Publications by authors named "Matteo Merlo"
Article Synopsis
- The understanding of cardiac amyloidosis has significantly evolved in the past decade, leading to better diagnostic and treatment methods.
- This complex disease requires collaboration among various medical specialists to ensure timely diagnosis, risk assessment, and effective management.
- The inter-society consensus document aims to standardize diagnostic approaches in Italy and address clinical challenges for healthcare providers working with patients suspected of having cardiac amyloidosis.
Article Synopsis
- * A retrospective analysis was conducted on 811 patients from the DIAMOND study, which included a total of 1281 patients diagnosed in Italy between 2016-2021, focusing on characteristics leading to their diagnosis and calculating their respective scores.
- * Findings showed that only 1% of patients had early diagnoses, with significant differences in prognostic variable distribution based on diagnostic pathways, and both NAC and Columbia scores were linked to all-cause mortality.
Background: Patients with nonischemic dilated cardiomyopathy (DCM), severe left ventricular (LV) dysfunction, and complete left bundle branch block benefit from cardiac resynchronization therapy (CRT). However, a large heterogeneity of response to CRT is described. Several predictors of response to CRT have been identified, but the role of the underlying genetic background is still poorly explored.
View Article and Find Full Text PDFBackground And Aims: The discordance between QRS voltages on electrocardiogram (ECG) and left ventricle (LV) wall thickness (LVWT) on echocardiogram (echo) is a recognized red flag (RF) of amyloid cardiomyopathy (AC) and can be measured by specific indexes. No head-to-head comparison of different ECG/echo indexes among subjects with echocardiographic suspicion of AC has yet been undertaken. The study aimed at evaluating the performance and the incremental diagnostic value of different ECG/echo indexes in this subset of patients.
View Article and Find Full Text PDFBackground: The prognosis for heart failure (HF) patients remains poor, with a high mortality rate, and a marked reduction in quality of life (QOL) and functional status. This study aims to explore the ongoing needs of HF management and the epidemiology of patients followed by Italian HF clinics, with a specific focus on cardiac contractility modulation (CCM).
Research Design And Methods: Data from patients admitted to 14 HF outpatients clinics over 4 weeks were collected and compared to the results of a survey open to physicians involved in HF management operating in Italian centers.
Article Synopsis
- The study aimed to characterize the diagnostic pathways leading to wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) and assess their association with patient survival.
- A total of 1281 patients were analyzed, with most diagnosed through heart failure (51%), followed by incidental imaging (23%) and clinical pathways (19%).
- Findings revealed that patients diagnosed via the heart failure pathway were typically older and had worse prognoses, but survival outcomes were mainly influenced by age, NYHA functional class, and comorbidities rather than the specific diagnostic pathway.
[Rationale and significance of the Italian Network for Cardiac Amyloidosis].
G Ital Cardiol (Rome)
February 2023
The perspective on amyloidosis has changed deeply over the last 10 years following major advances in diagnosis and treatment options, especially in cardiac amyloidosis. This intrinsically heterogeneous disease exposes to the risk of fragmentation of knowledge and requires the interaction among experts of different specialties and subspecialties. Suspicion of disease, timely recognition and confirmation of final diagnosis, prognostic stratification, clinical management and therapeutic strategies represent essential steps to be taken.
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- - The study explores how different genetic backgrounds influence patient outcomes in cardiomyopathies (CMPs), finding that focusing on genotype rather than just phenotype offers better predictive accuracy for adverse events.
- - In a cohort of 281 patients, it was found that sudden cardiac death and major arrhythmias occurred more frequently in those without the dilated cardiomyopathy (DCM) phenotype, with certain genotypes (like LMNA) showing poorer survival trends.
- - The results highlight that while phenotypic diversity exists in genetic CMPs, basing patient classification on genetic factors provides a more reliable method for predicting outcomes compared to using phenotypic characteristics alone.
Background: Several risk factors have been identified to predict worse outcomes in patients affected by SARS-CoV-2 infection. Machine learning algorithms represent a novel approach to identifying a prediction model with a good discriminatory capacity to be easily used in clinical practice. The aim of this study was to obtain a risk score for in-hospital mortality in patients with coronavirus disease infection (COVID-19) based on a limited number of features collected at hospital admission.
View Article and Find Full Text PDFAim: To investigate the prevalence of amyloid cardiomyopathy (AC) and the diagnostic accuracy of echocardiographic red flags of AC among consecutive adult patients undergoing transthoracic echocardiogram for reason other than AC in 13 Italian institutions.
Methods And Results: This is an Italian prospective multicentre study, involving a clinical and instrumental work-up to assess AC prevalence among patients ≥55 years old with an echocardiogram suggestive of AC (i.e.
Introduction: The role of sex compared to comorbidities and other prognostic variables in patients with coronavirus disease (COVID-19) is unclear.
Methods: This is a retrospective observational study on patients with COVID-19 infection, referred to 13 cardiology units. The primary objective was to assess the difference in risk of death between the sexes.
Article Synopsis
- * A total of 341 patients were analyzed, with findings indicating that patients with elevated levels of both NPs and troponin had a significantly higher risk of death, even when adjusted for other health factors.
- * The results suggest that NPs can help identify patients at risk of poor outcomes, even in those with normal troponin levels, highlighting their potential as a useful biomarker in COVID-19 prognosis.
Background And Aim Of The Work: The delivery of care to patients with COVID-19 enhanced many psychological issues among healthcare workers (HCWs), exacerbating the risk of burnout and compromising the efficacy and quality of services provided to patients. In this context, the peculiarities regarding professional roles in delivering care to patients with COVID-19 might reflect daily lived experiences that could impact psychological outcomes in specific professional groups. However, daily lived experiences considering different groups of HCWs have been poorly investigated, especially with a longitudinal qualitative study.
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- The study focused on hospitalized COVID-19 patients to evaluate the impact of a history of atrial fibrillation (AF) on their clinical outcomes.
- Among the 696 patients, those with a history of AF had significantly higher mortality rates (38.7% vs 20.8%) and faced more in-hospital complications like new-onset AF and acute heart failure.
- Even after adjusting for other serious health factors, the presence of AF remained a critical risk factor for worse outcomes in these patients.
Objective: Despite growing evidence about myocardial injury in hospitalized COronaVIrus Disease 2019 (COVID-19) patients, the mechanism behind this injury is only poorly understood and little is known about its association with SARS-CoV-2-mediated myocarditis. Furthermore, definite evidence of the presence and role of SARS-CoV-2 in cardiomyocytes in the clinical scenario is still lacking.
Methods: We histologically characterized myocardial tissue of 40 patients deceased with severe SARS-CoV-2 infection during the first wave of the pandemic.
Aims: Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact.
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- Glucocorticoid therapy has been found effective in reducing mortality in hospitalized COVID-19 patients, based on a study of 706 patients from the Cardio-COVID-Italy registry.
- The study showed that patients treated with glucocorticoids had a significantly lower risk of in-hospital mortality (adjusted HR 0.44) compared to those who weren't treated, especially those with specific clinical conditions.
- The benefits of glucocorticoids were particularly noticeable in patients with poor respiratory function (lower PaO/FiO ratio and oxygen saturation) and higher levels of systemic inflammation (higher CRP levels).
Aims: To assess the prognostic value of a history of heart failure (HF) in patients with coronavirus disease 2019 (COVID-19).
Methods And Results: We enrolled 692 consecutive patients admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. Mean age was 67.
Article Synopsis
- The study investigated pulmonary embolism (PE) in COVID-19 patients across 13 Cardiology Units in Italy, finding that 7.5% of 689 patients developed PE during their stay.
- Patients with PE were generally younger, had a higher BMI, and more severe respiratory issues, and had significantly higher D-dimer levels compared to those without PE.
- A linear relationship between D-dimer concentrations and the incidence of PE was identified, indicating the need for further research into the implications of bleeding events and the role of D-dimer in this patient population.
Article Synopsis
- Myocardial injury in COVID-19 patients, indicated by elevated troponin levels, correlates with higher mortality rates, especially in older and sicker populations in Europe and the US.
- A multicenter study in Italy involved 614 hospitalized COVID-19 patients and found that 45.3% had elevated troponin levels.
- Patients with elevated troponin were older and had higher rates of comorbidities like hypertension and heart disease, leading to a significant increase in their in-hospital mortality risk.
Background: Fulminant myocarditis (FM) is a form of acute myocarditis characterized by severe left ventricular systolic dysfunction requiring inotropes and/or mechanical circulatory support. A single-center study found that a patient with FM had better outcomes than those with acute nonfulminant myocarditis (NFM) presenting with left ventricular systolic dysfunction, but otherwise hemodynamically stable. This was recently challenged, so disagreement still exists.
View Article and Find Full Text PDFBackground: Persistent left ventricular (LV) systolic dysfunction in patients with acute lymphocytic myocarditis (LM) is widely unexplored.
Objectives: To assess the frequency and predictors of persistent LV dysfunction in patients with LM and reduced LVEF at admission.
Methods And Results: We retrospectively evaluated 89 consecutive patients with histologically-proven acute myocarditis enrolled at three Italian referral hospitals.