Alessandro Candreva

University Hospital of Zurich

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Bernard De Bruyne

University of Lausanne

Carlos Collet

Onze Lieve Vrouwziekenhuis Hospital

Emanuele Gallinoro

University of Milan

Jeroen Sonck

Onze Lieve Vrouwziekenhuis Hospital

Christian Templin

Universitätsmedizin Greifswald

Emanuele Barbato

Sapienza University of Rome

Barbara E. Stähli

University Hospital of Zurich

Takuya Mizukami

Onze Lieve Vrouwziekenhuis Hospital

Niya Mileva

Medical University of Sofia

Frank Ruschitzka

University Hospital of Zurich

Cooperative Institutions

University of Zurich

144

University Hospital of Zurich

135

Onze Lieve Vrouwziekenhuis Hospital

Istituti di Ricovero e Cura a Carattere Scientifico

Zurich Heart House

University of Lausanne

German Centre for Cardiovascular Research

Cardiovascular Research Center

Deutsches Herzzentrum der Charité

University of Naples Federico II

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MitraClip and Transcatheter Aortic Valve Implantation (TAVI): State of the Art 2015

Current Heart Failure Reports (2015)

Alessandro Candreva Francesco Maisano Maurizio Taramasso

MitraClip

Vascular surgery

10.1007/s11897-015-0275-3

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Citations (3)

Clinical and electrocardiographic features of patients with myocardial infarction with non-obstructive coronary artery disease (MINOCA)

Journal of Cardiovascular Medicine (2020)

Jan dal Fabbro Alessandro Candreva Valentina A. Rossi Mohammady Shahin Nooraldaem Yousif

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is often an underdiagnosed and undertreated condition. This study aimed to evaluate clinical and ECG characteristics of MINOCA in a large cohort of patients admitted for acute coronary syndrome.All coronary angiograms performed at the University Heart Center in Zurich (Switzerland) between 2012 and 2016 were investigated. MINOCA was defined according to European Society of Cardiology guidelines and patients were divided into two groups, based on the presence or absence of coronary sclerosis at angiogram[nonobstructive coronary artery disease (noCAD) and normal coronary arteries (NCA)]), after exclusion of myocarditis and Takotsubo syndrome.Out of 13 669 angiographic studies, 3695 were diagnosed with acute coronary syndrome; of these, 244 patients presented MINOCA (6.6%). Patients with noCAD were more likely to be older (67.9 vs. 59.2 years, P < 0.001) with higher prevalence of traditional cardiovascular risk factors (hypertension 64.1 vs. 41.2%, P = 0.002; diabetes 19.7 vs. 10.8%, P = 0.036; hypercholesterolemia 36.6 vs. 23.5%, P = 0.037). On surface ECG, anterior ST- segment elevation was more frequent in NCA patients (13.7 vs. 5.0%, P = 0.016). Secondary prevention therapy was significantly more prescribed in noCAD compared with NCA patients (acetylsalicylic acid 68.3 vs. 21.6%, P less than 0.001; statins 76.1 vs. 22.5%, P less than 0.001; angiotensin-converting enzyme inhibitor-AT1 blockers 51.4 vs. 31.3%, P = 0.006). One-year mortality was very low (0.4% for noCAD patients).noCAD patients were older, with higher prevalence of cardiovascular risk factors and more frequently discharged with secondary prevention therapy. NCA patients presented more frequently anterior ST- segment elevation. Further diagnostic tests should be highly recommended to determine the underlying mechanism of MINOCA.

Coronary arteries

10.2459/jcm.0000000000001027

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Future culprit detection based on angiography‐derived FFR

Catheterization and Cardiovascular Interventions (2021)

Mattia Pagnoni David Meier Alessandro Candreva Luc Maillard Julien Adjedj

We sought to characterize the hemodynamic impact of mild coronary artery disease (CAD) using quantitative flow ratio (QFR, an angiography-derived fractional flow reserve [FFR]) in a population of patients with only non-significant CAD at baseline that subsequently experienced a myocardial infarction (MI).The discriminatory value of FFR in patients with mild CAD remains imperfect.We retrospectively included patients who underwent invasive coronary angiography for an MI, in whom another angiogram had been performed within the previous 5 years. Three-dimensional quantitative coronary angiography, QFR, and lesion length analysis were conducted on lesions responsible for the MI (future culprit lesions, [FCL]) as well as on control lesions (non-culprit lesions, [NCL]).Eighty-three FCL and 117 NCL were analyzed in 83 patients: FCL were more severe (median % diameter of stenosis [DS] 39.1% [29.8; 45.7] vs. 29.8% [25.0; 37.2], p < .001), had lower QFR values (0.94 [0.86; 0.98] vs. 0.98 [0.96; 1.00], p < .001) and tended to be longer (15.2 mm [10.0; 27.3] vs. 12.7 mm [9.3; 22.4], p = .070) than NCL. In lesions with an interval < 2 years between baseline angiography and MI, the difference in QFR was more pronounced compared to the lesions with a longer interval (FCL: 0.92 [0.85; 0.97] vs. NCL: 0.98 [0.94; 1.00], p < .001 and FCL: 0.96 [0.88; 1.00] vs. NCL: 0.98 [0.96;1.00], p = .006 respectively) CONCLUSION: Mild coronary stenoses that are subsequently responsible for an MI (FCL) exhibit a higher DS and lower QFR years before the event. Furthermore, FCL with a lower QFR at baseline appear to lead earlier to MI.

Culprit

Fractional Flow Reserve

10.1002/ccd.29736

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Unsupervised mitral valve segmentation in echocardiography with neural network matrix factorization.

EasyChair preprint (2019)

Luca Corinzia Jesse Provost Alessandro Candreva Maurizio Tamarasso Francesco Maisano

Mitral valve segmentation is a crucial first step to establish a machine learning pipeline that can support practitioners into performing the diagnosis of mitral valve diseases, surgical planning, and intraoperative procedures. To this end, we propose a totally automated and unsupervised mitral valve segmentation algorithm, based on a neural network low-dimension matrix factorization of the echocardiography video. The method is evaluated in a collection of echocardiography video of patients with a variety of mitral valve diseases and exceeds the state-of-the-art method in all the metrics considered.

10.29007/6kbt

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Long-term Outcome of Patients with Atrial Fibrillation and High Risk of Stroke treated with Oral Anticoagulation or Left Atrial Appendage-Occlusion – A Cardinality Matched Analysis

Cardiology (2024)

Thomas Gilhofer Victoria Bokemeyer Victor Schweiger Mario Gehler Jonathan Michel

Introduction: Atrial fibrillation (AF) poses a significant risk of stroke. Left atrial appendage occlusion (LAAO) is an alternative for patients with contraindications to oral anticoagulation (OAC) or with high risk of bleeding. This study aims to compare the outcomes of LAAO versus conventional stroke prevention in high-risk AF-patients. Methods: This secondary analysis incorporates data from the prospective Swiss-AF and Beat-AF cohorts, and the Zurich LAAO Registry. Cardinality matching was performed to create two comparable cohorts: conventional treatment (92% OAC) and LAAO. The primary endpoint was a composite of stroke, cardiovascular (CV) death, and clinically relevant bleeding. Kaplan-Meier method with competing risk analysis was used. Results: Each group included 468 patients (age 76.4 [70.5, 82.0] years, 33% female). The LAAO group exhibited higher baseline bleeding risk (HAS BLED 2.0 [1.0–3.0] versus 3.0 [3.0–4.0]; p < 0.001). Median follow-up time: 6.0 (4.7–7.0) years in conventional treatment group and 4.0 (1.5–6.1) in LAAO group. No significant difference in the primary composite endpoint (HR 0.87, 95% CI: 0.72–1.06, p = 0.18), stroke risk (HR 1.14, 95% CI: 0.66–1.97, p = 0.64), or CV mortality (HR 1.08, 95% CI: 0.82–1.42, p = 0.60) was observed between groups. LAAO correlated with a significantly lower risk of clinically relevant bleeding (HR 0.61, 95% CI: 0.47–0.80, p < 0.001). Conclusion: In this cardinality matched analysis with long-term follow-up, LAAO showed similar stroke and CV death rates but lower clinically relevant bleeding risk compared to conventional therapy in high-risk AF-patients.

Stroke

Clinical endpoint

Major bleeding

Lower risk

Bleed

10.1159/000541907

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MINOCA und die invasive Messung der kardialen Mikrozirkulation

Therapeutische Umschau (2021)

Alessandro Candreva Alexander Gotschy Christian Templin

Zusammenfassung. Bei ca. 10 % der Patienten, die mit dem Verdacht auf einen akuten Myokardinfarkts eine Koronarangiographie erhalten, lässt sich keine obstruktive Läsion der Koronararterien nachweisen. Diese Fälle werden als Myokardinfarkt mit nichtobstruktiven Koronararterien (MINOCA) klassifiziert, wenn nach einer strukturierten diagnostischen Abklärung alternative kardiale oder extra-kardiale Ursachen ausgeschlossen werden können. Eine Differenzialdiagnose zu MINOCA ist das Takotsubo Syndrom, dessen Pathophysiologie noch weitgehend unklar ist. Man vermutet, dass die mikrovaskuläre Dysfunktion eine wesentliche Rolle in der Genese der Erkrankung spielt, sodass intrakoronare Flussmessungen möglicherweise relevante pathophysiologische Aspekte aufdecken könnten.

10.1024/0040-5930/a001236

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TCT-348 Physiological and Angiographic Outcomes of PCI in Calcified Lesions After Rotational Atherectomy or Intravascular Lithotripsy

Journal of the American College of Cardiology (2021)

Emanuele Gallinoro Giovanni Monizzi Jeroen Sonck Alessandro Candreva Niya Mileva

Atherectomy

Intravascular Ultrasound

10.1016/j.jacc.2021.09.1201

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Abstract 15772: Cardiogenic Shock in Takotsubo Syndrome

Circulation (2018)

Davide Di Vece Rodolfo Citro Victoria L. Cammann Ken Kato Sebastiano Gili

Background: The clinical course of takotsubo syndrome (TTS) can be complicated by several life-threatening conditions, including cardiogenic shock (CS). To date, the impact of CS on outcomes of pat...

Takotsubo Syndrome

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Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy

European Heart Journal (2021)

Emanuele Gallinoro Giovanni Monizzi Alessandro Candreva Jeroen Sonck Niya Mileva

Abstract Background Percutaneous coronary interventions (PCI) in calcified coronary artery lesions is associated with impaired stent expansion, higher rate of periprocedural complications and cardiac mortality. Lesion preparation using dedicated calcium modifying techniques such as RA or IVL has been advocated. Studies comparing these technologies are lacking. Objectives To compare the in-stent pressure gradient, evaluated by virtual fractional flow-reserve, in calcific lesions treated using either rotational atherectomy (RA) or intravascular lithotripsy (IVL). Methods Patients undergoing either RA- or IVL-assisted PCI from two European centers were included. Propensity score matching (1:2) was performed to control for potential bias. Primary outcome was post- PCI in-stent pressure gradient calculated by virtual fractional flow reserve (vFFRgrad, calculated as the difference between the vFFR at the proximal minus distal edge of the stent). Secondary outcomes included the proportion of patients with complete functional revascularization defined as of distal vFFR post PCI (vFFRpost) ≥0.90. Results From a cohort of 210 patients, 105 matched patients (70 RA and 35 IVL) were included. Pre-PCI vFFR did not differ between groups (0,65±0,13 RA and 0,67±0,11 IVL). After PCI, in-stent pressure gradient was significantly lower in the IVL group (0.032±0.026 vs 0.043±0.026 in the RA group, p=0.024). The proportion of vessels with functional complete revascularization was similar between the two groups (32.9% vs. 37.1% in the RA and IVL group, respectively; p=0.669) Conclusions Calcific lesions preparation with IVL is effective and resulted in improved in-stent pressure gradient compared to RA. Approximately one third of the patients undergoing PCI for a severely calcified lesion achieved functional revascularization with no difference between rotational RA and IVL. Funding Acknowledgement Type of funding sources: None. In stent gradients after RA and IVL

Fractional Flow Reserve

10.1093/eurheartj/ehab724.1239

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Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms

Structural Heart (2023)

Ankur Kalra Rajiv Das Mohammad Alkhalil Iryna Dykun Alessandro Candreva

Bicuspid aortic valve (BAV) is a common congenital valvular malformation, which may lead to early aortic valve disease and bicuspid-associated aortopathy. A novel BAV classification system was recently proposed to coincide with transcatheter aortic valve replacement being increasingly considered in younger patients with symptomatic BAV, with good clinical results, yet without randomized trial evidence. Procedural technique, along with clinical outcomes, have considerably improved in BAV patients compared with tricuspid aortic stenosis patients undergoing transcatheter aortic valve replacement. The present review summarizes the novel BAV classification systems and examines contemporary surgical and transcatheter approaches.

Bicuspid valve

Valve replacement

10.1016/j.shj.2023.100227

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Citations (6)