Curriculum-Vitae

Carmine Muto    ( Napoli 08/08/1958 )

  • Laurea in medicina e chirurgia università Federico II Napoli (1990/91)

  • Specialista in geriatria , perfezionato in Elettrofisiologia Clinica presso l’Università Cattolica del sacro cuore (1996/96),cardiologia.

  • Assistente medico di Cardiologia,Ospedale Pellegrini Nuovo (1991)

  • Dirigente medico di cardiologia     A.S.L.   CE2   (2003)

  • Dirigente medico di cardiologia Ospedale Loreto Mare Napoli (2003)

 

Cardiologo interventista esperto nel trattamento delle aritmie, mediante ablazioni trans-catetere , e nel trattamento dello scompenso cardiaco mediante impianti di stimolatori Bi-Ventricolari  CRT.

 

Oltre 8000 procedure eseguite: Impianti di Pacemakers, impianti di Defibrillatori, impianti di Defibrillatori Biventricolari, Cardioversioni elettriche, Studi Elettrofisiologici Endocavitari, Ablazioni trans catetere.

 

Responsabile di  numerosi corsi di perfezionamento per la terapia non farmacologica dello scompenso cardiaco (impianti di stimolatori bi ventricolari CRT), e per le ablazioni trans catetere, di aritmie complesse, mediante l’uso di sistemi di mappaggio tridimensionali.

 

Collaborazioni scientifiche con istituti di ricerca nazionali, e internazionali

 

Collaborazione nella stesura del trattato Italiano  di Elettrofisiologia e Cardiostimolazione Cardiaca (2009)

 

Presidente regionale AIAC (2006/08)

 

Membro della commissione Avarie e complicanze dei device impiantabili AIAC (2006/08)

 

Relazioni a congressi nazionali e  internazionali , tra i principali: ESC ,AHA, HRS, Progres in clinical pacing, Venice arrhythmias, Cardiostim, World congress on cardiac pacing and electrophysiology AMCO, AIAC.

Principale investigatore in studi multicentrici : LODO CRT, NARROW CRT, RIGHT- PACE. Co- investigatore in studi multicentrici internazionali.

Citazioni in lavori scientifici di notevole rilevanza internazionale, tra cui:

linee guida dell’immaging ecocardiografica, per l’impianto di stimolatori bi ventricolari  (gruppi di lavoro delle società scientifiche italiane dell’ìmmaging ecocardiografica),  (LODO CRT TRIALS  Muto e tal HR 2010)

 

2012 EHRA/HRS  expert consensus statement on cardiac resynchronization therapy in heartfailure: implant and follow-up recommendations and management.

            
 Developed in partnership with the European Heart Rhyth Association (EHRA) A registered branch of the European Socie  of Cardiology (ESC), and the Heart Rhythm Society; and in collaboration with the Heart Failure Society of America (HFSA), the American Society of Echocardiography (ASE), the American Heart  Association (AHA), the European Association of Echocardiography (EAE) of the ESC and the Heart Failure Association of the ESC (HFA).Endorsed by the governing bodies of EACVI, AHA, ASE, HFSA, HFA,
(LODO CRT TRIALS  Muto e tal HR 2010)

Pubblicazioni scientifiche:

Lead complications, device infections, and clinical outcomes in the first year after implantation of cardiac resynchronization therapy-defibrillator and cardiac resynchronization therapy-pacemaker.

Schuchert AMuto CMaounis TFrank RBoulogne EPolauck APadeletti Lfor the MASCOT study group.

Europace 2012 Aug 26. [Epub ahead of print]

Friedrich-Ebert Hospital, Medical Clinic, Friesenstr. 11, D 24531 Neumünster, Germany.

Abstract

AIMS: The decision to implant a cardiac resynchronization therapy (CRT) system with (defibrillator, CRT-D) or without (pacemaker, CRT-P) cardioverter defibrillator should weigh its benefits and risks. This study examined the (i) incidence of loss of capture and infectious complications and (ii) 1-year clinical outcomes of 402 CRT-D and CRT-P recipients enrolled in the MASCOT study.METHODS AND RESULTS: The indications for CRT-D or CRT-P were posed by the implanting physicians. All (i) losses of atrial and right and left ventricular capture, (ii) system-related infections, and (iii) clinical outcomes, including hospitalizations for worsening heart failure (HF) and deaths from all causes, were recorded up to 1 year of follow-up. Cardiac resynchronization therapy-defibrillator was implanted in 228 (57%) and CRT-P in 174 (43%) patients. The incidence of loss of capture was greater in CRT-D with 21 patients (9.2%) than in CRT-P with 6 patient (3.5%) recipients (P = 0.01), while the infection rates were 1.3% (3 patients) and 1.2% (2 patients), respectively (ns). In the CRT-D group, 42 of 228 patients (18.4%) died or were hospitalized for HF, compared with 38 of 174 patients (21.8%) in the CRT-P group (ns). In the CRT-D group, 23 patients (10.1%) were hospitalized for worsening HF and 20 (8.8%) patients died, vs. 22 (12.6%) and 19 (10.9%) patients, respectively, in the CRT-P group (ns for both comparisons).CONCLUSIONS: Cardiac resynchronization therapy-defibrillator was implanted in 57% of candidates for CRT. Within 1 year after device implant, the incidence of loss of capture at any lead was nearly three-fold greater among CRT-D than among CRT-P recipients. System-related infections were infrequent and clinical outcomes were similar in both groups.

  N. Engl J Med 2012 Jan

Subclinical atrial fibrillation and the risk of stroke.

Healey JSConnolly SJGold MRIsrael CWVan Gelder ICCapucci ALau CPFain EYang SBailleul CMorillo CACarlson M,Themeles EKaufman ESHohnloser SHASSERT Investigators.

 

Collaborators (328)

Connolly S, Bailleul C, Capucci A, Carlson M, Fain E, Healey JS, Hohnloser S, Israel C, Lau CP, Morillo C, Themeles E, Van Gelder I, Crystal E, Armagenian L, Blomstrom P, Brandes A, Connolly S, Costantini O, Dahl T, Divakaramenon S, Eikelboom J,Fodor G, Goto S, Guimaraes HP, Halon D, Hartikainen J, Healey JS, Hohnloser S, Hussan M, Israel C, Kaufman E, Keltai M,Kristensen KS, Lau C, Lonn E, Mairesse GH, Morillo C, Nair G, Nayak H, Oldgren J, Onalan O, Parkash R, Peker A, Sandhu R,Simmers T, Swissa M, Thibault B, Turazza F, Zimlichman R, Dorian P, Ellenbogen K, Roberts RS, Andrews J, Bourgeois C,Ecker C, Bouchez D, Boulogne E, Daems K, Willems V, Aasen-Johnston L, Biggs T, Blankensteiner J, Lidén Mascher K, Palo M, Bourguiba A, Razani M, Bodden C, Huemmer A, Scheiner J, Yakzan M, Lau E, Lau S, Yim L, Day K, Watson D, Tkach Y,Gazzola C, Guidotto T, Silvestri P, Ichishima Y, Manabe M, Hubregtse M, Silva C, Garcia de Rivera R, Llorente E, Santamaria Rebollo P, Castaneda M, Dalal Y, Oza A, Saberi L, Shkurovich S, Djuric A, Napoleoni R, Pogue J, Themeles E, Yang S, Mond HG, Benzer W, Bitschnau R, Formanek M, Mlczoch J, Teubl A, Trinks S, Weber H, Zweng A, El Allaf D, Leroy JL, Mairesse GH, Ayala-Paredes F, Beaudoin J, Becker G, Birnie DH, Blier L, Cameron DA, Crystal E, Divakaramenon S, Guerra PG, Houde G, Janmohamed A, Khaykin Y, Kus T, Lai C, Lashevsky I, Lau C, Leather R, Marchand F, Nair G, Nath A, Nigro F, Ottinger B,Parkash R, Ribas S, Sapp JL, Shearer B, Sinha SN, Sterns L, Sturmer ML, Talajic M, Tang AS, Tang A, Thibault B, Tung S,Van Kieu C, Winger K, Brandes A, Hoejberg S, Karlsen M, Pedersen OD, Salo TM, Cransac F, Cung TT, Davy JM, Brachmann J, Duray GZ, Hansen C, Heuer HH, Himmrich E, Holt SH, Israel CW, Karolyi L, Kloppe AK, Lawo TL, Lemke BL, Mijic DM,Mügge A, Neubauer H, Neuzner J, Schade A, Schmitt J, Schumacher B, Seidl K, Spitzer SG, Cokkinos DV, Maounis TN,Poulos GD, Chan NY, Fan KY, Lau CP, Leung SK, Siu DC, Tam LW, Tsang CY, Tse HF, McFadden S, McGrath F, Sheahan R,Antonelli D, Freedberg NA, Geist M, Glikson M, Gurevitz O, Halfin Z, Katz A, Khalameizer V, Kuznitz H, Luria D, Militianu A,Steinvil A, Strasberg B, Swissa M, Tarchitzki D, Viskin S, Zeltser D, Carreras G, Coppola A, Eligiato M, Liberti F, Lisi F, Muto C, Pelargonio G, Pratola C, Rauhe WG, Scipione P, Sisto F, Speca G, Toselli T, Tuccillo B, Villani GQ, Abe H, Kanda G,Kohno R, Manaka T, Mizutani K, Nagatomo T, Noro M, Okajima K, Sakata T, Shoda M, Sugi K, Yagishita D, Kim YN, Khelae S, Omar R, Atar D, Hegrenæs L, Nesvold A, Alves MA, Cunha PM, Francisco A, Madeira FJ, Martins VP, Morais CM, Rebelo AM, Sanfins VM, Silva FJ, Torres AM, Cazorla M, Gusi G, Martín A, Martínez A, Matiello ML, Mont L, Frick E, Jakobsson S,Lönnerholm S, Österberg BL, Chen WJ, Liu YB, Breuls NP, Hazeleger R, Scholten MF, Tuininga YS, Van Gelder IC, Abdullah EE, Abi-Samra F, Ahern TS, Akula DN, Athill C, Baer ML, Barber MJ, Belott P, Birgersdotter-Green UM, Brodine WN, Browne KF, Cardona F, Caruso AC, Ciuffo AC, Cole CR, Conard L, Cooper JM, Costantini O, Costeas CA, Croitoru M, Curtis GP,Deering TF, Donahue T, Edwards TS, Fu EU, Glenn JL, Goodman JS, Grogan EW, Gursoy AS, Hughes DG, Jaffe BD, Jazayeri MR, Kall JG, Kaplan AJ, Kaufman ES, Kavesh NG, Khan MN, Kushner JA, Lan DZ, Lee JK, Leman RB, Liu ZG, Machell CH,Nath S, Nayak HM, Ngo MM, Nichols AJ, Nsah EN, Pritchard T, Roelke M, Rogers JD, Sandler MJ, Schuger CD, Sheppard RC,Sholevar DP, Silva EA, Silver MT, Sklar J, Strobel JS, Strunk BL, Sturdivant JL, Telfer EA, Tran AT, VanHamersveld DD, Villareal RP.

Population Health Research Institute, McMaster University, Hamilton, ON, Canada.

Abstract

BACKGROUND:

One quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. We evaluated whether subclinical episodes of rapid atrial rate detected by implanted devices were associated with an increased risk of ischemic stroke in patients who did not have other evidence of atrial fibrillation.

METHODS:

We enrolled 2580 patients, 65 years of age or older, with hypertension and no history of atrial fibrillation, in whom a pacemaker or defibrillator had recently been implanted. We monitored the patients for 3 months to detect subclinical atrial tachyarrhythmias (episodes of atrial rate >190 beats per minute for more than 6 minutes) and followed them for a mean of 2.5 years for the primary outcome of ischemic stroke or systemic embolism. Patients with pacemakers were randomly assigned to receive or not to receive continuous atrial overdrive pacing.

RESULTS:

By 3 months, subclinical atrial tachyarrhythmias detected by implanted devices had oc  curred in 261 patients (10.1%). Subclinical atrial tachyarrhythmias were associated with an increased risk of clinical atrial fibrillation (hazard ratio, 5.56; 95% confidence interval [CI], 3.78 to 8.17; P<0.001) and of ischemic stroke or systemic embolism (hazard ratio, 2.49; 95% CI, 1.28 to 4.85; P=0.007). Of 51 patients who had a primary outcome event, 11 had had subclinical atrial tachyarrhythmias detected by 3 months, and none had had clinical atrial fibrillation by 3 months. The population attributable risk of stroke or systemic embolism associated with subclinical atrial tachyarrhythmias was 13%. Subclinical atrial tachyarrhythmias remained predictive of the primary outcome after adjustment for predictors of stroke (hazard ratio, 2.50; 95% CI, 1.28 to 4.89; P=0.008). Continuous atrial overdrive pacing did not prevent atrial fibrillation.

CONCLUSIONS:

Subclinical atrial tachyarrhythmias, without clinical atrial fibrillation, occurred frequently in patients with pacemakers and were associated with a significantly increased risk of ischemic stroke or systemic embolism. (Funded by St. Jude Medical; ASSERT ClinicalTrials.gov number, NCT00256152.).

 

  Am.Heart J. 2012 Mar

Low-dose dobutamine test associated with interventricular dyssynchrony: a useful tool to identify cardiac resynchronization therapy responders: data from the LOw dose DObutamine stress-echo test in Cardiac Resynchronization Therapy (LODO-CRT) phase 2 study.

Gasparini M, Muto C, Iacopino S, Zanon F, Dicandia C, Distefano G, Favale S, Peraldo Neja C, Bragato R, Davinelli M, Mangoni L, Denaro A.

Am.Heart J. 2012 Mar;163(3):422-9. doi: 10.1016/j.ahj.2011.11.015. Epub 2012 Jan 20.

 

IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy.OSPEDALE L. MARE NAPOLI

Abstract

BACKGROUND:

Cardiac resynchronization therapy (CRT) is effective in patients with heart failure, but 30% to 50% of subjects are classified as nonresponders. Identifying responders remains a challenging task.

AIMS:

The LODO-CRT trial investigated the association between left ventricular contractile reserve (LVCR) and clinical and echocardiographic long-term CRT response.

METHODS:

This is a multicenter, prospective, observational study. Left ventricular contractile reserve was detected using a dobutamine stress echocardiography test, defined as an ejection fraction increase of >5 points. Clinical CRT response was defined as the absence of major cardiovascular events (ie, cardiovascular death or heart failure hospitalization). Echocardiographic response was defined as a left ventricle end-systolic volume reduction of >10%.

RESULTS:

A total of 221 CRT-indicated patients were studied (80% presented LVCR). During a mean follow-up of 15 ± 5 months, 17 patients died and 16 were hospitalized due to heart failure. The proportion of clinical responders was 155 (88%) of 177 and 33 (75%) of 44 (P = .036) in the groups with and without LVCR, respectively. Kaplan-Meier analysis showed a significant difference in cardiac survival/hospitalization between patients with and without LVCR. The proportion of echocardiographic responders was 144 (87%) of 166 and 16 (42%) of 38 in the groups with and without LVCR (P < .001), respectively; LVCR showed 90% sensitivity and 87% positive predictive value to prefigure echocardiographic CRT responders. Multivariable analysis identified LVCR and interventricular dyssynchrony as independent predictors of CRT response. The concomitant presence of both facto rs showed 99% specificity and 83% sensitivity in detecting responders.

 

 

 Heart Rhithm 2010 Nov;

Presence of left ventricular contractile reserve predicts midterm response to cardiac resynchronization therapy--results from the LOw dose DObutamine stress-echo test in Cardiac Resynchronization Therapy (LODO-CRT) trial.

Muto C, Gasparini M, Neja CP, Iacopino S, Davinelli M, Zanon F, Dicandia C, Distefano G, Donati R, Calvi V, Denaro A, Tuccillo B.

Heart Rhithm 2010 Nov;7(11):1600-5. doi: 10.1016/j.hrthm.2010.07.036. Epub 2010 Aug 3.

Ospedale Santa Maria di Loreto Mare, Napoli, Italia. carminemuto@libero.it

Abstract

BACKGROUND:

Cardiac resynchronization therapy (CRT) is effective in selected patients with heart failure (HF). Nevertheless, the nonresponder rate remains high. The low-dose dobutamine stress-echo (DSE) test detects the presence of left ventricular (LV) contractile reserve (LVCR) in HF patients of any etiology and may be useful in predicting response to resynchronization.

OBJECTIVE:

The purpose of this study was to present the results of the LODO-CRT trial, which evaluated whether LVCR presence at baseline increases the chances of response to CRT.

METHODS:

LODO-CRT is a multicenter prospective study that enrolled CRT candidates according to guidelines. LVCR presence was defined as an LV ejection fraction increase >5 units during DSE test. CRT response is assessed at 6-month follow-up as an LV end-systolic volume reduction ≥10%.

RESULTS:

Two hundred seventy-one patients were enrolled. The DSE test was feasible without complications in 99% of patients. Nine patients died from noncardiac disease, and 31 presented inadequate data. Two hundred thirty-one patients were included in the analysis. Mean patient age was 67 ± 10 years; 95% were in New York Heart Association class III, and 42% had HF of ischemic etiology. Mean QRS and LV ejection fraction were 147 ± 25 ms and 27% ± 6%, respectively. LVCR presence was found in 185 subjects (80%). At follow-up, 170 (74%) patients responded to CRT, 145/185 in the group with LVCR (78%) and 25/46 (54%) in the group without LVCR. Difference in responder proportion to CRT was 24% (P <.001). Reported test sensitivity is 85%.

CONCLUSION:

The DSE test in CRT candidates is safe and feasible. LVCR presence at baseline increases the chances of response to CRT.

  

 Congest. Heart Fail. 2010 May-Jun

Low-dose dobutamine stress echocardiography to assess left ventricular contractile reserve for cardiac resynchronization therapy: data from the Low-Dose Dobutamine Stress Echocardiography to Predict Cardiac Resynchronization Therapy Response (LODO-CRT) trial.

Iacopino S, Gasparini M, Zanon F, Dicandia C, Distefano G, Curnis A, Donati R, Neja CP, Calvi V, Davinelli M, Novelli V, Muto C.

Congest. Heart Fail. 2010 May-Jun;16(3):104-10. doi: 10.1111/j.1751-7133.2010.00141.x.

 

Sant'Anna Hospital, Catanzaro, Italy. iacopino@iol.it

Abstract

Cardiac resynchronization therapy (CRT) is an effective methodology indicated in selected heart failure patients. Identifying responders to the therapy is still challenging. Most studies report that at least 30% of the patients are nonresponders. Baseline characteristics of the Low-Dose Dobutamine Stress Echocardiography to Predict Cardiac Resynchronization Therapy Response (LODO-CRT) trial population are presented. The study investigates dobutamine stress echocardiography's role in predicting CRT response. Two hundred seventy-one CRT candidates were studied. Mean age was 67+/-10 years, 69% were male, 96% had New York Heart Association class III disease, and 39% had heart failure of ischemic etiology. Mean QRS and left ventricular ejection fraction were 146+/-24 ms and 26%+/-6%, respectively. Seventy-seven percent of participants showed contractile reserve. Left ventricular end-diastolic volume was shown to be independently associated with contractile reserve presence. In particular, more dilated ventricles are associated with a lower chance of having contractile reserve. The LODO-

 

 Pacing clin Elettrophisiol  2009 Mar;

 

Effect of right ventricular apical pacing in survivors of myocardial infarction.

Muto C, Ascione L, Canciello M, Carreras G, Iengo R, Ottaviano L, Calvanese R, Accadia M, Celentano E, Ciardiello C, Tuccillo B.

Pacing clin Elettrophisiol  2009 Mar;32 Suppl 1:S173-6. doi: 10.1111/j.1540-8159.2008.02279.x.

 

Electrophysiology and Echocardiography, Department of Cardiology, S.M. Loreto Mare Hospital, Naples, Italy. carminemuto@yahoo.it

Abstract

BACKGROUND:

Much information is available regarding the possible negative effects of long-term right ventricular (RV) apical pacing, which may cause worsening of heart failure. However, very limited data are available regarding the effects of RV pacing in patients with a previous myocardial infarction (MI).

METHODS AND RESULTS:

We screened 115 consecutive post-MI patients and matched a group of 29 pacemaker (PM) recipients with a group of 49 unpaced patients, for age, left ventricular (LV) ejection fraction, and site of MI. During a median follow-up of 54 months, echocardiograms showed a decrease in LV ejection fraction in the paced group, from 51 +/- 10 to 39 +/- 11 (P < 0.01), and a minimal change in the unpaced group, from 57 +/- 8 to 56 +/- 7 (P = 0.98). Similar change was observed in systolic and diastolic diameters and volumes.

CONCLUSIONS:

The study showed that, in post-MI patients, RV apical pacing was associated with a worsening of LV function, suggesting that, among MI survivors, the need for a PM is a marker of worse outcome.

CRT trial enrolled a cohort of patients fulfilling criteria for CRT. Dobutamine stress echocardiography was highly feasible and safe in this population. Contractile reserve was associated with healthier ventricles.

 

 Europace 2009 May;11(5):587-93.

Dual-chamber implantable cardioverter defibrillators reduce clinical adverse events related to atrial fibrillation when compared with single-chamber defibrillators: a subanalysis of the DATAS trial.

Ricci RP, Quesada A, Almendral J, Arribas F, Wolpert C, Adragao P, Zoni-Berisso M, Navarro X, DeSanto T, Grammatico A, Santini M;DATAS study Investigators.

Collaborators (109)

Lüderitz B, Schwab J, Lewalter T, Schimpf R, Pignalberi C, Russo M, Neri SF, Hanrath P, Stellbrink Ch, Mischke K, Koos R,Brugada J, Mont L, Matas M, Gill J, Simon R, Rinaldi A, Gall N, Glikson M, Roda J, Villalba S, Palanca V, Belchi J, Muto C,Canciello M, Carreras G, Tuccillo B, Arenal A, Gonzalez-Torrecillas E, Atienza F, Borggrefe M, Spehl S, Merino JL, Peinado R,La Paz H, Rodriguez JC, Medina O, García J, Morgado F, Lozano I, Toquero J, Arroyo R, Ormaetxe JM, Arkotxa M, Steinbeck G, Hoffman E, Janko S, Dorwarth U, Geist M, Turkisher V, Della Bella P, Fassini G, Carbucicchio C, Giraldi F, Golino P,Viscusi M, Mascia F, Tercedor L, Alvarez M, Martinez JG, Ibañez A, Moya A, Rodriguez E, Alonso C, Gil ML, Sanz J, Garcia-Civera R, Ruiz R, Morell S, SanJuan R, García-Alberola A, Martinez J, Sanchez JJ, Manz M, Burkhardt D, Markewitz A,Castellanos E, Rodriguez-Padial L, Sassara M, Achilli A, Scabbia E, Olagüe J, Pareja JE, Sancho-Tello MJ, La Fe H, Hohnloser S, Grönefeld G, Fuchs T, Jung W, Schwick N, Roggenbuck-Schwilk B, Lemke B, Lawo T, Deneke T, Holt S, Baumann G,Bondke H, Claus M, Maresta A, Silvani S, Cornacchia D, Tampieri E, Manzano JJ, Medina A, Caballero E, Wangüemert F,Robles JA, Korte T, Viñolas X.

Heart Diseases Department, San Filippo Neri Hospital, Via Martinotti 20, 00135 Rome, Italy. renatopietroricci@tin.it

Abstract

AIMS:

The aim of the present analysis of the DATAS study was to compare the impact of dual- vs. single-chamber defibrillators on atrial fibrillation (AF) occurrence and AF-related clinical events in patients with Class I indication for implantable cardioverter defibrillators (ICDs) and no indication for dual-chamber pacing.

METHODS AND RESULTS:

Three hundred and thirty-four patients were randomized, through a centralized assignment, to single-chamber ICDs, dual-chamber ICDs programmed as single-chamber ICDs, and dual ICDs with full diagnostics and AF prevention and therapy capabilities. The latter two groups in the first 8 months of the study, when the study design was that of a randomized parallel trial, were compared in the present analysis. The primary endpoint was composed by the following AF-related clinical events: permanent AF, AF-related hospitalizations, cardiac-embolic events, and inappropriate ICD shocks due to AF misclassification. Two hundred and twenty-three patients were available for this analysis, of whom 111 in the single-chamber-simulated group and 112 in the dual-chamber true group. Atrial fibrillation-related composite endpoint raw incidence was 9 of 111 (8.1%) in the single-chamber group vs. 1 of 112 (0.9%) in the dual-chamber group (P = 0.0098 by Fisher's exact test). Single-chamber ICDs were associated with a significantly higher risk to develop the AF-related composite endpoint by Cox regression analysis (hazard ratio 8.25, 95% CI 1.03-65.96, P = 0.047) and by the Kaplan-Meier survival analysis (log-rank test, P = 0.047).

CONCLUSION:

Dual-chamber ICDs compared with single-chamber ICDs reduced the incidence of an endpoint composed by permanent AF, AF

 

 

 Am Heart J. 2008 Oct;

Efficacy of LOw-dose DObutamine stress-echocardiography to predict cardiac resynchronization therapy response (LODO-CRT) multicenter prospective study: design and rationale.

Muto C, Gasparini M, Iacopino S, Peraldo C, Curnis A, Sassone B, Diotallevi P, Davinelli M, Valsecchi S, Tuccillo B.

Am Heart J. 2008 Oct;156(4):656-61. doi: 10.1016/j.ahj.2008.06.011. Epub 2008 Aug 27.

 

Ospedale Santa Maria di Loreto Mare, Napoli, Italy.

Abstract

BACKGROUND:

Although cardiac resynchronization therapy (CRT) has a well-demonstrated therapeutic effect in selected patients with advanced heart failure on optimized drug therapy, nonresponder rate remains high. The LODO-CRT is designed to improve patient selection for CRT. Design and rationale of this study are presented herein.

METHODS:

LODO-CRT is a multicenter prospective study, started in late 2006, that enrolls patients with conventional indications for CRT (symptomatic stable New York Heart Association class III-IV on optimized drug therapy, QRS > or =120 milliseconds, left ventricular [LV] dilatation, LV ejection fraction < or =35%). This study is designed to assess the predictive value of LV contractile reserve (LVCR), determined through dobutamine stress echocardiography (defined as an LV ejection fraction increase >5 units), in predicting CRT response during follow-up. Assessment of CRT effects will follow 2 sequential phases: in phase 1, CRT response end point is defined as LV end-systolic volume reduction > or =10% at 6 months; in phase 2, both LV end-systolic volume reduction and clinical status via a clinical composite score will be evaluated at 12 months follow-up. Predictive value of LVCR will be compared to other measures, such as LV dyssynchrony measures, through adjusted multivariable analysis. For the purpose of the study, target patient number is 270 (with 95% confidence, 80% power, alpha < or = .05). Enrollment should be complete by the end of 2008.

CONCLUSIONS:

The LODO-CRT trial is testing the hypothesis that LVCR assessment, using low-dose dobutamine stress echocardiography test, should effectively predict positive response to CRT both in terms of the reverse remodeling process as well as favorable long-term clinical outcome. Moreover, the predictive value of LVCR will be compared to that of conventional intra-LV dyssynchrony measures.

-related hospitalizations, and ICD shocks deemed inappropriate due to AF misclassification.

 

 Europace  2008 May;10(5):528-35. Epub 2008 Apr 7.

Dual-chamber defibrillators reduce clinically significant adverse events compared with single-chamber devices: results from the DATAS (Dual chamber and Atrial Tachyarrhythmias Adverse events Study) trial.

Almendral J, Arribas F, Wolpert C, Ricci R, Adragao P, Cobo E, Navarro X, Quesada A; DATAS Steering Committee; DATAS Writing Committee; DATAS Investigators.

Collaborators (105)

Lüderitz B, Schwab J, Lewalter T, Schimpf R, Santini M, Ricci R, Pignalberi C, Russo M, Hanrath P, Stellbrink Ch, Mischke K,Koos R, Brugada J, Mont L, Matas M, Gill J, Simon R, Rinaldi A, Gall N, Glikson M, Roda J, Villalba S, Palanca V, Belchi J,Muto C, Canciello M, Carreras G, Tuccillo B, Arenal A, Gonzalez-Torrecillas E, Atienza F, Borggrefe M, Spehl S, Merino JL,Peinado R, Rodriguez JC, Medina O, García J, Morgado F, Lozano I, Toquero J, Arroyo R, Ormaetxe JM, Arkotxa M, Steinbeck G, Hoffman E, Janko S, Dorwarth U, Geist M, Turkisher V, Della Bella P, Fassini G, Carbucicchio C, Giraldi F, Golino P,Viscusi M, Mascia F, Tercedor L, Alvarez M, Martinez JG, Ibañez A, Moya A, Rodriguez E, Alonso C, Lopez Gil M, Sanz J,Garcia-Civera R, Ruiz R, Morell S, SanJuan R, García-Alberola A, Martinez J, Sanchez JJ, Manz M, Burkhardt D, Markewitz A,Castellanos E, Rodriguez-Padial L, Sassara M, Achilli A, Scabbia E, Olagüe J, Pareja JE, Sancho-Tello MJ, Hohnloser S,Grönefeld G, Fuchs T, Jung W, Schwick N, Roggenbuck-Schwilk B, Lemke B, Lawo T, Deneke T, Holt S, Baumann G, Bondke H, Claus M, Maresta A, Silvani S, Cornacchia D, Tampieri E, Manzano JJ, Medina A, Caballero E, Wangüemert F.

Cardiology Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain. almendral@secardiologia.es

Abstract

AIMS:

This randomized trial evaluated clinically significant adverse events (CSAEs), in patients implanted with dual-chamber (DC) vs. single-chamber (SC) implantable cardioverter defibrillator (ICD). DC-ICD had atrial tachyarrhythmia (AT) therapy capabilities. Strict programming recommendations were reinforced.

METHODS AND RESULTS:

Patients with conventional SC-ICD indication were randomized to DC-ICD, SC-ICD, or a DC-ICD programmed as an SC-ICD (SC-simulated) and followed for 16 months. Patients in the DC and SC-simulated groups crossed over after 8 months. The primary endpoint was a composite of CSAE: all-cause mortality; invasive intervention; hospitalization (> 24 h) for cardiovascular causes; inappropriate shocks (two or more episodes); and sustained symptomatic AT lasting > 48 h. The outcome variable was a pre-specified score that corrected for clinical severity and follow-up duration. Three hundred and thirty-four patients were analysed (DC-ICD, n = 112; SC-ICD, n = 111; SC-simulated, n = 111). The mean left ventricular ejection fraction was 0.36 +/- 0.13, 69% were in functional class > or = II. CSAE occurred in 65 DC-ICD, 82 SC-ICD, and 84 SC-simulated patients. The outcome variable was 33% lower in the DC-ICD group (OR 0.31; 95% CI 0.14-0.67; P = 0.0028). Mortality was 4% in DC, 9% in SC, and 10% in SC-simulated.

CONCLUSION:

In patients with a standard SC-ICD indication, DC-ICD was associated with less CSAE when compared with

 

 J Cardiuvasolular Elettrophisiol 2008 Jul;19(7):693-701. Epub 2008 Mar 4.

Persistent atrial fibrillation worsens heart rate variability, activity and heart rate, as shown by a continuous monitoring by implantable biventricular pacemakers in heart failure patients.

Puglisi A, Gasparini M, Lunati M, Sassara M, Padeletti L, Landolina M, Botto GL, Vincenti A, Bianchi S, Denaro A, Grammatico A, Boriani G; InSync III Italian Registry Investigators

Collaborators (87)

Gasparini M, Galimberti P, Regoli F, Gronda E, Lunati M, Cattafi G, Magenta G, Paolucci M, Vecchi R, Achilli A, Sassara M,Gaita F, Bocchiardo M, DiDonna P, Caponi D, Padeletti L, Pieragnoli P, Tavazzi L, Landolina M, Frattini F, Rordorf R, Pentimalli F, Vicentini A, Favilli R, Vincenti A, De Ceglia S, Cirò A, Puglisi A, Peraldo C, Bianchi S, Orazi S, Botto G, Luzi M, Sagone A,Boriani G, Biffi M, Martignani C, Frabetti L, Cesario A, Vado A, Zanon F, Molon G, Barbieri E, Bertaglia E, Carboni A, Ardissino D, Gonzi G, Serra V, Vergara G, Ravazzi PA, Diotallevi P, Curnis A, Mascioli G, Sassone B, Bridda A, De Fabrizio G, Alfano F,Luzzi G, Tomasi C, Maresta A, Piancastelli M, Perego G, Inama G, Mantovan R, Neri G, Fusco A, Vicentini A, Baraldi P,Briedda M, Zardo F, Vaglio A, Delise P, Romanò M, Orvieni C, Bardelli G, Tuccillo B, Muto C, Occhetta E, Montani E, Altamura G, Sabato D, Santini M, Ricci R, Raviele A, Gasparini G, Spampinato A, Martelli M.

 

Abstract

BACKGROUND:

Atrial fibrillation (AF) induces loss of atrial contribution, heart rate irregularity, and fast ventricular rate. Objectives: The objectives of the study were to accurately measure AF incidence and to investigate the mutual temporal patterns of AF and heart failure (HF) in patients indicated to cardiac resynchronization therapy.

METHODS:

Four hundred ten consecutive patients (70% male, age 69 +/- 11) with advanced HF (NYHA = 3.0 +/- 0.6), low ejection fraction (EF = 27 +/- 9%), and ventricular conduction delay (QRS = 165 +/- 29 ms) received a biventricular pacemaker. Enrolled patients were divided into two groups: G1 = 249 patients with no AF history, G2 = 161 patients with history of paroxysmal/persistent AF.

RESULTS:

In a median follow-up of 13 months, AF episodes longer than 5 minutes occurred in 105 of 249 (42.2%) G1 patients and 76 of 161 (47.2%) G2 patients, while AF episodes longer than one day occurred in 14 of 249 (5.6%) G1 patients and in 36 of 161 (22.4%) G2 patients. Device diagnostics monitored daily values of patient activity, night heart rate (NHR), and heart rate variability (HRV). Comparing 30-day periods before AF onset and during persistent AF, significant (P < 0.0001) changes were observed in patient activity, which decreased from 221 +/- 13 to 162 +/- 12 minutes, and in NHR, which increased from 68 +/- 3 to 94 +/- 7 bpm. HRV significantly decreased (from 75 +/- 5 ms before AF onset to 60 +/- 6 ms after AF termination). NHR during AF was significantly (P < 0.01) and inversely correlated (R(2)= 0.73) with activity, with a significant lower activity associated with NHR >or= 88 bpm.

CONCLUSION:

AF is frequent in HF patients. Persistent AF is associated with statistically significant decrease in patient activity and HRV and NHR increase.

SC-ICD.

  Am Heart J. 2008 Sep;156(3):520-6. doi: 10.1016/j.ahj.2008.04.013. Epub 2008 Jul 7.

Atrial fibrillation in recipients of cardiac resynchronization therapy device: 1-year results of the randomized MASCOT trial.

Padeletti L, Muto C, Maounis T, Schuchert A, Bongiorni MG, Frank R, Vesterlund T, Brachmann J, Vicentini A, Jauvert G, Tadeo G, Gras D, Lisi F, Dello Russo A,Rey JL, Boulogne E, Ricciardi G; Management of Atrial fibrillation Suppression in AF-HF COmorbidity Therapy Study Group.

Abstract

BACKGROUND:

Atrial fibrillation (AF) is associated with increased morbidity and mortality in patients suffering from heart failure (HF). Patients in New York Heart Association HF classes III or IV, with systolic dysfunction and a wide QRS, are candidates for cardiac resynchronization therapy (CRT), and might benefit from atrial overdrive pacing (AOP).

METHODS:

The Management of Atrial fibrillation Suppression in AF-HF COmorbidity Therapy (MASCOT) trial enrolled 409 CRT device recipients (79% men), who were randomly assigned to AOP ON (n = 197), versus AOP OFF (n = 197) and followed up for 1 year. Their mean age was 68 +/- 10 years, left ventricular ejection fraction 25 +/- 6%, QRS duration 163 +/- 29 milliseconds. New York Heart Association class III was present in 86% of patients and 19% had a history of paroxysmal AF. The primary study end point was incidence of permanent AF at 1 year.

RESULTS:

Atrial overdrive pacing increased the percentage of atrial pacing from 30% to 80% (P < .0001), was well tolerated, and did not interfere with (a) delivery of CRT (95% mean ventricular pacing in both groups), (b) response to CRT (70% responders in the control vs 67% in the treatment group), or (c) cardiac function (left ventricular ejection fraction increased from 24.5% +/- 6.2% to 32.7% +/- 10.9% in the control and from 25.8% +/- 6.8% to 33.1% +/- 12.6% in the treatment group). The incidence of permanent AF was 3.3% in both groups. By logistic regression analysis, a history of AF (P < .001) and absence of antiarrhythmic drugs (P = .002) were associated with permanent AF.

CONCLUSIONS:

In this first trial of a specific AF prevention algorithm in CRT recipients, AOP was safe and did not worsen HF. The prevention algorithm did not lower the 1-year incidence of AF.

 

 J Am Soc. Echocardiograf.2008 Sep;21(9):1055-61. doi: 10.1016/j.echo.2008.06.002. Epub 2008 Jul 23.

End-diastolic wall thickness as a predictor of reverse remodelling after cardiac resynchronization therapy: a two-dimensional echocardiographic study.

Ascione L, Muto C, Iengo R, Celentano E, Accadia M, Rumolo S, D'Andrea A, Carreras G, Canciello M, Tuccillo B.

S. Maria of Loreto Hospital, Naples, Italy.

Abstract

BACKGROUND:

The aim of this study was to evaluate whether in patients with ischemic heart failure (HF) with mechanical dyssynchrony the echocardiographic assessment of the extent of scarred ventricular tissue by end-diastolic wall thickness (EDWT) could predict reverse remodeling (RR) after cardiac resynchronization therapy (CRT). Recent studies using cardiac magnetic resonance imaging have shown that the burden of myocardial scar is an important factor influencing response to CRT, despite documented mechanical dyssynchrony. EDWT assessed by two-dimensional (2D) resting echocardiography is a simple and reliable marker to identify scar tissue in patients with ischemic left ventricular dysfunction.

METHODS:

Seventy-four patients with ischemic HF were evaluated 1 week before and 6 months after CRT. Inclusion criteria were New York Heart Association class III or IV, ejection fraction < 35%, QRS duration > 120 ms, and mechanical intraventricular dyssynchrony >/= 65 ms. The left ventricle was divided into 16 segments; left ventricular (LV) segments with EDWT < 6 mm were considered scarred. Percentage global scar area (GSA) was calculated by dividing the number of scarred LV segments by 16.

RESULTS:

RR, defined as a reduction of LV end-systolic volume >/= 15%, was found in 38 patients (51.4%) with ischemic HF. A significant inverse linear relationship was found between GSA and RR (r = -0.57; P = .0001). Mean percentage GSA was significantly higher in nonresponders (31.6 +/- 18% vs 6.4 +/- 11%; P < .001). GSA </= 18% showed sensitivity and specificity of 94.7% and 77.8%, respectively (area under the curve, 0.86; 95% confidence interval, 0.71-0.95; P < .0001), to predict RR.

CONCLUSION:

The extent of ventricular segments with EDWT < 6 mm assessed by 2-D echocardiography is an important factor influencing response to CRT at follow-up. GSA may represent an essential simple adjunct to mechanical asynchrony to better select patients suitable for CRT.

 

 Pacing Clin. Elettrophisiol. 2008 Jul;31(7):819-27. doi: 10.1111/j.1540-8159.2008.01096.x.

A radial global dyssynchrony index as predictor of left ventricular reverse remodeling after cardiac resynchronization therapy.

Ascione L, Iengo R, Accadia M, Rumolo S, Celentano E, D'Andrea A, De Michele M, Muto C, Carreras G, Maglione M, Tuccillo B, Roelandt J.

Division of Cardiology, S. Maria di Loreto Hospital, Naples, Italy.

Abstract

BACKGROUND:

Cardiac mechanical efficiency requires that opposing left ventricular regions are coupled both in shortening and lengthening during the same phase of cardiac cycle. Aim of this study was to evaluate whether global measures of mechanical dyssynchrony are able to predict reverse remodeling of the left ventricle in patients receiving cardiac resynchronization therapy (CRT).

METHODS:

Sixty-two patients underwent a clinical examination, including New York Heart Association class evaluation and 6-minute walking distance and both echocardiographic study before and 6 months after CRT. Intraventricular dyssynchrony was evaluated by two-dimensional strain echocardiography, measuring the amount of uncoordinated contraction and relaxation between septum and free wall for both longitudinal and radial function and was presented as the longitudinal global dyssynchrony index (LGDI) and the radial global dyssynchrony index (RGDI). Reverse remodeling was defined by a left ventricular end systolic volume reduction >or= 15%.

RESULTS:

After CRT 39 patients showed reverse remodeling. In this group, RGDI (0.74 +/- 0.26 vs 0.32 +/- 0.30; P = 0.0001) and LGDI (0.52 +/- 0.28 vs 0.30 +/- 0.24; P = 0.002) were significantly higher than in nonresponders. A receiver-operating characteristic curve analysis showed that RGDI >0.47 and LGDI >0.34 had a sensitivity and a specificity to predict reverse remodeling of 87% and 74%, 82%, and 74%, respectively. Stepwise forward multiple logistic regression analysis showed that RGDI (O.R.:13.4; 95%C.I.:4.2-120.5; P < 0.0001) was an independent determinant of a positive response to CRT. A radial global dyssynchrony index predicts left ventricular reverse remodeling after CRT.

 

 J Interv. Card. Elettrophisiol. 2008 Nov;23(2):121-6. doi: 10.1007/s10840-008-9255-9. Epub 2008 Jun 28.

Presence of left ventricular contractile reserve, evaluated by means of dobutamine stress-echo test, is able to predict response to cardiac resynchronization therapy.

Tuccillo B, Muto C, Iengo R, Accadia M, Rumolo S, Canciello M, Carreras G, Calvanese R, Celentano E, Davinelli M, Valsecchi S, Ascione L.

Santa Maria di Loreto Mare Hospital, Naples, Italy.

Abstract

INTRODUCTION:

We evaluated whether the dobutamine stress-echo test can select responders to cardiac resynchronization therapy (CRT). Up to 50% of patients do not respond to CRT. Lack of response may be due to a significant amount of scar or fibrotic tissue at myocardial level.

METHODS AND RESULTS:

We studied 42 CRT patients. After clinical and echocardiographic evaluation, all patients underwent a dobutamine stress-echo test to assess contractile reserve. Cut-off for the test was an increase of 25% of the left ventricular ejection fraction. Patients were implanted with a CRT-defibrillator and followed up at 6 months. Cut-off for CRT response was a reduction of 15% of left ventricular end-systolic volume. Twenty-five patients responded to CRT; all of them showed presence of contractile reserve. The test showed a sensitivity of 100% and a specificity of 88%.

CONCLUSION:

Contractile reserve was a strong predictive factor of response to CRT in the studied population.

 

 J cardiovasc elettrophisiol.2007 Sep;18(10):1032-6. Epub 2007 Jul 30.

Effect of pacing the right ventricular mid-septum tract in patients with permanent atrial fibrillation and low ejection fraction.

Muto C, Ottaviano L, Canciello M, Carreras G, Calvanese R, Ascione L, Iengo R, Accadia M, Celentano E, Tuccillo B.

Electrophysiology Laboratory, Department of Cardiology, S.M. Loreto Mare Hospital, Naples, Italy.

Abstract

INTRODUCTION:

Permanent right ventricular (RV) pacing leads have been traditionally implanted in the right ventricular apex (RVA). Nowadays, some deleterious effects of RVA pacing have been recognized. The aim of this study was to evaluate the effect of different sites of RV pacing in patients with permanent atrial fibrillation (AF) and low ejection fraction (LEF) needing a pacemaker (PM) implantation.

METHODS:

Two hundred seventy-three patients with permanent AF and EF <30% underwent a one-chamber rate responsive (VVIR) PM implant procedure. Patients were divided into two groups: Group A, including 113 patients with the pacing lead tip placed in the RV mid-septum, and Group B of 120 patients with the pacing lead tip placed at the apex of RV. All patients had clinical and Echo control after 1, 3, 6, 12, and 18 months after PM implantation to assess New York Heart Association (NYHA) class and EF.

 

 

 

 J Cardiovasc Med. 2007 Jun;8(6):414-8.

Is it possible to create a linear lesion with no local electrograms? Comparison between a three-dimensional mapping system and conventional fluoroscopy for cavotricuspid isthmus ablation of typical atrial flutter.

Muto C, Canciello M, Carreras G, Ottaviano L, Ascione L, Angelini S, Tuccillo B.

Department of Cardiology, S. Maria di Loreto Nuovo Hospital, Naples, Italy.

Abstract

OBJECTIVE:

The aim of this prospective, randomised study was to evaluate the efficacy, safety and long-term outcomes of the complete disappearance of local electrograms along the linear lesion using the EnSite NavX three-dimensional mapping system as compared with conventional fluoroscopy for ablation of typical atrial flutter (AFL).

METHODS:

Seventy-three patients with spontaneous AFL episodes were randomised to undergo fluoroscopy-guided (group I, n=35) or EnSite NavX-guided (group II, n=38) ablation. When bidirectional isthmus block was achieved, the catheter was navigated back along the ablation line to assess the presence of local potentials along the lesion line.

RESULTS:

Bidirectional isthmus block was achieved in all patients. Mean total fluoroscopy time was 19.8 +/- 4.1 min in group I and 9.1 +/- 3.5 min in group II (P<0.001); mean fluoroscopy time required for radiofrequency ablation was 6.9 +/- 1.4 min in group I and 0.6 +/- 0.3 min in group II (P<0.001). During a follow-up of 16 +/- 9 months, three patients in group I (10%) experienced recurrence of AFL as opposed to none in group II (P<0.005).

CONCLUSIONS:

NavX technology allows accurate re-navigation of the lesion line to assess the presence of local potentials during an ablation procedure for typical AFL. Electroanatomic activation mapping can accurately identify gaps in the linear radiofrequency lesion with no AFL recurrence compared with 20% of recurrences after a standard procedure.

 

RESULTS:

After 18 months, NYHA class changed in Group A from 2.9 +/- 0.4 at implant to 1.7 +/- 0.3 at 18 months (P = 0.01), and in Group B from 3.0 +/- 0.5 at implant to 3.3 +/- 0.6 at 18 months (P = n.s.). EF increased in Group A: 28 +/- 2% at implant, 33 +/- 1% at 18 months (P = 0.0125), while no significant changes were observed in Group B: at implant 27 +/- 2%, 26 +/- 2% at 18 months (P = n.s.).

CONCLUSION:

The present study suggests that more physiological pacing from the RV sept can improve EF and quality of life (QoL) in patients with permanent AF and low EF needing a PM.

 Cardiology  2007;108(4):358-62. Epub 2007 Feb 14.

Is it possible to perform a linear lesion with no local electrograms using a three-dimensional mapping system for the ablation of typical atrial flutter?

Muto C, Ottaviano L, Canciello M, Carreras G, Angelini S, Tuccillo B.

Department of Cardiology, S.M. Loreto Nuovo, Naples, Italy.

Abstract

AIMS:

A randomized prospective study to evaluate the efficacy, safety and long-term outcomes of the complete disappearance of local electrograms along the linear lesion using the EnSite NavX three-dimensional mapping system compared to the conventional fluoroscopy-based mapping for the ablation of typical atrial flutter (AFL).

METHODS:

83 patients with spontaneous AFL episodes were randomized to the conventional procedure (group I, 41 patients) or to the EnSite NavX three-dimensional mapping system (group II, 42 patients). When bidirectional block was achieved, a renavigation of the ablation line was performed to verify the absence of local potentials along the line.

RESULTS:

In all patients, bidirectional isthmus block was achieved. Total mean fluoroscopy time was 19.8 +/- 4.1 min and 9.1 +/- 3.5 min (p < 0.001) and radiofrequency (RF) mean fluoroscopy time was 6.9 +/- 1.4 min and 0.6 +/- 0.3 min (p < 0.001), respectively, in group I and II. During long-term follow-up of 16 +/- 9 months, there were 4 (10%) AFL recurrences in group I and 0 in group II (p < 0.005).

CONCLUSION:

NavX accurately renavigates the lesion line and verifies local potentials. The electro-anatomic activation map accurately identifies gaps in the RF lesion line and no recurrences were found compared with 10% recurrences after standard procedures for typical AFL.

 

 Minerva Cardioangiology (c) 2007 S. Karger AG, Basel. 2002 Feb;50(1):53-61.

Aortic atheroma. An unknown source of ischemic stroke.

[Article in English, Italian]

Accadia M, Ascione L, Tartaglia PF, Guarini P, De Michele M, Muto C, Sacra C, Tuccillo B.

Divisione di Cardiologia con UTIC, Ospedale Loreto Mare, Naples, Italy.

Abstract

Cerebrovascular mortality represents 25% of all cardiovascular mortality. Defining the pathological mechanism of an episode of ischemic stroke is important for epidemiological, prognostic and overall therapeutic purposes. About 1/4 of ischemic strokes are defined as being of unknown cause. The use of transesophageal echocardiography for studying the aortic arch and thoracic aorta, revealed that aortic atheroma can be considered as an embolic source. Retrospective studies documented a significant prevalence of atheroma >4 mm in the aortic arch in patients with previous stroke (15%); while prospective studies documented an increased risk for cardiovascular events in patients with plaque of =/> 4 mm in thickness at the level of the thoracic aorta compared with controls without these lesions: in particular, the incidence of recurrent stroke is 12%/year, while the incidence of cardiovascular events is 26%. Plaques defined unstable and at risk of embolic event are protrudent, >4 mm in thickness, without calcification and have on their surface mobile thrombus. Embolization from a protrudent atheroma can have a iatrogenic cause, that is cardiac catheterization or placement of an intra-aortic balloon- pump or during cardiopulmonary bypass. The management of the subject with aortic atheroma is not well defined. Encouraging dates with the use of statins are from a recent meta-analysis also anticoagulant treatment versus antiplatelet treatment, reduced incidence of stroke in a significant manner. The surgical therapy of aortic endoarterectomy, has, at this moment, a limited indication, because is not without risk. Transesophageal ecocardiography is a method of choice for the study of the aortic atheroma and it should be done in every patient with stroke by unknown cause.

 

 Iurnal of cardiovascular diagnosis and procedure 1999 january

Left ventricular hypertrophy and risk of ventricular arrhythmia and sudden cardiac death in hypertensive elderly patients

 Cacciapuoti F. Muto C.  Minicucci F. Briganti LMirra G. and Giovanni D’angelo G.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

























Scompenso Cardiaco e Aritmie