Papers by Sergio Bongioanni
European Heart Journal Supplements, May 1, 2022
European Heart Journal Supplements, May 1, 2023
European Heart Journal Supplements, May 1, 2023
European Heart Journal Supplements, Dec 14, 2022
Background Subcutaneous ICD (S-ICD) is a safe and effective tool in preventing sudden cardiac dea... more Background Subcutaneous ICD (S-ICD) is a safe and effective tool in preventing sudden cardiac death (SCD) and it has the potential to overcome the limitations of transvenous ICDs. Because of increased left ventricular mass and unpredictable electrical substrate, concerns regarding the safety and efficacy of S-ICD in hypertrophic cardiomyopathy (HCM) patients have been raised. Material and Methods We retrospectively collected clinical data from consecutive HCM patients who underwent ICD implantation and were followed at our Cardiology Department from January 2000 to January 2022. Results Among 702 HCM patients, 52 (7.4%) received an ICD (female, 30.7%; mean age at implantation, 49 ± 20; primary prevention, 86.5%; S-ICD, 13%; single-chamber ICD, 50%). During a mean follow up of 8 ± 5 years, 27 shocks occurred in 20 (38%) patients of which 11 appropriate shocks (AS) in 9 (17%) patients and 16 inappropriate shocks (IS) in 11 (21%) patients, respectively after 4.3 ± 3 and 5 ± 4 years. AS were due to ventricular tachycardia (7) and ventricular fibrillation (4) and occurred in 9 patients with transvenous ICD vs. 0 in S-ICD patients (100% vs. 0%, p=0.32). IS were due to AF (8), PSVT (3), sinus tachycardia (2), and oversensing (3), with a non-significant trend towards a higher rate in patients with transvenous ICD compared to those with S-ICD (33% vs 14%, p=0.41). Device-related complications (DC) were recorded in 14 (27%) patients and were secondary to lead fracture (6), pocket hematoma (3), pneumothorax (1), device malfunctioning (1), endocarditis (2), and venous thrombosis (1). Compared to S-ICD, transvenous ICD was associated with a non-significant higher risk of DC (31% vs. 0%, p=0.17). Conclusions In HCM patients at high risk of SCD, when compared to transvenous ICD, S-ICD is related to a non-significant lower rate of IS and DC, with similar rate of AS. Further randomized studies as well as large prospective registries are needed to confirm these findings.
Giornale italiano di cardiologia, Feb 1, 2002
La rottura di cuore nell'infarto miocar-dico acuto (IMA) è attualmente la seconda causa di m... more La rottura di cuore nell'infarto miocar-dico acuto (IMA) è attualmente la seconda causa di morte ospedaliera dopo lo scom-penso cardiaco1-8. La stima della frequenza di tale evento è però ancora controversa. I dati sono estre-mamente contrastanti a seconda che pro-vengano ...
European Heart Journal Supplements, Dec 14, 2022
PubMed, Feb 1, 1999
Left ventricular free wall rupture (LVFWR) may complicate an acute myocardial infarction (AMI); i... more Left ventricular free wall rupture (LVFWR) may complicate an acute myocardial infarction (AMI); its frequency ranges from 1 to 6 percent. In the era of coronary care units, LVFWR is the second cause of in-hospital death, after pump failure. The subacute presentation accounts for 2-3 percent of total hospital admissions for AMI. Heart rupture may not be suddenly fatal and sometimes there is enough time for surgical repair. Electromechanical dissociation is neither the only nor the main clinical presentation. More subtle symptoms occurring hours or days before the final event include unexplained hypotension and transient bradycardia and some ECG features such as persistent ST-segment elevation with T-waves failing to invert in the same leads. On echocardiographic subcostal view, pericardial effusion of more than 5-10 mm, with echo-dense masses overlying the heart independently of cardiac tamponade, is highly suggestive of heart rupture. If pericardiocentesis yields hemorrhagic fluid, surgical intervention is mandatory, providing both diagnostic confirmation and definitive treatment. Medical management strategies (prolonged bed rest, beta-blockade therapy) are still experimental but could become suitable for particular subsets of patients (elderly patients and patients at a high surgical risk). We report two cases of subacute LVFWR and review the currently available literature.
International Journal of Cardiology, Dec 1, 2018
Background: Psoriasis has been associated with a higher prevalence of cardiovascular disease risk... more Background: Psoriasis has been associated with a higher prevalence of cardiovascular disease risk factors. However, there is inadequate quantification on the association between psoriasis and acute coronary syndrome (ACS), particularly in the elderly. Therefore, the aim of the present study was to assess the risk of ACS according to history of psoriasis in subjects aged 75 years and older. Methods: We carried out a case control study based on 1455 cases and 1108 controls. Cases were all the patients admitted in the randomized Elderly ACS 2 trial. Controls were selected from subjects aged ≥75 years included in the Prevalence of Actinic Keratoses in the Italian Population Study (PraKtis), based on a representative sample of the general Italian population. Odds ratios (OR) of ACS according to history of psoriasis were obtained using a multiple logistic regression model including terms for age, sex and smoking. Results: The prevalence of psoriasis was lower among cases (12/1455, 0.8%) than among controls (18/1108, 1.6%). The multivariate OR of ACS according to history of psoriasis was 0.51 (95% confidence interval: 0.23-1.09). Conclusions: Our data does not support an association between psoriasis and risk of ACS in the elderly.
European Heart Journal Supplements, May 1, 2023
European Heart Journal Supplements
Background Since 2014, European Guidelines have recommended using a novel clinical risk predictio... more Background Since 2014, European Guidelines have recommended using a novel clinical risk prediction model, called the HCM Risk-SCD, to identify which patients with hypertrophic cardiomyopathy (HCM) who are at higher risk for sudden cardiac death (SCD) and would benefit most from having a prophylactic cardioverter defibrillator (ICD) implantable. In recent years, evidence has called into question the effectiveness of this model in patient selection. Material and Methods Data from consecutive patients with HCM and ICD who were followed at our Cardiology Department from January 2000 to January 2022 were retrospectively collected. Results Among 702 HCM patients, 52 (7%) received an ICD (female, 31%; mean age at implantation, 49 ± 20; S-ICD, 13%; single-chamber ICD, 50%). Of them, 7 (13%) patients were implanted for secondary prevention while 45 (87%) for primary prevention. Out of the 45 primary prevention patients, 7 (16%) experienced 8 appropriate shocks (AS) while 10 (22%) had 15 inap...
Journal of Cardiovascular Medicine
European Heart Journal Supplements
Background “Restrictive phenotype” is an uncommon presentation of Hypertrophic Cardiomyopathy (HC... more Background “Restrictive phenotype” is an uncommon presentation of Hypertrophic Cardiomyopathy (HCM), associated with severe functional limitation and poor prognosis. For this reason, current therapeutic aims are prevention of complications through periodic follow–ups and diagnostic investigations, up to the ICD placement. Objectives The primary aim of this study was to evaluate the impact of the restrictive filling pattern in HCM on the incidence of complex composite outcome included arrhythmic events, events related to heart failure and general events, correlating it to clinical and imaging data. Methods This study is an experimental, multicentric, retrospective and non–randomized analysis, including all patients over the age of 18 suffering from classical HCM, excluding phenocopies and systolic dysfunction. Patients were followed up and selected by specialized Centers of Trieste and Turin and divided by degree of diastolic dysfunction, particularly on the basis of the presence or ...
European Heart Journal - Cardiovascular Imaging, 2019
A pseudoaneurysm (Ps) of the left ventricle (LV) is a severe complication of acute myocardial inf... more A pseudoaneurysm (Ps) of the left ventricle (LV) is a severe complication of acute myocardial infarction (AMI) resulting from a free cardiac wall rupture that is contained by the pericardium, thrombus or adhesions We present the case of a 49 years old man, affected by mastocitosis, in hematological follow-up, admitted for chest pain, ECG modification and elevated troponin levels. The coronary angiography, performed the day after admission, showed a critical lesion of proximal ramus intermedius, treated by angioplasty and drug eluting stent implant. Initially suspected diagnosis was NSTEMI, but during the following days, the patient presented atypical chest pain and fever and an abnormal enzymatic curve evolution, with persistent elevated level of HS-troponin I. Echocardiogram showed a mild pericardial effusion and preserved ejection fraction. Symptoms were interpreted as post-infarction pericarditis and treated with NSAID and colchicine, with good clinical response and progressive reduction of pericardial effusion. However, for this atypical clinical course, a cardiac magnetic resonance (CMR) was arranged, in order not to miss an alternative diagnosis, as myocarditis with bystanding coronary disease. CMR scan, performed two weeks later, surprisingly showed a pseudoaneurysmatic formation (36 mm x 21 mm), outpouching from the basal anterior wall, with a small neck (14 mm), with systolic espansion and two small thrombi inside (figure A-B). The formation was easily seen by CEMRA (Figure C-D). Ps wall showed no late gadolinium enhancement [Figure E], since myocardium was absent and only pericardium was impeding a fatal heart rupture. A small organized pericardial effusion was also present. Urgent Cardiac surgery consult was requested to decide the following management. Due to clinical stability, initially the cardiac surgeon decided for a watchful waiting, deferring the intervention to permit the healing of the Ps surrounding tissue. However, 5 days later, the patient presented a recurrence of chest pain and troponin elevation, with echocardiographic evidence of increasing Ps dimensions. An urgent cardiac surgery was performed. Intraoperative findings confirm CMR suspicion of Ps, excluded by a Dacron patch through transaortic approach, with good result (Figure F). Cardiac pseudoaneurysms represent a mechanical complication of AMI, with rupture contained only by pericardium. Unlike true aneurysms, which are commonly seen in anterior AMI, anterior Ps are rare (only 18% of Ps). Because Ps of the LV has a high risk of spontaneous rupture with catastrophic consequences, early surgical intervention is recommended and its recognition is of paramount clinical importance In this case, CMR provided a new unsuspected diagnosis of a potential life-threatening condition and dramatically change the patient management.
Journal of Cardiovascular Medicine, Mar 20, 2023
Giornale italiano di cardiologia (2006), Jul 1, 2022
Giornale italiano di cardiologia, 1998
Fixed subaortic stenosis is considered to be an acquired condition. It is often associated with c... more Fixed subaortic stenosis is considered to be an acquired condition. It is often associated with congenital heart disease, creating a turbulence in the left ventricle outflow tract. Familial forms of fixed subaortic stenosis are very unusual. We report a remarkable familial cluster in which fixed subaortic stenosis is associated with hypertrophic cardiomyopathy. Fourteen relatives of a patient affected with hypertrophic cardiomyopathy and fixed subaortic stenosis underwent cardiological examination, electrocardiogram and echo-doppler study. Two of the proband's sisters showed an association between asymmetrical hypertrophic cardiomyopathy and fixed subaortic stenosis. The brother presented a subaortic ridge and concentric left ventricular hypertrophy. The other members of the family (another brother and the third-generation relatives) were unaffected. While the association between fixed subaortic stenosis and hypertrophic cardiomyopathy has commonly been reported, there is little...
European Heart Journal Supplements
Introduction Apical Hypertrophic Cardiomyopathy (ApHCM) characterized by persistent diastolic api... more Introduction Apical Hypertrophic Cardiomyopathy (ApHCM) characterized by persistent diastolic apical contraction results in dynamic apical small-vessel obstruction with microvascular ischemia. Of note, endomyocardial fibrosis (EMF) and calcification are described only in few patients. Case presentation We report 5 cases of ApHCM with apical intramyocardial calcification. They presented characteristic ECG pattern and fibrosis at echocardiogram. All patients presented a preserved ejection fraction (EF), except for one patient with mild reduced EF. Global longitudinal strain was reduced in 3 patients. Diastolic dysfunction was evidenced in 3 patients. Right ventricle involvement was detected in one patient only.On cardiac magnetic resonance, a superficial hypo-intense component, compatible with calcium and a deep layer featured by late gadolinium enhancement (LGE) related to fibrotic tissue, were revealed. LGE was present in all of patients in the apex. One patient presented an apical ...
International Journal of Cardiology
Journal of the American College of Cardiology, 2022
Giornale italiano di cardiologia, Nov 1, 2004
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Papers by Sergio Bongioanni