GVM Care and Research

Lugo, Italy

GVM Care and Research

Lugo, Italy
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Damy T.,AP HP | Damy T.,French Institute of Health and Medical Research | Damy T.,University Paris Est Creteil | Ghio S.,Fondazione IRCCS Policlinico San Matteo | And 11 more authors.
Journal of the American College of Cardiology | Year: 2013

Objectives: The aim of this study was to investigate the impact of cardiac resynchronization therapy (CRT) on right ventricular (RV) function and the influence of RV dysfunction on the echocardiographic and clinical response to CRT among patients enrolled in the CARE-HF (Cardiac Resynchronization-Heart Failure) trial. Background: Cardiac resynchronization therapy prolongs survival in appropriately selected patients with heart failure but the benefit might be diminished in patients with RV dysfunction. Methods: Of 813 patients enrolled in the CARE-HF study, 688 had tricuspid plane systolic excursion (TAPSE) measured at baseline, and 345 of these were assigned to CRT. Their median (interquartile range) age was 66 (58 to 71) years, left ventricular (LV) ejection fraction was 24% (21% to 28%), and TAPSE was 19 (16 to 22) mm. Baseline LV function and size and QRS duration were similar among TAPSE tertiles, but those in the worst tertile (TAPSE <17.4 mm) were more likely to have ischemic heart disease. Results: Overall, CRT improved LV but not RV structure and function with little evidence of an interaction with TAPSE. During a median (interquartile range) follow-up of 748 (582 to 950) days, 213 deaths occurred. Patients with lower TAPSE had a higher mortality, regardless of assigned treatment (p < 0.001). Greater inter-ventricular mechanical delay, New York Heart Association functional class, mitral regurgitation, and N-terminal pro-B-type natriuretic peptide, lower TAPSE, and assignment to the control group were independently associated with higher mortality. Reduction in mortality with CRT was similar in each tertile of TAPSE. Conclusions: Right ventricular dysfunction is a powerful determinant of prognosis among candidates for CRT, regardless of treatment assigned, but did not diminish the prognostic benefits of CRT among patients enrolled in the CARE-HF trial. (Care-HF CArdiac Resynchronization in Heart Failure; NCT00170300) © 2013 American College of Cardiology Foundation.

Tepe G.,RodMed Klinikum | Laird J.,University of California at Davis | Schneider P.,Kaiser Permanente | Brodmann M.,Landeskrankenhaus Universitatsklinikum | And 11 more authors.
Circulation | Year: 2014

Background: Drug-coated balloons (DCBs) have shown promise in improving the outcomes for patients with peripheral artery disease. We compared a paclitaxel-coated balloon with percutaneous transluminal angioplasty (PTA) for the treatment of symptomatic superficial femoral and popliteal artery disease. Methods and Results: The IN.PACT SFA Trial is a prospective, multicenter, single-blinded, randomized trial in which 331 patients with intermittent claudication or ischemic rest pain attributable to superficial femoral and popliteal peripheral artery disease were randomly assigned in a 2:1 ratio to treatment with DCB or PTA. The primary efficacy end point was primary patency, defined as freedom from restenosis or clinically driven target lesion revascularization at 12 months. Baseline characteristics were similar between the 2 groups. Mean lesion length and the percentage of total occlusions for the DCB and PTA arms were 8.94±4.89 and 8.81±5.12 cm (P=0.82) and 25.8% and 19.5% (P=0.22), respectively. DCB resulted in higher primary patency versus PTA (82.2% versus 52.4%; P<0.001). The rate of clinically driven target lesion revascularization was 2.4% in the DCB arm in comparison with 20.6% in the PTA arm (P<0.001). There was a low rate of vessel thrombosis in both arms (1.4% after DCB and 3.7% after PTA [P=0.10]). There were no device- or procedurerelated deaths and no major amputations. Conclusions: In this prospective, multicenter, randomized trial, DCB was superior to PTA and had a favorable safety profile for the treatment of patients with symptomatic femoropopliteal peripheral artery disease. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique Identifiers: NCT01175850 and © 2014 The Authors.

Magne J.,French Institute of Health and Medical Research | Pibarot P.,University of Québec | Sengupta P.P.,Mount Sinai School of Medicine | Donal E.,University of Rennes 1 | And 3 more authors.
JACC: Cardiovascular Imaging | Year: 2015

Pulmonary hypertension (PH) is a classic pathophysiological consequence of left-sided valvular heart disease (VHD). However, as opposed to other forms of PH, there are relatively few published data on the prevalence, impact on outcome, and management of PH with VHD. The objective of this paper is to present a systematic review of PH in patients with VHD. PH is found in 15% to 60% of patients with VHD and is more frequent among symptomatic patients. PH is associated with higher risk of cardiac events under conservative management, during valve replacement or repair procedures, and even following successful corrective procedures. In addition to its usefulness in assessing the presence and severity of VHD, Doppler echocardiography is a key tool in diagnosis of PH and assessment of its repercussion on right ventricular function. Assessment of pulmonary arterial pressure during exercise stress echocardiography may provide additional prognostic information beyond resting evaluation. Cardiac magnetic resonance is also useful for assessing right ventricular geometry and function, which provide additional prognostic information in patients with VHD and PH. © 2015 by the American College of Cardiology Foundation.

Zuffi A.,GVM Care and Research | Biondi-Zoccai G.,University of Turin | Colombo F.,GVM Care and Research
Catheterization and Cardiovascular Interventions | Year: 2010

Pulmonary artery catheterization is a useful tool for the diagnosis and management of lung or cardiac disease. This procedure is considered safe and associated with a low incidence of major complications. However, pulmonary artery rupture during right heart catheterization, albeit rare, remains a severe complication. Despite modern management with metal-coil embolization, selective intubation and deployment of bronchial blocker, the mortality rate may be as high as 50%. In this case, we report a new approach to deal with a Swan-Ganz-induced pulmonary artery rupture based on stent graft implantation leading to successful sealing of the pulmonary perforation with final patency and normal antegrade blood flow in the pulmonary branch. © 2010 Wiley-Liss, Inc.

Roffi M.,University of Geneva | Cremonesi A.,GVM Care and Research
Journal of Cardiovascular Surgery | Year: 2013

In the absence of randomized data, the optimal management of patients with severe carotid and coronary artery disease (CAD), especially those undergoing coronary bypass grafting (CABG), remains unsettled. As a general rule, in patients with multilevel atherosclerotic disease the symptomatic vascular discrict should be treated first. The entirely surgical approach with carotid endarterectomy (CEA) and CABG is associated with high event rates. Therefore, whenever in the work-up prior to cardiac surgery severe carotid disease is identified, the indication for CABG should be reassessed and the feasibility of percutaneous coronary intervention (PCI) as an alternative treatment should be explored. If PCI is not an option, carotid artery stenting (CAS) prior to open heart should be considered if the expertise is available. Although perioperative stroke is multifactorial and the value of revascularization of asymptomatic carotid disease prior to open heart surgery remains controversial, treatment of patients with severe bilateral carotid stenosis appears reasonable for perioperative stroke prevention. The aim of carotid revascularization in patient with unilateral severe carotid stenosis should more long-term stroke prevention than merely perioperative stroke reduction. The main advantage of CAS compared with CEA in patients with advanced CAD is the reduction of perioperative myocardial infarction, an event associated to long term mortality.

Garbi M.,King's College | Chambers J.,Guys And St Thomas Hospital | Vannan M.A.,Piedmont Heart Institute | Lancellotti P.,University of Liège | Lancellotti P.,GVM Care and Research
JACC: Cardiovascular Imaging | Year: 2015

Valve stress echocardiography (VSE) is increasingly used both within specialist valve clinics and within dedicated VSE services, mandating practical guidance for referral, procedure, reporting, and clinical implementation of results. Therefore, a didactic VSE guide was compiled based on current European Society of Cardiology and American College of Cardiology/American Heart Association valve disease management guidelines, review of existing evidence, and the authors' extensive experience with VSE. The VSE indications were grouped into 3 categories: symptoms despite nonsevere valve disease, asymptomatic severe valve disease, and valve disease with reduced left ventricular systolic function. The aim of the test, the type of stress to be used, the sequence of image acquisition, the information to be included in the report, and the implication of the VSE results for clinical management were described for every indication and summarized in user-friendly tables. © 2015 American College of Cardiology Foundation.

Griffo R.,La Colletta Hospital | Ambrosetti M.,Cardiovascular Rehabilitation Unit | Tramarin R.,Cardiac Rehabilitation Unit | Fattirolli F.,University of Florence | And 4 more authors.
International Journal of Cardiology | Year: 2013

Background and aim: Secondary prevention is a priority after coronary revascularization. We investigate the impact of a cardiac rehabilitation (CR) program on lifestyle, risk factors and medication modifications and analyze predictors of poor behavioral changes and events in patients after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Methods: Multicenter (n = 62), prospective, longitudinal survey in post-CABG or -PCI consecutive patients after a comprehensive CR program. Cardiac risk factors, lifestyle habits, medication and 1 year cardiovascular events were collected. Logistic regression analyzed the association between risk factors, events and predictors of non-adherence to treatment and lifestyle. Results: At 1 year, of the 1262 patients (66 ± 10 years, CABG 69%, PCI 31%), 94% were taking antiplatelet agents (vs. 91.8% at CR admission and 91.7% at CR discharge, p = ns), 87% statins (vs. 67.5%, p <.0001, and 86.3%, p = ns), 80.7% beta-blockers (vs. 67.4%, p <.0001, and 88.8%, p = ns), and 81.1% ACE inhibitors (vs. 57.5% p <.0001, and 77.7%, p = ns). 89.9% of the patients showed good adherence to treatment, 72% adhered to diet and 51% to exercise recommendations; 74% of smokers stopped smoking. Younger age was predictive of smoking resumption (OR 8.9, CI 3.5-22.8). Pre-event sedentary lifestyle (OR 3.3, CI 1.3-8.7) was predictive of poor diet. Older patients with comorbidity (OR 3.1; CI, 1.8-5.2) tended to persist in sedentary lifestyle and discontinue therapy and diet recommendations. Age, diabetes, smoking and PCI indication were predictors of recurrent CV events which occurred in 142 patients. Conclusion: Participation in CR results in excellent treatment after revascularization, as well as a good lifestyle and medication adherence at 1 year and provides further confirmation of the benefit of secondary prevention. Several clinical characteristics may predict poor behavioral changes. © 2012 Elsevier Ireland Ltd.

Reil J.-C.,Universitatsklinikum des Saarlandes | Robertson M.,University of Glasgow | Ford I.,University of Glasgow | Borer J.,New York University | And 4 more authors.
European Journal of Heart Failure | Year: 2013

AimsLeft bundle branch block (LBBB) increases morbidity and mortality in heart failure (HF). Heart rate reduction with ivabradine improves outcomes in patients with systolic HF. Therefore, we aimed to analyse the impact of LBBB on outcomes in patients with systolic HF as a function of heart rate, and the relationship between LBBB and the effect of treatment with ivabradine.Methods and resultsPatients from the SHIFT (n = 6505) were divided into groups with (n = 912) or without (n = 5593) LBBB at baseline, and according to tertiles of heart rate (70-73, 74-80, and ≥81 b.p.m.). The effect of LBBB, heart rate, and ivabradine on the primary endpoint (cardiovascular death or HF hospitalization) and other endpoints was analysed. LBBB was associated with increases in the primary endpoint by 65%, cardiovascular mortality by 49%, HF hospitalization by 86%, and all-cause mortality by 49% (all P < 0.001). No interaction appeared between the impact of heart rate on outcomes and presence of LBBB (P = 0.83 for the primary endpoint); thus LBBB increases risk for all heart rates. No interaction was apparent in the effect of ivabradine with LBBB or without LBBB. Ivabradine did not increase the prevalence of bradycardia in patients with LBBB.ConclusionLBBB increases risk in HF patients with heart rates ≥70 b.p.m. in sinus rhythm, unmodulated by heart rate. Ivabradine was safe in LBBB. Its effect was directionally similar to that in patients without LBBB, but did not reach statistical significance, possibly due to lack of power to test this effect because of the small number of LBBB patients. © The Author 2012. Published by Oxford University Press on behalf of the European Society of Cardiology.

Fattouch K.,University of Palermo | Sampognaro R.,GVM Care and Research | Speziale G.,GVM Care and Research | Ruvolo G.,University of Palermo
Annals of Thoracic Surgery | Year: 2011

Background: Despite a wide development in aortic leaflets repair techniques, aortic valve annuloplastic procedures are still poorly investigated. We present our aortic valve annuloplastic system consisting of a handmade prosthetic ring with 2 components for reshaping the aortic annulus and sinotubular junction (STJ) and illustrates our surgical approach and clinical results. Methods: Since February 2003, 45 patients with aortic valve regurgitation underwent aortic annuloplasty using the new ring. Mean patient age was 58 ± 16 years (range, 46 to 76 years). The ring has 2 components: a circular ring used to undersize the circumference of the aortoventricular junction and 3-crown-like shape ring used for STJ remodeling. The circular ring was sutured into the left ventricular outflow tract in the aortic subvalvular position and the STJ ring was sutured from the outside of the aortic root just at the level of the STJ. The 3 vertical bands of the STJ ring were fixed to the underlying circular ring to stabilize the continuity between the STJ and nadir of the aortic valve. Results: No in-hospital death occurred. Two patients had residual trivial aortic valve regurgitation postoperatively, and 3 patients required treatment for residual aortic regurgitation (more than mild). Mean length of the coaptation surface was 10 ± 2 mm. The mean clinical follow-up (100% complete) was 22 ± 16 months. All patients were free from cardiac and valve-related events, and no complications due to ring implantation occurred. Conclusions: This ring reshapes the functional aortic annulus and stabilizes all components of the native aortic valve stent to improve long-term results of valve repair. © 2011 The Society of Thoracic Surgeons.

Borer J.S.,New York University | Tavazzi L.,GVM Care and Research
Trends in Cardiovascular Medicine | Year: 2016

Despite dramatic advances in therapy for heart failure (HF) during the past 3 decades, hospitalization and mortality rates remain relatively high. In recent decades, it has become apparent that HF is divisible into two equally lethal but pathophysiologically different sub-classes, the first comprising patients with LV systolic dysfunction [heart failure with reduced ejection fraction (HFrEF)] and the other, approximately equal in size, involving patients with "preserved" systolic function [heart failure with preserved ejection fraction (HFpEF)]. Evidence-based event reducing therapy currently is available only for HFrEF. With the completion of seminal trials of beta blockers, now part of standard therapy for HFrEF, it was apparent that heart rate slowing is an underlying basis of clinical effectiveness of HFrEF therapy. With the discovery of the "f current" that modulates the slope of spontaneous diastolic depolarization of the sino-atrial node, a non-beta blockade approach to heart rate slowing became available. Ivabradine, the first FDA-approved f-current blocker for HFrEF, markedly reduces hospitalizations for worsening heart failure, while also progressively reducing mortality as pre-therapy heart rate increases, and also promotes beneficial left ventricular remodeling, improves health-related quality of life and is effective despite a wide range of comorbidities. The drug is well tolerated and adverse effects are relatively few. Ivabradine represents an important addition to the armamentarium for mitigation of HFrEF. © 2016 Elsevier Inc.

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