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Article ; Online: When the responsibility for a crime is shared between several actors. The case of hypertensive heart failure with preserved ejection fraction.

Coiro, Stefano / Verdecchia, Paolo / Angeli, Fabio

2023 Volume 120, Page(s) 29–31

MeSH term(s)	Humans ; Stroke Volume ; Heart Failure ; Hypertension ; Crime
Language	English
Publishing date	2023-11-27
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1038679-8
ISSN	1879-0828 ; 0953-6205
ISSN (online)	1879-0828
ISSN	0953-6205
DOI	10.1016/j.ejim.2023.11.022
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Article ; Online: Gli studi di non-inferiorità.

Angeli, Fabio / Verdecchia, Paolo / Coiro, Stefano / Santucci, Andrea / Notaristefano, Francesco / Bartolini, Claudia / Reboldi, Gianpaolo

Giornale italiano di cardiologia (2006)

2024 Volume 25, Issue 4, Page(s) 262–269

Abstract: Superiority trials are designed to test the hypothesis that a given diagnostic or therapeutic strategy is better than (i.e. "superior to") placebo or an active control. Conversely, non-inferiority trials test the hypothesis that a newer (i.e. alternative) ...

Title translation	Non-inferiority trials.
Abstract	Superiority trials are designed to test the hypothesis that a given diagnostic or therapeutic strategy is better than (i.e. "superior to") placebo or an active control. Conversely, non-inferiority trials test the hypothesis that a newer (i.e. alternative) strategy is not "unacceptably worse" than a control (i.e. "traditional", or "older") strategy. Non-inferiority trials are increasingly conducted in clinical medicine more often when a "newer" strategy is supposed to offer a relevant advantage in terms other than clinical efficacy (i.e. better tolerability, less cost, simpler regimen, etc.) versus a "gold standard" traditional strategy. The principle underlying non-inferiority trials is that the above advantage justifies the preferential use of the newer strategy in the clinical practice even if the clinical efficacy of the "new" appears to be a bit worse than that of the "old", albeit not unacceptably worse (i.e. not beyond a pre-specified value). The demonstration of non-inferiority requires that the confidence interval of the point estimate (e.g. the hazard ratio) does not cross a pre-specified limit. The definition of such pre-specified limit, the so called "non-inferiority margin", is a pivotal point when planning non-inferiority trials. It denotes the maximally tolerated worse effect of the alternative strategy, compared with the traditional one, required to conclude that an alternative strategy is non-inferior to the traditional "gold standard". The non-inferiority margin is derived from previous trials evaluating the efficacy of the traditional strategy vs placebo. We reviewed the principles and the practical aspects in the design and conduct of non-inferiority trials.
Language	Italian
Publishing date	2024-03-21
Publishing country	Italy
Document type	English Abstract ; Journal Article
ZDB-ID	2272414-X
ISSN	1972-6481 ; 1827-6806
ISSN (online)	1972-6481
ISSN	1827-6806
DOI	10.1714/4244.42207
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Article ; Online: Impact of mobile intensive care units on STEMI delays and outcomes-Is it simply a matter of time?

Coiro, Stefano / Cavallini, Claudio

European journal of internal medicine

2020 Volume 73, Page(s) 27–29

MeSH term(s)	Humans ; Inpatients ; Intensive Care Units ; Myocardial Infarction ; ST Elevation Myocardial Infarction/therapy
Language	English
Publishing date	2020-02-06
Publishing country	Netherlands
Document type	Editorial ; Comment
ZDB-ID	1038679-8
ISSN	1879-0828 ; 0953-6205
ISSN (online)	1879-0828
ISSN	0953-6205
DOI	10.1016/j.ejim.2020.01.022
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Article: Nonbacterial Thrombotic Endocarditis with Multiple Systemic Emboli in a Patient with Primary Lung Cancer.

Benedetti, Martina / Morroni, Sara / Fiaschini, Paola / Coiro, Stefano / Savino, Ketty

Journal of cardiovascular echography

2022 Volume 32, Issue 2, Page(s) 129–131

Abstract: Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that refers to a spectrum of noninfectious lesions of cardiac valves that is most commonly seen in advanced malignancy. We describe a case report of a 63-year-old male with NBTE and multiple ...

Abstract	Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that refers to a spectrum of noninfectious lesions of cardiac valves that is most commonly seen in advanced malignancy. We describe a case report of a 63-year-old male with NBTE and multiple embolizations (encephalic, coronary, splenic, and renal). The patient was admitted to the emergency department for stroke. During hospitalization, the patient complained of left leg pain and a venous echo color Doppler of the lower limbs was performed, showing bilateral distal deep-vein thrombosis. A thoracoabdominal computed tomography scan, which was performed to rule out pulmonary embolism, revealed a primary lung cancer and subcarinal lymphadenopathy. As collateral findings, multiple ischemic lesions in the spleen and in both kidneys were identified. In addition, areas of subendocardial hypodensity compatible with ischemia were also highlighted. An electrocardiogram showed acute myocardial infarction and focused echocardiographic evaluation displayed hypokinesis of the lateral and posterior in the mid- and distal segments and aortic and mitral valve vegetations, confirmed by a transesophageal echocardiography. Empiric antimicrobial therapy was started; all blood culture sets were negative and the patient was apyretic throughout the hospitalization. These findings supported the hypothesis of NBTE with multiple embolizations during a hypercoagulable state associated with advanced lung cancer.
Language	English
Publishing date	2022-08-17
Publishing country	India
Document type	Case Reports
ZDB-ID	2734045-4
ISSN	2347-193X ; 2211-4122
ISSN (online)	2347-193X
ISSN	2211-4122
DOI	10.4103/jcecho.jcecho_68_21
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Article: A Rare Case of Isolated Right Ventricular Loeffler's Endocarditis in Primary Hypereosinophilic Syndrome.

Padoan, Laura / Coiro, Stefano / Sforna, Stefano / Del Pinto, Maurizio / Savino, Ketty

Journal of cardiovascular echography

2023 Volume 33, Issue 3, Page(s) 139–143

Abstract: Hypereosinophilic syndrome (HES) is a systemic disorder with various manifestations, characterized by hypereosinophilia and caused by primary or secondary conditions. Loeffler's endocarditis (LE) represents a frequent cardiac manifestation of HES, caused ...

Abstract	Hypereosinophilic syndrome (HES) is a systemic disorder with various manifestations, characterized by hypereosinophilia and caused by primary or secondary conditions. Loeffler's endocarditis (LE) represents a frequent cardiac manifestation of HES, caused by infiltration of the myocardium by eosinophilic cells, which determines endocardial damage, with subsequent inflammation, thrombosis, and fibrosis of either one or both ventricles. The diagnosis of cardiac involvement is based on a multimodality approach (i.e., two-dimensional transthoracic echocardiography [2D-TTE], speckle-tracking echocardiography [STE], and cardiac magnetic resonance [CMR]), with different findings depending on the stage of disease. STE may be useful in the initial phase when traditional imaging techniques may result negative, whereas CMR allows myocardial tissue characterization along with a better definition of the right ventricle. We present a rare case of LE with isolated right ventricular involvement in a patient with HES caused by chronic eosinophilic leukemia with constitutively activated fusion tyrosine kinase on chromosome 4q12, successfully treated with imatinib mesylate.
Language	English
Publishing date	2023-11-20
Publishing country	India
Document type	Case Reports
ZDB-ID	2734045-4
ISSN	2347-193X ; 2211-4122
ISSN (online)	2347-193X
ISSN	2211-4122
DOI	10.4103/jcecho.jcecho_22_23
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Article: Therapy of Type 2 diabetes: more gliflozines and less metformin?

Verdecchia, Paolo / Murdolo, Giuseppe / Coiro, Stefano / Santucci, Andrea / Notaristefano, Francesco / Angeli, Fabio / Cavallini, Claudio

European heart journal supplements : journal of the European Society of Cardiology

2023 Volume 25, Issue Suppl B, Page(s) B171–B176

Abstract: Metformin is a frequently used anti-diabetic drug. In addition to the well-known modulating properties on glyco-metabolic control, metformin reduces cardiovascular (CV) risk partly independently of its anti-hyperglycaemic effect. The use of 'new' anti- ... ...

Abstract	Metformin is a frequently used anti-diabetic drug. In addition to the well-known modulating properties on glyco-metabolic control, metformin reduces cardiovascular (CV) risk partly independently of its anti-hyperglycaemic effect. The use of 'new' anti-diabetic drugs, inhibitors of the renal Na-glucose co-transporter (SGLTs-I or 'gliflozines') and GLP-1 receptor agonists (GLP1-RAs), has further contributed to challenge the strictly 'gluco-centric' view of diabetic CV disease. Several controlled trials have demonstrated that the cardio-renal benefits of gliflozines and GLP1-RAs are present regardless of the presence of metformin as 'background' therapy. The impact on the 'cardio-renal continuum' exerted by SGLTs-I was also noted in non-diabetic patients with heart failure and reduced or preserved ventricular function and different levels of renal function. These drugs reduced re-hospitalization, CV mortality, and progression to end-stage renal disease. These clinical acquisitions, implemented by Scientific Societies, have led to a change in the therapeutic approach to diabetic cardio-renal disease. Although metformin still represents a valid therapeutic option to be offered particularly to 'naïve' diabetic patients without previous cardio-renal events, SGLTs-I and/or GLP1-RAs emerge as 'first-line' drugs in diabetic patients with previous CV events, or at high CV risk, without having to request 'on board' metformin therapy.
Language	English
Publishing date	2023-04-21
Publishing country	England
Document type	Journal Article
ZDB-ID	1463769-8
ISSN	1554-2815 ; 1520-765X
ISSN (online)	1554-2815
ISSN	1520-765X
DOI	10.1093/eurheartjsupp/suad098
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Article ; Online: Multi-modality assessment of congestion in acute heart failure: Associations with left ventricular ejection fraction and prognosis.

Palazzuoli, Alberto / Ruocco, Gaetano / Pellicori, Pierpaolo / Gargani, Luna / Coiro, Stefano / Lamiral, Zohra / Ambrosio, Giuseppe / Rastogi, Tripti / Girerd, Nicolas

Current problems in cardiology

2024 Volume 49, Issue 3, Page(s) 102374

Abstract: Background: Integrating clinical examination with ultrasound measures of congestion could improve risk stratification in patients hospitalized with acute heart failure (AHF).: Aim: To investigate the prevalence of clinical, echocardiographic and lung ...

Abstract	Background: Integrating clinical examination with ultrasound measures of congestion could improve risk stratification in patients hospitalized with acute heart failure (AHF). Aim: To investigate the prevalence of clinical, echocardiographic and lung ultrasound (LUS) signs of congestion according to left ventricular ejection fraction (LVEF) and their association with prognosis in patients with AHF. Methods: We pooled the data of four cohorts of patients (N = 601, 74.9±10.8 years, 59 % men) with AHF and analysed six features of congestion at enrolment: clinical (peripheral oedema and respiratory rales), biochemical (BNP/NT-proBNP≥median), echocardiographic (inferior vena cava (IVC)≥21 mm, pulmonary artery systolic pressure (PASP)≥40 mmHg, E/e'≥15) and B-lines ≥25 (8-zones) in those with reduced (<40 %, HFrEF), mildly reduced (40-49 %, HFmrEF and preserved (≥50 %HFpEF) LVEF. Results: Compared to patients with HFmrEF (n = 110) and HFpEF (n = 201), those with HFrEF (N = 290) had higher natriuretic peptides, but prevalence of clinical (39 %), echocardiographic (IVC≥21 mm: 56 %, E/e'≥15: 57 %, PASP≥40 mmHg: 76 %) and LUS (48 %) signs of congestion was similar. In multivariable analysis, clinical (HR: 3.24(2.15-4.86), p < 0.001), echocardiographic [(IVC≥21 mm (HR:1.91, 1.21-3.03, p=0.006); E/e'≥15 (HR:1.54, 1.04-2.28, p = 0.031)] and LUS (HR:2.08, 1.34-3.24, p = 0.001) signs of congestion were significantly associated with all-cause mortality and/or HF re-hospitalization. Adding echocardiographic and LUS features of congestion to a model than included age, sex, systolic blood pressure, clinical congestion and natriuretic peptides, improved prediction at 90 and 180 days. Conclusions: Clinical and ultrasound signs of congestion are highly prevalent in patients with AHF, regardless of LVEF and their combined assessment improves risk stratification.
MeSH term(s)	Male ; Humans ; Female ; Stroke Volume/physiology ; Ventricular Function, Left/physiology ; Heart Failure/diagnosis ; Heart Failure/epidemiology ; Prognosis ; Natriuretic Peptide, Brain
Chemical Substances	Natriuretic Peptide, Brain (114471-18-0)
Language	English
Publishing date	2024-01-05
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	441230-8
ISSN	1535-6280 ; 0146-2806
ISSN (online)	1535-6280
ISSN	0146-2806
DOI	10.1016/j.cpcardiol.2024.102374
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Article: Certainties fading away: β-blockers do not worsen chronic obstructive pulmonary disease.

Verdecchia, Paolo / Cavallini, Claudio / Coiro, Stefano / Riccini, Clara / Angeli, Fabio

European heart journal supplements : journal of the European Society of Cardiology

2021 Volume 23, Issue Suppl E, Page(s) E172–E176

Abstract: For many years, β-blockers have been considered contraindicated in patients with heart failure (HF) and in those with bronchial asthma or even chronic obstructive pulmonary disease (COPD) although without clear evidence of asthma. Today, despite ... ...

Abstract	For many years, β-blockers have been considered contraindicated in patients with heart failure (HF) and in those with bronchial asthma or even chronic obstructive pulmonary disease (COPD) although without clear evidence of asthma. Today, despite overwhelming evidence of the usefulness of β-blockers, especially in HF with reduced left ventricular ejection fraction (HFrEF), and in ischaemic heart disease, some reluctance persists in using these drugs when COPD coexists. Such resistance is due to the fear that a possible worsening of bronchospasm induced by β-blockers could induce negative effects greater than the benefits. The Guidelines of the European Society of Cardiology clearly suggest that: (i) implantation of a cardiac defibrillator (ICD) are not contraindicated in COPD without clear evidence of bronchial asthma; (ii) β-blockers are only 'relatively' contraindicated when there is certainty of bronchial asthma with a documented bronchodilator response to the β2 stimulant. Therefore, bronchial asthma is not an absolute contraindication to β-blockers. The cardiologist should not limit the diagnosis of COPD to clinical suspicion, but should rely on a spirometry examination associated with any bronchodilation tests. In any case, selective β1 blockers are preferred, starting at a basic dose, which ensure a better dilator response to bronchodilators and in any case cause less bronchospasm than non-selective β-blockers. Unfortunately, there is still some reluctance to the use of β-blockers in patients with COPD associated with HF, which should be eliminated.
Language	English
Publishing date	2021-10-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1463769-8
ISSN	1554-2815 ; 1520-765X
ISSN (online)	1554-2815
ISSN	1520-765X
DOI	10.1093/eurheartj/suab116
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Article ; Online: Exercise-induced B-lines for the diagnosis of heart failure with preserved ejection fraction: a two-centre study.

Coiro, Stefano / Echivard, Mathieu / Simonovic, Dejan / Duarte, Kevin / Santos, Mario / Deljanin-Ilic, Marina / Kobayashi, Masatake / Ambrosio, Giuseppe / Girerd, Nicolas

Clinical research in cardiology : official journal of the German Cardiac Society

2023 Volume 112, Issue 8, Page(s) 1129–1142

Abstract: Background: Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging despite the use of scores/algorithms. This study intended to assess the diagnostic value of exercise lung ultrasound (LUS) for HFpEF diagnosis.: ... ...

Abstract	Background: Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging despite the use of scores/algorithms. This study intended to assess the diagnostic value of exercise lung ultrasound (LUS) for HFpEF diagnosis. Methods: We studied two independent case-control studies of HFpEF patients and control subjects undergoing different exercise protocols: (i) submaximal exercise stress echocardiography (ESE) with LUS performed by expert cardiologists (N = 116, HFpEF = 65.5%), and (ii) maximal cycle ergometer test (CET) (N = 54, HFpEF = 50%) with LUS performed by unexperienced physicians shortly trained for the study. B-line kinetics (i.e. peak values and their changes from rest) were assessed. Results: In the ESE cohort, the C-index (95% CI) of peak B-lines for HFpEF diagnosis was 0.985 (0.968-1.000), whereas the C-index of rest and exercise HFA-PEFF scores (i.e. including stress echo findings) were < 0.90 (CI 0.823-0.949), and that of H2FPEF score was < 0.70 (CI 0.558-0.764). The C-index increase of peak B-lines on top of the above-mentioned scores was significant (C-index increase > 0.090 and P-value < 0.001 for all). Similar results were observed for change B-lines. Peak B-lines > 5 (sensitivity = 93.4%, specificity = 97.5%) and change B-lines > 3 (sensitivity = 94.7%, specificity = 87.5%) were the best cutoffs for HFpEF diagnosis. Adding peak or change B-lines on top of HFpEF scores and BNP significantly improved diagnostic accuracy. Peak B-lines showed a good diagnostic accuracy in the LUS beginner-led CET cohort (C-index = 0.713, 0.588-0.838). Conclusions: Exercise LUS showed excellent diagnostic value for HFpEF diagnosis regardless of different exercise protocols/level of expertise, with additive diagnostic accuracy on top of available scores and natriuretic peptides.
MeSH term(s)	Humans ; Echocardiography, Stress/methods ; Exercise Test ; Heart Failure/diagnosis ; Lung/diagnostic imaging ; Stroke Volume ; Ventricular Function, Left
Language	English
Publishing date	2023-05-21
Publishing country	Germany
Document type	Controlled Clinical Trial ; Journal Article ; Multicenter Study
ZDB-ID	2213295-8
ISSN	1861-0692 ; 1861-0684
ISSN (online)	1861-0692
ISSN	1861-0684
DOI	10.1007/s00392-023-02219-y
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Article ; Online: Hypotension in heart failure is less harmful if associated with high or increasing doses of heart failure medication: Insights from the Swedish Heart Failure Registry.

Girerd, Nicolas / Coiro, Stefano / Benson, Lina / Savarese, Gianluigi / Dahlström, Ulf / Rossignol, Patrick / Lund, Lars H

European journal of heart failure

2023 Volume 26, Issue 2, Page(s) 359–369

Abstract: Aims: Heart failure (HF) medication may reduce blood pressure (BP). Low BP is associated with worse outcomes but how this association is modified by HF medication has not been studied. We evaluated the association between BP and outcomes according to HF ...

Abstract	Aims: Heart failure (HF) medication may reduce blood pressure (BP). Low BP is associated with worse outcomes but how this association is modified by HF medication has not been studied. We evaluated the association between BP and outcomes according to HF medication dose in HF with reduced ejection fraction (HFrEF). Methods and results: We studied HFrEF patients from the Swedish HF registry (2000-2018). Associations between systolic BP (SBP) and cardiovascular death (CVD) and/or HF hospitalization (HFH) were analysed according to doses of renin-angiotensin system (RAS) inhibitors, beta-blockers and mineralocorticoid receptor antagonists (MRA). Among 42 040 patients (median age 74.0), lower baseline SBP was associated with higher risk of CVD/HFH (adjusted hazard ratio [HR] per 10 mmHg higher SBP: 0.92, 95% confidence interval [CI] 0.92-0.93), which was less high risk under optimized RAS inhibitor and beta-blocker doses (10% decrease in event rates per 10 mmHg SBP increase in untreated patients vs. 7% decrease in patients at maximum dose, both adjusted p < 0.02). Among the 13 761 patients with repeated measurements, 9.9% reported a SBP decrease >10 mmHg when HF medication doses were increased, whereas 24.6% reported a SBP decrease >10 mmHg with stable/decreasing doses. Decreasing SBP was associated with higher risk of CVD/HFH in patients with stable (HR 1.10, 95% CI 1.04-1.17) or decreasing (HR 1.29, 95% CI 1.18-1.42) HF medication dose but not in patients with an increase in doses (HR 0.94, 95% CI 0.86-1.02). Conclusions: The association of lower SBP with higher risk of CVD/HFH is attenuated in patients with optimized HF medication. These results suggest that low or declining SBP should not limit HF medication optimization.
MeSH term(s)	Humans ; Aged ; Heart Failure/drug therapy ; Heart Failure/epidemiology ; Sweden/epidemiology ; Stroke Volume/physiology ; Hypotension/chemically induced ; Hypotension/epidemiology ; Hypotension/drug therapy ; Antihypertensive Agents ; Adrenergic beta-Antagonists/therapeutic use ; Registries
Chemical Substances	Antihypertensive Agents ; Adrenergic beta-Antagonists
Language	English
Publishing date	2023-11-21
Publishing country	England
Document type	Journal Article
ZDB-ID	1483672-5
ISSN	1879-0844 ; 1388-9842
ISSN (online)	1879-0844
ISSN	1388-9842
DOI	10.1002/ejhf.3066
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