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Martini, L., Mandoli, G., Pastore, M., Pagliaro, A., Bernazzali, S., Maccherini, M., . . . Cameli, M. (2024). Heart transplantation and biomarkers: a review about their usefulness in clinical practice. Frontiers in Cardiovascular Medicine, 11, Article ID 1336011.
Open this publication in new window or tab >>Heart transplantation and biomarkers: a review about their usefulness in clinical practice
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2024 (English)In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 11, article id 1336011Article, review/survey (Refereed) Published
Abstract [en]

Advanced heart failure (AdvHF) can only be treated definitively by heart transplantation (HTx), yet problems such right ventricle dysfunction (RVD), rejection, cardiac allograft vasculopathy (CAV), and primary graft dysfunction (PGD) are linked to a poor prognosis. As a result, numerous biomarkers have been investigated in an effort to identify and prevent certain diseases sooner. We looked at both established biomarkers, such as NT-proBNP, hs-troponins, and pro-inflammatory cytokines, and newer ones, such as extracellular vesicles (EVs), donor specific antibodies (DSA), gene expression profile (GEP), donor-derived cell free DNA (dd-cfDNA), microRNA (miRNA), and soluble suppression of tumorigenicity 2 (sST2). These biomarkers are typically linked to complications from HTX. We also highlight the relationships between each biomarker and one or more problems, as well as their applicability in routine clinical practice.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
biomarker, CAV, heart transplantation, PGD, rejection, RVD
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-221053 (URN)10.3389/fcvm.2024.1336011 (DOI)001156589900001 ()2-s2.0-85184163796 (Scopus ID)
Available from: 2024-02-21 Created: 2024-02-21 Last updated: 2024-02-21Bibliographically approved
Vancheri, F., Longo, G. & Henein, M. Y. (2024). Left ventricular ejection fraction: clinical, pathophysiological, and technical limitations. Frontiers in Cardiovascular Medicine, 11, Article ID 1340708.
Open this publication in new window or tab >>Left ventricular ejection fraction: clinical, pathophysiological, and technical limitations
2024 (English)In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 11, article id 1340708Article, review/survey (Refereed) Published
Abstract [en]

Risk stratification of cardiovascular death and treatment strategies in patients with heart failure (HF), the optimal timing for valve replacement, and the selection of patients for implantable cardioverter defibrillators are based on an echocardiographic calculation of left ventricular ejection fraction (LVEF) in most guidelines. As a marker of systolic function, LVEF has important limitations being affected by loading conditions and cavity geometry, as well as image quality, thus impacting inter- and intra-observer measurement variability. LVEF is a product of shortening of the three components of myocardial fibres: longitudinal, circumferential, and oblique. It is therefore a marker of global ejection performance based on cavity volume changes, rather than directly reflecting myocardial contractile function, hence may be normal even when myofibril's systolic function is impaired. Sub-endocardial longitudinal fibers are the most sensitive layers to ischemia, so when dysfunctional, the circumferential fibers may compensate for it and maintain the overall LVEF. Likewise, in patients with HF, LVEF is used to stratify subgroups, an approach that has prognostic implications but without a direct relationship. HF is a dynamic disease that may worsen or improve over time according to the underlying pathology. Such dynamicity impacts LVEF and its use to guide treatment. The same applies to changes in LVEF following interventional procedures. In this review, we analyze the clinical, pathophysiological, and technical limitations of LVEF across a wide range of cardiovascular pathologies.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
aortic regurgitation, aortic stenosis, echocardiography, implantable cardioverter defibrillator, left ventricular ejection fraction, mitral regurgitation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-221673 (URN)10.3389/fcvm.2024.1340708 (DOI)38385136 (PubMedID)2-s2.0-85185511174 (Scopus ID)
Available from: 2024-02-29 Created: 2024-02-29 Last updated: 2024-02-29Bibliographically approved
Mandoli, G. E., Cameli, M., Pastore, M. C., Loiacono, F., Righini, F. M., D’Ascenzi, F., . . . Henein, M. Y. (2024). Left ventricular fibrosis as a main determinant of filling pressures and left atrial function in advanced heart failure. European Heart Journal Cardiovascular Imaging, 25(4), 446-453
Open this publication in new window or tab >>Left ventricular fibrosis as a main determinant of filling pressures and left atrial function in advanced heart failure
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2024 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 25, no 4, p. 446-453Article in journal (Refereed) Published
Abstract [en]

Aims: Advanced heart failure (AdHF) is characterized by variable degrees of left ventricular (LV) dysfunction, myocardial fibrosis, and raised filling pressures which lead to left atrial (LA) dilatation and cavity dysfunction. This study investigated the relationship between LA peak atrial longitudinal strain (PALS), assessed by speckle-tracking echocardiography (STE), and invasive measures of LV filling pressures and fibrosis in a group of AdHF patients undergoing heart transplantation (HTX).

Methods and results: We consecutively enrolled patients with AdHF who underwent HTX at our Department. Demographic and basic echocardiographic data were registered, then invasive intracardiac pressures were obtained from right heart catheterization, and STE was also performed. After HTX, biopsy specimens from explanted hearts were collected to quantify the degree of LV myocardial fibrosis. Sixty-four patients were included in the study (mean age 62.5 ± 11 years, 42% female). The mean LV ejection fraction (LVEF) was 26.7 ± 6.1%, global PALS was 9.65 ± 4.5%, and mean pulmonary capillary wedge pressure (PCWP) was 18.8 ± 4.8 mmHg. Seventy-three % of patients proved to have severe LV fibrosis. Global PALS was inversely correlated with PCWP (R = −0.83; P < 0.0001) and with LV fibrosis severity (R = −0.78; P < 0.0001) but did not correlate with LVEF (R = 0.15; P = 0.2). Among echocardiographic indices of LV filling pressures, global PALS proved the strongest [area under the curve 0.955 (95% confidence interval 0.87–0.99)] predictor of raised (>18 mmHg) PCWP.

Conclusion: In patients with AdHF, reduced global PALS strongly correlated with the invasively assessed LV filling pressure and degree of LV fibrosis. Such relationship could be used as non-invasive indicator for optimum patient stratification for therapeutic strategies.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
biopsy, fibrosis, heart failure, left atrial strain, pulmonary capillary wedge pressure, transplantation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-223228 (URN)10.1093/ehjci/jead340 (DOI)001134743800001 ()38109280 (PubMedID)2-s2.0-85188188770 (Scopus ID)
Available from: 2024-04-19 Created: 2024-04-19 Last updated: 2024-04-19Bibliographically approved
Mandoli, G. E., Landra, F., Chiantini, B., Bonadiman, L., Pastore, M. C., Focardi, M., . . . Henein, M. Y. (2024). Myocardial work indices predict hospitalization in patients with advanced heart failure. Diagnostics, 14(11), Article ID 1196.
Open this publication in new window or tab >>Myocardial work indices predict hospitalization in patients with advanced heart failure
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2024 (English)In: Diagnostics, ISSN 2075-4418, Vol. 14, no 11, article id 1196Article in journal (Refereed) Published
Abstract [en]

Background: An increasing proportion of heart failure (HF) patients progress to the advanced stage (AdHF) with high event rates and limited treatment options. Echocardiography, particularly Speckle Tracking-derived myocardial work (MW), is useful for HF diagnosis and prognosis. We aimed to assess MW’s feasibility in the prognostic stratification of AdHF.

Methods: We retrospectively screened patients with AdHF who accessed our hospital in 2018–2022. We excluded subjects with inadequate acoustic windows; unavailable brachial artery cuff pressure at the time of the echocardiography; atrial fibrillation; and mitral or aortic regurgitation. We measured standard parameters and left ventricular (LV) strain (LS) and MW. The population was followed up to determine the composite outcomes of all-cause mortality, left ventricular assist device implantation and heart transplantation (primary endpoint), as well as unplanned HF hospitalization (secondary endpoint).

Results: We enrolled 138 patients, prevalently males (79.7%), with a median age of 58 years (IQR 50–62). AdHF etiology was predominantly non-ischemic (65.9%). Thirty-five patients developed a composite event during a median follow-up of 636 days (IQR 323–868). Diastolic function, pulmonary pressures, and LV GLS and LV MW indices were not associated with major events. Contrarily, for the secondary endpoint, the hazard ratio for each increase in global work index (GWI) by 50 mmHg% was 0.90 (p = 0.025) and for each increase in global constructive work (GCW) by 50 mmHg% was 0.90 (p = 0.022). Kaplan–Meier demonstrated better endpoint-free survival, with an LV GWI ≥ 369 mmHg%.

Conclusions: GWI and GCW, with good feasibility, can help in the better characterization of patients with AdHF at higher risk of HF hospitalization and adverse events, identifying the need for closer follow-up or additional HF therapy.

Place, publisher, year, edition, pages
MDPI, 2024
Keywords
end-stage heart failure, myocardial work, prognosis, speckle tracking
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-226959 (URN)10.3390/diagnostics14111196 (DOI)001245560800001 ()38893722 (PubMedID)2-s2.0-85195949733 (Scopus ID)
Available from: 2024-06-24 Created: 2024-06-24 Last updated: 2024-06-24Bibliographically approved
Lisi, M., Luisi, G. A., Pastore, M. C., Mandoli, G. E., Benfari, G., Ilardi, F., . . . D’Andrea, A. (2024). New perspectives in the echocardiographic hemodynamics multiparametric assessment of patients with heart failure. Heart Failure Reviews
Open this publication in new window or tab >>New perspectives in the echocardiographic hemodynamics multiparametric assessment of patients with heart failure
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2024 (English)In: Heart Failure Reviews, ISSN 1382-4147, E-ISSN 1573-7322Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

International Guidelines consider left ventricular ejection fraction (LVEF) as an important parameter to categorize patients with heart failure (HF) and to define recommended treatments in clinical practice. However, LVEF has some technical and clinical limitations, being derived from geometric assumptions and is unable to evaluate intrinsic myocardial function and LV filling pressure (LVFP). Moreover, it has been shown to fail to predict clinical outcome in patients with end-stage HF. The analysis of LV antegrade flow derived from pulsed-wave Doppler (stroke volume index, stroke distance, cardiac output, and cardiac index) and non-invasive evaluation of LVFP have demonstrated some advantages and prognostic implications in HF patients. Speckle tracking echocardiography (STE) is able to unmask intrinsic myocardial systolic dysfunction in HF patients, particularly in those with LV preserved EF, hence allowing analysis of LV, right ventricular and left atrial (LA) intrinsic myocardial function (global peak atrial LS, (PALS)). Global PALS has been proven a reliable index of LVFP which could fill the gaps "gray zone" in the previous Guidelines algorithm for the assessment of LV diastolic dysfunction and LVFP, being added to the latest European Association of Cardiovascular Imaging Consensus document for the use of multimodality imaging in evaluating HFpEF. The aim of this review is to highlight the importance of the hemodynamics multiparametric approach of assessing myocardial function (from LVFP to stroke volume) in patients with HF, thus overcoming the limitations of LVEF.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
Diagnosis, Echocardiography, Heart failure, Hemodynamics, Prognosis, Stroke volume
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-223236 (URN)10.1007/s10741-024-10398-7 (DOI)001187208500001 ()38507022 (PubMedID)2-s2.0-85188188643 (Scopus ID)
Available from: 2024-04-19 Created: 2024-04-19 Last updated: 2024-04-19
Picano, E., Pierard, L., Peteiro, J., Djordjevic-Dikic, A., Sade, L. E., Cortigiani, L., . . . Henein, M. Y. (2024). The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease: a clinical consensus statement from the European Association of Cardiovascular Imaging of the ESC. European Heart Journal Cardiovascular Imaging, 25(2), e65-e90
Open this publication in new window or tab >>The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease: a clinical consensus statement from the European Association of Cardiovascular Imaging of the ESC
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2024 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 25, no 2, p. e65-e90Article in journal (Refereed) Published
Abstract [en]

Since the 2009 publication of the stress echocardiography expert consensus of the European Association of Echocardiography, and after the 2016 advice of the American Society of Echocardiography-European Association of Cardiovascular Imaging for applications beyond coronary artery disease, new information has become available regarding stress echo. Until recently, the assessment of regional wall motion abnormality was the only universally practiced step of stress echo. In the state-of-the-art ABCDE protocol, regional wall motion abnormality remains the main step A, but at the same time, regional perfusion using ultrasound-contrast agents may be assessed. Diastolic function and pulmonary B-lines are assessed in step B; left ventricular contractile and preload reserve with volumetric echocardiography in step C; Doppler-based coronary flow velocity reserve in the left anterior descending coronary artery in step D; and ECG-based heart rate reserve in non-imaging step E. These five biomarkers converge, conceptually and methodologically, in the ABCDE protocol allowing comprehensive risk stratification of the vulnerable patient with chronic coronary syndromes. The present document summarizes current practice guidelines recommendations and training requirements and harmonizes the clinical guidelines of the European Society of Cardiology in many diverse cardiac conditions, from chronic coronary syndromes to valvular heart disease. The continuous refinement of imaging technology and the diffusion of ultrasound-contrast agents improve image quality, feasibility, and reader accuracy in assessing wall motion and perfusion, left ventricular volumes, and coronary flow velocity. Carotid imaging detects pre-obstructive atherosclerosis and improves risk prediction similarly to coronary atherosclerosis. The revolutionary impact of artificial intelligence on echocardiographic image acquisition and analysis makes stress echo more operator-independent and objective. Stress echo has unique features of low cost, versatility, and universal availability. It does not need ionizing radiation exposure and has near-zero carbon dioxide emissions. Stress echo is a convenient and sustainable choice for functional testing within and beyond coronary artery disease.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
carbon, cost, ischaemia, prognosis, viability, radiation, environment, stress, sustainability
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-218959 (URN)10.1093/ehjci/jead250 (DOI)001096919400001 ()37798126 (PubMedID)2-s2.0-85178890803 (Scopus ID)
Available from: 2024-01-04 Created: 2024-01-04 Last updated: 2024-03-06Bibliographically approved
Dini, F. L., Baldini, U., Bytyci, I., Pugliese, N. R., Bajraktari, G. & Henein, M. Y. (2023). Acute pericarditis as a major clinical manifestation of long COVID-19 syndrome. International Journal of Cardiology, 374, 129-134
Open this publication in new window or tab >>Acute pericarditis as a major clinical manifestation of long COVID-19 syndrome
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2023 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 374, p. 129-134Article in journal (Refereed) Published
Abstract [en]

Background: The long COVID-19 syndrome has been recently described and some reports have suggested that acute pericarditis represents important manifestation of long COVID-19 syndrome. The aim of this study was to identify the prevalence and clinical characteristics of patients with long COVID-19, presenting with acute pericarditis.

Methods: We retrospectively included 180 patients (median age 47 years, 62% female) previously diagnosed with COVID-19, exhibiting persistence or new-onset symptoms ≥12 weeks from a negative naso-pharyngeal SARS CoV2 swamp test. The original diagnosis of COVID-19 infection was determined by a positive swab. All patients had undergone a thorough physical examination. Patients with suspected heart involvement were referred to a complete cardiovascular evaluation. Echocardiography was performed based on clinical need and diagnosis of acute pericarditis was achieved according to current guidelines.

Results: Among the study population, shortness of breath/fatigue was reported in 52%, chest pain/discomfort in 34% and heart palpitations/arrhythmias in 37%. Diagnosis of acute pericarditis was made in 39 patients (22%). Mild-to-moderate pericardial effusion was reported in 12, while thickened and bright pericardial layers with small effusions (< 5 mm) with or without comet tails arising from the pericardium (pericardial B-lines) in 27. Heart palpitations/arrhythmias (OR:3.748, p = 0.0030), and autoimmune disease and allergic disorders (OR:4.147, p = 0.0073) were independently related to the diagnosis of acute pericarditis, with a borderline contribution of less likelihood of hospitalization during COVID-19 (OR: 0.100, p = 0.0512).

Conclusion: Our findings suggest a high prevalence of acute pericarditis in patients with long COVID-19 syndrome. Autoimmune and allergic disorders, and palpitations/arrhythmias were frequently associated with pericardial disease.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Acute pericarditis, COVID-19, SARS-CoV2
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-202257 (URN)10.1016/j.ijcard.2022.12.019 (DOI)000963714400001 ()36513284 (PubMedID)2-s2.0-85144783643 (Scopus ID)
Available from: 2023-01-05 Created: 2023-01-05 Last updated: 2023-06-19Bibliographically approved
Santangelo, G., Henein, M. Y., Faggiano, A., Carugo, S. & Faggiano, P. (2023). Cardiology consultation on non-cardiac wards: the need for optimal skills and competences. Minerva cardiology and angiology, 71(1), 1-4
Open this publication in new window or tab >>Cardiology consultation on non-cardiac wards: the need for optimal skills and competences
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2023 (English)In: Minerva cardiology and angiology, E-ISSN 2724-5772, Vol. 71, no 1, p. 1-4Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Edizioni Minerva Medica, 2023
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-205182 (URN)10.23736/S2724-5683.22.06186-5 (DOI)36321888 (PubMedID)2-s2.0-85148113304 (Scopus ID)
Available from: 2023-02-28 Created: 2023-02-28 Last updated: 2023-02-28Bibliographically approved
Lisi, M., Flamigni, F., Russo, M., Cameli, M., Mandoli, G. E., Pastore, M. C., . . . Rubboli, A. (2023). Incidence and mortality of infective endocarditis in the last decade: a single center study. Journal of Cardiovascular Medicine, 24(2), 105-112
Open this publication in new window or tab >>Incidence and mortality of infective endocarditis in the last decade: a single center study
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2023 (English)In: Journal of Cardiovascular Medicine, ISSN 1558-2027, E-ISSN 1558-2035, Vol. 24, no 2, p. 105-112Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Infective endocarditis (IE) is a significant disease characterized by high mortality and complications. The aim of this study was to evaluate the incidence/100 000 inhabitants and the in-hospital mortality/100 000 inhabitants of IE during the last 10 years in the province of Ravenna.

METHODS AND RESULTS: We reviewed the public hospitals discharge database from January 2010 to December 2020 using the international classification of disease codification (ICD-9) for IE. We used the Italian national statistical institute (ISTAT) archive to estimate the number of Ravenna inhabitants/year. In 10 years, we identified a total of 407 patients with diagnosis of IE.The incidence of IE increased significantly from 6.29 cases/100 000 inhabitants in 2010 to 19.58 cases/100 000 inhabitants in 2020 ( P  < 0.001). Also, the in-hospital mortality from IE increased over the same number of years, from 1.8 deaths/100 000 inhabitants in 2010 to 4.4 deaths/100 000 inhabitants in 2020 ( P  < 0.001). The mortality rate (%) of IE over the years did not increase ( P = 0.565). Also, over the years there was no difference in the site of infection ( P  = 0.372), irrespective of the valve localization or type, native valve ( P  = 0.347) or prosthetic valve ( P  = 0.145). On logistic regression analysis, age was the only predictor of in-hospital mortality (odds ratio 1.045, 95% confidence interval: 1.015; 1.075, P  = 0.003).

CONCLUSIONS: Ravenna-based data on IE showed increased disease incidence but unchanged mortality rate over 10 years of follow-up. Age remains the sole predictor of population-based mortality, irrespective of the nature of the valve, native or substitute, and the organism detected on microbiology.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-203793 (URN)10.2459/JCM.0000000000001410 (DOI)000906008100004 ()36574285 (PubMedID)2-s2.0-85145425219 (Scopus ID)
Available from: 2023-01-20 Created: 2023-01-20 Last updated: 2023-09-05Bibliographically approved
Bytyçi, I., Morina, D., Bytyqi, S., Bajraktari, G. & Henein, M. Y. (2023). Percutaneous coronary intervention is not superior to optimal medical therapy in chronic coronary syndrome: a meta-analysis. Journal of Clinical Medicine, 12(4), Article ID 1395.
Open this publication in new window or tab >>Percutaneous coronary intervention is not superior to optimal medical therapy in chronic coronary syndrome: a meta-analysis
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2023 (English)In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 4, article id 1395Article, review/survey (Refereed) Published
Abstract [en]

(1) Background and Aim: Conflicting evidence exists regarding the benefits of percutaneous coronary intervention (PCI) on survival and symptomatic relief of patients with chronic coronary syndrome (CCS) compared with optimal medical therapy (OMT). This meta-analysis is to evaluate the short- and long-term clinical benefit of PCI over and above OMT in CCS. (2) Methods: Main endpoints were major adverse cardiac events (MACEs), all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), urgent revascularization, stroke hospitalization, and quality of life (QoL). Clinical endpoints at very short (≤3 months), short- (<12 months), and long-term (≥ 12 months) follow-up were evaluated. (3) Results: Fifteen RCTs with a total of 16,443 patients with CCS (PCI n = 8307 and OMT n = 8136) were included in the meta-analysis. At mean follow-up of 27.7 months, the PCI group had similar risk of MACE (18.2 vs. 19.2 %; p < 0.32), all-cause mortality (7.09 vs. 7.88%; p = 0.56), CV mortality (8.74 vs. 9.87%; p = 0.30), MI (7.69 vs. 8.29%; p = 0.32), revascularization (11.2 vs. 18.3%; p = 0.08), stroke (2.18 vs. 1.41%; p = 0.10), and hospitalization for anginal symptoms (13.5 vs. 13.9%; p = 0.69) compared with OMT. These results were similar at short- and long-term follow-up. At the very short-term follow-up, PCI patients had greater improvement in the QoL including physical limitation, angina frequency, stability, and treatment satisfaction (p < 0.05 for all) but such benefits disappeared at the long-term follow-up. (4) Conclusions: PCI treatment of CCS does not provide any long-term clinical benefit compared with OMT. These results should have significant clinical implications in optimizing patient's selection for PCI treatment.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
chronic coronary syndrome, optimal medial therapy, percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-208222 (URN)10.3390/jcm12041395 (DOI)000938579200001 ()36835935 (PubMedID)2-s2.0-85153938707 (Scopus ID)
Available from: 2023-05-12 Created: 2023-05-12 Last updated: 2023-05-12Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-6089-5614

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