Sacco Dott.ssa Alice
Pubblicazioni su PubMed
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Organ perfusion pressure at admission and clinical outcomes in patients hospitalized for acute heart failure.
Eur Heart J Acute Cardiovasc Care2023 Oct;():. doi: zuad133.
Bocchino Pier Paolo, Cingolani Marco, Frea Simone, Angelini Filippo, Gallone Guglielmo, Garatti Laura, Sacco Alice, Raineri Claudia, Pidello Stefano, Morici Nuccia, De Ferrari Gaetano Maria
Abstract
BACKGROUND:
Hypoperfusion portends adverse outcomes in acute heart failure (AHF). The gradient between end-organ inflow and outflow pressures may more closely reflect hypoperfusion than mean arterial pressure (MAP) alone. The aim of this study was to investigate organ perfusion pressure (OPP), calculated as MAP minus central venous pressure (CVP), as a prognostic marker in AHF.
METHODS:
The SNIP-AHF study was a multicenter retrospective cohort study of 200 consecutive patients hospitalized for AHF treated with sodium nitroprusside. Only patients with both MAP and invasive CVP data available from the SNIP-AHF cohort were included in this analysis. The primary endpoint was to assess OPP as a predictor of worsening heart failure (WHF), defined as the worsening of signs and symptoms of heart failure leading to intensification of therapy at 48?hours.
RESULTS:
146 patients fulfilling the inclusion criteria were included (mean age: 61.1?±?13.5 years, 32 [21.9%] females; mean body mass index: 26.2?±?11.7?kg/m2; mean left ventricular ejection fraction: 23.8%±11.4%, mean MAP: 80.2?±?13.2?mmHg, mean CVP: 14.0?±?6.1?mmHg). WHF occurred in 14 (9.6%) patients. At multivariable models including hemodynamic variables (OPP, shock index and CVP), OPP at admission was the best predictor of WHF at 48?hours (OR 0.91 [95%CI 0.86-0.96], p-value?=?0.001) with an optimal cut-off value of 67.5?mmHg (specificity 47.3%, sensitivity 100%, AUC 0.784?±?0.054). In multivariable models including univariable significant parameters available at first bedside assessment, namely New York Heart Association functional class, OPP, shock index, CVP and left ventricular end-diastolic diameter, OPP consistently and significantly predicted WHF at 48?hours.
CONCLUSIONS:
In this retrospective analysis on patients hospitalized for AHF treated with sodium nitroprusside, on-admission OPP significantly predicted WHF at 48?hours with high sensitivity.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction.
ESC Heart Fail2023 Dec;10(6):3472-3482. doi: 10.1002/ehf2.14510.
Bertaina Maurizio, Morici Nuccia, Frea Simone, Garatti Laura, Briani Martina, Sorini Carlotta, Villanova Luca, Corrada Elena, Sacco Alice, Moltrasio Marco, Ravera Amelia, Tedeschi Michele, Bertoldi Letizia, Lettino Maddalena, Saia Francesco, Corsini Anna, Camporotondo Rita, Colombo Costanza Natalia Julia, Bertolin Stephanie, Rota Matteo, Oliva Fabrizio, Iannaccone Mario, Valente Serafina, Pagnesi Matteo, Metra Marco, Sionis Alessandro, Marini Marco, De Ferrari Gaetano Maria, Kapur Navin K, Pappalardo Federico, Tavazzi Guido
Abstract
AIMS:
The present analysis from the multicentre prospective Altshock-2 registry aims to better define clinical features, in-hospital course, and management of cardiogenic shock complicating acutely decompensated heart failure (ADHF-CS) as compared with that complicating acute myocardial infarction (AMI-CS).
METHODS AND RESULTS:
All patients with AMI-CS or ADHF-CS enrolled in the Altshock-2 registry between March 2020 and February 2022 were selected. The primary objective was the characterization of ADHF-CS patients as compared with AMI-CS. In-hospital length of stay and mortality were secondary endpoints. One-hundred-ninety of the 238 CS patients enrolled in the aforementioned period were considered for the present analysis: 101 AMI-CS (80% ST-elevated myocardial infarction and 20% non-ST-elevated myocardial infarction) and 89 ADHF-CS. As compared with AMI-CS, ADHF-CS patients were younger [63 (IQR 59-76) vs. 67 (IQR 54-73) years, P = 0.01], but presented with higher creatinine [1.6 (IQR 1.0-2.6) vs. 1.2 (IQR 1.0-1.4) mg/dL, P
CONCLUSIONS:
ADHF-CS is characterized by a higher prevalence of end-organ and biventricular dysfunction at presentation, a longer hospital length of stay, and higher need of heart replacement therapies when compared with AMI-CS. In-hospital mortality was similar between the two aetiologies. Our data warrant development of new management protocols focused on CS aetiology.
© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Hospital-Acquired Anemia in Patients with Acute Coronary Syndrome: Epidemiology and Potential Impact on Long-Term Outcome.
Am J Med2023 Dec;136(12):1203-1210.e4. doi: 10.1016/j.amjmed.2023.08.012.
Colombo Claudia, Rebora Paola, Montalto Claudio, Cantoni Silvia, Sacco Alice, Mauri Marco, Andreano Anita, Russo Antonio Giampiero, De Servi Stefano, Savonitto Stefano, Morici Nuccia
Abstract
BACKGROUND:
Anemia (either pre-existing or hospital-acquired) is considered an independent predictor of mortality in acute coronary syndromes. However, it is still not clear whether anemia should be considered as a marker of worse health status or a therapeutic target. We sought to investigate the relationship between hospital-acquired anemia and clinical and laboratory findings and to assess the association with mortality and major cardiovascular events at long-term follow-up.
METHODS:
Patients consecutively admitted at Niguarda Hospital between February 2014 and November 2020 for an acute coronary syndrome were included in this cohort analysis and classified as anemic at admission (group A), with normal hemoglobin at admission but developing anemia during hospitalization (hospital-acquired anemia) (group B); and with normal hemoglobin levels throughout admission (group C).
RESULTS:
Among 1294 patients included, group A included 353 (27%) patients, group B 468 (36%), and group C 473 patients (37%). In terms of cardiovascular burden and incidence of death, major cardiovascular events and bleeding at 4.9-year median follow-up, group B had an intermediate risk profile as compared with A and C. Baseline anemia was an independent predictor of death (hazard ratio 1.51; 95% confidence interval, 1.02-2.25; P = .04) along with frailty, Charlson comorbidity Index, estimated glomerular filtration rate, previous myocardial infarction, and left ventricular ejection fraction. Conversely, hospital-acquired anemia was not associated with increased mortality (hazard ratio 1.18; 95% confidence interval, 0.8-1.75; P = .4).
CONCLUSIONS:
Hospital-acquired anemia affects one-third of patients hospitalized for acute coronary syndrome and is associated with age, frailty, and comorbidity burden, but was not found to be an independent predictor of long-term mortality.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Advanced heart failure: from definitions to therapeutic options.
Eur Heart J Suppl2023 May;25(Suppl C):C283-C291. doi: 10.1093/eurheartjsupp/suad028.
Garascia Andrea, Palazzini Matteo, Tedeschi Andrea, Sacco Alice, Oliva Fabrizio, Gentile Piero
Abstract
Advanced heart failure (AHF) represents an ominous stage of heart failure (HF), where the expected prognosis remains poor regardless of the improvement in medical knowledge. In this review, we summarize the definition, prognosis, physiopathology, and clinical/therapeutic management of the disease, focusing on the fast and timely referral of the patient to the AHF facilities. We provide an insight of the diagnostic and therapeutic 'work up' performed in an Italian AHF hub, implying a deep phenotypical patients characterization in order to evaluate candidacy to the therapeutic gold standards as heart transplantation (HTx) and left ventricular assist device (LVAD).
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Effect of a quality-improvement intervention on end-of-life care in cardiac intensive care unit.
Eur J Clin Invest2023 Jul;53(7):e13982. doi: 10.1111/eci.13982.
Sacco Alice, Tavecchia Giovanni, Ditali Valentina, Garatti Laura, Villanova Luca, Colombo Claudia, Viola Giovanna, Scavelli Francesca, Varrenti Marisa, Milani Martina, Morici Nuccia, Tavazzi Guido, Lissoni Barbara, Forni Lorena, Gorni Giovanna, Saporetti Giorgia, Oliva Fabrizio
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SCAI stage reclassification at 24?h predicts outcome of cardiogenic shock: Insights from the Altshock-2 registry.
Catheter Cardiovasc Interv2023 Jan;101(1):22-32. doi: 10.1002/ccd.30484.
Morici Nuccia, Frea Simone, Bertaina Maurizio, Sacco Alice, Corrada Elena, Dini Carlotta Sorini, Briani Martina, Tedeschi Michele, Saia Francesco, Colombo Costanza, Rota Matteo, Oliva Fabrizio, Iannaccone Mario, De Ferrari Gaetano M, Sionis Alessandro, Kapur Navin K, Tavazzi Guido, Pappalardo Federico
Abstract
BACKGROUND:
Cardiogenic shock (CS) includes several phenotypes with heterogenous hemodynamic features. Timely prognostication is warranted to identify patients requiring treatment escalation. We explored the association of the updated Society for Cardiovascular Angiography and Interventions (SCAI) stages classification with in-hospital mortality using a prospective national registry.
METHODS:
Between March 2020 and February 2022 the Altshock-2 Registry has included 237 patients with CS of all etiologies at 11 Italian Centers. Patients were classified according to their admission SCAI stage (assigned prospectively and independently updated according to the recently released version). In-hospital mortality was evaluated for association with both admission and 24-h SCAI stages.
RESULTS:
The overall in-hospital mortality was 38%. Of the 237 patients included and staged according to the updated SCAI classification, 20 (8%) had SCAI shock stage B, 131 (55%) SCAI stage C, 61 (26%) SCAI stage D and 25 (11%) SCAI stage E. In-hospital mortality stratified according to the SCAI classification at 24?h was 18% for patients in SCAI stage B, 27% for SCAI stage C, 63% for SCAI stage D and 100% for SCAI stage E. Both the revised SCAI stages on admission and at 24?h were associated with in-hospital mortality, but the classification potential slightly increased at 24-h. After adjusting for age, sex, lactate level, eGFR, CVP, inotropic score and mechanical circulatory support [MCS], SCAI classification at 24?h was an independent predictor of in-hospital mortality.
CONCLUSIONS:
In the Altshock-2 registry the utility of SCAI shock stages to identify risk of in-hospital mortality increased at 24?h after admission. Escalation of treatment (either pharmacological or with MCS) should be tailored to achieve prompt clinical improvement within the first 24?h after admission. Registration: http://www.
CLINICALTRIALS:
gov; Unique identifier: NCT04295252.
© 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
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Left Ventricular Unloading in Acute on Chronic Heart Failure: From Statements to Clinical Practice.
J Pers Med2022 Sep;12(9):. doi: 1463.
Sacco Alice, Morici Nuccia, Oreglia Jacopo Andrea, Tavazzi Guido, Villanova Luca, Colombo Claudia, Garatti Laura, Mondino Michele Giovanni, Nava Stefano, Pappalardo Federico
Abstract
Cardiogenic shock remains a deadly complication of acute on chronic decompensated heart failure (ADHF-CS). Despite its increasing prevalence, it is incompletely understood and therefore often misdiagnosed in the early phase. Precise diagnosis of the underlying cause of CS is fundamental for undertaking the correct therapeutic strategy. Temporary mechanical circulatory support (tMCS) is the mainstay of management: identifying and selecting optimal patients through understanding of the hemodynamics and a prompt profiling and timing, is key for success. A recent statement from the American Heart Association provided pragmatic suggestions on tMCS device selection, escalation, and weaning strategies. However, several areas of uncertainty still remain in clinical practice. Accordingly, we present an overview of the main pitfalls that can occur during patients' management with tMCS through a clinical case. This case illustrates the strict interdependency between left ventricular unloading and right ventricular dysfunction in the case of low filling pressures. Moreover, it further illustrates the pivotal role of stepwise escalation of therapy in a patient with an ADHF-CS and its peculiarities as compared to other forms of acute heart failure.
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The impact of transcatheter edge-to-edge repair on right ventricle-pulmonary artery coupling in patients with functional mitral regurgitation.
Eur J Clin Invest2023 Jan;53(1):e13869. doi: e13869.
Tua Lorenzo, Mandurino-Mirizzi Alessandro, Colombo Claudia, Morici Nuccia, Magrini Giulia, Nava Stefano, Frassica Romina, Montalto Claudio, Ferlini Marco, Sacco Alice, Musca Francesco, Moreo Antonella, Ghio Stefano, Oreglia Jacopo, Oltrona-Visconti Luigi, Oliva Fabrizio, Crimi Gabriele
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Sodium nitroprusside in acute heart failure: A multicenter historic cohort study.
Int J Cardiol2022 Dec;369():37-44. doi: 10.1016/j.ijcard.2022.08.009.
Garatti Laura, Frea Simone, Bocchino Pier Paolo, Angelini Filippo, Cingolani Marco, Sacco Alice, Rondinara Giulia Maria, Bagnardi Vincenzo, Sala Isabella Maria, Kapur Navin K, Colombo Paolo C, De Ferrari Gaetano Maria, Morici Nuccia
Abstract
AIMS:
Despite evidence of hemodynamic benefit of sodium nitroprusside (SNP) treatment for acute heart failure (AHF), there are limited data about its efficacy and safety. This study aimed to assess the effectiveness and safety of SNP treatment, to explore the impact of N-terminal pro-B natriuretic peptide (NT-proBNP) reduction on clinical endpoints and to identify possible predictors of clinical response.
METHODS AND RESULTS:
Multicenter retrospective cohort study of 200 patients consecutively admitted for AHF in 2 Italian Centers. Primary endpoint was the reduction of NT-proBNP levels ?25% from baseline values within 48 h from the onset of SNP infusion. Secondary and safety endpoints included all-cause mortality, rehospitalization for HF at 1, 3 and 6 months, length of hospital stay (LOS) and severe hypotension. 131 (66%) patients experienced a NT-proBNP reduction ?25% within 48 h from treatment onset, irrespective of initial systolic blood pressure (SBP). Left ventricular end diastolic diameter (LVEDD) was the only independent predictor of treatment efficacy. Patients who achieved the primary endpoint (i.e., 'responders') had lower LOS (median 15 [IQR:10-27] vs 19 [IQR:12-35] days, p-value = 0.033) and a lower incidence of all-cause mortality and rehospitalization for HF at 1 and 3 months compared to "non responders" (p-value <0.050). Severe hypotension was observed in 10 (5%) patients, without any adverse clinical consequence.
CONCLUSION:
SNP is a safe and effective treatment of AHF, particularly in patients with dilated left ventricle. Reduced NT-proBNP levels in response to SNP is associated to shorter LOS and lower risk of 1- and 3-month re-hospitalizations for HF.
CLINICAL TRIAL REGISTRATION:
http://www.
CLINICALTRIALS:
gov. Unique identifier: NCT05027360.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Systemic leak capillary syndrome with myocardial involvement and cardiogenic shock: a case report.
Eur Heart J Case Rep2022 Jul;6(7):ytac262. doi: ytac262.
Garatti Laura, Wu Maddalena Alessandra, Ammirati Enrico, Sacco Alice
Abstract
BACKGROUND:
Systemic capillary leak syndrome (SCLS) is a potentially fatal disorder characterized by relapses of hypovolemic shock episodes.
CASE SUMMARY:
We present a case of a 58-year-old man who presented to the Emergency Department with a history of recurrent episodes of syncope in the last hours. A few days before medical contact the patient complained of sore throat, fever, and flu-like symptoms. He was initially admitted with a diagnosis of suspected myopericarditis. Forty-eight hours later, the haemodynamic status suddenly deteriorated to a mixed cardiogenic and shock; an endomyocardial biopsy showed localized inflammatory infiltrates and areas of necrosis of cardiomyocytes with positive viral search for parvovirus B19 (PVB19), therefore the patient was treated with methylprednisolone pulses. Based on the concurrent presence of the typical triad of hypotension, hypoalbuminaemia, and haemoconcentration we suspected systemic leak capillary syndrome potentially triggered by the PVB19 infection with acute myocarditis. The clinical conditions further deteriorated with rhabdomyolysis and acute kidney injury: we started continuous veno-venous haemofiltration adding a cytokines adsorber. In the following hours, we observed a significant clinical improvement. The patient was discharged 1 month later and 5 months after discharge he experienced a new attack of SCLS, this time without myocardial involvement and with prompt symptoms resolution.
CONCLUSION:
Systemic capillary leak syndrome is a potentially fatal disorder: early recognition of this entity and prompt initiation of supportive therapy are warranted, therefore, it is paramount that an emergency physician thinks of SCLS in patients with signs of cardiogenic shock and the classical triad of hypotension, hypoalbuminia, and haemoconcentration.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Pulmonary Artery Catheter Monitoring in Patients with Cardiogenic Shock: Time for a Reappraisal?
Card Fail Rev2022 Jan;8():e15. doi: e15.
Bertaina Maurizio, Galluzzo Alessandro, Morici Nuccia, Sacco Alice, Oliva Fabrizio, Valente Serafina, D'Ascenzo Fabrizio, Frea Simone, Sbarra Pierluigi, Petitti Elisabetta, Prever Silvia Brach, Boccuzzi Giacomo, Zanini Paola, Attisani Matteo, Rametta Francesco, De Ferrari Gaetano Maria, Noussan Patrizia, Iannaccone Mario
Abstract
Cardiogenic shock represents one of the most dramatic scenarios to deal with in intensive cardiology care and is burdened by substantial short-term mortality. An integrated approach, including timely diagnosis and phenotyping, along with a well-established shock team and management protocol, may improve survival. The use of the Swan-Ganz catheter could play a pivotal role in various phases of cardiogenic shock management, encompassing diagnosis and haemodynamic characterisation to treatment selection, titration and weaning. Moreover, it is essential in the evaluation of patients who might be candidates for long-term heart-replacement strategies. This review provides a historical background on the use of the Swan-Ganz catheter in the intensive care unit and an analysis of the available evidence in terms of potential prognostic implications in this setting.
Copyright © 2022, Radcliffe Cardiology.
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Prognostic implications of pulmonary artery catheter monitoring in patients with cardiogenic shock: A systematic review and meta-analysis of observational studies.
J Crit Care2022 Jun;69():154024. doi: 10.1016/j.jcrc.2022.154024.
Bertaina Maurizio, Galluzzo Alessandro, Rossello Xavier, Sbarra Pierluigi, Petitti Elisabetta, Prever Silvia Brach, Boccuzzi Giacomo, D'Ascenzo Fabrizio, Frea Simone, Pidello Stefano, Morici Nuccia, Sacco Alice, Oliva Fabrizio, Valente Serafina, De Ferrari Gaetano Maria, Ugo Fabrizio, Rametta Francesco, Attisani Matteo, Zanini Paola, Noussan Patrizia, Iannaccone Mario
Abstract
PURPOSE:
To investigate the impact of pulmonary artery catheter (PAC) monitoring on survival of cardiogenic shock(CS), in the light of the controversies in available evidence.
MATERIALS AND METHODS:
MEDLINE, EMBASE, Cochrane library and Web of Science were systematically screened to identify most relevant studies on patients with CS comparing PAC use to non-use during hospital stay. Short-term mortality was the primary endpoint and the use of Mechanical Circulatory Support (MCS) devices was the secondary one.
RESULTS:
Six observational studies including 1,166,762 patients were selected. The most frequent etiology of CS was post-myocardial infarction (75% [95% CI 55-89%] in PAC-group and 81%[95% CI 47-95%] in non-PAC group). Overall, PAC was used in 33%(95% CI 24-44%) of cases. Pooling data adjusted for confounders, a significant association between the PAC-group and a reduction in short-term mortality emerged when compared to the non-PAC group (36%[95% CI 27-45%] vs 47%[95% CI 35-59%];AdjustedOR 0.71, 95% CI 0.59-0.87, p
CONCLUSIONS:
PAC was associated with lower incidence of short-term mortality in CS pooling adjusted observational studies. Prospective studies are needed to confirm our hypothesis and better clarify the mechanisms of this potential prognostic benefit.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Percutaneous Coronary Revascularization after Out-of-Hospital Cardiac Arrest: A Review of the Literature and a Case Series.
J Clin Med2022 Mar;11(5):. doi: 1395.
Scavelli Francesca, Cartella Iside, Montalto Claudio, Oreglia Jacopo Andrea, Villanova Luca, Garatti Laura, Colombo Claudia, Sacco Alice, Morici Nuccia
Abstract
Out-of-hospital cardiac arrest (OHCA) is still associated with high mortality and severe complications, despite major treatment advances in this field. Ischemic heart disease is a common cause of OHCA, and current guidelines clearly recommend performing immediate coronary angiography (CAG) in patients whose post-resuscitation electrocardiogram shows ST-segment elevation (STE). Contrarily, the optimal approach and the advantage of early revascularization in cases of no STE is less clear, and decisions are often based on the individual experience of the center. Numerous studies have been conducted on this topic and have provided contradictory evidence; however, more recently, results from several randomized clinical trials have suggested that performing early CAG has no impact on overall survival in patients without STE.
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Non-ST-elevation acute coronary syndrome in chronic kidney disease: prognostic implication of an early invasive strategy.
Minerva Cardiol Angiol2023 Feb;71(1):44-50. doi: 10.23736/S2724-5683.21.05839-7.
Sacco Alice, Montalto Claudio, Bravi Francesca, Ruzzenenti Giacomo, Garatti Laura, Oreglia Jacopo A, Bartorelli Antonio L, Crimi Gabriele, LA Vecchia Carlo, Savonitto Stefano, Leonardi Sergio, Oliva Fabrizio G, Morici Nuccia
Abstract
BACKGROUND:
The optimal timing of PCI for NSTE-ACS with CKD is unclear. The aim of our study was to assess whether early percutaneous coronary intervention (PCI) (within 24 hours from admission) is associated with improved in-hospital (mortality or acute kidney injury) and long-term events (composite of mortality, myocardial infarction, stroke and bleeding events) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) with chronic kidney disease (CKD).
METHODS:
We retrospectively studied NSTE-ACS patients who underwent PCI in large tertiary centers. CKD was defined as estimated glomerular filtration rate (eGFR)
RESULTS:
We included 821 patients, mean age was 69±12 years; 492 (60%) received an early PCI, and 273 (33%) had an eGFR
CONCLUSIONS:
In conclusion in a cohort of NSTE-ACS patients, an early invasive strategy does not independently affect prognosis.
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Uric acid associated with acute heart failure presentation in Acute Coronary Syndrome patients.
Eur J Intern Med2022 May;99():30-37. doi: 10.1016/j.ejim.2022.01.018.
Rebora Paola, Centola Marco, Morici Nuccia, Sacco Alice, Occhino Giuseppe, Viola Giovanna, Oreglia Jacopo, Castini Diego, Persampieri Simone, Sabatelli Ludovico, Ferrante Giulia, Lucreziotti Stefano, Carugo Stefano, Valsecchi Maria Grazia, Oliva Fabrizio, Giannattasio Cristina, Maloberti Alessandro
Abstract
We focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure (HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcomes were acute HF and cardiogenic shock at admission, secondary outcomes were the use of Non Invasive Ventilation (NIV) and the admission Left Ventricular Ejection Fraction (LVEF). We consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to June 2019. Median age was 68 (first-third quartile 59-77) years and males were 970 (76%). All the evaluated outcomes occurred more frequently in the hyperuricemic subjects (UA higher than 6 mg/dL for females and 7 mg/dL for males, n = 292): acute HF 35.8 vs 11.1% (p
Copyright © 2022. Published by Elsevier B.V.
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Rare Causes of Acute Coronary Syndrome: The JAK2 V617F Mutation-Positive Myeloproliferative Neoplasms: A Cardio-Hematological Perspective.
Thromb Haemost2022 Aug;122(8):1429-1431. doi: 10.1055/a-1742-0361.
Cantoni Silvia, Colombo Claudia, Soriano Francesco, Oreglia Jacopo Andrea, Sacco Alice, Veronese Silvio, Brunelli Dario, Rubboli Andrea, Morici Nuccia
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Intermediate-high-risk pulmonary embolism treated with local ultrasound-facilitated thrombolysis: a single-center experience.
J Cardiovasc Med (Hagerstown)2022 May;23(5):347-349. doi: 10.2459/JCM.0000000000001295.
Sacco Alice, Serafini Lisa, Occhi Lucia, Morici Nuccia, Rampoldi Antonio
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Effect of landiolol in patients with tachyarrhythmias and acute decompensated heart failure (ADHF): a case series.
ESC Heart Fail2022 Feb;9(1):766-770. doi: 10.1002/ehf2.13763.
Ditali Valentina, Garatti Laura, Morici Nuccia, Villanova Luca, Colombo Claudia, Oliva Fabrizio, Sacco Alice
Abstract
Tachycardia and rapid tachyarrhythmias are common in acute clinical settings and may hasten the deterioration of haemodynamics in patients with acute decompensated heart failure (ADHF), treated with inotropes. The concomitant use of a short-acting ?1-selective beta-blocker, such as landiolol, could rapidly and safely restore an adequate heart rate without any negative inotropic effect. We present a case series of five patients with left ventricular dysfunction, admitted to our Intensive Cardiac Care Unit with ADHF deteriorated to cardiogenic shock, treated with a combination of landiolol and inotropes. Landiolol was effective in terms of rate control and haemodynamics optimization, enabling de-escalation of catecholamine dosing in all patients. The infusion was always well tolerated without hypotension. In conclusion, a continuous infusion of a low dose of landiolol (3-16 mcg/kg/min) to manage tachycardia and ventricular or supraventricular tachyarrhythmias in haemodynamically unstable patients may be considered.
© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Intra-aortic Balloon Pump for Acute-on-Chronic Heart Failure Complicated by Cardiogenic Shock.
J Card Fail2022 Jul;28(7):1202-1216. doi: 10.1016/j.cardfail.2021.11.009.
Morici Nuccia, Marini Claudia, Sacco Alice, Tavazzi Guido, Saia Francesco, Palazzini Matteo, Oliva Fabrizio, Ferrari Gaetano Maria De, Colombo Paolo C, Kapur Navin K, Garan Arthur Reshad, Pappalardo Federico
Abstract
The intra-aortic balloon pump (IABP) is widely implanted as temporary mechanical circulatory support for cardiogenic shock (CS). However, its use is declining following the results of the IABP-SHOCK II trial, which failed to show a clinical benefit of the IABP in acute coronary syndrome (ACS)-related CS. Acute-on-chronic heart failure has become an increasingly recognized, distinct cause of CS (HF-CS). The pathophysiology of HF-CS differs from that of ACS-CS because it typically represents the progression from a state of congestion (with relatively preserved cardiac output) to a low-output state with hypoperfusion. The IABP is a volume-displacement pump that promotes forward flow from a high-capacitance reservoir to low-capacitance vessels, improving peripheral perfusion and decreasing left ventricular afterload in the setting of high filling pressures. The IABP can improve ventricular-vascular coupling and, therefore, myocardial energetics. Additionally, many patients with HF-CS are candidates for cardiac replacement therapies (left ventricular assist device or heart transplantation) and, therefore, may benefit from a bridge strategy that stabilizes the hemodynamics and end-organ function in preparation for more durable therapies. Notably, the new United Network for Organ Sharing donor heart allocation system has recently prioritized patients on IABP support. This review describes the role of IABP in the treatment of HF-CS. It also briefly discusses new strategies for vascular access as well as fully implantable versions for longer duration of support.
Copyright © 2021 Elsevier Inc. All rights reserved.
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The Role of Uric Acid in Acute and Chronic Coronary Syndromes.
J Clin Med2021 Oct;10(20):. doi: 4750.
Maloberti Alessandro, Biolcati Marco, Ruzzenenti Giacomo, Giani Valentina, Leidi Filippo, Monticelli Massimiliano, Algeri Michela, Scarpellini Sara, Nava Stefano, Soriano Francesco, Oreglia Jacopo, Sacco Alice, Morici Nuccia, Oliva Fabrizio, Piani Federica, Borghi Claudio, Giannattasio Cristina
Abstract
Uric acid (UA) is the final product of the catabolism of endogenous and exogenous purine nucleotides. While its association with articular gout and kidney disease has been known for a long time, new data have demonstrated that UA is also related to cardiovascular (CV) diseases. UA has been identified as a significant determinant of many different outcomes, such as all-cause and CV mortality, and also of CV events (mainly Acute Coronary Syndromes (ACS) and even strokes). Furthermore, UA has been related to the development of Heart Failure, and to a higher mortality in decompensated patients, as well as to the onset of atrial fibrillation. After a brief introduction on the general role of UA in CV disorders, this review will be focused on UA's relationship with CV outcomes, as well as on the specific features of patients with ACS and Chronic Coronary Syndrome. Finally, two issues which remain open will be discussed: the first is about the identification of a CV UA cut-off value, while the second concerns the possibility that the pharmacological reduction of UA is able to lower the incidence of CV events.
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Predicting survival in patients with acute decompensated heart failure complicated by cardiogenic shock.
Int J Cardiol Heart Vasc2021 Jun;34():100809. doi: 100809.
Morici Nuccia, Viola Giovanna, Antolini Laura, Alicandro Gianfranco, Dal Martello Michela, Sacco Alice, Bottiroli Maurizio, Pappalardo Federico, Villanova Luca, De Ponti Laura, La Vecchia Carlo, Frigerio Maria, Oliva Fabrizio, Fried Justin, Colombo Paolo, Garan Arthur Reshad
Abstract
BACKGROUND:
Acute decompensated heart failure (ADHF) complicated by cardiogenic shock (CS) has unique pathophysiological background requiring specific patient stratification, management and therapeutic targets. Accordingly, the aim of this study was to derive a simple stratification tool to predict survival in patients with ADHF complicated by CS.
METHODS AND RESULTS:
Using logistic regression, univariable testing was performed to identify the variables potentially associated with 28-day mortality. We propose a new logistic model (ALC-Shock score) based on three easy parameters (age, serum creatinine and serum lactate at the ICU admission) as a powerful predictor of survival or successful bridge to heart replacement therapy at 28-day follow-up in this specific population. A multivariable analysis (logistic model) was performed to evaluate the association between selected variables and outcome (overall death at 28-day follow up). The score was then validated in a different cohort of 93 ADHF-CS patients and compared to a previous developed score (the Cardshock score).Overall, 28-day mortality was 34%. The ALC-shock score showed better discrimination (Area Under the Curve-AUC- 0.82; 95% CI 0.73-0.91) as compared to the Cardshock score (AUC 0.67; 95% CI 0.55-0.79) (p = 0.009) to predict 28-days overall mortality. In the validation cohort the AUC for the ALC-shock score was 0.66.
CONCLUSIONS:
A simple score including age, lactates and creatinine on admission could be considered to predict short-term mortality in CS-ADHF patients in order to drive towards a treatment intensification.
© 2021 The Author(s).
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Acute cardiovascular syndrome in the Italian multiethnic society.
J Cardiovasc Med (Hagerstown)2022 Jan;23(1):e11-e14. doi: 10.2459/JCM.0000000000001207.
Sacco Alice, Palazzini Matteo, Portoghese Alessandro, Ruzzenenti Giacomo, De Ponti Laura, Morici Nuccia, Brunelli Dario, Giannattasio Cristina, Oliva Fabrizio
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The other side of the coin: 'centralization' against 'optimization' in COVID-19 pandemic.
ESC Heart Fail2021 Jun;8(3):2354-2356. doi: 10.1002/ehf2.13289.
Morici Nuccia, Sacco Alice, Forleo Giovanni, Brunelli Dario, De Luca Giuseppe, Savonitto Stefano
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The opportunities out of uncertainty.
J Eval Clin Pract -
Ten golden rules for reforestation to optimize carbon sequestration, biodiversity recovery and livelihood benefits.
Glob Chang Biol2021 Apr;27(7):1328-1348. doi: 10.1111/gcb.15498.
Di Sacco Alice, Hardwick Kate A, Blakesley David, Brancalion Pedro H S, Breman Elinor, Cecilio Rebola Loic, Chomba Susan, Dixon Kingsley, Elliott Stephen, Ruyonga Godfrey, Shaw Kirsty, Smith Paul, Smith Rhian J, Antonelli Alexandre
Abstract
Urgent solutions to global climate change are needed. Ambitious tree-planting initiatives, many already underway, aim to sequester enormous quantities of carbon to partly compensate for anthropogenic CO emissions, which are a major cause of rising global temperatures. However, tree planting that is poorly planned and executed could actually increase CO emissions and have long-term, deleterious impacts on biodiversity, landscapes and livelihoods. Here, we highlight the main environmental risks of large-scale tree planting and propose 10 golden rules, based on some of the most recent ecological research, to implement forest ecosystem restoration that maximizes rates of both carbon sequestration and biodiversity recovery while improving livelihoods. These are as follows: (1) Protect existing forest first; (2) Work together (involving all stakeholders); (3) Aim to maximize biodiversity recovery to meet multiple goals; (4) Select appropriate areas for restoration; (5) Use natural regeneration wherever possible; (6) Select species to maximize biodiversity; (7) Use resilient plant material (with appropriate genetic variability and provenance); (8) Plan ahead for infrastructure, capacity and seed supply; (9) Learn by doing (using an adaptive management approach); and (10) Make it pay (ensuring the economic sustainability of the project). We focus on the design of long-term strategies to tackle the climate and biodiversity crises and support livelihood needs. We emphasize the role of local communities as sources of indigenous knowledge, and the benefits they could derive from successful reforestation that restores ecosystem functioning and delivers a diverse range of forest products and services. While there is no simple and universal recipe for forest restoration, it is crucial to build upon the currently growing public and private interest in this topic, to ensure interventions provide effective, long-term carbon sinks and maximize benefits for biodiversity and people.
© 2021 Royal Botanic Garden, Kew. Global Change Biology published by John Wiley & Sons Ltd.
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Early intra-aortic balloon pump in acute decompensated heart failure complicated by cardiogenic shock: Rationale and design of the randomized Altshock-2 trial.
Am Heart J2021 Mar;233():39-47. doi: 10.1016/j.ahj.2020.11.017.
Morici Nuccia, Marini Claudia, Sacco Alice, Tavazzi Guido, Cipriani Manlio, Oliva Fabrizio, Rota Matteo, De Ferrari Gaetano Maria, Campolo Jonica, Frigerio Gianfranco, Valente Serafina, Leonardi Sergio, Corrada Elena, Bottiroli Maurizio, Grosseto Daniele, Cacciavillani Luisa, Frigerio Maria, Pappalardo Federico,
Abstract
BACKGROUND:
Cardiogenic shock (CS) is a systemic disorder associated with dismal short-term prognosis. Given its time-dependent nature, mechanical circulatory support may improve survival. Intra-aortic balloon pump (IABP) had gained widespread use because of the easiness to implant and the low rate of complications; however, a randomized trial failed to demonstrate benefit on mortality in the setting of acute myocardial infarction. Acute decompensated heart failure with cardiogenic shock (ADHF-CS) represents a growing resource-intensive scenario with scant data and indications on the best management. However, a few data suggest a potential benefit of IABP in this setting. We present the design of a study aimed at addressing this research gap.
METHODS AND DESIGN:
The Altshock-2 trial is a prospective, randomized, multicenter, open-label study with blinded adjudicated evaluation of outcomes. Patients with ADHF-CS will be randomized to early IABP implantation or to vasoactive treatments. The primary end point will be 60 days patients' survival or successful bridge to heart replacement therapy. The key secondary end point will be 60-day overall survival; 60-day need for renal replacement therapy; in-hospital maximum inotropic score, maximum duration of inotropic/vasopressor therapy, and maximum sequential organ failure assessment score. Safety end points will be in-hospital occurrence of bleeding events (Bleeding Academic Research Consortium >3), vascular access complications and systemic (noncerebral) embolism. The sample size for the study is 200 patients.
IMPLICATIONS:
The Altshock-2 trial will provide evidence on whether IABP should be implanted early in ADHF-CS patients to improve their clinical outcomes.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Arterial elastance modulation by intra-aortic balloon counterpulsation in patients with acute decompensated heart failure and low-output state.
J Cardiovasc Med (Hagerstown)2021 Mar;22(3):231-232. doi: 10.2459/JCM.0000000000001088.
Sacco Alice, Tavazzi Guido, Morici Nuccia, Viola Giovanna, Meani Paolo, Oliva Fabrizio G, Pappalardo Federico
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Heart-Kidney Transplanted patient affected by COVID-19 pneumonia treated with tocilizumab on top of immunosuppressive maintenance therapy.
Int J Cardiol Heart Vasc2020 Aug;29():100596. doi: 100596.
Ammirati Enrico, Travi Giovanna, Orcese Carloandrea, Sacco Alice, Auricchio Sara, Frigerio Maria, Puoti Massimo
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Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome.
Eur J Intern Med2020 Dec;82():62-67. doi: 10.1016/j.ejim.2020.07.013.
Centola Marco, Maloberti Alessandro, Castini Diego, Persampieri Simone, Sabatelli Ludovico, Ferrante Giulia, Lucreziotti Stefano, Morici Nuccia, Sacco Alice, Oliva Fabrizio, Rebora Paola, Giannattasio Cristina, Mafrici Antonio, Carugo Stefano
Abstract
BACKGROUND:
To assess the association between admission serum uric acid (SUA) levels and in-hospital outcomes in a real-world patients population with acute coronary syndrome (ACS) and to investigate the potential incremental prognostic value of SUA added to GRACE score (GRACE-SUA score).
METHODS:
The data of consecutive ACS patients admitted to Coronary Care Unit of San Paolo and Niguarda hospitals in Milan (Italy) were retrospectively analyzed.
RESULTS:
1088 patients (24% female) were enrolled. Mean age was 68 years (IQR 60-78). STEMI and NSTE-ACS patients were 504 (46%) and 584 (54%) respectively. SUA (OR 1.72 95%CI 1.33-2.22, p
CONCLUSIONS:
High admission levels of SUA are independently associated with in-hospital adverse outcomes and mortality in a contemporary population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality in this study population.
Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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Long-Term Risk of Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome: Prognostic Role of Complete Blood Cell Count.
Angiology2020 Oct;71(9):831-839. doi: 10.1177/0003319720938619.
Morici Nuccia, Molinari Valentina, Cantoni Silvia, Rubboli Andrea, Antolini Laura, Sacco Alice, Cattaneo Marco, Alicandro Gianfranco, Oreglia Jacopo A, Oliva Fabrizio, Giannattasio Cristina, Brunelli Dario, La Vecchia Carlo, Valgimigli Marco, Savonitto Stefano
Abstract
Individual parameters of complete blood count (CBC) have been associated with worse outcome in patients with acute coronary syndrome (ACS). However, the prognostic role of CBC taken as a whole has never been evaluated for long-term incidence of major adverse cardiovascular events (MACEs). Patients were grouped according to their hematopoietic cells' inflammatory response at different time points during hospital stay. Patients with admission white blood cell count >10 × 10/L, discharge hemoglobin 250 × 10/L were defined as "high-risk CBC." Among 1076 patients with ACS discharged alive, 129 (12%) had a "high-risk CBC" and 947 (88%) had a "low-risk CBC." Patients with "high-risk CBC" were older and had more comorbidities. Over a median follow-up of 665 days, they experienced a higher incidence of MACE compared to "low-risk CBC" patients (18.6% vs 8.1%). After adjustment for age, age-adjusted Charlson comorbidity index, female sex, cardiac arrest, suboptimal discharge therapy, coronary artery bypass, and ejection fraction, a high-risk CBC was significantly associated with increased MACE occurrence (adjusted hazard ratio 1.80; 95% CI: 1.09-3.00). The CBC was a prognostic marker in patients with ACS, and its evaluation at admission and discharge could better classify patient's risk and improve therapeutic management.
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Clinical outcome in solid organ transplant recipients with COVID-19: A single-center experience.
Am J Transplant2020 Sep;20(9):2628-2629. doi: 10.1111/ajt.16069.
Travi Giovanna, Rossotti Roberto, Merli Marco, Sacco Alice, Perricone Giovanni, Lauterio Andrea, Colombo Valeriana G, De Carlis Luciano, Frigerio Maria, Minetti Enrico, Belli Luca S, Puoti Massimo
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[Relevance of complete blood count parameters in the assessment of acute coronary syndromes: a combined hematological and cardiological perspective].
G Ital Cardiol (Rome)2019 Dec;20(12):694-705. doi: 10.1714/3271.32379.
Morici Nuccia, Cantoni Silvia, Soriano Francesco, Viola Giovanna, De Stefano Valerio, Veas Nicolas, Oreglia Jacopo A, Esposito Giuseppe, Sacco Alice, Savonitto Stefano
Abstract
The aim of this review is to explore the available evidence concerning the relationship between the different parameters of the complete blood count, its pathophysiological changes and cardiovascular disease, specifically focusing on the acute ischemic setting. Erythrocytes, leukocytes and platelets undergo significant and more or less durable changes over time in response to conditions of systemic inflammatory, infectious and neoplastic disease. This is the reason why blood cell count parameters can (and should) be implemented in the global assessment of the patient with acute coronary syndrome.From the literature review it emerges that anemia and thrombocytopenia have an independent negative prognostic role in the medium and long term, being markers of the overall frailty of patients with ischemic heart disease. On the other hand, essential thrombocythemia and polycythemia vera, two chronic myeloproliferative neoplasms, are characterized by an important increase in thrombotic risk. Both conditions are given a brief description for the particular importance of the close collaboration between cardiologists and hematologists in the diagnosis and treatment of these diseases in the context of ischemic heart disease.
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Recurrent stent thrombosis in a patient with acute coronary syndrome and ischemic colitis: between life-threatening thrombosis and life-threatening bleeding.
Platelets2020 Aug;31(6):820-824. doi: 10.1080/09537104.2019.1678122.
Morici Nuccia, Cantoni Silvia, Soriano Francesco, Sacco Alice, Viola Giovanna, Esposito Giuseppe, Oreglia Jacopo A, Cattaneo Marco, Savonitto Stefano
Abstract
Complete blood count should always be considered to tailor diagnosis and appropriate management in patients with acute ischemic heart disease. We present a challenging case of recurrent acute coronary syndrome, in the context of very high thrombotic risk due to concomitant inflammatory disease. Although no general guidelines exist for the switch between antiplatelet agents, particularly in the acute setting, in specific cases, the availability of different orally- and i.v.-acting agents and platelet function tests may allow to discriminate among multiple possible mechanisms of drug failure or side effects in the individual patient.
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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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Use of PRECISE-DAPT Score and Admission Platelet Count to Predict Mortality Risk in Patients With Acute Coronary Syndrome.
Angiology2019 Oct;70(9):867-877. doi: 10.1177/0003319719848547.
Morici Nuccia, Tavecchia Giovanni A, Antolini Laura, Caporale Maria R, Cantoni Silvia, Bertuccio Paola, Sacco Alice, Meani Paolo, Viola Giovanna, Brunelli Dario, Oliva Fabrizio, Lombardi Federico, Segreto Antonio, Oreglia Jacopo A, La Vecchia Carlo, Cattaneo Marco, Valgimigli Marco, Savonitto Stefano
Abstract
The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been validated to predict bleeding complications in patients undergoing stent implantation and dual antiplatelet therapy. This score does not include the platelet count (PC), which has been shown to be an independent marker of mortality in patients with acute coronary syndrome (ACS). We assessed the role of the PRECISE-DAPT score calculated on admission for mortality risk prediction and evaluated whether the predictive accuracy of this score improved by adding the PC. In a retrospective cohort study of 1000 patients with ACS, after adjustment for relevant covariates, a PRECISE-DAPT score ?25 was independently associated with mortality (hazard ratio [HR]: 7.91; 95% confidence interval [CI]: 4.37-14.30). When this score was combined with PC, compared to patients with PRECISE-DAPT
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Acute myocardial infarction complicating ischemic stroke: is there room for cangrelor?
Platelets2020 ;31(1):120-123. doi: 10.1080/09537104.2019.1609663.
Morici Nuccia, Nava Stefano, Sacco Alice, Viola Giovanna, Oreglia Jacopo, Meani Paolo, Oliva Fabrizio, Ranucci Marco, Leonardi Sergio, Rossini Roberta
Abstract
Acute myocardial infarction (AMI) complicating ischemic stroke is a well known and undertreated event. A conservative management is not infrequent in these settings, due to the fear of hemorrhagic complications related to antithrombotic therapy. Notably, an invasive approach with a primary percutaneous coronary intervention (PCI) has been shown to be associated with a lower in-hospital mortality in patients with concomitant ischemic stroke and AMI. The optimal antiplatelet regimen in these cases has been not clearly defined, yet. We report two cases of patients with AMI complicating ischemic stroke, successfully treated with cangrelor infusion, which was started during PCI and maintained up to 48 h at bridge therapy dosage (0.75 mcg/kg/min). Both patients underwent successful PCI in the acute phase, and neither ischemic nor hemorrhagic complications occurred during in-hospital stay.
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Letter to the editor regarding the results of the retrospective study "Predictors of intra-aortic balloon pump hemodynamic failure in non-acute myocardial infarction cardiogenic shock" published in the American Heart Journal.
Am Heart J2019 Jul;213():123. doi: 10.1016/j.ahj.2019.03.002.
Sacco Alice, Morici Nuccia, Oliva Fabrizio
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Cardiogenic shock: old and new circulatory assist devices: the role of counter-pulsation.
Eur Heart J Suppl2019 Mar;21(Suppl B):B59-B60. doi: 10.1093/eurheartj/suz020.
Viola Giovanna, Morici Nuccia, Sacco Alice, Stucchi Miriam, Brunelli Dario, Cipriani Manlio, Garascia Andrea, Bottiroli Maurizio, Frigerio Maria, Oliva Fabrizio
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Long-term survival and major outcomes in post-cardiotomy extracorporeal membrane oxygenation for adult patients in cardiogenic shock.
Ann Cardiothorac Surg2019 Jan;8(1):116-122. doi: 10.21037/acs.2018.12.04.
Meani Paolo, Matteucci Matteo, Jiritano Federica, Fina Dario, Panzeri Francesco, Raffa Giuseppe M, Kowalewski Mariusz, Morici Nuccia, Viola Giovanna, Sacco Alice, Oliva Fabrizio, Alyousif Amal, Heuts Sam, Gilbers Martijn, Schreurs Rick, Maessen Jos, Lorusso Roberto
Abstract
Extracorporeal membrane oxygenation (ECMO) in the veno-arterial (VA) configuration is an established method for the treatment of refractory cardiogenic shock. Such a condition characterizes the postoperative course of approximatively 1% of cardiac surgery patients. Although some studies have reported ECMO-related short-term results, little is known about the long-term outcomes of VA-ECMO therapy in the post-cardiotomy setting. Therefore, an extensive literature search was conducted regarding articles published after 1990 reporting postoperative ECMO use. PubMed, EMBASE and Web of Science were searched for sources. In-hospital mortality was high in post-cardiotomy VA-ECMO patients, ranging from 24.8% to 52%. Long-term results were poorly reported. However, based on the limited information available, hospital survivors showed a favorable outcome, with improvement in overall clinical condition, quality of life and limited hospital readmission for cardiac-related events. To conclude, in-hospital outcome in post-cardiotomy ECMO is often unfavorable, post-discharge results show satisfactory condition, with stable improvement of overall patient clinical status and low rate of hospital readmission and cardiac-related adverse events. Data reporting is, however, scarce and hence new and detailed studies are still warranted to investigate such aspects.
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Management of cardiogenic shock in acute decompensated chronic heart failure: The ALTSHOCK phase II clinical trial.
Am Heart J2018 Oct;204():196-201. doi: 10.1016/j.ahj.2018.07.009.
Morici Nuccia, Oliva Fabrizio, Ajello Silvia, Stucchi Miriam, Sacco Alice, Cipriani Manlio Gianni, De Bonis Michele, Garascia Andrea, Gagliardone Maria Pia, Melisurgo Giulio, Russo Claudio Francesco, La Vecchia Carlo, Frigerio Maria, Pappalardo Federico
Abstract
Management of acute decompensated heart failure patients presenting with cardiogenic shock (CS) is not straightforward, as few data are available from clinical trials. Stabilization before left ventricle assist device (LVAD) or heart transplantation (HTx) is strongly advocated, as patients undergoing LVAD implant or HTx in critical status have worse outcomes. This was a multicenter phase II study with a Simon 2-stage design, including 24 consecutive patients treated with low-moderate epinephrine doses, whose refractory CS prompted implantation of intra-aortic balloon pump (IABP) which was subsequently upgraded with peripheral venoarterial extracorporeal membrane oxygenation. At admission, patients had severe left ventricular dysfunction and overt CS, 7 patients could be managed only with inotropic therapy, and 16 patients were transitioned to IABP and 1 to IABP and venoarterial extracorporeal membrane oxygenation; the median duration of epinephrine therapy was 7?days (interquartile range 6-15), and the median dose was 0.08 ?g/kg/min (interquartile range 0.05-0.1); 21 patients (87.5%) survived at 60?days (primary outcome); among them, 13 (61.9%) underwent LVAD implantation, 2 (9.5%) underwent HTx, and 6 (28.6%) improved on medical treatment, indicating that early and intensive treatment of CS in chronic advanced heart failure patients with low-dose epinephrine and timely short-term mechanical circulatory support leads to satisfactory outcomes.
Copyright © 2018 Elsevier Inc. All rights reserved.
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Protracted aortic valve closure during peripheral veno-arterial extracorporeal life support: is intra-aortic balloon pump an effective solution?
Perfusion2019 Jan;34(1):35-41. doi: 10.1177/0267659118787426.
Meani Paolo, Delnoij Thijs, Raffa Giuseppe M, Morici Nuccia, Viola Giovanna, Sacco Alice, Oliva Fabrizio, Heuts Sam, Sels Jan-Willem, Driessen Rob, Roekaerts Paul, Gilbers Martijn, Bidar Elham, Schreurs Rick, Natour Ehsan, Veenstra Leo, Kats Suzanne, Maessen Jos, Lorusso Roberto
Abstract
BACKGROUND:
Left ventricular (LV) afterload increase with protracted aortic valve (AV) closure may represent a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The aim of the present study was to assess the effects of an intra-aortic balloon pump (IABP) to overcome such a hemodynamic shortcoming in patients submitted to peripheral V-A ECMO.
METHODS:
Among 184 adult patients who were treated with peripheral V-A ECMO support at Medical University Center Maastricht Hospital between 2007 and 2018, patients submitted to IABP implant for protracted AV closure after V-A ECMO implant were retrospectively identified. All clinical and hemodynamic data, including echocardiographic monitoring, were collected and analyzed.
RESULTS:
During the study period, 10 subjects (mean age 60 years old, 80% males) underwent IABP implant after peripheral V-A ECMO positioning due to the diagnosis of protracted AV closure and inefficient LV unloading as assessed by echocardiography and an absence of pulsation in the arterial pressure wave. Recovery of blood pressure pulsatility and enhanced LV unloading were observed in 8 patients after IABP placement, with no significant differences in the main hemodynamic parameters, inotropic therapy or in the ECMO flow (p=0.48). The weaning rate in this patient subgroup (mean ECMO duration 8 days), however, was only 10%, with another patient finally transplanted, leading to a 20% survival-to-hospital discharge.
CONCLUSION:
IABP placement was an effective solution in order to reverse the protracted AV closure and impaired LV unloading observed during peripheral V-A ECMO support. However, the impact on the weaning rate and survival needs further investigations.
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Real-world application of currently available decision models for dual antiplatelet therapy duration in acute coronary syndrome.
J Cardiovasc Med (Hagerstown)2018 Jun;19(6):310-313. doi: 10.2459/JCM.0000000000000655.
Morici Nuccia, Piccinelli Enrico, Brunelli Dario, Sacco Alice, Viola Giovanna, Oreglia Jacopo A, Oliva Fabrizio, Valgimigli Marco
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von Willebrand factor and its cleaving protease ADAMTS13 balance in coronary artery vessels: Lessons learned from thrombotic thrombocytopenic purpura. A narrative review.
Thromb Res2017 Jul;155():78-85. doi: 10.1016/j.thromres.2017.05.011.
Morici Nuccia, Cantoni Silvia, Panzeri Francesco, Sacco Alice, Rusconi Chiara, Stucchi Miriam, Oliva Fabrizio, Cattaneo Marco
Abstract
BACKGROUND:
Deficiency of the von Willebrand factor-cleaving protease ADAMTS13 is central to the pathophysiology of thrombotic thrombocytopenic purpura (TTP), a microangiopathic syndrome that presents as an acute medical emergency. In this review we will explore the evidence of a two-way relationship between TTP and ACS. Moreover, we will review the evidence emerged from epidemiological studies of an inverse relationship between the plasma levels of ADAMTS13 and the risk of ACS.
METHODS AND RESULTS:
Pubmed, MEDLINE and EMBASE, CINHAL, COCHRANE and Google Scholar databases were searched from inception to January 2017. The search yielded 43 studies representing 23 unique patient cases, 5 case series, 5 cohort studies and 10 case-control studies. Most ACS cases developing in the setting of TTP resolved with standard treatment of the underlying microangiopathy, with only a few requiring coronary invasive management. Antiplatelet therapy was not usually prescribed and all of the currently used P2Y were felt to be a potential trigger for a TTP-like syndrome, although our review revealed that the occurrence of TTP in patients treated with new P2Y antagonists is rare. Most studies confirmed the inverse association among ADAMTS13 levels and ACS.
CONCLUSIONS:
The heart is a definite target organ in TTP. The clinical spectrum of its involvement is probably influenced by local factors that add on to the systemic deficiency characteristic of TTP. It follows that patients with TTP should be carefully monitored for ACS events, especially when multiple risk factors for coronary disease exist.
Copyright © 2017 Elsevier Ltd. All rights reserved.
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Vasopressors and inotropes in cardiogenic shock: is there room for "adrenaline resuscitation"?
Crit Care2016 Sep;20(1):302. doi: 302.
Morici Nuccia, Stucchi Miriam, Sacco Alice, Bottiroli Maurizio A, Oliva Fabrizio,
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Allogeneic peripheral blood stem cell transplantation and accelerated atherosclerosis: An intriguing association needing targeted surveillance. Lessons from a rare case of acute anterior myocardial infarction.
Eur Heart J Acute Cardiovasc Care2020 Oct;9(7):NP3-NP7. doi: 10.1177/2048872616652311.
Scudiero Laura, Soriano Francesco, Morici Nuccia, Grillo Giovanni, Belli Oriana, Sacco Alice, Cipriani Manlio, Pedrotti Patrizia, Quattrocchi Giuseppina, Klugmann Silvio, Oliva Fabrizio
Abstract
We report the case of a 23-year-old man who developed an acute ST-elevation myocardial infarction secondary to acute thrombotic occlusion of the proximal left anterior descending coronary artery five years after undergoing chemotherapy, radiotherapy, haematopoietic stem cell transplantation for acute lymphoblastic leukaemia and bulky mediastinal mass involving the pleura and pericardium. His medical history also included Graft versus Host Disease developed 13 months after transplantation and acute myocarditis three months before the actual hospital admission. To the best of our knowledge, coronary artery disease as a complication of haematopoietic stem cell transplantation and low-dose mediastinal radiation therapy in young patients has been rarely reported in the medical literature. Clinicians should have a high degree of suspicion of coronary artery disease in patients treated with allogeneic haematopoietic stem cell transplantation, especially in patients previously treated with target mediastinal radiotherapy, as a group at risk of premature and significantly accelerated atherosclerosis, in order to make a timely and correct diagnosis.
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Cardiogenic shock: How to overcome a clinical dilemma. Unmet needs in Emergency medicine.
Int J Cardiol2015 ;186():19-21. doi: 10.1016/j.ijcard.2015.02.111.
Morici Nuccia, Sacco Alice, Paino Roberto, Oreglia Jacopo Andrea, Bottiroli Maurizio, Senni Michele, Nichelatti Michele, Canova Paolo, Russo Claudio, Garascia Andrea, Kulgmann Silvio, Frigerio Maria, Oliva Fabrizio
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Delayed, severe thrombocytemia after abciximab infusion for primary angioplasty in acute coronary syndromes: Moving between systemic bleeding and stent thrombosis.
Platelets2015 ;26(5):498-500. doi: 10.3109/09537104.2014.898181.
Giupponi Luca, Cantoni Silvia, Morici Nuccia, Sacco Alice, Giannattasio Cristina, Klugmann Silvio, Savonitto Stefano
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Bridge with intravenous antiplatelet therapy during temporary withdrawal of oral agents for surgical procedures: a systematic review.
Intern Emerg Med2014 Mar;9(2):225-35. doi: 10.1007/s11739-013-1041-8.
Morici Nuccia, Moja Lorenzo, Rosato Valentina, Sacco Alice, Mafrici Antonio, Klugmann Silvio, D'Urbano Maurizio, La Vecchia Carlo, De Servi Stefano, Savonitto Stefano
Abstract
Patients needing surgery within 1 year after drug-eluting cardiac stent implantation are challenging to manage because of an increased thrombotic and bleeding risk. A "bridge therapy" with short-acting antiplatelet agents in the perioperative period is an option. We assessed the outcome and safety of such a bridge therapy in cardiovascular and non-cardiovascular surgery. We performed a comprehensive search of MEDLINE, EMBASE, the Cochrane Library, and ongoing trial registers, irrespective of type of design. Our primary outcome was the success rate of bridge therapy in terms of freedom from cardiac ischaemic adverse events, whereas secondary outcome was freedom from bleeding/transfusion. We also performed combined success rate for each bridge therapy drug (tirofiban, eptifibatide, and cangrelor). We included eight case series and one randomised controlled trial. Among the 420 patients included, the technique was effective 96.2 % of the times [95 % confidence interval (CI) 94.4-98.0 %]. The success rate was 100 % for tirofiban (4 studies), 93.8 % for eptifibatide (4 studies), and 96.2 % for cangrelor (1 study). Freedom from bleeding/transfusion events was observed in 72.6 % of the times (95 % CI 68.4-76.9 %), and was higher with cangrelor (88.7 %; 95 % CI 82.7-94.7 %) than with other drugs (81.0 % for tirofiban and 58.6 % for eptifibatide). Evidence from case series and one randomised controlled trial suggests that, in patients with recent coronary stenting undergoing major surgery, perioperative bridge therapy with intravenous antiplatelet agents is an effective and safe treatment option to ensure low rate of ischaemic events.
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Time from adenosine di-phosphate receptor antagonist discontinuation to coronary bypass surgery in patients with acute coronary syndrome: meta-analysis and meta-regression.
Int J Cardiol2013 Oct;168(3):1955-64. doi: 10.1016/j.ijcard.2012.12.087.
Morici Nuccia, Moja Lorenzo, Rosato Valentina, Oreglia Jacopo Andrea, Sacco Alice, De Marco Federico, Bruschi Giuseppe, Klugmann Silvio, La Vecchia Carlo, Savonitto Stefano
Abstract
BACKGROUND:
Adenosine di-phosphate receptor antagonists (ADPRAs) blunt hemostasis for several days after administration. This effect, aimed at preventing cardiac ischemic complications particularly in patients with acute coronary syndromes (ACS), may increase perioperative bleeding in the case of cardiac surgery. Practice Guidelines recommend withholding ADPRAs for at least 5days prior to surgery, though with a weak base of evidence. The purpose of this study was to systematically review observational and experimental studies of early or late preoperative discontinuation of ADPRAs prior to coronary artery bypass grafting (CABG) for patients with ACS.
METHODS:
MEDLINE, EMBASE, the Cochrane Library databases up to December 2011; and reference lists. Observational and experimental studies that compared early ADPRA discontinuation with late discontinuation, or no discontinuation, in patients with ACS undergoing CABG.
RESULTS:
There were 19 studies, including 14,046 participants, 395 deaths and 309 reoperations due to bleeding. ADPRA late discontinuation up to CABG was associated with an increased risk of postoperative mortality (OR 1.46, 95% confidence interval (CI) 1.10 to 1.93) and reoperations due to bleeding (OR 2.18; 95% CI 1.47 to 2.62). Between-study heterogeneity was low. Meta-analysis limited to high quality or prospective studies gave consistent results. In most instances, the 95% prediction intervals for summary risk estimates confirmed the risk across study groups.
CONCLUSIONS:
ADPRA late discontinuation prior to CABG is associated with an increased risk of death and reoperations due to bleeding in patients with ACS. The confidence in the estimates of risk for late discontinuation is moderate to high.
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial.
JACC Cardiovasc Interv2012 Sep;5(9):906-16. doi: 10.1016/j.jcin.2012.06.008.
Savonitto Stefano, Cavallini Claudio, Petronio A Sonia, Murena Ernesto, Antonicelli Roberto, Sacco Alice, Steffenino Giuseppe, Bonechi Francesco, Mossuti Ernesto, Manari Antonio, Tolaro Salvatore, Toso Anna, Daniotti Alessandro, Piscione Federico, Morici Nuccia, Cesana Bruno M, Jori M Cristina, De Servi Stefano,
Abstract
OBJECTIVES:
This study sought to determine the risk versus benefit ratio of an early aggressive (EA) approach in elderly patients with non-ST-segment elevation acute coronary syndromes (NSTEACS).
BACKGROUND:
Elderly patients have been scarcely represented in trials comparing treatment strategies in NSTEACS.
METHODS:
A total of 313 patients ? 75 years of age (mean 82 years) with NSTEACS within 48 h from qualifying symptoms were randomly allocated to an EA strategy (coronary angiography and, when indicated, revascularization within 72 h) or an initially conservative (IC) strategy (angiography and revascularization only for recurrent ischemia). The primary endpoint was the composite of death, myocardial infarction, disabling stroke, and repeat hospital stay for cardiovascular causes or severe bleeding within 1 year.
RESULTS:
During admission, 88% of the patients in the EA group underwent angiography (55% revascularization), compared with 29% (23% revascularization) in the IC group. The primary outcome occurred in 43 patients (27.9%) in the EA group and 55 (34.6%) in the IC group (hazard ratio [HR]: 0.80; 95% confidence interval [CI]: 0.53 to 1.19; p = 0.26). The rates of mortality (HR: 0.87; 95% CI: 0.49 to 1.56), myocardial infarction (HR: 0.67; 95% CI: 0.33 to 1.36), and repeat hospital stay (HR: 0.81; 95% CI: 0.45 to 1.46) did not differ between groups. The primary endpoint was significantly reduced in patients with elevated troponin on admission (HR: 0.43; 95% CI: 0.23 to 0.80), but not in those with normal troponin (HR: 1.67; 95% CI: 0.75 to 3.70; p for interaction = 0.03).
CONCLUSIONS:
The present study does not allow a definite conclusion about the benefit of an EA approach when applied systematically among elderly patients with NSTEACS. The finding of a significant interaction for the treatment effect according to troponin status at baseline should be confirmed in a larger size trial. (Italian Elderly ACS Study; NCT00510185).
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Tako-Tsubo like syndrome triggered by meperidine.
Med J Malaysia2011 Dec;66(5):520-1.
Sacco Alice, Morici Nuccia, Belli Oriana, Bossi Irene, Mafrici Antonio, Klugmann Silvio
Abstract
We present a case of "inverted Tako-Tsubo" syndrome in a woman sedated with meperidine before undergoing a colonscopy. We discuss possible etiology of this ventricular dysfunction.
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Epinephrine for acute decompensated heart failure and low output state: friend or foe?
Int J Cardiol2011 Jun;149(3):384-5. doi: 10.1016/j.ijcard.2011.03.006.
Morici Nuccia, Sacco Alice, Oliva Fabrizio, Ferrari Stefano, Paino Roberto, Milazzo Filippo, Frigerio Maria, Pirola Roberto, Klugmann Silvio, Mafrici Antonio
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Target populations and relevant therapeutic end points to further improve outcomes in NSTEACS patients.
Future Cardiol2009 Jan;5(1):27-41. doi: 10.2217/14796678.5.1.27.
Savonitto Stefano, Morici Nuccia, Sacco Alice, Klugmann Silvio
Abstract
An aggressive pharmaco-interventional approach has been shown to improve long-term outcome among high-risk patients with acute coronary syndromes without ST-segment elevation (NSTEACS). However, these patients continue to represent a minority among those enrolled in clinical trials, thus precluding the possibility to further improve therapeutic efficacy. Target populations that are not adequately addressed by the majority of therapeutic trials are mainly the elderly and those with reduced renal function, who all show unfavorable outcome after an episode of NSTEACS. In order to allow comparison among different studies, a prerequisite for the planning of meaningful trials should be a uniform definition of the study end points besides mortality, particularly with reference to recurrent myocardial infarction, and rehospitalization owing to cardiovascular instability or severe bleeding. In addition to trial design issues, improvements in the regulatory rules for drug development and in hospital networking conceal significant opportunities to improve treatment of NSTEACS.
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[Diagnosis and treatment of non-ST-elevation acute coronary syndromes. Common clinical lessons and a few differences between the ESC and the ACC/AHA guidelines published in 2007].
G Ital Cardiol (Rome)2008 May;9(5):314-9.
Savonitto Stefano, Caracciolo Michela, Sacco Alice, Klugmann Silvio
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