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Salvalaggio A, Cacciavillani M, Tiengo C, Cipriani A, Frizziero L, Fedrigo M, Rizzo S, Angelini A, Gasparotti R, Briani C. Multimodal evaluation of carpal tunnel syndrome in a pre-symptomatic TTR mutation carrier. J Neurol Sci 2023; 448:120596. [PMID: 36870789 DOI: 10.1016/j.jns.2023.120596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Affiliation(s)
- A Salvalaggio
- Neurology Unit, Department of Neuroscience, University of Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Italy
| | | | - C Tiengo
- Plastic Surgery Unit, Department of Neuroscience, University of Padova, Italy
| | - A Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - L Frizziero
- Ophthalmology Unit, Department of Neuroscience, University of Padova, Italy
| | - M Fedrigo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, Pathology Unit, University of Padova, Italy
| | - S Rizzo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, Pathology Unit, University of Padova, Italy
| | - A Angelini
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, Pathology Unit, University of Padova, Italy
| | - R Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - C Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Italy.
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2
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Salvalaggio A, Cipriani A, Righetto S, Artioli P, Sinigiani G, De Michieli L, Cason M, Pilichou K, Cecchin D, Briani C. Incidental cardiac uptake of 99mTc-diphosphonates is predictive of poor outcome: data from 9616 bone scintigraphies. J Nucl Cardiol 2022; 29:3419-3425. [PMID: 35437680 DOI: 10.1007/s12350-022-02961-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/27/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Bone scintigraphy (BS) is highly diagnostic for amyloid transthyretin (ATTR) cardiomyopathy. Prevalence and prognostic value of BS cardiac uptake is not well established. Our aim was to assess the prevalence of subclinical cardiac ATTR amyloidosis in patients undergoing [99mTc]MDP/DPD scintigraphy and to define their phenotype and prognosis. METHODS AND RESULTS BS scans performed for any clinical indications from 2009 to 2020 were reviewed. Patients were stratified according to Perugini visual score of cardiac uptake. Follow-up data were collected. Among 9616 BS scans, 0.7% (n = 67) showed cardiac uptake. In 47 (70%) patients, Perugini score was 1 and in 20 (30%) patients uptake was ≥ 2, suggesting cardiac ATTR amyloidosis. Forty subjects (61%) died during the follow-up (mean 47 ± 30 months). Compared with patients with Perugini score 1, those Perugini score ≥ 2 showed increased death rate (P = .018). Two (2/67) subjects were investigated for TTR gene mutations resulting negative. CONCLUSIONS In patients undergoing BS for different clinical indications, cardiac uptake suggesting cardiac ATTR amyloidosis is a rare, but still neglected finding, thus preventing possible diagnosis of ATTR cardiomyopathy. Importantly, cardiac uptake negatively affects the survival. Physicians should be aware of this rare, but crucial finding for timely diagnosis and treatment.
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Affiliation(s)
- A Salvalaggio
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padua, Italy
| | - A Cipriani
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - S Righetto
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| | - P Artioli
- Department of Medicine (DIMED), Nuclear Medicine Unit, University-Hospital of Padova, Padua, Italy
| | - G Sinigiani
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - L De Michieli
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - M Cason
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - K Pilichou
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - D Cecchin
- Department of Medicine (DIMED), Nuclear Medicine Unit, University-Hospital of Padova, Padua, Italy
| | - C Briani
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy.
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3
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Brunetti G, Cavigli L, Graziano F, Cipriani A, Perazzolo Marra M, Bauce B, Corrado D, Zorzi A. Reproducibility of exercise-induced premature ventricular beats predicts concealed non-ischemic left ventricular scar on cardiac magnetic resonance in athletes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Non-ischemic left ventricular scar (NLVS) at cardiac magnetic resonance (CMR) is a common substrate of apparently idiopathic premature ventricular beats (PVBs) in athletes. PVBs morphology, complexity and exercise-behavior are known predictors of NLVS. It remains to be established whether reproducibility of PVBs at exercise testing correlates with CMR findings.
Purpose
We aimed to evaluate the possible role of PVBs reproducibility at repeated exercise testing in predicting the presence of an underlying NLVS in athletes who underwent CMR for apparently idiopathic ventricular arrhythmias.
Methods
We included all consecutive competitive athletes referred to our center for the evidence of PVBs during pre-participation screening, who underwent two maximal exercise testings within one month (the first at the time of pre-participation screening, the second at the time of outpatient evaluation at our sports cardiology clinic). Exclusion criteria were known heart disease, family history of cardiomyopathy or channelopathy, abnormal ECG and echocardiography. We also excluded athletes with “common/usually benign” PVBs (non-exercise-induced infundibular or fascicular PVBs) as well as those on ongoing antiarrhythmic therapy. Reproducibility was defined as the presence of PVBs with same morphology and exercise-behavior in two subsequent tests. LGE on CMR was quantified with 5-SD method, using a threshold of 5% to define the presence of pathological LVNS.
Results
A total of 64 apparently healthy competitive athletes (86% males, mean age of 33±14 years old) were included. On CMR, NLVS was identified in 26 (41%). PVBs reproducibility criteria was met in 32 athletes (50%). A statistically significant difference in PVBs reproducibility was found between patients with and without LVNS [26 (100%) versus 6 (16%), p<0,001], irrespective of other factors such as age, sex, biventricular volumes and function (Figure 1). Among the 26 patients with NLVS, 18 (69%) showed PVBs with right-bundle branch block (R-BBB) with superior axis configuration, alone or associated with other morphologies. These arrhythmic patterns were confirmed by a second test in all cases. Among the 38 patients with normal CMR, the first exercise test showed R-BBB/superior axis PVBs, alone or associated with other morphologies, in 22 (57%); the second test confirmed such pattern in only 6 (16%), showing instead different morphologies in 8 (21%) and no PVBs in 24 (63%). Figure 2 represents an example of two cases included in the study.
Conclusion
In apparently healthy athletes who underwent CMR for “uncommon” PVBs, the presence of underlying LVNS was predicted by ventricular arrhythmia reproducibility. Specifically, reproducibility of PVBs with RBBB/superior axis morphology was highly predictive of a positive CMR. This finding may be very relevant for appropriate prescription of CMR in athletes with apparently idiopathic ventricular arrhythmias.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Brunetti
- University Hospital of Padova , Padua , Italy
| | | | - F Graziano
- University Hospital of Padova , Padua , Italy
| | - A Cipriani
- University Hospital of Padova , Padua , Italy
| | | | - B Bauce
- University Hospital of Padova , Padua , Italy
| | - D Corrado
- University Hospital of Padova , Padua , Italy
| | - A Zorzi
- University Hospital of Padova , Padua , Italy
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4
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Porcari A, Rossi M, Cappelli F, Canepa M, Musumeci B, Cipriani A, Tini G, Varra' GG, Argiro' A, Sessarego E, Sinigiani G, Di Bella G, Rapezzi C, Sinagra G, Merlo M. Incidence and risk factors for pacemaker implantation in light chain and transthyretin cardiac amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The incidence and risk factors of pacemaker (PM) implantation in patients with cardiac amyloidosis (CA) are largely unexplored.
Purpose
We sought to characterise the trends in the incidence of permanent PM and to identify baseline predictors of future PM implantation in light chain (AL) and transthyretin (ATTR) CA.
Methods
Multicentre, retrospective, observational study. Consecutive patients with AL and ATTR-CA diagnosed or referred at participating Centres between 2017 and 2020 were included. Clinical data recorded within ± 1 month from baseline evaluation were collected from electronic medical records. The primary outcome of the study was the need for clinically-indicated PM implantation. Reversible causes of conduction system disease were systematically ruled out before PM implantation. Patients with PM (n=41) and/or permanent defibrillator in situ (n=13) at the time of CA diagnosis were excluded.
Results
The study population consisted of 405 patients: 29.4% AL, 14.6% variant ATTR and 56% wild-type ATTR; 82.5% were males, with median age 76 years. During a median follow-up of 33 months (interquartile range 21–46), 36 (8.9%) patients experienced the primary outcome: 10 patients with AL-CA, 2 with variant ATTR-CA and 24 with wild-type ATTR-CA (p=0.08). At multivariable analysis, history of atrial fibrillation (hazard ratio [HR] 3.80, p=0.002), PR interval (HR 1.013, p=0.002) and QRS >120 ms (HR 4.7, p=0.001) on baseline ECG were independently associated with PM implantation (Figure 1). In the individual patient, the contemporary presence of these 3 factors yielded the highest risk of PM implantation (HR 6.26, p=0.003).
Conclusion
In a large cohort of AL and ATTR-CA, the incidence of PM implantation was high accounting for ≈9% of patients in the 3 years following the diagnosis. History of atrial fibrillation, longer PR interval and QRS >120 ms identified CA patients at high-risk of future PM implantation (Figure 2).
CA patients with these features might need close monitoring during follow-up for the development of conduction system disease requiring PM implantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Porcari
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - M Rossi
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - F Cappelli
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - M Canepa
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - B Musumeci
- Sapienza University of Rome, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology , Rome , Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health , Padua , Italy
| | - G Tini
- Sapienza University of Rome, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology , Rome , Italy
| | - G G Varra'
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - A Argiro'
- Careggi University Hospital, Cardiomyopathy Unit , Florence , Italy
| | - E Sessarego
- Ospedale Policlinico San Martino IRCCS, Cardiovascular Unit, Department of Internal Medicine , Genoa , Italy
| | - G Sinigiani
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health , Padua , Italy
| | - G Di Bella
- University of Messina, Department of Cardiology , Messina , Italy
| | - C Rapezzi
- University of Ferrara, Cardiothoracic Department , Ferrara , Italy
| | - G Sinagra
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
| | - M Merlo
- Giuliano Isontina University Health Authority, Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department , Trieste , Italy
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5
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Cecere A, Cipriani A, Ravagnin A, Graziano F, Brunetti G, De Conti G, Motta R, De Lazzari M, Iliceto S, Perazzolo Marra M. Quantification of left ventricular fibrosis in arrhythmic mitral valve prolapse patients: comparison of different semi-automated techniques assessed by cardiac magnetic resonance. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) fibrosis has a key role in arrhythmogenesis in mitral valve prolapse (MVP) patients. Cardiac magnetic resonance (CMR) demonstrated able to clearly identify LV fibrosis with the post-contrast late gadolinium enhancement (LGE) images. Despite the pivotal role of LV fibrosis in the arrhythmogenesis, a quantification and identification of reproducible method able to accurately measure LGE in arrhythmic MVP patients has not been recognized.
Purpose
We aimed to measure and compare different semi-quantitative methods for LGE quantification assessed by CMR, in order to identify the most reproducible one, in arrhythmic MVP patients.
Methods
66 arrhythmic MVP patients with normal systolic function and without significant regurgitation were enrolled. Semi-automated gray-scale thresholding technique using full with at half maximum (FWHM) and 2, 3 and 5 standard deviation (SD) above the remote myocardium were used and compared with visual assessment (Fig. 1).
Results
LGE was identified in 41 arrhythmic MVP patients (62%) and quantified (Fig. 2). The mean quantity of LGE visually assessed was 2.40±1.07% or 1.40±0.82 g. With FWHM, LGE resulted 3.56±1.23% or 1.99±1.13 g. Using thresholding, the mean LGE quantity was 9.2±3.1% or 4.82±2.28 g for 2-SD, 5.72±1.75% or 3.06±1.47 g for 3-SD and 2.36±0.99% or 1.29±0.79 g for 5-SD. The 5-SD measurement in percentage demonstrated a good correlation with LGE quantification visually assessed (2.402±1.075 vs 2.363±0.9909, p: 0.543). Despite all semi-quantitative methods for LGE quantification demonstrated a good intra and inter-observer agreement, the 5-SD threshold quantification, both in percentage and in grams, revealed the less intra-observer (respectively, ICC: 0.976 and 0.966) and inter-observer variability (respectively ICC: 0.948 and 0.935) when compared with visual assessment.
Conclusion
This is the first study that quantified and compared different CMR semi-automated methods for LGE assessment in a population of arrhythmic MVP patients. The 5-SD gray-scale threshold technique in percentage revealed the best correlation with the visual assessment and an optimal reproducibility.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Cecere
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - A Cipriani
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - A Ravagnin
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - F Graziano
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - G Brunetti
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - G De Conti
- University of Padua – Azienda Ospedaliera, Radiology Unit , Padua , Italy
| | - R Motta
- University of Padua – Azienda Ospedaliera, Radiology Unit, Department of Medicine , Padua , Italy
| | - M De Lazzari
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - S Iliceto
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
| | - M Perazzolo Marra
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padua , Italy
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6
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Agostini F, Campese S, Vianello R, Pizzi M, Cipriani A, Zanetti M. A post processing pipeline to prepare raw data for machine learning algorithms in cardiac magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Artificial Intelligence is an emergent tool in clinical practice for post processing of medical images. Machine Learning (ML) pipelines are created for data of interest extraction and algorithm application. A common issue in data extraction is represented by noisy datasets, like those of CMR studies, characterized by multiple images, acquired by different techniques, axis orientation and contrast timing.
Purpose
A ML pipeline for extraction of LGE images from raw DICOM data is presented. Additionally, steps for normalization of image number and automatically heart localization are outlined.
Methods and Results
642 consecutive CMR studies were analyzed.
Pipeline, Part 1. By looking at the metadata in raw files, ‘SequenceName’ tag was used to discard cine images, ‘ScanningSequence’ tag to select Gradient Recall and Inversion Recovery techniques (Inversion Time > 100 ms), ‘SequenceVariant’ tag to discard Steady State images (See Fig. 1). Orientation of the major axis was computed and ‘Axial’ or ‘Coronal’ images removed. Scans were grouped together by image orientation (requesting a min and max number of elements per group) and only the group with the largest number of files was selected. Finally, DICOMs were grouped by image shape (demanding a min number of elements), and only the series with the highest resolution was retained. Then, for each subject, the extracted series consists of a 3D-array (N,H,W), with N number of slices, and (H,W) image resolution. The attributes were not homogeneous between subjects.
Pipeline, Part 2. Given a desired final number of slices and resolution, the 3D-array was reshaped through a spline interpolation. In order to have a focus on the heart, a Region of Interest (ROI) extractor was implemented, based on a YOLO network for object detection. The network was applied on all the slices (Fig. 2); then the images were cropped by keeping the largest bounding box. This step allowed us to remove the background by only selecting the relevant ROIs. To manage the data more easily, images were saved as a NumPy Array, while other useful Dicom metadata (e.g. weight, age, …) were stored using the json standard.
At the end of the ML pipeline, images can be reduced to a common resolution and forwarded to ML algorithms.
By using this pipeline, a great amount of information not needed for LGE analysis can be discarded, granting a significant reduction in terms of data storage. In our series, the original dataset extended for about 200 GB; by requesting 10 slices per subject with a resolution of 128 by 128 pixels (also extracting heart ROI) the final dimension was reduced to 108 MB.
Conclusions
In this work, we presented a post-processing pipeline for CRM images and LGE analysis. Given in input raw CRM the pipeline is able to (i) remove unuseful data, (ii) extract heart ROIs storing also Dicom metadata, (iii) normalize slices and image resolution, and (iv) store the processed CRM into ready-format for ML techniques. Fig.1:Pipeline Schematic RepresentationFig.2:YOLO Heart Extraction
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Affiliation(s)
| | - S Campese
- University of Padua , Padova , Italy
| | | | - M Pizzi
- University of Padua , Padova , Italy
| | | | - M Zanetti
- University of Padua , Padova , Italy
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7
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Campese S, Agostini F, Sciarretta T, Pizzi M, Cipriani A, Zanetti M. Myocardial fibrosis detection using kernel methods: preliminary results from a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Asserting the presence of myocardial fibrosis from cardiac magnetic resonance (CMR) images is sometimes a complex task, even for experienced cardiac imagers. The application of artificial intelligence models to the evaluation process can be of help for enhancing diagnostic accuracy.
Purpose
In this work, we tested two different Machine Learning (ML) algorithms, namely kernel methods with Support Vector Machine (SVM) and Convolutional Neural Network (CNN) to a cohort of consecutive CMR studies. The goal was a binary classification task, aimed to identify myocardial scar (present/absent).
Methods
Dataset consisted of 642 CMR scans, equally divided into healthy and fibrosis-affected. Raw DICOM files were preprocessed through an automated pipeline, in order to retrieve only short-axis post contrast acquisitions. Heart regions were then individuated using a YOLO network, in order to remove the background and focus only on data of interest. Finally, for each subject 10 slices were extracted through interpolation, and all images resized to 128 by 128 pixels. Dataset was divided into training and test sets, with proportions 80%-20%.
Results
The first analysis was based on state-of-the-art CNN models, pre-trained on the ImageNet dataset. The training of the models was optimized using "reduce learning rate on the plateau", "early stopping", and standard data augmentation techniques. Experiments showed that CNNs-based models led to poor performances.
The second attempt was based on kernel methods and SVM. Before feeding the input to the algorithm, dimensionality reduction was implemented using a Principal Component Analysis retaining 99% of the variance. The resulting 335 features were passed as input to an SVM, testing different kernels (e.g. Linear, Gaussian, Cossim). Models were trained and optimized using a Grid Search with a 5-fold Cross-Validation. The best SVM configuration displayed an accuracy of 68% and a sensitivity of 60%.
Improved results could be obtained using state-of-the-art Multiple Kernel Learning algorithms, leading to 71% accuracy and sensitivity of 72% (with a 12% increment with respect to the previous algorithm).
Conclusions
Our preliminary results of this study showed the possibility for a ML system to learn to identify myocardial fibrosis, directly from raw CMR images. In particular, kernel methods were able to achieve good and significant results, even with small amounts of data, suggesting room for improvement. In future works, we plan to furtherly explore kernel methods to improve the results and to build an end-to-end solution for cardiac imagers.
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Affiliation(s)
- S Campese
- University of Padua , Padova , Italy
| | | | | | - M Pizzi
- University of Padua , Padova , Italy
| | | | - M Zanetti
- University of Padua , Padova , Italy
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8
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De Angelis E, Ravera A, Ammirati E, Tedeschi A, Polito M, Pieroni M, Gentile P, Merlo M, Van De Heyning C, Bekelaarh T, Cipriani A, Camilli M, Sanna T, Sinagra G, Bonnefoy–cudraz E, Bochaton T, Hayek A, Aloia A. C75 PHEOCHROMOCYTOMA–INDUCED CARDIOGENIC SHOCK: A MULTICENTER ANALYSIS OF CLINICAL PROFILES, MANAGEMENT AND OUTCOMES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Pheochromocytoma is a rare neuroendocrine tumor that arises from the adrenal gland and overproduces catecholamines; it is an infrequent cause of cardiogenic shock (CS). Several case reports have investigated pheochromocytoma–induced CS, but larger studies have not yet been carried out.
Objectives
Our work aims to describe a multicenter experience in the diagnosis and management of patients with pheochromocytoma–induced CS, and to raise awareness around this rare condition. Methods: We enrolled all patients with a diagnosis of pheochromocytoma–induced CS admitted to the intensive care units of 8 European referral Hospitals.
Results
Among the 17 patients (47% males, mean age 49,5 years), we found that pulmonary congestion was the mostly represented clinical feature (82%). The most represented echocardiographic left ventricle (LV) pattern was the reverse Takotsubo (TTS) pattern with apical hyperkinesis associated with basal– to mid–ventricular hypokinesis (47%). Elevated systemic vascular resistances (SVR) were observed. Endomyocardial biopsy of the LV was performed in one patient showing contraction band necrosis, oedema and inflammatory reaction. 76% of patients were treated with dobutamine, 70% needed noradrenaline, 29% adrenaline, 23.5% were treated with levosimendan and 17% with milrinone. Mechanical circulatory support devices (MCS) were necessary for 65% of patients. All patients benefited from pheochromocytoma’s surgical excision, with 4 patients operated on while under ECLS. All patients recovered, excepted one (presenting a severe left ventricular dilatation at admission) who required cardiac transplantation.
Conclusion
Pheochromocytoma is an infrequent cause of CS, with most often a TTS–like presentation. It should be suspected in case of a CS with high initial SVR and rapid deterioration. MCS must be considered in the most severe cases. The main challenge is to stabilize the patient, mostly with MCS, since it remains a reversible cause of CS with a low mortality rate. Adrenalectomy can safely be performed even when the patient is under MCS.
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Affiliation(s)
- E De Angelis
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Ravera
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - E Ammirati
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Tedeschi
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - M Polito
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - M Pieroni
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - P Gentile
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - M Merlo
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - C Van De Heyning
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - T Bekelaarh
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Cipriani
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - M Camilli
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - T Sanna
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - G Sinagra
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - E Bonnefoy–cudraz
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - T Bochaton
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Hayek
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
| | - A Aloia
- PRESIDIO OSPEDALIERO SAN LUCA, VALLO DELLA LUCANIA; AZIENDA OSPEDALIERA UNIVERSITARIA “SAN GIOVANNI DI DIO E RUGGI D‘ARAGONA”, SALERNO; DE GASPERIS CARDIO CENTER GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO; OSPEDALE SAN DONATO, AREZZO; AZIENDA SANITARIA UNIVERSITARIA “GIULIANO ISONTINA”, UNIVERSITÀ DI TRIESTE, TRIESTE; OSPEDALE UNIVERSITARIO DI ANVERSA, ANVERSA; AZIENDA OSPEDALIERA UNIVERSITAR
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9
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Graziano F, Schiavon M, Paiaro S, Cipriani A, Brunetti G, Corrado D, Zorzi A. Cost-effectiveness of the cardiovascular pre-participation screening in children practicing sport. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
In Italy, preparticipation screening of competitive athletes is mandatory. The age at which pre-participation screening (PPS) should start is established by each sport federation and it is sometimes under 10 years old. The aim of this study is to detect both PPS efficacy and cost in paediatric age and to define the cut-off age from which it is more cost-effective.
Methods
We retrospectively enrolled 25251 athletes aged ≤15 to evaluate the prevalence of cardiovascular (CV) diseases and cost-effectiveness ratio who underwent PPS from 2011 to 2020. In addition, we retrospectively studied a subgroup of 1307 competitive athletes aged 7-15 who underwent PPS from January 2019 to February 2020 for an in-depth analysed regarding costs. Cardiovascular preparticipation screening included first-line investigations (history, physical examination, resting ECG and exercise testing) and further examinations in case of abnormalities at first-line tests.
Results
In the period 2010-2020, 66 athletes were permanently disqualified for a CV disease (0,11%), 26 for a CV disease at risk of sudden cardiac death (0.05%), with a prevalence of 0.15% over 12 years old versus 0.01% under 12 (p<0.001). In the cost analysis subgroup, second-line investigations were prescribed to 5% of athletes because of abnormalities at first line tests: 1 was disqualified for a CV disease (0,07%). The cost for each athlete was 69,80€. Between 2011 and 2020, 58185 PPS were carried out. The overall cost of PPS was about €4 million, the cost for each diagnosis of any CV disease was 61.535€, and for each CV disease at risk of sudden cardiac death was 156.204€.
Conclusion
The cost-effectiveness of PPS before competitive sports in the pediatric age is lower than reported for older athletes in previously published studies. According to our data, starting PPS before 12 years of age does not appear to be justified.
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Affiliation(s)
- F Graziano
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - M Schiavon
- AULSS 6, Department of Sports Medicine, Padova, Italy
| | - S Paiaro
- AULSS 6, Department of Sports Medicine, Padova, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - G Brunetti
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - D Corrado
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - A Zorzi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
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10
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Brunetti G, Cardaioli F, De Lazzari M, Cipriani A, Cecere AG, Cecchetto A, Baritussio A, Giorgi B, Motta R, De Conti G, Tarantini G, Cacciavillani L, Iliceto S, Perazzolo Marra M. Left ventricular thrombosis following apical myocardial infarction: may CMR strain analysis tell us something? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left ventricular thrombosis (LVT) is a possible complication following myocardial infarction (MI). Besides infarct size, risk factors for LVT include ST-elevated MI (STEMI), anterior and apical location, reduced left ventricular ejection fraction (LVEF) and the presence of microvascular obstruction. Echocardiography quantified myocardial strain has been associated with LVT following MI. Recently, global longitudinal strain, calculated with feature tracking (FT) - CMR, emerged as an independent predictor of major cardiovascular events following MI. Anyway, the relationship between abnormalities on FT-CMR and LVT following MI is still unexplored. Aim of our study is to investigate the possible association between abnormal strain on FT-CMR and LVT following apical STEMI.
Methods
We performed a retrospective analysis including all patients with a previous apical STEMI, who underwent CMR at our Institute between August 2013 and October 2020. Patients with ongoing anticoagulant therapy were excluded. Differences in global and segmental strain on CMR between patients with and without LVT were tested in a propensity-matched sample, using LVEF, age, gender, time from MI diagnosis and number of LV segments with transmural late gadolinium enhancement (LGE) as covariates to assign propensity score. Furthermore, difference in terms of apical to global radial strain percentual deviation (AGD), calculated as [(Global Radial Strain – Apical Radial Strain)/Global Radial Strain] * 100, was tested.
Results
Of 356 patients with apical STEMI undergoing CMR at our center, 37 (10.4%) were diagnosed with LVT. After performing a propensity score matching, we obtained a sample of 36 pairs, with a mean age of 65 (SD 11) years, and a median EF of 35% (IQR 27-42); 59 (82%) of them were male. A significant difference in terms of apical radial strain was found between the two groups, with a median strain of 10.75 (IQR 6.8–16.5) in patients without LVT compared to a value of 5.25 (IQR 2.7–9-6) in patients with LVT (p = 0.007). No differences were found in terms of global longitudinal, radial and circumferential strain (p = 0.19, p= 0.2 and p= 0.49 respectively) and segmental circumferential and longitudinal strain. When considering the AGD parameter, a significant difference was found between the two groups, with a median deviation of 12% (IQR -20; +48) in patients without LVT and 51% (IQR +47; +75) in patients with LVT (p= 0.0003). Furthermore, an AGD value of 26% was found to be the most accurate in terms of sensitivity and specificity applying a Receiver Operating Characteristic (ROC) curve analysis (AUC 0.74; CI 0.62-0.85).
Conclusions
Among patients with transmural MI involving LV apex, reduced apical radial strain on FT-CMR is associated with the presence of LV thrombosis. Furthermore, among patients developing LV thrombi, a greater apical radial strain deviation from the global one was found, with a threshold value of 26% at ROC curve analysis.
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Affiliation(s)
- G Brunetti
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - F Cardaioli
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - M De Lazzari
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - A Cipriani
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - AG Cecere
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - A Cecchetto
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - A Baritussio
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - B Giorgi
- University of Padua, Radiology Unit, Department of Medicine, Institute of Radiology, University of Padua , Padova, Italy
| | - R Motta
- University of Padua, Radiology Unit, Department of Medicine, Institute of Radiology, University of Padua , Padova, Italy
| | - G De Conti
- University of Padua, Radiology Unit, Department of Medicine, Institute of Radiology, University of Padua , Padova, Italy
| | - G Tarantini
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - L Cacciavillani
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - S Iliceto
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - M Perazzolo Marra
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
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11
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Cecere A, De Lazzari M, Cipriani A, Giorgi B, Motta R, Iliceto S, Perazzolo Marra M. Left ventricular myocardial deformation abnormalities in arrhythmic mitral valve prolapse: which comes first? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Arrhythmic mitral valve prolapse (MVP) is characterized by left ventricular (LV) fibrosis in the basal inferolateral wall and papillary muscles. We hypothesized that LV fibrosis are driven by excessive mechanical forces acting on myocardial susceptible cells, representing the last step in the MVP-induced myocardial stretch process. Purpose. We aimed to evaluate the LV myocardial deformation, using strain assessed with cardiac magnetic resonance (CMR), in arrhythmic MVP patients with normal LV ejection fraction (LVEF) and absent/trivial mitral regurgitation (MR) and its correlation with the presence of LV fibrosis, detected by late gadolinium enhancement (LGE) in post-contrast CMR images. Methods. We enrolled consecutive arrhythmic MVP patients with normal LVEF and no/trivial MR. Sixty-nine (39 female; median age: 40 years) patients without MVP, arrhythmias or cardiovascular history served as control group. All patients underwent CMR for identification of LGE and evaluation of LV myocardial deformation. Results. A total of 66 patients were enrolled (47 female; median age: 44 years). In the overall MVP population, LGE was present in 41 patients (62.1%). MVP patients without LGE (25 patients, 37.9%) presented a higher global radial (median: 42.19 vs 33; p: <0.0001) and higher global longitudinal strain (median: -21.61 vs -18.10; p: <0.0001), compared to the control group. A reduction of regional basal posterolateral radial (BPL median: 50.60 vs 67.30; p: 0.0015) and longitudinal strain (BPL median: -23.50 vs -26.70; p: 0.0186) were observed in the MVP patients as compared with controls (Figures A-D). Conversely to the basal region, mid anterolateral and posterolateral region presented a higher radial (MAL median: 52.60 vs 31.10; p: < 0.0001 and MPL median: 52.80 vs 21.50; p: < 0.0001) and longitudinal strain (MAL median: -24.80 vs -18.30; p: < 0.0001 and MPL median: -25.30 vs -14.80; p: < 0.0001), when compared to control group. MVP patients with LGE had a lower global radial (median: 36.48 vs 42.19; p: <0.0047), longitudinal (median: -19.18 vs -21.61; p: 0.0013) and circumferential strain (median: -17.80 vs -19.28; p: 0.0134) compared with those without fibrosis. According to MVP patients without LGE, the presence of fibrosis is associated with a lower regional radial (BAL median: 64.40 vs 82.80; p: 0.0481; MAL median: 42.60 vs 52.60; p: 0.0287) and circumferential strain (BAL median: -21.90 vs -24.20; p: 0.0174; BPL median: -16.80 vs -18.80; p: 0.0411; MPL median: -15.50 vs -19.40; p: 0.0077) in the LV basal-mid lateral walls (Figures E-I). Conclusions. Arrhythmic MVP patients with normal LV systolic function and absent/trivial MR presented an abnormal myocardial deformation pattern. The reduced strain in BPL wall of MVP patients without LGE could be considered as an early marker of MVP-induced myocardial stress, that could promote, time by time, LV fibrosis and arrhythmias in MVP patients.
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Affiliation(s)
- A Cecere
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M De Lazzari
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - A Cipriani
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - B Giorgi
- University of Padua – Azienda Ospedaliera, Radiology Unit, Department of Medicine, Padua, Italy
| | - R Motta
- University of Padua – Azienda Ospedaliera, Radiology Unit, Department of Medicine, Padua, Italy
| | - S Iliceto
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M Perazzolo Marra
- University of Padua – Azienda Ospedaliera, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
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Solmi M, Wade TD, Byrne S, Del Giovane C, Fairburn CG, Ostinelli EG, De Crescenzo F, Johnson C, Schmidt U, Treasure J, Favaro A, Zipfel S, Cipriani A. Comparative efficacy and acceptability of psychological interventions for the treatment of adult outpatients with anorexia nervosa: a systematic review and network meta-analysis. Lancet Psychiatry 2021; 8:215-224. [PMID: 33600749 DOI: 10.1016/s2215-0366(20)30566-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/25/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND No consistent first-option psychological interventions for adult outpatients with anorexia nervosa emerges from guidelines. We aimed to compare stand-alone psychological interventions for adult outpatients with anorexia nervosa with a specific focus on body-mass index, eating disorder symptoms, and all-cause dropout rate. METHODS In this systematic review and network meta-analysis, we assessed randomised controlled trials about stand-alone pharmacological or non-pharmacological treatments of adult outpatients with anorexia nervosa, defined according to standardised criteria, with data for at least two timepoints relating to either body-mass index or global eating disorder psychopathology. We searched Cochrane CENTRAL, CINAHL, MEDLINE, and PsychINFO for published and unpublished literature from inception until March 20, 2020. The primary outcomes were the change in body mass index and clinical symptoms, and the secondary outcome was all-cause dropout rate, which were all assessed for treatment as usual, cognitive behavioural therapy (CBT), Maudsley anorexia treatment for adults, family-based treatment, psychodynamic-oriented psychotherapies, a form of CBT targeting compulsive exercise, and cognitive remediation therapy followed by CBT. Global and local inconsistencies for the network meta-analysis were measured, and CINeMA was used to assess the confidence in evidence for primary outcomes. The protocol is registered in PROSPERO (CRD42017064429). FINDINGS Of 14 003 studies assessed for their title and abstract, 16 (0·1%) randomised controlled trials for psychological treatments were included in the systematic review, of which 13 (0·1%) contributed to the network meta-analysis, with 1047 patients in total (of whom 1020 [97·4%] were female). None of the interventions outperformed treatment as usual in our primary outcomes, but the all-cause dropout rate was lower for CBT than for psychodynamic-oriented psychotherapies (OR 0·54, 95% CI 0·31-0·93). Heterogeneity or inconsistency emerged only for a few comparisons. Confidence in the evidence was low to very low. INTERPRETATION Compared with treatment as usual, specific psychological treatments for adult outpatients with anorexia nervosa can be associated with modest improvements in terms of clinical course and quality of life, but no reliable evidence supports clear superiority or inferiority of the specific treatments that are recommended by clinical guidelines internationally. Our analysis is based on the best data from existing clinical studies, but these findings should not be seen as definitive or universally applicable. There is an urgent need to fund new research to develop and improve therapies for adults with anorexia nervosa. Meanwhile, to better understand the effects of available treatments, participant-level data should be made freely accessible to researchers to eventually identify whether specific subgroups of patients are more likely to respond to specific treatments. FUNDING Flinders University, National Institute for Health Research Oxford Health Biomedical Research Centre.
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Affiliation(s)
- M Solmi
- Neurosciences Department and Neuroscience Centre, University of Padua, Padua, Italy
| | - T D Wade
- Discipline of Psychology, Flinders University, Adelaide, SA, Australia
| | - S Byrne
- School of Psychological Sciences, The University of Western Australia, Perth, WA, Australia
| | - C Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - C G Fairburn
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - E G Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, UK
| | - F De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C Johnson
- Discipline of Psychology, Flinders University, Adelaide, SA, Australia
| | - U Schmidt
- Department of Psychological Medicine, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, London, UK
| | - J Treasure
- Department of Psychological Medicine, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, London, UK
| | - A Favaro
- Neurosciences Department and Neuroscience Centre, University of Padua, Padua, Italy
| | - S Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
| | - A Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, UK.
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Bettella N, De Lazzari M, Zorzi A, Vessella T, Cipriani A, Motta R, Perazzolo Marra M, Corrado D. Relationship between papillary muscles abnormalities and apparently unexplained infero-lateral T-wave inversion in athletes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
To evaluate by cardiac magnetic resonance (CMR) if left ventricle papillary muscle abnormalities, such as hypertrophy and abnormal location, may be the anatomo-functional substrates responsible for TWI inversion in lateral or infero-lateral leads in otherwise healthy athletes.
Methods
We included competitive athletes with TWI in lateral or infero-lateral leads in the absence of cardiac diseases detected by CMR. The control population included healthy athletes with normal ECG, matched for age and gender. We compared thickness, volume (both absolute and relative to the cardiac mass) and position of the papillary muscles between cases and controls.
Results
We included 53 athletes with apparently unexplained TWI in the lateral or infero-lateral leads (median age 20 years (17–42), 86.8% males) and 53 athletes with no TWI matched for age and gender. 4 patients (7.6%) had family history for cardiomyopathy or sudden cardiac death. Athletes with TWI showed more hypertrophic papillary muscles compared to controls, with statistically significant difference in diameter, area and volume (p<0.01). The median ratio between the papillary muscles and the left ventricular mass was 4.4% among athletes with TWI versus 3% among those without TWI (p<0.001). Papillary muscles showed apical displacement in 47% of cases, compared to 17% in the control group (p=0.001).
Conclusions
Idiopathic TWI in lateral or infero-lateral leads is associated with left ventricle papillary muscle hypertrophy and their apical displacement detected by CMR. The comprehension of clinical and prognostic significance of papillary muscle abnormalities responsible for these ventricular repolarization alterations requires further studies.
Example
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Bettella
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - M De Lazzari
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - A Zorzi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - T Vessella
- Center for Sports Medicine, ULSS2 Marca Trevigiana, Treviso, Italy, Treviso, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - R Motta
- University of Padua, Department of medicine, Padova, Italy
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - D Corrado
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
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14
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Mattesi G, Baldi E, Guerra F, Toniolo M, Cipriani A, Cauti F, Marcantoni L, Manfrin M, Lanzillo C, Savastano S, Zorzi A. Prognostic role of left ventricular late gadolinium enhancement (LV-LGE) in patients who received implantable cardioverter defibrillator (ICD) for secondary prevention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
LV myocardial fibrosis detected as LGE on cardiac magnetic resonance (CMR) is a predictor of arrhythmic risk in primary prevention both in ischaemic and non-ischaemic cardiomyopathy. However, we still do not know the prognostic role of LV-LGE in patients who suffered cardiac arrest (CA).
Purpose
To evaluate the prognostic role of CMR, and in particular of LV-LGE suggesting myocardial scar, in predicting appropriate ICD interventions in secondary prevention patients.
Methods
Ninety-seven consecutive patients 1) aged ≥14 years 2) hospitalized for CA because of ventricular arrhythmias from 2009/01/01 3) who underwent/undergoing a CMR within one month from the event 4) who received/receiving an ICD for secondary prevention and 5) with at least 1 year-follow-up, were enrolled for this multicentric study.
Results
97 patients (68 males, 70%), mean age 46±16 years, were enrolled. Seventy-six percent of patients received bystander cardiopulmonary resuscitation (CPR) and ventricular fibrillation (VF) was the first rhythm in 86% of cases. ST elevation was present in 18% of cases at the admission; however, angiography was found negative in 80% of patients. Myocardial oedema and LGE were identified in 26% and 64% of patients respectively. A diagnosis was made in 83.5% of cases, while in the remaining 16.5% CA was considered idiopathic. During a four-year-follow-up, 25% of patients had appropriate ICD therapy (10% of which ATP only). A significant correlation between LGE and appropriate ICD intervention was not found (p=0.89).
Conclusions
One fourth of patients who received ICD for secondary prevention had appropriate ICD therapy during a four-year-follow-up. In this setting, LV-LGE does not provide a prognostic value.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Mattesi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - E Baldi
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - F Guerra
- Marche Polytechnic University of Ancona, Ancona, Italy
| | - M Toniolo
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - F Cauti
- San Giovanni Calibita Hospital, Roma, Italy
| | - L Marcantoni
- Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | | | - S Savastano
- Policlinic Foundation San Matteo IRCCS, Pavia, Italy
| | - A Zorzi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
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15
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Zorzi A, Crescenzi C, Vessella T, Cipriani A, Panattoni G, De Lazzari M, Perazzolo-Marra M, Sarto P, Corrado D, Calo' L. Predictors of left ventricular scar at cardiac magnetic resonance in athletes with apparently idiopathic ventricular arrhythmias. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In athletes with ventricular arrhythmias (VA) and otherwise unremarkable clinical findings, cardiac magnetic resonance (CMR) may reveal concealed pathological substrates. The aim of this multicentre study was to evaluate which VA characteristics were associated with CMR abnormalities.
Methods
We enrolled a consecutive series of 251 competitive athletes (74% males, mean age 28.5±14.5 years) who underwent CMR for evaluation of VA. We included athletes with >100 premature ventricular beats (PVBs)/24-hour or ≥1 repetitive VA (couplets, triplets or non-sustained ventricular tachycardia) on 12-lead 24-hour ambulatory ECG monitoring and negative family history, electrocardiogram and echocardiogram. Features of VA that were evaluated included number, morphology, repetitivity and response to exercise testing.
Results
Left-ventricular late gadolinium-enhancement (LGE) was documented in 28 (11%) athletes, mostly (N=25) with a subepicardial/midmyocardial (non-ischemic) distribution. On 24-hour ECG monitoring, PVBs with a right-bundle-branch-block and intermediate/superior axis configuration or multiple morphologies were documented in 24/28 (86%) athletes with versus 55/223 (25%) without LGE (p<0.001). More than 2000 PVBs were recorded in 6 (21%) athletes with versus 127 (57%) without positive CMR (p<0.001). At exercise testing, repetitive VA occurred at high work-load in 12 (43%) athletes with versus 26 (12%) without LGE (p<0.001). At multivariable analysis, all three VA features independently correlated with CMR abnormalities.
Conclusions
In athletes with apparently idiopathic VA, simple characteristics such as number and morphology of PVBs on 12-lead 24-hour ambulatory ECG monitoring and response to exercise testing predicted the presence of concealed myocardial abnormalities on CMR. These findings may help cost-effective CMR prescription.
Flow chart
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Zorzi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - C Crescenzi
- Policlinico Casilino, Rome, Italy, Roma, Italy
| | - T Vessella
- Center for Sports Medicine, ULSS2 Marca Trevigiana, Treviso, Italy, Treviso, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - G Panattoni
- Policlinico Casilino, Rome, Italy, Roma, Italy
| | - M De Lazzari
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - M Perazzolo-Marra
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - P Sarto
- Center for Sports Medicine, ULSS2 Marca Trevigiana, Treviso, Italy, Treviso, Italy
| | - D Corrado
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - L Calo'
- Policlinico Casilino, Rome, Italy, Roma, Italy
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16
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Goodday SM, Kormilitzin A, Vaci N, Liu Q, Cipriani A, Smith T, Nevado-Holgado A. Maximizing the use of social and behavioural information from secondary care mental health electronic health records. J Biomed Inform 2020; 107:103429. [PMID: 32387393 DOI: 10.1016/j.jbi.2020.103429] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The contribution of social and behavioural factors in the development of mental health conditions and treatment effectiveness is widely supported, yet there are weak population level data sources on social and behavioural determinants of mental health. Enriching these data gaps will be crucial to accelerating precision medicine. Some have suggested the broader use of electronic health records (EHR) as a source of non-clinical determinants, although social and behavioural information are not systematically collected metrics in EHRs, internationally. OBJECTIVE In this commentary, we highlight the nature and quality of key available structured and unstructured social and behavioural data using a case example of value counts from secondary mental health data available in the UK from the UK Clinical Record Interactive Search (CRIS) database; highlight the methodological challenges in the use of such data; and possible solutions and opportunities involving the use of natural language processing (NLP) of unstructured EHR text. CONCLUSIONS Most structured non-clinical data fields within secondary care mental health EHR data have too much missing data for adequate use. The utility of other non-clinical fields reported semi-consistently (e.g., ethnicity and marital status) is entirely dependent on treating them appropriately in analyses, quantifying the many reasons behind missingness in consideration of selection biases. Advancements in NLP offer new opportunities in the exploitation of unstructured text from secondary care EHR data particularly given that clinical notes and attachments are available in large volumes of patients and are more routinely completed by clinicians. Tackling ways to re-use, harmonize, and improve our existing and future secondary care mental health data, leveraging advanced analytics such as NLP is worth the effort in an attempt to fill the data gap on social and behavioural contributors to mental health conditions and will be necessary to fulfill all of the domains needed to inform personalized interventions.
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Affiliation(s)
- S M Goodday
- Department of Psychiatry, University of Oxford, United Kingdom; 4youandme, Seattle, WA, USA.
| | - A Kormilitzin
- Department of Psychiatry, University of Oxford, United Kingdom
| | - N Vaci
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Q Liu
- Department of Psychiatry, University of Oxford, United Kingdom
| | - A Cipriani
- Department of Psychiatry, University of Oxford, United Kingdom
| | - T Smith
- Oxford Health NHS Foundation Trust, United Kingdom
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17
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Furukawa TA, Salanti G, Cowen PJ, Leucht S, Cipriani A. No benefit from flexible titration above minimum licensed dose in prescribing antidepressants for major depression: systematic review. Acta Psychiatr Scand 2020; 141:401-409. [PMID: 31891415 DOI: 10.1111/acps.13145] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In fixed-dose antidepressant trials, the lower range of the licensed dose achieves the optimal balance between efficacy and tolerability. Whether flexible upward titration while side-effects permit provides additional benefits is unknown. METHODS We did a systematic review of placebo-controlled randomized trials that examined selective serotonin reuptake inhibitors (SSRIs), venlafaxine or mirtazapine in the acute treatment of major depression. Our primary outcome was response, defined as 50% or greater reduction in depression severity. Secondary outcomes included drop-outs due to adverse effects and drop-outs for any reason. We conducted random-effects meta-analyses to calculate the ratios of odds ratios (RORs) between trials comparing the flexible dose titrating above the minimum licensed dose against placebo and those comparing the fixed minimum licensed dose against placebo. RESULTS We included 123 published and unpublished randomized controlled trials (29 420 participants). There was no evidence supporting efficacy of the flexible dosing over the fixed low dose of SSRIs (ROR 0.96, 95% CI: 0.73 to 1.25), venlafaxine (1.24, 0.96 to 1.60) or mirtazapine (0.77, 0.33 to 1.78). No important differences were noted for tolerability or for any subgroup analyses except the superior efficacy of venlafaxine flexible dosing between 75 and 150 mg over the fixed 75 mg (1.30, 1.02 to 1.65). CONCLUSION There was no evidence to support added value in terms of efficacy, tolerability or acceptability of flexibly titrating up the dosage over the minimum licensed dose of SSRIs or mirtazapine. For venlafaxine, increased efficacy can be expected by flexibly titrating up to 150 mg.
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Affiliation(s)
- T A Furukawa
- Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - G Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - P J Cowen
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - S Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - A Cipriani
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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18
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Carrer A, Cipriani A, Rizzo S, Giorgi B, Lacognata C, Cacciavillani L, Tarantini G, Basso C, Iliceto S, Perazzolo Marra M. 351Cannabinoids-induced toxic myocarditis underlying apical ballooning syndrome: a case proven by combined cardiac magnetic resonance and endomyocardial biopsy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez126.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Carrer
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - S Rizzo
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - B Giorgi
- University of Padova, Department of Medicine, Padua, Italy
| | | | - L Cacciavillani
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - G Tarantini
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - C Basso
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
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19
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Perazzolo Marra M, Zanetti C, Bariani R, Cipriani A, Rizzon G, Giorgi B, Lacognata C, Quaia E, Aliberti C, Basso C, Corrado D, Rigato I, Bauce B, Tona F, Iliceto S. 529Relationship between ventricular mechanics and fibro-fatty replacement on cardiac magnetic resonance in arrhythmogenic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez115.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Perazzolo Marra
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - C Zanetti
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - R Bariani
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - G Rizzon
- University of Padova, Division of Radiology, Department of Medicine, Padua, Italy
| | - B Giorgi
- University of Padova, Division of Radiology, Department of Medicine, Padua, Italy
| | - C Lacognata
- University of Padova, Division of Radiology, Department of Medicine, Padua, Italy
| | - E Quaia
- University of Padova, Division of Radiology, Department of Medicine, Padua, Italy
| | - C Aliberti
- University of Padova, Division of Radiology, Department of Medicine, Padua, Italy
| | - C Basso
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - D Corrado
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - I Rigato
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - B Bauce
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - F Tona
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
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20
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Cipriani A, Carrer A, De Lazzari M, Zorzi A, Lacognata C, Piaserico S, Aliberti C, Bauce B, Iliceto S, Corrado D, Perazzolo Marra M. P377Arrhythmogenic cardiomyopathy in epidermolysis bullosa: are desmosomes at fault for both? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Cipriani
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - A Carrer
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M De Lazzari
- University Hospital of Padova, Department of Cardiologic, Thoracic and Vascular Science, Padua, Italy
| | - A Zorzi
- University Hospital of Padova, Department of Cardiologic, Thoracic and Vascular Science, Padua, Italy
| | - C Lacognata
- University of Padova, Department of Radiology, Padua, Italy
| | - S Piaserico
- University of Padova, Department of Medicine, Padua, Italy
| | - C Aliberti
- University of Padova, Department of Radiology, Padua, Italy
| | - B Bauce
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - D Corrado
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
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21
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Figliozzi S, Cipriani A, Zorzi A, Andres AL, Aliberti C, Iliceto S, Corrado D, Rigato I, Perazzolo Marra M, Bauce B. P359A very unusual cause of exercise-induced ventricular arrhythmias in the athlete. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Cipriani
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - A Zorzi
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - A L Andres
- University Hospital of Padova, Division of Radiology, Azienda Ospedaliera di Padova, Padua, Italy
| | - C Aliberti
- University Hospital of Padova, Division of Radiology, Azienda Ospedaliera di Padova, Padua, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - D Corrado
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - I Rigato
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - B Bauce
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
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22
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Quinto L, Cipriani A, De Lazzari M, Simeti G, Migliore F, Lacognata C, Zucchetta P, Aliberti C, Quaia E, Iliceto S, Perazzolo Marra M. P357Never stop at the first diagnosis, though very plausible. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Quinto
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy, Padua, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy, Padua, Italy
| | - M De Lazzari
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy, Padua, Italy
| | - G Simeti
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy, Padua, Italy
| | - F Migliore
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy, Padua, Italy
| | - C Lacognata
- University Hospital of Padova, Division of Radiology Department of Medicine University of Padova Italy, Padua, Italy
| | - P Zucchetta
- University Hospital of Padova, Division of Radiology Department of Medicine University of Padova Italy, Padua, Italy
| | - C Aliberti
- University Hospital of Padova, Division of Radiology Department of Medicine University of Padova Italy, Padua, Italy
| | - E Quaia
- University Hospital of Padova, Division of Radiology Department of Medicine University of Padova Italy, Padua, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy, Padua, Italy
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences University of Padova Italy, Padua, Italy
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23
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Ristori J, Fisher A, Cipriani A, Maggi M. PS-01-005 The effect of hormonal treatment on sexual distress in transgender persons: A two-year follow-up study. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Leucht S, Levine SZ, Samara M, Cipriani A, Davis JM, Furukawa TA. Possibly no baseline severity effect for antidepressants versus placebo but for antipsychotics. Why? Eur Arch Psychiatry Clin Neurosci 2018; 268:621-623. [PMID: 30178421 DOI: 10.1007/s00406-018-0940-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany. .,Department of Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | | | - M Samara
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - A Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - J M Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA.,Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - T A Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
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25
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Zorzi A, Mastella G, Cipriani A, Sciacca F, Berton G, Tollot S, Niero A, De Lazzari M, Schiavon M, Corrado D. 475Ventricular arrhythmias at 24-hours ambulatory ECG monitoring: young versus senior competitive athletes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Zorzi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - G Mastella
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - F Sciacca
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - G Berton
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - S Tollot
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - A Niero
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - M De Lazzari
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - M Schiavon
- AULSS 6, Department of Sports Medicine, Padova, Italy
| | - D Corrado
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
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Zorzi A, Mastella G, Pontolan L, Berton G, Sciacca F, Tollot S, Tikvina S, Cipriani A, Schiavon M, Corrado D. P658Prevalence and determinant of ventricular arrhythmias at 24-hours ambulatory ECG monitoring in young competitive athletes and sedentary controls. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Zorzi
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - G Mastella
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - L Pontolan
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - G Berton
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - F Sciacca
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - S Tollot
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - S Tikvina
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - A Cipriani
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
| | - M Schiavon
- AULSS 6, Department of Sports Medicine, Padova, Italy
| | - D Corrado
- University of Padova, Department of Cardiac, Thoracic and Vascular sciences, Padua, Italy
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Furukawa TA, Maruo K, Noma H, Tanaka S, Imai H, Shinohara K, Ikeda K, Yamawaki S, Levine SZ, Goldberg Y, Leucht S, Cipriani A. Initial severity of major depression and efficacy of new generation antidepressants: individual participant data meta-analysis. Acta Psychiatr Scand 2018; 137:450-458. [PMID: 29611870 DOI: 10.1111/acps.12886] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The role of baseline severity as effect modifier in various psychiatric disorders is a topic of controversy and of clinical import. This study aims to examine whether baseline severity modifies the efficacy of various antidepressants for major depression through individual participant data (IPD) meta-analysis. METHOD We identified all placebo-controlled, double-blind randomised trials of new generation antidepressants in the acute phase treatment of major depression conducted in Japan and requested their IPD through the public-private partnerships (PPPs) between the relevant academic societies and the pharmaceutical companies. The effect modification by baseline depression severity was examined through six increasingly complex competing mixed-effects models for repeated measures. RESULTS We identified eleven eligible trials and obtained IPD from six, which compared duloxetine, escitalopram, mirtazapine, paroxetine or bupropion against placebo (total n = 2464). The best-fitting model revealed that the interaction between baseline severity and treatment was not statistically significant (coefficient = -0.04, 95% confidence interval: -0.16 to 0.08, P = 0.49). Several sensitivity analyses confirmed the robustness of the findings. CONCLUSION We may expect as much benefit from antidepressant treatments for mild, moderate or severe major depression. Clinical practice guidelines will need to take these findings into consideration.
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Affiliation(s)
- T A Furukawa
- Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - K Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - H Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - S Tanaka
- Department of Clinical Biostatistics, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - H Imai
- Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - K Shinohara
- Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - K Ikeda
- Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - S Yamawaki
- Academic-Industrial Cooperation Office, Hiroshima University, Hiroshima, Japan
| | - S Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Y Goldberg
- Department of Statistics, Faculty of Social Sciences, University of Haifa, Haifa, Israel
| | - S Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - A Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK
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Rizzo S, De Lazzari M, De Gaspari M, Cipriani A, Rigato I, Tarantini G, Pilichou K, Giorgi B, Corrado D, Bauce B, Iliceto S, Thiene G, Basso C, Perazzolo Marra M. P1596Tissue characterization in Arrhythmogenic Cardiomyopathy: diagnostic impact of combined endomyocardial biopsy and cardiac magnetic resonance approach. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marwood L, Taylor R, Goldsmith K, Romeo R, Holland R, Pickles A, Hutchinson J, Dietch D, Cipriani A, Nair R, Attenburrow MJ, Young AH, Geddes J, McAllister-Williams RH, Cleare AJ. Study protocol for a randomised pragmatic trial comparing the clinical and cost effectiveness of lithium and quetiapine augmentation in treatment resistant depression (the LQD study). BMC Psychiatry 2017; 17:231. [PMID: 28651526 PMCID: PMC5485607 DOI: 10.1186/s12888-017-1393-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Approximately 30-50% of patients with major depressive disorder can be classed as treatment resistant, widely defined as a failure to respond to two or more adequate trials of antidepressants in the current episode. Treatment resistant depression is associated with a poorer prognosis and higher mortality rates. One treatment option is to augment an existing antidepressant with a second agent. Lithium and the atypical antipsychotic quetiapine are two such add-on therapies and are currently recommended as first line options for treatment resistant depression. However, whilst neither treatment has been established as superior to the other in short-term studies, they have yet to be compared head-to-head in longer term studies, or with a superiority design in this patient group. METHODS The Lithium versus Quetiapine in Depression (LQD) study is a parallel group, multi-centre, pragmatic, open-label, patient randomised clinical trial designed to address this gap in knowledge. The study will compare the clinical and cost effectiveness of the decision to prescribe lithium or quetiapine add-on therapy to antidepressant medication for patients with treatment resistant depression. Patients will be randomised 1:1 and followed up over 12 months, with the hypothesis being that quetiapine will be superior to lithium. The primary outcomes will be: (1) time to all-cause treatment discontinuation over one year, and (2) self-rated depression symptoms rated weekly for one year via the Quick Inventory of Depressive Symptomatology. Other outcomes will include between group differences in response and remission rates, quality of life, social functioning, cost-effectiveness and the frequency of serious adverse events and side effects. DISCUSSION The trial aims to help shape the treatment pathway for patients with treatment resistant depression, by determining whether the decision to prescribe quetiapine is superior to lithium. Strengths of the study include its pragmatic superiority design, broad inclusion criteria (external validity) and longer follow up than previous studies. TRIAL REGISTRATION ISRCTN registry: ISRCTN16387615 , registered 28 February 2016. ClinicalTrials.gov: NCT03004521 , registered 17 November 2016.
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Affiliation(s)
- L. Marwood
- 0000 0001 2322 6764grid.13097.3cCentre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - R. Taylor
- 0000 0001 2322 6764grid.13097.3cCentre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - K. Goldsmith
- 0000 0001 2322 6764grid.13097.3cBiostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - R. Romeo
- 0000 0001 2322 6764grid.13097.3cHealth Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - R. Holland
- 0000 0001 2322 6764grid.13097.3cBiostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - A. Pickles
- 0000 0001 2322 6764grid.13097.3cBiostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - J. Hutchinson
- grid.451089.1Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK ,0000 0001 0462 7212grid.1006.7Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - A. Cipriani
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,0000 0004 0573 576Xgrid.451190.8Oxford Health NHS Foundation Trust, Oxford, UK
| | - R. Nair
- grid.439606.eTees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - M.-J. Attenburrow
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,0000 0004 0573 576Xgrid.451190.8Oxford Health NHS Foundation Trust, Oxford, UK
| | - A. H. Young
- 0000 0001 2322 6764grid.13097.3cCentre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - J. Geddes
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,0000 0004 0573 576Xgrid.451190.8Oxford Health NHS Foundation Trust, Oxford, UK
| | - R. H. McAllister-Williams
- grid.451089.1Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK ,0000 0001 0462 7212grid.1006.7Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - A. J. Cleare
- 0000 0001 2322 6764grid.13097.3cCentre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
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Duffy A, Patten S, Goodday S, Weir A, Heffer N, Cipriani A. Efficacy and tolerability of lithium in treating acute mania in youth with bipolar disorder: protocol for a systematic review. Int J Bipolar Disord 2017; 5:22. [PMID: 28447333 PMCID: PMC5468355 DOI: 10.1186/s40345-017-0092-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/28/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Epidemiological, clinical, and high-risk studies have provided evidence that the peak period for onset of diagnosable episodes of mania and hypomania starts in mid-to-late adolescence. Moreover, clinically significant manic symptoms may occur even earlier, especially in children at familial risk. Lithium is the gold standard treatment for acute mania in adults, yet to our knowledge, there is no published systematic review assessing lithium treatment of mania in children or adolescents. This is a major gap in knowledge needed to inform clinical practice. AIM As a working group within the ISBD Task Force on Lithium Treatment ( http://www.isbd.org/active-task-forces ), our aim is to complete a systematic review of the efficacy, tolerability, and acceptability of lithium compared with placebo and other active drugs in treating mania in children and adolescents diagnosed with bipolar disorder. METHODS We will include double- or single-blind randomized controlled trials in patients aged less than 18 years. No restrictions will be made by study publication date or language. Several electronic databases will be searched along with secondary sources such as bibliographies and trial registry websites for published and unpublished studies. Response rates to lithium compared with placebo or other active drugs will be the primary efficacy outcome. Primary tolerability and acceptability outcomes will be rates of serious adverse events and dropouts, respectively. Secondary outcomes will include rates of remission, severity of manic symptoms at different time points, and incidence of specific adverse events. DISCUSSION Findings from this systematic review are critically needed to inform clinical practice. We should not generalize findings from adult studies, as children and adolescents are undergoing accelerated physiological and brain development. Therefore, efficacy, tolerability, and acceptability of lithium treatment of acute mania in children compared to adults may be very different. This systematic review has been registered in PROSPERO (CRD42017055675).
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Affiliation(s)
- A Duffy
- Mood Disorders Centre of Ottawa, University of Ottawa Health Services, 100 Marie Curie Private, Suite 300, Ottawa, ON, K1N 6N5, Canada. .,Department of Psychiatry, Hotel Dieu Hospital, Queen's University, 166 Brock Street, Kingston, ON, K7L 5G2, Canada.
| | - S Patten
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - S Goodday
- Department of Epidemiology, University of Toronto, Toronto, ON, Canada
| | - A Weir
- Mood Disorders Centre of Ottawa, University of Ottawa Health Services, 100 Marie Curie Private, Suite 300, Ottawa, ON, K1N 6N5, Canada.,Department of Epidemiology, University of Ottawa, Ottawa, ON, Canada
| | | | - A Cipriani
- Department of Psychiatry, Oxford University, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
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Cipriani A, Saunders K, Attenburrow MJ, Stefaniak J, Panchal P, Stockton S, Lane TA, Tunbridge EM, Geddes JR, Harrison PJ. A systematic review of calcium channel antagonists in bipolar disorder and some considerations for their future development. Mol Psychiatry 2016; 21:1324-32. [PMID: 27240535 PMCID: PMC5030455 DOI: 10.1038/mp.2016.86] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/01/2016] [Accepted: 04/15/2016] [Indexed: 12/17/2022]
Abstract
l-type calcium channel (LTCC) antagonists have been used in bipolar disorder for over 30 years, without becoming an established therapeutic approach. Interest in this class of drugs has been rekindled by the discovery that LTCC genes are part of the genetic aetiology of bipolar disorder and related phenotypes. We have therefore conducted a systematic review of LTCC antagonists in the treatment and prophylaxis of bipolar disorder. We identified 23 eligible studies, with six randomised, double-blind, controlled clinical trials, all of which investigated verapamil in acute mania, and finding no evidence that it is effective. Data for other LTCC antagonists (diltiazem, nimodipine, nifedipine, methyoxyverapamil and isradipine) and for other phases of the illness are limited to observational studies, and therefore no robust conclusions can be drawn. Given the increasingly strong evidence for calcium signalling dysfunction in bipolar disorder, the therapeutic candidacy of this class of drugs has become stronger, and hence we also discuss issues relevant to their future development and evaluation. In particular, we consider how genetic, molecular and pharmacological data can be used to improve the selectivity, efficacy and tolerability of LTCC antagonists. We suggest that a renewed focus on LTCCs as targets, and the development of 'brain-selective' LTCC ligands, could be one fruitful approach to innovative pharmacotherapy for bipolar disorder and related phenotypes.
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Affiliation(s)
- A Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. E-mail: or
| | - K Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - M-J Attenburrow
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - J Stefaniak
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - P Panchal
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - S Stockton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - T A Lane
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - E M Tunbridge
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - J R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - P J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. E-mail: or
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 443] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Cipriani A, Conte P, Bonanomi E, Foresti C. 21. Feasibility of the EEG-continuous monitoring in infants with neonatal helmet-CPAP. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cipriani A, Barbui C, Rendell J, Geddes JR. Clinical and regulatory implications of active run-in phases in long-term studies for bipolar disorder. Acta Psychiatr Scand 2014; 129:328-42. [PMID: 24289821 DOI: 10.1111/acps.12223] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The integration of new treatments into the market and routine clinical practice should be dependent on robustness of evidence from randomised controlled trials (RCTs). We assessed study designs of long-term studies for bipolar disorder of all second-generation antipsychotics (SGAs) submitted to the Food and Drug Administration (FDA) and the completeness of evidence submitted to the regulatory agency. METHOD Systematic review of double-blind RCTs comparing SGAs with placebo or active drugs in adults. FDA website and electronic databases were searched until July 2013. RESULTS Six placebo-controlled trials comparing aripiprazole, olanzapine, quetiapine and ziprasidone were found in the FDA website. Electronic searches found four additional RCTs about aripiprazole, olanzapine or quetiapine. All RCTs (either submitted to FDA or not) selected patients who responded to acute treatment to increase the treatment effect observed in the long-term phase (enrichment design). By contrast, in the prescribing information sheets for all SGAs, the reported indication was 'maintenance treatment of bipolar disorder'. CONCLUSION Extrapolation of results from enrichment studies to the more general population of patients should be carried out cautiously because average treatment benefits are likely to be less in unselected patients. Clear guidance for regulatory submission of RCTs is needed.
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Affiliation(s)
- A Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy
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Bovina N, Cipriani A, Zadra M, Foresti C. 85. Technical approach to the neurophysiologic electroencephalogram in neonatal intensive care units. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Barbui C, Cipriani A, Furukawa TA, Salanti G, Higgins JPT, Churchill R, Watanabe N, Nakagawa A, Omori IM, Geddes JR. Making the best use of available evidence: the case of new generation antidepressants: A response to: Are all antidepressants equal? Evidence-Based Mental Health 2009; 12:101-4. [DOI: 10.1136/ebmh.12.4.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- M.E. Cuff
- Midwest Center for Structural Genomics, Biosciences Division, Argonne National Laboratory, Argonne, Illinois 60439
- Structural Biology Center, Biosciences Division, Argonne National Laboratory, Argonne, Illinois 60439
| | - H. Li
- Midwest Center for Structural Genomics, Biosciences Division, Argonne National Laboratory, Argonne, Illinois 60439
| | - S. Moy
- Midwest Center for Structural Genomics, Biosciences Division, Argonne National Laboratory, Argonne, Illinois 60439
| | - J. Watson
- Midwest Center for Structural Genomics, Biomolecular Structure and Modeling Group, European Bioinformatics Institute, Birkbeck College, Cambridge, CB10 1SD, United Kingdom
| | - A. Cipriani
- Midwest Center for Structural Genomics, Biosciences Division, Argonne National Laboratory, Argonne, Illinois 60439
| | - A. Joachimiak
- Midwest Center for Structural Genomics, Biosciences Division, Argonne National Laboratory, Argonne, Illinois 60439
- Structural Biology Center, Biosciences Division, Argonne National Laboratory, Argonne, Illinois 60439
- Correspondence to: Dr. Andrzej Joachimiak, Biosciences Division, Midwest Center for Structural Genomics and Structural Biology Center, Argonne National Laboratory, 9700 S. Cass Ave. Argonne, IL 60439.
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Omori IM, Watanabe N, Nakagawa A, Akechi T, Cipriani A, Barbui C, McGuire H, Churchill R, Furukawa TA. Efficacy, tolerability and side-effect profile of fluvoxamine for major depression: meta-analysis. J Psychopharmacol 2009; 23:539-50. [PMID: 18562407 DOI: 10.1177/0269881108089876] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fluvoxamine, one of the oldest selective serotonin reuptaking inhibitors, is commonly prescribed to patients with major depression. Several studies have reviewed the efficacy and tolerability of fluvoxamine for the treatment of major depression. However, these reviews are outdated, have not been systematic and/or suffered from several methodological weaknesses. We conducted a systematic review to synthesize the best available evidence on the efficacy of fluvoxamine for adult patients suffering from major depression in comparison with other active antidepressive agents. Relevant randomized controlled trials were identified through a comprehensive search. The primary outcome was a relative risk of response, and the secondary outcome was a relative risk of remission. Tolerability and side-effect profile were also examined. Fifty-three trials were included. There were no large differences between fluvoxamine and any other antidepressants in terms of efficacy and tolerability. There is evidence of differing side effect profiles, especially when comparing gastrointestinal side effects between fluvoxamine and tricyclics. Clinicians should focus on practically or clinically relevant differences including those in side-effect profiles.
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Affiliation(s)
- I M Omori
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
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Barbui C, Cipriani A. Cognitive improvements with antipsychotics: real or practice effect? Evidence-Based Mental Health 2008; 11:42. [DOI: 10.1136/ebmh.11.2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Barbui C, Furukawa TA, Cipriani A. Effectiveness of selective serotonin reuptake inhibitors. CMAJ 2008. [DOI: 10.1503/cmaj.1080028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Cipriani A, Dieterich M, Barbui C. Review: Atypical antipsychotics are effective adjuncts for treatment resistant depression but increase discontinuation due to adverse effects. Evidence-Based Mental Health 2008; 11:14. [DOI: 10.1136/ebmh.11.1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cipriani A, Barbui C. Adding aripiprazole improves major depressive disorder following incomplete response to antidepressants alone. Evidence-Based Mental Health 2008; 11:15. [DOI: 10.1136/ebmh.11.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cipriani A, Signoretti A, Barbui C. Review: Antipsychotic plus mood stabiliser co-therapy is more effective than mood stabiliser mono-therapy at reducing acute bipolar mania. Evidence-Based Mental Health 2007. [DOI: 10.1136/ebmh.10.3.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- C Barbui
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy.
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Zhang R, Joachimiak G, Jiang S, Cipriani A, Collart F, Joachimiak A. Structure of phage protein BC1872 from Bacillus cereus, a singleton with new fold. Proteins 2006; 64:280-3. [PMID: 16596646 PMCID: PMC2792010 DOI: 10.1002/prot.20910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | | | - A. Joachimiak
- Correspondence to: Andrzej Joachimiak, Structural Biology Center and Midwest Center for Structural Genomics, Biosciences, Argonne National Laboratory, 9700 South Cass Ave., Bldg. 202, Argonne, IL 60439.
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Abstract
BACKGROUND The main objectives in treating mania are to control dangerous behaviour, reduce suicide, produce appropriate acute sedation and shorten the episode of mood disturbance. Among different drugs, haloperidol has for many years been used in treating psychotic patients, but it has a troublesome side effect profile. OBJECTIVES To assess the effects of haloperidol for the treatment of mania in comparison with placebo or other active drugs, either as monotherapy or add-on treatment. SEARCH STRATEGY We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (11 October 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005), MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL (1982-2003), PsycINFO (1872-2003) and reference lists. We also contacted experts, triallists and pharmaceutical companies in the field. SELECTION CRITERIA Randomised trials comparing haloperidol with placebo or other active treatment in the treatment of acute manic or mixed episodes in patients with bipolar disorder or schizoaffective disorder. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials. MAIN RESULTS Fifteen trials involving 2022 people were included. Compared to placebo, haloperidol was more effective at reducing manic symptoms, both as monotherapy (Weighted Mean Difference (WMD) -5.85, 95% Confidence Interval (CI) -7.69 to -4.00) and as adjunctive treatment to lithium or valproate (WMD -5.20, 95% CI -9.26 to -1.14). There was a statistically significant difference, with haloperidol being less effective than aripiprazole (Relative Risk (RR) 1.45, 95% CI 1.22 to 1.73). No significant differences between haloperidol and risperidone, olanzapine, carbamazepine or valproate were found. Compared with placebo, a statistically significant difference in favour of haloperidol in failure to complete treatment (RR 0.74, 95% Cl 0.57 to 0.96) was reported. Haloperidol was associated with less weight gain than olanzapine (RR: 0.28, 95% CI 0.12 to 0.67), but with a higher incidence of tremor (RR: 3.01, 95% CI 1.55 to 5.84) and other movement disorders. AUTHORS' CONCLUSIONS There is some evidence that haloperidol is an effective treatment for acute mania. From the limited data available, there was no difference in overall efficacy of treatment between haloperidol and olanzapine or risperidone. Some evidence suggests that haloperidol could be less effective than aripiprazole. Referring to tolerability, when considering the poor evidence comparing drugs, clinicians and patients should consider different side effect profiles as an important issue to inform their choice.
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Affiliation(s)
- A Cipriani
- University of Verona, Department of Medicine and Public Health, Section of Psychiatry, Policlinico "G.B.Rossi", Pzz.le L.A. Scuro, 10, 37134 Verona, Italy. andrea.cipriani@ univr.it
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Santo A, Genestreti G, Terzi A, Azzoni P, Caffo O, Galligioni E, Cipriani A, Binato E, Cartei G, Cetto G. Preliminary results of G versus GViElC: A phase III trial of gemcitabine associated to vindesine or gemcitabine alone in elderly or poor performance patients with advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17083 Background: Monochemotherapy with gemcitabine (GEM) or vinorelbine is considered the standard treatment in elderly or poor performance (PS) patients (pts) with advanced NSCLC. Many topics report a synergic enhancement of antitumor effect of GEM if associated to Vindesine (VDS). The aim of this study is to evaluate if GEM combined to VDS produces an advantage in terms of overall survival (OS) compared to GEM alone without enhancement of toxicity. Methods: Chemonaive pts with stage IIIB/IV NSCLC, aged ≥ 70 years with PS < 2 or aged < 70 years with PS > 2 were enrolled. Pts were randomized to receive either GEM 1200 mg/m2 day 1 and 8 every 21 days for three cycles (arm 1) or GEM 1000 mg/m2 and VDS 3 mg/m2 (max dose 5 mg) both drugs infused on day 1 and 8 every 21 days for three cycles (arm 2). Pts of both arms received other three cycles in case of responsive or stable disease. Overall survival (OS) was the primary end-point, secondary end-points were time-to-progression and toxicity. First interim analysis was planned at 120 pts enrolled. Results: From May 2002 to December 2005, 107 pts from 13 Italian institutions were enrolled. Their characteristics are: 24 stage IIIB and 83 stage IV, 79 pts with ≥ 70 years (ECOG PS 0–1) and 28 pts with < 70 years (ECOG PS > 2). In arm 1 there were enrolled 55 pts while 52 pts in arm 2: both arms were well balanced with pts characteristics. Conclusions: The enrollment of this phase III trial is ongoing: we are achieving first step for an interim analysis to assess if GEM associated to VDS produces an advantage in terms of OS compared to standard treatment as GEM in monochemotherapy without toxicity enhancement. (Supported by GIVOP: Gruppo Interdisciplinare Veronese di Oncologia Polmonare). No significant financial relationships to disclose.
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Affiliation(s)
- A. Santo
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
| | - G. Genestreti
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
| | - A. Terzi
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
| | - P. Azzoni
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
| | - O. Caffo
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
| | - E. Galligioni
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
| | - A. Cipriani
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
| | - E. Binato
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
| | - G. Cartei
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
| | - G. Cetto
- University of Verona, Verona, Italy; Azienda Ospedaliera of Verona, Verona, Italy; Bussolengo Hospital, Bussolengo, Italy; Azienda Ospedaliera of Trento, Trento, Italy; Azienda Ospedaliera of Padova, Padova, Italy
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Abstract
BACKGROUND Depression is common in primary care and it is associated with marked personal, social and economic morbidity, and creates significant demands on service providers in terms of workload. Treatment is predominantly pharmaceutical or psychological. Fluoxetine, the first of a group of antidepressant (AD) agents known as selective serotonin reuptake inhibitors (SSRIs), has been studied in many randomised controlled trials (RCTs) in comparison with tricyclic (TCA), heterocyclic and related ADs, and other SSRIs. These comparative studies provided contrasting findings. In addition, systematic reviews of RCTs have always considered the SSRIs as a group, and evidence applicable to this group of drugs might not be applicable to fluoxetine alone. The present systematic review assessed the efficacy and tolerability profile of fluoxetine in comparison with TCAs, SSRIs and newer agents. OBJECTIVES To determine the efficacy of fluoxetine, compared with other ADs, in alleviating the acute symptoms of depression, and to review its acceptability. SEARCH STRATEGY Relevant studies were located by searching the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), the Cochrane Central Register of Controlled Trials (CENTRAL), Medline (1966-2004) and Embase (1974-2004). Non-English language articles were included. SELECTION CRITERIA Only RCTs were included. For trials which have a crossover design only results from the first randomisation period were considered. DATA COLLECTION AND ANALYSIS Data were independently extracted by two reviewers using a standard form. Responders to treatment were calculated on an intention-to-treat basis: drop-outs were always included in this analysis. When data on drop-outs were carried forward and included in the efficacy evaluation, they were analysed according to the primary studies; when dropouts were excluded from any assessment in the primary studies, they were considered as treatment failures. Scores from continuous outcomes were analysed including patients with a final assessment or with the last observation carried forward. Tolerability data were analysed by calculating the proportion of patients who failed to complete the study and who experienced adverse reactions out of the total number of randomised patients. The primary analyses used a fixed effects approach, and presented Peto Odds Ratio (PetoOR) and Standardised Mean Difference (SMD). MAIN RESULTS On a dichotomous outcome fluoxetine was less effective than dothiepin (PetoOR: 2.09, 95% CI 1.08 to 4.05), sertraline (PetoOR: 1.40, 95% CI 1.11 to 1.76), mirtazapine (PetoOR: 1.64, 95% CI 1.01 to 2.65) and venlafaxine (Peto OR: 1.40, 95% CI 1.15 to 1.70). On a continuous outcome, fluoxetine was more effective than ABT-200 (Standardised Mean Difference (SMD) random effects: - 1.85, 95% CI - 2.25 to - 1.45) and milnacipran (SMD random effects: - 0.38, 95% CI - 0.71 to - 0.06); conversely, it was less effective than venlafaxine (SMD random effect: 0.11, 95% CI 0.00 to 0.23), however these figures were of borderline statistical significance. Fluoxetine was better tolerated than TCAs considered as a group (PetoOR: 0.78, 95% CI 0.68 to 0.89), and was better tolerated in comparison with individual ADs, in particular than amitriptyline (PetoOR: 0.64, 95% CI 0.47 to 0.85) and imipramine (PetoOR: 0.79, 95% CI 0.63 to 0.99), and among newer ADs than ABT-200 (PetoOR: 0.21, 95% CI 0.10 to 0.41), pramipexole (PetoOR: 0.20, 95% CI 0.08 to 0.47) and reboxetine (PetoOR: 0.61, 95% CI 0.40 to 0.94). AUTHORS' CONCLUSIONS There are statistically significant differences in terms of efficacy and tolerability between fluoxetine and certain ADs, but the clinical meaning of these differences is uncertain, and no definitive implications for clinical practice can be drawn. From a clinical point of view the analysis of antidepressants' safety profile (adverse effect and suicide risk) remains of crucial importance and more reliable data about these outcomes are needed. Waiting for more robust evidence, treatment decisions should be based on considerations of clinical history, drug toxicity, patient acceptability, and cost. We need for large, pragmatic trials, enrolling heterogeneous populations of patients with depression to generate clinically relevant information on the benefits and harms of competitive pharmacological options. A meta-analysis of individual patient data from the randomised trials is clearly necessary.
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Affiliation(s)
- A Cipriani
- Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Policlinico "G.B.Rossi", Pzz.le L.A. Scuro, 10, 37134 Verona, Italy.
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Brambilla P, Cipriani A, Hotopf M, Barbui C. Side-effect profile of fluoxetine in comparison with other SSRIs, tricyclic and newer antidepressants: a meta-analysis of clinical trial data. Pharmacopsychiatry 2005; 38:69-77. [PMID: 15744630 DOI: 10.1055/s-2005-837806] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the last ten years, SSRIs have increasingly replaced TCAs as comparators of newer antidepressants (ADs), because of their better tolerability profile. In particular, fluoxetine has become a reference drug for the treatment of depression, but the occurrence of individual side effects in depressed subjects treated with fluoxetine and each comparator AD have not been systematically investigated. METHODS This meta-analysis investigated the frequency of side effects induced by fluoxetine or alternative ADs and compared the occurrence of individual side effects in depressed subjects. All randomised clinical trials (RCTs) comparing fluoxetine with any other AD drug in patients with major depression were located by searching the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Controlled Trials Register. Two reviewers independently extracted information. RESULTS Significantly less percentage of patients treated with fluoxetine experienced any side effects in comparison with TCAs (50.9 % vs 60.3 %, 29 RCTs; RR = 0.84, p = 0.003), but not in comparison with other SSRIs (59.4 % vs 59.3 %, 15 RCTs; RR = 1.00, p = 0.902). In addition, fluoxetine was better tolerated in comparison with TCAs and related ADs (RR 0.61, 95 % CI 0.52, 0.71), but not in comparison with other SSRIs. Regard to individual side effects, activating (insomnia, agitation, tremor and anxiety) and gastrointestinal adverse events (nausea, vomiting, diarrhoea, weight loss and anorexia) were significantly more frequent in fluoxetine-treated patients, whereas cholinergic side effects were significantly less frequent. CONCLUSIONS Fluoxetine compared to other ADs had more activating and gastrointestinal adverse effects, which often require additional pharmacotherapy or other managements strategies, leading to discontinuation and non-compliance and increasing the costs. This information is relevant to base on evidence the prescription of ADs in everyday clinical practice.
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Affiliation(s)
- P Brambilla
- Department of Pathology and Experimental Medicine, Section of Psychiatry, University of Udine, Udine, Italy.
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Santo A, Giovannini M, Terzi A, Pedersini R, Tommasini A, Festi G, Cipriani A, Falezza G, Soardi G, Cesaro G, Manno P, Pavarana M, Maluta F, Calabrò F, Cetto G. 816 Malignant pleural mesothelioma (MPM): analysis of consecutive 65 patients (pts). EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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