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Article ; Online: Safety and efficacy of very low LDL-cholesterol intensive lowering: a meta-analysis and meta-regression of randomized trials.

Patti, Giuseppe / Spinoni, Enrico Guido / Grisafi, Leonardo / Mehran, Roxana / Mennuni, Marco

European heart journal. Cardiovascular pharmacotherapy

2023 Volume 9, Issue 2, Page(s) 138–147

Abstract: Aims: We performed a study-level meta-analysis to provide more robust evidence on safety of very low LDL-cholesterol (LDL-C) levels.: Background: Concerns on the safety of LDL-C values achieved with potent lipid-lowering therapies have been raised.!## ...

Abstract	Aims: We performed a study-level meta-analysis to provide more robust evidence on safety of very low LDL-cholesterol (LDL-C) levels. Background: Concerns on the safety of LDL-C values achieved with potent lipid-lowering therapies have been raised. Methods and results: We searched randomized trials reporting clinical outcomes with intensive lipid-lowering treatments leading to very low (<40 mg/dL) LDL-C levels vs. a control group with higher LDL-C levels. Only studies with follow-up duration ≥ 3 months were considered. Primary endpoint was the incidence of various safety measures. A total of 10 randomized trials were overall included, with 38 427 patients being in the very low LDL-C group vs. 70 668 in the control group. Median follow-up duration was 28.8 months. The incidence of all safety outcomes was similar in the two groups: non-cardiovascular death: OR 1.13, 95% CI 0.87-1.45; P = 0.36; any adverse events: OR 1.00, 0.90-1.11, P = 0.94; adverse events leading to drug discontinuation: OR 1.00, 0.87-1.15, P = 0.99; cancer: OR 1.02, 0.95-1.10, P = 0.57; haemorrhagic stroke OR 0.89, 0.66-1.20, P = 0.44; new-onset diabetes: OR 1.16, 0.91-1.47, P = 0.23; neurocognitive disorders: OR 0.97, 0.91-1.04, P = 0.41; haepatobiliary disorders: OR 0.99, 0.83-1.18, P = 0.93; muscle disorders: OR 0.94, 0.77-1.13, P = 0.49; cataract: OR 1.28, 0.78-2.10, P = 0.34. The rates of major adverse cardiovascular events were significantly lower in the very low LDL-C group: OR 0.82, 0.72-0.94, P = 0.005. Conclusion: This meta-analysis indicates that very low LDL-C levels on intensive lipid-lowering treatments are not associated with any adverse event and maintain a persistent reduction of cardiovascular events.
MeSH term(s)	Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Cholesterol, LDL ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/chemically induced ; Randomized Controlled Trials as Topic ; Cholesterol
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Cholesterol, LDL ; Cholesterol (97C5T2UQ7J)
Language	English
Publishing date	2023-01-20
Publishing country	England
Document type	Meta-Analysis ; Journal Article
ZDB-ID	2808613-2
ISSN	2055-6845 ; 2055-6837
ISSN (online)	2055-6845
ISSN	2055-6837
DOI	10.1093/ehjcvp/pvac049
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Article: Electroanatomic visualization of reentrant circuit of left fascicular ventricular tachycardia guiding a fluoroless ablation.

Scaglione, Marco / Cerrato, Natascia / Spinoni, Enrico Guido / Battaglia, Alberto / Geuna, Francesco / Caponi, Domenico

HeartRhythm case reports

2023 Volume 9, Issue 10, Page(s) 745–748

Language	English
Publishing date	2023-08-02
Publishing country	United States
Document type	Case Reports
ZDB-ID	2834871-0
ISSN	2214-0271
ISSN	2214-0271
DOI	10.1016/j.hrcr.2023.07.020
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Article ; Online: Safety and Efficacy of Selective, Clopidogrel-Based Strategies in Acute Coronary Syndrome: A Study-Level Meta-analysis.

Patti, Giuseppe / Grisafi, Leonardo / Spinoni, Enrico Guido / Rognoni, Andrea / Mennuni, Marco

Thrombosis and haemostasis

2022 Volume 122, Issue 10, Page(s) 1732–1743

Abstract: Objectives: To investigate outcomes with selective, clopidogrel-based therapies versus conventional treatment in patients undergoing percutaneous coronary intervention (PCI), especially for acute coronary syndrome.: Background: Safety and efficacy ... ...

Abstract	Objectives: To investigate outcomes with selective, clopidogrel-based therapies versus conventional treatment in patients undergoing percutaneous coronary intervention (PCI), especially for acute coronary syndrome. Background: Safety and efficacy of alternative, selective, clopidogrel-based therapies after PCI are not robustly established. Methods: We performed a study-level meta-analysis on six randomized trials investigating selective clopidogrel-based therapies (three on unguided de-escalation, Results: The incidence of major bleeding and MACE was similar in the selective, clopidogrel-based therapy versus the conventional treatment arm (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.51-1.01, Conclusion: As compared with prasugrel/ticagrelor treatment, alternative, selective, clopidogrel-based approaches provide a similar protection from cardiovascular events, reduce the risk of any bleeding, and are associated with a greater net benefit. These beneficial effects were prevalent with unguided de-escalation to clopidogrel.
MeSH term(s)	Acute Coronary Syndrome/therapy ; Clopidogrel/adverse effects ; Hemorrhage/etiology ; Humans ; Percutaneous Coronary Intervention/adverse effects ; Platelet Aggregation Inhibitors/adverse effects ; Prasugrel Hydrochloride ; Ticagrelor ; Treatment Outcome
Chemical Substances	Platelet Aggregation Inhibitors ; Clopidogrel (A74586SNO7) ; Prasugrel Hydrochloride (G89JQ59I13) ; Ticagrelor (GLH0314RVC)
Language	English
Publishing date	2022-04-18
Publishing country	Germany
Document type	Journal Article ; Meta-Analysis
ZDB-ID	518294-3
ISSN	2567-689X ; 0340-6245
ISSN (online)	2567-689X
ISSN	0340-6245
DOI	10.1055/a-1827-8041
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Article ; Online: Infective endocarditis complicating COVID-19 pneumonia: a case report.

Spinoni, Enrico Guido / Degiovanni, Anna / Della Corte, Francesco / Patti, Giuseppe

European heart journal. Case reports

2020 Volume 4, Issue 6, Page(s) 1–5

Abstract: Background: During the COVID-19 outbreak, cardiovascular imaging, especially transoesophageal echocardiography (TOE), may expose healthcare personnel to virus contamination and should be performed only if strictly necessary. On the other hand, ... ...

Abstract	Background: During the COVID-19 outbreak, cardiovascular imaging, especially transoesophageal echocardiography (TOE), may expose healthcare personnel to virus contamination and should be performed only if strictly necessary. On the other hand, transthoracic echocardiography (TTE) and TOE represent the first-line imaging exams for the diagnosis of infective endocarditis (IE). To date, this is the first case of COVID-19 complicated by IE. Case summary: We present the case of a 57-year-old man with severe COVID-19 pneumonia requiring mechanical ventilation. During the intensive care unit (ICU) stay, he developed fever and positive haemocoltures for methicillin-resistant Discussion: In COVID-19 patients, echocardiography remains the leading imaging exam for the diagnosis of IE. If the suspicion of IE is high, even in this setting of patients, TTE or TOE (if TTE is non-conclusive) are mandatory. A high degree of attention must be paid and appropriate preventive measures taken to avoid contamination of healthcare personnel.
Language	English
Publishing date	2020-11-07
Publishing country	England
Document type	Journal Article
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytaa366
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Article ; Online: Usefulness of a multiparametric evaluation including global longitudinal strain for an early diagnosis of acute myocarditis.

Degiovanni, Anna / Pastore, Maria Concetta / Spinoni, Enrico Guido / Focardi, Marta / Cameli, Matteo / Patti, Giuseppe

The international journal of cardiovascular imaging

2021 Volume 37, Issue 11, Page(s) 3203–3211

Abstract: Cardiac magnetic resonance imaging (CMRI) represents the main imaging modality for diagnosing acute myocarditis. However, its limited availability could entail missing or delayed diagnosis. A reduction of left ventricular global longitudinal strain (LV ... ...

Abstract	Cardiac magnetic resonance imaging (CMRI) represents the main imaging modality for diagnosing acute myocarditis. However, its limited availability could entail missing or delayed diagnosis. A reduction of left ventricular global longitudinal strain (LV GLS) by speckle tracking echocardiography (STE) correlates with amount of oedema in acute myocarditis and here may be early detected. Aim was to evaluate the diagnostic and prognostic role of 3-layers LV GLS in patients with acute myocarditis. Out of 122 patients with suspected acute myocarditis, a total of 86 consecutive patients with CMRI-confirmed acute myocarditis admitted in two Italian institutions were retrospectively screened. Exclusion criteria were met in 29 patients because of poor acoustic window or missing data. A total of 57 patients were then included. Clinical characteristics, laboratory examinations, transthoracic echocardiography data and STE parameters were collected early after hospitalization. In the study population, mean age was 38.8 ± 15.6 years, the prevalence of male gender was 90%. On admission, 22 patients (39%) had fever (body temperature > 37.5 °), mean white blood cell (WBC) count was 10.9 ± 1.7/10^3 and overall LV ejection fraction was 50.1% ± 11.2. An epicardial LV GLS < 18% was present in 74% of patients, and a model including at least one of LV GLS < 18% (absolute value), fever and WBC > 10.0/10^3 was able to identify all patients with CMRI-diagnosed acute myocarditis. An epicardial LV GLS < 15.3% (absolute value) at baseline significantly predicted the lack of myocarditis resolution during follow-up (AUC 0.76, 95% CI 0.58-0.93, p = 0.02). A multiparametric model including epicardial LV GLS, fever and elevated WBC count on admission could be useful for early diagnosing an acute myocarditis, especially when CMRI is not promptly available. Baseline epicardial LV GLS may also identify patients with less-likely myocarditis resolution.
MeSH term(s)	Adult ; Early Diagnosis ; Echocardiography ; Humans ; Male ; Middle Aged ; Myocarditis/diagnostic imaging ; Predictive Value of Tests ; Retrospective Studies ; Ventricular Function, Left ; Young Adult
Language	English
Publishing date	2021-06-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2055311-0
ISSN	1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
ISSN (online)	1875-8312 ; 1573-0743
ISSN	1569-5794 ; 0167-9899
DOI	10.1007/s10554-021-02299-9
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Article ; Online: Atrio-ventricular block in a young patient with multisystemic c-antineutrophilic cytoplasmic antibody vasculitis with myocardial involvement: a case report.

De Zan, Giulia / Spinoni, Enrico Guido / Degiovanni, Anna / Rosso, Greta / Guglielmetti, Gabriele / Dell'Era, Gabriele / Cantaluppi, Vincenzo / Patti, Giuseppe

Journal of cardiovascular medicine (Hagerstown, Md.)

2022 Volume 24, Issue 2, Page(s) 143–146

MeSH term(s)	Humans ; Vasculitis
Language	English
Publishing date	2022-11-15
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2223461-5
ISSN	1558-2035 ; 1558-2027
ISSN (online)	1558-2035
ISSN	1558-2027
DOI	10.2459/JCM.0000000000001408
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Zs.A 5210: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Safety and Efficacy of Selective, Clopidogrel-Based Strategies in Acute Coronary Syndrome: A Study-Level Meta-analysis

Patti, Giuseppe / Grisafi, Leonardo / Spinoni, Enrico Guido / Rognoni, Andrea / Mennuni, Marco

Thrombosis and Haemostasis

2022 Volume 122, Issue 10, Page(s) 1732–1743

Abstract	Objectives: To investigate outcomes with selective, clopidogrel-based therapies versus conventional treatment in patients undergoing percutaneous coronary intervention (PCI), especially for acute coronary syndrome. Background: Safety and efficacy of alternative, selective, clopidogrel-based therapies after PCI are not robustly established. Methods: We performed a study-level meta-analysis on six randomized trials investigating selective clopidogrel-based therapies (three on unguided de-escalation, N = 3,473; three on guided clopidogrel therapy, N = 7,533). Control groups received ticagrelor or prasugrel treatment. Main endpoints were major bleeding, any bleeding, major adverse cardiovascular events (MACE), and net clinical endpoint. Results: The incidence of major bleeding and MACE was similar in the selective, clopidogrel-based therapy versus the conventional treatment arm (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.51–1.01, p = 0.06; OR: 0.93, 0.72–1.20, p = 0.58; respectively). The rates of any bleeding were lower in the selective, clopidogrel-based therapy versus conventional treatment group (OR: 0.57, 95% CI: 0.40–0.80, p = 0.001); this greater safety was significant for unguided de-escalation (OR: 0.43, 95% CI: 0.32–0.58, p = 0.00001) and nonsignificant for guided clopidogrel therapy (OR: 0.72, 95% CI: 0.51–1.02, p = 0.07; p for interaction: 0.03). The incidence of the net clinical endpoint was fewer in the selective, clopidogrel-based therapy versus the conventional treatment arm (OR: 0.59, 95% CI: 0.41–0.85, p = 0.004); this benefit was significant for unguided de-escalation (OR: 0.50, 95% CI: 0.39–0.64, p < 0.00001) and nonsignificant for guided clopidogrel therapy (OR 0.85, 95% CI: 0.62–1.16, p = 0.30; p for interaction: 0.01). Conclusion: As compared with prasugrel/ticagrelor treatment, alternative, selective, clopidogrel-based approaches provide a similar protection from cardiovascular events, reduce the risk of any bleeding, and are associated with a greater net benefit. These beneficial effects were prevalent with unguided de-escalation to clopidogrel.
Keywords	acute coronary syndrome ; percutaneous coronary intervention ; de-escalation ; guided clopidogrel therapy ; MACE
Language	English
Publishing date	2022-04-18
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	518294-3
ISSN	2567-689X ; 0340-6245
ISSN (online)	2567-689X
ISSN	0340-6245
DOI	10.1055/a-1827-8041
Database	Thieme publisher's database

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Article ; Online: Early effects of left bundle branch area pacing on ventricular activation by speckle tracking echocardiography.

Dell'Era, Gabriele / Ghiglieno, Chiara / Degiovanni, Anna / De Vecchi, Federica / Porcellini, Stefano / Santagostino, Matteo / Veroli, Alessandro / D'Amico, Anthea / Spinoni, Enrico Guido / Patti, Giuseppe

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

2023 Volume 67, Issue 2, Page(s) 341–351

Abstract: Background: Left bundle branch area pacing (LBBAP) is an emerging cardiac pacing modality that preserves fast electrical activation of the ventricles and provides very good electrical measures. Little is known on mechanical ventricular activation during ...

Abstract	Background: Left bundle branch area pacing (LBBAP) is an emerging cardiac pacing modality that preserves fast electrical activation of the ventricles and provides very good electrical measures. Little is known on mechanical ventricular activation during this pacing modality. Methods: We prospectively enrolled patients receiving LBBAP. Electrocardiographic and electrical parameters were evaluated at implantation, < 24 h and 3 months. Transthoracic echocardiography with strain analysis was performed at baseline and after 3 months, when ventricular mechanical activation and synchrony were analyzed by time-to-peak standard deviation (TPSD) of strain curves for both ventricles. Intraventricular left ventricular (LV) dyssynchrony was investigated by LV TPSD and interventricular dyssynchrony by left ventricle-right ventricle TPSD (LV-RV TPSD). Results: We screened 58 patients with permanent pacing indication who attempted LBBAP. Procedural success was obtained in 56 patients (97%). Strain data were available in 50 patients. QRS duration was 124.1 ± 30.7 ms at baseline, while paced QRS duration was 107.7 ± 13.6 ms (p < 0.001). At 3 months after LBBAP, left ventricular ejection fraction (LVEF) increased from 52.9 ± 10.6% at baseline to 56.9 ± 8.4% (p = 0.004) and both intraventricular LV dyssynchrony and interventricular dyssynchrony significantly improved (LV TPSD reduction from 38.2 (13.6-53.9) to 15.1 (8.3-31.5), p < 0.001; LV-RV TPSD from 27.9 (10.2-41.5) to 13.9 (4.3-28.7), p = 0.001). Ameliorations with LBBAP were consistent in all subgroups, irrespective of baseline QRS duration, types of intraventricular conduction abnormalities, and LVEF. Conclusions: Echocardiographic strain analysis shows that LBBAP determines a fast and synchronous biventricular contraction with a stereotype mechanical activation, regardless of baseline QRS duration, pattern, and LV function.
MeSH term(s)	Humans ; Heart Ventricles/diagnostic imaging ; Stroke Volume ; Cardiac Pacing, Artificial ; Ventricular Function, Left ; Echocardiography ; Electrocardiography ; Treatment Outcome
Language	English
Publishing date	2023-08-21
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/s10840-023-01616-7
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Article ; Online: Infective endocarditis complicating COVID-19 pneumonia

Spinoni, Enrico Guido / Degiovanni, Anna / Della Corte, Francesco / Patti, Giuseppe

European Heart Journal - Case Reports ; ISSN 2514-2119

a case report

2020

Abstract: Abstract Background During the COVID-19 outbreak, cardiovascular imaging, especially transoesophageal echocardiography (TOE), may expose healthcare personnel to virus contamination and should be performed only if strictly necessary. On the other hand, ... ...

Abstract	Abstract Background During the COVID-19 outbreak, cardiovascular imaging, especially transoesophageal echocardiography (TOE), may expose healthcare personnel to virus contamination and should be performed only if strictly necessary. On the other hand, transthoracic echocardiography (TTE) and TOE represent the first-line imaging exams for the diagnosis of infective endocarditis (IE). To date, this is the first case of COVID-19 complicated by IE. Case summary We present the case of a 57-year-old man with severe COVID-19 pneumonia requiring mechanical ventilation. During the intensive care unit (ICU) stay, he developed fever and positive haemocoltures for methicillin-resistant Staphylococcus aureus infection. TTE did not identify endocardial vegetations. TOE was then performed and outlined IE of the aortic valve on the non-coronary cusp. Antibiotic therapy was given with progressive resolution of the septic state and improvement of inflammatory signs. After 30 days of ICU stay, the patient was transferred to the Sub-ICU and then to a rehabilitation hospital. A close follow-up has been scheduled: after full recovery, a new echocardiography will be performed (TTE and TOE, if the former is non-conclusive) to consider surgical valve repair in the case of persistence/progression of the valvular lesion or deterioration of the valve function. Discussion In COVID-19 patients, echocardiography remains the leading imaging exam for the diagnosis of IE. If the suspicion of IE is high, even in this setting of patients, TTE or TOE (if TTE is non-conclusive) are mandatory. A high degree of attention must be paid and appropriate preventive measures taken to avoid contamination of healthcare personnel.
Keywords	covid19
Language	English
Publisher	Oxford University Press (OUP)
Publishing country	uk
Document type	Article ; Online
DOI	10.1093/ehjcr/ytaa366
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Article: Predictive Value of Echocardiographic Pulmonary to Left Atrial Ratio for In-Hospital Death in Patients with COVID-19.

Renda, Giulia / Mennuni, Marco G / Pizzoferrato, Giovanni / Esposto, Daniele / Alberani, Angela / De Vecchi, Simona / Degiovanni, Anna / Giubertoni, Ailia / Spinoni, Enrico Guido / Grisafi, Leonardo / Sagazio, Emanuele / Ucciferri, Claudio / Falasca, Katia / Vecchiet, Jacopo / Gallina, Sabina / Patti, Giuseppe

Diagnostics (Basel, Switzerland)

2023 Volume 13, Issue 2

Abstract: Background: Echocardiographic Pulmonary to Left Atrial Ratio (ePLAR) represents an accurate and sensitive non-invasive tool to estimate the trans-pulmonary gradient. The prognostic value of ePLAR in hospitalized patients with COVID-19 remains unknown. We ...

Abstract	Background: Echocardiographic Pulmonary to Left Atrial Ratio (ePLAR) represents an accurate and sensitive non-invasive tool to estimate the trans-pulmonary gradient. The prognostic value of ePLAR in hospitalized patients with COVID-19 remains unknown. We aimed to investigate the predictive value of ePLAR on in-hospital mortality in patients with COVID-19. Methods: One hundred consecutive patients admitted to two Italian institutions for COVID-19 undergoing early (<24 h) echocardiographic examination were included; ePLAR was determined from the maximum tricuspid regurgitation continuous wave Doppler velocity (m/s) divided by the transmitral E-wave: septal mitral annular Doppler Tissue Imaging e′-wave ratio (TRVmax/E:e′). The primary outcome measure was in-hospital death. Results: patients who died during hospitalization had at baseline a higher prevalence of tricuspid regurgitation, higher ePLAR, right-side pressures, lower Tricuspid Annular Plane Systolic Excursion (TAPSE)/ systolic Pulmonary Artery Pressure (sPAP) ratio and reduced inferior vena cava collapse than survivors. Patients with ePLAR > 0.28 m/s at baseline showed non-significant but markedly increased in-hospital mortality compared to those having ePLAR ≤ 0.28 m/s (27% vs. 10.8%, p = 0.055). Multivariate Cox regression showed that an ePLAR > 0.28 m/s was independently associated with an increased risk of death (HR 5.07, 95% CI 1.04−24.50, p = 0.043), particularly when associated with increased sPAP (p for interaction = 0.043). Conclusions: A high ePLAR value at baseline predicts in-hospital death in patients with COVID-19, especially in those with elevated pulmonary arterial pressure. These results support an early ePLAR assessment in patients admitted for COVID-19 to identify those at higher risk and potentially guide strategies of diagnosis and care.
Language	English
Publishing date	2023-01-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13020224
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