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Papers by lorenzo pistelli
European Heart Journal Supplements, Dec 1, 2021
at echocardiography, and whether it varies in different locations of STEMI and with adenosine (AD... more at echocardiography, and whether it varies in different locations of STEMI and with adenosine (ADO) challenge, is still unknown. Methods and results: Fifty-three patients (age 65 6 12.5 years, 44 male, 20 anterior and 33 non-anterior, P ¼ 0.01) underwent rest/stress echocardiography at 7 6 2 days after successfully treated STEMI, and at 6-months follow-up. Global LS (GLS), ischaemic and remote LS (iLS and rLS) were analysed in anterior and non-anterior STEMI. Both at rest and at follow-up, GLS was stratified by ejection fraction (EF) into three groups: EF < 40%, 40-49%, and 50%. Normal subjects, undergoing ADO stress echo, represented controls. Anterior STEMI showed lower GLS than controls (P < 0.001) and non-anterior STEMI (P < 0.001). ADO increased GLS in controls (P ¼ 0.05), but neither in anterior nor in non-anterior STEMI, GLS changed during ADO stress, although significantly improved at follow-up (P < 0.001 and P ¼ 0.002, respectively). In anterior STEMI, rLS was comparable to iLS at rest, during stress and at follow-up (P ¼ ns), while in non-anterior STEMI rLS was higher than iLS throughout the study (P < 0.001). Patients with EF < 40% and 40-49% had similar values of GLS, iLS, and rLS, which were, both at rest and at follow-up, lower than those of patients with EF 50% (P < 0.001). Conclusions: In the subacute phase, anterior STEMI shows the worst impairment of LS in both ischaemic and remote regions. Strain reserve to ADO is absent in remote myocardium, as well as in ischaemic zone, regardless of MI location. Global, ischaemic and remote LS may improve at follow-up.
Journal of Clinical Medicine, May 30, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Pacing and Clinical Electrophysiology, Apr 10, 2023
IntroductionCardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalization an... more IntroductionCardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalization and all‐cause mortality in HF patients with left bundle branch block (LBBB). Biventricular pacing (BVP) is the gold standard for achieving CRT, but about 30%–40% of patients do not respond to BVP‐CRT. Recent studies showed that left bundle branch pacing (LBBP) provided remarkable results in CRT. Therefore, we conducted a meta‐analysis aiming to compare LBBP‐CRT versus BVP‐CRT in HF patients.MethodsWe systematically searched the electronic databases for studies published from inception to December 29, 2022 and focusing on LBBP‐CRT versus BVP‐CRT in HF patients. The primary endpoint was HF hospitalization. The effect size was estimated using a random‐effect model as Risk Ratio (RR) and mean difference (MD).ResultsTen studies enrolling 1063 patients met the inclusion criteria. Compared to BVP‐CRT, LBBP‐CRT led to significant reduction in HF hospitalization [7.9% vs.14.5%; RR: 0.60 (95%CI: 0.39–0.93); p = .02], QRSd [MD: 30.26 ms (95%CI: 26.68–33.84); p < .00001] and pacing threshold [MD: −0.60 (95%CI: −0.71 to −0.48); p < .00001] at follow up. Furthermore, LBBP‐CRT improved LVEF [MD: 5.78% (95%CI: 4.78–6.77); p < .00001], the rate of responder [88.5% vs.72.5%; RR: 1.19 (95%CI: 1.07–1.32); p = .002] and super‐responder [60.8% vs. 36.5%; RR: 1.56 (95%CI: 1.27–1.91); p < .0001] patients and the NYHA class [MD: −0.42 (95%CI: −0.71 to −0.14); p < .00001] compared to BVP‐CRT.ConclusionIn HF patients, LBBP‐CRT was superior to BVP‐CRT in reducing HF hospitalization. Further significant benefits occurred within the LBBP‐CRT group in terms of QRSd, LVEF, pacing thresholds, NYHA class and the rate of responder and super‐responder patients.
European Radiology, Apr 19, 2021
Objectives To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracki... more Objectives To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracking (FT) myocardial strain analysis in patients with suspected acute myocarditis and its association with myocardial oedema. Methods Forty-eight patients with suspected acute myocarditis and 35 control subjects underwent CMR. FT CMR analysis of systolic longitudinal (LS), circumferential (CS) and radial strain (RS) was performed. Additionally, the protocol allowed for the assessment of T1 and T2 relaxation times. Results When compared with healthy controls, myocarditis patients demonstrated reduced LS,
European Heart Journal Supplements, Dec 14, 2022
Backgrounds Psoriasis is a chronic skin inflammatory disease, characterized by immune-mediated re... more Backgrounds Psoriasis is a chronic skin inflammatory disease, characterized by immune-mediated reaction and hyperproliferation of keratinocytes. It is typically associated with several comorbidities; in particular, there are numerous evidence of a link between this condition and cardiovascular (CV) disease. Nevertheless, little is known about its role as an independent cardiovascular risk factor. Purpose The aim of this longitudinal study is to evaluate the role of Psoriasis as an independent CV risk factor, to establish the relationship between severity and duration of Psoriasis and CV damage and to find reliable markers to stratify CV risk in these patients. Methods 33 patients affected by mild Psoriasis without comorbidities were enrolled in this longitudinal study and were compared with 33 healthy subjects. The severity of Psoriasis was assessed with the PASI (Psoriasis Area and Severity Index) score: a score <10 was used to classify psoriasis as mild. Both groups underwent an echocardiogram, with evaluation of 2-dimensional strain (2D-SE), and a Doppler of carotid-femoral pulse wave velocity (PWV). The same evaluation was performed at 2-year follow-up. Results A total of 66 patients was included: 33 (50%) with mild psoriasis without comorbidities and 33 (50%) healthy subjects. Comparable clinical and echocardiographic baseline characteristics were observed between the two groups, except for Global Longitudinal Strain (GLS), which was significantly lower (p=0.002) in the Psoriasis group (22.39 ± 2.28%) than in controls (24.15 ± 2.17%), and PWV, that was significantly lower (p=0.004) in controls (8.06±1.68 m/sec) than in the psoriasis group (9.23 ± 1.53 m/sec). Significant correlations between GLS, disease duration and patient age at diagnosis were found, as in coronary artery disease (CAD) and cardiomyopathies. At 2-year follow-up, no significant changes in demographic or clinical characteristics were found within the Psoriasis group. The PASI score did not change significantly, no patient needed any systemic therapy (6 needed an increase in topical drugs) and none of the patients developed any conventional cardiovascular risk factor. There were no significant differences in echocardiographic parameters and no CV events occurred. Conclusions According to our data, mild Psoriasis determines subclinical cardiac and vascular damage. However, at two-year follow-up, no CV changes in initially healthy patients were found.
Reviews in Cardiovascular Medicine, May 25, 2022
TakoTsubo Syndrome (TTS) is a stress-induced cardiac disease characterized by temporary and segme... more TakoTsubo Syndrome (TTS) is a stress-induced cardiac disease characterized by temporary and segmental left ventricle dysfunction, typically involving the apex. Post-menopause women are more frequently affected. ECG and clinical features at presentation may be similar to those observed in acute coronary syndrome (ACS). However underlying pathomechanisms are completely different and, for what concerns TTS, extremely debated and not yet completely understood. Some hypotheses have been proposed during years, mostly regarding catecholamine-induced cardiotoxicity and microvascular dysfunction, usually following a trigger event which may be either "emotional" (primary TTS) or "physical" (secondary TTS). Additional modulators like neuroendocrine disorders (particularly hypothalamic-pituitary-adrenal axis dysfunction and estrogen drop in menopause) may play a crucial role in TTS onset. Despite being originally considered more benign than ACS, several studies have enlightened that TTS and STEMI are burdened by the same inhospital mortality and complications. However, TTS and ACS complications somehow differ for what concerns incidence, the underlying mechanisms, and both long-and short-term outcomes. Full recovery in TTS requires weeks to months and cases of recurrences have been described, but no single clinical feature seems to predict subsequent episodes so far. By now, apart from inhibitors of the Renin-Angiotensin-Aldosterone System (RAASi), no drug has proved to be effective either in the acute or chronic phase in reducing mortality, improving outcome, or preventing recurrences.
Cor et vasa, Nov 1, 2022
Takotsubo syndrom (TTS) je formou kardiomyopatie navozené akutním stresem s dysfunkcí levé komory... more Takotsubo syndrom (TTS) je formou kardiomyopatie navozené akutním stresem s dysfunkcí levé komory ve většině případů bez obstrukční ischemické choroby srdeční, i když ta může být přítomna v 10-29 % případů. Spouštěčem pro rozvoj takotsubo syndromu může být i málo invazivní výkon spojený s fyzickým nebo emocionálním stresem. Popis případu: Popisujeme případ 87leté ženy s vysokou, již dříve přítomnou zátěží stresem, u níž došlo k rozvoji takotsubo syndromu s neobvyklými symptomy po nekomplikované implantaci trvalého kardiostimulátoru. Závěry: Tento případ ukazuje, že TTS je nutno zvažovat jako potenciální komplikaci po implantaci kardiostimulátoru, zvláště u postmenopauzálních žen. Je třeba vytvořit multicentrické registry a provést další studie, abychom zjistili, jak a u které kategorie pacientů mohou i málo invazivní výkony vést ke vzniku TTS.
Cor et vasa, Nov 1, 2022
Na naše oddělení byla přijata 64letá žena k implantaci dvoudutinového kardiostimulátoru. Samotný ... more Na naše oddělení byla přijata 64letá žena k implantaci dvoudutinového kardiostimulátoru. Samotný výkon se obešel bez jakékoli komplikace. Jedna komorová elektroda s aktivní fi xací byla umístěna v hrotu pravé komory. Brzy po implantaci začal pacientku sužovat neproduktivní kašel, jednoznačně související s komorovou stimulací. Transtorakální echokardiografi e prokázala malý perikardiální výpotek podél apikálních segmentů. U pacientky bylo provedeno urgentní CT vyšetření s kontrastní látkou, které potvrdilo perikardiální výpotek a přítomnost elektrody v myokardu hrotu pravé komory. Pro přetrvávání symptomů jsme se rozhodli přemístit pravokomorovou elektrodu do středu mezikomorového septa. Po výkonu kašel okamžitě vymizel.
Jacc-cardiovascular Interventions, Nov 1, 2022
Journal of Cardiovascular Echography, 2022
Lipomatous hypertrophy of the interatrial septum (LHIS) is a histologically benign cardiac lesion... more Lipomatous hypertrophy of the interatrial septum (LHIS) is a histologically benign cardiac lesion that is defined by excessive fat accumulation in the area of the interatrial septum (IAS) that does not include the fossa ovalis. Another unusual illness is lipomatosis, which is defined as a broad overgrowth of mature adipose tissue that involves a large portion of an extremity or trunk. We describe a rare case with significant LHIS accompanied by subcutaneous lipomatosis. Echocardiography revealed a mass in the right atrium in this patient. Magnetic resonance imaging revealed that this mass was composed of the adipose tissue and was an extension of a huge thickened IAS. Furthermore, this significant hypertrophy of the IAS was in direct continuation with the excessive mediastinal and epicardial fat.
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, May 7, 2022
Cor et vasa, Jun 20, 2023
Vznik trombózy po zavedení transvenózní elektrody představuje podceňovaný problém. Přes její vyso... more Vznik trombózy po zavedení transvenózní elektrody představuje podceňovaný problém. Přes její vysokou incidenci zůstává většina případů nediagnostikovaných, protože je klinicky němá. Byla popsána řada rizikových faktorů predisponujících k tvorbě sraženin na elektrodách přístroje. Protože nejsou k dispozici žádné doporučené postupy (guidelines) ani důkazy ohledně optimální léčby, záleží způsob odstraňování endokavitárních sraženin z elektrod kardiostimulátoru na individuální volbě mezi chirurgickou extrakcí katétrem, trombolýzou nebo antikoagulační léčbou. U některých pacientů může léčbu dále komplikovat křehká rovnováha mezi krvácivými a trombotickými příhodami. Popis případu: Popisujeme případ 86letého muže se srdečním selháním a silně sníženou ejekční frakcí v důsledku chronické ischemické kardiomyopatie. Bylo u něj zjištěno několik komorbidit a v anamnéze měl hlubokou žilní trombózu i závažné krvácení. U pacienta došlo k rozvoji plicní embolie: v místě vzniku tromboembolie visela na elektrodě kardiostimulátoru sraženina. Závěr: Antikoagulace s antagonisty vitaminu K umožnila poměrně bezpečné řešení problému s trombózou (nebo tromboembolií) a krvácením.
European Heart Journal Supplements, Dec 1, 2021
European Heart Journal Supplements, Dec 1, 2021
Aims: Coronary provocative test with acetylcholine (ACh) is of utmost importance and increasingly... more Aims: Coronary provocative test with acetylcholine (ACh) is of utmost importance and increasingly used in patients with myocardial ischaemia and non-obstructive coronary arteries. However, data on safety, predictors, and prognostic role of complications during intracoronary provocative testing are scarce. We aimed at assessing the safety of ACh provocative test in patients with myocardial ischaemia and non-obstructive coronary arteries. Moreover, we evaluated the predictors and the prognostic implications of complications occurring during the provocative test. Methods and results: We prospectively enrolled consecutive patients undergoing intracoronary ACh provocative test for suspected myocardial ischaemia with angiographic evidence of non-obstructive coronary arteries. Complications during the ACh test were collected. Occurrence of major adverse cardiac events (MACE), arrhythmic events at 24-h ECG dynamic Holter monitoring and angina status were assessed at follow-up. We enrolled 310 patients [mean age 60.6 6 11.9; 169 (54.5%) chronic coronary syndromes (CCS) and 141 (45.5%) with myocardial infarction and nonobstructive coronary arteries (MINOCA)]. The overall incidence of complications was low (9%) with a similar incidence in MINOCA and CCS [10 (7.1%) vs. 18 (10.7%), P ¼ 0.276, respectively]. At multivariate logistic regression analysis, a previous history of paroxysmal atrial fibrillation [odds ratio (OR): 12.324, confidence interval (CI): 95% (4.641-32.722), P ¼ 0.015] and moderate/severe diastolic dysfunction [OR: 3.827, 95% CI (1.296-11.304), P ¼ 0.015] were independent predictors for occurrence of complications. The occurrence of complications was not associated with a worse clinical outcome at follow-up (median follow-up 22 months) in terms of both MACE, arrhythmic events and angina burden. Conclusions: Intracoronary provocative testing with ACh test is safe in patients with myocardial ischaemia and non-obstructive coronary arteries (including MINOCA patients). History of paroxysmal atrial fibrillation and moderate/severe diastolic dysfunction predicted the occurrence of complications during ACh test. However, occurrence of complications did not portend a worse prognosis at follow-up in terms of MACE, arrhythmic events, and angina burden.
European Heart Journal Supplements, Dec 1, 2021
Aims: Arterial hypertension (AH) is one of the main determinants of clinical disorders during pre... more Aims: Arterial hypertension (AH) is one of the main determinants of clinical disorders during pregnancy affecting 2% to 10% of pregnancies with a substantial public health impact. Both endothelial injury and increased vascular reactivity have been reported to be involved in the pathogenesis of pre-eclampsia syndrome. Abnormal patterns in brachial artery Doppler velocities have been shown to be predictive of pre-eclampsia in first trimester. The aim of this study is to investigate whether flow-mediated dilation (FMD) and Doppler flow derived-parameters can predict the occurrence of AH. Methods and results: The study population consisted of pregnant women (mean age 32 years) who had been referred to the IRCCS Fondazione Ca' Granda Policlinico of Milan. None of them had any medical issues and was taking any medications at the time of pregnancy. FMD was performed on left brachial artery according to expert recommendation. Measurements of brachial artery diameter and flow have been collected at rest, shortly before cuff release and then 5-, 15-, 30-, 60-, and 90-s during hyperaemia phase. Among Doppler measurements, systolic and diastolic velocity (V s and V d , respectively) as well as mean velocity (mean V) were considered. In addition, the pulsatility index (PI) and resistance index (RI) were calculated. A 3-months follow-up was planned in order to detect the presence of AH. All data were expressed as the median. U-test (Mann-Whitney analysis) was performed to test difference among hypertensives and nonhypertensives We recruited 48 women (median age 32 yeas) whose 4 (8.5%) developed AH during pregnancy. These latter had statistically significant higher systolic velocity measured at 5 s after the release of distal occlusion (126 cm/s vs. 173 cm/s; P < 0.05). No other velocity Doppler data [diastolic velocity (V d), mean velocity (mean V), PI, RI, TAMAX, and TAMEAN] showed a statistical significant association with AH development. Conclusions: The present study suggests that the vascular assessment through Doppler during FMD procedure may foresee the development of hypertensive disorder in pregnancy. Our result provides the first evidence that the peak systolic velocity of brachial artery may represent a marker of early endothelial activation or damage, that can be directly involved in the pathophysiological mechanisms of the hypertensive disorders in pregnancy. 232 A multidisciplinary case of multiple myeloma with cardiac and renal involvement: a look beyond amyloidosis
Pacing and Clinical Electrophysiology
IntroductionCephalic vein cutdown (CVC) and axillary vein puncture (AVP) are both recommended for... more IntroductionCephalic vein cutdown (CVC) and axillary vein puncture (AVP) are both recommended for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile.MethodsWe systematically searched Medline, Embase, and Cochrane electronic databases up to September 5, 2022, for studies that evaluated the efficacy and safety of AVP and CVC reporting at least one clinical outcome of interest. The primary endpoints were acute procedural success and overall complications. The effect size was estimated using a random‐effect model as risk ratio (RR) and relative 95% confidence interval (CI).ResultsOverall, seven studies were included, which enrolled 1771 and 3067 transvenous leads (65.6% [n = 1162] males, average age 73.4 ± 14.3 years). Compared to CVC, AVP showed a significant increase in the primary endpoint (95.7 % vs. 76.1 %; RR: 1.24; 95% CI: 1.09–1.40; p = .001) (...
Journal of Clinical Medicine
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. The left atrial appenda... more Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. The left atrial appendage (LAA) is the most likely source of thrombus formation in patients with non-valvular atrial fibrillation (NVAF). Left atrial appendage closure (LAAC) represents an effective alternative to NOAC in patients with NVAF. Expert consensus documents recommend intraprocedural imaging by means of either transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) in addition to standard fluoroscopy to guide LAAC. TEE-guided LAAC usually requires general anesthesia. The ICE technique is a “minimalist approach”, without general anesthesia, but ICE imaging techniques are not yet simplified and standardize, and the ICE may result in inferior image quality compared with that of TEE. Another “minimalist approach” can be the use of ICE via the esophageal route (ICE-TEE), that jet is validated to identify the presence of LAA thrombi in patients and to perform other procedures. In our ...
Sensors
A diagnosis of Brugada syndrome (BrS) is based on the presence of a type 1 electrocardiogram (ECG... more A diagnosis of Brugada syndrome (BrS) is based on the presence of a type 1 electrocardiogram (ECG) pattern, either spontaneously or after a Sodium Channel Blocker Provocation Test (SCBPT). Several ECG criteria have been evaluated as predictors of a positive SCBPT, such as the β-angle, the α-angle, the duration of the base of the triangle at 5 mm from the r’-wave (DBT- 5 mm), the duration of the base of the triangle at the isoelectric line (DBT- iso), and the triangle base/height ratio. The aim of our study was to test all previously proposed ECG criteria in a large cohort study and to evaluate an r’-wave algorithm for predicting a BrS diagnosis after an SCBPT. We enrolled all patients who consecutively underwent SCBPT using flecainide from January 2010 to December 2015 in the test cohort and from January 2016 to December 2021 in the validation cohort. We included the ECG criteria with the best diagnostic accuracy in relation to the test cohort in the development of the r’-wave algor...
European Heart Journal Supplements, Dec 14, 2022
Journal of Clinical Medicine
Heart failure (HF) is a complex, multifactorial, progressive clinical condition affecting 64.3 mi... more Heart failure (HF) is a complex, multifactorial, progressive clinical condition affecting 64.3 million people worldwide, with a strong impact in terms of morbidity, mortality and public health costs. In the last 50 years, along with a better understanding of HF physiopathology and in agreement with the four main models of HF, many therapeutic options have been developed. Recently, the European Society of Cardiology (ESC) HF guidelines enthusiastically introduced inhibitors of the sodium-glucose cotransporter (SGLT2i) as first line therapy for HF with reduced ejection fraction (HFrEF) in order to reduce hospitalizations and mortality. Despite drugs developed as hypoglycemic agents, data from the EMPA-REG OUTCOME trial encouraged the evaluation of the possible cardiovascular effects, showing SGLT2i beneficial effects on loading conditions, neurohormonal axes, heart cells’ biochemistry and vascular stiffness, determining an improvement of each HF model. We want to give a boost to their...
European Heart Journal Supplements, Dec 1, 2021
at echocardiography, and whether it varies in different locations of STEMI and with adenosine (AD... more at echocardiography, and whether it varies in different locations of STEMI and with adenosine (ADO) challenge, is still unknown. Methods and results: Fifty-three patients (age 65 6 12.5 years, 44 male, 20 anterior and 33 non-anterior, P ¼ 0.01) underwent rest/stress echocardiography at 7 6 2 days after successfully treated STEMI, and at 6-months follow-up. Global LS (GLS), ischaemic and remote LS (iLS and rLS) were analysed in anterior and non-anterior STEMI. Both at rest and at follow-up, GLS was stratified by ejection fraction (EF) into three groups: EF < 40%, 40-49%, and 50%. Normal subjects, undergoing ADO stress echo, represented controls. Anterior STEMI showed lower GLS than controls (P < 0.001) and non-anterior STEMI (P < 0.001). ADO increased GLS in controls (P ¼ 0.05), but neither in anterior nor in non-anterior STEMI, GLS changed during ADO stress, although significantly improved at follow-up (P < 0.001 and P ¼ 0.002, respectively). In anterior STEMI, rLS was comparable to iLS at rest, during stress and at follow-up (P ¼ ns), while in non-anterior STEMI rLS was higher than iLS throughout the study (P < 0.001). Patients with EF < 40% and 40-49% had similar values of GLS, iLS, and rLS, which were, both at rest and at follow-up, lower than those of patients with EF 50% (P < 0.001). Conclusions: In the subacute phase, anterior STEMI shows the worst impairment of LS in both ischaemic and remote regions. Strain reserve to ADO is absent in remote myocardium, as well as in ischaemic zone, regardless of MI location. Global, ischaemic and remote LS may improve at follow-up.
Journal of Clinical Medicine, May 30, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Pacing and Clinical Electrophysiology, Apr 10, 2023
IntroductionCardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalization an... more IntroductionCardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalization and all‐cause mortality in HF patients with left bundle branch block (LBBB). Biventricular pacing (BVP) is the gold standard for achieving CRT, but about 30%–40% of patients do not respond to BVP‐CRT. Recent studies showed that left bundle branch pacing (LBBP) provided remarkable results in CRT. Therefore, we conducted a meta‐analysis aiming to compare LBBP‐CRT versus BVP‐CRT in HF patients.MethodsWe systematically searched the electronic databases for studies published from inception to December 29, 2022 and focusing on LBBP‐CRT versus BVP‐CRT in HF patients. The primary endpoint was HF hospitalization. The effect size was estimated using a random‐effect model as Risk Ratio (RR) and mean difference (MD).ResultsTen studies enrolling 1063 patients met the inclusion criteria. Compared to BVP‐CRT, LBBP‐CRT led to significant reduction in HF hospitalization [7.9% vs.14.5%; RR: 0.60 (95%CI: 0.39–0.93); p = .02], QRSd [MD: 30.26 ms (95%CI: 26.68–33.84); p < .00001] and pacing threshold [MD: −0.60 (95%CI: −0.71 to −0.48); p < .00001] at follow up. Furthermore, LBBP‐CRT improved LVEF [MD: 5.78% (95%CI: 4.78–6.77); p < .00001], the rate of responder [88.5% vs.72.5%; RR: 1.19 (95%CI: 1.07–1.32); p = .002] and super‐responder [60.8% vs. 36.5%; RR: 1.56 (95%CI: 1.27–1.91); p < .0001] patients and the NYHA class [MD: −0.42 (95%CI: −0.71 to −0.14); p < .00001] compared to BVP‐CRT.ConclusionIn HF patients, LBBP‐CRT was superior to BVP‐CRT in reducing HF hospitalization. Further significant benefits occurred within the LBBP‐CRT group in terms of QRSd, LVEF, pacing thresholds, NYHA class and the rate of responder and super‐responder patients.
European Radiology, Apr 19, 2021
Objectives To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracki... more Objectives To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracking (FT) myocardial strain analysis in patients with suspected acute myocarditis and its association with myocardial oedema. Methods Forty-eight patients with suspected acute myocarditis and 35 control subjects underwent CMR. FT CMR analysis of systolic longitudinal (LS), circumferential (CS) and radial strain (RS) was performed. Additionally, the protocol allowed for the assessment of T1 and T2 relaxation times. Results When compared with healthy controls, myocarditis patients demonstrated reduced LS,
European Heart Journal Supplements, Dec 14, 2022
Backgrounds Psoriasis is a chronic skin inflammatory disease, characterized by immune-mediated re... more Backgrounds Psoriasis is a chronic skin inflammatory disease, characterized by immune-mediated reaction and hyperproliferation of keratinocytes. It is typically associated with several comorbidities; in particular, there are numerous evidence of a link between this condition and cardiovascular (CV) disease. Nevertheless, little is known about its role as an independent cardiovascular risk factor. Purpose The aim of this longitudinal study is to evaluate the role of Psoriasis as an independent CV risk factor, to establish the relationship between severity and duration of Psoriasis and CV damage and to find reliable markers to stratify CV risk in these patients. Methods 33 patients affected by mild Psoriasis without comorbidities were enrolled in this longitudinal study and were compared with 33 healthy subjects. The severity of Psoriasis was assessed with the PASI (Psoriasis Area and Severity Index) score: a score <10 was used to classify psoriasis as mild. Both groups underwent an echocardiogram, with evaluation of 2-dimensional strain (2D-SE), and a Doppler of carotid-femoral pulse wave velocity (PWV). The same evaluation was performed at 2-year follow-up. Results A total of 66 patients was included: 33 (50%) with mild psoriasis without comorbidities and 33 (50%) healthy subjects. Comparable clinical and echocardiographic baseline characteristics were observed between the two groups, except for Global Longitudinal Strain (GLS), which was significantly lower (p=0.002) in the Psoriasis group (22.39 ± 2.28%) than in controls (24.15 ± 2.17%), and PWV, that was significantly lower (p=0.004) in controls (8.06±1.68 m/sec) than in the psoriasis group (9.23 ± 1.53 m/sec). Significant correlations between GLS, disease duration and patient age at diagnosis were found, as in coronary artery disease (CAD) and cardiomyopathies. At 2-year follow-up, no significant changes in demographic or clinical characteristics were found within the Psoriasis group. The PASI score did not change significantly, no patient needed any systemic therapy (6 needed an increase in topical drugs) and none of the patients developed any conventional cardiovascular risk factor. There were no significant differences in echocardiographic parameters and no CV events occurred. Conclusions According to our data, mild Psoriasis determines subclinical cardiac and vascular damage. However, at two-year follow-up, no CV changes in initially healthy patients were found.
Reviews in Cardiovascular Medicine, May 25, 2022
TakoTsubo Syndrome (TTS) is a stress-induced cardiac disease characterized by temporary and segme... more TakoTsubo Syndrome (TTS) is a stress-induced cardiac disease characterized by temporary and segmental left ventricle dysfunction, typically involving the apex. Post-menopause women are more frequently affected. ECG and clinical features at presentation may be similar to those observed in acute coronary syndrome (ACS). However underlying pathomechanisms are completely different and, for what concerns TTS, extremely debated and not yet completely understood. Some hypotheses have been proposed during years, mostly regarding catecholamine-induced cardiotoxicity and microvascular dysfunction, usually following a trigger event which may be either "emotional" (primary TTS) or "physical" (secondary TTS). Additional modulators like neuroendocrine disorders (particularly hypothalamic-pituitary-adrenal axis dysfunction and estrogen drop in menopause) may play a crucial role in TTS onset. Despite being originally considered more benign than ACS, several studies have enlightened that TTS and STEMI are burdened by the same inhospital mortality and complications. However, TTS and ACS complications somehow differ for what concerns incidence, the underlying mechanisms, and both long-and short-term outcomes. Full recovery in TTS requires weeks to months and cases of recurrences have been described, but no single clinical feature seems to predict subsequent episodes so far. By now, apart from inhibitors of the Renin-Angiotensin-Aldosterone System (RAASi), no drug has proved to be effective either in the acute or chronic phase in reducing mortality, improving outcome, or preventing recurrences.
Cor et vasa, Nov 1, 2022
Takotsubo syndrom (TTS) je formou kardiomyopatie navozené akutním stresem s dysfunkcí levé komory... more Takotsubo syndrom (TTS) je formou kardiomyopatie navozené akutním stresem s dysfunkcí levé komory ve většině případů bez obstrukční ischemické choroby srdeční, i když ta může být přítomna v 10-29 % případů. Spouštěčem pro rozvoj takotsubo syndromu může být i málo invazivní výkon spojený s fyzickým nebo emocionálním stresem. Popis případu: Popisujeme případ 87leté ženy s vysokou, již dříve přítomnou zátěží stresem, u níž došlo k rozvoji takotsubo syndromu s neobvyklými symptomy po nekomplikované implantaci trvalého kardiostimulátoru. Závěry: Tento případ ukazuje, že TTS je nutno zvažovat jako potenciální komplikaci po implantaci kardiostimulátoru, zvláště u postmenopauzálních žen. Je třeba vytvořit multicentrické registry a provést další studie, abychom zjistili, jak a u které kategorie pacientů mohou i málo invazivní výkony vést ke vzniku TTS.
Cor et vasa, Nov 1, 2022
Na naše oddělení byla přijata 64letá žena k implantaci dvoudutinového kardiostimulátoru. Samotný ... more Na naše oddělení byla přijata 64letá žena k implantaci dvoudutinového kardiostimulátoru. Samotný výkon se obešel bez jakékoli komplikace. Jedna komorová elektroda s aktivní fi xací byla umístěna v hrotu pravé komory. Brzy po implantaci začal pacientku sužovat neproduktivní kašel, jednoznačně související s komorovou stimulací. Transtorakální echokardiografi e prokázala malý perikardiální výpotek podél apikálních segmentů. U pacientky bylo provedeno urgentní CT vyšetření s kontrastní látkou, které potvrdilo perikardiální výpotek a přítomnost elektrody v myokardu hrotu pravé komory. Pro přetrvávání symptomů jsme se rozhodli přemístit pravokomorovou elektrodu do středu mezikomorového septa. Po výkonu kašel okamžitě vymizel.
Jacc-cardiovascular Interventions, Nov 1, 2022
Journal of Cardiovascular Echography, 2022
Lipomatous hypertrophy of the interatrial septum (LHIS) is a histologically benign cardiac lesion... more Lipomatous hypertrophy of the interatrial septum (LHIS) is a histologically benign cardiac lesion that is defined by excessive fat accumulation in the area of the interatrial septum (IAS) that does not include the fossa ovalis. Another unusual illness is lipomatosis, which is defined as a broad overgrowth of mature adipose tissue that involves a large portion of an extremity or trunk. We describe a rare case with significant LHIS accompanied by subcutaneous lipomatosis. Echocardiography revealed a mass in the right atrium in this patient. Magnetic resonance imaging revealed that this mass was composed of the adipose tissue and was an extension of a huge thickened IAS. Furthermore, this significant hypertrophy of the IAS was in direct continuation with the excessive mediastinal and epicardial fat.
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, May 7, 2022
Cor et vasa, Jun 20, 2023
Vznik trombózy po zavedení transvenózní elektrody představuje podceňovaný problém. Přes její vyso... more Vznik trombózy po zavedení transvenózní elektrody představuje podceňovaný problém. Přes její vysokou incidenci zůstává většina případů nediagnostikovaných, protože je klinicky němá. Byla popsána řada rizikových faktorů predisponujících k tvorbě sraženin na elektrodách přístroje. Protože nejsou k dispozici žádné doporučené postupy (guidelines) ani důkazy ohledně optimální léčby, záleží způsob odstraňování endokavitárních sraženin z elektrod kardiostimulátoru na individuální volbě mezi chirurgickou extrakcí katétrem, trombolýzou nebo antikoagulační léčbou. U některých pacientů může léčbu dále komplikovat křehká rovnováha mezi krvácivými a trombotickými příhodami. Popis případu: Popisujeme případ 86letého muže se srdečním selháním a silně sníženou ejekční frakcí v důsledku chronické ischemické kardiomyopatie. Bylo u něj zjištěno několik komorbidit a v anamnéze měl hlubokou žilní trombózu i závažné krvácení. U pacienta došlo k rozvoji plicní embolie: v místě vzniku tromboembolie visela na elektrodě kardiostimulátoru sraženina. Závěr: Antikoagulace s antagonisty vitaminu K umožnila poměrně bezpečné řešení problému s trombózou (nebo tromboembolií) a krvácením.
European Heart Journal Supplements, Dec 1, 2021
European Heart Journal Supplements, Dec 1, 2021
Aims: Coronary provocative test with acetylcholine (ACh) is of utmost importance and increasingly... more Aims: Coronary provocative test with acetylcholine (ACh) is of utmost importance and increasingly used in patients with myocardial ischaemia and non-obstructive coronary arteries. However, data on safety, predictors, and prognostic role of complications during intracoronary provocative testing are scarce. We aimed at assessing the safety of ACh provocative test in patients with myocardial ischaemia and non-obstructive coronary arteries. Moreover, we evaluated the predictors and the prognostic implications of complications occurring during the provocative test. Methods and results: We prospectively enrolled consecutive patients undergoing intracoronary ACh provocative test for suspected myocardial ischaemia with angiographic evidence of non-obstructive coronary arteries. Complications during the ACh test were collected. Occurrence of major adverse cardiac events (MACE), arrhythmic events at 24-h ECG dynamic Holter monitoring and angina status were assessed at follow-up. We enrolled 310 patients [mean age 60.6 6 11.9; 169 (54.5%) chronic coronary syndromes (CCS) and 141 (45.5%) with myocardial infarction and nonobstructive coronary arteries (MINOCA)]. The overall incidence of complications was low (9%) with a similar incidence in MINOCA and CCS [10 (7.1%) vs. 18 (10.7%), P ¼ 0.276, respectively]. At multivariate logistic regression analysis, a previous history of paroxysmal atrial fibrillation [odds ratio (OR): 12.324, confidence interval (CI): 95% (4.641-32.722), P ¼ 0.015] and moderate/severe diastolic dysfunction [OR: 3.827, 95% CI (1.296-11.304), P ¼ 0.015] were independent predictors for occurrence of complications. The occurrence of complications was not associated with a worse clinical outcome at follow-up (median follow-up 22 months) in terms of both MACE, arrhythmic events and angina burden. Conclusions: Intracoronary provocative testing with ACh test is safe in patients with myocardial ischaemia and non-obstructive coronary arteries (including MINOCA patients). History of paroxysmal atrial fibrillation and moderate/severe diastolic dysfunction predicted the occurrence of complications during ACh test. However, occurrence of complications did not portend a worse prognosis at follow-up in terms of MACE, arrhythmic events, and angina burden.
European Heart Journal Supplements, Dec 1, 2021
Aims: Arterial hypertension (AH) is one of the main determinants of clinical disorders during pre... more Aims: Arterial hypertension (AH) is one of the main determinants of clinical disorders during pregnancy affecting 2% to 10% of pregnancies with a substantial public health impact. Both endothelial injury and increased vascular reactivity have been reported to be involved in the pathogenesis of pre-eclampsia syndrome. Abnormal patterns in brachial artery Doppler velocities have been shown to be predictive of pre-eclampsia in first trimester. The aim of this study is to investigate whether flow-mediated dilation (FMD) and Doppler flow derived-parameters can predict the occurrence of AH. Methods and results: The study population consisted of pregnant women (mean age 32 years) who had been referred to the IRCCS Fondazione Ca' Granda Policlinico of Milan. None of them had any medical issues and was taking any medications at the time of pregnancy. FMD was performed on left brachial artery according to expert recommendation. Measurements of brachial artery diameter and flow have been collected at rest, shortly before cuff release and then 5-, 15-, 30-, 60-, and 90-s during hyperaemia phase. Among Doppler measurements, systolic and diastolic velocity (V s and V d , respectively) as well as mean velocity (mean V) were considered. In addition, the pulsatility index (PI) and resistance index (RI) were calculated. A 3-months follow-up was planned in order to detect the presence of AH. All data were expressed as the median. U-test (Mann-Whitney analysis) was performed to test difference among hypertensives and nonhypertensives We recruited 48 women (median age 32 yeas) whose 4 (8.5%) developed AH during pregnancy. These latter had statistically significant higher systolic velocity measured at 5 s after the release of distal occlusion (126 cm/s vs. 173 cm/s; P < 0.05). No other velocity Doppler data [diastolic velocity (V d), mean velocity (mean V), PI, RI, TAMAX, and TAMEAN] showed a statistical significant association with AH development. Conclusions: The present study suggests that the vascular assessment through Doppler during FMD procedure may foresee the development of hypertensive disorder in pregnancy. Our result provides the first evidence that the peak systolic velocity of brachial artery may represent a marker of early endothelial activation or damage, that can be directly involved in the pathophysiological mechanisms of the hypertensive disorders in pregnancy. 232 A multidisciplinary case of multiple myeloma with cardiac and renal involvement: a look beyond amyloidosis
Pacing and Clinical Electrophysiology
IntroductionCephalic vein cutdown (CVC) and axillary vein puncture (AVP) are both recommended for... more IntroductionCephalic vein cutdown (CVC) and axillary vein puncture (AVP) are both recommended for transvenous implantation of leads for cardiac implantable electronic devices (CIEDs). Nonetheless, it is still debated which of the two techniques has a better safety and efficacy profile.MethodsWe systematically searched Medline, Embase, and Cochrane electronic databases up to September 5, 2022, for studies that evaluated the efficacy and safety of AVP and CVC reporting at least one clinical outcome of interest. The primary endpoints were acute procedural success and overall complications. The effect size was estimated using a random‐effect model as risk ratio (RR) and relative 95% confidence interval (CI).ResultsOverall, seven studies were included, which enrolled 1771 and 3067 transvenous leads (65.6% [n = 1162] males, average age 73.4 ± 14.3 years). Compared to CVC, AVP showed a significant increase in the primary endpoint (95.7 % vs. 76.1 %; RR: 1.24; 95% CI: 1.09–1.40; p = .001) (...
Journal of Clinical Medicine
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. The left atrial appenda... more Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. The left atrial appendage (LAA) is the most likely source of thrombus formation in patients with non-valvular atrial fibrillation (NVAF). Left atrial appendage closure (LAAC) represents an effective alternative to NOAC in patients with NVAF. Expert consensus documents recommend intraprocedural imaging by means of either transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) in addition to standard fluoroscopy to guide LAAC. TEE-guided LAAC usually requires general anesthesia. The ICE technique is a “minimalist approach”, without general anesthesia, but ICE imaging techniques are not yet simplified and standardize, and the ICE may result in inferior image quality compared with that of TEE. Another “minimalist approach” can be the use of ICE via the esophageal route (ICE-TEE), that jet is validated to identify the presence of LAA thrombi in patients and to perform other procedures. In our ...
Sensors
A diagnosis of Brugada syndrome (BrS) is based on the presence of a type 1 electrocardiogram (ECG... more A diagnosis of Brugada syndrome (BrS) is based on the presence of a type 1 electrocardiogram (ECG) pattern, either spontaneously or after a Sodium Channel Blocker Provocation Test (SCBPT). Several ECG criteria have been evaluated as predictors of a positive SCBPT, such as the β-angle, the α-angle, the duration of the base of the triangle at 5 mm from the r’-wave (DBT- 5 mm), the duration of the base of the triangle at the isoelectric line (DBT- iso), and the triangle base/height ratio. The aim of our study was to test all previously proposed ECG criteria in a large cohort study and to evaluate an r’-wave algorithm for predicting a BrS diagnosis after an SCBPT. We enrolled all patients who consecutively underwent SCBPT using flecainide from January 2010 to December 2015 in the test cohort and from January 2016 to December 2021 in the validation cohort. We included the ECG criteria with the best diagnostic accuracy in relation to the test cohort in the development of the r’-wave algor...
European Heart Journal Supplements, Dec 14, 2022
Journal of Clinical Medicine
Heart failure (HF) is a complex, multifactorial, progressive clinical condition affecting 64.3 mi... more Heart failure (HF) is a complex, multifactorial, progressive clinical condition affecting 64.3 million people worldwide, with a strong impact in terms of morbidity, mortality and public health costs. In the last 50 years, along with a better understanding of HF physiopathology and in agreement with the four main models of HF, many therapeutic options have been developed. Recently, the European Society of Cardiology (ESC) HF guidelines enthusiastically introduced inhibitors of the sodium-glucose cotransporter (SGLT2i) as first line therapy for HF with reduced ejection fraction (HFrEF) in order to reduce hospitalizations and mortality. Despite drugs developed as hypoglycemic agents, data from the EMPA-REG OUTCOME trial encouraged the evaluation of the possible cardiovascular effects, showing SGLT2i beneficial effects on loading conditions, neurohormonal axes, heart cells’ biochemistry and vascular stiffness, determining an improvement of each HF model. We want to give a boost to their...