Chiara Mina - Academia.edu (original) (raw)

Papers by Chiara Mina

CardioVascular and Interventional Radiology, 2006

Objective: To evaluate the efficacy of subclavian stenosis percutaneous transfemoral angioplasty ... more Objective: To evaluate the efficacy of subclavian stenosis percutaneous transfemoral angioplasty (PTA)-treatment in patients with intermittent or complete subclavian steal syndrome (SSS), and coronary-subclavian steal syndrome (C-SSS) after left internal mammary artery-interventricular anterior artery (LIMA-IVA) by pass graft. Methods: We studied 42 patients with coronary subclavian steal syndrome subdivided in two groups; the first group consisted of 15 patients who presented an intermittent vertebral-subclavian steal, while the second group consisted of 27 patients with a complete vertebral-subclavian steal. All patients were treated with angioplasty and stent application and were followed up for a period of 5 years by echocolordoppler examination to evaluate any subclavian restenosis. Results: Subclavian restenosis was significantly increased in patients with a complete subclavian steal syndrome. The restenosis rate was 6.67% in the first group and 40.75% in the second group, These patients had 9.1 fold-increase risk (CI confidence interval 0.95-86.48) in restenosis. Conclusion: Patients with a complete subclavian and coronary steal syndrome present a higher risk of subclavian restenosis.

Journal of Cardiovascular Medicine, 2015

In 2009, irregular heart beat and exertional dyspnoea occurred and frequent premature ventricular... more In 2009, irregular heart beat and exertional dyspnoea occurred and frequent premature ventricular beats and two episodes of sustained ventricular tachycardia were recorded. The echocardiogram revealed a biventricular dilatation and severe dysfunction (right ventricular fractional area change 23%; Left ventricular ejection fraction, 31%). The right ventricle (RV) presented diastolic bulging of the apex and infero-lateral wall, while left ventricular apex and the lateral wall had a two-layered myocardial

European journal of heart failure, Jul 24, 2017

The use of β-blockers represents a milestone in the treatment of heart failure with reduced eject... more The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0....

International journal of cardiology, Jan 6, 2018

The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (A... more The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) even...

Progress in transplantation (Aliso Viejo, Calif.), 2018

Peripheral neuropathy can affect patients with heart failure, though its prevalence is unknown. A... more Peripheral neuropathy can affect patients with heart failure, though its prevalence is unknown. After heart transplantation, it can influence the postoperative course and quality of life, but screening for neuromuscular disease is not routinely performed. The aim of this study was to identify the factors associated with neuropathy in a population of patients with heart failure who are candidates for heart transplantation. Data regarding patients' clinical history, including recent hospitalizations, were collected. All patients underwent a complete neurological examination and a neurophysiological protocol including nerve conduction studies and concentric needle electromyography. Thirty-two patients were included in the study, and neuropathy was diagnosed in 10 (31.3%). Neuropathy was associated with the number of admissions ( P = .023; odds ratio [OR]: 1.96) and the total number of days of hospitalization in the year prior to inclusion in the study ( P = .010; OR: 1.03). The maj...

ASAIO journal (American Society for Artificial Internal Organs : 1992), Jan 18, 2017

Pulmonary hypertension (PH) is a disease characterized by progressive adverse remodeling of the d... more Pulmonary hypertension (PH) is a disease characterized by progressive adverse remodeling of the distal pulmonary arteries, resulting in elevated pulmonary vascular resistance and load pressure on the right ventricle (RV), ultimately leading to RV failure. Invasive hemodynamic testing is the gold standard for diagnosing PH and guiding patient therapy. We hypothesized that lumped-parameter and biventricular finite-element (FE) modeling may lead to noninvasive predictions of both PH-related hemodynamic and biomechanical parameters that induce PH. We created patient-specific biventricular FE models that characterize the biomechanical response of the heart and coupled them with a lumped-parameter model that represents the systemic and pulmonic circulation. Simulations were calibrated by adjusting the pulmonary vascular resistance and myocardial contractility parameters through matching imaging data of ventricular chambers. Linear regression analysis demonstrated that the lumped-derived R...

European Heart Journal – Cardiovascular Imaging

In patients with pulmonary hypertension (PH) right ventricular (RV) remodeling and function depen... more In patients with pulmonary hypertension (PH) right ventricular (RV) remodeling and function depend not only on pulmonary pressure but also on intrinsic properties of pulmonary artery wall. RV function is a well-recognized determinant of clinical outcome in PH patients. Data regarding the impact of pulmonary artery stiffness (PAS) assessed by echocardiography on PH patients' outcome are scarce. Due to the common embryological origin of the proximal segments of the great vessels, aortic elastic properties may also be impaired in this setting. Purpose. To assess pulmonary and aortic stiffness parameters in PH patients receiving specific vasodilator therapy using 2D transthoracic echocardiography and the PAS impact on clinical outcome in these patients. Methods. Forty-seven patients (40615 years, 35 women) with PH (13 with idiopathic pulmonary arterial hypertension (PAH), 17 with congenital heart disease, 6 with connective tissue disease, 6 with chronic thromboembolic PH and 5 with other forms of PAH) treated with either bosentan, sildenafil, or both and 33 healthy volunteers with similar age and gender (40611 years, 21 women) were studied. Clinical parameters, B-type natriuretic peptide (BNP) and PAS parameters were assessed: pulsatility, capacitance, elastic modulus, compliance, dynamic compliance, beta-index, pulmonary strain. Moreover, following parameters of aortic stiffness (AS) were also assessed: strain, pulse pressure, elastic modulus and beta index. PH patients were followed-up for 23 months (2-49). An endpoint of cardiac death was defined. Results. PH patients had higher right chambers size, PA size (both transversal and longitudinal end-diastolic diameter), impaired PAS parameters compared to healthy volunteers (all p <0.001). All parameters of AS were also significantly impaired in patients with PH as compared to controls, with p values ranging from 0,002 to 0,049. At the end-of-follow-up, there was a significant impairment in pulmonary dynamic compliance (7.2664.06 vs 5.6863.69 mmHg-1, p¼0.028), distensibility (0.2460.14 vs 0.1960.12 mmHg-1, p¼0.018), elastic modulus (575.16346.9 vs 926.36776.7 mmHg, p¼0.004), beta index (9.9666.04 vs 15.46614.34, p¼0.011), strain (6.4763.08 vs 5.3163.20 %, p¼0.043) and pulsatility (13.4566.61 vs 11.0166.81 %, p¼0.044). During follow-up, 7 patients died. Amongst PAS parameters, patients who reached the endpoint had at baseline a decreased PA capacitance (0.5460.20 vs 0.8660.51 ml/(mmHg*m2), p¼0.011). Moreover, baseline PA capacitance significantly correlated with end-of-follow-up 6 minutes walk distance (r¼0.34, p ¼ 0.032) and BNP levels (r¼-0.37, p¼0,021). Conclusions: In PH patients PA stiffness impacts clinical parameters and patient outcome. The therapeutic implications of this finding remain to be further studied.

European journal of heart failure, Jul 24, 2017

The use of β-blockers represents a milestone in the treatment of heart failure with reduced eject... more The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0....

European journal of internal medicine, Jan 28, 2016

Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predict... more Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown. Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (<11g/dL), low (11-12 for females, 11-13 for males), normal (12-15 for females, 13-15 for males) and high (>15) Hb, respectively. Median follow-up was 1363days (606-1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR)=0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire population. Considering Hb groups sepa...

European Journal of Heart Failure, 2016

Obesity has been found to be protective in heart failure (HF), a finding leading to the concept o... more Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HF patients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF.

European journal of preventive cardiology, Jan 26, 2014

Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, indepen... more Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO2AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. We tested the prognostic role of VO2AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p = 0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO2) showed a prognostic capacity (C-...

Neurological Sciences, 2015

Neuropathies may affect heart reinnervation and functional outcome after heart transplantation (H... more Neuropathies may affect heart reinnervation and functional outcome after heart transplantation (HT). In this study, neurological evaluations, standard nerve conduction studies, and electromyography were performed in 32 HT candidates without a previous history of neuromuscular disorder. Ten patients underwent HT and were revaluated 3 months later. We found that before HT 10 (31.3 %) patients had sensorimotor polyneuropathy (18.8 %) or sensory polyneuropathy (12.5 %). After HT, the percentage of patients with a neuromuscular disorder increased to 70 %, most of them showing new or worsening neuropathies or neuromyopathies. The most sensitive abnormality that indicated neuromuscular involvement after HT was a reduction of the compound muscle action potential (CMAP) of the deep peroneal nerve. In conclusion, neuromuscular disorders are common in HT candidates, and they further increase in occurrence after HT. A reduction of the deep peroneal nerve CMAP amplitude after HT may help to identify patients who need a more detailed neurophysiological evaluation. The diagnosis of neuromuscular disorders before and after HT may contribute to the development of more accurate therapeutic and rehabilitative strategies for these patients.

Circulation Journal, 2015

on behalf of the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) Sc... more on behalf of the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) Score Research Group Background: Chronic kidney disease is associated with sympathetic activation and muscle abnormalities, which may contribute to decreased exercise capacity. We investigated the correlation of renal function with peak exercise oxygen consumption (V O2) in heart failure (HF) patients. Methods and Results: We recruited 2,938 systolic HF patients who underwent clinical, laboratory, echocardiographic and cardiopulmonary exercise testing. The patients were stratified according to estimated glomerular filtration rate (eGFR). Mean follow-up was 3.7 years. The primary outcome was a composite of cardiovascular death and urgent heart transplantation at 3 years. On multivariable regression, eGFR was predictor of peakV O2 (P<0.0001). Other predictors were age, sex, body mass index, HF etiology, NYHA class, atrial fibrillation, resting heart rate, Btype natriuretic peptide, hemoglobin, and treatment. After adjusting for significant covariates, the hazard ratio for primary outcome associated with peakV O2 <12 ml • kg −1 • min −1 was 1.75 (95% confidence interval (CI): 1.06-2.91; P=0.0292) in patients with eGFR ≥60, 1.77 (0.87-3.61; P=0.1141) in those with eGFR of 45-59, and 2.72 (1.01-7.37; P=0.0489) in those with eGFR <45 ml • min −1 • 1.73 m −2. The area under the receiver-operating characteristic curve for peakV O2 <12 ml • kg −1 • min −1 was 0.63 (95% CI: 0.54-0.71), 0.67 (0.56-0.78), and 0.57 (0.47-0.69), respectively. Testing for interaction was not significant. Conclusions: Renal dysfunction is correlated with peakV O2. A peakV O2 cutoff of 12 ml • kg-1 • min-1 offers limited prognostic information in HF patients with more severely impaired renal function.

European Journal of Heart Failure

Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A m... more Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A multiparametric approach is the best method to stratify prognosis. In 2012, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was proposed to assess the risk of cardiovascular mortality and urgent heart transplantation. The aim of the present study was to compare the prognostic accuracy of MECKI score to that of HF Survival Score (HFSS) and Seattle HF Model (SHFM) in a large, multicentre cohort of HF patients with reduced ejection fraction.

European Journal of Internal Medicine, 2015

Cirrhotic cardiomyopathy has been characterized by impaired contractile response to stress and/or... more Cirrhotic cardiomyopathy has been characterized by impaired contractile response to stress and/or altered diastolic relaxation, with electrophysiological abnormalities in the absence of known cardiac disease. However, the clinical significance of diastolic dysfunction (DDF) in cirrhotic patients has not been clarified. We studied 84 cirrhotic patients with normal systolic function to evaluate the prevalence of DDF using tissue Doppler imaging, and to investigate the possible correlation of DDF with outcomes (hospitalization, death) and with the specific causes of death. The mean follow-up was 10±8months. DDF was diagnosed in 22 patients (26.2%). Patients with DDF more frequently had ascites (90.9% vs. 64.5 %; p=0.026), lower levels of albumin (OR: 5.39; p=0.004), higher NT-proBNP levels, and longer QTc interval (464±23ms vs. 452±30ms; p=0.039). At follow-up, patients with DDF did not have a higher incidence of adverse events in terms of hospitalization and death. The presence of diastolic dysfunction has not been found to be clearly associated with outcome, and prognosis has been determined primarily by the severity of liver disease.

European journal of preventive cardiology, Aug 26, 2014

Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, indepen... more Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO2AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. We tested the prognostic role of VO2AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p = 0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO2) showed a prognostic capacity (C-...

Introduction: Superficial venous thrombosis (SVT) has been considered for a long time a limited c... more Introduction: Superficial venous thrombosis (SVT) has been considered for a long time a limited clinical condition with a low importance, but this approach has changed in recent years, when several studies demonstrated spreading to deep veins occurring from 7.3 to 44%, with high prevalence of pulmonary embolism. Materials and methods: To evaluate the prevalence of genetic risk factors for VTE in patients suffering from SVT on both normal and varicose vein, and to understand their role on spreading to deep veins, we studied 107 patients with SVT, without other risk factors. Ultrasound examination was performed, and the presence of FV Leiden, Prothrombin G20210A mutation, and MTHFR C677T mutation was researched. Results: In the patients where SVT occurred in normal veins, the presence of FV Leiden was 26.3% of the non-spreading and 60% of the spreading to deep veins SVT; Prothrombin mutation was found in 7.9% of the former case and in 20% of the latter; MTHFR C677T mutation was found respectively in 23.7% and 40%. In the patients with SVT on varicose veins, the presence of these factors was less evident (6.7%, 4.4% and 6.7% respectively), but their prevalence was considerably higher (35.7%, 7.4% and 21.4% respectively) in SVT spreading to deep veins than in non-spreading. Conclusions: Our data demonstrate the high prevalence of these mutations, especially FV Leiden and associations, in patients with SVT on normal veins and their role in the progression to deep vein system.

International Journal of Cardiology, 2016

Heart transplantation (HTx) improves the quality of life and survival in patients affected by end... more Heart transplantation (HTx) improves the quality of life and survival in patients affected by end-stage heart failure. The purpose of the current study is to present the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; clinical data and results of HTx in a single Center of Sicily. Focus on survival after pre and post HTx mechanical circulatory support use will be performed. 133 HTx were done from 2004 to the end of 2015.The average donor age was 34±13.5years and the proportion of male donors was 67%. Percentage of use of mechanical circulatory support to bridge patients to HTx was 18%. Overall pre-transplant mechanical circulatory support was not correlated to worse post-transplant prognosis, p=0.757. Severe primary early graft failure requiring extra corporeal membrane oxygenator support strongly impact the early mortality after heart transplantation (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The results of HTx at ISMETT are comparable to those reported in high volume Italian transplant centers as well as in the ISHLT registry. The favorable outcome can be related to focus on multidisciplinary approach, strict recipients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; selection and young donor population. Post HTx mechanical circulatory support use in general remains associated with worse post-transplant outcomes. This does not apply to pre-op mechanical circulatory support population.

CardioVascular and Interventional Radiology, 2006

Objective: To evaluate the efficacy of subclavian stenosis percutaneous transfemoral angioplasty ... more Objective: To evaluate the efficacy of subclavian stenosis percutaneous transfemoral angioplasty (PTA)-treatment in patients with intermittent or complete subclavian steal syndrome (SSS), and coronary-subclavian steal syndrome (C-SSS) after left internal mammary artery-interventricular anterior artery (LIMA-IVA) by pass graft. Methods: We studied 42 patients with coronary subclavian steal syndrome subdivided in two groups; the first group consisted of 15 patients who presented an intermittent vertebral-subclavian steal, while the second group consisted of 27 patients with a complete vertebral-subclavian steal. All patients were treated with angioplasty and stent application and were followed up for a period of 5 years by echocolordoppler examination to evaluate any subclavian restenosis. Results: Subclavian restenosis was significantly increased in patients with a complete subclavian steal syndrome. The restenosis rate was 6.67% in the first group and 40.75% in the second group, These patients had 9.1 fold-increase risk (CI confidence interval 0.95-86.48) in restenosis. Conclusion: Patients with a complete subclavian and coronary steal syndrome present a higher risk of subclavian restenosis.

Journal of Cardiovascular Medicine, 2015

In 2009, irregular heart beat and exertional dyspnoea occurred and frequent premature ventricular... more In 2009, irregular heart beat and exertional dyspnoea occurred and frequent premature ventricular beats and two episodes of sustained ventricular tachycardia were recorded. The echocardiogram revealed a biventricular dilatation and severe dysfunction (right ventricular fractional area change 23%; Left ventricular ejection fraction, 31%). The right ventricle (RV) presented diastolic bulging of the apex and infero-lateral wall, while left ventricular apex and the lateral wall had a two-layered myocardial

European journal of heart failure, Jul 24, 2017

The use of β-blockers represents a milestone in the treatment of heart failure with reduced eject... more The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0....

International journal of cardiology, Jan 6, 2018

The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (A... more The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) even...

Progress in transplantation (Aliso Viejo, Calif.), 2018

Peripheral neuropathy can affect patients with heart failure, though its prevalence is unknown. A... more Peripheral neuropathy can affect patients with heart failure, though its prevalence is unknown. After heart transplantation, it can influence the postoperative course and quality of life, but screening for neuromuscular disease is not routinely performed. The aim of this study was to identify the factors associated with neuropathy in a population of patients with heart failure who are candidates for heart transplantation. Data regarding patients' clinical history, including recent hospitalizations, were collected. All patients underwent a complete neurological examination and a neurophysiological protocol including nerve conduction studies and concentric needle electromyography. Thirty-two patients were included in the study, and neuropathy was diagnosed in 10 (31.3%). Neuropathy was associated with the number of admissions ( P = .023; odds ratio [OR]: 1.96) and the total number of days of hospitalization in the year prior to inclusion in the study ( P = .010; OR: 1.03). The maj...

ASAIO journal (American Society for Artificial Internal Organs : 1992), Jan 18, 2017

Pulmonary hypertension (PH) is a disease characterized by progressive adverse remodeling of the d... more Pulmonary hypertension (PH) is a disease characterized by progressive adverse remodeling of the distal pulmonary arteries, resulting in elevated pulmonary vascular resistance and load pressure on the right ventricle (RV), ultimately leading to RV failure. Invasive hemodynamic testing is the gold standard for diagnosing PH and guiding patient therapy. We hypothesized that lumped-parameter and biventricular finite-element (FE) modeling may lead to noninvasive predictions of both PH-related hemodynamic and biomechanical parameters that induce PH. We created patient-specific biventricular FE models that characterize the biomechanical response of the heart and coupled them with a lumped-parameter model that represents the systemic and pulmonic circulation. Simulations were calibrated by adjusting the pulmonary vascular resistance and myocardial contractility parameters through matching imaging data of ventricular chambers. Linear regression analysis demonstrated that the lumped-derived R...

European Heart Journal – Cardiovascular Imaging

In patients with pulmonary hypertension (PH) right ventricular (RV) remodeling and function depen... more In patients with pulmonary hypertension (PH) right ventricular (RV) remodeling and function depend not only on pulmonary pressure but also on intrinsic properties of pulmonary artery wall. RV function is a well-recognized determinant of clinical outcome in PH patients. Data regarding the impact of pulmonary artery stiffness (PAS) assessed by echocardiography on PH patients' outcome are scarce. Due to the common embryological origin of the proximal segments of the great vessels, aortic elastic properties may also be impaired in this setting. Purpose. To assess pulmonary and aortic stiffness parameters in PH patients receiving specific vasodilator therapy using 2D transthoracic echocardiography and the PAS impact on clinical outcome in these patients. Methods. Forty-seven patients (40615 years, 35 women) with PH (13 with idiopathic pulmonary arterial hypertension (PAH), 17 with congenital heart disease, 6 with connective tissue disease, 6 with chronic thromboembolic PH and 5 with other forms of PAH) treated with either bosentan, sildenafil, or both and 33 healthy volunteers with similar age and gender (40611 years, 21 women) were studied. Clinical parameters, B-type natriuretic peptide (BNP) and PAS parameters were assessed: pulsatility, capacitance, elastic modulus, compliance, dynamic compliance, beta-index, pulmonary strain. Moreover, following parameters of aortic stiffness (AS) were also assessed: strain, pulse pressure, elastic modulus and beta index. PH patients were followed-up for 23 months (2-49). An endpoint of cardiac death was defined. Results. PH patients had higher right chambers size, PA size (both transversal and longitudinal end-diastolic diameter), impaired PAS parameters compared to healthy volunteers (all p <0.001). All parameters of AS were also significantly impaired in patients with PH as compared to controls, with p values ranging from 0,002 to 0,049. At the end-of-follow-up, there was a significant impairment in pulmonary dynamic compliance (7.2664.06 vs 5.6863.69 mmHg-1, p¼0.028), distensibility (0.2460.14 vs 0.1960.12 mmHg-1, p¼0.018), elastic modulus (575.16346.9 vs 926.36776.7 mmHg, p¼0.004), beta index (9.9666.04 vs 15.46614.34, p¼0.011), strain (6.4763.08 vs 5.3163.20 %, p¼0.043) and pulsatility (13.4566.61 vs 11.0166.81 %, p¼0.044). During follow-up, 7 patients died. Amongst PAS parameters, patients who reached the endpoint had at baseline a decreased PA capacitance (0.5460.20 vs 0.8660.51 ml/(mmHg*m2), p¼0.011). Moreover, baseline PA capacitance significantly correlated with end-of-follow-up 6 minutes walk distance (r¼0.34, p ¼ 0.032) and BNP levels (r¼-0.37, p¼0,021). Conclusions: In PH patients PA stiffness impacts clinical parameters and patient outcome. The therapeutic implications of this finding remain to be further studied.

European journal of heart failure, Jul 24, 2017

The use of β-blockers represents a milestone in the treatment of heart failure with reduced eject... more The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0....

European journal of internal medicine, Jan 28, 2016

Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predict... more Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown. Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (<11g/dL), low (11-12 for females, 11-13 for males), normal (12-15 for females, 13-15 for males) and high (>15) Hb, respectively. Median follow-up was 1363days (606-1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR)=0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire population. Considering Hb groups sepa...

European Journal of Heart Failure, 2016

Obesity has been found to be protective in heart failure (HF), a finding leading to the concept o... more Obesity has been found to be protective in heart failure (HF), a finding leading to the concept of an obesity paradox. We hypothesized that a preserved cardiorespiratory fitness in obese HF patients may affect the relationship between survival and body mass index (BMI) and explain the obesity paradox in HF.

European journal of preventive cardiology, Jan 26, 2014

Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, indepen... more Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO2AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. We tested the prognostic role of VO2AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p = 0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO2) showed a prognostic capacity (C-...

Neurological Sciences, 2015

Neuropathies may affect heart reinnervation and functional outcome after heart transplantation (H... more Neuropathies may affect heart reinnervation and functional outcome after heart transplantation (HT). In this study, neurological evaluations, standard nerve conduction studies, and electromyography were performed in 32 HT candidates without a previous history of neuromuscular disorder. Ten patients underwent HT and were revaluated 3 months later. We found that before HT 10 (31.3 %) patients had sensorimotor polyneuropathy (18.8 %) or sensory polyneuropathy (12.5 %). After HT, the percentage of patients with a neuromuscular disorder increased to 70 %, most of them showing new or worsening neuropathies or neuromyopathies. The most sensitive abnormality that indicated neuromuscular involvement after HT was a reduction of the compound muscle action potential (CMAP) of the deep peroneal nerve. In conclusion, neuromuscular disorders are common in HT candidates, and they further increase in occurrence after HT. A reduction of the deep peroneal nerve CMAP amplitude after HT may help to identify patients who need a more detailed neurophysiological evaluation. The diagnosis of neuromuscular disorders before and after HT may contribute to the development of more accurate therapeutic and rehabilitative strategies for these patients.

Circulation Journal, 2015

on behalf of the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) Sc... more on behalf of the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) Score Research Group Background: Chronic kidney disease is associated with sympathetic activation and muscle abnormalities, which may contribute to decreased exercise capacity. We investigated the correlation of renal function with peak exercise oxygen consumption (V O2) in heart failure (HF) patients. Methods and Results: We recruited 2,938 systolic HF patients who underwent clinical, laboratory, echocardiographic and cardiopulmonary exercise testing. The patients were stratified according to estimated glomerular filtration rate (eGFR). Mean follow-up was 3.7 years. The primary outcome was a composite of cardiovascular death and urgent heart transplantation at 3 years. On multivariable regression, eGFR was predictor of peakV O2 (P<0.0001). Other predictors were age, sex, body mass index, HF etiology, NYHA class, atrial fibrillation, resting heart rate, Btype natriuretic peptide, hemoglobin, and treatment. After adjusting for significant covariates, the hazard ratio for primary outcome associated with peakV O2 <12 ml • kg −1 • min −1 was 1.75 (95% confidence interval (CI): 1.06-2.91; P=0.0292) in patients with eGFR ≥60, 1.77 (0.87-3.61; P=0.1141) in those with eGFR of 45-59, and 2.72 (1.01-7.37; P=0.0489) in those with eGFR <45 ml • min −1 • 1.73 m −2. The area under the receiver-operating characteristic curve for peakV O2 <12 ml • kg −1 • min −1 was 0.63 (95% CI: 0.54-0.71), 0.67 (0.56-0.78), and 0.57 (0.47-0.69), respectively. Testing for interaction was not significant. Conclusions: Renal dysfunction is correlated with peakV O2. A peakV O2 cutoff of 12 ml • kg-1 • min-1 offers limited prognostic information in HF patients with more severely impaired renal function.

European Journal of Heart Failure

Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A m... more Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A multiparametric approach is the best method to stratify prognosis. In 2012, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was proposed to assess the risk of cardiovascular mortality and urgent heart transplantation. The aim of the present study was to compare the prognostic accuracy of MECKI score to that of HF Survival Score (HFSS) and Seattle HF Model (SHFM) in a large, multicentre cohort of HF patients with reduced ejection fraction.

European Journal of Internal Medicine, 2015

Cirrhotic cardiomyopathy has been characterized by impaired contractile response to stress and/or... more Cirrhotic cardiomyopathy has been characterized by impaired contractile response to stress and/or altered diastolic relaxation, with electrophysiological abnormalities in the absence of known cardiac disease. However, the clinical significance of diastolic dysfunction (DDF) in cirrhotic patients has not been clarified. We studied 84 cirrhotic patients with normal systolic function to evaluate the prevalence of DDF using tissue Doppler imaging, and to investigate the possible correlation of DDF with outcomes (hospitalization, death) and with the specific causes of death. The mean follow-up was 10±8months. DDF was diagnosed in 22 patients (26.2%). Patients with DDF more frequently had ascites (90.9% vs. 64.5 %; p=0.026), lower levels of albumin (OR: 5.39; p=0.004), higher NT-proBNP levels, and longer QTc interval (464±23ms vs. 452±30ms; p=0.039). At follow-up, patients with DDF did not have a higher incidence of adverse events in terms of hospitalization and death. The presence of diastolic dysfunction has not been found to be clearly associated with outcome, and prognosis has been determined primarily by the severity of liver disease.

European journal of preventive cardiology, Aug 26, 2014

Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, indepen... more Oxygen uptake at the anaerobic threshold (VO2AT), a submaximal exercise-derived variable, independent of patients' motivation, is a marker of outcome in heart failure (HF). However, previous evidence of VO2AT values paradoxically higher in HF patients with permanent atrial fibrillation (AF) than in those with sinus rhythm (SR) raised uncertainties. We tested the prognostic role of VO2AT in a large cohort of systolic HF patients, focusing on possible differences between SR and AF. Altogether 2976 HF patients (2578 with SR and 398 with AF) were prospectively followed. Besides a clinical examination, each patient underwent a maximal cardiopulmonary exercise test (CPET). The follow-up was analysed for up to 1500 days. Cardiovascular death or urgent cardiac transplantation occurred in 303 patients (250 (9.6%) patients with SR and 53 (13.3%) patients with AF, p = 0.023). In the entire population, multivariate analysis including peak oxygen uptake (VO2) showed a prognostic capacity (C-...

Introduction: Superficial venous thrombosis (SVT) has been considered for a long time a limited c... more Introduction: Superficial venous thrombosis (SVT) has been considered for a long time a limited clinical condition with a low importance, but this approach has changed in recent years, when several studies demonstrated spreading to deep veins occurring from 7.3 to 44%, with high prevalence of pulmonary embolism. Materials and methods: To evaluate the prevalence of genetic risk factors for VTE in patients suffering from SVT on both normal and varicose vein, and to understand their role on spreading to deep veins, we studied 107 patients with SVT, without other risk factors. Ultrasound examination was performed, and the presence of FV Leiden, Prothrombin G20210A mutation, and MTHFR C677T mutation was researched. Results: In the patients where SVT occurred in normal veins, the presence of FV Leiden was 26.3% of the non-spreading and 60% of the spreading to deep veins SVT; Prothrombin mutation was found in 7.9% of the former case and in 20% of the latter; MTHFR C677T mutation was found respectively in 23.7% and 40%. In the patients with SVT on varicose veins, the presence of these factors was less evident (6.7%, 4.4% and 6.7% respectively), but their prevalence was considerably higher (35.7%, 7.4% and 21.4% respectively) in SVT spreading to deep veins than in non-spreading. Conclusions: Our data demonstrate the high prevalence of these mutations, especially FV Leiden and associations, in patients with SVT on normal veins and their role in the progression to deep vein system.

International Journal of Cardiology, 2016

Heart transplantation (HTx) improves the quality of life and survival in patients affected by end... more Heart transplantation (HTx) improves the quality of life and survival in patients affected by end-stage heart failure. The purpose of the current study is to present the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; clinical data and results of HTx in a single Center of Sicily. Focus on survival after pre and post HTx mechanical circulatory support use will be performed. 133 HTx were done from 2004 to the end of 2015.The average donor age was 34±13.5years and the proportion of male donors was 67%. Percentage of use of mechanical circulatory support to bridge patients to HTx was 18%. Overall pre-transplant mechanical circulatory support was not correlated to worse post-transplant prognosis, p=0.757. Severe primary early graft failure requiring extra corporeal membrane oxygenator support strongly impact the early mortality after heart transplantation (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The results of HTx at ISMETT are comparable to those reported in high volume Italian transplant centers as well as in the ISHLT registry. The favorable outcome can be related to focus on multidisciplinary approach, strict recipients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; selection and young donor population. Post HTx mechanical circulatory support use in general remains associated with worse post-transplant outcomes. This does not apply to pre-op mechanical circulatory support population.