Fabio Chirillo - Academia.edu (original) (raw)

Papers by Fabio Chirillo

European Heart Journal, Jun 20, 2010

Percutaneous coronary intervention with bare metal stent (BMS) in chronic total coronary occlusio... more Percutaneous coronary intervention with bare metal stent (BMS) in chronic total coronary occlusions (CTOs) is associated with a higher rate of angiographic restenosis and reocclusion than that observed in subtotal stenoses. Preliminary reports have suggested a better performance of drug-eluting stents in CTO. In this multicentre, randomized trial, we compared the mid-term angiographic and clinical outcome of sirolimus-eluting stent (SES) or BMS implantation after successful recanalization of CTO. Methods and results Patients with CTO older than 1 month, after successful recanalization, were randomized to implantation of SES (78 patients) or BMS (74 patients) in 13 Italian centres. Clopidogrel therapy was prescribed for 6 months. The primary endpoint was in-segment minimal luminal diameter (MLD) at 8-month follow-up. Secondary clinical endpoints included death, myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR) at 24 months. Patients treated with SES showed, at in-segment analysis, a larger MLD (1.98 + 0.57 vs. 0.98 + 0.80 mm, P , 0.001), a lower late luminal loss (20.06 + 0.49 vs. 1.11 + 0.79 mm, P , 0.001), and lower restenosis (9.8 vs. 67.7%, P , 0.001) and reocclusion (0 vs. 17%, P ¼ 0.001) rates. At 24-month follow-up, patients in the SES group experienced fewer major adverse cardiac events (50.0 vs. 17.6%, P , 0.001) mainly due to a lower rate of both TLR (44.9 vs. 8.1%, P , 0.001) and TVR (44.9 vs. 14.9%, P , 0.001). Conclusion In CTO, SES is markedly superior to BMS in terms of restenosis and reocclusion rate, and incidence of repeat revascularization at 24 months. Clinicaltrials.gov identifier: NCT00220558

Catheterization and Cardiovascular Diagnosis, Dec 1, 1990

Two cases of massive mitral regurgitation due to mitral valve disruption following percutaneous b... more Two cases of massive mitral regurgitation due to mitral valve disruption following percutaneous balloon valvuloplasty are reported. This severe complication occurred in two elderly women with recurrent mitral stenosis after previous surgical commissurotomy. Due to their unstable hernodynamic and clinical condition, both patients underwent emergency valve replacement. At surgery, the cornrnissures appeared fused and heavily calcified; the chordae tendineae thickened, shortened, and fused; and the leaflets presented a large tear with sheared edges. Because the technical aspects of both procedures were unremarkable, the anatomic features of the mitral valve seemed to affect the occurrence of severe mitral regurgitation. Percutaneous balloon valvuloplasty should be therefore applied carefully to patients with prior surgical valvotomy, in whom the structural alterations of the mitral apparatus may predispose to severe valvular damage.

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PubMed, 1991

In order to evaluate the short and mid-term results of percutaneous aortic balloon valvuloplasty,... more In order to evaluate the short and mid-term results of percutaneous aortic balloon valvuloplasty, 40 consecutive elderly patients with symptomatic severe calcific aortic stenosis, underwent the procedure consecutively, with follow-up by clinical evaluation and Doppler echocardiography. Over a mean follow-up period of 11.2 months there were 5 deaths, and 12 patients underwent subsequent aortic valve replacement. Doppler echocardiography revealed an increase in aortic valve area from 0.62 +/- 0.20 cm2 to 0.91 +/- 0.23 cm2 after the procedure, but there was a significant trend toward restenosis by 12 months follow-up in 23 of 32 patients (72%). Restenosis was accompanied by symptomatic deterioration in 18 of 23 patients (78%). Although balloon valvuloplasty may often improve haemodynamics and relieve symptoms, these benefits seem to be short-lived in most cases. Restenosis has a high rate of occurrence. Aortic balloon valvuloplasty should be reserved for truly inoperable cases and for haemodynamically-unstable patients, who may later undergo surgery.

International Journal of Cardiology, May 1, 1991

To determine the utility of transesophageal echocardiographic monitoring during percutaneous ball... more To determine the utility of transesophageal echocardiographic monitoring during percutaneous balloon mitral valvotomy, we analyzed data from 40 consecutive patients who had been randomly assigned to undergo balloon mitral valvotomy under transesophageal echocardiographic guidance or without echo. All procedures were carried out under general anaesthesia. The completion rate (100% vs 73%), the procedure time (108 +/- 28 min vs 65 +/- 18 min), the X-ray exposure time (62 +/- 13 vs 33 +/- 12 min), resulted significantly (P less than 0.001) more favorable in the echo-monitored patients. Moreover, a lower rate of major complications (cardiac tamponade, large residual atrial shunting, and severe mitral regurgitation) was noted in the echo-monitored patients. The achieved final area of the mitral valve did not differ significantly between the two groups. From an evaluation of results as a whole, 96% of the echo-monitored procedures were successful, whereas only 40% of the procedures conducted without echocardiographic control achieved a satisfactory final result in absence of major complications. We conclude that transesophageal echocardiography is a safe, effective, and valuable tool to monitor each step of balloon mitral valvotomy in order to shorten the time of the procedure, and to improve the results of this complex interventional catheterization technique.

Viruses

Background: The present study aimed to examine longitudinal trends in hospitalizations for acute ... more Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 202...

Discussion of Clinical Cases

Left ventricular isolated hypoplasia is a seldom-described cardiac abnormality. Right ventricular... more Left ventricular isolated hypoplasia is a seldom-described cardiac abnormality. Right ventricular hypoplasia is usually associated with congenital anomalies of the pulmonary or the tricuspid valve, whereas biventricular isolated apical hypoplasia has never been described. We report the case of a 48-year-old man with no history of known cardiac disease who was found to have a complex cardiac abnormality characterized by: 1) Deficiency of the myocardium within the biventricular apex with adipose tissue infiltration; 2) Truncated right ventricle because of an absent trabecular portion of the inflow tract; 3) Truncated and spherical left ventricular apex; 4) Origin of the mitral papillary muscle in the flattened anterior left ventricular apex. Multimodality imaging was performed to delineate the morphological and functional characteristics of this cardiomyopathy fully. To the best of our knowledge, this is the first description of a new cardiac abnormality characterized by the hypoplasi...

European Heart Journal, 2018

Background: Perioperative major cardiovascular and cerebrovascular events (MACCE) are common afte... more Background: Perioperative major cardiovascular and cerebrovascular events (MACCE) are common after non-cardiac surgery and contribute to 30-day postoperative mortality. Preoperative risk prediction tools are limited. Murine experiments revealed that immunological reactions have a substantial impact on perioperative atherosclerotic plaque stability. Regulatory T cells (Tregs) have been shown to prevent progression of atherosclerosis and to promote plaque stabilizing effects. The "Leukocytes and Cardiovascular Perioperative Events-1" (LeukoCAPE-1) study demonstrated an association between preoperative levels Tregs and perioperative cardiovascular events. Purpose: The aim of the here presented LeukoCAPE-2 study was to validate the previously derived cut off of 0.027 Tregs/nl for prediction of perioperative cardiovascular events (NCT03105427, ethic committee approval: S-351/2016). Methods: In this single-center prospective observational cohort study, 233 elevated risk, coronary artery disease patients scheduled for non-cardiac surgery were recruited. Blood was drawn prior to surgery to quantify circulating CD25highCD127low Tregs by flow cytometry. High-sensitivity cardiac Troponin T (hs-cTnT) was measured preoperatively and on postoperative day one to three to detect MINS (defined as postoperative hs-cTnT >20 pg/ml and <65 pg/ml with an increase of 5 pg/ml or ≥65 pg/ml). ECGs were recorded preoperatively and on postoperative day 3. The primary endpoint was a composite of cardiac death, myocardial infarction, myocardial ischemia, myocardial injury after noncardiac surgery (MINS) and stroke and was registered until postoperative day 30. Categorical data were analyzed using Fisher's exact test. Non-parametric Mann-Whitney U test was used for comparison between two groups. Risk prediction based on preoperative Tregs was evaluated using receiver operating characteristic (ROC) analysis. Cut off values were calculated using Youden's index. Results: In the final analysis set the composite primary endpoint occurred in 84 of 220 patients (38%). The cut off value of 0.027 Tregs/nl derived from the LeukoCAPE-1 study was predictive for MACCE and reached a sensitivity of 35% and specificity of 85% (OR=2.89 [1.52; 5.39]; p=0.0015). ROC analyses support the predictive value of Tregs for MACCE (AUC=0.64; 95% CI [0.559; 0.711]; p=0.0008). Using Youden's index for LeukoCAPE-2 study the highest sensitivity (76%) and specificity (49%) was calculated for a cut off value of 0.05137 Tregs/nl (OR=3.02 [1.62; 5.63]; p=0.0003). Patients with MACCE showed significantly lower preoperative Treg values compared to patients without MACCE (Median [IQR] 0.

Europace, 2001

Animal studies have suggested that the temperature of the electrode-tissue interface during radio... more Animal studies have suggested that the temperature of the electrode-tissue interface during radiofrequency (RF) catheter ablation accurately predict lesion size. Clinical studies have showed that convective cooling of the catheter by blood flow influences power delivery. METHODS: We used RF catheter ablation as an alternative to surgical incisions, to perform AF surgery in patients with AF who underwent mitral surgery. We randomized patients to receive RF ablation (group 1) or conventional therapy (group 2) for AF. We performed endocardial bilateral isolation of pulmonary veins from the left atrium using an electrosurgical probe with malleable shaft and 7 electrodes, that is able to create a linear lesion up to 95ram in a single RF pulse (ThermaLine, Boston Scientific). We excluded left atrial appendage with a RF linear lesion. RESULTS. We randomized 4 patients (3F, 1M mean age 69 + 7 yrs) in group 1 and 4 patients (2F, 2M mean age 66 + 9 yrs) in group 2, All patients had permanent AF with a duration time more than 1 year. The mean left atrial diameter was 51mm in group 1 and 49ram in group 2. Electrical cardioversion was ineffective in all patients. The mean duration of procedure with concomitant mitral surgery was 75 minutes and 73 minutes in group 1 and 2 respectively. The mean duration time for RF ablation was 7 + 2 minutes with a 1 RF pulse up to 2 minutes for each ablation line for a total of 3 RF pulses for each patient (right pulmonary veins, left pulmonary veins, left atrial appendage). Sinus rhythm was restored in all patients in group 1 with echocardiographic documentation of left and right atria contraction. In a mean follow-up of 6 ± 2 months, 1 AF recurrence occurred in group 1, successfully cardioverted. All patients in group 1 are in sinus rhythm, one with concomitant antiarrhythmic drug. All patients in group 2 are in AF. No complications were observed in both groups. The mean power needed to achieve a temperature of 50°C was 5W, with a mean impedance of 72 Ohm. CONCLUSIONS: Peculiarity of intraoperative use of RF energy is the lower power needed to achieve the target temperature to create transmural lesions (50°C). Without convective cooling of the catheter by blood flow, larger electrodes can be used for larger and deeper lesions.

American Heart Journal, 2006

Sirolimus-eluting stent implantation improves the outcome in simple coronary artery lesions compa... more Sirolimus-eluting stent implantation improves the outcome in simple coronary artery lesions compared with bare metal stents, but there is limited evidence of their safety and efficacy when implanted in complex lesions like coronary bifurcations. SCANDSTENT was a randomized controlled study comparing implantation of sirolimus-eluting stents with bare-metal stents in patients with complex coronary artery disease. This substudy evaluates the angiographic and clinical outcome of 126 patients with lesions located in a coronary bifurcation. The baseline characteristics of the patients were comparable: 15% had diabetes, and 1.7 stents were implanted per lesion. At follow-up, the minimum lumen diameter of the main branch was 2.35 mm in patients who received sirolimus-eluting stents compared with 1.68 mm in those who received bare-metal stents, and that of the side branch was 1.70 versus 1.19 mm (both P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The late lumen loss in the main branch was 0.12 mm in the sirolimus-eluting stent group versus 0.99 mm in the bare-metal stent group and 0.03 versus 0.56 mm in the side branch (both P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Thus, sirolimus-eluting stents reduced the restenosis rate from 28.3% to 4.9% in the main branch and from 43.4% to 14.8% in the side branches (both P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Major adverse cardiac events occurred in 9% with sirolimus-eluting stents versus 28% with bare-metal stents (P = .01), and stent thrombosis was observed in 0% versus 9% (P = .02). Sirolimus-eluting stent implantation improves both the angiographic and clinical outcomes considerably compared with that of bare-metal stents in patients with stenoses located in coronary bifurcations.

The American Journal of Cardiology, 1992

ABSTRACT

European Heart Journal, 2017

Journal of the American College of Cardiology, 2019

Background: Over the last decade, the opioid crisis has led to a significant increase in the rate... more Background: Over the last decade, the opioid crisis has led to a significant increase in the rate of infective endocarditis (IE) related to injection drug use (IDU). IDU has traditionally been associated with right sided IE, however, data describing IE in persons who inject drugs (PWID) in the "contemporary" drug epidemic are limited. The objective of this study was to provide an updated description of left sided IE (LSIE) and non-LSIE in PWID. Methods: All patients ≥18 years old admitted to a tertiary, academic center in North Carolina with a diagnosis of IE who met possible or definite modified Duke criteria between December 2011 and April 2018 were identified. PWID were defined as active users if IDU had occurred within 3 months of presentation. PWID with IE were subdivided into LSIE and non-LSIE. Relevant clinical, laboratory, imaging, and outcome data were then extracted and analyzed using univariate and multivariate analysis. Results: One-hundred and twenty-nine consecutive patients were identified as active PWID with IE. Of those, 54 (42%) were identified as having LSIE. As compared to PWID with non-LSIE, PWID with LSIE were older (median age of 35 vs 28.5, p < 0.01), were more likely to have prosthetic valve IE (99% vs 85%, p < 0.01) and had less infections with Staphylococcus aureus (SA) (59% vs 92%, p < 0.01). PWID with LSIE had higher rates of cardiac valve surgery (31% vs 13%, p < 0.01) and stroke (52% vs 0%, p < 0.01). Ten-week mortality rates were higher as well (22% vs 5%, p < 0.01). On multivariate analysis, fungal infection (OR 10.7, 95CI 2.2-51.9) and LSIE (OR 5.3, 95CI 1.7-17) were associated with 10-week mortality in PWID with IE. Conclusion: Our study challenges the conventional concept that the vast majority of IDU related IE is right sided as 42% of PWID in our cohort had LSIE. Notable features of LSIE in PWID were frequent strokes, less involvement of native valves, lower rates of SA infection, and significantly higher mortality as compared to PWID with non-LSIE.

Circulation

The diagnosis of infective endocarditis (IE) is sometimes difficult when there are discrepancies ... more The diagnosis of infective endocarditis (IE) is sometimes difficult when there are discrepancies between blood cultures, transesophageal echocardiography (TEE) and clinical judgment. The aim of this study was to assess the incremental diagnostic value of 18 F-FDG-PET/CT in 45 consecutive patients (73% male, mean age 61 ± 26 years) with suspected IE and inconclusive tests at admission. In 28 patients (19 with a cardiac valvular (15) or nonvalvular (4) device) with blood cultures positive for germs typically involved in IE the initial TEE was negative or inconclusive. In 10 patients presenting with fever TEE identified cardiac lesion possibly related to IE (ruptured mitral chordae, thickened valve leaflet, thickened prosthetic annulus), but blood cultures were persistently negative. Finally, 7 patients had metastatic or embolic lesions and a predisposing cardiac condition, but TEE was negative. When previous unknown lesions detected by PET/CT were confirmed by succeeding examinations,...

Nous decrivons une complication, non signalee jusqu'a present, due a une embolie recidivante ... more Nous decrivons une complication, non signalee jusqu'a present, due a une embolie recidivante d' une endocardite du coeur droit. Il s'agit d'un homme de 36 ans qui a developpe une endocardite a Candida albicans de la valve tricuspide apres une suite chirurgicale compliquee et un sejour prolonge dans l'Unite de soins intensifs avec un catheter a demeure. Le remplacement de la valve etant trop risque, le patient a recu seulement un traitement medical. Les embolies septiques recidivantes dans la circulation pulmonaire ont produit une grave hypertension pulmonaire secondaire. Apres cinq ans de diagnostic d'endocardite a Candida albicans, le patient est encore en vie, accusant simplement une dyspnee d'effort et une hemoptysie dues a une severe hypertension pulmonaire. Le pronostic de l'hypertension pulmonaire grave etant tres mauvais, il est important de connaitre cette complication dans le traitement des malades ayant une endocardite candidosiques du coeur...

Postępy w Kardiologii Interwencyjnej = Advances in Interventional Cardiology, 2021

Corresponding author: Eustaquio Maria Onorato MD, Centro Cardiologico Monzino, Istituto di Ricove... more Corresponding author: Eustaquio Maria Onorato MD, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University School of Milan, Milan, Italy, phone: +39 348 6939883, e-mail: eustaquio.onorato@gmail.com Received: 6.01.2021, accepted: 4.02.2021 Balloon leakage dilation over arterio-aorta rail support greatly facilitates a complex aortic paravalvular leak closure

European Heart Journal: Case Reports, 2021

Background Peripartum cardiomyopathy (PPCM) is usually characterized by overt heart failure, but ... more Background Peripartum cardiomyopathy (PPCM) is usually characterized by overt heart failure, but other clinical scenarios are possible, sometimes making the diagnosis challenging. Case summary We report a case series of four patients with PPCM. The first patient presented with acute heart failure due to left ventricular (LV) systolic dysfunction. Following medical treatment, LV function recovered completely at 1 month. The second patient had systemic and pulmonary thromboembolism, secondary to severe biventricular dysfunction with biventricular thrombi. The third patient presented with myocardial infarction with non-obstructed coronary arteries and evidence of an aneurysm of the mid-anterolateral LV wall. The fourth patient, diagnosed with PPCM 11 years earlier, presented with sustained ventricular tachycardia. A repeat cardiac magnetic resonance, compared to the previous one performed 11 years earlier, showed an enlarged LV aneurysm in the mid-LV anterolateral wall with worsened gl...

Journal of Clinical Medicine

Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysf... more Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33–62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5–8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related...