Francesco Lo Giudice | Imperial College London (original) (raw)
Papers by Francesco Lo Giudice
ESC heart failure, Jun 13, 2024
Echo Research and Practice, Jun 3, 2024
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart di... more Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j. jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates
‘Drop the pressure’ – Investigating and treating pulmonary vascular disease
Clinical research in cardiology, Apr 15, 2024
European Journal of Echocardiography, 2010
Introduction: Transoesophageal echocardiography (TOE) has become routine during cardiac surgery f... more Introduction: Transoesophageal echocardiography (TOE) has become routine during cardiac surgery for evaluation of cardiac function and valve morphology prior and after repair of cardiac disease. Major complications of TOE are reported to be rare, especially in the hands of experienced investigators. However,a TOE probe might cause minor injuries in the stomach, especially if the procedure takes several hours. We therefore hypothesized that minor injuries are a common sequel of long-time TOE during cardiac surgery. Material and Methods: After induction of anesthesia in patients undergoing elective cardiac interventions, endoscopy of pharynx, esophagus and stomach was performed in order to exclude any previous lesion. A TOE probe was then inserted as part of the routine procedure and left in place until the operation was finished and the patient in stable condition to be transferred to the intensive care unit. The TOE probe was then removedand endoscopy was performed a second time to detect any new lesions in the stomach. All lesions of the mucosa were documented (type, localization, and number) as well the time needed for the TOE examinations before and after the cardiopulmonary bypass (CPB). Data are expressed as mean + standard deviation. Results: After approval of the Ethics committee and obtaining informed consent ten patients were included in our study. Duration of TOE probes in situ was 453 + 20 minutes. Of the ten patients included in the study only 1 patient had no lesion. In two patients only 1 lesion and in the others more than one could be detected. Five patients had 2 lesions and the last 2 patients had 3 and 4 lesions, respectively (1,9 + 1,1 lesions per patient). Most of the lesions were localized in the esophagus (10) and in the stomach (6); 2 lesions were detected in the pharynx and 1 lesion in the gastroesophageal junction. Most of the lesions were petechiae (9) and hematomas (6), while mucosal erosions and erythemas were present only two times. Severe lesions could not be detected. Conclusions: Our results have shown that minor injuries are caused frequently by TOE probes where the oesophageal and gastric mucosa are the most involved areas. A bigger sample size is needed to confirm if a longer duration the TOE probe in situ (more than 7 hours) is associated with more lesions. Furthermore, more lesions could also affect ICU and hospital length of stay.
European Journal of Echocardiography, 2010
Introduction: Transoesophageal echocardiography (TOE) has become routine during cardiac surgery f... more Introduction: Transoesophageal echocardiography (TOE) has become routine during cardiac surgery for evaluation of cardiac function and valve morphology prior and after repair of cardiac disease. Major complications of TOE are reported to be rare, especially in the hands of experienced investigators. However,a TOE probe might cause minor injuries in the stomach, especially if the procedure takes several hours. We therefore hypothesized that minor injuries are a common sequel of long-time TOE during cardiac surgery. Material and Methods: After induction of anesthesia in patients undergoing elective cardiac interventions, endoscopy of pharynx, esophagus and stomach was performed in order to exclude any previous lesion. A TOE probe was then inserted as part of the routine procedure and left in place until the operation was finished and the patient in stable condition to be transferred to the intensive care unit. The TOE probe was then removedand endoscopy was performed a second time to detect any new lesions in the stomach. All lesions of the mucosa were documented (type, localization, and number) as well the time needed for the TOE examinations before and after the cardiopulmonary bypass (CPB). Data are expressed as mean + standard deviation. Results: After approval of the Ethics committee and obtaining informed consent ten patients were included in our study. Duration of TOE probes in situ was 453 + 20 minutes. Of the ten patients included in the study only 1 patient had no lesion. In two patients only 1 lesion and in the others more than one could be detected. Five patients had 2 lesions and the last 2 patients had 3 and 4 lesions, respectively (1,9 + 1,1 lesions per patient). Most of the lesions were localized in the esophagus (10) and in the stomach (6); 2 lesions were detected in the pharynx and 1 lesion in the gastroesophageal junction. Most of the lesions were petechiae (9) and hematomas (6), while mucosal erosions and erythemas were present only two times. Severe lesions could not be detected. Conclusions: Our results have shown that minor injuries are caused frequently by TOE probes where the oesophageal and gastric mucosa are the most involved areas. A bigger sample size is needed to confirm if a longer duration the TOE probe in situ (more than 7 hours) is associated with more lesions. Furthermore, more lesions could also affect ICU and hospital length of stay.
Journal of Cardiovascular Medicine, Sep 1, 2009
Few data are available in the literature regarding the characteristics and prognosis of asymptoma... more Few data are available in the literature regarding the characteristics and prognosis of asymptomatic patients with idiopathic dilated cardiomyopathy (DCM). To determine the frequency with which patients affected by DCM are diagnosed in the asymptomatic state as well as to evaluate the natural history of such patients and the factors influencing their outcome. Moreover, we sought to compare the outcome of asymptomatic patients with that of patients with signs of overt heart failure at the time of first evaluation. We analyzed the data of 747 patients with DCM enlisted in the Heart Muscle Disease Registry of Trieste from 1978 to 2007. We divided our population into four groups; group 1 comprised 118 asymptomatic [New York Heart Association (NYHA) I] patients without a history of congestive symptoms (16%), group 2 comprised 102 asymptomatic (NYHA I) patients (14%) with a positive anamnesis for heart failure stabilized in medical therapy, group 3 comprised 327 patients (44%) with signs of mild heart failure (NYHA II) and group 4 comprised 200 patients (26%) in NYHA III-IV. During the follow-up of 112+/-63 months, 46 (21%) of 220 asymptomatic patients with DCM died or underwent heart transplantation. By Cox proportional model, left ventricular ejection fraction of 30% or less was a unique independent predictor either for death/heart transplantation (hazard ratio 3.15, 95% confidence interval 1.5-6.7, P=0.003) or for sudden death/major ventricular arrhythmias (hazard ratio 3.9, 95% confidence interval 1.7-9.3, P=0.002). Patients from group 1 had a trend for a better outcome with respect to those from group 2 (P=0.06). In comparison with the asymptomatic patients, those with signs of overt heart failure at baseline had a worse prognosis. The proportion of asymptomatic patients with DCM at the moment of first evaluation at our center is significant (30%). Among them, those without a previous history of heart failure had a less advanced disease and a trend for a better long-term outcome on optimal medical treatment. Therefore, early diagnosis may offer better long-term quality of life and even better survival. Further studies on larger populations are indicated.
European Heart Journal Supplements, Dec 14, 2022
Background Risk scores are important tools for the prognostic stratification of pulmonary arteria... more Background Risk scores are important tools for the prognostic stratification of pulmonary arterial hypertension (PAH). Their performance and the additional impact of comorbidities across age groups is unknown. Methods Patients with PAH enrolled from 2001 to 2021 were divided in ≥ 65 years old vs <65 years old patients. Study outcome was 5-year all-cause mortality. FPHN, FPHN non-invasive, COMPERA and REVEAL 2.0 risk scores were calculated and patients categorized at low, intermediate and high risk. Number of comorbidities was calculated. Results Among 383 patients, 152 (40%) were ≥ 65 years old. Older patients had more comorbidities, with the exception of obesity and diabetes (number of comorbidities 2, IQR 1-3, vs 1, IQR 0-2 in <65 years patients). At 5-year follow-up, 36% of ≥ 65 years patients vs 10% of <65 years patients died. Except for the COMPERA, risk scores correctly discriminated the different classes of risk in the overall cohort and in the older and younger groups. REVEAL 2.0 showed the best accuracy in the total cohort (C-index 0.74) and in younger (C-index 0.72) and older (C-index 0.69) patients. Number of comorbidities was associated with higher 5-year mortality, and consistently increased the accuracy of risk scores, in younger but not in older patients, with the highest accuracy achieved in addition to REVEAL 2.0 (C-index 0.79). Conclusions Risk scores have similar accuracy in the prognostic stratification of older vs younger PAH patients. REVEAL 2.0 had the best performance in older patients. Comorbidities increased the accuracy of risk scores only in younger patients.
PubMed, Sep 1, 2004
Background: A recognized drawback of ST-elevation acute myocardial infarction (STEMI) after fibri... more Background: A recognized drawback of ST-elevation acute myocardial infarction (STEMI) after fibrinolysis is persistent coronary occlusion or a less than TIMI 3 flow. The present study describes the results of systematic pre-discharge coronary angiography and revascularization, whenever indicated, following fibrinolytic therapy for STEMI. Methods: Consecutive patients admitted with the diagnosis of STEMI between April 1, 2000 and April 30, 2002 were included in the study. Patients with contraindications to thrombolytic therapy and/or patients not eligible for angiography were excluded. All patients received "accelerated" treatment with alteplase and had a coronary angiography at least 24 hours later, in order to perform, if anatomically feasible, angioplasty with stenting. Angioplasty of non-infarct-related coronary arteries was allowed. The mortality, reinfarction and new revascularization rates were evaluated during index hospitalization and up to 30 days and 6 months. Results: Eighty patients underwent cardiac catheterization at a median of 6.5 days following admission; in 86.3% of cases a patent infarct-related artery was found; in 71% of patients a coronary angioplasty was performed, with stenting in 88% of cases. Procedure-related complications were infrequent. No deaths occurred during hospitalization and at 30 days; at 6 months the mortality rate was 1.3%. In-hospital reinfarction occurred in 3.8% of patients, in 4% at 30 days and in 5.3% at 6 months. The rate of any new revascularization was 2.6% at 30 days and 11% at 6 months. Conclusions: Although obtained in a small observational study, our data, unlike those from previous studies, suggest that an invasive strategy after fibrinolysis in STEMI is safe and associated with low mortality and morbidity rates in the short and medium-terms.
PubMed, Sep 1, 2011
At present, high-risk pulmonary embolism represents a cardiovascular emergency burdened with high... more At present, high-risk pulmonary embolism represents a cardiovascular emergency burdened with high in-hospital mortality and characterized by acute right ventricular dysfunction and hemodynamic impairment. In addition to circulatory support and anticoagulation, thrombolytic therapy has become the cornerstone of the treatment in patients presenting with this condition. Despite the recommendations, a consistent proportion of patients does not currently receive thrombolytic therapy. Although performed in a limited number of patients, transcatheter and surgical embolectomy procedures are an alternative or synergistic therapeutic strategy to thrombolysis, enabling a prompt resolution of right ventricular volume overload. In this review, data from the literature are discussed with the aim of defining an algorithm for the treatment of high-risk patients.
The emPHasis-10 health-related quality of life score is an independent predictor of mortality in ... more The emPHasis-10 health-related quality of life score is an independent predictor of mortality in idiopathic and connective tissue disease-related pulmonary arterial hypertension, and has utility in risk stratification. https://bit.ly/2MrLFLn Cite this article as: Lewis RA, Armstrong I, Bergbaum C, et al. EmPHasis-10 health-related quality of life score predicts outcomes in patients with idiopathic and connective tissue disease-associated pulmonary arterial hypertension: results from a UK multicentre study.
European Heart Journal, Oct 1, 2022
Journal of Heart and Lung Transplantation, Apr 1, 2023
Journal of The American Society of Echocardiography, Nov 1, 2020
Background: Right ventricular (RV) function and right atrial (RA) remodeling are major determinan... more Background: Right ventricular (RV) function and right atrial (RA) remodeling are major determinants of outcome in pulmonary arterial hypertension (PAH). Strain echocardiography is emerging as a valuable approach for the study of RV and RA function. We sought to assess the incremental prognostic value of serial combined speckle-tracking examination of right chambers in newly diagnosed therapy-na€ ıve PAH patients. Methods: The study endpoint was a composite of all-cause mortality, hospitalizations due to worsening PAH, and initiation of parenteral prostanoids. Patients were assessed at baseline and at first revaluation after initiation of treatment. Right ventricular free-wall longitudinal strain (FWLS) and RA peak atrial longitudinal strain (PALS) were used as measures of RV and RA function. Results: Eighty-three patients were included. Mean RV-FWLS and RA-PALS were À13.9% 6 6.1% and 23.1% 6 11.4%. The best performing prognostic score among the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension, French Pulmonary Hypertension Registry, and Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) scores was the REVEAL (area under the curve = 0.79, P < .001). With the identified cutoffs, both RV-FWLS (hazard ratio for RV-FWLS < À13.2% = 0.366; 95% CI, 0.159-0.842; P = .018) and RA-PALS (hazard ratio for RA-PALS > 20% = 0.399; 95% CI, 0.176-0.905; P = .028) were independently associated with the primary outcome after correction for the REVEAL score. The combined assessment of RV-FWLS and RA-PALS in addition to the REVEAL score determined a net improvement in prediction of 0.439 (95% CI, 0.070-0.888, P = .04). At 5 months (interquartile range, 4-8) of follow-up, RV-FWLS and RA-PALS improved significantly only in patients free from the primary outcome (P < .001 and P = .001, respectively). Conclusions: The combined assessment of RV-FWLS and RA-PALS determined an improvement in outcome prediction of validated prognostic risk scores and should be considered within the multiparametric evaluation of patients with PAH.
European Heart Journal, Aug 1, 2017
Chronic thromboembolic pulmonary hypertension / Impact of new parameters on aortic stenosis outco... more Chronic thromboembolic pulmonary hypertension / Impact of new parameters on aortic stenosis outcomes cTnT concentrations increased linearly in serum samples spiked with homogenized skeletal muscle of healthy individuals (n=3) or skeletal myopathy patients (n=9). Western blot experiments using cTnT antibodies invariably detected bands in skeletal muscle that were present at a lower molecular weight than cTnT in myocardium. LC/MS-MS analysis detected skeletal but not cardiac TnT in these bands. No relevant bands were detected in liver tissue (negative control). Conclusion: cTnT measurements are chronically elevated in a considerable proportion of patients with skeletal muscle disease despite normal cTnI values. The source of elevated cardiac TnT levels in these patients is likely skeletal but not cardiac muscle.
Journal of Cardiovascular Medicine, Oct 1, 2019
Aims The study aimed at evaluating the reliability and reproducibility of various noninvasive ech... more Aims The study aimed at evaluating the reliability and reproducibility of various noninvasive echocardiographic techniques for the estimation of the main hemodynamic parameters in clinical practice.
ESC heart failure, Jun 13, 2024
Echo Research and Practice, Jun 3, 2024
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart di... more Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j. jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates
‘Drop the pressure’ – Investigating and treating pulmonary vascular disease
Clinical research in cardiology, Apr 15, 2024
European Journal of Echocardiography, 2010
Introduction: Transoesophageal echocardiography (TOE) has become routine during cardiac surgery f... more Introduction: Transoesophageal echocardiography (TOE) has become routine during cardiac surgery for evaluation of cardiac function and valve morphology prior and after repair of cardiac disease. Major complications of TOE are reported to be rare, especially in the hands of experienced investigators. However,a TOE probe might cause minor injuries in the stomach, especially if the procedure takes several hours. We therefore hypothesized that minor injuries are a common sequel of long-time TOE during cardiac surgery. Material and Methods: After induction of anesthesia in patients undergoing elective cardiac interventions, endoscopy of pharynx, esophagus and stomach was performed in order to exclude any previous lesion. A TOE probe was then inserted as part of the routine procedure and left in place until the operation was finished and the patient in stable condition to be transferred to the intensive care unit. The TOE probe was then removedand endoscopy was performed a second time to detect any new lesions in the stomach. All lesions of the mucosa were documented (type, localization, and number) as well the time needed for the TOE examinations before and after the cardiopulmonary bypass (CPB). Data are expressed as mean + standard deviation. Results: After approval of the Ethics committee and obtaining informed consent ten patients were included in our study. Duration of TOE probes in situ was 453 + 20 minutes. Of the ten patients included in the study only 1 patient had no lesion. In two patients only 1 lesion and in the others more than one could be detected. Five patients had 2 lesions and the last 2 patients had 3 and 4 lesions, respectively (1,9 + 1,1 lesions per patient). Most of the lesions were localized in the esophagus (10) and in the stomach (6); 2 lesions were detected in the pharynx and 1 lesion in the gastroesophageal junction. Most of the lesions were petechiae (9) and hematomas (6), while mucosal erosions and erythemas were present only two times. Severe lesions could not be detected. Conclusions: Our results have shown that minor injuries are caused frequently by TOE probes where the oesophageal and gastric mucosa are the most involved areas. A bigger sample size is needed to confirm if a longer duration the TOE probe in situ (more than 7 hours) is associated with more lesions. Furthermore, more lesions could also affect ICU and hospital length of stay.
European Journal of Echocardiography, 2010
Introduction: Transoesophageal echocardiography (TOE) has become routine during cardiac surgery f... more Introduction: Transoesophageal echocardiography (TOE) has become routine during cardiac surgery for evaluation of cardiac function and valve morphology prior and after repair of cardiac disease. Major complications of TOE are reported to be rare, especially in the hands of experienced investigators. However,a TOE probe might cause minor injuries in the stomach, especially if the procedure takes several hours. We therefore hypothesized that minor injuries are a common sequel of long-time TOE during cardiac surgery. Material and Methods: After induction of anesthesia in patients undergoing elective cardiac interventions, endoscopy of pharynx, esophagus and stomach was performed in order to exclude any previous lesion. A TOE probe was then inserted as part of the routine procedure and left in place until the operation was finished and the patient in stable condition to be transferred to the intensive care unit. The TOE probe was then removedand endoscopy was performed a second time to detect any new lesions in the stomach. All lesions of the mucosa were documented (type, localization, and number) as well the time needed for the TOE examinations before and after the cardiopulmonary bypass (CPB). Data are expressed as mean + standard deviation. Results: After approval of the Ethics committee and obtaining informed consent ten patients were included in our study. Duration of TOE probes in situ was 453 + 20 minutes. Of the ten patients included in the study only 1 patient had no lesion. In two patients only 1 lesion and in the others more than one could be detected. Five patients had 2 lesions and the last 2 patients had 3 and 4 lesions, respectively (1,9 + 1,1 lesions per patient). Most of the lesions were localized in the esophagus (10) and in the stomach (6); 2 lesions were detected in the pharynx and 1 lesion in the gastroesophageal junction. Most of the lesions were petechiae (9) and hematomas (6), while mucosal erosions and erythemas were present only two times. Severe lesions could not be detected. Conclusions: Our results have shown that minor injuries are caused frequently by TOE probes where the oesophageal and gastric mucosa are the most involved areas. A bigger sample size is needed to confirm if a longer duration the TOE probe in situ (more than 7 hours) is associated with more lesions. Furthermore, more lesions could also affect ICU and hospital length of stay.
Journal of Cardiovascular Medicine, Sep 1, 2009
Few data are available in the literature regarding the characteristics and prognosis of asymptoma... more Few data are available in the literature regarding the characteristics and prognosis of asymptomatic patients with idiopathic dilated cardiomyopathy (DCM). To determine the frequency with which patients affected by DCM are diagnosed in the asymptomatic state as well as to evaluate the natural history of such patients and the factors influencing their outcome. Moreover, we sought to compare the outcome of asymptomatic patients with that of patients with signs of overt heart failure at the time of first evaluation. We analyzed the data of 747 patients with DCM enlisted in the Heart Muscle Disease Registry of Trieste from 1978 to 2007. We divided our population into four groups; group 1 comprised 118 asymptomatic [New York Heart Association (NYHA) I] patients without a history of congestive symptoms (16%), group 2 comprised 102 asymptomatic (NYHA I) patients (14%) with a positive anamnesis for heart failure stabilized in medical therapy, group 3 comprised 327 patients (44%) with signs of mild heart failure (NYHA II) and group 4 comprised 200 patients (26%) in NYHA III-IV. During the follow-up of 112+/-63 months, 46 (21%) of 220 asymptomatic patients with DCM died or underwent heart transplantation. By Cox proportional model, left ventricular ejection fraction of 30% or less was a unique independent predictor either for death/heart transplantation (hazard ratio 3.15, 95% confidence interval 1.5-6.7, P=0.003) or for sudden death/major ventricular arrhythmias (hazard ratio 3.9, 95% confidence interval 1.7-9.3, P=0.002). Patients from group 1 had a trend for a better outcome with respect to those from group 2 (P=0.06). In comparison with the asymptomatic patients, those with signs of overt heart failure at baseline had a worse prognosis. The proportion of asymptomatic patients with DCM at the moment of first evaluation at our center is significant (30%). Among them, those without a previous history of heart failure had a less advanced disease and a trend for a better long-term outcome on optimal medical treatment. Therefore, early diagnosis may offer better long-term quality of life and even better survival. Further studies on larger populations are indicated.
European Heart Journal Supplements, Dec 14, 2022
Background Risk scores are important tools for the prognostic stratification of pulmonary arteria... more Background Risk scores are important tools for the prognostic stratification of pulmonary arterial hypertension (PAH). Their performance and the additional impact of comorbidities across age groups is unknown. Methods Patients with PAH enrolled from 2001 to 2021 were divided in ≥ 65 years old vs <65 years old patients. Study outcome was 5-year all-cause mortality. FPHN, FPHN non-invasive, COMPERA and REVEAL 2.0 risk scores were calculated and patients categorized at low, intermediate and high risk. Number of comorbidities was calculated. Results Among 383 patients, 152 (40%) were ≥ 65 years old. Older patients had more comorbidities, with the exception of obesity and diabetes (number of comorbidities 2, IQR 1-3, vs 1, IQR 0-2 in <65 years patients). At 5-year follow-up, 36% of ≥ 65 years patients vs 10% of <65 years patients died. Except for the COMPERA, risk scores correctly discriminated the different classes of risk in the overall cohort and in the older and younger groups. REVEAL 2.0 showed the best accuracy in the total cohort (C-index 0.74) and in younger (C-index 0.72) and older (C-index 0.69) patients. Number of comorbidities was associated with higher 5-year mortality, and consistently increased the accuracy of risk scores, in younger but not in older patients, with the highest accuracy achieved in addition to REVEAL 2.0 (C-index 0.79). Conclusions Risk scores have similar accuracy in the prognostic stratification of older vs younger PAH patients. REVEAL 2.0 had the best performance in older patients. Comorbidities increased the accuracy of risk scores only in younger patients.
PubMed, Sep 1, 2004
Background: A recognized drawback of ST-elevation acute myocardial infarction (STEMI) after fibri... more Background: A recognized drawback of ST-elevation acute myocardial infarction (STEMI) after fibrinolysis is persistent coronary occlusion or a less than TIMI 3 flow. The present study describes the results of systematic pre-discharge coronary angiography and revascularization, whenever indicated, following fibrinolytic therapy for STEMI. Methods: Consecutive patients admitted with the diagnosis of STEMI between April 1, 2000 and April 30, 2002 were included in the study. Patients with contraindications to thrombolytic therapy and/or patients not eligible for angiography were excluded. All patients received "accelerated" treatment with alteplase and had a coronary angiography at least 24 hours later, in order to perform, if anatomically feasible, angioplasty with stenting. Angioplasty of non-infarct-related coronary arteries was allowed. The mortality, reinfarction and new revascularization rates were evaluated during index hospitalization and up to 30 days and 6 months. Results: Eighty patients underwent cardiac catheterization at a median of 6.5 days following admission; in 86.3% of cases a patent infarct-related artery was found; in 71% of patients a coronary angioplasty was performed, with stenting in 88% of cases. Procedure-related complications were infrequent. No deaths occurred during hospitalization and at 30 days; at 6 months the mortality rate was 1.3%. In-hospital reinfarction occurred in 3.8% of patients, in 4% at 30 days and in 5.3% at 6 months. The rate of any new revascularization was 2.6% at 30 days and 11% at 6 months. Conclusions: Although obtained in a small observational study, our data, unlike those from previous studies, suggest that an invasive strategy after fibrinolysis in STEMI is safe and associated with low mortality and morbidity rates in the short and medium-terms.
PubMed, Sep 1, 2011
At present, high-risk pulmonary embolism represents a cardiovascular emergency burdened with high... more At present, high-risk pulmonary embolism represents a cardiovascular emergency burdened with high in-hospital mortality and characterized by acute right ventricular dysfunction and hemodynamic impairment. In addition to circulatory support and anticoagulation, thrombolytic therapy has become the cornerstone of the treatment in patients presenting with this condition. Despite the recommendations, a consistent proportion of patients does not currently receive thrombolytic therapy. Although performed in a limited number of patients, transcatheter and surgical embolectomy procedures are an alternative or synergistic therapeutic strategy to thrombolysis, enabling a prompt resolution of right ventricular volume overload. In this review, data from the literature are discussed with the aim of defining an algorithm for the treatment of high-risk patients.
The emPHasis-10 health-related quality of life score is an independent predictor of mortality in ... more The emPHasis-10 health-related quality of life score is an independent predictor of mortality in idiopathic and connective tissue disease-related pulmonary arterial hypertension, and has utility in risk stratification. https://bit.ly/2MrLFLn Cite this article as: Lewis RA, Armstrong I, Bergbaum C, et al. EmPHasis-10 health-related quality of life score predicts outcomes in patients with idiopathic and connective tissue disease-associated pulmonary arterial hypertension: results from a UK multicentre study.
European Heart Journal, Oct 1, 2022
Journal of Heart and Lung Transplantation, Apr 1, 2023
Journal of The American Society of Echocardiography, Nov 1, 2020
Background: Right ventricular (RV) function and right atrial (RA) remodeling are major determinan... more Background: Right ventricular (RV) function and right atrial (RA) remodeling are major determinants of outcome in pulmonary arterial hypertension (PAH). Strain echocardiography is emerging as a valuable approach for the study of RV and RA function. We sought to assess the incremental prognostic value of serial combined speckle-tracking examination of right chambers in newly diagnosed therapy-na€ ıve PAH patients. Methods: The study endpoint was a composite of all-cause mortality, hospitalizations due to worsening PAH, and initiation of parenteral prostanoids. Patients were assessed at baseline and at first revaluation after initiation of treatment. Right ventricular free-wall longitudinal strain (FWLS) and RA peak atrial longitudinal strain (PALS) were used as measures of RV and RA function. Results: Eighty-three patients were included. Mean RV-FWLS and RA-PALS were À13.9% 6 6.1% and 23.1% 6 11.4%. The best performing prognostic score among the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension, French Pulmonary Hypertension Registry, and Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) scores was the REVEAL (area under the curve = 0.79, P < .001). With the identified cutoffs, both RV-FWLS (hazard ratio for RV-FWLS < À13.2% = 0.366; 95% CI, 0.159-0.842; P = .018) and RA-PALS (hazard ratio for RA-PALS > 20% = 0.399; 95% CI, 0.176-0.905; P = .028) were independently associated with the primary outcome after correction for the REVEAL score. The combined assessment of RV-FWLS and RA-PALS in addition to the REVEAL score determined a net improvement in prediction of 0.439 (95% CI, 0.070-0.888, P = .04). At 5 months (interquartile range, 4-8) of follow-up, RV-FWLS and RA-PALS improved significantly only in patients free from the primary outcome (P < .001 and P = .001, respectively). Conclusions: The combined assessment of RV-FWLS and RA-PALS determined an improvement in outcome prediction of validated prognostic risk scores and should be considered within the multiparametric evaluation of patients with PAH.
European Heart Journal, Aug 1, 2017
Chronic thromboembolic pulmonary hypertension / Impact of new parameters on aortic stenosis outco... more Chronic thromboembolic pulmonary hypertension / Impact of new parameters on aortic stenosis outcomes cTnT concentrations increased linearly in serum samples spiked with homogenized skeletal muscle of healthy individuals (n=3) or skeletal myopathy patients (n=9). Western blot experiments using cTnT antibodies invariably detected bands in skeletal muscle that were present at a lower molecular weight than cTnT in myocardium. LC/MS-MS analysis detected skeletal but not cardiac TnT in these bands. No relevant bands were detected in liver tissue (negative control). Conclusion: cTnT measurements are chronically elevated in a considerable proportion of patients with skeletal muscle disease despite normal cTnI values. The source of elevated cardiac TnT levels in these patients is likely skeletal but not cardiac muscle.
Journal of Cardiovascular Medicine, Oct 1, 2019
Aims The study aimed at evaluating the reliability and reproducibility of various noninvasive ech... more Aims The study aimed at evaluating the reliability and reproducibility of various noninvasive echocardiographic techniques for the estimation of the main hemodynamic parameters in clinical practice.