Lorenzo Menicanti - Academia.edu (original) (raw)
Papers by Lorenzo Menicanti
Journal of Cardiovascular Medicine, 2017
European Journal of Cardio-Thoracic Surgery
Journal of Thoracic and Cardiovascular Surgery
Diabetes, 2012
Increased morbidity and mortality associated with ischemic heart failure (HF) in type 2 diabetic ... more Increased morbidity and mortality associated with ischemic heart failure (HF) in type 2 diabetic patients requires a deeper understanding of the underpinning pathogenetic mechanisms. Given the implication of microRNAs (miRNAs) in HF, we investigated their regulation and potential role. miRNA expression profiles were measured in left ventricle biopsies from 10 diabetic HF (D-HF) and 19 nondiabetic HF (ND-HF) patients affected by non–end stage dilated ischemic cardiomyopathy. The HF groups were compared with each other and with 16 matched nondiabetic, non-HF control subjects. A total of 17 miRNAs were modulated in D-HF and/or ND-HF patients when compared with control subjects. miR-216a, strongly increased in both D-HF and ND-HF patients, negatively correlated with left ventricular ejection fraction. Six miRNAs were differently expressed when comparing D-HF and ND-HF patients: miR-34b, miR-34c, miR-199b, miR-210, miR-650, and miR-223. Bioinformatic analysis of their modulated targets s...
Journal of Clinical Medicine
Background: Hospital mortality and admission to the Intensive Care Unit (ICU) are markers of dise... more Background: Hospital mortality and admission to the Intensive Care Unit (ICU) are markers of disease severity in COVID-19 patients. Cardiovascular co-morbidities are one of the main determinants of negative outcomes. In this study we investigated the impact of cardiovascular co-morbidities on mortality and admission to the ICU in first-wave COVID-19 patients. Methods: A multicenter, retrospective, cohort study. A total of 1077 patients were analyzed for mortality and ICU admission. Cardiovascular risk factors were explored as determinants of the outcomes after correction for other confounders. Results: In the multivariable model, after correction for age, only a history of heart failure remained independently associated (p = 0.0013) with mortality (hazard ratio 2.22, 95% confidence interval 1.37 to 3.62). Age showed a mortality risk increase of 8% per year (hazard ratio 1.08, 95% confidence interval 1.05 to 1.10, p = 0.001). The transition from ward to the ICU had, as a single deter...
JACC: Cardiovascular Interventions, 2015
CONCLUSIONS LMWHþGPI and UFHþGPI are the most effective and bivalirudin the safest AC for PCI. AC... more CONCLUSIONS LMWHþGPI and UFHþGPI are the most effective and bivalirudin the safest AC for PCI. AC selection maybe tailored to patient's risk profile.
The Journal of Thoracic and Cardiovascular Surgery, 2014
, MS, b on behalf of the OBSERVANT Research Group Background: Despite the widespread use of trans... more , MS, b on behalf of the OBSERVANT Research Group Background: Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. Methods: There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. Results: Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level (P .02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level (P .005), but with a similar New York Heart Association class, frailty score, EuroSCORE (P ¼ NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention (P .01). Women showed a smaller aortic annulus than men in both populations (P<.001). Female sex was an independent predictor in the AVR population for risk-adjusted 30-day mortality (odds ratio [OR], 2.34; P ¼ .043) and transfusions (OR, 1.47; P ¼ .003), but not for risk-adjusted acute myocardial infarction, stroke, vascular complications, permanent atrioventricular block (P ¼ NS). Female sex was an independent predictor in the TAVI population for risk-adjusted major vascular complications (OR, 2.92; P ¼ .018) and transfusions (OR, 1.93; P ¼ .003), but proved protective against moderate to severe postprocedural aortic insufficiency (P ¼ .018). Conclusions: Female sex is a risk factor for mortality after aortic valve replacement, for major vascular complications after TAVI, and for transfusions after both approaches.
The Journal of Thoracic and Cardiovascular Surgery, 2014
e on behalf of the OBSERVANT Research Group Objective: Despite demonstration of the superior outc... more e on behalf of the OBSERVANT Research Group Objective: Despite demonstration of the superior outcomes of transcatheter aortic valve implantation (TAVI) versus optimal medical therapy for severe left ventricular systolic dysfunction, studies comparing TAVI and surgical aortic valve replacement (AVR) in this high-risk group have been lacking. Methods: We performed propensity matching for age, gender, baseline comorbidities, previous interventions, priority at hospital admission, frailty score, New York Heart Association class, EuroSCORE, and associated cardiac diseases. Next, the 30-day mortality and procedure-related morbidity of 162 patients (81 TAVI vs 81 AVR) with severe left ventricular systolic dysfunction (ejection fraction 35%) were analyzed at the Italian National Institute of Health. Results: The 30-day mortality was comparable (P ¼ .37) between the 2 groups. The incidence of periprocedural acute myocardial infarction (P ¼ .55), low output state (P ¼ .27), stroke (P ¼ .36), and renal dysfunction (peak creatinine level, P ¼ .57) was also similar between the 2 groups. TAVI resulted in significantly greater postprocedural permanent pacemaker implantation (P ¼ .01) and AVR in more periprocedural transfusions (P <.01) despite a similar transfusion rate per patient (2.8 AE 3.7 for TAVI vs 4.4 AE 3.8 for AVR; P ¼ .08). The postprocedural intensive care unit stay (median, 2 days after TAVI vs 3 days after AVR; P ¼ .34), intermediate care unit stay (median, 0 days after both TAVI and AVR; P ¼ .94), and hospitalization (median, 11 days after TAVI vs 14 days after AVR; P ¼ .51) were comparable. Conclusions: In patients with severe left ventricular systolic dysfunction, both TAVI and AVR are valid treatment options, with comparable hospital mortality and periprocedural morbidity. Comparisons of the mid-to long-term outcomes are mandatory.
Journal of Personalized Medicine
Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic stra... more Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic strategy for ischemic heart failure (HF) patients, although the survival benefit is still debated. We investigated a real-world population treated with SVR in a single center with high case volumes. From July 2001 to June 2017, 648 patients (111 females) underwent SVR; coronary surgery was performed in 582 patients. Data were analyzed by dividing the population into two groups: Group I (371 patients operated between July 2001 and December 2007) and Group II (277 patients operated between January 2008 and June 2017). At baseline, Group I patients were more symptomatic for angina (47.4% versus 19.4%, p < 0.0001) and less symptomatic for HF (NYHA class III/IV, 46.3% versus 57%, p = 0.0071). The end-diastolic volume (106 mL/m2 versus 118.3 mL/m2, p < 0.0001) and the end-systolic volume (70.5 mL/m2 versus 81.5 mL/m2, p < 0.0001) were lower in Group I. The presence of 3-vessel coronary ar...
Journal of the American College of Cardiology, Jan 17, 2018
Guidelines recommend the use of implanted cardioverter-defibrillators in patients with Brugada sy... more Guidelines recommend the use of implanted cardioverter-defibrillators in patients with Brugada syndrome and induced ventricular tachyarrhythmias, but there is no evidence supporting it. This prospective registry study was designed to explore clinical and electrophysiological predictors of malignant ventricular tachyarrhythmia inducibility in Brugada syndrome. A total of 191 consecutive selected patients with (group 1; n = 88) and without (group 2; n = 103) Brugada syndrome-related symptoms were prospectively enrolled in the registry. Patients underwent electrophysiological study and substrate mapping or ablation before and after ajmaline testing (1 mg/kg/5 min). Overall, before ajmaline testing, 53.4% of patients had ventricular tachyarrhythmia inducibility, which was more frequent in group 1 (65.9%) than in group 2 (42.7%; p < 0.001). Regardless of clinical presentation, larger substrates with more fragmented long-duration ventricular potentials were found in patients with induc...
Circulation. Arrhythmia and electrophysiology, 2018
Clinical outcomes after ablation of persistent atrial fibrillation remain suboptimal. Identificat... more Clinical outcomes after ablation of persistent atrial fibrillation remain suboptimal. Identification of AF drivers using a novel integrated mapping technique may be crucial to ameliorate the clinical outcome. Persistent AF patients were prospectively enrolled to undergo high-density electrophysiological mapping to identify repetitive-regular activities (RRas) before modified circumferential pulmonary vein (PV) ablation. They have been randomly assigned (1:1 ratio) to ablation of RRa followed by modified circumferential PV ablation (mapping group; n=41) or modified circumferential PV ablation alone (control group; n=40). The primary end point was freedom from arrhythmic recurrences at 1 year. In total, 81 persistent AF patients (74% male; mean age, 61.7±10.6 years) underwent mapping/ablation procedure. The regions exhibiting RRa were 479 in 81 patients (5.9±2.4 RRa per patient): 232 regions in the mapping group (n=41) and 247 in the control group (n=40). Overall, 185 of 479 (39%) RRa...
European heart journal, Jan 12, 2017
The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently i... more The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently included in the guidelines for myocardial revascularization of the European Society of Cardiology and Association for Cardio-Thoracic Surgery as a risk stratification tool for surgical and percutaneous myocardial revascularization. The present study introduces an updated version of the ACEF (ACEF II) inclusive of emergency surgery and pre-operative anaemia. The development series includes 7011 consecutive cardiac surgery patients operated at a single institution. The validation series includes 1687 consecutive cardiac surgery patients operated in a different institution. The five factors included in the ACEF II were assessed in a multivariable logistic regression model testing their independent role as predictors of operative (in hospital or 30 days after surgery) mortality. Based on the odds ratio of each predictor, the ACEF II score is calculated as age(years)/ejection fraction (%). Add...
Translational pediatrics, 2017
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2017
The PARTNER group recently published a comparison between the latest generation SAPIEN 3 transcat... more The PARTNER group recently published a comparison between the latest generation SAPIEN 3 transcatheter aortic valve implantation (TAVI) system (Edwards Lifesciences, Irvine, CA, USA) and surgical aortic valve replacement (SAVR) in intermediate-risk patients, apparently demonstrating superiority of the TAVI and suggesting that TAVI might be the preferred treatment method in this risk class of patients. Nonetheless, assessment of the non-randomized methodology used in this comparison reveals challenges that should be addressed in order to elucidate the validity of the results. The study by Thourani and colleagues showed several major methodological concerns: suboptimal methods in propensity score analysis with evident misspecification of the propensity scores (PS; no adjustment for the most significantly different covariates: left ventricular ejection fraction, moderate-severe mitral regurgitation and associated procedures); use of PS quintiles rather than matching; inference on not-a...
Circulation. Arrhythmia and electrophysiology, 2017
There is emerging evidence that localization and elimination of abnormal electric activity in the... more There is emerging evidence that localization and elimination of abnormal electric activity in the epicardial right ventricular outflow tract may be beneficial in patients with Brugada syndrome. A total of 135 symptomatic Brugada syndrome patients having implantable cardiac defibrillator were enrolled: 63 (group 1) having documented ventricular tachycardia (VT)/ventricular fibrillation (VF) and Brugada syndrome-related symptoms, and 72 (group 2) having inducible VT/VF without ECG documentation at the time of symptoms. About 27 patients of group 1 experienced multiple implantable cardiac defibrillator shocks for recurrent VT/VF episodes. Three-dimensional maps before and after ajmaline determined the arrhythmogenic electrophysiological substrate (AES) as characterized by prolonged fragmented ventricular potentials. Primary end point was identification and elimination of AES leading to ECG pattern normalization and VT/VF noninducibility. Extensive areas of AES were found in the right v...
Seminars in Thoracic and Cardiovascular Surgery, 2017
Coronary artery bypass is often the first procedure cardiac surgeons are confronted with during t... more Coronary artery bypass is often the first procedure cardiac surgeons are confronted with during their residencies. This article discusses the surgical steps and the potential difficulties encountered during this procedure and how they can be solved. The &amp;quot;point of view&amp;quot; of an experienced surgeon is provided to the trainees and to the readers.
European journal of preventive cardiology, May 1, 2017
Background Anaemia and iron deficiency are frequent following major surgery. The present study ai... more Background Anaemia and iron deficiency are frequent following major surgery. The present study aims to identify the iron deficiency patterns in cardiac surgery patients at their admission to a cardiac rehabilitation programme, and to determine which perioperative risk factor(s) may be associated with functional and absolute iron deficiency. Design This was a retrospective study on prospectively collected data. Methods The patient population included 339 patients. Functional iron deficiency was defined in the presence of transferrin saturation <20% and serum ferritin ≥100 µg/l. Absolute iron deficiency was defined in the presence of serum ferritin values <100 µg/l. Results Functional iron deficiency was found in 62.9% of patients and absolute iron deficiency in 10% of the patients. At a multivariable analysis, absolute iron deficiency was significantly ( p = 0.001) associated with mechanical prosthesis mitral valve replacement (odds ratio 5.4, 95% confidence interval 1.9-15) an...
Cardiovascular research, 2017
Antisense long noncoding RNAs (ncRNAs) are transcripts emerging from the opposite strand of a cod... more Antisense long noncoding RNAs (ncRNAs) are transcripts emerging from the opposite strand of a coding-RNA region and their role in heart failure (HF) is largely unknown. Additionally, HF and Alzheimer's disease (AD) share several non-genetic effectors and risk factors. We investigated the regulation of the β-secretase-1 (BACE1) gene and of its antisense transcript BACE1-AS in ischaemic HF. BACE1 and BACE1-AS expression was measured in left ventricle biopsies from 18 patients affected by non-end stage ischaemic HF and 17 matched controls. The levels of both transcripts were increased in HF patients. Likewise, both transcripts increased also in a mouse model of ischaemic HF, and their expression was directly correlated. BACE1-AS was expressed by all cardiac cell types and BACE1-AS up- or down-modulation in cultured cardiomyocytes and endothelial cells induced a concordant regulation of the cognate BACE1 transcript. Interestingly, BACE1 increase also induced the intracellular accumu...
Interactive CardioVascular and Thoracic Surgery, 2016
OBJECTIVES: Postoperative bleeding in cardiac surgery remains an important complication, leading ... more OBJECTIVES: Postoperative bleeding in cardiac surgery remains an important complication, leading to increased morbidity and mortality. Different interventions are possible to prevent/treat postoperative bleeding. The present study aims to investigate the effectiveness of these interventions in a real-world scenario. METHODS: This is a retrospective study based on 19 670 consecutive adult cardiac surgery patients operated from 2000 to 2015. During the study period, the following interventions have been applied and tested for effectiveness with a before versus after analysis: thromboelastography (TEG)-based diagnosis and treatment in actively bleeding patients; platelet function tests (PFTs); timing of surgery based on PFTs; fresh frozen plasma (FFP)-free strategy using prothrombin complex concentrate and fibrinogen concentrate. RESULTS: TEG-based diagnostic and therapeutic approach resulted in a significant (P = 0.006) reduction of postoperative bleeding and significant (P = 0.001) increase in platelet concentrate transfusion rate. Timing of surgery based on PFTs resulted in a significant reduction of postoperative bleeding (P = 0.001), surgical re-exploration rate (P = 0.002), FFP (P = 0.001) and platelet concentrate (P = 0.016) transfusion rate. FFP-free strategy was associated with a significant decrease in postoperative bleeding (P = 0.005) and FFP transfusions (P = 0.001). The combination of all the interventions was associated with a significant (P = 0.001) reduction in postoperative bleeding, surgical re-exploration rate and FFP transfusions, whereas platelet concentrate transfusion rate was significantly (P = 0.001) higher. CONCLUSIONS: Despite a continuous increase in the bleeding risk profile, the application of a bundle of interventions is effective in controlling postoperative bleeding and related complications. Platelet transfusions remain unreplaceable in the present scenario.
European Heart Journal – Cardiovascular Imaging, 2016
In heart failure patients with reduced ejection fraction (HFrEF), exercise-induced functional mit... more In heart failure patients with reduced ejection fraction (HFrEF), exercise-induced functional mitral regurgitation (MR) may affect functional capacity and outcome. We sought to study functional and cardiac phenotypes of HFrEF patients according to the MR degree. Methods and results We performed rest and exercise echocardiography (Ex-Echo), simultaneously combined with cardiopulmonary exercise test (CPET), in 102 HFrEF patients, identifying 3 groups: non-severe (ERO ,20 mm 2) MR (group A), exercise-induced severe (ERO ≥20 mm 2) MR (group B), and rest severe MR (group C). Patients were tracked for the composite end point of death and heart failure hospitalization. Group B (ERO: rest¼ 14 + 5 mm 2 , Ex¼ 28 + 6 mm 2 ; P ¼ , 0.001) had a functional impairment (workload ¼ 56 + 21 vs. 50 + 17 watts, P ¼ 0.42; peak VO 2 ¼ 11.8 + 3.2 vs. 11.5 + 3.0 mL/Kg/min, P ¼ 0.70) similar to Group C (ERO: rest ¼ 29 + 7 mm 2 , Ex ¼ 42 + 7 mm 2 , P ¼ , 0.001), associated with comparable advanced left ventricle remodelling (end diastolic indexed volume ¼ 107 + 34 vs. 115 + 30 mL/m 2 , P ¼ 0.27), characterized by exercise-induced pulmonary hypertension (PH) (Ex systolic pulmonary pressures ¼ 63 + 16 mmHg). Group C showed the worse cardiac phenotype (right ventricle dilatation, dysfunction, and rest PH) with severe ventilatory impairment (VE/VCO 2 ¼ 41.2 + 11) compared with Groups A and B. Moreover, Group C had the higher rate of death and HF hospitalization. Conclusions In HFrEF patients, severe dynamic MR produces functional limitation similar to rest severe MR, characterized by dynamic PH. Rest severe MR reflects the most advanced bi-ventricular remodelling associated with rest PH, the most unfavourable ventilatory profile, and the worst mid-term outcome.
Journal of Cardiovascular Medicine, 2017
European Journal of Cardio-Thoracic Surgery
Journal of Thoracic and Cardiovascular Surgery
Diabetes, 2012
Increased morbidity and mortality associated with ischemic heart failure (HF) in type 2 diabetic ... more Increased morbidity and mortality associated with ischemic heart failure (HF) in type 2 diabetic patients requires a deeper understanding of the underpinning pathogenetic mechanisms. Given the implication of microRNAs (miRNAs) in HF, we investigated their regulation and potential role. miRNA expression profiles were measured in left ventricle biopsies from 10 diabetic HF (D-HF) and 19 nondiabetic HF (ND-HF) patients affected by non–end stage dilated ischemic cardiomyopathy. The HF groups were compared with each other and with 16 matched nondiabetic, non-HF control subjects. A total of 17 miRNAs were modulated in D-HF and/or ND-HF patients when compared with control subjects. miR-216a, strongly increased in both D-HF and ND-HF patients, negatively correlated with left ventricular ejection fraction. Six miRNAs were differently expressed when comparing D-HF and ND-HF patients: miR-34b, miR-34c, miR-199b, miR-210, miR-650, and miR-223. Bioinformatic analysis of their modulated targets s...
Journal of Clinical Medicine
Background: Hospital mortality and admission to the Intensive Care Unit (ICU) are markers of dise... more Background: Hospital mortality and admission to the Intensive Care Unit (ICU) are markers of disease severity in COVID-19 patients. Cardiovascular co-morbidities are one of the main determinants of negative outcomes. In this study we investigated the impact of cardiovascular co-morbidities on mortality and admission to the ICU in first-wave COVID-19 patients. Methods: A multicenter, retrospective, cohort study. A total of 1077 patients were analyzed for mortality and ICU admission. Cardiovascular risk factors were explored as determinants of the outcomes after correction for other confounders. Results: In the multivariable model, after correction for age, only a history of heart failure remained independently associated (p = 0.0013) with mortality (hazard ratio 2.22, 95% confidence interval 1.37 to 3.62). Age showed a mortality risk increase of 8% per year (hazard ratio 1.08, 95% confidence interval 1.05 to 1.10, p = 0.001). The transition from ward to the ICU had, as a single deter...
JACC: Cardiovascular Interventions, 2015
CONCLUSIONS LMWHþGPI and UFHþGPI are the most effective and bivalirudin the safest AC for PCI. AC... more CONCLUSIONS LMWHþGPI and UFHþGPI are the most effective and bivalirudin the safest AC for PCI. AC selection maybe tailored to patient's risk profile.
The Journal of Thoracic and Cardiovascular Surgery, 2014
, MS, b on behalf of the OBSERVANT Research Group Background: Despite the widespread use of trans... more , MS, b on behalf of the OBSERVANT Research Group Background: Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. Methods: There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. Results: Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level (P .02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level (P .005), but with a similar New York Heart Association class, frailty score, EuroSCORE (P ¼ NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention (P .01). Women showed a smaller aortic annulus than men in both populations (P<.001). Female sex was an independent predictor in the AVR population for risk-adjusted 30-day mortality (odds ratio [OR], 2.34; P ¼ .043) and transfusions (OR, 1.47; P ¼ .003), but not for risk-adjusted acute myocardial infarction, stroke, vascular complications, permanent atrioventricular block (P ¼ NS). Female sex was an independent predictor in the TAVI population for risk-adjusted major vascular complications (OR, 2.92; P ¼ .018) and transfusions (OR, 1.93; P ¼ .003), but proved protective against moderate to severe postprocedural aortic insufficiency (P ¼ .018). Conclusions: Female sex is a risk factor for mortality after aortic valve replacement, for major vascular complications after TAVI, and for transfusions after both approaches.
The Journal of Thoracic and Cardiovascular Surgery, 2014
e on behalf of the OBSERVANT Research Group Objective: Despite demonstration of the superior outc... more e on behalf of the OBSERVANT Research Group Objective: Despite demonstration of the superior outcomes of transcatheter aortic valve implantation (TAVI) versus optimal medical therapy for severe left ventricular systolic dysfunction, studies comparing TAVI and surgical aortic valve replacement (AVR) in this high-risk group have been lacking. Methods: We performed propensity matching for age, gender, baseline comorbidities, previous interventions, priority at hospital admission, frailty score, New York Heart Association class, EuroSCORE, and associated cardiac diseases. Next, the 30-day mortality and procedure-related morbidity of 162 patients (81 TAVI vs 81 AVR) with severe left ventricular systolic dysfunction (ejection fraction 35%) were analyzed at the Italian National Institute of Health. Results: The 30-day mortality was comparable (P ¼ .37) between the 2 groups. The incidence of periprocedural acute myocardial infarction (P ¼ .55), low output state (P ¼ .27), stroke (P ¼ .36), and renal dysfunction (peak creatinine level, P ¼ .57) was also similar between the 2 groups. TAVI resulted in significantly greater postprocedural permanent pacemaker implantation (P ¼ .01) and AVR in more periprocedural transfusions (P <.01) despite a similar transfusion rate per patient (2.8 AE 3.7 for TAVI vs 4.4 AE 3.8 for AVR; P ¼ .08). The postprocedural intensive care unit stay (median, 2 days after TAVI vs 3 days after AVR; P ¼ .34), intermediate care unit stay (median, 0 days after both TAVI and AVR; P ¼ .94), and hospitalization (median, 11 days after TAVI vs 14 days after AVR; P ¼ .51) were comparable. Conclusions: In patients with severe left ventricular systolic dysfunction, both TAVI and AVR are valid treatment options, with comparable hospital mortality and periprocedural morbidity. Comparisons of the mid-to long-term outcomes are mandatory.
Journal of Personalized Medicine
Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic stra... more Surgical ventricular restoration (SVR) has repeatedly been suggested as a viable therapeutic strategy for ischemic heart failure (HF) patients, although the survival benefit is still debated. We investigated a real-world population treated with SVR in a single center with high case volumes. From July 2001 to June 2017, 648 patients (111 females) underwent SVR; coronary surgery was performed in 582 patients. Data were analyzed by dividing the population into two groups: Group I (371 patients operated between July 2001 and December 2007) and Group II (277 patients operated between January 2008 and June 2017). At baseline, Group I patients were more symptomatic for angina (47.4% versus 19.4%, p < 0.0001) and less symptomatic for HF (NYHA class III/IV, 46.3% versus 57%, p = 0.0071). The end-diastolic volume (106 mL/m2 versus 118.3 mL/m2, p < 0.0001) and the end-systolic volume (70.5 mL/m2 versus 81.5 mL/m2, p < 0.0001) were lower in Group I. The presence of 3-vessel coronary ar...
Journal of the American College of Cardiology, Jan 17, 2018
Guidelines recommend the use of implanted cardioverter-defibrillators in patients with Brugada sy... more Guidelines recommend the use of implanted cardioverter-defibrillators in patients with Brugada syndrome and induced ventricular tachyarrhythmias, but there is no evidence supporting it. This prospective registry study was designed to explore clinical and electrophysiological predictors of malignant ventricular tachyarrhythmia inducibility in Brugada syndrome. A total of 191 consecutive selected patients with (group 1; n = 88) and without (group 2; n = 103) Brugada syndrome-related symptoms were prospectively enrolled in the registry. Patients underwent electrophysiological study and substrate mapping or ablation before and after ajmaline testing (1 mg/kg/5 min). Overall, before ajmaline testing, 53.4% of patients had ventricular tachyarrhythmia inducibility, which was more frequent in group 1 (65.9%) than in group 2 (42.7%; p < 0.001). Regardless of clinical presentation, larger substrates with more fragmented long-duration ventricular potentials were found in patients with induc...
Circulation. Arrhythmia and electrophysiology, 2018
Clinical outcomes after ablation of persistent atrial fibrillation remain suboptimal. Identificat... more Clinical outcomes after ablation of persistent atrial fibrillation remain suboptimal. Identification of AF drivers using a novel integrated mapping technique may be crucial to ameliorate the clinical outcome. Persistent AF patients were prospectively enrolled to undergo high-density electrophysiological mapping to identify repetitive-regular activities (RRas) before modified circumferential pulmonary vein (PV) ablation. They have been randomly assigned (1:1 ratio) to ablation of RRa followed by modified circumferential PV ablation (mapping group; n=41) or modified circumferential PV ablation alone (control group; n=40). The primary end point was freedom from arrhythmic recurrences at 1 year. In total, 81 persistent AF patients (74% male; mean age, 61.7±10.6 years) underwent mapping/ablation procedure. The regions exhibiting RRa were 479 in 81 patients (5.9±2.4 RRa per patient): 232 regions in the mapping group (n=41) and 247 in the control group (n=40). Overall, 185 of 479 (39%) RRa...
European heart journal, Jan 12, 2017
The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently i... more The age, creatinine, and ejection fraction (ACEF) score was introduced in 2009 and is presently included in the guidelines for myocardial revascularization of the European Society of Cardiology and Association for Cardio-Thoracic Surgery as a risk stratification tool for surgical and percutaneous myocardial revascularization. The present study introduces an updated version of the ACEF (ACEF II) inclusive of emergency surgery and pre-operative anaemia. The development series includes 7011 consecutive cardiac surgery patients operated at a single institution. The validation series includes 1687 consecutive cardiac surgery patients operated in a different institution. The five factors included in the ACEF II were assessed in a multivariable logistic regression model testing their independent role as predictors of operative (in hospital or 30 days after surgery) mortality. Based on the odds ratio of each predictor, the ACEF II score is calculated as age(years)/ejection fraction (%). Add...
Translational pediatrics, 2017
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2017
The PARTNER group recently published a comparison between the latest generation SAPIEN 3 transcat... more The PARTNER group recently published a comparison between the latest generation SAPIEN 3 transcatheter aortic valve implantation (TAVI) system (Edwards Lifesciences, Irvine, CA, USA) and surgical aortic valve replacement (SAVR) in intermediate-risk patients, apparently demonstrating superiority of the TAVI and suggesting that TAVI might be the preferred treatment method in this risk class of patients. Nonetheless, assessment of the non-randomized methodology used in this comparison reveals challenges that should be addressed in order to elucidate the validity of the results. The study by Thourani and colleagues showed several major methodological concerns: suboptimal methods in propensity score analysis with evident misspecification of the propensity scores (PS; no adjustment for the most significantly different covariates: left ventricular ejection fraction, moderate-severe mitral regurgitation and associated procedures); use of PS quintiles rather than matching; inference on not-a...
Circulation. Arrhythmia and electrophysiology, 2017
There is emerging evidence that localization and elimination of abnormal electric activity in the... more There is emerging evidence that localization and elimination of abnormal electric activity in the epicardial right ventricular outflow tract may be beneficial in patients with Brugada syndrome. A total of 135 symptomatic Brugada syndrome patients having implantable cardiac defibrillator were enrolled: 63 (group 1) having documented ventricular tachycardia (VT)/ventricular fibrillation (VF) and Brugada syndrome-related symptoms, and 72 (group 2) having inducible VT/VF without ECG documentation at the time of symptoms. About 27 patients of group 1 experienced multiple implantable cardiac defibrillator shocks for recurrent VT/VF episodes. Three-dimensional maps before and after ajmaline determined the arrhythmogenic electrophysiological substrate (AES) as characterized by prolonged fragmented ventricular potentials. Primary end point was identification and elimination of AES leading to ECG pattern normalization and VT/VF noninducibility. Extensive areas of AES were found in the right v...
Seminars in Thoracic and Cardiovascular Surgery, 2017
Coronary artery bypass is often the first procedure cardiac surgeons are confronted with during t... more Coronary artery bypass is often the first procedure cardiac surgeons are confronted with during their residencies. This article discusses the surgical steps and the potential difficulties encountered during this procedure and how they can be solved. The &amp;quot;point of view&amp;quot; of an experienced surgeon is provided to the trainees and to the readers.
European journal of preventive cardiology, May 1, 2017
Background Anaemia and iron deficiency are frequent following major surgery. The present study ai... more Background Anaemia and iron deficiency are frequent following major surgery. The present study aims to identify the iron deficiency patterns in cardiac surgery patients at their admission to a cardiac rehabilitation programme, and to determine which perioperative risk factor(s) may be associated with functional and absolute iron deficiency. Design This was a retrospective study on prospectively collected data. Methods The patient population included 339 patients. Functional iron deficiency was defined in the presence of transferrin saturation <20% and serum ferritin ≥100 µg/l. Absolute iron deficiency was defined in the presence of serum ferritin values <100 µg/l. Results Functional iron deficiency was found in 62.9% of patients and absolute iron deficiency in 10% of the patients. At a multivariable analysis, absolute iron deficiency was significantly ( p = 0.001) associated with mechanical prosthesis mitral valve replacement (odds ratio 5.4, 95% confidence interval 1.9-15) an...
Cardiovascular research, 2017
Antisense long noncoding RNAs (ncRNAs) are transcripts emerging from the opposite strand of a cod... more Antisense long noncoding RNAs (ncRNAs) are transcripts emerging from the opposite strand of a coding-RNA region and their role in heart failure (HF) is largely unknown. Additionally, HF and Alzheimer's disease (AD) share several non-genetic effectors and risk factors. We investigated the regulation of the β-secretase-1 (BACE1) gene and of its antisense transcript BACE1-AS in ischaemic HF. BACE1 and BACE1-AS expression was measured in left ventricle biopsies from 18 patients affected by non-end stage ischaemic HF and 17 matched controls. The levels of both transcripts were increased in HF patients. Likewise, both transcripts increased also in a mouse model of ischaemic HF, and their expression was directly correlated. BACE1-AS was expressed by all cardiac cell types and BACE1-AS up- or down-modulation in cultured cardiomyocytes and endothelial cells induced a concordant regulation of the cognate BACE1 transcript. Interestingly, BACE1 increase also induced the intracellular accumu...
Interactive CardioVascular and Thoracic Surgery, 2016
OBJECTIVES: Postoperative bleeding in cardiac surgery remains an important complication, leading ... more OBJECTIVES: Postoperative bleeding in cardiac surgery remains an important complication, leading to increased morbidity and mortality. Different interventions are possible to prevent/treat postoperative bleeding. The present study aims to investigate the effectiveness of these interventions in a real-world scenario. METHODS: This is a retrospective study based on 19 670 consecutive adult cardiac surgery patients operated from 2000 to 2015. During the study period, the following interventions have been applied and tested for effectiveness with a before versus after analysis: thromboelastography (TEG)-based diagnosis and treatment in actively bleeding patients; platelet function tests (PFTs); timing of surgery based on PFTs; fresh frozen plasma (FFP)-free strategy using prothrombin complex concentrate and fibrinogen concentrate. RESULTS: TEG-based diagnostic and therapeutic approach resulted in a significant (P = 0.006) reduction of postoperative bleeding and significant (P = 0.001) increase in platelet concentrate transfusion rate. Timing of surgery based on PFTs resulted in a significant reduction of postoperative bleeding (P = 0.001), surgical re-exploration rate (P = 0.002), FFP (P = 0.001) and platelet concentrate (P = 0.016) transfusion rate. FFP-free strategy was associated with a significant decrease in postoperative bleeding (P = 0.005) and FFP transfusions (P = 0.001). The combination of all the interventions was associated with a significant (P = 0.001) reduction in postoperative bleeding, surgical re-exploration rate and FFP transfusions, whereas platelet concentrate transfusion rate was significantly (P = 0.001) higher. CONCLUSIONS: Despite a continuous increase in the bleeding risk profile, the application of a bundle of interventions is effective in controlling postoperative bleeding and related complications. Platelet transfusions remain unreplaceable in the present scenario.
European Heart Journal – Cardiovascular Imaging, 2016
In heart failure patients with reduced ejection fraction (HFrEF), exercise-induced functional mit... more In heart failure patients with reduced ejection fraction (HFrEF), exercise-induced functional mitral regurgitation (MR) may affect functional capacity and outcome. We sought to study functional and cardiac phenotypes of HFrEF patients according to the MR degree. Methods and results We performed rest and exercise echocardiography (Ex-Echo), simultaneously combined with cardiopulmonary exercise test (CPET), in 102 HFrEF patients, identifying 3 groups: non-severe (ERO ,20 mm 2) MR (group A), exercise-induced severe (ERO ≥20 mm 2) MR (group B), and rest severe MR (group C). Patients were tracked for the composite end point of death and heart failure hospitalization. Group B (ERO: rest¼ 14 + 5 mm 2 , Ex¼ 28 + 6 mm 2 ; P ¼ , 0.001) had a functional impairment (workload ¼ 56 + 21 vs. 50 + 17 watts, P ¼ 0.42; peak VO 2 ¼ 11.8 + 3.2 vs. 11.5 + 3.0 mL/Kg/min, P ¼ 0.70) similar to Group C (ERO: rest ¼ 29 + 7 mm 2 , Ex ¼ 42 + 7 mm 2 , P ¼ , 0.001), associated with comparable advanced left ventricle remodelling (end diastolic indexed volume ¼ 107 + 34 vs. 115 + 30 mL/m 2 , P ¼ 0.27), characterized by exercise-induced pulmonary hypertension (PH) (Ex systolic pulmonary pressures ¼ 63 + 16 mmHg). Group C showed the worse cardiac phenotype (right ventricle dilatation, dysfunction, and rest PH) with severe ventilatory impairment (VE/VCO 2 ¼ 41.2 + 11) compared with Groups A and B. Moreover, Group C had the higher rate of death and HF hospitalization. Conclusions In HFrEF patients, severe dynamic MR produces functional limitation similar to rest severe MR, characterized by dynamic PH. Rest severe MR reflects the most advanced bi-ventricular remodelling associated with rest PH, the most unfavourable ventilatory profile, and the worst mid-term outcome.