SOSTIENICI
Vargiu Dott.ssa Sara
Pubblicazioni su PubMed
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Complexity of scar and ventricular arrhythmias in dilated cardiomyopathy of any etiology: Long-term data from the SCARFEAR (Cardiovascular Magnetic Resonance Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapy Delivery) Registry.
Clin Cardiol2018 Apr;41(4):494-501. doi: 10.1002/clc.22911.
Pedretti Stefano, Vargiu Sara, Baroni Matteo, Dellegrottaglie Santo, Lanzarin Barbara, Roghi Alberto, Milazzo Angela, Quattrocchi Giuseppina, Lunati Maurizio, Pedrotti Patrizia
Abstract
BACKGROUND:
Late gadolinium enhancement (LGE) assessed with cardiovascular magnetic resonance (CMR) correlates with ventricular arrhythmias and survival in patients with structural heart disease. Whether some LGE characteristics may specifically improve prediction of arrhythmic outcomes is unknown.
HYPOTHESIS:
We sought to evaluate scar characteristics assessed with CMR to predict implantable cardioverter-defibrillator (ICD) interventions in dilated cardiomyopathy of different etiology.
METHODS:
96 consecutive patients evaluated with CMR received an ICD. Biventricular volumes, ejection fraction, and myocardial LGE were evaluated. LGE was defined as "complex" (Cx-LGE) in presence of ?1 of the following: ischemic pattern, involving ?2 different coronary territories; epicardial pattern; global endocardial pattern; and presence of ?2 different patterns. The primary endpoint was occurrence of any appropriate ICD intervention. A composite secondary endpoint of cardiovascular death, cardiac transplantation, or ventricular assist device implantation was also considered.
RESULTS:
During a median follow-up of 75 months, 30 and 25 patients reached the primary and secondary endpoints, respectively. Cx-LGE was correlated with a worse primary endpoint survival (log-rank P
CONCLUSIONS:
Cx-LGE identified at CMR imaging seems promising as an independent and specific prognostic factor of ventricular arrhythmias requiring ICD therapy in dilated cardiomyopathy of different etiologies.
© 2018 Wiley Periodicals, Inc.
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Refractory ventricular tachycardia caused by inflow cannula mechanical injury in a patient with left ventricular assist device: Catheter ablation and pathological findings.
J Arrhythm2017 Oct;33(5):494-496. doi: 10.1016/j.joa.2017.04.007.
Pedretti Stefano, Cipriani Manlio, Bonacina Edgardo, Vargiu Sara, Gil Ad Vered, Frigerio Maria, Lunati Maurizio
Abstract
In patients with left ventricular assist device (LVAD), a minority of post-operative ventricular tachycardias (VTs) is caused by contact between the inflow cannula and the endocardium. Currently, electrophysiologic characteristics and pathologic features of this condition are lacking. We report on a case of a successfully ablated mechanical VT. After VT recurrence, heart transplantation took place. Pathologic observations were consistent with direct tissue injury and inflammation, eventually contributing to persisting arrhythmias. Radiofrequency catheter ablation can be a safe and effective option to treat arrhythmias caused by inflow cannula interference in the short term, although a high recurrence rate is expected.
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A case of premature ventricular contractions, ventricular tachycardia, and arrhythmic storm induced by right ventricular pacing during cardiac resynchronization therapy: Electrophysiological mechanism and catheter ablation.
J Arrhythm2015 Dec;31(6):401-5. doi: 10.1016/j.joa.2015.06.002.
Pedretti Stefano, Vargiu Sara, Paolucci Marco, Lunati Maurizio
Abstract
A 77-year-old man with ischemic cardiomyopathy and a cardiac resynchronization therapy-defibrillator (CRT-D) device came to our attention due to incessant ventricular tachycardia and multiple implantable cardioverter defibrillator (ICD) shocks. An electrocardiogram showed non-sustained monomorphic ventricular tachycardias (NSVTs) constantly occurring after each biventricular stimulation. During an electrophysiological study, NSVTs reproducibly recurred only after right ventricular (RV) pacing; LV pacing did not induce any NSVTs. The activation map was consistent with a localized reentry at the interventricular septum, and a double exit; at the LV exit site, a single radiofrequency energy application immediately interrupted the occurrence of the NSVTs. Current evidence supports LV pacing to be pro-arrhythmogenic in few CRT patients. This unusual case shows that RV pacing during CRT could produce frequent ventricular arrhythmias and arrhythmic storm. Catheter ablation can be considered an effective therapeutic option, especially when CRT maintenance is highly advisable.
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Women with nonischemic cardiomyopathy have a favorable prognosis and a better left ventricular remodeling than men after cardiac resynchronization therapy.
J Cardiovasc Med (Hagerstown)2016 Apr;17(4):291-8. doi: 10.2459/JCM.0000000000000187.
Cipriani Manlio, Landolina Maurizio, Oliva Fabrizio, Ghio Stefano, Vargiu Sara, Rordorf Roberto, Raineri Claudia, Ammirati Enrico, Petracci Barbara, Campo Claudia, Bisetti Silvia, Lunati Maurizio
Abstract
AIMS:
Cardiac resynchronization therapy (CRT) is a well established therapy in heart failure patients who are on optimal medical therapy and have reduced left ventricular ejection fraction (LVEF) and wide QRS complexes. Although women and patients with nonischemic cardiomyopathy are under-represented in CRT trials and registries, there is evidence that these two groups of patients can benefit more from CRT. The aim of our analysis was to investigate the impact of female sex on mortality in a population that included a high percentage of patients (61%) with nonischemic cardiomyopathy.
METHODS:
We analyzed data on 507 consecutive patients (20% women) who received CRT at two Italian Heart Transplant centers and were followed up for a maximum of 48 months.
RESULTS:
After multivariate adjustment, women showed a trend toward better survival with regard to all-cause mortality [hazard ratio (HR) 0.32, confidence interval (CI) 0.10-1.04; P = 0.059]. However, this benefit was limited to nonischemic patients with regard to all-cause mortality (HR 0.20, CI 0.05-0.87, P = 0.032) and cardiovascular mortality (HR 0.14, CI 0.02-1.05, P = 0.056).
CONCLUSION:
Female CRT recipients, at mid-term, have a favorable prognosis than male patients and this benefit appears to be more evident in nonischemic patients. Thus, we strongly believe that the apparent under-utilization of CRT in females is an anomaly that should be corrected.
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Left ventricular ejection fraction overcrossing 35% after one year of cardiac resynchronization therapy predicts long term survival and freedom from sudden cardiac death: single center observational experience.
Int J Cardiol2014 Mar;172(1):64-71. doi: 10.1016/j.ijcard.2013.12.005.
Frigerio Maria, Lunati Maurizio, Pasqualucci Daniele, Vargiu Sara, Foti Grazia, Pedretti Stefano, Vittori Claudia, Cattafi Giuseppe, Magenta Giovanni, Campo Claudia, Bisetti Silvia, Mercuro Giuseppe
Abstract
BACKGROUND:
Reverse remodeling and increased LVEF after CRT correlate with survival and heart failure hospitalizations, but their relationship with the risk of SCD is unclear. We aimed to evaluate whether exceeding a threshold value of 35% for left ventricular ejection fraction (LVEF) 1 year after cardiac resynchronization therapy (CRT) predicts survival and freedom from sudden cardiac death (SCD).
METHODS:
330 patients who survived ? 6 months after CRT (males 80%, age 62 ± 11 years) were grouped according to 1-year LVEF ? 35% (Group 1, n=187, 57%) or >35% (Group 2, n=143, 43%). According to changes vs. baseline (reduction of left end-systolic volume [LVESV] ? 10% or increase of LVEF% > 10 units), patients were also classified as echocardiographic (Echo) non-responders (Group A, n=152, 46%) or responders (Group B, n=178, 54%).
RESULTS:
At baseline, LVESV volume was larger and LVEF was lower in Group 1 vs. Group 2 (p35% was associated with freedom from SCD/VF.
CONCLUSIONS:
LVEF >35% after 1 year of CRT characterizes a favorable long-term outcome, with a very low risk for SCD.
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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Role of extended external loop recorders for the diagnosis of unexplained syncope, pre-syncope, and sustained palpitations.
Europace2014 Jun;16(6):914-22. doi: 10.1093/europace/eut337.
Locati Emanuela T, Vecchi Anna Maria, Vargiu Sara, Cattafi Giuseppe, Lunati Maurizio
Abstract
AIMS:
To assess the diagnostic yield of new external loop recorders (ELRs) in patients with history of syncope, pre-syncope, and sustained palpitations.
METHODS AND RESULTS:
Since 2005, we have established a registry including patients who consecutively received ELR monitoring for unexplained syncope or pre-syncope/palpitations. The registry included 307 patients (61% females, age 58 ± 19 years, range 8-94 years) monitored by high-capacity memory ELR of two subsequent generations: SpiderFlash-A(®) (SFA(®), Sorin CRM), storing two-lead electrocardiogram (ECG) patient-activated recordings by loop-recording technique (191 patients, 54 patients with syncope, years 2005-09), and SpiderFlash-T(®) (SFT(®)), adding auto-trigger detection for pauses, bradycardia, and supraventricular/ventricular arrhythmias (116 patients, 38 patients with syncope, years 2009-12). All the patients previously underwent routine workup for syncope or palpitation, including one or more 24 h Holter, not conclusive for diagnosis. Mean monitoring duration was 24.1 ± 8.9 days. Among 215 patients with palpitations, a conclusive diagnosis was obtained in 184 patients (86% diagnostic yield for palpitation). Among 92 patients with syncope, a conclusive diagnosis was obtained in 16 patients (17% clinical diagnostic yield for syncope), with recording during syncope of significant arrhythmias in 9 patients, and sinus rhythm in 7 patients. Furthermore, asymptomatic arrhythmias were de novo detected in 12 patients (13%), mainly by auto-trigger detection, suggesting an arrhythmic origin of the syncope.
CONCLUSIONS:
The diagnostic yield of ELR in patients with syncope, pre-syncope, or palpitation of unknown origin after routine workup was similar to implantable loop recorder (ILR) within the same timeframe, therefore, ELR could be considered for patients candidate for long-term ECG monitoring, stepwise before ILR.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.
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[New implantable devices for patient management: role and perspectives of remote monitoring of implantable cardioverter-defibrillators].
G Ital Cardiol (Rome)2012 Oct;13(10 Suppl 2):36S-40S. doi: 10.1714/1167.12918.
Locati Emanuela T, Vargiu Sara, Mulargia Ederina, Ardito Corrado, Schirru Milena, Pedretti Stefano, Negrini Franca, Lunati Maurizio
Abstract
A large number of studies have demonstrated that remote control of implantable devices (home monitoring, HM) is beneficial for patients, as it allows strict and tailored controls with earlier identification of potential problems, by avoiding unnecessary visits. HM is also beneficial for hospitals, as it progressively reduces the resources necessary for routine controls and contributes to a better management of critical patients. According to current European and Italian guidelines, HM can replace standard ambulatory monitoring, thereby decreasing the number of outpatient visits for each individual patient (it is possible to schedule a comprehensive clinical evaluation at 1 year rather than every 6-8 months, while performing controls at 1 and 3 months by remote transmission). At present, however, reimbursement of HM services is not covered by the National Health System and, as a consequence, cannot be performed as an institutional activity within the hospital. In addition, many critical issues remain to be resolved before the HM system can be fully implemented into daily clinical management, particularly in patients with heart failure at higher risk for sudden cardiac death.
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Cardiac effects of L-thyroxine administration in borderline hypothyroidism.
Int J Cardiol2008 May;126(2):190-5.
Mariotti Stefano, Zoncu Sandra, Pigliaru Francesca, Putzu Claudia, Cambuli Valentina M, Vargiu Sara, Deidda Martino, Mercuro Giuseppe
Abstract
OBJECTIVE:
To investigate the clinical relevance of l-thyroxine (l-T(4)) substitution therapy in borderline hypothyroidism.
DESIGN:
To assess whether and to what extent administration of l-T(4) is able to modify systolic and diastolic function in patients with subclinical hypothyroidism and in subjects with autoimmune thyroiditis and normal serum TSH.
METHODS:
We studied 26 patients with classical Hashimoto's thyroiditis [18 with increased serum TSH (>3 mU/ml - Group A), and 8 with normal serum TSH (
RESULTS:
In both groups A and B we confirmed a significant impairment of systolic ejection (p
CONCLUSION:
Our data confirm previous evidence that subclinical hypothyroidism is associated with a cardiac dysfunction, even when this is very mild (i.e. with serum TSH still comprised in the normal range), and show that these abnormalities are reversible with l-T(4) replacement therapy.
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Cardiac function in borderline hypothyroidism: a study by pulsed wave tissue Doppler imaging.
Eur J Endocrinol2005 Apr;152(4):527-33.
Zoncu Sandra, Pigliaru Francesca, Putzu Claudia, Pisano Lorella, Vargiu Sara, Deidda Martino, Mariotti Stefano, Mercuro Giuseppe
Abstract
OBJECTIVE:
In subclinical hypothyroidism (SH), impaired diastolic function has been documented at rest and on effort, while systolic dysfunction has only been assessed on effort.
DESIGN:
The aim of the present study was: (a) to further assess systolic function at rest in SH; and (b) to ascertain whether cardiac dysfunction could precede TSH increase in euthyroid patients with a high risk of developing SH.
METHODS:
We studied 32 patients with classical Hashimoto's thyroiditis (22 with increased serum TSH (> 3 mU/ml - group A), and 10 with normal serum TSH (
RESULTS:
When compared with group C, PWTDI indices showed that in both groups A and B there was a significant impairment of systolic ejection (P
CONCLUSION:
PWTDI is a sensitive technique that allows detection of both diastolic and systolic abnormalities, not only in patients with SH, but also in euthyroid subjects with a high risk of developing thyroid failure. Futhermore, the significant correlations of several PWTDI indices with serum FT(3) and TSH concentrations strongly support the concept of a continuum spectrum of a slight thyroid failure in autoimmune thyroiditis extending to subjects with serum TSH still within the normal range.
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