Publications by authors named "Luca Baldetti"
Percutaneous coronary intervention (PCI) is a proven therapy for acute myocardial infarction (AMI) cardiogenic shock (CS). Dual anti-platelet therapy (i.e.
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- The study focused on the effects of Impella malrotation on patients in cardiogenic shock, identifying the malrotation in 36% of cases.
- Findings indicated that those with malrotation experienced significantly worse pulmonary pressures, higher right atrial pressure, and elevated serum lactate levels compared to those without malrotation.
- The conclusions suggest that Impella malrotation leads to suboptimal left ventricular unloading and aggravated pulmonary and right ventricular conditions, though major adverse outcomes did not significantly differ.
Formal assessment of myocardial viability (MV) is challenging in acute myocardial infarction-related cardiogenic shock (AMI-CS) patients receiving Impella mechanical circulatory support, as the cardiac magnetic resonance gold standard technique is not feasible due to the metallic components of the device. 18-fluorodesoxyglucose metabolic myocardial positron emission tomography (FDG-PET) may represent a valid and feasible alternative to obtain semi-quantitative and objective evidence of MV during Impella support. We hereby report the first series of sequential AMI-CS patients who received FDG-PET scanning to assess MV during Impella support to demonstrate the safety and feasibility of this approach.
View Article and Find Full Text PDF[The pulmonary artery catheter in the intensive cardiac care unit].
G Ital Cardiol (Rome)
September 2024
More than 50 years after its introduction in clinical practice, the increase in the intensity of care offered by the cardiac intensive care units, the shift in the population of patients treated and the wider availability of circulatory supports, still makes the pulmonary artery catheter (PAC) an essential tool for diagnosis, monitoring and prognosis in patients suffering from cardiogenic shock. In this review, we will discuss how to identify those patients who can benefit most from its use, the configuration and the correct insertion technique of a PAC. A pragmatic guide will also be provided for the interpretation of the hemodynamic indexes (direct and calculated) that the PAC is able to reveal as well as a summary of the most common errors in reading or interpreting the pressure curves provided by the PAC.
View Article and Find Full Text PDFIntroduction: Exogenous haptoglobin administration may enhance plasma-free hemoglobin (pfHb) clearance during hemolysis and reduce its end-organ damage: we systematically reviewed and summarized available evidence on the use of haptoglobin as a treatment for hemolysis of any cause.
Methods: We included studies describing haptoglobin administration as treatment or prevention of hemolysis-related complications. Only studies with a control group reporting at least one of the outcomes of interest were included in the quantitative synthesis.
Article Synopsis
- * In a study of 200 patients with pure CS, 24.5% developed MS, with lower blood pressure, liver damage, and suspected infection identified as independent predictors of its occurrence.
- * MS is associated with higher in-hospital mortality (53.1% vs. 27.8%) and longer hospital stays, while using temporary mechanical support can reduce the chances of death for affected patients.
Article Synopsis
- The study aimed to assess malnutrition's prevalence and impact on patients with severe heart failure (HF), defined by specific clinical markers, using the geriatric nutritional risk index (GNRI).
- Among 510 patients analyzed, 35.1% were classified as malnourished (GNRI ≤98), with lower body mass index (BMI) and higher natriuretic peptide levels linked to this condition.
- Results indicated that malnourished patients had significantly higher one-year mortality rates (41.1%) compared to non-malnourished patients (22.4%), highlighting malnutrition as a critical risk factor for mortality in severe HF cases.
Article Synopsis
- A study aimed to validate the multi-domain definition of frailty proposed by the HFA-ESC in patients with heart failure, highlighting its high prevalence.
- The analysis of 854 patients revealed that the risk of death and hospitalization increased with the number of frailty domains fulfilled, indicating a direct relationship between frailty and adverse health outcomes.
- The Frailty Index (FI) demonstrated slightly better effectiveness than the domain count in predicting mortality risk, showcasing its potential as a useful tool for assessing frailty in heart failure patients.
Article Synopsis
- Researchers aimed to determine if 24-hour invasive haemodynamic profiling offers better prognostic information than initial assessments for predicting in-hospital death in patients with acute decompensated heart failure cardiogenic shock (ADHF-CS).
- The study included 127 patients, revealing that factors like age and pulmonary elastance (PaE) were strong predictors of mortality; the overall in-hospital death rate was 26.8%.
- Specifically, PaE was the strongest predictor of in-hospital death, with a defined cut-off value, and highlighted the importance of classifying patients based on their haemodynamic measurements for better risk assessment.
Implantation of durable left ventricular assist device (LVAD) in cardiogenic shock (CS) patients after acute myocardial infarction (AMI) poses specific challenges (small left ventricular size, acute infarct area, need for antithrombotic therapy, status Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 1 with impaired organ function and derangements in coagulation and inflammatory parameters) which may affect outcomes. We reviewed data of all AMI-CS patients who were implanted LVAD after Impella support at a referral center with the aim to analyze feasibility, timing, and outcomes of durable LVAD implantation after tMCS with Impella due to AMI-CS. Twenty-one patients were treated between 2013 and 2023: all were in Society for Cardiovascular Angiography & Interventions (SCAI) class D-E and INTERMACS 1-2 at presentation, median LV ejection fraction (EF) and LV end-diastolic diameter (EDD) were 15 (10-20)% and 57 (54-60) mm, respectively.
View Article and Find Full Text PDFWe reported a case of blood culture-negative infective endocarditis on a native valve, where the clinical presentation was exclusively related to extensive cerebral ischemia secondary to multiple systemic septic cardioembolic events. The cause was ascribed to subacute infection, presumably transmitted by cat scratch, documented by positive serologic findings.
View Article and Find Full Text PDFCharacteristics and outcomes of patients with tricuspid regurgitation and advanced heart failure.
J Cardiovasc Med (Hagerstown)
March 2024
Article Synopsis
- A research study aimed to assess the impact of tricuspid regurgitation on outcomes for patients with advanced heart failure, utilizing data from the multicenter HELP-HF registry.
- The study included 1,085 patients, revealing that those with severe tricuspid regurgitation had significantly higher 1-year all-cause mortality rates compared to those with mild or moderate regurgitation.
- Key factors linked to severe tricuspid regurgitation included atrial fibrillation and pulmonary hypertension, highlighting the importance of managing this condition for improving patient outcomes.
Clinical and prognostic implications of heart failure hospitalization in patients with advanced heart failure.
J Cardiovasc Med (Hagerstown)
February 2024
Article Synopsis
- Hospitalization for heart failure significantly affects outcomes in patients with advanced heart failure, with inpatients showing worse overall health compared to outpatients.
- In a study of 1149 patients, those hospitalized at enrollment had a higher one-year all-cause mortality or heart failure hospitalization rate (50.9%) than outpatients (36.8%).
- The findings suggest that hospitalization indicates a poor prognosis, highlighting the need for targeted interventions like mechanical support or heart transplantation for these high-risk patients.
Monitoring of the patient supported with a temporary mechanical circulatory support (tMCS) is crucial in achieving the best possible outcome. Monitoring is a continuous and labour-intensive process, as cardiogenic shock (CS) patients can rapidly deteriorate and may require new interventions within a short time period. Echocardiography and invasive haemodynamic monitoring form the cornerstone of successful tMCS support.
View Article and Find Full Text PDFA growing body of evidence indicates that the benefits of temporary mechanical circulatory support (tMCS) in patients with cardiogenic shock (CS) is dependent on its aetiology and timing of implantation. As such, appropriate diagnosis, screening, selection, and treatment is crucial to achieving good outcomes with tMCS. Here, the latest guidance on CS phenotypes and diagnostics for correctly identifying tMCS candidates is discussed.
View Article and Find Full Text PDFAim: The impact of mitral regurgitation (MR) in patients with advanced heart failure (HF) is poorly known. We aimed to evaluate the impact of MR on clinical outcomes of a real-world, contemporary, multicentre population with advanced HF.
Methods: The HELP-HF registry enrolled patients with HF and at least one "I NEED HELP" criterion, at four Italian centres between January 2020 and November 2021.
Background: The changing demographic of heart failure (HF) increases the exposure to non-cardiovascular (non-CV) events. We investigated the distribution of non-CV mortality/morbidity and the characteristics associated with higher risk of non-CV events in patients with advanced HF.
Methods: Patients from the HELP-HF registry were stratified according to the number of 2018 HFA-ESC criteria for advanced HF.
Aim: Persistent symptoms despite guideline-directed medical therapy (GDMT) and poor tolerance of GDMT are hallmarks of patients with advanced heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data on GDMT use, dose, and prognostic implications are lacking.
Methods And Results: We included 699 consecutive patients with HFrEF and at least one 'I NEED HELP' marker for advanced HF enrolled in a multicentre registry.
Background: The "I Need Help" markers have been proposed to identify patients with advanced heart failure (HF). We evaluated the prognostic impact of these markers on clinical outcomes in a real-world, contemporary, multicenter HF population.
Methods: We included consecutive patients with HF and at least 1 high-risk "I Need Help" marker from 4 centers.
Aims: Patients with heart failure (HF) with reduced ejection fraction (EF) (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF) may all progress to advanced HF, but the impact of EF in the advanced setting is not well established. Our aim was to assess the prognostic impact of EF in patients with at least one 'I NEED HELP' marker for advanced HF.
Methods And Results: Patients with HF and at least one high-risk 'I NEED HELP' criterion from four centres were included in this analysis.
Background: The clinical value of high-risk coronary plaque characteristics (CPCs) to inform intensified medical therapy or revascularization of non-flow-limiting lesions remains uncertain.
Objectives: The authors performed a systematic review and meta-analysis to study the prognostic impact of CPCs on patient-level and lesion-level major cardiovascular adverse events (MACE).
Methods: Thirty studies (21 retrospective, 9 prospective) with 30,369 patients evaluating the association of CPCs with MACE were included.