Villanova Dott. Luca

Pubblicazioni su PubMed

• Effect of a quality-improvement intervention on end-of-life care in cardiac intensive care unit.
  Eur J Clin Invest

  2023 Mar;():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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• Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock.
  Eur J Heart Fail

  2023 Feb;():. doi: 10.1002/ejhf.2796.
  
  Schrage Benedikt, Sundermeyer Jonas, Beer Benedikt Norbert, Bertoldi Letizia, Bernhardt Alexander, Blankenberg Stefan, Dauw Jeroen, Dindane Zouhir, Eckner Dennis, Eitel Ingo, Graf Tobias, Horn Patrick, Kirchhof Paulus, Kluge Stefan, Linke Axel, Landmesser Ulf, Luedike Peter, Lüsebrink Enzo, Mangner Norman, Maniuc Octavian, Winkler Sven Möbius, Nordbeck Peter, Orban Martin, Pappalardo Federico, Pauschinger Matthias, Pazdernik Michal, Proudfoot Alastair, Kelham Matthew, Rassaf Tienush, Reichenspurner Hermann, Scherer Clemens, Schulze Paul Christian, Schwinger Robert H G, Skurk Carsten, Sramko Marek, Tavazzi Guido, Thiele Holger, Villanova Luca, Morici Nuccia, Wechsler Antonia, Westenfeld Ralf, Winzer Ephraim, Westermann Dirk
  
  Abstract
  
  AIMS:
  Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment.
  
  METHODS AND RESULTS:
  In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30-day mortality was assessed in a 1:1 propensity-matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30-day mortality (hazard ratio 0.76, 95% confidence interval 0.59-0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access-site related ischaemia (6.7% vs. 0%).
  
  CONCLUSION:
  In patients with non-ischaemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings.
  
  © 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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• Left Ventricular Unloading in Acute on Chronic Heart Failure: From Statements to Clinical Practice.
  J Pers Med

  2022 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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• Percutaneous Coronary Revascularization after Out-of-Hospital Cardiac Arrest: A Review of the Literature and a Case Series.
  J Clin Med

  2022 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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• Effect of landiolol in patients with tachyarrhythmias and acute decompensated heart failure (ADHF): a case series.
  ESC Heart Fail

  2022 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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• Predicting survival in patients with acute decompensated heart failure complicated by cardiogenic shock.
  Int J Cardiol Heart Vasc

  2021 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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• Appropriateness of use criteria in echocardiography: an Italian experience.
  J Cardiovasc Med (Hagerstown)

  2017 Aug;18(8):635-636. doi: 10.2459/JCM.0000000000000510.
  
  Morrone Doralisa, Villanova Luca, Huqi Alda, Guarini Giacinta, Marzilli Mario
  
  
  
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