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Article ; Online: Focus sulle linee guida ESC dell’endocardite infettiva 2023: alla luce delle nuove evidenze.

Imazio, Massimo / Milli, Massimo

Giornale italiano di cardiologia (2006)

2023 Volume 24, Issue 12, Page(s) 941–944

Title translation	Focus on 2023 ESC guidelines for the management of infective endocarditis: in light of new evidence.
MeSH term(s)	Humans ; Endocarditis, Bacterial/therapy ; Endocarditis/therapy
Language	Italian
Publishing date	2023-11-27
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2272414-X
ISSN	1972-6481 ; 1827-6806
ISSN (online)	1972-6481
ISSN	1827-6806
DOI	10.1714/4139.41337
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Article: The Role of the Left Atrium: From Multimodality Imaging to Clinical Practice: A Review.

Beltrami, Matteo / Dei, Lorenzo-Lupo / Milli, Massimo

Life (Basel, Switzerland)

2022 Volume 12, Issue 8

Abstract: In recent years, new interest is growing in the left atrium (LA). LA functional analysis and measurement have an essential role in cardiac function evaluation. Left atrial size and function are key elements during the noninvasive analysis of diastolic ... ...

Abstract	In recent years, new interest is growing in the left atrium (LA). LA functional analysis and measurement have an essential role in cardiac function evaluation. Left atrial size and function are key elements during the noninvasive analysis of diastolic function in several heart diseases. The LA represents a "neuroendocrine organ" with high sensitivity to the nervous, endocrine, and immune systems. New insights highlight the importance of left atrial structural, contractile, and/or electrophysiological changes, introducing the concept of "atrial cardiomyopathy", which is closely linked to underlying heart disease, arrhythmias, and conditions such as aging. The diagnostic algorithm for atrial cardiomyopathy should follow a stepwise approach, combining risk factors, clinical characteristics, and imaging. Constant advances in imaging techniques offer superb opportunities for a comprehensive evaluation of LA function, underlying specific mechanisms, and patterns of progression. In this literature review, we aim to suggest a practical, stepwise algorithm with integrative multimodality imaging and a clinical approach for LA geometry and functional analysis. This integrates diastolic flow analysis with LA remodelling by the application of traditional and new diagnostic imaging techniques in several clinical settings such as heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), and mitral regurgitation (MR).
Language	English
Publishing date	2022-08-04
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662250-6
ISSN	2075-1729
ISSN	2075-1729
DOI	10.3390/life12081191
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Article: Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting.

Beltrami, Matteo / Fumagalli, Carlo / Milli, Massimo

World journal of cardiology

2021 Volume 13, Issue 1, Page(s) 1–10

Abstract: Heart Failure (HF) in elderly patients is a systemic syndrome where advanced age, comorbidities with organ system deterioration, frailty and impaired cognition significantly impact outcome. Cardiac cachexia, sarcopenia and frailty despite overlap in ... ...

Abstract	Heart Failure (HF) in elderly patients is a systemic syndrome where advanced age, comorbidities with organ system deterioration, frailty and impaired cognition significantly impact outcome. Cardiac cachexia, sarcopenia and frailty despite overlap in definitions are different clinical entities that frequently coexist in HF patients. However, these co-factors often remain unaddressed, resulting in poor quality-of-life, prolonged physical disability and exercise intolerance and finally with higher rehospitalization rates and mortality. Strategy aim to increase muscle mass and muscle strength and delay the occurrence of frailty state appear essential in this regard. Common HF drugs therapy (b-blockers, angiotensin-converting enzyme inhibitors) and prescription of physical exercise program remain the cornerstone of therapeutic approach in HF patients with new promising data regarding nutritional supplementation. However, the treatment of all these conditions still remain debated and only a profound knowledge of the specific mechanisms and patterns of disease progression will allow to use the appropriate therapy in a given clinical setting. For all these reasons we briefly review current knowledge on frailty, sarcopenia and cachexia in HF patients with the attempt to define clinically significant degrees of multiorgan dysfunction, specific "red alert" thresholds in clinical practice and therapeutic approach.
Language	English
Publishing date	2021-01-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2573665-6
ISSN	1949-8462
ISSN	1949-8462
DOI	10.4330/wjc.v13.i1.1
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Article: The Treatment of Heart Failure in Patients with Chronic Kidney Disease: Doubts and New Developments from the Last ESC Guidelines.

Beltrami, Matteo / Milli, Massimo / Dei, Lorenzo Lupo / Palazzuoli, Alberto

Journal of clinical medicine

2022 Volume 11, Issue 8

Abstract: Patients with heart failure (HF) and associated chronic kidney disease (CKD) are a population less represented in clinical trials; additionally, subjects with more severe estimated glomerular filtration rate reduction are often excluded from large ... ...

Abstract	Patients with heart failure (HF) and associated chronic kidney disease (CKD) are a population less represented in clinical trials; additionally, subjects with more severe estimated glomerular filtration rate reduction are often excluded from large studies. In this setting, most of the data come from post hoc analyses and retrospective studies. Accordingly, in patients with advanced CKD, there are no specific studies evaluating the long-term effects of the traditional drugs commonly administered in HF. Current concerns may affect the practical approach to the traditional treatment, and in this setting, physicians are often reluctant to administer and titrate some agents acting on the renin angiotensin aldosterone system and the sympathetic activity. Therefore, the extensive application in different HF subtypes with wide associated conditions and different renal dysfunction etiologies remains a subject of debate. The role of novel drugs, such as angiotensin receptor blocker neprilysin inhibitors and sodium glucose linked transporters 2 inhibitors seems to offer a new perspective in patients with CKD. Due to its protective vascular and hormonal actions, the use of these agents may be safely extended to patients with renal dysfunction in the long term. In this review, we discussed the largest trials reporting data on subjects with HF and associated CKD, while suggesting a practical stepwise algorithm to avoid renal and cardiac complications.
Language	English
Publishing date	2022-04-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11082243
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Article: The relevance of specific heart failure outpatient programs in the COVID era: an appropriate model for every disease.

Beltrami, Matteo / Bartolini, Simone / Milli, Massimo / Palazzuoli, Alberto

Reviews in cardiovascular medicine

2021 Volume 22, Issue 3, Page(s) 677–690

Abstract: Heart Failure (HF) is characterized by an elevated readmission rate, with almost 50% of events occurring after the first episode over the first 6 months of the post-discharge period. In this context, the vulnerable phase represents the period when ... ...

Abstract	Heart Failure (HF) is characterized by an elevated readmission rate, with almost 50% of events occurring after the first episode over the first 6 months of the post-discharge period. In this context, the vulnerable phase represents the period when patients elapse from a sub-acute to a more stabilized chronic phase. The lack of an accurate approach for each HF subtype is probably the main cause of the inconclusive data in reducing the trend of recurrent hospitalizations. Most care programs are based on the main diagnosis and the HF stages, but a model focused on the specific HF etiology is lacking. The HF clinic route based on the HF etiology and the underlying diseases responsible for HF could become an interesting approach, compared with the traditional programs, mainly based on non-specific HF subtypes and New York Heart Association class, rather than on detailed etiologic and epidemiological data. This type of care may reduce the 30-day readmission rates for HF, increase the use of evidence-based therapies, prevent the exacerbation of each comorbidity, improve patient compliance, and decrease the use of resources. For all these reasons, we propose a dedicated outpatient HF program with a daily practice scenario that could improve the early identification of symptom progression and the quality-of-life evaluation, facilitate the access to diagnostic and laboratory tools and improve the utilization of financial resources, together with optimal medical titration and management.
MeSH term(s)	Ambulatory Care/organization & administration ; COVID-19 ; Cardiology Service, Hospital/organization & administration ; Delivery of Health Care, Integrated/organization & administration ; Heart Failure/diagnosis ; Heart Failure/epidemiology ; Heart Failure/physiopathology ; Heart Failure/therapy ; Humans ; Patient Readmission ; Prognosis ; Telemedicine/organization & administration
Language	English
Publishing date	2021-09-26
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2108910-3
ISSN	1530-6550
ISSN	1530-6550
DOI	10.31083/j.rcm2203077
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Article ; Online: Relationship between measures of left ventricular systolic and diastolic dysfunction and clinical and biomarker status in patients with hypertrophic cardiomyopathy.

Beltrami, Matteo / Bartolini, Simone / Pastore, Maria Concetta / Milli, Massimo / Cameli, Matteo

Archives of cardiovascular diseases

2022 Volume 115, Issue 11, Page(s) 598–609

Abstract: The evaluation of left ventricular (dys)function is at the core of clinical cardiology practice in patients with hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy proceeds along paradigms that are profoundly different and follows disease-specific ... ...

Abstract	The evaluation of left ventricular (dys)function is at the core of clinical cardiology practice in patients with hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy proceeds along paradigms that are profoundly different and follows disease-specific patterns of progression towards heart failure. By automatically applying a standard approach, much information is lost or misplaced, and severe degrees of dysfunction may be erroneously interpreted as mild by such an assumption. This is mostly evident during the assessment of systolic function, in which a superficial evaluation of standard variables, often relatively preserved (even in advanced stages), may lead to underestimation of clinical severity, with potential consequences, such as late referral for transplantation. Currently, specific biomarkers-particularly N-terminal prohormone of B-type natriuretic peptide and high-sensitivity cardiac troponin I-play a key role in the diagnosis, treatment and risk stratification of hypertrophic cardiomyopathy. Elevated biomarkers seem to depict patients with more severe disease, adding diagnostic and prognostic information to conventional assessments, such as left ventricular ejection fraction, New York Heart Association class and left ventricular outflow tract obstruction. For all these reasons, we provide a review of current knowledge on systo-diastolic function in patients with hypertrophic cardiomyopathy, in an attempt to define clinically significant degrees of dysfunction, biomarker status and specific "red alert" thresholds in clinical practice.
MeSH term(s)	Humans ; Stroke Volume ; Ventricular Function, Left ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/diagnosis ; Systole ; Ventricular Dysfunction, Left/diagnosis ; Ventricular Dysfunction, Left/etiology ; Biomarkers
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-09-29
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2408778-6
ISSN	1875-2128 ; 1875-2136
ISSN (online)	1875-2128
ISSN	1875-2136
DOI	10.1016/j.acvd.2022.07.002
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Article ; Online: Impact of dexmedetomidine on electrophysiological properties and arrhythmia inducibility in adult patients referred for reentrant supraventricular tachycardia ablation.

Bernardini, Andrea / Paoletti Perini, Alessandro / Padeletti, Margherita / Signorini, Umberto / Ciliberti, Davide / Poli, Claudio / Milli, Massimo / Giomi, Andrea

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing

2023 Volume 67, Issue 2, Page(s) 371–378

Abstract: Background: Drugs used for sedation/analgesia may affect the basic cardiac electrophysiologic properties or even supraventricular tachycardia (SVT) inducibility. Dexmedetomidine (DEX) is a selective alpha-2 adrenergic agonist with sedative and analgesic ...

Abstract	Background: Drugs used for sedation/analgesia may affect the basic cardiac electrophysiologic properties or even supraventricular tachycardia (SVT) inducibility. Dexmedetomidine (DEX) is a selective alpha-2 adrenergic agonist with sedative and analgesic properties. A comprehensive evaluation on use of DEX for reentrant SVT ablation in adults is lacking. The present study aims to systematically assess the impact of DEX on cardiac electrophysiology and SVT inducibility. Methods: Hemodynamic, electrocardiographic, and electrophysiological parameters and SVT inducibility were assessed before and after DEX infusion in patients scheduled for ablation of reentrant SVT. Results: The population of this prospective observational study included 55 patients (mean age of 58.7 ± 14 years, 29 males [52.7%]). A decrease in systolic and diastolic blood pressure and in heart rate was observed after DEX infusion (p = 0.001 for all). DEX increased corrected sinus node refractory time, atrial effective refractory period, AH interval, AV Wenckebach cycle length, and AV node effective refractory period without affecting the His-Purkinje conduction or ventricular myocardium refractoriness. No AV blocks or sinus arrests occurred during DEX infusion. Globally, there was no difference in SVT inducibility in basal condition or after DEX infusion (46/55 [83.6%] vs. 43/55 [78.1%] patients; p = 0.55), without a difference in isoprenaline use (p = 1.0). In 4 (7.3%) cases, the SVT was inducible only after DEX infusion. In 34.5% of cases, DEX infusion unmasked the presence of an obstructive sleeping respiratory pattern, represented mainly by snoring. Conclusions: DEX depresses sinus node function and prolongs atrioventricular refractoriness without significantly affecting the rate of SVT inducibility in patients scheduled for reentrant SVT ablation.
MeSH term(s)	Male ; Adult ; Humans ; Middle Aged ; Aged ; Dexmedetomidine ; Tachycardia, Supraventricular/drug therapy ; Tachycardia, Supraventricular/surgery ; Arrhythmias, Cardiac ; Atrioventricular Node ; Heart Rate ; Electrocardiography
Chemical Substances	Dexmedetomidine (67VB76HONO)
Language	English
Publishing date	2023-09-29
Publishing country	Netherlands
Document type	Observational Study ; Journal Article
ZDB-ID	1329179-8
ISSN	1572-8595 ; 1383-875X
ISSN (online)	1572-8595
ISSN	1383-875X
DOI	10.1007/s10840-023-01640-7
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Article ; Online: An operational approach to the execution of MR examinations in patients with CIED.

Guerrini, Laura / Mazzocchi, Silvia / Giomi, Andrea / Milli, Massimo / Carpi, Roberto

La Radiologia medica

2020 Volume 125, Issue 12, Page(s) 1311–1321

Abstract: In the context of the increasing spread of cardiac active implantable heart devices (CIEDs) in the population and of the wide diagnostic/therapeutic utility of magnetic resonance (MRI) examinations, the goal of this paper is to provide the experience of ... ...

Abstract	In the context of the increasing spread of cardiac active implantable heart devices (CIEDs) in the population and of the wide diagnostic/therapeutic utility of magnetic resonance (MRI) examinations, the goal of this paper is to provide the experience of the Santa Maria Nuova Hospital of the USL Tuscany Center in Florence and to report an organizational proposal to perform, in the hospital settings, MRI examinations on patients carrying CIED. This report is intended to show the operational choices of a Radiology Department which organizes this activity in accordance with the new Italian regulatory framework in the field of safety of MR sites (Ministero della Salute in Decreto Ministeriale 10 agosto 2018 Determinazione degli standard di sicurezza e impiego per le apparecchiature a risonanza magnetica, 2018).
MeSH term(s)	Abdomen/diagnostic imaging ; Adult ; Aged ; Aged, 80 and over ; Ankle Joint/diagnostic imaging ; Brain/diagnostic imaging ; Defibrillators, Implantable ; Electrodes, Implanted ; Equipment Safety ; Europe ; Humans ; Informed Consent ; Italy ; Legislation, Medical ; Magnetic Resonance Imaging/methods ; Magnetic Resonance Imaging/statistics & numerical data ; Middle Aged ; Models, Organizational ; Pacemaker, Artificial ; Pelvis/diagnostic imaging ; Risk Assessment ; Spine/diagnostic imaging ; Thigh/diagnostic imaging
Language	English
Publishing date	2020-05-04
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	205751-7
ISSN	1826-6983 ; 0033-8362
ISSN (online)	1826-6983
ISSN	0033-8362
DOI	10.1007/s11547-020-01206-x
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Article: The role of fibrosis, inflammation, and congestion biomarkers for outcome prediction in candidates to cardiac resynchronization therapy: is "response" the right answer?

Beltrami, Matteo / Galluzzo, Alessandro / Brocci, Riccardo Tappa / Paoletti Perini, Alessandro / Pieragnoli, Paolo / Garofalo, Manuel / Halasz, Geza / Milli, Massimo / Barilli, Maria / Palazzuoli, Alberto

Frontiers in cardiovascular medicine

2023 Volume 10, Page(s) 1180960

Abstract: Background: Cardiac resynchronization therapy (CRT) is an established treatment in selected patients suffering from heart failure with reduced ejection fraction (HFrEF). It has been proposed that myocardial fibrosis and inflammation could influence CRT " ...

Abstract	Background: Cardiac resynchronization therapy (CRT) is an established treatment in selected patients suffering from heart failure with reduced ejection fraction (HFrEF). It has been proposed that myocardial fibrosis and inflammation could influence CRT "response" and outcome. Our study investigated the long-term prognostic significance of cardiac biomarkers in HFrEF patients with an indication for CRT. Methods: Consecutive patients referred for CRT implantation were retrospectively evaluated. The soluble suppression of tumorigenicity 2 (sST2), galectin-3 (Gal-3), N-terminal portion of the B-type natriuretic peptide (NT-proBNP), and estimated glomerular filtration rate (eGFR) were measured at baseline and after 1 year of follow-up. Multivariate analyses were performed to evaluate their correlation with the primary composite outcome of cardiovascular mortality and heart failure hospitalizations at a mean follow-up of 9 ± 2 years. Results: Among the 86 patients enrolled, 44% experienced the primary outcome. In this group, the mean baseline values of NT-proBNP, Gal-3, and sST2 were significantly higher compared with the patients without cardiovascular events. At the multivariate analyses, baseline Gal-3 [cut-off: 16.6 ng/ml, AUC: 0.91, Conclusion: In HFrEF patients with CRT, sST2, Gal-3, and renal function were associated with the combined endpoint of cardiovascular death and HF hospitalizations at long-term follow-up, while the echocardiographic CRT response did not seem to influence the outcome of the patients.
Language	English
Publishing date	2023-06-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2023.1180960
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Article ; Online: Esophageal visualization changes atrial fibrillation ablation strategy: from encircling to segmental approach.

Susi, Filippo / Mascia, Giuseppe / Milli, Massimo / Di Mario, Carlo / Giaccardi, Marzia

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing

2020 Volume 59, Issue 3, Page(s) 617–618

MeSH term(s)	Atrial Fibrillation/diagnostic imaging ; Atrial Fibrillation/surgery ; Catheter Ablation ; Esophagus/diagnostic imaging ; Esophagus/surgery ; Humans ; Pulmonary Veins/surgery
Language	English
Publishing date	2020-06-03
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1329179-8
ISSN	1572-8595 ; 1383-875X
ISSN (online)	1572-8595
ISSN	1383-875X
DOI	10.1007/s10840-020-00774-2
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