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  • 1
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    Cardiovascular risk factors and mortality in hospitalized patients with COVID-19: systematic review and meta-analysis of 45 studies and 18,300 patients
    Springer Science and Business Media LLC ; 2021
    In:  BMC Cardiovascular Disorders Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Cardiovascular Disorders, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: A high prevalence of cardiovascular risk factors including age, male sex, hypertension, diabetes, and tobacco use, has been reported in patients with Coronavirus disease 2019 (COVID-19) who experienced adverse outcome. The aim of this study was to investigate the relationship between cardiovascular risk factors and in-hospital mortality in patients with COVID-19. Methods MEDLINE, Cochrane, Web of Sciences, and SCOPUS were searched for retrospective or prospective observational studies reporting data on cardiovascular risk factors and in-hospital mortality in patients with COVID-19. Univariable and multivariable age-adjusted analyses were conducted to evaluate the association between cardiovascular risk factors and the occurrence of in-hospital death. Results The analysis included 45 studies enrolling 18,300 patients. The pooled estimate of in-hospital mortality was 12% (95% CI 9–15%). The univariable meta-regression analysis showed a significant association between age (coefficient: 1.06; 95% CI 1.04–1.09; p  〈  0.001), diabetes (coefficient: 1.04; 95% CI 1.02–1.07; p  〈  0.001) and hypertension (coefficient: 1.01; 95% CI 1.01–1.03; p = 0.013) with in-hospital death. Male sex and smoking did not significantly affect mortality. At multivariable age-adjusted meta-regression analysis, diabetes was significantly associated with in-hospital mortality (coefficient: 1.02; 95% CI 1.01–1.05; p = 0.043); conversely, hypertension was no longer significant after adjustment for age (coefficient: 1.00; 95% CI 0.99–1.01; p = 0.820). A significant association between age and in-hospital mortality was confirmed in all multivariable models. Conclusions This meta-analysis suggests that older age and diabetes are associated with higher risk of in-hospital mortality in patients infected by SARS-CoV-2. Conversely, male sex, hypertension, and smoking did not independently correlate with fatal outcome.
    Type of Medium: Online Resource
    ISSN: 1471-2261
    URL: Article
    DOI: 10.1186/s12872-020-01816-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 2
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    Prognostic Implications of Right Ventricular Function and Pulmonary Pressures Assessed by Echocardiography in Hospitalized Patients with COVID-19
    MDPI AG ; 2021
    In:  Journal of Personalized Medicine Vol. 11, No. 12 ( 2021-11-24), p. 1245-
    Details
    In: Journal of Personalized Medicine, MDPI AG, Vol. 11, No. 12 ( 2021-11-24), p. 1245-
    Abstract: Aims: Pulmonary involvement in Coronavirus disease 2019 (COVID-19) may affect right ventricular (RV) function and pulmonary pressures. The prognostic value of tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PAPS), and TAPSE/PAPS ratios have been poorly investigated in this clinical setting. Methods and results: This is a multicenter Italian study, including consecutive patients hospitalized for COVID-19. In-hospital mortality and pulmonary embolism (PE) were identified as the primary and secondary outcome measures, respectively. The study included 227 (16.1%) subjects (mean age 68 ± 13 years); intensive care unit (ICU) admission was reported in 32.2%. At competing risk analysis, after stratifying the population into tertiles, according to TAPSE, PAPS, and TAPSE/PAPS ratio values, patients in the lower TAPSE and TAPSE/PAPS tertiles, as well as those in the higher PAPS tertiles, showed a significantly higher incidence of death vs. the probability to be discharged during the hospitalization. At univariable logistic regression analysis, TAPSE, PAPS, and TAPSE/PAPS were significantly associated with a higher risk of death and PE, both in patients who were and were not admitted to ICU. At adjusted multivariable regression analysis, TAPSE, PAPS, and TAPSE/PAPS resulted in independently associated risk of in-hospital death (TAPSE: OR 0.85, CI 0.74–0.97; PAPS: OR 1.08, CI 1.03–1.13; TAPSE/PAPS: OR 0.02, CI 0.02 × 10−1–0.2) and PE (TAPSE: OR 0.7, CI 0.6–0.82; PAPS: OR 1.1, CI 1.05–1.14; TAPSE/PAPS: OR 0.02 × 10−1, CI 0.01 × 10−2–0.04). Conclusions: Echocardiographic evidence of RV systolic dysfunction, increased PAPS, and poor RV-arterial coupling may help to identify COVID-19 patients at higher risk of mortality and PE during hospitalization.
    Type of Medium: Online Resource
    ISSN: 2075-4426
    URL: Article
    DOI: 10.3390/jpm11121245
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
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  • 3
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    Response to: Correspondence on ‘Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome’ by John E Madias
    BMJ ; 2022
    In:  Heart Vol. 108, No. 15 ( 2022-08), p. 1242.2-1243
    Details
    In: Heart, BMJ, Vol. 108, No. 15 ( 2022-08), p. 1242.2-1243
    Type of Medium: Online Resource
    ISSN: 1355-6037 , 1468-201X
    URL: Article
    DOI: 10.1136/heartjnl-2022-321278
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 4
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    622 Long term prognostic impact of right ventricular dysfunction in patients with COVID-19
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal Supplements Vol. 23, No. Supplement_G ( 2021-12-08)
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 23, No. Supplement_G ( 2021-12-08)
    Abstract: The characteristics and clinical course of hospitalized patients with Coronavirus disease 2019 (COVID-19) have been widely described, while long-term data are still poor. The aim of this study was to evaluate the long-term clinical outcome and its association with right ventricular (RV) dysfunction in hospitalized patients with COVID-19. Methods and results This was a retrospective multicentre study of consecutive COVID-19 patients hospitalized at seven Italian Hospitals from 28 February to 20 April 2020. The study population was divided into two groups according to echocardiographic evidence of RV dysfunction defined by tricuspid annular plane systolic excursion (TAPSE) value & lt;17 mm in accordance with the current guidelines. The primary study outcome was 1-year mortality. The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); RV dysfunction was diagnosed in 63 cases (28%). Patients with RV dysfunction were older (75 vs. 67 years, P  & lt; 0.001) and showed a higher prevalence of coronary artery disease (27% vs. 11%, P = 0.003), heart failure (5% vs. 22%; P  & lt; 0.001), chronic obstructive pulmonary disease (13% vs. 38%; P  & lt; 0.001), and chronic kidney disease (12% vs. 39%; P  & lt; 0.001). Left ventricular ejection fraction (LVEF) was significantly lower in patients with RV dysfunction that in those without (55% vs. 50%; P  & lt; 0.001). The rate of mortality at 1-year was significantly higher in patients with RV dysfunction as compared with those without (67% vs. 28%; P ≤ 0.001). After propensity score matching, patients with RV dysfunction showed a significantly lower long-term survival than patients without RV dysfunction (62% vs. 29%, P  & lt; 0.001). At multivariable Cox regression analysis, TAPSE, LVEF and acute respiratory distress syndrome during the hospitalization were independently associated with 1-year mortality (Table). Conclusions RV dysfunction is a relatively common finding in hospitalized patients with COVID-19 and is independently associated with an higher risk of mortality at one-year follow-up.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartj/suab135.022
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 5
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    618 Clinical conditions and echocariographic parameters associated with mortality in COVID-19
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal Supplements Vol. 23, No. Supplement_G ( 2021-12-08)
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 23, No. Supplement_G ( 2021-12-08)
    Abstract: Coronavirus disease 2019 (COVID-19) is a recently recognized viral infective disease which can be complicated by acute respiratory stress syndrome (ARDS) and cardiovascular complications including severe arrhythmias, acute coronary syndromes, myocarditis, and pulmonary embolism. The aim of the present study was to identify the clinical conditions and echocardiographic parameters associated with in-hospital mortality in COVID-19. Methods and results This is a multicentre retrospective observational study including seven Italian centres. Patients hospitalized with COVID-19 from 1 March to 22 April 2020, were included into the study population. The association between baseline variables and the risk of in-hospital mortality was assessed through multivariable logistic regression and competing risk analyses. Out of 1401 patients admitted at the participating centres with confirmed diagnosis of COVID-19, 226 (16.1%) underwent transthoracic echocardiography (TTE) and were included in the present analysis. The mean age was 68.9 ± 13.9 years and male sex was reported in 141 patients (62.4%). Admission in intensive care unit was required for 72 patients (31.9%); in-hospital death occurred in 68 patients (30.1%). At multivariable analysis, left ventricular ejection fraction (LVEF, P  & lt; 0.001), tricuspid annular plane systolic excursion (TAPSE, P  & lt; 0.001), and ARDS (P  & lt; 0.001) were independently associated with in-hospital mortality. At competing risk analysis, we found a significantly higher risk of mortality in patients with ARDS vs. those without ARDS (HR: 7.66; CI: 3.95–14.8), in patients with TAPSE ≤ 17 mm vs. those with TAPSE  & gt; 17 mm (HR: 5.08; CI: 3.15–8.19), and in patients with LVEF ≤ 50% vs. those with LVEF  & gt; 50% (HR: 4.06; CI: 2.50–6.59) (Figure). Conclusions TTE might be a useful tool in risk stratification of patients with COVID-19. In particular, reduced LVEF as well as reduced TAPSE may help to identify patients at higher risk of death during hospitalization. Our preliminary findings need to be confirmed in larger, prospective studies.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartj/suab135.021
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 6
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    747 Long-term effects of pharmacological treatment in patients with takotsubo syndrome with or without hypertension: a report from the takotsubo Italian network
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal Supplements Vol. 23, No. Supplement_G ( 2021-12-08)
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 23, No. Supplement_G ( 2021-12-08)
    Abstract: Hypertension (HT) is one of the most frequent comorbidities reported in patients with Takotsubo syndrome (TTS). However, the clinical outcome as well as the effect of pharmacological treatment on long-term follow-up have never been investigated in this cohort. To investigate the impact of the pharmacological treatment with beta-blocker (BB) and/or renin–angiotensin–aldosterone system inhibitor (RAASi) on long-term outcome of TTS patients with and without HT. Methods and results This study included TTS patients prospectively included in the Takotsubo Italian Network register from January 2007 to December 2018. The study population was divided in two groups according to the presence or not of HT. The effect of BB and RAASi at discharge was evaluated in these groups. The primary outcome was the composite of all-cause death and TTS recurrence; secondary outcomes were the single components of the primary outcome. The propensity score weighting technique was employed to account for potential selection bias in treatment assignment at discharge. The study population included 825 patients [median age 72 (63–78) years; 8.1% were males]; 525 (63.6%) patients had history of HT and 300 (36.4%) patients did not. At median follow-up of 24.0 months (11.0–38.0), the primary outcome occurred in 102 patients (12.4%); all-cause death and TTS recurrence were reported in 76 (9.2%) and 33 (4.0%), respectively. There were no differences in terms of the primary outcome (adjusted HR: 1.082; 95% CI: 0.689–1.700; P = 0.733), all-cause death (adjusted HR: 1.214; 95% CI: 0.706–2.089; P = 0.483) and TTS recurrence (adjusted HR: 0.795; 95% CI: 0.373–1.694; P = 0.552) between patients with vs. without HT. Among patients with HT, those receiving BB at discharge showed a significantly lower risk of the primary outcome (adjusted HR: 0.375; 95% CI: 0.228–0.617; P  & lt; 0.001) compared with patients not receiving BB. There was also a significantly lower risk of all-cause death (adjusted HR: 0.381; 95% CI: 0.217–0.666; P  & lt; 0.001) and TTS recurrence (adjusted HR: 0.393; 95% CI: 0.155–0.998; P = 0.049) in patients treated with BB. Among patients without HT, there was no significant association of BB treatment with any of the study outcomes. RAASi treatment showed no significant effect on the primary and secondary outcomes. These results were consistent between patients with and without HT. Conclusions TTS patients with HT patients experienced a survival benefit from BB treatment in terms of both all-cause death and TTS recurrence; this effect was not confirmed in patients without HT. Conversely, RAASi did not affect long-term outcome, independently from the coexistence of HT. Albeit hypothesis-generating, a such evidence supports a tailored pharmacological therapy after discharge in TTS patients taking into account the coexistence of HT.
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartj/suab142.008
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 7
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    Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome
    Elsevier BV ; 2021
    In:  Thrombosis Research Vol. 198 ( 2021-02), p. 34-39
    Details
    In: Thrombosis Research, Elsevier BV, Vol. 198 ( 2021-02), p. 34-39
    Type of Medium: Online Resource
    ISSN: 0049-3848
    URL: Article
    DOI: 10.1016/j.thromres.2020.11.017
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 8
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    1048 MYOCARDIAL WORK AND OUTCOME IN PATIENTS PARADOXICAL WITH LOW FLOW, LOW GRADIENT AORTIC STENOSIS
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal Supplements Vol. 24, No. Supplement_K ( 2022-12-15)
    Details
    In: European Heart Journal Supplements, Oxford University Press (OUP), Vol. 24, No. Supplement_K ( 2022-12-15)
    Abstract: The aim of this study was to investigate the potential impact of non-invasive derived myocardial work (MW) indexes on outcome of patients with severe paradoxical low flow, low gradient (PLFLG AS) undergoing transcatheter aortic valve implantation (TAVI). Methods Complete demographic, clinical characteristics, laboratory analyses and echocardiographic parameters were collected. Severe PLFLG AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient & lt; 40 mmHg and stroke volume index & lt;36 ml/m2 and preserved LVEF & gt;50%. MW was obtained from the non-invasive strain-pressure loop obtained pressure by combining GLS and the left ventricular systolic pressure, which was derived by adding the mean aortic valve gradient to systolic brachial pressure. Constructive MW (CMW), MW index (MWI), MW efficiency (MWE), and wasted MW (WMW) were measured. The normal values ​​considered for the MW parameters were: MWI ≥ 1300 mmHg%; CMW ≥ 1500 mmHg%; WMW & lt; 240 mmHg%; MWE ≥ 90%. Odds ratio, sensitivity and specificity were used to quantify the ability of MW parameters (abnormal vs normal values) in predicting the primary outcome defined as all-causes mortality. Results study population included 30 patients with severe PLFLG AS undergoing TAVI. The most frequent comorbidities were hypertension (93%; n=28), dyslipidaemia (66%; n=20), diabetes (23%; n=7). Atrial fibrillation/flutter and chronic kidney disease were identified in 12 (40%) and 18 (60%) patients, respectively. Concomitant coronary artery disease and history of stroke were reported in 23% (n=7) and 10% (n=3), respectively. Society of Thoracic Surgeons score in overall population was mean 11,34±4,34. During median of 209 days (IQR: 104–213 days) all-causes mortality occurred in 13 patients (43%) (just 1 for non-cardiac death). Abnormal values of MWI, CMW and MWE identified significant statistical correlation with primary outcome [(odds ratio for primary outcome: 7.5 (95% confidence interval: 1.4 to 39.8); 7.5 (1.4 to 39.5) and 5.2 (1.1 to 25.3) respectively, Table 1)]. The MWI, CMW and MWE have the same sensitivity (62%) but higher specificity (82% for MWI and CMW, 88% for WMW and 76% for MWE). Conclusion In a population of patients with PLFLG-AS characterized by normal ejection fraction the abnormal MW parameters seem to be significantly associated with all-causes mortality during mid-term follow up and might provide additional information on outcome of this peculiar subgroup of patients with AS. Table 1
    Type of Medium: Online Resource
    ISSN: 1520-765X , 1554-2815
    URL: Article
    DOI: 10.1093/eurheartjsupp/suac121.185
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 9
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    Predictors of sacubitril/valsartan high dose tolerability in a real world population with HFrEF
    Wiley ; 2022
    In:  ESC Heart Failure Vol. 9, No. 5 ( 2022-10), p. 2909-2917
    Details
    In: ESC Heart Failure, Wiley, Vol. 9, No. 5 ( 2022-10), p. 2909-2917
    Abstract: The angiotensin receptor‐neprilysin inhibitor (ARNI) sacubitril/valsartan (Sac/Val) demonstrated to be superior to enalapril in reducing hospitalizations, cardiovascular and all‐cause mortality in patients with ambulatory heart failure and reduced ejection fraction (HFrEF), in particular when it is maximally up‐titrated. Unfortunately, the target dose is achieved in less than 50% of HFrEF patients, thus undermining the beneficial effects on the outcomes. In this study, we aimed to evaluate the role of Sac/Val and its titration dose on reverse cardiac remodelling and determine which echocardiographic index best predicts the up‐titration success. Methods and results From January 2020 to June 2021, we retrospectively identified 95 patients (65.6 [59.1–72.8] years; 15.8% females) with chronic HFrEF who were prescribed Sac/Val from the HF Clinics of 5 Italian University Hospitals and evaluated the tolerability of Sac/Val high dose (the ability of the patient to achieve and stably tolerate the maximum dose) as the primary endpoint in the cohort. We used a multivariable logistic regression analysis, with a stepwise backward selection method, to determine the independent predictors of Sac/Val maximum dose tolerability, using, as candidate predictors, only variables with a P ‐value 〈 0.1 in the univariate analyses. Candidate predictors identified for the multivariable backward logistic regression analysis were age, sex, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dyslipidaemia, atrial fibrillation, systolic blood pressure (SBP), baseline tolerability of ACEi/ARBs maximum dose, left ventricle global longitudinal strain (LVgLS), LV ejection fraction (EF), tricuspid annulus plane systolic excursion (TAPSE), right ventricle (RV) fractional area change (FAC), RV global and free wall longitudinal strain (RVgLS and RV‐FW‐LS). After the multivariable analysis, only one categorical (ACEi/ARBs maximum dose at baseline) and three continuous (younger age, higher SBP, and higher TAPSE), resulted significantly associated with the study outcome variable with a strong discriminatory capacity (area under the curve 0.874, 95% confidence interval (CI) (0.794–0.954) to predict maximum Sac/Val dose tolerability. Conclusions Our study is the first to analyse the potential role of echocardiography and, in particular, of RV dysfunction, measured by TAPSE, in predicting Sac/Val maximum dose tolerability. Therefore, patients with RV dysfunction (baseline TAPSE 〈 16 mm, in our cohort) might benefit from a different strategy to titrate Sac/Val, such as starting from the lowest dose and/or waiting for a more extended period of observation before attempting with the higher doses.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v9.5
    DOI: 10.1002/ehf2.13982
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 10
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    Loeffler’s Endocarditis: An Integrated Multimodality Approach
    Elsevier BV ; 2020
    In:  Journal of the American Society of Echocardiography Vol. 33, No. 12 ( 2020-12), p. 1427-1441
    Details
    In: Journal of the American Society of Echocardiography, Elsevier BV, Vol. 33, No. 12 ( 2020-12), p. 1427-1441
    Type of Medium: Online Resource
    ISSN: 0894-7317
    URL: Article
    DOI: 10.1016/j.echo.2020.09.002
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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