITZ-COVID19 Registry.
  BMJ Open

  2022 Nov;12(11):e062382. doi: e062382.
  
  Gulizia Michele Massimo, Fabbri Gianna, Lucci Donata, Di Pasquale Giuseppe, Gabrielli Domenico, Campodonico Jeness, Mauro Andrea, Inciardi Riccardo, Di Lorenzo Emilio, Oliva Fabrizio, Nardi Federico, Colivicchi Furio, De Luca Leonardo,
  
  Abstract
  
  OBJECTIVE:
  The aim of the study was to describe the epidemiology and outcome of patients hospitalised during the COVID-19 pandemic in intensive cardiac care units (ICCs).
  
  DESIGN:
  Non-interventional, retrospective and prospective, nationwide study.
  
  SETTING:
  109 private or public ICCs in Italy.
  
  PARTICIPANTS:
  6054 consecutive patients admitted to Italian ICCs during COVID-19 pandemic.
  
  PRIMARY AND SECONDARY OUTCOME MEASURES:
  To obtain accurate and up-to-date information on epidemiology and outcome of patients admitted to ICCs during the COVID-19 pandemic, the impact that the COVID-19 infection may have determined on the organisational pathways and in-hospital management of the various clinical conditions being admitted to ICCs.
  
  RESULTS:
  Acute coronary syndromes were the most frequent ICC discharge diagnoses followed by heart failure and hypokinetic arrhythmias. The prevalence of COVID-19 positivity was approximately 3%. Most patients with a COVID-19 diagnosis at discharge (52%) arrived to ICC from other wards, in particular 22% from non-cardiology ICCs. The overall mortality was 4.2% during ICC and 5.8% during hospital stay. The cause of in-hospital death was cardiac in 74.4% of the cases, non-cardiovascular in 13.5%, vascular in 5.8% and related to COVID-19 in 6.3% of the patients.
  
  CONCLUSIONS:
  This study provides a unique nationwide picture of current ICC care during COVID-19 pandemic.
  
  TRIAL REGISTRATION NUMBER:
  NCT04744415.
  
  © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
  
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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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• SCAI stage reclassification at 24?h predicts outcome of cardiogenic shock: Insights from the Altshock-2 registry.
  Catheter Cardiovasc Interv

  2023 Jan;101(1):22-32. doi: 10.1002/ccd.30484.
  
  Morici Nuccia, Frea Simone, Bertaina Maurizio, Sacco Alice, Corrada Elena, Dini Carlotta Sorini, Briani Martina, Tedeschi Michele, Saia Francesco, Colombo Costanza, Rota Matteo, Oliva Fabrizio, Iannaccone Mario, De Ferrari Gaetano M, Sionis Alessandro, Kapur Navin K, Tavazzi Guido, Pappalardo Federico
  
  Abstract
  
  BACKGROUND:
  Cardiogenic shock (CS) includes several phenotypes with heterogenous hemodynamic features. Timely prognostication is warranted to identify patients requiring treatment escalation. We explored the association of the updated Society for Cardiovascular Angiography and Interventions (SCAI) stages classification with in-hospital mortality using a prospective national registry.
  
  METHODS:
  Between March 2020 and February 2022 the Altshock-2 Registry has included 237 patients with CS of all etiologies at 11 Italian Centers. Patients were classified according to their admission SCAI stage (assigned prospectively and independently updated according to the recently released version). In-hospital mortality was evaluated for association with both admission and 24-h SCAI stages.
  
  RESULTS:
  The overall in-hospital mortality was 38%. Of the 237 patients included and staged according to the updated SCAI classification, 20 (8%) had SCAI shock stage B, 131 (55%) SCAI stage C, 61 (26%) SCAI stage D and 25 (11%) SCAI stage E. In-hospital mortality stratified according to the SCAI classification at 24?h was 18% for patients in SCAI stage B, 27% for SCAI stage C, 63% for SCAI stage D and 100% for SCAI stage E. Both the revised SCAI stages on admission and at 24?h were associated with in-hospital mortality, but the classification potential slightly increased at 24-h. After adjusting for age, sex, lactate level, eGFR, CVP, inotropic score and mechanical circulatory support [MCS], SCAI classification at 24?h was an independent predictor of in-hospital mortality.
  
  CONCLUSIONS:
  In the Altshock-2 registry the utility of SCAI shock stages to identify risk of in-hospital mortality increased at 24?h after admission. Escalation of treatment (either pharmacological or with MCS) should be tailored to achieve prompt clinical improvement within the first 24?h after admission. Registration: http://www.
  
  CLINICALTRIALS:
  gov; Unique identifier: NCT04295252.
  
  © 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
  
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• Use of Levosimendan in Patients with Advanced Heart Failure: An Update.
  J Clin Med

  2022 Oct;11(21):. doi: 6408.
  
  Masarone Daniele, Kittleson Michelle M, Pollesello Piero, Marini Marco, Iacoviello Massimo, Oliva Fabrizio, Caiazzo Angelo, Petraio Andrea, Pacileo Giuseppe
  
  Abstract
  
  Levosimendan is an inodilator drug that, given its unique pharmacological actions and safety profile, represents a viable therapeutic option in patients with heart failure with reduced ejection fraction in the advanced stage of the disease (advHFrEF). Pulsed levosimendan infusion in patients with advHFrEF improves symptoms and clinical and hemodynamic status, prevents recurrent hospitalizations, and enables optimization of guidelines-directed medical therapy. Furthermore, considering its proprieties on right ventricular function and pulmonary circulation, levosimendan could be helpful for the prevention and treatment of the right ventricular dysfunction post-implanting a left ventricular assist device. However, to date, evidence on this issue is scarce and has yielded mixed results. Finally, preliminary experiences indicate that treatment with levosimendan at scheduled intervals may serve as a "bridge to transplant" strategy in patients with advHFrEF. In this review, we summarized the clinical pharmacology of levosimendan, the available evidence in the treatment of patients with advHFrEF, as well as a hypothesis for its use in patients with advanced heart failure with preserved ejection fraction.
  
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• Inclisiran: A New Pharmacological Approach for Hypercholesterolemia.
  Rev Cardiovasc Med

  2022 Nov;23(11):375. doi: 375.
  
  Di Fusco Stefania Angela, Maggioni Aldo Pietro, Bernelli Chiara, Perone Francesco, De Marzo Vincenzo, Conte Edoardo, Musella Francesca, Uccello Giuseppe, Luca Leonardo De, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Therapeutic approaches based on gene silencing technologies represent a new opportunity to manage hypercholesterolemia. Inclisiran is a small interfering RNA that targets proprotein convertase subtilisin/kexin type 9 (PCSK9) mRNA. Clinical studies have demonstrated that inclisiran is effective, safe, and well-tolerated in reducing low-density lipoprotein cholesterol (LDL-C) in patients with familial hypercholesterolemia, atherosclerotic cardiovascular disease, and atherosclerotic cardiovascular disease risk equivalents. A meta-analysis of phase 3 trials demonstrated a 51% reduction in LDL-C levels at 18 months as compared with placebo. Adverse event incidence was found to be comparable in individuals treated with inclisiran and those receiving placebo, though the reactions at the site of injection were more common in patients receiving inclisiran as compared with those receiving placebo. The recommended inclisiran dose is 284 mg administered as a subcutaneous injection to be repeated after three months with a subsequent 6-month maintenance regimen. Overall, since the pharmacological efficacy of inclisiran in LDL-C reduction is comparable to that of monoclonal antibodies against PCSK9, the longer effect duration and the favorable safety profile may favor this newer approach for hypercholesterolemia management.
  
  Copyright: © 2022 The Author(s). Published by IMR Press.
  
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• [Cardio-oncogeriatrics: ANMCO position paper on cardio-oncology management of elderly patients].
  G Ital Cardiol (Rome)

  2022 Nov;23(11):878-891. doi: 10.1714/3900.38828.
  
  Bisceglia Irma, Canale Maria Laura, Camilli Massimiliano, Gallucci Giuseppina, Laudisio Alice, Lestuzzi Chiara, Russo Giulia, Turazza Fabio, Fiscella Damiana, Paccone Andrea, Maurea Nicola, Parrini Iris, Di Fusco Stefania Angela, Lucà Fabiana, Mistrulli Raffaella, Zuccalà Giuseppe, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Geriatric patients are an increasing population and cancer treatment in this population is a challenging and unsolved issue. Ageing is characterized by low-grade inflammation (inflamm-ageing), an important driver for age-related diseases such as cardiovascular diseases and cancer. These chronic conditions share pathophysiological bases, risk factors and may coexist. The burden of comorbidities lowers the threshold for cardiotoxic effects of oncologic treatments. Geriatric assessment is helpful in identifying the peculiar vulnerabilities of this complex population, but a multidisciplinary approach (with oncologists and cardio-oncologists) is needed to improve the appropriateness of care. In this ANMCO position paper, we define the role of cardio-oncologists in the different scenarios of older cancer patients (active cancer, long-term survivors), the importance of geriatric assessment, the unmet needs of survivors and the complexity of comorbidity management.
  
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• [The network for myocardial infarction in Italy: ANMCO role in 20 years of progresses and prospects].
  G Ital Cardiol (Rome)

  2022 Nov;23(11):821-825. doi: 10.1714/3900.38820.
  
  Di Fusco Stefania Angela, Di Pasquale Giuseppe, Mistrulli Raffella, Sorini Dini Carlotta, Gasparetto Nicola, De Luca Leonardo, Gabrielli Domenico, Oliva Fabrizio, Scherillo Marino, Colivicchi Furio
  
  
  
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• CMV seroprevalence and coronary CMV-DNA detection in immunocompetent patients with heart diseases.
  Minerva Med

  2023 Jun;114(3):289-299. doi: 10.23736/S0026-4806.22.07778-3.
  
  Cento Valeria, Colagrossi Luna, Bossi Irene, Armenia Daniele, Nava Alice, Piccinelli Enrico, Maloberti Alessandro, Inglese Elvira, Matarazzo Elisa, DI Ruscio Federica, Paba Pierpaolo, Marcuccilli Fabbio, Perrone Marco, Chiricolo Gaetano, Alteri Claudia, Scaglione Francesco, Vismara Chiara, Campisi Daniela A, Fanti Diana, Romeo Francesco, Andreoni Massimo, Oliva Fabrizio, Ceccherini-Silberstein Francesca, Giannattasio Cristina, Perno Carlo F
  
  Abstract
  
  BACKGROUND:
  Acute coronary syndromes (ACS) are a major cause of morbidity and mortality. As cytomegalovirus (CMV) may contribute to cardio-vascular (CV) manifestations, we sought to provide a proof-of-concept for the involvement of coronary and/or systemic CMV-reactivation as a possible ACS trigger.
  
  METHODS:
  We prospectively enrolled consecutive patients undergoing a coronary angiography for ACS (acute-cases, N.=136), or non-ACS reasons (chronic-cases, N.=57). Matched coronary and peripheral blood-samples were processed for quantification of CMV-DNAemia (RT-PCR), CMV-IgG/IgM, and CMV-IgG avidity (ELISA). Peripheral-blood samples from 17 healthy subjects were included as controls.
  
  RESULTS:
  Out of the 193 cases included, 18.1% were aged ?55 years, 92.5% were Central-European, and 100% immunocompetent. CMV-IgG seroprevalence was 91.7% (95%CI: 87.8-95.6), significantly higher than in healthy-controls (52.9% [95%CI: 29.2-76.5]; P
  CONCLUSIONS:
  CMV-IgG seroprevalence was high in patients with heart diseases. CMV-DNAemia can be found, although uncommonly, in coronary circulation during an ACS, with increased prevalence in older subjects and in absence of CV risk-factors, identifying possible areas for novel interventions.
  
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• [ANMCO Position paper: Cardiovascular disease in women - prevention, diagnosis, treatment and organization of care].
  G Ital Cardiol (Rome)

  2022 Oct;23(10):775-792. doi: 10.1714/3881.38644.
  
  Francese Giuseppina Maura, Aspromonte Nadia, Valente Serafina, Geraci Giovanna, Pavan Daniela, Bisceglia Irma, Caforio Alida Linda Patrizia, Colavita Angela Rita, Cutolo Ada, De Angelis Maria Carmen, Di Fusco Stefania Angela, Enea Iolanda, Fiscella Damiana, Frongillo Doriana, Gil Ad Vered, Giubilato Simona, Giuffrida Clea, Ingianni Nadia, Lucà Fabiana, Marcantoni Lina, Martinis Flavia, Marzullo Raffaella, Masciocco Gabriella, Parrini Iris, Rakar Serena, Resta Manuela, Riva Letizia, Rossini Roberta, Russo Domitilla, Russo Giulia, Russo Maria Giovanna, Scardovi Angela Beatrice, De Luca Leonardo, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Cardiovascular diseases are still the main cause of death among women despite the improvements in treatment and prognosis achieved in the last 30 years of research. The determinant factors and causes have not been completely identified but the role of "gender" is now recognized. It is well known that women tend to develop cardiovascular disease at an older age than men, and have a high probability of manifesting atypical symptoms not often recognized. Other factors may also co-exist in women, which may favor the onset of specific cardiac diseases such as those with a sex-specific etiology (differential effects of estrogens, pregnancy pathologies, etc.) and those with a different gender expression of specific and prevalent risk factors, inflammatory and autoimmune diseases and cancer. Whether the gender differences observed in cardiovascular outcomes are influenced by real biological differences remains a matter of debate.This ANMCO position paper aims at providing the state of the research on this topic, with particular attention to the diagnostic aspects and to care organization.
  
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• Endothelial Dysfunction in Patients with Advanced Heart Failure Treated with Levosimendan Periodic Infusion Compared with Optimal Medical Therapy: A Pilot Study.
  Life (Basel)

  2022 Aug;12(9):. doi: 1322.
  
  Maloberti Alessandro, Sun Jinwei, Zannoni Jessica, Occhi Lucia, Bassi Ilaria, Fabbri Saverio, Colombo Valentina, Gualini Elena, Algeri Michela, Varrenti Marisa, Masciocco Gabriella, Perna Enrico, Oliva Fabrizio, Cipriani Manlio, Frigerio Maria, Giannattasio Cristina
  
  Abstract
  
  Endothelial dysfunction (ED) is frequently found in patients with heart failure (HF). Among several pharmacological agents reported to improve endothelial function, levosimendan seems to be a promising one, even though, to date, only two previously published studies have evaluated its effects on ED in these patients. The aim of our pilot study was to further investigate the role of periodic levosimendan infusion on endothelial function in patients affected by advanced HF. In this cross-sectional study, three different groups were enrolled: 20 patients with advanced HF treated with periodic levosimendan (LEVO), 20 patients with HF on optimal medical therapy (OMT), and 20 healthy subjects (control group). ED was evaluated through flow-mediated dilation (FMD) at the level of the brachial artery. The three groups presented similar ages with significant differences in gender distribution, systolic blood pressure, and chronic kidney disease (eGFR
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• The impact of transcatheter edge-to-edge repair on right ventricle-pulmonary artery coupling in patients with functional mitral regurgitation.
  Eur J Clin Invest

  2023 Jan;53(1):e13869. doi: e13869.
  
  Tua Lorenzo, Mandurino-Mirizzi Alessandro, Colombo Claudia, Morici Nuccia, Magrini Giulia, Nava Stefano, Frassica Romina, Montalto Claudio, Ferlini Marco, Sacco Alice, Musca Francesco, Moreo Antonella, Ghio Stefano, Oreglia Jacopo, Oltrona-Visconti Luigi, Oliva Fabrizio, Crimi Gabriele
  
  
  
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• Report from the Cardio-Oncology Symposium at the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Annual Congress.
  Future Cardiol

  2023 Sep;19(11):519-522. doi: 10.2217/fca-2022-0063.
  
  Camilli Massimiliano, Cardinale Daniela M, Pedrotti Patrizia, Turazza Fabio M, Aspromonte Nadia, Canale Maria Laura, Bisceglia Irma, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Overview of the meeting The Cardio-Oncology Symposium at the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Annual Meeting mainly focused on the diagnosis, management and prevention of cardiovascular toxicity of cancer drugs, in particular, cardiac dysfunction induced by anthracyclines. Although a variety of cardiac biomarkers and imaging modalities are available, there remains no consensus regarding their appropriate use to identify early and late cardiotoxicity and to guide preventive strategies. At the same time, the multitude of pharmacological trials, aimed at preventing cardiac damage through a neurohormonal blockade, provided conflicting results. Nevertheless, the advent of novel heart failure medications can change the decision-making of the cardio-oncologist. This symposium attempted to harmonize these issues.
  
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• [Management of elderly patients in the cardiac intensive care unit: how to balance between appropriateness and futility].
  G Ital Cardiol (Rome)

  2022 Sep;23(9):686-702. doi: 10.1714/3860.38452.
  
  Rossini Roberta, Chiappetta Daniela, Ferlini Marco, Giubilato Simona, Gasparetto Nicola, Sorini Dini Carlotta, Trambaiolo Paolo, Oliva Fabrizio, Valente Serafina, Colivicchi Furio
  
  Abstract
  
  The number of elderly patients admitted to cardiac intensive care units (CICU) is significantly increasing. Nowadays, novel diagnostic and therapeutic tools allow to treat the vast majority of cardiac acute diseases, nonetheless care of elderly patients requires a careful clinical evaluation. A favorable proportion of cost-effectiveness is warranted, aimed at avoiding futile procedures or treatments. On the other hand, the availability of minimally invasive procedures carries forward old limits to treatments in elderly patients in CICU. It appears evident that age cannot per se represent a limit in the care of elderly people. The present review gives insights in the management of the most common cardiovascular disease settings in elderly patients in the CICUs, thus providing important tools in complex decision-making.
  
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• [Long COVID: nosographic aspects and clinical epidemiology].
  G Ital Cardiol (Rome)

  2022 Sep;23(9):651-662. doi: 10.1714/3860.38447.
  
  Abrignani Maurizio G, Maloberti Alessandro, Temporelli Pier Luigi, Binaghi Giulio, Cesaro Arturo, Ciccirillo Francesco, Oliva Fabrizio, Gabrielli Domenico, Riccio Carmine, Gulizia Michele Massimo, Colivicchi Furio
  
  Abstract
  
  Recent evidence shows that a range of persistent or new symptoms can manifest after 4-12 weeks in a subset of patients who have recovered from acute SARS-CoV-2 infection, and this condition has been coined long COVID by COVID-19 survivors among social support groups. Long COVID can affect the whole spectrum of people with COVID-19, from those with very mild acute disease to the most severe forms. Like the acute form, long COVID has multisystemic aspects. Patients can manifest with a very heterogeneous multitude of symptoms, including fatigue, post-exertional malaise, dyspnea, cognitive impairment, sleep disturbances, anxiety and depression, muscle pain, brain fog, anosmia/dysgeusia, headache, and limitation of functional capacity, which impact their quality of life. Because of the extreme clinical heterogeneity, and also due to the lack of a shared, specific definition, it is very difficult to know the real prevalence and incidence of this condition. Risk factors for developing long COVID would be female sex, initial severity, and comorbidities. Globally, with the re-emergence of new waves, the population of people infected with SARS-CoV-2 continues to expand rapidly, necessitating a more thorough understanding of potential sequelae of COVID-19. This review summarizes up to date definitions and epidemiological aspects of long COVID.
  
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• BLITZ-HF: a nationwide initiative to evaluate and improve adherence to acute and chronic heart failure guidelines.
  Eur J Heart Fail

  2022 Nov;24(11):2078-2089. doi: 10.1002/ejhf.2605.
  
  Gulizia Michele Massimo, Orso Francesco, Mortara Andrea, Lucci Donata, Aspromonte Nadia, De Luca Leonardo, Di Tano Giuseppe, Leonardi Giuseppe, Navazio Alessandro, Pulignano Giovanni, Colivicchi Furio, Di Lenarda Andrea, Oliva Fabrizio,
  
  Abstract
  
  AIMS:
  To assess adherence to guideline recommendations among a large network of Italian cardiology sites in the management of acute and chronic heart failure (HF) and to evaluate if an ad-hoc educational intervention can improve their performance on several pharmacological and non-pharmacological indicators.
  
  METHODS AND RESULTS:
  BLITZ-HF was a cross-sectional study based on a web-based recording system with pop-up reminders on guideline recommendations used during two 3-month enrolment periods carried out 3 months apart (Phase 1 and 3), interspersed by face-to-face macro-regional benchmark analyses and educational meetings (Phase 2). Overall, 7218 patients with acute and chronic HF were enrolled at 106 cardiology sites. During the enrolment phases, 3920 and 3298 patients were included, respectively, 84% with chronic HF and 16% with acute HF in Phase 1, and 74% with chronic HF and 26% with acute HF in Phase 3. At baseline, adherence to guideline recommendations was already overall high for most indicators. Among acute HF patients, an improvement was obtained in three out of eight indicators, with a significant rise in echocardiographic evaluation. Among chronic HF patients with HF and preserved or mid-range ejection fraction, performance increased in two out of three indicators: creatinine and echocardiographic evaluations. An overall performance improvement was observed in six out of nine indicators in ambulatory HF with reduced ejection fraction patients with a significant increase in angiotensin receptor-neprilysin inhibitor prescription rates.
  
  CONCLUSIONS:
  Within a context of an already elevated level of adherence to HF guideline recommendations, a structured multifaceted educational intervention could be useful to improve performance on specific indicators. Extending this approach to other non-cardiology healthcare professionals, who usually manage patients with HF, should be considered.
  
  © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
  
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• Physical activity and the heart: from well-established cardiovascular benefits to possible adverse effects.
  Trends Cardiovasc Med

  2024 Jan;34(1):18-25. doi: 10.1016/j.tcm.2022.06.004.
  
  Zilio Filippo, Di Fusco Stefania Angela, Flori Marco, Malvezzi Caracciolo D'Aquino Marco, Pollarolo Luigi, Ingianni Nadia, Lucà Fabiana, Riccio Carmine, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  The favorable effects of physical activity on the cardiovascular system have been well described in scientific literature. Physical activity reduces cardiovascular morbidity and mortality in both healthy subjects and in patients with cardiovascular disease. However, different intensity levels of physical activity have a different impact on the cardiovascular system. Some data support the hypothesis of a "physical activity paradox": repetitive exposure to vigorous physical activity may induce biological effects that counteract the benefits of moderate intensity levels of physical activity. In this review, we report the main effects of acute and chronic physical activity on the cardiovascular system and we summarize the biochemical mechanisms that may explain these effects.
  
  Copyright © 2022. Published by Elsevier Inc.
  
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• Potential pathophysiologic mechanisms underlying the inherent risk of cancer in patients with atherosclerotic cardiovascular disease.
  Int J Cardiol

  2022 Sep;363():190-195. doi: 10.1016/j.ijcard.2022.06.048.
  
  Di Fusco Stefania Angela, Cianfrocca Cinzia, Bisceglia Irma, Spinelli Antonella, Alonzo Alessandro, Mocini Edoardo, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Imperoli Giuseppe, Colivicchi Furio
  
  Abstract
  
  Emerging evidence demonstrates an intimate interplay between cardiovascular disease and cancer pathophysiology. The aim of this review is to shed light on the common biological pathways underlying cardiovascular disease and cancer. These common pathways form the basis of "reverse cardio-oncology". We focus on the role of inflammation, stress response, cell proliferation, angiogenesis and tissue remodeling, neurohormonal system activation, and genomic instability as pathogenic pathways shared by cardiovascular disease and cancer. We also discuss shared mediators that may have a potential role as biomarkers for risk prediction in both diseases. Furthermore, we highlight current knowledge on biological pathways and mediators that are upregulated in diabetes and myocardial infarction and may be involved in tumorigenesis. On the basis of the shared pathophysiologic mechanisms, we also suggest an integrated approach to reduce the global burden of both cardiovascular disease and cancer.
  
  Copyright © 2022 Elsevier B.V. All rights reserved.
  
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• Exploring the link between star and planet formation with Ariel.
  Exp Astron (Dordr)

  2022 ;53(2):225-278. doi: 10.1007/s10686-021-09754-4.
  
  Turrini Diego, Codella Claudio, Danielski Camilla, Fedele Davide, Fonte Sergio, Garufi Antonio, Guarcello Mario Giuseppe, Helled Ravit, Ikoma Masahiro, Kama Mihkel, Kimura Tadahiro, Kruijssen J M Diederik, Maldonado Jesus, Miguel Yamila, Molinari Sergio, Nikolaou Athanasia, Oliva Fabrizio, Pani? Olja, Pignatari Marco, Podio Linda, Rickman Hans, Schisano Eugenio, Shibata Sho, Vazan Allona, Wolkenberg Paulina
  
  Abstract
  
  The goal of the Ariel space mission is to observe a large and diversified population of transiting planets around a range of host star types to collect information on their atmospheric composition. The planetary bulk and atmospheric compositions bear the marks of the way the planets formed: Ariel's observations will therefore provide an unprecedented wealth of data to advance our understanding of planet formation in our Galaxy. A number of environmental and evolutionary factors, however, can affect the final atmospheric composition. Here we provide a concise overview of which factors and effects of the star and planet formation processes can shape the atmospheric compositions that will be observed by Ariel, and highlight how Ariel's characteristics make this mission optimally suited to address this very complex problem.
  
  © The Author(s) 2021.
  
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• ANMCO position paper on antithrombotic treatment of patients with atrial fibrillation undergoing intracoronary stenting and/or acute coronary syndromes.
  Eur Heart J Suppl

  2022 May;24(Suppl C):C254-C271. doi: 10.1093/eurheartj/suac020.
  
  De Luca Leonardo, Rubboli Andrea, Lettino Maddalena, Tubaro Marco, Leonardi Sergio, Casella Gianni, Valente Serafina, Rossini Roberta, Sciahbasi Alessandro, Natale Enrico, Trambaiolo Paolo, Navazio Alessandro, Cipriani Manlio, Corda Marco, De Nardo Alfredo, Francese Giuseppina Maura, Napoletano Cosimo, Tizzani Emanuele, Nardi Federico, Roncon Loris, Caldarola Pasquale, Riccio Carmine, Gabrielli Domenico, Oliva Fabrizio, Massimo Gulizia Michele, Colivicchi Furio
  
  Abstract
  
  Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with or without acute coronary syndromes (ACS) represent a subgroup with a challenging pharmacological management. Indeed, if on the one hand, antithrombotic therapy should reduce the risk related to recurrent ischaemic events and/or stent thrombosis; on the other hand, care must be taken to avoid major bleeding events. In recent years, several trials, which overall included more than 12 000 patients, have been conducted demonstrating the safety of different therapeutic combinations of oral antiplatelet and anticoagulant agents. In the present ANMCO position paper, we propose a decision-making algorithm on antithrombotic strategies based on scientific evidence and expert consensus to be adopted in the periprocedural phase, at the time of hospital discharge, and in the long-term follow-up of patients with AF undergoing PCI with/without ACS.
  
  Published on behalf of the European Society of Cardiology. © The Author(s) 2022.
  
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• Corrigendum: Cardio-Oncology in the COVID Era (Co & Co): The Never Ending Story.
  Front Cardiovasc Med

  2022 ;9():903766. doi: 903766.
  
  Bisceglia Irma, Canale Maria Laura, Gallucci Giuseppina, Turazza Fabio Maria, Lestuzzi Chiara, Parrini Iris, Russo Giulia, Maurea Nicola, Quagliariello Vincenzo, Oliva Stefano, Di Fusco Stefania Angela, Lucà Fabiana, Tarantini Luigi, Trambaiolo Paolo, Moreo Antonella, Geraci Giovanna, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  [This corrects the article DOI: 10.3389/fcvm.2022.821193.].
  
  Copyright © 2022 Bisceglia, Canale, Gallucci, Turazza, Lestuzzi, Parrini, Russo, Maurea, Quagliariello, Oliva, Di Fusco, Lucà, Tarantini, Trambaiolo, Moreo, Geraci, Gabrielli, Gulizia, Oliva and Colivicchi.
  
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• ANMCO statement on the use of sodium-glucose cotransporter 2 inhibitors in patients with heart failure: a practical guide for a streamlined implementation.
  Eur Heart J Suppl

  2022 May;24(Suppl C):C272-C277. doi: 10.1093/eurheartj/suac017.
  
  Di Fusco Stefania Angela, Gronda Edoardo, Mocini Edoardo, Lucà Fabiana, Bisceglia Irma, De Luca Leonardo, Caldarola Pasquale, Cipriani Manlio, Corda Marco, De Nardo Alfredo, Francese Giuseppina Maura, Napoletano Cosimo, Navazio Alessandro, Riccio Carmine, Roncon Loris, Tizzani Emanuele, Nardi Federico, Urbinati Stefano, Valente Serafina, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Imperoli Giuseppe, Colivicchi Furio
  
  Abstract
  
  Sodium-glucose cotransporter 2 (SGLT2) inhibitors, dapagliflozin, and empagliflozin, first developed as glucose-lowering agents for the treatment of Type 2 diabetes, have been demonstrated to improve prognosis in patients with heart failure and reduced ejection fraction (HFrEF) regardless of the presence of diabetes. Since these drugs have only recently been included among the four pillars of HFrEF treatment, cardiologists are still unfamiliar with their use in this setting. This article provides an up-to-date practical guide for the initiation and monitoring of patients treated with SGLT2 inhibitors.
  
  Published on behalf of the European Society of Cardiology. © The Author(s) 2022.
  
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• ANMCO position paper 'Appropriateness of prescribing direct oral anticoagulants in stroke and systemic thromboembolism prevention in adult patients with non-valvular atrial fibrillation'.
  Eur Heart J Suppl

  2022 May;24(Suppl C):C278-C288. doi: 10.1093/eurheartj/suac015.
  
  Mocini David, Di Fusco Stefania Angela, De Luca Leonardo, Caldarola Pasquale, Cipriani Manlio, Corda Marco, Di Lenarda Andrea, De Nardo Alfredo, Francese Giuseppina Maura, Napoletano Cosimo, Navazio Alessandro, Riccio Carmine, Roncon Loris, Tizzani Emanuele, Nardi Federico, Urbinati Stefano, Valente Serafina, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  The appropriateness of prescribing direct oral anticoagulants [dabigatran, rivaroxaban, apixaban, and edoxaban (DOACs)] is regulated on the criteria established in Phase III trials. These criteria are reported in the summary of the product characteristics of the four DOACs. In clinical practice, prescriptions are not always in compliance with established indications. In particular, the use of lower doses than those recommended in drug data sheets is not uncommon. Literature data show that the inappropriate prescription of reduced doses causes drug underexposure and up to a three-fold increase in the risk of stroke/ischaemic transient attack, systemic thromboembolism, and hospitalization. Possible causes of the deviation between the dose that should be prescribed and that prescribed in the real world include erroneous prescription, an overstated haemorrhagic risk perception, and the presence of frail and complex patients in clinical practice who were not included in pivotal trials, which makes it difficult to apply study results to the real world. For these reasons, we summarize DOAC indications and contraindications. We also suggest the appropriate use of DOACs in common clinical scenarios, in accordance with what international guidelines and national and international health regulatory bodies recommend.
  
  Published on behalf of the European Society of Cardiology. © The Author(s) 2022.
  
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• ANMCO position paper: 2022 focused update of appropriate use criteria for multimodality imaging: aortic valve disease.
  Eur Heart J Suppl

  2022 May;24(Suppl C):C289-C297. doi: 10.1093/eurheartj/suac027.
  
  Nardi Federico, Pino Paolo Giuseppe, De Luca Leonardo, Riccio Carmine, Cipriani Manlio, Corda Marco, Francese Giuseppina Maura, Gabrielli Domenico, Oliva Fabrizio, Gulizia Michele Massimo, Colivicchi Furio
  
  Abstract
  
  This document addresses the evaluation of the Appropriate Use Criteria (AUC) of multimodality imaging in the diagnosis and management of aortic valve disease. The goal of this AUC document is to provide a comprehensive resource for multimodality imaging in the context of aortic valve disease, encompassing multiple imaging modalities. Clinical scenarios are developed in a simple way to illustrate patient presentations encountered in everyday practice.
  
  Published on behalf of the European Society of Cardiology. © The Author(s) 2022.
  
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• [ANMCO Position paper: Antithrombotic treatment of patients with atrial fibrillation undergoing intracoronary stenting and/or acute coronary syndromes].
  G Ital Cardiol (Rome)

  2022 May;23(5):379-395. doi: 10.1714/3796.37818.
  
  De Luca Leonardo, Rubboli Andrea, Lettino Maddalena, Tubaro Marco, Leonardi Sergio, Casella Gianni, Valente Serafina, Rossini Roberta, Sciahbasi Alessandro, Natale Enrico, Trambaiolo Paolo, Navazio Alessandro, Cipriani Manlio, Corda Marco, De Nardo Alfredo, Francese Giuseppina Maura, Napoletano Cosimo, Tizzani Emanuele, Roncon Loris, Caldarola Pasquale, Riccio Carmine, Gabrielli Domenico, Oliva Fabrizio, Gulizia Michele Massimo, Colivicchi Furio
  
  Abstract
  
  Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with or without acute coronary syndromes (ACS) represent a subgroup with a challenging pharmacological management. Indeed, if on the one hand antithrombotic therapy should reduce the risk related to recurrent ischemic events and/or stent thrombosis, on the other hand care should be taken to avoid major bleeding events. In recent years, several trials, which overall included more than 12 000 patients, have been conducted demonstrating the safety of different therapeutic combinations of oral antiplatelet and anticoagulant agents. In the present ANMCO position paper we propose a decision-making algorithm on antithrombotic strategies based on scientific evidence and expert consensus to be adopted in the periprocedural phase, at the time of hospital discharge and in the long-term follow-up of patients with AF undergoing PCI with/without ACS.
  
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• [ANMCO Position paper: Care pathway for advanced heart failure patients candidate for heart transplantation/ventricular assist device].
  G Ital Cardiol (Rome)

  2022 May;23(5):340-378. doi: 10.1714/3796.37817.
  
  Iacoviello Massimo, Cipriani Manlio, Valente Serafina, Marini Marco, Ammirati Enrico, Benvenuto Manuela, Cassaniti Leonarda Rosaria, De Maria Renata, Gori Mauro, Municinò Annamaria, Navazio Alessandro, Amodeo Vincenzo, Aspromonte Nadia, Barili Fabio, Casolo Giancarlo, Clemenza Francesco, Di Eusanio Marco, Di Lenarda Andrea, Di Tano Giuseppe, Domenicucci Stefano, Faggian Giuseppe, Francese Giuseppina Maura, Frongillo Doriana, Gilardi Rossella, Iacovoni Attilio, Imazio Massimo, Livi Ugolino, Maiello Ciro, Milano Aldo, Mondino Michele, Moreo Antonella Maurizia, Mortara Andrea, Murrone Adriano, Palmieri Vittorio, Pelenghi Stefano, Pini Daniela, Pistono Massimo, Porcu Maurizio, Potena Luciano, Rinaldi Mauro, Romanò Massimo, Roncon Loris, Rossini Roberta, Russo Claudio Francesco, Scotto di Uccio Fortunato, Urbinati Stefano, Zecchin Massimo, Caldarola Pasquale, Oliveti Alessandra, Frigerio Maria, Musumeci Francesco, Gulizia Michele Massimo, Oliva Fabrizio, Gabrielli Domenico, Colivicchi Furio
  
  Abstract
  
  Heart failure is a complex clinical syndrome with a severe prognosis, despite therapeutic progress. The management of the advanced stages of the syndrome is particularly complex in patients who are referred to palliative care as well as in those who are candidates for cardiac replacement therapy. For the latter group, a prompt recognition of the transition to the advanced stage as well as an early referral to the centers for cardiac replacement therapy are essential elements to ensure that patients follow the most appropriate diagnostic-therapeutic pathway. The aim of this document is to focus on the main diagnostic and therapeutic aspects related to the advanced stages of heart failure and, in particular, on the management of patients who are candidates for cardiac replacement therapy.
  
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• [Timing of coronary angiography in non-ST-elevation acute coronary syndrome: comment to the 2021 ACC/AHA/SCAI guideline].
  G Ital Cardiol (Rome)

  2022 May;23(5):316-318. doi: 10.1714/3796.37811.
  
  Murrone Adriano, Oliva Fabrizio, Scotto di Uccio Fortunato, Gulizia Michele Massimo, Gabrielli Domenico, Colivicchi Furio
  
  
  
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• Pulmonary Artery Catheter Monitoring in Patients with Cardiogenic Shock: Time for a Reappraisal?
  Card Fail Rev

  2022 Jan;8():e15. doi: e15.
  
  Bertaina Maurizio, Galluzzo Alessandro, Morici Nuccia, Sacco Alice, Oliva Fabrizio, Valente Serafina, D'Ascenzo Fabrizio, Frea Simone, Sbarra Pierluigi, Petitti Elisabetta, Prever Silvia Brach, Boccuzzi Giacomo, Zanini Paola, Attisani Matteo, Rametta Francesco, De Ferrari Gaetano Maria, Noussan Patrizia, Iannaccone Mario
  
  Abstract
  
  Cardiogenic shock represents one of the most dramatic scenarios to deal with in intensive cardiology care and is burdened by substantial short-term mortality. An integrated approach, including timely diagnosis and phenotyping, along with a well-established shock team and management protocol, may improve survival. The use of the Swan-Ganz catheter could play a pivotal role in various phases of cardiogenic shock management, encompassing diagnosis and haemodynamic characterisation to treatment selection, titration and weaning. Moreover, it is essential in the evaluation of patients who might be candidates for long-term heart-replacement strategies. This review provides a historical background on the use of the Swan-Ganz catheter in the intensive care unit and an analysis of the available evidence in terms of potential prognostic implications in this setting.
  
  Copyright © 2022, Radcliffe Cardiology.
  
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• Clinical Impact and Prognostic Role of Triglyceride to High-Density Lipoprotein Cholesterol Ratio in Patients With Chronic Coronary Syndromes at Very High Risk: Insights From the START Study.
  Front Cardiovasc Med

  2022 ;9():874087. doi: 874087.
  
  De Luca Leonardo, Temporelli Pier Luigi, Colivicchi Furio, Gonzini Lucio, Fasano Maria Luisa, Pantaleoni Massimo, Greco Gabriella, Oliva Fabrizio, Gabrielli Domenico, Gulizia Michele Massimo
  
  Abstract
  
  BACKGROUND:
  Several studies have reported that the combination of high TG and low HDL-C, as simplified by the TG/HDL-C ratio, was a predictor of cardiovascular disease independent of LDL-C level. Nevertheless, poor data are available on the predictive role of TG/HDL-C ratio in very high risk (VHR) patients with chronic coronary syndromes (CCS).
  
  METHODS:
  Using the data from the STable Coronary Artery Diseases RegisTry (START) study, an Italian nationwide registry, we assessed the association between the TG/HDL-C ratio and baseline clinical characteristics, pharmacological treatment, and major adverse cardio-cerebrovascular events (MACCE) at 1 year in a large cohort of CCS patients at VHR.
  
  RESULTS:
  VHR patients with both TG and HDL-C levels available were grouped in tertiles of TG/HDL-C ratio: low (TG/HDL-C ratio 3.3, = 1,028). At 1 year from enrolment, 232 (7.6%) patients presented a MACCE, with a higher incidence in the higher tertile, even though not statistically significant (6.0, 8.2, and 8.4% in the low, middle and high tertile, respectively; = 0.08). At multivariable analysis, the TG/HDL-C ratio in tertiles did not result an independent predictor of the MACCE ( = 0.29) at 1-year follow-up (HR: 1.30; 95% CI: 0.93-1.82; = 0.12 middle vs. lower tertile, and HR: 1.22; 95% CI: 0.87-1.72; = 0.25 higher vs. lower).
  
  CONCLUSIONS:
  In the present large, nationwide cohort of CCS patients at VHR a high TG/HD ratio did not emerge as independent predictor of MACCE at 1 year. Further studies with a longer follow-up are needed to better define the prognostic role of TG/HDL ratio in CCS.
  
  Copyright © 2022 De Luca, Temporelli, Colivicchi, Gonzini, Fasano, Pantaleoni, Greco, Oliva, Gabrielli and Gulizia.
  
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• Incidence, Characteristics, and Management of Patients with Recurrent Myocardial Infarctions: Insights from the EYESHOT POST-MI.
  J Interv Cardiol

  2022 ;2022():4593325. doi: 4593325.
  
  De Luca Leonardo, Colivicchi Furio, Gabrielli Domenico, Lucci Donata, Grippo Gabriele, Piemonte Francesco, Villari Bruno, Di Lenarda Andrea, Oliva Fabrizio, Gulizia Michele Massimo
  
  Abstract
  
  BACKGROUND:
  It is unknown whether patients who survived two or multiple episodes of myocardial infarction (MI) present different clinical characteristics and management than patients at their first MI.
  
  METHODS:
  The EYESHOT post-MI was a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. In 3 months of enrolment, 165 Italian cardiology centers included 1633 consecutive post-MI patients. In the present analysis, we stratified the study cohort according to the number of prior MI episodes (i.e., 1, 2 or ?3).
  
  RESULTS:
  Among the 1618 patients enrolled with complete data on MI history, 1335 (82.5%) were at their first MI episode, 209 (12.9%) had a history of 2 MIs, and the remaining 74 (4.6%) had ? 3 prior MIs. Patients with a history of multiple MIs were increasingly older and presented a significantly higher rate of risk factors compared to those at their first MI. During the year prior to enrolment, patients with 2 or ?3 MI episodes more frequently underwent coronary angiography compared to the other group (
  CONCLUSIONS:
  Our data suggest that patients with multiple MIs managed by cardiologists in routine clinical practice present an incremental clinical risk, more frequently undergo coronary angiography, and are more intensively managed with pharmacological therapies compared to patients at their first MI episode.
  
  Copyright © 2022 Leonardo De Luca et al.
  
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• Prognostic implications of pulmonary artery catheter monitoring in patients with cardiogenic shock: A systematic review and meta-analysis of observational studies.
  J Crit Care

  2022 Jun;69():154024. doi: 10.1016/j.jcrc.2022.154024.
  
  Bertaina Maurizio, Galluzzo Alessandro, Rossello Xavier, Sbarra Pierluigi, Petitti Elisabetta, Prever Silvia Brach, Boccuzzi Giacomo, D'Ascenzo Fabrizio, Frea Simone, Pidello Stefano, Morici Nuccia, Sacco Alice, Oliva Fabrizio, Valente Serafina, De Ferrari Gaetano Maria, Ugo Fabrizio, Rametta Francesco, Attisani Matteo, Zanini Paola, Noussan Patrizia, Iannaccone Mario
  
  Abstract
  
  PURPOSE:
  To investigate the impact of pulmonary artery catheter (PAC) monitoring on survival of cardiogenic shock(CS), in the light of the controversies in available evidence.
  
  MATERIALS AND METHODS:
  MEDLINE, EMBASE, Cochrane library and Web of Science were systematically screened to identify most relevant studies on patients with CS comparing PAC use to non-use during hospital stay. Short-term mortality was the primary endpoint and the use of Mechanical Circulatory Support (MCS) devices was the secondary one.
  
  RESULTS:
  Six observational studies including 1,166,762 patients were selected. The most frequent etiology of CS was post-myocardial infarction (75% [95% CI 55-89%] in PAC-group and 81%[95% CI 47-95%] in non-PAC group). Overall, PAC was used in 33%(95% CI 24-44%) of cases. Pooling data adjusted for confounders, a significant association between the PAC-group and a reduction in short-term mortality emerged when compared to the non-PAC group (36%[95% CI 27-45%] vs 47%[95% CI 35-59%];AdjustedOR 0.71, 95% CI 0.59-0.87, p
  CONCLUSIONS:
  PAC was associated with lower incidence of short-term mortality in CS pooling adjusted observational studies. Prospective studies are needed to confirm our hypothesis and better clarify the mechanisms of this potential prognostic benefit.
  
  Copyright © 2022 Elsevier Inc. All rights reserved.
  
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• [ESC/EACTS Guidelines for the management of valvular heart disease: what's new from the cardiologist's perspective].
  G Ital Cardiol (Rome)

  2022 Mar;23(3):160-164. doi: 10.1714/3751.37332.
  
  Bossi Irene, Oliva Fabrizio
  
  
  
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• [Sacubitril/valsartan in oncologic patients with cardiotoxicity: another weapon in our pharmacological armory?].
  G Ital Cardiol (Rome)

  2022 Apr;23(4):278-285. doi: 10.1714/3766.37537.
  
  Camilli Massimiliano, Bisceglia Irma, Canale Maria Laura, Di Tano Giuseppe, Oliva Fabrizio, Gabrielli Domenico, Gulizia Michele Massimo, Colivicchi Furio
  
  Abstract
  
  Myocardial dysfunction and heart failure (HF), frequently described as cardiotoxicity, are the most concerning cardiovascular complications of cancer therapies, causing an increase in morbidity and mortality, even due to early discontinuation of antineoplastic drugs. Research efforts have been done to prevent and treat this phenomenon, in particular through early administration of drugs inducing renin-angiotensin-aldosterone system blockade. Sacubitril/valsartan, a combination of an angiotensin receptor blocker and a neprilysin inhibitor pro-drug, has recently represented a game changer in the scenario of treatment of HF with reduced ejection fraction. However, patients with HF induced by cancer therapy were a priori excluded from the approval study. Therefore, safety and efficacy of this drug in this special population require further investigation. Available evidence, even though only derived from case reports or observational studies, seems to confirm the promising role of this new pharmacological strategy, paving the way for the use of sacubitril/valsartan in cardio-oncology. Prevention and treatment of HF in these highly vulnerable patients is a special need to allow full oncologic treatment and improve overall survival, highlighting the need for ad hoc prospective studies.
  
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• Lipoprotein(a): a risk factor for atherosclerosis and an emerging therapeutic target.
  Heart

  2022 Dec;109(1):18-25. doi: 10.1136/heartjnl-2021-320708.
  
  Di Fusco Stefania Angela, Arca Marcello, Scicchitano Pietro, Alonzo Alessandro, Perone Francesco, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Imperoli Giuseppe, Colivicchi Furio
  
  Abstract
  
  Lipoprotein(a) (Lp(a)) is a complex circulating lipoprotein, and increasing evidence has demonstrated its role as a risk factor for atherosclerotic cardiovascular disease (ASCVD) and as a possible therapeutic target. Lp(a) atherogenic effects are attributed to several potential mechanisms in addition to cholesterol accumulation in the arterial wall, including proinflammatory effects mainly mediated by oxidised phospholipids. Several studies have found a causal and independent relationship between Lp(a) levels and cardiovascular risk. Furthermore, several studies also suggest a causal association between Lp(a) levels and calcific aortic valve stenosis. Available lipid-lowering agents have at best moderate impact on Lp(a) levels. Among available therapies, antibody proprotein convertase subtilisin/kexin type 9 inhibitors are the most effective in reducing Lp(a). Potent Lp(a)-lowering treatments that target expression are under development. Lp(a) level measurement poses some challenges due to the absence of a definitive reference method and the reporting of Lp(a) values as molar (nanomoles per litre (nmol/L)) or mass concentrations (milligrams per decilitre (mg/dL)) by different assays. Currently, Lp(a) measurement is recommended to refine cardiovascular risk in specific clinical settings, that is, in individuals with a family history of premature ASCVD, in patients with ASCVD not explained by standard risk factors or in those with recurrent events despite optimal management of traditional risk factors. Patients with high Lp(a) levels should be managed with more intensive approaches to treat other modifiable cardiovascular risk factors. Overall, this review focuses on Lp(a) as an ASCVD risk factor and therapeutic target. Furthermore, it reports practical recommendations for Lp(a) measurement and interpretation and updated evidence on Lp(a)-lowering approaches.
  
  © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
  
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• Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy.
  Minerva Cardiol Angiol

  2023 Feb;71(1):44-50. doi: 10.23736/S2724-5683.21.05839-7.
  
  Sacco Alice, Montalto Claudio, Bravi Francesca, Ruzzenenti Giacomo, Garatti Laura, Oreglia Jacopo A, Bartorelli Antonio L, Crimi Gabriele, LA Vecchia Carlo, Savonitto Stefano, Leonardi Sergio, Oliva Fabrizio G, Morici Nuccia
  
  Abstract
  
  BACKGROUND:
  The optimal timing of PCI for NSTE-ACS with CKD is unclear. The aim of our study was to assess whether early percutaneous coronary intervention (PCI) (within 24 hours from admission) is associated with improved in-hospital (mortality or acute kidney injury) and long-term events (composite of mortality, myocardial infarction, stroke and bleeding events) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) with chronic kidney disease (CKD).
  
  METHODS:
  We retrospectively studied NSTE-ACS patients who underwent PCI in large tertiary centers. CKD was defined as estimated glomerular filtration rate (eGFR)
  RESULTS:
  We included 821 patients, mean age was 69±12 years; 492 (60%) received an early PCI, and 273 (33%) had an eGFR
  CONCLUSIONS:
  In conclusion in a cohort of NSTE-ACS patients, an early invasive strategy does not independently affect prognosis.
  
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• COVID-19, Vaccines, and Thrombotic Events: A Narrative Review.
  J Clin Med

  2022 Feb;11(4):. doi: 948.
  
  Abrignani Maurizio G, Murrone Adriano, De Luca Leonardo, Roncon Loris, Di Lenarda Andrea, Valente Serafina, Caldarola Pasquale, Riccio Carmine, Oliva Fabrizio, Gulizia Michele M, Gabrielli Domenico, Colivicchi Furio, On Behalf Of The Working Group On Anti-Covid-Vaccination Of The Associazione Nazionale Medici Cardiologi Ospedalieri Anmco
  
  Abstract
  
  The coronavirus disease 2019 (COVID-19), a deadly pandemic that has affected millions of people worldwide, is associated with cardiovascular complications, including venous and arterial thromboembolic events. Viral spike proteins, in fact, may promote the release of prothrombotic and inflammatory mediators. Vaccines, coding for the spike protein, are the primary means for preventing COVID-19. However, some unexpected thrombotic events at unusual sites, most frequently located in the cerebral venous sinus but also splanchnic, with associated thrombocytopenia, have emerged in subjects who received adenovirus-based vaccines, especially in fertile women. This clinical entity was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia, probably caused by cross-reacting anti-platelet factor-4 antibodies activating platelets. For this reason, the regulatory agencies of various countries restricted the use of adenovirus-based vaccines to some age groups. The prevailing opinion of most experts, however, is that the risk of developing COVID-19, including thrombotic complications, clearly outweighs this potential risk. This point-of-view aims at providing a narrative review of epidemiological issues, clinical data, and pathogenetic hypotheses of thrombosis linked to both COVID-19 and its vaccines, helping medical practitioners to offer up-to-date and evidence-based counseling to their often-alarmed patients with acute or chronic cardiovascular thrombotic events.
  
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• Cardio-Oncology in the COVID Era (Co & Co): The Never Ending Story.
  Front Cardiovasc Med

  2022 ;9():821193. doi: 821193.
  
  Bisceglia Irma, Canale Maria Laura, Gallucci Giuseppina, Turazza Fabio Maria, Lestuzzi Chiara, Parrini Iris, Russo Giulia, Maurea Nicola, Quagliariello Vincenzo, Oliva Stefano, Di Fusco Stefania Angela, Lucà Fabiana, Tarantini Luigi, Trambaiolo Paolo, Moreo Antonella, Geraci Giovanna, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  The pathophysiology of some non-communicable diseases (NCDs) such as hypertension, cardiovascular disease (CVD), diabetes, and cancer includes an alteration of the endothelial function. COVID-19 is a pulmonary and vascular disease with a negative impact on patients whose damaged endothelium is particularly vulnerable. The peculiar SARS-CoV-2-induced "endothelitis" triggers an intriguing immune-thrombosis that affects both the venous and arterial vascular beds. An increased liability for infection and an increased likelihood of a worse outcome have been observed during the pandemic in patients with active cancer and in cancer survivors. "Overlapping commonalities" between COVID-19 and Cardio-Oncology have been described that include shared phenotypes of cardiovascular toxicities such as left ventricular dysfunction, ischemic syndromes, conduction disturbances, myocarditis, pericarditis and right ventricular failure; shared pathophysiologic mechanisms such as inflammation, release of cytokines, the renin-angiotensin-aldosterone-pathway, coagulation abnormalities, microthrombosis and endothelial dysfunction. For these features and for the catalyst role of NCDs (mainly CVD and cancer), we should refer to COVID-19 as a "syndemic." Another challenging issue is the persistence of the symptoms, the so-called "long COVID" whose pathogenesis is still uncertain: it may be due to persistent multi-organ viral attacks or to an abnormal immune response. An intensive vaccination campaign is the most successful pharmacological weapon against SARS-CoV-2, but the increasing number of variants has reduced the efficacy of the vaccines in controlling SARS-CoV-2 infections. After a year of vaccinations we have also learned more about efficacy and side-effects of COVID-19 vaccines. An important byproduct of the COVID-19 pandemic has been the rapid expansion of telemedicine platforms across different care settings; this new modality of monitoring cancer patients may be useful even in a post pandemic era. In this paper we analyze the problems that the cardio-oncologists are facing in a pandemic scenario modified by the extensive vaccination campaign and add actionable recommendations derived from the ongoing studies and from the syndemic nature of the infection.
  
  Copyright © 2022 Bisceglia, Canale, Gallucci, Turazza, Lestuzzi, Parrini, Russo, Maurea, Quagliariello, Oliva, Di Fusco, Lucà, Tarantini, Trambaiolo, Moreo, Geraci, Gabrielli, Gulizia, Oliva and Colivicchi.
  
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• Uric acid associated with acute heart failure presentation in Acute Coronary Syndrome patients.
  Eur J Intern Med

  2022 May;99():30-37. doi: 10.1016/j.ejim.2022.01.018.
  
  Rebora Paola, Centola Marco, Morici Nuccia, Sacco Alice, Occhino Giuseppe, Viola Giovanna, Oreglia Jacopo, Castini Diego, Persampieri Simone, Sabatelli Ludovico, Ferrante Giulia, Lucreziotti Stefano, Carugo Stefano, Valsecchi Maria Grazia, Oliva Fabrizio, Giannattasio Cristina, Maloberti Alessandro
  
  Abstract
  
  We focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure (HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcomes were acute HF and cardiogenic shock at admission, secondary outcomes were the use of Non Invasive Ventilation (NIV) and the admission Left Ventricular Ejection Fraction (LVEF). We consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to June 2019. Median age was 68 (first-third quartile 59-77) years and males were 970 (76%). All the evaluated outcomes occurred more frequently in the hyperuricemic subjects (UA higher than 6 mg/dL for females and 7 mg/dL for males, n = 292): acute HF 35.8 vs 11.1% (p 
  Copyright © 2022. Published by Elsevier B.V.
  
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• Effect of landiolol in patients with tachyarrhythmias and acute decompensated heart failure (ADHF): a case series.
  ESC Heart Fail

  2022 Feb;9(1):766-770. doi: 10.1002/ehf2.13763.
  
  Ditali Valentina, Garatti Laura, Morici Nuccia, Villanova Luca, Colombo Claudia, Oliva Fabrizio, Sacco Alice
  
  Abstract
  
  Tachycardia and rapid tachyarrhythmias are common in acute clinical settings and may hasten the deterioration of haemodynamics in patients with acute decompensated heart failure (ADHF), treated with inotropes. The concomitant use of a short-acting ?1-selective beta-blocker, such as landiolol, could rapidly and safely restore an adequate heart rate without any negative inotropic effect. We present a case series of five patients with left ventricular dysfunction, admitted to our Intensive Cardiac Care Unit with ADHF deteriorated to cardiogenic shock, treated with a combination of landiolol and inotropes. Landiolol was effective in terms of rate control and haemodynamics optimization, enabling de-escalation of catecholamine dosing in all patients. The infusion was always well tolerated without hypotension. In conclusion, a continuous infusion of a low dose of landiolol (3-16 mcg/kg/min) to manage tachycardia and ventricular or supraventricular tachyarrhythmias in haemodynamically unstable patients may be considered.
  
  © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
  
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• [ANMCO Position paper: Prescription appropriateness of direct oral anticoagulants for stroke and systemic thromboembolis with non-valvular atrial fibrillation].
  G Ital Cardiol (Rome)

  2021 Dec;22(12):1024-1033. doi: 10.1714/3698.36882.
  
  Mocini David, Di Fusco Stefania Angela, De Luca Leonardo, Caldarola Pasquale, Cipriani Manlio, Corda Marco, Di Lenarda Andrea, De Nardo Alfredo, Francese Giuseppina Maura, Napoletano Cosimo, Navazio Alessandro, Riccio Carmine, Roncon Loris, Tizzani Emanuele, Urbinati Stefano, Valente Serafina, Gulizia Michele Massimo, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  The prescription appropriateness of direct oral anticoagulants (DOACs [dabigatran, rivaroxaban, apixaban, and edoxaban]) is carefully regulated, taking into account the criteria established in phase III trials and listed in the summary of the product characteristics of the four DOACs. In clinical practice, prescriptions are not always in compliance with established indications. In particular, the use of doses lower than those recommended in drug data sheets is relatively frequent. Literature data show that the inappropriate prescription of DOAC doses causes drug underexposure and an up to three-fold increase in the risk of stroke/transient ischemic attack, systemic thromboembolism, and hospitalizations. Possible causes of the deviation between the dose that should be prescribed and that actually employed may include erroneous prescriptions, an overstated bleeding risk perception, and the presence of frail patients, who were not included in pivotal trials. For these reasons, we summarize DOAC indications and contraindications and suggest the appropriate use of DOACs in common clinical scenarios, in accordance with what international guidelines and national and international health regulatory agencies recommend.
  
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• [COVID-19, vaccines, and thrombotic events].
  G Ital Cardiol (Rome)

  2021 Dec;22(12):969-980. doi: 10.1714/3698.36874.
  
  Abrignani Maurizio Giuseppe, Murrone Adriano, De Luca Leonardo, Roncon Loris, Di Lenarda Andrea, Valente Serafina, Caldarola Pasquale, Riccio Carmine, Oliva Fabrizio, Gulizia Michele Massimo, Gabrielli Domenico, Colivicchi Furio
  
  Abstract
  
  COVID-19, a deadly pandemic that has affected millions of people worldwide, is also associated with cardiovascular complications, such as venous and arterial thromboembolic events. The viral spike protein, in fact, may promote the release of prothrombotic and inflammatory mediators. Vaccines, coding for the spike protein, are the primary measure for preventing COVID-19. However, some unexpected thrombotic events at unusual sites, most frequently the cerebral venous and splanchnic districts, with associated thrombocytopenia, have emerged in subjects who received adenovirus-based vaccines, especially in fertile women. This clinical entity has been rapidly recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia, probably caused by cross-reacting antiplatelet factor 4 antibodies activating platelets. This prompted the regulatory agencies of various countries to restrict the use of adenovirus-based vaccines to specific age groups. The prevailing opinion of most experts, however, is that the risk of developing COVID-19 disease, including thrombosis, clearly outweighs this potential extremely low risk.This paper aims at providing a comprehensive review of epidemiological issues, clinical data and pathogenetic hypotheses of thrombosis linked to both COVID-19 and its vaccines, helping cardiologists to offer an up-to-date and evidence-based counseling to their often-alarmed patients with acute or chronic coronary syndromes.
  
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• Impact of Working from Home on Cardiovascular Health: An Emerging Issue with the COVID-19 Pandemic.
  Int J Environ Res Public Health

  2021 Nov;18(22):. doi: 11882.
  
  Di Fusco Stefania Angela, Spinelli Antonella, Castello Lorenzo, Mocini Edoardo, Gulizia Michele Massimo, Oliva Fabrizio, Gabrielli Domenico, Imperoli Giuseppe, Colivicchi Furio
  
  Abstract
  
  Mandatory working from home is one of the consequences of the COVID-19 pandemic for a large number of workers. Transition to working from home may significantly impact lifestyle, psychosocial status, and the overall health of workers. This review summarizes available data about the effects of lockdown measures, particularly working from home, on cardiovascular risk factors including sedentary lifestyle, unhealthy diet pattern, psychological distress, smoking, alcohol misuse, and cardiometabolic parameters. Finally, we suggest countermeasures that can attenuate the negative health impact of working from home. Indeed, timely and tailored interventions implemented by companies in cooperation with the health care system could allow workers to benefit more from some of the advantages associated with working from home.
  
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• Intra-aortic Balloon Pump for Acute-on-Chronic Heart Failure Complicated by Cardiogenic Shock.
  J Card Fail

  2022 Jul;28(7):1202-1216. doi: 10.1016/j.cardfail.2021.11.009.
  
  Morici Nuccia, Marini Claudia, Sacco Alice, Tavazzi Guido, Saia Francesco, Palazzini Matteo, Oliva Fabrizio, Ferrari Gaetano Maria De, Colombo Paolo C, Kapur Navin K, Garan Arthur Reshad, Pappalardo Federico
  
  Abstract
  
  The intra-aortic balloon pump (IABP) is widely implanted as temporary mechanical circulatory support for cardiogenic shock (CS). However, its use is declining following the results of the IABP-SHOCK II trial, which failed to show a clinical benefit of the IABP in acute coronary syndrome (ACS)-related CS. Acute-on-chronic heart failure has become an increasingly recognized, distinct cause of CS (HF-CS). The pathophysiology of HF-CS differs from that of ACS-CS because it typically represents the progression from a state of congestion (with relatively preserved cardiac output) to a low-output state with hypoperfusion. The IABP is a volume-displacement pump that promotes forward flow from a high-capacitance reservoir to low-capacitance vessels, improving peripheral perfusion and decreasing left ventricular afterload in the setting of high filling pressures. The IABP can improve ventricular-vascular coupling and, therefore, myocardial energetics. Additionally, many patients with HF-CS are candidates for cardiac replacement therapies (left ventricular assist device or heart transplantation) and, therefore, may benefit from a bridge strategy that stabilizes the hemodynamics and end-organ function in preparation for more durable therapies. Notably, the new United Network for Organ Sharing donor heart allocation system has recently prioritized patients on IABP support. This review describes the role of IABP in the treatment of HF-CS. It also briefly discusses new strategies for vascular access as well as fully implantable versions for longer duration of support.
  
  Copyright © 2021 Elsevier Inc. All rights reserved.
  
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• The Role of Uric Acid in Acute and Chronic Coronary Syndromes.
  J Clin Med

  2021 Oct;10(20):. doi: 4750.
  
  Maloberti Alessandro, Biolcati Marco, Ruzzenenti Giacomo, Giani Valentina, Leidi Filippo, Monticelli Massimiliano, Algeri Michela, Scarpellini Sara, Nava Stefano, Soriano Francesco, Oreglia Jacopo, Sacco Alice, Morici Nuccia, Oliva Fabrizio, Piani Federica, Borghi Claudio, Giannattasio Cristina
  
  Abstract
  
  Uric acid (UA) is the final product of the catabolism of endogenous and exogenous purine nucleotides. While its association with articular gout and kidney disease has been known for a long time, new data have demonstrated that UA is also related to cardiovascular (CV) diseases. UA has been identified as a significant determinant of many different outcomes, such as all-cause and CV mortality, and also of CV events (mainly Acute Coronary Syndromes (ACS) and even strokes). Furthermore, UA has been related to the development of Heart Failure, and to a higher mortality in decompensated patients, as well as to the onset of atrial fibrillation. After a brief introduction on the general role of UA in CV disorders, this review will be focused on UA's relationship with CV outcomes, as well as on the specific features of patients with ACS and Chronic Coronary Syndrome. Finally, two issues which remain open will be discussed: the first is about the identification of a CV UA cut-off value, while the second concerns the possibility that the pharmacological reduction of UA is able to lower the incidence of CV events.
  
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• Direct Oral Anticoagulants in Patients with Obesity and Atrial Fibrillation: Position Paper of Italian National Association of Hospital Cardiologists (ANMCO).
  J Clin Med

  2021 Sep;10(18):. doi: 4185.
  
  Mocini David, Di Fusco Stefania Angela, Mocini Edoardo, Donini Lorenzo Maria, Lavalle Carlo, Di Lenarda Andrea, Riccio Carmine, Caldarola Pasquale, De Luca Leonardo, Gulizia Michele Massimo, Oliva Fabrizio, Gabrielli Domenico, Colivicchi Furio
  
  Abstract
  
  The use of the direct oral anticoagulants dabigatran, rivaroxaban, apixaban and edoxaban (DOACs) offers some major advantages over warfarin and other vitamin K antagonists (VKAs). One advantage is the possibility to use a fixed dose in normal-weight patients, overweight patients and patients with obesity. However, the "one size fits all" strategy raised a concern regarding the possibility to undertreat patients with a high body mass index. No randomized controlled trials (RCTs) have ever compared VKAs and DOACs in this population. We analyzed data from the literature on DOAC pharmacokinetics and pharmacodynamics, results from the four pivotal phase III trials on non-valvular atrial fibrillation, retrospective observational studies and metanalyses. While we are aware of the limitation imposed by the absence of specific RCTs, we propose the position of the Italian Association of Hospital Cardiologists (ANMCO) on the use of DOACs in patients with obesity based on the existing evidence.
  
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• [ANMCO Position paper: Double, triple or quadruple therapy for heart failure with reduced ejection fraction. Current evidence and new strategies].
  G Ital Cardiol (Rome)

  2021 Oct;22(10):861-868. doi: 10.1714/3666.36518.
  
  Di Lenarda Andrea, Di Tano Giuseppe, Cipriani Manlio, Oliva Fabrizio, Imazio Massimo, Murrone Adriano, Caldarola Pasquale, Iacoviello Massimo, Urbinati Stefano, Colivicchi Furio, Gabrielli Domenico
  
  Abstract
  
  The triple therapy (angiotensin-converting enzyme [ACE] inhibitors or angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists) certificated by the 2012 guidelines for symptomatic patients with heart failure and reduced ejection fraction, reaffirmed in the following document of 2016 with the introduction of angiotensin receptor-neprilysin inhibitors (ARNI), has not yet reached an adequate implementation in clinical practice (where the majority of patients is only treated with the double treatment of ACE-inhibitors or angiotensin receptor blockers and beta-blockers). Among the reasons for this general failure, we should consider the enrollment of unselected cases from the real world, without exclusion criteria for age, comorbidity and stage of the disease, the therapeutic inertia of many cardiologists and not least the clinical and organizational complexity of the conventional scheme of implementation of therapy indicated by the guidelines. Not only the prescription of triple therapy is inadequate, but also the "target doses" defined by the large randomized controlled trials should be considered unrealistic in the majority of patients, who often achieve a therapeutic effect at lower doses, generally better tolerated ("target effect"). The new guidelines forthcoming will certify a further step forward with the quadruple therapy (sodium-glucose co-transporter 2 inhibitors, ARNI, beta-blockers and mineralocorticoid receptor antagonists), underlining how a fourfold intervention with different pharmacological mechanisms is able to determine the greatest benefits in patients with systolic heart failure. The discussion is open on the possibility of simplifying and speeding up the conventional implementation scheme of treatment, exploiting the ability of all these pharmacological principles to exert a significant and rapid favorable effect on prognosis already at a low dose in the first 4-8 weeks of treatment.
  
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• [ANMCO Position paper: Use of sacubitril/valsartan in hospitalized patients with acute heart failure].
  G Ital Cardiol (Rome)

  2021 Oct;22(10):854-860. doi: 10.1714/3666.36517.
  
  Di Tano Giuseppe, Di Lenarda Andrea, Iacoviello Massimo, Oliva Fabrizio, Urbinati Stefano, Aspromonte Nadia, Cipriani Manlio, Caldarola Pasquale, Murrone Adriano, Gulizia Michele Massimo, Colivicchi Furio, Gabrielli Domenico
  
  Abstract
  
  Sacubitril/valsartan (S/V) has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and improve symptoms in chronic heart failure with reduced ejection fraction compared to enalapril. After 7 years since the publication of the results of PARADIGM-HF, further insight has been gained with potential new indications. Two prospective randomized multicenter studies (PIONEER-HF and TRANSITION) in patients hospitalized for acute heart failure (AHF) have shown an improved clinical outcome and biomarker profile as compared to enalapril, and good tolerability, safety and feasibility of initiating in-hospital administration of S/V. Furthermore, some studies have highlighted the favorable effects of S/V in attenuating adverse myocardial remodeling, supporting an early benefit after treatment. Observational data from non-randomized studies in AHF report that in-hospital and pre-discharge prescription of evidence-based drugs associated with better survival still remains suboptimal. Additionally, the COVID-19 pandemic has also negatively impacted on outpatient activities. Therefore, hospitalization, a real crossroads in the history of heart failure, must become a management and therapeutic opportunity for our patients. The objective of this ANMCO position paper is to encourage and facilitate early S/V administration in stabilized patients during hospitalization after an AHF episode, with the aim of improving care efficiency and clinical outcome.
  
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• [Cardiac contractility modulation in heart failure with reduced ejection fraction: critical review of evidence and application perspectives].
  G Ital Cardiol (Rome)

  2021 Sep;22(9):727-741. doi: 10.1714/3660.36450.
  
  Biffi Mauro, Aspromonte Nadia, Bongiorni Maria Grazia, Clemenza Francesco, D'Onofrio Antonio, De Ferrari Gaetano Maria, Giallauria Francesco, Grimaldi Massimo, Oliva Fabrizio, Senni Michele, Tondo Claudio, Zecchin Massimo, Cappannoli Luigi, Giannotti Santoro Mario, Ziacchi Matteo, Porcari Aldostefano, Sinagra Gianfranco
  
  Abstract
  
  This critical review illustrates the pathophysiological aspects and available scientific evidence about cardiac contractility modulation therapy. A useful algorithm dealing with the essential decisional knots to consider for device implantation in patients with heart failure in NYHA class >II and ejection fraction ?45% is presented. The present review paves the way for the development of an Italian registry aiming at analyzing the characteristics of implanted patients based on a multiparametric approach, including cardiac biomarkers, to identify clinical profiles and predictors of response to therapy. The "Answers and Questions" section provides useful insights into pathophysiology, technical specifications, clinically relevant scenarios and future perspectives.
  
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• ANMCO POSITION PAPER: Use of sacubitril/valsartan in hospitalized patients with acute heart failure.
  Eur Heart J Suppl

  2021 Aug;23(Suppl C):C176-C183. doi: 10.1093/eurheartj/suab078.
  
  Di Tano Giuseppe, Di Lenarda Andrea, Iacoviello Massimo, Oliva Fabrizio, Urbinati Stefano, Aspromonte Nadia, Cipriani Manlio, Caldarola Pasquale, Murrone Adriano, Gulizia Michele Massimo, Colivicchi Furio, Gabrielli Domenico
  
  Abstract
  
  Sacubitril/valsartan (S/V) has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and improve symptoms in chronic heart failure with reduced ejection fraction compared with enalapril. After 7?years since the publication of the results of PARADIGM-HF, further insight has been gained with potential new indications. Two prospective randomized multicentre studies (PIONEER-HF and TRANSITION) in patients hospitalized for acute heart failure (AHF) have shown an improved clinical outcome and biomarker profile as compared with enalapril, and good tolerability, safety, and feasibility of initiating in-hospital administration of S/V. Furthermore, some studies have highlighted the favourable effects of S/V in attenuating adverse myocardial remodelling, supporting an early benefit after treatment. Observational data from non-randomized studies in AHF report that in-hospital and pre-discharge prescription of evidence-based drugs associated with better survival still remain suboptimal. Additionally, the COVID-19 pandemic has also negatively impacted on outpatient activities. Therefore, hospitalization, a real crossroad in the history of heart failure, must become a management and therapeutic opportunity for our patients. The objective of this ANMCO position paper is to encourage and facilitate early S/V administration in stabilized patients during hospitalization after an AHF episode, with the aim of improving care efficiency and clinical outcome.
  
  Published on behalf of the European Society of Cardiology. © The Author(s) 2021.
  
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• Predicting survival in patients with acute decompensated heart failure complicated by cardiogenic shock.
  Int J Cardiol Heart Vasc

  2021 Jun;34():100809. doi: 100809.
  
  Morici Nuccia, Viola Giovanna, Antolini Laura, Alicandro Gianfranco, Dal Martello Michela, Sacco Alice, Bottiroli Maurizio, Pappalardo Federico, Villanova Luca, De Ponti Laura, La Vecchia Carlo, Frigerio Maria, Oliva Fabrizio, Fried Justin, Colombo Paolo, Garan Arthur Reshad
  
  Abstract
  
  BACKGROUND:
  Acute decompensated heart failure (ADHF) complicated by cardiogenic shock (CS) has unique pathophysiological background requiring specific patient stratification, management and therapeutic targets. Accordingly, the aim of this study was to derive a simple stratification tool to predict survival in patients with ADHF complicated by CS.
  
  METHODS AND RESULTS:
  Using logistic regression, univariable testing was performed to identify the variables potentially associated with 28-day mortality. We propose a new logistic model (ALC-Shock score) based on three easy parameters (age, serum creatinine and serum lactate at the ICU admission) as a powerful predictor of survival or successful bridge to heart replacement therapy at 28-day follow-up in this specific population. A multivariable analysis (logistic model) was performed to evaluate the association between selected variables and outcome (overall death at 28-day follow up). The score was then validated in a different cohort of 93 ADHF-CS patients and compared to a previous developed score (the Cardshock score).Overall, 28-day mortality was 34%. The ALC-shock score showed better discrimination (Area Under the Curve-AUC- 0.82; 95% CI 0.73-0.91) as compared to the Cardshock score (AUC 0.67; 95% CI 0.55-0.79) (p = 0.009) to predict 28-days overall mortality. In the validation cohort the AUC for the ALC-shock score was 0.66.
  
  CONCLUSIONS:
  A simple score including age, lactates and creatinine on admission could be considered to predict short-term mortality in CS-ADHF patients in order to drive towards a treatment intensification.
  
  © 2021 The Author(s).
  
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• Myocarditis After BNT162b2 and mRNA-1273 Vaccination.
  Circulation

  2021 Aug;144(6):506-508. doi: 10.1161/CIRCULATIONAHA.121.055913.
  
  Larson Kathryn F, Ammirati Enrico, Adler Eric D, Cooper Leslie T, Hong Kimberly N, Saponara Gianluigi, Couri Daniel, Cereda Alberto, Procopio Antonio, Cavalotti Cristina, Oliva Fabrizio, Sanna Tommaso, Ciconte Vincenzo Antonio, Onyango George, Holmes David R, Borgeson Daniel D
  
  Abstract
  
  Supplemental Digital Content is available in the text.
  
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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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• Acute cardiovascular syndrome in the Italian multiethnic society.
  J Cardiovasc Med (Hagerstown)

  2022 Jan;23(1):e11-e14. doi: 10.2459/JCM.0000000000001207.
  
  Sacco Alice, Palazzini Matteo, Portoghese Alessandro, Ruzzenenti Giacomo, De Ponti Laura, Morici Nuccia, Brunelli Dario, Giannattasio Cristina, Oliva Fabrizio
  
  
  
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• Temporal Relation Between Second Dose BNT162b2 mRNA Covid-19 Vaccine and Cardiac involvement in a Patient with Previous SARS-COV-2 Infection.
  Int J Cardiol Heart Vasc

  2021 Apr;():100778. doi: 100778.
  
  Ammirati Enrico, Cavalotti Cristina, Milazzo Angela, Pedrotti Patrizia, Soriano Francesco, Schroeder Jan W, Morici Nuccia, Giannattasio Cristina, Frigerio Maria, Metra Marco, Camici Paolo G, Oliva Fabrizio
  
  Abstract
  
  The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ijcha.2021.100774. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at
  
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• Temporal relation between second dose BNT162b2 mRNA Covid-19 vaccine and cardiac involvement in a patient with previous SARS-COV-2 infection.
  Int J Cardiol Heart Vasc

  2021 Jun;34():100774. doi: 100774.
  
  Ammirati Enrico, Cavalotti Cristina, Milazzo Angela, Pedrotti Patrizia, Soriano Francesco, Schroeder Jan W, Morici Nuccia, Giannattasio Cristina, Frigerio Maria, Metra Marco, Camici Paolo G, Oliva Fabrizio
  
  
  
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• Uric acid in chronic coronary syndromes: Relationship with coronary artery disease severity and left ventricular diastolic parameter.
  Nutr Metab Cardiovasc Dis

  2021 May;31(5):1501-1508. doi: 10.1016/j.numecd.2021.01.023.
  
  Maloberti Alessandro, Bossi Irene, Tassistro Elena, Rebora Paola, Racioppi Angelo, Nava Stefano, Soriano Francesco, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo, Vallerio Paola, Pirola Roberto, De Chiara Benedetta, Oliva Fabrizio, Moreo Antonella, Valsecchi Maria Grazia, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND AND AIMS:
  Uric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation.
  
  METHODS AND RESULTS:
  231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function.
  
  CONCLUSIONS:
  In conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.
  
  Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
  
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• Early intra-aortic balloon pump in acute decompensated heart failure complicated by cardiogenic shock: Rationale and design of the randomized Altshock-2 trial.
  Am Heart J

  2021 Mar;233():39-47. doi: 10.1016/j.ahj.2020.11.017.
  
  Morici Nuccia, Marini Claudia, Sacco Alice, Tavazzi Guido, Cipriani Manlio, Oliva Fabrizio, Rota Matteo, De Ferrari Gaetano Maria, Campolo Jonica, Frigerio Gianfranco, Valente Serafina, Leonardi Sergio, Corrada Elena, Bottiroli Maurizio, Grosseto Daniele, Cacciavillani Luisa, Frigerio Maria, Pappalardo Federico,
  
  Abstract
  
  BACKGROUND:
  Cardiogenic shock (CS) is a systemic disorder associated with dismal short-term prognosis. Given its time-dependent nature, mechanical circulatory support may improve survival. Intra-aortic balloon pump (IABP) had gained widespread use because of the easiness to implant and the low rate of complications; however, a randomized trial failed to demonstrate benefit on mortality in the setting of acute myocardial infarction. Acute decompensated heart failure with cardiogenic shock (ADHF-CS) represents a growing resource-intensive scenario with scant data and indications on the best management. However, a few data suggest a potential benefit of IABP in this setting. We present the design of a study aimed at addressing this research gap.
  
  METHODS AND DESIGN:
  The Altshock-2 trial is a prospective, randomized, multicenter, open-label study with blinded adjudicated evaluation of outcomes. Patients with ADHF-CS will be randomized to early IABP implantation or to vasoactive treatments. The primary end point will be 60 days patients' survival or successful bridge to heart replacement therapy. The key secondary end point will be 60-day overall survival; 60-day need for renal replacement therapy; in-hospital maximum inotropic score, maximum duration of inotropic/vasopressor therapy, and maximum sequential organ failure assessment score. Safety end points will be in-hospital occurrence of bleeding events (Bleeding Academic Research Consortium >3), vascular access complications and systemic (noncerebral) embolism. The sample size for the study is 200 patients.
  
  IMPLICATIONS:
  The Altshock-2 trial will provide evidence on whether IABP should be implanted early in ADHF-CS patients to improve their clinical outcomes.
  
  Copyright © 2020 Elsevier Inc. All rights reserved.
  
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• [ANMCO/SIC Consensus document on the management of myocarditis].
  G Ital Cardiol (Rome)

  2020 Dec;21(12):969-989. doi: 10.1714/3472.34551.
  
  Cipriani Manlio, Merlo Marco, Gabrielli Domenico, Ammirati Enrico, Autore Camillo, Basso Cristina, Caforio Alida, Caldarola Pasquale, Camici Paolo, Di Lenarda Andrea, Frustaci Andrea, Imazio Massimo, Oliva Fabrizio, Pedrotti Patrizia, Perazzolo Marra Martina, Rapezzi Claudio, Urbinati Stefano, Zecchin Massimo, Filardi Pasquale Perrone, Colivicchi Furio, Indolfi Ciro, Frigerio Maria, Sinagra Gianfranco
  
  Abstract
  
  Myocarditis is an inflammatory heart disease that can occur acutely, as in acute myocarditis, or persistently, as in chronic myocarditis or chronic inflammatory cardiomyopathy. Different agents can induce myocarditis, with viruses being the most common triggers. Generally, acute myocarditis affects relatively young people and men more than women. Myocarditis has a broad spectrum of clinical presentations and evolution trajectories, although most cases resolve spontaneously. Patients with reduced left ventricular ejection fraction, heart failure symptoms, advanced atrioventricular block, sustained ventricular arrhythmias or cardiogenic shock (the latter known as fulminant myocarditis) are at increased risk for death and heart transplantation. The presentation of chronic inflammatory cardiomyopathy may be more subtle, with progressive symptoms of heart failure or appearance of rhythm disturbance, not rarely preceded by an infective episode. Autoimmune disorder or systemic inflammatory conditions can be another significant predisposing substrate of myocarditis, especially in women. Emerging causes of myocarditis are drug-related like the new anticancer therapies, the immune checkpoint inhibitors. In this Italian Association of Hospital Cardiologists (ANMCO) and Italian Society of Cardiology (SIC) expert consensus document on myocarditis, we propose diagnostic strategies for identifying possible causes of the disease and factors associated with increased risk. Finally, we propose potential treatments and when referring patients to tertiary centers, especially for high-risk patients. Even if endomyocardial biopsy is the invasive diagnostic tool for making definitive diagnosis and differentiation of histological subtypes (i.e., lymphocytic vs eosinophilic vs giant cell myocarditis), it is not always readily available in all centers. Thus, we propose when this exam is mandatory or when it can be postponed or substituted by cardiac magnetic resonance imaging. This document reflects the Italian perspective on managing patients with myocarditis and their follow-up, considering also current US and European scientific position statements.
  
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• Arterial elastance modulation by intra-aortic balloon counterpulsation in patients with acute decompensated heart failure and low-output state.
  J Cardiovasc Med (Hagerstown)

  2021 Mar;22(3):231-232. doi: 10.2459/JCM.0000000000001088.
  
  Sacco Alice, Tavazzi Guido, Morici Nuccia, Viola Giovanna, Meani Paolo, Oliva Fabrizio G, Pappalardo Federico
  
  
  
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• Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use.
  Card Fail Rev

  2020 Mar;6():e19. doi: e19.
  
  Papp Zoltán, Agostoni Piergiuseppe, Alvarez Julian, Bettex Dominique, Bouchez Stefan, Brito Dulce, ?erný Vladimir, Comin-Colet Josep, Crespo-Leiro Marisa G, Delgado Juan F, Édes Istvan, Eremenko Alexander A, Farmakis Dimitrios, Fedele Francesco, Fonseca Cândida, Fruhwald Sonja, Girardis Massimo, Guarracino Fabio, Harjola Veli-Pekka, Heringlake Matthias, Herpain Antoine, Heunks Leo Ma, Husebye Tryggve, Ivancan Vi?nja, Karason Kristjan, Kaul Sundeep, Kivikko Matti, Kubica Janek, Masip Josep, Matskeplishvili Simon, Mebazaa Alexandre, Nieminen Markku S, Oliva Fabrizio, Papp Julius-Gyula, Parissis John, Parkhomenko Alexander, Põder Pentti, Pölzl Gerhard, Reinecke Alexander, Ricksten Sven-Erik, Riha Hynek, Rudiger Alain, Sarapohja Toni, Schwinger Robert Hg, Toller Wolfgang, Tritapepe Luigi, Tschöpe Carsten, Wikström Gerhard, von Lewinski Dirk, Vrtovec Bojan, Pollesello Piero
  
  Abstract
  
  Levosimendan was first approved for clinic use in 2000, when authorisation was granted by Swedish regulatory authorities for the haemodynamic stabilisation of patients with acutely decompensated chronic heart failure. In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitisation and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced heart failure, right ventricular failure and pulmonary hypertension, cardiac surgery, critical care and emergency medicine. Levosimendan is currently in active clinical evaluation in the US. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and non-cardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, UK and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute heart failure arena in recent times and charts a possible development trajectory for the next 20 years.
  
  Copyright © 2020, Radcliffe Cardiology.
  
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• Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome.
  Eur J Intern Med

  2020 Dec;82():62-67. doi: 10.1016/j.ejim.2020.07.013.
  
  Centola Marco, Maloberti Alessandro, Castini Diego, Persampieri Simone, Sabatelli Ludovico, Ferrante Giulia, Lucreziotti Stefano, Morici Nuccia, Sacco Alice, Oliva Fabrizio, Rebora Paola, Giannattasio Cristina, Mafrici Antonio, Carugo Stefano
  
  Abstract
  
  BACKGROUND:
  To assess the association between admission serum uric acid (SUA) levels and in-hospital outcomes in a real-world patients population with acute coronary syndrome (ACS) and to investigate the potential incremental prognostic value of SUA added to GRACE score (GRACE-SUA score).
  
  METHODS:
  The data of consecutive ACS patients admitted to Coronary Care Unit of San Paolo and Niguarda hospitals in Milan (Italy) were retrospectively analyzed.
  
  RESULTS:
  1088 patients (24% female) were enrolled. Mean age was 68 years (IQR 60-78). STEMI and NSTE-ACS patients were 504 (46%) and 584 (54%) respectively. SUA (OR 1.72 95%CI 1.33-2.22, p 
  CONCLUSIONS:
  High admission levels of SUA are independently associated with in-hospital adverse outcomes and mortality in a contemporary population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality in this study population.
  
  Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use.
  J Cardiovasc Pharmacol

  2020 Jul;76(1):4-22. doi: 10.1097/FJC.0000000000000859.
  
  Papp Zoltán, Agostoni Piergiuseppe, Alvarez Julian, Bettex Dominique, Bouchez Stefan, Brito Dulce, ?erný Vladimir, Comin-Colet Josep, Crespo-Leiro Marisa G, Delgado Juan F, Édes István, Eremenko Alexander A, Farmakis Dimitrios, Fedele Francesco, Fonseca Cândida, Fruhwald Sonja, Girardis Massimo, Guarracino Fabio, Harjola Veli-Pekka, Heringlake Matthias, Herpain Antoine, Heunks Leo M A, Husebye Tryggve, Ivancan Vi?nja, Karason Kristjan, Kaul Sundeep, Kivikko Matti, Kubica Janek, Masip Josep, Matskeplishvili Simon, Mebazaa Alexandre, Nieminen Markku S, Oliva Fabrizio, Papp Julius G, Parissis John, Parkhomenko Alexander, Põder Pentti, Pölzl Gerhard, Reinecke Alexander, Ricksten Sven-Erik, Riha Hynek, Rudiger Alain, Sarapohja Toni, Schwinger Robert H G, Toller Wolfgang, Tritapepe Luigi, Tschöpe Carsten, Wikström Gerhard, Lewinski Dirk von, Vrtovec Bojan, Pollesello Piero
  
  Abstract
  
  Levosimendan was first approved for clinical use in 2000, when authorization was granted by Swedish regulatory authorities for the hemodynamic stabilization of patients with acutely decompensated chronic heart failure (HF). In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitization and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced HF, right ventricular failure, pulmonary hypertension, cardiac surgery, critical care, and emergency medicine. Levosimendan is currently in active clinical evaluation in the United States. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and noncardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom, and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute HF arena in recent times and charts a possible development trajectory for the next 20 years.
  
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• Long-Term Risk of Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome: Prognostic Role of Complete Blood Cell Count.
  Angiology

  2020 Oct;71(9):831-839. doi: 10.1177/0003319720938619.
  
  Morici Nuccia, Molinari Valentina, Cantoni Silvia, Rubboli Andrea, Antolini Laura, Sacco Alice, Cattaneo Marco, Alicandro Gianfranco, Oreglia Jacopo A, Oliva Fabrizio, Giannattasio Cristina, Brunelli Dario, La Vecchia Carlo, Valgimigli Marco, Savonitto Stefano
  
  Abstract
  
  Individual parameters of complete blood count (CBC) have been associated with worse outcome in patients with acute coronary syndrome (ACS). However, the prognostic role of CBC taken as a whole has never been evaluated for long-term incidence of major adverse cardiovascular events (MACEs). Patients were grouped according to their hematopoietic cells' inflammatory response at different time points during hospital stay. Patients with admission white blood cell count >10 × 10/L, discharge hemoglobin 250 × 10/L were defined as "high-risk CBC." Among 1076 patients with ACS discharged alive, 129 (12%) had a "high-risk CBC" and 947 (88%) had a "low-risk CBC." Patients with "high-risk CBC" were older and had more comorbidities. Over a median follow-up of 665 days, they experienced a higher incidence of MACE compared to "low-risk CBC" patients (18.6% vs 8.1%). After adjustment for age, age-adjusted Charlson comorbidity index, female sex, cardiac arrest, suboptimal discharge therapy, coronary artery bypass, and ejection fraction, a high-risk CBC was significantly associated with increased MACE occurrence (adjusted hazard ratio 1.80; 95% CI: 1.09-3.00). The CBC was a prognostic marker in patients with ACS, and its evaluation at admission and discharge could better classify patient's risk and improve therapeutic management.
  
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• Risk scores did not reliably predict individual risk of mortality for patients with decompensated heart failure.
  J Clin Epidemiol

  2020 Sep;125():38-46. doi: 10.1016/j.jclinepi.2020.05.020.
  
  Scrutinio Domenico, Guida Pietro, Ammirati Enrico, Oliva Fabrizio, Passantino Andrea
  
  Abstract
  
  OBJECTIVE:
  We investigated the performance of four prognostic tools in predicting 180-day mortality for patients admitted for acute decompensated heart failure (ADHF) by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) over a range of risk thresholds, in addition to discrimination and calibration.
  
  STUDY DESIGN AND SETTING:
  We studied 1,458 patients. The risk assessment was performed using the Acute Decompensated Heart Failure National Registry (ADHERE) model and the Get With The Guidelines (GWTG), ADHF/NT-proBNP, and Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND) risk scores.
  
  RESULTS:
  C-statistics ranged from 0.727 for the ADHERE model to 0.767 for the ADHF/NT-proBNP score. The ADHF/NT-proBNP risk score, the ADHERE model, and the ASCEND risk score, but not the GWTG risk score, were also well calibrated. Sensitivity and PPV were modest at the >30% risk threshold and ranged from 55% for the ADHF/NT-proBNP risk score to 38.8% for the ADHERE model and from 46.7% for the ADHF/NT-proBNP risk score to 42.1% for the ASCEND risk score, respectively. There was a modest agreement between the risk scores in classifying the patients across risk strata or in classifying those who died as being at >30% risk of death.
  
  CONCLUSION:
  Although risk assessment tools work well for stratifying patients, their use in estimating the risk of mortality for individuals has limited clinical utility.
  
  Copyright © 2020 Elsevier Inc. All rights reserved.
  
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• Centralization of the ST elevation myocardial infarction care network in the Lombardy region during the COVID-19 outbreak.
  Int J Cardiol

  2020 Aug;312():24-26. doi: 10.1016/j.ijcard.2020.04.062.
  
  Ferlini Marco, Andreassi Aida, Carugo Stefano, Cuccia Claudio, Bianchini Beatrice, Castiglioni Battistina, D' Urbano Maurizio, Guagliumi Giulio, Lettieri Corrado, Lettino Maddalena, Marenzi Giancarlo, Metra Marco, Migliori Maurizio, Montorfano Matteo, Oliva Fabrizio, Savonitto Stefano, Seregni Romano, Visconti Luigi Oltrona
  
  
  
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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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• [Myocardial infarction with non-obstructive coronary arteries (MINOCA): diagnosis, pathogenesis, therapy and prognosis].
  G Ital Cardiol (Rome)

  2019 Sep;20(9):499-511. doi: 10.1714/3207.31839.
  
  Buono Andrea, Pedrotti Patrizia, Soriano Francesco, Veas Nicolas, Oliva Fabrizio, Oreglia Jacopo, Ammirati Enrico
  
  Abstract
  
  The term MINOCA (myocardial infarction with non-obstructive coronary arteries) defines acute myocardial infarction with angiographic evidence of no significant coronary artery stenosis. Heterogeneous diseases are labelled as MINOCA. Incidence and epidemiological aspects differ on the basis of etiological causes. MINOCA include plaque (causing
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• Getting to the heart of the matter in a multisystem disorder: Erdheim-Chester disease.
  Lancet

  2019 Aug;394(10198):e19. doi: 10.1016/S0140-6736(19)31787-8.
  
  Buono Andrea, Bassi Ilaria, Santolamazza Caterina, Moreo Antonella, Pedrotti Patrizia, Sacco Alice, Morici Nuccia, Giannattasio Cristina, Oliva Fabrizio, Ammirati Enrico
  
  
  
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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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• Treating Patients Following Hospitalisation for Acute Decompensated Heart Failure: An Insight into Reducing Early Rehospitalisations.
  Card Fail Rev

  2019 May;5(2):78-82. doi: 10.15420/cfr.2018.46.2.
  
  Iacovoni Attilio, D'Elia Emilia, Gori Mauro, Oliva Fabrizio, Lorini Ferdinando Luca, Senni Michele
  
  Abstract
  
  Heart failure (HF) is a pandemic syndrome characterised by raised morbidity and mortality. An acute HF event requiring hospitalisation is associated with a poor prognosis, in both the short and the long term. Moreover, early rehospitalisation after discharge negatively affects HF management and survival rates. Cardiovascular and non-cardiovascular conditions combine to increase rates of HF hospital readmission at 30 days. A tailored approach for HF pharmacotherapy while the patient is in hospital and immediately after discharge could be useful in reducing early adverse events that cause rehospitalisation and, consequently, prevent worsening HF and readmission during the vulnerable phase after discharge.
  
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• Use of PRECISE-DAPT Score and Admission Platelet Count to Predict Mortality Risk in Patients With Acute Coronary Syndrome.
  Angiology

  2019 Oct;70(9):867-877. doi: 10.1177/0003319719848547.
  
  Morici Nuccia, Tavecchia Giovanni A, Antolini Laura, Caporale Maria R, Cantoni Silvia, Bertuccio Paola, Sacco Alice, Meani Paolo, Viola Giovanna, Brunelli Dario, Oliva Fabrizio, Lombardi Federico, Segreto Antonio, Oreglia Jacopo A, La Vecchia Carlo, Cattaneo Marco, Valgimigli Marco, Savonitto Stefano
  
  Abstract
  
  The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been validated to predict bleeding complications in patients undergoing stent implantation and dual antiplatelet therapy. This score does not include the platelet count (PC), which has been shown to be an independent marker of mortality in patients with acute coronary syndrome (ACS). We assessed the role of the PRECISE-DAPT score calculated on admission for mortality risk prediction and evaluated whether the predictive accuracy of this score improved by adding the PC. In a retrospective cohort study of 1000 patients with ACS, after adjustment for relevant covariates, a PRECISE-DAPT score ?25 was independently associated with mortality (hazard ratio [HR]: 7.91; 95% confidence interval [CI]: 4.37-14.30). When this score was combined with PC, compared to patients with PRECISE-DAPT
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• [ANMCO/FADOI/SIAARTI/SIC/SIMG/SIMI/SIMEU consensus document: The clinical care pathway of acute heart failure patients from symptom onset to discharge from the emergency department].
  G Ital Cardiol (Rome)

  2019 May;20(5):289-334. doi: 10.1714/3151.31321.
  
  Mortara Andrea, Gabrielli Domenico, Pugliese Francesco Rocco, Corcione Antonio, Perticone Francesco, Fontanella Andrea, Mercuro Giuseppe, Cricelli Claudio, Iacoviello Massimo, D'Ambrosio Gaetano, Guarracino Fabio, Modesti Pietro Amedeo, Vescovo Giorgio, De Maria Renata, Iacovoni Attilio, Macera Francesca, Palmieri Vittorio, Pasqualucci Daniele, Battistoni Ilaria, Alunni Gianfranco, Aspromonte Nadia, Caldarola Pasquale, Campanini Mauro, Caporale Roberto, Casolo Giancarlo, Cipriani Manlio, Di Tano Giuseppe, Domenicucci Stefano, Murrone Adriano, Nardi Federico, Navazio Alessandro, Oliva Fabrizio, Parretti Damiano, Urbinati Stefano, Valente Serafina, Valeriano Valentina, Zuin Guerrino, Metra Marco, Sinagra Gianfranco, Gulizia Michele Massimo, Di Lenarda Andrea
  
  Abstract
  
  Acute heart failure (AHF) represents a relevant burden for emergency departments worldwide. AHF patients have markedly worse long-term outcomes than patients with other acute cardiac diseases (e.g. acute coronary syndromes); mortality or readmissions rates at 3 months approximate 33%, whereas 1-year mortality from index discharge ranges from 25% to 50%.The multiplicity of healthcare professionals acting across the care pathway of AHF patients represents a critical factor, which generates the need for integrating the different expertise and competence of general practitioners, emergency physicians, cardiologists, internists, and intensive care physicians to focus on care goals able to improve clinical outcomes.This consensus document results from the cooperation of the scientific societies representing the different healthcare professionals involved in the care of AHF patients and describes shared strategies and pathways aimed at ensuring both high quality care and better outcomes. The document describes the patient journey from symptom onset to the clinical suspicion of AHF and home management or referral to emergency care and transportation to the hospital, through the clinical diagnostic pathway in the emergency department, acute treatment, risk stratification and discharge from the emergency department to ordinary wards or home. The document analyzes the potential role of a cardiology fast-track and Observation Units and the transition to outpatient care by general practitioners and specialist heart failure clinics.The increasing care burden and complex problems generated by AHF are unlikely to be solved without an integrated multidisciplinary approach. Efficient networking among emergency departments, intensive care units, ordinary wards and primary care settings is crucial to achieve better outcomes. Thanks to the joint effort of qualified scientific societies, this document aims to achieve this goal through an integrated, shared and applicable pathway that will contribute to a homogeneous care management of AHF patients across the country.
  
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• Acute myocardial infarction complicating ischemic stroke: is there room for cangrelor?
  Platelets

  2020 ;31(1):120-123. doi: 10.1080/09537104.2019.1609663.
  
  Morici Nuccia, Nava Stefano, Sacco Alice, Viola Giovanna, Oreglia Jacopo, Meani Paolo, Oliva Fabrizio, Ranucci Marco, Leonardi Sergio, Rossini Roberta
  
  Abstract
  
  Acute myocardial infarction (AMI) complicating ischemic stroke is a well known and undertreated event. A conservative management is not infrequent in these settings, due to the fear of hemorrhagic complications related to antithrombotic therapy. Notably, an invasive approach with a primary percutaneous coronary intervention (PCI) has been shown to be associated with a lower in-hospital mortality in patients with concomitant ischemic stroke and AMI. The optimal antiplatelet regimen in these cases has been not clearly defined, yet. We report two cases of patients with AMI complicating ischemic stroke, successfully treated with cangrelor infusion, which was started during PCI and maintained up to 48 h at bridge therapy dosage (0.75 mcg/kg/min). Both patients underwent successful PCI in the acute phase, and neither ischemic nor hemorrhagic complications occurred during in-hospital stay.
  
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• Letter to the editor regarding the results of the retrospective study "Predictors of intra-aortic balloon pump hemodynamic failure in non-acute myocardial infarction cardiogenic shock" published in the American Heart Journal.
  Am Heart J

  2019 Jul;213():123. doi: 10.1016/j.ahj.2019.03.002.
  
  Sacco Alice, Morici Nuccia, Oliva Fabrizio
  
  
  
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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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• Recombinant LCAT (Lecithin:Cholesterol Acyltransferase) Rescues Defective HDL (High-Density Lipoprotein)-Mediated Endothelial Protection in Acute Coronary Syndrome.
  Arterioscler Thromb Vasc Biol

  2019 May;39(5):915-924. doi: 10.1161/ATVBAHA.118.311987.
  
  Ossoli Alice, Simonelli Sara, Varrenti Marisa, Morici Nuccia, Oliva Fabrizio, Stucchi Miriam, Gomaraschi Monica, Strazzella Arianna, Arnaboldi Lorenzo, Thomas Michael J, Sorci-Thomas Mary G, Corsini Alberto, Veglia Fabrizio, Franceschini Guido, Karathanasis Sotirios K, Calabresi Laura
  
  Abstract
  
  Objective- Aim of this study was to evaluate changes in LCAT (lecithin:cholesterol acyltransferase) concentration and activity in patients with an acute coronary syndrome, to investigate if these changes are related to the compromised capacity of HDL (high-density lipoprotein) to promote endothelial nitric oxide (NO) production, and to assess if rhLCAT (recombinant human LCAT) can rescue the defective vasoprotective HDL function. Approach and Results- Thirty ST-segment-elevation myocardial infarction (STEMI) patients were enrolled, and plasma was collected at hospital admission, 48 and 72 hours thereafter, at hospital discharge, and at 30-day follow-up. Plasma LCAT concentration and activity were measured and related to the capacity of HDL to promote NO production in cultured endothelial cells. In vitro studies were performed in which STEMI patients' plasma was added with rhLCAT and HDL vasoprotective activity assessed by measuring NO production in endothelial cells. The plasma concentration of the LCAT enzyme significantly decreases during STEMI with a parallel significant reduction in LCAT activity. HDL isolated from STEMI patients progressively lose the capacity to promote NO production by endothelial cells, and the reduction is related to decreased LCAT concentration. In vitro incubation of STEMI patients' plasma with rhLCAT restores HDL ability to promote endothelial NO production, possibly related to significant modification in HDL phospholipid classes. Conclusions- Impairment of cholesterol esterification may be a major factor in the HDL dysfunction observed during acute coronary syndrome. rhLCAT is able to restore HDL-mediated NO production in vitro, suggesting LCAT as potential therapeutic target for restoring HDL functionality in acute coronary syndrome.
  
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• Response by Ammirati et al to Letter Regarding Article, "Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis".
  Circulation

  2019 Mar;139(10):1346-1347. doi: 10.1161/CIRCULATIONAHA.118.039063.
  
  Ammirati Enrico, Cipriani Manlio, Frigerio Maria, Oliva Fabrizio, Camici Paolo G
  
  
  
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• Long-term survival and major outcomes in post-cardiotomy extracorporeal membrane oxygenation for adult patients in cardiogenic shock.
  Ann Cardiothorac Surg

  2019 Jan;8(1):116-122. doi: 10.21037/acs.2018.12.04.
  
  Meani Paolo, Matteucci Matteo, Jiritano Federica, Fina Dario, Panzeri Francesco, Raffa Giuseppe M, Kowalewski Mariusz, Morici Nuccia, Viola Giovanna, Sacco Alice, Oliva Fabrizio, Alyousif Amal, Heuts Sam, Gilbers Martijn, Schreurs Rick, Maessen Jos, Lorusso Roberto
  
  Abstract
  
  Extracorporeal membrane oxygenation (ECMO) in the veno-arterial (VA) configuration is an established method for the treatment of refractory cardiogenic shock. Such a condition characterizes the postoperative course of approximatively 1% of cardiac surgery patients. Although some studies have reported ECMO-related short-term results, little is known about the long-term outcomes of VA-ECMO therapy in the post-cardiotomy setting. Therefore, an extensive literature search was conducted regarding articles published after 1990 reporting postoperative ECMO use. PubMed, EMBASE and Web of Science were searched for sources. In-hospital mortality was high in post-cardiotomy VA-ECMO patients, ranging from 24.8% to 52%. Long-term results were poorly reported. However, based on the limited information available, hospital survivors showed a favorable outcome, with improvement in overall clinical condition, quality of life and limited hospital readmission for cardiac-related events. To conclude, in-hospital outcome in post-cardiotomy ECMO is often unfavorable, post-discharge results show satisfactory condition, with stable improvement of overall patient clinical status and low rate of hospital readmission and cardiac-related adverse events. Data reporting is, however, scarce and hence new and detailed studies are still warranted to investigate such aspects.
  
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• Repetitive levosimendan treatment in the management of advanced heart failure.
  Eur Heart J Suppl

  2018 Dec;20(Suppl I):I11-I20. doi: 10.1093/eurheartj/suy040.
  
  Oliva Fabrizio, Comin-Colet Josep, Fedele Francesco, Fruhwald Friedrich, Gustafsson Finn, Kivikko Matti, Borbély Attila, Pölzl Gerhard, Tschöpe Carsten
  
  Abstract
  
  Inotropes may be an appropriate treatment for patients with advanced heart failure (AdHF) who remain highly symptomatic despite optimized standard therapies. Objectives for inotrope use in these situations include relief of symptoms and improvement of quality of life, and reduction in unplanned hospitalizations and the costs associated with such episodes. All of these goals must be attained without compromising survival. Encouraging findings with intermittent cycles of intravenous levosimendan have emerged from a range of exploratory studies and from three larger controlled trials (LevoRep, LION-HEART, and LAICA) which offered some evidence of clinical advantage. In these settings, however, obtaining statistically robust data may prove elusive due to the difficulties of endpoint assessment in a complex medical condition with varying presentation and trajectory. Adoption of a composite clinical endpoint evaluated in a hierarchical manner may offer a workable solution to this problem. Such an instrument can explore the proposition that repetitive administration of levosimendan early in the period after discharge from an acute episode of worsening heart failure may be associated with greater subsequent clinical stability vis-à-vis standard therapy. The use of this methodology to develop a 'stability score' for each patient means that all participants in such a trial contribute to the overall outcome analysis through one or more of the hierarchical endpoints; this has helpful practical implications for the number of patients needed and the length of follow-up required to generate endpoint data. The LeoDOR study (NCT03437226), outlined in this review, has been designed to explore this new approach to outcome assessment in AdHF.
  
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• Acutely decompensated heart failure with chronic obstructive pulmonary disease: Clinical characteristics and long-term survival.
  Eur J Intern Med

  2019 Feb;60():31-38. doi: 10.1016/j.ejim.2018.11.002.
  
  Scrutinio Domenico, Guida Pietro, Passantino Andrea, Ammirati Enrico, Oliva Fabrizio, Lagioia Rocco, Raimondo Rosa, Venezia Mario, Frigerio Maria
  
  Abstract
  
  BACKGROUND:
  Chronic obstructive pulmonary disease (COPD) is among the most common comorbidities in patients hospitalized with heart failure and is generally associated with poor outcomes. However, the results of previous studies with regard to increased mortality and risk trajectories were not univocal. We sought to assess the prognostic impact of COPD in patients admitted for acutely decompensated heart failure (ADHF) and investigate the association between use of ?-blockers at discharge and mortality in patients with COPD.
  
  METHODS:
  We studied 1530 patients. The association of COPD with mortality was examined in adjusted Fine-Gray proportional hazard models where heart transplantation and ventricular assist device implantation were treated as competing risks. The primary outcome was 5-year all-cause mortality.
  
  RESULTS:
  After adjusting for establisked risk markers, the subdistribution hazard ratios (SHR) of 5-year mortality for COPD patients compared with non-COPD patients was 1.25 (95% confidence intervals [CIs] 1.06-1.47; p?=?.007). The relative risk of death for COPD patients increased steeply from 30 to 180?days, and remained noticeably high throughout the entire follow-up. Among patients with comorbid COPD, the use of ?-blockers at discharge was associated with a significantly reduced risk of 1-year post-discharge mortality (SHR 0.66, 95%CIs 0.53-0.83; p??.001).
  
  CONCLUSIONS:
  Our data indicate that ADHF patients with comorbid COPD have a worse long-term survival than those without comorbid COPD. Most of the excess mortality occurred in the first few months following hospitalization. Our data also suggest that the use of ?-blockers at discharge is independently associated with improved survival in ADHF patients with COPD.
  
  Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• Mycotic coronary aneurysms.
  J Cardiovasc Med (Hagerstown)

  2019 Jan;20(1):10-15. doi: 10.2459/JCM.0000000000000734.
  
  Buono Andrea, Maloberti Alessandro, Bossi Irene M, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo A, Moreo Antonella, Russo Claudio F, Oliva Fabrizio, Giannattasio Cristina
  
  Abstract
  
  : Mycotic coronary aneurysm is a rare infective disease of arterial vessel walls. Their development could be linked to the presence of an infective endocarditis or could represent a primary infection at the site of an implanted intracoronary stent. Bacterial agents, particularly Staphylococcus aureus, are the most common etiological agents. Due to an aspecific clinical presentation and examination, diagnosis could be challenging. Multiple imaging techniques (both invasive and noninvasive) are often required to reach the final diagnosis. Prognosis is characterized by high morbidity and mortality rates and, in fact, a tempestive treatment is required, although, to date, scanty data concerning the optimal treatment choice are present in literature.
  
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• [ANMCO position paper on sacubitril/valsartan in the management of patients with heart failure].
  G Ital Cardiol (Rome)

  2018 Oct;19(10):568-590. doi: 10.1714/2978.29843.
  
  Di Tano Giuseppe, Di Lenarda Andrea, Gabrielli Domenico, Aspromonte Nadia, De Maria Renata, Frigerio Maria, Iacoviello Massimo, Mortara Andrea, Murrone Adriano, Nardi Federico, Oliva Fabrizio, Pontremoli Roberto, Scherillo Marino, Senni Michele, Urbinati Stefano, Gulizia Michele Massimo
  
  Abstract
  
  Sacubitril/valsartan, the first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is the first medication to demonstrate a mortality benefit in patients with chronic heart failure and reduced ejection fraction (HFrEF) since the early 2000s. Sacubitril/valsartan simultaneously suppresses renin-angiotensin-aldosterone system activation through blockade of angiotensin II type 1 receptors and enhances the activity of vasoactive peptides including natriuretic peptides, through inhibition of neprilysin, the enzyme responsible for their degradation. In the landmark PARADIGM-HF trial, patients with HFrEF treated with sacubitril/valsartan had a 20% reduction in the primary composite endpoint of cardiovascular death or heart failure hospitalization, a 20% lower risk of cardiovascular death, a 21% to 20% lower risk of a first heart failure hospitalization, and a 16% to 20% lower risk of death from any cause, compared with subjects allocated to enalapril (all p
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• Antithrombotic therapy in ventricular assist device (VAD) management: From ancient beliefs to updated evidence. A narrative review.
  Int J Cardiol Heart Vasc

  2018 Sep;20():20-26. doi: 10.1016/j.ijcha.2018.06.005.
  
  Morici Nuccia, Varrenti Marisa, Brunelli Dario, Perna Enrico, Cipriani Manlio, Ammirati Enrico, Frigerio Maria, Cattaneo Marco, Oliva Fabrizio
  
  Abstract
  
  Platelets play a key role in the pathogenesis of ventricular assist device (VAD) thrombosis; therefore, antiplatelet drugs are essential, both in the acute phase and in the long-term follow-up in VAD management. Aspirin is the most used agent and still remains the first-choice drug for lifelong administration after VAD implantation. Anticoagulant drugs are usually recommended, but with a wide range of efficacy targets. Dual antiplatelet therapy, targeting more than one pathway of platelet activation, has been used for patients developing a thrombotic event, despite an increased risk of bleeding complications. Although different strategies have been attempted, bleeding and thrombotic events remain frequent and there are no uniform strategies adopted for pharmacological management in the short and mid- or long-term follow up. The aim of this article is to provide an overview of the evidence from randomized clinical trials and observational studies with a focus on the pathophysiologic mechanisms underlying bleeding and thrombosis in VAD patients and the best antithrombotic regimens available.
  
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• Scheduled intermittent inotropes for Ambulatory Advanced Heart Failure. The RELEVANT-HF multicentre collaboration.
  Int J Cardiol

  2018 Dec;272():255-259. doi: 10.1016/j.ijcard.2018.08.048.
  
  Oliva Fabrizio, Perna Enrico, Marini Marco, Nassiacos Daniele, Cirò Antonio, Malfatto Gabriella, Morandi Fabrizio, Caico Ivan, Perna Gianpiero, Meloni Sabina, Vincenzi Antonella, Villani Alessandra, Vecchi Andrea Lorenzo, Minoia Chiara, Verde Alessandro, De Maria Renata,
  
  Abstract
  
  BACKGROUND:
  Ambulatory Advanced Heart Failure (AAHF) is characterized by recurrent HF hospitalizations, escalating diuretic requirements, intolerance to neurohormonal antagonists, end-organ dysfunction, short-term reduced life expectancy despite optimal medical management (OMM). The role of intermittent inotropes in AAHF is unclear. The RELEVANT-HF registry was designed to obtain insight on the effectiveness and safety of compassionate scheduled repetitive 24-hour levosimendan infusions (LEVO) in AAHF patients.
  
  METHODS:
  185 AAHF NYHA class III-IV patients, with ?2 HF hospitalizations/emergency visits in the previous 6?months and systolic dysfunction, were treated with LEVO at tailored doses (0.05-0.2??g/kg/min) without prior bolus every 3-4?weeks. We compared data on HF hospitalizations (percent days spent in hospital, DIH) in the 6?months before and after treatment start.
  
  RESULTS:
  Infusion-related adverse events occurred in 23 (12.4%) patients the commonest being ventricular arrhythmias (16, 8.6%). During follow-up, 37 patients (20%) required for clinical instability treatment adjustments (decreases in infusion dose, rate of infusion or interval). From the 6?months before to the 6?months after treatment start we found lower DIH (9.4 (8.2) % vs 2.8 (6.6) %, p?0.0001), cumulative number (1.3 (0.6) vs 1.8 (0.8), p?=?0.0001) and length of HF admissions (17.4 (15.6) vs 21.6 (13.4) days, p?=?0.0001). One-year survival was 86% overall and 78% free from death/LVAD/urgent transplant.
  
  CONCLUSIONS:
  In AAHF patients, who remain symptomatic despite OMM, LEVO is well tolerated and associated with lower overall length of hospital stay during six months. This multicentre clinical experience underscores the need for a randomized controlled trial of LEVO impact on outcomes in AAHF patients.
  
  Copyright © 2018 Elsevier B.V. All rights reserved.
  
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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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• Protracted aortic valve closure during peripheral veno-arterial extracorporeal life support: is intra-aortic balloon pump an effective solution?
  Perfusion

  2019 Jan;34(1):35-41. doi: 10.1177/0267659118787426.
  
  Meani Paolo, Delnoij Thijs, Raffa Giuseppe M, Morici Nuccia, Viola Giovanna, Sacco Alice, Oliva Fabrizio, Heuts Sam, Sels Jan-Willem, Driessen Rob, Roekaerts Paul, Gilbers Martijn, Bidar Elham, Schreurs Rick, Natour Ehsan, Veenstra Leo, Kats Suzanne, Maessen Jos, Lorusso Roberto
  
  Abstract
  
  BACKGROUND:
  Left ventricular (LV) afterload increase with protracted aortic valve (AV) closure may represent a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The aim of the present study was to assess the effects of an intra-aortic balloon pump (IABP) to overcome such a hemodynamic shortcoming in patients submitted to peripheral V-A ECMO.
  
  METHODS:
  Among 184 adult patients who were treated with peripheral V-A ECMO support at Medical University Center Maastricht Hospital between 2007 and 2018, patients submitted to IABP implant for protracted AV closure after V-A ECMO implant were retrospectively identified. All clinical and hemodynamic data, including echocardiographic monitoring, were collected and analyzed.
  
  RESULTS:
  During the study period, 10 subjects (mean age 60 years old, 80% males) underwent IABP implant after peripheral V-A ECMO positioning due to the diagnosis of protracted AV closure and inefficient LV unloading as assessed by echocardiography and an absence of pulsation in the arterial pressure wave. Recovery of blood pressure pulsatility and enhanced LV unloading were observed in 8 patients after IABP placement, with no significant differences in the main hemodynamic parameters, inotropic therapy or in the ECMO flow (p=0.48). The weaning rate in this patient subgroup (mean ECMO duration 8 days), however, was only 10%, with another patient finally transplanted, leading to a 20% survival-to-hospital discharge.
  
  CONCLUSION:
  IABP placement was an effective solution in order to reverse the protracted AV closure and impaired LV unloading observed during peripheral V-A ECMO support. However, the impact on the weaning rate and survival needs further investigations.
  
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• Differences in biochemical markers between Heart-transplanted and Left Ventricular Assist Device implanted patients, during cardiac rehabilitation.
  Sci Rep

  2018 Jul;8(1):10816. doi: 10816.
  
  Racca Vittorio, Castiglioni Paolo, Panzarino Claudia, Saresella Marina, Marventano Ivana, Verde Alessandro, Oliva Fabrizio, Ferratini Maurizio
  
  Abstract
  
  Heart transplant (HTx) and left ventricular assist device (LVAD) implant are the best options for symptomatic end stage heart failure, but LVAD patients show lower rehabilitative outcome than HTx patients. To investigate the causes, we compared biomarkers levels and their association with rehabilitative outcome in 51 HTx and in 46 LVAD patients entering the same cardiac rehabilitation program. In both groups, routine biomarkers were measured at start (T1) and end (T2) of cardiac rehabilitation while homocysteine, leptine and IGF-1 were measured at T1 only. HTx patients had lower lymphocyte, platelets, glucose, total proteins and albumin at T1; differences with LVAD patients vanished during rehabilitation when new cases of diabetes were observed in HTx. By contrast, total cholesterol, LDL and HDL fractions, leptin and IGF-1 were higher in HTx patients. The increase from T1 to T2 in six-minute walking test distance, measure of functional rehabilitation outcome, was positively associated with homocysteine and IGF-1 levels in HTx patients. In conclusion, during rehabilitation care should be paid to the early occurrence of dyslipidemia and hyperglycemia in HTx patients, which also require a proper protein dietary support. IGF-1, dangerously low in LVAD patients, might contribute to their lower rehabilitative outcome.
  
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• Application of competing risks analysis improved prognostic assessment of patients with decompensated chronic heart failure and reduced left ventricular ejection fraction.
  J Clin Epidemiol

  2018 Nov;103():31-39. doi: 10.1016/j.jclinepi.2018.07.006.
  
  Scrutinio Domenico, Guida Pietro, Passantino Andrea, Ammirati Enrico, Oliva Fabrizio, Lagioia Rocco, Frigerio Maria
  
  Abstract
  
  OBJECTIVE:
  The Kaplan-Meier method may overestimate absolute mortality risk (AMR) in the presence of competing risks. Urgent heart transplantation (UHT) and ventricular assist device implantation (VADi) are important competing events in heart failure. We sought to quantify the extent of bias of the Kaplan-Meier method in estimating AMR in the presence of competing events and to analyze the effect of covariates on the hazard for death and competing events in the clinical model of decompensated chronic heart failure with reduced ejection fraction (DCHFrEF).
  
  STUDY DESIGN AND SETTING:
  We studied 683 patients. We used the cumulative incidence function (CIF) to estimate the AMR at 1 year. CIF estimate was compared with the Kaplan-Meier estimate. The Fine-Gray subdistribution hazard analysis was used to assess the effect of covariates on the hazard for death and UHT/VADi.
  
  RESULTS:
  The Kaplan-Meier estimate of the AMR was 0.272, whereas the CIF estimate was 0.246. The difference was more pronounced in the patient subgroup with advanced DCHF (0.424 vs. 0.338). The Fine-Gray subdistribution hazard analysis revealed that established risk markers have qualitatively different effects on the incidence of death or UHT/VADi.
  
  CONCLUSION:
  Competing risks analysis allows more accurately estimating AMR and better understanding the association between covariates and major outcomes in DCHFrEF.
  
  Copyright © 2018 Elsevier Inc. All rights reserved.
  
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• [Paclitaxel-coated balloons for in-stent restenosis treatment: long-term clinical results and predictors of recurrent target lesion revascularization].
  G Ital Cardiol (Rome)

  2018 Apr;19(4):232-238. doi: 10.1714/2898.29217.
  
  Bossi Irene, D'Anna Margherita, Vaccaro Valentina, Caria Maria Paola, Colombo Paola, De Marco Federico, Oreglia Jacopo, Piccalò Giacomo, Piccaluga Emanuela, Soriano Francesco, Oliva Fabrizio, Klugmann Silvio
  
  Abstract
  
  BACKGROUND:
  The aim of this study was to report clinical outcomes in patients treated with paclitaxel-coated balloons (PCB) for in-stent restenosis (ISR) in both bare metal (BMS) and drug-eluting stent (DES).
  
  METHODS:
  Between May 2009 and December 2015, we treated 155 ISR in 140 patients. At recruitment, 35% of patients had diabetes. Among the lesions, 125 were first occurrence (55 within BMS and 70 within DES) and 30 recurrent; 24 ISR were multi-metal layered. Mean reference diameter was 2.79 ± 0.52 mm and mean lesion length 13.2 ± 7.1 mm. PCB use included 32 Dior I, 97 InPact Falcon, 18 Panthera Lux, and 8 Restore DEB.
  
  RESULTS:
  At a median follow-up of 442 days, we observed 18 target lesion revascularizations (TLR), one myocardial infarction, 3 cardiac deaths, and 5 non-cardiac deaths. TLR occurrence differed according to type of ISR (4% within BMS, 14% within DES, 28% within recurrent ISR; p
  CONCLUSIONS:
  Our results confirm the safety and efficacy of PCB for ISR treatment both within BMS and DES. PCB type and recurrent ISR correlate with subsequent TLR.
  
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• 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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• Reduction of heart rate in patients with heart failure aiming to improve ventricular-arterial coupling.
  Int J Cardiol

  2018 Aug;265():172. doi: 10.1016/j.ijcard.2018.04.106.
  
  Buono Andrea, Oliva Fabrizio, Ammirati Enrico
  
  
  
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• Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry.
  Circulation

  2018 Sep;138(11):1088-1099. doi: 10.1161/CIRCULATIONAHA.118.035319.
  
  Ammirati Enrico, Cipriani Manlio, Moro Claudio, Raineri Claudia, Pini Daniela, Sormani Paola, Mantovani Riccardo, Varrenti Marisa, Pedrotti Patrizia, Conca Cristina, Mafrici Antonio, Grosu Aurelia, Briguglia Daniele, Guglielmetto Silvia, Perego Giovanni B, Colombo Stefania, Caico Salvatore I, Giannattasio Cristina, Maestroni Alberto, Carubelli Valentina, Metra Marco, Lombardi Carlo, Campodonico Jeness, Agostoni Piergiuseppe, Peretto Giovanni, Scelsi Laura, Turco Annalisa, Di Tano Giuseppe, Campana Carlo, Belloni Armando, Morandi Fabrizio, Mortara Andrea, Cirò Antonio, Senni Michele, Gavazzi Antonello, Frigerio Maria, Oliva Fabrizio, Camici Paolo G,
  
  Abstract
  
  BACKGROUND:
  There is controversy about the outcome of patients with acute myocarditis (AM), and data are lacking on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management, and long-term outcome of patients with AM based on a retrospective multicenter registry from 19 Italian hospitals.
  
  METHODS:
  A total of 684 patients with suspected AM and recent onset of symptoms (70 years of age and those >50 years of age without coronary angiography were excluded. The final study population comprised 443 patients (median age, 34 years; 19.4% female) with AM diagnosed by either endomyocardial biopsy or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance.
  
  RESULTS:
  At presentation, 118 patients (26.6%) had left ventricular ejection fraction
  CONCLUSIONS:
  In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with left ventricular ejection fraction
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• Real-world application of currently available decision models for dual antiplatelet therapy duration in acute coronary syndrome.
  J Cardiovasc Med (Hagerstown)

  2018 Jun;19(6):310-313. doi: 10.2459/JCM.0000000000000655.
  
  Morici Nuccia, Piccinelli Enrico, Brunelli Dario, Sacco Alice, Viola Giovanna, Oreglia Jacopo A, Oliva Fabrizio, Valgimigli Marco
  
  
  
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• Mineralocorticoid receptor antagonists for heart failure: a real-life observational study.
  ESC Heart Fail

  2018 Jun;5(3):267-274. doi: 10.1002/ehf2.12244.
  
  Bruno Noemi, Sinagra Gianfranco, Paolillo Stefania, Bonomi Alice, Corrà Ugo, Piepoli Massimo, Veglia Fabrizio, Salvioni Elisabetta, Lagioia Rocco, Metra Marco, Limongelli Giuseppe, Cattadori Gaia, Scardovi Angela B, Carubelli Valentina, Scrutino Domenico, Badagliacca Roberto, Guazzi Marco, Raimondo Rosa, Gentile Piero, Magrì Damiano, Correale Michele, Parati Gianfranco, Re Federica, Cicoira Mariantonietta, Frigerio Maria, Bussotti Maurizio, Vignati Carlo, Oliva Fabrizio, Mezzani Alessandro, Vergaro Giuseppe, Di Lenarda Andrea, Passino Claudio, Sciomer Susanna, Pacileo Giuseppe, Ricci Roberto, Contini Mauro, Apostolo Anna, Palermo Pietro, Mapelli Massimo, Carriere Cosimo, Clemenza Francesco, Binno Simone, Belardinelli Romualdo, Lombardi Carlo, Perrone Filardi Pasquale, Emdin Michele, Agostoni Piergiuseppe
  
  Abstract
  
  AIMS:
  Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population-based analysis, the long-term effects of MRA treatment in HFrEF patients.
  
  METHODS AND RESULTS:
  We analysed data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset. Analysis was performed in patients treated (n = 3163) and not treated (n = 2883) with MRA. The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Ten years' survival was analysed through Kaplan-Meier, compared by log-rank test and propensity score matching. At 10 years' follow-up, the MRA-untreated group had a significantly lower number of events than the MRA-treated group (P 
  CONCLUSIONS:
  In conclusion, MRA treatment does not affect the composite of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation in a real-life setting. A meticulous patient follow-up, as performed in trials, is likely needed to match the positive MRA-related benefits observed in clinical trials.
  
  © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
  
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• Female gender and mortality risk in decompensated heart failure.
  Eur J Intern Med

  2018 May;51():34-40. doi: 10.1016/j.ejim.2018.01.011.
  
  Scrutinio Domenico, Guida Pietro, Passantino Andrea, Lagioia Rocco, Raimondo Rosa, Venezia Mario, Ammirati Enrico, Oliva Fabrizio, Stucchi Miriam, Frigerio Maria
  
  Abstract
  
  BACKGROUND:
  Still there is conflicting evidence about gender-related differences in prognosis among patients with heart failure. This prognostic uncertainty may have implications for risk stratification and planning management strategy. The aim of the present study was to explore the association between gender and one-year mortality in patients admitted with acute decompensated heart failure (ADHF).
  
  METHODS:
  We studied 1513 patients. The Cumulative Incidence Function (CIF) method was used to estimate the absolute rate of mortality, heart transplantation (HT)/ventricular assist device (VAD) implantation, and survival free of HT/VAD implantation at 1year. An interaction analysis was performed to assess the association between covariates, gender, and mortality risk. Propensity score matching and Cox regression were used to compare mortality rates in the gender subgroups.
  
  RESULTS:
  The CIF estimates of 1-year mortality, HT/VAD implantation, and survival free of HT/VAD implantation at 1year were 33.1%, 7.0%, and 59.9% for women and 30.2%, 10.2%, and 59.6% for men, respectively. Except for diabetes, there was no significant interaction between gender, covariates, and mortality risk. In the matched cohort, the hazard ratio of death for women was 1.19 (95% confidence intervals [CIs]: 0.90-1.59; p=.202). After adjusting for age and baseline risk, the hazard ratio of death for women was 1.18 (95% CIs: 0.95-1.43; p=.127). The use of gender-specific predictive models did not allow improving the accuracy of risk prediction.
  
  CONCLUSIONS:
  Our data strongly suggest that women and men have comparable outcome in the year following a hospitalization for ADHF.
  
  Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• The inodilator levosimendan in repetitive doses in the treatment of advanced heart failure.
  Eur Heart J Suppl

  2017 Mar;19(Suppl C):C8-C14. doi: 10.1093/eurheartj/sux004.
  
  Delgado Juan F, Oliva Fabrizio, Reinecke Alexander
  
  Abstract
  
  Inotropes may be an appropriate response for some patients with advanced heart failure who remain highly symptomatic despite optimization of evidence-based therapy. These patients need to be supported waiting for a heart transplant or ventricular assist device, or may be candidates for inotropy as an intervention in its own right to maintain a patient in the best achievable circumstances. Objectives in such a situation include relieving symptoms, improving quality of life and reducing unplanned hospitalizations and the costs associated with such admissions. Levosimendan, a calcium sensitizer and potassium channel opener with inotrope and vasodilator actions, has emerged as a potentially valuable addition to the armamentarium in this context, used in repeated or intermittent cycles of therapy. Detailed proposals and guidance are offered for the identification of candidate patients with good prospects of a beneficial response to levosimendan, and for the safe and effective implementation of a course of therapy.
  
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• Heart rate as a prognostic marker and therapeutic target in acute and chronic heart failure.
  Int J Cardiol

  2018 Feb;253():97-104. doi: 10.1016/j.ijcard.2017.09.191.
  
  Oliva Fabrizio, Sormani Paola, Contri Rachele, Campana Carlo, Carubelli Valentina, Cirò Antonio, Morandi Fabrizio, Di Tano Giuseppe, Mortara Andrea, Senni Michele, Metra Marco, Ammirati Enrico
  
  Abstract
  
  Since increased heart rate (HR) is associated with higher mortality in several cardiac disorders, HR is considered not only a physiological indicator but also a prognostic and biological marker. In heart failure (HF), it represents a therapeutic target in chronic phase. The use or up-titration of beta-blockers, a milestone in HF with reduced left ventricular ejection fraction (LVEF) treatment, is at times limited by patients' hemodynamic profile or intolerance. Ivabradine, a HR-lowering drug inhibiting the f-current in pacemaker cells, has been shown to improve outcome in patients with chronic HF, in sinus rhythm with increased HR beyond beta-blocker therapy. The rationale for this review is to update the role of HR as a prognostic biomarker and a potential therapeutic target in other scenarios than chronic HF; namely, in patients with coexisting atrial fibrillation (AF), in HF with preserved LVEF (HFpEF), in acute HF, and in patients discharged after an episode of acute HF. Preliminary studies and case reports that evaluated the use of ivabradine in the setting of acute HF will be summarized. Recent results of HR reduction in the setting of HFpEF with ivabradine will be presented. Finally, data from large registries and trials that evaluated the prognostic impact of HR in patients with acute HF and sinus rhythm or AF will be reviewed, showing that only patients in sinus rhythm may benefit from HR reduction.
  
  Copyright © 2017. Published by Elsevier B.V.
  
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• End-stage heart failure: Two surgical approaches with different rehabilitative outcomes.
  PLoS One

  2017 ;12(10):e0185717. doi: e0185717.
  
  Racca Vittorio, Castiglioni Paolo, Panzarino Claudia, Oliva Fabrizio, Perna Enrico, Ferratini Maurizio
  
  Abstract
  
  BACKGROUND:
  A rising number of patients are surgically treated for heart failure at the more advanced stage, thanks to the increasing use of left ventricular assist device (LVAD) as a reliable alternative to heart transplantation (HTx). However, it is still unknown whether differences exist between the two surgical approaches in the efficacy of rehabilitation programmes. Therefore, aim of this study was to evaluate whether functional capacity and rehabilitative outcomes differ between HTx and implantation of LVAD.
  
  METHODS AND RESULTS:
  We enrolled 51 patients with HTx and 46 with LVAD upon admission to our rehabilitation-unit. We evaluated six-minute walking test (6MWT), resting oxygen saturation (SaO2) and nutritional assessment before and after a standardised cardiovascular rehabilitation programme. HTx and LVAD groups differed in age, anthropometric variables, gender distribution. Upon enrolment, 6MWT distance was similar in the two groups, whereas malnutrition was less frequent and the waist circumference/height ratio (WHtR) was greater in LVAD patients. SaO2 was greater in HTx patients. Rehabilitation improved SaO2, 6MWT distance and nutritional status. The difference in malnutrition disappeared, but WHtR remained higher in the LVAD and SaO2 higher in the HTx patients; the 6MWT distance improved more in the HTx patients. Multivariate linear regression analysis confirmed that the type of intervention was independent predictor of 6MWT distance after rehabilitation.
  
  CONCLUSIONS:
  HTx patients improve more rapidly and perform better after rehabilitation, suggesting the need for more tailored rehabilitation training for LVAD patients.
  
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• Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long-term comparison.
  Eur J Heart Fail

  2018 Apr;20(4):700-710. doi: 10.1002/ejhf.989.
  
  Agostoni Piergiuseppe, Paolillo Stefania, Mapelli Massimo, Gentile Piero, Salvioni Elisabetta, Veglia Fabrizio, Bonomi Alice, Corrà Ugo, Lagioia Rocco, Limongelli Giuseppe, Sinagra Gianfranco, Cattadori Gaia, Scardovi Angela B, Metra Marco, Carubelli Valentina, Scrutinio Domenico, Raimondo Rosa, Emdin Michele, Piepoli Massimo, Magrì Damiano, Parati Gianfranco, Caravita Sergio, Re Federica, Cicoira Mariantonietta, Minà Chiara, Correale Michele, Frigerio Maria, Bussotti Maurizio, Oliva Fabrizio, Battaia Elisa, Belardinelli Romualdo, Mezzani Alessandro, Pastormerlo Luigi, Guazzi Marco, Badagliacca Roberto, Di Lenarda Andrea, Passino Claudio, Sciomer Susanna, Zambon Elena, Pacileo Giuseppe, Ricci Roberto, Apostolo Anna, Palermo Pietro, Contini Mauro, Clemenza Francesco, Marchese Giovanni, Gargiulo Paola, Binno Simone, Lombardi Carlo, Passantino Andrea, Filardi Pasquale Perrone
  
  Abstract
  
  AIMS:
  Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A multiparametric approach is the best method to stratify prognosis. In 2012, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was proposed to assess the risk of cardiovascular mortality and urgent heart transplantation. The aim of the present study was to compare the prognostic accuracy of MECKI score to that of HF Survival Score (HFSS) and Seattle HF Model (SHFM) in a large, multicentre cohort of HF patients with reduced ejection fraction.
  
  METHODS AND RESULTS:
  We collected data on 6112 HF patients and compared the prognostic accuracy of MECKI score, HFSS, and SHFM at 2- and 4-year follow-up for the combined endpoint of cardiovascular death, urgent cardiac transplantation, or ventricular assist device implantation. Patients were followed up for a median of 3.67?years, and 931 cardiovascular deaths, 160 urgent heart transplantations, and 12 ventricular assist device implantations were recorded. At 2-year follow-up, the prognostic accuracy of MECKI score was significantly superior [area under the curve (AUC) 0.781] to that of SHFM (AUC 0.739) and HFSS (AUC 0.723), and this relationship was also confirmed at 4?years (AUC 0.764, 0.725, and 0.720, respectively).
  
  CONCLUSION:
  In this cohort, the prognostic accuracy of the MECKI score was superior to that of HFSS and SHFM at 2- and 4-year follow-up in HF patients in stable clinical condition. The MECKI score may be useful to improve resource allocation and patient outcome, but prospective evaluation is needed.
  
  © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.
  
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• [Management of outpatients with cardiac disease: follow-up timing and modalities].
  G Ital Cardiol (Rome)

  2017 Jun;18(6):467-484. doi: 10.1714/2700.27608.
  
  Rossini Roberta, Lina Daniela, Ferlini Marco, Belotti Giuseppina, Caico Salvatore Ivan, Caravati Fabrizio, Faggiano Pompilio, Iorio Annamaria, Lauri Davide, Lettieri Corrado, Locati Emanuela Teresa, Maggi Antonio, Massari Ferdinando, Mortara Andrea, Moschini Luigi, Musumeci Giuseppe, Nassiacos Daniele, Negri Fabrizio, Pecora Domenico, Pierini Simona, Pedretti Roberto, Ravizza Pierfranco, Romano Michele, Oliva Fabrizio
  
  Abstract
  
  The increasing rate of cardiovascular diseases, the improved survival after the acute phase, the aging of the population and the implementation of primary prevention caused an exponential increase in outpatient cardiac performance, thereby making it difficult to maintain a balance between the citizen-patient request and the economic sustainability of the healthcare system. On the other side, the prescription of many diagnostic tests with a view to defensive medicine and the related growth of patients' expectations, has led several scientific societies to educational campaigns highlighting the concept that "less is more".The present document is aimed at providing the general practitioner with practical information about a prompt diagnosis of signs/symptoms (angina, dyspnea, palpitations, syncope) of the major cardiovascular diseases. It will also provide an overview about appropriate use of diagnostic exams (echocardiogram, stress test), about the appropriate timing of their execution, in order to ensure effectiveness, efficiency, and equity of the health system.
  
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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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• Repetitive use of levosimendan in advanced heart failure: need for stronger evidence in a field in dire need of a useful therapy.
  Int J Cardiol

  2017 Sep;243():389-395. doi: 10.1016/j.ijcard.2017.05.081.
  
  Pölzl Gerhard, Altenberger Johann, Baholli Loant, Beltrán Paola, Borbély Attila, Comin-Colet Josep, Delgado Juan F, Fedele Francesco, Fontana Antonella, Fruhwald Friedrich, Giamouzis Gregory, Giannakoulas George, Garcia-González Martín J, Gustafsson Finn, Kaikkonen Kari, Kivikko Matti, Kubica Jacek, von Lewinski Dirk, Löfman Ida, Malfatto Gabriella, Manito Nicolás, Martínez-Sellés Martin, Masip Josep, Merkely Bela, Morandi Fabrizio, Mølgaard Henning, Oliva Fabrizio, Pantev Emil, Papp Zoltán, Perna Gian Piero, Pfister Roman, Piazza Vito, Bover Ramón, Rangel-Sousa Diego, Recio-Mayoral Alejandro, Reinecke Alexander, Rieth Andreas, Sarapohja Toni, Schmidt Gunter, Seidel Mirko, Störk Stefan, Vrtovec Bojan, Wikström Gerhard, Yerly Patrik, Pollesello Piero
  
  Abstract
  
  Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach. In these settings, levosimendan has potential advantages over conventional inotropes (catecholamines and phosphodiesterase inhibitors), such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalization and improves quality of life. However, previous clinical studies of intermittent infusions of levosimendan were not powered to show statistical significance on key outcome parameters. A panel of 45 expert clinicians from 12 European countries met in Rome on November 24-25, 2016 to review the literature and envision an appropriately designed clinical trial addressing these needs. In the earlier FIGHT trial (daily subcutaneous injection of liraglutide in heart failure patients with reduced ejection fraction) a composite Global Rank Score was used as primary end-point where death, re-hospitalization, and change in N-terminal-prohormone-brain natriuretic peptide level were considered in a hierarchical order. In the present study, we tested the same end-point post hoc in the PERSIST and LEVOREP trials on oral and repeated i.v. levosimendan, respectively, and demonstrated superiority of levosimendan treatment vs placebo. The use of the same composite end-point in a properly powered study on repetitive levosimendan in advanced heart failure is strongly advocated.
  
  Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
  
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• von Willebrand factor and its cleaving protease ADAMTS13 balance in coronary artery vessels: Lessons learned from thrombotic thrombocytopenic purpura. A narrative review.
  Thromb Res

  2017 Jul;155():78-85. doi: 10.1016/j.thromres.2017.05.011.
  
  Morici Nuccia, Cantoni Silvia, Panzeri Francesco, Sacco Alice, Rusconi Chiara, Stucchi Miriam, Oliva Fabrizio, Cattaneo Marco
  
  Abstract
  
  BACKGROUND:
  Deficiency of the von Willebrand factor-cleaving protease ADAMTS13 is central to the pathophysiology of thrombotic thrombocytopenic purpura (TTP), a microangiopathic syndrome that presents as an acute medical emergency. In this review we will explore the evidence of a two-way relationship between TTP and ACS. Moreover, we will review the evidence emerged from epidemiological studies of an inverse relationship between the plasma levels of ADAMTS13 and the risk of ACS.
  
  METHODS AND RESULTS:
  Pubmed, MEDLINE and EMBASE, CINHAL, COCHRANE and Google Scholar databases were searched from inception to January 2017. The search yielded 43 studies representing 23 unique patient cases, 5 case series, 5 cohort studies and 10 case-control studies. Most ACS cases developing in the setting of TTP resolved with standard treatment of the underlying microangiopathy, with only a few requiring coronary invasive management. Antiplatelet therapy was not usually prescribed and all of the currently used P2Y were felt to be a potential trigger for a TTP-like syndrome, although our review revealed that the occurrence of TTP in patients treated with new P2Y antagonists is rare. Most studies confirmed the inverse association among ADAMTS13 levels and ACS.
  
  CONCLUSIONS:
  The heart is a definite target organ in TTP. The clinical spectrum of its involvement is probably influenced by local factors that add on to the systemic deficiency characteristic of TTP. It follows that patients with TTP should be carefully monitored for ACS events, especially when multiple risk factors for coronary disease exist.
  
  Copyright © 2017 Elsevier Ltd. All rights reserved.
  
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• [Follow-up strategies after percutaneous coronary intervention: prognostic stratification and multidisciplinary management based on patient risk profile].
  G Ital Cardiol (Rome)

  2017 Jan;18(1):3-12. doi: 10.1714/2655.27229.
  
  Musumeci Giuseppe, Faggiano Pompilio, Ferlini Marco, Lettieri Corrado, Castiglioni Battistina, Maggi Antonio, Negri Fabrizio, Colombo Paola, Oliva Fabrizio, Pedretti Roberto F E, Centola Marco, Rossini Roberta
  
  Abstract
  
  The number of percutaneous coronary interventions (PCI) is increasing worldwide. Follow-up strategies after PCI are extremely heterogeneous and can greatly affect the cost of medical care. In the present paper, practical advises are provided with respect to a tailored follow-up strategy on the basis of patients' risk profile. Clinical and interventional cardiologists, cardiac rehabilitators, and general practitioners equally contributed to the creation of the present document and defined three follow-up strategies and types and timing of clinical and instrumental evaluations in post-PCI patients.
  
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• [The slow acceptance of new oral anticoagulants in Italy: a critical analysis of a problem].
  G Ital Cardiol (Rome)

  2017 Mar;18(3):208-218. doi: 10.1714/2674.27398.
  
  Botto Giovanni Luca, Cuccia Claudio, Gronda Edoardo, Lombardi Federico, Lunati Maurizio, Maggi Antonio, Massari Ferdinando Maria, Musumeci Giuseppe, Oliva Fabrizio, Visconti Luigi Oltrona, Proto Cesare, Pusineri Enrico, Ageno Walter
  
  Abstract
  
  The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) into clinical practice has revolutionized the prevention and the therapeutic approaches to thromboembolic events in patients with nonvalvular atrial fibrillation and represents with no doubts one of the most remarkable advances in the history of cardiovascular medicine over the last years. NOACs beyond a comparable efficacy with vitamin K antagonists allow to overcome the limitations of this last category of drugs owing to their less drug to drug interactions and a predictable anticoagulant effect that allows a fixed dose administration without the need for continuous monitoring. However, the penetration of NOACs into the Italian market is still lower than predicted with respect to their use in other European countries.The aim of this review is to critically analyze the reasons behind this attitude through the adoption of the nominal group technique, a methodology that permits to reach an official consensus.
  
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• Prognostic role of ?-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database.
  Eur J Heart Fail

  2017 Jul;19(7):904-914. doi: 10.1002/ejhf.775.
  
  Paolillo Stefania, Mapelli Massimo, Bonomi Alice, Corrà Ugo, Piepoli Massimo, Veglia Fabrizio, Salvioni Elisabetta, Gentile Piero, Lagioia Rocco, Metra Marco, Limongelli Giuseppe, Sinagra Gianfranco, Cattadori Gaia, Scardovi Angela B, Carubelli Valentina, Scrutino Domenico, Badagliacca Roberto, Raimondo Rosa, Emdin Michele, Magrì Damiano, Correale Michele, Parati Gianfranco, Caravita Sergio, Spadafora Emanuele, Re Federica, Cicoira Mariantonietta, Frigerio Maria, Bussotti Maurizio, Minà Chiara, Oliva Fabrizio, Battaia Elisa, Belardinelli Romualdo, Mezzani Alessandro, Pastormerlo Luigi, Di Lenarda Andrea, Passino Claudio, Sciomer Susanna, Iorio Annamaria, Zambon Elena, Guazzi Marco, Pacileo Giuseppe, Ricci Roberto, Contini Mauro, Apostolo Anna, Palermo Pietro, Clemenza Francesco, Marchese Giovanni, Binno Simone, Lombardi Carlo, Passantino Andrea, Perrone Filardi Pasquale, Agostoni Piergiuseppe
  
  Abstract
  
  AIMS:
  The use of ?-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared ?-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of ?-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of ?-selectivity and dosage regimens.
  
  METHODS AND RESULTS:
  In 5242 HFrEF patients, we investigated the role of: (i) ?-blocker treatment vs. non-?-blocker treatment, (ii) ?1-/?2-receptor-blockers vs. ?1-selective blockers, and (iii) daily ?-blocker dose. Patients were followed for 3.58?years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on ?-blockers, while 807 (13.2%) were not. At 5?years, ?-blocker-patients showed a better outcome than non-?-blocker-subjects [hazard ratio (HR) 0.48, P?0.0001], while also considering potential confounders. A comparable prognosis was observed at 5?years in the ?1-/?2-receptor-blocker (n?=?2219) vs. ?1-selective group (n?=?2216) (HR 0.95, P?=?ns). A better prognosis was observed in high-dose (>2?5?mg carvedilol equivalent daily dose, n?=?1005) patients than in both medium dose (12.5-25?mg, n?=?1431) and low dose (
  CONCLUSION:
  In a large population of chronic HFrEF patients, ?-blockers were associated with a more favourable prognosis without any difference between ?1- and ?2-receptor-blockers vs. ?1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.
  
  © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.
  
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• Relationship among body mass index, NT-proBNP, and mortality in decompensated chronic heart failure.
  Heart Lung

  2017 ;46(3):172-177. doi: 10.1016/j.hrtlng.2017.01.005.
  
  Scrutinio Domenico, Passantino Andrea, Guida Pietro, Ammirati Enrico, Oliva Fabrizio, Sarzi Braga Simona, La Rovere Maria Teresa, Lagioia Rocco, Frigerio Maria, Di Somma Salvatore
  
  Abstract
  
  BACKGROUND:
  Obesity has been suggested to confer a survival benefit in acute heart failure. The concentrations of NT-proBNP may be reduced in patients with high body mass index (BMI).
  
  OBJECTIVES:
  To investigate the relationship among BMI, NT-proBNP, and mortality risk in decompensated chronic heart failure (DCHF).
  
  METHODS:
  This was a retrospective study. We studied 1001 patients with DCHF. Hazard ratios (HR) were calculated with Cox regression analysis.
  
  RESULTS:
  During the 1-year follow-up, 295 patients died. Compared with normal-weight patients, the unadjusted HR for death were 1.02 (95% CIs 0.79-1.33; p = 0.862) for patients with a BMI of 25.0-29.9 kg/m and 0.83 (95% CIs 0.61-1.12; p = 0.213) for patients with a BMI ? 30 kg/m. NT-proBNP remained independently associated with mortality across the BMI categories. There was no statistically significant interaction between BMI and NT-proBNP levels for risk prediction.
  
  CONCLUSIONS:
  Obesity was not associated with mortality risk. NT-proBNP remained an independent prognostic factor across the BMI categories.
  
  Copyright © 2017 Elsevier Inc. All rights reserved.
  
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• Portico Sheathless Transcatheter Aortic Valve Implantation via Distal Axillary Artery.
  Ann Thorac Surg

  2017 Feb;103(2):e175-e177. doi: 10.1016/j.athoracsur.2016.07.065.
  
  Bruschi Giuseppe, Colombo Paola, Botta Luca, Nava Stefano, Merlanti Bruno, Belli Oriana, Musca Francesco, Soriano Francesco, Russo Claudio F, Oliva Fabrizio
  
  Abstract
  
  Transcatheter aortic valve implantation has been designed to treat older patients affected by severe aortic stenosis who are considered high-risk surgical candidates because of multiple comorbidities. The least invasive approach for transcatheter aortic valves implantation should be considered the transfemoral retrograde route, because it is minimally invasive and is feasible with local anesthesia and mild sedation. Despite significant technical improvements in recent years, the transfemoral approach is contraindicated in cases of severe peripheral artery disease. We describe the first case of a Portico transcatheter aortic valve implantation system (St. Jude Medical, Minneapolis, MN) made through the distal axillary artery in a 90-year-old patient affected by severe aortic stenosis.
  
  Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
  
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• Arterial Stiffness in Aortic Stenosis: Relationship with Severity and Echocardiographic Procedures Response.
  High Blood Press Cardiovasc Prev

  2017 Mar;24(1):19-27. doi: 10.1007/s40292-016-0176-x.
  
  Bruschi Giuseppe, Maloberti Alessandro, Sormani Paola, Colombo Giulia, Nava Stefano, Vallerio Paola, Casadei Francesca, Bruno Jolie, Moreo Antonella, Merlanti Bruno, Russo Claudio, Oliva Fabrizio, Klugmann Silvio, Giannattasio Cristina
  
  Abstract
  
  INTRODUCTION:
  Aortic stenosis (AS) is more than only a degenerative disease, it could be also an atherosclerotic-like process involving the valve instead of the vessels. Little is known about the relation of arterial stiffness and AS.
  
  AIM:
  We sought to determine wether pulse wave velocity (PWV), is related to AS severity and to the procedures response, both as surgical aortic-valve-replacement (AVR) and trascatheter-aortic-valve-implantation (TAVI).
  
  METHODS:
  30 patients with severe AS were treated (15 AVR, 15 TAVI). Before the procedures (t0) and after 1 week (t1) echocardiography and PWV were evaluated.
  
  RESULTS:
  On the whole population, subjects with higher PWV showed higher transvalvular pressure gradient at baseline (mean: 56.5 ± 15.1 vs 45.4 ± 9.5; peak: 93.3 ± 26.4 vs 73.3 ± 14.9, p = 0.02) and, a significantly greater response to the procedures (mean: -42.9 ± 17.2 vs -27.9 ± 10.1, peak: -68.7 ± 29.2 vs -42.8 ± 16.4, p = 0.02). When the two different procedures groups were separated, data were confirmed only in the TAVI subgroup.
  
  CONCLUSIONS:
  In patients undergoing procedures for AS, PWV is correlated with transvalvular gradient and, in TAVI subjects, is able to predict the echocardiographic response. Baseline evaluation of PWV in patients candidates to TAVI can help the selection of subjects, even if larger and longer studies are needed before definitive conclusion can be drawn.
  
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• Quantitative changes in late gadolinium enhancement at cardiac magnetic resonance in the early phase of acute myocarditis.
  Int J Cardiol

  2017 Mar;231():216-221. doi: 10.1016/j.ijcard.2016.11.282.
  
  Ammirati Enrico, Moroni Francesco, Sormani Paola, Peritore Angelica, Milazzo Angela, Quattrocchi Giuseppina, Cipriani Manlio, Oliva Fabrizio, Giannattasio Cristina, Frigerio Maria, Roghi Alberto, Camici Paolo G, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  The presence of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has diagnostic and prognostic value in patients with acute myocarditis (AM). Aim of our study was to quantify the changes in LGE extension (LGE%) early after AM and evaluate its relations with biventricular function and morphology.
  
  METHODS:
  We investigated 76 consecutive patients with AM (acute onset of chest pain/heart failure/ventricular arrhythmias not explained by other causes, and raised troponin) that met CMR criteria based on myocardial oedema at T2-weighted images and LGE on post-contrast images at median time of 6days from onset of symptoms. We quantified LGE% at baseline and after 148days in 49 patients.
  
  RESULTS:
  Median left ventricular (LV)-ejection fraction (EF) was 64% (interquartile range [Q1-Q3]: 56-67%), and LGE% 9.4% (Q1-Q3: 7.5-13.2%). LGE% was correlated with LV end-systolic volume index (LV-ESVi; r=+0.34; p=0.003). LGE% was inversely correlated with LV-EF (r=-0.31; p=0.009) and time to CMR scan (r=-0.25; p=0.028). In the 49 patients with a second CMR scan, despite no significant variations in LV-EF, a significant decrease of LGE% was observed (p
  CONCLUSIONS:
  In the acute phase of AM the LGE extension is a dynamic process that reflects impairment of LV function and is time dependent. LGE% appears one of the CMR parameters with the largest relative variations in the first months after AM.
  
  Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
  
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• Predictors of Long-Term Mortality in Older Patients Hospitalized for Acutely Decompensated Heart Failure: Clinical Relevance of Natriuretic Peptides.
  J Am Geriatr Soc

  2017 Apr;65(4):822-826. doi: 10.1111/jgs.14561.
  
  Passantino Andrea, Guida Piero, Lagioia Rocco, Ammirati Enrico, Oliva Fabrizio, Frigerio Maria, Scrutinio Domenico
  
  Abstract
  
  BACKGROUND:
  Acute heart failure is a common cause of hospitalization among older patients. Optimized risk stratification might improve the outcome for this subgroup of patients. Natriuretic peptides have been used in the diagnosis of heart failure and in evaluating the prognosis of patients hospitalized for heart failure. However, their utility in the elderly is still controversial.
  
  OBJECTIVE:
  To evaluate long-term survival and prognostic factors for elderly patients hospitalized for acutely decompensated heart failure and evaluate the prognostic utility of NT-proBNP.
  
  DESIGN:
  Retrospective, multicenter cohort study.
  
  SETTING:
  Two Italian hospitals.
  
  PARTICIPANTS:
  Two hundred seventy-nine patients, aged >75 years; hospitalized for decompensation of chronic, established heart failure.
  
  METHODS:
  Baseline clinical data were recorded at admission. The primary outcome was long-term mortality.
  
  RESULTS:
  In-hospital, 12-month and 5-year mortality were, respectively, 10%, 36%, and 77%. NT-proBNP, eGFR, hemoglobin, diabetes, systolic blood pressure, and moderate to severe tricuspid regurgitation were independently associated with long-term prognosis and were entered into a multivariate model, with a C-index of 0.765 for the determination of high-risk patients. The C-index for NT-proBNP to predict mortality at 2 and 12 months was 0.740 and 0.756, respectively. The optimal cutoff point for predicting mortality at 2 and 12 months was 8,444 pg/mL (hazard ratio 5.33) and 8,275 pg/mL (hazard ratio 6.03), respectively.
  
  CONCLUSION:
  Elderly patients hospitalized for acutely decompensated heart failure had a poor long-term outcome, especially in the subgroup with reduced ejection fraction (EF). In addition to EF and comorbidities, NT-pro-BNP remained independently prognostic among elderly patients hospitalized with heart failure.
  
  © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
  
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• Extreme giant aneurysms of three coronary arteries causing heart failure as late sequelae of Kawasaki disease.
  Eur Heart J

  2017 Mar;38(10):759-760. doi: 10.1093/eurheartj/ehw510.
  
  Ammirati Enrico, Burns Jane C, Moreo Antonella, Daniels Lori B, Oliva Fabrizio
  
  
  
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• Long-term prognostic implications of the ADHF/NT-proBNP risk score in patients admitted with advanced heart failure.
  J Heart Lung Transplant

  2016 Oct;35(10):1264-1267. doi: 10.1016/j.healun.2016.07.007.
  
  Scrutinio Domenico, Guida Pietro, Ammirati Enrico, Oliva Fabrizio, Frigerio Maria
  
  
  
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• Mast cells and acute coronary syndromes: relationship between serum tryptase, clinical outcome and severity of coronary artery disease.
  Open Heart

  2016 ;3(2):e000472. doi: e000472.
  
  Morici Nuccia, Farioli Laura, Losappio Laura Michelina, Colombo Giulia, Nichelatti Michele, Preziosi Donatella, Micarelli Gianluigi, Oliva Fabrizio, Giannattasio Cristina, Klugmann Silvio, Pastorello Elide Anna
  
  Abstract
  
  OBJECTIVE:
  To assess the relationship between serum tryptase and the occurrence of major cardiovascular and cerebrovascular events (MACCE) at 2-year follow-up in patients admitted with acute coronary syndrome (ACS). To compare serum tryptase to other validated prognostic markers (maximum high-sensitivity troponin (hs-Tn), C reactive protein (CRP) levels at admission, Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score).
  
  METHODS:
  We measured serum tryptase at admission in 140 consecutive patients with ACS and in 50 healthy controls. The patients' follow-up was maintained for 2?years after discharge. The predictive accuracy of serum tryptase for 2-year MACCE was assessed and compared with hs-Tn, CRP and SYNTAX score.
  
  RESULTS:
  Serum tryptase levels at admission were significantly higher in patients with ACS compared with the control group (p=0.0351). 2 years after discharge, 28/140 patients (20%) experienced MACCE. Serum tryptase levels, maximum hs-Tn measurements and SYNTAX score were higher in patients who experienced MACCE compared with those without (p
  CONCLUSIONS:
  In patients with ACS, serum tryptase measured during index admission is significantly correlated to the development of MACCE up to 2?years, demonstrating a possible long-term prognostic role of this biomarker.
  
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• Heart failure and anemia: Effects on prognostic variables.
  Eur J Intern Med

  2017 Jan;37():56-63. doi: 10.1016/j.ejim.2016.09.011.
  
  Cattadori Gaia, Agostoni Piergiuseppe, Corrà Ugo, Sinagra Gianfranco, Veglia Fabrizio, Salvioni Elisabetta, Bonomi Alice, La Gioia Rocco, Scardovi Angela B, Ferraironi Alessandro, Emdin Michele, Metra Marco, Di Lenarda Andrea, Limongelli Giuseppe, Raimondo Rosa, Re Federica, Guazzi Marco, Belardinelli Romualdo, Parati Gianfranco, Caravita Sergio, Magrì Damiano, Lombardi Carlo, Frigerio Maria, Oliva Fabrizio, Girola Davide, Mezzani Alessandro, Farina Stefania, Mapelli Massimo, Scrutinio Domenico, Pacileo Giuseppe, Apostolo Anna, Iorio AnnaMaria, Paolillo Stefania, Filardi Pasquale Perrone, Gargiulo Paola, Bussotti Maurizio, Marchese Giovanni, Correale Michele, Badagliacca Roberto, Sciomer Susanna, Palermo Pietro, Contini Mauro, Giannuzzi Pantaleo, Battaia Elisa, Cicoira Mariantonietta, Clemenza Francesco, Minà Chiara, Binno Simone, Passino Claudio, Piepoli Massimo F,
  
  Abstract
  
  BACKGROUND:
  Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown.
  
  METHODS:
  Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (15) Hb, respectively.
  
  RESULTS:
  Median follow-up was 1363days (606-1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR)=0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO), ventilatory efficiency (VE/VCO slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire population. Considering Hb groups separately, peakVO (very low Hb HR=0.549, low Hb HR=0.613, normal Hb HR=0.618, high Hb HR=0.542) and LVEF (very low Hb HR=0.49, low Hb HR=0.692, normal Hb HR=0.697, high Hb HR=0.694) maintained their prognostic roles. High VE/VCO slope was associated with poor prognosis only in patients with low and normal Hb.
  
  CONCLUSIONS:
  Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO and LVEF, but not VE/VCO slope, maintain their prognostic power also in HF patients with Hb
  Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• Vasopressors and inotropes in cardiogenic shock: is there room for "adrenaline resuscitation"?
  Crit Care

  2016 Sep;20(1):302. doi: 302.
  
  Morici Nuccia, Stucchi Miriam, Sacco Alice, Bottiroli Maurizio A, Oliva Fabrizio,
  
  
  
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• A new access for transcatheter aortic valve implantation: Distal axillary artery.
  Int J Cardiol

  2016 Nov;223():810-812. doi: 10.1016/j.ijcard.2016.08.290.
  
  Bruschi Giuseppe, Colombo Paola, Merlanti Bruno, Nava Stefano, Belli Oriana, Musca Francesco, Soriano Francesco, Botta Luca, Calini Angelo, De Caria Daniele F, Oliva Fabrizio, Russo Claudio F
  
  
  
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• Ticagrelor for left ventricular assist device thrombosis: A new therapeutic option to be evaluated with caution.
  Int J Cardiol

  2016 Oct;221():58-9. doi: 10.1016/j.ijcard.2016.06.304.
  
  Morici Nuccia, Perna Enrico, Cipriani Manlio, Femia Eti Alessandra, Oliva Fabrizio, Frigerio Maria, Cattaneo Marco
  
  
  
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• Prognostic impact of comorbidities in hospitalized patients with acute exacerbation of chronic heart failure.
  Eur J Intern Med

  2016 Oct;34():63-67. doi: 10.1016/j.ejim.2016.05.020.
  
  Scrutinio Domenico, Passantino Andrea, Guida Pietro, Ammirati Enrico, Oliva Fabrizio, Braga Simona Sarzi, La Rovere Maria Teresa, Lagioia Rocco, Frigerio Maria
  
  Abstract
  
  BACKGROUND:
  To assess the impact of comorbidities on long-term all-cause mortality in patients hospitalized with exacerbated signs/symptoms of previously chronic stable HF (AE-CHF).
  
  METHODS:
  1119 patients admitted for AE-CHF and with NT-proBNP levels >900pg/mL were enrolled. Univariable and multivariable Cox analyses were performed to assess the association of age, gender, hypertension, diabetes, obesity, atrial fibrillation, coronary heart disease (CHD), chronic obstructive pulmonary disease, previous cerebrovascular accidents, chronic liver disease (CLD), thyroid disease, renal impairment (RI), and anemia with 3-year all-cause mortality.
  
  RESULTS:
  During the follow-up, 441 patients died and 126 underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. 45.8% of the fatal events and 52.4% of HT/VAD implantations occurred within 180days after admission. Increasing age (p=.012), obesity (p=.037), atrial fibrillation (p=.030), CHD (p=.015), CLD (p=.001), RI (p<.001 and anemia were independently associated with all-cause mortality. most of the prognostic impact chd took place within first after admission. male gender was mortality beyond compared normal weight obesity better overall survival. obese patients however had significantly lower nt-probnp concentrations less frequently presented hypotension hyponatremia severe left ventricular systolic dysfunction despite a similar prevalence dyspnea at>
  CONCLUSIONS:
  Several comorbidities are associated with long-term risk of death in hospitalized patients with worsening HF, although the nature of this association does appear to be complex. Our data may help to raise awareness about the clinical relevance of comorbid conditions.
  
  Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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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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• The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion.
  Int J Cardiol

  2016 Sep;218():150-157. doi: 10.1016/j.ijcard.2016.05.009.
  
  Nieminen Markku S, Buerke Michael, Cohen-Solál Alain, Costa Susana, Édes István, Erlikh Alexey, Franco Fatima, Gibson Charles, Gorjup Vojka, Guarracino Fabio, Gustafsson Finn, Harjola Veli-Pekka, Husebye Trygve, Karason Kristjan, Katsytadze Igor, Kaul Sundeep, Kivikko Matti, Marenzi Giancarlo, Masip Josep, Matskeplishvili Simon, Mebazaa Alexandre, Møller Jacob E, Nessler Jadwiga, Nessler Bohdan, Ntalianis Argyrios, Oliva Fabrizio, Pichler-Cetin Emel, Põder Pentti, Recio-Mayoral Alejandro, Rex Steffen, Rokyta Richard, Strasser Ruth H, Zima Endre, Pollesello Piero
  
  Abstract
  
  Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently been defined as exclusion criteria in trials and registries. As a consequence, guideline recommendations are mostly driven by observational studies, even though these patients have a particularly poor prognosis compared to heart failure patients without signs of coronary artery disease. In acute heart failure, and especially in cardiogenic shock related to ischemic conditions, vasopressors and inotropes are used. However, both pathophysiological considerations and available clinical data suggest that these treatments may have disadvantageous effects. The inodilator levosimendan offers potential benefits due to a range of distinct effects including positive inotropy, restoration of ventriculo-arterial coupling, increases in tissue perfusion, and anti-stunning and anti-inflammatory effects. In clinical trials levosimendan improves symptoms, cardiac function, hemodynamics, and end-organ function. Adverse effects are generally less common than with other inotropic and vasoactive therapies, with the notable exception of hypotension. The decision to use levosimendan, in terms of timing and dosing, is influenced by the presence of pulmonary congestion, and blood pressure measurements. Levosimendan should be preferred over adrenergic inotropes as a first line therapy for all ACS-AHF patients who are under beta-blockade and/or when urinary output is insufficient after diuretics. Levosimendan can be used alone or in combination with other inotropic or vasopressor agents, but requires monitoring due to the risk of hypotension.
  
  Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
  
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• Allogeneic peripheral blood stem cell transplantation and accelerated atherosclerosis: An intriguing association needing targeted surveillance. Lessons from a rare case of acute anterior myocardial infarction.
  Eur Heart J Acute Cardiovasc Care

  2020 Oct;9(7):NP3-NP7. doi: 10.1177/2048872616652311.
  
  Scudiero Laura, Soriano Francesco, Morici Nuccia, Grillo Giovanni, Belli Oriana, Sacco Alice, Cipriani Manlio, Pedrotti Patrizia, Quattrocchi Giuseppina, Klugmann Silvio, Oliva Fabrizio
  
  Abstract
  
  We report the case of a 23-year-old man who developed an acute ST-elevation myocardial infarction secondary to acute thrombotic occlusion of the proximal left anterior descending coronary artery five years after undergoing chemotherapy, radiotherapy, haematopoietic stem cell transplantation for acute lymphoblastic leukaemia and bulky mediastinal mass involving the pleura and pericardium. His medical history also included Graft versus Host Disease developed 13 months after transplantation and acute myocarditis three months before the actual hospital admission. To the best of our knowledge, coronary artery disease as a complication of haematopoietic stem cell transplantation and low-dose mediastinal radiation therapy in young patients has been rarely reported in the medical literature. Clinicians should have a high degree of suspicion of coronary artery disease in patients treated with allogeneic haematopoietic stem cell transplantation, especially in patients previously treated with target mediastinal radiotherapy, as a group at risk of premature and significantly accelerated atherosclerosis, in order to make a timely and correct diagnosis.
  
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• Incremental utility of prognostic variables at discharge for risk prediction in hospitalized patients with acutely decompensated chronic heart failure.
  Heart Lung

  2016 ;45(3):212-9. doi: 10.1016/j.hrtlng.2016.03.004.
  
  Scrutinio Domenico, Passantino Andrea, Guida Pietro, Ammirati Enrico, Oliva Fabrizio, Lagioia Rocco, Sarzi Braga Simona, Agostoni Piergiuseppe, Frigerio Maria
  
  Abstract
  
  OBJECTIVES:
  To assess the incremental prognostic utility of discharge serum creatinine (SCr), systolic blood pressure (SBP), and NT-proBNP and sodium concentrations in hospitalized patients with acutely decompensated chronic heart failure.
  
  BACKGROUND:
  Whether key prognostic variables at discharge provide incremental prognostic information beyond that provided by a model based on admission variables (referent) remains incompletely defined.
  
  METHODS:
  The primary outcome was a composite of death, urgent heart transplantation, or ventricular assist device implantation at 1 year. The gain in predictive performance was assessed using C index, Bayesian Information Criterion, and Net Reclassification Improvement.
  
  RESULTS:
  The best fit was obtained when discharge NT-proBNP was added to the referent model. No interaction between admission and discharge NT-proBNP was found. Discharge SCr, SBP, and sodium did not improve goodness-of-fit.
  
  CONCLUSIONS:
  Admission and discharge NT-proBNP provide complementary and independent prognostic information; as such, they should be taken into account concurrently.
  
  Copyright © 2016 Elsevier Inc. All rights reserved.
  
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• [Heart rate and outcome in patients with acute and chronic heart failure].
  G Ital Cardiol (Rome)

  2016 Mar;17(3 Suppl 1):3S-16. doi: 10.1714/2192.23678.
  
  Oliva Fabrizio, Ammirati Enrico, Campana Carlo, Carubelli Valentina, Cirò Antonio, Di Tano Giuseppe, Mortara Andrea, Senni Michele, Morandi Fabrizio, Metra Marco
  
  Abstract
  
  Heart rate (HR) is not only a physical sign but also a biomarker. High HR in several cardiac disorders is associated with increased mortality. In heart failure (HF), HR represents an important therapeutic target, both in the acute and chronic phase. Beta-blockers are a milestone of recommended treatments in HF patients with reduced ejection fraction. However, hemodynamic profile or intolerance may limit the use or the optimization of beta-blocker treatment, both during hospitalization and outpatient follow-up. More recently, ivabradine has become available, a drug that lowers HR by blocking the I(f) current in the pacemaker cells at the sinoatrial node level. In the SHIFT trial, ivabradine was shown to improve the outcome of patients with chronic HF, in sinus rhythm, with HR >70 b/min while on beta-blockers. Preliminary data have shown that this drug has a good safety profile and lowers effectively HR even during hospitalization due to worsening HF. However, further studies are warranted to understand if an earlier administration of ivabradine can lead to a better prognosis beyond symptom control and improved hemodynamics. In patients with atrial fibrillation and HF, the target is the restoration of sinus rhythm, alternatively rate control should be pursued with beta-blockers, amiodarone or digitalis, even if there is no clear evidence of an association between ventricular rate response in patients with atrial fibrillation at discharge after an HF hospitalization and major cardiovascular events. In this review, the studies that point to a role of HR both as a biomarker and a therapeutic target in patients with acute and chronic HF are described. In addition, the proportions of patients who do not reach target HR values at discharge after an acute decompensated HF episode or in the chronic phase are evaluated based on the Italian registries.
  
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• Tricuspid Annular Plane Systolic Excursion in Acute Decompensated Heart Failure: Relevance for Risk Stratification.
  Can J Cardiol

  2016 Aug;32(8):963-9. doi: 10.1016/j.cjca.2015.09.019.
  
  Scrutinio Domenico, Catanzaro Raffaella, Santoro Daniela, Ammirati Enrico, Passantino Andrea, Oliva Fabrizio, La Rovere Maria Teresa, De Salvo Maria, Guzzetti Daniela, Vaninetti Raffaella, Venezia Mario, Frigerio Maria
  
  Abstract
  
  BACKGROUND:
  Although the prognostic value of right ventricular dysfunction in chronic heart failure (HF) has been studied extensively, it remains insufficiently characterized in the setting of acute decompensated HF (ADHF). We sought to assess whether measurement of tricuspid annular plane systolic excursion (TAPSE) or TAPSE-to-estimated pulmonary arterial systolic pressure (ePASP) ratio allows improvement of risk prediction in ADHF.
  
  METHODS:
  Four hundred ninety-nine patients with ADHF were studied. Cox regression analyses were used to analyze the association of TAPSE and TAPSE-to-ePASP ratio with 1-year mortality and logistic regression analyses to analyze the association of the 2 variables of interest with adverse in-hospital outcome (AiHO) (in-hospital death plus worsening HF).
  
  RESULTS:
  During the 365-day follow-up, 143 patients (28.7%) died. At univariable analysis, both TAPSE (P = 0.026) and TAPSE-to-ePASP ratio (P
  CONCLUSIONS:
  Our data strongly suggest that early assessment of TAPSE or TAPSE-to-ePASP ratio does not improve prediction of 1-year mortality over other key risk markers in ADHF. Nonetheless, the TAPSE-to-ePASP ratio did appear to be independently associated with AiHO.
  
  Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
  
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• Asymptomatic aortic mural thrombus in a minimally atherosclerotic vessel.
  Interact Cardiovasc Thorac Surg

  2016 Mar;22(3):371-3. doi: 10.1093/icvts/ivv349.
  
  Maloberti Alessandro, Oliva Fabrizio, De Chiara Benedetta, Giannattasio Cristina
  
  Abstract
  
  Aortic mural thrombi in a normal (non-aneurysmal or minimally atherosclerotic) vessel are an uncommon condition. They are usually located in the descending aorta and, less frequently, in the aortic arch or in the abdominal aorta. The typical clinical presentation is the appearance of symptoms/signs of peripheral arterial embolization, such as lower limb or visceral ischaemia, but these can also be accidentally found in asymptomatic patients. We report the case of a 40-year old man with untreated hypertension and dyslipidaemia admitted to hospital for atypical chest pain associated with an elevation in high-sensitivity troponin T with normal creatine kinase isoenzime MB creatine kinase isoenzyme. Elektrocardiogram (EKG) and transthoracic echocardiography were non-diagnostic; in order to exclude an aortic dissection, a gated chest computed tomography was performed and showed an aortic thrombus on a minimally atherosclerotic wall. Then, a transoesophageal echocardiography confirmed an aortic floating thrombus (7 × 4 mm). Cardiac surgeons advised against surgery and therapy with antiplatelet, low molecular weight heparin, ?-blocker, antihypertensive and lipid-lowering drugs was initiated. A complete resolution of the thrombus was observed at the 12-day tomographic control.
  
  © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
  
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• A life-threatening presentation of eosinophilic granulomatosis with polyangiitis.
  J Cardiovasc Med (Hagerstown)

  2016 Dec;17 Suppl 2():e109-e111. doi: 10.2459/JCM.0000000000000330.
  
  Ammirati Enrico, Cipriani Manlio, Musca Francesco, Bonacina Edgardo, Pedrotti Patrizia, Roghi Alberto, Astaneh Arash, Schroeder Jan W, Nonini Sandra, Russo Claudio F, Oliva Fabrizio, Frigerio Maria
  
  Abstract
  
  : Necrotizing eosinophilic myocarditis (NEM) is a life-threatening condition that needs rapid diagnosis by endomyocardial biopsy and hemodynamic support usually by mechanical circulatory systems. We present the case of a 25-year-old Caucasian man who developed a refractory cardiogenic shock due to a NEM that was supported with a peripheral veno-arterial extracorporeal membrane oxygenation associated with intravenous steroids and recovered after 2 weeks. Further instrumental investigations lead to the final diagnosis of NEM as first presentation of eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), remarking the importance of identifying the systemic disorder that usually triggers the eosinophilic damage of the myocardium.
  
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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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• [Primary prevention of sudden cardiac death through a wearable cardioverter-defibrillator].
  G Ital Cardiol (Rome)

  2015 ;16(7-8):418-25. doi: 10.1714/1954.21242.
  
  Gabrielli Domenico, Benvenuto Manuela, Baroni Matteo, Oliva Fabrizio, Capucci Alessandro
  
  Abstract
  
  Nowadays, the implantable cardioverter-defibrillator is the gold standard for the prevention of sudden cardiac death due to tachyarrhythmias. However, its use is not free from short and long-term risks. In the last years, the wearable cardioverter-defibrillator (WCD) has become a widespread option for patients who need a safe and reversible protection against ventricular tachyarrhythmias. Notwithstanding this, its everyday application is restricted by several limitations, including the risk of inappropriate shocks, the device size and the need for strict compliance of both patients and caregivers. In this review, we report the most relevant literature data on WCD usage along with the main fields of applications and future perspectives.
  
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• [Ventricular aneurysm as a complication of giant cell myocarditis].
  G Ital Cardiol (Rome)

  2015 Jun;16(6):389-90. doi: 10.1714/1934.21040.
  
  Ammirati Enrico, Roghi Alberto, Oliva Fabrizio, Turazza Fabio M, Frigerio Maria, Pedrotti Patrizia
  
  Abstract
  
  Ventricular aneurysm as late complication has been described in cardiac sarcoidosis and occasionally in giant cell myocarditis. The images from the present case of ventricular aneurysm formation as a late complication of giant cell myocarditis underline a potential cause of sudden arrhythmic death in patients who survive this life-threatening condition in the absence of recurrent inflammation and with preserved left ventricular ejection fraction. Follow-up with cardiac magnetic resonance can detect small aneurysms, and an implantable cardioverter-defibrillator may be considered when this complication occurs.
  
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• Eosinophilic myocarditis: a paraneoplastic event.
  Lancet

  2015 Jun;385(9986):2546. doi: 10.1016/S0140-6736(15)60903-5.
  
  Ammirati Enrico, Stucchi Miriam, Brambatti Michela, Spanò Francesca, Bonacina Edgardo, Recalcati Fabio, Cerea Giulio, Vanzulli Angelo, Frigerio Maria, Oliva Fabrizio
  
  
  
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• The 30-day metric in acute heart failure revisited: data from IN-HF Outcome, an Italian nationwide cardiology registry.
  Eur J Heart Fail

  2015 Oct;17(10):1032-41. doi: 10.1002/ejhf.290.
  
  Di Tano Giuseppe, De Maria Renata, Gonzini Lucio, Aspromonte Nadia, Di Lenarda Andrea, Feola Mauro, Marini Marco, Milli Massimo, Misuraca Gianfranco, Mortara Andrea, Oliva Fabrizio, Pulignano Giovanni, Russo Giulia, Senni Michele, Tavazzi Luigi,
  
  Abstract
  
  AIMS:
  Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short-term post-discharge mortality is substantial.
  
  METHODS AND RESULTS:
  Using data from the prospective, nationwide Registry IN-HF Outcome, we analysed the incidence and predictors of 30-day mortality or readmissions and associated days-alive-out-of-hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21-2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40-3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01-1.04, P = 0.002) and renin-angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35-0.77, P = 0.001) independently predicted 30-day all-cause mortality and/or readmission (c-statistic = 0.695). Per cent 30-day DAOH was lower in patients with in-hospital inotrope use, no renin-angiotensin system inhibitors prescription at discharge, New York Heart Association III-IV class at discharge, and correlated inversely with length of stay and age.
  
  CONCLUSION:
  A clinical and biohumoral profile consistent with chronic advanced heart failure and end-organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow-up.
  
  © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.
  
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• The patient perspective: Quality of life in advanced heart failure with frequent hospitalisations.
  Int J Cardiol

  2015 Jul;191():256-64. doi: 10.1016/j.ijcard.2015.04.235.
  
  Nieminen Markku S, Dickstein Kenneth, Fonseca Cândida, Serrano Jose Magaña, Parissis John, Fedele Francesco, Wikström Gerhard, Agostoni Piergiuseppe, Atar Shaul, Baholli Loant, Brito Dulce, Colet Josep Comín, Édes István, Gómez Mesa Juan E, Gorjup Vojka, Garza Eduardo Herrera, González Juanatey José R, Karanovic Nenad, Karavidas Apostolos, Katsytadze Igor, Kivikko Matti, Matskeplishvili Simon, Merkely Béla, Morandi Fabrizio, Novoa Angel, Oliva Fabrizio, Ostadal Petr, Pereira-Barretto Antonio, Pollesello Piero, Rudiger Alain, Schwinger Robert H G, Wieser Manfred, Yavelov Igor, Zymli?ski Robert
  
  Abstract
  
  End of life is an unfortunate but inevitable phase of the heart failure patients' journey. It is often preceded by a stage in the progression of heart failure defined as advanced heart failure, and characterised by poor quality of life and frequent hospitalisations. In clinical practice, the efficacy of treatments for advanced heart failure is often assessed by parameters such as clinical status, haemodynamics, neurohormonal status, and echo/MRI indices. From the patients' perspective, however, quality-of-life-related parameters, such as functional capacity, exercise performance, psychological status, and frequency of re-hospitalisations, are more significant. The effects of therapies and interventions on these parameters are, however, underrepresented in clinical trials targeted to assess advanced heart failure treatment efficacy, and data are overall scarce. This is possibly due to a non-universal definition of the quality-of-life-related endpoints, and to the difficult standardisation of the data collection. These uncertainties also lead to difficulties in handling trade-off decisions between quality of life and survival by patients, families and healthcare providers. A panel of 34 experts in the field of cardiology and intensive cardiac care from 21 countries around the world convened for reviewing the existing data on quality-of-life in patients with advanced heart failure, discussing and reaching a consensus on the validity and significance of quality-of-life assessment methods. Gaps in routine care and research, which should be addressed, were identified. Finally, published data on the effects of current i.v. vasoactive therapies such as inotropes, inodilators, and vasodilators on quality-of-life in advanced heart failure patients were analysed.
  
  Copyright © 2015. Published by Elsevier Ireland Ltd.
  
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• [Why NAO: Know How. Why and how to choose the new oral anticoagulant in cardiological clinical practice].
  G Ital Cardiol (Rome)

  2015 Mar;16(3):161-74. doi: 10.1714/1820.19826.
  
  Rossini Roberta, Pecora Domenico, Ferlini Marco, Gentile Francesco, Moschini Luigi, Pedrinazzi Claudio, Ravizza Pierfranco, Romano Michele, Canova Paolo, Oliva Fabrizio
  
  Abstract
  
  Although it is well recognized that warfarin dramatically reduces the risk for ischemic stroke, its use for stroke prevention in patients with atrial fibrillation is often inadequate. Even among patients with other known risk factors for stroke (e.g., high blood pressure) and no contraindications to warfarin, warfarin therapy is prescribed in less than 60% of cases. In addition, safety and efficacy of warfarin therapy depend on adequate anticoagulation effect, but time in therapeutic range is 63%. Notably, major bleeding and intracranial hemorrhage represent a feared, though infrequent, complication. Aspirin monotherapy for stroke prevention in patients with atrial fibrillation should be discouraged, as it does not provide adequate protection against stroke and is associated with a significant increase in bleeding complications. New oral anticoagulants have a favorable risk-benefit profile, resulting in significant reductions in stroke, intracranial hemorrhage and mortality, with similar rates of major bleeding compared to warfarin but increased risk for gastrointestinal bleeding. The present review describes the new oral anticoagulants dabigatran, rivaroxaban, apixaban and edoxaban with a focus on the results from major randomized clinical trials and meta-analyses. It also provides practical suggestions for their use in daily clinical practice, introducing a dedicated, novel application for smartphones and tablets.
  
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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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• Predicting short-term mortality in advanced decompensated heart failure - role of the updated acute decompensated heart failure/N-terminal pro-B-type natriuretic Peptide risk score.
  Circ J

  2015 ;79(5):1076-83. doi: 10.1253/circj.CJ-14-1219.
  
  Scrutinio Domenico, Ammirati Enrico, Passantino Andrea, Guida Pietro, D'Angelo Luciana, Oliva Fabrizio, Ciccone Marco Matteo, Iacoviello Massimo, Dentamaro Ilaria, Santoro Daniela, Lagioia Rocco, Sarzi Braga Simona, Guzzetti Daniela, Frigerio Maria
  
  Abstract
  
  BACKGROUND:
  The first few months after admission are the most vulnerable period in patients with acute decompensated heart failure (ADHF).
  
  METHODS AND RESULTS:
  We assessed the association of the updated ADHF/N-terminal pro-B-type natriuretic peptide (NT-proBNP) risk score with 90-day and in-hospital mortality in 701 patients admitted with advanced ADHF, defined as severe symptoms of worsening HF, severely depressed left ventricular ejection fraction, and the need for i.v. diuretic and/or inotropic drugs. A total of 15.7% of the patients died within 90 days of admission and 5.2% underwent ventricular assist device (VAD) implantation or urgent heart transplantation (UHT). The C-statistic of the ADHF/NT-proBNP risk score for 90-day mortality was 0.810 (95% CI: 0.769-0.852). Predicted and observed mortality rates were in close agreement. When the composite outcome of death/VAD/UHT at 90 days was considered, the C-statistic decreased to 0.741. During hospitalization, 7.6% of the patients died. The C-statistic for in-hospital mortality was 0.815 (95% CI: 0.761-0.868) and Hosmer-Lemeshow ?(2)=3.71 (P=0.716). The updated ADHF/NT-proBNP risk score outperformed the Acute Decompensated Heart Failure National Registry, the Organized Program to Initiate Lifesaving Treatment in Patients Hospitalized for Heart Failure, and the American Heart Association Get with the Guidelines Program predictive models.
  
  CONCLUSIONS:
  Updated ADHF/NT-proBNP risk score is a valuable tool for predicting short-term mortality in severe ADHF, outperforming existing inpatient predictive models.
  
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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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• [The serotonin syndrome: why should cardiologists be aware and scared of it].
  G Ital Cardiol (Rome)

  2015 Jan;16(1):34-43. doi: 10.1714/1776.19248.
  
  Temporelli Pier Luigi, Boccanelli Alessandro, Desideri Giovambattista, Faggiano Pompilio, Mora Gabriele, Oliva Fabrizio, Terrosu Pierfranco
  
  Abstract
  
  The serotonin syndrome (SS) represents a life-threatening adverse drug reaction, caused by serotonin overload in the central and peripheral nervous system, producing autonomic instability, neuromuscular and cardiovascular abnormalities, and cognitive alterations. The incidence of SS has been growing over the last few years, as a consequence of population aging and the steadily increasing use of pro-serotoninergic agents in clinical practice, in the presence of various comorbidities, mainly cardiovascular. Cardiologists often use combination therapies including serotoninergic agents, and should therefore consider the risk of serotoninergic adverse events caused by inappropriate drug interactions. SS is often difficult to diagnose and may be life-threatening if not adequately managed. Considering the several published case reports of overdose or not recommended associations, a greater awareness by clinicians about the potential risks associated with inappropriate use of these drugs is needed, as well as better information on the clinical features and therapeutic approaches to SS.
  
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• Giant cell myocarditis successfully treated with antithymocyte globuline and extracorporeal membrane oxygenation for 21 days.
  J Cardiovasc Med (Hagerstown)

  2016 Dec;17 Suppl 2():e151-e153. doi: 10.2459/JCM.0000000000000250.
  
  Ammirati Enrico, Oliva Fabrizio, Belli Oriana, Bonacina Edgardo, Pedrotti Patrizia, Turazza Fabio Maria, Roghi Alberto, Paino Roberto, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  : A 31-year-old man presenting with cardiogenic shock and left ventricular ejection fraction of 10% received the diagnosis of giant cell myocarditis by endomyocardial biopsy. The patient was successfully treated with high-dose inotropes, intra-aortic balloon pump and venoarterial extracorporeal membrane oxygenation for 21 days associated with combined immunosuppression (thymoglobulin, steroids, cyclosporine). Immunosuppression including thymoglobulin is the regimen associated with the highest probability of recovery in case of giant cell myocarditis. Immunosuppression needs time to be effective; thus, hemodynamic support must be guaranteed. In the present case, we observed that full recovery can be obtained up to 21 days of support with extracorporeal membrane oxygenation and adequate immunosuppression.
  
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• Cumulative analysis on 4802 patients confirming that women benefit more than men from cardiac resynchronization therapy.
  Int J Cardiol

  2015 Mar;182():454-6. doi: 10.1016/j.ijcard.2015.01.028.
  
  Cipriani Manlio, Ammirati Enrico, Landolina Maurizio, Oliva Fabrizio, Ghio Stefano, Rordorf Roberto, Lunati Maurizio
  
  
  
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• [Cost-effectiveness and budget impact of ivabradine in heart failure therapy].
  G Ital Cardiol (Rome)

  2014 Nov;15(11):626-33. doi: 10.1714/1694.18508.
  
  Polistena Barbara, Maggioni Aldo Pietro, Oliva Fabrizio, Spandonaro Federico
  
  Abstract
  
  BACKGROUND:
  Cost-effectiveness of ivabradine was assessed by the National Institute for Health and Clinical Excellence (NICE) in 2012, based on the data derived from the SHIFT trial: NICE considered ivabradine cost-effective for treating chronic heart failure, supporting drug reimbursement by the national healthcare system (NHS). The aim of this study was to assess the cost-effectiveness of ivabradine on top of standard care in heart failure therapy, by adapting a Markovian model to the Italian population and organization, previously developed for submission to national regulatory bodies.
  
  METHODS:
  The demographic and clinical characteristics of the Italian population were derived from both the SHIFT trial and the IN-HF Outcome registry (Italian real practice data). Costs were drawn from the Italian NHS information system. All analyses adopted the Italian NHS perspective.
  
  RESULTS:
  In a lifetime horizon, in the base case, our assessment confirms that adoption of ivabradine seems socially acceptable with a cost per quality-adjusted life year (QALY) of ?17,434.86 (incremental cost of ?2,952.85 and QALYs gained 0.21). The incremental cost/life-year gained (LYG) is ?15,557.24 (LYG gained 0.24) and hospitalization costs avoided are ?3,420.77 (avoided hospitalizations 0.76). A probabilistic sensitivity analysis showed that ivabradine on top of standard treatment is cost-effective in more than 87% of cases accepting a threshold of ?30,000, and in more than 93% of cases with a threshold of ?40,000.
  
  CONCLUSIONS:
  The results obtained for the Italian population and in the organizational context of the Italian NHS show social acceptability (cost per QALY) of ivabradine therapy in the treatment of heart failure.
  
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• Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation.
  Eur J Prev Cardiol

  2015 Aug;22(8):1046-55. doi: 10.1177/2047487314551546.
  
  Magrì Damiano, Agostoni Piergiuseppe, Corrà Ugo, Passino Claudio, Scrutinio Domenico, Perrone-Filardi Pasquale, Correale Michele, Cattadori Gaia, Metra Marco, Girola Davide, Piepoli Massimo F, Iorio AnnaMaria, Emdin Michele, Raimondo Rosa, Re Federica, Cicoira Mariantonietta, Belardinelli Romualdo, Guazzi Marco, Limongelli Giuseppe, Clemenza Francesco, Parati Gianfranco, Frigerio Maria, Casenghi Matteo, Scardovi Angela B, Ferraironi Alessandro, Di Lenarda Andrea, Bussotti Maurizio, Apostolo Anna, Paolillo Stefania, La Gioia Rocco, Gargiulo Paola, Palermo Pietro, Minà Chiara, Farina Stefania, Battaia Elisa, Maruotti Antonello, Pacileo Giuseppe, Contini Mauro, Oliva Fabrizio, Ricci Roberto, Sinagra Gianfranco,
  
  Abstract
  
  BACKGROUND:
  Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO2AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties.
  
  DESIGN:
  We tested the prognostic role of VO2AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF.
  
  METHODS:
  Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET).
  
  RESULTS:
  The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p?=?0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO2) showed a prognostic capacity (C-index) similar to that obtained including VO2AT (0.76 vs 0.72). Also, left ventricular ejection fraction, ventilation vs carbon dioxide production slope, ?-blocker and digoxin therapy proved to be significant prognostic indexes. The receiver-operating characteristic (ROC) curves analysis showed that the best predictive VO2AT cut-off for the SR group was 11.7?ml/kg/min, while it was 12.8?ml/kg/min for the AF group.
  
  CONCLUSIONS:
  VO2AT, a submaximal CPET-derived parameter, is reliable for long-term cardiovascular mortality prognostication in stable systolic HF. However, different VO2AT cut-off values between SR and AF HF patients should be adopted.
  
  © The European Society of Cardiology 2014.
  
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• Women with nonischemic cardiomyopathy have a favorable prognosis and a better left ventricular remodeling than men after cardiac resynchronization therapy.
  J Cardiovasc Med (Hagerstown)

  2016 Apr;17(4):291-8. doi: 10.2459/JCM.0000000000000187.
  
  Cipriani Manlio, Landolina Maurizio, Oliva Fabrizio, Ghio Stefano, Vargiu Sara, Rordorf Roberto, Raineri Claudia, Ammirati Enrico, Petracci Barbara, Campo Claudia, Bisetti Silvia, Lunati Maurizio
  
  Abstract
  
  AIMS:
  Cardiac resynchronization therapy (CRT) is a well established therapy in heart failure patients who are on optimal medical therapy and have reduced left ventricular ejection fraction (LVEF) and wide QRS complexes. Although women and patients with nonischemic cardiomyopathy are under-represented in CRT trials and registries, there is evidence that these two groups of patients can benefit more from CRT. The aim of our analysis was to investigate the impact of female sex on mortality in a population that included a high percentage of patients (61%) with nonischemic cardiomyopathy.
  
  METHODS:
  We analyzed data on 507 consecutive patients (20% women) who received CRT at two Italian Heart Transplant centers and were followed up for a maximum of 48 months.
  
  RESULTS:
  After multivariate adjustment, women showed a trend toward better survival with regard to all-cause mortality [hazard ratio (HR) 0.32, confidence interval (CI) 0.10-1.04; P = 0.059]. However, this benefit was limited to nonischemic patients with regard to all-cause mortality (HR 0.20, CI 0.05-0.87, P = 0.032) and cardiovascular mortality (HR 0.14, CI 0.02-1.05, P = 0.056).
  
  CONCLUSION:
  Female CRT recipients, at mid-term, have a favorable prognosis than male patients and this benefit appears to be more evident in nonischemic patients. Thus, we strongly believe that the apparent under-utilization of CRT in females is an anomaly that should be corrected.
  
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• Quality of life and emotional distress early after left ventricular assist device implant: a mixed-method study.
  Artif Organs

  2015 Mar;39(3):220-7. doi: 10.1111/aor.12362.
  
  Modica Maddalena, Ferratini Maurizio, Torri Anna, Oliva Fabrizio, Martinelli Luigi, De Maria Renata, Frigerio Maria
  
  Abstract
  
  Patients who temporarily or permanently rely on left ventricular assist devices (LVADs) for end-stage heart failure face complex psychological, emotional, and relational problems. We conducted a mixed-method study to investigate quality of life, psychological symptoms, and emotional and cognitive reactions after LVAD implant. Twenty-six patients admitted to cardiac rehabilitation were administered quality of life questionnaires (Short Form 36 of the Medical Outcomes Study and Minnesota Living with Heart Failure Questionnaire), the Hospital Anxiety and Depression Scale, and the Coping Orientation for Problem Experiences inventory, and underwent three in-depth unstructured interviews within 2 months after LVAD implant. Quality of life assessment (Short Form 36) documented persistently low physical scores whereas mental component scores almost achieved normative values. Clinically relevant depression and anxiety were observed in 18 and 18% of patients, respectively; avoidant coping scores correlated significantly with both depression and anxiety (Pearson correlation coefficients 0.732, P?0.001 and 0.764, P?0.001, respectively). From qualitative interviews, factors that impacted on LVAD acceptance included: device type, disease experience during transplant waiting, nature of the assisted organ, quality of patient-doctor communication, the opportunity of sharing the experience, and recipient's psychological characteristics. Quality of life improves early after LVAD implant, but emotional distress may remain high. A multidimensional approach that takes into account patients' psychological characteristics should be pursued to enhance LVAD acceptance.
  
  Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
  
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• [Right ventricular dysfunction in advanced heart failure].
  G Ital Cardiol (Rome)

  2014 ;15(7-8):430-40. doi: 10.1714/1596.17420.
  
  Cipriani Manlio, De Chiara Benedetta, Ammirati Enrico, Roghi Alberto, D'Angelo Luciana, Oliva Fabrizio, Moreo Antonella, Bonacina Edgardo, Martinelli Luigi
  
  Abstract
  
  The role of the right ventricle has often been underestimated in heart failure. It has been thought that the right cavity has a less prominent impact on symptoms, therapeutic approach, and prognosis. Right ventricular dysfunction is a complex issue and its diagnosis has acquired a relevant role, in particular with the improvement of new therapeutic options such as ventricular assist devices. The complex geometry of the right ventricle and its interaction with the left ventricle are still a matter of debate, leaving several open questions about the best therapeutic approach to manage right ventricular dysfunction. Echocardiography remains the first-line imaging technique, but an integrated multimodality evaluation with clinical, biochemical and hemodynamic parameters, and cardiovascular magnetic resonance imaging can provide a more comprehensive way to choose the most appropriate treatment for patients with heart failure associated with right ventricular dysfunction.
  
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• Renal dysfunction and accuracy of N-terminal pro-B-type natriuretic peptide in predicting mortality for hospitalized patients with heart failure.
  Circ J

  2014 ;78(10):2439-46.
  
  Scrutinio Domenico, Mastropasqua Filippo, Guida Pietro, Ammirati Enrico, Ricci Vitoantonio, Raimondo Rosa, Frigerio Maria, Lagioia Rocco, Oliva Fabrizio
  
  Abstract
  
  BACKGROUND:
  Renal dysfunction may confound the clinical interpretation of N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration. This study investigated whether renal dysfunction influences the prognostic accuracy of NT-proBNP in acute decompensated heart failure (ADHF).
  
  METHODS AND RESULTS:
  We studied 908 ADHF patients. The primary outcome was 12-month mortality. Interaction between estimated glomerular filtration rate (eGFR) and NT-proBNP in predicting mortality was tested with the likelihood ratio test. The patients were classified into 3 eGFR strata: ?60, 30-59, and 5,180 pg/ml was 2.09 (P
  CONCLUSIONS:
  There was no evidence of interaction between eGFR and NT-proBNP in predicting mortality. The NT-proBNP cut-off of 5,180 ng/L provided independent prognostic information, irrespective of the level of residual renal function.
  
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• Left ventricular or Bi-ventricular assist device? How dobutamine stress echocardiography can untie the dilemma of right ventricular dysfunction.
  Int J Cardiol

  2014 Nov;177(1):e6-8. doi: 10.1016/j.ijcard.2014.07.194.
  
  Ammirati Enrico, Cipriani Manlio, De Chiara Benedetta, D'Angelo Luciana, Belli Oriana, Moreo Antonella, Oliva Fabrizio, Martinelli Luigi, Frigerio Maria
  
  
  
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• Treatment with inotropes and related prognosis in acute heart failure: contemporary data from the Italian Network on Heart Failure (IN-HF) Outcome registry.
  J Heart Lung Transplant

  2014 Oct;33(10):1056-65. doi: 10.1016/j.healun.2014.05.015.
  
  Mortara Andrea, Oliva Fabrizio, Metra Marco, Carbonieri Emanuele, Di Lenarda Andrea, Gorini Marco, Midi Paolo, Senni Michele, Urso Renato, Lucci Donata, Maggioni Aldo P, Tavazzi Luigi,
  
  Abstract
  
  BACKGROUND:
  In the recent Italian Network on Heart Failure (IN-HF) Outcome registry, including 1,855 patients with acute heart failure (AHF), we reviewed the use of inotropes and their prognostic implication on in-hospital and 12-month mortality.
  
  METHODS:
  IN-HF Outcome is a prospective, multicenter, observational, study involving 61 Italian cardiology centers. AHF patients have been enrolled over a 2-year period and followed-up for 1 year. Inotropes were used in 360 patients (19.4%).
  
  RESULTS:
  Patients who received inotropes had a more severe clinical and hemodynamic profile than those who did not and exhibited a significantly higher rate of in-hospital (21.4% vs 2.7%, p 130 mm Hg in 17.5%. Multivariable analyses showed use of inotropes was the strongest predictor of all-cause death. These data were confirmed by propensity score analyses. According to SBP at entry, the 2 groups with SBP > 110 mm Hg who took inotropes, despite a more favorable clinical profile, exhibited a similar worse prognosis, particularly at 1 year: 56.3% (? 110 mm Hg), 43.7% (111-130 mm Hg), and 40.3% (>130 mm Hg) vs 17.7%.
  
  CONCLUSIONS:
  Inotropes were used in nearly 20% of the patient admitted for AHF, and this treatment was associated with a short-term to medium-term poor prognosis. An inappropriate use of inotropes in patients with normal to high SBP, and presumably preserved cardiac output, may have significantly contributed to affect the all-group outcome.
  
  Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
  
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• Transcatheter treatment of chronic mitral regurgitation with the MitraClip system: an Italian consensus statement.
  J Cardiovasc Med (Hagerstown)

  2014 Mar;15(3):173-88. doi: 10.2459/JCM.0000000000000004.
  
  Maisano Francesco, Alamanni Francesco, Alfieri Ottavio, Bartorelli Antonio, Bedogni Francesco, Bovenzi Francesco M, Bruschi Giuseppe, Colombo Antonio, Cremonesi Alberto, Denti Paolo, Ettori Federica, Klugmann Silvio, La Canna Giovanni, Martinelli Luigi, Menicanti Lorenzo, Metra Marco, Oliva Fabrizio, Padeletti Luigi, Parolari Alessandro, Santini Francesco, Senni Michele, Tamburino Corrado, Ussia Gian P, Romeo Francesco
  
  Abstract
  
  New percutaneous technologies are rapidly emerging for the treatment of structural heart disease including mitral valve disease. Preliminary data suggest a potential clinical benefit of percutaneous treatment of mitral regurgitation by the MitraClip procedure in selected patients. Until final data are available from randomized, controlled, multicenter clinical trials, there is an urgent need for a consensus among all the operators involved in the treatment of patients with mitral regurgitation, including clinical cardiologists, heart failure specialists, surgeons, interventional cardiologists, and imaging experts. In the absence of evidence-based guidelines, the heart-team approach is the most reliable method of making proper decisions. This study is the result of multidisciplinary consensus activity, and has the aim of helping physicians in the difficult task of making decisions for the treatment of patients with mitral regurgitation. It is the result of a joint effort of the major Italian Cardiology and Cardiac Surgery Societies, working together to find a proper balance between the points of view of the clinical cardiologist, the interventional cardiologist, and the cardiac surgeon.
  
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• Current indications for heart transplantation and left ventricular assist device: a practical point of view.
  Eur J Intern Med

  2014 Jun;25(5):422-9. doi: 10.1016/j.ejim.2014.02.006.
  
  Ammirati Enrico, Oliva Fabrizio, Cannata Aldo, Contri Rachele, Colombo Tiziano, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  Heart transplantation (HTx) is considered the "gold standard" therapy of refractory heart failure (HF), but it is accessible only to few patients because of the paucity of suitable heart donors. On the other hand, left ventricular assist devices (LVADs) have proven to be effective in improving survival and quality of life in patients with refractory HF. The challenge encountered by multidisciplinary teams in dealing with advanced HF lies in identifying patients who could benefit more from HTx as compared to LVAD implantation and the appropriate timing. The decision-making is based on clinical parameters, imaging-based data and risk scores. Current outcome of HF patients supported by LVAD (2-year survival around 70%) is rapidly improving and leads the way to a new therapeutic strategy. Patients who have a low likelihood to gain access to the heart graft pool could benefit more from LVAD implantation (defined as bridge to transplantation indication) than from remaining on HTx waiting list with the likely risk of clinical deterioration or removal from the list because patients are no longer suitable for transplantation. LVAD has also demonstrated to be effective in patients who are not considered eligible candidates for HTx with a destination therapy indication. HTx should be reserved to those patients for whom the maximum clinical benefit can be expected, such as young patients with no comorbidities. Here we discuss the current listing criteria for HTx and indications to implant of LVAD for patients with refractory acute and chronic HF based on the guidelines and the practical experience of our center.
  
  Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• In-hospital and 1-year outcomes of acute heart failure patients according to presentation (de novo vs. worsening) and ejection fraction. Results from IN-HF Outcome Registry.
  Int J Cardiol

  2014 May;173(2):163-9. doi: 10.1016/j.ijcard.2014.02.018.
  
  Senni Michele, Gavazzi Antonello, Oliva Fabrizio, Mortara Andrea, Urso Renato, Pozzoli Massimo, Metra Marco, Lucci Donata, Gonzini Lucio, Cirrincione Vincenzo, Montagna Laura, Di Lenarda Andrea, Maggioni Aldo P, Tavazzi Luigi,
  
  Abstract
  
  BACKGROUND:
  To investigate the outcomes of hospitalized patients with both de-novo and worsening heart failure (HF) with preserved left ventricular ejection fraction (LVEF) (HFpEF) (LVEF ? 50%), compared to those with reduced LVEF (HFrEF).
  
  METHODS AND RESULTS:
  We studied 1669 patients (22.6% HFpEF) hospitalized for acute HF in the prospective multi-center nationwide Italian Network on Heart Failure (IN-HF) Outcome Registry. In all patients LVEF was assessed during hospitalization. De-novo HF presentations constituted 49.6% of HFpEF and 43.1% of HFrEF hospitalizations. All-cause mortality during hospitalization was lower in HFpEF than HFrEF (2.9% vs 6.5%, p=0.01), but this mortality difference was not significant at 1 year (19.6% vs 24.4%, p=0.06), even after adjusting for clinical covariates. Similarly, there were no differences in 1-year mortality between HFpEF and HFrEF when compared by cause of death (cardiovascular vs non-cardiovascular) or mode of presentation (worsening HF vs de novo). Rehospitalization rates (all-cause, non-cardiovascular, cardiovascular, HF-related) at 90 days and 1 year were also similar. Mode of presentation influenced rehospitalizations in HFpEF, where those presenting with worsening HFpEF had higher all-cause (36.8% vs 21.6%, p=0.001), cardiovascular (28.1% vs 14.9%, p=0.002), and HF-related (21.1% vs 7.7%, p=0.0003) rehospitalization rates at 1 year compared to those with de novo presentations.
  
  CONCLUSIONS:
  Outcomes at 1 year following hospitalization for HFpEF are as poor as that of HFrEF. A prior history of HF decompensation or hospitalization identifies patients with HFpEF at particularly high risk of recurrent events. These findings may have implications for clinical practice, quality and process improvements and trial design.
  
  Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
  
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• [The ROSE study].
  G Ital Cardiol (Rome)

  2014 Jan;15(1):9-12. doi: 10.1714/1394.15512.
  
  Campana Carlo, Oliva Fabrizio
  
  
  
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• Circulatory shock.
  N Engl J Med

  2014 Feb;370(6):582. doi: 10.1056/NEJMc1314999.
  
  Ammirati Enrico, Oliva Fabrizio, Frigerio Maria
  
  
  
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• The ADHF/NT-proBNP risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure.
  J Heart Lung Transplant

  2014 Apr;33(4):404-11. doi: 10.1016/j.healun.2013.12.005.
  
  Scrutinio Domenico, Ammirati Enrico, Guida Pietro, Passantino Andrea, Raimondo Rosa, Guida Valentina, Sarzi Braga Simona, Canova Paolo, Mastropasqua Filippo, Frigerio Maria, Lagioia Rocco, Oliva Fabrizio
  
  Abstract
  
  BACKGROUND:
  The acute decompensated heart failure/N-terminal pro-B-type natriuretic peptide (ADHF/NT-proBNP) score is a validated risk scoring system that predicts mortality in hospitalized heart failure patients with a wide range of left ventricular ejection fractions (LVEFs). We sought to assess discrimination and calibration of the score when applied to patients with advanced decompensated heart failure (AHF).
  
  METHODS:
  We studied 445 patients hospitalized for AHF, defined by the presence of severe symptoms of worsening HF at admission, severely depressed LVEF, and the need for intravenous diuretic and/or inotropic drugs. The primary outcome was cumulative (in-hospital and post-discharge) mortality and post-discharge 1-year mortality. Separate analyses were performed for patients aged ? 70 years. A Seattle Heart Failure Score (SHFS) was calculated for each patient discharged alive.
  
  RESULTS:
  During follow-up, 144 patients (32.4%) died, and 69 (15.5%) underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. After accounting for the competing events (VAD/HT), the ADHF/NT-proBNP score's C-statistic for cumulative mortality was 0.738 in the overall cohort and 0.771 in patients aged ? 70 years. The C-statistic for post-discharge mortality was 0.741 and 0.751, respectively. Adding prior (?6 months) hospitalizations for HF to the score increased the C-statistic for post-discharge mortality to 0.759 in the overall cohort and to 0.774 in patients aged ? 70 years. Predicted and observed mortality rates by quartiles of score were highly correlated. The SHFS demonstrated adequate discrimination but underestimated the risk. The ADHF/NT-proBNP risk calculator is available at http://www.fsm.it/fsm/file/NTproBNPscore.zip.
  
  CONCLUSIONS:
  Our data suggest that the ADHF/NT-proBNP score may efficiently predict mortality in patients hospitalized with AHF.
  
  Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
  
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• [What cardiologists should know to manage acute complications in mechanical circulatory support recipients].
  G Ital Cardiol (Rome)

  2013 Oct;14(10):659-68. doi: 10.1714/1335.14832.
  
  Marini Marco, Raineri Claudia, Di Tano Giuseppe, Cipriani Manlio, Oliva Fabrizio, De Maria Renata,
  
  Abstract
  
  Patients with advanced heart failure refractory to optimal medical treatment have a high mortality and a poor quality of life with frequent hospital admissions. The lack of alternative treatment options has prompted the development of mechanical circulatory support (MCS) devices, first as bridge to heart transplant and subsequently as destination therapy as a valid alternative to transplant. Last generation MCS devices are mechanically reliable and their management has become increasingly less complex. Nowadays, medium-term survival does not significantly differ between MCS and heart transplant recipients. MCS management programs require a multidisciplinary team to optimize the pathway leading to rehabilitation and improved quality of life and decrease the frequent occurrence of complications. However, in the near future with the growing number of implants, the chances for clinical cardiologists to come across a MCS recipient will increase. The management of general or acute problems will no longer be limited to tertiary implanting centers. A key issue to improve patient outcomes is the provision of a smooth and careful transition from the hospital environment to home care. The aim of this review is to start this process by providing basic notions and general indications through several scenarios of MCS recipients presenting to the emergency room for acute clinical problems.
  
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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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• Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome.
  Int J Cardiol

  2013 Oct;168(4):3691-7. doi: 10.1016/j.ijcard.2013.06.020.
  
  Cioffi Giovanni, Mortara Andrea, Di Lenarda Andrea, Oliva Fabrizio, Lucci Donata, Senni Michele, Cacciatore Giuseppe, Chinaglia Alessandra, Tarantini Luigi, Metra Marco, Maggioni Aldo Pietro, Tavazzi Luigi,
  
  Abstract
  
  BACKGROUND:
  Chronic renal dysfunction (RD) frequently coexists with heart failure (HF) and influences outcome. Patients with acute HF (AHF) and severe RD are frequently excluded in the trials. We characterized these subjects and assessed incidence and predictors of in-hospital and one-year mortalities.
  
  METHODS:
  We selected the 455 patients included in the "IN-HF Outcome" Italian registry belonging to the lowest quartile of estimated glomerular filtration rate (eGFR
  RESULTS:
  Mean eGFR at entry in severe RD patients was 28±9 ml/min/1.73 m(2). Compared to 1368 patients with more preserved eGFR, they were older, with more co-morbidities and more frequently ischemic etiology of HF. In-hospital and one-year all-cause mortality rates were 14% and 44% respectively, twice higher than the entire population. Predictors of in-hospital mortality were an abnormal status of consciousness, older age, hyponatremia, lower systolic blood pressure and eGFR. The same conditions (except eGFR) predicted one-year mortality together with the absence of diabetes and no treatment with beta-blockers or diuretics.
  
  CONCLUSIONS:
  In patients with AHF and severe RD, in-hospital and one-year all-cause mortality rates are very high. Independent predictors such as older age, and signs of hypoperfusion and hyponatremia may be identified but preventing and reversing RD remain the key targets for the clinical management of these patients.
  
  © 2013.
  
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• [Treatment of advanced heart failure in women: heart transplantation and ventricular assist devices].
  G Ital Cardiol (Rome)

  2012 May;13(5 Suppl 1):35S-41S.
  
  Cipriani Manlio, Macera Francesca, Verde Alessandro, Bruschi Giuseppe, del Medico Marta, Oliva Fabrizio, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  Women candidates for heart transplantation are definitely less than men, just 20% of all patients transplanted; even in the INTERMACS registry they represent only 21% of all ventricular assist devices (VAD) implanted. The reasons for this big difference are discussed in this article. Why women are less frequently assessed for unconventional therapies? Are they sicker or just less regarded? Our experience and the literature show us clear epidemiological, clinical and treatment differences that could lead to a lower prevalence of end-stage disease in women of an age suitable for unconventional therapies. Once on the transplant list, women wait less than men for a heart transplant, because they present with more severe disease, have a lower body mass index and undergo less VAD implants. After transplantation women's survival is comparable to men's, although they usually complain of a lower quality of life. Females receive less often a VAD than men. The main reasons for this include presentation with advanced heart failure at an older age than men, worse outcomes related to small body surface area, and lower survival rates on VAD when implanted as bridge to heart transplantation.
  
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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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• [ANMCO statement on prevention of thromboembolism in atrial fibrillation and role of the new oral anticoagulants].
  G Ital Cardiol (Rome)

  2013 Apr;14(4):295-322. doi: 10.1714/1257.13889.
  
  Colonna Paolo, Abrignani Maurizio G, Colivicchi Furio, Verdecchia Paolo, Alunni Gianfranco, Bongo Angelo S, Ceravolo Roberto, Oliva Fabrizio, Rakar Serena, Riccio Carmine, Scherillo Marino, Valle Roberto, Bovenzi Francesco,
  
  Abstract
  
  The introduction in the therapeutic armamentarium of three new oral anticoagulants for the prevention of thromboembolism in atrial fibrillation (AF) has stimulated the development of this position paper from the Italian Association of Hospital Cardiologists (ANMCO). First, the pathophysiology of arterial thromboembolism in AF is reviewed, describing the mechanisms of action of the new oral anticoagulants, their pharmacology and pharmacokinetics, and highlighting differences and similarities observed in preclinical studies and trials. Stratification of thromboembolic and bleeding risk is made using different risk scores; a comprehensive analysis of the various international guidelines should emphasize convergences or divergences. An in-depth examination of the limitations of current therapeutic strategies for the prevention of stroke in non-valvular AF provides insight into the difficulty in maintaining adequate adherence to therapy with warfarin and a constant and effective anticoagulation, without wide fluctuations in prothrombin time international normalized ratio (INR) values. Clinical trials of new oral anticoagulants for AF are discussed in detail in the present document, with a focus on similarities and differences, efficacy and safety data, and the net clinical benefit of each new oral anticoagulant. Results obtained in elderly patients, or in patients with renal, liver and ischemic heart disease or previous stroke are reported separately, as well as those regarding combination therapy with antiplatelet agents. Finally, this document provides indications, practical applications and cost-effectiveness analysis of each new oral anticoagulant. It is of utmost importance to know how treatment should be started, how you should switch from warfarin, which patients should be maintained on warfarin, how and when cardioversion, catheter ablation or appendage closure should be performed, what drug and food interactions may affect these medications, and how treatment adherence may be improved to avoid therapy discontinuation. An accurate examination of the risk of bleeding is also provided, with special reference to laboratory monitoring of renal and hepatic function, timing for discontinuing these medications prior to surgery, and treatment of patients with major and minor bleeding.
  
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• Multicenter prospective observational study on acute and chronic heart failure: one-year follow-up results of IN-HF (Italian Network on Heart Failure) outcome registry.
  Circ Heart Fail

  2013 May;6(3):473-81. doi: 10.1161/CIRCHEARTFAILURE.112.000161.
  
  Tavazzi Luigi, Senni Michele, Metra Marco, Gorini Marco, Cacciatore Giuseppe, Chinaglia Alessandra, Di Lenarda Andrea, Mortara Andrea, Oliva Fabrizio, Maggioni Aldo P,
  
  Abstract
  
  BACKGROUND:
  Clinical observational studies on heart failure (HF) deal mostly with hospitalized patients, few with chronic outpatients, all with no or limited longitudinal observation.
  
  METHODS AND RESULTS:
  This is a multicenter, nationwide, prospective observational trial on a population of 5610 patients, 1855 hospitalized for acute HF (AHF) and 3755 outpatients with chronic HF (CHF), followed up for 1 year. The cumulative total mortality rate at 1 year was 24% in AHF (19.2% in 797 patients with de novo HF and 27.7% in 1058 with worsening HF) and 5.9% in CHF. Cardiovascular deaths accounted for 73.1% and 65.3% and HF deaths for 42.4% and 40.5% of total deaths in AHF and CHF patients, respectively. One-year hospitalization rates were 30.7% in AHF and 22.7% in CHF patients. Among the independent predictors of 1-year all-cause death, age, low systolic blood pressure, anemia, and renal dysfunction were identified in both acute and chronic patients. A few additional variables were significant only in AHF (signs of cerebral hypoperfusion, low serum sodium, chronic obstructive pulmonary disease, and acute pulmonary edema), whereas others were observed only in CHF patients (lower body mass index, higher heart rate, New York Heart Association class, large QRS, and severe mitral regurgitation).
  
  CONCLUSIONS:
  In this contemporary data set, patients with CHF had a relatively low mortality rate compared with those with AHF. Rates of adverse outcomes in patients admitted for AHF remain very high either in-hospital or after discharge. Most deaths were cardiovascular in origin and ?40% of deaths were directly related to HF.
  
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• Clinical utility of N-terminal pro-B-type natriuretic peptide for risk stratification of patients with acute decompensated heart failure. Derivation and validation of the ADHF/NT-proBNP risk score.
  Int J Cardiol

  2013 Oct;168(3):2120-6. doi: 10.1016/j.ijcard.2013.01.005.
  
  Scrutinio Domenico, Ammirati Enrico, Guida Pietro, Passantino Andrea, Raimondo Rosa, Guida Valentina, Sarzi Braga Simona, Pedretti Roberto F E, Lagioia Rocco, Frigerio Maria, Catanzaro Raffaella, Oliva Fabrizio
  
  Abstract
  
  BACKGROUND:
  NT-proBNP has been associated with prognosis in acute decompensated heart failure (ADHF). Whether NT-proBNP provides additional prognostic information beyond that obtained from standard clinical variables is uncertain. We sought to assess whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) determination improves risk reclassification of patients with ADHF and to develop and validate a point-based NT-proBNP risk score.
  
  METHODS:
  This study included 824 patients with ADHF (453 in the derivation cohort, 371 in the validation cohort). We compared two multivariable models predicting 1-year all-cause mortality, including clinical variables and clinical variables plus NT-proBNP. We calculated the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI). Then, we developed and externally validated the NT-proBNP risk score.
  
  RESULTS:
  One-year mortalities for the derivation and validation cohorts were 28.3% and 23.4%, respectively. Multivariable predictors of mortality included chronic obstructive pulmonary disease, estimated glomerular filtration rate, sodium, hemoglobin, left ventricular ejection fraction, and moderate to severe tricuspid regurgitation. Adding NT-proBNP to the clinical variables only model significantly improved the NRI (0.129; p=0.0027) and the IDI (0.037; p=0.0005). In the derivation cohort, the NT-proBNP risk score had a C index of 0.839 (95% CI: 0.798-0.880) and the Hosmer-Lemeshow statistic was 1.23 (p=0.542), indicating good calibration. In the validation cohort, the risk score had a C index of 0.768 (95% CI: 0.711-0.817); the Hosmer-Lemeshow statistic was 2.76 (p=0.251), after recalibration.
  
  CONCLUSIONS:
  The NT-proBNP risk score provides clinicians with a contemporary, accurate, easy-to-use, and validated predictive tool. Further validation in other datasets is advisable.
  
  Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
  
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• [Proposal for updated listing criteria for heart transplantation and indications to implant of left ventricular assist devices].
  G Ital Cardiol (Rome)

  2013 Feb;14(2):110-9. doi: 10.1714/1218.13523.
  
  Ammirati Enrico, Oliva Fabrizio, Colombo Tiziano, Botta Luca, Cipriani Manlio, Cannata Aldo, Verde Alessandro, Turazza Fabio M, Russo Claudio F, Paino Roberto, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  Heart transplantation (HTx) is considered to be the gold standard treatment for advanced heart failure (HF) but it is available only for a minority of patients, due to paucity of donor hearts (278 HTx were performed in 2011 in Italy). Patients listed for HTx have a prolonged waiting time (that is about 2.3 years in the 2006-2010 time period in Italy) that is superior compared with patients who receive HTx (median time around 6 months), to underline the presence of an allocation system that prioritizes candidates in critical conditions. Patients listed for HTx have a poor quality of life and their annual mortality is around 8-10%. Another 10-15% of HTx candidates are removed from the waiting list each year because they are no longer suitable for transplantation. On the other hand, continuous-flow left ventricular assist devices (LVADs) have been demonstrated to improve survival and quality of life of patients with advanced/refractory HF. LVAD therapy can represent a valid alternative to HTx, and it is recommended for patients with advanced HF in the recent edition of the European Society of Cardiology guidelines on HF management. In the United States, a larger number of centers compared with European ones started to apply a strategy of LVAD implant for many patients who meet clinical criteria for listing for HTx. Data from our center concerning the last 6 years of LVAD implant (51 implants since 2006) reported a 75.5% survival rate at 1 year. In Italian series, as in our center, current HTx survival is only slightly superior (83% survival rate at 1 year), based on data from the Italian National Transplant Center. We report a proposal for updated listing criteria for HTx and indications for LVAD implant in patients with advanced acute and chronic HF. Criteria for identifying suitable patients for HTx and/or LVAD considering the shortage of donors are discussed.
  
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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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• Acute heart failure patient profiles, management and in-hospital outcome: results of the Italian Registry on Heart Failure Outcome.
  Eur J Heart Fail

  2012 Nov;14(11):1208-17. doi: 10.1093/eurjhf/hfs117.
  
  Oliva Fabrizio, Mortara Andrea, Cacciatore Giuseppe, Chinaglia Alessandra, Di Lenarda Andrea, Gorini Marco, Metra Marco, Senni Michele, Maggioni Aldo P, Tavazzi Luigi,
  
  Abstract
  
  AIMS:
  Registries and surveys improve knowledge of the 'real world'. This paper aims to describe baseline clinical profiles, management strategies, and the in-hospital outcome of patients admitted to hospital for an acute heart failure (AHF) episode.
  
  METHODS AND RESULTS:
  IN-HF Outcome is a nationwide, prospective, multicentre, observational study conducted in 61 Cardiology Centres in Italy. Up to December 2009, 5610 patients had been enrolled, 1855 (33%) with AHF and 3755 (67%) with chronic heart failure (CHF). Baseline and in-hospital outcome data of AHF patients are presented. Mean age was 72 ± 12 years, and 39.8% were female. Hospital admission was due to new-onset heart failure (HF) in 43% of cases. Co-morbid conditions were observed more frequently in the worsening HF group, while those with de novo HF showed a higher heart rate, blood pressure, and more preserved left ventricular ejection fraction (LVEF). Electrical devices were previously implanted in 13.3% of the entire group. Inotropes were administered in 19.4% of the patients. The median duration of hospital stay was 10 days (interquartile range 7-15). All-cause in-hospital death was 6.4%, similar in worsening and de novo HF. Older age, hypotension, cardiogenic shock, pulmonary oedema, symptoms of hypoperfusion, hyponatraemia, and elevated creatinine were independent predictors of all-cause death.
  
  CONCLUSION:
  Our registry confirms that in-hospital mortality in AHF is still high, with a long length of stay. Pharmacological treatment seems to be practically unchanged in the last decades, and the adherence to HF guidelines concerning implantable cardioverter defibrillators/cardiac resynchronization therapy is still very low. Some AHF phenotypes are characterized by worst prognosis and need specific research projects.
  
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• Predicting heart failure outcome from cardiac and comorbid conditions: the 3C-HF score.
  Int J Cardiol

  2013 Feb;163(2):206-11. doi: 10.1016/j.ijcard.2011.10.071.
  
  Senni Michele, Parrella Piervirgilio, De Maria Renata, Cottini Ciro, Böhm Michael, Ponikowski Piotr, Filippatos Gerasimos, Tribouilloy Christophe, Di Lenarda Andrea, Oliva Fabrizio, Pulignano Giovanni, Cicoira Mariantonietta, Nodari Savina, Porcu Maurizio, Cioffi Gianni, Gabrielli Domenico, Parodi Oberdan, Ferrazzi Paolo, Gavazzi Antonello
  
  Abstract
  
  BACKGROUND:
  Prognostic stratification in heart failure (HF) is crucial to guide clinical management and treatment decision-making. Currently available models to predict HF outcome have multiple limitations. We developed a simple risk stratification model, based on routinely available clinical information including comorbidities, the Cardiac and Comorbid Conditions HF (3C-HF) Score, to predict all-cause 1-year mortality in HF patients.
  
  METHODS:
  We recruited in a cohort study 6274 consecutive HF patients at 24 Cardiology and Internal Medicine Units in Europe. 2016 subjects formed the derivation cohort and 4258 the validation cohort. We entered information on cardiac and comorbid candidate prognostic predictors in a multivariable model to predict 1-year outcome.
  
  RESULTS:
  Median age was 69 years, 35.8% were female, 20.6% had a normal ejection fraction, and 65% had at least one comorbidity. During 5861 person-years follow-up, 12.1% of the patients met the study end-point of all-cause death (n=750) or urgent transplantation (n=9). The variables that contributed to outcome prediction, listed in decreasing discriminating ability, were: New York Heart Association class III-IV, left ventricular ejection fraction
  CONCLUSIONS:
  The 3C-HF score, based on easy-to-obtain cardiac and comorbid conditions and applicable to the 1-year time span, represents a simple and valuable tool to improve the prognostic stratification of HF patients in daily practice.
  
  Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
  
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• Use of implantable cardioverter defibrillator and cardiac resynchronization therapy: an Italian survey study on 220 cardiology departments.
  J Cardiovasc Med (Hagerstown)

  2012 Nov;13(11):675-83. doi: 10.2459/JCM.0b013e32834bd918.
  
  Inama Giuseppe, Pedrinazzi Claudio, Landolina Maurizio, Oliva Fabrizio, Senni Michele, Proclemer Alessandro, Berisso Massimo Zoni, Pirelli Salvatore,
  
  Abstract
  
  OBJECTIVES:
  To evaluate the criteria for the use of implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT) and other strategies in order to reduce the incidence of sudden death among adults at high risk and to identify the major barriers for the implementation of quality of care involving Italian cardiology departments in the context of 'Progetto Aritmie Area Scompenso Cardiaco ANMCO'. An additional aim was to evaluate how European Guidelines are applied in 'real-life' scenarios.
  
  METHODS:
  The clinical survey involved 220 centres. An 11-item questionnaire with prespecified multiple choice answers was used. In the specific clinical section, three clinical scenarios were described: the first concerning a patient with non-ischaemic dilated cardiomyopathy and left ventricular ejection fraction (LVEF) 35%; the second, a patient with ischaemic dilated cardiomyopathy and LVEF 30%; and the third, a patient with ischaemic dilated cardiomyopathy and LVEF between 30 and 40%. For each clinical scenario, the centres were asked to indicate whether ICD implantation should be indicated and which diagnostic tests or clinical predictors should be used to stratify the risk.
  
  RESULTS:
  The mean number of procedures (ICD and CRT, ICD alone, CRT alone) performed in each centre was 59 per year with a total number of 11 ?229 procedures per year. ICD, alone or with CRT, was the most common procedure performed with a mean number of 52 implants per centre per year. Concomitant diseases represented the most frequent (>94% of the cases) contraindication. Arrhythmic risk stratification was tested in 76.4% of the centres. Most of the centres (76.4%) stated that they routinely performed adjunctive tests, in addition to LVEF, to identify individuals at higher risk prior to ICD implantation, whereas 23.6% reported that they did not perform any risk stratification. The tools most frequently used for risk stratification (alone or in combination) were as follows: QRS duration on 12-lead ECG (71% of centres), presence of non-sustained ventricular tachycardia on 24-h recording (90%) and programmed ventricular stimulation (65%).
  
  CONCLUSION:
  This survey reveals a fairly good correspondence between the therapeutic choices made by the Italian centres involved in the study and the recommendations set out in the guidelines of the Italian, European and American scientific societies.
  
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• [Selection criteria for referral to cardiac rehabilitation centers].
  Monaldi Arch Chest Dis

  2011 Mar;76(1):1-12.
  
  Greco Cesare, Cacciatore Giuseppe, Gulizia Michele, Martinelli Luigi, Oliva Fabrizio, Olivari Zoran, Seccareccia Fulvia, Temporelli Pier Luigi, Urbinati Stefano, , ,
  
  Abstract
  
  Current guidelines state that cardiac rehabilitation is indicated after the acute phase of major cardiovascular diseases and interventions; on the other hand implementation of these indications is difficult because of several barriers, i.e. the number of patients per year with an indication exceeds by far the accommodation offer of cardiac rehabilitation centers; the demand for access to cardiac rehabilitation from acute cardiac care hospitals is low because the attention is focused on the acute phase of cardiac diseases. The present Consensus Document describes the changes in clinical epidemiology of the main cardiovascular diseases, showing that complications are increasingly more frequent in the postacute phase, especially in the setting of myocardial infarction. The Joint ANMCO/IACPR-GICR Committee defines priority criteria based on clinical risk for admission to cardiac rehabilitation centers as inpatients. This Consensus Document represents, therefore, an important step forward in the search for continuity of care in high-risk patients during the post-acute phase.
  
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• [Selection criteria for patient admission to cardiac rehabilitation centers].
  G Ital Cardiol (Rome)

  2011 Mar;12(3):219-29.
  
  Greco Cesare, Cacciatore Giuseppe, Gulizia Michele, Martinelli Luigi, Oliva Fabrizio, Olivari Zoran, Seccareccia Fulvia, Temporelli Pier Luigi, Urbinati Stefano, , ,
  
  Abstract
  
  Current guidelines state that cardiac rehabilitation is indicated after the acute phase of major cardiovascular diseases and interventions; on the other hand implementation of these indications is difficult because of several barriers, i.e. the number of patients per year with an indication exceeds by far the accommodation offer of cardiac rehabilitation centers; the demand for access to cardiac rehabilitation from acute cardiac care hospitals is low because the attention is focused on the acute phase of cardiac diseases. The present Consensus Document describes the changes in clinical epidemiology of the main cardiovascular diseases, showing that complications are increasingly more frequent in the post-acute phase, especially in the setting of myocardial infarction. The Joint ANMCO/IACPR-GICR Committee defines priority criteria based on clinical risk for admission to cardiac rehabilitation centers as inpatients. This Consensus Document represents, therefore, an important step forward in the search for continuity of care in high-risk patients during the post-acute phase.
  
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• Prevalence and prognostic role of anaemia in patients with acute heart failure and preserved or depressed ventricular function.
  Intern Emerg Med

  2013 Mar;8(2):147-55. doi: 10.1007/s11739-011-0601-z.
  
  Tarantini Luigi, Oliva Fabrizio, Cantoni Silvia, Cioffi Giovanni, Agnoletto Virginia, Alunni Gianfranco, De Cian Francesca, Di Lenarda Andrea, Lucci Donata, Pulignano Giovanni, Scelsi Laura, Maggioni Aldo Pietro, Tavazzi Luigi
  
  Abstract
  
  Observations available for patients with acute heart failure (HF) show conflicting results, and the prognostic role of anaemia ascertained on hospital admission is not well defined. We investigated the database of the Italian Survey on Acute Heart Failure (IS-AHF) to analyze prevalence, factors associated with and the prognostic role of anaemia (defined as haemoglobin 40%) ejection fraction (EF). The median haemoglobin level of the 2,318 patients considered in this analysis was 13 g/dl (inter-quartile range 11.5-14.3). The prevalence of anaemia was 31%. Patients who had anaemia were older, more frequently female gender, hospitalized for a chronic destabilized HF, had higher prevalence of preserved EF, hyponatremia, elevated troponin and other comorbidities (including diabetes, peripheral artery disease, chronic renal failure) than those who did not have anaemia. During the hospital stay, they were treated with higher doses of diuretics, and more frequently required mechanical ventilation and ultrafiltration, and less frequently received ACEi/ARB, aldosterone blockers and beta-blockers at hospital discharge. In-hospital mortality was 12.1 and 5.3% in patients with and without anaemia, respectively (p
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• Orthotopic heart transplantation with donors greater than or equal to 60 years of age: a single-center experience.
  Eur J Cardiothorac Surg

  2011 Jul;40(1):e55-61. doi: 10.1016/j.ejcts.2011.02.013.
  
  Bruschi Giuseppe, Colombo Tiziano, Oliva Fabrizio, Morici Nuccia, Botta Luca, Cannata Aldo, Frigerio Maria, Martinelli Luigi
  
  Abstract
  
  OBJECTIVES:
  Heart transplantation is the best therapeutic option for patients suffering from end-stage heart failure, but donor organ availability still represents a major problem. This had led to a shift toward extended donor criteria. The aim of the present study is to analyze the short- and long-term results of heart transplantation in patients with donor age ? 60 years.
  
  METHODS:
  Since November 1985, 890 patients have been transplanted at our center. We consider, for the present study, only primary adult heart transplantations performed after 1990, totaling 761 patients, mean age at transplantation 49.8 years, and 616 patients being male (81%). We compare the short- and long-term results of patients transplanted with donors younger than 60 years or ? 60 years.
  
  RESULTS:
  Since 1990, at our center, 711 patients have been heart transplanted with a donor younger than 60 years, while 50 patients received a heart from a donor older than 60 years. No differences have been reported in the etiology of cardiomyopathy, previous surgery, or mean ischemic time. Patients transplanted with donors ? 60 years of age were significantly older compared to the younger donors' group. Donor cause of death was a cerebrovascular accident in 82% of donors ? 60 years versus 41% in younger donors. Patients' heart transplanted with donors ? 60 years had a higher incidence of acute graft failure with a hospital mortality of 32% (16 patients) significantly higher compared with 10.2% for the other group. No differences were noticed in the incidence of renal failure, acute rejection treated, coronary allograft vasculopathy, and neoplasm during long-term follow-up.
  
  CONCLUSIONS:
  It was possible to expand the cardiac donor pool by accepting allografts from donors ? 60 years of age in selected cases by performing a coronary angiogram. A meticulous donor evaluation and a careful risk assessment between the risk of death on the waiting list and probable increased hospital mortality are needed.
  
  Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
  
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• Epinephrine for acute decompensated heart failure and low output state: friend or foe?
  Int J Cardiol

  2011 Jun;149(3):384-5. doi: 10.1016/j.ijcard.2011.03.006.
  
  Morici Nuccia, Sacco Alice, Oliva Fabrizio, Ferrari Stefano, Paino Roberto, Milazzo Filippo, Frigerio Maria, Pirola Roberto, Klugmann Silvio, Mafrici Antonio
  
  
  
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• Sensitivity and positive predictive value of implantable intrathoracic impedance monitoring as a predictor of heart failure hospitalizations: the SENSE-HF trial.
  Eur Heart J

  2011 Sep;32(18):2266-73. doi: 10.1093/eurheartj/ehr050.
  
  Conraads Viviane M, Tavazzi Luigi, Santini Massimo, Oliva Fabrizio, Gerritse Bart, Yu Cheuk-Man, Cowie Martin R
  
  Abstract
  
  AIMS:
  Early recognition of impending decompensation and timely intervention may prevent heart failure (HF) hospitalization. We investigated the performance of OptiVol® intrathoracic fluid monitoring for the prediction of HF events in chronic HF patients newly implanted with a device (implantable cardioverter-defibrillator with or without cardiac resynchronization therapy).
  
  METHODS AND RESULTS:
  SENSE-HF was a prospective, multi-centre study that enrolled 501 patients. Phase I (double blinded, 6 months) determined the sensitivity and positive predictive value (PPV) of the OptiVol data in predicting HF hospitalizations. Of 58 adjudicated HF hospitalizations that occurred during the first 6 months in Phase I, 12 were predicted by OptiVol (sensitivity = 20.7%). Sensitivity appeared to be dynamic in nature and at the end of Phase I, had increased to 42.1%. With 253 OptiVol detections, PPV for Phase I was 4.7%. Phase II/III (unblinded, 18 months) determined the PPV of the first OptiVol Patient Alert for detection of worsening HF status with signs and/or symptoms of pulmonary congestion. A total of 233 patients noted such an OptiVol alert and for 210, HF status was evaluated within 30 days. Heart failure status had worsened for 80 patients (PPV = 38.1%).
  
  CONCLUSIONS:
  An intrathoracic impedance-derived fluid index had low sensitivity and PPV in the early period after implantation of a device in chronic HF patients. Sensitivity improved within the first 6 months after implant. Further studies are needed to assess the place of this monitoring technology in the clinical management of patients with HF.
  
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• [Continuity of care in patients with cardiac failure after acute event].
  Monaldi Arch Chest Dis

  2010 Jun;74(2):58-63.
  
  Tridico Caterina, Fontana Giancarlo, Diaco Tommaso, Oliva Fabrizio, Giordano Amerigo, Senni Michele, Filippi Alessandro, Marzegalli Maurizio, Fiorini Gianfrancesco, Ambrosetti Marco, Febo Oreste, ,
  
  
  
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• [Current perspectives in telemonitoring and devices in chronic heart failure patients: lights and shadows].
  G Ital Cardiol (Rome)

  2010 May;11(5 Suppl 2):33S-37S.
  
  Mortara Andrea, Oliva Fabrizio, Di Lenarda Andrea
  
  Abstract
  
  The complexity of an integrated approach, mandatory for chronic diseases such as heart failure, might be simplified by the availability of new technologies for remote data transmission at relatively low costs. Home telemonitoring for complex patients opens new perspectives for the safe discharge of chronically severe patients and intensive surveillance for unstable subjects, and shows potential benefits on patients' quality of life and cost containment. Systematic reviews and meta-analyses document a 30-35% decrease in mortality and a 15-20% reduction in hospital admissions. Critical issues remain the presence of health facilities and professionals both in hospital and in the community adequately prepared for patient management through the telemonitoring tool, the selection of patients who may benefit most from it, and financial reimbursement of remote monitoring. The main indication to telemonitoring is the patient at high risk of short-term hemodynamic deterioration, but psychosocial issues should also be considered. New perspectives for tailored management of heart failure patients come from the recent availability of implantable devices able to record hemodynamic parameters. Current evidence is, however, insufficient to affirm their reliability, efficacy, cost-effectiveness, and management changes that may derive from their use.
  
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• [Consensus document on endomyocardial biopsy of the Associazione per la Patologia Cardiovascolare Italiana].
  G Ital Cardiol (Rome)

  2009 Sep;10(9 Suppl 1):3S-50S.
  
  Leone Ornella, Rapezzi Claudio, Sinagra Gianfranco, Angelini Annalisa, Arbustini Eloisa, Bartoloni Giovanni, Basso Cristina, Caforio Alida L P, Calabrese Fiorella, Coccolo Fabio, d'Amati Giulia, Mariesi Emiliano, Milanesi Ornella, Nodari Savina, Oliva Fabrizio, Perkan Andrea, Prandstraller Daniela, Pucci Angela, Ramondo Angelo, Silvestri Furio, Valente Marialuisa, Thiene Gaetano, ,
  
  Abstract
  
  The Italian Scientific Associations of Cardiologists and Cardiovascular Pathologists have produced this consensus document on the diagnostic role of endomyocardial biopsy (EMB) in terms of techniques, analysis and reporting. The document is intended for clinical cardiologists, hemodynamic experts, electrophysiologists, surgical pathologists, and cardiac surgeons. It has three main aims: a) to collocate EMB in the context of currently available tools for diagnosis of heart diseases; b) to provide recommendations for rational implementation; c) to outline key characteristics (standards) for Italian cardiology and surgical pathology centers that perform and analyze EMB. A general lack of prospective, controlled studies addressing EMB prohibited the use of traditional evidence-based recommendations that rely on classes of available evidence. Thus, it was agreed that three key points should be taken into account: a) the specific pathology to be diagnosed (or excluded); b) the existence of any alternative, non-invasive diagnostic techniques; c) the overall consequences of reaching a definite diagnosis on patients' clinical management. Accordingly, we propose recommendations for EMB based on the following levels of diagnostic value: level 1: no alternative method exists to reach a definite diagnosis that can have obvious consequences for clinical management; level 2a: no alternative method exists to reach a definite diagnosis; however, the implications for clinical management are uncertain; level 2b: no alternative method exists to reach a definite diagnosis; however, the diagnosis would not influence clinical management; level 3: an alternative method exists to reach a definite diagnosis. The second part of the document proposes current protocols for the preparation, analysis and reporting of EMB in the context of each main pathologic entity. Particular attention is given to tissue characterization and implementation of molecular tests.
  
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• Evolution of renal function during and after an episode of cardiac decompensation: results from the Italian survey on acute heart failure.
  J Cardiovasc Med (Hagerstown)

  2010 Apr;11(4):234-43. doi: 10.2459/JCM.0b013e3283334e12.
  
  Tarantini Luigi, Cioffi Giovanni, Gonzini Lucio, Oliva Fabrizio, Lucci Donata, Di Tano Giuseppe, Maggioni Aldo Pietro, Tavazzi Luigi,
  
  Abstract
  
  BACKGROUND:
  Renal dysfunction is frequently associated with heart failure and strongly influences the outcome of heart failure patients. Although recommended pharmacological interventions for heart failure may contribute to the development of, or worsen renal dysfunction, their relations with renal function have not been fully explored in an unselected community population. METHODS AND AIM: We studied 1008 patients recruited in the Italian survey on acute heart failure to assess the prevalence, the prognostic role of renal function and the relations between the changes in renal function and the pharmacological interventions during hospitalization and at 6-month follow-up. Patients were categorized using the National Kidney Foundation cut-offs for degree of renal function measured by the glomerular filtration rate.
  
  RESULTS:
  Moderate-to-severe renal dysfunction was diagnosed in 59% of patients at hospital admission and 61% at discharge. These patients were older and had a higher prevalence of diabetes, anemia, history of hypertension, myocardial infarction and hospitalization for heart failure than those with normal or mildy impaired renal function. At admission the former were treated more frequently with diuretics, angiotensin converting enzyme-inhibitor (ACEi) or angiotensin receptor blockers (ARBs) than the latter. Diuretics were given at higher dose and for a longer time during the hospital stay while beta-blockers, digoxin, antialdosterone agents, ACEi and ARBs were given less frequently in patients who had moderate-to-severe renal dysfunction than those who did not. High-dose diuretic treatment, inability to start or maintain beta-blockers during hospital stay and the nonprescription of ACEi/ARBs at discharge emerged, by multivariate analysis, as predictors of death at 6-month follow-up (mortality rate = 14%), independent of the persistence of moderate-to-severe renal dysfunction over time, anemia, male sex and history of heart failure.
  
  CONCLUSIONS:
  In acute heart failure, renal dysfunction is frequent and impacts prognosis. In this setting, the pharmacological interventions are significantly associated with changes in renal function and 6-month mortality.
  
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• [Inotrope therapy in acute heart failure: a critical review of clinical and scientific evidence for levosimendan in the context of traditional treatment].
  G Ital Cardiol (Rome)

  2009 Jul;10(7):422-33.
  
  Ambrosio Giuseppe, Di Lenarda Andrea, Fedele Francesco, Gabrielli Domenico, Metra Marco, Oliva Fabrizio, Perna Gianpiero, Senni Michele, De Maria Renata
  
  Abstract
  
  The clinical heterogeneity of acute heart failure and the low number of controlled trials, to date, are the main causes of the lack of agreement on therapeutic objectives, uncertainty on the most appropriate management, and difficulties to obtain robust evidence for the treatment of this syndrome. The inappropriate use of inotropic agents is one the most common pitfalls shown by registries. Two to 10% of patients admitted for acute heart failure present with a low output syndrome, a clinical profile associated with high mortality, where inotropes may be a rational therapeutic choice. Crucial points for an effective use of inotropes are an accurate evaluation and selection of patients, tailoring of therapeutic schemes and strict patient monitoring. Beta-adrenergic agonists and phosphodiesterase inhibitors increase myocardial oxygen demand, favor arrhythmias and may cause peripheral vasodilation with a secondary decrease in coronary perfusion pressure. These effects may translate in myocardial ischemia, loss of cardiomyocytes and accelerated ventricular remodeling with worse prognosis. Levosimendan, a novel inotropic agent studied according to the principles of evidence-based medicine, augments myocardial contractility without changes in intracellular calcium concentrations, and with minimal impact on myocardial oxygen consumption. This paper, based on an expert consensus, aims to suggest criteria for the appropriate use of inotropic agents in acute heart failure, based on a critical appraisal of the existing evidence and clinical experience.
  
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• Monitoring intrathoracic impedance with an implantable defibrillator reduces hospitalizations in patients with heart failure.
  Pacing Clin Electrophysiol

  2009 Mar;32(3):363-70. doi: 10.1111/j.1540-8159.2008.02245.x.
  
  Catanzariti Domenico, Lunati Maurizio, Landolina Maurizio, Zanotto Gabriele, Lonardi Gabriele, Iacopino Saverio, Oliva Fabrizio, Perego Giovanni B, Varbaro Annamaria, Denaro Alessandra, Valsecchi Sergio, Vergara Giuseppe,
  
  Abstract
  
  PURPOSE:
  Some implantable cardioverter-defibrillators (ICDs) are now able to monitor intrathoracic impedance. The aim of the study was to describe the use of such monitoring in clinical practice and to evaluate the clinical impact of the fluid accumulation alert feature of these ICDs.
  
  METHODS AND RESULTS:
  Five hundred thirty-two heart failure (HF) patients implanted with these ICDs were followed up for 11 +/- 7 months. A clinical event (CE) was deemed to have occurred if it resulted in hospitalization or milder manifestations of HF deterioration. Three hundred sixty-two acute decreases in intrathoracic impedance (Z events) occurred in 230 patients. Of these episodes, 171 (47%) were associated with a CE within 2 weeks of the Z event. In another 71 (20%) Z events, drug therapy was adjusted despite the absence of overt signs of clinical deterioration. The rate of unexplained Z events was 0.25 per patient-year and 25 hospitalizations were not associated with Z events. The audible alert was disabled in a group of 102 patients (OFF group). HF hospitalizations occurred in 29 (7%) patients in the ON group and 20 (20%, P
  CONCLUSIONS:
  The ICD reliably detected CE and yielded low rates of unexplained and undetected events. The alert capability seemed to reduce the number of HF hospitalizations by allowing timely detection and therapeutic intervention.
  
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• [Management of advanced chronic heart failure].
  G Ital Cardiol (Rome)

  2008 Oct;9(10 Suppl 1):112S-117S.
  
  Oliva Fabrizio, Macera Francesca, Verde Alessandro, Frigerio Maria
  
  Abstract
  
  Because of the progressive ageing of the population and the extensive use of recommended drugs, the number of patients with advanced chronic heart failure constantly increases. Several studies showed the efficacy of neurohormonal antagonists and electric devices in NYHA class III-IV patients; however, there is no agreement on the management of refractory heart failure, especially for patients who are not candidates for heart transplantation, because of age or comorbidity. The treatment with intravenous inotropic agents is considered a palliative care. The growing experience with implant of left ventricular assist devices, on the other hand, is encouraging and suggests more extensive use of these devices, both as bridge to transplant and as destination therapy.
  
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• [Changes in patient survival and quality of life after heart transplantation].
  G Ital Cardiol (Rome)

  2008 Jul;9(7):461-71.
  
  Frigerio Maria, Oliva Fabrizio, Turazza Fabio M, Macera Francesca, Galvanin Silvia, Verde Alessandro, Bruschi Giuseppe, Pedrazzini Giovanna
  
  Abstract
  
  Heart transplantation was performed firstly in 1967, but it became a valuable option in the 1980s, due to the availability of cyclosporine and of the technique for rejection monitoring by means of serial endomyocardial biopsies. Post-transplant survival improved over the years, mainly due to a reduction in early mortality for infection or acute rejection. Expected 1-year and 5-year survivals are around 85% and 70%, respectively. During the past 20-30 years, better therapies for heart failure have been developed, leading to restriction of heart transplant candidacy to truly refractory heart failure. On the contrary, the criteria for donor acceptance have been liberalized, due to the discrepancy between heart transplant candidates and available organs. It must be kept in mind that renal and/or hepatic insufficiency that may be a consequence of heart failure, pulmonary hypertension, and donor age, all remain risk factors for mortality after transplantation. In order to maintain and possibly improve the results of heart transplantation, effective strategies to increase safely the donor pool are of utmost importance. Moreover, long-term post-transplant recipients present new challenges to research and clinical practice. Mechanical circulatory support devices represent a surgical bridge or an alternative to transplantation; their expansion is limited by costs, organizational burden, and by patient difficulties in accepting this therapy.
  
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• Aminothiol redox alterations in patients with chronic heart failure of ischaemic or non-ischaemic origin.
  J Cardiovasc Med (Hagerstown)

  2007 Dec;8(12):1024-8.
  
  Campolo Jonica, Caruso Raffaele, De Maria Renata, Parolini Marina, Oliva Fabrizio, Roubina Elena, Cighetti Giuliana, Frigerio Maria, Vitali Ettore, Parodi Oberdan
  
  Abstract
  
  OBJECTIVE:
  Oxidative stress plays a role in the progression of chronic heart failure (CHF), but whether and how ischaemic heart disease (IHD) or non-IHD aetiology may account for differential redox alterations is currently unclear. We assessed the relation between thiol redox state and lipid peroxidation, as a marker of oxidative stress, in patients with CHF of ischaemic or non-ischaemic origin.
  
  METHODS:
  Blood reduced glutathione, plasma total and reduced cysteine, cysteinylglycine, homocysteine, glutathione, plasma alpha-tocopherol, ascorbic acid, and free malondialdehyde were assessed in 43 CHF heart transplant candidates (24 IHD and 19 non-IHD) and 30 controls matched for age, gender and number of atherosclerotic risk factors.
  
  RESULTS:
  Reduced cysteine was increased in CHF patients compared with controls. The highest levels were found in IHD versus non-IHD patients versus controls. Malondialdehyde levels were significantly higher in IHD patients than in controls, whereas antioxidant vitamins did not differ among the three groups.
  
  CONCLUSIONS:
  Specific abnormalities in the thiol pattern are associated with heart failure aetiology in CHF patients. Our findings point to the possible role of reduced cysteine in the progression of chronic IHD to heart failure status, as an additional pro-oxidant stimulus for worsening oxidative stress.
  
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• [Heart failure: critical patients].
  G Ital Cardiol (Rome)

  2007 Sep;8(9):568-73.
  
  Fabbri Gianna, Gorini Marco, Maggioni Aldo P, Oliva Fabrizio,
  
  Abstract
  
  Patients with heart failure in the "real world" are often elderly and with multiple comorbid diseases. These conditions create a dilemma for the physician responsible for the treatment of heart failure and are associated with a substantial underutilization of evidence-based treatments. Clarifying the prognostic impact of comorbidities in heart failure could provide more precise risk stratification and optimize the management of these patients. The negative prognostic impact of concomitant diseases has been shown in several studies: in the TEMISTOCLE study, carried out in Italy on patients hospitalized for heart failure in Internal Medicine and Cardiology wards, the presence of comorbidities was associated with higher in-hospital mortality and prolonged length of stay. In the IN-CHF registry, enrolling out patients with heart failure in a cardiological setting, the rate of coexisting diseases is not very high according to the epidemiological characteristics of this population. Renal impairment, particularly in patients >70 years old, and chronic obstructive pulmonary disease (COPD) are frequent comorbid diseases in heart failure. Renal impairment has been recognized as an independent risk factor for morbidity and mortality in heart failure while the role of COPD is controversial. Patients with renal dysfunction and COPD have largely been excluded from randomized controlled trials for safety reasons, so data are scarce. In the IN-CHF registry the prevalence of elderly patients with renal impairment (serum creatinine > or = 2 mg/dl and age > or = 70 years) is 5.1%; this subgroup of patients has an increased risk for both 1-year death (28.1 vs 11.2%) and hospital admission (34.9 vs 22.5%) compared with the remaining population. The prescription pattern has been evaluated in the last years (2003-2005) and shows that angiotensin system inhibitors (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers) as well as beta-blockers are less prescribed in these patients (78.9 vs 86.1% and 42.2 vs 55.9%, respectively). The prevalence of patients with COPD in the registry was 13.2%: considerable differences in COPD prevalence estimates exist in the general population depending on many factors such as method for diagnosis or lack of agreement on diagnostic criteria. COPD patients were older and with more severe symptoms; with respect to the pharmacological treatment, beta-blockers are significantly less prescribed in COPD patients while a similar proportion of patients are receiving angiotensin system antagonists. The adjusted analysis shows that COPD in not an independent predictor of 1-year mortality in this population while it is independently associated with 1-year all-cause hospitalization. Non-cardiovascular hospital admissions seem to be more influenced by the presence of this comorbidity than cardiovascular admissions.
  
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• [Heart failure: the importance of a disease management program].
  G Ital Cardiol (Rome)

  2007 Jun;8(6):353-8.
  
  Fabbri Gianna, Gorini Marco, Maggioni Aldo P, Oliva Fabrizio,
  
  Abstract
  
  Heart failure remains a growing public health problem, hospitalizations represent the main cost component of heart failure care and the poor quality of life of patients is often worsened by frequent admissions. A multidisciplinary approach and specific disease management programs are a potentially useful instrument to reducing hospitalizations in heart failure patients. These concepts have recently been discussed in a consensus document by all the Scientific Societies involved in the care of heart failure patients. The effectiveness of intervention programs delivering continuity of care by a multidisciplinary team achieved a promising reduction in admissions, but the results of the studies have not been univocal for category of strategies and about the effect on survival. Telephone intervention significantly decreased heart failure admissions but not all-cause admissions and mortality. The multicenter randomized DIAL study, comparing a centralized telephone intervention program delivering continuity of care by a multidisciplinary team with usual care in patients with heart failure, confirms these findings. After a mean 16-month follow-up, there was a benefit mostly due to a significant reduction in admissions for heart failure, but mortality was similar in both groups. Data on 9000 patients from the IN-CHF registry show that hospitalizations are a serious problem in Italy: 44% of the patients had at least one hospitalization for heart failure in the year prior to the entry visit and this is the most powerful independent predictor of rehospitalization during the follow-up. Nearly a quarter of the population with follow-up data availability (92%) has been rehospitalized in the year after enrollment; patients in advanced functional class (32.1% hospitalization rate) and with ischemic etiology (25.0%) are more likely to be hospitalized than those in NYHA class I-II and without ischemic etiology. In a survey carried out recently in Italy, in 1152 patients admitted for decompensated heart failure, readmission rate was even higher: more than 40% of patients have been readmitted once in the 6 months after discharge and 7.2% had two or more admissions.
  
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• Hydrotherapy in advanced heart failure: the cardio-HKT pilot study.
  Monaldi Arch Chest Dis

  2006 Dec;66(4):247-54.
  
  Municinó Annamaria, Nicolino Annamaria, Milanese Manlio, Gronda Edoardo, Andreuzzi Bruno, Oliva Fabrizio, Chiarella Francesco,
  
  Abstract
  
  BACKGROUND:
  In-water exercise, hydrotherapy, may offer an attractive alternative to conventional training in markedly compromised patients with advanced HF. This Pilot Study evaluates the safety and efficacy of Cardio-Hydrokinesitherapy (Cardio-HKT) in patients with advanced HF on optimal medical therapy. Cardio-HKT is a novel rehabilitation program that includes training sessions in warm water (31 degrees C), integrated by educational and psycho-behavioural sessions to promote healthy life style modifications.
  
  METHODS:
  We studied 18 adult patients with advanced HF, LVEF II and peak oxygen uptake (peak VO2)
  RESULTS:
  All patients completed the Cardio-HKT rehabilitation program without complications. The 6mWT improved from 453 +/- 172 m to 571 +/- 120 m (p
  CONCLUSIONS:
  Our results support the safety and efficacy of the innovative Cardio-HKT rehabilitation program in patients with advanced HF.
  
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• Bridge to transplantation with the MicroMed DeBakey ventricular assist device axial pump: a single centre report.
  J Cardiovasc Med (Hagerstown)

  2006 Feb;7(2):114-8.
  
  Bruschi Giuseppe, Ribera Elena, Lanfranconi Marco, Russo Claudio, Colombo Tiziano, Garatti Andrea, Oliva Fabrizio, Milazzo Filippo, Frigerio Maria, Vitali Ettore
  
  Abstract
  
  OBJECTIVE:
  Left ventricular assist devices (VADs) are an accepted therapy to bridge patients with end-stage heart failure to heart transplantation. The DeBakey VAD, a continuous axial flow pump weighing 93 g, has been introduced into clinical practice as a bridge to transplant.
  
  METHODS:
  Starting from April 2000,17 patients (12 males, five females, mean age 44.3 +/- 12.8 years; 11 dilated idiopathic cardiomyopathy, five ischaemic cardiomyopathy, one pulsatile device failure) with end-stage heart failure were implanted with a DeBakey VAD as a bridge to transplantation at our institution. Before implant, all patients suffered from severe heart failure (New York Heart Association functional class IV) despite optimal medical therapy and were put on the waiting list for heart transplantation. Mean cardiac index was 1.59 +/- 0.51 l/min/m2.
  
  RESULTS:
  Fourteen patients were successfully transplanted after 99 +/- 117 days of assistance (range 11-443 days). Two patients died during assistance of multiorgan failure, one patient is still on VAD. No patient needed additional right ventricular mechanical support. Left ventricular/left VAD thrombosis occurred in one patient who was successfully treated conservatively. No clinical elevation of plasma free haemoglobin was detected. Neither device, driveline, abdominal pocket infection nor device failure occurred.
  
  CONCLUSIONS:
  In our experience with the continuous axial flow DeBakey VAD, a high success rate was obtained associated with a low risk of complications. All the patients tolerated continuous blood flow for extended periods that makes this device a valuable alternative to pulsatile VADs as a bridge to transplantation.
  
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• Nationwide survey on acute heart failure in cardiology ward services in Italy.
  Eur Heart J

  2006 May;27(10):1207-15.
  
  Tavazzi Luigi, Maggioni Aldo P, Lucci Donata, Cacciatore Giuseppe, Ansalone Gerardo, Oliva Fabrizio, Porcu Maurizio,
  
  Abstract
  
  AIMS:
  Chronic heart failure (HF) is recognized as an important public health problem but little attention has been focused on acute-stage HF.
  
  METHODS AND RESULTS:
  Nationwide, prospective, observational study setting 206 cardiology centres with intensive cardiac care units. During 3 months, 2807 patients diagnosed as having de novo acute HF (44%) or worsening chronic HF (56%) were enrolled. Acute pulmonary oedema was the presenting clinical feature in 49.6% of patients, cardiogenic shock in 7.7%, and worsened NYHA functional class in 42.7% of cases. Anaemia (Hb or =1.5 mg%) in 47%, and hyponatraemia (40% was found in 34% of cases. Intravenous diuretics, nitrates, and inotropes were given to 95, 51, and 25% of patients, respectively. The median duration of hospital stay was 9 days. In-hospital mortality rate was 7.3%. Older age, use of inotropic drugs, elevated troponin, hyponatraemia, anaemia, and elevated blood urea nitrogen were independent predictors of all-cause death; prior revascularization procedures and elevated blood pressure were indicators of a better outcome. The rehospitalization rate within 6 months was 38.1%, all-cause mortality from discharge to 6 months was 12.8%.
  
  CONCLUSION:
  Acute HF is an ominous condition, needing more research activity and resources.
  
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• [Mechanical assist devices in advanced heart failure. Indications and perspectives].
  G Ital Cardiol (Rome)

  2006 Feb;7(2):91-108.
  
  Colombo Tiziano, Russo Claudio, Lanfranconi Marco, Bruschi Giuseppe, Garatti Andrea, Milazzo Filippo, Catena Emanuele, Oliva Fabrizio, Turazza Fabio, Frigerio Maria, Vitali Ettore
  
  Abstract
  
  Congestive heart failure is recognized as a major public health issue and is the leading cause of death in western countries. Heart transplantation currently remains the gold standard option for end-stage heart failure patients. Heart transplantation is also one of the most limited therapies, not only with regard to the lack of donor hearts but also because of the surgical limitations inherent to the clinical aspects of this severely ill patient population. Mechanical circulatory support systems have been developed as effective adjuvant therapeutic options in these terminally ill patients. Over the past two decades, mechanical circulatory support devices have steadily evolved in the clinical management of end-stage heart failure, and have emerged as a standard of care for the treatment of acute and chronic heart failure refractory to conventional medical therapy. Future blood pumps should be smaller and totally implantable, as well as more efficient, biocompatible, and reliable.
  
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• [Prevention, a primary objective according to the last revision of the European Society of Cardiology guidelines on chronic heart failure: is it possible to intervene early in high-risk patients?].
  Ital Heart J Suppl

  2005 Nov;6(11):716-9.
  
  Tarantini Luigi, Pulignano Giovanni, Oliva Fabrizio, Alunni Gianfranco, Di Lenarda Andrea
  
  
  
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• Fulminant myocarditis during HIV seroconversion: recovery with temporary left ventricular mechanical assistance.
  Ital Heart J

  2004 Mar;5(3):228-31.
  
  Brucato Antonio, Colombo Tiziano, Bonacina Edgardo, Orcese Carloandrea, Vago Luca, Oliva Fabrizio, Distefano Giada, Frigerio Maria, Paino Roberto, Violin Michela, Agati Salvatore, Vitali Ettore
  
  Abstract
  
  A 32-year-old male was admitted to our intensive care unit for low cardiac output syndrome. Echocardiography was suggestive of extensive hypokinesia and the ejection fraction was 0.22. Serological tests, including anti-HIV antibodies (ELISA), were negative. The patient was intubated and an intra-aortic balloon pump was inserted. Twenty-four hours after admission a paracorporeal left ventricular assist device (LVAD-MEDOS) was implanted. The left ventricular function showed progressive improvement with normalization of the ejection fraction on day 19. The device was removed on day 20. Before discharge, the patient admitted that he had had unprotected sex with numerous male acquaintances; anti-HIV testing turned positive. The final diagnosis was fulminant myocarditis during HIV seroconversion.
  
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• [Heart failure in the elderly: do differences in etiology and pathophysiology require different therapeutic strategies? Pros].
  Ital Heart J

  2003 Dec;4 Suppl 8():39S-44S.
  
  Frigerio Maria, Oliva Fabrizio
  
  
  
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• [Is it time to organize a "new " campaign against congestive heart failure?].
  Ital Heart J Suppl

  2003 Mar;4(3):232-6.
  
  Mangia Rolando, Senni Michele, Cacciatore Giuseppe, Del Sindaco Donatella, Pozzi Roberto, Di Lenarda Andrea, Oliva Fabrizio, Clemenza Francesco, Porcu Maurizio
  
  
  
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• Prevention and management of chronic heart failure in management of asymptomatic patients.
  Am J Cardiol

  2003 May;91(9A):4F-9F.
  
  Frigerio Maria, Oliva Fabrizio, Turazza Fabio M, Bonow Robert O
  
  Abstract
  
  Symptomatic heart failure is preceded by a somewhat prolonged asymptomatic stage in many patients. The number of patients with asymptomatic heart dysfunction is about 4-fold greater than the number of patients with clinically overt heart failure. Pharmacologic treatment with angiotensin-converting enzyme inhibitors and beta-blockers (in particular carvedilol) of asymptomatic patients with systolic left ventricular (LV) dysfunction can prevent or delay the occurrence of symptoms and reduce mortality in the long term. Thus, it would be of utmost importance to recognize and appropriately treat these patients before they develop heart failure symptoms. The cost-effectiveness of screening for asymptomatic heart dysfunction in the general population and in cohorts at risk has not been extensively evaluated. A normal electrocardiogram has a high negative predictive value in patients at risk. Echocardiography is the best tool for diagnosis and characterization of heart dysfunction, but extensive use is limited by availability and cost. Natriuretic peptides (brain natriuretic peptide and N-terminal pro-brain natriuretic peptide) are very sensitive markers of heart dysfunction and volume overload, and their measurement has been proposed as a first-line test to select patients who need echocardiography. The definition of the etiology of LV dysfunction--in particular, of the ischemic etiology--has prognostic and therapeutic implications. In addition to revascularization, pharmacologic treatment with antiplatelets and statins is helpful in preventing new ischemic events and the development of heart failure. The prevention, or at least the delay, of clinical manifestations of heart failure is strongly related to an effective approach to the asymptomatic stage. Therefore, it is important to educate the entire medical community, particularly physicians in the primary care setting, about recognition and treatment of these patients.
  
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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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• [Refractory heart failure. Models of hospital, ambulatory, and home management].
  Ital Heart J Suppl

  2002 Aug;3(8):837-50.
  
  Oliva Fabrizio, Alunni Gianfranco
  
  Abstract
  
  Chronic heart failure is an enormous and growing public health problem and is reaching epidemic proportions. Its economic impact is dramatic; two thirds of expenses are for hospitalizations and relatively little is being spent for medications and outpatient visits. Most of the hospitalizations, deaths and costs are incurred by a relatively small minority of patients who may be described as having "complex", "advanced", "refractory" or "end-stage" heart failure; however, in essence they are patients who have severe symptoms and/or recurrent hospitalizations and/or emergency department visits despite maximal oral therapy. Many of the recommendations regarding the management of these patients are based more on experience than on evidence from controlled trials. This, because such patients require an individualized therapy which limits their inclusion in large trials and because support is less easily available when testing specific strategies than when testing specific agents. Improving the treatment of this group of patients by optimizing their medical regimen, aggressive monitoring and providing early intervention to avert heart failure can reduce their morbidity, mortality and costs of care. Refractory heart failure is not a single disease and it is extremely unlikely that all patients should be treated in a similar manner; before selecting the appropriate therapy, the clinician must categorize and profile the patient. The first step should be a re-evaluation of the previous treatment because many patients are treated suboptimally. It is also important to identify reversible or precipitating factors. For patients with advanced heart failure, the initial goal of therapy is to improve symptoms; the next goal is to maintain the improvement and to prevent later deterioration. The appropriate treatment plan will reflect the presence of comorbidities, the patients' history regarding previous responses to therapy, their own expectations with regard to daily life. The most common symptoms causing hospitalizations are those related to congestion; the distinction between the rising filling pressures and low cardiac output puts the focus on the adjustment of further medical therapy. The persistence of congestion confers a worse prognosis and urgency for the consideration of surgical therapies. It has been repeatedly shown that in case of heart failure, fewer hospitalizations and lower costs are necessary after referral to programs that provide multidisciplinary care. This care includes heart failure physician specialists with specifically trained clinical nurses. Other important components of a comprehensive management program for advanced heart failure are patient education, rehabilitation and the availability of adequate social service. We have entered a difficult era marked by a collision course between increasing scientific discoveries and restricted resources; a better care for heart failure, integrating improved medical practice with the necessity of bearing the financial pressures in mind, constitutes a great opportunity for medicine.
  
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• Patient selection for biventricular pacing.
  J Cardiovasc Electrophysiol

  2002 Jan;13(1 Suppl):S63-7.
  
  Lunati Maurizio, Paolucci Marco, Oliva Fabrizio, Frigerio Maria, Magenta Giovanni, Cattafi Giuseppe, Vecchi Rita, Vicini Ilaria, Cavaglià Sergio
  
  Abstract
  
  INTRODUCTION:
  Biventricular pacing improves functional status in the majority of patients with drug-refractory heart failure, dilated cardiomyopathy, and interventricular conduction delay. The aim of this study was to analyze the baseline clinical and functional data of a cohort of patients implanted with a biventricular stimulation system in a single-center experience, to verify if the pathophysiologic characteristics of patients affect outcome, and to determine if preliminary identification of the right candidates for the new therapy is possible with noninvasive parameters.
  
  METHODS AND RESULTS:
  Since March 1999, 52 patients with advanced heart failure (idiopathic cardiomyopathy 50%, ischemic cardiomyopathy 35%, other etiology 15%) and left bundle branch block underwent cardiac resynchronization and were followed prospectively. Paired analysis over mean (+/- SD) follow-up of 348 +/- 154 days showed an overall significant decrease of QRS width (baseline 194 +/- 33.2 msec vs follow-up 159.6 +/- 20.1 msec), New York Heart Association (NYHA) functional class (baseline 3.2 +/- 0.5 vs follow-up 2.3 +/- 0.5), quality-of-life score (baseline 54 +/- 25 vs follow-up 25 +/- 16), and increase of maximal VO2 (baseline 12.6 +/- 2.5 mL/kg/min vs follow-up 15.0 +/- 3.3 mL/kg/min). There were 80% responders (documented, persistent decrease > or = 1 NYHA class) and 20% nonresponders (same NYHA class or decline of status; need for heart transplant; death due to progressive pump failure). No significant differences in baseline clinical and functional variables between the two subgroups were observed. In responders, there was a highly significant global improvement of all variables; in nonresponders, no parameters changed between baseline and follow-up.
  
  CONCLUSION:
  These data confirm the role of biventricular pacing in improving the functional status of the great majority of a selected patient population having advanced heart failure and left bundle branch block with wide QRS complex. Basal demographic, clinical, and functional characteristics are not helpful in preliminary selection of responders. Simple evaluation of NYHA class confirms favorable outcome (improvement of functional and hemodynamic status).
  
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