Santolamazza Dott.ssa Caterina
Pubblicazioni su PubMed
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Clinical characteristics and outcome of end stage hypertrophic cardiomyopathy: Role of age and heart failure phenotypes.
Int J Cardiol2024 Apr;400():131784. doi: 10.1016/j.ijcard.2024.131784.
Musumeci Beatrice, Tini Giacomo, Biagini Elena, Merlo Marco, Calore Chiara, Ammirati Enrico, Zampieri Mattia, Russo Domitilla, Grilli Giulia, Santolamazza Caterina, Vio Riccardo, Rubino Marta, Ditaranto Raffaello, Del Franco Annamaria, Sormani Paola, Parisi Vanda, Monda Emanuele, Francia Pietro, Cipriani Alberto, Limongelli Giuseppe, Sinagra Gianfranco, Olivotto Iacopo, Boni Luca, Autore Camillo
Abstract
BACKGROUND:
A minority of patients with hypertrophic cardiomyopathy (HCM) presents advanced heart failure (HF) during their clinical course, in the context of left ventricular (LV) remodeling with reduced LV ejection fraction (LVEF), or of severe diastolic dysfunction without impaired LVEF. Aim of this study was to describe a multicentric end stage (ES) HCM population and analyze clinical course and outcome among its different phenotypes.
METHODS:
Data of all HCM patients from 7 Italian referral centres were retrospectively evaluated. ES was diagnosed in presence of: LVEF
RESULTS:
Study population included 331 ES patients; 87% presented ES-rEF and 13% ES-pEF. At ES recognition, patients with ES-pEF were more commonly females, had more frequently NYHA III/IV, atrial fibrillation and greater maximal LV wall thickness. Over a median follow-up of 5.6 years, 83 (25%) patients died, 46 (15%) experienced arrhythmic events and (26%) 85 received advanced HF treatments. Incidence of HCM-related and all-cause mortality, and of combined arrhythmic events did not differ in ES-pEF and ES-rEF patients, but ES-pEF patients were less likely to receive advanced HF treatments. Older age at ES recognition was an independent predictor of increased HCM-related mortality (p = 0.01) and reduced access to advanced HF treatments (p
CONCLUSIONS:
Two different HCM-ES phenotypes can be recognized, with ES-pEF showing distinctive features at ES recognition and receiving less frequently advanced HF treatments. Older age at ES recognition has a major impact on outcomes.
Copyright © 2024 Elsevier B.V. All rights reserved.
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Exploring the Prognostic Performance of MECKI Score in Heart Failure Patients with Non-Valvular Atrial Fibrillation Treated with Edoxaban.
J Clin Med2023 Dec;13(1):. doi: 94.
Mapelli Massimo, Mattavelli Irene, Salvioni Elisabetta, Capra Nicolò, Bonomi Alice, Cattadori Gaia, Pezzuto Beatrice, Campodonico Jeness, Piotti Arianna, Nava Alessandro, Piepoli Massimo, Magrì Damiano, Paolillo Stefania, Corrà Ugo, Raimondo Rosa, Lagioia Rocco, Vignati Carlo, Badagliacca Roberto, Perrone Filardi Pasquale, Senni Michele, Correale Michele, Cicoira Mariantonietta, Metra Marco, Guazzi Marco, Limongelli Giuseppe, Parati Gianfranco, De Martino Fabiana, Bandera Francesco, Bussotti Maurizio, Re Federica, Lombardi Carlo M, Scardovi Angela B, Sciomer Susanna, Passantino Andrea, Emdin Michele, Santolamazza Caterina, Perna Enrico, Passino Claudio, Sinagra Gianfranco, Agostoni Piergiuseppe,
Abstract
INTRODUCTION:
Risk stratification in heart failure (HF) is essential for clinical and therapeutic management. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a validated prognostic model for assessing cardiovascular risk in HF patients with reduced ejection fraction (HFrEF). From the validation of the score, the prevalence of HF patients treated with direct oral anticoagulants (DOACs), such as edoxaban, for non-valvular atrial fibrillation (NVAF) has been increasing in recent years. This study aims to evaluate the reliability of the MECKI score in HFrEF patients treated with edoxaban for NVAF.
MATERIALS AND METHODS:
This study included consecutive outpatients with HF and NVAF treated with edoxaban ( = 83) who underwent a cardiopulmonary exercise test (CPET). They were matched by propensity score with a retrospective group of HFrEF patients with NVAF treated with vitamin K antagonists (VKAs) from the MECKI score registry ( = 844). The study endpoint was the risk of cardiovascular mortality, urgent heart transplantation, or Left Ventricle Assist Device (LVAD) implantation.
RESULTS:
Edoxaban patients were treated with a more optimized HF therapy and had different clinical characteristics, with a similar MECKI score. After propensity score, 77 patients treated with edoxaban were successfully matched with the MECKI-VKA control cohort. In both groups, MECKI accurately predicted the composite endpoint with similar area under the curves (AUC = 0.757 vs. 0.829 in the MECKI-VKA vs. edoxaban-treated group, respectively, = 0.452). The two populations' survival appeared non-significantly different at the 2-year follow-up.
CONCLUSIONS:
this study confirms the prognostic accuracy of the MECKI score in HFrEF patients with NVAF treated with edoxaban, showing improved predictive power compared to VKA-treated patients.
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Real-world candidacy to mavacamten in a contemporary hypertrophic obstructive cardiomyopathy population.
Eur J Heart Fail2024 Jan;26(1):59-64. doi: 10.1002/ejhf.3120.
Bertero Edoardo, Chiti Chiara, Schiavo Maria Alessandra, Tini Giacomo, Costa Paolo, Todiere Giancarlo, Mabritto Barbara, Dei Lorenzo-Lupo, Giannattasio Alessia, Mariani Davide, Lofiego Carla, Santolamazza Caterina, Monda Emanuele, Quarta Giovanni, Barbisan Davide, Mandoli Giulia Elena, Mapelli Massimo, Sguazzotti Maurizio, Negri Francesco, De Vecchi Simona, Ciabatti Michele, Tomasoni Daniela, Mazzanti Andrea, Marzo Francesca, de Gregorio Cesare, Raineri Claudia, Vianello Pier Filippo, Marchi Alberto, Biagioni Giulia, Insinna Eleonora, Parisi Vanda, Ditaranto Raffaello, Barison Andrea, Giammarresi Andrea, De Ferrari Gaetano Maria, Priori Silvia, Metra Marco, Pieroni Maurizio, Patti Giuseppe, Imazio Massimo, Perugini Enrica, Agostoni Piergiuseppe, Cameli Matteo, Merlo Marco, Sinagra Gianfranco, Senni Michele, Limongelli Giuseppe, Ammirati Enrico, Vagnarelli Fabio, Crotti Lia, Badano Luigi, Calore Chiara, Gabrielli Domenico, Re Federica, Musumeci Giuseppe, Emdin Michele, Barbato Emanuele, Musumeci Beatrice, Autore Camillo, Biagini Elena, Porto Italo, Olivotto Iacopo, Canepa Marco
Abstract
AIMS:
In the EXPLORER-HCM trial, mavacamten reduced left ventricular outflow tract obstruction (LVOTO) and improved functional capacity of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients. We sought to define the potential use of mavacamten by comparing real-world HOCM patients with those enrolled in EXPLORER-HCM and assessing their eligibility to treatment.
METHODS AND RESULTS:
We collected information on HOCM patients followed up at 25 Italian HCM outpatient clinics and with significant LVOTO (i.e. gradient ?30?mmHg at rest or??50?mmHg after Valsalva manoeuvre or exercise) despite pharmacological or non-pharmacological therapy. Pharmacological or non-pharmacological therapy resolved LVOTO in 1044 (61.2%) of the 1706 HOCM patients under active follow-up, whereas 662 patients (38.8%) had persistent LVOTO. Compared to the EXPLORER-HCM trial population, these real-world HOCM patients were older (62.1?±?14.3 vs. 58.5?±?12.2?years, p?=?0.02), had a lower body mass index (26.8?±?5.3 vs. 29.7?±?4.9?kg/m , p?0.0001) and a more frequent history of atrial fibrillation (21.5% vs. 9.8%, p?=?0.027). At echocardiography, they had lower left ventricular ejection fraction (LVEF, 66?±?7% vs. 74?±?6%, p?0.0001), higher left ventricular outflow tract gradients at rest (60?±?27 vs. 52?±?29?mmHg, p?=?0.003), and larger left atrial volume index (49?±?16 vs. 40?±?12?ml/m , p?0.0001). Overall, 324 (48.9%) would have been eligible for enrolment in the EXPLORER-HCM trial and 339 (51.2%) for treatment with mavacamten according to European guidelines.
CONCLUSIONS:
Real-world HOCM patients differ from the EXPLORER-HCM population for their older age, lower LVEF and larger atrial volume, potentially reflecting a more advanced stage of the disease. About half of real-world HOCM patients were found eligible to mavacamten.
© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Heart failure patients with improved ejection fraction: Insights from the MECKI score database.
Eur J Heart Fail2023 Nov;25(11):1976-1984. doi: 10.1002/ejhf.3031.
Agostoni Piergiuseppe, Pluchinotta Francesca Romana, Salvioni Elisabetta, Mapelli Massimo, Galotta Arianna, Bonomi Alice, Magrì Damiano, Perna Enrico, Paolillo Stefania, Corrà Ugo, Raimondo Rosa, Lagioia Rocco, Badagliacca Roberto, Perrone Filardi Pasquale, Apostolo Anna, Senni Michele, Iorio Annamaria, Correale Michele, Campodonico Jeness, Palermo Pietro, Cicoira Mariantonietta, Metra Marco, Guazzi Marco, Limongelli Giuseppe, Contini Mauro, Pezzuto Beatrice, Sinagra Gianfranco, Parati Gianfranco, Cattadori Gaia, Carriere Cosimo, Cittar Marco, Matassini Maria Vittoria, Salzano Andrea, Cittadini Antonio, Masè Marco, Bandera Francesco, Bussotti Maurizio, Mattavelli Irene, Re Federica, Vignati Carlo, Lombardi Carlo, Scardovi Angela B, Sciomer Susanna, Passantino Andrea, Emdin Michele, Di Lenarda Andrea, Passino Claudio, Santolamazza Caterina, Moscucci Federica, Zaffalon Denise, Piepoli Massimo,
Abstract
AIMS:
Improvement of left ventricular ejection fraction is a major goal of heart failure (HF) treatment. However, data on clinical characteristics, exercise performance and prognosis in HF patients who improved ejection fraction (HFimpEF) are scarce. The study aimed to determine whether HFimpEF patients have a distinct clinical phenotype, biology and prognosis than HF patients with persistently reduced ejection fraction (pHFrEF).
METHODS AND RESULTS:
A total of 7948 patients enrolled in the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database were evaluated (median follow-up of 1490?days). We analysed clinical, laboratory, electrocardiographic, echocardiographic, exercise, and survival data from HFimpEF (n?=?1504) and pHFrEF (n?=?6017) patients. The primary endpoint of the study was the composite of cardiovascular death, left ventricular assist device implantation, and urgent heart transplantation. HFimpEF patients had lower HF severity: left ventricular ejection fraction 44.0 [41.0-47.0] versus 29.7 [24.1-34.5]%, B-type natriuretic peptide 122 [65-296] versus 373 [152-888] pg/ml, haemoglobin 13.5 [12.2-14.6] versus 13.7 [12.5-14.7] g/dl, renal function by the Modification of Diet in Renal Disease equation 72.0 [56.7-89.3] versus 70.4 [54.5-85.3] ml/min, peak oxygen uptake 62.2 [50.7-74.1] versus 52.6 [41.8-64.3]% predicted, minute ventilation-to-carbon dioxide output slope 30.0 [26.9-34.4] versus 32.1 [28.0-38.0] in HFimpEF and pHFrEF, respectively (p?0.001 for all). Cardiovascular mortality rates were 26.6 and 46.9 per 1000 person-years for HFimpEF and pHFrEF, respectively (p?0.001). Kaplan-Meier analysis showed that HFimpEF had better a long-term prognosis compared with pHFrEF patients. After adjustment for variables differentiating HFimpEF from pHFrEF, except echocardiographic parameters, the Kaplan-Meier curves showed the same prognosis.
CONCLUSIONS:
Heart failure with improved ejection fraction represents a peculiar group of HF patients whose clinical, laboratory, electrocardiographic, echocardiographic, and exercise characteristics parallel the recovery of systolic function. Nonetheless, these patients remain at risk for adverse outcome.
© 2023 European Society of Cardiology.
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Left Heart Disease Phenotype in Elderly Patients with Pulmonary Arterial Hypertension: Insights from the Italian PATRIARCA Registry.
J Clin Med2022 Nov;11(23):. doi: 7136.
Toma Matteo, Miceli Roberta, Bonsante Edoardo, Colombo Davide, Confalonieri Marco, Garascia Andrea, Ghio Stefano, Lattanzio Mariangela, Lombardi Carlo Maria, Paciocco Giuseppe, Piccinino Cristina, Rota Irene, Santolamazza Caterina, Scelsi Laura, Scuri Piermario, Stolfo Davide, Vincenzi Antonella, Volpiano Lorenzo, Vicenzi Marco, Ameri Pietro
Abstract
Pulmonary arterial hypertension (PAH) in the elderly is often associated with left heart disease (LHD), prompting concerns about the use of pulmonary vasodilators. The PATRIARCA registry enrolled ?70 year-old PAH or chronic thromboembolic pulmonary hypertension (CTEPH) patients at 11 Italian centers from 1 December 2019 through 15 September 2022. After excluding those with CTEPH, post-capillary PH at the diagnostic right heart catheterization (RHC), and/or incomplete data, 23 (33%) of a total of 69 subjects met the criteria proposed in the AMBITION trial to suspect LHD. Diabetes [9 (39%) vs. 6 (13%), p = 0.01] and chronic kidney disease [14 (61%) vs. 12 (26%), p = 0.003] were more common, and the last RHC pulmonary artery wedge pressure [14 ± 5 vs. 10 ± 3 mmHg, p
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Does moderate hyperkalemia influence survival in HF? Insights from the MECKI score data base.
Int J Cardiol2023 Jan;371():273-277. doi: 10.1016/j.ijcard.2022.09.030.
Toto Federica, Salvioni Elisabetta, Magrì Damiano, Sciomer Susanna, Piepoli Massimo, Badagliacca Roberto, Galotta Arianna, Baracchini Nikita, Paolillo Stefania, Corrà Ugo, Raimondo Rosa, Lagioia Rocco, Filardi Pasquale Perrone, Iorio Annamaria, Senni Michele, Correale Michele, Cicoira Mariantonietta, Perna Enrico, Metra Marco, Guazzi Marco, Limongelli Giuseppe, Sinagra Gianfranco, Parati Gianfranco, Cattadori Gaia, Bandera Francesco, Bussotti Maurizio, Mapelli Massimo, Cipriani Manlio, Bonomi Alice, Cunha Gonçalo, Re Federica, Vignati Carlo, Garascia Andrea, Lombardi Carlo, Scardovi Angela B, Passantino Andrea, Emdin Michele, Passino Claudio, Santolamazza Caterina, Girola Davide, Zaffalon Denise, Vizza Dario, De Martino Fabiana, Agostoni Piergiuseppe,
Abstract
BACKGROUND:
The prognostic role of moderate hyperkalemia in reduced ejection fraction (HFrEF) patients is still controversial. Despite this, it affects the use of renin-angiotensin-aldosterone system inhibitors (RAASi) with therapy down-titration or discontinuation.
OBJECTIVES:
Aim of the study was to assess the prognostic impact of moderate hyperkalemia in chronic HFrEF optimally treated patients.
METHODS AND RESULTS:
We retrospectively analyzed MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) database, with median follow-up of 4.2 [IQR 1.9-7.5] years. Data on K levels were available in 7087 cases. Patients with K plasma level ? 5.6 mEq/L and 4 and
CONCLUSIONS:
Moderate hyperkalemia does not influence patients' outcome in a large cohort of ambulatory HFrEF patients.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Pick Your Threshold: A Comparison Among Different Methods of Anaerobic Threshold Evaluation in Heart Failure Prognostic Assessment.
Chest2022 Nov;162(5):1106-1115. doi: 10.1016/j.chest.2022.05.039.
Salvioni Elisabetta, Mapelli Massimo, Bonomi Alice, Magrì Damiano, Piepoli Massimo, Frigerio Maria, Paolillo Stefania, Corrà Ugo, Raimondo Rosa, Lagioia Rocco, Badagliacca Roberto, Filardi Pasquale Perrone, Senni Michele, Correale Michele, Cicoira Mariantonietta, Perna Enrico, Metra Marco, Guazzi Marco, Limongelli Giuseppe, Sinagra Gianfranco, Parati Gianfranco, Cattadori Gaia, Bandera Francesco, Bussotti Maurizio, Re Federica, Vignati Carlo, Lombardi Carlo, Scardovi Angela B, Sciomer Susanna, Passantino Andrea, Emdin Michele, Passino Claudio, Santolamazza Caterina, Girola Davide, Zaffalon Denise, De Martino Fabiana, Agostoni Piergiuseppe,
Abstract
BACKGROUND:
In clinical practice, anaerobic threshold (AT) is used to guide training and rehabilitation programs, to define risk of major thoracic or abdominal surgery, and to assess prognosis in heart failure (HF). AT of oxygen uptake (V.O; V.OAT) has been reported as an absolute value (V.OATabs), as a percentage of predicted peak V.O (V.OAT%peak_pred), or as a percentage of observed peak V.O (V.OAT%peak_obs). A direct comparison of the prognostic power among these different ways to report AT is missing.
RESEARCH QUESTION:
What is the prognostic power of these different ways to report AT?
STUDY DESIGN AND METHODS:
In this observational cohort study, we screened data of 7,746 patients with HF with a history of reduced ejection fraction (
RESULTS:
This study considered 6,157 patients with HF with identified AT. Follow-up was median, 4.2 years (25th-75th percentiles, 1.9-5.0 years). Both V.OATabs (mean ± SD, 823 ± 305 mL/min) and V.OAT%peak_pred (mean ± SD, 39.6 ± 13.9%), but not V.OAT%peak_obs (mean ± SD, 69.2 ± 17.7%), well stratified the population regarding prognosis (composite end point: cardiovascular death, urgent heart transplant, or left ventricular assist device). Comparing area under the receiver operating characteristic curve (AUC) values, V.OATabs (0.680) and V.OAT%peak_pred (0.688) performed similarly, whereas V.OAT%peak_obs (0.538) was significantly weaker (P
INTERPRETATION:
In HF, V.OAT%peak_pred is the best way to report V.O at AT in relationship to prognosis, with a prognostic power comparable to that of peak V.O and, remarkably, in patients with severe HF.
Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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Heart Rate in Patients with SARS-CoV-2 Infection: Prevalence of High Values at Discharge and Relationship with Disease Severity.
J Clin Med2021 Nov;10(23):. doi: 5590.
Maloberti Alessandro, Ughi Nicola, Bernasconi Davide Paolo, Rebora Paola, Cartella Iside, Grasso Enzo, Lenoci Deborah, Del Gaudio Francesca, Algeri Michela, Scarpellini Sara, Perna Enrico, Verde Alessandro, Santolamazza Caterina, Vicari Francesco, Frigerio Maria, Alberti Antonia, Valsecchi Maria Grazia, Rossetti Claudio, Epis Oscar Massimiliano, Giannattasio Cristina, On The Behalf Of The Niguarda Covid-Working Group
Abstract
The most common arrhythmia associated with COronaVIrus-related Disease (COVID) infection is sinus tachycardia. It is not known if high Heart Rate (HR) in COVID is simply a marker of higher systemic response to sepsis or if its persistence could be related to a long-term autonomic dysfunction. The aim of our work is to assess the prevalence of elevated HR at discharge in patients hospitalized for COVID-19 and to evaluate the variables associated with it. We enrolled 697 cases of SARS-CoV2 infection admitted in our hospital after February 21 and discharged within 23 July 2020. We collected data on clinical history, vital signs, laboratory tests and pharmacological treatment. Severe disease was defined as the need for Intensive Care Unit (ICU) admission and/or mechanical ventilation. Median age was 59 years (first-third quartile 49, 74), and male was the prevalent gender (60.1%). 84.6% of the subjects showed a SARS-CoV-2 related pneumonia, and 13.2% resulted in a severe disease. Mean HR at admission was 90 ± 18 bpm with a mean decrease of 10 bpm to discharge. Only 5.5% of subjects presented HR > 100 bpm at discharge. Significant predictors of discharge HR at multiple linear model were admission HR (mean increase = ? = 0.17 per bpm, 95% CI 0.11; 0.22,
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Nonresponse to Acute Vasodilator Challenge and Prognosis in Heart Failure With Pulmonary Hypertension.
J Card Fail2021 Aug;27(8):869-876. doi: 10.1016/j.cardfail.2021.01.021.
Ghio Stefano, Crimi Gabriele, Houston Brian, Montalto Claudio, Garascia Andrea, Boffini Massimo, Temporelli Pier Luigi, La Rovere Maria Teresa, Pacileo Giuseppe, Panneerselvam Kavin, Santolamazza Caterina, D'angelo Luciana, Moschella Martina, Scelsi Laura, Marro Matteo, Masarone Daniele, Ameri Pietro, Rinaldi Mauro, Guazzi Marco, D'alto Michele, Tedford Ryan J
Abstract
BACKGROUND:
An acute vasodilator challenge is recommended in patients with heart failure and pulmonary hypertension during heart transplant evaluation. The aim of the study was to assess which hemodynamic parameters are associated with nonresponsiveness to the challenge.
METHODS AND RESULTS:
This study is a retrospective analysis of 402 patients with heart failure with pulmonary hypertension who underwent right heart catheterization and a pulmonary vasodilator challenge. Among the 140 who fulfilled the transplant guidelines eligibility criteria for the vasodilator challenge, 38 were responders and 102 nonresponders. At multivariable analysis, a diastolic blood pressure of 5 Woods units, and pulmonary artery compliance of
CONCLUSIONS:
In patients with heart failure and pulmonary hypertension, low pulmonary arterial compliance, high pulmonary vascular resistance, and low diastolic blood pressure predict the nonresponsiveness to acute vasodilator challenge whilst a poor right ventricular function predicts a dismal prognosis.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Getting to the heart of the matter in a multisystem disorder: Erdheim-Chester disease.
Lancet2019 Aug;394(10198):e19. doi: 10.1016/S0140-6736(19)31787-8.
Buono Andrea, Bassi Ilaria, Santolamazza Caterina, Moreo Antonella, Pedrotti Patrizia, Sacco Alice, Morici Nuccia, Giannattasio Cristina, Oliva Fabrizio, Ammirati Enrico
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Clinical and prognostic impact of chronotropic incompetence in patients with hypertrophic cardiomyopathy.
Int J Cardiol2018 Nov;271():125-131. doi: 10.1016/j.ijcard.2018.04.019.
Magri Damiano, Agostoni Piergiuseppe, Sinagra Gianfranco, Re Federica, Correale Michele, Limongelli Giuseppe, Zachara Elisabetta, Mastromarino Vittoria, Santolamazza Caterina, Casenghi Matteo, Pacileo Giuseppe, Valente Fabio, Morosin Marco, Musumeci Beatrice, Pagannone Erika, Maruotti Antonello, Uguccioni Massimo, Volpe Massimo, Autore Camillo
Abstract
BACKGROUND:
A blunted heart rate (HR) response is associated with an impaired peak oxygen uptake (pVO), a powerful outcome predictor in hypertrophic cardiomyopathy (HCM). The present multicenter study sought to determine the prognostic role for exercise-induced HR response in HCM.
METHODS:
A total of 681 consecutive HCM outpatients on optimized treatment were recruited. The heart failure (HF) end-point was death due to HF, cardiac transplantation, NYHA III-IV class progression, HF worsening leading to hospitalization and severe functional deterioration leading to septal reduction. The sudden cardiac death (SCD) end-point included SCD, aborted SCD and appropriate implantable cardioverter defibrillator discharges.
RESULTS:
During a median follow-up of 4.2?years (25-75th centile: 3.9-5.2), 81 patients reached the HF and 23 the SCD end-point. Covariates with independent effects on the HF end-point were left atrial diameter, left ventricular ejection fraction, maximal left ventricular outflow tract gradient and exercise cardiac power (ECP?=?pVO?systolic blood pressure) (C-Index?=?0.807) whereas the HCM Risk-SCD score and the ECP remained associated with the SCD end-point (C-Index?=?0.674). When the VO-derived variables were not pursued, peak HR (pHR) re-entered in the multivariate HF model (C-Index?=?0.777) and, marginally, in the SCD model (C-index?=?0.656). A pHR?=?70% of the maximum predicted resulted as the best cut-off value in predicting the HF-related events.
CONCLUSIONS:
The cardiopulmonary exercise test is pivotal in the HCM management, however the pHR remains a meaningful alternative parameter. A pHR?70% identified a HCM population at high risk of HF-related events, thus calling for a reappraisal of the chronotropic incompetence threshold in HCM.
Copyright © 2018 Elsevier B.V. All rights reserved.
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Monotherapy and Dual Combination Therapies Based on Olmesartan: A Comprehensive Strategy to Improve Blood Pressure Control.
High Blood Press Cardiovasc Prev2017 Sep;24(3):243-253. doi: 10.1007/s40292-017-0216-1.
Volpe Massimo, Santolamazza Caterina, Mastromarino Vittoria, Coluccia Roberta, Battistoni Allegra, Tocci Giuliano
Abstract
Olmesartan medoxomil is an antihypertensive drug of the class of angiotensin II type 1 (AT1) receptor antagonists (or blockers), characterized by tight and prolonged binding to AT1 receptor compared to other molecules within the same class. These characteristics produce effective and sustained blood pressure reductions in hypertensive patients at different cardiovascular risk profile with a good tolerability profile. After a brief description of the pharmacological characteristics of olmesartan, we will provide a thorough overview of the clinical studies that investigated its efficacy and safety in the clinical management of hypertensive patients both in monotherapy and in dual combination therapies with either thiazide diuretics or calcium channel blockers. These studies demonstrated that olmesartan-based antihypertensive strategy may indeed provide sustained BP control over the 24-h period in a wide proportion of hypertensive patients, thus contributing to a substantial progress in hypertension management. Finally, since growing evidence suggest that olmesartan may also exert potential favourable effects at vascular level, thereby antagonizing the vascular inflammatory process involved in the development and progression of atherosclerosis, the main clinical studies addressing this issue will be also discussed.
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Triple Combination Therapies Based on Olmesartan: A Personalized Therapeutic Approach to Improve Blood Pressure Control.
High Blood Press Cardiovasc Prev2017 Sep;24(3):255-263. doi: 10.1007/s40292-017-0217-0.
Volpe Massimo, Santolamazza Caterina, Mastromarino Vittoria, Coluccia Roberta, Battistoni Allegra, Tocci Giuliano
Abstract
Recent epidemiological surveys have demonstrated that effective and sustained blood pressure (BP) control is achieved in a relatively small proportion of treated hypertensive patients. Indeed, treatment of hypertension represents a key strategy for preventing coronary artery disease, stroke, congestive heart failure and cardiovascular death. Several interventions have been proposed by international guidelines for ameliorating hypertension management and control, mostly including integrated and multi-dimensional pharmacological and non-pharmacological strategies. In particular, numerous evidence demonstrated that a more extensive use of combination therapy may represent a valid therapeutic option for treating hypertensive patients at different risk profile. This strategy has been definitely strengthened by the availability of single pill fixed-dose combinations. Among potential combination therapies, those based on the association of renin-angiotensin system antagonists, thiazide diuretics and calcium channel blockers are very effective in lowering BP levels and well tolerated. We will provide here an overview of clinical evidence supporting the use of triple combination therapy, with a focus on that based on olmesartan medoxomil, a thiazide diuretic (hydrochlorothiazide) and a calcium channel blocker (amlodipine besylate), which is available in multiple dosages. Finally, in view of the recognised importance of single-pill combination therapy for treating hypertension, we will examine the potential benefits of dual (fixed) combination therapy based on olmesartan medoxomil with either thiazide diuretic hydrochlorothiazide or calcium channel blocker amlodipine in terms of efficacy, safety and tolerability profile.
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Cardiopulmonary Exercise Test in Hypertrophic Cardiomyopathy.
Ann Am Thorac Soc2017 Jul;14(Supplement_1):S102-S109. doi: 10.1513/AnnalsATS.201611-884FR.
Magrì Damiano, Santolamazza Caterina
Abstract
Understanding the functional limitation in hypertrophic cardiomyopathy, the most common inherited heart disease, is challenging. In addition to the occurrence of disease-related complications, several factors are potential determinants of exercise limitation, including left ventricular hypertrophy, myocardial fiber disarray, left ventricular outflow tract obstruction, microvascular ischemia, and interstitial fibrosis. Furthermore, drugs commonly used in the daily management of these patients may interfere with exercise capacity, especially those with a negative chronotropic effect. Cardiopulmonary exercise testing can safely and objectively evaluate the functional capacity of these patients and help the physician in understanding the mechanisms that underlie this limitation. Features that reduce exercise capacity may predict progression to heart failure in these patients and even the risk of sudden cardiac death.
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QT spatial dispersion and sudden cardiac death in hypertrophic cardiomyopathy: Time for reappraisal.
J Cardiol2017 Oct;70(4):310-315. doi: 10.1016/j.jjcc.2017.01.006.
Magrì Damiano, Santolamazza Caterina, Limite Luca, Mastromarino Vittoria, Casenghi Matteo, Orlando Paola, Pagannone Erika, Musumeci Maria Beatrice, Maruotti Antonello, Ricotta Agnese, Oliviero Giada, Piccirillo Gianfranco, Volpe Massimo, Autore Camillo
Abstract
BACKGROUND:
The 12-lead surface electrocardiographic (ECG) analysis is able to provide independent predictors of prognosis in several cardiovascular settings, including hypertrophic cardiomyopathy (HCM). The present single-center study investigated the possible ability of several ECG-derived variables in stratifying sudden cardiac death (SCD) risk and, possibly, in improving the accuracy of the 2014 European Society of Cardiology guidelines.
METHODS:
A total of 221 consecutive HCM outpatients were recruited and prospectively followed. All of them underwent a full clinical and instrumental examination, including a 12-lead surface ECG to calculate the dispersion for the following intervals: QRS, Q-Tend (QT), Q-Tpeak (QTp), Tpeak-Tend (TpTe), J-Tpeak (JTp), and J-Tend (JT). The study composite end-point was SCD, aborted SCD, and appropriate implantable cardioverter defibrillator (ICD) interventions.
RESULTS:
During a median follow-up of 4.4 years (25th-75th interquartile range: 2.4-9.4 years), 23 patients reached the end-point at 5-years (3 SCD, 3 aborted SCD, 17 appropriate ICD interventions). At multivariate analysis, the spatial QT dispersion corrected according to Bazett's formula (QTcd) remains independently associated to the study endpoint over the HCM Risk-SCD score (C-index 0.737). A QTcd cut-off value of 93ms showed the best accuracy in predicting the SCD endpoint within the entire HCM study cohort (sensitivity 56%, specificity 75%, positive predictive value 22%, negative predictive value 97%).
CONCLUSION:
Our data suggest that the QTcd might be helpful in SCD risk stratification, particularly in those HCM categories classified at low-intermediate SCD risk according to the contemporary guidelines.
Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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O072. An uncommon case of sinusal arrest in Cluster Headache.
J Headache Pain2015 Dec;16(Suppl 1):A126. doi: A126.
De Biase Luciano, Santolamazza Caterina, D'Alonzo Lidia
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Prognostic Implications of Defibrillation Threshold Testing in Patients With Hypertrophic Cardiomyopathy.
J Cardiovasc Electrophysiol2017 Jan;28(1):103-108. doi: 10.1111/jce.13121.
Francia Pietro, Adduci Carmen, Semprini Lorenzo, Palano Francesca, Santini Daria, Musumeci Beatrice, Santolamazza Caterina, Volpe Massimo, Autore Camillo
Abstract
INTRODUCTION:
In hypertrophic cardiomyopathy (HCM) patients the need for defibrillation threshold (DFT) testing at the time of ICD implantation is debated. Moreover, its prognostic implications have never been explored. In a cohort of HCM patients we sought to (a) investigate factors prompting DFT testing, (b) evaluate ICD efficacy by testing DFT, (c) compare DFT in patients with and without massive LVH, and (d) assess whether DFT testing predicts shock efficacy for spontaneous VT/VF.
METHODS AND RESULTS:
We retrospectively analyzed a cohort of HCM patients implanted with an ICD. DFT was tested at the discretion of the implanting physician with a 10 J safety margin. During follow-up, ICD interventions were evaluated. The study population included 66 patients. DFT was determined in 25 (38%) patients. Age (HR: 0.95; 95%CI: 0.92-0.98; P = 0.004) and massive LVH (HR: 6.0; 95%CI: 2.03-18.8; P = 0.001) affected the decision to test DFT. DFT was at least 10 J less than maximal ICD output in 25/25. Safety margin was similar among patients with and without massive LVH (15 ± 3 J vs. 14 ± 2 J; P = 0.42). During follow-up (median 53 months) 15 shocks were delivered for 12 VT/VF in 7 patients. One VF ended spontaneously after a failed shock. Of 4 unsuccessful shocks, 2 occurred in 1 patient with DFT testing and 2 were delivered in 2 patients without. All unsuccessful shocks were ?35 J.
CONCLUSION:
Young age and massive LVH prompt DFT testing. Contemporary ICDs are safe and effective in HCM patients independently from the magnitude of LVH. DFT testing does not predict shock efficacy for spontaneous VT/VF.
© 2016 Wiley Periodicals, Inc.
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Hypertension in Patients with Heart Failure with Reduced Ejection Fraction.
Curr Cardiol Rep2016 Dec;18(12):127.
Volpe Massimo, Santolamazza Caterina, Tocci Giuliano
Abstract
Hypertension (HTN) is a well-known health problem associated with considerable morbidity and mortality and it is an important risk factor for the development of heart failure (HF). These findings support the need for optimizing the antihypertensive strategies to prevent the progression to HF. Interestingly, the progression from HTN to HF, among other things, may be a consequence of inappropriate over-activation of the renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system (SNS), and the natriuretic peptide system (NPS). In the present review, we will discuss the pathophysiological aspects of the progression from HTN to HF with reduced ejection fraction (HFrEF) and we will focus on the evolution of different pharmacological therapies which are reported to be effective in reducing BP and improving HF outcomes, paying particular attention to the recent trials that have demonstrated the efficacy of the combined therapy of RAAS blockade and Neprilysin (NEP) inhibitor in lowering BP and mediating several beneficial actions within cardiovascular tissues, such as avoiding the worsening of HF.
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Heart Failure Progression in Hypertrophic Cardiomyopathy?- Possible Insights From Cardiopulmonary Exercise Testing.
Circ J2016 Sep;80(10):2204-11. doi: 10.1253/circj.CJ-16-0432.
Magrì Damiano, Re Federica, Limongelli Giuseppe, Agostoni Piergiuseppe, Zachara Elisabetta, Correale Michele, Mastromarino Vittoria, Santolamazza Caterina, Casenghi Matteo, Pacileo Giuseppe, Valente Fabio, Morosin Marco, Musumeci Beatrice, Pagannone Erika, Maruotti Antonello, Uguccioni Massimo, Volpe Massimo, Autore Camillo
Abstract
BACKGROUND:
Heart failure (HF) progression and its complications represent major emergent concerns in hypertrophic cardiomyopathy (HCM). We investigated the possible adjunctive role of cardiopulmonary exercise testing (CPET) in predicting HF-related events. An exercise-derived risk model, theHYPertrophicExercise-derivedRiskHF(HYPERHF), has been developed.
METHODS AND RESULTS:
A multicenter cohort of 620 consecutive HCM outpatients was recruited and followed (2007 to 2015). The endpoint was death from HF, cardiac transplantation, NYHA III-IV class progression, severe functional deterioration leading to hospitalization for septal reduction, and hospitalization for HF worsening. During a median follow-up of 3.8 years (25-75th centile: 2.3-5.3 years), 84 patients reached the endpoint. Peak circulatory power (peak oxygen consumption * peak systolic blood pressure), ventilatory efficiency and left atrial diameter were independently associated with the endpoint and, accordingly, integrated into the HYPERHFmodel (C index: 0.849; best cutoff value equal to 15%).
CONCLUSIONS:
CPET is useful in the evaluation of HCM patients. In this context, the HYPERHFscore might allow early identification of those patients at high risk of HF progression and its complications. (Circ J 2016; 80: 2204-2211).
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Cardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy.
Heart2016 Apr;102(8):602-9. doi: 10.1136/heartjnl-2015-308453.
Magrì Damiano, Limongelli Giuseppe, Re Federica, Agostoni Piergiuseppe, Zachara Elisabetta, Correale Michele, Mastromarino Vittoria, Santolamazza Caterina, Casenghi Matteo, Pacileo Giuseppe, Valente Fabio, Musumeci Beatrice, Maruotti Antonello, Volpe Massimo, Autore Camillo
Abstract
BACKGROUND:
In hypertrophic cardiomyopathy (HCM), most of the factors associated with the risk of sudden cardiac death (SCD) are also involved in the pathophysiology of exercise limitation. The present multicentre study investigated possible ability of cardiopulmonary exercise test in improving contemporary strategies for SCD risk stratification.
METHODS:
A total of 623 consecutive outpatients with HCM, from five tertiary Italian HCM centres, were recruited and prospectively followed, between September 2007 and April 2015. The study composite end point was SCD, aborted SCD and appropriate implantable cardioverter defibrillator (ICD) interventions.
RESULTS:
During a median follow-up of 3.7?years (25th-75th centile: 2.2-5.1?years), 25 patients reached the end point at 5 years (3 SCD, 4 aborted SCD, 18 appropriate ICD interventions). At multivariate analysis, ventilation versus carbon dioxide relation during exercise (VE/VCO2 slope) remains independently associated to the study end point either when challenged with the 2011 American College of Cardiology Foundation/American Heart Association guidelines-derived score (C index 0.748) or with the 2014 European Society of Cardiology guidelines-derived score (C index 0.750). A VE/VCO2 slope cut-off value of 31 showed the best accuracy in predicting the SCD end point within the entire HCM study cohort (sensitivity 64%, specificity 72%, area under the curve 0.72).
CONCLUSIONS:
Our data suggest that the VE/VCO2 slope might improve SCD risk stratification, particularly in those HCM categories classified at low-intermediate SCD risk according to contemporary guidelines. There is a need for further larger studies, possibly on independent cohorts, to confirm our preliminary findings.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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New therapies for arterial hypertension.
Panminerva Med2016 Mar;58(1):34-47.
Pagliaro Beniamino, Santolamazza Caterina, Rubattu Speranza, Volpe Massimo
Abstract
Arterial hypertension is the most common chronic disease in developed countries and it is the leading risk factor for stroke, ischemic heart disease, congestive heart failure, chronic renal failure and peripheral artery disease. Its prevalence appears to be about 30-45% of the general population. Recent European guidelines estimate that up to 15-20% of the hypertensive patients are not controlled on a dual antihypertensive combination and they require three or more different antihypertensive drug classes to achieve adequate blood pressure control. The guidelines confirmed that diuretics, beta-blockers, calcium-channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are suitable for the initiation and maintenance of antihypertensive treatment, either as monotherapy or in combination therapy. Very few antihypertensive agents have reached the market over the last few years, but no new therapeutic class has really emerged. The long-term adherence to cardiovascular drugs is still low in both primary and secondary prevention of cardiovascular diseases. In particular, the issue of compliance is persistently high in hypertension, despite the fixed-dose combination therapy. As a consequence, a cohort of high-risk hypertensive population, represented by patients affected by refractory and resistant hypertension, can be identified. Therefore, the need of controlling BP in high-risk patients may be addressed, in part, by the development of new drugs, devices and procedures that are designed to treat hypertension and comorbidities. In this review we will comprehensively discuss the current literature on recent therapeutic advances in hypertension, including both medical therapy and interventional procedures.
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Erythropoiesis-stimulating agents in heart failure: leave it or re-take it?
Eur J Heart Fail2015 Nov;17(11):1089-90. doi: 10.1002/ejhf.432.
Volpe Massimo, Santolamazza Caterina, Mastromarino Vittoria
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Phytochemical Compounds and Protection from Cardiovascular Diseases: A State of the Art.
Biomed Res Int2015 ;2015():918069. doi: 918069.
Pagliaro Beniamino, Santolamazza Caterina, Simonelli Francesca, Rubattu Speranza
Abstract
Cardiovascular diseases represent a worldwide relevant socioeconomical problem. Cardiovascular disease prevention relies also on lifestyle changes, including dietary habits. The cardioprotective effects of several foods and dietary supplements in both animal models and in humans have been explored. It was found that beneficial effects are mainly dependent on antioxidant and anti-inflammatory properties, also involving modulation of mitochondrial function. Resveratrol is one of the most studied phytochemical compounds and it is provided with several benefits in cardiovascular diseases as well as in other pathological conditions (such as cancer). Other relevant compounds are Brassica oleracea, curcumin, and berberine, and they all exert beneficial effects in several diseases. In the attempt to provide a comprehensive reference tool for both researchers and clinicians, we summarized in the present paper the existing literature on both preclinical and clinical cardioprotective effects of each mentioned phytochemical. We structured the discussion of each compound by analyzing, first, its cellular molecular targets of action, subsequently focusing on results from applications in both ex vivo and in vivo models, finally discussing the relevance of the compound in the context of human diseases.
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Pathogenesis of target organ damage in hypertension: role of mitochondrial oxidative stress.
Int J Mol Sci2014 Dec;16(1):823-39. doi: 10.3390/ijms16010823.
Rubattu Speranza, Pagliaro Beniamino, Pierelli Giorgia, Santolamazza Caterina, Castro Sara Di, Mennuni Silvia, Volpe Massimo
Abstract
Hypertension causes target organ damage (TOD) that involves vasculature, heart, brain and kidneys. Complex biochemical, hormonal and hemodynamic mechanisms are involved in the pathogenesis of TOD. Common to all these processes is an increased bioavailability of reactive oxygen species (ROS). Both in vitro and in vivo studies explored the role of mitochondrial oxidative stress as a mechanism involved in the pathogenesis of TOD in hypertension, especially focusing on atherosclerosis, heart disease, renal failure, cerebrovascular disease. Both dysfunction of mitochondrial proteins, such as uncoupling protein-2 (UCP2), superoxide dismutase (SOD) 2, peroxisome proliferator-activated receptor ? coactivator 1-? (PGC-1?), calcium channels, and the interaction between mitochondria and other sources of ROS, such as NADPH oxidase, play an important role in the development of endothelial dysfunction, cardiac hypertrophy, renal and cerebral damage in hypertension. Commonly used anti-hypertensive drugs have shown protective effects against mitochondrial-dependent oxidative stress. Notably, few mitochondrial proteins can be considered therapeutic targets on their own. In fact, antioxidant therapies specifically targeted at mitochondria represent promising strategies to reduce mitochondrial dysfunction and related hypertensive TOD. In the present article, we discuss the role of mitochondrial oxidative stress as a contributing factor to hypertensive TOD development. We also provide an overview of mitochondria-based treatment strategies that may reveal useful to prevent TOD and reduce its progression.
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Inadequate RAAS suppression is associated with excessive left ventricular mass and systo-diastolic dysfunction.
Clin Res Cardiol2013 Oct;102(10):725-33. doi: 10.1007/s00392-013-0585-y.
Gregori Mario, Tocci Giuliano, Marra Andrea, Pignatelli Giulia, Santolamazza Caterina, Befani Alberto, Ciavarella Giuseppino Massimo, Ferrucci Andrea, Paneni Francesco
Abstract
BACKGROUND:
Inadequate suppression of renin-angiotensin-aldosterone system (RAAS) following postural maneuvers may have detrimental effects on cardiac structure and function. In this study, we aimed to appraise the clinical significance of this phenomenon by assessing its relation with inappropriate ventricular mass (ILVM), an adverse phenotype of LV remodeling and dysfunction.
METHODS:
Both supine and upright plasma renin activity (PRA) and aldosterone concentrations (PAC) were measured in 115 young newly diagnosed hypertensive subjects. 24-h ambulatory blood pressure monitoring and echocardiographic evaluation including tissue Doppler imaging (TDI) were also performed. Patients were divided as follows: (1) normal PRA and PAC (N) (n = 63); (2) suppressible RAAS (SR) in supine position (n = 27); (3) not suppressible RAAS (NSR) (n = 25). ILVM was expressed as the observed/predicted LV mass ratio ×100 (%PLVM), while LV dysfunction (LVD) was identified by TDI-derived myocardial performance index (MPI).
RESULTS:
NSR showed a higher prevalence of ILVM than SR and N. As compared with N and SR, NSR patients had reduced indices of systolic and diastolic function. MPI of the LV as well as prevalence of LVD was also significantly higher in the NSR group. Regression models showed that lack of RAAS suppression was independently associated with ILVM and LVD.
CONCLUSIONS:
Prevalence of ILVM and LVD is higher in patients without clinostatic RAAS suppression. Our findings encourage the assessment of RAAS deregulation to better estimate individual cardiovascular risk in patients with arterial hypertension.
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Preclinical effects of healthy obesity on inappropriate left ventricular mass and systolic function.
Int J Cardiol2013 Sep;167(6):3047-9. doi: 10.1016/j.ijcard.2012.11.089.
Paneni Francesco, Gregori Mario, Marra Andrea, Passerini Jasmine, Santolamazza Caterina, Befani Alberto, Ciavarella Giuseppino Massimo, Magrì Damiano, Tocci Giuliano, Ferrucci Andrea, Volpe Massimo
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